Introduction. Class 3 obesity (BMI≥40 kg/m2) is a growing health problem worldwide associated with considerable comorbidity including Type 2 diabetes mellitus (T2DM). The multidisciplinary medical management of obesity can be difficult in T2DM due to potential weight gain from medications including sulphonylureas and insulin. However, newer weight-neutral/losing diabetes medications can aid additional weight loss. The aim of this study was to compare weight loss outcomes of patients with and without T2DM, and in patients with T2DM, to compare diabetes outcomes and change in medications at 6 months. Methods. All patients entering a multidisciplinary weight management metabolic program in a publicly funded hospital clinic in Sydney between March 2018 and March 2019, with BMI≥40 kg/m2 and aged ≥18 years were included. Data was collected from patient clinical and electronic notes at baseline and 6 months. Results. Of the 180 patients who entered the program, 53.3% had T2DM at baseline. There was no difference in percentage weight loss in those with or without T2DM (4.2±4.9% vs. 3.6±4.7%, p=0.35). Additionally, T2DM patients benefited from a 0.47% reduction in HbA1c (p<0.01) and a reduction in the number of medications from baseline to 6 months (1.8±1.0/patient vs. 1.0±1.2/patient, p<0.001). T2DM patients who started on weigh-neutral/losing medications in the program lost more weight than those started on weight-gaining medications (7.7±5.3% vs. 2.4±3.8%, p=0.015). Conclusions. Patients with class 3 obesity had significant weight loss at 6 months in this program. Patients with T2DM at baseline had comparable weight loss at 6 months, a significant improvement in glycaemic control, and a reduction in diabetes medication load. Additionally, patients with T2DM who were started on weight-neutral/losing medications lost significantly more weight than those started on weight-gaining medications, and these medications should be preferentially used in class 3 obesity and comorbid T2DM.

BackgroundColonoscopy plays an important role in the clinical screening and management of colorectal cancer. The traditional ‘see one, do one, teach one’ training style for such invasive procedure is resource intensive and ineffective. Given that colonoscopy is difficult, and time-consuming to master, the use of virtual reality simulators to train gastroenterologists in colonoscopy operations offers a promising alternative.MethodsIn this paper, a realistic and real-time interactive simulator for training colonoscopy procedure is presented, which can even include polypectomy simulation. Our approach models the colonoscopy as thick flexible elastic rods with different resolutions which are dynamically adaptive to the curvature of the colon. More material characteristics of this deformable material are integrated into our discrete model to realistically simulate the behavior of the colonoscope.ConclusionWe present a simulator for training colonoscopy procedure. In addition, we propose a set of key aspects of our simulator that give fast, high fidelity feedback to trainees. We also conducted an initial validation of this colonoscopic simulator to determine its clinical utility and efficacy.

We aimed to assess weight loss and metabolic outcomes by severity of weight-related complications following an intensive non-surgical weight management program (WMP) in an Australian public hospital. A retrospective cohort study of all patients aged ≥18 years with body mass index (BMI) ≥ 40 enrolled in the WMP during March 2018–March 2019 with 12-month follow-up information were stratified using the Edmonton Obesity Staging System (EOSS). Of 178 patients enrolled in the WMP, 112 (62.9%) completed at least 12 months’ treatment. Most patients (96.6%) met EOSS-2 (56.7%) or EOSS-3 (39.9%) criteria for analysis. Both groups lost significant weight from baseline to 12 months; EOSS-2: 139.4 ± 31.8 kg vs. 131.8 ± 31.8 kg (p < 0.001) and EOSS-3: 141.4 ± 24.2 kg vs. 129.8 ± 24.3 kg (p < 0.001). After adjusting for baseline age, sex and employment status, mean weight loss was similar but a greater proportion of EOSS-3 achieved >10% weight loss compared to EOSS-2, (40% vs. 15.9%, p = 0.024). Changes in metabolic parameters including HbA1c, BP and lipids did not differ between EOSS-2 and 3. Despite increased clinical severity, adult patients with class 3 obesity achieved clinically meaningful weight loss and similar improvements in metabolic parameters compared to patients with less severe complications after 12 months in an intensive non-surgical WMP.

Background This systematic review and meta‐analysis aimed to assess the efficacy and safety of the Absorb bioabsorbable vascular scaffold (BVS) versus everolimus‐eluting metallic stents (EES) at 3 years. Methods We searched MEDLINE, EMBASE, CENTRAL and relevant websites for articles published between 30 November 2006 and 18 December 2017. The primary efficacy outcome was target lesion revascularization (TLR), and the primary safety outcome was definite or probable stent (scaffold) thrombosis. Secondary outcomes included target lesion failure, myocardial infarction (MI), death, all revascularization and a patient‐oriented composite end‐point. We derived odds ratios (ORs) for the outcomes according to a fixed‐effects model. His study was registered with PROSPERO (CRD42017084290). Results We included five trials comprising data for 3,575 patients randomized to receive BVS (n = 2,256) or EES (n = 1,319). Patients treated with the BVS had a non‐statistically significant increased risk of TLR (OR 1.30 [95% CI 0.95–1.78]; p = 0.10). Patients treated with the BVS had a higher risk of definite or probable stent thrombosis (OR 2.68 [95% CI 1.57–4.58]; p < 0.001), target lesion failure (1.41 [1.12–1.78]; p = 0.004), MI (1.49 [1.13–1.98]; p = 0.005) and a patient‐oriented composite end‐point (1.21 [1.01–1.44]; p = 0.038) than those treated with an EES. Patients treated with the BVS had no statistically significant difference in death (0.80 [0.51–1.25]; p = 0.325) and all revascularization (1.12 [0.91–1.40]; p = 0.052) compared to those treated with an EES. Conclusion Everolimus‐eluting bioabsorbable vascular scaffolds are inferior to everolimus‐eluting metallic stents at 3 years.

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