Bariatric surgery: predictors of outcome : results from a national database (SOREG) with particular emphasis on patients’ age.

A global pandemic of obesity and its health-related concerns, in form of comorbidities, increased risk of mortality, and reduced health-related quality of life, is ongoing. At the same time, conservative treatment for obesity, including life-style changes (mainly diet regimens and physical activity), is most often associated with unsatisfactory long-term results, and the most effective treatment for obesity itself as well as obesity-related health problems is surgery (1-3). Due to the increase in obesity, a simultaneously rise in bariatric procedures has occurred. Further, due to a worldwide increasing age, as well as rise in age-related obesity, bariatric procedures in patients over 60 years has also increased. Thus, between 1999 and 2005 older patients (≥60 years) accounted for 2,7% of the total number of procedures, compared to almost 10% during the period 2009-2013 (4). The safety and outcome of bariatric surgery for elderly has been debated, while benefits of preoperative weight loss before surgery is more consolidated (5-7). In conclusion, the aim of this thesis was to evaluate the effects of bariatric surgery in relation to preoperative weight loss and outcome in the elderly. In the first (I) paper, the correlation between preoperative weight loss and preoperative body mass index (BMI) in relation to postoperative weight loss was analysed. We used a cohort of 9,570 patients in a complete data set. A preoperative weight loss in the 25th, 50th, and 75th percentile of 0%, 4.5%, and 8.6% was seen, respectively. Patients in the 50th percentile were compared for preoperative weight loss with reference (25th percentile), with a postoperative weight loss 5.0 and 5.3% higher at one and two years, respectively (p45.7 kg/m2) was seen, with a 15.2% and 13.6% higher total weight reduction after one and two years compared to the reference (25th percentile) for preoperative weight loss. The risk for complications and mortality in relation to age after gastric bypass was evaluated in the second (II) paper (n = 47 600). In the entire cohort, the 30-days follow-up rate was 98.1% with a risk of any complication at 8.4%, whereas patients in the age-groups 50-54 years, 55-59 years and ≥ 60 years, had a significantly increased risk at 9.8%, 10.0%, and 10.2%, respectively, for any complication. In a multivariate analysis, the risk of major surgical complications such, as anastomotic leak, bleeding, and deep infections/abscesses, were all increased significantly by 14-41% for patients aged 50-54, years with a small but not significantly increased risk for those of an older age. The risk of medical complications (thromboembolic, cardiovascular, and pulmonary complications) was significantly higher for patients ≥ 60 years with, a total mortality of 0.03%. In the third (III) paper, the resolution of obesity-related comorbidities (type 2 diabetes, hypertension, dyslipidaemia, OSAS, and depression) after gastric bypass in relation to age over time (at one, two and five years, postoperatively) was evaluated (n=57,215). Resolution was defined as no longer in need of pharmacological (or CPAP) treatment. The follow-up rates for eligible patients were 89%, 69%, and 59 % at one, two, and five years, respectively, and 64 % in patients for those older than 60 at five years. The prevalence of most comorbidities at baseline was higher in patients over 60 years, compared to younger ones. For those 60 and above, a relative improvement compared to preoperative prevalence for diabetes, hypertension, dyslipidaemia, and OSAS of 45%, 10%, 24, and 62%, respectively, was seen at five years. In the fourth (IV) paper, health-related quality of life (SF-36 and OP) was evaluated at one, two and five years after gastric bypass, and the same cohort as in paper III was used. Further, in all age groups, the mental aspects of QoL (MCS) returns nearly to baseline after five years, compared to PCS and OP, with a maintained improvement up to five years after surgery. In conclusion, patients over 60 had an improvement in parity with younger individuals with regard to MCS, PCS and OP. In summary, an association was found between a preoperative low caloric diet and a subsequent weight loss before surgery, and a better maintained weight loss up to two years after surgery. This is particularly evident for those with the highest levels of BMI. Gastric bypass in the elderly (≥ 60 years) exhibits an increased, but acceptable, risk for complications and mortality compared to younger patients. Further, the elderly have good resolutions, although not in the same range as younger patients, of obesity-related comorbidities, and good effects on health-related quality of life, comparable to younger individuals, up to five years after gastric bypass. Taken together, these result support that a preoperative weight loss, in line with the association to a reduced risk of complications, entails a better maintained weight loss as well. Furthermore, elderly have a good effect on obesity-related comorbidity and health-related quality of life, with acceptable but increased surgical risk

Replication study: a cross-country field observation study of real world PIN usage at ATMs and in various electronic payment scenarios:towards understanding why people do, or do not, shield PIN entry

In this paper, we describe the study we carried out to replicate and extend the field observation study of real world ATM use carried out by De Luca et al., published at the SOUPS conference in 2010. Replicating De Luca et al.'s study, we observed PIN shielding rates at ATMs in Germany. We then extended their research by conducting a similar field observation study in Sweden and the United Kingdom. Moreover, in addition to observing ATM users (withdrawing), we also observed electronic payment scenarios requiring PIN entry. Altogether, we gathered data related to 930 observations. Similar to De Luca et al., we conducted follow-up interviews, the better to interpret our findings. We were able to confirm De Luca et al.'s findings with respect to low PIN shielding incidence during ATM cash withdrawals, with no significant differences between shielding rates across the three countries. PIN shielding incidence during electronic payment scenarios was significantly lower than incidence during ATM withdrawal scenarios in both the United Kingdom and Sweden. Shielding levels in Germany were similar during both withdrawal and payment scenarios. We conclude the paper by suggesting a number of explanations for the differences in shielding that our study revealed

Peripheral nerve-derived VEGF promotes arterial differentiation via neuropilin 1-mediated positive feedback

In developing limb skin, peripheral nerves are required for arterial differentiation, and guide the pattern of arterial branching. In vitro experiments suggest that nerve-derived VEGF may be important for arteriogenesis, but its role in vivo remains unclear. Using a series of nerve-specific Cre lines, we show that VEGF derived from sensory neurons, motoneurons and/or Schwann cells is required for arteriogenesis in vivo. Arteriogenesis also requires endothelial expression of NRP1, an artery-specific coreceptor for VEGF^(164) that is itself induced by VEGF. Our results provide the first evidence that VEGF is necessary for arteriogenesis from a primitive capillary plexus in vivo, and show that in limb skin the nerve is indeed the principal source of this signal. They also suggest a model in which a `winner-takes-all' competition for VEGF may control arterial differentiation, with the outcome biased by a VEGF^(164)-NRP1 positive-feedback loop. Our results also demonstrate that nerve-vessel alignment is a necessary, but not sufficient, condition for nerve-induced arteriogenesis. Different mechanisms therefore probably underlie these endothelial patterning and differentiation processes

Using Viscum album extracts (ISCADOR) for successful management of neoplasms of the skin in horses and cats in consideration of aspects relevant to human medicine.

Background: Mistletoe extracts (Viscum album extracts, VAE) such as ISCADOR, have been used successfully in human oncology for many years. In veterinary medicine, there have been reports of successful treatment, but scientific data on efficacy are lacking. Two studies were therefore conducted to assess whether VAE can serve as an adjunct to standard treatment in horses and cats. Methods: As part of a placebo-controlled double-blind study (study 1), 53 horses with equine sarcoid (a solitary or multifocal skin tumor) were treated with VAE pini (pine mistletoe) in progressively increasing doses (n=32) or with a sodium chloride solution (n=21). Three times a week for 15 weeks. All horses were observed over a period of 12 months for tumor recurrence and cure. In an observational study (study 2), 44 cats with fibrosarcoma, a very common skin tumor with a high rate of recurrence, were treated postoperatively with 0.1% (0.5ml per dose) oral VAE quercus (oak mistletoe) twice daily, and disease free survival was measured. Results: In study 1, treatment with ISCADOR led to significantly better results than placebo. Improvement was seen in 41% of the cases (placebo 14%), and cure was achieved in 28% of the cases (placebo 14%). In study 2, disease-free survival time in cats treated postoperatively with VAE quercus was 438 days compared with 365 to 475 days for conventional chemotherapies and 120 to 261 days for surgery alone, as seen in literature. Aggressive surgery combined with radiation and chemotherapy led to markedly superior results (661 to 986 days). Conclusion: The study 1 was able to demonstrate, for the first time, the efficacy of VAE compared to placebo control. This study also showed that the effect of VAE apparently extends considerably beyond the treatment period; unexpectedly, only very few recurrences were observed between the end of treatment and the 12th month of observation. The results of the study 2 show that oral administration of mistletoe preparations also yields satisfactory prophylactic effects. The discussion surrounding oral treatment and the question whether it can replace injection treatment must therefore be continued, even in human medicine

Circuit de commande pour Anti Collision Lamps ACL

Objectif Les ACL sont des ampoules 28V/200W utilisés dans le domaine de l’éclairage professionnel. Habituellement, 8 ampoules sont branchées en série sur le réseau. Suite à ce montage, une commande individuelle de la luminosité n’est pas possible. L’appareil conçu dans ce projet met toutes les ampoules en parallèle sur un bus de tension continue à 28Vdc. La commande individuelle est maintenant possible. Une protection anti-courtcircuit est aussi conçue afin de sécuriser l’installation. Pour alimenter le bus de tension continue, un pont H résonnant est utilisé. Pour diminuer au mieux les pertes de ce système, un redresseur actif est utilisé. Ce dernier fonctionne en utilisant la tension induite d’une self saturable. Résultats L’alimentation du bus de tension continue au travers du redresseur actif n’a pas pu être réalisée car le signal de la self saturable n’est pas assez fiable. La protection anti-court-circuit fonctionne correctement. La lampe fait du bruit lorsque celle est alimentée par des flancs de courant trop brusques à des fréquences audibles. La solution consisterait à l’alimenter à des fréquences élevées.Ziel ACLs sind Lampen 28V/200W, welche im Bereich der professionellen Beleuchtung verwendet werden. Normalerweise sind 8 Lampen in Serie am Netz angeschlossen. Durch diese Anordnung ist eine individuelle Lichtsteuerung nicht möglich. Mit dem in diesem Projekt zu entwickelnden Gerät werden alle Lampen parallel auf einen Spannungsbus von 28Vdc gelegt: Dadurch wird die individuelle Ansteuerung ermöglicht. Zur besseren Sicherheit wird auch eine Kurzschlusssicherheit realisiert. Der Spannungsbus wird mittels einer resonanten H-Brückenschaltung verwirklicht. Resultate Der synchrone Gleichrichter konnte nicht getestet werden da die Steuersignalgenerierung mit Sättigungsdrossel nicht zuverlässig funktioniert. Die Kurzschlusssicherheit funktioniert einwandfrei. Im Betrieb der Lampe entsteht ein störendes Geräusch, weil die Ansteuerung mit steilen Stromflanken sich in hörbaren Frequenzen abspielt. Zur Behebung dieses Geräusches können Speisungen mit höheren Schaltfrequenzen verwendet werden

Dynamic General Equilibrium and T-Period Fund Separation

In a dynamic general equilibrium model, we derive conditions for a mutual fund separation property by which the savings decision is separated from the asset allocation decision. With logarithmic utility functions, this separation holds for any heterogeneity in discount factors, while the generalization to constant relative risk aversion holds only for homogeneous discount factors but allows for any heterogeneity in endowments. The logarithmic case provides a general equilibrium foundation for the growth-optimal portfolio literature. Both cases yield equilibrium asset pricing formulas that allow for investor heterogeneity, in which the return process is endogenous and asset prices are determined by expected discounted relative dividends. Our results have simple asset pricing implications for the time series as well as the cross section of relative asset prices. It is found that on data from the Dow Jones Industrial Average, a risk aversion smaller than in the logarithmic case fits bes

Argumentationsleitfaden zum Ökologischen Landbau für Multiplikatoren „Nachgefragt: 25 Antworten zum Stand des Wissens rund um Öko-Landbau und Bio-Lebensmittel“

Die Nachfrage nach Bio-Produkten steigt stetig. Damit nimmt zugleich das Interesse an der Ökologischen Lebensmittelwirtschaft immer weiter zu. Neben grundsätzlichen Fragen zu Anbau, Handel und Verarbeitung werden häufig auch kritische Nachfragen gestellt: Sind Bio-Lebensmittel gesünder? Kann ich Bio vertrauen? Kann man mit Bio die Welt ernähren? Die Broschüre „Nachgefragt: 25 Antworten zum Stand des Wissens rund um Öko-Landbau und Bio-Lebensmittel“ beantwortet diese und weitere Fragen kurz und dennoch fundiert. Sie stützt sich auf neue wissenschaftliche Erkenntnisse und bietet die Möglichkeit, die gesellschaftliche Diskussion über Bio zu versachlichen und Vorurteilen angemessen zu begegnen. Neben der Darstellung der besonderen Leistungen der Ökologischen Lebensmittelwirtschaft werden ebenso ihre Herausforderungen und Entwicklungspotenziale benannt. Quellenangaben ermöglichen die Vertiefung einzelner Sachverhalte. Zu den Themenfeldern Grundlagen, Erzeugung, Verarbeitung, Vermarktung, Qualität, Umweltwirkungen sowie Ökologische Lebensmittelwirtschaft und Gesellschaft werden 25 Fragen so beantwortet, dass die wichtigsten Gesichtspunkte zu der jeweiligen Frage „auf einen Blick“ in einer logischen Argumentationskette zur Verfügung stehen. Quellenverweise ermöglichen es, einzelne Sachverhalte zu vertiefen; Grafiken, Tabellen und Fotos veranschaulichen die Themen. Damit ist der Argumentationsleitfaden ein wichtiges Instrument für Journalisten, Politiker oder Multiplikatoren der Branche, wie Verbandsvertreter oder Ausbilder, um sich schnell und doch umfassend zu informieren. Die Broschüre ist kostenlos und vollständig unter http://www.boelw.de/bioargumente.html verfügbar

Synthesis and characterization of an oxo-bridged rhenium(V) complex with an amine-phenol tetradentate ligand

The oxo-bridged dinuclear complex [(μ-O){ReO(sal2hpn)}2].EtOH was prepared by the reaction of trans-[ReOCl3(PPh3)2] with N,N’-propylenebis(salicylideneamine) (H2sal2hpn) in ethanol. An X-ray crystallographic study showed that each sal2hpn is coordinated as a tetradentate dianionic chelate. The axis of the molecule is formed by the O=Re-O-Re=O moiety, with the average O=Re-O and Re-O-Re bond angles equal to 165.2(2)° and 164.8(2)° respectively. The average Re=O bond equals 1.697(5) Å, and the Re-O bonds have an average length of 1.928(4) Å. The structure has a monoclinic space group Cc with a = 13.7747(2) Å, b = 26.8715(4) Å, c = 9.6478(1) Å, β = 92.4202(9)°, V = 3567.92(8) Å3 and Z = 4.   KEY WORDS: Oxo-bridge, Rhenium(V), Dimeric, Crystal structure  Bull. Chem. Soc. Ethiop. 2007, 21(1), 83-88.

Dispersed fs-FWM for Investigations of Low Frequency Vibrations of Transient Species in Combustion

Understanding the role of peroxides in combustion, in atmospheric and in surface science involves investigations on a molecular level, at which energy transfers and rearrangements of the nuclei dictate the chemistry. Due to their high reactivity they appear as unstable transient species, which impedes detailed spectroscopic investigations. Low frequency modes, especially internal and hindered rotations with energies less than 200 cm-1 play an important role for the determination of molecular energies and reaction rates. Unfortunately, these motions are in general difficult to address. Femtosecond four-wave mixing (fs-FWM) is a powerful tool that allows for investigations of ground state dynamics of molecules. The high peak-power output of fs-lasers, facilitates the excitation of weak Raman coherences. Results from the combustion relevant di-tert-butyl peroxide molecule are exemplified