Endoscopic therapy for weight loss: Gastroplasty, duodenal sleeves, intragastric balloons, and aspiration

A new paradigm in the treatment of obesity and metabolic disease is developing. The global obesity epidemic continues to expand despite the availability of diet and lifestyle counseling, pharmacologic therapy, and weight loss surgery. Endoscopic procedures have the potential to bridge the gap between medical therapy and surgery. Current primary endoscopic bariatric therapies can be classified as restrictive, bypass, spaceoccupying, or aspiration therapy. Restrictive procedures include the USGI Primary Obesity Surgery Endolumenal procedure, endoscopic sleeve gastroplasty using Apollo Over Stitch, Trans Oral GAstroplasty, gastric volume reduction using the ACE stapler, and insertion of the TERIS restrictive device. Intestinal bypass has been reported using the EndoB arrier duodenal-jejunal bypass liner. A number of space-occupying devices have been studied or are in use, including intragastric balloons(Orbera, Reshape Duo, Heliosphere BAG, Obalon), Transpyloric Shuttle, and Sati Sphere. The Aspire Assist aspiration system has demonstrated efficacy. Finally, endoscopic revision of gastric bypass to address weight regain has been studied using Apollo Over Stitch, the USGI Incisionless Operating Platform Revision Obesity Surgery Endolumenal procedure, Stomaphyx, and endoscopic sclerotherapy. Endoscopic therapies for weight loss are potentially reversible, repeatable, less invasive, and lower cost than various medical and surgical alternatives. Given the variety of devices under development, in clinical trials, and currently in use, patients will have multiple endoscopic options with greater efficacy than medical therapy, and with lower invasiveness and greater accessibility than surgery.

Prevalence of excessive internet use and its correlation with associated psychopathology in 11th and 12th grade students

Background Globally, the number of internet users has crossed the three-billion mark, while in India users grew over 17% in the first 6 months of 2015 to 354 million. This study presented a background on internet use and the existence of excessive internet use. Aim To study the extent of internet use in 11th and 12th grade students and the psychopathology, if any, associated with excessive internet use. Methods 426 students who met the inclusion criteria were recruited from 11 th and 12th grade classes from Kendriya Vidyalaya, New Delhi, India, and were assessed by Young's Internet Addiction Test and the Strength and Difficulties Questionnaire. Results Among the 426 students, the mean internet addiction total score was 36.63 (20.78), which indicated mild level of internet addiction. 1.41%(six students) was diagnosed as excessive internet users, while 30.28% and 23.94% were classified as moderate and mild internet users, respectively. The prevalence of internet addiction between gender was 58.22% in males and 41.78% in females. While both positive (prosocial) and negative (hyperactivity, emotional, conduct and peer problem) impacts of internet use were reported by students, in the current study excessive use of internet had a negative impact on students' lives as compared with positive impact, which was statistically significant (p<0.0001). Conclusion Excessive internet use led to abnormal behaviours which cause negative consequences to users. Early diagnosis of risk factors related to excessive internet use, provides education about responsible use and supervision of students by family members.

Production of biodiesel from unused algal biomass in Punjab, India

Biodiesel from inedible sources has become prominent in last few decades. But it is economically incompatible with petroleum diesel. At the same time, both petro-diesel and biodiesels are concerned with environmental pollution, global warming, etc. Algae, on the other hand, utilize CO2 for their growth and can minimize some sort of pollution level and results in carbon credit for a country. In Punjab, India, algae are seen to grow in many water bodies. But all those are taken away and dumped in vats. Some of this huge biomass was used for production of biodiesel in this work. Extraction of oil from algae was conducted by using Soxtherm（solvent extraction）. An amount of 9 wt% of algal oil was extracted by comparatively costly hexane, whereas 8% extraction was done by cheaper acetone. In the transesterification reaction, molar ratio（methanol： oil） of 6：1, catalyst（KOH） concentration of 3 wt%, reaction temperature of 60 °C, 60 min reaction time and a settling time of 2.5 h were found to be optimum conditions to get maximum ester with minimum free fatty acid content and viscosity. A statistical analysis for the transesterification procedure also showed a methanol-to-oil molar ratio of 6：1 and catalyst concentration of 3 wt% to be the optimum. Characterization of biodiesel was done and compared with ASTM/BIS standards. Most important properties of biodiesel ester like viscosity（3.12 c St or 3.12 mm2/s）, cloud and pour point（-1 and-6 °C, respectively）, flash and fire point（153 and 158 °C）, carbon residue content（0.03%）, acid number（0.36 mg of KOH/gm） were within the range of concerned standards.

Weight loss endoscopy: Development, applications, and current status

Obesity and its comorbidities- including diabetes and obstructive sleep apnea- have taken a large and increasing toll on the United States and the rest of the world. The availability of commercial, clinical, and operative therapies for weight management have not been effective at a societal level. Endoscopic bariatric therapy is gaining acceptance as more effective than diet and lifestyle measures, and less invasive than bariatric surgery. Various endoscopic therapies are analogues of the restrictive or bypass components of bariatric surgery, utilizing gastric remodeling or intestinal anastomosis to achieve proven weight loss and metabolic benefits. Others, such as aspiration therapy, employnovel mechanisms of action. Intragastric balloons have recently been approved by the United States Food and Drug Administration, and a number of other technologies have completed large multicenter trials(such as AspireA ssist aspiration therapy and Primary Obesity Surgery Endolumenal). Endoscopic sleeve gastroplasty and transoral outlet reduction for endoscopic revision of gastric bypass have proven safe and effective in a number of studies. As devices are approved for use, data will continue to accumulate for safety, effectiveness, and cost effectiveness. Bariatric endoscopists should be prepared to appropriately target and apply various endoscopic bariatric therapies in the context of a comprehensive long-term weight management program.

Tight near-total corrosive strictures of the proximal esophagus with concomitant involvement of the hypopharynx: Flexible endoscopic management using a novel technique

AIM To investigate the role of a novel minimally invasive endoscopic technique in the management of tight neartotal corrosive strictures of the proximal esophagus involving the hypopharynx.METHODS Two patients with near-total corrosive strictures of the proximal esophagus involving the hypopharynx were managed with the novel endoscopic technique. The technique involved passing a 0.025-inch flexible guidewire across the stricture, and stricture dilatation, using 10 F coaxial diathermy and balloon dilators, followed byelectro-incision of the proximal aspect of the residual eccentric stricture by means of a novel approach using a wire-guided sphincterotome.RESULTS Both patients were successfully managed on an outpatient department basis with the complete relief of symptoms and resolution of strictures on endoscopy and an esophagogram. No adverse events were seen during or after the procedure. There was no recurrence of symptoms at a follow-up of over a year in both cases. There was a significant improvement in the body mass index of both patients after the procedure.CONCLUSION We report a novel flexible endoscopic technique for the management of complex hypopharyngo-esophageal strictures. In experienced hands, the procedure is relatively simple, safe and effective with a durable response.

Diuretic Activity of Ethanol Extract of Piper attenuatum Leaves Might Be Due to the Inhibition of Carbonic Anhydrase Enzyme:An in vivo and in silico Investigation

Background:Ayurvedic system of medicine is well established for prevention and treatment of renal problems.There are vast number of medicinal plants mentioned in Ayurvedic system of medicine,including Piper attenuatum Buch.-Ham.ex Miq.,which has been known to exhibit diuretic properties.Objective:To investigate possible mechanism and diuretic activity of ethanol extract of P.attenuatum leaves.Methods:Present study reports an in vivo diuretic activity of ethanol extracts of P.attenuatum leaves.Twenty-four Sprague-Dawley male rats were deprived from food and water for 20 h,followed by being divided into four groups to receive normal saline,Furosemide,and two doses of the ethanol extract,respectively.Further,the ethanol extract were subjected for prelimnary phytochemical screening test,and analytical investigation was performed via high-performance thin-layer chromatography(HPTLC),followed by effectiveness exploration of putative bioactive compounds from P.attenuatum against human carbonic anhydrase(hCA)enzyme using molecular docking tool.Results:During phytochemicals screening,several groups of compounds such as amides,terpenoids,proteins,flavonoids,and glycosides have been identified.Further,HPTLC reveals presence of carbohydrates,proteins,amino acids,steroids,alkaloids,flavonoids,tannins,glycosides,and terpenoids.Significant diuretic action was revealed for both 200 mg/kg bw and 400 mg/kg bw of ethanol extract of P.attenuatum leaves.Interestingly,molecular docking analysis demonstrated greater binding affinity of compounds such as Cepharadione A,Nor-cepharadione B,Galbelgin,Crotepoxide,and Pipoxide chlorohydrin out of total 23 studied compounds against hCA isoforms(a key biomarker for diuretic)and score is comparable with standard drug Acetazolamide.Conclusion:It was concluded from the present studies that ethanol extract of P.attenuatum leaves exhibits signifi-cant diuretic activity.The activity may be correlated due to the presence of Cepharadione A,Norcepharadione B,Galbelgin,Crotepoxide,and Pipoxide chlorohydrin as key component responsible for inhibition of hCA isoforms.

Influence of deposition rate on the structural, optical and electrical properties of electron beam evaporated SnO_2 thin films for transparent conducting electrode applications

The role of deposition rate in the structural, optical and electrical properties of SnOthin films deposited by electron beam evaporation method is investigated by varying the deposition powers viz. 50, 75, and 100 W.The structural characterization of the films is done by X-ray diffraction(XRD) technique. The surface morphology of the films is studied by scanning electron microscopy(SEM). Rutherford back scattering(RBS) measurements revealed the thickness of the films ranging from 200 nm to 400 and also a change in the concentration of oxygen vacancies which is found to be the maximum in the film deposited at the lowest deposition rate. Optical absorption spectrum is recorded using the UV–V is spectroscopy and the films are found to be transparent in nature. A shift in the absorption edge is observed and is attributed to a different level of allowed energy states in conduction band minimum. The Hall effect and electrical measurements show a variation in the carrier concentrations, mobility and resistivity of the films. In order to explore a better compromise in electrical and optical properties for transparent electrode applications, skin depths calculations are also done to find the optimized values of carrier concentration and mobility.