Is it necessary to perform full pathologic review of all gastric remnants following sleeve gastrectomy?

BACKGROUND: This study attempts to determine if enough pathological abnormalities in gastric remnants from sleeve gastrectomy exist to warrant full pathologic evaluation in all remnants. METHODS: Data was collected on patients undergoing sleeve gastrectomy between 08/01/2011 and 06/30/2014. Significant abnormalities were classified as any pathology that might require follow-up or treatment beyond standard follow-up. Age, comorbidities, gender, and Helicobacter pylori titers were analyzed and compared with pathology specimens using 95% confidence intervals and Phi contingency coefficients. RESULTS: Full pathologic evaluation was available for 351/387 patients (91.2%). No examples of malignancy or dysplasia were identified. Gastritis was the most common abnormality. There was a statistically significant association between preoperative H. pylori and significantly abnormal pathology (p = 0.003). Other comorbidities had no association. CONCLUSIONS: These results suggest that full pathologic evaluation of the gastric remnant following sleeve gastrectomy is unnecessary, particularly when gross pathology is not noted at initial operation.

Extended methamphetamine self-administration enhances reinstatement of drug seeking and impairs novel object recognition in rats.

RATIONALE: Methamphetamine is a highly addictive psychostimulant, and chronic methamphetamine users show high rates of relapse. Furthermore, prolonged methamphetamine abuse can lead to psychiatric symptoms and has been associated with various cognitive dysfunctions. However, the impact of self-administered methamphetamine on cognitive dysfunction and relapse has not been concurrently examined in an animal model. OBJECTIVES: The present study determined the effects of short- vs. long-access contingent methamphetamine on self-administration, extinction responding, reinstatement of methamphetamine seeking, and cognitive performance on an object exploration task. MATERIALS AND METHODS: Long-Evans rats self-administered methamphetamine i.v. (0.02 mg/infusion) or received saline during daily sessions (1 or 2 h) for 10 days, followed by either maintained short- (1 or 2 h) or long-access (6 h) self-administration for 14 days. Lever responding was extinguished prior to reinstatement, which consisted of presentation of drug-paired cues or a priming injection of methamphetamine (1.0 mg/kg). Animals were also tested on an object exploration task prior to self-administration and at 10-12 days after cessation of self-administration, thus providing a comparison of pre-methamphetamine exposure with post-methamphetamine exposure. RESULTS: Long-access methamphetamine self-administration resulted in escalation of daily intake. Furthermore, animals in both short- and long-access groups showed robust conditioned-cued and drug-primed reinstatement, with long access resulting in enhanced methamphetamine-primed reinstatement. Methamphetamine self-administration also led to access-dependent impairments on novel object recognition but failed to impair recognition of spatial reconfiguration. CONCLUSIONS: Extended methamphetamine self-administration enhances drug-primed reinstatement and decreases novel object recognition, indicating that prolonged contingent methamphetamine increases motivation for drug seeking following withdrawal while increasing cognitive deficits.

The neural circuitry underlying reinstatement of heroin-seeking behavior in an animal model of relapse.

Reinstatement of extinguished drug-seeking has been utilized in the study of the neural substrates of relapse to drugs of abuse, particularly cocaine. However, limited studies have examined the circuitry that drives the reinstatement of heroin-seeking behavior in the presence of conditioned cues, or by heroin itself. In order to test the hypothesis that the circuitry underlying reinstatement in heroin-experienced animals would show overlapping, yet distinct differences from cocaine-experienced animals, we used transient inhibition of several cortical, striatal, and limbic brain regions during reinstatement of heroin-seeking produced by heroin-paired cues, or by a single priming dose of heroin. Rats lever pressed for i.v. heroin discretely paired with a conditioned stimulus (CS) during daily 3-h sessions for a period of 2 weeks, followed by daily extinction of lever responding. Subsequent reinstatement of heroin-seeking was measured as lever responding in the absence of heroin reinforcement. The first set of reinstatement tests involved response-contingent CS presentations following bilateral intracranial infusion of either a combination of GABA receptor agonists (baclofen-muscimol, B/M) or vehicle (saline) into one of 13 different brain regions. The second set of reinstatement tests involved a single heroin injection (0.25 mg/kg, s.c.) following either B/M or vehicle infusions. Our results showed that vehicle-infused animals reinstated to both CS presentations and a priming injection of heroin, while B/M inactivation of several areas known to be important for the reinstatement of cocaine-seeking also attenuated heroin-seeking in response to CS presentations and/or a priming dose of heroin. However, as predicted, inactivation of areas previously shown to not affect cocaine-seeking significantly attenuated heroin-seeking, supporting the hypothesis that the circuitry underlying the reinstatement of heroin-seeking is more diffusely distributed than that for cocaine.

Synchronization by reactive coupling and nonlinear frequency pulling.

We present a detailed analysis of a model for the synchronization of nonlinear oscillators due to reactive coupling and nonlinear frequency pulling. We study the model for the mean field case of all-to-all coupling, deriving results for the initial onset of synchronization as the coupling or nonlinearity increase, and conditions for the existence of the completely synchronized state when all the oscillators evolve with the same frequency. Explicit results are derived for the Lorentzian, triangular, and top-hat distributions of oscillator frequencies. Numerical simulations are used to construct complete phase diagrams for these distributions.

Synchronization by nonlinear frequency pulling.

We analyze a model for the synchronization of nonlinear oscillators due to reactive coupling and nonlinear frequency pulling motivated by the physics of arrays of nanoscale oscillators. We study the model for the mean field case of all-to-all coupling, deriving results for the onset of synchronization as the coupling or nonlinearity increase, and the fully locked state when all the oscillators evolve with the same frequency.

Serving amputee patients in rural settings.

Managing care for amputee patients becomes complicated in a rural setting, where members of the care team are spread out and have overlapping roles. The solution to this situation is to start communication early in the process of getting a prosthesis.

Antiischemic and antiarrhythmic activities of some novel alinidine analogs in the rat heart.

The antiischemic and antiarrhythmic effects of alinidine and a number of novel alinidine analogs were examined by using perfused rat-heart models. In the isolated working rat heart, the alinidine analog TH91:21 (10 microM; a butyl derivative) significantly increased the postischemic recovery of the heart in terms of both power and efficiency when compared with the control group. In the in situ perfused heart model, this same compound, along with TH91:22 (10 microM; a pentyl derivative) also significantly reduced the severity of both ischemia- and reperfusion-induced arrhythmias in both paced and unpaced hearts. Thus this study is the first to demonstrate the potent antiarrhythmic efficacy of two novel alinidine analogs TH91:21 and TH91:22, with TH91:21 also demonstrated to be a potent antiischemic agent in the isolated working rat heart. Although the mode of action of these compounds remains unclear, results from this study suggest that it is not simply a result of bradycardia or blockade of KATP channels, two actions these compounds possess. These compounds thus possess a novel and beneficial pharmacologic profile worthy of further study.

Recognizing and treating fibromyalgia.

Fibromyalgia is a chronic medical condition characterized by widespread body pain and uncontrollable fatigue. It is often accompanied by many other problems such as irritable bowel, headaches, sleep disorder, and poor circulation. Diagnostic criteria including tender point locations and various other symptoms are provided to aid in recognizing fibromyalgia. Treatment options including the latest drug therapies and self-help therapies should assist the health care provider in treating the fibromyalgia patient. The clinician and the patient must work closely together to identify the combination of treatment options and medications that are most beneficial to each patient. Patient education is crucial since patients who understand their medical condition will be better able to manage their symptoms. Through further research and education, an improved quality of life for patients with fibromyalgia and their families can be attained.

The influence of signal variation, bias, noise and effect size on statistical significance in treatment studies of the common cold.

Many groups are working on new and improved methods of common cold treatment that include antivirals, synthetic viral receptor, compounds which block symptom pathways, and combinations of these approaches. Because the common cold syndrome is in large part subjective, symptom measurement remains an important parameter in evaluating the effectiveness of cold treatments. This review examines the features of the experimental and natural cold testing methods that effect recognition of illness signal and influence its variance and strength. Also, the importance of changes in signal variance and in the magnitude of therapeutic effect size as they relate to statistical probability were compared using a symptom data set from young adults with experimental rhinovirus colds.

Structure-activity relationship of glibenclamide analogs: a comparison of potency as levcromakalim antagonists in rat aorta vs. affinity for [3H]-glibenclamide binding to membranes from rat cerebral cortex.

Glibenclamide and analogs were tested for their ability to antagonize the vasorelaxant actions of the K+ channel opener levcromakalim in rat thoracic aorta, and to displace [3H]-glibenclamide binding from rat cerebral cortex membranes. Aortic ring segments were suspended in organ baths to record isometric tension. Tissues were precontracted with K+ (20 mM), and full concentration-relaxation curves were constructed to levcromakalim (0.01-30 microM) in the absence and presence of glibenclamide or analog. The majority of the amidoethylbenzenesulfonylurea based compounds (exemplified by glibenclamide) caused parallel rightward shifts in the levcromakalim concentration-effect curves without effecting the maximum response to levcromakalim. Sulfonamide based compounds were generally inactive, with the exception of the compound DK#1 (laboratory code), which was unusually active as an antagonist of levcromakalim-mediated responses. The compounds were 1,000 to 10,000 times more potent at displacing [3H]-glibenclamide binding from rat cerebral cortex membranes. There was a strong correlation between the activity of amidoethylbenzenesulfonylurea based compounds as antagonists of the effects of levcromakalim and their ability to displace [3H]-glibenclamide binding. The slope of the regression line indicated that structural modification to these compounds has a more dramatic effect on their actions as levcromakalim antagonists than on their ability to displace [3H]-glibenclamide binding. This relationship of activity for the amidoethylbenzenesulfonylureas did not hold in the case of the sulfonamide derivatives. The results show that, for the processes characterized in this study (vascular levcromakalim antagonism vs. sulfonylurea receptor affinity), there are quantitative differences in their sensitivities to sulfonamide/sulfonylurea based compounds. Such differentiation may be important in the development of tissue-specific compounds.

Comparison of the cromakalim antagonism and bradycardic actions of a series of novel alinidine analogues in the rat.

Alinidine, and eight derivatives, were synthesized and tested for their ability to antagonise the actions of the K+ channel opener cromakalim in rat thoracic aorta, and for their ability to induce bradycardia in rat isolated spontaneously beating right atria. Ring segments of rat thoracic aorta were suspended in organ baths to record isometric tension. Tissues were precontracted with K+ (20 mM), and full concentration-relaxation curves constructed to cromakalim (0.01-30 microM) in the absence and presence of increasing concentrations of alinidine/derivative. The majority of the compounds tested caused rightward shifts in the cromakalim concentration-effect curves. Rat spontaneously beating right atria were suspended in organ baths to record rate of contraction. Addition of alinidine/derivative caused a concentration-dependent negative chronotropic response. In terms of structure-activity relationships, increasing the length of the N-allyl side-chain on the alinidine molecule (from 3 carbon (3C), to 5C) resulted in a significant increase in the activity of the compounds as both bradycardic agents and cromakalim antagonists. The most potent compounds in both cases (bradycardic agent and cromakalim antagonist) had no double bond in the side chain. The results suggest that the carbon side-chain influences the activity of alinidine-related compounds both as cromakalim antagonists and as bradycardic agents. However, while similar structure-activity relationships appear to apply for both effects in some instances, there was no significant correlation between the two actions of the alinidine analogues. The results suggest that the ability of alinidine-derivatives to induce bradycardia or to block K+ channels opened by cromakalim can be differentiated on the basis of structure.

Potassium channel openers and other regulators of KATP channels.

1. Interest in ATP-sensitive K (KATP) channels first arose when it was shown that hypoglycaemic sulphonylureas, such as glibenclamide, closed these channels in pancreatic beta-cells to cause insulin release. The demonstration that certain smooth muscle relaxants (K channel openers) may exert their actions through opening a similar channel in vascular smooth muscle fueled further investigation of these channels and their physiological role in a variety of tissue types, including various types of smooth muscle, cardiac and skeletal muscle and neural and endocrine organ function. 2. The K channel openers have a variety of potential therapeutic applications, including disorders of smooth muscle hyperreactivity, such as hypertension, and a great deal of research has focused on this field. More recently, attention has turned to the cardiac actions of these compounds and this area is discussed in detail. One of the current problems is the lack of selectivity of KATP channel regulators. However, there have been a number of recent encouraging reports suggesting that, under certain pathophysiological conditions, the action of the K channel openers may be enhanced, conferring upon them some degree of selectivity. 3. A number of endogenous regulators of these channels have been identified, particularly in the category of endogenous openers of these channels. At present though, the physiological role of these channels and the endogenous regulators identified, is unclear. 4. It is evident that, although advances have been made, much work is still required to increase our understanding and ultimately to allow selective pharmacological manipulation of these channels to become a therapeutic reality.

Prevalence of sexual harassment among rural community care workers.

This study identified the prevalence of sexual harassment and the demographic characteristics of rural, midwestern community care workers (CCWs). To prevent premature institutionalization, community care workers provide home-based assistance that enables elderly persons to remain in their homes. Data were collected from 735 CCWs to determine their demographic characteristics and the prevalence of sexual harassment at the work site. The prevalence portion of the instrument provided data which indicated that 27.8% of the CCWs were harassed on the job and that 15% of the workers were harassed by their elderly client. Demographic characteristics were collected which showed that 94.8% of the CCWs were women, 60.4% were married, and 89.8% were white. Discussion and recommendations drawn from the results of the collected data are included in this article.

Using significance tests to evaluate equivalence between two experimental groups.

Equivalency testing, a statistical method often used in biostatistics to determine the equivalence of 2 experimental drugs, is introduced to social scientists. Examples of equivalency testing are offered, and the usefulness of the method to the social scientist is discussed.

PIP: Equivalency testing. currently used by biostatisticians to determine whether 2 drugs have an equally effective outcome, offers social scientists a method for analysis of various interventions. This is the method of choice when researchers are able to specify a small, non-zero difference between 2 treatments that can serve to define an equivalence interval around a difference of zero. The goal is to reject the null hypothesis and provide evidence for an alternative hypothesis that the difference between 2 groups is smaller than that specified in the null hypothesis. The process involves the definition of equivalency and the performance of 2 simultaneous 1-sided tests of the hypothesis. The Westlake confidence interval approach to equivalency is applied, for illustrative purposes, to data generated by 3 social scientific studies. In the 1st example, the procedure was used to determine whether the mean Minnesota Multiphasic Personality Inventory scores of drug addicted subjects were within 10% of the means of scores of alcoholic subjects. The 2nd study represented an attempt to assess the relative effectiveness of several therapeutic approaches (psychotherapy alone, psychotherapy in combination with antidepressant medication, behavioral approaches, cognitive therapy) to the treatment of depression. Finally, the 3rd study compared baseline characteristic equivalence among nonpregnant black adolescents, pregnant adolescents who carried to term, and those who aborted. It is noted that this method offers a means of evaluating published negative findings to determine whether a reasonable definition of equivalence exists. Moreover, equivalency testing can be used in the social sciences to justify the pooling of study groups.

Appropriate short-term risk in psychiatry and the law.

Effective treatment decisions sometimes require substantial risk of short-term harm, which can be shown after-the-fact to have been preventable, thereby carrying some liability risk. To err on the side of short-term comfort or safety, however, may greatly increase the overall and long-term risks. For instance, to intrusively restrain a borderline patient from threatened acting out, may (1) fuel a regressive cycle that heightens future risk, (2) deprive the clinician of therapeutic leverage, and/or (3) so disrupt the treatment system that other patients unnecessarily suffer. Long-term thinking is not always convincing to judge or juror, because of less direct causal connections; hence, there is pressing need to develop rational criteria for when it should hold sway. Two competing trends of legal doctrine are relevant: risk-benefit analysis (utilitarian) and absolute values (absolutist). Presumptions of appropriate short-term risk separately weigh five relevant factors, in interaction with one another: imminent safety, long-term risk, voluntariness of other agent, therapeutic boundaries, and social values. Forensic psychiatrists are advised to take a stronger stand in support of short-term risk, when needed to enhance long-term safety and optimal standards of care.