瘦身耳贴：为脂肪搬家

天啊!简直太郁闷了．原本曲线曼妙的我竟然由玲珑果冻妹变成了她的姐姐——脂肪果冻妹!虽然镜子中的我笑容依然是甜蜜的，可是却一点也不可爱了!     

Predictors of excessive blood loss during operative treatment of hip fractures

OBJECTIVES: To determine the total blood loss and transfusion needs during operative treatments of hip fracture, and identify predictors of excessive blood loss. METHOD: A prospective study of 242 consecutive patients operated for hip fractures over a 6 month period. The main outcome measure of blood loss was assessed by blood volume in the drainage system and swab weight. A loss of more than 480 mls was considered as excessive blood loss. RESULTS: The study consisted of 190 women and 52 men, mean age was 81.6 years (range 44-99). More than one-third of patients (34%) lost more than 480 mls of blood, and mean units transfused per patient was 2.3. Univariate predictors of increased blood loss were patients of American Society of Anaesthesiology (ASA) grade III and IV, patients at risk of cerebral or cardiac ischemia from volume depletion as defined by the American College of Physicians, patients with two or more pre-existing medical conditions and patients who had a hemiarthroplasty carried out. However, with subsequent multivariate analysis, patients who had undergone a hemiarthroplasty and those at risk predicted increased blood loss. CONCLUSION: Pre-operative characteristics can help determine which patients should have either blood requested on the day of surgery (group and cross-match) or the customary group and save policy.     

Weight loss during medical weight management does not predict weight loss after bariatric surgery: a retrospective cohort study

BackgroundMany bariatric surgical centers mandate achieving weight loss targets through medical weight management (MWM) programs before offering bariatric surgery, but the evidence for this is unclear.ObjectivesTo examine the relationship between weight changes during (1) MWM, and (2) preoperative low-energy-diet (LED), and weight changes at 12 and 24 months after surgery.SettingMulticenter community- and acute-based MWM services referring to one regional bariatric center, United Kingdom.MethodsA retrospective cohort study of patients who attended MWM and then underwent a primary laparoscopic bariatric procedure (adjustable gastric banding [LAGB], or Roux-en-Y gastric bypass [RYGB]) in a single bariatric center in the United Kingdom between 2013 and 2015. Data were collected from patient electronic records.ResultsTwo hundred eight patients were included (LAGB n = 128, RYGB n = 80). Anthropometric data were available for 94.7% and 88.0% of participants at 12 and 24 months, respectively. There was no relationship between weight loss during MWM and after surgery at either 12 or 24 months. Weight loss during the preoperative LED predicted greater weight loss after LAGB (β = .251, P = .006) and less weight loss after RYGB (β = −.390, P = .003) at 24 months, after adjusting for age, sex, ethnicity, baseline weight, and LED duration.ConclusionsWeight loss in MWM does not predict greater weight loss outcomes up to 24 months after LAGB or RYGB. Greater weight loss during the preoperative LED predicted greater weight loss after LAGB and less weight loss after RYGB. Our results suggest that patients should not be denied bariatric surgery because of not achieving weight loss in MWM. Weight loss responses to preoperative LEDs as a predictor of postsurgical weight loss requires further investigation.     

Hyperbaric therapy for bilateral visual loss during hemodialysis

Bilateral vision loss during hemodialysis is a rare but devastating entity, with grim prognosis for sight. The etiologies are diverse but share ischemia as a common mechanism. This is a report of a patient with bilateral sight loss during hemodialysis, with early hyperbaric treatment and return of visual acuity to baseline. Hyperbaric treatment should be considered, where early administration is possible, for bilateral blindness during hemodialysis.     

Predictors of complication and suboptimal weight loss after laparoscopic Roux-en-Y gastric bypass: a series of 188 patients

HYPOTHESIS: An analysis of patients undergoing laparoscopic Roux-en-Y gastric bypass (RYGB) may identify factors predictive of complication and of suboptimal weight loss. DESIGN: Inception cohort. SETTING: Metropolitan university hospital. PATIENTS: One hundred eighty-eight consecutive patients with severe obesity who met National Institutes of Health consensus guidelines for bariatric surgery. INTERVENTIONS: Laparoscopic RYGB. MAIN OUTCOME MEASURES: Complications requiring therapeutic intervention and percentage of excess body weight lost at 1 year after surgery. RESULTS: Of the 188 patients who underwent laparoscopic RYGB, 50 (26.6%) developed complications that required an invasive therapeutic intervention, including 2 deaths. The average follow-up was 351 days (range, 89-1019 days). Multivariate analysis by stepwise logistic regression identified surgeon experience, sleep apnea (P =.003; odds ratio, 3.0; 95% confidence interval, 1.3-7.1), and hypertension (P =.07; odds ratio, 2.0; 95% confidence interval, 1.0-4.0) as predictors of complications. The most common complication requiring therapeutic intervention was stricture at the gastrojejunal anastomosis, occurring in 27 patients (14.4%). Of the 115 patients who underwent surgery more than 1 year previously, 1-year follow-up data were available for 93 (81%). The body mass index (weight in kilograms divided by the square of height in meters) decreased from 53 +/- 8 preoperatively to 35 +/- 6 at 1 year. The mean +/- SD percentage of excess body weight lost at 1 year was 61% +/- 14%. Diabetes mellitus was negatively correlated with percentage of excess body weight lost at 1 year (P =.06). CONCLUSIONS: Surgeon experience, sleep apnea, and hypertension are associated with complications after laparoscopic RYGB. Diabetes mellitus may be associated with poorer postoperative weight loss.     

Number of weight loss attempts and maximum weight loss before Roux-en-Y laparoscopic gastric bypass surgery are not predictive of postoperative weight loss

BackgroundMany insurance companies have mandated that bariatric surgery candidates already satisfying the National Institutes of Health criteria make an additional attempt at medically supervised weight loss. The objective of this study was to determine whether a correlation exists between the number of weight loss attempts (WLAs) or maximal preoperative weight loss (MWL) and the percentage of excess weight loss (%EWL) after laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery.MethodsThe WLAs and MWL data were collected by bariatric medical record review. The postoperative %EWL was obtained by retrospective review of a prospectively enrolled bariatric database. Patients whose records contained 1 year of follow-up data and either the WLAs or MWL were included in the study. The data were analyzed using Pearson correlations and odds ratios.ResultsFrom September 2001 to 2006, 530 patients underwent LRYGB. Of these, 384 met the study criteria (82.6% were women). The mean WLAs was 4.3 ± 1.8. The mean MWL was 46.6 ± 31.2 lb (21.2 ± 14.2 kg). At surgery, the mean patient age was 43.3 ± 9.3 years, and the mean body mass index was 48.0 ± 5.9 kg/m². At 1 year after LRYGB, the mean body mass index was 30.2 ± 5.0 kg/m², and the mean %EWL was 72.3% ± 15.3%. Statistical analysis revealed no correlations between the %EWL at 1 year after LRYGB and the WLAs (R² = .011) or MWL (R² = .005).ConclusionNeither the WLAs nor the MWL correlated with the %EWL at 1 year after LRYGB. Our results showed no evidence that the WLAs or MWL before surgery correlates with the %EWL in patients undergoing LRYGB.     

Predictors of bone loss after hip fracture

Although accelerated bone mineral density (BMD) loss follows hip fracture, little is known about factors associated with this loss. We examined potential predictors of BMD loss in a cohort of community-dwelling women who had sustained hip fracture and who were followed for 1 year after fracture. BMD was measured at the femoral neck, intertrochanteric region, and total body, during hospitalization and 2, 6, and 12 months later. Demographic, health, lifestyle, clinical, surgical, and functional characteristics at baseline, and postfracture activity were evaluated for associations with baseline BMD and BMD 1 year later. To examine possible BMD-dependent effects, high and low baseline BMD groups were defined. None of the studied factors consistently predicted either baseline BMD or BMD at 1 year after fracture, among women with either high or low baseline BMD. Baseline BMD was the only factor that substantially and consistently predicted change, explaining 70% to 90% of variation. These results suggest that BMD will not be preserved by general rehabilitative measures and that prompt, specific intervention to minimize bone loss after hip fracture is an essential element of clinical management of the hip fracture patient.     

质子重离子治疗肿瘤患者显著体质量下降影响因素分析及预测模型建立

目的通过分析质子重离子放疗期间显著体质量下降的影响因素,建立预测模型。方法收集375例住院接受质子或重离子治疗的肿瘤患者的一般人口学资料、临床特征、放疗前营养和活动状态资料。采用χ~2检验对变量进行单因素分析,选取有统计学意义的变量,进行多因素Logistic回归分析。通过Logistic回归模型中OR值对自变量进行赋值,建立预测模型。绘制ROC曲线,根据曲线下面积评估模型预测性能,并计算模型的诊断的灵敏度、特异度。结果 375例肿瘤患者质子重离子治疗期间,43例(11.47%)出现了显著体质量下降。Logistic回归分析显示,肿瘤部位、手术史、放疗次数、放疗射线与放疗期间显著体质量下降的发生显著相关(P<0.05,P<0.01)。以上述4个因素的OR值进行赋分,建立放疗期间显著体质量下降预测模型,其ROC曲线下面积及95%CI为0.859(0.798~0.920)。取4分为模型的临界值时,预测的灵敏度、特异度较高。结论质子重离子治疗期间采用质子联合光子、质子联合重离子或重离子联合光子治疗的患者,放疗次数≥31次,头颈部肿瘤、无手术史的患者显著体质量下降发生率较高。临床医务人员可对得分≥4分的高风险患者给予预防性营养支持措施,以降低治疗期间显著体质量下降发生率。     

Physiology of weight loss surgery

The clinical outcomes achieved by bariatric surgery have been impressive. However, the physiologic mechanisms and complex metabolic effects of bariatric surgery are only now beginning to be understood. Ongoing research has contributed a large amount of data and shed new light on the science behind obesity and its treatment, and this article reviews the current understanding of metabolic and bariatric surgery physiology.     

Lack of efficacy of dual intragastric balloon therapy on weight loss and patient dissatisfaction

BackgroundDual intragastric balloon (DIGB) therapy is a non-surgical, restrictive method of weight loss. We evaluated weight loss and patient satisfaction after DIGB removal.MethodsBetween 2016 and 2019, 35 patients had DIGB therapy. A retrospective review of weight loss at balloon removal and follow-up, adverse events during DIGB therapy, and patient satisfaction was performed.ResultsAt follow-up after balloon removal (22.3 ± 10.5 months), mean percent excess weight loss (%EWL) was significantly decreased compared to %EWL at removal (4.7 ± 42.7% vs 32.4 ± 38.8%, p = .001). Weight regain occurred in 22/31 (71%) patients. Adverse events during DIGB therapy included: nausea, abdominal pain, reflux, pancreatitis, and gastric outlet obstruction. Twenty-five (71.4%) patients completed a satisfaction questionnaire. Only 3/25 (12%) patients were satisfied, and 92% would not choose DIGB for weight loss.ConclusionWeight loss achieved from DIGB on average was not maintained after balloon removal. Most patients were not satisfied and would not choose DIGB again.     

Previous weight loss as a predictor of weight loss outcomes after laparoscopic adjustable gastric banding

Introduction

Weight loss after laparoscopic adjustable gastric banding (LAGB) can be influenced by a variety of factors. The objective of this study is to investigate whether the maximum amount of previous weight loss with diet and exercise, prior to evaluation for bariatric surgery, is predictive of postoperative weight loss success among primary LAGB patients.

Methods

A retrospective cohort study was designed from a prospectively collected database at a single institution. Inclusion criteria consisted of age ≥18 years, initial body mass index (BMI) ≥35 kg/m², intake information on the maximum weight loss at any time prior to referral to our bariatric practice, and at least 2 years of postoperative follow-up. Patients with prior bariatric surgery were excluded. Outcomes included mean % excess weight loss (EWL), percent that achieved weight loss success (%EWL ≥ 40), and percent with suboptimal weight loss (%EWL < 20) at 2 years post-LAGB.

Results

In the study, 462 primary LAGB patients were included. Mean previous weight loss was 29.7 lb (SD 27.6, range 0–175). These patients were divided into four previous weight loss groups (0, 1–20, 21–50, >50 lb) for analysis. In adjusted multivariate analyses, patients with >50 lb of maximum previous weight loss had a significantly higher mean %EWL, (p < 0.0001) and %BMIL (p < 0.0001), were more likely to reach weight loss success (≥40 % EWL, p = 0.047), and were less likely to experience suboptimal weight loss (<20 % EWL, p = 0.027) at 2 years postoperatively.

Conclusion

Previous weight loss appears to be a significant predictor of weight loss after LAGB. With multiple options for weight loss surgery, this study helps elucidate which patients may be more likely to achieve greater weight loss with the LAGB, allowing clinicians to appropriately counsel patients preoperatively.