Artificial Neural Networks in the Outcome Prediction of Adjustable Gastric Banding in Obese Women

Obesity is unanimously regarded as a global epidemic and a major contributing factor to the development of many common illnesses. Laparoscopic Adjustable Gastric Banding (LAGB) is one of the most popular surgical approaches worldwide. Yet, substantial variability in the results and significant rate of failure can be expected, and it is still debated which categories of patients are better suited to this type of bariatric procedure. The aim of this study was to build a statistical model based on both psychological and physical data to predict weight loss in obese patients treated by LAGB, and to provide a valuable instrument for the selection of patients that may benefit from this procedure.The study population consisted of 172 obese women, with a mean ± SD presurgical and postsurgical Body Mass Index (BMI) of 42.5 ± 5.1 and 32.4 ± 4.8 kg/m(2), respectively. Subjects were administered the comprehensive test of psychopathology Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Main goal of the study was to use presurgical data to predict individual therapeutical outcome in terms of Excess Weight Loss (EWL) after 2 years. Multiple linear regression analysis using the MMPI-2 scores, BMI and age was performed to determine the variables that best predicted the EWL. Based on the selected variables including age, and 3 psychometric scales, Artificial Neural Networks (ANNs) were employed to improve the goodness of prediction. Linear and non linear models were compared in their classification and prediction tasks: non linear model resulted to be better at data fitting (36% vs. 10% variance explained, respectively) and provided more reliable parameters for accuracy and mis-classification rates (70% and 30% vs. 66% and 34%, respectively).ANN models can be successfully applied for prediction of weight loss in obese women treated by LAGB. This approach may constitute a valuable tool for selection of the best candidates for surgery, taking advantage of an integrated multidisciplinary approach

‘Psychopathological profile and metabolic correlates in a sample of obese subjects’

BACKGROUND: The World Health Organization (WHO) has defined obesity as a chronic condition characterized by excessive body weight due to accumulation of adipose tissue sufficient to affect negatively the state of health. Numerous literature data show high rates of comorbidity between obesity and psychiatric disorders particulary mood disorders and eating disorders. There is increasing evidence of elevated inflammatory markers in obesity and alterations in the inflammatory system have been associated with psychiatric disorders. Most previous studies examined small samples with schizofrenya or depression, and the literature is inconsistent with regard to understanding the underlying mechanisms of the association between obesity, psychiatric disorders and the infiammatory profile. The aim of the study was to make a comparison of citokine plasma levels and plasmatic fasting glycemia and induced hyperglycemia curve between patients with or without Axis I/II and subtreschold disorders. METHODS: 110 women candidates to bariatric surgey were consecutively recruited. The diagnostic assessment was conducted using the SCID-I for DSM-IV diagnoses and the SCID II for personality disorders , by psychiatrists trained and certified to the use of the interviews. Plasma levels of fasting glycemia and induced hyperglycemia, IL-6, PAI-1, TNF-alpha, GH were misuread. RESULTS: Our finding supports the hypothesis for a complex integration of endocrine and metabolic factors (glucose, IL-6, PAI-1, TNF-alpha, GH) and psychiatric symptoms in the development both obesity and psychiatric disorders. However, forasmuch as the study is an observational study, further evaluations should be made by comparing our sample with healthy controls and evaluating plasma hormones after stimulation test

Psychopathological behaviour and cognition in morbid obesity

Background: Obesity is a chronic condition with high prevalence and multifaceted aetiology, accompanied by an increased risk of morbidity and mortality. Obesity has several negative effects on the psychological status, and the severity of psychological disorders correlates with the degree of obesity. Objective: Aim of this review is to provide an overview of the literature concerning the psychological distress associated with severe obesity, which contributes to deterioration of the quality of life of affected patients. Methods: Dysfunctional eating behaviours and eating disorders, psychiatric comorbidity, cognition and quality of life will be discussed together with the most common drugs that can be employed to treat the various disorders in this peculiar clinical setting. The effects of bariatric surgery will be also reviewed. Results: Obesity is often the result of pathological behaviours implemented in an eating disorder. Inconsistent results have been reported with regard to the effect of severe obesity on cognition, which recognize a multifaceted aetiology. Serotonergic agents play an important role in the management of patients with obesity and binge episodes, fluoxetine being currently a drug approved for this disorder. The efficacy of lorcaserin, a combination of bupropion and naltrexone, or antiepileptic medications (topiramate and zonisamide) has also been proposed. A neuroprotective role of leptin and oestrogen has been hypothesized. Bariatric surgery is a helpful treatment of morbid obese patients, with long-term favourable results on the psychopathological profile. Conclusion: Psychological, psychoeducational and psychopharmacological treatment can facilitate weight loss in morbid obese subjects with psychopathological comorbidities. A precise definition of the mechanisms affecting appetite, satiety and energy balance is expected to foster the development of new effective antiobesity drugs

Psychiatric Aspects of Obesity: A Narrative Review of Pathophysiology and Psychopathology

In the last decades, obesity has become a major concern for clinical and public health. Despite the variety of available treatments, the outcomes remain-by and large-still unsatisfactory, owing to high rates of nonresponse and relapse. Interestingly, obesity is being associated with a growing surge of neuropsychiatric problems, certainly related to the pathogenesis of this condition, and likely to be of great consequence as for its treatment and prognosis. In a neurobiologic direction, a sturdy body of evidence has recently shown that the immune-metabolic-endocrine dyscrasias, notoriously attached to excess body weight/adiposity, affect and impair the morpho-functional integrity of the brain, thus possibly contributing to neuroprogressive/degenerative processes and behavioral deviances. Likewise, in a neuropsychiatric perspective, obesity displays complex associations with mood disorders and affective temperamental dimensions (namely cyclothymia), eating disorders characterized by overeating/binge-eating behaviors, ADHD-related executive dysfunctions, emotional dysregulation and motivational-addictive disturbances. With this review, we attempt to provide the clinician a synoptic, yet exhaustive, tool for a more conscious approach to that subset of this condition, which could be reasonably termed "psychiatric" obesity

Prevalence and psychiatric comorbidities of night-eating behavior in obese bariatric patients: preliminary evidence for a connection between night-eating and bipolar spectrum disorders

PURPOSE: The co-occurrence of obesity, eating and mood disorders has been frequently reported in clinical and epidemiological settings. This study aimed to explore the prevalence of night-eating obese patients referred for bariatric surgery and to identify associated psychopathology and psychiatric comorbidity. METHODS: The sample was composed of 121 obese patients consecutively enrolled between November 2010 and May 2012 during psychiatric evaluations for bariatric intervention. Clinical features and psychiatric diagnoses were collected. Night-eating was investigated through the administration of the Night-eating Questionnaires (NEQ) and was defined as the presence of self-reported evening hyperphagia and/or nocturnal ingestions. Binge-eating and purging behaviors and general psychopathology were respectively assessed using the Bulimic Investigatory Test, Edinburgh and the Symptom Checklist-90-Revised. RESULTS: Night-eating was reported by twenty subjects (16.5%). Patients with night-eating behavior were significantly more frequently diagnosed with bipolar spectrum disorders and with comorbid eating and mood disorders in comparison with other patients. Night-eating patients showed significantly more binging/purging behaviors and greater severity of somatization, obsessive–compulsive symptoms, phobic anxiety, psychoticism and sleep disorders. Patients with bipolar disorder type 1 or 2 scored significantly higher than those without mood disorders at NEQ total score, mood/sleep and nocturnal ingestions subscales, but also scored significantly higher than other patients with mood disorders at the latter subscale. CONCLUSION: Patients with evening hyperphagia and/or nocturnal ingestions should be carefully evaluated to detect possible bipolar spectrum disorders and other eating disorders. Prompt management of these conditions should be provided before bariatric interventions. LEVEL OF EVIDENCE: V, cross-sectional descriptive study. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40519-021-01306-1

Psychopathological and psychiatric evaluation of patients affected by lipodystrophy

PURPOSE: Lipodystrophy is a collection of rare disorders defined by complete or partial loss of adipose tissue, due to abnormal adipocyte production, function, or distribution; it shares the main metabolic complications with obesity. Aims of the present study were to investigate the psychopathological characteristics of non-HIV lipodystrophic patients in comparison with a group of obese patients, a group of patients affected by oncologic chronic illness, and a control group of healthy subjects. METHODS: All participants were female: 16 non-HIV lipodystrophic women (mean age 42 ± 12 years), 20 women with breast cancer (adenocarcinoma with a positive sentinel lymph node in outpatients awaiting chemotherapy, mean age 44 ± 5 years), 20 obese women (mean age 40 ± 3 years), and 20 healthy women (mean age 40 ± 2 years). Each lipodystrophic patient received a psychiatric assessment, following the diagnostic criteria for DSM-5. Patients and controls received a battery of self-report instruments measuring general psychopathology, body image concerns, eating habits and food craving, and pain concerns. The following psychopathological rating scales were used: SCL-90-R (Symptom Check List) for general psychopathology, BUT (Body Uneasiness Test) for body image, FCQ-T (Food Cravings Questionnaire Trait) for food craving, and WHYMPI (West Haven Yale Multidimensional Pain Inventory) for multidimensional pain inventory. RESULTS: The psychiatric assessment of the 16 lipodystrophic patients revealed: three lifetime mood disorder, six current mood disorder, six lifetime anxiety disorder, five current anxiety disorder, four current somatic symptom disorder with predominant pain, six current binge eating disorder, 11 eating disorder not otherwise specified, two borderline personality disorder, one obsessive-compulsive personality disorder, one avoidant personality disorder, and five personality disorder not otherwise specified. In SCL-90-R scale, the subscale sensitivity showed a significantly higher score in the lipodystrophic and oncologic groups compared to healthy subjects. The subscale paranoid ideation showed a significantly higher score in the lipodystrophic group vs all the other groups. The total score of BUT scale was significantly higher in the lipodystrophic compared to healthy subjects. In WHYMPI scale, the scores of pain interference and family support were significantly higher in the lipodystrophic group. The scores of negative responses were significantly higher in the lipodystrophic group vs healthy subjects. In FCQ-T scale, the score of Cues dimension in lipodystrophic patients was significantly lower as compared with all the other groups. CONCLUSIONS: Our findings suggest that lipodystrophic patients have an increased prevalence of mood, anxiety, pain, and eating disorders. LEVEL OF EVIDENCE: Level III. Evidence obtained from case-control analytic study

Diverging cell wall strategies for drought adaptation in two maize inbreds with contrasting lodging resistance

The plant cell wall is a plastic structure of variable composition that constitutes the first line of defence against environmental challenges. Lodging and drought are two stressful conditions that severely impact maize yield. In a previous work, we characterised the cell walls of two maize inbreds, EA2024 (susceptible) and B73 (resistant) to stalk lodging. Here, we show that drought induces distinct phenotypical, physiological, cell wall, and transcriptional changes in the two inbreds, with B73 exhibiting lower tolerance to this stress than EA2024. In control conditions, EA2024 stalks had higher levels of cellulose, uronic acids and p‐coumarate than B73. However, upon drought EA2024 displayed increased levels of arabinose‐enriched polymers, such as pectin‐arabinans and arabinogalactan proteins, and a decreased lignin content. By contrast, B73 displayed a deeper rearrangement of cell walls upon drought, including modifications in lignin composition (increased S subunits and S/G ratio; decreased H subunits) and an increase of uronic acids. Drought induced more substantial changes in gene expression in B73 compared to EA2024, particularly in cell wall‐related genes, that were modulated in an inbred‐specific manner. Transcription factor enrichment assays unveiled inbred‐specific regulatory networks coordinating cell wall genes expression. Altogether, these findings reveal that B73 and EA2024 inbreds, with opposite stalk‐lodging phenotypes, undertake different cell wall modification strategies in response to drought. We propose that the specific cell wall composition conferring lodging resistance to B73, compromises its cell wall plasticity, and renders this inbred more susceptible to drought.This work was supported by the Grants AGL2014-58126-R; RTC-2016-5816-2 and PID2022-142786NB-I00 funded by MCIN/AEI/10.13039/501100011033 and ERDF “A way to make Europe” and received financial support from the CONSOLIDER-INGENIO programme (CSD2007-00036) from the Spanish Ministerio de Ciencia e Innovación. S.C. was financed with a PhD contract (PRE2019-089329) funded by MCIN/AEI/10.13039/501100011033 and by “ESF Investing in your future”, and by SEV-2015-0533-19-1 and CEX2019-000902-S funded by MCIN/AEI/10.13039/501100011033. A.M.-R. was financed with a PhD contract from the Consejería de Educación de Castilla y León and the Fondo Social Europeo (ORDEN EDU/601/2020, July 7th). This work was also supported by the SGR programmes (2017SGR710 and 2021-SGR-01131) from the Secretaria d'Universitats i Recerca del Departament d'Empresa i Coneixement de la Generalitat de Catalunya and by the CERCA Programme/Generalitat de Catalunya. This work was financially supported by RYC2021-033414-l to R.U funded by MCIN/AEI/10.13039/501100011033 by the “European Union Next Generation EU/PRTR”. Finally, we acknowledge financial support from the Grants SEV-2015-0533-19-1 and CEX2019-000902-S funded by MCIN/AEI/10.13039/501100011033.info:eu-repo/semantics/publishedVersio

Eating disorders and emotional dysregulation are associated with insufficient weight loss after bariatric surgery: a 1-year observational follow-up study

PurposeSubjects with obesity, especially those seeking bariatric surgery, exhibit high rates of mental disorders and marked psychopathological traits. The primary objective of this prospective, non-interventional study was to investigate whether the presence of different psychiatric disorders, attention deficit/hyperactivity disorder (ADHD) symptomatology and emotional dysregulation influenced weight loss at 1-year follow-up after surgery.MethodsSubjects consecutively referred for pre-surgical evaluation at the Obesity Center of Pisa University Hospital were recruited. Psychiatric diagnoses were made through the Mini-International Neuropsychiatric Interview (MINI) and ADHD symptomatology was assessed with the Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS). Emotional dysregulation was investigated through the WRAADDS and self-report questionnaires. After surgery, weight and obesity-related comorbidities were monitored during follow-up.ResultsOf the 99 participants recruited, 76 underwent surgery and 65 could be reevaluated 1 year after surgery. Subjects with insufficient weight loss (excess body mass index loss <= 53%, n = 15) had more frequent lifetime binge eating disorder (BED) and BED-mood disorders comorbidity than subjects with favorable post-surgical outcome. Additionally, they scored higher on both physician-administered and self-report scales assessing emotional dysregulation, which represents a nuclear symptom of ADHD in adults. At the logistic regression analysis, older age, higher preoperative excess body mass index and greater affective instability were predictors of reduced weight loss at 1-year follow-up.ConclusionEmotional dysregulation seems to be associated with a worse outcome after bariatric surgery. Further studies with larger samples and longer follow-up are needed to confirm the influence of different psychiatric disorders and psychopathological traits on post-surgical outcome

Construcción de una ¨capa arable¨ en suelos pobres: Conceptos esenciales aplicados a la altillanura

<p>Legend: ANX – Anxiety; FRS – Fears; OBS – Obsessiveness; DEP – Depression; HEA - Health Concerns; BIZ - Bizarre Mentation; ANG – Anger; CYN – Cynicism; ASP - Antisocial Practices; TPA - Type A; LSE - Low Self-Esteem; SOD - Social Discomfort; FAM - Family Problems; WRK - Work Interference; TRT - Negative Treatment Indicators.</p><p>*Chi-Square <i>X</i>² test p<0.05 as compared with the normative population.</p