Weight loss and co-morbidity resolution between different races and ethnicities after gastric bypass

BackgroundSeveral studies have demonstrated that minorities and Hispanic ethnicities have disproportionally greater burden of morbid obesity in the United States. However, the majority of bariatric procedures are performed in the non-Hispanic white population.ObjectivesThe objective of this study was to investigate the weight loss and remission of obesity-related co-morbidities based on race and ethnicity.SettingThe Longitudinal Assessment of Bariatric Surgery prospective, multicenter, observational study was used to collect patients from 10 different health centers across the United States.MethodsRetrospective analysis of a prospective, multicenter, observational study over a 5-year follow-up.ResultsAll patients who underwent primary gastric bypass and provided racial/ethnic information were included in the study (n = 1695). Regardless of race or ethnicity, total weight loss was maintained over a 5-year follow-up, which included 87% of the original cohort. However, whites had on average 1.94% higher adjusted total weight loss compared with blacks (P < .0001). After adjusting for confounders there were no significant differences in resolution of co-morbidities, including diabetes.ConclusionAll patients regardless of race or ethnicity have significant and sustained total weight loss and resolution of co-morbidities after gastric bypass at 5-year follow-up.     

Predicting Carpal Bone Kinematics Using an Expanded Digital Database of Wrist Carpal Bone Anatomy and Kinematics

The wrist can be considered a 2 degrees‐of‐freedom joint with all movements reflecting the combination of flexion–extension and radial–ulnar deviation. Wrist motions are accomplished by the kinematic reduction of the 42 degrees‐of‐freedom of the individual carpal bones. While previous studies have demonstrated the minimal motion of the scaphoid and lunate as the wrist moves along the dart‐thrower's path or small relative motion between hamate‐capitate‐trapezoid, an understanding of the kinematics of the complete carpus across all wrist motions remains lacking. To address this, we assembled an open‐source database of in vivo carpal motions and developed mathematical models of the carpal kinematics as a function of wrist motion. Quadratic surfaces were trained for each of the 42‐carpal bone degrees‐of‐freedom and the goodness of fits were evaluated. Using the models, paths of wrist motion that generated minimal carpal rotations or translations were determined. Model predictions were best for flexion–extension, radial–ulnar deviation, and volar–dorsal translations for all carpal bones with R ² > 0.8, while the estimates were least effective for supination‐pronation with R ² < 0.6. The wrist path of motion's analysis indicated that the distal row of carpal bones moves rigidly together (<3° motion), along the anatomical axis of wrist motion, while the bones in the proximal row undergo minimal motion when the wrist moves in a path oblique to the main axes. The open‐source dataset along with its graphical user interface and mathematical models should facilitate clinical visualization and enable new studies of carpal kinematics and function. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2661–2670, 2019     

Our Next Pandemic Ethics Challenge? Allocating “Normal” Health Care Services

The pandemic creates unprecedented challenges to society and to health care systems around the world. Like all crises, these provide a unique opportunity to rethink the fundamental limiting assumptions and institutional inertia of our established systems. These inertial assumptions have obscured deeply rooted problems in health care and deflected attempts to address them. As hospitals begin to welcome all patients back, they should resist the temptation to go back to business as usual. Instead, they should retain the more deliberative, explicit, and transparent ways of thinking that have informed the development of crisis standards of care. The key lesson to be learned from those exercises in rational deliberation is that justice must be the ethical foundation of all standards of care. Justice demands that hospitals take a safety-net approach to providing services that prioritizes the most vulnerable segments of society, continue to expand telemedicine in ways that improve access without exacerbating disparities, invest in community-based care, and fully staff hospitals and clinics on nights and weekends.     

Interstitial granulomatous dermatitis and granulomatous arteritis in the setting of PD-1 inhibitor therapy for metastatic melanoma

Checkpoint inhibition has become an important target in the management of malignant melanoma. As anti-CTLA4 inhibitors and anti-PD1 antibodies are increasingly utilized, reports of immune-related adverse events (IRAEs) are becoming more frequent. Common noted cutaneous IRAEs are morbilliform, lichenoid, bullous, granulomatous, psoriasiform, and eczematous eruptions. We report a case of interstitial granulomatous dermatitis and granulomatous arteritis in the setting of nivolumab (anti-PD1) monotherapy for metastatic melanoma. There are many different causes for granulomatous vasculitis, such as herpes virus infection, lymphoproliferative disorders, systemic vasculitis, and inflammatory bowel disease. This report adds to the growing literature on granulomatous IRAEs due to checkpoint inhibition.     

Neural stem cell replacement: a possible therapy for neurodevelopmental disorders?

<正>Neurodevelopmental disorders are characterized by an abnormal development of the central nervous system,leading to a myriad of symptoms and diseases,including intellectual disability,attention deficits,impairments in learning and memory,speech disorders and repetitive behavior(Telias and Ben-Yosef,2014).Common major neurodevelopmental disorders include autism and autism     

Aerosolized ribavirin: the most expensive drug for pneumonia

Dramatic, overnight cost increases of important orphan and generic medications have recently come under public and government scrutiny. We highlight the case of aerosolized ribavirin, an important antiviral agent in hematopoietic stem cell transplantation which, because of substantial price increases, may now cost more than the transplant procedure itself.     

The Bladder Is Not Sterile: History and Current Discoveries on the Urinary Microbiome

In the human body, there are 10 bacterial cells for every one human cell. This fact highlights the importance of the National Institutes of Health’s initiative to map the human microbiome. The Human Microbiome Project was the first large-scale mapping of the human microbiome of five body sites: GI tract, mouth, vagina, skin, and nasal cavity using culture-independent methods. The bladder was not originally tested because it was considered to be sterile and there were complexities regarding sample collection. Over the last couple years, our team along with other investigators has shown that a urinary microbiome exists and for most individuals, it plays a protective role.