Bariatric endoscopy is an emerging subspecialty for gastroenterologists encompassing a broad array of procedures including primary endoscopic bariatric and metabolic therapies and the treatment of complications of bariatric surgery. In addition, comprehensive understanding of lifestyle intervention and pharmacotherapy are essential to successful outcomes. This review summarizes goals and steps of training for this emerging field.
Bariatric Surgery ; Drug Therapy ; Endoscopy ; Life Style

Objectives: Chronic rhinitis may contribute to a persistently decreased quality of life in patients undergoing surgical treatment for obstructive sleep apnea (OSA). This study aimed to characterize the role of OSA in pediatric patients with refractory chronic rhinitis after adenoidectomy. Methods: We reviewed the charts of patients <18 years of age with a history of OSA who underwent adenoidectomy at an academic medical center from October 2012 to December 2018 and that were seen in the clinic for follow-up. They were identified through the Current Procedural Terminology (CPT) codes 42830 and 42831 with the exclusion of CPT 42820 for tonsillectomy and adenoidectomy. Patients with a prior diagnosis of OSA who had refractory symptoms were compared with those who had symptoms resolution using chi-square analysis and t-tests. Results: Thirty-six (35.0%) patients with refractory symptoms following adenoidectomy and 52 (37.4%) patients without refractory symptoms had a history of OSA before surgery (p=0.80). In patients with refractory symptoms, the average age (3.8 years) and male sex (n=24, 66.7%) did not differ significantly from the age (4.42 years) and male sex (n=36, 69.2%) percentages of patients without refractory symptoms. The mean apnea/hypopnea-index (AHI) (p=0.91), completion of the sleep study (p=0.41), history of snoring (p=0.92), and tonsil size (p=0.42) did not differ significantly between the groups. However, patients with refractory symptoms had a significantly higher mean body mass index (BMI) (19.58) than those who did not (17.77, p=0.04) and completed a higher number of allergy evaluations (p=0.02). Conclusions While the history and severity of OSA did not differ significantly in patients with refractory nasal symptoms after adenoidectomy, these patients had a significantly higher BMI and completion of allergy evaluation.

Variations of the anterior cerebral artery-anterior communicating artery complex are commonly identified in aneurysm surgery. An infraoptic course of the anterior cerebral artery is exceedingly rare. Robison first described this anomaly from an anatomic dissection in 1959. A unilateral anomalous infraoptic anterior cerebral artery is more common than anomalies of bilateral infraoptic anterior cerebral arteries. We present the case of an unruptured aneurysm at the anterior communicating artery in a patient with bilateral infraoptic anterior cerebral arteries, identified by computed tomography angiography and verified during surgery. Implications for aneurysm formation and surgical treatment are discussed.
Aneurysm ; Angiography ; Anterior Cerebral Artery* ; Arteries ; Humans ; Intracranial Aneurysm* ; Vascular Surgical Procedures

Background/Aims: Upper gastrointestinal bleeding (UGIB) is a life-threatening condition that necessitates early identification and intervention and is associated with substantial morbidity, mortality, and socioeconomic burden. However, several diagnostic challenges remain regarding risk stratification and the optimal timing of endoscopy. The PillSense System is a noninvasive device developed to detect blood in patients with UGIB in real time. This study aimed to assess the safety and performance characteristics of PillSense using a simulated bleeding model. Methods: A preclinical study was performed using an in vivo porcine model (14 animals). Fourteen PillSense capsules were endoscopically placed in the stomach and blood was injected into the stomach to simulate bleeding. The safety and sensitivity of blood detection and pill excretion were also investigated. Results: All the sensors successfully detected the presence or absence of blood. The minimum threshold was 9% blood concentration, with additional detection of increasing concentrations of up to 22.5% blood. All the sensors passed naturally through the gastrointestinal tract. Conclusions This study demonstrated the ability of the PillSense System sensor to detect UGIB across a wide range of blood concentrations. This ingestible device detects UGIB in real time and has the potential to be an effective tool to supplement the current standard of care. These favorable results will be further investigated in future clinical studies.

Objective To explore the outcomes of computer-assisted design of therapeutic personalized footwear for diabetic foot.Methods Fifty-eight cases of diabetic foot were included in the study.Ten items of data from theses patients were measured with methods provided by Salford University.All characteristics of the footwear were calculated with computer.Shoes were specially designed with the formula and computational method provided by Safford university.All patients had worn the shoes for 13 months.Special questionnaires were used to measure the outcomes.Results Thirty-two cases had been followed up for one month,25 cases for 2 months,25 cases for 3 months and 42 cases for 13 months.The score had improved from 67.94±15.14 before wearing the shoes to 78.13±1.44 thirteen months after wearing.The health score of the foot had improved.There was significant difference between before and after wearing the footwears.Conclusion Special-designed diabetic shoes play an important role in the prevention of ulcer for diabetic foot patients.Computational method and data model obtained from Salford university needs to be modified when applying it for Chinese.

While Onyx embolization of cerebrospinal arteriovenous shunts is well-established, clinical researchers continue to broaden applications to other vascular lesions of the neuraxis. This report illustrates the application of Onyx (eV3, Plymouth, MN) embolization to vertebral body lesions, specifically, a vertebral hemangioma and renal cell carcinoma vertebral body metastatic lesion.
Carcinoma, Renal Cell ; Hemangioma

The diagnosis or exclusion of pulmonary embolism (PE) remains challenging for emergency physicians. Symptoms can be vague or non-existent, and the clinical presentation shares features with many other common diagnoses. Diagnostic testing is complicated, as biomarkers, like the D-dimer, are frequently false positive, and imaging, like computed tomography pulmonary angiography, carries risks of radiation and contrast dye exposure. It is therefore incumbent on emergency physicians to be both vigilant and thoughtful about this diagnosis. In recent years, several advances in treatment have also emerged. Novel, direct-acting oral anticoagulants make the outpatient treatment of low risk PE easier than before. However, the spectrum of PE severity varies widely, so emergency physicians must be able to risk-stratify patients to ensure the appropriate disposition. Finally, PE response teams have been developed to facilitate rapid access to advanced therapies (e.g., catheter directed thrombolysis) for patients with high-risk PE. This review will discuss the clinical challenges of PE diagnosis, risk stratification and treatment that emergency physicians face every day.
Angiography ; Anticoagulants ; Biomarkers ; Catheters ; Diagnosis* ; Diagnostic Tests, Routine ; Emergencies* ; Emergency Service, Hospital* ; Hospital Rapid Response Team ; Humans ; Outpatients ; Pulmonary Embolism* ; Venous Thrombosis

Neck pain presents as a symptom of dull pain or discomfort mainly along the trapezius muscle. Dry needling is an invasive procedure which uses acupuncture needle directed at myofascial trigger points. The aim of the study was to evaluate the effectiveness of dry needling in managing patients with neck pain. A pre-test-post-test interventional study design was used. Patient education package was provided to 32 respondents who fulfilled the inclusion criteria. A 13-item Pain Catastrophizing Scale (PCS) questionnaire was used to assess Rumination, Magnification and Helplessness. Subjective pain intensity was measured by Visual Analogue Scale (VAS). These questionnaires were given before and after the dry needling intervention. The findings reported that respondents scored high in pre-test total PCS score (27.41±13.652). Post-test result revealed a significant improvement in total PCS score (23.06±13.938) (p = 0.000). Post-test VAS score (4.78±1.237) was also significantly better than pre-test (6.47±1.414) (p = 0.000). There was no significant difference in pre-test PCS in terms of marital status (p > 0.05) whereas there was significant difference between marital status and rumination in post-test (Z = -2.303, p = 0.021). There was significant difference between pre-test magnification in terms of respondents’ occupation (p = 0.008) and race (p = 0.035) but no significant difference in post-test. Respondents’ age group showed no significant differences between pre-test and post-test PCS and VAS (p > 0.05). In conclusion, patients who received dry needling showed improvement in pain intensity and catastrophizing towards neck pain.
Neck Pain

No abstract available.
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