The first survey addressing patients with BMI over 50: a survey of 789 bariatric surgeons

Background: Bariatric surgery in patients with BMI over 50 kg/m2 is a challenging task. The aim of this study was to address main issues regarding perioperative management of these patients by using a worldwide survey. Methods: An online 48-item questionnaire-based survey on perioperative management of patients with a BMI superior to 50 kg/m2 was ideated by 15 bariatric surgeons from 9 different countries. The questionnaire was emailed to all members of the International Federation of Surgery for Obesity (IFSO). Responses were collected and analyzed by the authors. Results: 789 bariatric surgeons from 73 countries participated in the survey. Most surgeons (89.9%) believed that metabolic/bariatric surgery (MBS) on patients with BMI over 50 kg/m2 should only be performed by expert bariatric surgeons. Half of the participants (55.3%) believed that weight loss must be encouraged before surgery and 42.6% of surgeons recommended an excess weight loss of at least 10%. However, only 3.6% of surgeons recommended the insertion of an Intragastric Balloon as bridge therapy before surgery. Sleeve Gastrectomy (SG) was considered the best choice for patients younger than 18 or older than 65 years old. SG and One Anastomosis Gastric Bypass were the most common procedures for individuals between 18 and 65 years. Half of the surgeons believed that a 2-stage approach should be offered to patients with BMI > 50 kg/m2, with SG being the first step. Postoperative thromboprophylaxis was recommended for 2 and 4 weeks by 37.8% and 37.7% of participants, respectively. Conclusion: This survey demonstrated worldwide variations in bariatric surgery practice regarding patients with a BMI superior to 50 kg/m2. Careful analysis of these results is useful for identifying several areas for future research and consensus building

Endoscopic internal drainage for the management of leak, fistula, and collection after sleeve gastrectomy: our experience in 617 consecutive patients

Background: Endoscopy plays a pivotal role in the management of adverse events (AE) following bariatric surgery. Leaks, fistulae, and post-operative collection after sleeve gastrectomy (SG) may occur in up to 10% of cases. Objectives: To evaluate the efficacy and safety of endoscopic internal drainage (EID) for the management of leak, fistula, and collection following SG. Setting: Retrospective, observational, single center study on patients referred from several bariatric surgery departments to an endoscopic referral center. Methods: EID was used as first-line treatment for the management of leaks, fistulae, and collections. Leaks and fistulae were treated with double pigtail stent (DPS) deployment in order to guarantee internal drainage and second intention cavity obliteration. Collections were treated with endoscropic ultrasound (EUS)–guided deployment of DPS or lumen apposing metal stents. Results: A total of 617 patients (83.3% female; mean age, 43.1 yr) were enrolled in the study for leak (n = 300, 48.6%), fistula (n = 285, 46.2%), and collection (n = 32, 5.2%). Median follow-up was 19.5 months. Overall clinical success was 84.7% whereas 15.3% of cases required revisional surgery after EID failure. Clinical success according to type of AE was 89.5%, 78.5%, and 90% for leak, fistula, and collection, respectively. A total of 10 of 547 (1.8%) presented a recurrence during follow-up. A total of 28 (4.5%) AE related to the endoscopic treatment occurred. At univariate logistic regression predictors of failure were: fistula (OR 2.012), combined endoscopic approach (OR 2.319), need for emergency surgery (OR 1.755), and previous endoscopic treatment (OR 4.818). Conclusion: Early EID for the management of leak, fistula, and post-operative collection after SG seems a safe and effective first-line approach with good long-term results

Global management of a common, underrated surgical task during the COVID-19 pandemic. Gallstone disease. An international survery

Background: Since the Coronavirus disease-19(COVID-19) pandemic, the healthcare systems are reallocating their medical resources, with consequent narrowed access to elective surgery for benign conditions such as gallstone disease(GD). This survey represents an overview of the current policies regarding the surgical management of patients with GD during the COVID-19 pandemic. Methods: A Web-based survey was conducted among 36 Hepato-Prancreato-Biliary surgeons from 14 Countries. Through a 17-item questionnaire, participants were asked about the local management of patients with GD since the start of the COVID-19 pandemic. Results: The majority (n = 26,72.2%) of surgeons reported an alarming decrease in the cholecystectomy rate for GD since the start of the pandemic, regardless of the Country: 19(52.7%) didn't operate any GD, 7(19.4%) reduced their surgical activity by 50–75%, 10(27.8%) by 25–50%, 1(2.8%) maintained regular activity. Currently, only patients with GD complications are operated. Thirty-two (88.9%) participants expect these changes to last for at least 3 months. In 15(41.6%) Centers, patients are currently being screened for SARS-CoV-2 infection before cholecystectomy [in 10(27.8%) Centers only in the presence of suspected infection, in 5(13.9%) routinely]. The majority of surgeons (n = 29,80.6%) have adopted a laparoscopic approach as standard surgery, 5(13.9%) perform open cholecystectomy in patients with known/suspected SARS-CoV-2 infection, and 2(5.6%) in all patients. Conclusion: In the ongoing COVID-19 emergency, the surgical treatment of GD is postponed, resulting in a huge number of untreated patients who could develop severe morbidity. Updated guidelines and dedicated pathways for patients with benign disease awaiting elective surgery are mandatory to prevent further aggravation of the overloaded healthcare systems

Bovine endometrial stromal cells display osteogenic properties

The endometrium is central to mammalian fertility. The endometrial stromal cells are very dynamic, growing and differentiating throughout the estrous cycle and pregnancy. In humans, stromal cells appear to have progenitor or stem cell capabilities and the cells can even differentiate into bone. It is not clear whether bovine endometrial stromal cells exhibit a similar phenotypic plasticity. So, the present study tested the hypothesis that bovine endometrial stromal cells could be differentiated along an osteogenic lineage. Pure populations of bovine stromal cells were isolated from the endometrium. The endometrial stromal cell phenotype was confirmed by morphology, prostaglandin secretion, and susceptibility to viral infection. However, cultivation of the cells in standard endometrial cell culture medium lead to a mesenchymal phenotype similar to that of bovine bone marrow cells. Furthermore, the endometrial stromal cells developed signs of osteogenesis, such as alizarin positive nodules. When the stromal cells were cultured in a specific osteogenic medium the cells rapidly developed the characteristics of mineralized bone. In conclusion, the present study has identified that stromal cells from the bovine endometrium show a capability for phenotype plasticity similar to mesenchymal progenitor cells. These observations pave the way for further investigation of the mechanisms of stroma cell differentiation in the bovine reproductive tract

Global management of a common, underrated surgical task during the COVID-19 pandemic: Gallstone disease - An international survery

Background: Since the Coronavirus disease-19(COVID-19) pandemic, the healthcare systems are reallocating their medical resources, with consequent narrowed access to elective surgery for benign conditions such as gallstone disease(GD). This survey represents an overview of the current policies regarding the surgical management of patients with GD during the COVID-19 pandemic. Methods: A Web-based survey was conducted among 36 Hepato-Prancreato-Biliary surgeons from 14 Countries. Through a 17-item questionnaire, participants were asked about the local management of patients with GD since the start of the COVID-19 pandemic. Results: The majority (n = 26,72.2%) of surgeons reported an alarming decrease in the cholecystectomy rate for GD since the start of the pandemic, regardless of the Country: 19(52.7%) didn't operate any GD, 7(19.4%) reduced their surgical activity by 50–75%, 10(27.8%) by 25–50%, 1(2.8%) maintained regular activity. Currently, only patients with GD complications are operated. Thirty-two (88.9%) participants expect these changes to last for at least 3 months. In 15(41.6%) Centers, patients are currently being screened for SARS-CoV-2 infection before cholecystectomy [in 10(27.8%) Centers only in the presence of suspected infection, in 5(13.9%) routinely]. The majority of surgeons (n = 29,80.6%) have adopted a laparoscopic approach as standard surgery, 5(13.9%) perform open cholecystectomy in patients with known/suspected SARS-CoV-2 infection, and 2(5.6%) in all patients. Conclusion

Evaluation precision of RTK technique with the use of GNSS Continually Operated Reference Stations

295 σ.Η συνεχής εξέλιξη των Παγκόσμιων Δορυφορικών Συστημάτων Πλοήγησης GNSS (GPS, GLONASS, GALILEO, κ.ά.), όσον αφορά τη χρήση τους σε γεωδαιτικές εφαρμογές για τον προσδιορισμό θέσεων στη φυσική γήινη επιφάνεια, οδήγησε στη δημιουργία των παγκόσμιων και ευρωπαϊκών δικτύων μόνιμων σταθμών αναφοράς, σε εθνική, περιφερειακή, ή τοπική κλίμακα. Έτσι ενώ μέχρι σήμερα για μετρήσεις πραγματικού χρόνου αλλά και μετεπεξεργασίας, απαιτούνταν 2 δέκτες, τον 2ο δέκτη έχει αντικαταστήσει ο μόνιμος σταθμός αναφοράς, με αποτέλεσμα να είναι πλέον δυνατό να πραγματοποιούνται μετρήσεις με την ύπαρξη ενός και μόνο δέκτη. Η αποστολή διορθώσεων πραγματικού χρόνου δεν γίνεται μέσω ραδιοζεύξης αλλά μέσω ίντερνετ, ενώ τα δεδομένα των μετρήσεων του σταθμού αναφοράς αποθηκεύονται σε server όπου μέσω ίντερνετ υπάρχει δυνατότητα ανάκτησής τους για μετεπεξεργασία. Οι διορθώσεις πραγματικού χρόνου λαμβάνονται είτε από ένα μόνο σταθμό αναφοράς, (τεχνική single base), είτε ταυτόχρονα από περισσότερους σταθμούς αναφοράς, (δικτυακή τεχνική). Οι ακρίβειες που επιτυγχάνονται για μετρήσεις σε πραγματικό χρόνο κυμαίνονται για την τεχνική RTK έως 2cm, για την τεχνική DGPS έως και 1μ, ενώ για εφαρμογές μετεπεξεργασίας λίγα χιλιοστά. Ακολουθώντας αυτή την εξέλιξη, δημιουργήθηκε στην Ελλάδα από την Κτηματολόγιο Α.Ε. το σύστημα HEPOS, το οποίο αποτελεί το πρώτο Ελληνικό δίκτυο Μόνιμων Σταθμών Αναφοράς GPS. Παράλληλα 6 ιδιωτικές εταιρείες έχουν ιδρύσει πλήθος σταθμών αναφοράς GNSS σε όλη την Ελλάδα. Σκοπός της διπλωματικής εργασίας είναι η αξιολόγηση της ακρίβειας εντοπισμού της τεχνικής RTK με χρήση μόνιμων σταθμών αναφοράς. Έγινε χρήση όλων των διαθέσιμων τεχνικών RTK, τόσο της τεχνικής single base, όσο και των δικτυακών τεχνικών, (MAC, FKP, VRS). Πραγματοποιήθηκαν μετρήσεις με όλους τους διαθέσιμους σταθμούς στην Ελλάδα με αποστάσεις που φτάνουν έως και τα 375km, ενώ χρησιμοποιήθηκαν 5 διαφορετικοί GNSS δέκτες με δυνατότητα χρήσης και των GLONASS δορυφόρων.The continuous development of the Global Navigation Satellite Systems-GNSS, (GPS, GLONASS, Galileo), with regard to their use in geodetic applications for positioning on the natural earthy surface, led to the creation of global and European Networks of Permanent Reference Stations, in regional, national or local scale, as well as to the use of network positioning techniques. Following the example of this development, the HEPOS system was created in Greece by Ktimatologio S.A. and constitutes the first Greek Network of Permanent GPS Reference Stations and also a lot of private companies have established their own Reference Stations. Aim of diplomatic work is the evaluation of precision of the RTK technique with the use of permanent reference stations. Became use of all available RTK techniques, such as single base, and also as much as the network techniques, (MAC, FKP, VRS). The connection became with crowd of stations in all Greece with distances that reach until the 375km, while were used 5 different GNSS receivers with ability of using GLONASS satellites.Ιωάννης Α. Λαϊνά

Industrial location in greece: fostering green transition and synergies between industrial and spatial planning policies

Greece represents a very peculiar case of industrial development due to a series of historical evolutions. Hence, the present paper aims to discuss the shift from the unregulated and un-planned spatial development paradigm of productive activities to the one of modern “Business parks” (hereinafter BPs), expected to adapt to international standards the location and function of industrial activity, in the Greek territory. Inherent problems and constraints hampering the modernization of industrial development are presented and specific policy recommendations are for-mulated, with the aim of embedding the industrial parks in sustainable territorial development. This is done through a four-step methodology including (a) an inventory of BPs from the international milieu and the review of current trends in view of the green transition, (b) an analysis of the effects of Greek regulations on the development of the so-called “Organized Receptors of Manufacturing and Business Activities” (OYMEDs) and the suggestion of guiding principles as BPs become more attractive, and (c) the construction of a system of indicators that may govern the transformation of existing parks into eco-industrial parks (EIPs) and monitor their multiple performances. Lastly, an attempt to apply this system of indicators on a national and local level was carried out. Findings show that the regulatory and operational framework concerning BPs in Greece requires a comprehensive revision so as to (a) increase synergies of BPs with the implemented or planned territorial policies, (b) establish collaborative mechanisms acting as catalysts of creativity and inno-vation, c) introduce a system of indicators to monitor the development of BPs on the basis of the international framework for eco-industrial parks (EIPs), and (d) pursue an evidence-based industrial policy on national and local levels. A critical outcome is also that strong coordination between spatial and industrial policy is needed, through a high-level inter-ministerial body. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

Outpatient management of severe early OHSS by administration of GnRH antagonist in the luteal phase: an observational cohort study

<p>Abstract</p> <p>Background</p> <p>Management of established severe OHSS requires prolonged hospitalization, occasionally in intensive care units, accompanied by multiple ascites punctures, correction of intravascular fluid volume and electrolyte imbalance. The aim of the present study was to evaluate whether it is feasible to manage women with severe OHSS as outpatients by treating them with GnRH antagonists in the luteal phase.</p> <p>Methods</p> <p>This is a single-centre, prospective, observational, cohort study. Forty patients diagnosed with severe OHSS, five days post oocyte retrieval, were managed as outpatients after administration of GnRH antagonist (0.25 mg) daily from days 5 to 8 post oocyte retrieval, combined with cryopreservation of all embryos. The primary outcome measure was the proportion of patients with severe OHSS, in whom outpatient management was not feasible.</p> <p>Results</p> <p>11.3% (95% CI 8.3%-15.0%) of patients (40/353) developed severe early OHSS. None of the 40 patients required hospitalization following luteal antagonist administration and embryo cryopreservation. Ovarian volume, ascites, hematocrit, WBC, serum oestradiol and progesterone decreased significantly (P < 0.001) by the end of the monitoring period, indicating rapid resolution of severe OHSS.</p> <p>Conclusions</p> <p>The current study suggests, for the first time, that successful outpatient management of severe OHSS with antagonist treatment in the luteal phase is feasible and is associated with rapid regression of the syndrome, challenging the dogma of inpatient management. The proposed management is a flexible approach that minimizes unnecessary embryo transfer cancellations in the majority (88.7%) of high risk for OHSS patients.</p

Association between body mass index and oocyte maturation in patients triggered with GnRH agonist who are at high risk for severe ovarian hyperstimulation syndrome: an observational cohort study

Research question: Is body-mass index (BMI) associated with oocyte maturation in women at high risk for developing severe ovarian hyperstimulation syndrome (OHSS) who are triggered with gonadotrophin releasing hormone (GnRH) agonist? Design: Prospective observational cohort study. A total of 113 patients at high risk for severe OHSS (presence of at least 19 follicles &gt;= 11 mm) pre-treated with gonadotrophin releasing hormone (GnRH) antagonists and recombinant FSH were administered 0.2 mg triptorelin to trigger final oocyte maturation. Patients were classified in two groups depending on their BMI: BMI less than 25 kg/m(2) (n = 72) and BMI 25 kg/m(2) or over (n = 41). Baseline, ovarian stimulation and embryological characteristics, as well as luteal-phase hormone profiles, were compared in patients classified into the two BMI groups. The main outcome measure was the number of mature oocytes. Results: A significantly higher number of mature (metaphase II) oocytes (19 [18-21] versus 16 [13-20], P = 0.029) was present in women with BMI less than 25 kg/m(2) compared with those with BMI 25 kg/m(2) or greater. The number of retrieved oocytes, the number of fertilized oocytes, oocyte retrieval, maturation and fertilization rates were similar in the two groups. A significantly higher dose of recombinant FSH was required for patients with BMI 25 kg/m(2) or greater compared with patients with BMI less than 25 kg/m(2) (1875 [1650-2150] IU versus 1650 [1600-1750] IU, P = 0.003) and the two groups displayed different luteal phase hormonal profiles. Conclusions: Among women at high risk for developing severe OHSS who are triggered with a standard dose (0.2 mg) of the GnRH agonist triptorelin, women with BMI 25 kg/m(2) or greater had significantly fewer mature oocytes, required a higher total dose of recombinant FSH compared with women with BMI less than 25 kg/m(2)