Revisional Bariatric Surgery in Israel: Findings from the Israeli Bariatric Surgery Registry.

BACKGROUND: Bariatric surgery (BS) is a proven sustainable approach for obesity, and its frequency is increasing worldwide. However, the frequency of revision surgery (RS) is also increasing. This study aimed to evaluate the RS rate in Israel and compare RS to primary surgery (PS). METHODS: Data were obtained from the Israeli Bariatric Surgery Registry. All patients aged > 18 years who underwent BS between June 2013 and December 2016 were considered for inclusion. Sociodemographic and clinical data were analyzed. RESULTS: PS was performed in 28,707 patients and RS was performed in 4026 patients. The mean body mass index values were 42.1 ± 5.0 and 41.3 ± 7.0 kg/m2 in the PS and RS groups, respectively. Hypertension, type 2 diabetes mellitus, dyslipidemia, and fatty liver were less frequent in the RS group than in the PS group. The percentage total weight loss (%TWL) values 6 months and 1 year postoperatively were 25.1 ± 8.1% and 30.5 ± 9.5%, respectively, in the PS group and 18.5 ± 8.9% and 23.12 ± 11.4%, respectively, in the RS group (P < 0.001). Complications were noted in 856 (3.5%) and 210 (6.2%) patients from the PS and RS groups, respectively. A multilinear regression model found that more weight loss was significantly associated with RS type (revision bypass vs. revision restrictive surgery). CONCLUSIONS: The RS rate is continuously increasing, and it should be tapered according to indications and feasibility. Our findings indicate that RS can be performed with acceptable complication rates and that restrictive surgery should be converted to bypass surgery to achieve acceptable weight loss with fewer complications.

Sleeve Gastrectomy in Different Age Groups: a Comparative Study of 5-Year Outcomes.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has been used more frequently over the past 10 years. As the population ages, a larger number of older people will suffer from weight-related comorbidities, resulting in bariatric surgery becoming a dominant solution for improving health and quality of life. We assessed the long-term outcomes of LSG in elderly patients. METHODS: We conducted a retrospective chart review of patients who underwent LSG between January 2007 and August 2009. We subdivided 123 patients into <35 (n = 43), 35-55 (n = 59), and >55 (n = 21) age groups. RESULTS: The respective mean excess body mass index loss and excess weight loss were 42.5% ± 3.1% and 41.3% ± 12.3% for the <35 age group, 48.7% ± 4.1% and 45.6% ± 10.6% for the 35-55 age group, and 53.6% ± 4.6% and 52.1% ± 11.1% for the >55 age group. The follow-up compliance rates at the 5-year visit were 23.85, 31.11, and 47.61% for the <35, 35-55, and >55 age groups, respectively. The corresponding Bariatric Analysis and Reporting Outcome System scores were 3.7 ± 1.1, 4.0 ± 0.7, and 5.3 ± 1.3. The comorbidities of all the patients improved significantly, with a non-significant distribution between the three groups for each comorbidity. CONCLUSIONS: LSG is a useful tool for people who want to modify their eating habits and lose weight healthily. This study suggests that long-term weight loss, improvements in comorbidity, and compliance to follow-up are significant for patients >55 years old.

ICSH recommendations for assessing automated high-performance liquid chromatography and capillary electrophoresis equipment for the quantitation of HbA2.

Automated high performance liquid chromatography and Capillary electrophoresis are used to quantitate the proportion of Hemoglobin A2 (HbA2 ) in blood samples order to enable screening and diagnosis of carriers of ß-thalassemia. Since there is only a very small difference in HbA2 levels between people who are carriers and people who are not carriers such analyses need to be both precise and accurate. This paper examines the different parameters of such equipment and discusses how they should be assessed.

Over-the-Scope Clip (OTSC) System for Sleeve Gastrectomy Leaks.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is currently being widely accepted for its role in the treatment of morbid obesity. Staple-line leakage is one of the most reported complications found in 0.5-7 % of the population, in which the Over-the-Scope Clip (OTSC) (Ovesco Endoscopy, Tübingen, Germany), a novel device, is employed. We present our experience with this system in LSG leaks. METHODS: A retrospective analysis of prospectively collected data from patients with LSG leakage was performed, and these patients were treated with the OTSC system. Efficiency was defined as complete oral nutrition without any evidence of additional leakage. RESULTS: Overall, 26 patients underwent endoscopic OTSC treatment. The median age was 39 years (range 26-60), and 12 were male patients (46.15 %). The mean body mass index (BMI) was 42.89 kg/m(2), and 10 patients (38.46 %) came from a revisional bariatric procedure (SRVG or LAGB). Twenty-two patients (84.61 %) had upper staple-line leaks (near the GEJ), and the remaining 4 (15.38 %) had lower antral leaks. Number of endoscopy sessions ranged from 2 to 7 (median 3). There were five failures: 2 of them had an antral leak, and the remaining 3 had an upper staple-line leak. Twenty-one (80.76 %) leaks were successfully treated within 32 days' median time till complete oral nutrition was attained (range 14-70). CONCLUSIONS: The success rate was high with the OTSC system, and it is concluded to be a safe and effective treatment for LSG leaks.

Preventing Ralstonia solanacearum adhesion with glycans from cashew, cocoa, coffee, pumpkin, and tomato seed extract.

Ralstonia solanacearum wilts many plants, causing heavy agricultural losses. Its pathogenic strain ATCC 11696 produces 2 hemagglutinating lectins: RSL and RS-IIL. These lectins may bind to terminal l-fucose-, d-arabinose-, and d-mannose-bearing seedling xylem cell wall glycans, thus enabling pathogen adhesion to them, with devastating infection establishment. Blocking the active sites of these lectins with seed embryo-surrounding oligo- and poly-saccharides hampers binding of the lectins to the embryos. The current study shows that seeds of cashew, cocoa, coffee, pumpkin, and tomato contain low and high molecular mass glycans that block RSL and RS-IIL (like its homologous Pseudomonas aeruginosa PA-IIL lectin). The blocking of the pathogen lectins, which is attributable to the documented composition of the oligo- and poly-saccharides of these seeds, is similar to that observed with animal glycoproteins of avian egg whites (protecting their embryos from infections) and of milk and royal jelly, which likewise protect mammal and bee neonates, respectively. RSL was most strongly inhibited by cashew seed glycans, and RS-IIL by coffee seed glycans. Western blot analyses with these lectins instead of antibodies revealed the hitherto undescribed presence of lectin-binding glycoproteins in the coffee, pumpkin, tomato, and cashew (but not cocoa) seeds. The use of these lectins for unveiling potent embryo-protecting seed glycans might be helpful for seedling-bioprotection projects similar to those planned for animal protection against antibiotic-resistant infections.

Preventing Pseudomonas aeruginosa and Chromobacterium violaceum infections by anti-adhesion-active components of edible seeds.

BACKGROUND: Pseudomonas aeruginosa adhesion to animal/human cells for infection establishment involves adhesive proteins, including its galactose- and fucose-binding lectins PA-IL (LecA) and PA-IIL (LecB). The lectin binding to the target-cell receptors may be blocked by compatible glycans that compete with those of the receptors, functioning as anti-adhesion glycodecoys. The anti-adhesion treatment is of the utmost importance for abrogating devastating antibiotic-resistant P. aeruginosa infections in immunodeficient and cystic fibrosis (CF) patients. This strategy functions in nature in protecting embryos and neonates. We have shown that PA-IL, PA-IIL, and also CV-IIL (a PA-IIL homolog produced in the related pathogen Chromobacterium violaceum) are highly useful for revealing natural glycodecoys that surround embryos in diverse avian eggs and are supplied to neonates in milks and royal jelly. In the present study, these lectins were used as probes to search for seed embryo-protecting glycodecoys. METHODS: The lectin-blocking glycodecoy activities were shown by the hemagglutination-inhibition test. Lectin-binding glycoproteins were detected by Western blotting with peroxidase-labeled lectins. RESULTS: The present work reports the finding - by using PA-IL, PA-IIL, and CV-IIL - of rich glycodecoy activities of low (< 10 KDa) and high MW (> 10 kDa) compounds (including glycoproteins) in extracts of cashew, cocoa, coffee, pumpkin, and tomato seeds, resembling those of avian egg whites, mammal milks, and royal jelly. CONCLUSIONS: Edible seed extracts possess lectin-blocking glycodecoys that might protect their embryos from infections and also might be useful for hampering human and animal infections.

The CONFbal scale: a measure of balance confidence--a key outcome of rehabilitation.

OBJECTIVE: Optimising balance confidence is the goal of rehabilitation among people with mobility problems. The aim of this study was to examine the measurement properties of the CONFbal scale of balance confidence, and comment on its importance in rehabilitation. The 10-item CONFbal scale can also be referred to as a 'falls self-efficacy scale'. STUDY 1: INTERNAL CONSISTENCY AND TEST-RETEST RELIABILITY: DESIGN: CONFbal was administered on two occasions, 1 week apart, using a standardised procedure. SETTING: Three day centres in south-west London. PARTICIPANTS: Older people (n=45, mean age 81 years, standard deviation 7) without any recent change in mobility. RESULTS: The 10 scale items were summed to give an index of balance confidence. Cronbach's alpha for the items was 0.91, with an intra-class correlation coefficient of 0.95. The within-subject standard deviation was 1.145, giving a minimal detectable change of three scale points. This suggests that a change in score of three points following treatment indicates a true difference. STUDY 2: CONCURRENT VALIDITY: SETTING: Geriatric medical wards in three south-west London hospitals. PARTICIPANTS: One hundred and fifty-three people (mean age 81 years, standard deviation 6) completed the test battery prior to discharge. DATA: CONFbal; postural instability; perceived unsteadiness; previous mobility; falls in the last 3 years. RESULTS: CONFbal scores (lower scores indicate greater balance confidence) were related to an index of postural instability [correlation coefficient (r)=0.75], previous mobility (r=-0.76) and perceived unsteadiness (r=0.48), but demonstrated a weak relationship with experience of falling (r=0.26). CONCLUSIONS: The CONFbal scale demonstrates excellent internal consistency, excellent test-retest reliability, and a small minimal detectable change which allows users to judge whether or not there has been a true clinical improvement. Relationships between the CONFbal scale and other relevant physical and psychological variables support its validity in this population.

Blocking of Pseudomonas aeruginosa and Ralstonia solanacearum Lectins by plant and microbial branched polysaccharides used as food additives.

Pseudomonas aeruginosa antibiotic resistance prompted the search for glycodecoys that would block its lectin-dependent adhesion to human cells. We have used the lectins of this pathogen, PA-IL (galactophilic LecA) and PA-IIL (fucophilic LecB), and two additional pathogenic bacterial lectins, CV-IIL (fucophilic, of Chromobacterium violaceum) and RS-IIL (mannophilic, of Ralstonia solanacearum), for assaying the pathogenic lectin-blocking abilities of some plant and microbial polysaccharidic food additives, adding the mannophilic plant lectin Con A as a reference. Locust-bean and guar galactomannans and acacia gum very strongly inhibited PA-IL. The other lectins, excluding CV-IIL, were very strongly inhibited by yeast mannan. Xanthan and inulin were weak inhibitors. The differential blocking of these lectins by galactosylated branches of plant polysaccharides and by mannan matched their inhibition by avian egg whites, human milk, and royal jelly (protecting animal embryos and neonates from infections). The nondigestability and nontoxicity of the food additives are advantageous for curing gastrointestinal and external infections.

Honey and royal jelly, like human milk, abrogate lectin-dependent infection-preceding Pseudomonas aeruginosa adhesion.

Pseudomonas aeruginosa antibiotic resistance has led to the search of natural compounds, which would competitively block its fucose>fructose/mannose-binding lectin (PA-IIL) that mediates its biofilm formation and adhesion to animal cells. Such compounds were found in human milk (HM) and avian egg whites. The present research has revealed that honey and royal jelly (RJ), which are assigned to protect beehive progeny and are applied for human infection therapy, match HM in PA-IIL blocking. The function of their fructose (higher in honey) and mannosylated glycoproteins (higher in RJ) as powerful decoys in PA-IIL neutralization is of ecological/biological importance and implementability for the antibacterial adhesion therapeutic strategy.

Guanosine gel for sequence-dependent separation of polymorphic ssDNA.

The separation of fluorescent-labeled ssDNA fragments of equal length based on differences in sequence was achieved through the use of guanosine gels (G-gels) formed by guanosine-5'-monophosphate (GMP) in capillary gel electrokinetic chromatography (CGEKC) with LIF detection. Baseline resolution was achieved for homodimers and homopentamers of A, T, and C. G-gel CGEKC provided better resolution than CZE, MEKC, or a sieving gel in CGE. Resolution improved with increasing GMP, indicating that the interaction is linked to structural organization of the G-gel. Fluorescence intensity and anisotropy show that the order of interaction with G-gels is T>C>A. We then investigated four conformationally similar, polymorphic 76-mers with A/G substitutions that are utilized in forensic DNA typing. Resolution was achieved by CGEKC but not CZE or CGE. In CGEKC, the negatively charged G-gels and oligonucleotides electromigrate toward the positive inlet while being driven by EOF to the negative outlet. The net forward velocity is the greatest for oligonucleotides most closely associated with the slower, more cumbersome G-gel network. For the 76-mers, resolution increases with increasing difference in guanosine content between strands and, for a given difference, with increasing total guanosines in the strands.

Statin escape phenomenon: Does it really exist?

BACKGROUND: The normalization of blood lipid profile has become an accepted method of primary and secondary prevention of vascular disease, with statins being the most popular group of medicines prescribed to lower cholesterol and LDL cholesterol levels. The failure of statins, administered in an appropriate dose, to maintain the optimal level of LDL cholesterol is a rare phenomenon, and is still not well understood in patients compliant for both medication and diet. The entity of "statin escape phenomenon", proposed to explain the failure of statins in some of these patients, has not been studied or characterized extensively, and reports of its prevalence are scarce. METHODS: Patients with hyperlipidemia type 2a or 2b who had been treated with statins for at least 1 year and who were followed up in the lipid clinic on a regular basis every 3-4 months were included in this study. The charts of patients whose LDL cholesterol levels were elevated by 15% or more while receiving the same treatment were analyzed, and patients with putative statin escape phenomenon were included in the study and further characterized. RESULTS: Forty-five of 358 statin-treated patients demonstrated a 15% increase in LDL cholesterol levels, leading to suspicion of statin escape phenomenon. However, a strict exclusion analysis left only two patients without evident potential triggers for the observed elevation in LDL cholesterol. CONCLUSIONS: Whether a statin escape phenomenon really exists is still not certain, but if it does exist, it is probably an uncommon event with a low prevalence.

Do forceps biopsies truthfully reflect the nature of endoscopically uncovered polypoid lesions of the colon?

BACKGROUND: Total excision of colonic polyps is not always attainable and in some patients it is clinically contraindicated. Also, a resected polyp may be lost at any step between its endoscopic removal and its embedding in paraffin. The aim of this study was to compare the histological features of colonic polyps as analysed by the study of biopsy-forceps obtained samples with those assessed on scrutinizing the totally resected growths. PATIENTS AND METHODS: This prospective study included a cohort of 59 patients in whom, in the course of an elective colonoscopy, a total excision of a 6 mm-sized or larger polyp was called for. Sizeable biopsies were obtained by means of an Olympus Multibyte forceps prior to the total polypectomy. Subsequent to the study of the polypectomy specimens, the forceps biopsy samples were submitted for histological examination. The pathologists were blinded as to the source of the tissue they were studying. The diagnoses rendered by evaluating the biopsy samples and polypectomy specimens of each patient were contrasted with each other. RESULTS: Major discrepancies between the histological features of the fragments captured by the biopsy-forceps and the factual nature of the totally removed polyps were uncovered in 11 (18.6%) of 59 cases. Intriguingly, the grade of the tumours was underrated in all the 11 cases, as judged by contrasting the tentative diagnoses of the forceps-biopsies with the decisive diagnoses of the polypectomies. Importantly, 2 adenocarcinomas would have been missed by just looking at the forceps-retrieved sample. CONCLUSIONS: In our experience, a discordance of 18.6% is to be expected between the diagnoses rendered after examining forceps-biopsies of and totally excised colonic polyps. Nevertheless, it is advisable to procure biopsies prior to the excision of the growths, because on those occasions in which patients' growths cannot be removed or have not been retrieved for one reason or another, a small forceps-captured tissue sample correctly reflects the characteristics of the polyp in 81.4% of the cases. Finally, the biopsies may be discarded in the event that total removal was successful.

Hepatitis C virus-related arthritis: characteristics and response to therapy with interferon alpha.

OBJECTIVE: To characterize hepatitis C virus (HCV)-related arthropathy and to evaluate the response to treatment with interferon-alpha (INF-alpha). METHODS: We studied 28 HCV-infected patients with arthritis. All patients underwent complete clinical, laboratory and radiological evaluation, including assessment and follow-up by a rheumatologist. Twenty-five patients were treated with INF-alpha for a median period of 12 months. RESULTS: All patients were HCV-RNA positive (genotype 1b in 65%). The mean duration of arthropathy-related symptoms prior to the diagnosis of HCV infection was 12 months. 19 patients (68%) had symmetric polyarthritis and 19 (68%) had morning stiffness > or = 60 min. None of the patients had erosive disease or subcutaneous nodules. 12 (43%) had detectable cryoglobulin (mean cryocrit: 3.6 +/- 3.5%), 17 (61%) had rheumatoid factor (RF) (median titer: 1:80), and only 15 (54%) had elevated ESR. 14 patients (50%) had > or = 4 ACR (American College of Rheumatology) criteria for the diagnosis of rheumatoid arthritis (RA), 9 of whom were mistakenly diagnosed and previously treated as RA patients. Only 3 patients had a satisfactory response to previous treatment with anti-inflammatory or disease modifying drugs. Complete or partial response of arthritis-related symptoms in INF-alpha treated patients was observed in 44% and 32%, respectively. Cryoglobulin became undetectable in 9 of 12 patients. However, a complete biochemical and virological end-of-treatment response was achieved in only 8 (36%) and 5 patients (20%), respectively. CONCLUSION: HCV arthropathy should be considered in the differential diagnosis of any patient with arthritis, even in the absence of liver disease. Treatment with interferon-alpha may lead to substantial clinical improvement of HCV-related arthritis even without a complete biochemical or virological response.

Treatment of refractory, symptomatic, hepatitis C virus related mixed cryoglobulinemia with ribavirin and interferon-alpha.

OBJECTIVE: To assess the benefit of interferon-alpha/ribavirin combination therapy in hepatitis C virus (HCV) infected patients with symptomatic mixed cryoglobulinemia (MC) who failed to respond to treatment with interferon-alpha (IFN-alpha). METHODS: Nine patients (mean age 57 +/- 14 yrs) with type II symptomatic MC who failed to respond to IFN-alpha monotherapy were re-treated with combination treatment of IFN-alpha 3 times weekly and ribavirin 15 mg/kg daily for 6 months. Five of 9 patients had previously received additional treatment during IFN-alpha monotherapy. Clinical and laboratory evaluations (including cryocrit level) were performed weekly for the first month and monthly thereafter. RESULTS: Baseline mean alanine aminotransferase (ALT) and cryocrit levels were 119 +/- 97 IU/l and 7.9% +/- 10%, respectively. All patients were HCV-RNA positive and 5 had cirrhosis. At the end of therapy, mean ALT level was 84 +/- 79 IU/l (p = 0.02), while normal ALT levels were observed in 4 of 9 patients (44%). However, complete virological response was achieved in only 2 patients (22%). Cryoglobulin became undetectable within 6 weeks of therapy in 7 patients (78%) and decreased significantly in 2 others (p = 0.008). A substantial improvement in MC related symptoms (arthralgia/arthritis, proteinuria, skin vasculitis) was achieved in all patients within 10 weeks of combination therapy, although polyneuropathy related symptoms were relatively resistant to treatment. CONCLUSION: Symptomatic, refractory HCV related MC should be considered as an indication for combination therapy with IFN-alpha and ribavirin. Improvement in MC related symptoms can be achieved even without complete biochemical or virological response.

Accuracy of the OMRON M4 automatic blood pressure measuring device.

Despite widespread use of the automatic blood pressure (BP) measuring device OMRON M4, there is little formal validation on its accuracy. A study was conducted to assess the accuracy of the OMRON M4 compared with the true indirect BP measured by mercury sphygmomanometer (MS). A rapid method for the evaluation of automatic blood pressure measurement devices (READ) was applied for this study. The READ is based on numerous BP measurements at rest and during a standardised postural challenge in a small number of subjects who exhibit a wide range of BPs. Blood pressure measurements were done in supine position for 10 min followed by head-up tilt for 30 min and again supine for 10 min. The automatic device (AU) and the MS were connected to one arm-cuff by means of a T connector. A stethoscope with dual sets of ear-pieces was used for duplicate MS measurements (MS1 and MS2). The MS1, MS2 and AU measurements were taken simultaneously in a blinded manner. Three units of the automatic instrument were evaluated. An average of 111 measurements per unit were performed, every BP category being present in >/=15 MS measurements. The differences between MS1 and MS2 measurements (DeltaBP: MS1-MS2) were utilized to assess the consistency of true indirect BP and the differences between AU and MS measurements (DeltaBP:AU-MS2) were utilized to assess the accuracy of the AU. The following characteristics of the OMRON M4 were assessed: (1) grade of accuracy, (2) aberration pattern, (3) consistency of the aberration-pattern, and (4) correlation between levels of BP and DeltaBP: AU-MS. For MS paired readings, 92-100% of systolic and 99-100% of diastolic readings fell within 5 mm Hg difference range, that is consistent with a British Hypertension Society grade A of both. For AU compared to MS2, 29-64% of systolic and 73-94% of diastolic readings fell within 5 mm Hg and 49-86% of systolic and 86-99% of diastolic readings fell within 10 mm Hg and the devices qualified C, D and C, respectively. All devices exhibited irregular and inconsistent aberration patterns, making the design of correction formulas impractical. In conclusion, the OMRON M4 device did not meet the requirements of the British Hypertension Society and, therefore, cannot be recommended for clinical use.

Pulsatile venous insufficiency in severe tricuspid regurgitation: does pulsatility protect against complications of venous disease?

Prior observations showed that the consequences of venous hypertension depend not only on the magnitude of the venous pressure but also on the efficiency of compensatory mechanisms that protect against the effects of excessive pressures on the microcirculation. Pulsatile venous insufficiency (PVI) associated with severe tricuspid regurgitation (TR) provides the opportunity to investigate the effect of the pulsatile shear stress on the outcome of venous insufficiency. The authors conducted a study to assess the flow characteristics and clinical outcome of PVI associated with TR. Five patients were evaluated, presenting venous insufficiency associated with ectasia, varices, and visible systolic pulsations of the leg veins. Characteristics of the venous flow were assessed by duplex ultrasound. In two patients, flow in the distal calf veins was evaluated by power Doppler sonography, and the supine-to-sitting leukocyte trapping was calculated. Results of the latter measurements were compared with measurements in five control patients who presented chronic nonpulsatile venous insufficiency. A survey of complications of PVI was conducted. On follow-up for 6 to 15 years (average 9.4 years) none of the patients developed venous thrombosis, phlebitis, or cutaneous ulcer. Flow in the distal calf vessels was increased in PVI (12-20 vessels/field) as compared with nonpulsatile venous insufficiency (0-7 vessels/field). Leukocyte trapping in the upright position was diminished in PVI (0.8-3%) as compared with nonpulsatile venous insufficiency (7-22%). In conclusion, PVI is characterized by increased flow in the distal calf veins, diminished leukocyte trapping, and a benign clinical course. These data are in agreement with experimental studies showing that pulsatile shear stress enhances secretion of cytokines by venous endothelial cells and, consequently, counteracts a predisposition to platelet aggregation, hypercoagulability, and white cell adhesion and promotes healing of leg ulcers.

In-field validation of automatic blood pressure measuring devices.

The method for rapid evaluation of automatic blood pressure (BP) measurement devices (READ) is based on numerous BP measurements at rest and during a standardised postural challenge in a small number of subjects with a wide range of BPs. The present study proposes additional parameters of the READ for in-field validation of automatic BP measurement devices. BP measurements were done in supine position for 10 min followed by head-up tilt for 30 min and again supine for 10 min. BPs were determined simultaneously by automatic (AU) and mercury sphygmomanometric (MS) measurements on the same arm. The BP differences DeltaBP:AU-MS were calculated. Three units of the Colin BP-8800 and the Datex-Engstrom Cardiocaptrade mark II were evaluated. Based on DeltaBP(AU-MS), the grade of accuracy, aberration patterns and correlates of accuracy were assessed for each unit. Per unit, an average of 121 measurements were done, every BP category being met in >/=20 MS measurements. In general, the AU systolic BP values were higher than MS systolic BP values (mean systolic DeltaBP = 1.26 +/- 17.1 mm Hg) and AU diastolic BP values were lower than MS diastolic BP values (mean diastolic DeltaBP = -12.31 +/- 7.8 mm Hg). All units classified into category D of the British Hypertension Society grading system and exhibited inconsistent aberration patterns, making design of correction formulas impractical. Inaccuracy of the instruments was independent on mode of measurement, posture, magnitude of the BP and heart rate, early or late measurements from beginning of the head-up tilt test, and prolonged use of the unit. The READ permitted to identify rapidly the degree of accuracy of automatic BP measuring devices. Identification of the aberration pattern of an instrument could be the basis for calculating equations for correction of the measured BP. Further studies will show which parameters of the READ may expose specific defects of the instruments. Journal of Human Hypertension (2000) 14, 37-42.