Post-surgery Patients Research Articles

Portion perfection and Emotional Freedom Techniques to assist bariatric patients post surgery: A randomised control trial

BackgroundAlthough significant health improvements are indicated from weight-loss following bariatric surgery, many individuals are unable to lose weight or maintain their weight-loss. The current study aimed to assess whether post-surgery care comprising Emotional Freedom Techniques (EFT), an emerging energy psychology intervention, combined with a behaviour-based nutrition and portion control eating plan in an online self-guided delivery would aid weight-loss and maintenance in bariatric patients. MethodsA 6-month randomised controlled parallel-group trial. Participants (N = 343; aged 21–69 years; BMI ≥30 kg/m2) had undergone bariatric surgery (12 + months prior) and were randomly assigned to one of three treatment groups: Portion Perfection for Bariatric Patients (PPBP; n = 109), PPBP combined with an eight-week online self-paced EFT treatment (n = 107), and a treatment as usual (TAU) control (n = 127). Participants completed measures of BMI, emotional eating, uncontrolled eating, food cravings, and self-esteem at 8-week post-treatment (n = 158) and 6-month follow-up (n = 109). ResultsMixed-design analyses of variances were conducted to examine the effect of the interventions on outcome measures (pre-intervention, 8-week post-intervention, and 6-month follow-up). Emotional eating decreased significantly from pre-intervention to post-intervention for the PPBP and PPBP with EFT groups, and at 6-month follow-up for the TAU group only. There were no statistically significant between-group differences in other outcome variables. However, at 6-months the PPBP with EFT group experienced the greatest improvements in emotional eating (-16.33%), uncontrolled eating (-9.36%), and self-esteem (+4.43%), compared to PPBP only or TAU. ConclusionThe effect of EFT combined with the eating plan on psychological variables was largely inconsistent with prior research and discussion of how this may be optimised in future trials is discussed. Clinical trial registrationACTRN12616001257459.

IL-6 promotes PD-L1 expression in monocytes and macrophages by decreasing protein tyrosine phosphatase receptor type O expression in human hepatocellular carcinoma.

BackgroundWe have previously discovered a relationship between the low expression of protein tyrosine phosphatase, receptor type O (PTPRO) in tumor-infiltrating T cells and immunosuppression. The aim of the present study was to investigate the relationship between decreased PTPRO and increased programmed death ligand 1 (PD-L1) in both the peripheral monocytes and tumor-infiltrating macrophages of human hepatocellular carcinoma (HCC).MethodsThe expression and correlation of all the indices were explored in monocytes and tumor-infiltrating macrophages within both human and mice HCC. The mechanic regulations were studied by using both in vitro and in vivo studies.ResultsWe found a significant decrease in PTPRO in HCC peripheral monocytes that was associated with increased PD-L1 expression in peripheral monocytes and tumor-associated macrophages (TAMs) in HCC. Monocyte PD-L1 and PTPRO therefore could serve as valuable prognostic indicators for post-surgery patients with HCC and were associated with increased T-cell exhaustion (Tim3+T cells). A depletion of PTPRO promoted PD-L1 secretion in both monocytes and macrophages through the JAK2/STAT1 and JAK2/STAT3/c-MYC pathways. Increased IL-6 expression was associated with activation of JAK2/STAT3/c-MYC and with decreased PTPRO expression through the STAT3/c-MYC/miR-25–3 p axis. Monocytes and TAMs showed significantly increased miR-25–3 p expression, which could target the 3′ untranslated region of PTPRO. The miR-25–3 p expression positively correlated with serum IL-6 levels, but inversely correlated with PTPRO in HCC monocytes. IL-6/STAT3/c-MYC activation enhanced in vitro miR-25–3 p transcription and decreased PTPRO, while further promoting PD-L1 secretion. Adoptive cell transfer of c-MYC/miR-25–3 p–modified monocytes promoted tumor growth by downregulating PTPRO and causing a PD-L1–induced immunosuppression in an orthotopic tumor transplantation model.ConclusionsIncreased serum IL-6 downregulated PTPRO expression in HCC monocytes and macrophages by activating STAT3/c-MYC/miR-25–3 p and by further enhancing PD-L1 expression through JAK2/STAT1 and JAK2/STAT3/c-MYC signaling.

Investigation of Plasma cell-free cancer genome chromosomal instability as a tool for targeted minimally invasive biomarkers for primary liver cancer diagnoses.

PurposeTo characterize plasma cell‐free cancer genome chromosomal instabilities (CIN) in patients with liver cancer and to evaluate the potential of CIN as minimally invasive biomarkers for primary liver cancer (PLC) diagnoses.Experimental DesignWe collected 196 plasma samples from 172 individuals in two cohorts, a discovery cohort of surgery ineligible PLC patients and a validation cohort of hepatectomy patients with pathological disease confirmations. All samples were subjected to HiSeq X10 sequencing followed by a customized bioinformatics workflow Ultrasensitive Chromosome Aneuploidy Detection (UCAD).ResultsIn the discovery cohort, 29 significant copy number changes were identified in plasma from surgery‐ineligible PLC. Twenty‐two (95.7%) surgery‐ineligible liver cancers were identified as harboring copy number changes in at least 1 of 29 segments. Meanwhile 40/41 (97.6%) noncancers harbored no changes. In the validation cohort, 54 (69.4%) surgery‐eligible liver cancers were identified with positive screening, all of which were subsequently confirmed as cancer by pathological examination. Moreover, 26/27 = 96.3% noncancers were identified with negative screening. UCAD‐positive screening was significantly associated with microvascular invasion (OR > 10, 95% CI:[2.53,]), tumor stages B and C (OR = 8.59, 95% CI [1.07, 400]), and tumor size ≥ 3 cm (OR = 5.68, 95% CI [1.43, 28.1]). Furthermore, we collected 29 followed‐up plasma samples from 19 postsurgery patients. Nine (31.0%) postsurgery samples from 6 (31.5%) patients were identified with positive screening. Among them, 3 patients (50.0%) with positive screening were then confirmed as having disease recurrences.ConclusionsIn addition to AFP, plasma cell‐free DNA sequencing is a useful tool for primary liver cancer diagnoses.

Performance and improvement of the DiaRem score in diabetes remission prediction: a study with diverse procedure types.

The DiaRem score has proven to be a reliable predictor tool for diabetes remission in Roux-en-Y gastric bypass (RYGB), as well as laparoscopic adjustable gastric band (LAGB) and laparoscopic sleeve gastrectomy (LSG). To our knowledge there are no studies that analyze DiaRem in patients undergoing biliopancreatic diversion with duodenal switch (BPD/DS). To test the validity of the DiaRem score as a predictor of type 2 diabetes remission at 1 year post surgery in patients who underwent LABG, LSG, RYGB, and BPD/DS, as well as to develop and test a novel model that uses DiaRem to predict type 2 diabetes remission by procedure type (LABG, LSG, RYGB, and BPD/DS). University Medical Center, United States. A retrospective review of institutional records identified patients who underwent primary bariatric procedures (LAGB, LSG, RYGB, and BPD/DS) between January 1, 2000 to April 10, 2017, had a diagnosis of diabetes and had complete preoperative and 1-year postoperative follow-up information. A univariable logistic regression model was fit to assess the association between DiaRem score and diabetes remission. A multivariable logistic regression model was created, including procedure type and other preoperative characteristics. The area under the receiver operating curve (AUROC) was calculated to analyze the performance of both models for the entire cohort as well as a BPD/DS only subgroup. A total study cohort of 602 was obtained. The majority of patients underwent RYGB (456; 75.7%), followed by LSG (84; 14.0%), BPD/DS (35; 5.8%), and LAGB (27; 4.5%). The multivariable regression model with RYGB as the reference procedure, showed that BPD/DS results in higher odds of type 2 diabetes remission at 1 year post surgery (adjusted odds ratio [OR] 3.29, 95% confidence interval [CI] 1.27, 8.51), while LSG (adjusted OR .52, 95%CI .29, .93) and LAGB resulted in lower odds (adjusted OR.23, 95% CI.09,.60). The univariable DiaRem model and the novel model were determined to be moderately strong in classifying diabetes remission in the entire cohort (AUROC: .79, 95% CI: .75, .83 and .82, 95% CI: .79, .85, respectively) as well as in the BPD/DS sub-group (AUROC: .85, 95% CI: .70, .99 and .84, 95% CI .69, .99, respectively). Our study shows that the DiaRem score is a reliable tool to predict diabetes remission, amongst a wide variety of different procedures as well as specifically those receiving BPD/DS. Our novel model, which takes into account procedure type, not only shows that BPD/DS patients have thehighest odds of diabetes remission than other procedures, but also that this model performs significantly better at predicting diabetes remission than DiaRem alone.

A survey of cannabis use for symptom palliation in breast cancer patients by age and stage.

12108 Background: Most US states have legalized medical cannabis for the treatment of serious conditions, including cancer. It is not well known which symptoms breast cancer patients seek to control with cannabis. Methods: Members of the Breastcancer.org and Healthline communities were invited to participate in this survey between 12/16/2019 and 1/19/2020. Eligibility criteria included age ≥18 years, resident of the US and a breast cancer diagnosis within the past 5 years. Eligible respondent data were analyzed for the symptomatic profile of cannabis users. Symptoms were compared between two groups using a Chi-square test of independence. The survey was led by Socanna, conducted by Outcomes Insights, and supported by a grant from Ananda Health/Ecofibre. Results: Among the 832 respondents who completed screening, 725 met the eligibility criteria, and 612 (84%) completed the survey. The median age of respondents was 57 years, and 85% had non-metastatic disease An estimated 42% of respondents have used medical cannabis to treat symptoms or side effects of breast cancer. Medical cannabis users reported using cannabis to treat insomnia (70%), joint and muscle aches, discomfort, stiffness, or pain (59%), anxiety (57%), and stress (51%). The medical cannabis users less than 50-year-old were more likely to use cannabis to treat these symptoms than their over 50-year-old counterparts, however, the differences were not statistically significant. Medical cannabis users under age 50 used cannabis significantly more than over 50 to treat nausea/vomiting (58% vs 40%; p = 0.010) and inflammation (34% vs 20%; p = 0.021). Medical cannabis users with metastatic disease were more likely to use medical cannabis to treat chronic pain 60% vs 41%; p = 0.017) than non-metastatic users. Post-surgery patients were most likely to use cannabis for nerve pain; and those who were beyond treatment, for stress. Patients suffered an average of 5 symptoms. Conclusions: A significant proportion of breast cancer patients reported using cannabis to treat a combination of symptoms from their cancer and its treatment. Although younger patients are somewhat more likely to use this form of palliative management, older patients are suffering from the same symptoms and their use is nearly as high. More research is needed on the personalization of safe and effective symptomatic management with medical cannabis, for people of all ages, stages, and forms of treatment.

IL-6 influences PD-L1 expression in monocytes and macrophages by effecting protein tyrosine phosphatase receptor type O expression in-human breast cancer.

e15570 Background: We have previously discovered a relationship between the low expression of protein tyrosine phosphatase, receptor type O (PTPRO) in tumor-infiltrating T cells and immunosuppression. The aim of the present study was to investigate the relationship between decreased PTPRO and increased programmed death ligand 1 (PD-L1) in both the peripheral monocytes and tumor-infiltrating macrophages of human breast cancer (BC). Methods: The expression and correlation of all the indices were explored in monocytes and tumor infiltrating macrophages within both human and mice BC. The mechanic regulations were studied by using both in vitro and in vivo studies. Results: We found a significant decrease in PTPRO in BC peripheral monocytes that was associated with increased PD-L1 expression in peripheral monocytes and tumor-associated macrophages (TAMs) in BC. Monocyte PD-L1 and PTPRO therefore could serve as valuable prognostic indicators for post-surgery patients with BC and were associated with increased T cell exhaustion (Tim3+ T cells). A depletion of PTPRO promoted PD-L1 secretion in both monocytes and macrophages through the JAK2/STAT1 and JAK2/STAT3/c-MYC pathways. Increased IL-6 expression was associated with activation of JAK2/STAT3/c-MYC and with decreased PTPRO expression through the STAT3/c-MYC/miR-25-3p axis. Monocytes and TAMs showed significantly increased miR-25-3p expression, which could target the 3' untranslated region of PTPRO. The miR-25-3p expression positively correlated with serum IL-6 levels, but inversely correlated with PTPRO in BC monocytes. IL-6/STAT3/c-MYC activation enhanced in vitro miR-25-3p transcription and decreased PTPRO, while further promoting PD-L1 secretion. Adoptive cell transfer of c-MYC/miR-25-3p–modified monocytes promoted tumor growth by downregulating PTPRO and causing a PD-L1–induced immunosuppression in breast tumor model. Conclusions: Increased serum IL-6 downregulated PTPRO expression in BC monocytes and macrophages by activating STAT3/c-MYC/miR-25-3p and by further enhancing PD-L1 expression through JAK2/STAT1 and JAK2/STAT3/c-MYC signaling.

A Longitudinal, Prospective Study to Evaluate the Effects of Treatment on the Inhibitory Control Function After Transsphenoidal Surgery for Pituitary Adenomas.

Injured cognitive abilities have been reported in patients with pituitary adenoma. However, to date, few researchers have directly investigated the electrophysiological study of inhibitory control function of pituitary patients both pre- and postsurgery. Thus, this study aimed to identify the factors affecting the inhibitory control function of pituitary patients. Thirty presurgery pituitary patients were recruited and 26 patients of them completed the postsurgery follow-up. Thirty healthy people were recruited for control group. Visual Go/Nogo tasks were carried out by the patients and controls to assess the inhibitory control function before surgery and 6 months after the surgery, respectively. The function of inhibitory control was analyzed with the components of N2 and P3. Across 3 groups, Nogo stimuli evoked larger frontal-central N2nogo and P3nogo than Go stimuli did. Furthermore, N2d of presurgery patients (-1.14 μV) and postsurgery patients(-0.61 μV) were significantly decreased compared with that of control group (-3.09 μV), F(2, 83) = 13.92, P < .01, whereas no difference was detected between pre- and postsurgery groups. There was no remarkable difference in the amplitude of P3d among the 3 groups, F(2, 83) = 0.19, P > .05. With regard to the amplitude of P3 for Go condition, The P3 amplitude of healthy group (4.38 μV) was larger than both pre- and postsurgery (1.00 μV and 3.01 μV). With regard to the amplitude of P3 for Nogo condition, The P3 amplitude of healthy group (5.25 μV) was larger than both pre- and postsurgery groups (2.35 μV and 4.18 μV). These results indicated that presurgery patients showed the dysfunction of inhibition, due to the nerve tissue damage or brain structure alteration caused by the presurgery physical pressure from tumor and abnormal hormone levels. Postsurgery patients showed a tendency toward recovery, but there was no obvious improvement in the inhibitory control function after successful treatments.

Fungal ball of the maxillary sinus and the risk of persistent sinus dysfunction after simple antrostomy

Maxillary sinus fungal ball is a common cause of unilateral maxillary sinusitis. Fungal balls or mycetomas are primarily treated with surgery to remove the fungus. However, this assumes the pre-fungal ball sinus cavity was normal and post-surgery patients may suffer from mucostasis in the sinus cavity with persistent symptoms. It is proposed that fungal balls are potentially a feature of impaired mucus clearance as they are a pathology in their own right. A case series of consecutive patients undergoing antrostomy for maxillary sinus fungal ball was performed. Patient factors including age, gender, smoking status, comorbidities (allergy, asthma, and reflux), disease specific factors including duration of symptoms, microbiology (bacterial co-infection, Gram-positive and/or Gram-negative) and preoperative radiologic findings (extent of sinus development, and neo-osteogenesis/bone thickness) were collected. The primary outcome was sinus function defined by evidence of a normal functioning maxillary sinus, with the absence of mucostasis or pooling, on endoscopic exam at three months, six months and last follow-up. Endoscopic evaluation of inflammation was also collected. 28 patients (age 58.5±15.5years, 64.3% female) were assessed. Mucostasis was present at three months in 39.3%, at six months in 32.1%, and 17.9% at last follow-up. There was no comorbidity or radiologic finding that was associated with failure to normalize. Those patients with mucostasis had a higher modified Lund-Mackay endoscopic score at last follow-up (5.0±0.7 v 0.2±0.6, p<0.01). Long term post-operative mucostasis occurred in 17.9% of patients following an adequate maxillary antrostomy for treatment of a fungal ball. Patients with mucostasis had persistent mucosal inflammation and a greater need for further surgery (modified medial maxillectomy).

Impact of bariatric surgery on body image satisfaction among patients attending King Saud medical city

Objectives: The aim of the study is to assess the impact of bariatric surgery on body image among patients from King Saud medical city using unmatched case-control study among 94 pre-bariatric surgery and 94 post bariatric surgery, selected through systematic random sampling. Findings : bariatric surgery improved body image during the first year, and post-surgery patients are 5 times likely to have positive body image than pre-operative (p < 0.01). There is a need for psychological care for preoperative patients, since number of patients from pre-bariatric surgery group shown symptoms of body dysmorphic disorder. Further research is needed regarding psycho-social factors that could have an impact on body image. Novelty: This is an original research. Data was collected by body image questionnaire. Analysis was done using SPSS with significance level set at p < 0.05. t-test was used to compare the mean body image scores, higher the scores reflecting higher body image impairment. Verbal consent was taken from participants and the subjects\' confidentiality is maintained by researchers. Keywords: Bariatric surgery; Body image; Patients; King Saud Medical City; Saudi Arabia

SAT-202 Hypoglycemia Following Unilateral Pheochromocytoma Resection in the Immediate Post-Surgical Period

IntroductionHypoglycemia in the immediate post-resection period of unilateral pheochromocytoma is a potential complication but not very well recognized.Clinical CaseA 47 year old female with past medical history of Hypertension, coronary artery disease, Myocardial infarction, Depression, Systemic lupus erythematosus presented to the hospital initially for elective robotic assisted Left adrenalectomy. CT scan showed a big left adrenal mass with normal right adrenal gland. It was clinically diagnosed as Pheochromocytoma as outpatient by primary internist. Biochemical studies showed elevated serum metanephrines and normetanephrines, and urine normetanephrine.Post-surgery (< 24 hours) patient had episodes of fasting hypoglycemia with blood glucose levels as low as 68 mg/dl, accompanied with neuroglycopenic symptoms like tremors, sweating and palpitations.High dose ACTH stimulation test was performed. Serum cortisol levels were tested as 5.1, 11.7 and 14.4 mcg/dl within 0, 30 minutes and 60 minutes of Cosyntropin 250 mcg IV injection.The patient was started on Prednisone 5 mg daily to prevent any further episodes, which was successful, and was stopped by the patient one week after discharge, without any more hypoglycemia episodes. Further endocrinology work up could not be done as the patient did not follow up.Post-surgical pathology showed a 7x 5.5 x4 cm mass, which was confirmed as pheochromocytoma histopathologically and immunohistochemically by positive chromogranin, synaptophysin and BCl2 and negative for calretinin and S100.Discussion and ConclusionThe etiology of hypoglycemia after resection of unilateral pheochromocytoma can be explained by impaired glucagon secretion and decreased gluconeogenesis due to the suppression from higher catecholamine levels in the blood pre-operatively. The second mechanism is rebound insulin secretion from the pancreas due to sudden withdrawal of catecholamines.In our patient, the transient hypocortisolemia could be another reason. The lack of immunohistochemical evidence in post-surgical pathology report excluded cortisol- secreting tumor. Another rare situation, ACTH-secreting pheochromocytoma, has been reported but was not checked in the case.In a word, hypoglycemia is common after surgical removal of unilateral pheochromocytoma. Careful monitoring of patients’ glucose level in immediate post-resection period is essential to prevent transient hypoglycemia

QTc prolongation after haloperidol administration in critically ill patients post cardiovascular surgery: A cohort study and review of the literature.

From case reports, haloperidol administration has been associated with QTc prolongation, torsades de pointes, and sudden cardiac death. In a vulnerable population of critically ill patients after cardiac surgery, however, it is unclear whether haloperidol administration affects the QTc interval. Thus, the aim of this study is to explore the effect of haloperidol in low doses on this interval. This retrospective cohort study was performed on a cardio-surgical intensive care unit (ICU), screened 2,216 patients and eventually included 68 patients with delirium managed with oral and intravenous haloperidol. In this retrospective analysis, electrocardiograms were taken prior and within 24 h after haloperidol administration. The effect of haloperidol on QTc was determined with a Person correlation, and inter-group differences were measured with new long QT comparisons. In total, 68 patients were included, the median age was 71 (64-79) years and predominantly male (77%). Haloperidol administration followed ICU admission by three days and the cumulative dose was 4 (2-9) mg. As a result, haloperidol administration did not affect the QTc (r = 0.144, p = 0.23). In total, 31% (21/68 patients) had a long QT before and 27.9% (19/68 patients) after haloperidol administration. Only 12% (8/68 patients) developed a newly onset long QT. These patients were not different in the route of administration, cumulative haloperidol doses, comorbidities, laboratory findings, or medications. These results indicated that low-dose intravenous haloperidol was safe and not clinically relevant for the development of a newly onset long QT syndrome or adverse outcomes and support recent findings inside and outside the ICU setting.

Diffusion tensor magnetic resonance imaging of the postoperative spine with metallic implants.

There has been a growing need to understand the mechanism of development of acute spinal cord injury (SCI) and to optimize treatment. The paramagnetic nature of metallic implants has hampered the application of diffusion tensor imaging (DTI) in postsurgical SCI monitoring. We describe here a successful implementation of spinal DTI in postsurgical SCI patients. Data were acquired using a single-shot turbo-spin-echo sequence, where an extra gradient is applied before the refocusing pulse train to eliminate contributions from the non-Carr-Purcell-Meiboom-Gill components following a diffusion preparation block where a single-spin echo scheme is deployed. The DTI images were acquired in axial orientation with a 2 x 2 x 4 mm3 resolution and a total of 18 slices. Diffusion gradients were applied in six directions with b values of 0 and 600 seconds/mm2 . The whole scan took ~10 minutes. The sequence was compared with SENSE-DW-EPI and ZOOM-DW-EPI on a phantom, eight patients with either anterior or posterior titanium alloy implants, and a pork loin with a similar implant. The protocol resulted in dramatically reduced geometric distortions compared with routine imaging sequences, however, the SNR efficiency was compromised. The spinal cord signal displacement was 0.68±1.00 mm (mean±SD, n = 8) for the proposed protocol, and 5.14±3.07 and 2.82±1.60 mm for the SENSE-DW-EPI and ZOOM-DW-EPI sequences, respectively. Fiber tracking was achieved in the presence of implants, which in one case was accompanied by central spinal cord caviation. Mathematical analysis concluded that the proposed protocol would be generally applicable in the spinal cord when the titanium alloy implant is ~15 mm away (<0.5 kHz B0 field drift). The protocol described is capable of DTI in postsurgery SCI patients with metallic implants at sufficient resolution and SNR.

New applanation tonometer for myopic patients after laser refractive surgery

This study assesses the agreement between intraocular pressure (IOP) measurements taken with the Goldmann applanation tonometer (GAT) and a new experimental applanation tonometer with a convexly shaped apex (CT) after laser myopic refractive surgery. Two different CT radii (CT1 and CT2) were designed with a finite element analyser, and a prospective double masked study on 102 eyes from 102 patients was carried out. A Bland-Altman plot and intra-class correlation coefficient (ICC) were calculated to assess the agreement between GAT measurements and the measurements of both CT1 and CT2 before and after myopic laser assisted in situ keratomileusis (LASIK; n = 73) and photorefractive keratectomy (PRK; n = 29). We evaluated a subset of two subgroups (n = 36 each) for intra and inter-observer (IA/IE) error. From the whole cohort, the best IOP agreement was observed between GATpre and CT1post surgery: 16.09 ± 2.92 vs 16.42 ± 2.87 (p < 0.001); ICC = 0.675 (95% CI: 0.554–0.768). In the analysis of LASIK vs PRK, GATpre and CT1post showed the highest agreement, although LASIK measurements were more accurate than PRK, as the ICC = 0.718 (95% CI: 0.594–0.812) and ICC = 0.578 (95% CI: 0.182–0.795) respectively. Excellent agreement was observed for IA/IE, and there was an ICC > 0.8 (95% CI) in all cases. CT1 proved more accurate in the LASIK subgroup. In conclusion, our new version of GAT could be used with post-surgery LASIK patients as a more accurate measurement device compared to the current reference tonometer.

The utility of DSM-5 indicators of loss of control eating for the bariatric surgery population.

This study investigated the utility of DSM-5 indicators of loss of control (LOC) eating in adult bariatric surgery patients who presented with binge-eating episodes. Participants (all women) were 40 preoperative and 28 postoperative bariatric surgery patients reporting objective binge eating (OBE), 46 preoperative and 52 postoperative with subjective binge-eating (SBE), 53 bulimia nervosa (BN) controls, and 34 binge-eating disorder (BED) controls. Face-to-face Eating Disorder Examination interviews and questionnaires were administered. ANOVA, T-test, χ 2 , and regressions compared the groups in terms of LOC indicators endorsed and to explain disordered eating psychopathology. The indicator most commonly reported by bariatric patients with OBE was "feeling disgusted" (90% and 75% of pre- and postoperative groups), and the least endorsed was "eating alone" (40 and 28.6%). These indicators were reported by >84.9% of the BN and BED. Bariatric patients (pre- or post-surgery) with OBE only reported a higher number of indicators than patients with SBE only (t(150) = 2.34, p = .021). A higher number of indicators reported were associated with increased eating-related psychopathology (F(1,134) = 31.06, p < .001), but only for the post-surgery patients. The LOC indicators proposed by DSM-5 need to be refined or revised for the bariatric population. Highlights Bariatric patients endorse fewer LOC indicators than BN or BED during a binge-eating episode. Some of the DSM-5 LOC indicators may not be suited to assess episodes of loss of control eating among bariatric patients. The Higher the number of LOC indicators reported, the higher the eating-related psychopathology.

HEPARIN-INDUCED THROMBOCYTOPENIA POST RECENT CORONARY ARTERY BYPASS GRAFTING CAUSING LOSS OF VENOUS GRAFTS

Heparin induced thrombocytopenia (HIT) is a life-threatening idiosyncratic reaction to heparin products. Loss of bypass grafts can possibly happen in post coronary artery bypass surgery (CABG) patients who develop HIT. A 78-year-old male with a past medical history significant for coronary artery

Plasma Lysyl-tRNA Synthetase 1 (KARS1) as a Novel Diagnostic and Monitoring Biomarker for Colorectal Cancer

Colorectal cancer (CRC) is one of the leading causes of world cancer deaths. To improve the survival rate of CRC, diagnosis and post-operative monitoring is necessary. Currently, biomarkers are used for CRC diagnosis and prognosis. However, these biomarkers have limitations of specificity and sensitivity. Levels of plasma lysyl-tRNA synthetase (KARS1), which was reported to be secreted from colon cancer cells by stimuli, along with other secreted aminoacyl-tRNA synthetases (ARSs), were analyzed in CRC and compared with the currently used biomarkers. The KARS1 levels of CRC patients (n = 164) plasma were shown to be higher than those of healthy volunteers (n = 32). The diagnostic values of plasma KARS1 were also evaluated by receiving operating characteristic (ROC) curve. Compared with other biomarkers and ARSs, KARS1 showed the best diagnostic value for CRC. The cancer specificity and burden correlation of plasma KARS1 level were validated using azoxymethane (AOM)/dextran sodium sulfate (DSS) model, and paired pre- and post-surgery CRC patient plasma. In the AOM/DSS model, the plasma level of KARS1 showed high correlation with number of polyps, but not for inflammation. Using paired pre- and post-surgery CRC plasma samples (n = 60), the plasma level of KARS1 was significantly decreased in post-surgery samples. Based on these evidence, KARS1, a surrogate biomarker reflecting CRC burden, can be used as a novel diagnostic and post-operative monitoring biomarker for CRC.

Whole-brain chemical exchange saturation transferimaging with optimized turbo spinecho readout.

To achieve fast whole-brain chemical exchange saturation transfer (CEST) imaging with negligible susceptibility artifact. An optimized turbo spin echo readout module, also known as sampling perfection with application optimized contrasts by using different flipangle evolutions (SPACE), was deployed in the CEST sequence. The SPACE-CEST sequence was tested in a phantom, 6 healthy volunteers, and 3 brain tumor patients on a 3T human scanner. A dual-echo gradientecho sequence was used for B0 inhomogeneity mapping. In addition, the proposed SPACE-CEST sequence was compared with the widely used turbo spin echo-CEST sequence for amide proton transfer-weighted (APTw) images. The SPACE-CEST sequence generated highly consistent APTw maps to those of the turbo spin echo-CEST sequence in the phantom. In healthy volunteers, the SPACE-CEST sequence yielded whole-brain 2.8-mm isotropic APTw source images within 5 minutes, with no discernible susceptibility artifact. As for the B0 maps in the whole brain, its mean, median, and standard deviation B0 offset values were 5.0 Hz, 5.6 Hz, and 16 Hz, respectively. Regarding the APTw map throughout the whole brain, its mean, median, and standard deviation values were 0.78%, 0.56%, and 1.74%, respectively. The SPACE-CEST sequence was also successfully applied to a postsurgery brain tumor patient, suggesting no disease progression. In addition, on the newly diagnosed brain tumor patients, the SPACE-CEST and turbo spin echo-CEST sequences yielded essentially identical APTw values. The proposed SPACE-CEST technique can rapidly generate whole-brain CEST source images with negligible susceptibility artifact.

Lower urinary symptoms, resilience, and post-traumatic stress symptoms among rectal cancer patients after surgery.

Disturbance of urinary function is a common complication after rectal cancer surgery, and it may affect patients' psychological well-being, consequently may develop post-traumatic stress disorder. Personal resilience might increase people's ability to manage life's challenges. However, limited study to explore their relationships. This study examined the relationships among lower urinary symptoms, resilience, and post-traumatic stress symptoms (PTSS) in post-surgery patients with rectal cancer. A cross-sectional study design was used and included 188 patients with diagnosed rectal cancer who had undergone surgery over 24 months and were recruited from a hospital in southern Taiwan. The outcome measurements included a resilience scale, International Prostate Symptom Score (IPSS), the Chinese Davidson Trauma Scale, personal characteristics, and disease-related variables. There were significant relationships among age at diagnosed, self-reported physical status, perceived satisfied with recovery, urinary tract symptoms, resilience, and overall PTSS. The stepwise regression demonstrated that five factors, self-reported physical status, resilience, urinary tract symptoms, age at diagnosed and gender, and together explained 27.7% of overall PTSS variance (10.7, 6.7, 3.7, 4.8 and 1.8% of variance, respectively). The study demonstrates that patients with diagnosed rectal cancers long-term outcomes of PTSS, urinary tract symptoms, and resilience after surgery; in addition, self-reported physical status, resilience, urinary tract symptoms, age at diagnosed and gender are the major predictors of PTSS. A better understanding of the long-term outcomes of post-surgery in rectal cancer patients and its related factors may help to decreasing the PTSS after surviving cancer.

Intraperitoneal Administration of Telmisartan Prevents Postsurgical Adhesion Band Formation

BackgroundAngiotensin II receptor blockers (ARBs) have a potential role in reducing inflammation and fibrosis. We have integrated systems and molecular biology approaches to investigate the therapeutic potential of ARBs in preventing postsurgical adhesion band formation. Material and methodswe have followed the ARRIVE guidelines point by point during experimental studies. Telmisartan (1 and 9 mg/kg), valsartan (1 and 9 mg/kg), and losartan (1 and 10 mg/kg) were administered intraperitoneally in different groups of male albino Wistar rat. After 7 d of treatment, macroscopic evidence and score of fibrotic bands based on scaling methods was performed. Moreover, the anti-inflammatory and antifibrosis effects of telmisartan on reduction of fibrotic bands were investigated by using histopathology, ELISA, and real-time polymerase chain reaction methods. ResultsTelmisartan, but not losartan or valsartan, prevented the frequency as well as the stability of adhesion bands. Telmisartan appears to elicit anti-inflammatory responses by attenuating submucosal edema, suppressing proinflammatory cytokines, decreasing proinflammatory cell infiltration, and inhibiting oxidative stress at the site of peritoneal surgery. We also showed that telmisartan prevents fibrotic adhesion band formation by reducing excessive collagen deposition and suppression of profibrotic genes expression at the peritoneum adhesion tissues. ConclusionsThese results support the potential application of telmisartan in preventing postsurgical adhesion band formation by inhibiting key pathologic responses of inflammation and fibrosis in postsurgery patients.

Algorithm for primary care physicians in the management of valvular heart disease in India

In India, the burden of valvular heart disease (VHD) is high due to rheumatic heart disease (RHD). Factors like poverty, overcrowded dwellings, under-nutrition, cultural constraints, and suboptimal medical care contribute to the high prevalence of RHD. The diagnosis of VHD is a problem in routine practice and many cases are either missed in early stages. Also, late identification/ referral of complications in post valvular surgery patients of VHD by physicians working in the periphery to a large extent but not limited to periphery only. Hence, the need of the hour is to enhance the knowledge of Primary care physicians and create an easy-to-use algorithm for physicians to facilitate early identification and diagnosis of VHD and complications in post cardiac surgery patients for timely referral to reduce mortality and morbidity associated with VHD. The algorithm will act as a tool to recognize early signs and symptoms of VHD for early diagnosis of VHD & its management. The algorithm will also facilitate early referral to specialist and identification of post-operative complications in patients who have undergone surgery for VHD. Valvular heart disease patients after prosthetic valve implantation are at a risk of thrombo-embolic and therefore require lifelong follow up and anticoagulant therapy in order to alleviate morbidity and mortality which also needs to be cascaded down to the primary care physicians based on evidence-based recommendations on anti-coagulation management. This easy-to-use guide/algorithm will help physicians better their clinical practice in India, ultimately benefiting the patient outcomes.