Endoscopic management of obesity: Impact of endoscopic sleeve gastroplasty on weight loss and co-morbidities at six months and one year.

INTRODUCTION: Endoscopic sleeve gastroplasty (ESG) is one of the new minimally invasive endoscopic treatments aimed at inducing weight loss. Its effectiveness in terms of weight loss is proven. Gastric volume reduction and delayed gastric emptying are the mechanisms that drive weight loss. However, potential benefits for co-morbidities in relation to weight loss after ESG are still being investigated. This study aims to evaluate the effect of ESG procedures on major obesity-associated co-morbidities, and on some biological parameters. PATIENTS AND METHODS: This is a series of consecutive cases from a prospective observational study carried out in a specialized center that follows a standardized care pathway for the multimodal management of obesity. Patients who have undergone ESG with endoscopic and laboratory follow-up at six and twelve months after this intervention were included in the study. Prospectively recorded data on weight loss, co-morbidities and laboratory parameters at six and twelve months after surgery was analyzed retrospectively. Changes in body mass index (BMI), absolute weight loss (AWL), percent of excess weight loss (%EWL) and percent total weight loss (%TWL) were assessed at six and twelve months. Reduction in various obesity-related co-morbidities (arterial hypertension [AHT], type 2 diabetes mellitus [T2DM], gastroesophageal reflux disease [GERD], obstructive sleep apnea syndrome [OSAS] and dyslipidemia was also evaluated at six and twelve months. Changes in blood glucose, liver function tests and lipid blood tests were also analyzed at six and twelve months. RESULTS: From October 2016 to July 2021, 99 of the 227 patients who underwent ESG in our unit (43.6%) subsequently underwent a complete endoscopic and laboratory follow-up at six and twelve months. The initial BMI was 42.7±7.8kg/m2 and age was 45±12.7 years. Seventy-four patients (74.8%) were female. Total weight loss (%TWL) and excess weight loss (%EWL) were 16.6±7.4% and 43.3±21.2%, respectively, at six months, 16.6±9.6% and 42.9±25.6%, respectively, at one year. At six and twelve month follow-up, a statistically significant reduction was observed for the rates of T2DM (30.8 and 32.7%), hypertension (18.4 and 22.1%), GERD (28 and 25.7%), OSAS (15.8 and 25.5%) and dyslipidemia (69.2 and 77.2%) (P<0.001). A statistically significant difference was found in the reduction in blood glucose between the pre-operative period and six months post-operatively (P<0.01) and between the pre-operative period and twelve months post-operatively (P<0.01). The reduction in triglycerides and total cholesterol between the pre-operative values and at six months was statistically significant (P<0.01) as was the reduction at twelve months (P<0.01) (P=0.017). For liver function tests, the reduction in AST was statistically significant at six and twelve months after ESG (P=0.048) (P=0.048) as was ALT (P<0.01) (P<0.01) respectively. From October 2016 to July 2021, of the 227 patients who underwent ESG, 99 (43.6%) had follow-up gastro-duodenoscopy at 6 and 12 months. %TWL and %EWL were respectively 16.6±7.4% and 43.3%±21.2 at 6 months, 16.6±9.6% and 42.9±25.6% at one year. Statistically significant reduction rates at 6 and 12 months were observed in T2DM (30.8 and 32.7%), AHT (18.4 and 22.1%), GERD (28 and 25.7%), OSAS (15.8 and 25.5%) and dyslipidemia (69.2 and 77.2%) (P<0.001). Moreover, glycemic levels were statistically significantly reduced between the pre-operative period and 6 months post-operative (1.11±0.22mg/L vs. 1.01±0.17mg/L, P<0.01), and between the pre-operative period and 12 months post-operative (1.11±0.22mg/L vs. 1.06±0.32mg/L, P<0.01). A statistically significant reduction was also observed in triglycerides and total cholesterol levels at 6 months (1.52±0.74mmol/L vs. 1.14±0.52mmol/L, P<0.01) (1.94±0.4mmol/L vs. 1.85±0.36mmol/L, P<0.01) and at 12 months (1.52±0.74mmol/L vs. 1.18±0.67mmol/L, P<0.01) (1.94±0.4mmol/L vs. 1.82±0.39mmol/L, P=0.017) and in AST (27.2±11.7 IU/L vs. 23.7 IU/L; P=0.048) (27.2±11.7 IU/L vs. 24.7±14.65 IU/L, P=0.048) and ALAT levels (34±21.32 IU/L vs. 22.3±10.4 IU/L, P<0.01 and 34±21.32 IU/L vs. 27.07±25 IU/L, P<0.01) at 6 and 12 months after ESG, respectively. CONCLUSION: ESG is a well-tolerated and safe surgical procedure that is effective in terms of weight loss and reduction of obesity-related co-morbidities at six months and one year. This procedure could thus be adopted on a broader clinical scale and be more widely promoted as an effective treatment for morbid obesity.

Controlled cross-over study in normal subjects of naloxone-preceding-lactate infusions; respiratory and subjective responses: relationship to endogenous opioid system, suffocation false alarm theory and childhood parental loss.

BACKGROUND: The expanded suffocation false alarm theory (SFA) hypothesizes that dysfunction in endogenous opioidergic regulation increases sensitivity to CO2, separation distress and panic attacks. In panic disorder (PD) patients, both spontaneous clinical panics and lactate-induced panics markedly increase tidal volume (TV), whereas normals have a lesser effect, possibly due to their intact endogenous opioid system. We hypothesized that impairing the opioidergic system by naloxone could make normal controls parallel PD patients' response when lactate challenged. Whether actual separations and losses during childhood (childhood parental loss, CPL) affected naloxone-induced respiratory contrasts was explored. Subjective panic-like symptoms were analyzed although pilot work indicated that the subjective aspect of anxious panic was not well modeled by this specific protocol. METHOD: Randomized cross-over sequences of intravenous naloxone (2 mg/kg) followed by lactate (10 mg/kg), or saline followed by lactate, were given to 25 volunteers. Respiratory physiology was objectively recorded by the LifeShirt. Subjective symptomatology was also recorded. RESULTS: Impairment of the endogenous opioid system by naloxone accentuates TV and symptomatic response to lactate. This interaction is substantially lessened by CPL. CONCLUSIONS: Opioidergic dysregulation may underlie respiratory pathophysiology and suffocation sensitivity in PD. Comparing specific anti-panic medications with ineffective anti-panic agents (e.g. propranolol) can test the specificity of the naloxone+lactate model. A screen for putative anti-panic agents and a new pharmacotherapeutic approach are suggested. Heuristically, the experimental unveiling of the endogenous opioid system impairing effects of CPL and separation in normal adults opens a new experimental, investigatory area.

Visual memory deficits in temporal lobe epilepsy: toward a multifactorial approach.

Temporal lobe epilepsies (TLE) are associated with material-specific memory deficits depending on the side of seizure origin. However, while verbal memory deficits have been consistently reported in patients with left-sided TLE, the relationship between visual memory deficits and right-sided TLE is more complex. Here, we review factors that influence the pattern of lateralization and the nature of visual memory impairments in TLE and discuss the possible relationship between these deficits and perceptual impairments in TLE patients.

Processing of famous faces and medial temporal lobe event-related potentials: a depth electrode study.

The present study aims at analyzing the modulation of two types of event-related potentials originating from the human medial temporal lobe, the rhinal AMTL-N400 and the hippocampal P600 by the processing of famous faces. Therefore, we used a face recognition paradigm in which subjects had to discriminate the faces of famous persons from the faces of non-famous persons. Eleven patients with unilateral medial temporal lobe epilepsy undergoing intrahippocampal depth electrode recording for presurgical evaluation participated in this study. Event-related potentials (ERP) were recorded while a sequence of famous and non-famous faces was presented to the patients. The presentation of each face was repeated. The faces evoked N400-like potentials (anterior medial temporal lobe N400, AMTL-N400) in the rhinal cortex and P600-like potentials in the hippocampus. ERPs elicited by famous faces were contrasted with ERPs elicited by non-famous faces. The first presentation of famous faces elicited an enhanced AMTL-N400 and an enhanced hippocampal P600 in comparison to the second presentations of the famous faces or the (first and second presentation of the) non-famous faces. This findings are discussed in terms of associative semantic memory processes and the retrieval of person-specific information from long-term memory stores triggered by the processing of famous faces.

Hippocampal function and visual object processing in temporal lobe epilepsy.

Limbic event-related potentials related to verbal but not to visual recognition memory have been found to be attenuated within the epileptic hippocampus of patients with temporal lobe epilepsy (TLE). To identify hippocampal contributions to visual processing and memory we recorded intracranial ERPs directly from within the epileptic and the non-epileptic hippocampus in 12 patients with unilateral TLE during a visual object decision and naming task. While the non-epileptic hippocampus differentiated reliably between real and nonsense objects, this effect was completely eliminated within the epileptic mesial temporal lobe. This finding suggests that the hippocampus proper contributes to the semantic processing of visual objects and may help to explain visual memory deficits in TLE.

Identification of spatially filtered stimuli as function of the semantic category.

The different weight of spatial frequency content in the identification of visual objects was investigated. Subjects were required to identify spatially filtered pictures of animals, vegetables and nonliving objects, displayed at 9 resolution levels of filtering following a coarse-to-fine order. Results showed that spatial frequency content differentially affected the three categories of stimuli. Data suggested a different involvement of low and high spatial frequency channels in visual processing of objects in relation to the semantic category.

What is so special about mangroves?

The title question of this short paper has been addressed to me countless times by persons from all walks of life. The paper is a concise answer to the question; it might go halfway towards satisfying the questioners, but not more than halfway. This paper identifies the uniqueness of mangrove ecosystems in that they are created and sustained by a small number of rooted vascular plants in the intertidal area of the tropics. In addition to being a marginal ecosystem, a mangrove is unique in that, as an ecosystem it has various interactions with other ecosystems, both adjoining and remote in space and time. Another unique feaure of mangroves is that, unlike most marginal ecosystems, they are highly productive and dynamic. Healthy mangrove ecosystems also have the peculiar ability to immobilize heavy metals

What is so special about mangroves?

The title question of this short paper has been addressed to me countless times by persons from all walks of life. The paper is a concise answer to the question; it might go halfway towards satisfying the questioners, but not more than halfway. This paper identifies the uniqueness of mangrove ecosystems in that they are created and sustained by a small number of rooted vascular plants in the intertidal area of the tropics. In addition to being a marginal ecosystem, a mangrove is unique in that, as an ecosystem it has various interactions with other ecosystems, both adjoining and remote in space and time. Another unique feaure of mangroves is that, unlike most marginal ecosystems, they are highly productive and dynamic. Healthy mangrove ecosystems also have the peculiar ability to immobilize heavy metals.

A pergunta formulada no título foi dirigida à autora por várias pessoas de todos os tipos e afazeres. A presente nota é uma tentativa de resposta, a fim de satisfazê-las ao menos em parte. Uma resposta curta não poderia atender a mais do que uma fração da pergunta, pois, necessariamente, deve ser concisa. Este texto identifica a principal peculiaridade dos manguezais no fato de serem criados e mantidos por um pequeno número de plantas vasculares arraigadas no solo da faixa tropical entre marés. O manguezal é um ecossistema marginal com grande e variado número de interações com outros ecossistemas, próximos, adjacentes ou remotos no tempo e no espaço. Outra particularidade é que, diferentemente da maioria dos ecossistemas marginais, é um sistema altamente dinâmico, muito produtivo e com capacidade de imobilizar sais de metais pesados.

Hand preference in Italian students.

Italian undergraduates (N = 2326) were administered the Italian revised version of Edinburgh Handedness Inventory (Salmaso & Longoni, 1985). Left-handedness was documented in relation to sex, university faculty, geographic origin and handedness pressure. A greater proportion (7.9%) of left-handedness was found compared to previous works on Italian samples. Additional results indicated a difference in left-handedness incidence among Southern, Central and Northern Italian regions. Results are discussed in terms of social and cultural influence.

What is so special about mangroves?

The title question of this short paper has been addressed to me countless times by persons from all walks of life. The paper is a concise answer to the question; it might go halfway towards satisfying the questioners, but not more than halfway. This paper identifies the uniqueness of mangrove ecosystems in that they are created and sustained by a small number of rooted vascular plants in the intertidal area of the tropics. In addition to being a marginal ecosystem, a mangrove is unique in that, as an ecosystem it has various interactions with other ecosystems, both adjoining and remote in space and time. Another unique feature of mangroves is that, unlike most marginal ecosystems, they are highly productive and dynamic. Healthy mangrove ecosystems also have the peculiar ability to immobilize heavy metals.

Finding pathogenicity islands and gene transfer events in genome data.

MOTIVATION: There is a growing literature on wavelet theory and wavelet methods showing improvements on more classical techniques, especially in the contexts of smoothing and extraction of fundamental components of signals. G+C patterns occur at different lengths (scales) and, for this reason, G+C plots are usually difficult to interpret. Current methods for genome analysis choose a window size and compute a chi(2) statistics of the average value for each window with respect to the whole genome. RESULTS: Firstly, wavelets are used to smooth G+C profiles to locate characteristic patterns in genome sequences. The method we use is based on performing a chi(2) statistics on the wavelet coefficients of a profile; thus we do not need to choose a fixed window size, in that the smoothing occurs at a set of different scales. Secondly, a wavelet scalogram is used as a measure for sequence profile comparison; this tool is very general and can be applied to other sequence profiles commonly used in genome analysis. We show applications to the analysis of Deinococcus radiodurans chromosome I, of two strains of Helicobacter pylori (26695, J99) and two of Neisseria meningitidis (serogroup B strain MC58 and serogroup A strain Z2491). We report a list of loci that have different G+C content with respect to the nearby regions; the analysis of N. meningitidis serogroup B shows two new large regions with low G+C content that are putative pathogenicity islands. AVAILABILITY: Software and numerical results (profiles, scalograms, high and low frequency components) for all the genome sequences analyzed are available upon request from the authors.

Category effects on the processing of plane-rotated objects.

We examined the effects of plane rotations on the identification of exemplars of three semantic categories. In the first two experiments line drawings belonging to three categories (animals, inanimate objects, and vegetables) were presented at four orientations (0 degree, 60 degrees, 120 degrees, and 180 degrees of clockwise rotation). The response time was found to depend on stimulus category. In particular, whereas rotation effects were shown for animals, no effect at all was found for vegetables and only partial effects were found for inanimate objects. The unclear pattern found for inanimate objects was further examined in experiment 3 where the orientation effects on the identification of two subsets of the inanimate category were studied. The hypothesis of view-observation frequency was confirmed. In experiment 4, line drawings of objects at different orientations were presented in physically degraded versions. The minimum amount of visual information necessary to identify rotated stimuli was found to vary as a function of stimulus category as well. Results are discussed, combining current research on both viewpoint-dependence/independence and neural systems involved in category processing.

Wavelet change-point prediction of transmembrane proteins.

MOTIVATION: A non-parametric method, based on a wavelet data-dependent threshold technique for change-point analysis, is applied to predict location and topology of helices in transmembrane proteins. A new propensity scale generated from a transmembrane helix database is proposed. RESULTS: We show that wavelet change-point performs well for smoothing hydropathy and transmembrane profiles generated using different scales. We investigate which wavelet bases and threshold functions are overall most appropriate to detect transmembrane segments. Prediction accuracy is based on the analysis of two data sets used as standard benchmarks for transmembrane prediction algorithms. The analysis of a test set of 83 proteins results in accuracy per segment equal to 98.2%; the analysis of a 48 proteins blind-test set, i.e. containing proteins not used to generate the propensity scales, results in accuracy per segment equal to 97.4%. We believe that this method can also be applied to the detection of boundaries of other patterns such as G + Cisochores and dot-plots. AVAILABILITY: The transmembrane database, TMALN and source code are available upon request from the authors.

A transparent tool for seemingly difficult calibrations: the parallel calibration method.

A new easy-to-understand calibration method for the analysis of spectral data is developed. The "parallel calibration" method is logically simple and intuitive yet often provides an improvement over more complex standard calibration methods. A description of the algorithm with a technical justification for the parallel algorithm is presented, underscoring the simplicity of the approach. In addition, performance as compared to that of the standard methods of classical least-squares (CLS) and partial least-squares (PLS) regression is studied. Calibrations are carried out on a computer-generated simulation data set as well as two scientific data sets. The results show that the parallel method gives results comparable to or better than those of CLS and PLS methods in terms of mean squared error.