Importance Although bariatric surgery is the most cost-effective treatment for severe obesity, less than 1% of severely obese patients undergo it. Reasons for low utilization are unclear. Objectives To identify patient and referring provider characteristics associated with the likelihood of undergoing bariatric surgery. Evidence Review PubMed, PsycINFO, CINAHL, and the Cochrane databases were searched for reports published between January 1, 1998, and December 31, 2014. Reports were eligible if they presented descriptive data regarding facilitators or barriers to bariatric surgery or if they reported statistical associations between patient or provider characteristics and referral to or receipt of bariatric surgery. Frequency effect sizes were calculated as the proportion of studies reporting a finding. Findings Of the 7,212 reports identified in the initial search, 53 were included in full-text review. Nine reports met our inclusion criteria and were included in analyses. Of those, four included descriptive findings, six reported statistical associations, and one included both. One report included providers as study participants, whereas eight included patients. Four of nine studies identified an association between female gender and a greater willingness to undergo bariatric surgery. Lack of knowledge about bariatric surgery was a barrier in two studies. Five of nine cited patient concerns about the outcomes and safety of bariatric surgery as a barrier to undergoing it. Patients were more likely to pursue bariatric surgery when it was recommended by referring providers. Providers who believed that obesity treatment should be covered by insurance were more likely to recommend bariatric surgery. Conclusions and Relevance Limited patient and referring provider knowledge about the safety and effectiveness of bariatric surgery are important barriers to bariatric surgery utilization. Future efforts focused on improving knowledge and identification of the critical determinants of obesity treatment decision making from both the provider and patient perspectives would have an important public heath impact.

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Background and Purpose-The purpose of this study was to assess the frequency, severity, and predictors of neurological deficits after adjuvant embolization for cerebral arteriovenous malformations. Methods-From 1997 to 2006, 202 of 275 patients with arteriovenous malformation received embolization before microsurgery (nϭ176) or radiosurgery (nϭ26). Patients were examined before and after endovascular embolization and at clinical follow-up (mean, 43.4Ϯ34.6 months). Outcome was classified according to the modified Rankin Scale. New neurological deficits after embolization were defined as minimal (no change in overall modified Rankin Scale), moderate (modified Rankin Scale Յ2), or significant (modified Rankin Scale Ͼ2). Results-Two hundred two patients were treated in 377 embolization procedures. There were a total of 29 new clinical deficits after embolization (8% of procedures; 14% of patients), of which 19 were moderate or significant. Postembolization deficits resolved in a significant number of patients over time (PϽ0.0001). Five patients had persistent neurological deficits due to embolization (1.3% of procedures; 2.5% of patients). In multivariate analysis, the following variables significantly predicted new neurological deficit after embolization: complex arteriovenous malformation with treatment plan specifying more than one embolization procedure (OR, 2.7; 95% CI, 1.4 to 8.6), diameter Ͻ3 cm (OR, 3.2; 95% CI, 1.2 to 9.1), diameter Ͼ6 cm (OR, 6.2; 95% CI, 1.0 to 57.0), deep venous drainage (OR, 2.7; 95% CI, 1.1 to 6.9), or eloquent location (OR, 2.4; 95% CI, 1.0 to 5.7). These variables were weighted and used to compute an arteriovenous malformation Embolization Prognostic Risk Score for each patient. A score of 0 predicted no new deficits, a score of 1 predicted a new deficit rate of 6%, a score of 2 predicted a new deficit rate of 15%, a score of 3 predicted a new deficit rate of 21%, and a score of 4 predicted a new deficit rate of 50% (PϽ0.0001). Conclusions-Small

The management of cerebral arteriovenous malformations (AVMs) continues to present a challenge to neurosurgeons. The natural history of this condition, as well as the morbidity and mortality of therapeutic interventions, remains incompletely elucidated. Predictive factors and grading scales in AVM management allow risk-benefit analysis of treatment options and comparison of outcomes. Stereotactic radiosurgery is one of the established treatment modalities for AVMs and is generally used to treat lesions that are high risk for surgical resection. Radiosurgery aims to obliterate AVMs and thus prevent hemorrhage or seizure without any new or worsening of existing symptoms. Lesion characteristics and postsurgical complications differ markedly in patientstreated by radiosurgery versus microsurgery. Radiosurgery-based grading systems account for factors that have been associated with various aspects of radiosurgical outcomes including obliteration, hemorrhage, and postoperative complications, particularly those induced by radiation. The purpose of this paper is to describe the most current predictive factors and grading systems for radiosurgical treatment of cerebral AVMs.

This is a follow-up study of eight operated spinal cord tumors in children. 1) The patients are seven males and one female ranging in age from six months to eleven years old. 2) The level of tumor development is one in cervical, one in cervico-dorsal, four in dorsal, one in dorso-lumobar and one in cauda equina. 3) The transverse distribution consists of four extradural, three intradural-extramedullary and one intramedullary tumors. Pathological diagnosis shows two epidermoids, one each neurinoma, meningioma, glioma, lipoma, liposarcoma and neuroblastoma. These distributions are much different from adults' cases. 4) Long neglected cases are frequent because of wrong or no diagnosis. 5) The results of operations reveal four imporvement, one stationary, two postoperative deaths and one death one year postoperatively. These results are inferior to those in the adults' cases. 6) Making earlier diagnosis should be mandatory to improve postoperative results. For this purpose, it is stressed that the determination of Elasberrg-Dyke curve is essential because earlier and clearer detection is feasible for the bony change on the roentgenogram by the tumor growth in children than in adults (five cases out of eight: 62%).

Epithelial cell adhesion molecule EpCAM is expressed in pluripotent embryonic stem cells (ESC) in vitro, but is repressed in differentiated cells, except epithelia and carcinomas. Molecular functions ofEpCAM, possibly imposing such repression, were primarily studied in malignant cells and might not apply to non-pathologic differentiation. Here, we comprehensively describe timing and rationale for EpCAM regulation in early murine gastrulation and ESC differentiation using single cell RNA-sequencing datasets, in vivo and in vitro models including CRISPR-Cas9-engineered ESC-mutants. We demonstrate expression of EpCAM in inner cell mass, epiblast, primitive/visceral endoderm, and strict repression in the most primitive, nascent Flk1 + mesoderm progenitors at E7.0. Selective expression of EpCAM was confirmed at mid-gestation and perinatal stages. The rationale for strict patterning was studied in ESC differentiation. Gain/loss-of-function demonstrated supportive functions of EpCAM in achieving full pluripotency and guided endodermal differentiation, but repressive functions in mesodermal differentiation as exemplified with cardiomyocyte formation. We further identified embryonic Ras (ERas) as novel EpCAM interactor of EpCAM and an EpCAM/ERas/AKT axis that is instrumental in differentiation regulation. Hence, spatiotemporal patterning of EpCAM at the onset of gastrulation, resulting in early segregation of interdependent EpCAM + endodermal and EpCAM − /vimentin + mesodermal clusters represents a novel regulatory feature during ESC differentiation.Epithelial cell adhesion molecule EpCAM was originally described as a cell surface antigen highly expressed in human carcinomas 1 . Today, we know that EpCAM is present as a heart-shaped cis-dimer at the cell surface 2 , and that it has a broader but nevertheless sharply restricted expression pattern in undifferentiated pluripotent

These findings contribute to a small but growing body of research demonstrating differential effects of oxytocin in men and women.

Social anxiety disorder (SAD) is one of the most prevalent psychiatric disorders in the United States. Although evidenced-based behavioral treatments are available, less than 20% of those with SAD receive treatment. Internet-based interventions can address barriers to treatment access, and guided Internet-based treatments have been demonstrated to be effective for SAD. However, the optimal role (if any) of the therapist in such programs remains unclear. We examined the acceptability and efficacy of a novel Internet-based cognitive-behavior therapy for SAD that utilizes traditional behavioral interventions (e.g., exposure) within the context of a model emphasizing mindfulness and psychological acceptance. Forty-two participants were randomized to an eight-module self-help intervention with ( n = 20) or without ( n = 22) adjunctive therapist support; the therapist support was delivered through 10 to 15 min of weekly videoconferencing and daily text messages. Both groups experienced a significant reduction in SAD symptoms and improvements in functioning and quality of life, with no significant differences between groups in both completer-only and intent-to-treat analyses. However, the therapist support group evidenced lower attrition than the minimal support group (20% vs. 50%). Implications for dissemination and future directions are discussed.