The associations between bariatric surgery and hip or knee arthroplasty, and hip or knee osteoarthritis: Propensity score-matched cohort studies.

To investigate the associations between bariatric surgery and hip or knee arthroplasty, and secondary care hip or knee osteoarthritis (OA). We performed cohort studies using data from Swedish nationwide healthcare registries. Patients aged 18-79 years who underwent bariatric surgery between 2006 and 2019 were matched on their propensity score (PS) to up to 2 obese patients ("unexposed episodes") in risk-set sampling. After a 1-year run-in period, episodes were followed in an "as-treated" approach. Using Cox proportional hazard regression, we calculated hazard ratios (HR) with 95% confidence intervals (CIs) of hip or knee arthroplasty overall and in subgroups of age, sex, joint location, arthroplasty type, bariatric surgery type, and by duration of follow-up if proportional hazard assumptions were violated. In a secondary cohort, we assessed the outcome incident secondary care hip or knee osteoarthritis (OA). Among 39'392 bariatric surgery episodes when compared to 61'085 ​PS-matched unexposed episodes (47'594 unique patients), the risk of hip or knee arthroplasty was strongest increased within the first three years of follow-up (HR 1.79, 95% CI 1.56-2.07), decreased thereafter, but remained elevated throughout follow-up. In a secondary cohort of 37'929 exposed when compared to 58'600 ​PS-matched unexposed episodes, the risk of hip or knee osteoarthritis was decreased (HR 0.84, 95% CI 0.79-0.90). Bariatric surgery is associated with increased risks of hip or knee arthroplasty, but also with decreased risks of secondary care OA. This contradiction supports the hypothesis that bariatric surgery may act as an enabler for hip or knee arthroplasty

Metaxa2 Database Builder: enabling taxonomic identification from metagenomic or metabarcoding data using any genetic marker

Motivation: Correct taxonomic identification of DNA sequences is central to studies of biodiversity using both shotgun metagenomic and metabarcoding approaches. However, no genetic marker gives sufficient performance across all the biological kingdoms, hampering studies of taxonomic diversity in many groups of organisms. This has led to the adoption of a range of genetic markers for DNA metabarcoding. While many taxonomic classification software tools can be re-trained on these genetic markers, they are often designed with assumptions that impair their utility on genes other than the SSU and LSU rRNA. Here, we present an update to Metaxa2 that enables the use of any genetic marker for taxonomic classification of metagenome and amplicon sequence data. Results: We evaluated the Metaxa2 Database Builder on 11 commonly used barcoding regions and found that while there are wide differences in performance between different genetic markers, our software performs satisfactorily provided that the input taxonomy and sequence data are of high quality. Availability and implementation: Freely available on the web as part of the Metaxa2 package at http://microbiology.se/software/metaxa2/. Supplementary information: Supplementary data are available at Bioinformatics online

Flow Changes after Endovascular Treatment of a Wide-Neck Anterior Communicating Artery Aneurysm by using X-configured Kissing Stents (Cross-Kissing Stents) Technique

Endovascular treatment for a wide-neck anterior communicating artery (AcomA) aneurysm remains technically challenging. Stent-assisted embolization has been proposed as an alternative of treatment of complex aneurysms. The X-configuration double-stent-assisted technique was used to achieve successful coiling of wide-neck AcomA aneurysm. Implanted stent can alter intra-arterial flow. Follow-up angiograms 4 months later showed flow changes due to used X-technique of stents implantation and filling of the anterior cerebral artery from the opposite internal carotid artery

Eudor-a: a Naturalistic, European Multi-centre Clinical Study of Edor Test in Adult Patients with Primary Depression

Introduction: Previous findings suggested that electrodermal hyporeactivity has a high sensitivity (up to 97%) and high raw specificity (up to 98%) for suicide. Aim: To evaluate prevalence, sensitivity and specificity of electrodermal hyporeactivity for suicide and suicide attempt, with and without death intent and with violent method or not, in adult patients with a primary diagnosis of depression. Methods: At each study site at least 100 patients with a primary diagnosis of depression, also in remission, will be recruited. Depressive symptomatology will be evaluated through the Montgomery-Asberg Depression Scale. Previous suicide attempts will be registered and the death intent of the worst attempt will be rated according to the first eight items of the Beck Suicide Intent Scale. The risk of suicide will be assessed according to rules and traditions at the centre. The EDOR Test (ElectroDermal Orienting Reactivity) will be performed. Two fingers are put on gold electrodes. Through headphones a moderately strong tone is presented now and then during the test. Sensors located within the electrodes are able to register the electrodermal response to those tones, measuring the skin conductance (i.e. electrodermal activity from sweat gland activity). Each patient will be followed up for one year for actions of intentional self-harm that require medical care and for suicide. The death intent will also be rated. Expected results: It is expected that the EDOR test detects a previously unknown neuropsychological dysfunction that is independent of the depressive state and can predict suicidality with a high sensitivity and specificit

Preferences for treatment of Attention-Deficit/Hyperactivity Disorder (ADHD): a discrete choice experiment

<p>Abstract</p> <p>Background</p> <p>While there is an increasing emphasis on patient empowerment and shared decision-making, subjective values for attributes associated with their treatment still need to be measured and considered. This contribution seeks to define properties of an ideal drug treatment of individuals concerned with Attention-Deficit/Hyperactivity Disorder (ADHD). Because of the lack of information on patient needs in the decision-makers assessment of health services, the individuals' preferences often play a subordinate role at present. Discrete Choice Experiments offer strategies for eliciting subjective values and making them accessible for physicians and other health care professionals.</p> <p>Methods</p> <p>The evidence comes from a Discrete Choice Experiments (DCE) performed in 2007. After reviewing the literature about preferences of ADHS we conducted a qualitative study with four focus groups consisting of five to eleven ADHS-patients each. In order to achieve content validity, we aimed at collecting all relevant factors for an ideal ADHS treatment. In a subsequent quantitative study phase (n = 219), data was collected in an online or paper-pencil self-completed questionnaire. It included sociodemographic data, health status and patients' preferences of therapy characteristics using direct measurement (23 items on a five-point Likert-scale) as well as a Discrete-Choice-Experiment (DCE, six factors in a fold-over design).</p> <p>Results</p> <p>Those concerned were capable of clearly defining success criteria and expectations. In the direct assessment and the DCE, respondents attached special significance to the improvement of their social situation and emotional state (relative importance 40%). Another essential factor was the desire for drugs with a long-lasting effect over the day (relative importance 18%). Other criteria, such as flexibility and discretion, were less important to the respondents (6% and 9%, respectively).</p> <p>Conclusion</p> <p>Results point out that ADHD patients and their family members have clear ideas of their needs. This is especially important against the backdrop of present discussions in the healthcare sector on the relevance of patient reported outcomes (PROs) and shared decision-making. The combination of the methods used in this study offer promising strategies to elicit subjective values and making them accessible for health care professionals in a manner that drives health choices.</p

What contributes to patient and parent satisfaction with medication in the treatment of children with ADHD? A report on the development of a new rating scale

Satisfaction with medication is important in the evaluation of overall treatment outcome. There is a lack of consistent and validated rating scales for satisfaction with medication in ADHD, therefore comparison across studies is difficult. Here, we analyse the psychometric properties of the satisfaction with medication scale (SAMS), a new item-based questionnaire that assesses satisfaction with ADHD medication. Furthermore, we evaluate the predictive effect of ADHD symptoms and quality of life (QoL) on satisfaction. Data on satisfaction with Equasym XL® (methylphenidate) were collected in the OBSEER study using the parent (SAMS-P, n = 589) and patient (SAMS-S, n = 552) versions of the SAMS questionnaire. Internal consistency, item-total and cross-informant correlations, and the stability of satisfaction ratings over time were assessed. Satisfaction with medication scores were then correlated with ratings of ADHD symptoms and QoL. Rates of overall satisfaction with Equasym XL® among parents and children were high (>70%), as was internal consistency for both SAMS-P and SAMS-S (Cronbach’s alpha > 0.9). Similarly, item-total correlations were high (r = 0.71–0.90) for SAMS-P and medium–high (r = 0.57–0.77) for SAMS-S. Cross-informant correlations and the stability of satisfaction ratings were moderate (r = 0.54–0.59 and 0.48–0.60, respectively). ADHD symptom and QoL ratings were significantly negative and positive predictors of satisfaction, explaining 36–52% of satisfaction variance at the final visit. The results show that parent and patient satisfaction was high and could be assessed reliably with the new SAMS questionnaire. Parent and patient ratings were moderately correlated, and symptom severity, functional impairment and QoL were the most significant predictors of satisfaction

Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: A 2021 Update

Background: This is the second updated Enhanced Recovery After Surgery (ERAS®) Society guideline, presenting a consensus for optimal perioperative care in bariatric surgery and providing recommendations for each ERAS item within the ERAS® protocol.Methods: A principal literature search was performed utilizing the Pubmed, EMBASE, Cochrane databases and ClinicalTrials.gov through December 2020, with particular attention paid to meta-analyses, randomized controlled trials and large prospective cohort studies. Selected studies were examined, reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. After critical appraisal of these studies, the group of authors reached consensus regarding recommendations.Results: The quality of evidence for many ERAS interventions remains relatively low in a bariatric setting and evidence-based practices may need to be extrapolated from other surgeries.Conclusion: A comprehensive, updated evidence-based consensus was reached and is presented in this review by the ERAS® Society.</p

Measurement of the Bovine Pancreatic Trypsin Inhibitors by Radioimmunoassay

Bovine pancreas contains two polypeptide trypsin inhibitors that are not homologous and differ in their inhibitory activity towards chymotrypsin, kallikrein, elastase, and other serine proteinases. The Kunitz inhibitor and the Kazal inhibitor are present in approximately equimolar concentrations in bovine pancreatic tissue, yet only the Kazal inhibitor is detectable in the pancreatic juice. The Kazal inhibitor has been named the pancreatic secretory trypsin inhibitor, PSTI because its concentration in the pancreatic juice parallels that of the exocrine secretory proteins. The Kunitz inhibitor is considered the intracellular inhibitor, however, no direct information is available concerning the intracellular localization of these inhibitors in the pancreas. The preparation of /sup 125/I-labeled derivatives of Kazal and Kunitz inhibitors by the lactoperoxidase method and a radioimmunoassay for each inhibitor are described. (auth