A SIMPLE Performance Assessment of Bariatric Procedures and Post-operative Weight Regain.

BACKGROUND: When assessing and reporting the performance of bariatric procedures, longitudinal total weight loss % (TWL%) is the preferred method of choice. This averages out significant individual weight regains. Due to no assessment of individual weight trajectories, numerous patients with weight recidivism are missed in the overall assessment of the applied procedures. MATERIALS AND METHODS: The SIMPLE acronym (Survival analysis of Interpolated weight trajectories in a Markov chain, assessing Predictors, Longitudinal TWL% and individual procedure success and relapse Events) provides a framework to assess the performance of bariatric procedures in everyday practice, identifying a procedures' overall performance both in terms of longitudinal total weight loss % and individual events of weight regain. The SIMPLE approach is demonstrated on a cohort of 907 bariatric patients collected over 7 years. Six hundred eighteen patients received a primary RYGB, 81 a primary SG, while 208 were conversions to either a RYGB (n = 198) or SG (n = 10). Successful surgery was defined as 20% TWL; a weight regain as a 15% increase from the lowest individually attained weight post-surgery. RESULTS: The longitudinal TWL% performance at 5 years was 34.5%, 21.3%, and 22.9% for the primary RYGB, primary sleeve gastrectomy, and conversion operation, respectively. However, nearly 20% of the conversion operations never reached success, while 33.5% registered a relapse event within 5 years. CONCLUSION: The combined approach of the SIMPLE assessment clearly showed that a non-trivial amount of individuals did not achieve success or regained significant weight after surgery. This indicates that a combined approach to reporting bariatric performance is preferred.

Paternal organic solvent exposure and adverse pregnancy outcomes: a meta-analysis.

BACKGROUND: Organic solvents are widely used, but conflicting reports exist concerning paternal exposure and adverse pregnancy outcomes. We conducted a meta-analysis to assess the risks of spontaneous abortions (SAs) and major malformations (MMs) after paternal exposure to organic solvents. METHODS: Medline, Toxline, Reprotox, and Embase from 1966 to 2003 were searched. Two independent reviewers searched for cohort and case-control studies in any language on adult human males exposed chronically to any organic solvent. Two non-blinded independent extractors used a standardized form for data extraction; disagreements were resolved through consensus discussion. RESULTS: Forty-seven studies were identified; 32 exclusions left 14 useable studies. Overall random effects odds ratios and 95% confidence intervals (CI95%) were 1.30 (CI95%: 0.81-2.11, N=1,248) for SA, 1.47 (CI95%: 1.18-1.83, N=384,762) for MMs, 1.86 (CI95%: 1.40-2.46, N=180,242) for any neural tube defect, 2.18 (CI95%: 1.52-3.11, N=107,761) for anencephaly, and 1.59 (CI95%: 0.99-2.56, N=96,517; power=56.3%) for spina bifida. CONCLUSIONS: Paternal exposure to organic solvents is associated with an increased risk for neural tube defects but not SAs.