The role of tumor necrosis factor-α and natural killer cells in uterine artery function and pregnancy outcome in the stroke prone spontaneously hypertensive rat

Women with chronic hypertension are at increased risk of maternal and fetal morbidity and mortality. We have previously characterized the stroke-prone spontaneously hypertensive rat (SHRSP) as a model of deficient uterine artery function and adverse pregnancy outcome compared with the control Wistar–Kyoto. The activation of the immune system plays a role in hypertension and adverse pregnancy outcome. Therefore, we investigated the role of tumor necrosis factor-[alpha] in the SHRSP phenotype in an intervention study using etanercept (0.8 mg/kg SC) at gestational days 0, 6, 12, and 18 in pregnant SHRSP compared with vehicle-treated controls (n=6). Etanercept treatment significantly lowered systolic blood pressure after gestational day 12 and increased litter size in SHRSP. At gestational day 18, etanercept improved the function of uterine arteries from pregnant SHRSP normalizing the contractile response and increasing endothelium-dependent relaxation, resulting in increased pregnancy-dependent diastolic blood flow in the uterine arteries. We identified that the source of excess tumor necrosis factor-[alpha] in the SHRSP was a pregnancy-dependent increase in peripheral and placental CD3– CD161+ natural killer cells. Etanercept treatment also had effects on placental CD161+ cells by reducing the expression of CD161 receptor, which was associated with a decrease in cytotoxic granzyme B expression. Etanercept treatment improves maternal blood pressure, pregnancy outcome, and uterine artery function in SHRSP by antagonizing signaling from excess tumor necrosis factor-[alpha] production and the reduction of granzyme B expression in CD161+ natural killer cells in SHRSP

Patient experiences of adjusting to life in the first two years after bariatric surgery: a qualitative study

Background: There is a limited amount of research into the experiences of those who have undergone bariatric surgery, and how this impacts on their everyday lives and social interactions. Methods Semi-structured interviews were carried out with 18 participants (11 female, 7 male) who had undergone permanent bariatric surgical procedures 5-24 months prior to interview at a large NHS hospital in North East England. Constructivist grounded theory was used, with a constant comparative analytic framework. Results Participants conceptualised social encounters after bariatric surgery as being underpinned by risk. Their attitudes towards social situations guided their actions in the context of social interaction. Three profiles of attitudes towards risk were constructed: Risk Accepters, Risk Contenders and Risk Challengers. These profiles were based on participant-reported narratives of their experiences in the first two years post-surgically Conclusions The social complexities occurring as a consequence of bariatric surgery require adjustments to patients’ lives. Participants reported that the social aspects of bariatric surgery do not appear to be widely understood by those who have had bariatric surgery. The three risk attitude profiles that emerged from our data offer an understanding of ways in which patients adjust to life and can be used reflexively by healthcare professionals in the support of patients both pre- and post-operatively

Preoperative neutrophil-lymphocyte ratio and outcome from coronary artery bypass grafting

Background: An elevated preoperative white blood cell count has been associated with a worse outcome after coronary artery bypass grafting (CABG). Leukocyte subtypes, and particularly the neutrophil-lymphocyte (N/L) ratio, may however, convey superior prognostic information. We hypothesized that the N/L ratio would predict the outcome of patients undergoing surgical revascularization. Methods: Baseline clinical details were obtained prospectively in 1938 patients undergoing CABG. The differential leukocyte was measured before surgery, and patients were followed-up 3.6 years later. The primary end point was all-cause mortality. Results: The preoperative N/L ratio was a powerful univariable predictor of mortality (hazard ratio [HR] 1.13 per unit, P 3.36). Conclusion: An elevated N/L ratio is associated with a poorer survival after CABG. This prognostic utility is independent of other recognized risk factors.Peer reviewedAuthor versio

Zinc deficiency after gastric bypass for morbid obesity: a systematic review

The final publication is available at Springer via http://dx.doi.org/10.1007/s11695-016-2474-8 Up to 50% of patients have zinc deficiency before bariatric surgery.Roux-en-Y gastric bypass (RYGB) is the commonest bariatric procedure worldwide. It can further exacerbate zinc deieciency by reducing intake as well as absorption. The British Obesity and Metabolic Surgery Society therefore, recommends that zinc level should be monitored routinely following gastric bypass. However the American guidance does not recommend such monitoring for all RYGB patients and reserves it for patients with 'specific findings' This review concludes that clinically relevant zinc deficiency is rare after RYGB Routine monitoring of zinc levels is hence unnecessary for asymptomatic patients after RYGB and should be reserved for patients with skin lesions, hair loss, pica, disgeusia, hypogonadism, or erectile dysfunction in male patients and unexplained iron deficiency anaemia

A survey of bariatric surgical and reproductive health professionals' knowledge and provision of contraception to reproductive-aged bariatric surgical patients

BACKGROUND: Over 80 % of bariatric surgical patients are women with obesity in their reproductive years. Obesity adversely affects fertility; the rapid weight loss following bariatric surgery can increase fecundity. Current guidelines recommend avoiding pregnancy for up to 24 months following surgery, but little is known about current contraceptive care of women who undergo bariatric surgery. Two surveys were undertaken with bariatric surgical and contraceptive practitioners in England to establish current contraceptive practices in both groups. METHODS: Two anonymous on-line surveys were sent to all 382 members of the British Obesity and Metabolic Surgery Society (BOMSS) and an estimated 300 contraceptive practitioners in the North East of England. RESULTS: The BOMSS survey elicited a response rate of 17 % (n = 65), mainly from bariatric surgeons (n = 24 (36 %)). Most respondents (97 %) acknowledged the need to educate patients, but contraceptive information was only provided by 7 % (n = 4) of respondents in bariatric surgical clinics. Less than half of respondents were confident discussing contraception, and the majority requested further training, guidance and communication with contraceptive practitioners. The majority of respondents to the contraceptive practitioner survey were general practitioners (28 %, n = 20). Three quarters of respondents reported little knowledge of bariatric surgery, and many reported not seeing women with obesity requiring contraception before (66 %, n = 45) or after surgery (71 %, n = 49). CONCLUSIONS: There is a need to increase knowledge levels of contraception within bariatric surgical teams and to understand why, despite increasing levels of bariatric surgery, women do not seem to be appearing for advice in contraceptive settings

Ascertaining the place of social media and technology for bariatric patient support: what do allied health practitioners think?

Abstract Background There is an increasing presence of patient-led social media, mobile apps and patient support technology, but little is known about the role of these in the support of bariatric surgery patients in the UK. This study aimed to seek the views of allied health professionals (AHPs) working in bariatric surgical teams to understand their current perceptions of the role of social media, mobile apps and patient-support technology within bariatric surgery in the UK. Methods A confidential, printed survey was distributed to the AHPs at the British Obesity and Metabolic Surgery Society (BOMSS) 7th Annual Scientific Conference in January 2016. An email to AHPs who did not attend the conference was sent requesting voluntary participation in the same survey on-line through Survey Monkey® within two weeks of the conference. Results 95 responses in total were received, which was a 71% response rate (n= 134). Responses were from Nurses (34%, n= 46), Dietitians (32%, n=32), Psychologists (16%, n=12) and 1 Nutritionist, 1 Physiotherapist, 1 Patient Advocate, 1 surgeon and 9 respondents did not fill in their title. Conclusion The use of social media and mobile apps by patients is increasing, with AHPs concerned about misinformation; advice may differ from what is given in clinic. Technologies, e.g. telehealth and videoconferencing are not widely used in bariatric surgery in the UK. AHPs are unclear about the role of technologies for bariatric surgical patient support. Further discussions are needed to understand the potential of technology with AHPS supporting/facilitating patients as this becomes more commonplace

Formación Integral en competencias para Impresión 3D

[EN] Competences, skills and habilities adquired by students in the learning process must be determined by the learning outcomes, previously defined. In the 3D-PRISM European Project, the learning outcomes for 3D-printing students have been stablished. The process for determining the learning outcomes did take in consideration the opinion of University and Professionals of the manufacturing industry. The proposed methodology comprises 4 phases: creation of the profiles for the professionals in the 3D-printing industry, creation of the questionnaire based in previous documental research, on-line questionnaire and data collection and processing[ES] Los conocimientos, competencias y/o habilidades adquiridas por el alumnado en el proceso de formación, han de estar determinadas por los resultados de aprendizaje previamente establecidos. En el Proyecto Europeo 3D-PRISM se han establecido los resultados de aprendizaje en materia de Impresión 3D. El proceso ha sido llevado a cabo mediante el dialogo establecido entre la Universidad y la sociedad representada por expertos profesionales y docentes en la materia. La metodología propuesta en este trabajo se basa en cuatro fases: elaboración de los perfiles de los expertos en materia de impresión 3D, elaboración de un cuestionario basado en una investigación documental previa, distribución on-line de los cuestionarios y la recopilación de los datos obtenidos y tratamiento de los datos.Los autores desean agradecer el apoyo financiero recibido a través del proyecto ERASMUS +: 3D PRINTING SKILLS FOR MANUFACTURIN G 2015-1-UK01-KA202-013432.Benavente, R.; Patrao, I.; Small, G.; Tsianos, N. (2017). Formación Integral en competencias para Impresión 3D. En In-Red 2017. III Congreso Nacional de innovación educativa y de docencia en red. Editorial Universitat Politècnica de València. 756-768. https://doi.org/10.4995/INRED2017.2017.6766OCS75676

Supermassive Black Holes: Connecting the Growth to the Cosmic Star Formation Rate

In this Letter, we present a model connecting the cosmic star formation rate (CSFR) to the growth of supermassive black holes. Considering that the evolution of the massive black hole is dominated by accretion (Soltan's argument) and that the accretion process can be described by a probabilistic function directly regulated by the CSFR, we obtain the evolution of the black hole mass density. Then using the quasar luminosity function, we determine both the functional form of the radiative efficiency and the evolution of the quasar duty-cycle as functions of the redshift. We analyze four different CSFRs showing that the quasar duty-cycle, $\delta(z)$, peaks at $z\sim 8.5-11$ and so within the window associated with the reionization of the Universe. In particular, $\delta_{\rm max}\sim 0.09-0.22$ depending on the CSFR. The mean radiative efficiency, $\bar\eta(z)$, peaks at $z\sim 0.1-1.3$ with $\bar\eta_{\rm max}\sim 0.10-0.46$ depending on the specific CSFR used. Our results also show that is not necessary a supercritical Eddington accretComment: accepted for publication in MNRAS Letters (5 pages, 6 figures), Some typos fixed; MNRAS Letters 17 Aug 201