Comparación de parámetros metabólicos en pacientes adultos y ancianos sometidos a cirugía bariátrica: Una cohorte prospectiva

Introduction: The aim was to evaluate metabolic parameters in a group of patients older than 65 years old compared to younger adults at three and six months after bariatric surgery (BS). Materials and methods: Prospective analytic study of a cohort of 40 patients under BS since 2015 to 2018. Participants were divided into two groups (Group A: ≥65; B: <65 years old). Anthropometrics and metabolic parameters were assessed before and 3 and 6 months after BS. The excess weight loss percentage (EWLP) and the Triglycerides/HDLc ratio, as a marker of insulin resistance, were also evaluated. A p <0.05 was statistically significant. Results: Forty patients were under BS, we included thirty six: 21 patients were at group A (Median age: 59, RIQ: 48-61 years old) and 15 at group B (median age 67, RIQ: 66-69 years old), the prevalence of patients with type 2 diabetes was 53% (n=8) in group B vs 43% (n=9) at group A. After 3 and 6 months of BS, we found no statistical difference between groups in WL and the EWLP and the decrease in fasting blood glucose (FBG), HbAc1 % levels but a significant rise in the levels of HDLc in group B. We observed a statistically decrease in the TAG/HDLc ratio and a positive correlation between HbA1c% and levels of FBG, HDLc and the TAG/HDLc ratio in group B. Moreover, we found a reduction in the use of antidiabetics and lipid lowering drugs in this age group.Conclusion: We found a significant benefit in metabolic effects of BS in the≥65 y/o cohort, especially by decreasing insulin resistance, even in those patients without diagnosis of DM2. We need more studies and a greater sample size to generalize these results.Introducción: El Objetivo fue evaluar los parámetros metabólicos en pacientes adultos ≥ 65 años en comparación con adultos < 65 años sometidos a CB pre y post intervención.Materiales y métodos: Estudio analítico de cohorte prospectiva en 40 pacientes sometidos a CB durante el periodo julio de 2015 y marzo de 2018. Los pacientes fueron divididos en dos grupos (A: ≥65 años; B: < 65 años) y se evaluaron previo a la cirugía (basal), y a los 3 y 6 meses posteriores al acto quirúrgico parámetros antropométricos y parámetros bioquímicos. Se calculó el porcentaje de peso perdido (PEPP) y se evaluó el índice Triglicéridos/HDLc (TAG/HDLc) como marcador de insulinorresistencia.Resultados: De los 40 pacientes sometidos a la CB, se incluyeron 36: 21 pacientes eran del grupo A (mediana de edad: 59, RIQ: 48-61 años) y 15 pacientes del grupo B (mediana de edad: 67, RIQ: 66-69 años), el porcentaje de pacientes con diabetes mellitus tipo 2 era de 53%(n=8) en B vs 43% (n=9) en A. Luego de 3 y 6 meses post CB se observó en el grupo B un descenso en el peso, índice de masa corporal y porcentaje de exceso de peso perdido (PEPP) no significativo, disminución en los niveles de glucemia y HbA1c sumado a un aumento significativo en los niveles de HDLc, además de un descenso significativo del índice TAG/HDLc en el grupo B. Se encontró una correlación positiva entre los niveles de HbA1c y PEPP, HDLc y el índice TAG/HDLc así como el descenso del uso de antidiabéticos e hipolipemiantes en el grupo B. Conclusiones: la CB logró similares resultados antropométricos en el grupo de pacientes ≥ de 65 años presentando una mejoría significativa en los paramétricos metabólicos a los 3 y 6 meses, principalmente en la insulinorresistencia, lo cual apoyaría el beneficio de la CB en este grupo etario

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Simulation of fast wave current drive in tokamaks in the ion cyclotron frequency range

To perform realistic simulations of radio-frequency current drive in tokamaks in the ion cyclotron range of frequencies, the wave fields evaluated by the toroidal full-wave code TORIC have been used to build the quasilinear electron diffusion coefficient, which, in turn, is used by a recently developed solver of the bounce-averaged quasilinear Fokker-Planck kinetic equation, QLEFOPS. Applications to possible fast wave current drive experiments in ASDEX Upgrade are presented. The effects of varying the target electron temperature, the background Ohmic current, and, within the relatively limited possibilities, the directivity of the antenna have been investigated. The results are in reasonable agreement with the predictions of the parametrization of the current drive (CD) efficiency proposed by Ehst and Karney based on the adjoint method for the solution of the kinetic equation. The detailed analysis which was necessary to guarantee consistency between the two codes, on the other hand, has put into evidence characteristics of this CD scheme, which, to some extent, are likely to limit the efficiency achievable in practice. In particular, the normalized quasilinear diffusion coefficient for realistic power densities turns out to be far too small for the development of a quasilinear plateau. In the absence of suprathermal electrons, sufficient absorption can be achieved only by positioning the spectrum of parallel phase velocities excited by the antenna close to the thermal region, where the theoretical efficiency is poor.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

MIND: un modello per la specifica di un'interfaccia utente grafica

SIGLEITItal

Comparación de parámetros metabólicos en pacientes adultos y ancianos sometidos a cirugía bariátrica: una cohorte prospectiva

Introduction: The aim was to evaluate metabolic parameters in a group of patients older than 65 years old compared to younger adults at three and six months after bariatric surgery (BS). Material and Methods: Prospective analytic study of a cohort of 40 patients under BS since June, 2015 to March, 2018. Participants were divided into two groups (Group A: ≥65; B: <65 years old). Anthropometrics and metabolic parameters were assessed before and 3 and 6 months after BS. The excess weight loss percentage (EWLP) and the Triglycerides/HDLc (TAG/HDLc) ratio, as a marker of insulin resistance, were also evaluated. A p <0.05 was statistically significant. Results: Forty patients were under BS, we included thirty six: 21 patients were at group A (median age: 59, RIQ: 48-61 years old) and 15 at group B (median age 67, RIQ: 66-69 years old), the prevalence of patients with type 2 diabetes was 53% (n=8) in group B vs. 43% (n=9) at group A. After 3 and 6 months of BS, we found no statistical difference between groups in weight loss and the EWLP and the decrease in fasting blood glucose (FBG), HbAc1% levels but a significant rise in the levels of HDLc in group B. We observed a statistically decrease in the TAG/HDLc ratio and a positive correlation between HbA1c% and levels of FBG, HDLc and the TAG/HDLc ratio in group B. Moreover, we found a reduction in the use of antidiabetics and lipid lowering drugs in this age group.Conclusions: The metabolic effects of BS achieved significant benefits in the ≥65 y/o cohort, especially by decreasing insulin resistance, even in those patients without diagnosis of type 2 diabetesIntroducción: El objetivo fue evaluar los parámetros metabólicos en pacientes adultos ≥65 años en comparación con adultos <65 años a los 3 y 6 meses de ser sometidos a cirugía bariátrica (CB). Material y Métodos: Estudio analítico de cohorte prospectiva en 40 pacientes sometidos a CB du-rante el periodo julio de 2015 y marzo de 2018. Los pacientes fueron divididos en dos grupos (A: ≥65 años; B: <65 años) y se evaluaron parámetros antropométricos y parámetros bioquímicos antes de la CB y a los 3 y 6 meses posteriores. Se calculó el porcentaje de peso perdido (PEPP) y se evaluó el índice triglicéridos/HDLc (TAG/HDLc) como marcador de insulinorresistencia. Una p<0.05 se consi-deró estadísticamente significativa. . Resultados: De los 40 pacientes sometidos a la CB, se incluyeron 36: 21 pacientes eran del grupo A (mediana de edad: 59, RIQ: 48-61 años) y 15 pacientes del grupo B (mediana de edad: 67, RIQ: 66-69 años), el porcentaje de pacientes con diabetes mellitus tipo 2 era de 53% (n=8) en B vs. 43% (n=9) en A. Luego de 3 y 6 meses post- CB se observó en el grupo B un descenso en el peso, índice de masa corporal y porcentaje de exceso de peso perdido (PEPP) no significativo, disminución en los niveles de glucemia y HbA1c sumado a un aumento significativo en los niveles de HDLc, además de un descenso significativo del índice TAG/HDLc en el grupo B. Se encontró una correlación positiva entre los niveles de HbA1c y PEPP, HDLc y el índice TAG/HDLc así como el descenso del uso de an-tidiabéticos e hipolipemiantes en el grupo B. Conclusiones: Los efectos metabólicos de la CB alcanzaron beneficios significativos en la cohorte de AM, especialmente al reducir la insulinoresistencia, incluso en aquellos pacientes sin diagnóstico de diabetes tipo 2