Prevalence of Defaecatory Disorders in Morbidly Obese Patients Before and After Bariatric Surgery

BACKGROUND: The prevalence of obesity is increasing worldwide and has lately reached epidemic proportions in western countries. Several epidemiological studies have consistently shown that both overweight and obesity are important risk factors for the development of various functional defaecatory disorders (DDs), including faecal incontinence and constipation. However, data on their prevalence as well as effectiveness of bariatric surgery on their correction are scant. The primary objective of this study was to estimate the effect of morbid obesity on DDs in a cohort of patients listed for bariatric surgery. We also evaluated preliminary results of the effects of sleeve gastrectomy on these disorders. PATIENTS AND METHODS: A questionnaire-based study was proposed to morbidly obese patients having bariatric surgery. Data included demographics, past medical, surgical and obstetrics histories, as well as obesity related co-morbidities. Wexner Constipation Score (WCS) and the Faecal Incontinence Severity Index (FISI) questionnaires were used to evaluate constipation and incontinence. For the purpose of this study, we considered clinically relevant a WCS ≥5 and a FISI score ≥10. The same questionnaires were completed at 3 and 6 months follow-up after surgery. RESULTS: A total of 139 patients accepted the study and 68 underwent sleeve gastrectomy and fully satisfied our inclusion criteria with a minimum follow-up of 6 months. Overall, mean body mass index (BMI) at listing was 47 ± 7 kg/m(2) (range 35-67 kg/m(2)). Mean WCS was 4.1 ± 4 (range 0-17), while mean FISI score (expressed as mean±standard deviation) was 9.5 ± 9 (range 0-38). Overall, 58.9% of the patients reported DDs according to the above-mentioned scores. Twenty-eight patients (20%) had WCS ≥5. Thirty-five patients (25%) had a FISI ≥10 while 19 patients (13.7%) reported combined abnormal scores. Overall, DDs were more evident with the increase of obesity grade: Mean BMI decreased significantly from 47 ± 7 to 36 ± 6 and to 29 ± 4 kg/m(2) respectively at 3 and 6 months after surgery (p < 0.0001). According to the BMI decrease, the mean WCS decreased from 3.7 ± 3 to 3.1 ± 4 and to 1.6 ± 3 respectively at 3 and 6 months (p = 0.02). Similarly, the FISI score decreased from 10 ± 8 to 3 ± 4 and to 1 ± 2 respectively at 3 and 6 months (p = 0.0001). CONCLUSIONS: Defaecatory disorders are common in morbidly obese patients. The risk of DDs increases with BMI. Bariatric surgery reduces DDs, mainly faecal incontinence, and these findings correlated with BMI reduction

Evaluation of self-absorption of manganese emission lines in Laser Induced Breakdown Spectroscopy measurements

This paper is part of a more general study aimed to the determination of the best experimental procedures for reliable quantitative measurements of Fe-Mn alloys by LIBS. In this work, attention is pointed on the self-absorption processes, whose effect deeply influences the LIBS measurements, reflecting in non-linear calibration curves. The effect of self-absorption on the line intensity can be quantified by defining a self absorption coefficient, that measures the deviation of the line intensity from the linear extrapolation of the curve of growth in the optically thin regime. The authors demonstrated in a previous paper that self absorption coefficients could be calculated once the electron density of the plasma is known and the Stark coefficients of the lines are available. However, when the Stark coefficients of the lines of interest are not known, a different approach is needed. In this work a new method for evaluation of self absorption coefficients in LIBS measurements is presented, which does not require the knowledge of Stark coefficients. In order to understand the basic principles and setting out the theoretical tools that will be used for the analysis o f the alloys, a preliminary study was done on pure Mn; LIBS spectra were acquired in different experimental conditions, at different laser energies and different delays after the laser irradiation o f the sample. Moreover, collinear double pulse measurements were also performed. Analytical relations were derived and experimental procedures devised for evaluation o f the self absorption coefficients of several Mn lines, which are important for characterization and control of the experimental conditions in which the analysis is performed

Evaluation of self-absorption of manganese emission lines in laser induced breakdown spectroscopy measurements

This paper is part o f a more general study aimed to the determination o f the best experimental procedures for reliable quantitative measurements o f F e-M n alloys by LIBS. In this work, attention is pointed on the self-absorption processes, whose effect deeply influences the LIBS measurements, reflecting in non-linear calibration curves. The effect o f self-absorption on the line intensity can be quantified by defining a self absorption coefficient, that measures the deviation o f the line intensity from the linear extrapolation o f the curve o f growth in the optically thin regime. The authors demonstrated in a previous paper that self absorption coefficients could be calculated once the electron density o f the plasma is known and the Stark coefficients o f the lines are available. However, when the Stark coefficients o f the lines o f interest are not known, a different approach is needed. In this work a new method for evaluation o f self absorption coefficients in LIBS measurements is presented, which does not require the knowledge o f Stark coefficients. In order to understand the basic principles and setting out the theoretical tools that w ill be used for the analysis o f the alloys, a preliminary study was done on pure Mn; LIBS spectra were acquired in different experimental conditions, at different laser energies and different delays after the laser irradiation o f the sample. Moreover, collinear double pulse measurements were also performed. Analytical relations were derived and experimental procedures devised for evaluation o f the self absorption coefficients o f several Mn lines, which are important for characterization and control o f the experimental conditions in which the analysis is performed.Facultad de Ingenierí

Lack of effect of lowering LDL cholesterol on cancer: meta-analysis of individual data from 175,000 people in 27 randomised trials of statin therapy

&lt;p&gt;Background: Statin therapy reduces the risk of occlusive vascular events, but uncertainty remains about potential effects on cancer. We sought to provide a detailed assessment of any effects on cancer of lowering LDL cholesterol (LDL-C) with a statin using individual patient records from 175,000 patients in 27 large-scale statin trials.&lt;/p&gt; &lt;p&gt;Methods and Findings: Individual records of 134,537 participants in 22 randomised trials of statin versus control (median duration 4.8 years) and 39,612 participants in 5 trials of more intensive versus less intensive statin therapy (median duration 5.1 years) were obtained. Reducing LDL-C with a statin for about 5 years had no effect on newly diagnosed cancer or on death from such cancers in either the trials of statin versus control (cancer incidence: 3755 [1.4% per year [py]] versus 3738 [1.4% py], RR 1.00 [95% CI 0.96-1.05]; cancer mortality: 1365 [0.5% py] versus 1358 [0.5% py], RR 1.00 [95% CI 0.93–1.08]) or in the trials of more versus less statin (cancer incidence: 1466 [1.6% py] vs 1472 [1.6% py], RR 1.00 [95% CI 0.93–1.07]; cancer mortality: 447 [0.5% py] versus 481 [0.5% py], RR 0.93 [95% CI 0.82–1.06]). Moreover, there was no evidence of any effect of reducing LDL-C with statin therapy on cancer incidence or mortality at any of 23 individual categories of sites, with increasing years of treatment, for any individual statin, or in any given subgroup. In particular, among individuals with low baseline LDL-C (&#60;2 mmol/L), there was no evidence that further LDL-C reduction (from about 1.7 to 1.3 mmol/L) increased cancer risk (381 [1.6% py] versus 408 [1.7% py]; RR 0.92 [99% CI 0.76–1.10]).&lt;/p&gt; &lt;p&gt;Conclusions: In 27 randomised trials, a median of five years of statin therapy had no effect on the incidence of, or mortality from, any type of cancer (or the aggregate of all cancer).&lt;/p&gt

Evaluation of self-absorption of manganese emission lines in laser induced breakdown spectroscopy measurements

This paper is part o f a more general study aimed to the determination o f the best experimental procedures for reliable quantitative measurements o f F e-M n alloys by LIBS. In this work, attention is pointed on the self-absorption processes, whose effect deeply influences the LIBS measurements, reflecting in non-linear calibration curves. The effect o f self-absorption on the line intensity can be quantified by defining a self absorption coefficient, that measures the deviation o f the line intensity from the linear extrapolation o f the curve o f growth in the optically thin regime. The authors demonstrated in a previous paper that self absorption coefficients could be calculated once the electron density o f the plasma is known and the Stark coefficients o f the lines are available. However, when the Stark coefficients o f the lines o f interest are not known, a different approach is needed. In this work a new method for evaluation o f self absorption coefficients in LIBS measurements is presented, which does not require the knowledge o f Stark coefficients. In order to understand the basic principles and setting out the theoretical tools that w ill be used for the analysis o f the alloys, a preliminary study was done on pure Mn; LIBS spectra were acquired in different experimental conditions, at different laser energies and different delays after the laser irradiation o f the sample. Moreover, collinear double pulse measurements were also performed. Analytical relations were derived and experimental procedures devised for evaluation o f the self absorption coefficients o f several Mn lines, which are important for characterization and control o f the experimental conditions in which the analysis is performed.Facultad de Ingenierí

Length of carotid stenosis predicts peri-procedural stroke or death and restenosis in patients randomized to endovascular treatment or endarterectomy.

BACKGROUND: The anatomy of carotid stenosis may influence the outcome of endovascular treatment or carotid endarterectomy. Whether anatomy favors one treatment over the other in terms of safety or efficacy has not been investigated in randomized trials. METHODS: In 414 patients with mostly symptomatic carotid stenosis randomized to endovascular treatment (angioplasty or stenting; n = 213) or carotid endarterectomy (n = 211) in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS), the degree and length of stenosis and plaque surface irregularity were assessed on baseline intraarterial angiography. Outcome measures were stroke or death occurring between randomization and 30 days after treatment, and ipsilateral stroke and restenosis ≥50% during follow-up. RESULTS: Carotid stenosis longer than 0.65 times the common carotid artery diameter was associated with increased risk of peri-procedural stroke or death after both endovascular treatment [odds ratio 2.79 (1.17-6.65), P = 0.02] and carotid endarterectomy [2.43 (1.03-5.73), P = 0.04], and with increased long-term risk of restenosis in endovascular treatment [hazard ratio 1.68 (1.12-2.53), P = 0.01]. The excess in restenosis after endovascular treatment compared with carotid endarterectomy was significantly greater in patients with long stenosis than with short stenosis at baseline (interaction P = 0.003). Results remained significant after multivariate adjustment. No associations were found for degree of stenosis and plaque surface. CONCLUSIONS: Increasing stenosis length is an independent risk factor for peri-procedural stroke or death in endovascular treatment and carotid endarterectomy, without favoring one treatment over the other. However, the excess restenosis rate after endovascular treatment compared with carotid endarterectomy increases with longer stenosis at baseline. Stenosis length merits further investigation in carotid revascularisation trials

Prevalence of dementia in Tuscany: results from four population-based epidemiological studies

OBJECTIVE: to provide information on epidemiology of dementia in Tuscany needed to plan for dedicated health and social services. DESIGN: analysis of pooled baseline data from 4 population-based longitudinal studies. SETTING: 4 municipalities in Tuscany. PARTICIPANTS: 4,056 elderly subjects enrolled in 4 longitudinal studies. MAIN OUTCOME MEASURES: age- and sex-specific dementia prevalence rates and estimated number of demented people, by degree of cognitive impairment and BADL disability in the elderly population of Tuscany. RESULTS: out of the evaluated subjects, 293 are demented. Prevalence of dementia increases from about 1 % in the 65-69 age group to about 28 % in the 90+ age group both among women and men. About 43% of the demented study subjects suffer from severe mental deterioration (MMSE &lt; 14) and56% are disabled in at least one Basic Activity of Daily Living (BADL). We estimate that about 19 thousand demented elderly men and 40 thousand demented elderly women are currently living in Tuscany of whom 26 thousand severely mentally impaired and 34 thousand disabled in at least one BADL. The resulting overall dementia prevalence standardised on the Italian 65+ population is 5,3% for men and 7,7% for women. CONCLUSIONS: these estimates could be used as a basis for the evaluation and the planning of social and health care services dedicated to demented people

Statins but Not Aspirin Reduce Thrombotic Risk Assessed by Thrombin Generation in Diabetic Patients without Cardiovascular Events: The RATIONAL Trial

The systematic use of aspirin and statins in patients with diabetes and no previous cardiovascular events is controversial. We sought to assess the effects of aspirin and statins on the thrombotic risk assessed by thrombin generation (TG) among patients with type II diabetes mellitus and no previous cardiovascular events.Prospective, randomized, open, blinded to events evaluation, controlled, 2×2 factorial clinical trial including 30 patients randomly allocated to aspirin 100 mg/d, atorvastatin 40 mg/d, both or none. Outcome measurements included changes in TG levels after treatment (8 to 10 weeks), assessed by a calibrated automated thrombogram. At baseline all groups had similar clinical and biochemical profiles, including TG levels. There was no interaction between aspirin and atorvastatin. Atorvastatin significantly reduced TG measured as peak TG with saline (85.09±55.34 nmol vs 153.26±75.55 nmol for atorvastatin and control groups, respectively; p = 0.018). On the other hand, aspirin had no effect on TG (121.51±81.83 nmol vs 116.85±67.66 nmol, for aspirin and control groups, respectively; p = 0.716). The effects of treatments on measurements of TG using other agonists were consistent.While waiting for data from ongoing large clinical randomized trials to definitively outline the role of aspirin in primary prevention, our study shows that among diabetic patients without previous vascular events, statins but not aspirin reduce thrombotic risk assessed by TG.ClinicalTrials.gov NCT00793754