Challenges in PhD education due to COVID-19 - disrupted supervision or business as usual: a cross-sectional survey of Swedish biomedical sciences graduate students

BackgroundIt remains unclear to what extent the SARS-CoV-2/COVID-19 pandemic disrupted the normal progression of biomedical and medical science graduate programs and if there was a lasting impact on the quality and quantity of supervision of PhD-students. To date, multiple editorials and commentaries indicate the severity of the disruption without providing sufficient evidence with quantifiable data.MethodsAn online survey was submitted to the administrative offices of biomedical and medical PhD-programs at eight major universities in Sweden to gauge the impact of the pandemic on the students. It consisted of multiple-choice and open-ended questions where students could provide examples of positive and/or negative supervision strategies. Open answered questions were coded as either examples of positive or negative support.ResultsPhD students were divided into two groups: those with improved or unchanged supervision during the pandemic (group 1, n = 185), versus those whose supervision worsened (group 2, n = 69). Group 1 received more help from supervisors and more frequent supervision via both online and alternative platforms (email/messages and telephone). There was no significant difference in educational-stage, gender or caretaking responsibilities between the groups.ConclusionsIt is important for the scientific community to learn how to provide the best possible supervision for PhD students during the pandemic. Our data suggests that more frequent supervision, and using a diverse array of meeting platforms is helpful. In addition, it is important for the students to feel that they have their supervisor's emotional support. Several students also expressed that they would benefit from an extension of their PhD programs due to delays caused by the pandemic

Patient's experience of surplus skin after laparoscopic Gastric Bypass

Bakgrund Tidigare studier av patienter som har opererats för övervikt med Gastric Banding visar att många patienter får besvär med överskottshud efter operationen. Det finns däremot ingen studie som undersöker om och i så fall i vilken grad patienterna har besvär av överskottshud efter laparaskopisk Gastric Bypass som ger en förväntat stor viktnedgång. Syfte Syftet med denna studie var att undersöka om personer som har opererats för övervikt enligt Gastric Bypass har problem med överskottshud och hur de i så fall upplever detta samt om det finns något samband mellan överskottshud och patientens ålder, viktnedgång och aktivitetsgrad. Metod Ett för denna studie konstruerat frågeformulär skickades ut till de personer som hade opererats med laparaskopisk Gastric Bypass på Sahlgrenska Universitetssjukhuset mellan år 2002 – 2004. Formuläret skickades till 148 personer och svarsfrekvensen var 76 %. Resultat Av de 112 personer som besvarade frågeformuläret uppgav 94 personer (84 %) att de hade besvär av överskottshud. Denna satt framför allt på magen, överarmarna och på insidan av låren och den gav bl.a. besvär med svamp och klåda, problem att hitta kläder, psykiska besvär och den försvårade fysisk aktivitet. Statistiskt fler kvinnor än män hade problem med överskottshud. Konklusion De medicinska riskerna med fetma minskar i och med viktnedgången efter en laparaskopisk Gastric Bypass men för många personer kvarstår psykosociala problem på grund av besvär med överskottshud

Excess skin after bariatric surgery - patients' perspective and objective measurements

Most of the world's population lives in countries where overweight and obesity kills more people than underweight. The only effective treatment is found to be bariatric surgery. Excess skin is an undervalued, negative effect following the massive weight loss after the procedure. Aim: The general aim of this thesis was to investigate the experience and the development of excess skin after massive weight loss following bariatric surgery. Materials and method: Super obese patients filled in a questionnaire concerning experience and discomfort from excess skin after massive weight loss following bariatric surgery. Their experiences were correlated to circumference measurements of hip and waist. The questionnaire was developed further and test – retest was performed to test the reliability. Sahlgrenska Excess Skin Questionnaire, SESQ, aims to investigate excess skin on different body parts from the patients’ perspective. In a longitudinal follow up, patients filled in SESQ and objective measurements of excess skin were made. Excess skin, ptosis and circumference were measured in a standardized way. Correlations were made between patients’ subjective experiences and the objective measurements. The measuring protocol, designed to measure excess skin in massive weight loss patients, was evaluated regarding inter rater reliability by two testers. Results: The SESQ consists of three different parts, I: demographic data, II: symptoms of excess skin and III: assessment and discomfort of excess skin on different body parts. The test-retest reliability of SESQ showed a kappa coefficient of 0.44 to 0.81 concerning parts I and II, and an ICC of 0.72 to 0.92 for part III. In addition, face validity was performed with ten post bariatric patients.   Weight loss after bariatric surgery in super obese and obese patients is associated with substantial experience and discomfort from excess skin. The excess skin is most commonly located on the abdomen, upper arms and thighs, and women experience more discomfort on several body parts than men. The excess skin causes intertriginous problems, such as fungus and eczema. It is heavy, which causes pain and hinders physical activity and is also a severe psychocosmetic problem. Repeated, objective, measurements of obese patients demonstrate that all ptosis and excess skin measurements decreased after weight reduction due to surgery except for the ptosis on the thighs, which had increased significantly. Comparison of objective measurements with the patients’ subjective reports of experience and discomfort from excess skin gave little or low correlation for both obese and super obese patients. The prediction analysis indicates that, for every centimeter of ptosis on the abdomen preoperatively, there is a twofold higher odds of having a postoperative ptosis on the abdomen > 3 cm (OR=2.32). Measurements of ptosis and excess skin had high or good reliability even though the size of the ptosis varied by several centimetres and the majority of the measurements had an ICC > 0.9 despite the fact that the measurers were from different professions. In summary: The SESQ is a reliable questionnaire for assessing excess skin from the patients’ perspective and the measuring protocol represents a useful instrument for providing a consistent and objective assessment of excess skin. While the extent of excess skin that was measured is reduced in comparison with before the operation, patients seem to become more aware, inconvenienced and discomforted by it on several body parts after weight loss. Discomfort from excess skin correlates fairly well to the extent of excess skin or circumference measurements in super obese or obese patients

Glycemic Control and Metabolic Adaptation in Response to High-Fat versus High-Carbohydrate Diets—Data from a Randomized Cross-Over Study in Healthy Subjects

Granular study of metabolic responses to alterations in the ratio of dietary macro-nutrients can enhance our understanding of how dietary modifications influence patients with impaired glycemic control. In order to study the effect of diets enriched in fat or carbohydrates, fifteen healthy, normal-weight volunteers received, in a cross-over design, and in a randomized unblinded order, two weeks of an iso-caloric high-fat diet (HFD: 60E% from fat) and a high-carbohydrate diet (HCD: 60E% from carbohydrates). A mixed meal test (MMT) was performed at the end of each dietary period to examine glucose clearance kinetics and insulin and incretin hormone levels, as well as plasma metabolomic profiles. The MMT induced almost identical glycemia and insulinemia following the HFD or HCD. GLP-1 levels were higher after the HFD vs. HCD, whereas GIP did not differ. The HFD, compared to the HCD, increased the levels of several metabolomic markers of risk for the development of insulin resistance, e.g., branched-chain amino acid (valine and leucine), creatine and α-hydroxybutyric acid levels. In normal-weight, healthy volunteers, two weeks of the HFD vs. HCD showed similar profiles of meal-induced glycemia and insulinemia. Despite this, the HFD showed a metabolomic pattern implying a risk for a metabolic shift towards impaired insulin sensitivity in the long run

Lipoxins reduce obesity-induced adipose tissue inflammation in 3D-cultured human adipocytes and explant cultures.

Adipose tissue inflammation drives obesity-related cardiometabolic diseases. Enhancing endogenous resolution mechanisms through administration of lipoxin A4, a specialized pro-resolving lipid mediator, was shown to reduce adipose inflammation and subsequently protects against obesity-induced systemic disease in mice. Here, we demonstrate that lipoxins reduce inflammation in 3D-cultured human adipocytes and adipose tissue explants from obese patients. Approximately 50% of patients responded particularly well to lipoxins by reducing inflammatory cytokines and promoting an anti-inflammatory M2 macrophage phenotype. Responding patients were characterized by elevated systemic levels of C-reactive protein, which causes inflammation in cultured human adipocytes. Responders appeared more prone to producing anti-inflammatory oxylipins and displayed elevated prostaglandin D2 levels, which has been interlinked with transcription of lipoxin-generating enzymes. Using explant cultures, this study provides the first proof-of-concept evidence supporting the therapeutic potential of lipoxins in reducing human adipose tissue inflammation. Our data further indicate that lipoxin treatment may require a tailored personalized-medicine approach