scholarly journals Bariatric Surgery—from the Non-surgical Approach to the Post-Surgery Individual Care: Role of Endoscopy in Bariatric Therapy

2021 ◽  
Author(s):  
Dörte Wichmann ◽  
Dietmar Stüker ◽  
Ulrich Schweizer ◽  
Alfred Königsrainer ◽  
Rami Archid
Keyword(s):  
Flexible Endoscopy ◽  
Study Data ◽  
Obese Patients ◽  
Endoscopic Bariatric Therapy ◽  
Post Surgery ◽  
Lipid Metabolism Disorders ◽  
Individual Care ◽  
Treatment Of Obesity

Obesity is the underlying constant for the development of the most common modern diseases such as insulin resistance, high blood pressure, lipid metabolism disorders, non-alcoholic steatohepatitis (fatty liver), joint problems and various malignancies. The role of endoscopic diagnostic and therapy in obese patients is highlighted in this chapter. In this chapter all devices and methods used in flexible endoscopy for diagnostic and treatment in obese patients are introduced. Role of endoscopy is presented in three parts: in preoperative setting, in post-operative complication management and instead of surgery as endoscopic bariatric therapy. If possible presentation of the effectiveness is compiled with study data. Finally, the interaction between endoscopy and surgery in the treatment of obesity is complex, essential and promising. Endoscopy is indispensable in preoperative preparation, as a primary therapeutic approach, and also in the detection and treatment of acute complications and long-term complications of obesity surgery.

scholarly journals ACLR GRAFT STRAND NUMBER: LONG-TERM FOLLOW-UP ON 400 PATIENTS

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0017
Author(s):  
Julien T Aoyama ◽  
Joshua T Bram ◽  
John Todd R. Lawrence ◽  
Theodore J Ganley
Keyword(s):  
Multivariate Regression ◽  
Normal Weight ◽  
Obese Patients ◽  
Long Term Outcomes ◽  
Post Surgery ◽  
Graft Rupture ◽  
Long Term Follow Up ◽  
Graft Diameter

Background: Studies on pediatric anterior cruciate ligament reconstructions (ACLRs) often focus on graft choice, as rates of these injuries have risen in recent years. Large multicenter studies have found younger age and smaller graft size to be risk factors for graft failure and contralateral tears, but despite large sample sizes these studies have not looked specifically at graft strand number. Therefore the purpose of this study was to use a large sample size to ask whether ACLR graft strand number affects long-term outcomes. Hypothesis/Purpose: Examine long-term effects of ACLR graft strand number using a large cohort. Methods: This was a retrospective comparison study of all patients presenting between 1/1/2008 and 12/31/16 for a first-time ACLR at a single pediatric hospital. After querying medical records for all ACLRs using CPT codes, graft strand number, graft diameter, and other variables were abstracted. Long-term outcomes on graft rupture, contralateral ACL tear, and subsequent meniscus injury were collected via phone calls and REDCap emails. Patient groups were compared for differences in graft strand number and diameter using bivariate analyses, and differences in long-term outcomes were analyzed using multivariate regression. Results: 436 patients met the inclusion criteria also completed the long-term follow-up on outcomes. Long-term follow-up ranged from 18 months post surgery to 10 years post surgery. Patients with larger graft diameter were significantly less likely to suffer a complication (graft rupture, contralateral ACL tear, or subsequent meniscus injury) in multivariate regression (p=0.03), while strand number, sex, weight, and age showed no significant difference. Transphyseal reconstructions had larger graft diameters (8.8mm) than partial hybrid (8.6mm) and all-epiphyseal reconstructions (8.3mm) (p<0.001), but had no differences in graft strand number. Males had larger graft diameters (8.9mm) than females (8.6mm) (p=0.03), but also had no differences in graft strand number. Obese patients had larger graft diameters (9.1mm) than overweight (8.9mm) and normal weight patients (8.6mm) (p=0.002). Obese patients also had more graft strands (6.9) than overweight (6.2) or normal weight patients (6.1), but this difference was not significant (p=0.051). Conclusion: This data supports the existing literature that pediatric ACLR patients with larger graft diameters are less likely to suffer long-term complications. Using both a large patient cohort and long-term follow-up, this data also showed that graft strand number was not significantly correlated with outcomes. This suggests that strand number is not important when constructing ACLR grafts, as long as sufficient graft diameter can be achieved.

scholarly journals Managing Consumer Loyalty

2020 ◽  
Vol 11 (1) ◽  
pp. 21-47
Author(s):  
Shivani Saini ◽  
Jagwinder Singh
Keyword(s):  
Study Data ◽  
Service Firms ◽  
Consumer Loyalty ◽  
Consumer Experience ◽  
Direct And Indirect Impacts ◽  
Indirect Impacts ◽  
Service Groups ◽  
Positive Effect

A growing body of academic and practitioner literature has highlighted the role of consumer experience management in maintaining long-term relationships with consumers. However, related studies are still divergent and there is little empirical evidence available to support the positive effect of consumer experience management on attitudinal and behavioural loyalty. The present study aims to fill this gap by investigating the direct and indirect impacts of consumer experience efforts on attitudinal and behavioural loyalty. To conduct an empirical study, data was collected from consumers of three service firms: health, retail, and wellness. By means of AMOS17.0, using CFA and SEM techniques, the measurement and comparison of structural models was carried out to test the invariance across three service groups. This article has significant implications for academicians well as marketers of service firms.

scholarly journals Neuropeptide Y in normal eating and in genetic and dietary-induced obesity

2006 ◽  
Vol 361 (1471) ◽  
pp. 1159-1185 ◽  
Author(s):  
B Beck
Keyword(s):  
Neuropeptide Y ◽  
Diet Composition ◽  
High Energy ◽  
Glucose Sensing ◽  
Feeding Regulation ◽  
Treatment Of Obesity ◽  
The Brain ◽  
Diet Type

Neuropeptide Y (NPY) is one the most potent orexigenic peptides found in the brain. It stimulates food intake with a preferential effect on carbohydrate intake. It decreases latency to eat, increases motivation to eat and delays satiety by augmenting meal size. The effects on feeding are mediated through at least two receptors, the Y1 and Y5 receptors. The NPY system for feeding regulation is mostly located in the hypothalamus. It is formed of the arcuate nucleus (ARC), where the peptide is synthesized, and the paraventricular (PVN), dorsomedial (DMN) and ventromedial (VMN) nuclei and perifornical area where it is active. This activity is modulated by the hindbrain and limbic structures. It is dependent on energy availability, e.g. upregulation with food deprivation or restriction, and return to baseline with refeeding. It is also sensitive to diet composition with variable effects of carbohydrates and fats. Leptin signalling and glucose sensing which are directly linked to diet type are the most important factors involved in its regulation. Absence of leptin signalling in obesity models due to gene mutation either at the receptor level, as in the Zucker rat, the Koletsky rat or the db / db mouse, or at the peptide level, as in ob / ob mouse, is associated with increased mRNA abundance, peptide content and/or release in the ARC or PVN. Other genetic obesity models, such as the Otsuka–Long–Evans–Tokushima Fatty rat, the agouti mouse or the tubby mouse, are characterized by a diminution in NPY expression in the ARC nucleus and by a significant increase in the DMN. Further studies are necessary to determine the exact role of NPY in these latter models. Long-term exposure to high-fat or high-energy palatable diets leads to the development of adiposity and is associated with a decrease in hypothalamic NPY content or expression, consistent with the existence of a counter-regulatory mechanism to diminish energy intake and limit obesity development. On the other hand, an overactive NPY system (increased mRNA expression in the ARC associated with an upregulation of the receptors) is characteristic of rats or rodent strains sensitive to dietary-induced obesity. Finally, NPY appears to play an important role in body weight and feeding regulation, and while it does not constitute the only target for drug treatment of obesity, it may nevertheless provide a useful target in conjunction with others.

scholarly journals Long-Term Neuropsychological Outcomes Following Temporal Lobe Epilepsy Surgery: An Update of the Literature

Healthcare ◽  
2021 ◽  
Vol 9 (9) ◽  
pp. 1156
Author(s):  
Ioanna Alexandratou ◽  
Panayiotis Patrikelis ◽  
Lambros Messinis ◽  
Athanasia Alexoudi ◽  
Anastasia Verentzioti ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Neuropsychological Function ◽  
Post Surgery ◽  
Long Term Follow Up ◽  
Neuropsychological Outcomes ◽  
Selective Surgery

We present an update of the literature concerning long-term neuropsychological outcomes following surgery for refractory temporal lobe epilepsy (TLE). A thorough search was conducted through the PubMed and Medline electronic databases for studies investigating neuropsychological function in adult patients undergoing resective TLE surgery and followed for a mean/median > five years period. Two independent reviewers screened citations for eligibility and assessed relevant studies for the risk of bias. We found eleven studies fulfilling the above requirements. Cognitive function remained stable through long-term follow up despite immediate post-surgery decline; a negative relation between seizure control and memory impairment has emerged and a possible role of more selective surgery procedures is highlighted.

Impact of weight loss on the cardiovascular system after bariatric surgery

2016 ◽  
Vol 62 (5) ◽  
pp. 43
Author(s):  
Bianca Maria Leca ◽  
Ionuț Stanca ◽  
Suzana Florea ◽  
Simona Fica ◽  
Anca Elena Sîrbu
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Left Ventricle ◽  
Cardiovascular System ◽  
Negative Response ◽  
Obese Patients ◽  
Left Ventricle Mass ◽  
Post Surgery ◽  
Number Of Patients

Introduction. Obesity is a chronic disease with a great impact on the cardiovascular system through its association with type II diabetes, hypertension, dyslipidemia, metabolic syndrome (MetS) and also through direct alterations in cardiac performance and morphology. Recent long term studies prove that substantial weight loss obtained via bariatric surgery is capable of improving cardiac risk factors associated with severe obesity, decreasing the mortality rates.Aim: to assess the long-term changes in cardiovascular risk and cardiac structure in obese patients who had lost weight after laparoscopic sleeve gastrectomy (LSG).Methods. Fifty-two severe obese patients (44±9 years, 57.7% women, BMI=45±8 kg/m2) underwent clinical and biochemical examination and Doppler echocardiograms before and 5 years after LSG.Results. Pre-operatively, 78.4% of patients were hypertensive, 46.2% had diabetes, 73.1% MetS and 44.2% presented left ventricle hypertrophy (LVH), reflecting high cardio-metabolic risk. The patients reassessment was made 61.7±10.5 months after LSG, when a decrease in BMI of 21.9±10% was achieved (p<0.001). The prevalence of hypertension (64.7%), diabetes (32.7%) and MetS (28.8%) decreased compared to the pre-operative examination (p=0.019, p<0.001, p=0.036). An increase in left ventricle mass and left ventricle mass index (LVMI) (p<0.001) and in the prevalence of LVH (57.7%-p=0.001) was recorded. Patients were divided into two groups based on the decrease in LVMI (positive response-38.5%) or increase in LVMI post-surgery (negative response-61.5%), compared with pre-operative values. The group of patients with negative response had lost less weight (p=0.006), had a poor glycemic control (p=0.022), and higher systolic (p=0.004) and diastolic (p=0.030) pressure values compared to the first evaluation.Conclusion. The increase of LVMI after LSG indicates that this study should continue, including a larger number of patients. It is important to identify the factors that can predict an inappropriate response to surgery, in order to prevent and treat them.

Uncertainty in the management of thyroid cancer.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 238-238
Author(s):  
Megan Haymart ◽  
Mousumi Banerjee ◽  
Di Yang ◽  
Andrew Stewart ◽  
James Sisson ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Hormone ◽  
Radioactive Iodine ◽  
Hormone Replacement ◽  
Thyroid Hormone Replacement ◽  
Cancer Management ◽  
Post Surgery ◽  
Iodine Treatment

238 Background: Little is known about treatment practices in thyroid cancer, a cancer that is increasing in incidence. We sought to identify aspects of thyroid cancer management that have the greatest variation and thereby uncertainty in management. Methods: We surveyed 944 physicians involved in thyroid cancer care from 251 hospitals affiliated with the U.S. National Cancer Database. Using vignettes and additional survey items, physicians were asked questions in the following four domains: thyroid surgery, radioactive iodine use, thyroid hormone replacement post-surgery, and long-term thyroid cancer management. To identify aspects of thyroid cancer management with the greatest uncertainty, we calculated the ratio of observed variation to hypothetical maximum variation under the assumed distribution of the response. Ratios closer to 1 indicate greater uncertainty. Results: There is large uncertainty in multiple aspects of thyroid cancer management, including the role of central lymph node dissections, the role of pretreatment scans before radioactive iodine treatment, and all aspects of long-term thyroid cancer management, including applications of ultrasound and radioactive iodine scans. For the management of small thyroid cancers, uncertainty exist in all domains, including optimal extent of surgery and the role of both radioactive iodine treatment and suppressive doses of thyroid hormone replacement. Conclusions: We identified areas of uncertainty in thyroid cancer management. Since both a lack of data and a lack of acceptance of the existing data may be contributing to the variation demonstrated, to improve the management of thyroid cancer there is a need for more research and more research dissemination.

scholarly journals First-in-man feasibility study of a novel ingestible magnetically inflated balloon capsule for treatment of obesity

2020 ◽  
Vol 08 (05) ◽  
pp. E607-E610 ◽  
Author(s):  
Hung Leng Kaan ◽  
Phuoc Thien Phan ◽  
Anthony Meng Huat Tiong ◽  
Muneaki Miyasaka ◽  
Soo Jay Phee ◽  
...  
Keyword(s):  
Feasibility Study ◽  
Animal Studies ◽  
Obese Patients ◽  
Proof Of Concept ◽  
External Magnet ◽  
Inflated Balloon ◽  
Term Efficacy ◽  
Treatment Of Obesity ◽  
Established Treatment

AbstractIntragastric balloons (IGBs) are an established treatment option for obesity. Major barriers to dissemination of IGBs include lack of long-term efficacy outcomes, safety concerns, cost, and tolerability. We developed a novel ingestible magnetically inflated balloon capsule (IMI-BC) in hopes of overcoming these challenges. The IMI-BC is significantly cheaper than IGBs currently available on the market. We performed proof-of-concept animal studies and a first-in-human feasibility study to demonstrate the feasibility of inflating the IMI-BC using an external magnet. Further studies are currently being conducted to evaluate the safety, tolerability, and long-term efficacy of the IMI-BC. When fully developed, we anticipate that this device will benefit obese patients.

scholarly journals Lower long-term mortality in obese patients with community-acquired pneumonia: possible role of CRP

Clinics ◽  
2019 ◽  
Vol 74 ◽  
Author(s):  
Jin Chen ◽  
Jia Wang ◽  
Hui Jiang ◽  
Mao-Chun Li ◽  
Si-Yuan He ◽  
...  
Keyword(s):  
Community Acquired Pneumonia ◽  
Obese Patients ◽  
Long Term Mortality

scholarly journals Predictive Role of Body Image in Bulimic Behaviors Among Obese Patients Qualified for Bariatric Surgery

2021 ◽  
Vol 12 ◽  
Author(s):  
Barbara Bȩtkowska-Korpała ◽  
Aleksandra Ćwiȩk ◽  
Bernadetta Izydorczyk ◽  
Anna Starowicz-Filip ◽  
Piotr Major
Keyword(s):  
Bariatric Surgery ◽  
Body Image ◽  
Surgical Treatment ◽  
Obese Patients ◽  
Predictive Role ◽  
Treatment Of Obesity ◽  
Eat 26 ◽  
Surgical Treatment Of Obesity ◽  
Bulimic Behaviors

Bulimic behavior and the associated experience of one's own body are of great importance in the course of surgical treatment for obesity. This study determined the predictive role of multidimensional body image on bulimic-type eating behaviors among individuals scheduled for the surgical treatment of obesity. This study was conducted in a clinical setting on a group of 100 obese patients who were treated at the Centre for the Surgical Treatment of Obesity at the University Hospital in Krakow (Poland) and were qualified for bariatric surgery. Body image was examined with Cash's Multidimensional Body-Self Relations Questionnaire (MBSRQ) and bulimic behavior with David M. Garner's Eating Attitudes Test (EAT-26). Part A of the EAT-26 focused only on the bulimia and food preoccupation scale. Part B included sex, age, and body mass index (BMI) in the predictive model. A stepwise multiple regression analysis was conducted to assess psychological predictors of eating behavior. For binary variables, a logistic regression analysis was conducted for the whole group and for the women's group alone. Owing to the small sample size of men, regression analyses were not conducted. Higher values were observed in the Appearance Orientation dimension among women when compared to men. Appearance evaluation and age were found to be significant predictors for bulimic behaviors in the whole group. In regression models for behavior in the last 6 months, the predictors were found to be Health Evaluation and Appearance Orientation for laxative use, and Overweight Preoccupation for vomiting for weight control. Health-promoting behaviors in obesity treatment were conditioned as follows: for exercise, the predictors were sex and Fitness Orientation and for weight loss, they were Overweight Preoccupation and Body Areas Satisfaction. Our study shows that different bulimic behaviors are variously conditioned by body image dimensions, some of which are predictors of behaviors that are risk factors for obesity and poor outcomes of bariatric treatment, whereas others increase the chance of pro-health behaviors among obese individuals.

scholarly journals Sleeve gastrectomy with loop bipartition as a novel procedure for management of type 2 diabetes in obese patients

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
R S Ezz ◽  
M M Abouzeid ◽  
M M Helmy ◽  
M M Elhusseini
Keyword(s):  
Type 2 Diabetes ◽  
Sleeve Gastrectomy ◽  
First Year ◽  
Obese Patients ◽  
Single Anastomosis ◽  
Marked Weight

Abstract Background Amidst the current worldwide epidemic of type 2 diabetes mellitus (T2DM), the global diabetes health burden is projected to reach 522 million in 2030, with much of this increase occurring in developing countries. Aim of the work to evaluate the role of laparoscopic sleeve gastrectomy with loop bipartition (single anastomosis sleeve ileal bypass) as a bariatric and metabolic procedure in control of type 2 diabetes in obese patients. Patients and methods This prospective cohort study included 20 obese adult patients with type 2 DM recently diagnosed within last 5 years. Some of them have other associated comorbidities. They were recruited at department of surgery Ain Shams University. The follow up was obtained during the first year post-operative. Results In this study, complete remission of diabetes was achieved in 75% of the patients by the 3rd post-operative month and in 95% by the end of the study. This was beside marked weight reduction and improvement of lipid profile without causing micronutrients deficiencies during the study period. Conclusion SASI bypass can be one of the most efficient metabolic procedures and could be associated with less risks. The procedure should be considered under investigations until enough long term data are available. Thus it is worth to be explored in research aiming for more data.

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