Two cuts are better than one.


Original image by Calvin Klein Inc. – Edited by Richard Kizzee

When told “you will need surgery,” many people feel helpless. If someone is going to look inside your body, you had better have some say in how they do it. Vrije Universiteit Amsterdam is home to a group of researchers who show why opting for minimally invasive gastric surgery may be a safer option than fully open surgery.

Stomach (gastric) cancer is the cause of 10% of cancer deaths worldwide. This type of cancer often calls for total gastrectomy, full removal of the stomach, to be stopped. Two methods generally exist for approaching the stomach to remove it. A single, long incision can be made allowing for surgery through a fist sized hole. Another approach is making multiple small incisions (about wide enough to poke a finger in) for surgery.

Researchers of this study compared open total gastrectomy (OTG) with minimally invasive total gastrectomy (MITG) for markers of surgical quality and patient outcome. This was done by analyzing the results of 12 studies involving a total of 1,360 patients, of whom 768 underwent OTG and 592 MITG. The results of their meta-study showed (average differences in parentheses):

Shorter operation time: OTG (48.06 minutes faster)
Lower blood loss: MITG (160.70 mL less)
Lower time to recovery: MITG (1.05 days sooner)
Shorter length of hospital stay: MITG (2.43 days less)
Less postoperative complications: MITG (32.72% less)
Completeness of procedure: Equal

Both techniques were equally excellent at removing cancer from the patients, however, the minimally invasive technique left people recovering faster and with less complications after surgery. The benefits of MITG seen here may also apply to da Vinci robotic surgery in general.

If you or a loved one need surgery, remember that techniques are improving every day. Whether opting for open or minimally invasive (or even robotic) surgery, you are in good hands.

Jennifer Straatman, Nicole van der Wielen, Miguel A. Cuesta, Elly S. M. de Lange – de Klerk, Elise P. Jansma, Donald L. van der Peet. Minimally Invasive Versus Open Total Gastrectomy for Gastric Cancer: A Systematic Review and Meta-analysis of Short-Term Outcomes and Completeness of Resection. World Journal of Surgery, 2016.
DOI: 10.1007/s00268-015-3223-1


I’m not bipolar, my mother had my blood tested.


Carrie Mathison – Monique Nazareth

Assessing mood is inherently subjective.
“I’m sad.”
– “How sad are you?”
“Very sad.”
– “. . .”
However, scientifically quantifiable means of determining the severity of mood disorders are on the rise. Through the cooperation of researchers of the United States, Europe, and Australia spanning from the University of Texas to Deakin University, a blood compound (BDNF) was identified as an indicator of bipolar mood swings.

Brain-derived neurotrophic factor (BDNF) is a protein that aids in the development and survival of neurons. BDNF works to promote growth of neurons and synapses in the brain, eyes, and kidneys among other places. This protein has important links to obesity, epilepsy, schizophrenia, and as seen in this study, bipolar disorder.

Bipolar disorder causes intense emotionally states (overly happy or extreme hopelessness) that last for unusually long periods of time. In a state of mania, one might be easily distracted, sleep very little, overestimate their personal abilities, and act impulsively on high risk high pleasure activities. During a depressive episode the person might feel tired, lack concentration, drastically change eating habits, and actively think of death or suicide.

The researchers of this study analyzed the data of 52 studies published from 2005 to 2015 that looked at levels BDNF circulating within 3,339 individuals in manic, depressive, or euthymic (moderately happy) states compared to 3,142 healthy control participants. The goal was to find a link between amount of BDNF in the blood and current manic or depressed signs. The meta-analysis showed BDNF levels significantly dropped during manic and depressed episodes (Hedges’ g = -0.57 and -0.93 respectively), while euthymia showed no change in BDNF.

Not only did BDNF decrease more with increasing severity of bipolar episode, but individuals treated for their manic episodes showed increases in BDNF with medication. The BDNF increase was not seen with depressive episode treatment, but this could be due to depression signs persisting through treatment (Read as: science is good at depressing people, but bad at cheering them up).

If further research finds that BDNF levels are decreasing before depressive or manic episodes, this protein could be used as a forecaster of bipolar mood jumps. BDNF currently shows the most promise as a biomarker for activity.

In conjunction with other blood assays, BDNF may be able to help determine if in fact someone is bipolar, how severe their mood swings are, and give a more numeric answer to “how sad are you?”.

Brisa S. Fernandes, Marc L. Molendijk, Cristiano A. Köhler, Jair C. Soares, Cláudio Manuel G. S. Leite, Rodrigo Machado-Vieira, Thamara L. Ribeiro, Jéssica C. Silva, Paulo M. G. Sales, João Quevedo, Viola Oertel-Knöchel, Eduard Vieta, Ana González-Pinto, Michael Berkand, André F. Carvalho. Peripheral brain-derived neurotrophic factor (BDNF) as a biomarker in bipolar disorder: a meta-analysis of 52 studies. BioMed Central Medicine, 2015.
DOI: 10.1186/s12916-015-0529-7