The Future of Endobariatrics: Bridging the Gap.

With the growing global burden of obesity, the field of endobariatrics has emerged as a promising alternative, filling the void between lifestyle interventions with modest efficacy and more invasive surgical procedures. This article explores the latest advancements in endobariatric therapies, encompassing endoscopic sleeve gastroplasty (ESG), intragastric balloons (IGB), endoscopic metabolic therapies, and promising pharmacologic and surgical combination approaches that integrate multiple therapeutic modalities. It also outlines the critical factors and strategic considerations necessary for the successful integration of endobariatric interventions into clinical practice.

Navigating the Predictive Landscape: DiaRem's Role in Unveiling Outcomes for Diabetes Remission following ESG.

PURPOSE: Rising obesity and type 2 diabetes mellitus (T2DM) rates can be mitigated by various strategies, with a 10% total body weight loss (TBWL) threshold often required for T2DM remission. T2DM remission rates after bariatric surgery like Roux-en-Y gastric bypass (RYGB) are well established; endoscopic sleeve gastroplasty (ESG) is a less invasive option that averages 15% TBWL and allows for T2DM remission. This study explores the DiaRem (Diabetes Remission post-RYGB) score's ability to predict T2DM remission 1-year post-ESG. MATERIALS AND METHODS: We conducted a retrospective cohort study on 39 individuals with T2DM who underwent ESG. Age, utilization of diabetes medications, insulin administration, and hemoglobin A1c levels were used to calculate the DiaRem score. The area under the receiver operating characteristic curve (AUC) was employed to evaluate the discriminative ability of DiaRem in distinguishing diabetes remission. RESULTS: Among the 39 patients with a median hemoglobin A1c of 6.7, 12.8% required insulin, and 43.6% used diabetes medication. At 1-year post-ESG, 69.2% of patients experienced diabetes remission with a median %TWBL of 12.7. The DiaRem score's ability to detect diabetes resolution for ESG patients had a sensitivity of 100% and a specificity of 58.3%, at the optimal cutoff value of 10. The AUC was 0.779 (95% CI 0.546-0.959). CONCLUSION: Our study demonstrated the DiaRem score's predictive value for T2DM remission post-ESG, highlighting its utility in clinical decision-making for ESG-related outcomes. Further investigation is needed to identify alternative indicators that may enhance predictive accuracy, thus refining personalized decision-making for this patient group.

Accuracy of repetition of digitized and synthesized speech for young children in background noise.

PURPOSE: The present study investigated the intelligibility of digitized and synthesized speech output in background noise for children 3-5 years old. The purpose of the study was to determine whether there was a difference in the intelligibility (ability to repeat) of 3 types of speech output (digitized, DECTalk synthesized, and MacinTalk synthesized) in single words and sentences, presented within and out of context. METHOD: The dependent variable was speech intelligibility (number of individual words repeated correctly). The study used a mixed-model design. Ninety typically developing children (3-5 years old) were assigned to each of 3 speech type conditions. Participants were asked to repeat 20 words and 10 short sentences. Half of the stimuli were preceded by contextual information (topic cue), and half were presented without any context. RESULTS: Young children have difficulty accurately repeating some digitized and synthesized messages in background noise. Overall, the older children (4- and 5-year-olds) performed better than the 3-year-old children. Increasing information through context or longer messages (i.e., sentences) did facilitate intelligibility overall, although there was a statistically significant Message Length x Context x Speech Type interaction. CONCLUSIONS: For 3-5-year-olds, the intelligibility of single words is very low (55%-77%). The intelligibility of sentences is higher, but the sole use of sentences for communication is problematic. Contextual information facilitates intelligibility and is a promising approach for ensuring effective communication. Future research is needed to improve the intelligibility of speech output at the single word level in order to maximize the benefits of speech output.