Follow-up after bariatric surgery: is it time to tailor it? Analysis of early predictive factors of 3-year weight loss predictors of unsuccess in bariatric patients

Bariatric surgery (BS) is the most effective treatment strategy for obesity. Nevertheless, a subset of patients does not reach a successful weight loss or experience long-term weight regain. Conflicting evidence exists regarding predictors of BS outcomes. We aimed to define the early factors linked to 3 year unsuccessful weight loss in order to promote a tailored close follow-up. We enrolled 443 patients who underwent BS from January 2014 to December 2018 with a 3 year follow-up. An unsuccessful BS outcome was defined as a percentage of total weight loss (%TWL) <20. We compared the characteristics between successful and unsuccessful patients in order to identify predictor factors of unsuccess after surgery. We found that the proportion of patients with unsuccessful weight loss progressively increased from one to three years after BS. In a multiple regression model, only 1 month %TWL and sleeve gastrectomy (SG) were significantly associated with 3 year unsuccessful weight loss. We stratified our cohort in four groups according to the risk of BS unsuccess, in terms of 1 month %TWL and type of surgery (SG vs gastric bypass). Interestingly, groups showed a significant difference in terms of %TWL at each follow-up point. Patients submitted to SG with lower 1 month %TWL must be considered at higher risk of future weight regain; consequently, they require a tailored and closer follow-up.[GRAPHICS]. © 2022, The Author(s)

CMS physics technical design report : Addendum on high density QCD with heavy ions

Peer reviewe

Time-Domain Measurement and Spectral Analysis of Non-Stationary Low-Frequency Magnetic Field Emissions on Board of Rolling Stock

This paper deals with the assessment of low-frequency magnetic-field emissions (MFE) in the engine-driver cab and the passengers\u2019 compartments of rolling stock. For emissions\u2019 measurement, an experimental setup is designed, involving a three-axial magnetic-field sensor mounted on an antenna positioner, and optically linked to the data-handling system. Measurement is accomplished in the time domain and allows one to retrieve digitized time series of the spatial components of the magnetic-flux density (MFD) vector, at specific points in the measurement volume. Worst case emissions are related to the train operating modes by referring to an experiment that includes acceleration from an initial stop, inertial motion, and braking up to a new stop. The nonstationary behavior of the most relevant MFD sinusoidal components is evidenced, and it is accounted in the spectral analysis by resorting to short-time Fourier transform based on a fixed-length time windows of proper duration. For safety assessment, a compliance check of MFE levels with exposure limits is proposed, based on the computation of an instantaneous safety parameter, obtained by extending requirements developed in the International Commission on Non-Ionizing Radiation Protection guidelines for the simpler case of multiple-frequency steady-state fields

PPH versus THD: a comparison of two techniques for III and IV degree haemorrhoids. Personal experience.

Aim. The aim of our study was to evaluate, through prospective randomized study, the outcome and the immediate and late complications of the two types of surgery most widely used for degree III-IV haemorrhoids. Methods. A total of 122 patients with degree III and IV hemorrhoids were elected for surgical intervention and, randomly, underwent surgery for PPH or THD. We assessed the most common immediate postoperative complications. The patients have', been followed for three months with a mean follow-up at 1 month and 3 months after surgery. Parameters taken into consideration were: bleeding, pain at rest and after evacuation, soiling, constipation and tenesmus Results. Five patients in PPH group (7.9%) had a major postoperative bleeding, whereas no such episode occurred in THD group (P=ns). In percentage terms, VAS score was lower in THD group than in PPH group, although the difference was not statistically significant. Finally parameters values observed, during the follow-up, proved to be lower for THD group compared to PPH group. Conclusion. PPH and THD are two surgical treatments for degree III and IV haemorrhoids with low perioperative complications and good results in the short term. However, our experience shows that better results in terms of pain and fewer postoperative complications are obtained after THD surgery, such surgery is less invasive and more adaptable to the needs of day surgery

PEG placement in patients with ALS

Introduction: Percutaneous endoscopic gastrostomy is one of the most common techniques to guarantee enteral nutrition in patients who are not able to eat. This procedure is an important therapeutic tool to treat dysphagia in patients with amyotrophic lateral sclerosis. Materials and methods: From January 2005 to December 2010, 47 patients with amyotrophic lateral sclerosis were referred to the Artificial Nutrition Unit, University Hospital, Siena for percutaneous en-doscopic gastrostomy. These study participants included 24 women and 23 men with a mean age of 68.5 years (range 39-85 years). Results: The total number of days of enteral nutrition by percutaneous endoscopic gastrostomy was 23,608, with a mean of 491 days (range 1-1,836). In 9 patients the treatment lasted less than 100 days. In all patients nutritional indexes and body mass index improved 3 months after treatment compared to baseline. Conclusions: We also observed that the decision for percutaneous endoscopic gastrostomy placement should be taken early in the course of the disease as restricted pulmonary function will reduce the chance of successful placement. © 2012 SINPE-GASAPE

Is sleeve gastrectomy a therapeutic procedure for all obese patients?

Background: Laparoscopic sleeve gastrectomy (LSG) is a worldwide surgical procedure for morbid obesity. However patients selection is still anecdotal. The aim of this study is to analyse clinical and anthropometric parameters correlated with LSG and to check the validity of this procedure for different categories of obese patients. Methods: Two-hundred one consecutive patients were submitted to LSG as a primary bariatric procedure between 2008 and 2014. One year follow-up was completed in 159 patients. Smaller groups of patients completed 2 and 3 years follow-up (78, 46 patients respectively). Median preoperative body mass index (BMI) was 45.4 kg/m2 (range: 34.8-73.8); 135 patients (80%) had one or more comorbidities. Potential correlations between age, gender, preoperative BMI, preoperative excess weight, early excess weight loss (EWL) and 1 and 3 year-EWL were investigated. Results: All procedures were regularly completed with laparoscopic approach without conversion to laparotomy. Postoperative complications occurred in six patients (3.7%); no postoperative mortality was observed. Median one-year BMI and EWL were 32.8 kg/m2 and 55.34%, respectively. Three year-EWL was significantly influenced by age, and early EWL. A complete normalization of glycemic levels after the three-year follow-up was also observed in high percentage of diabetic patients. In patients with preoperative BMI>50 kg/m2 we observed most failure cases in terms of EWL and the worst metabolic results. Conclusions: Our experience indicates that LSG is a safe procedure with satisfactory three-year late weight loss in patients with preoperative BMI <50 kg/m2. Promising results, in terms of improvements of comorbidities, were also observed. These results make LSG one of the most attractive first stage surgical procedure for morbid obesity

The treatment of breast cancer in one day surgery. A four year experience

The number of short-stay surgery procedures has progressively increased since the concept of short-stay surgery was first introduced. Initially this type of surgery was reserved for patients undergoing inguinal hernia repair, proctological surgery, and various minor procedures. Careful patient selection makes it possible to apply one-day surgery to other surgical specialties including breast cancer surgery. Reducing the length of hospital stay lowers health care costs, and shortens waiting lists. The most important benefits for patients are a more rapid return to work and positive psychological effects. Exclusion criteria for one-day surgery are the lack of home care, excessive distance from place of treatment and the presence of any concomitant pathology that is a contraindication to this type of surgery. We report our experience in oncological surgery of the breast in one-day surgery

Engineered Prototypes of the Barrel and Forward Single-Sided Silicon Modules of CMS: Milestone Report

This is intended to describe the main features of the first engineered versions of the basic single-sided detector modules for the barrel and forward silicon tracker of CMS