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51.
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Dan Azagury Tara E Mokhtari Luis Garcia Ulysses S Rosas Trit Garg Homero Rivas John Morton 《Surgery》2019,165(3):565-570
Background
Laparoscopic Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy, and laparoscopic adjustable gastric banding all lead to substantial weight loss in obese patients. Long-term weight loss can be highly variable beyond 1-year postsurgery. This study examines and compares the frequency distribution of weight loss and lack of treatment effect rates after laparoscopic Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy, and laparoscopic adjustable gastric banding.Methods
A total of 1,331 consecutive patients at a single academic institution were reviewed from a prospectively collected database. Preoperative data collected included demographics, body mass index, and percent excess weight loss. Postoperative BMI and %EWL were collected at 12, 24, and 36 months. Percent excess weight loss was analyzed by the percentiles of excess weight lost, and the distribution of percent excess weight loss was evaluated in 10% increments. Lack of a successful treatment effect was defined as <25% excess weight loss.Results
Of the 1,331 patients, 72.4% (963) underwent laparoscopic Roux-en-Y gastric bypass, 18.3% (243) laparoscopic sleeve gastrectomy, and 9.4%(125) laparoscopic adjustable gastric banding. Mean percent excess weight loss was greatest for laparoscopic Roux-en-Y gastric bypass, followed by laparoscopic sleeve gastrectomy, and then by laparoscopic adjustable gastric banding at every time point: at 2 years mean percent excess weight loss was 77.9± 24.4 for laparoscopic Roux-en-Y gastric bypass, 50.8 ± 25.8 for laparoscopic sleeve gastrectomy, and 40.8± 25.9 for laparoscopic adjustable gastric banding (P < .0001). The rates of a successful treatment effect s for laparoscopic Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy, and laparoscopic adjustable gastric banding were 0.9%, 5.2%, and 24.3% at 1 year; 0.3%, 11.1%, and 26.0% at 2 years; and 1.0%, 25.3%, and 30.2% at 3 years. At 1 year, the odds ratio of lack of a successful treatment effect of laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass was 6.305 (2.125–19.08; P?=?.0004), the odds ratio for laparoscopic adjustable gastric banding versus laparoscopic Roux-en-Y gastric bypass was 36.552 (15.64–95.71; P < .0001), and the odds ratio for laparoscopic adjustable gastric banding versus laparoscopic sleeve gastrectomy was 5.791 (2.519–14.599; P < .0001). At 2 years, the odds ratio for laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass increased to 70.7 (9.4–531.7; P < .0001), the odds ratio for laparoscopic adjustable gastric banding versus laparoscopic Roux-en-Y gastric bypass increased to 128.1 (16.8–974.3; P < .0001), and the odds ratio for laparoscopic adjustable gastric banding versus laparoscopic sleeve gastrectomy decreased to 1.8 (0.9–3.6; P?=?.09).Conclusion
This study emphasizes the existing variability in weight loss across bariatric procedures as well as in the lack of a treatment effect for each procedure. Although laparoscopic adjustable gastric banding has the greatest rate of a lack of a successful treatment effect, the rate remained stable over 3 years postoperatively. Laparoscopic sleeve gastrectomy showed a doubling in the rate of a lack of a successful treatment effect every year reaching 25% at year 3. The rates for lack of a successful treatment effect for laparoscopic Roux-en-Y gastric bypass remained stable at about 1% for the first 3 years postoperatively. 相似文献53.
54.
Fraudulent business practices, such as those leading to the Enron scandal and the
conviction of Bernard Madoff, evoke a strong sense of public outrage. But fraudulent or
dishonest actions are not exclusive to the realm of big corporations or to evil
individuals without consciences. Dishonest actions are all too prevalent in everyone’s
daily lives, because people are constantly encountering situations in which they can gain
advantages by cutting corners. Whether it’s adding a few dollars in value to the stolen
items reported on an insurance claim form or dropping outlier data points from a figure to
make a paper sound more interesting, dishonesty is part of the human condition. Here, we
explore how people rationalize dishonesty, the implications for scientific research, and
what can be done to foster a culture of research integrity. 相似文献
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骨碎补是历代临床常用中药,具有疗伤止痛、补肾强骨、消风祛斑等功效。其主要含黄酮、苯丙素、三萜、酚酸及其苷等类化学成分,现代研究表明骨碎补具有抗骨质疏松、促进骨折愈合、促软骨再生、护牙健齿、保护肾功能、抗炎、防治中毒性耳聋、降血脂等多种生物活性,开发前景广阔。本文对近年来骨碎补的化学成分、药理作用及临床应用研究进行综述,以期为骨碎补的进一步深入系统的研究和开发利用提供依据。 相似文献
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目的:探讨新生血管特异性结合肽GX1二聚体对胃癌新生血管生成的影响。方法:化学合成GX1二聚体、GX1单体、对照肽二聚体,CCK-8实验、管状结构形成实验、迁移实验研究GX1二聚体对胃癌血管内皮细胞(co-HUVEC)增殖、微管形成、迁移能力的影响,流式细胞学技术分析其对细胞周期分布和凋亡的影响。结果:CCK-8结果显示,GX1二聚体与对照肽二聚体及PBS对照组相比,100~200 μmol/L可抑制co-HUVEC增殖,具有统计学差异(P<0.05),并呈剂量依赖性,GX1二聚体较单体抑制作用增强,并有统计学差异(P<0.05)。管状结构形成实验、细胞损伤迁移实验结果显示,与对照肽二聚体及对照组PBS 相比,GX1二聚体及GX1单体,均可抑制胃癌内皮细胞管状结构的形成及迁移,且二聚体抑制作用强于单体;对照肽二聚体仅有轻微的抑制胃癌内皮细胞管状结构的形成及迁移。流式细胞术分析显示,与对照肽二聚体及PBS对照组相比,GX1二聚体及GX1单体均可诱导细胞凋亡(P<0.05),且GX1二聚体的诱导作用强于GX1单体(P<0.05),而对细胞周期分布则无明显影响。结论:GX1二聚体和GX1单体均可抑制胃癌新生血管内皮细胞增殖、微管形成、迁移能力及诱导凋亡,且GX1二聚体较GX1单体作用增强。GX1二聚体有望代替单体成为胃癌新生血管靶向治疗小肽类药物。 相似文献
60.
日间手术在国外已有上百年的发展历史,现已成为欧美国家重要手术模式。我国于20世纪初开始开展日间手术,但目前尚未普及,发展不平衡问题比较突出,存在认识不清、开展不规范、与医保支付对接不畅等问题。日间手术是一种使国家、医院和病人三方均受益的新型手术模式。近年来,国家相关管理部门积极引导,开展日间手术的医院明显增多,可以预见,我国日间手术即将进入快速发展的新阶段。因此,有条件的医院可以从简单、易操作的病种开始,落实临床路径,积累经验,再逐步稳妥展开。在保证质量的前提下,不断拓展日间手术范围,提高三、四级手术比例。同时,积极与医保支付政策对接,采取灵活的方式,获得医保的支持,更好地促进我国日间手术的快速发展。 相似文献