Reporting Weight Loss 2021: Position Statement of the Dutch Society for Metabolic and Bariatric Surgery (DSMBS).

Prevailing recommendations on reporting weight loss after bariatric and metabolic surgery are not evidence-based. They promote the outcome metric percentage excess weight loss (%EWL), sometimes indicated as percentage excess body mass index loss (%EBMIL). Many studies proved that this popular outcome measure, in contrast to other weight loss metrics, is inaccurate and error-sensitive when comparing weight loss within and between studies. It is inappropriate for assessing poor weight loss response and weight regain as well. The percentage (total) weight loss metric is the best alternative. The Dutch Society for Metabolic and Bariatric Surgery (DSMBS) recommends to stop using the %EWL (or %EBMIL) metric as primary outcome measure in all cases and calls on the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) to propagate this evidence-based recommendation.

Interpretation of laboratory results after gastric bypass surgery: the effects of weight loss and time on 30 blood tests in a 5-year follow-up program.

BACKGROUND: Long-term follow-up with blood tests is essential for bariatric surgery to be a successful treatment for obesity and related co-morbidities. Adverse effects, deficiencies, and metabolic improvements need to be controlled. OBJECTIVE: We investigated the effects of time and weight loss on laboratory results in each postoperative phase after laparoscopic Roux-en-Y gastric bypass (LRYGB). SETTING: Bariatric center of excellence, general hospital, Netherlands. METHODS: We retrospectively evaluated results of 30 blood tests, preoperatively and at 6 months, 1 year, 2 years, and 5 years after LRYGB. The 2019 Dutch bariatric chart was used to define weight loss responses as outstanding (>p[percentile curve]+1 SD), average (p+1 SD to p-1 SD), and poor (

Cobbler's Awl Causing a Rare Pediatric Paraspinal Injury Managed Using 3D CT.

Pediatric spinal injuries are very uncommon, accounting for a small percentage of all spinal injuries. Domestic accidents such as falling and bumping are frequent events during childhood. In this case report, we present a rare penetrating trauma by a cobbler's awl at the paraspinal level. The patient was referred to the ED after a needle became impaled into his back due to an accident that occurred at home. The patient's neurologic assessment was normal. A radiologic study of the patient showed a cobbler's awl penetrating the paravertebral muscle at the fourth lumbar vertebra level. The needle was removed promptly after an emergency surgical procedure. Postprocedure no complications occurred.

Geometric Effect on the Nonlinear Force-Displacement Relationship of Awl-Shaped Serpentine Microsprings for In-Plane Deformation.

Even when made by brittle materials, awl-shaped serpentine microsprings (ASSMs) were found to have a nonlinear displacement-force relationship similar to springs made by ductile material. It is found that the nonlinear displacement-force relationship is due to the geometry and dimensions of the ASSMs. The geometric effect of the nonlinear force-displacement relationship of ASSMs for in-plane motion was investigated. A theoretical solution was derived to analyze this nonlinearity. By successfully fabricating and measuring an ASSM, the theoretical results agreed well with the experimental results. The results indicated that ASSMs have a nonlinear force-displacement relationship, which is similar to that of hardening springs. The taper angle has a significant effect on the nonlinear displacement of ASSMs. When the taper angle was small, no obvious effect appeared on the nonlinearity of the microsprings with different numbers of turns. When the beam length increased, the critical force for nonlinear deflection decreased.

Areas of work-life in Spanish hostelry professionals: explanatory power on burnout dimensions.

BACKGROUND: Researchers have studied for decades workplace stress and burnout to identify their relationship to health and wellness. This research has focused on stress levels in people, as well as on environmental and personal factors that contribute to experiencing stress or burnout. In addition to the burnout measurement questionnaires (MBI-GS), Leiter and Maslach designed a model to evaluate the areas of work environment that relate to this construct (Areas of Worklife Scale-AWLS). The goal of the present research was to analyze the psychometric properties of a Spanish translation of the MBI (GS) and the AWLS with a Spanish-speaking population. This work makes a substantial contribution by addressing the need to use validated measures and methods when exploring the positive and negative aspects of organizations. These conditions provide a means to accurately evaluate the impact of interventions aimed to address stress and burnout. METHOD: Cross-sectional study with self-report measures. The sample was comprised of 452 managers and employees (hotels, restaurants, catering) of Aragón (Spain). There were approximately equal numbers of women and men (45,4% vs. 54,6%). The average age of participants was 36.6 years (SD = 10.03). A battery of questionnaires was used: Socio-demographic and work characteristics, Scale of stress and health symptoms, Maslach Burnout Inventory-General Survey (MBI-GS), Areas of Worklife Scale (AWLS). RESULTS: The results showed optimal psychometric properties in both questionnaires, especially in terms of the predictive capacity of the AWLS in each of the MBI-GS dimensions. CONCLUSIONS: The best explained dimension is that of emotional exhaustion. The manageable load variable is the one that most contributes to predicting burnout levels. For future interventions, the results confirm the need to verify the levels of each area of work, in order to focus on the most deteriorated ones.

LSG vs MGB-OAGB-3 Year Follow-up Data: a Randomised Control Trial.

AIM: The objective of this study is to compare 3-year follow-up results of one anastomosis gastric bypass (MGB-OAGB) and laparoscopic sleeve gastrectomy (LSG) in terms of weight loss, complications, resolution of comorbidities and quality of life. MATERIALS AND METHODS: A prospective randomised study of results between 100 LSG patients and 101 MGB-OAGB patients was done from 2012 to 2015. The results were compared regarding operative outcomes, percentage of excess weight loss (%EWL), complications, resolution of comorbidities and quality of life (BAROS score) at 3 years follow-up. RESULTS: Follow-up was achieved in 93 MGB-OAGB vs 92 LSG patients for 3-year period. The average %EWL for MGB-OAGB vs LSG was 66.48 vs 61.15% at the end of 3 years respectively, which was statistically insignificant. Diabetes remission was seen in 89.13% of MGB-OAGB patients and 81.82% of LSG patients. Remission of hypertension was seen in 74% of MGB-OAGB patients and 72.22% of LSG patients. Bariatric analysis reporting and outcome system (BAROS) with comorbidity in LSG patients and MGB-OAGB patients was 6.03 and 6.96 respectively, whereas in patients without comorbidity, BAROS score was 3.86 in LSG group and 4.34 in MGB-OAGB group. CONCLUSIONS: In our study, at 36 months follow up, there was no significant difference between LSG and MGB-OAGB in %EWL and remission of HTN. Type 2 diabetes mellitus (T2DM) remission rates were higher after MGB-OAGB as compared to LSG but the difference was statistically insignificant. MGB-OAGB patients with comorbidities have a better quality of life and BAROS score compared to LSG patients.

Sensitivity and Specificity of 50% Excess Weight Loss (50%EWL) and Twelve Other Bariatric Criteria for Weight Loss Success.

BACKGROUND: Criteria for bariatric weight loss success are numerous. Most of them are arbitrary. None of them is evidence-based. Our objective was to determine their sensitivity and specificity. METHODS: Thirteen common bariatric weight loss criteria were compared to a benchmark reflecting the gold standard in bariatric surgery. We used an elaborate baseline BMI-independent weight loss percentile chart, based on retrospective data after laparoscopic Roux-en-Y gastric bypass (LRYGB), performed between 2007 and 2017. Percentile curves p31.6 (patients' expectation), p25 (interquartile range), p15.9 (1 standard deviation (SD) below median), and p10.9 (surgeons' goal) were used as possible cutoff for success to determine true or false positive and negative results beyond 1 year. RESULTS: We operated 4497 primary LRYGB patients, with mean follow-up 22 (± 1 SD 19; range 0-109) months, 3031 patients with last result ≥ 1 year, 518 ≥ 5 years. For all four cutoff percentile curves for success, specificities were low (2-72%) for criteria < 35 body mass index (BMI), ≥ 25percentage excess BMI loss (%EBMIL), ≥ 50%EBMIL, ≥ 15 percentage total weight loss (%TWL), ≥ 20%TWL, ≥ 25 percentage excess weight loss (%EWL), and high (83-96%) for < 30 BMI. No criterion had > 80% specificity and sensitivity for a cutoff above p15.9. For p15.9, they were both > 80% for criteria ≥ 10 BMI reduction and ≥ 50%EWL, both > 90% for ≥ 25%TWL and ≥ 35 percentage alterable weight loss (%AWL). All criteria had high sensitivities for all cutoff percentile curves (87-100%), except < 30 BMI (65-78%). CONCLUSIONS: For the first time, common bariatric criteria for weight loss success were systematically validated. Most criteria recognized success very well (high sensitivities), but ≥ 15%TWL, ≥ 20%TWL, < 35BMI, ≥ 25%EWL, ≥ 25%EBMIL, and ≥ 50%EBMIL left too many poor responders unnoticed (low specificities). Bariatric weight loss success is best assessed by comparing results to percentile curve 1 SD below median (p15.9) in a bariatric baseline BMI-independent weight loss percentile chart. Criteria ≥ 35%AWL and ≥ 25%TWL came close to that curve, both with > 90% sensitivity and specificity. Among others, criterion ≥ 50%EBMIL did not.

Cardiorespiratory action of opioid/tachykinin agonist peptide hybrid in anaesthetized rats: Transduction pathways.

AWL3106 composed of opioid (dermorphin) and tachykinin (substance P7-11) pharmacophores is a new compound with high analgesic potency and markedly reduced ability to induce tolerance and dependence. The present study aimed to determine the respiratory and cardiovascular responses evoked by this peptide in urethane-chloralose anaesthetized, spontaneously breathing rats in the presence or absence of vagal connection. Intravenous injection of AWL3106 at a dose of 0.3µmol/kg in intact rats resulted in apnoea lasting 5.1 ± 0.7s. Breathing that followed was of diminished frequency (F) and augmented tidal volume (VT) with no significant impact on minute ventilation. AWL3106-challenge induced biphasic fall in arterial blood pressure with no effect on heart rate. Midcervical and supranodosal sectioning the vagal nerves prevented the occurrence of the apnoea and abrogated the post-AWL3106 reduction in F but failed to eliminate the increase in VT. Hypotensive response appeared to be less profound following supranodose vagotomy. NaloxoneHCl abolished solely the occurrence of apnoea. However additional blockade of tachykinin NK1 receptors with SR140333 was required to abolish VT increase, deceleration of breathing and to markedly suppress AWL3106-induced hypotension. The present study shows that extravagally controlled stimulation of VT maintains fairly regular ventilation by levelling the bradypnoeic effects. Although the peptide showed no cardiac effects, hypotension occurring beyond the vagal loop may limit future therapeutic benefits of this chimeric compound.

Cardiorespiratory activity of C-terminal pentapeptide of substance P in anaesthetized rats.

Experiments were performed in anaesthetized, spontaneously breathing rats to: (1) analyse the respiratory and cardiovascular effects of C-terminal fragment of substance P (AWL2077) as referred to those exerted by the parent undecapeptide, (2) determine the involvement of lung vagal afferents to these responses. Each peptide was injected intravenously at a dose of 0.3µmol/kg into neurally intact or midcervically vagotomized rats. Administration of both compounds decreased tidal volume, minute ventilation, mean arterial blood pressure and heart rate, showing stimulatory (SP) and depressive (AWL2077) effects on the rate of breathing. Midcervical vagotomy reversed (post-SP) and precluded (post-AWL2077) respiratory rate responses and eliminated bradycardia evoked by both peptides. These findings indicate that the examined C-terminal pentapeptide was convergent with, but less potent than substance P in central depression of tidal volume and displayed divergence in the peripheral effect on respiratory timing.

Algorithm for weight loss after gastric bypass surgery considering body mass index, gender, and age from the Bariatric Outcome Longitudinal Database (BOLD).

BACKGROUND: Insight into the effects of gender and age on bariatric weight loss can be disturbed by the well-known influence of initial body mass index (BMI) on excess weight loss (%EWL). Alternative metrics can be found that eliminate this influence. Their formulas can be used to construct an algorithm in which mean weight loss becomes a constant value, describing the effectiveness of the operation independent of the initial BMI. The objective of this study was to create an algorithm describing weight loss after LRYGB in search for a better outcome metric to demonstrate unequivocally the influence of patient characteristics on bariatric results. METHODS: Nadir weight loss results of BOLD patients, grouped by gender and age (<40 yr and ≥40 yr), with ≥2 years follow-up after LRYGB and initial BMI ≥30 and<80 kg/m(2), are expressed in 26 different metrics with formula: 100%×(initial BMI - nadir BMI)/(initial BMI - a) with "reference BMI" a = 0-25 kg/m(2). For each subgroup, the "optimal reference BMI" (a) generating the smallest deviation and without significant difference in outcome between lighter and heavier patients is used to construct an algorithm (Mann-Whitney U test; P<.0002). Mean nadir relative weight loss results (b) are compared. RESULTS: A total of 8945 patients met inclusion criteria (mean initial BMI, 47.7 kg/m(2); median age, 48 yr; 20.0% male). Both female subgroups had optimal reference BMI: a = 10 kg/m(2); both male subgroups: a = 17 kg/m(2). LRYGB effectiveness (b) was significantly higher for younger patients and for female patients. The %EWL metric rendered different significances. CONCLUSIONS: Both genders have age-independent metrics for which nadir relative weight loss after LRYGB is not influenced by initial BMI. The resulting algorithm nadir BMI = a + (100%-b) × (initial BMI-a) consists of an inert part (a = 10-17 kg/m(2)) on which the bariatric effectiveness (b) does not act and an alterable part (initial BMI-a) on which it does. The proposed metric percentage alterable weight loss (%AWL) reduces results to constant values for bariatric effectiveness (b), facilitating research on the precise effect of patient characteristics and surgical variables on postoperative weight loss better than %EWL, a metric able to produce false conclusions. Women and younger patients had significantly more weight loss; initial BMI had no effect.

Effects of Several Phytoparasitic Nematodes on the Growth of Basil, Ocimum basilicum.

Greenhouse experiments were conducted in 15-cm-d pots of steamed Myakka fine sand to determine the host status and tolerance of common basil (Ocimum basilicum) to several important phytoparasitic nematodes in Florida. Populations of Meloidogyne incognita, Belonolaimus longicaudatus, and Pratylenchus scribneri increased and caused significant suppression of foliage and root growth during a 10-month period. The population of Paratrichodorus christiei increased and caused a significant reduction in foliage yield but did not reduce root growth. Dolichodorus heterocephalus also increased in number without affecting foliage yield or root growth. Basil was a poor host for Hoplolaimus galeatus and was not damaged by this nematode.

Description and SEM Observations of Dolichodorus marylandicus n. sp. With a Key to Species of Dolichodorus.

Dolichodorus marylandicus n. sp. is described and illustrated from grass (Zoysia japonica) in College Park, Maryland. Specimens have also been collected from perennial bluegrass (Poa pratensis) pasture at Beltsville, Maryland, and from pine (Pinus sp.) in North Carolina. This new species is related to D. heterocephalus Cobb, D. similis Golden, and D. aestuarius Chow &Taylor. Females are distinct in having a longer styler and shorter body length than D. aestuarius. The excretory pore is at the level of the isthmus or slightly posterior and the tail is abruptly reduced in diameter, tapering to an acuminate terminus. The tails of D. similis and D. heterocephalus conically taper to a median point, with D. similis having an especially long tail. D. marylandicus does not possess the rounded, sclerotized accessory structures adjacent to the vulva observed in lateral views of D. similis and D. heterocephalus. SEM observations of D. heterocephalus and D. marylandicus revealed details of the head of males and females, and species difference in shape of the oral disc.