Obesity management: Update on orlistat

Over the past 20 years obesity has become a worldwide concern of frightening proportion. The World Health Organization estimates that there are over 400 million obese and over 1.6 billion overweight adults, a figure which is projected to almost double by 2015. This is not a disease restricted to adults – at least 20 million children under the age of 5 years were overweight in 2005 (WHO 2006). Overweight and obesity lead to serious health consequences including coronary artery disease, stroke, type-2 diabetes, heart failure, dyslipidemia, hypertension, reproductive and gastrointestinal cancers, gallstones, fatty liver disease, osteoarthritis and sleep apnea (Padwal et al 2003)

Metastatic Renal Cell Carcinoma to the Contralateral Ureter: A Rare Phenomenon

AbstractMetastatic renal cell carcinoma (RCC) to the contralateral ureter is a rare phenomenon. We report a metastatic RCC to the contralateral ureter 5 months after right radical nephrectomy for Fuhrman grade 3/4 clear cell adenocarcinoma with pathologic T3 staging. The distal ureter was excised followed by partial ileal ureteral substitution. Pathology confirmed metastatic clear cell RCC Fuhrman grade 2/4. Ileal ureteral substitution has been shown to provide good long-term functional outcomes and should be considered as a possible option for surgical treatment of ureteral metastasis

Tracking Cyber Adversaries with Adaptive Indicators of Compromise

A forensics investigation after a breach often uncovers network and host indicators of compromise (IOCs) that can be deployed to sensors to allow early detection of the adversary in the future. Over time, the adversary will change tactics, techniques, and procedures (TTPs), which will also change the data generated. If the IOCs are not kept up-to-date with the adversary's new TTPs, the adversary will no longer be detected once all of the IOCs become invalid. Tracking the Known (TTK) is the problem of keeping IOCs, in this case regular expressions (regexes), up-to-date with a dynamic adversary. Our framework solves the TTK problem in an automated, cyclic fashion to bracket a previously discovered adversary. This tracking is accomplished through a data-driven approach of self-adapting a given model based on its own detection capabilities. In our initial experiments, we found that the true positive rate (TPR) of the adaptive solution degrades much less significantly over time than the naive solution, suggesting that self-updating the model allows the continued detection of positives (i.e., adversaries). The cost for this performance is in the false positive rate (FPR), which increases over time for the adaptive solution, but remains constant for the naive solution. However, the difference in overall detection performance, as measured by the area under the curve (AUC), between the two methods is negligible. This result suggests that self-updating the model over time should be done in practice to continue to detect known, evolving adversaries.Comment: This was presented at the 4th Annual Conf. on Computational Science & Computational Intelligence (CSCI'17) held Dec 14-16, 2017 in Las Vegas, Nevada, US

Nebulized heparin is associated with fewer days of mechanical ventilation in critically ill patients: a randomized controlled trial

INTRODUCTION: Prolonged mechanical ventilation has the potential to aggravate or initiate pulmonary inflammation and cause lung damage through fibrin deposition. Heparin may reduce pulmonary inflammation and fibrin deposition. We therefore assessed whether nebulised heparin improved lung function in patients expected to require prolonged mechanical ventilation. METHODS: Fifty patients expected to require mechanical ventilation for more than 48 hours were enrolled in a double-blind randomised placebo-controlled trial of nebulised heparin (25,000 U) or placebo (normal saline) 4 or 6 hourly, depending on patient height. The study drug was continued while the patient remained ventilated to a maximum of 14 days from randomisation. RESULTS: Nebulised heparin was not associated with a significant improvement in the primary end-point, the average daily partial pressure of oxygen to inspired fraction of oxygen ratio while mechanically ventilated, but was associated with improvement in the secondary end-point ventilator free days amongst survivors at day 28 (22.6 4.0 versus 18.0 7.1, treatment difference 4.6 days, 95% CI 0.9 to 8.3, P = 0.02). Heparin administration was not associated with any increase in adverse events. CONCLUSIONS: Nebulised heparin was associated with fewer days of mechanical ventilation in critically ill patients expected to require prolonged mechanical ventilation. Further trials are required to confirm these findings. Trial registration: The Australian Clinical Trials Registry (ACTR-12608000121369

Effect of diet versus diet and exercise on weight loss and body composition in class II and III obesity: A systematic review

Class II and III obesity (BMI >35 kg·m2) have increased dramatically in recent years. Current clinical guidelines suggest diet and exercise as first line treatment for adults throughout the spectrum of overweight and obesity. However, to date there is no systematic review that examines the effects of diet and exercise on this high risk population. This systematic review will examine the combined effects of diet versus diet and exercise on body composition in severe obesity. Medline and Cinahl were searched for randomised controlled trials comparing diet and exercise to diet alone. Studies published until July 2013 were included if they used reliable methods for analysing body composition in adults with BMI ≥ 35 kg·m2. Five of 459 studies met the inclusion criteria. Two studies, both in older adults, reported that exercise reduced lean mass loss during weight loss. Two studies showed that exercise facilitated (greater) fat mass loss. The remaining study reported no differences in body composition when exercise is added to energy restriction. Exercise training during energy restriction for individuals with BMI ≥35 kg.m2 may influence body composition outcomes but the evidence is limited. Further studies should focus on the efficacy of different exercise protocols during energy restriction for this population in order to better inform decision making for the treatment of severe obesity in respect to favourable body composition outcomes

An International Society and Journal for Equity in Health: 10 years on

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Commentary June 2010 marked the 10th Anniversary of the foundation meeting of the International Society for Equity in Health (ISEqH). The formation of the Society was a bold statement, with ambitions to be a global body "to promote equity in health and health services internationally through education, research, publication, communication and charitable support"[1]. The Society particularly aimed to be an organisation that facilitated research on how better to understand and address inequities in health. The main activities of the Society have been a series of biannual conferences as well as the establishment of the International Journal for Equity in Health, the official (but independent) publication of the Society. This paper sets out to record some of the milestones of the Society drawing on the reflections of key researchers who attended the conferences as well as others. The history of the Society will help shape its future and how it responds to important issues facing all interested in global efforts to address continuing and unacceptable inequities in health

Collinear and Soft Limits of Multi-Loop Integrands in N=4 Yang-Mills

It has been argued in arXiv:1112.6432 that the planar four-point integrand in N=4 super Yang-Mills theory is uniquely determined by dual conformal invariance together with the absence of a double pole in the integrand of the logarithm in the limit as a loop integration variable becomes collinear with an external momentum. In this paper we reformulate this condition in a simple way in terms of the amplitude itself, rather than its logarithm, and verify that it holds for two- and three-loop MHV integrands for n>4. We investigate the extent to which this collinear constraint and a constraint on the soft behavior of integrands can be used to determine integrands. We find an interesting complementarity whereby the soft constraint becomes stronger while the collinear constraint becomes weaker at larger n. For certain reasonable choices of basis at two and three loops the two constraints in unison appear strong enough to determine MHV integrands uniquely for all n.Comment: 27 pages, 14 figures; v2: very minor change

Bony metastases from breast cancer - a study of foetal antigen 2 as a blood tumour marker

Background : Foetal antigen 2 (FA-2), first isolated in the amniotic fluid, was shown to be the circulating form of the aminopropeptide of the alpha 1 chain of procollagen type I. Serum concentrations of FA-2 appeared to be elevated in a number of disorders of bone metabolism. This paper is the first report of its role as a marker of bone metabolism in metastatic breast cancer. Methods: Serum FA-2 concentrations were measured by radioimmunoassay in 153 women with different stages of breast cancer and in 34 normal controls. Results: Serum FA-2 was significantly elevated in women with bony metastases (p < 0.015). Its levels were not significantly different among women with non-bony metastases, with non-metastatic disease, as well as among normal controls. Conclusions: FA-2 is a promising blood marker of bone metabolism. Further studies to delineate its role in the diagnosis and management of bony metastases from breast cancer are required