ABSTRACT
BACKGROUND: Although laparoscopic adjustable gastric banding (LAGB) is a popular metabolic/bariatric procedure, few prospective studies have assessed its outcomes. This study aimed to prospectively assess LAGB safety and effectiveness outcomes using the MIDBAND™ (MID, Dardilly, France). METHODS: Between May 2005 and September 2006, 262 morbidly obese patients underwent primary gastric banding with pars flaccida technique in 13 French medical centers. Excess weight loss and change in body mass index (BMI, kilogram per square meter), percentage of patients with comorbidities, and obesity-related complications were recorded. Patients were followed at 6-month intervals for 3 years. A multivariable individual growth model was used to analyze weight change over time and determine potential predictors of weight loss. RESULTS: The majority of patients were female (n = 233, 89%), with mean age of 36.4 ± 9.7 years. At 3 years, LAGB with MIDBAND resulted in significant decrease in mean BMI from 41.8 ± 4.2 to 30.7 ± 5.8 (p < 0.0001). Median excess weight loss and excess BMI loss were 61% and 68%, respectively. The prevalence of obesity-related comorbidities had significantly decreased from 71% to 15% (p < 0.0001). Complications were observed in 26 patients (10%); device-related complications occurred in 20 patients (8.2%), requiring band removal in 8 (3.3%), and port revision in 8 (3.3%). Individual growth analysis identified significant predictors of weight loss including the number of follow-up visits. CONCLUSION: Prospective outcomes demonstrate the safety and efficacy of gastric banding over time using the MIDBAND. Individual growth modeling demonstrated that postoperative weight loss is strongly related to the frequency and consistency of follow-up visits.
Subject(s)
Gastroplasty/methods , Laparoscopy , Obesity, Morbid/surgery , Postoperative Complications/epidemiology , Adolescent , Adult , Body Mass Index , Comorbidity , Device Removal , Diabetes Mellitus/epidemiology , Female , Follow-Up Studies , France/epidemiology , Gastroplasty/adverse effects , Gastroplasty/instrumentation , Humans , Hypertension/epidemiology , Joint Diseases/epidemiology , Laparoscopy/methods , Male , Middle Aged , Obesity, Morbid/complications , Obesity, Morbid/epidemiology , Patient Selection , Postoperative Complications/etiology , Postoperative Complications/surgery , Prevalence , Prospective Studies , Quality of Life , Respiration Disorders/epidemiology , Time Factors , Treatment Outcome , Weight Loss , Young AdultABSTRACT
INTRODUCTION: Delayed ventricular repolarization is associated with rare, but often fatal, polymorphic tachyarrhythmias named Torsades de Pointes. ICH S7B guideline recommends an integrated approach for cardiovascular preclinical evaluation of new drug candidates, including action potential assays (as a Purkinje fiber test) but also proarrhythmia models. The aim of this preliminary study was to compare the respective value of two preclinical in vitro rabbit cardiac preparations-the Purkinje fiber and the isolated perfused heart (Langendorff method)-based on effects of dofetilide, a selective IKr inhibitor. METHODS: Transmembrane action potentials from rabbit Purkinje fibers were recorded using a conventional intracellular glass microelectrode. Electrocardiograms from rabbit isolated hearts were evaluated for QRS, QT and T wave durations (Tpeak-Tend). The pacing protocol was the same for both preparations (basal rate of 80 bpm and pacing of 40, 60 and 140 bpm). Dofetilide was tested in both systems at concentrations of 1, 3 and 10 nmol/L. RESULTS: In Purkinje fibers dofetilide induced a concentration- and reverse use-dependent increase in action potential durations measured at 50 and 90% of repolarization. At 10 nmol/L, only 3/10 fibers showed early after depolarizations. In the isolated heart model, dofetilide also induced a similar concentration- and reverse use-dependent increase in QT-interval. From 3 nmol/L, major changes in T wave morphology, R-on-T extrasystoles and TdP were observed, mainly at low rate. Prior to arrhythmias, T wave shape and duration were markedly altered suggesting an increase in the heterogeneity of cardiac ventricular repolarization. CONCLUSIONS: The effects of dofetilide were comparable in the two models for delayed repolarization but the isolated heart appears to be a better predictor for arrhythmias and a unique in vitro model to assess arrhythmogenic potential of QT prolonging compounds at least when associated with IKr/hERG inhibition.
Subject(s)
Arrhythmias, Cardiac/physiopathology , Disease Models, Animal , Heart/physiology , Purkinje Fibers/physiology , Action Potentials/drug effects , Action Potentials/physiology , Animals , Arrhythmias, Cardiac/drug therapy , Dose-Response Relationship, Drug , Heart/drug effects , In Vitro Techniques , Male , Phenethylamines/pharmacology , Phenethylamines/therapeutic use , Purkinje Fibers/drug effects , Rabbits , Sulfonamides/pharmacology , Sulfonamides/therapeutic useABSTRACT
The full vibrational Hamiltonian for the inversion of NH(3) and H(2)NO has been diagonalized in a basis set that is the direct product of functions of the inversion coordinate and of harmonic vibrational functions independent of this inversion coordinate. The kinetic part of the Hamiltonian matrix is constructed with the use of the closure relation for these vibrational functions. The method is tested with the potential function which is supposed to be harmonic for the vibrations orthogonal to the inversion coordinate: the first computed levels are in good agreement with experimental levels for NH(3). For higher levels, anharmonic terms should be included.
