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Longitudinal Intravital Image resolution associated with Tumor-Infiltrating Lymphocyte Motility inside Cancer of the breast Versions.
Laparoscopic gastric plication (LGCP) is a newer metabolic/bariatric surgical operation that requires no resection, no implantable device or bypass. We report outcomes in a cohort of LGCP patients at 10-year follow-up. Body mass index (BMI, kg/m2) evolution, total weight loss (%), and comorbidities were recorded. Repeated measures analysis of variance (ANOVA) was used to asses BMI change over 10 years. We have completed data of 86,9 % (109/125) of patients entering the study between 2009 and 2010, 21,6 % of all the patients were men. Mean age was 45,8 ±10,9 years, and mean baseline BMI was 42,1± 5,4 kg/m2. We observed still some weight reduction at 10 years. Hypertension and diabetes were the most frequent comorbidities. Incidence of diabetes decreased within ten years after the procedure, as well as the medication for diabetes decreased, on the other hand we observed no change in hyperlipoproteinemia. There were 16,8 % elective reoperations due to insufficient weight loss, out of that 19 % decided for malabsorptive procedure. There was no mortality or emergencies. At ten years follow-up, LGCP proved to be safe and effective method for obesity treatment.Bariatric and metabolic surgery underwent substantial changes in its history. In the early nineties of the last century, the most important was introduction of laparoscopic procedures. Laparoscopic operations lead to worldwide adoption of bariatric surgery. Shift from bariatric to metabolic surgery represents another substantial change in treatment philosophy. In metabolic surgery, it is improvement/remission of metabolic parameters, such as type 2 diabetes mellitus and others, rather than weight loss what is the most important measure of success. Despite undoubtful success of surgical treatments, only a small proportion of the potentially eligible patients undergoes the operation. There are often fears of both patients and referring physicians of excessive invasiveness, risks and irreversible anatomical changes, mistrust in treatment results. Ongoing research targets these points, the goal is to master less invasive options than standard laparoscopic operations. Direct involvement of other medical specialties, such as gastroenterology or invasive radiology, in patient treatment is essential as well. Gastroenterology and endoscopic gastric plication, partial jejunal bypass and others may serve as the examples. Invasive radiology may offer potentially effective treatment modalities, such as embolization of left gastric artery. There's a trend in patients' preferences, towards less invasive treatment, even though it may result in moderate effectivity, rather than vice versa, choosing highly invasive, more risky treatment, regardless its expected higher efficacy.Increasing prevalence of obesity and its complications in practically all developed countries worldwide is one of the most cardinal problems of current healthcare. Obesity is an important risk factor for the development of type 2 diabetes mellitus and it is closely interconnected with arterial hypertension, dyslipidemia and other diseases commonly referred to as metabolic syndrome or insulin resistance syndrome. Overall, this combination of diseases markedly increases risk of cardiovascular morbidity and mortality. In this paper, we provide a review of current possibilities of pharmacological modulation of body weight in patients with obesity both with and without diabetes. We also briefly mention the treatment possibilities using bariatric surgery and endoscopy, and discuss the perspectives of pharmacological modulation of body weight in patients with diabetes in the context of ongoing research programmes.Setting the right eating habits is one of the basic pillars of non-pharmacological treatment of obese patient. Nutritional interventions led by dietitians are a key part of obesity management. The principle of modern nutritional therapy is not the transmission of general information about nutrition, but individualized recommendations. The task of a dietitian is to provide information that is specific, requested, at the right time and in the right form, information that is understandable to the patient and can be included in his/her life. Dietitian creates a therapeutic relationship with the patient based on trust and accompanies them on his path to mastering the principle of a diet for weight loss. There is thus a shift from a rigid approach to dietary treatment of obese patients, where instead of prescribing a diet aiming at weight loss, the patient is given space for their own active involvement. Emphasis is placed on the long-term sustainability of the newly set regime. Therefore, not only the present comorbidities of obesity, but also other factors such as the patient's daily routine, level of physical activity and individual habits are considered in a well-performed nutritional intervention.Diet therapy of obesity and its metabolic complications is focused on the reversal of chronic positive energy balance, systemic inflammation and adipose tissue dysfunction. The priority in the treatment is caloric restriction together with increased nutritional quality, prevention of nutritional deficits, care of intestinal microbioma, reduction of the organism's exposure to contaminants and increase of the protective components in the diet. The recommended daily energy dose ranges from very low-calorie diets (1.5 to 3 MJ) to low-calorie diets (5 to 7 MJ). According to common EASD and ADA guidelines, the following energy-restricted types of diets are recommended in the management and prevention of metabolic complications of obesity in the form of type 2 diabetes mellitus Mediterranean, DASH, low-carbohydrate, and vegetarian style of diet. Particular attention is required for the diet following metabolic-bariatric surgery, which is focused on the prevention and treatment of potential nutritional deficits.Obesity is a metabolic disorder conditioned by several factors with the individual genetic proneness to accumulation of body fat with a positive energetic balance. If such definition describes the essential nature of obesity aptly, the treatment thereof ought to be the realm of somatic medicine and somatically oriented physicians, which is, unfortunately, frequently the case. Yet, not only being a disorder concerning improper body composition, but also a difference in cognitive processes and emotions of the obese, obesity needs to be considered in a more complex manner. The life of the obese consists of periods of strict, starvation diets on one hand and total loss of control and excessive calorie intake. check details Therefore, the corresponding therapy also needs to be provided in a more complex fashion, i.e. it is not solely the somatic disorder that should be addressed, but also the emotions and cognitions which induce the undesirable behaviour. Generally, it is possible to summarise that cognition and emotions are likely to be anticipated, directed and controlled by affecting the stimuli promoting the erratic attitude.
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