Regaining Trust

Chinese consumers still lack confidence in Bausch & Lomb contact lens care products after some users in Singapore and elsewhere developed eye problems Since cases of keratitis, an eye infection linked to contact lens use, were reported in Singapore earlier this year, the safety of Bausch & Lomb's contact lens solution has raised doubts in many regions and countries. China, a big consumer of contact lenses,

Weight loss maintenance after bariatric surgery

Metabolic and bariatric surgery(MBS)is an effective treatment for patients with morbid obesity and its comorbidities.However,many patients experience weight regain(WR)after achieving their nadir weight.Establishing the definition of WR is challenging as postoperative WR has various definitions.Risk factors for WR after MBS include anatomical,racial,hormonal,metabolic,behavioral,and psychological factors,and evaluating such factors preoperatively is necessary.Long-term regular follow-up and timely treatment by a multidisciplinary team are important because WR after surgery is multi-factorial.Although lifestyle interventions that focus on appropriate dietary education,physical activity education or interventions,and behavioral psychological interventions are suggested,more well-designed studies are needed because studies evaluating intervention methods and the effectiveness of WR prevention are lacking.Antiobesity drugs can be used to prevent and manage patients with WR after MBS;however,more research is needed to determine the timing,duration,and type of anti-obesity drugs used to prevent WR.

Bariatric surgery and long-term nutritional issues

Bariatric surgery is recognized as a highly effective therapy for obesity since it accomplishes sustained weight loss, reduction of obesity-related comorbidities and mortality, and improvement of quality of life. Overall, bariatric surgery is associated with a 42% reduction of the cardiovascular risk and 30% reduction of all-cause mortality. This review focuses on some nutritional consequences that can occur in bariatric patients that could potentially hinder the clinical benefits of this therapeutic option. All bariatric procedures, to variable degrees, alter the anatomy and physiology of the gastrointestinal tract; this alteration makes these patients more susceptible to developing nutritional complications, namely, deficiencies of macro-and micro-nutrients, which could lead to disabling diseases such as anemia, osteoporosis, protein malnutrition. Of note is the evidence that most obese patients present a number of nutritional deficits already prior to surgery, the most important being vitamin D and iron deficiencies. This finding prompts the need for a complete nutritional assessment and, eventually, an adequate correction of pre-existing deficits before surgery. Another critical issue that follows bariatric surgery is post-operative weight regain, which is commonly associated with the relapse of obesity-related comorbidities. Nu-tritional complications associated with bariatric surgery can be prevented by life-long nutritional monitoring with the administration of multivitamins and mineral supplements according to the patient's needs.

Endoscopic therapy of weight regain after bariatric surgery

Weight regain following primary bariatric surgery occurs in a significant proportion of patients and is attributed to epidemiological,anatomical and metabolic factors.Surgical revision of these patients has significant risks and limited benefits.Endoscopic revisions that reduce gastric pouch size and diameter of the gastrojejunal anastomosis may offer an effective,safe,less invasive and even reproducible treatment.We herein discuss the indication,selection and feasibility of different endoscopic techniques that could be used in the management of weight regain following primary bariatric surgery.Future research could optimize a personalized approach not only in the endoscopic management but also in combination with other therapeutic modalities for weight regain after bariatric surgery.

Syphilis testing algorithms:A review

The methods and strategies used to screen for syphilis and to confirm initially reactive results can vary significantly across clinical laboratories.While the performance characteristics of these different approaches have been evaluated by multiple studies,there is not,as of yet,a single,universally recommende dalgorithm for syphilis testing.To clarify the currently available options for syphilis testing,this update will summarize the clinical challenges to diagnosis,review the specific performance characteristics of treponemal and non-treponemal tests,and finally,summarize select studies published over the past decade which have evaluated these approaches.Specifically,this review will discuss the traditional and reverse sequence syphilis screening algorithms commonly used in the United States,alongside a discussion of the European Centre for Disease Prevention and Control syphilis algorithm.Ultimately,in the United States,the decision of which algorithm to use is largely dependent on laboratory resources,the local incidence of syphilis and patient demographics.

Therapeutic endoscopy for the treatment of post-bariatric surgery complications

Obesity rates continue to climb worldwide.Obesity often contributes to other comorbidities such as type 2 diabetes,hypertension,heart disease and is a known risk factor for many malignancies.Bariatric surgeries are by far the most invasive treatment options available but are often the most effective and can result in profound,durable weight loss with improvement in or resolution of weight associated comorbidities.Currently performed bariatric surgeries include Rouxen-Y gastric bypass,sleeve gastrectomy,and laparoscopic gastric banding.These surgeries are associated with significant weight loss,but also with significant rates of major complications.The complexity of these patients and surgical anatomies makes management of these complications by a multidisciplinary team critical for optimal outcomes.Minimally invasive treatments for complications are typically preferred because of the high risk associated with repeat operations.Endoscopy plays a large role in both the diagnosis and the management of complications.Endoscopy can provide therapeutic interventions for many bariatric surgical complications including anastomotic strictures,anastomotic leaks,choledocholithiasis,sleeve stenosis,weight regain,and eroded bands.Endoscopists should be familiar with the various surgical anatomies as well as the various therapeutic options available.This review article serves to delineate the current role of endoscopy in the management of complications after bariatric surgery.

Status of bariatric endoscopy–what does the surgeon need to know? A review

BACKGROUND Obesity is a chronic and multifactorial disease with a variety of potential treatment options available.Currently,there are several multidisciplinary therapeutic options for its management,including conservative,endoscopic,and surgical treatment.AIM To clarify indications,technical aspects,and outcomes of bariatric endoscopy.METHODS Narrative review of current literature based on electronic databases including MEDLINE(PubMed),Cochrane Library,and SciELO.RESULTS Bariatric endoscopy is in constant development and comprises primary and revisional treatment options as well as management of surgical complications.Various devices act upon different mechanisms of action,which may be individualized to each patient.Despite favorable results for the endoscopic treatment of obesity,prospective randomized studies with long-term follow-up are required to fully validate primary and revisional endoscopic therapies.Regarding the management of bariatric surgery complications,endoscopic therapy may be considered the procedure of choice in a variety of situations.Still,as there is no standardized algorithm,local experience should be considered in decision-making.CONCLUSION The treatment of patients with obesity is complex,and a multidisciplinary approach is essential.Bariatric endoscopy has shown impressive results both in the treatment of obesity and its surgical complications,and therefore,must be part of the armamentarium in the fight against this disease.

Determinates of Regain in Body Mass Index among Malnourished Aids Patients on Therapeutic Food in Amhara National Regional State, Northwest Ethiopia: A Retrospective Cohort Study

Although its utilization is greatly disputed, ready-to-use therapeutic food has been started as clinical nutrition care and treatment for malnourished adult AIDS patients since 2011 in Amhara National Regional State. However, factors determining the intended outcome (weight gain) have not been properly investigated. The main objective of the study was to assess improvement in body mass index and to identify its determinant factors. A retrospective cohort study design was conducted. Cluster sampling was employed to select health facilities in which the service was provided in the region. Of the 44 health facilities, nine were selected using lottery method, and all patients receiving the care in these health institutions were included in the study. Using tailored structured checklist, data were collected, organized and cleaned. Using paired T-test existence of difference between the mean of body mass index at admission and at 3rd visit was measured. Finally analysis of association between some selected independent variables with the outcome variable was done using logistic regression model at 95% CI and p 2). Paired T-test revealed that there was a statistically significant difference between mean of body mass index at admission and at the 3rd visit. Good ready-to-use therapeutic food treatment adherence (AOR 11.145;95% CI 6.556, 18.946), moderate acute malnutrition at admission (AOR 6.71;95% CI 2.618, 17.195), good ART adherence (AOR 2.136;95% CI, 1.269, 3.595) and being male (AOR 1.73;95% CI 1.052, 2.850) have a statistically significant contribution for body mass index improvement. The study identifies factors that determine gain in body mass index among AIDS patients on ready-to-use therapeutic food. However, although the study revealed a statistically significant difference between body mass index during enrolment, and after three months, we disagreed with the right and left utilization of imported food because of lack of sustainability, and aid dependency. We rather recommend interventions that encourage households to produce food with similar outcomes from locally available food staff.

Weight regain after bariatric surgery: Promoters and potential predictors

Obesity is globally viewed as chronic relapsing disease.Bariatric surgery offers the most efficient and durable weight loss approach.However,weight regain after surgery is a distressing issue as obesity can revert.Surgical procedures were originally designed to reduce food intake and catalyze weight loss,provided that its role is marginalized in long-term weight maintenance.Consequently,it is essential to establish a scientifically standardized applicable definitions for weight regain,which necessitates enhanced comprehension of the clinical situation,as well as have realistic expectations concerning weight loss.Moreover,several factors are proposed to influence weight regain as psychological,behavioral factors,hormonal,metabolic,anatomical lapses,as well as genetic predisposition.Recently,there is a growing evidence of utilization of scoring system to anticipate excess body weight loss,along with characterizing certain biomarkers that identify subjects at risk of suboptimal weight loss after surgery.Furthermore,personalized counseling is warranted to help select bariatric procedure,reinforce self-monitoring skills,motivate patient,encourage mindful eating practices,to avoid recidivism.

IN BRIEF

CNPC regains its leading position in the domestic oil and gas industry In 2018, PetroChina realized operating income of RMB2.77 trillion and a total profit of RMB 110.56 billion, ranking first for profit among domestic oil and gas enterprises and regaining the leading position in the domestic oil and gas industry.

Observation of a Chemical Softener’s Effects on Stem-Specific Lignocellulosic <i>Brassica napus</i>(Type: Canola) (Cultivar: HYHEAR 3) Fiber Quality

Chemical softener (Cepreton UN) is used to soften the cellulosic fiber (cotton) in the textile industries to make clothes better to touch. Therefore, this study investigated the effects of Cepreton UN on both physical (length, aspect ratio, contact angle, and moisture regain) and mechanical (load at break, elongation at break, tensile stress, young’s modulus, and tenacity) properties of the lignocellulosic canola (HYREAR 3) fibers extracted from narrow, medium, and wide stems. ANOVA showed that fiber diameter had strong effects on elongation at break, load at break, tensile stress, young’s modulus, and aspect ratio for all fibers. Corrgram values showed that tensile stress, young’s modulus, and aspect ratio were negatively correlated to fiber diameter whereas load at break and tenacity were mostly positively correlated to fiber diameter. The fibers were treated with 2% and 10% Cepreton UN and compared with control fibers. In most cases, the fiber diameter was decreased in both 2% and 10% treated medium stem fibers. The mean values of elongation at break, load at break, tenacity, and contact angle were decreased for 10% and increased for 2% and the mean values of tensile stress, young’s modulus, and aspect ratio were decreased for 2% and increased for 10% treated medium stem fibers. Moisture regain (%) mostly decreased for 2%, and increased for 10% treated fibers. Low pH (4.5) had an almost similar effect on fibers as 2% Cepreton UN. Overall, 2% Cepreton UN treatment is found to be better than 10% to make canola fibers less stiff and low pH was found to be an alternative softener treatment strategy.

Comparison of the ability of wavelet index and bispectral index for reflecting regain of consciousness in patients undergone surgery

Background Wavelet index （WLI） is a new parameter for monitoring depth of anesthesia based on Wavelet analysis. We observed the change of WLI and bispectral index （BIS） in patients regain of consciousness （ROC） in the absence of frontalis electromyographic （EMG） interference. The aim of this study was to compare the ability of WLI and BIS for reflecting ROC in patients undergone surgery. Methods Twelve patients who were scheduled for maxillofacial surgeries were enrolled in the study. BIS and WLI values were monitored continually. After being given midazolam and remifentanil, patients were asked to squeeze the investigator＇s hand ever 30 seconds. Patients were continuously given propofol until loss of consciousness （LOC1）. Tunstalrs isolated forearm technique was used to test the surgical consciousness in patients. After total muscle relaxation endotracheal intubations were performed, and the patients were connected to a ventilator. Then, propofol was withdrawn until the patients showed regain of consciousness （ROC1） and an awareness reaction. After the command test, patients were readministered with propofol until loss of consciousness （LOC2）. After surgery, all of the sedatives were withdrawn, and the patients were let to regain consciousness （ROC2）, Results The BIS values of twelve patients at ROC1 after using muscle relaxant were much lower than those at LOC1 and ROC2 without using muscle relaxant, showing statistical significance （P 〈0.05）. Meanwhile, the WLI values of twelve patients at ROC1 after using muscle relaxant were much higher than those at LOC1 and equal to ROC2 without using muscle relaxant, showing statistical significances （P 〈0.05） between ROC1 and LOCI. Conclusions This study showed that under muscle relaxation or facial paralysis, when there is no EMG signal, BIS can not accurately reflect regain of consciousness in surgical patients, but WLI can reflect it accurately. So WLI may have advantages for reflecting state of consciousness in surgical patients.

CD4+T cells memorize obesity and promote weight regain

Body weight regain often causes failure of obesity therapies while the underlying mechanism remains largely unknown.In this study,we report that immune cells,especially CD4+T cells,mediate the‘memory’of previous obese status.In a weight gain-loss-regain model,we found that C57BL/6J mice with an obesity history showed a much faster rate of body weight regain.This obesity memory could last for at least 2 months after previously obese mice were kept at the same body weight as non-obese mice.Surprisingly,such obesity memory was abrogated by dexamethasone treatment,whereas immunodeficient Rag1−/−and H2A−/−mice failed to establish such memory.Rag1−/−mice repossessed the obesity memory when immune cells or CD4+T cells isolated from previously obese mice were transferred.Furthermore,depletion of CD4+T cells led to obesity memory ablation.Taken together,we conclude that CD4+T cells mediate obesity memory and promote weight regain.

Made-in-China Regains Face

As the grand celebration of Christmas Day approaches,people all over the world once again get caught up in the festive atmosphere that embraces the traditional spending spree.And being a time for children and gift giving,it’s almost a given that most of us will be buying a toy at this holiday season.The chances that the toy chosen will carry a"Made-in-China"label are high as more than 80 percent of the world’s toys are now made here.