Renal sinus fat is expanded in patients with obesity and/or hypertension and reduced by bariatric surgery associated with hypertension remission

Prevalence of obesity has extended into pandemic-like proportions in the last few decades. Obesity (body mass index (BMI) ≥30 kg/m2) leads to a myriad of complications such as hypertension, type 2 diabetes, chronic kidney disease as well as neurodegenerative diseases and different types of cancer. Based on individual tendencies, obesity related excess fat is distributed between visceral and subcutaneous adipose tissue compartments. It has been shown that visceral adipose tissue (VAT) has a greater association with the development of comorbidities compared to subcutaneous adipose tissue (SAT). Visceral adipose tissue compartments include fat around abdominal organs as well as inside sinus-like structures. The subject of interest regarding this study was to measure fat accumulation in the renal sinus, a hilum structure where blood vessels, lymph vessels and ureters enter the kidney. It is considered that fat accumulation at the renal sinus creates increased mechanical pressure against the soft venous structures, hence leading to the activation of blood pressure altering renin-angiotensin-aldosterone -system. This theory might explain at least partly the phenomenon of obesity-related hypertension. When it comes to remission from obesity related comorbidities, amount of weight lost and the maintenance of the new weight play a crucial role. Based on several studies, bariatric surgery has been recognized as the most efficient way to lose weight as well as achieve remission from metabolic comorbidities compared to conservative methods. Much to our interest, both hypertension and chronic kidney disease can be alleviated as a result of bariatric surgery. Hence, in this study we wanted to assess whether the amount of RSF decreases after bariatric surgery and whether the change in the amount of RSF associates with remission from hypertension. The study population consisted of 74 patients with obesity and 46 lean control subjects. The groups were well-matched for age and sex. Both groups underwent broad metabolic blood sample analyses and MR-imaging. Patients with obesity were studied before and after bariatric surgery. The MRI data were analysed using a “single slice technique” as proposed by Foster et al. Renal function was evaluated with estimated GFR according to the EPI-CKD formula. This study resulted in several outcomes: First, patients with obesity accumulated more fat in the renal sinus compared to healthy lean individuals. Patients with hypertension also have larger RSF, compared to normotensive subjects and in the pooled data renal sinus fat correlates inversely with eGFR. Following bariatric surgery, RSF was decreased and patients who achieved hypertension remission had a larger decrease in RSF compared to patients who did not achieve remission. Finally, in patients with no hypertension remission, a larger decrease in RSF was associated with a decrease in the number of antihypertensive drugs used. The study results were in line with previous findings. We were able to demonstrate an association between RSF change and remission from hypertension, as well as the number of antihypertensive drugs needed. However, we could not show a direct link between RSF and blood pressure values, probably because of the masking effect of antihypertensive drugs used by patients with hypertension diagnosis. A significant strength of our study was our thorough assessment of MRI both pre and post bariatric surgery. Limitations of the present study were the relatively small study population and the greater number of women studied compared to men. Also, our analyses provided us with larger RSF areas than previously reported data which on the other hand did not seem to affect the main findings. In conclusion, we were able to add valuable information to the previously existing findings and thus support the theory suggesting the role of RSF in the pathogenesis of obesity related hypertension

Applying machine learning to replicate large-eddy simulation results on urban pollutant dispersion

Non peer reviewe

Can soil improving cropping systems reduce the loss of soil biodiversity within agricultural soils?

Soil biodiversity, including abundance and function of species living in the soils are important aspects of soil health, and acknowledges that soil is a living ecosystem. The decline of soil biodiversity can lead to a simplification of the soil food web and the inter-relationships as a result of poor soil management. The impact of agricultural management has been shown to reduce diversity, with damaging consequences for nutrient cycling, soil structure and potentially crop yields. However, research is often siloed and the effect of soil biodiversity on crop yields is overlooked by soil ecologists focusing on other ecosystem services; and the role of soil biodiversity on maintaining soil quality and improving crop yields is missed by agronomy researchers. Introducing specific soil improving cropping systems (SICS) have previously been considered as a method to combat soil threats (such as soil erosion or compaction) but have been overlooked as a method of reducing soil biodiversity losses within agriculture. As soil biodiversity loss is interlinked with these other soil threats, SICS will also potentially reduce the impact of them. Here, we review the range of SICS that can be utilised to reduce the threat of soil biodiversity loss, evaluating the effect of SICS on biodiversity across a wide range of organismal groups and consider the impact this will have on the sustainability of agricultural management. There are examples of measures and practices that combine high crop yields with the promotion of soil biodiversity. Selecting specific cropping systems designed to maintain or increase soil biodiversity (e.g., cover crops), promoting the stabilisation of the soil environment (minimum tillage), reducing chemical amendments (targeted spraying and biocontrol), or increasing biological amendments (adding organic matter) are all potential SICS that can be utilised

REPORT-SCS: minimum reporting standards for spinal cord stimulation studies in spinal cord injury

Objective. Electrical spinal cord stimulation (SCS) has emerged as a promising therapy for recovery of motor and autonomic dysfunctions following spinal cord injury (SCI). Despite the rise in studies using SCS for SCI complications, there are no standard guidelines for reporting SCS parameters in research publications, making it challenging to compare, interpret or reproduce reported effects across experimental studies. Approach. To develop guidelines for minimum reporting standards for SCS parameters in pre-clinical and clinical SCI research, we gathered an international panel of expert clinicians and scientists. Using a Delphi approach, we developed guideline items and surveyed the panel on their level of agreement for each item. Main results. There was strong agreement on 26 of the 29 items identified for establishing minimum reporting standards for SCS studies. The guidelines encompass three major SCS categories: hardware, configuration and current parameters, and the intervention. Significance. Standardized reporting of stimulation parameters will ensure that SCS studies can be easily analyzed, replicated, and interpreted by the scientific community, thereby expanding the SCS knowledge base and fostering transparency in reporting

Renal Sinus Fat Is Expanded in Patients with Obesity and/or Hypertension and Reduced by Bariatric Surgery Associated with Hypertension Remission

Renal sinus fat is a fat depot at the renal hilum. Because of its location around the renal artery, vein, and lymphatic vessels, an expanded renal sinus fat mass may have hemodynamic and renal implications. We studied whether renal sinus fat area (RSF) associates with hypertension and whether following bariatric surgery a decrease in RSF associates with improvement of hypertension. A total of 74 severely obese and 46 lean controls were studied with whole-body magnetic resonance imaging (MRI). A total of 42 obese subjects were re-studied six months after bariatric surgery. RSF was assessed by two independent researchers using sliceOmatic. Glomerular filtration rate (eGFR) was estimated according to the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). Patients with obesity accumulated more RSF compared to lean controls (2.3 [1.7-3.1] vs. 1.8 [1.4-2.5] cm(2), p = 0.03). Patients with hypertension (N = 36) had a larger RSF depot compared to normotensive subjects (2.6 [2.0-3.3] vs. 2.0 [1.4-2.5] cm(2), p = 0.0007) also after accounting for body mass index (BMI). In the pooled data, RSF was negatively associated with eGFR (r = -0.20, p = 0.03), whereas there was no association with systolic or diastolic blood pressure. Following bariatric surgery, RSF was reduced (1.6 [1.3-2.3] vs. 2.3 [1.7-3.1] cm(2), p = 0.03) along with other markers of adiposity. A total of 9/27 of patients achieved remission from hypertension. The remission was associated with a larger decrease in RSF, compared to patients who remained hypertensive (-0.68 [ -0.74 to -0.44] vs. -0.28 [ -0.59 to 0] cm(2), p = 0.009). The accumulation of RSF seems to be involved in the pathogenesis of hypertension in obesity. Following bariatric surgery, loss of RSF was associated with remission from hypertension

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

"Hallå, vi här då! Kom hit och hjälp oss!" : En sociologisk studie om produktionsanställdas upplevelse av jämställdhet inom tung industri

Denna studie har med ett sociologiskt perspektiv ämnat undersöka hur upplevelsen av jämställdhet ser ut bland produktionsanställda inom den starkt mansdominerade stålindustrin. Det studerade företaget är SSAB som är ett svensk-finskt stålföretag vilka är specialiserade på utveckling och tillverkning av höghållfasta stål. Årligen har företaget en produktionskapacitet om cirka 8,8 miljoner ton på sina produktionsanläggningar i Sverige, Finland och USA. År 2018 omsatte företaget 75 miljarder kronor. Av SSAB:s cirka 14 300 anställda runt om i världen så är 81 procent män, vilket inte gör företaget unikt sett till könsfördelningen inom stålindustrin. SSAB arbetar aktivt med att försöka förändra dessa siffror genom att rekrytera fler kvinnor. Detta som ett led i företagets långsiktiga jämställdhetsmål med tron på att kunna skapa en bättre prestationskultur och bättre kunna tillgodose kundernas behov genom en jämnare könsfördelning. Syftet med studien var att undersöka hur produktionsanställda upplever jämställdhet på arbetsplatsen. Detta gjordes genom kvalitativa semistrukturerade intervjuer med produktionsanställda på SSAB:s koksverk i Luleå. Resultatet tyder på att den upplevda jämställdheten bland de anställda främst handlar om att företaget rekryterar fler kvinnor och att det synliga därför blir hur fler kvinnor tillträder arbetsplatsen. Detta uppfattades av en del vara ett uttryck för att SSAB kvoterar kvinnor till företaget. Därför upplevdes detta jämställdhets initiativ vara negativt eftersom kompetens och kvalifikationer åsidosatts enligt anställda. Det efterfrågades även initiativ rörande förändringar av attityder, normer och värderingar, vilka ansågs ha inverkan på rådande arbetsplatskultur som under lång tid formats av män. Arbetsplatskulturen och jargongen uppfattades av många som hård, men samtidigt rolig och grunden för trivsel bland de anställda. Däremot uppfattades den även som gränslös och att en minskad chefsnärvaro på grund av en tidigare omorganisation kunde vara grunden till den upplevelsen vilket även synliggjorde en önskan om förändring på arbetsplatsen. De anställda menar att en förändring skulle kunna innebära ökad acceptans mellan kollegor och bättre jargong på arbetsplatsen.This study aims to investigate, from a sociological perspective, how the perception of gender equality appears among production employees in the highly male-dominated steel industry. The company studied is SSAB, which is a Swedish-Finnish steel company, specialized in development and manufacturing of high strength steels. Each year, the company has a production capacity of approximately 8.8 million tonnes at its production facilities in Sweden, Finland and the USA. In 2018, the company had sales of SEK 75 billion.   Of SSAB's approximately 14 300 employees around the world, 81 percent are men, which does not make the company unique in terms of gender distribution in the steel industry. SSAB is working actively to try to change these figures by recruiting more women. This as part of the company's long-term gender equality goal, with the belief that it can create a better performance culture and better meet the needs of customers through a more even gender distribution.   The purpose of the study was to investigate how production employees experience gender equality in the workplace. This was done by performing qualitative semi-structured interviews with production employees at SSAB's cookery plant in Luleå. The result indicates that the perceived gender equality among the employees is mainly about recruiting more women and that the visible is thus becoming more women taking up the workplace. This was perceived as an expression of SSAB quoting women to the company. Therefore, this initiative of gender equality was perceived to be negative, as the skills and qualifications were neglected according to employees.   Initiatives were also requested concerning changes in attitudes, norms and values, which were considered to have an impact on the prevailing workplace culture that has long been shaped by men. The workplace culture and jargon were perceived by many as hard, but at the same time fun and the basis for well-being among the employees. However, it was also perceived as limitless and that a reduced managerial presence due to a previous reorganization could be the basis for that experience, which also made a wish for change in the workplace. The employees believe that this could mean increased acceptance between colleagues and better jargon in the workplace

Trust and Reputation under Asymmetric Information

We study the role of information about the multiplier in a finitely repeated investment game. A high multiplier increases the reputational incentives of a trustee, leading to more repayments. Our perfect Bayesian equilibrium analysis shows that if the trustee is privately informed about the multiplier, both the expected frequency of investments and repayments as well as the expected payoffs of both players are higher compared to a situation where the multiplier is public knowledge. We test this result in a laboratory experiment. The data cannot confirm the predicted welfare dominance of private information about the multiplier. We discuss potential reasons for the deviation between theory and experimental data