The effects of bariatric surgery on psychological aspects of eating behaviour and food intake in humans.

Bariatric surgery has emerged as an increasingly popular weight loss intervention, with larger and more endurable weight loss compared to pharmacological and behavioural interventions. The degree of weight loss patients experience varies, between individuals, surgeries and over time. An explanation as to why differing weight loss trajectories exist post-surgery could be due to the complex interplay of individual differences in relation to eating behaviours and appetite. Thus the aim of this narrative review is to explore literature between 2008 and 2018, to assess the impact of impact of bariatric surgery on food selection and nutrient status, on eating behaviour traits and on disturbed and disordered eating behaviour, to determine their impact of weight loss success and weight loss trajectories. Immediately post-surgery, up until 1-2 years post-surgery, there is a reliance upon the surgery's alteration of the gastrointestinal tract to control food intake and subsequently lose weight. Energy intake is reduced, dietary adherence is higher, supplement intake is higher, appetite ratings are lower, there is a reduction in psychopathology, and an increase in wellbeing. After this point, patients become more susceptible to weight regain, as this is the point where passive observation of the weight reducing action of surgery, moves into more cognitive effort, on the part of the individual, to control energy intake. There are various factors which influence an individual's ability to successfully regulate their energy intake post-surgery, such as their level of Disinhibition, Restraint, Hunger, Emotional Eating, Uncontrolled Eating, psychopathology and wellbeing. The need for continued psychological and nutritional support post-surgery is necessary to reduce weight regain susceptibility.

Age, working memory, and on-line syntactic processing in sentence comprehension.

One hundred twenty-seven individuals who ranged in age from 18 to 90 years were tested on a reading span test and on measures of on-line and off-line sentence processing efficiency. Older participants had reduced working-memory spans compared with younger participants. The on-line measures were sensitive to local increases in processing load, and the off-line measures were sensitive to the syntactic complexity of the sentences. Older and younger participants showed similar effects of syntactic complexity on the on-line measures. There was some evidence that older participants were more affected than younger participants by syntactic complexity on the off-line measures. The results support the hypothesis that on-line processes involved in recognizing linguistic forms and determining the literal, preferred, discourse-coherent meaning of sentences constitute a domain of language processing that relies on its own processing resource or working-memory system.

Memory and encoding of spoken discourse following right hemisphere damage: evidence from the Auditory Moving Window (AMW) technique.

We investigated the hypotheses that impaired discourse processing following right hemisphere damage is mediated by task difficulty and is associated with deficits in discourse encoding. Spoken discourse passages differing in contextual predictability were presented to right hemisphere-damaged (RHD) patients and to non-brain-damaged (NBD) controls for subsequent recall using the Auditory Moving Window paradigm. To manipulate processing difficulty, speech segments were of normal or accelerated speech rates. The recall results showed that RHD adults recalled less than NBD controls overall and failed to recall major idea units better than minor idea units for high predictability passages presented at accelerated speech rates. Both RHD patients and NBD controls failed to recall major idea units better than minor idea units for low predictability passages, regardless of speech rate. The encoding results showed that RHD adults were both slower overall and differentially slower than NBD controls when listening to accelerated passage segments. Taken together, the encoding and recall results are consistent with the view that extracting passage gist under difficult listening conditions is especially vulnerable for patients with right hemisphere strokes.

Rectourethral fistula and massive rectal bleeding from iodine-125 prostate brachytherapy: a case report.

Iodine-125 brachytherapy is an effective well-tolerated treatment for localized prostate cancer. Gastrointestinal complications of brachytherapy (minor rectal bleeding or tenesmus) are uncommon. Rectal ulceration or rectourethral fistulas after prostate brachytherapy are rare. We present a case of massive refractory rectal bleeding and rectourethral fistula, a complication of prostate brachytherapy never before reported. As a result of the patient's life-threatening symptoms aggressive surgical therapy was necessary.

Chimpanzee sign language and Darwinian continuity: evidence for a neurological continuity for language.

The current article addresses the empirical validity of the Cartesian view of language by first examining a sample of the results generated by over 30 years of chimpanzee sign language studies and then examining some neurological and behavioral data that accounts for the similarity between human and nonhuman communication systems. Finally an attempt will be made to propose a unified model of language that accounts for these findings and shows how the Cartesian world view has proposed a theory of language that is incomplete.

The relationship between measures of working memory and sentence comprehension in patients with Alzheimer's disease.

Patients with dementia of the Alzheimer's type (DAT) and age- and education-matched older volunteers were tested on a battery of working memory tests, as well as on two tests of sentence comprehension. Patients had reduced spans and impaired central executive processes in working memory but showed normal effects of phonological and articulatory variables on span. On the sentence comprehension tasks, DAT patients showed effects of the number of propositions in a sentence but not of syntactic complexity. Impairment in the central executive processes of working memory in DAT patients was correlated with the effect of the number of propositions in a sentence on the sentence comprehension tasks. The results suggest that patients with DAT have working memory impairments that are related to their ability to map the meanings of sentences onto depictions of events in the world.

Activation of Broca's area by syntactic processing under conditions of concurrent articulation.

Regional cerebral blood flow (rCBF) was measured with positron emission tomography (PET) when 11 subjects made plausibility judgments about written sentences that varied in their syntactic complexity. While making their judgments, subjects uttered the word "double" aloud at a rate of one utterance per second to inhibit their ability to rehearse the sentences. Blood flow increased in Broca's area when subjects made judgments about the more complex sentences. This result replicates and extends previous findings that blood flow increases in this region when subjects process complex syntax under no interference conditions. The results of this experiment provide strong evidence that the increase in blood flow seen in Broca's area in association with processing syntactically complex structures is not due to subvocal rehearsal of those structures, but rather results from processing syntactic forms themselves.

Results of local excision of benign and malignant rectal lesions.

Local excision of selected rectal cancers is an acceptable alternative to radical surgery. The results of local excision of various rectal lesions using either the transanal or trans-sacral approach were reviewed over a 10-year period at this institution. A total of 56 procedures were performed on 47 patients (50 transanal/six trans-sacral). The trans-sacral approach was used six times on five patients for lesions averaging a distance of 8 cm from the anal verge. The transanal approach was used 50 times on two patients for lesions occurring at an average distance of 5 cm from the anal verge. Twenty-six malignant lesions were excised (25 transanal/one trans-sacral) with pathologies ranging from poorly to well-differentiated adenocarcinoma. Staging included 12 T1 lesions (46%), 10 T2 lesions (38%), and four T3 lesions (16%). Eighteen malignancies were completely excised and recurrence occurred in four of 18 (22%) with an average follow-up of 2.3 years (range 0-10 years). Local recurrence occurred in two patients (T1 and T2 lesions) and recurrence was in the form of distant metastasis in two patients (two T3 lesions). Three of the recurrences occurred in patients with T3 lesions (three of four; 75%), two occurred in a patient with a T2 lesion (two of 10; 20%), and one occurred in a patient with a T1 lesion (one of 12; 8%). There were no cancer-related deaths during the study period. Twenty-six premalignant lesions (adenomatous polyps) and four benign lesions were excised (25 transanal/five trans-sacral). Local recurrence occurred 10 times with an average follow-up of 1.8 years. In conclusion local excision of certain rectal cancers is an acceptable alternative in the treatment of these malignancies.

Sentinel lymph node mapping for carcinoma of the colon: a pilot study.

Sentinel lymph node (SLN) mapping has evolved into the standard of care for melanoma and may replace routine node dissection in the treatment of breast cancer. There are few data evaluating sentinel node mapping in patients with cancer of the colon. This trial represents our initial experience with SLN mapping for carcinoma of the colon. SLN mapping was performed in 22 patients most of whom had biopsy-proven adenocarcinoma of the colon. One milliliter of isosulfan blue was injected with a 25-gauge needle into the subserosa at four sites around the edge of the palpable tumor. The SLN was identified visually and excised. A standard lymphadenectomy was then performed. The SLN was analyzed with standard hematoxylin and eosin evaluation. Immunohistochemical techniques for carcinoembryonic antigen and cytokeratin (Imm) were performed if the H&E was negative. The mapping added approximately 5 minutes to the total operative time and no adverse reactions to the dye occurred. A SLN was identified in 20 of 22 cases. In cases with negative lymph nodes the SLN was predictive of all the regional nodes by both H&E and Imm (14 of 14). In patients with positive lymph nodes the SLN was predictive in all cases (six of six). In one case the only node with disease was the SLN, and in this case the diease was identified by only Imm; thus this patient was upstaged. SLN mapping is feasible and safe and can readily be performed in patients with colonic cancer. In conjunction with SLN mapping, Imm techniques may upstage a subset of patients likely to be at increased risk for metastatic disease. Consequently SLN mapping of colon cancer should be evaluated in large prospective trials.

PET studies of syntactic processing with auditory sentence presentation.

Sixteen subjects made plausibility judgments regarding auditorily presented cleft object and cleft subject sentences (It was the actress that the award thrilled; It was the award that thrilled the actress). rCBF increased in Broca's area, pars triangularis, when subjects processed the syntactically more complex cleft object sentences. The results are consistent with previous experiments using written materials and suggest that an increase in rCBF in Broca's area is associated with processing syntactically more complex sentences.

Verbal working memory and sentence comprehension.

This target article discusses the verbal working memory system used in sentence comprehension. We review the concept of working memory as a short-duration system in which small amounts of information are simultaneously stored and manipulated in the service of accomplishing a task. We summarize the argument that syntactic processing in sentence comprehension requires such a storage and computational system. We then ask whether the working memory system used in syntactic processing is the same as that used in verbally mediated tasks that involve conscious controlled processing. Evidence is brought to bear from various sources: the relationship between individual differences in working memory and individual differences in the efficiency of syntactic processing; the effect of concurrent verbal memory load on syntactic processing; and syntactic processing in patients with poor short-term memory, patients with poor working memory, and patients with aphasia. Experimental results from these normal subjects and patients with various brain lesions converge on the conclusion that there is a specialization in the verbal working memory system for assigning the syntactic structure of a sentence and using that structure in determining sentence meaning that is separate from the working memory system underlying the use of sentence meaning to accomplish other functions. We present a theory of the divisions of the verbal working memory system and suggestions regarding its neural basis.

Effects of syntactic structure and propositional number on patterns of regional cerebral blood flow.

Positron emission tomography (PET) was used to determine regional cerebral blood flow (rCBF) as a function of the syntactic form and propositional density of sentences. rCBF increased in the left pars opercularis, part of Broca's area, when subjects processed syntactically more complex sentences. There were no differences in rCBF in the perisylvian association cortex traditionally associated with language processing when subjects made plausibility judgments about sentences with two propositions as compared to sentences with one proposition, but rCBF increased in infero-posterior brain regions. These results suggest that there is a specialization of neural tissue in Broca's area for constructing aspects of the syntactic form of sentences to determine sentence meaning. They also suggest that this specialization is separate from the brain systems that are involved in utilizing the meaning of a sentence that has been understood to accomplish a task.

Task demands and sentence comprehension in patients with dementia of the Alzheimer's type.

Patients with dementia of the Alzheimer's type (DAT) and matched normal controls were given three tests of syntactic comprehension in which nonlinguistic visual and memory task demands were varied. In all tasks, subjects were presented spoken semantically reversible sentences with a variety of syntactic structures and required to match the sentence to a picture. In the first experiment, subjects matched the spoken sentence to one of two pictures that appeared either before or immediately following the presentation of the sentence. The target picture depicted the spoken sentence correctly and the foil depicted the reversed thematic roles to those in the sentence (i.e., it was a syntactic foil). The second experiment employed a sentence video-verification task in which subjects were required to determine if the spoken sentence matched a videotaped depiction of the action in the sentence or a syntactic foil. In the third experiment, in different conditions, subjects were required to determine whether the spoken sentence matched a single picture or to choose the picture that matched the sentence from an array of two or three pictures. In this experiment, both lexical and syntactic foils were used. In all tasks, DAT patients were affected by the number of propositions in the presented sentence, but not by the syntactic complexity of the sentence. Control subjects also were unaffected by the syntactic complexity of the sentence; the number-of-proposition effect was present in some experiments in the control population. Comparison of performance across the one-, two-, and three-picture versions of the task showed that the magnitude of the effect of number of propositions increased as the number of pictures in the array increased. In addition, analysis of the data from each of the tasks separately showed that the effect of number of propositions only occurred when subjects were attempting to match the target to a syntactic foil (one-picture version) or to choose between the target and a syntactic foil (two- and three-picture versions). The results support the view that patients with DAT do not have disturbances affecting syntactic processing. In addition, they suggest that the effect of number of propositions arises at a stage of analysis that is partially separate from assigning sentence meaning, such as in holding a representation of the sentence in memory until the pictures can be analyzed and encoded and/or in comparing the results of the picture analysis with a stored representation of the sentence meaning.

[Ileoanal reservoir: new concepts and current results]. / El reservorio ileoanal: nuevos conceptos y resultados actuales.

More than 1,800 ileoanal pouches have been performed at the Mayo Clinic since 1981 and results have been satisfactory in more than 90% of the patients. However, we continue to search for alternatives to improve postoperative results and avoid the complications that currently occur in a minority of patients. During the last two years new concepts and surgical techniques for the construction of the ileoanal reservoir have been described. Herein we present those innovations and compare them to our current institutional practice.

Working memory and on-line sentence comprehension in patients with Alzheimer's disease.

We examined the ability of patients with dementia of the Alzheimer's type (DAT) and normal controls to perform a sentence acceptability judgment task that required determining the referent for a reflexive pronoun. Performance on three different sentence types that differed in terms of syntactic complexity was assessed. Subjects performed the task alone and under two different dual-task conditions which required continuous, externally paced responses. DAT patients were more affected than controls by the dual-task conditions, but were not disproportionately impaired on the more complex sentence types. The failure of DAT patients to be disproportionately affected on the most complex sentence types in the dual-task conditions provides evidence for the separation of the processing resources that are used in sentence comprehension from those involved in other tasks.

Determinants of sentence comprehension in aphasic patients in sentence-picture matching tasks.

The results of two studies of sentence comprehension in aphasic patients using sentence-picture matching tests are presented. In the first study, 52 aphasic patients were tested on 10 sentence types. Analysis of the number of correct responses per sentence type showed effects of syntactic complexity and number of propositions. Factor analysis yielded first factors that accounted for two-thirds of the variance in performance to which all sentence types contributed. Clustering analysis yielded groups of patients whose performances progressively deteriorated and in which performance was more affected by sentence types that were harder for the group overall. These results were very similar to those previously obtained using an enactment task. In the second study, 17 aphasic patients were tested on the same 10 sentence types using both sentence-picture matching and enactment tasks. Correlational analyses showed that performance on the two tests was significantly correlated across both subjects and sentences. The results provide data relevant to the determinants of the complexity of a sentence in auditory comprehension.

The use of contextual information related to general world knowledge by right brain-damaged individuals in pronoun resolution.

This study investigated the ability of right brain-damaged individuals (RBD) to use contextual information to resolve ambiguous pronouns. Subjects were presented with sentence pairs and required to resolve the ambiguous pronoun in the second sentence. Contrary to the prevailing view that RBD patients have difficulty using contextual information to integrate language, the RBD group demonstrated a normal pattern of response, demonstrating a sensitivity to the pragmatic information contained in the leading sentence. They responded more quickly to sentences with a pragmatically constrained preferred referent than to those sentences for which there was no preferred referent. As well, they chose the preferred referent significantly more often than the non-preferred referent. These results suggest that RBD patients can use contextual information at the level of a minimal discourse (i.e., two sentences).

The use of contextual information by right brain-damaged individuals in the resolution of ambiguous pronouns.

Two experiments were conducted with the primary purpose of investigating the ability of right brain-damaged (RBD) individuals to use contextual information--at the level of the single sentence, in terms of the integration of information between clauses, and at the level of a minimal discourse (i.e., two sentences)--in the resolution of ambiguous pronouns. The investigation was extended to a group of left brain-damaged (LBD) and non-brain-damaged (NBD) individuals. Contrary to the prevailing view that RBD patients have difficulty in the use of contextual information to process language, both experiments were consistent in demonstrating that the RBD group was influenced by contextual information in a manner similar to that demonstrated by both the LBD and NBD groups.