Laparoscopic Gastric Banding Outcomes Do Not Depend on Device or Technique. Long-Term Results of a Prospective Randomized Study Comparing the Lapband® and the SAGB®.

BACKGROUND: Gastric banding still represents one of the most widely used bariatric procedures. It provides acceptable weight loss in many patients, but has frequent long-term complications. Because different types of bands may lead to different results, we designed a randomized study to compare the Lapband® with the SAGB®. We hereby report on the long-term results. METHODS: Between December 1998 and June 2002, 180 morbidly obese patients were randomized between Lapband® or SAGB®. Weight loss, long-term morbidity, and need for reoperation were evaluated. RESULTS: Long-term weight loss did not differ between the two bands. Patients who maintained their band had an acceptable long-term weight loss of between 50 and 60 % EBMIL. In both groups, about half the patients developed long-term complications, with about 50 % requiring major redo surgery. There was no difference in the overall rates of long-term complications or failures between the two groups, but patients who had a Lapband® were significantly more prone to develop band slippage/pouch dilatation (13.3 versus 0 %, p < 0,001). CONCLUSIONS: Although in the absence of complication, gastric banding leads to acceptable weight loss; the long-term complication and major reoperation rates are very high independently from the type of band used or on the operative technique. Gastric banding leads to relatively poor overall long-term results and therefore should not be considered the procedure of choice for the treatment of morbid obesity. Patients should be informed of the limited overall weight loss and the very high complication rates.

Rhétorique et cognition : perspectives théoriques et stratégies persuasives

D'une certaine manière, la rhétorique est un art cognitif. L'art de discourir en situation concrète dans l'espoir de faire adhérer l'auditoire à une thèse suppose une forte aptitude cognitive: celle de se représenter la façon dont l'auditoire lui-même se représente une situation rhétorique. Or, à partir du moment où agir sur les représentations d'autrui est facilité par des techniques rhétoriques ou sophistiques, la question de la tromperie verbale s'est immiscée dans des affaires de régulation sociale et, avec elle, des enjeux tant de crédibilité que de crédulité. Dans le cadre démocratique rendant encore plus aiguë une forme de dépendance à l'information d'autrui, la nécessité de croire tout comme la possibilité d'être leurré mettent à l'épreuve tant le fonctionnement social de la Cité que l'évaluation des informations et de leurs auteurs. Le but des contributions de cet ouvrage n'est pas de dénoncer les effets de certains schèmes argumentatifs que d'aucuns jugeraient fallacieux ni d'ajouter une couche nouvelle aux critiques des sophismes, mais d'étudier leur fonctionnement et leurs effets cognitifs hic et nunc. Quels sont les mécanismes langagiers et cognitifs qui expliquent la «performance» des arguments réputés fallacieux? Comment fonctionnent les stratégies rhétoriques à l'intersection entre cognition, sciences du langage et société? Cet ouvrage, issu du colloque Communication et Cognition: manipulation, persuasion et biais dans le langage, tenu à Neuchâtel du 26 au 28 janvier 2011, propose plusieurs propositions originales ou hypothèses stimulantes dans l'espoir qu'elles inspireront tant les chercheurs spécialisés en rhétorique et sciences du langage à aller voir du côté de la psychologie cognitive que les spécialistes de ce domaine à mettre en évidence la rhétoricité de leurs recherches. English version: In a way, rhetoric is a cognitive art. The art of speaking in concrete situations in the hope of gaining the audience's consent on a given issue requires the operation of a cognitive ability: that of being able to represent the way an audience represents itself a rhetorical situation. Nonetheless, once we consider that rhetorical or sophistic techniques influence people's representations, verbal deception becomes a matter of social regulation, together with issues of credibility and credulity. In a democratic context fostering a form of dependence towards other people's information, the necessity of believing everything and the possibility of being duped are challenges for both the social management of the City and the evaluation of information and of its sources. The contribution of the chapters of this volume is neither to be found in the condemnation of the fallacious effects of specific argument schemes nor in the addition of yet another layer to fallacy criticism, but in the study of how fallacies work, hic et nunc. What are the linguistic and cognitive mechanisms at play behind the "performance" of fallacious arguments? How do rhetorical strategies work at the interface of cognition, language science and society? This book gathers papers that were presented during the international conference Communication & Cognition: manipulation, persuasion and biases in language, held at the University of Neuchâtel in January 2011. A number of original proposals and stimulating hypotheses emerge from them: we hope that these will inspire researchers in the language sciences who specialise in rhetoric to take on board cognitive scientific insights but also researchers in cognitive science to engage with the rhetoricity of their own research.

Carboplatin and weekly paclitaxel doublet chemotherapy compared with monotherapy in elderly patients with advanced non-small-cell lung cancer: IFCT-0501 randomised, phase 3 trial.

BACKGROUND: Platinum-based doublet chemotherapy is recommended to treat advanced non-small-cell lung cancer (NSCLC) in fit, non-elderly adults, but monotherapy is recommended for patients older than 70 years. We compared a carboplatin and paclitaxel doublet chemotherapy regimen with monotherapy in elderly patients with advanced NSCLC. METHODS: In this multicentre, open-label, phase 3, randomised trial we recruited patients aged 70-89 years with locally advanced or metastatic NSCLC and WHO performance status scores of 0-2. Patients received either four cycles (3 weeks on treatment, 1 week off treatment) of carboplatin (on day 1) plus paclitaxel (on days 1, 8, and 15) or five cycles (2 weeks on treatment, 1 week off treatment) of vinorelbine or gemcitabine monotherapy. Randomisation was done centrally with the minimisation method. The primary endpoint was overall survival, and analysis was done by intention to treat. This trial is registered, number NCT00298415. FINDINGS: 451 patients were enrolled. 226 were randomly assigned monotherapy and 225 doublet chemotherapy. Median age was 77 years and median follow-up was 30.3 months (range 8.6-45.2). Median overall survival was 10.3 months for doublet chemotherapy and 6.2 months for monotherapy (hazard ratio 0.64, 95% CI 0.52-0.78; p<0.0001); 1-year survival was 44.5% (95% CI 37.9-50.9) and 25.4% (19.9-31.3), respectively. Toxic effects were more frequent in the doublet chemotherapy group than in the monotherapy group (most frequent, decreased neutrophil count (108 [48.4%] vs 28 [12.4%]; asthenia 23 [10.3%] vs 13 [5.8%]). INTERPRETATION: Despite increased toxic effects, platinum-based doublet chemotherapy was associated with survival benefits compared with vinorelbine or gemcitabine monotherapy in elderly patients with NSCLC. We feel that the current treatment paradigm for these patients should be reconsidered. FUNDING: Intergroupe Francophone de Cancérologie Thoracique, Institut National du Cancer.

Jejunojejunal intussusception after Roux-en-Y gastric bypass: a review.

Small bowel intussusception is a rare long-term complication after Roux-en-Y gastric bypass, the etiology of which remains unclear. Except for one series reporting on 23 patients, case reports represent the vast majority of all cases reported so far. With this complete review of the world literature, based on a total of 63 patients including 2 of our own cases, we provide an extensive overview of the subject. The origin of intussusception after gastric bypass is different from that of intussusception of other causes, in that there is usually no lead point. It is likely related to motility disorders in the divided small bowel, especially in the Roux limb. This rare condition may cause obstruction and lead to bowel necrosis if not recognized and treated promptly. Clinical presentation is not specific. Computerized tomography scan represents the diagnostic test of choice, but surgery is sometimes the only way to establish the diagnosis. Treatment may be limited to reduction if the small bowel is viable, but resection of the affected segment is recommended on the basis of this review, since it seems to result in fewer recurrences. Knowledge of this entity and a high index of suspicion are required to make the correct diagnosis and offer appropriate treatment in a timely fashion.

Induced-feeding bioassays for detection of Bacillus thuringiensis insecticidal activity against Epilachna paenulata (Coleoptera)

The objective of this work was to establish and test the induced-feeding bioassay in order to detect Bacillus thuringiensis insecticidal activity against Epilachna paenulata (Coleoptera: Coccinellidae). Larvae were induced to swallow high concentrations of spore-crystal suspensions of seven exotic and 30 Argentine B. thuringiensis strains. The great majority of strains showed no toxicity to E. paenulata larvae, and observed mortality was lower than 30%. Induced-feeding bioassay is feasible, and should be used for prospecting strains that produce right combinations of Cry proteins needed to an efficient pest control.

Transitoriness in cancer patients: a cross-sectional survey of lung and gastrointestinal cancer patients.

Despite earlier diagnosis and advancements in treatment, cancer remains a leading cause of death in the world (13% of all deaths according to the World Health Organization) among men and women. Cancer accounts for approximately 20% of the deaths in the USA every year. Here, we report the findings from a cross-sectional survey of psychosocial factors in lung and gastrointestinal cancer patients. The aim of the study was to explore the associations among transitoriness, uncertainty, and locus of control (LOC) with quality of life. Transitoriness is defined as a person's confrontation with life's finitude due to a cancer diagnosis. A total of 126 patients with lung or gastrointestinal cancer completed eight self-reporting questionnaires addressing demographics, spiritual perspective, symptom burden, transitoriness, uncertainty, LOC, and quality of life. Transitoriness, uncertainty, and LOC were significantly associated with one another (r = 0.3267, p = 0.0002/r = 0.1994, p = 0.0252, respectively). LOC/belief in chance has a significant inverse relationship with patients' quality of life (r = -0.2505, p = 0.0047). Transitoriness, uncertainty, and LOC were found to have a significant inverse relationship with patients' quality of life (transitoriness state: r = -0.5363, p = 0.0000/trait: r = -0.4629, p = 0.0000/uncertainty: r = -0.4929, p = 0.0000/internal LOC: r = 0.1759, p = 0.0489/chance LOC: r = -0.2505, p = 0.0047). Transitoriness, uncertainty, and LOC are important concepts as they adversely influence patients' quality of life. Incorporating this finding into the care of cancer patients may provide them with the support they need to cope with treatment and maintenance of a positive quality of life.