Weight regain following primary bariatric surgery occurs in a significant proportion of patients and is attributed to epidemiological,anatomical and metabolic factors.Surgical revision of these patients has significan...Weight regain following primary bariatric surgery occurs in a significant proportion of patients and is attributed to epidemiological,anatomical and metabolic factors.Surgical revision of these patients has significant risks and limited benefits.Endoscopic revisions that reduce gastric pouch size and diameter of the gastrojejunal anastomosis may offer an effective,safe,less invasive and even reproducible treatment.We herein discuss the indication,selection and feasibility of different endoscopic techniques that could be used in the management of weight regain following primary bariatric surgery.Future research could optimize a personalized approach not only in the endoscopic management but also in combination with other therapeutic modalities for weight regain after bariatric surgery.展开更多
Although its utilization is greatly disputed, ready-to-use therapeutic food has been started as clinical nutrition care and treatment for malnourished adult AIDS patients since 2011 in Amhara National Regional State. ...Although its utilization is greatly disputed, ready-to-use therapeutic food has been started as clinical nutrition care and treatment for malnourished adult AIDS patients since 2011 in Amhara National Regional State. However, factors determining the intended outcome (weight gain) have not been properly investigated. The main objective of the study was to assess improvement in body mass index and to identify its determinant factors. A retrospective cohort study design was conducted. Cluster sampling was employed to select health facilities in which the service was provided in the region. Of the 44 health facilities, nine were selected using lottery method, and all patients receiving the care in these health institutions were included in the study. Using tailored structured checklist, data were collected, organized and cleaned. Using paired T-test existence of difference between the mean of body mass index at admission and at 3rd visit was measured. Finally analysis of association between some selected independent variables with the outcome variable was done using logistic regression model at 95% CI and p 2). Paired T-test revealed that there was a statistically significant difference between mean of body mass index at admission and at the 3rd visit. Good ready-to-use therapeutic food treatment adherence (AOR 11.145;95% CI 6.556, 18.946), moderate acute malnutrition at admission (AOR 6.71;95% CI 2.618, 17.195), good ART adherence (AOR 2.136;95% CI, 1.269, 3.595) and being male (AOR 1.73;95% CI 1.052, 2.850) have a statistically significant contribution for body mass index improvement. The study identifies factors that determine gain in body mass index among AIDS patients on ready-to-use therapeutic food. However, although the study revealed a statistically significant difference between body mass index during enrolment, and after three months, we disagreed with the right and left utilization of imported food because of lack of sustainability, and aid dependency. We rather recommend interventions that encourage households to produce food with similar outcomes from locally available food staff.展开更多
Obesity is globally viewed as chronic relapsing disease.Bariatric surgery offers the most efficient and durable weight loss approach.However,weight regain after surgery is a distressing issue as obesity can revert.Sur...Obesity is globally viewed as chronic relapsing disease.Bariatric surgery offers the most efficient and durable weight loss approach.However,weight regain after surgery is a distressing issue as obesity can revert.Surgical procedures were originally designed to reduce food intake and catalyze weight loss,provided that its role is marginalized in long-term weight maintenance.Consequently,it is essential to establish a scientifically standardized applicable definitions for weight regain,which necessitates enhanced comprehension of the clinical situation,as well as have realistic expectations concerning weight loss.Moreover,several factors are proposed to influence weight regain as psychological,behavioral factors,hormonal,metabolic,anatomical lapses,as well as genetic predisposition.Recently,there is a growing evidence of utilization of scoring system to anticipate excess body weight loss,along with characterizing certain biomarkers that identify subjects at risk of suboptimal weight loss after surgery.Furthermore,personalized counseling is warranted to help select bariatric procedure,reinforce self-monitoring skills,motivate patient,encourage mindful eating practices,to avoid recidivism.展开更多
Background Wavelet index （WLI） is a new parameter for monitoring depth of anesthesia based on Wavelet analysis. We observed the change of WLI and bispectral index （BIS） in patients regain of consciousness （ROC） ...Background Wavelet index （WLI） is a new parameter for monitoring depth of anesthesia based on Wavelet analysis. We observed the change of WLI and bispectral index （BIS） in patients regain of consciousness （ROC） in the absence of frontalis electromyographic （EMG） interference. The aim of this study was to compare the ability of WLI and BIS for reflecting ROC in patients undergone surgery. Methods Twelve patients who were scheduled for maxillofacial surgeries were enrolled in the study. BIS and WLI values were monitored continually. After being given midazolam and remifentanil, patients were asked to squeeze the investigator＇s hand ever 30 seconds. Patients were continuously given propofol until loss of consciousness （LOC1）. Tunstalrs isolated forearm technique was used to test the surgical consciousness in patients. After total muscle relaxation endotracheal intubations were performed, and the patients were connected to a ventilator. Then, propofol was withdrawn until the patients showed regain of consciousness （ROC1） and an awareness reaction. After the command test, patients were readministered with propofol until loss of consciousness （LOC2）. After surgery, all of the sedatives were withdrawn, and the patients were let to regain consciousness （ROC2）, Results The BIS values of twelve patients at ROC1 after using muscle relaxant were much lower than those at LOC1 and ROC2 without using muscle relaxant, showing statistical significance （P 〈0.05）. Meanwhile, the WLI values of twelve patients at ROC1 after using muscle relaxant were much higher than those at LOC1 and equal to ROC2 without using muscle relaxant, showing statistical significances （P 〈0.05） between ROC1 and LOCI. Conclusions This study showed that under muscle relaxation or facial paralysis, when there is no EMG signal, BIS can not accurately reflect regain of consciousness in surgical patients, but WLI can reflect it accurately. So WLI may have advantages for reflecting state of consciousness in surgical patients.展开更多
Body weight regain often causes failure of obesity therapies while the underlying mechanism remains largely unknown.In this study,we report that immune cells,especially CD4+T cells,mediate the‘memory’of previous obe...Body weight regain often causes failure of obesity therapies while the underlying mechanism remains largely unknown.In this study,we report that immune cells,especially CD4+T cells,mediate the‘memory’of previous obese status.In a weight gain-loss-regain model,we found that C57BL/6J mice with an obesity history showed a much faster rate of body weight regain.This obesity memory could last for at least 2 months after previously obese mice were kept at the same body weight as non-obese mice.Surprisingly,such obesity memory was abrogated by dexamethasone treatment,whereas immunodeficient Rag1−/−and H2A−/−mice failed to establish such memory.Rag1−/−mice repossessed the obesity memory when immune cells or CD4+T cells isolated from previously obese mice were transferred.Furthermore,depletion of CD4+T cells led to obesity memory ablation.Taken together,we conclude that CD4+T cells mediate obesity memory and promote weight regain.展开更多
文摘Weight regain following primary bariatric surgery occurs in a significant proportion of patients and is attributed to epidemiological,anatomical and metabolic factors.Surgical revision of these patients has significant risks and limited benefits.Endoscopic revisions that reduce gastric pouch size and diameter of the gastrojejunal anastomosis may offer an effective,safe,less invasive and even reproducible treatment.We herein discuss the indication,selection and feasibility of different endoscopic techniques that could be used in the management of weight regain following primary bariatric surgery.Future research could optimize a personalized approach not only in the endoscopic management but also in combination with other therapeutic modalities for weight regain after bariatric surgery.
文摘Although its utilization is greatly disputed, ready-to-use therapeutic food has been started as clinical nutrition care and treatment for malnourished adult AIDS patients since 2011 in Amhara National Regional State. However, factors determining the intended outcome (weight gain) have not been properly investigated. The main objective of the study was to assess improvement in body mass index and to identify its determinant factors. A retrospective cohort study design was conducted. Cluster sampling was employed to select health facilities in which the service was provided in the region. Of the 44 health facilities, nine were selected using lottery method, and all patients receiving the care in these health institutions were included in the study. Using tailored structured checklist, data were collected, organized and cleaned. Using paired T-test existence of difference between the mean of body mass index at admission and at 3rd visit was measured. Finally analysis of association between some selected independent variables with the outcome variable was done using logistic regression model at 95% CI and p 2). Paired T-test revealed that there was a statistically significant difference between mean of body mass index at admission and at the 3rd visit. Good ready-to-use therapeutic food treatment adherence (AOR 11.145;95% CI 6.556, 18.946), moderate acute malnutrition at admission (AOR 6.71;95% CI 2.618, 17.195), good ART adherence (AOR 2.136;95% CI, 1.269, 3.595) and being male (AOR 1.73;95% CI 1.052, 2.850) have a statistically significant contribution for body mass index improvement. The study identifies factors that determine gain in body mass index among AIDS patients on ready-to-use therapeutic food. However, although the study revealed a statistically significant difference between body mass index during enrolment, and after three months, we disagreed with the right and left utilization of imported food because of lack of sustainability, and aid dependency. We rather recommend interventions that encourage households to produce food with similar outcomes from locally available food staff.
文摘Obesity is globally viewed as chronic relapsing disease.Bariatric surgery offers the most efficient and durable weight loss approach.However,weight regain after surgery is a distressing issue as obesity can revert.Surgical procedures were originally designed to reduce food intake and catalyze weight loss,provided that its role is marginalized in long-term weight maintenance.Consequently,it is essential to establish a scientifically standardized applicable definitions for weight regain,which necessitates enhanced comprehension of the clinical situation,as well as have realistic expectations concerning weight loss.Moreover,several factors are proposed to influence weight regain as psychological,behavioral factors,hormonal,metabolic,anatomical lapses,as well as genetic predisposition.Recently,there is a growing evidence of utilization of scoring system to anticipate excess body weight loss,along with characterizing certain biomarkers that identify subjects at risk of suboptimal weight loss after surgery.Furthermore,personalized counseling is warranted to help select bariatric procedure,reinforce self-monitoring skills,motivate patient,encourage mindful eating practices,to avoid recidivism.
文摘Background Wavelet index （WLI） is a new parameter for monitoring depth of anesthesia based on Wavelet analysis. We observed the change of WLI and bispectral index （BIS） in patients regain of consciousness （ROC） in the absence of frontalis electromyographic （EMG） interference. The aim of this study was to compare the ability of WLI and BIS for reflecting ROC in patients undergone surgery. Methods Twelve patients who were scheduled for maxillofacial surgeries were enrolled in the study. BIS and WLI values were monitored continually. After being given midazolam and remifentanil, patients were asked to squeeze the investigator＇s hand ever 30 seconds. Patients were continuously given propofol until loss of consciousness （LOC1）. Tunstalrs isolated forearm technique was used to test the surgical consciousness in patients. After total muscle relaxation endotracheal intubations were performed, and the patients were connected to a ventilator. Then, propofol was withdrawn until the patients showed regain of consciousness （ROC1） and an awareness reaction. After the command test, patients were readministered with propofol until loss of consciousness （LOC2）. After surgery, all of the sedatives were withdrawn, and the patients were let to regain consciousness （ROC2）, Results The BIS values of twelve patients at ROC1 after using muscle relaxant were much lower than those at LOC1 and ROC2 without using muscle relaxant, showing statistical significance （P 〈0.05）. Meanwhile, the WLI values of twelve patients at ROC1 after using muscle relaxant were much higher than those at LOC1 and equal to ROC2 without using muscle relaxant, showing statistical significances （P 〈0.05） between ROC1 and LOCI. Conclusions This study showed that under muscle relaxation or facial paralysis, when there is no EMG signal, BIS can not accurately reflect regain of consciousness in surgical patients, but WLI can reflect it accurately. So WLI may have advantages for reflecting state of consciousness in surgical patients.
基金This work was supported by the National Natural Science Foundation of China(Grant 31301217)the Ministry of Science and Technology of China(Grants 2015BAI08B02 and 2014BAI02B01).
文摘Body weight regain often causes failure of obesity therapies while the underlying mechanism remains largely unknown.In this study,we report that immune cells,especially CD4+T cells,mediate the‘memory’of previous obese status.In a weight gain-loss-regain model,we found that C57BL/6J mice with an obesity history showed a much faster rate of body weight regain.This obesity memory could last for at least 2 months after previously obese mice were kept at the same body weight as non-obese mice.Surprisingly,such obesity memory was abrogated by dexamethasone treatment,whereas immunodeficient Rag1−/−and H2A−/−mice failed to establish such memory.Rag1−/−mice repossessed the obesity memory when immune cells or CD4+T cells isolated from previously obese mice were transferred.Furthermore,depletion of CD4+T cells led to obesity memory ablation.Taken together,we conclude that CD4+T cells mediate obesity memory and promote weight regain.
