Endoscopic gastroplasty to treat medically uncontrolled obesity needs more quality data: A systematic review

Endoscopic gastroplasty (EG) has been used in clinical practice to treat obesity. This systematic review has the objective of assessing if there is an acceptable level of scientific evidence on the safety and effectiveness of EG. A thorough search strategy was used up to October 2018, including the 2 most common techniques: endoscopic suturing and the primary obesity surgery endolumenal procedure. The quality of the studies was evaluated through the Joanna Briggs Institute Critical Appraisal tools for use in Systematic Reviews—“Checklist for Case Series”—and summarized using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Only 1 randomized controlled trial (moderate GRADE evidence) was found, and the remaining were case reports or small case series (very low GRADE evidence). The literature has low scientific quality. All studies, with 1 exception, are small case series with short follow-up. One of the randomized controlled trials did not meet the primary endpoint for weight loss in both groups (EG × sham) after 1-year follow-up. The case series reported from 16% to 19% total weight loss, but few had more than 6 months of follow-up. Serious adverse events ranged from 2% to 10%. Based on current literature, there is not enough quality scientific evidence regarding long-term weight loss and the procedure’s safety to recommend the use of EG in current clinical practice.     

Efficacy of a weight loss program prior to robot assisted radical prostatectomy in overweight and obese men with prostate cancer

BackgroundObesity in prostate cancer patients is associated with poor prostate-cancer specific outcomes. Exercise and nutrition can reduce fat mass; however, few studies have explored this as a combined pre-surgical intervention in clinical practice.PurposeThis study examined the efficacy of a weight loss program for altering body composition in prostate cancer patients prior to robot assisted radical prostatectomy (RARP).MethodsA retrospective analysis of 43 overweight and obese prostate cancer patients, aged 47–80 years, who completed a very low-calorie diet (~3000–4000 kJ) combined with moderate-intensity exercise (90 min/day) prior to RARP. Whole body and regional fat mass (FM) and lean mass (LM) were assessed by dual-energy x-ray absorptiometry pre- and post-program. Body weight, waist circumference, and blood pressure were assessed weekly, with surgery-related adverse effects recorded at time of surgery and follow-up appointments.ResultsWith a median of 29 days (IQR: 24–35days) on the program, patients significantly (p < 0.001) reduced weight (−7.3 ± 2.9 kg), FM (−5.0 ± 2.6 kg), percent body fat (−3.1 ± 2.5%), trunk FM (−3.4 ± 1.8 kg), LM (−2.4 ± 1.8 kg), and appendicular LM (−1.2 ± 1.0 kg). Lower weight, FM, percent FM, trunk FM, and visceral FM were associated with less surgery-related adverse effects (r_s = 0.335 to 0.468, p < 0.010). Systolic and diastolic blood pressure were reduced (p < 0.001) by 15 ± 22 and 8 ± 10 mmHg, respectively over the weight loss intervention.ConclusionUndertaking a combined low-calorie diet and exercise program for weight loss in preparation for RARP resulted in substantial reductions in FM, with improvements in blood pressure, that may benefit surgical outcomes.     

African-American Adolescents’ Weight Loss Skills Utilization: Effects on Weight Change in a Sequential Multiple Assignment Randomized Trial

Objective

Successful weight loss interventions for African-Americans adolescents are lacking. Cognitive-behavioral interventions seek to develop weight loss skills (e.g., counting calories, goal setting, managing one's environment). Little is known about how well adolescents implement such skills in their daily lives. Study aims were to (1) examine weight loss skills utilization at midpoint and end of a 6-month cognitive-behavioral/motivational interviewing weight loss sequential multiple assignment randomized trial (SMART), and (2) determine if greater skill utilization predicted weight loss at treatment end and 3 months post-treatment.

Parts‐based representations of perceived face movements in the superior temporal sulcus

Facial motion is a primary source of social information about other humans. Prior fMRI studies have identified regions of the superior temporal sulcus (STS) that respond specifically to perceived face movements (termed fSTS), but little is known about the nature of motion representations in these regions. Here we use fMRI and multivoxel pattern analysis to characterize the representational content of the fSTS. Participants viewed a set of specific eye and mouth movements, as well as combined eye and mouth movements. Our results demonstrate that fSTS response patterns contain information about face movements, including subtle distinctions between types of eye and mouth movements. These representations generalize across the actor performing the movement, and across small differences in visual position. Critically, patterns of response to combined movements could be well predicted by linear combinations of responses to individual eye and mouth movements, pointing to a parts‐based representation of complex face movements. These results indicate that the fSTS plays an intermediate role in the process of inferring social content from visually perceived face movements, containing a representation that is sufficiently abstract to generalize across low‐level visual details, but still tied to the kinematics of face part movements.     

Perception of a Natural Joint After Total Knee Arthroplasty

BackgroundAssessing patients’ functional outcomes following total knee arthroplasty (TKA) with traditional scoring systems is limited by their ceiling effects. Patient’s Joint Perception (PJP) question of the reconstructed joint is also of significant interest. Forgotten Joint Score (FJS) was created as a more discriminating option. The actual score constituting a “forgotten joint” has not yet been defined. The primary objective of this study is to compare the PJP and the FJS in TKA patients to determine the FJS score that corresponds to the patient’s perception of a natural joint.MethodsOne hundred TKAs were assessed at a mean of 40.6 months of follow-up using the PJP question, FJS, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Correlation between the 3 scores and their ceiling effects were analyzed.ResultsWith PJP question, 39% of the patients perceived a natural joint (FJS: 92.9; 95% confidence interval [CI], 89.4-96.4), 12% an artificial joint with no restriction (FJS: 79.5; 95% CI, 65.7-93.3), 36% an artificial joint with minor restrictions (FJS: 70.0; 95% CI, 63.2-76.9), and 13% had major restrictions (FJS: 47.3; 95% CI. 32.8-61.7). PJP has a high correlation with FJS and WOMAC (Spearman’s rho, −0.705 and −0.680, respectively). FJS and WOMAC had a significant ceiling effect with both reaching the best possible score in >15%.ConclusionPatients perceiving their TKA as a natural knee based on PJP have a FJS ≥89. PJP has a good correlation with FJS and may be a shorter, simple, and acceptable alternative.