WR Group Research Articles

Safety and efficacy of delayed completion lobectomy following wedge resection vs. segmentectomy-a retrospective cohort study.

Data regarding the safety and efficacy of delayed completion lobectomy (CL) following sublobar resections remain scant. We evaluated the technical difficulty and short-term outcomes of CL occurring at least 3 months following the anatomical segmentectomy or wedge resection. Consecutive non-small cell lung cancer (NSCLC) patients who underwent a second resection within the same lobe at least 3 months after their initial resection from January 2013 to December 2019 at the Shanghai Pulmonary Hospital were retrospectively included. The patients were divided into a segmentectomy group (SG group) and a wedge resection group (WR group) based on their initial resection strategy. Baseline characteristics and short-term outcomes after CL between the two groups were compared. Twenty-five patients undergoing CL were included, nine in the SG group and 16 in the WR group. No deaths occurred within 30 days postoperatively, and the rate of overall postoperative complications was 28.0% (7/25). Statistically significant differences were found in rates of postoperative complications between the two groups (SG: 55.6% vs. WR: 12.5%, P=0.03) and in the use of bronchoplasty or angioplasty during the CL (SG: 33.3% vs. WR: 0.0%, P=0.04). After CL, no significant differences were found in 5-year recurrence-free survival (RFS) (WR: 66.7% vs. SG: 61.0%, P=0.31) or overall survival (OS) (WR: 93.8% vs. SG: 66.7%, P=0.06) between two groups. Delayed CL occurring over 3 months after sublobar resection is a safe and effective procedure, with no deaths occurring within 30 days postoperatively. As compared to a segmentectomy at the time of the index operation, a wedge resection may portend less morbidity, with a decreased risk of needing adjunctive bronchoplasty or angioplasty procedures during CL. After CL, 5-year RFS and OS were comparable between WR and SG groups.

O012 The Impact of Sleep Restriction on Reward learning in Healthy Adults

Abstract Sleep disruption can lead to enhanced reactivity towards pleasurable stimuli and impaired discrimination between rewarding and punishing cues. Thus, sleep may play a mechanistic role in the development and exacerbation of pathological reward-related behaviours (e.g., gambling, substance use, etc.). The study aimed to explore the impact of sleep restriction on reward processing. Involving a 7-night at-home sleep monitoring protocol, participants were randomly assigned an experimental condition: sleep restriction (5-hr time in bed/night; SR) or well-rested (9-hr/night; WR). Adherence to the prescribed sleep schedules was assessed daily. On the eighth day participants completed a battery of reward- learning tasks, 2-hrs post-habitual wake. Participants were healthy adults (n = 45, mean age = 25.4 yrs, 64% female). Total sleep time for the SR group (n = 18) was 297.4 mins, whilst the WR was 485.8 mins (n = 27). For the probabilistic reward task, response bias (RB) did not significantly differ between the SR and WR groups during the overall task (p = 0.28), or during blocks one (p = 0.26) or two (p = 0.90). However, at block three, the SR group showed higher RB as compared to the WR group (p = 0.03), indicating SR participants exhibited a systematic preference for the frequently rewarded cues, relative to the WR group. These preliminary results suggest initial reward responsiveness is not impacted by SR, but over time SR may produce heightened sensitivity to rewarding cues. This may indicate a role for sleep disruption in the maintenance of maladaptive appetitive behaviours.

Safety, efficacy, and selection strategy of laparoscopic local gastrectomy for gastrointestinal stromal tumors in the esophagogastric junction.

ObjectiveTo investigate the safety, efficacy, and selection strategy of laparoscopic local gastrectomy for stromal tumors in the esophagogastric junction.MethodsThirty-eight patients with mesenchymal tumors in the esophagogastric junction were retrospectively enrolled from April 2018 to July 2021 in which the upper edge of the tumor is less than 2 cm from the Z-line or has invaded the Z-line <1/2 circumference. Surgical outcomes, complications, recover, and postoperative gastroesophageal reflux of both groups were compared.Results27 patients underwent wedge resection, and 11 underwent resection by opening all of the layers of the stomach wall. Operative time (90.0 vs. 181.8 min, respectively, P = 0.001) was shorter for the WR group vs. RASW. Blood loss (20 vs. 50 ml, respectively, P = 0.012) was less for the WR group vs. RASW. Recovery of the RASW group was slower in terms of time to pass gas (2 vs. 3 days, P = 0.034), time to oral intake (2 vs. 4 days, P = 0.007), time to semi-liquid food intake (4 vs. 8 days, P = 0.003), and postoperative hospitalization (5 vs. 8 days, P = 0.001) vs. WR. In terms of short-term complications (≤30 days), no significant between-group differences were observed. Cardia stenosis did not occur in either group. In the WR group, one patient experienced mild reflux at 6 months and recovered 1 year after surgery. In the RASW group, one patient experienced severe gastroesophageal reflux at 6 months and 1 year after surgery, which was not entirely relieved by taking antacids. No other patients have gastroesophageal reflux.ConclusionLaparoscopic local gastrectomy is safe and feasible for mesenchymal tumors in the esophagogastric junction in which the upper edge of the tumor is less than 2 cm from the Z-line or has invaded the Z-line <1/2 circumference, and has achieved an excellent short-term effect. The choice of surgery is based on the relationship between the tumor and the position of the cardia.

The Weiss Ring, a Major Confounding Factor For Measurements of Peripapillary Retinal Nerve Fiber Layer Thickness: Short title: The Impact of the Weiss Ring On RNFL Thickness Measurements

To identify how the Weiss ring affects the measurement of mean and sectoral peripapillary retinal nerve fiber layer (pRNFL) thicknesses. Retrospective, cross-sectional study. Subjects were divided into two groups: controls (control group) and subjects in which a Weiss ring was visible on optical coherence tomography fundus images (WR group). Mean and sectoral pRNFL thicknesses were compared between the two groups. A total of 205 eyes were enrolled: 131 eyes in the control group and 74 eyes in the WR group. The mean pRNFL thicknesses of the control group and WR group were 97.2 ± 6.7µm and 94.6 ± 10.8 µm, respectively (P=.042). In sectoral thickness, the inferior sector of the WR group was 112.1 ± 23.2 µm, which was significantly thinner than that of the control group (125.5 ± 13.3 µm; P < .001). The Weiss ring was located in 10 eyes (13.5%) in the superior sector, 7 eyes (9.5%) in the temporal sector, 40 eyes (54.1%) in the inferior sector, and 17 eyes (23.0%) in the nasal sector. In analyses of reproducibility, the coefficient of variation and intraclass coefficient of the inferior sector measurement were 10.90% and 0.409, respectively, indicating low reliability of the measurement. Eyes with a Weiss ring showed thinner mean and inferior pRNFL thicknesses than normal controls, which would be a measurement error caused by the Weiss ring. This could be a major confounding factor for analyses of pRNFL changes, especially in glaucoma patients.

Does the primary tumor site in stage I extranodal natural killer/T-cell lymphoma matter?

The purpose of this study was to investigate whether the primary tumor site in stage I extranodal natural killer/T-cell lymphoma (ENKTCL) had a prognostic value. Between January 2009 and December 2015, 152 stage I ENKTCL patients with primary disease in the nasal cavity and Waldeyer's ring were enrolled for this retrospective study. All patients received extended field intensity-modulated radiotherapy alone without prophylactic cervical node irradiation at a total dose of 50 Gy. In this study, there were 122 patients whose primary tumors were localized in the nasal cavity (NC group), and no adjacent structures were involved. A total of 18 patients had a primary disease involving the nasal cavity and Waldeyer's ring (NC-WR group), and the remaining 12 patients had primary tumors confined to Waldeyer's ring (WR group). We found that there was no significant difference in cervical lymph node failure rates among the NC, NC-WR, and WR groups. In terms of the 5-year overall survival (OS) rates, there was a significant difference among the NC, NC-WR, and WR groups (p=0.004), with the WR group having the worst OS. Multivariate analyses showed that the primary site (p=0.011) and ECOG (Eastern Cooperative Oncology Group) score (p=0.013) were independent prognostic factors for OS. In summary, patients with stage I ENKTCL had a good local control rate with radiotherapy alone and without prophylactic cervical node irradiation (PCNI), regardless of the site of the primary tumor. So, we think PCNI for stage I ENKTCL patients is not necessary. Patients with a primary tumor site located in Waldeyer's ring had the worst prognosis. And combined treatment with radiotherapy and chemotherapy should be considered in patients with primary tumors located outside the nasal cavity.

Ghrelin, glucagon-like peptide-1, and peptide YY secretion in patients with and without weight regain during long-term follow-up after bariatric surgery: a cross-sectional study.

IntroductionWeight loss after bariatric surgery is attributed, at least in part, to the altered gastrointestinal (GI) hormone secretion, which is thought to be responsible for a number of beneficial metabolic effects.Material and methodsWe conducted a cross-sectional study. Twelve patients who underwent laparoscopic sleeve gastrectomy (SG) and 20 patients who underwent a variant of biliopancreatic diversion with Roux-en-Y gastric bypass and long limbs (BPD/RYGB-LL) were evaluated ≥ 7 years postoperatively. Ghrelin, glucagon-like peptide-1 (GLP-1), and peptide YY (PYY) secretion were compared between patients with successful weight loss maintenance (WM group) and patients with weight regain (WR group).ResultsIn both types of surgery, standard liquid mixed meal (SLMM) ingestion did not result in significant changes in fasting GI hormone levels. Fasting ghrelin levels did not differ between the WM group and the WR group in both types of surgery. In SG patients, SLMM ingestion elicited greater suppression of ghrelin levels in the WM group (p = 0.032). No difference in GLP-1 secretion was observed between the 2 groups of patients in both types of surgery. When patients were examined, regardless of the type of bariatric surgery they had undergone, postprandial PYY levels were lower in the WM group (p < 0.05), while fasting and postprandial PYY levels were correlated positively with an increase in body mass index (BMI) in the evaluation (Spearman’s rho ≥ 0.395, p < 0.03).ConclusionsOur data do not support the hypothesis that long-term weight regain after bariatric surgery is associated with an unfavourable GI hormone secretion pattern.

Effects of Water Restriction and Water Replenishment on the Content of Body Water with Bioelectrical Impedance among Young Adults in Baoding, China: A Randomized Controlled Trial (RCT).

Insufficient water intake may affect body composition. The purpose of this research was to explore the effects of water restriction and replenishment on body composition and to evaluate the optimum amount of water that improves body composition. A total of 76 young adults aged 18–23 years old (40 males and 36 females) in Baoding, China, were recruited in this randomized controlled trial, with a 100% completion rate. After fasting overnight for 12 h, at 8:00 a.m. of day 2, a baseline test, including anthropometric indices and collection of urine and blood samples, was explored. Participants were then subjected to water restriction for 24 h, and three meals with ≤75% water content were provided. At 8:00 AM of day 3, the same indices were determined as a dehydration test. Then, participants were randomly assigned into four groups: three water replenishment groups (WR groups 1, 2, and 3 given 1000, 500, and 200 mL of purified water, respectively) and one non-replenishment group (NR group, with no water). After 90 min, the same measurements were performed as a rehydration test. Compared with the baseline test, during the dehydration test, the intracellular water to total body water ratio (ICW/TBW) increased; and extracellular water (ECW), ECW/TBW (extracellular water to total body water ratio), and TBW decreased (all p < 0.05). For males, significant differences were found in ECW, ECW/ICW (extracellular water to intracellular water ratio), ICW/TBW, and ECW/TBW (all p < 0.05); for females, significant reductions were found in ICW, ECW, TBW, ECW/ICW, ICW/TBW, and ECW/TBW (all p < 0.05). Furthermore, significant differences were found in ICW, ECW, ICW/TBW, ECW/TBW, ECW/ICW, TBW, and TBW/BW between males and females during the baseline and dehydration test (all p < 0.05). Comparing the dehydration test with the rehydration test, there were significant interactions between time × volume in ICW and TBW (F = 3.002, p = 0.036; F = 2.907, p = 0.040); in males, these were only found in ICW (F = 3.061, p = 0.040); in females, they were found in ICW and TBW (F = 3.002, p = 0.036; F = 2.907, p = 0.040). The ICW levels in WR groups 1 and 2 were all higher than in the NR group (all p < 0.05); the TBW was higher in WR group 1 than in the NR group (p < 0.05). No significant differences were found between WR groups 1 and 2, either in males or in females (all p > 0.05). In the rehydration test, significant differences in body composition were found between males and females among the four groups (all p < 0.05). Water restriction had adverse effects on body composition, and females were more susceptible to water restriction than males. Water replenishment improved the water content of body composition, alleviating the adverse effects of water restriction on ICW and TBW. After water restriction for 36 h, the optimum volume of water to improve body composition among young male adults was 1000 mL, but this was not the case for females.

Slaughter and carcass characteristics of Kivircik lambs in different rearing seasons

The aim of this study was to determine the slaughter and carcass characteristics of Kivircik lambs reared in different seasons. A Total of 36 Kivircik male lambs, which were reared in different seasons, were used in the study; autumn rearing (AR, n= 12 lambs), spring-summer rearing (SSR, n= 12 lambs), winter rearing (WR, n= 12 lambs). All the lambs in a specific rearing season were slaughtered at approximately 134 days old. Pre-slaughter live weight, hot carcass weight and real dressing percentage for WR, SSR and AR groups were 27.97, 20.65, and 21.70 kg; 12.94, 7.83, and 8.87 kg, and 55.15, 50.25, and 50.05%, respectively (P &amp;lt; 0.001). WR lambs had significantly higher carcass and hind limb compactness score as well as ribs percentage than SSR and AR lambs (P &amp;lt; 0.001). The results indicated that lambs from WR group had better carcass characteristics than lambs from AR and SSR groups.

Immune Status Against Hepatitis B in Patients After Allogeneic Hematopoietic Cell Transplantation-Factors Affecting Early and Long-Lasting Maintenance of Protective Anti-HBs Titers.

The immunization of allogeneic hematopoietic cell transplantation (HCT) recipients against vaccine-preventable diseases is a part of posttransplantation guidelines. We conducted a prospective study to assess clinical and immunological parameters that would determine the response and long-term maintenance of protective antibody titers upon the hepatitis B virus (HBV) vaccination after HCT. The investigated variables included: vaccination of the HCT recipients and their donors prior to HCT, chronic graft versus host disease (cGVHD) and the timing of post-HCT vaccination, and B- and T-cell subtype status. Forty-two patients were immunized with three or more doses of recombinant hepatitis B surface antigen (rHBsAg) administered according to the individualized schedule of 0-1-2-6-(12) months. After vaccination, seroconversion was achieved in the whole group. The vaccines were categorized according to the antibody (Ab) titers as weak (WRs; 28.7%), good (GRs; 38%) or very good responders (VGRs; 3.3%). In multivariate logistic regression, severe cGVHD (OR= 15.5), and preceding donor immunization (OR= 0.13) were independent predictors of a weak response to vaccination. A prior belonging to the WR group impaired the durability of protection (OR= 0.17) at a median follow-up of 11.5 years. Patients with severe cGVHD showed a trend toward lower median Ab titers, although they required a higher rate of booster vaccine doses. All VGRs had CD4+ cells > 0.2 x 106/L. There was a lower mean rate of CD4+IL2+ lymphocytes in WRs. Vaccination demonstrated the immunomodulatory effect on B-cell and T-cell subsets and a Th1/Th2 cytokine profile, while shifts depended on a history of severe cGVHD and the type of vaccine responder. To conclude, vaccination of HCT donors against HBV allows a better response to vaccination in the respective HCT recipients. Double doses of rHBsAg should be considered in patients with cGVHD and in those not immunized before HCT. A dedicated intensified vaccination schedule should be administered to WRs.

Study of Radiotherapy on Extranodal Natural Killer (NK)/T-Cell Lymphoma of Stage IE

In this study, we will examine whether prophylactic cervical node irradiation (PCNI) is necessary for stage IE nasal type Extranodal natural killer (NK)/T-cell lymphoma (ENKTCL) and investigate the survival difference between patients with primary tumors originating from nasal cavity and the Waldeyer ring. From January 2009 to December 2015, 152 pathologically confirmed stage IE ENKTCL patients with nasal cavity and Waldeyer ring primary tumors were retrospectively analyzed. Those patients were divided into three groups according to their primary tumor locations: limited to the nasal cavity (NC group), originating from nasal cavity and invading the Waldeyer ring (NCWR group) and originating from the Waldeyer ring (WR group). All cases were treated with extended-field radiotherapy alone and no PCNI was performed. The overall survival (OS), progression-free survival (PFS) and distant recurrence free survival (DRFS) were obtained after long-term follow-up. Pearson’s chi-square test or Fisher’s exact test was used to analyze the distribution difference of clinical features among the three groups. Univariate and multivariate analyses were performed using the Kaplan-Meier method and the Cox proportional hazards regression. There were 140 cases with primary tumor originating from nasal cavity, including 122 cases in NC group and 18 cases in NCWR group. In addition, there are 12 cases in WR group. For NC group, NCWR group and WR group, the failure rates of cervical lymph nodes were 5.74%, 11.11% and 8.33%. The local recurrence rates were 6.56%, 11.11% and 8.33%. The distant metastasis rates were 11.48%, 22.22% and 41.67%, respectively. There was no significant difference in cervical lymph node failure rates and local recurrence rates among the three groups, but the distant metastasis rates were significantly different (P = 0.014).Survival analyses using Kaplan-Meier method and univariate COX model showed that the three groups had significantly different OS (P = 0.010), PFS (P = 0.019) and DRFS (P = 0.015). OS, PFS and DRFS in NC group was significantly better than those in WR group. However, there was no survival difference in OS, PFS and RFS between the NC group and NCWR group, as well as the NCWR group and WR group. Furthermore, multivariate COX survival analyses demonstrated that the primary site group and ECOG score were independent prognostic factors of OS. And the primary site group and B symptom were independent prognostic factors of PFS and DRFS. Stage IE ENKTCL patients with primary tumors originating from nasal cavity and the Waldeyer ring showed a similar low risk of cervical lymph node recurrence without PCNI, thus there is no need of PCNI for stage IE ENKTCL patients. The main cause of treatment failure was distant recurrence. Moreover, the OS, PFS and DRFS of the Waldeyer ring primary patients were inferior to the nasal cavity primary patients independent from other features, which indicated that they may need more systemic chemotherapy.

Readmissions in elderly patients with heart failure. A retrospective study

Heart failure is a major cause of morbidity and mortality worldwide. The prevalence increases with age and usually progresses, leading to repeated hospital admissions and significant symptom burden for patients. The correct management of these patients may decrease readmissions and increase quality of life. Our aim is to compare elderly patients with and without 1-year readmissions in an internal medicine ward, particularly in terms of mortality. Retrospective study, consulting patient’s clinical records, with a diagnosis of heart failure. The patients were characterized and divided in groups: with (wR) and without readmission (woR) within 1 year. Mortality was the primary outcome. Eighty-nine patients were included; 60 woR and 29 wR. There was no gender difference between groups, the wR group had older patients. The most frequent comorbidities included atrial fibrillation, hypertension and chronic renal failure stage 3 or higher. The most frequent cause of hospitalization was heart failure due to insufficient therapy or natural progression of the disease. The etiology of heart failure was mainly hypertensive and ischemic. The wR group had more patients classified as NYHA &gt;III. In relation to the primary outcome; mortality at 12 months was higher in the group with repeated admissions. The characterization of this population allows us to highlight the causes of decompensation and to review medication in order to increase the quality of life.

Wearable resistance sprint running is superior to training with no load for retaining performance in pre-season training for rugby athletes

This study determined the effects of a six-week lower-limb wearable resistance training (WRT) intervention on sprint running time, velocity, and horizontal force-velocity mechanical variables. Twenty-two collegiate/semi-professional rugby athletes completed pre- and post-intervention testing of three maximal effort 30 m sprints. A radar device was used to measure sprint running velocity from which horizontal force-velocity mechanical profiling variables were calculated. All athletes completed two dedicated sprint training sessions a week for six-weeks during pre-season. The intervention (wearable resistance, WR) group completed the sessions with 1% body mass load attached to the left and right shanks (i.e. 0.50% body mass load on each limb), whilst the control group completed the same sessions unloaded. For the control group, all variables were found to detrain significantly (p ≤ 0.05) over the training period with large detraining effects (ES > 0.80) for theoretical maximal horizontal force, slope of the force-velocity profile, maximal ratio of force, index of force application, 5 and 10 m times. For the WR group, there were no significant changes to any recorded variables (all p > 0.05) and all effects of training were trivial or small (ES < 0.50). After adjustment for baseline differences, significant between group differences were found for all variables (large effects, ES > 0.80) except theoretical maximal velocity, 30 m time, and maximal velocity. The addition of light wearable resistance to sprint training during a six-week pre-season block enables the maintenance of sprint performance and mechanical output qualities that otherwise would detrain due to inadequate training frequencies.

Effects of exposure to mild hyperbaric oxygen during unloading on muscle properties in rats.

This study investigated the effects of exposure to mild hyperbaric oxygen during unloading on the properties of the soleus muscle in rats, because exposure to mild hyperbaric oxygen enhances oxidative metabolism in cells and tissues. Therefore, exposure to mild hyperbaric oxygen should inhibit the unloading-induced degenerative changes in skeletal muscles. One group of 7-week-old male Wistar rats were unloaded by hindlimb suspension for 2weeks (HU, n = 12). A second group of age-matched rats were exposed to mild hyperbaric oxygen at 1317hPa with 40% oxygen for 3h a day during hindlimb suspension (HU + MHO, n = 12). A third group of age-matched rats without hindlimb suspension and exposure to mild hyperbaric oxygen were assigned as the controls (WR, n = 12). Soleus muscle weight (per body weight), succinate dehydrogenase (SDH) activity, and peroxisome proliferator-activated receptor γ coactivator-1α (Pgc-1α) mRNA levels were lower in the HU and HU + MHO groups than in the WR group, and these were higher in the HU + MHO group than in the HU group. The unloading-induced type shift from type I to type IIA fibers was inhibited by exposure to mild hyperbaric oxygen during unloading. It is concluded that the unloading-induced decrease in soleus muscle weight (per body weight) and type shift from type I to type IIA fibers in the soleus muscle were partially inhibited by exposure to mild hyperbaric oxygen during unloading.

Different Setting Conditions Affect Surface Characteristics and Microhardness of Calcium Silicate-Based Sealers.

Objective To investigate the effect of different setting conditions on surface microhardness and setting properties of calcium silicate-based sealers. Methods Three sealers, EndoSequence Bioceramic (BC; Brasseler USA, Savannah, GA, USA), Endoseal MTA (ES; Maruchi, Wonju, Korea), and Well-Root ST (WR; Vericom, Chuncheon, Korea), were compared. Specimens were exposed to either butyric acid (pH 5.4) or phosphate-buffered saline (PBS [pH 7.4]) for 48 h and stored at 100% humidity for 12 days. The control specimens were stored at 100% humidity for 14 days. Surface microhardness was measured, topographic changes were observed, and phase analysis was performed using X-ray diffraction. Microhardness according to storage conditions was compared using one-way analysis of variance and Tukey's multiple comparison tests (P < .05). Results The BC and ES sealers exhibited decreased microhardness when stored in acid or PBS compared with control (P < .05). In the WR group, acid exposure lowered microhardness of the specimens compared with control (P < .05). Scanning electron microscopy revealed different topographies in specimens from all tested sealers exposed to acid or PBS. Conclusion The surface microhardness of calcium silicate-based sealers was reduced by exposure to either acid or PBS. Acid solutions, however, had a more detrimental effect than PBS.

Physiological Responses of Indigenous Sheep under Water Restriction

Eighteen farm born indigenous hoggets were selected on the basis of body weight (25-30kg) and randomly divided in to three treatment groups viz. T1 (Control), T2 (WR1: 20%WR) and T3 (WR2: 40%WR) and each treatment comprised of six animals to evaluate physiological responses. The pulse rate (per min) recorded at 7.30 am significantly (P < 0.05) elevated in 40% WR group as compared to 20 and 0% WR groups whereas respiration rate (per min) and rectal temperature (0F) recorded at 2.30 pm significantly (P < 0.05) elevated when animals were subjected to 40% WR as compared to 20 and 0% WR indicated that the 40% water restriction was more stressful to the animals.

A117 - Weight Regain In Roux-En-Y Gastric Bypass Late Postoperative – Gut Hormones Role

The RQ values increased significantly in the three groups from baseline to the end of the 3-hour postprandial (PP) period. The DIT adjusted for body weight was not significant in the OB group at any PP moment compared to the basal moment. In the healthy and weight regain groups, this increase was significant until the end of the 3-hour period. The average values of the AUC for RQ and RMR in absolute terms did not differ between groups (p 1⁄4 0.3111 and p 1⁄4 0.1131, respectively). But, the mean AUC values for DIT adjusted for body weight differed between the groups, in that the average AUC value was significantly greater in the HW group than in the WR and the OB groups (p o0.0001 for both). The mean AUC value for DIT adjusted for body weight in the WR group was not significantly different from the OB group (p 1⁄4 0.6369). Conclusion: DIT appears to be increased in patients with adequate weight loss after RYGBP. The WR group showed similar DIT values to those of the OB group. The RQ values did not differ between groups. Prospective studies are needed to determine if the decreased DIT values in weight regain function as a cause or consequence of weight regain after RYGBP.

Mechanisms of long-term weight regain in patients undergoing sleeve gastrectomy

ObjectivesWeight regain after bariatric surgery may be associated with behavioral, metabolic, or mechanical factors alone or in combination. The aim of this study was to investigate which factors are related to weight regain in the long-term after sleeve gastrectomy (SG). MethodsA retrospective case–control study with 40 patients undergoing SG (32 women, 8 men; age 42.9 ± 10.7 y; preoperative body mass index 35 ± 2.8 kg/m2), was performed. Patients were grouped according percentile—>50% (cases) or <50% (controls)—of weight regain (%WR cutoff: 25% of weight loss). Weight history, anthropometry, glucose, insulin, homeostasis model assessment-estimated insulin resistance (HOMA-IR), thyroid-stimulating hormone, resting energy expenditure, body composition, dietary survey, psychological test, and physical activity were recorded. Residual gastric capacity was estimated using a radiologic method. Results (median [p25–p75])The evaluation was conducted 38.5 mo (34–41 mo) after SG. Percent weight regain ranged from 2.7% to 129.2% (25.4% [13–37.1]). Patients in the higher %WR group had a greater residual gastric volume (252.7 ± 108.4 versus 148.5 ± 25.3; P < 0.05) and the estimated volume was significantly correlated with %WR (r = 0.673; P = 0.023). Significantly higher body mass index (P = 0.001), resting energy expenditure (P = 0.04), fasting insulin (P = 0.01), and HOMA-IR (P = 0.02) were observed in the higher %WR group. A higher fat intake and a trend toward higher total energy intake were observed in the group with greater %WR. Clinical or borderline levels of anxiety were more frequently observed in the higher %WR group (70% versus 30%; P = 0.01). ConclusionsResults from the present study demonstrated that the most important factor associated with long-term weight regain after SG was residual gastric volume. Additional prospective studies with larger numbers of patients are necessary to confirm our results.

A Comparative, Prospective and Randomized Evaluation of Roux-en-Y Gastric Bypass With and Without the Silastic Ring: A 2-Year Follow Up Preliminary Report on Weight Loss and Quality of Life.

Currently, Roux-en-Y gastric bypass (RYGB) is one of the most widely used bariatric surgeries. Banding the pouch forms a banded gastric bypass operation, an accepted and frequently used variant. Placing a silastic ring around the pouch to band the gastric bypass operation increases the restriction mechanism. However, the ubiquitous use of the banded gastric bypass remains controversial. One of the controversies is the effect of the silastic ring on patients' perception of their well being after surgery because of the frequency of vomiting. A prospective, blindly randomized, comparative trial was undertaken to resolve this controversy. Four hundred subjects scheduled for gastric bypass surgery were randomized into two arms of the trial, 200 with a silastic ring (WR) and 200 without (NR). After 2-year follow-up, the variables associated with the scores of Bariatric Analysis and Reporting Outcome System (BAROS) were analyzed. The initial median weight (125 kg), BMI (47), and age (36 years) were the same in both the NR and WR groups. The median excess weight loss, weight regain, and incidence of vomiting were 71, 10.5, and 7.75%, respectively, in the NR group vs. 75.4 and 1.1, and 24.4% in the WR group. The mean QOL score was 79% in the NR group vs. 80% in the WR group. After 2-year follow-up, silastic ring placement in the RYGB resulted in greater weight loss and weight stability and a threefold greater incidence of vomiting. There was no difference in the scores in the quality of life analysis.

Mechanical Pleurodesis Does Not Reduce Recurrence of Spontaneous Pneumothorax: A Randomized Trial

Mechanical pleurodesis is widely used to treat primary spontaneous pneumothorax to decrease postoperative recurrence after thoracoscopic bullectomy, but it is unclear whether it actually reduces primary spontaneous pneumothorax recurrence. We aimed to investigate the effectiveness of mechanical pleurodesis after thoracoscopic treatment of primary spontaneous pneumothorax. In our parallel-group, prospective, randomized, controlled trail at 2 hospitals in China, 289 patients were enrolled from January 2010 to January 2013. Patients were randomly assigned (1:1) to receive thoracoscopic wedge resection only (WR group) or thoracoscopic wedge resection and mechanical pleurodesis (WR+MP group). This trial is registered with ClinicalTrial.gov (NCT01463553). Intraoperative bleeding and postoperative pleural drainage were significantly lower in the thoracoscopic WR only group. Postoperative recurrence rate did not significantly differ between groups (log-rank test p=0.791; Breslow test p=0.722). In the thoracoscopic WR only group, no recurrences were found when bullae were isolated or limited; recurrence was 7.5% with the presence of multiple bullae. Younger patients had an increased risk of recurrence (relative risk 3.015; 95% confidence interval 1.092 to 8.324). Thoracoscopic mechanical pleurodesis did not significantly decrease primary spontaneous pneumothorax recurrence compared with simple wedge resection, but intraoperative bleeding and postoperative pleural drainage rates were higher. Younger age increases the risk of recurrence.

Effects of distance and barriers between resources on bone and tendon strength and productive performance of broiler chickens

Lameness or leg weakness is becoming an important problem in broilers selected for rapid growth, and although the causes are not known, sedentary behavior could be a cause. Two experiments were conducted to study the effects of distance and the presence of ramps between resources (feed and water) on bone and tendon strength, ability to stand, and productive performance. In experiment 1, straight run Ross 708 chicks (n = 1,260) were randomly assigned to 1 of 3 treatments: 1.0, 3.3, or 6.6 m between resources (6 pen replicates/treatment). In experiment 2, Cobb 500 male chicks (n = 864) were randomly assigned to 1 of 4 treatments (2 × 2 factorial, 4 pen replications/treatment) consisting of 2 distances (3 or 8 m) with (WR) or without (NR) a ramp (a triangular prism 31 cm high and 132 cm wide at the base). At d 21, 45, and 56 (experiment 1), or at d 28, 35, 42, and 49 (experiment 2), birds were weighed, killed, and tibias collected to measure breaking strength (BBS), and abdominal fat (AbF) content. At d 49 (experiment 2), calcaneus tendons were also collected to measure breaking strength (TBS). Foot pad lesions and latency to lie (LTL) were determined before killing the birds. In experiment 1, distance did not affect BBS, LTL, foot pad lesions, or BW, but at d 49, birds in the 6.6 m treatment had lower AbF than birds in the other treatments. In experiment 2 at d 49, birds in the 8 m treatment tended to have a higher BBS than birds in the 3 m treatment (P = 0.09), whereas WR birds had lower tendon breaking strength than NR birds (P < 0.01); however, LTL was highest in 8-m NR birds. Final BW was not affected by distance, but birds in the NR group were heavier than birds in the WR group. Furthermore, AbF was lower in 8 m than in 3 m birds. Our results suggest that longer distances between resources have limited effects on bone strength, but increase the LTL, and may change feeding patterns and carcass characteristics, as evidenced by the lower AbF content. Ramps or inclination affected tendon breaking strength.