Prospective, Multicenter, 3-Year Trial of Laparoscopic Adjustable Gastric Banding with the MIDBAND?

Background

Although laparoscopic adjustable gastric banding (LAGB) is a popular metabolic/bariatric procedure, few prospective studies have assessed its outcomes. This study aimed to prospectively assess LAGB safety and effectiveness outcomes using the MIDBAND? (MID, Dardilly, France).

Methods

Between May 2005 and September 2006, 262 morbidly obese patients underwent primary gastric banding with pars flaccida technique in 13 French medical centers. Excess weight loss and change in body mass index (BMI, kilogram per square meter), percentage of patients with comorbidities, and obesity-related complications were recorded. Patients were followed at 6-month intervals for 3?years. A multivariable individual growth model was used to analyze weight change over time and determine potential predictors of weight loss.

Results

The majority of patients were female (n?=?233, 89%), with mean age of 36.4?±?9.7?years. At 3?years, LAGB with MIDBAND resulted in significant decrease in mean BMI from 41.8?±?4.2 to 30.7?±?5.8 (p?p?Conclusion Prospective outcomes demonstrate the safety and efficacy of gastric banding over time using the MIDBAND. Individual growth modeling demonstrated that postoperative weight loss is strongly related to the frequency and consistency of follow-up visits.     

Patient satisfaction after laparoscopic lateral suspension with mesh for pelvic organ prolapse: outcome report of a continuous series of 417 patients

Introduction and hypothesis

Sacropexy is considered the gold standard for the treatment of pelvic organ prolapse (POP) although dissection of the promontory may be challenging, particularly in obese women. Laparoscopic lateral suspension with mesh (LLS) could be an alternative.

Methods

LLS provides lateral attachment by fibrosis of a vesicovaginal mesh. Clinical evaluation was performed at 1 year using the simplified POP quantification system (POP-Q). Primary outcomes were objective and subjective cure at 1 year. After a mean of 7.2 years the rates of reoperation and complications were assessed as secondary outcomes. Patient satisfaction was evaluated by telephone interview using a ten-point-scale and the PGI-I scale. Factors predicting satisfaction were determined by logistic regression analysis.

Results

A total of 417 patients were treated between 2003 and 2011. At 1 year 78.4% of patients were asymptomatic and anatomic success rates were 91.6% for the anterior compartment, 93.6% for the apical compartment and 85.3% for the posterior compartment. The complication rate of Clavien-Dindo grade III or higher was 2.2%. The mesh exposure rate was 4.3% and the reoperation rate was 7.3%. Of the 417 patients, 214 participated in the telephone interview. Over 85% rated their situation as improved and satisfaction was associated with the absence of concomitant hysterectomy.

Conclusions

LLS is a safe technique with promising results in terms of a composite outcome, low complication rates and high long-term patient satisfaction. However, a randomized controlled trial is needed to establish the technique as an alternative to sacropexy in the treatment of POP in obese and high morbidity patients.

     

Poland综合征临床特点与治疗

目的 根据Poland综合征的临床特点,探讨其治疗策略.方法 对15例患者进行回顾性研究,将Poland综合征胸部畸形分为4类:轻度,女性;重度,女性;轻度,男性;重度,男性.分别行自身软组织填充或(和)硅凝胶乳房假体置入术.结果 随访6个月至4年,全部患者胸部外形对称,肌瓣全部成活,无假体包膜挛缩、移位,手术效果满意...     

右半结肠与左半结肠肿瘤性肠梗阻一期切除吻合的比较

目的:比较右半结肠与左半结肠癌肠梗阻一期切除吻合的近期结果.方法:回顾分析80例结肠癌肠梗阻行一期切除吻合患者的临床资料.结果:37例右半结肠癌及43例左半结肠癌肠梗阳患者行一期手术,2组患者平均住院时间为(31.6±12.8)d vs(29.6±14.8)d,P=0.518,平均住院费用为(52794.9±60 804.3)元vs(50 192.8±39 727.4)元,P=0.817,并发症率分别为21.6%(8/37)vs 25.6%(11/43),P=0.678,病死率为5.4%(2/37)vs2.3%(1/44),P=0.593,差异均无统计学意义.2组中各有1例发生吻合口瘘.结论:一期切除吻合对右半或左半结肠癌肠梗阻者同样安全.左半结肠吻合前,充分的结肠减压是必须的.     

Calcium absorption and bone mineral density in celiacs after long term treatment with gluten-free diet and adequate calcium intake

Calcium malabsorption, hypocalcemia and skeletal demineralization are well-recognized features of untreated celiac disease. This study investigates calcium absorption and bone mineral density (BMD) after a prolonged, over 4 years, treatment with a gluten-free diet. Twenty-four adult females with treated celiac disease and twenty age- and sex-matched control subjects were studied. Mean body mass index (MBI), energy intake, serum calcium, and serum 25(OH)D concentrations in treated celiacs did not differ from controls. However, while both dietary calcium and protein intake were significantly higher in celiacs (P<0.012), fractional calcium absorption was lower (mean percentage±SD; treated 39.8±12 versus controls 52.3±10, P<0.001). Thus, after adjusting for calcium intake, the estimated amount of calcium absorbed daily was similar in both groups. Whole body, spine and trochanter BMD were significantly lower in treated celiac patients compared with controls (P<0.05). There were significant inverse correlations between: serum parathyroid hormone (PTH) and femoral neck or total body BMD (P<0.01), PTH and duration of gluten-free diet (P=0.05), and fractional calcium absorption and alkaline phosphatase (P=0.022). Increased calcium intake could potentially compensate for the reduced fractional calcium absorption in treated adult celiac patients, but may not normalize the BMD. In addition, the inverse correlation between PTH and time following treatment is suggestive of a continuing long-term benefit of gluten withdrawal on bone metabolism in celiac patients.     

新型冠状病毒肺炎诊疗的若干思考

作为一种新发的传染性极强的呼吸道疾病,新型冠状病毒肺炎（COVID-19,以下简称新冠肺炎）在全球范围内传播、蔓延。目前,该病已经造成了数以百万计的人感染、近30万人死亡,严重威胁着人类生命财产安全等众多方面。本文通过在临床治疗过程中对该疾病特点及疾病演变规律的总结,为新冠肺炎的诊治提供参考。     

乳腺癌术后患者心理社会适应水平调查研究

目的 探讨乳腺癌患者心理社会适应水平现状,并分析其与生活质量的相关性,为提高乳腺癌患者生活质量提供新的方向。方法 选取2020年9月至2021年6月新疆某三甲医院就诊的264例乳腺癌患者作为研究对象,采用一般资料调查问卷、乳腺癌心理社会适应问卷、乳腺癌患者生命质量问卷进行调查,分析乳腺癌患者心理社会适应水平与生活质量的相关性。结果 乳腺癌患者心理社会适应水平得分为(147.59±17.59)分,生活质量得分为(95.83±15.04)分;相关性分析结果显示,乳腺癌患者心理社会适应水平得分与生活质量总分呈正相关(r=0.379,P<0.001);多元分层回归结果显示,心理社会适应水平进入生活质量影响因素模型,心理社会适应水平可独立解释乳腺癌生活质量14.70%的变异。结论 乳腺癌患者疾病心理社会适应处于中低水平,且与生活质量呈正相关,疾病心理社会适应水平是其生活质量的重要预测因子。     

组蛋白修饰影响肿瘤血管生成的研究进展

组蛋白修饰是表观遗传调控的一种重要方式,它通过相关修饰酶发生翻译后修饰从而改变染色质的结构和功能.肿瘤血管生成是肿瘤发生、发展、转移、复发过程中至关重要的一个环节.已有大量研究发现,组蛋白修饰和肿瘤血管生成有着密切联系,组蛋白修饰酶可以改变自身表达量或者直接作用于癌基因,也可以与热休克蛋白等相互作用促进或抑制肿瘤血管生...