The Anatomy of a Weight Recidivism and Revision Bariatric Surgical Clinic

Abstract. Weight recidivism in bariatric surgery failure is multifactorial. It ranges from inappropriate patient selection for primary surgery to technical/anatomic issues related to the original surgery. Most bariatric surgeons and centers focus on primary bariatric surgery while weight recidivism and its complications are very much secondary concerns. Methods. We report on our initial experience having established a dedicated weight recidivism and revisional bariatric surgery clinic. A single surgeon, dedicated nursing, dieticians, and psychologist developed care maps, goals of care, nonsurgical candidate rules, and discharge planning strategies. Results. A single year audit (2012) of clinical activity revealed 137 patients, with a mean age 49 ± 10.1 years (6 years older on average than in our primary clinic), 75% of whom were women with BMI 47 ± 11.5. Over three quarters had undergone a vertical band gastroplasty while 15% had had a laparoscopic adjustable gastric band. Only 27% of those attending clinic required further surgery. As for primary surgery, the role of the obesity expert clinical psychologist was a key component to achieving successful revision outcomes. Conclusion. With an exponential rise in obesity and a concomitant major increase in bariatric surgery, an inevitable increase in revisional surgery is becoming a reality. Anticipating this increase in activity, Alberta Health Services, Alberta, Canada, has established a unique and dedicated clinic whose early results are promising

Finite elements for higher order steel–concrete composite beams

none4noThis paper presents finite elements for a higher order steel–concrete composite beam model developed for the analysis of bridge decks. The model accounts for the slab–girder partial interaction, the overall shear deformability, and the shear‐lag phenomenon in steel and concrete components. The theoretical derivation of the solving balance conditions, in both weak and strong form, is firstly addressed. Then, three different finite elements are proposed, which are characterised by (i) linear interpolating functions, (ii) Hermitian polynomial interpolating functions, and (iii) interpolating functions, respectively, derived from the analytical solution expressed by means of exponential matrices. The performance of the finite elements is analysed in terms of the solution con-vergence rate for realistic steel–concrete composite beams with different restraints and loading con-ditions. Finally, the efficiency of the beam model is shown by comparing the results obtained with the proposed finite elements and those achieved with a refined 3D shell finite element model.openGara F.; Carbonari S.; Leoni G.; Dezi L.Gara, F.; Carbonari, S.; Leoni, G.; Dezi, L

On the validity of the reduced Salpeter equation

We adapt a general method to solve both the full and reduced Salpeter equations and systematically explore the conditions under which these two equations give equivalent results in meson dynamics. The effects of constituent mass, angular momentum state, type of interaction, and the nature of confinement are all considered in an effort to clearly delineate the range of validity of the reduced Salpeter approximations. We find that for $J\not{\hspace*{-1.0mm}=}0$ the solutions are strikingly similar for all constituent masses. For zero angular momentum states the full and reduced Salpeter equations give different results for small quark mass especially with a large additive constant coordinate space potential. We also show that $\frac{1}{m}$ corrections to heavy-light energy levels can be accurately computed with the reduced equation.Comment: Latex (uses epsf macro), 24 pages of text, 12 postscript figures included. Slightly revised version, to appear in Phys. Rev.

Sistem Berkas Digital untuk Berkas Penelitian di Universitas Klabat

Sistem penyimpanan hasil penelitian yang ada di Universitas Klabat (UNKLAB) merupakan sistem penyimpanan yang masih bersifat manual, dimana setiap penelitian di simpan di kantor fakultas dan di perpustakaan. Hal ini menyebabkan berkas yang ada tidak tersimpan dengan teratur dan kesulitan bagi pengguna untuk mengakses. Sehingga sangat dibutuhkan untuk dikembangkan sistem berkas digital penyimpanan berkas hasil penelitian. Sistem yang dirancang nantinya dapat menghubungkan mahasiswa dan dosen pada semua penelitaian yang ada di UNKLAB. Sistem berkas digital ini dibangun dengan menggunakan Framework CodeIgniter (CI) yang berbasis bahasa pemrograman PHP dan MySQL sebagai basisdata. Metode penelitian yang digunakan dalam pengembangan sistem berkas digital ini menggunakan metode spiral. Aplikasi sistem berkas digital memiliki kemampuan menyimpan dokumen, menampilkan isi dokumen dan multi user

QCDOC: A 10-teraflops scale computer for lattice QCD

The architecture of a new class of computers, optimized for lattice QCD calculations, is described. An individual node is based on a single integrated circuit containing a PowerPC 32-bit integer processor with a 1 Gflops 64-bit IEEE floating point unit, 4 Mbyte of memory, 8 Gbit/sec nearest-neighbor communications and additional control and diagnostic circuitry. The machine's name, QCDOC, derives from ``QCD On a Chip''.Comment: Lattice 2000 (machines) 8 pages, 4 figure

A consistent derivation of the quark--antiquark and three quark potentials in a Wilson loop context

In this paper we give a new derivation of the quark-antiquark potential in the Wilson loop context. This makes more explicit the approximations involved and enables an immediate extension to the three-quark case. In the $q\overline{q}$ case we find the same semirelativistic potential obtained in preceding papers but for a question of ordering. In the $3q$ case we find a spin dependent potential identical to that already derived in the literature from the ad hoc and non correct assumption of scalar confinement. Furthermore we obtain the correct form of the spin independent potential up to the $1/m^2$ order.Comment: 30 pages, Revtex (3 figures available as hard copies only), IFUM 452/F

Premature T cell aging in major depression: A double hit by the state of disease and cytomegalovirus infection

Childhood trauma; Major depressive disorder; T cytotoxic cellTrauma infantil; Trastorn depressiu major; cèl·lula T citotòxicaTrauma infantil; Trastorno depresivo mayor; célula T citotóxicaIntroduction Previous research indicates that premature T cell senescence is a characteristic of major depressive disorder (MDD). However, known senescence inducing factors like cytomegalovirus (CMV) infection or, probably, childhood adversity (CA) have not been taken into consideration so far. Objective Differentiation and senescent characteristics of T cells of MDD patients were investigated in relation to healthy controls (HC), taking the CMV seropositivity and CA into account. Methods 127 MDD and 113 HC of the EU-MOODSTRATIFICATION cohort were analyzed. Fluorescence activated cell sorting (FACS) analysis was performed to determine B, NK, and T cell frequencies. In a second FACS analysis, naïve, effector memory (Tem), central memory (Tcm), effector memory cells re-expressing RA (TEMRA), as well as CD28+ and CD27+ memory populations, were determined of the CD4+ and CD8+ T cell populations in a subsample (N = 35 MDD and N = 36 HC). CMV-antibody state was measured by IgG ELISA and CA by the Childhood Trauma Questionnaire. Results We detected a CMV-antibody positivity in 40% of MDD patients (35% HC, n. s.) with seropositive MDD cases showing a higher total childhood trauma score. Second, a higher inflation of memory CD4+ T helper cells in CMV seronegative patients as compared to seronegative HC and reduced numbers of naïve CD4+ T helper cells in CMV seropositive patients (not in CMV seropositive HC) were found. Third, a higher inflation of memory CD8+ T cytotoxic cells in CMV seropositive cases as compared to CMV seropositive HC, particularly of the TEMRA cells, became apparent. Higher percentages of CD4+ TEMRA and late stage CD27−CD28− TEMRA cells were similar in both HC and MDD with CMV seropositivity. Overall, apportioning of T cell subpopulations did not differ between CA positive vs negative cases. Conclusions MDD patients show several signs of a CMV independent “MDD specific” premature T cell aging, such as a CMV independent increase in CD4+ T memory cells and a latent naïve CD4 T-cell reduction and a latent CD8+ T-cell increase. However, these two latent T cell senescence abnormalities only become evident with CMV infection (double hit).This work was supported by the European Commission: EU 7th Framework program (grant number EU-FP7-CP-IP-2008-222963) and Horizon 2020 (grant number H2020-SC1-2016-2017/H2020-SC1-2017-Two-Stage-RTD) grants were received by HAD, Erasmus Medical Center Rotterdam. The funding source had no role in the study design, the data collection, the analysis and interpretation of data, the manuscript writing, and in the decision to submit the article for publication

Low-grade inflammation as a predictor of antidepressant and anti- inflammatory therapy response in MDD patients: a systematic review of the literature in combination with an analysis of experimental data collected in the EU-MOODINFLAME consortium

Terapia antiinflamatoria; Terapia antidepresiva; InflamaciónAnti-inflammatory therapy; Antidepressant therapy; InflammationTeràpia antiinflamatòria; Teràpia antidepressiva; InflamacióLow-grade inflammation plays a role not only in the pathogenesis of major depressive disorder (MDD) but probably also in the poor responsiveness to regular antidepressants. There are also indications that anti-inflammatory agents improve the outcomes of antidepressants. Aim: To study whether the presence of low-grade inflammation predicts the outcome of antidepressants, anti-inflammatory agents, or combinations thereof. Methods: We carried out a systematic review of the literature on the prediction capability of the serum levels of inflammatory compounds and/or the inflammatory state of circulating leukocytes for the outcome of antidepressant/anti-inflammatory treatment in MDD. We compared outcomes of the review with original data (collected in two limited trials carried out in the EU project MOODINFLAME) on the prediction capability of the inflammatory state of monocytes (as measured by inflammatory gene expression) for the outcome of venlafaxine, imipramine, or sertraline treatment, the latter with and without celecoxib added. Results: Collectively, the literature and original data showed that: 1) raised serum levels of pro-inflammatory compounds (in particular of CRP/IL-6) characterize an inflammatory form of MDD with poor responsiveness to predominately serotonergic agents, but a better responsiveness to antidepressant regimens with a) (add-on) noradrenergic, dopaminergic, or glutamatergic action or b) (add-on) anti-inflammatory agents such as infliximab, minocycline, or eicosapentaenoic acid, showing—next to anti-inflammatory—dopaminergic or lipid corrective action; 2) these successful anti-inflammatory (add-on) agents, when used in patients with low serum levels of CRP/IL-6, decreased response rates in comparison to placebo. Add-on aspirin, in contrast, improved responsiveness in such “non-inflammatory” patients; 3) patients with increased inflammatory gene expression in circulating leukocytes had a poor responsiveness to serotonergic/noradrenergic agents. Conclusions: The presence of inflammation in patients with MDD heralds a poor outcome of first-line antidepressant therapies. Immediate step-ups to dopaminergic or glutamatergic regimens or to (add-on) anti-inflammatory agents are most likely indicated. However, at present, insufficient data exist to design protocols with reliable inflammation parameter cutoff points to guide such therapies, the more since detrimental outcomes are possible of anti-inflammatory agents in “non-inflamed” patients.This study was financially supported by the EU via the MOODINFLAME project (EU-FP7-HEALTH-F2-2008-222963), the PSYCHAID (EU-FP7-PEOPLE-2009-IAPP-MarieCurie-286334), and the MOODSTRATIFICATION project (H2020-EU. 3.1.1., GA754740). NM and GA were additionally supported by the foundation "Immunitat und Seele." The funders had no role in study design, data collection, analysis and interpretation of data, the writing of the report, and the decision to submit the paper for publication

Efficacy of Sertraline Plus Placebo or Add-On Celecoxib in Major Depressive Disorder: Macrophage Migration Inhibitory Factor as a Promising Biomarker for Remission After Sertraline-Results From a Randomized Controlled Clinical Trial

Trastorno depresivo mayor; Tratamiento antiinflamatorio; CitocinaTrastorn depressiu major; Tractament antiinflamatori; CitocinaMajor depressive disorder; Anti-inflammatory treatment; CytokineIntroduction: Previous research delivers strong indications that inflammatory activation leads to treatment resistance in a subgroup of patients with Major Depressive Disorder (MDD). Thus, tailored interventions are needed. The present study aimed to find potential biomarkers that may enable patients to be stratified according to immune activation. Methods: A phase IIa randomized placebo-controlled trial was performed to assess levels of inflammatory compounds in responders/remitters and non-responders/non-remitters to sertraline plus celecoxib (n = 20) and sertraline plus placebo (n = 23). Levels of macrophage migration inhibitory factor, neopterin, and tumor necrosis factor alpha were determined by enzyme-linked immunosorbent assay; response and remission were measured by reduction of the Montgomery Åsberg Depression Rating Scale score. Results: Both treatment groups showed a significant decline in depression symptoms, but no difference was found between groups. A clear pattern emerged only for macrophage migration inhibitory factor: placebo remitters showed significantly lower baseline levels than non-remitters (a similar trend was seen in responders and non-responders) while celecoxib responders showed a trend for higher baseline levels than non-responders. Conclusion: Small subsample sizes are a notable limitation, wherefore results are preliminary. However, the present study provides novel insights by suggesting macrophage migration inhibitory factor as a promising biomarker for treatment choice.This present work was funded by the EU 7th Framework program (grant number EU-FP7-CP-IP-2008-222963/EU-FP7-PEOPLE-2009-IAPP-MarieCurie-286334) and Horizon 2020 (grant number H2020-SC1-2016-2017/H2020-SC1-2017-Two-Stage-RTD). Further, part of this work was supported by the foundation Immunität und Seele. The funders had no role in the study design, data collection and analysis, or decision to publish

Large Possible retardation effects of quark confinement on the meson spectrum II

We present the results of a study of heavy-light-quark bound states in the context of the reduced Bethe-Salpeter equation with relativistic vector and scalar interactions. We find that satisfactory fits may also be obtained when the retarded effect of the quark-antiquark interaction is concerned.Comment: 11 pages, RevTex, to appear in PR