Improvements in hepatic steatosis, obesity, and insulin resistance in adults with nonalcoholic fatty liver disease after the primary obesity surgery endoluminal 2.0 procedure.

BACKGROUND: The primary obesity surgery endoluminal 2.0 (POSE 2.0) procedure involves full-thickness gastric body plications to narrow the stomach using durable suture anchor pairs. We evaluated POSE 2.0 as a treatment strategy for nonalcoholic fatty liver disease (NAFLD) in patients with obesity. METHODS: Adults with obesity and NAFLD were prospectively allocated based on their preference to undergo POSE 2.0 with lifestyle modification or lifestyle modification alone (control). Primary end points were improvement in controlled attenuation parameter (CAP) and resolution of hepatic steatosis at 12 months. Secondary end points included %total body weight loss (%TBWL), change in serum measures of hepatic steatosis and insulin resistance, and procedure safety. RESULTS: 42 adult patients were included (20 in the POSE 2.0 arm and 22 in the control arm). At 12 months, POSE 2.0 significantly improved CAP, whereas lifestyle modification alone did not (P < 0.001 for POSE 2.0; P = 0.24 for control). Similarly, both resolution of steatosis and %TBWL were significantly higher with POSE 2.0 than with control at 12 months. Compared with controls, POSE 2.0 significantly improved liver enzymes, hepatic steatosis index, and aspartate aminotransferase to platelet ratio at 12 months. There were no serious adverse events. CONCLUSION : POSE 2.0 was effective for NAFLD in patients with obesity, with good durability and safety profile.

Turnkey algorithmic approach for the evaluation of gastroesophageal reflux disease after bariatric surgery.

Bariatric surgeries are often complicated by de-novo gastroesophageal reflux disease (GERD) or worsening of pre-existing GERD. The growing rates of obesity and bariatric surgeries worldwide are paralleled by an increase in the number of patients requiring post-surgical GERD evaluation. However, there is currently no standardized approach for the assessment of GERD in these patients. In this review, we delineate the relationship between GERD and the most common bariatric surgeries: sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), with a focus on pathophysiology, objective assessment, and underlying anatomical and motility disturbances. We suggest a stepwise algorithm to help diagnose GERD after SG and RYGB, determine the underlying cause, and guide the management and treatment.

Women family physicians' working conditions and career satisfaction: a multinational study.

BACKGROUND: As the proportion of women in family medicine increases, their well-being and job satisfaction become concerns. OBJECTIVES: This study aimed to uncover the working conditions and career satisfaction of women family physicians across multiple countries. METHODS: A cross-sectional survey of the WONCA Working Party on Women and Family Medicine listserv members to assess working conditions and career satisfaction, with snowballing recruitment. Aspects of physician job satisfaction were measured using the validated Physician Work-Life Survey and calculated as the sum of the scores of each positive item divided by the total number of questions and multiplied by 10. The association between satisfaction and the continent and the country income level was performed using a one-way ANOVA test (P < 0.05). RESULTS: A total of 315 participants across 49 countries responded to the survey with 205 complete responses. Women family physicians reported high overall career satisfaction (8.2 ± 2.3) but were less satisfied with some aspects of their career such as pay (5.3 ± 3.4), personal time (3.5 ± 2.6), and administrative tasks (3.2 ± 3.7). Despite the widespread experience of sexism at work, satisfaction with personal career aspects was universal at the continent and income level, while satisfaction with other career aspects relevant to relationships in work environment and resources varied. CONCLUSION: Women family physicians around the world are overall satisfied with their careers. However, variation in certain working conditions among countries leaves room for improvement, drawing attention to the need for national review of working environments and pay scales.

Augmented Quadruple-Phase Contrast Media Administration and Triphasic Scan Protocol Increases Image Quality at Reduced Radiation Dose During Computed Tomography Urography.

PURPOSE: The aim of this article was to investigate the opacification of the renal vasculature and the urogenital system during computed tomography urography by using a quadruple-phase contrast media in a triphasic scan protocol. MATERIALS AND METHODS: A total of 200 patients with possible urinary tract abnormalities were equally divided between 2 protocols. Protocol A used the conventional single bolus and quadruple-phase scan protocol (pre, arterial, venous, and delayed), retrospectively. Protocol B included a quadruple-phase contrast media injection with a triphasic scan protocol (pre, arterial and combined venous, and delayed), prospectively. Each protocol used 100 mL contrast and saline at a flow rate of 4.5 mL. Attenuation profiles and contrast-to-noise ratio of the renal arteries, veins, and urogenital tract were measured. Effective radiation dose calculation, data analysis by independent sample t test, receiver operating characteristic, and visual grading characteristic analyses were performed. RESULTS: In arterial circulation, only the inferior interlobular arteries in both protocols showed a statistical significance (P < 0.05). Venously, the inferior vena cava, proximal and distal renal veins demonstrated a significant opacification reduction in protocol B than in protocol A (P < 0.001). Protocol B showed a significantly higher mean contrast-to-noise ratio than protocol A (protocol B: 22.68 ± 13.72; protocol A: 14.75 ± 5.76; P < 0.001). Radiation dose was significantly reduced in protocol B (7.38 ± 2.22 mSv) than in protocol A (12.28 ± 2.72 mSv) (P < 0.001). Visual grading characteristic (P < 0.027) and receiver operating characteristic (P < 0.0001) analyses demonstrated a significant preference for protocol B. CONCLUSIONS: In computed tomography urography, augmented quadruple-phase contrast media and triphasic scan protocol usage increases the image quality at a reduced radiation dose.