Six month outcomes in patients experiencing weight gain after gastric bypass who underwent gastrojejunal revision using an endoluminal suturing device.

BACKGROUND: Weight gain after Roux-en-Y gastric bypass occurs in approximately 25 % of cases, and this may contribute to recurrence of comorbid conditions. Currently, adequate treatment strategies for this group of patients are limited. Endoscopic narrowing of the gastrojejunal anastomosis may result in a low-risk, minimally invasive treatment alternative compared to standard surgical revision. We assessed short-term outcomes in patients undergoing endoscopic gastrojejunal revisions (EGJR) using an endoluminal suturing device. METHODS: We performed an institutional review board-approved retrospective analysis of 25 consecutive patients who underwent EGJR. Patients preoperatively presented with a dilated gastrojejunal anastomosis of greater than 15 mm and weight gain. An endoluminal suturing device (Overstitch(TM), Apollo Endosurgery, Austin TX) was used to reduce the diameter of the anastomosis. Follow-up occurred at 2 and 6 weeks, 3 and 6 months, and 1 year RESULTS: Prior to EGJR, patients regained an average of 23.4 ± 13.2 kg from their weight loss nadir and had a mean body mass index of 42.2 ± 6.6 kg/m(2). At 6 weeks, 100 % of patients experienced weight loss (average 5.8 ± 4.4 kg; p < .001). At 3 months, 94 % had weight loss (average 7.0 ± 6.2 kg; p < .001). At 6 months, 91 % maintained weight loss (average 5.6 ± 6.2 kg; p = 0.013). Lastly, at 1 year following EGJR, 100 % of available cases maintained weight loss (average 7.5 ± 6.4 kg; p = 0.057). The average percent excess weight loss was 12.5, 15.4, 12.4, and 17.1 % at 6 weeks, 3 and 6 months, and 1 year, respectively. There was a negative time effect in the mixed effect model using both on-treatment and intent-to-treat analyses, illustrating a significant weight reduction over time. The average follow-up per patient was 146 days. There were no complications reported during the follow-up period. CONCLUSIONS: Six month follow-up for EGJR patients demonstrated a low-risk, minimally invasive treatment option to reverse weight gain subsequent to a failed gastric bypass. Procedures presented no complications and may provide an attractive alternative to standard surgical revision.

Association of LY9 in UK and Canadian SLE families.

Systemic lupus erythematosus (SLE) is a complex disease trait of unknown aetiology. Genome-wide linkage studies in human SLE identified several linkage regions, including one at 1q23, which contains multiple susceptibility genes, including the members of the signalling lymphocyte activation molecule (SLAM) locus. In mice there is a syntenic linkage region, Sle1. The SLAM genes are functionally related cell-surface receptors, which regulate signal transduction of cells in the immune system. Family-based association study in UK and Canadian SLE families identified variants in the promoter and coding region of SLAMF7 and LY9 contributing to SLE disease susceptibility. The strongest association was from rs509749, in exon 8 of LY9 (P=0.00209). rs509749 encodes a Val/Met nonsynonymous change in amino acid 602 in the cytoplasmic domain of LY9. In the parents and affected individuals from the Canadian SLE families, the risk allele of rs509049 skews the T-cell population by increasing the number of CD8+ memory T cells, while decreasing the proportion of CD4+ naïve T cells and activated T cells. Since rs509749 lies within the consensus binding site for SAP/SH2D1a, which influences downstream signalling events from LY9, the mechanism for increased CD8+ memory T cells may include differential binding SAP/SH2D1a to the cytoplasmic domain of LY9.

The role of the Toll receptor pathway in susceptibility to inflammatory bowel diseases.

The intestinal flora has long been thought to play a role either in initiating or in exacerbating the inflammatory bowel diseases (IBD). Host defenses, such as those mediated by the Toll-like receptors (TLR), are critical to the host/pathogen interaction and have been implicated in IBD pathophysiology. To explore the association of genetic variation in TLR pathways with susceptibility to IBD, we performed a replication study and pooled analyses of the putative IBD risk alleles in NFKB1 and TLR4, and we performed a haplotype-based screen for association to IBD in the TLR genes and a selection of their adaptor and signaling molecules. Our genotyping of 1539 cases of IBD and pooled analysis of 4805 cases of IBD validates the published association of a TLR4 allele with risk of IBD (odds ratio (OR): 1.30, 95% confidence interval (CI): 1.15-1.48; P=0.00017) and Crohn's disease (OR: 1.33, 95% CI: 1.16-1.54; P=0.000035) but not ulcerative colitis. We also describe novel suggestive evidence that TIRAP (OR: 1.16, 95% CI: 1.04-1.30; P=0.007) has a modest effect on risk of IBD. Our analysis, therefore, offers additional evidence that the TLR4 pathway - in this case, TLR4 and its signaling molecule TIRAP - plays a role in susceptibility to IBD.

The role of inflammatory bowel disease susceptibility loci in multiple sclerosis and systemic lupus erythematosus.

To date, three loci have been validated to confer susceptibility to inflammatory bowel disease (IBD): the CARD15/NOD2 gene, the discs large homolog 5 gene (DLG5), and the IBD5 locus on 5q31 (IBD5). We have explored the possibility that these loci may also be associated with susceptibility to two other chronic inflammatory diseases, multiple sclerosis (MS) and systemic lupus erythematosus (SLE). As the CARD15 risk alleles had previously been assessed in our collection of 496 MS trios, we focused our efforts on the DLG5 risk allele and the IBD5(risk) haplotype (IBD5(risk)) for MS. While there is no evidence of association within our MS sample with either of these polymorphisms, screening of 1027 subjects with SLE suggests that IBD5(risk) may have a modest contribution to disease risk in the subset of SLE subjects without lupus nephritis. In addition, a pooled analysis of existing published and unpublished data in 1305 cases of SLE genotyped for the CARD15 risk alleles suggests that only the CARD15(908R) IBD risk allele may have a strong effect on risk of SLE. Our data, therefore, suggest that both the CARD15 gene and the IBD5 locus may have a role as general susceptibility loci for certain common, genetically complex inflammatory diseases.

Using brain MERMER testing to detect knowledge despite efforts to conceal.

This experiment examined the accuracy and reliability of the memory and encoding related multifaceted electroencephalographic response (MERMER) technique for detecting information related to events subjects have experienced, despite subjects' efforts to conceal that knowledge. Information obtained through interviews was used to develop stimulus sets consisting of words and phrases presented to subjects visually by computer. Sets were composed of three types of stimuli: life experience-related (Probes), stimuli the subject was asked to memorize and respond to (Targets), and irrelevant information (Irrelevants). Each set of stimuli was tested on two individuals: (1) one individual who had participated in the event in question--and thus had the relevant information stored in his/her brain, and (2) one who had not. Six subjects were tested. Electrical brain responses to the stimuli were recorded non-invasively from the scalp and analyzed. MERMERs, (memory and encoding related multifaceted electroencephalographic responses), of which the P300 is a sub-component, were used to determine whether the subject had the relevant information stored in his brain (information present) or not (information absent), thus indicating whether or not each subject had participated in the real-life event in question. Bootstrapping was used to analyze and compare the responses to the three types of stimuli. As predicted, MERMERs were elicited by Probe stimuli only in the subjects who had participated in the investigated event, by Target stimuli in all subjects, and in no case by Irrelevant stimuli. For each of the six subjects, brain MERMER testing correctly determined whether the subject had participated in and consequently knew about the event in question (information present) or had not participated (information absent). The statistical confidence for this determination was 99.9% in five cases and 90.0% in one case. The article concludes with a discussion of areas of future research and the potential for using this new technology as an investigative tool in criminal cases.

Narcissistic processes: optimistic expectations, favorable self-evaluations, and self-enhancing attributions.

Three studies investigated the relationship between narcissism (as measured by the Narcissistic Personality Inventory; Raskin & Hall, 1979) and three forms of self-enhancement. In Study 1, narcissism positively correlated with predictions of own final course grades, but not with actual grades received. In Study 2, narcissism positively correlated with estimated current course grades; high narcissists tended to overestimate their grades, while low narcissists tended to underestimate them. In Study 3, narcissism was associated with optimistic expectations for own performance on a laboratory interdependence task and with attributions of a successful task outcome to own ability and effort, but it did not correlate with attributions to a partner's ability or effort, suggesting self-aggrandizement but not other-derogation. Narcissism was also associated with weaker gratitude and liking. Results are discussed in terms of their implications for the origins and generality of self-enhancement and for the relationship between narcissism and self-functioning in the social domain.

Optimal digital filters for long-latency components of the event-related brain potential.

A fundamentally important problem for cognitive psychophysiologists is selection of the appropriate off-line digital filter to extract signal from noise in the event-related brain potential (ERP) recorded at the scalp. Investigators in the field typically use a type of finite impulse response (FIR) filter known as moving average or boxcar filter to achieve this end. However, this type of filter can produce significant amplitude diminution and distortion of the shape of the ERP waveform. Thus, there is a need to identify more appropriate filters. In this paper, we compare the performance of another type of FIR filter that, unlike the boxcar filter, is designed with an optimizing algorithm that reduces signal distortion and maximizes signal extraction (referred to here as an optimal FIR filter). We applied several different filters of both types to ERP data containing the P300 component. This comparison revealed that boxcar filters reduced the contribution of high-frequency noise to the ERP but in so doing produced a substantial attenuation of P300 amplitude and, in some cases, substantial distortions of the shape of the waveform, resulting in significant errors in latency estimation. In contrast, the optimal FIR filters preserved P300 amplitude, morphology, and latency and also eliminated high-frequency noise more effectively than did the boxcar filters. The implications of these results for data acquisition and analysis are discussed.

The truth will out: interrogative polygraphy ("lie detection") with event-related brain potentials.

The feasibility of using Event Related Brain Potentials (ERPs) in Interrogative Polygraphy ("Lie Detection") was tested by examining the effectiveness of the Guilty Knowledge Test designed by Farwell and Donchin (1986, 1988). The subject is assigned an arbitrary task requiring discrimination between experimenter-designated targets and other, irrelevant stimuli. A group of diagnostic items ("probes"), which to the unwitting are indistinguishable from the irrelevant items, are embedded among the irrelevant. For subjects who possess "guilty knowledge" these probes are distinct from the irrelevants and are likely to elicit a P300, thus revealing their possessing the special knowledge that allows them to differentiate the probes from the irrelevants. We report two experiments in which this paradigm was tested. In Experiment 1, 20 subjects participated in one of two mock espionage scenarios and were tested for their knowledge of both scenarios. All stimuli consisted of short phrases presented for 300 ms each at an interstimulus interval of 1550 ms. A set of items were designated as "targets" and appeared on 17% of the trials. Probes related to the scenarios also appeared on 17% of the trials. The rest of the items were irrelevants. Subjects responded by pressing one switch following targets, and the other following irrelevants (and, of course, probes). ERPs were recorded from FZ, CZ, and PZ. As predicted, targets elicited large P300s in all subjects. Probes associated with a given scenario elicited a P300 in subjects who participated in that scenario. A bootstrapping method was used to assess the quality of the decision for each subject. The algorithm declared the decision indeterminate in 12.5% of the cases. In all other cases a decision was made. There were no false positives and no false negatives: whenever a determination was made it was accurate. The second experiment was virtually identical to the first, with identical results, except that this time 4 subjects were tested, each of which had a minor brush with the law. Subjects were tested to determine whether they possessed information on their own "crimes." The results were as expected; the Guilty Knowledge Test determined correctly which subject possessed which information. The implications of these data both for the practice of Interrogative Polygraphy and the interpretation of the P300 are discussed.

Talking off the top of your head: toward a mental prosthesis utilizing event-related brain potentials.

This paper describes the development and testing of a system whereby one can communicate through a computer by using the P300 component of the event-related brain potential (ERP). Such a system may be used as a communication aid by individuals who cannot use any motor system for communication (e.g., 'locked-in' patients). The 26 letters of the alphabet, together with several other symbols and commands, are displayed on a computer screen which serves as the keyboard or prosthetic device. The subject focuses attention successively on the characters he wishes to communicate. The computer detects the chosen character on-line and in real time. This detection is achieved by repeatedly flashing rows and columns of the matrix. When the elements containing the chosen character are flashed, a P300 is elicited, and it is this P300 that is detected by the computer. We report an analysis of the operating characteristics of the system when used with normal volunteers, who took part in 2 experimental sessions. In the first session (the pilot study/training session) subjects attempted to spell a word and convey it to a voice synthesizer for production. In the second session (the analysis of the operating characteristics of the system) subjects were required simply to attend to individual letters of a word for a specific number of trials while data were recorded for off-line analysis. The analyses suggest that this communication channel can be operated accurately at the rate of 0.20 bits/sec. In other words, under the conditions we used, subjects can communicate 12.0 bits, or 2.3 characters, per min.