Laparoscopic adjustable gastric banding for patients with body mass index of ≤35 kg/m

BACKGROUND: Many mild-to-moderately obese individuals (body mass index [BMI] 30-35 kg/m(2)) have serious diseases related to their obesity. Nonoperative therapy is ineffective in the long term, yet surgery has never been made widely available to this population. METHODS: Between 1996 and 2004, 93 patients with a BMI of 30-35 kg/m(2) underwent laparoscopic adjustable gastric banding with the LAP-BAND. All patients were referred by their primary physician, entered into a comprehensive bariatric surgery program at one Australian center, and operated on by one surgeon. Data on all patients were collected prospectively and entered into an electronic registry. The study parameters included preoperative age, gender, BMI, presence of co-morbidities, percentage of excess weight loss, and resolution of co-morbidities. RESULTS: The mean age was 44.6 years (range 16-76), mean weight was 98 kg, and the mean BMI was 32.7 kg/m(2) (range 30-34). Of the 93 patients, 42 (45%) had co-morbidities, including asthma, diabetes, hypertension, and sleep apnea. The proportion of patients in follow-up was 79%, 85%, and 89% at 1, 2, and 3 years, respectively. The mean weight was reduced to 71 kg at 1 year, 72 kg at 2 years, and 72 kg at 3 years. The mean BMI was reduced to 27.2 +/- 2.2, 27.3 +/- 3.1, and 27.6 +/- 3.7 kg/m(2), respectively, and the mean percentage of excess weight loss was 57.9% +/- 24.5%, 57.6 +/- 29.3%, and 53.8% +/- 32.8% at 1, 2, and 3 years, respectively. At 3 years, the BMI was 18-24 kg/m(2) in 34%, 25-29 kg/m(2) in 51%, and 30-35 kg/m(2) in 10%. At 3 years, the percentage of excess weight loss was <25% in 10%, 25-50% in 24%, 50-75% in 51%, and >75% in 10%. The co-morbidities improved or completely resolved in most patients. No mortality occurred. CONCLUSION: We are very encouraged by this series of low BMI patients treated with the LAP-BAND. Their weight loss has been good, the complications have been minimal, and the co-morbidities have partially or wholly resolved. With additional study, it is reasonable to expect the weight guidelines for bariatric surgery to be altered to include patients with a BMI of 30-35 kg/m(2).     

经皮颅-耳电刺激治疗轻中度抑郁症的随机单盲对照研究

目的：观察经皮颅-耳电刺激治疗轻中度抑郁症的临床疗效。方法：选取2019年12月至2020年12月中国中医科学院广安门医院收治的轻中度抑郁症患者140例作为研究对象,随机分为观察组（n=69）和对照组（n=71）。观察组采用华佗牌SDZ-IIB型电子针疗仪电刺激耳甲迷走神经和颅部印堂-百会穴,对照组予以口服草酸艾司西酞普兰片,2组均治疗8周。分别于治疗0、2、4、8周时观察2组患者蒙哥马利抑郁量表（MADRS）、汉密尔顿抑郁量表（HAMD-17项）、汉密尔顿焦虑量表（HAMA）评分,并在0、4、8周时评估2组患者匹兹堡睡眠质量指数（PSQI）评分,比较2组临床疗效。结果:1）在治疗8周后,2组的MADRS、HAMD-17、HAMA、PSQI量表评分均下降,与治疗前比较,差异均有统计学意义（均P<0.01）;2）观察组和对照组同步治疗8周后,MADRS和HAMD-17评分均改善,观察组优于对照组,2组比较,差异均有统计学意义（均P<0.05）;3）2组总有效率、临床治愈率比较,差异无统计学意义（P>0.05）,在改善轻中度抑郁症患者抑郁情绪方面2组疗效相当;4）观察组未观察到不良反应,对照组在治疗2周后的不良反应发生率为28.17%。结论：经皮颅-耳电刺激治疗可以改善轻中度抑郁症患者的抑郁情绪,且不良反应少,无药物依赖性,可作为轻中度抑郁症患者抗抑郁治疗的有效选择。     

活血散风、调和肝脾针刺法治疗轻中度原发性高血压临床研究

目的:观察活血散风、调和肝脾针刺法对轻中度原发性高血压的临床疗效。方法:选取120例原发性高血压患者,按随机数字表法分为针刺组和药物组,每组60例。针刺组给予活血散风、调和肝脾针刺降压法治疗,药物组给予降压药物治疗。2组均在治疗前、治疗后、随访1个月及3个月行24 h动态血压监测,观察血压平均值、血压变异性、昼夜血压负荷值及平滑指数的变化,比较2组血压达标率。结果:治疗后、随访1个月及3个月,针刺组24 h血压平均值、血压变异性、昼夜血压负荷值及平滑指数均优于治疗前及同期药物组(P<0.05)。治疗后,药物组24 h血压平均值、血压变异性、昼夜血压负荷值及平滑指数均优于治疗前(P<0.05);随访1个月及3个月,药物组24 h动态血压检测指标与治疗前比较,差异均无统计学意义(P>0.05)。针刺组治疗后及随访1个月、3个月,血压达标率分别为59.65%、38.60%和31.58%,优于药物组的41.07%、10.71%、5.36%(P<0.05)。结论:活血散风、调和肝脾针刺法对轻中度原发性高血压有良好的降压效果,且降压效果平稳。     

Hip joint mechanics during walking in individuals with mild-to-moderate hip osteoarthritis

The purpose of this case-control study was to characterise hip joint kinematics and moments during gait in people with mild-to-moderate hip osteoarthritis (OA). Eligible participants were allocated to the hip OA group (n = 27) or the age-matched control group (n = 26) based on radiographic and symptomatically defined inclusion criteria. Participants walked barefoot along a 10-m walkway at their self-selected gait speed. Trajectories of 43 markers attached to the trunk, pelvis, upper and lower limbs were recorded using a 12-camera motion capture system. Ground reaction force data were simultaneously collected. Individuals in the hip OA group had a 10% higher body mass, 13% slower self-selected walking speed, 10% shorter step length, 2% and 9% longer relative stance and double support duration (% stride) respectively, 41% lower sagittal plane hip range of motion, and 28% and 45% lower peak sagittal and transverse plane hip joint moments respectively during gait compared to controls (p < 0.05). The finding that individuals with mild-to-moderate hip OA experienced less net hip joint loading over a reduced range of hip motion for a longer proportion of the gait cycle when walking at their preferred gait speed suggest that the mechanics of the hip joint are altered in hip OA, and could have implications for disease progression through altered mechano-biological processes within the joint.     

Younger adults with mild-to-moderate COVID-19 exhibited more prevalent olfactory dysfunction in Taiwan

BackgroundCoronavirus Disease 2019 (COVID-19) is rapidly transmitted from person to person, causing global pandemic since December 2019. Instantly detecting COVID-19 is crucial for epidemic prevention. In this study, olfactory dysfunction is a significant symptom in mild to moderate COVID-19 patients but relatively rare in other respiratory viral infections. The Taiwan smell identification test (TWSIT) is a speedy and inexpensive option for accurately distinguishing anosmia that also quantifies the degree of anosmia. Using TWSIT in the outpatient clinic for early identifying the patients with mild to moderate COVID-19 can be promising.MethodsNineteen patients confirmed COVID-19 in central Taiwan were collected and divided into two groups: olfactory dysfunction and non-olfactory dysfunction. Demographic characteristics, laboratory findings, and the results of the olfactory test were compared between these two groups.FindingsThirteen (68.4%) of the 19 patients had olfactory dysfunction. The patients with olfactory dysfunction were younger than those without this symptom. The statistical difference in age distribution was significant between these two groups (IQR: 25.5–35.5 vs. IQR: 32.5–60.3; p-value: 0.012). There was no significant difference in gender, smoking history, comorbidities, travel history, respiratory tract infection symptoms, and laboratory findings between these two groups.ConclusionThis study demonstrated that young adults were prone to develop olfactory dysfunctions. In the flu season, olfactory dysfunction is considered a specific screening criterion for early detecting COVID-19 in the community. TWSIT can serve as a decent test for quantifying and qualifying olfactory dysfunction.     

果酸联合红蓝光治疗轻中度痤疮的临床疗效观察

目的 探讨果酸(薇诺娜)联合红蓝光治疗轻中度痤疮的临床效果.方法 选取自2015年4月至2016年5月在本院治疗的355例轻中度痤疮患者为研究对象,采用随机方法分为两组,观察组采用果酸联合红蓝光治疗,对照组采用果酸治疗,采用皮损减少率(Creduction rate of skin lesion)评价对比两组患者治疗前后的临床疗效.结果 采用果酸联合红蓝光治疗的效果更好,观察组在治疗3、6、9、12、15周后治疗总有效率分别为22.99％、39.04％、57.22％、59.89％、76.47％,对照组在治疗3、6、9、12、15周后治疗总有效率分别为13.69％、13.69％、20.23％、34.52％、39.29％,观察组明显大于同时段对照组,差异有统计学意义(P＜0.05).结论 采用果酸联合红蓝光治疗轻中度痤疮具有良好的治疗效果,值得临床推广应用.     

Transposición del vientre del oblicuo inferior sin desinserción en el tratamiento de la hipertropia en aducción

PurposeTo evaluate the efficacy and safety of inferior oblique muscle transposition and myopexy in patients with mild/moderate inferior oblique muscle overaction, with or without diplopia.MethodWe retrospectively analysed data for the 12 patients who underwent the technique. Data were collected from October 2018 to September 2021. Surgery was performed by suturing the inferior oblique belly to the sclera at 5 mm posterior to the temporal end of the inferior rectus. All 12 patients had mild hypertropia (≤ 6 prism diopters [pd]) in primary position and mild/moderate inferior oblique overaction. Mean preoperative hypertropia was 4.42 pd ± 1.62. Diplopia was recorded in 10 cases. The diagnoses were fourth nerve paresis (9), unilateral primary inferior oblique overaction (2) and dissociated vertical deviation (1). Torticollis was observed in 7 cases, 2 had subjective torsion and 2 objective torsion.ResultsMean age was 46.86 ± 25.1 years (50%: men). Diplopia resolved in 9 of the 10 cases. The mean final vertical deviation was 1.5 ± 2.93 (P = .001) pd in straight gaze. Of 7 mild overshoot in adduction, it disappeared in 3 and 4 remained the same. Of 5 moderate overshoot in adduction, 2 improved to mild and 3 disappeared. Torticollis was eliminated in 5 patients and improved in another 2. Mean time from surgery was 14.08 ± 8.05 months. There were no overcorrections.ConclusionsInferior oblique muscle transposition with myopexy is a safe and effective procedure in patients with mild-to-moderate inferior oblique muscle overaction and small-angle hypertropia, with or without diplopia.     

红蓝光联合阿达帕林凝胶治疗轻、中度痤疮的有效性和安全性分析

目的：分析红蓝光联合阿达帕林凝胶治疗轻、中度痤疮的有效性和安全性。方法：选取我院收治的210例轻、中度痤疮患者,将其随机分为三组,即红蓝光组（70例）,阿达帕林凝胶组（70例）,红蓝光联合阿达帕林凝胶组（70例）。红蓝光组给予红蓝光照射治疗,阿达帕林凝胶组给予外用的阿达帕林凝胶,红蓝光联合阿达帕林凝胶组给予红蓝光照射和外用的阿达帕林凝胶,比较各组临床疗效。结果：治疗后红蓝光联合阿达帕林凝胶组患者的皮损改变程度明显优于红蓝光组和阿达帕林凝胶组,差异具有统计学意义（P＜0．05）;红蓝光联合阿达帕林凝胶组的总有效率为94．29％显著高于红蓝光组和阿达帕林凝胶组,差异具有统计学意义（ P＜0．05）。结论：红蓝光联合阿达帕林凝胶治疗轻、中度痤疮的疗效明显高于红蓝光组和阿达帕林凝胶组,且安全性高,值得在医学临床上广泛的推广和应用。     

Cognitive and vocational rehabilitation after mild-to-moderate traumatic brain injury: A randomised controlled trial

BackgroundReturning to work is often a primary rehabilitation goal after traumatic brain injury (TBI). However, the evidence base for treatment options regarding return to work (RTW) and stable work maintenance remains scarce.ObjectiveThis study aimed to examine the effect of a combined cognitive and vocational intervention on work-related outcomes after mild-to-moderate TBI.MethodsIn this study, we compared 6 months of a combined compensatory cognitive training and supported employment (CCT-SE) intervention with 6 months of treatment as usual (TAU) in a randomised controlled trial to examine the effect on time to RTW, work percentage, hours worked per week and work stability. Eligible patients were those with mild-to-moderate TBI who were employed ≥ 50% at the time of injury, 18 to 60 years old and sick-listed ≥ 50% at 8 to 12 weeks after injury due to post-concussion symptoms, assessed by the Rivermead Post Concussion Symptoms Questionnaire. Both treatments were provided at the outpatient TBI department at Oslo University Hospital, and follow-ups were conducted at 3, 6 and 12 months after inclusion.ResultsWe included 116 individuals, 60 randomised to CCT-SE and 56 to TAU. The groups did not differ in characteristics at the 12-month follow-up. Overall, a high proportion had returned to work at 12 months (CCT-SE, 90%; TAU, 84%, P = 0.40), and all except 3 were stably employed after the RTW. However, a significantly higher proportion of participants in the CCT-SE than TAU group had returned to stable employment at 3 months (81% vs. 60%, P = 0.02).ConclusionThese results suggest that the CCT-SE intervention might help patients with mild-to-moderate TBI who are still sick-listed 8 to 12 weeks after injury in an earlier return to stable employment. However, the results should be replicated and a cost-benefit analysis performed before concluding.