Search

Background: The COVID-19 pandemic required immediate systematic change in healthcare delivery. Many institutions relied on telemedicine as an alternative to in-person visits. There is limited data in the bariatric surgery literature to determine how telemedicine impacts patient volume. This study evaluates the effects of using telemedicine for introductory bariatric surgery seminars on patient volume at a single institution. Methods: A retrospective review was performed before and after implementing virtual introductory seminars for bariatric surgery patients at a comprehensive metabolic and surgery center. The effect on attendance rates for introductory seminars and completion rates of bariatric surgery was evaluated. Results: The introductory seminar attendance rate for the in-person/pre-telemedicine period, April 2019 to February 2020, was compared to that of the virtual/post-telemedicine period, June 2020 to April 2021. A total of 836 patients registered for an introductory seminar during the pre-telemedicine period with a 65.79% attendance rate. In the post-telemedicine period, 806 patients registered with a 67.87% attendance rate, which was not statistically different (p = 0.37, 95% CI − 0.03–0.07). Completion rates of bariatric surgery were analyzed using June 2019 to October 2019 as the pre-telemedicine period and June 2020 to October 2020 as the post-telemedicine period. Similarly, there was no difference between the pre-telemedicine surgery rate of 23.43% and post-telemedicine surgery rate of 19.68% (p = 0.31, 95% CI − 0.11–0.04). Conclusion: Despite abruptly transitioning to virtual introductory bariatric seminars, there was no change in attendance rates nor was there a difference in the number of patients progressing through the program and undergoing bariatric surgery at our institution. This demonstrates similar efficacy of telemedicine and in-person introductory seminars for bariatric surgery patients, which supports telemedicine as a promising tool for this patient population in the post-pandemic era. [ABSTRACT FROM AUTHOR]

Background: Gastroesophageal Reflux Disease (GERD) is an extremely common condition with several medical and surgical treatment options. A multidisciplinary expert panel was convened to develop evidence-based recommendations to support clinicians, patients, and others in decisions regarding the treatment of GERD with an emphasis on evaluating different surgical techniques.Methods: Literature reviews were conducted for 4 key questions regarding the surgical treatment of GERD in both adults and children: surgical vs. medical treatment, robotic vs. laparoscopic fundoplication, partial vs. complete fundoplication, and division vs. preservation of short gastric vessels in adults or maximal versus minimal dissection in pediatric patients. Evidence-based recommendations were formulated using the GRADE methodology by subject experts. Recommendations for future research were also proposed.Results: The panel provided seven recommendations for adults and children with GERD. All recommendations were conditional due to very low, low, or moderate certainty of evidence. The panel conditionally recommended surgical treatment over medical management for adults with chronic or chronic refractory GERD. There was insufficient evidence for the panel to make a recommendation regarding surgical versus medical treatment in children. The panel suggested that once the decision to pursue surgical therapy is made, adults and children with GERD may be treated with either a robotic or a laparoscopic approach, and either partial or complete fundoplication based on surgeon-patient shared decision-making and patient values. In adults, the panel suggested either division or non-division of the short gastric vessels is appropriate, and that children should undergo minimal dissection during fundoplication.Conclusions: These recommendations should provide guidance with regard to surgical decision-making in the treatment of GERD and highlight the importance of shared decision-making and patient values to optimize patient outcomes. Pursuing the identified research needs may improve future versions of guidelines for the treatment of GERD. [ABSTRACT FROM AUTHOR]

Background: Bariatric surgery is the most effective long-term treatment for morbid obesity; however, it is under-utilized. This study examines the association between morbid obesity rates, bariatric surgeon presence, and utilization of bariatric surgery in the United States.Methods: Healthcare Cost and Utilization Project's 2013 National Inpatient Sample was used to determine the incidence of inpatient bariatric procedures using ICD-9 codes. The Center for Disease Control's 2013 Behavioral Risk Factor Surveillance System survey was analyzed to determine estimates of bariatric surgery qualified adults, aged 18-70, with BMI ≥ 40 or ≥ 35 with diabetes. The number of bariatric surgeons was determined from four online sources: searches of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program accredited bariatric programs, American Society for Metabolic and Bariatric Surgery membership, and two adjustable gastric band manufacturer "find a surgeon" search tools. Correlations between rates of morbid obesity, bariatric surgeon presence, and incidence of inpatient bariatric surgery were determined.Results: The defined bariatric surgery eligible population comprised between 3.6% (New England) to 6.8% (East South Central) of the total division population (p < 0.001). Incident rates of bariatric surgery ranged from 0.9% in East South Central to 2.2% in New England (p < 0.001). 2124 bariatric surgeons were identified. The rate of bariatric surgery by division was negatively correlated with division morbid obesity rates (r = - 0.65) and strongly positively correlated with surgeon presence (r = 0.91). After adjusting for demographic differences between divisions, surgeon presence remained highly associated with surgery utilization (p < 0.001).Conclusions: Rates of bariatric surgery procedures in the U.S. are minimally correlated with rates of morbid obesity and are strongly correlated with the number of available bariatric surgeons. Effective therapy for the morbidly obese may be limited by the lack of qualified surgeons. [ABSTRACT FROM AUTHOR]

Since its discovery in 1986, originally as B cell stimulating factor 2, the knowledge on IL-6 for immune homeostasis and its pathophysiological implications has rapidly increased. It is now clear that IL-6, alone or in combination with other cytokines, is an architect for shaping and generating immune responses which exerts profound activities on the induction of acute-phase reactions, the differentiation of B lymphocytes, the modulation of T cell apoptosis, the activation of T helper cells and the balance between regulatory T cells and Th17 cells. In parallel to the identification of these physiologic functions, IL-6 has emerged as a critical mediator for perpetuating chronic inflammation and autoimmunity and is increasingly recognized as a key cytokine for linking chronic inflammation to cancer development. In this review, we begin by briefly summarizing the molecular events of IL-6 regulation and signaling and then describe the role of IL-6 in orchestrating innate and adaptive immune responses and its immunopathological relevance for chronic inflammatory diseases. We further outline how IL-6 links chronic inflammation and cancer development and finally provide an outlook on novel therapeutic strategies targeting IL-6 signaling for the treatment of chronic inflammatory diseases and cancer. [ABSTRACT FROM AUTHOR]

As antibodies to tumor necrosis factor (TNF) suppress immune responses in Crohn's disease by binding to membrane-bound TNF (mTNF), we created a fluorescent antibody for molecular mTNF imaging in this disease. Topical antibody administration in 25 patients with Crohn's disease led to detection of intestinal mTNF+ immune cells during confocal laser endomicroscopy. Patients with high numbers of mTNF+ cells showed significantly higher short-term response rates (92%) at week 12 upon subsequent anti-TNF therapy as compared to patients with low amounts of mTNF+ cells (15%). This clinical response in the former patients was sustained over a follow-up period of 1 year and was associated with mucosal healing observed in follow-up endoscopy. These data indicate that molecular imaging with fluorescent antibodies has the potential to predict therapeutic responses to biological treatment and can be used for personalized medicine in Crohn's disease and autoimmune or inflammatory disorders. [ABSTRACT FROM AUTHOR]

Hepatic insulin resistance is a driving force in the pathogenesis of type 2 diabetes mellitus (T2DM) and is tightly coupled with excessive storage of fat and the ensuing inflammation within the liver. There is compelling evidence that activation of the transcription factor nuclear factor-κB (NF-κB) and downstream inflammatory signaling pathways systemically and in the liver are key events in the etiology of hepatic insulin resistance and β-cell dysfunction, although the molecular mechanisms involved are incompletely understood. We here test the hypothesis that receptor activator of NF-κB ligand (RANKL), a prototypic activator of NF-κB, contributes to this process using both an epidemiological and experimental approach. In the prospective population-based Bruneck Study, a high serum concentration of soluble RANKL emerged as a significant (P < 0.001) and independent risk predictor of T2DM manifestation. In close agreement, systemic or hepatic blockage of RANKL signaling in genetic and nutritional mouse models of T2DM resulted in a marked improvement of hepatic insulin sensitivity and amelioration or even normalization of plasma glucose concentrations and glucose tolerance. Overall, this study provides evidence for a role of RANKL signaling in the pathogenesis of T2DM. If so, translation to the clinic may be feasible given current pharmacological strategies to lower RANKL activity to treat osteoporosis. [ABSTRACT FROM AUTHOR]

Disparities exist in mammography use based on nativity status. Using the 2005 National Health Interview Survey, we examined the link between nativity status and mammography use in the past 2 years among women (≥40 years) and investigated whether acculturation was associated with mammography use among foreign-born women using multivariate analyses. Foreign-born women were less likely (OR = 0.75; 95% CI = 0.65, 0.87) to report mammography use compared to US born women. After adjusting for selected covariates, results were no longer statistically significant. Foreign-born women (≥65 years) who were not US citizens (i.e. less acculturated) were less likely (OR = 0.17; 95% CI = 0.06, 0.46) to report mammography use compared to naturalized citizens. Based on our findings, mammography use did not differ between US and foreign-born women. Therefore, the disparities in incidence and mortality rates observed between these groups may be due to other factors. [ABSTRACT FROM AUTHOR]

We examined awareness of osteoporosis prevention among peri- and post-menopausal South Asian women attending two community centers in the Dallas/Fort-Worth Metroplex. We conducted a quasi-experimental study (final N = 61) assessing knowledge about osteoporosis among South Asian women (≥40 years). The mean age was 52.3 years (SD = 8.72). Over 50% were college educated and 64% had no health insurance. We administered a baseline knowledge test, followed by a health education intervention and, 2 weeks later, by a post-test. Participants received one point for each correct answer and scores were added (≤14). Participants showed a significant increase in osteoporosis knowledge post intervention (paired t = −9.5, P < .01). For example, women reported highest knowledge gains on the following: adequate calcium intake is achievable from two glasses of milk a day; very thin women are at risk for developing osteoporosis, and family history of osteoporosis is a risk factor. Intervention completers were better prepared to prevent and manage osteoporosis. Results indicate the efficacy of educational intervention in improving osteoporosis awareness; and point to the potential for knowledge acquisition aimed at developing community-based prevention strategies at the community level. [ABSTRACT FROM AUTHOR]

Reflecting domestic demand pressures, the output gap has important implications for economic analysis. This paper assesses the usefulness of four commonly-used gap measures for a small set of European countries. The main results are that the policy implications can be very different depending on the gap measure and that, consequently, care should be exercised when employing any such measure. Moreover the paper investigates in a simple inflation forecasting framework the common assertion that the output gap could improve the forecasting accuracy. For annual observations, however, these measures rarely provide useful information and there is no single best measure across countries. [ABSTRACT FROM AUTHOR]

Studies of the impact of trade openness on growth are based either on cross-country analysis—which lacks transparency—or case studies—which lack statistical rigor. This paper applies a transparent econometric method drawn from the treatment evaluation literature (matching estimators) to make the comparison between treated (that is, open) and control (that is, closed) countries explicit while remaining within a statistical framework. Matching estimators highlight that common cross-country evidence is based on rather far-fetched country comparisons, which stem from the lack of common support of treated and control countries in the covariate space. The paper therefore advocates paying more attention to appropriate sample restriction in cross-country macro research.IMF Staff Papers (2009) 56, 447–475. doi:10.1057/imfsp.2008.39; published online 3 March 2009 [ABSTRACT FROM AUTHOR]

Methods are described for estimation of blood volume and extracellular space (ECS) in the whole body and in some organs withCr,C-thiocyanate andH-inulin. A mean blood volume of 47 ml/kg, a thiocyanate space of 350 ml/kg and a inulin space of 288 ml/kg were determined in the rat. The corresponding values of organs are shown in figures 1-3. [ABSTRACT FROM AUTHOR]