Analyzing the Effects of Psychotherapy on Weight Loss after Laparoscopic Gastric Bypass or Laparoscopic Adjustable Gastric Banding in Patients with Borderline Personality Disorder: A Prospective Study.

BACKGROUND AND AIMS: Personality disorders are frequently associated with eating disorders in obese patients and may negatively affect weight loss and maintenance after bariatric surgery. This non-randomized study aimed to assess the effects of different psychotherapeutic interventions on weight loss in a sample of patients with borderline personality disorder who underwent laparoscopic gastric bypass or laparoscopic adjustable gastric banding. MATERIALS AND METHODS: A total of 153 bariatric patients meeting borderline personality disorder criteria were chosen voluntarily and consecutively to undergo an interpersonal individual treatment (n = 50), a dialectical behavioral group treatment (n = 50), or treatment as usual (n = 53) for a year after surgery. Their body mass index was measured before and at the end of each treatment. RESULTS AND CONCLUSION: A total of 12 patients (7.8%) dropped out of the study. Significantly higher body mass index reductions were registered in both experimental groups (-14.2 and -9.4 kg/m2, respectively) compared with the treatment as usual group (-2.1 kg/m2; p < 0.01). Treated patients who underwent laparoscopic gastric bypass (total n = 94) showed better outcomes than those who underwent laparoscopic adjustable gastric banding (total n = 45), while no differences were observed in untreated patients. This study demonstrates the role of pre-operative psychological assessment and post-operative psychotherapeutic support in improving weight loss among bariatric patients with borderline personality disorder. A randomized controlled trial is needed to confirm these preliminary findings.

Effectiveness and persistence of a topical treatment for cervical ectropion with deoxyribonucleic acid.

AIM: The aim of this study was to estimate short and long term effectiveness of a topical treatment for cervical ectropion with 5 mg of deoxyribonucleic acid (DRNA). METHODS: A randomized case-control study was carried out. Two-hundred and twenty patients, colposcopically diagnosed with cervical ectropion, were consecutively enrolled and randomly divided into 2 groups: treated (group 1) and controls (group 2). The therapeutic plan consisted of DRNA 5 mg vaginal suppositories, administered for 15 days monthly; subsequently posology was reduced gradually. Both groups underwent a clinical and colposcopical follow-up on the 1st, 4th, 10th and 22nd months after the first examination. At the end of the study, the size of ectropion was considered a parameter of re-epithelialization and provided a criterion of treatment effectiveness. According to this protocol, subjects were defined improved, stable or worsened. Statistical analysis including Pearson chi2 tests, Fisher's exact tests, Yate's corrected chi2 and relative-risk (95% CI) was performed. RESULTS: Of the 220 enrolled patients, 140 completed the study protocol: 76 treated and 64 controls. Outcomes after treatment and follow-up consisted of: 74 (97.4%) improved in group 1, against 2 cases (3.1%) in group 2. High statistical significance was reported comparing outcome frequencies in the 2 groups (P<0.0001). CONCLUSIONS: This study shows a significant reduction (P<0.0001) in cervical ectropion size between cases (topical treatment with DRNA 5 mg) and controls. A follow-up of 22 months confirmed the persistence and effectiveness of this medical approach.

The effect of fontanel on scalp EEG potentials in the neonate.

OBJECTIVE: To define how fontanels affect scalp EEG potentials in neonates. METHOD: Realistic finite element method head models were generated with and without fontanels. The electrical activity of the whole cortex was simulated using distributed 54,620 concurrently active cortical dipoles with a uniform random distribution of current densities (0-40 µA/cm2). The overall effects of fontanels on scalp potentials were calculated from finite element forward solution in the vicinity the fontanel region by relative difference measure (RDM*) and magnification factor (MAG), and the skull conductivity was systematically varied from 0.003 to 0.3S/m. RESULTS: The neonatal scalp EEG topographies are comparable in models with and without fontanels, with highest amplitudes directly above the anterior fontanel. Quantitatively, comparison of these models elicits negligible differences (RDM*) ∼2% and MAG ∼1.0). However, fontanel contribution to scalp potential was shown to increase sharply with decreases in skull conductivity. CONCLUSIONS: These results suggest that fontanels may affect neonatal scalp EEG much less than traditionally assumed, and the effect is strongly dependent on skull conductivity. SIGNIFICANCE: Most neonatal EEG studies can be adequately performed without assuming distortions by fontanels.

Development and characterization of a human in vitro resorption assay: demonstration of utility using novel antiresorptive agents.

A human in vitro resorption assay has been developed using osteoclastoma-derived osteoclasts and used to evaluate novel antiresorptive agents including antagonists of the alphavbeta3 integrin, and inhibitors of cathepsin K and the osteoclast ATPase. The potency of novel compounds in the in vitro resorption assay correlates with functional assays for each class of inhibitor: the human alphavbeta3-mediated cell adhesion assay for the vitronectin receptor antagonists (r2 = 0.82), the chick osteoclast vacuolar ATPase enzyme assay for the H+-ATPase inhibitors (r2 = 0.77) and the recombinant human cathepsin K enzyme assay for the cathepsin K inhibitors (r2 = 0.80). Cell suspensions, rich in osteoclasts, are prepared by collagenase digestion of the tumor tissue. These cells can be stored long-term in liquid nitrogen and upon thawing maintain their bone-resorbing phenotype. The cryopreserved cells can be cultured on bovine cortical bone for 24-48 h and resorption can be measured by either confocal microscopy or biochemical assays. The resorptive activity of osteoclasts derived from a number of tumors can be inhibited reproducibly using a number of mechanistically unique antiresorptive compounds. In addition, the measurement of resorption pits by laser confocal microscopy correlates with the release of type I collagen C-telopeptides or N-telopeptides, as measured by enzyme-linked immunosorbent assay. Resorption can be measured reproducibly using a 48-h incubation of osteoclasts on bone slices, or a 24-h incubation with bone particles. This in vitro human osteoclast resorption assay provides a robust system for the evaluation of inhibitors of osteoclastic function that may be developed for the treatment of metabolic bone diseases such as osteoporosis.

Synthesis and structure-activity relationships of bafilomycin A1 derivatives as inhibitors of vacuolar H+-ATPase.

The macrolide antibiotic bafilomycin A1 is a highly potent and selective inhibitor of all the vacuolar ATPases (V-ATPases). With the aim of obtaining novel analogues specific for the osteoclast subclass of vacuolar ATPase, 31 derivatives of bafilomycin A1 were synthesized and tested for their ability to inhibit differentially the V-ATPase-driven proton transport in membrane vesicles derived from chicken osteoclasts (cOc) and bovine chromaffin granules (bCG). Although none of the new analogues were more potent than the parent compound, the obtained data provided a significant amount of information about the structural requirements for the inhibitory activity of bafilomycin A1. The different effects of a few analogues on the two enzymes could also suggest the possibility of a selective modulation of the V-ATPases in different tissues.

5-(5,6-Dichloro-2-indolyl)-2-methoxy-2,4-pentadienamides: novel and selective inhibitors of the vacuolar H+-ATPase of osteoclasts with bone antiresorptive activity.

The vacuolar H+-ATPase (V-ATPase), located on the ruffled border of the osteoclast, is a proton pump which is responsible for secreting the massive amounts of protons that are required for the bone resorption process. With the aim to identify new agents which are able to prevent the excessive bone resorption associated with osteoporosis, we have designed a novel class of potent and selective inhibitors of the osteoclast proton pump, starting from the structure of the specific V-ATPase inhibitor bafilomycin A1. Compounds 3a-d potently inhibited the V-ATPase in chicken osteoclast membranes (IC50 = 60-180 nM) and were able to prevent bone resorption by human osteoclasts in vitro at low-nanomolar concentrations. Notably, the EC50 of compound 3c in this assay was 45-fold lower than the concentration required for half-maximal inhibition of the V-ATPase from human kidney cortex. These results support the validity of the osteoclast proton pump as a useful molecular target to produce novel inhibitors of bone resorption, potentially useful as antiosteporotic agents.

Oxiracetam prevents the hippocampal cholinergic hypofunction induced by the NMDA receptor blocker AP7.

The intracerebroventricular injection of the N-methyl-D-aspartate (NMDA) receptor antagonist D,L-2-amino-7-phosphonoheptanoic acid (AP7) induces an increase of the hippocampal levels of acetylcholine (ACh) which is dose-dependent in the range 1.5-10 micrograms. Similar doses of AP7 failed to affect the ACh content of the striatum. The effect of the i.c.v. administration of 3.5 micrograms AP7 on hippocampal ACh levels was prevented by pretreatment with oxiracetam 100 mg/kg i.p. In the passive avoidance test the i.c.v. administration of 3.5 micrograms of AP7 caused severe amnesia which was antagonized in a dose-dependent manner by the pretreatment with oxiracetam. These results show that oxiracetam prevents the imbalance of cholinergic activity and the amnesia caused by blockade of NMDA receptors. The present study suggests that the hippocampal cholinergic activity is modulated by glutamatergic neuronal pathways and that the functional integrity of both systems is essential for learning and memory processes.

Effects of synthetic speech output and orthographic feedback on spelling in a student with autism: a preliminary study.

The effects of speech output and orthographic feedback on spelling performance were evaluated in this preliminary study. A nonspeaking student with autism was taught to spell words under three feedback conditions using a voice output communication aid. In the auditoryvisual condition, the participant received speech output and orthographic feedback. In the visual condition, the participant received only the orthographic feedback. In the auditory condition, the student received only speech output. An adapted alternating treatments design was used to evaluate the effects of the three feedback conditions. Although the participant reached criterion and maintained performance in each of the conditions, the provision of speech output alone and in combination with orthographic feedback resulted in more efficient spelling than the provision of orthographic feedback alone. Although replications with other subjects are necessary, findings suggest that speech output contributes to efficient spelling.

Assessment of an indirect ELISA in milk for the diagnosis of ovine Brucellosis.

The possibility of using an ELISA for the diagnosis of ovine brucellosis in milk (M-ELISA) was investigated. The aim of the study was to establish whether the specificity and sensitivity of the M-ELISA would be high enough to detect low levels of Brucella antibodies in ewe milk. The diagnostic performances of the test under study were established by means of reference standards and compared with conventional screening and confirmatory tests under field conditions. The diagnostic specificity of the M-ELISA established on a number of samples from Brucella-free flocks was 100% while relative to RBT and CFT positive reactors the M-ELISA demonstrated sensitivity of 65 and 83% respectively. Its sensitivity relative to culture positive animals was of 92%. The course of Brucella antibodies in milk of positive sheep was evaluated in colostrum and in mature milk for a period of 30 days after delivery and it appeared that concentrations of immunoglobulins in milk tend to sharply decrease soon after parturition while in blood serum these remained constantly high. It was concluded that the M-ELISA for Brucella antibodies in ewe milk can be regarded as a complementary diagnostic tool for individual testing but it would be poorly viable if used as a screening test applied to pooled flock milks.

Novel bone antiresorptive agents that selectively inhibit the osteoclast V-H+-ATPase.

The vacuolar proton pump (V-ATPase) located on the plasma membrane of the osteoclast is a potential molecular target for the discovery of novel bone antiresorptive agents useful for the treatment of osteoporosis. In order to design novel compounds able to selectively inhibit the osteoclast V-ATPase we firstly identified the minimal structural requirements of bafilomycin A1, a macrolide antibiotic which potently inhibits all V-ATPases. This information allowed the design of 2-(indole)pentadienamide derivatives whose optimization led to a novel class of potent inhibitors that demonstrated a high degree of selectivity for the osteoclast V-ATPase. The most interesting derivative, SB-242784, was able to inhibit bone resorption by human osteoclasts in vitro and to completely prevent ovariectomy-induced bone loss in rats when administered orally at 10 mg kg(-1) day(-1). Structure activity relationships of this class of compounds were investigated further by replacing the 2,4-pentadienoyl chain with suitable spacers able to maintain the correct orientation and distance between the indole ring and the amide moiety.

Choline incorporation into phospholipids in brain areas from spontaneously hypertensive rats: effect of oxiracetam treatment.

It has been demonstrated that spontaneously hypertensive rats (SHR) develop severe hypertension and cerebrovascular lesions on drinking 1% NaCl from weaning. These animals present a learning and memory impairment as well as impairment of both energy metabolism and membrane phospholipid turnover. We tested both choline uptake into the cells and incorporation into choline phosphoglyceride (CPG) by incubating slices from hippocampus and cortex. After 5 min of incubation, a noticeable decrease in free labelled choline content inside the cells as well as its incorporation into phospho-choline (PC) and CPG were found in the brain of SHR, as compared to Wistar-Kyoto (WK) rats. This may indicate that in the SHRs with cerebrovascular lesions there is a reduction in choline uptake which in turn causes a decline in CPG biosynthesis through de novo pathway. Oxiracetam treatment is able to restore the labeled choline content in the cells from SH rats, as well as the incorporation of choline into its derivatives PC and CPG, to the levels found in the WK or more. Tests performed in the presence of such a high affinity choline uptake as hemicholinium (HC) confirmed the capacity of oxiracetam to stimulate choline uptake into the cells even if the results obtained up to now are not sufficient to hypothesize a direct effect of oxiracetam on acetylcholine metabolism. In conclusion, from the results obtained it would seem reasonable to hypothesize that the effects of the drug above mentioned on the cholinergic system may be secondary to its effect on choline phosphoglycerides biosynthesis.

The effects of antecedent color on reading for students with learning disabilities and co-occurring attention-deficit/ hyperactivity disorder.

The effects of color on the reading recognition and comprehension of 3 students with learning disabilities and attention-deficit/hyperactivity disorder were assessed in a single-subject design. Color did not enhance sight-word learning; for longer reading comprehension tasks, color had an immediate effect across and within sessions.

Programming for efficiency: the effects of motion economy on vocational tasks for adults with severe and profound mental retardation.

Principles of motion economy were assessed with two vocational tasks for two adults with severe to profound mental retardation. Study 1 assessed task acquisition by comparing two tasks (collating three pages, bagging three ribbons), one task trained using the standard job site task analysis, the other trained using a motion economy-based task analysis (requiring less total distance movement to task completion) in two alternating treatments designs. Study 2 assessed task fluency by examining the effects of the motion economy-based task analysis on collating and bagging separately across the same two adults in four reversal designs. Neither task analysis was superior overall in acquisition (Study 1), but once each task was mastered, the motion economy-based task analysis enhanced fluency across both tasks for both participants (Study 2). The use of distance movement as a parameter of response efficiency is discussed when targeting job performance, productivity, and preference.

The effects of mastery training and explicit feedback on task design preference in a vocational setting.

The purpose of this study was to examine the effects of mastery training and explicit feedback on the selection behavior of two individuals with severe mental retardation across two different vocational task designs. The two design options were (a) a site-based (traditional) approach, and (b) a more efficient motion-economy based approach. The site-based design was developed from workshop-standard task analyses. The motion-economy design was developed by re-configuring the site-based design using principles of motion economy and resulted in less distance movement required for task completion. The study was comprised of four assessment phases: (a) no experience (i.e., participant had no experience with either site-based or motion-economy based designs), (b) after training (i.e., participant was trained to criterion level on both design options), (c) training and timer, and (d) training, timer, and work incentives. Selection behavior was affected by task efficiency, only when efficiency was made more salient by pairing task cues with work incentives.

Effects of experimenter surveillance on reactive self-monitoring.

Two women with mild and moderate mental retardation self-monitored their work productivity with and without experimenter surveillance. For both subjects, reactive effects of self-monitoring were found without surveillance. However, reactivity was much greater when an observer was present while subjects self-monitored their work output. Reactive effects for one subject did not occur until she experienced surveillance in a previous experimental phase, suggesting that the history of surveillance established the reactivity of self-monitoring. Surveillance is viewed as a setting event that may be an important variable in achieving and maintaining benefits of self-management programs for persons with developmental disabilities.

Behavioral momentum in the treatment of escape-motivated stereotypy.

Descriptive and experimental analyses of stereotypy by a woman with severe mental retardation showed that the behavior was maintained by escape from demands. A sequence of high-probability requests issued immediately prior to a task-related request established a momentum of compliance that increased compliance with task-related demands. Increases in compliance were accompanied by collateral reductions in stereotypic behavior. A mechanism of response covariation, called functional incompatibility, and an animal analogue study for testing the validity of this mechanism are proposed.

Effects of community and center-based settings on the alertness of persons with profound mental retardation.

We studied effects of different settings on the behavior of persons with profound mental retardation. Adaptive (alert) and nonadaptive behaviors were observed in two community settings and a center setting. Results of the descriptive assessment showed that participants engaged in a higher percentage of adaptive behaviors and a lower percentage of nonadaptive behaviors in the "high stimulation" community setting. The results are discussed in light of environmental setting events on persons with profound mental retardation.

Effects of response and trial repetition on sight-word training for students with learning disabilities.

Alternating treatments designs were used to compare the effects of trial repetition (one response within five trials per word) versus response repetition (five response repetitions within one trial per word) on sight-word acquisition for 3 elementary students diagnosed with specific learning disabilities in reading. Although both interventions occasioned the same number of accurate responses per word during training, the trial-repetition condition, which involved complete antecedent-response-feedback sequences, resulted in more words mastered for all 3 students.

The effects of speech output technology in the learning of graphic symbols.

The effects of auditory stimuli in the form of synthetic speech output on the learning of graphic symbols were evaluated. Three adults with severe to profound mental retardation and communication impairments were taught to point to lexigrams when presented with words under two conditions. In the first condition, participants used a voice output communication aid to receive synthetic speech as antecedent and consequent stimuli. In the second condition, with a nonelectronic communications board, participants did not receive synthetic speech. A parallel treatments design was used to evaluate the effects of the synthetic speech output as an added component of the augmentative and alternative communication system. The 3 participants reached criterion when not provided with the auditory stimuli. Although 2 participants also reached criterion when not provided with the auditory stimuli, the addition of auditory stimuli resulted in more efficient learning and a decreased error rate. Maintenance results, however, indicated no differences between conditions. Finding suggest that auditory stimuli in the form of synthetic speech contribute to the efficient acquisition of graphic communication symbols.

Effects of high-preference single-digit mathematics problem completion on multiple-digit mathematics problem performance.

The purpose of this study was to examine the effects of a sequence of three single-digit (1 digit x 1 digit) multiplication problems on the latency to initiate multiple-digit (3 digit x 3 digit) multiplication problems for 2 students in an alternative education school. Data showed that (a) during the preference assessment, both students selected the single-digit problems in a majority of the sessions, and (b) intervention resulted in a decrease in latency between problems for both students. Results are discussed in relation to using high-preference sequences to promote behavioral momentum in academic content areas.