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)

Capability of Sentinel-2 data for estimating maximum evapotranspiration and irrigation requirements for tomato crop in Central Italy

Abstract The occurrence of water shortages ascribed to projected climate change, especially in the Mediterranean region, fosters the interest in remote sensing (RS) applications to optimize water use in agriculture. Remote sensing evapotranspiration and water demand estimation over large cultivated areas were used to manage irrigation to minimize losses during the crop growing cycle. The research aimed to explore the potential of the MultiSpectral Instrument (MSI) sensor on board Sentinel-2A to estimate crop parameters, mainly surface albedo (α) and Leaf Area Index (LAI) that influence the dynamics of potential evapotranspiration (ETp) and Irrigation Water Requirements (IWR) of processing tomato crop (Solanum lycopersicum L.). Maximum tomato ETp was calculated according to the FAO Penman-Monteith equation (FAO-56 PM) using appropriate values of canopy parameters derived by processing Sentinel-2A data in combination with daily weather information. For comparison, we used the actual crop evapotranspiration (ETa) derived from the soil water balance (SWB) module in the Environmental Policy Integrated Climate (EPIC) model and calibrated with in-situ Root Zone Soil Moisture (RZSM). The experiment was set up in a privately-owned farm located in the Tarquinia irrigation district (Central Italy) during two growing seasons, within the framework of the EU Project FATIMA (FArming Tools for external nutrient Inputs and water Management). The results showed that canopy growth, maximum evapotranspiration (ETp) and IWR were accurately inferred from satellite observations following seasonal rainfall and air temperature patterns. The net estimated IWR from satellite observations for the two-growing seasons was about 272 and 338 mm in 2016 and 2017, respectively. Such estimated requirement was lower compared with the actual amount supplied by the farmer with sprinkler and drip micro-irrigation system in both growing seasons resulting in 364 (276 mm drip micro-irrigation, and 88 mm sprinkler) and 662 (574 mm drip micro-irrigation, and 88 mm sprinkler) mm, respectively. Our findings indicated the suitability of Sentinel-2A to predict tomato water demand at field level, providing useful information for optimizing the irrigation over extended farmland

Colorectal cancer after bariatric surgery (Cric-Abs 2020): Sicob (Italian society of obesity surgery) endorsed national survey

Background The published colorectal cancer (CRC) outcomes after bariatric surgery (BS) are conflicting, with some anecdotal studies reporting increased risks. The present nationwide survey CRIC-ABS 2020 (Colo-Rectal Cancer Incidence-After Bariatric Surgery-2020), endorsed by the Italian Society of Obesity Surgery (SICOB), aims to report its incidence in Italy after BS, comparing the two commonest laparoscopic procedures-Sleeve Gastrectomy (SG) and Roux-en-Y gastric bypass (GBP). Methods Two online questionnaires-first having 11 questions on SG/GBP frequency with a follow-up of 5-10 years, and the second containing 15 questions on CRC incidence and management, were administered to 53 referral bariatric, high volume centers. A standardized incidence ratio (SIR-a ratio of the observed number of cases to the expected number) with 95% confidence intervals (CI) was calculated along with CRC incidence risk computation for baseline characteristics. Results Data for 20,571 patients from 34 (63%) centers between 2010 and 2015 were collected, of which 14,431 had SG (70%) and 6140 GBP (30%). 22 patients (0.10%, mean age = 53 +/- 12 years, 13 males), SG: 12 and GBP: 10, developed CRC after 4.3 +/- 2.3 years. Overall incidence was higher among males for both groups (SG: 0.15% vs 0.05%; GBP: 0.35% vs 0.09%) and the GBP cohort having slightly older patients. The right colon was most affected (n = 13) and SIR categorized/sex had fewer values < 1, except for GBP males (SIR = 1.07). Conclusion Low CRC incidence after BS at 10 years (0.10%), and no difference between procedures was seen, suggesting that BS does not trigger the neoplasm development

An approach to prevent frailty in community dwelling older adults: a pilot study performed in Campania region in the framework of the PERSSILAA project

We developed and tested an innovative physical training method in older adults that embeds the gym program into everyday life in the most conservative way possible. Physical training was included in the activities of local parishes where older women from Southern Italy spend most of their free time and was delivered by trained physical therapists with the support of an ICT tool known as CoCo. 113 older women (aged 72.0 [69.0-75.0] years) noncompliant to conventional exercise programs participated to the study. 57 of them underwent the final anthropometric assessment and 50 the final physical tests. In study completers handgrip strength and physical performance evaluated with the chair-stand, the two minutes step and the chair-sit and -reach tests significantly improved. Quality of life as evaluated with the EuroQol-5dimension (EQ-5D) questionnaire improved as well. In conclusion, a training program designed to minimally impact on life habits of older people is effective in improving fitness in patients noncompliant to other to physical exercise programs

Elastofibroma dorsi: three cases of personal experience

Elastofibroma dorsi is a rare, slow growing, soft tissue lesion, which occurs mainly in elderly women, tipically located in the infrascapular region. This lesion is characterized by a poorly defined solid mass of fibroelastic and fatty tissue, enlarging into intermuscular spaces. Elastofibroma may simulate an aggressive behaviour, and differential diagnosis with malignant tumors is sometimes difficult. Surgical resection is generally recommended in symptomatic lesions or in the suspicion of malignancy. We report our experience of three cases of elastofibroma, two of which typically located in the infrascapular region and one located in the supraclavear fossa, atypical site never reported so far

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