Onchocerciais commonly called Riverblindness is a tropical disease transmitted by the blackfly. It is particularly prevalent in tropical Africa and parts of tropical America. It is estimated that 20 ...million people are affected by this disease. It affects humans and cattle. Human onchocerciasis is caused by the infective filariae of onchocerca volvulus, while cattle onchocerciasis is caused by infective filariae of onchocerca ochengi. Results of a study of the disease in North Cameroon (one of the countries in the affected region) led researchers to hypothesize that when high amounts of infective filariae of onchocerca ochengi are inoculated into humans, the humans develop immunity against onchocerca volvulus. Until now, the best control of this disease is by drug treatment, but persons who recover after a drug treatment are immediately susceptible and can be reinfected. One needs to find a way to protect this recovered class from reinfection. Using ordinary differential equations this researcher modelled the populations of the microfilariae and infective filariae of onchocerca volvulus and ochengi, respectively, in humans and cattle, respectively. Adopting the hypothesis that the presence of a large number of the infective filariae of onchocerca ochengi and onchocerca volvulus in humans and cattle, respectively, triggers an immune reaction against their respective onchocerca, the following results were obtained: (1) Conditions for the existence and local stability of the coexistence equilibrium and the competitive exclusion equilibria, and the extinction and persistence of onchocerciasis. (2) Possible control of human onchocerciasis by managing the cattle population. Using Matlab, these results are illustrated herein with two numerical examples.
Objectives: In this proof-of-concept trial, we examined the feasibility and preliminary efficacy of Understanding Social Situations (USS), a new social-cognitive intervention that targets higher ...level social-cognitive skills using methods common to neurocognitive remediation, including drill and practice and hierarchically structured training, which may compensate for the negative effects of cognitive impairment on learning. Method: Thirty-eight individuals with schizophrenia spectrum disorders completed the same baseline assessment of cognitive and social-cognitive functioning twice over a 1-month period to minimize later practice effects, then received 7-10 sessions of USS training, and then completed the same assessment again at posttreatment. Results: USS training was well tolerated and received high treatment satisfaction ratings. Large improvements on the USS Skills Test, which contained items similar to but not identical to training stimuli, suggest that we were effective in teaching specific training content. Content gains generalized to improvements on some of the social-cognitive tasks, including select measures of attributional bias and theory of mind. Importantly, baseline neurocognition did not impact the amount of learning during USS (as indexed by the USS Skills Test) or the amount of improvement on social-cognitive measures. Conclusions and Implications for Practice: USS shows promise as a treatment for higher level social-cognitive skills. Given the lack of relationship between baseline cognition and treatment effects, it may be particularly appropriate for individuals with lower range cognitive function.
Long-term diabetic response to gastric bypass Davies, Stephen W., MD, MPH; Efird, Jimmy T., PhD, MS; Guidry, Christopher A., MD, MS ...
The Journal of surgical research,
08/2014, Letnik:
190, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Abstract Background As obesity and type II diabetes continue to rise, bariatric surgery offers a solution, but few long-term studies are available. The purpose of this study was to evaluate the ...long-term outcomes of diabetic patients after gastric bypass. Materials and methods This was a retrospective cohort study of all diabetic patients undergoing gastric bypass at our institution, from 1998 to 2012. Patients were compared by postoperative diabetic response to treatment (i.e., response = off oral medication/insulin versus refractory = on oral medication/insulin) and followed at 1-, 3-, 5-, and 10-y intervals. Continuous data were analyzed using Student t -test or Wilcoxon rank-sum test. Multivariable, Cox proportional hazard regression model was performed to compute diabetic cure ratios and 95% confidence intervals. Results A total of 2454 bariatric surgeries were performed at our institution during the time period. A total of 707 diabetic patients were selected by Current Procedural Terminology codes for gastric bypass. Mean follow-up was 2.1 y. Incidence of diabetic response was 56% (1 y), 58% (3 y), 60% (5 y), and 44% (10 y). Postoperatively, responsive patients experienced greater percentage of total body weight loss (1 y P < 0.0001, 3 y P = 0.0087, and 5 y P = 0.013), and less hemoglobin A1c levels (1 y P = 0.035 and 3 y P = 0.040) at follow-up than refractory patients. Multivariable analysis revealed a significant, independent inverse trend in incidence of diabetic cure as both age and body mass index decreased ( Ptrend = 0.0019 and <0.0001, respectively). In addition, degenerative joint disease was independently associated with responsive diabetes (cure ratio = 1.6 95% confidence interval = 1.1–2.2). Conclusions At follow-up, both groups in our study experienced substantial weight loss; however, a greater loss was observed among the response group. Further research is needed to evaluate methods for optimizing patient care preoperatively and improving patient follow-up.
Background
The two most commonly performed procedures for bariatric surgery include Roux-en-Y gastric bypass (RYGB) and adjustable gastric banding (AGB). While many studies have commented on ...short-term, postoperative outcomes of these procedures, few have reported long-term data. The purpose of this study was to compare long-term, postoperative outcomes between RYGB and AGB.
Methods
This was a retrospective, cohort comparing all patients undergoing RYGB or AGB at our institution, from 01/1998 to 08/2012. Patients were followed at 1-, 3-, and 5-year intervals. Adjusted, Cox proportional hazard regression and mixed effects repeated measures modeling were performed to generate cure ratios (CR) and 95 % confidence intervals (CI).
Results
Two thousand four hundred twenty bariatric surgery patients (380 AGB, 2,040 RYGB) were identified by CPT code. Median (range) follow-up for patients was 3 (1–5) years. Preoperatively, RYGB patients were significantly younger, more obese, had higher hemoglobin A1c, and less often suffered from hypertension (HTN), dyslipidemia, and asthma as compared to AGB patients. Postoperatively, RYGB patients experienced significantly longer operating room times, higher incidences of intensive care unit admissions, longer hospital lengths of stay, and increased incidence of small bowel obstruction compared to AGB patients. After adjusting for statistically significant and clinically relevant factors e.g., age, gender, body mass index, degenerative joint disease (DJD), diabetes, HTN, dyslipidemia, heart disease, apnea, and asthma, RYGB was independently associated with a significantly greater percentage of total body weight loss (
p
= 0.0065) and greater CR (95 % CI) regarding gastroesophageal reflux disease 2.1(1.4–3.0), DJD 3.4(2.0–5.6), diabetes 3.4(2.2–5.4), apnea 3.1(1.9–5.3), HTN 5.5(3.4–8.8), and dyslipidemia 6.3(3.5–11) compared to AGB.
Conclusion
Our results support previous studies that have observed a greater weight loss associated with RYGB as compared to AGB and provide further evidence toward the long-term sustainability of this weight loss. Additionally, RYGB appears to result in a greater reduction of medical comorbidity.
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