Complications After Laparoscopic Roux-en-Y Gastric Bypass in 1573 Consecutive Patients: Are There Predictors?

BACKGROUND: Roux-en-Y gastric bypass (RYGBP), one of the commonest performed bariatric procedures, remains a technically challenging operation associated with significant morbidity in high-risk patients. This study was conducted in order to identify predictors of complications after laparoscopic RYGBP. METHODS: Our prospectively established database has been assessed to review 30-day and in-hospital complications graded according to a validated scoring system (Clavien-Dindo) and separated into minor (Clavien-Dindo I-IIIa) and major (Clavien-Dindo IIIb-IV) complications. Patient- and procedure-related factors were analyzed using univariate analysis. Significant factors associated with morbidity were introduced into a multivariate analysis to identify independent predictors. RESULTS: Between 1999 and 2012, 1573 patients underwent laparoscopic RYGBP, 374 male and 1199 female. Mean age was 41 years, and mean body mass index (BMI) was 44.5 kg/m(2). One hundred fifty-nine procedures were reoperations. One hundred fifty (9.5 %) patients developed at least one complication, and 43 (2.7 %) had major complications, leading to death in one case (0.06 %). Risk factors for morbidity were male gender (p̴1;=̴1;0.006) and overall experience of the team (p̴1;<̴1;0.0001). Prolonged 3-day antibiotic therapy was associated with significantly reduced overall (p̴1;<̴1;0.0001) and major (p̴1;=̴1;0.005) complication rates. Major complications were associated with smoking (p̴1;=̴1;0.016). CONCLUSIONS: The most significant individual risk factors for early complications after RYGBP are male gender, limited surgical experience, and single dose of antibiotics. RYGBP should be performed by experienced teams. Smoking should be discontinued before surgery. Prolonged antibiotic therapy could be considered, especially if a circular stapled gastrojejunostomy is performed with the anvil introduced transorally.

Posterior Sub-Tenon Triamcinolone Injection for Chronic Macular Oedema Associated With Non-Ischemic Branch or Central Retinal Vein Occlusion

Aims: To evaluate the effectiveness and safety of Posterior Sub-Tenon (PST) Triamcinolone Acetonide (TA) injection for persistent macular oedema associated with non-ischemic Central Retinal Vein Occlusion (CRVO) or Branch Retinal Vein Occlusion (BRVO) in non-vitrectomized eye. Methods: Fourteen consecutive eyes of 14 patients characterized by macular oedema lasting more than 3 months and with a visual acuity of less than 20/40 were enrolled. Six eyes presented with BRVO, 8 eyes with CRVO. PST injection of 40 mg TA was performed in topical anaesthesia. All patients were phakic, and followed for at least 6 months. Snellen visual acuity converted to LogMAR units and anatomic responses were evaluated before, and at 1, 3, 6, and 12 (if required) months after injections and re-injection considered. Results: In the BRVO group, mean foveal thickness was 548.2±49.50 μm preoperatively, and 452.8±56.2 μm and 280.8±62.5 μm at 1 and 12 month follow-up, respectively. Statistical analysis showed significant differences between preoperative and postoperative measurements (P<.05, paired t test) 3 months after injections. Improvement of visual acuity by at least 0.2 LogMAR was seen in 3(50%) of the 6 eyes. No re-injection was needed. In the CRVO group, mean foveal thickness was 543.7±34.4 μm preoperatively, and 283.0±29.0 μm and 234.8±23.6 μm at 1 and 12 month follow-up, respectively. Statistical analysis showed significant differences between preoperative and postoperative measurements (P<.05, paired t test). Improvement of visual acuity by at least 0.2 LogMAR was seen in 7 eyes (88%). Mean number of re-injection was of 2.1±0.3. Intraocular pressure elevation of 22 mm Hg or higher was found in 2/14 eyes (14%). Cataract progression was noted in 5/14 eyes (36%). Conclusions: PST injection of TA appears to be as safe and effective treatment for chronic macular oedema associated due to both non-ischemic BRVO or CRVO, with a better efficacy in BRVO.

Emerging bacterial pathogens: the past and beyond.

Since the 1950s, medical communities have been facing with emerging and reemerging infectious diseases, and emerging pathogens are now considered to be a major microbiologic public health threat. In this review, we focus on bacterial emerging diseases and explore factors involved in their emergence as well as future challenges. We identified 26 major emerging and reemerging infectious diseases of bacterial origin; most of them originated either from an animal and are considered to be zoonoses or from water sources. Major contributing factors in the emergence of these bacterial infections are: (1) development of new diagnostic tools, such as improvements in culture methods, development of molecular techniques and implementation of mass spectrometry in microbiology; (2) increase in human exposure to bacterial pathogens as a result of sociodemographic and environmental changes; and (3) emergence of more virulent bacterial strains and opportunistic infections, especially affecting immunocompromised populations. A precise definition of their implications in human disease is challenging and requires the comprehensive integration of microbiological, clinical and epidemiologic aspects as well as the use of experimental models. It is now urgent to allocate financial resources to gather international data to provide a better understanding of the clinical relevance of these waterborne and zoonotic emerging diseases.

Accidents vasculaires cérébraux caméléons dans un centre hospitalier universitsaire : facteurs de risque, circonstances et devenir

Objectif : Identifier les facteurs de risques, circonstances et devenir des patients avec un accident vasculaire cérébral ischémique (AVC) manqué (AVC caméléon) dans le département des urgences d'un hôpital universitaire. Méthode : Nous avons rétrospectivement revu tous les patients avec un AVC ischémique d'un registre construit prospectivement (Acute Stroke Registry and Analysis of Lausanne, ASTRAL) sur une durée de 8.25 années. Les AVC caméléons ont été définis comme un échec de suspicion d'AVC ou comme une exclusion erronée de diagnostic d'AVC. Ils ont été comparés aux AVC correctement suspectés à l'admission. Résultats : Quarante sept sur 2'200 AVC ont été manqués (2.1%). Ces AVC caméléons étaient soit peu sévères soit très sévères. L'analyse multivariée a montré chez les patients avec un AVC caméléon un plus jeune âge (odds ratio (OR) par année 0.98 p<0.01), moins de traitement hypolipémiant (OR 0.29, p=0.04), pression artérielle diastolique à l'admission plus basse (OR 0.98 p=0.04). Ils ont montré moins de déviation du regard (OR 0.21, p=0.04), et d'avantage d'AVC à localisation cérébelleuse (OR 3.78, p>0.01). Les AVC caméléons ont initialement été faussement diagnostiqués en tant qu'une autre pathologie neurologique (46.2% des cas) ou non neurologique (17%), en tant qu'une baisse de l'état de vigilance inexpliquée (21.3%), et en tant que maladie concomitante (19.1%). A 12 mois, les patients avec un AVC caméléon ont un devenir moins bon (OR ajusté 0.21, p<0.01) et une mortalité augmentée (OR ajusté 4 37 p<0.01). Conclusions : Le diagnostic d'AVC est manqué chez les patients jeunes avec un risque cérébrovasculaire peu élévé et peut être masqué par d'autres pathologies aiguës. Les AVC caméléons se présentent cliniquement soit avec un AVC peu sévère ou par une diminution de l'état de vigilance, avec moins de signes neurologiques focaux et sont plus fréquemment de localisation cérébelleuse. Le devenir est quant à lui moins bon avec également une mortalité augmentée à 12 mois. De telles trouvailles devraient rendre plus attentif le clinicien aux urgences du profil des AVC caméléons.

Yllätys yritysjohdon ennusteissa: Vaikutus osakekurssiin

Tutkielman tavoitteena oli selvittää Suomen osakemarkkinoiden hinnoittamistehokkuutta johdon ennustepoikkeamien tapauksessa. Tarkastelu-ajanjakso on 1.1.2000–31.12.2006. Kiinnostuneita oltiin erityisesti keski-pitkän ja pitkän aikavälin (10 kaupankäyntivuorokautta ja 40 kaupankäyntivuorokautta) epänormaaleista tuotoista. Työn empiriaosuus suoritettiin tapahtumatutkimusmenetelmää hyväksikäyttäen. Empiriaosuudessa laskettiin ennustepoikkeaman aiheuttamat epänormaalit tuotot pienimmän neliösumman regressiota hyväksikäyttäen. Positiivisten poikkeamien aiheuttamat epänormaalit tuotot eivät poikenneet tilastollisesti markkinatuotoista millään tarkasteluvälillä. Negatiivisten epänormaalien tuottojen poikkeamaa havaittiin 10 kaupankäyntivuorokautta ennustepoikkeaman julkaisun jälkeen. Toimialakohtaisessa tarkastelussa parillisten otosten t-testissä havaittiin, että terveydenhuollon, rahoituksen ja informaatioteknologian epänormaalit tuotot poikkesivat markkinatuotoista. Yrityskohtaisia tekijöitä tutkittiin yksinkertaisella t-testillä. Näistä velkaisuusasteella, beetalla, päivätuottojen keskihajonnalla, päivittäisellä liikevaihdolla sekä P/E-luvulla havaittiin voi-tavan ennustaa mahdollisten ennustepoikkeamien esiintymistiheyttä. Sen sijaan markkina-arvolla ja P/B-luvulla ei havaittu yhteyttä ennustepoikkeamien esiintymistiheyteen. Tutkittaessa käyttäytymistieteellisen rahoituksen olettamaa kaupankäyntivolyymin kasvusta ennustepoikkeamaa ympäröivänä aikana ei tilastollista merkittävyyttä löydetty.

Aplicação de métodos quimiométricos na especiação de Cr(VI) em solução aquosa

The equilibria, the spectra and the identities of the species of Cr(VI) that are present in aqueous solution have long been an active subject of discussion in the literature. In this paper, three different chemometric methodologies are applied to sets of UV/Visible spectra of aqueous Cr(VI) solutions, in order to solve a chemical system where there is no available information concerning the composition of the samples nor spectral information about the pure species. Imbrie Q-mode factor analysis, followed by varimax rotation and Imbrie oblique projection, were used to estimate the composition of Cr(VI) equilibrium solutions and, by combining these results with the k-matrix method, to obtain the pure spectra of the species. Evolving factor analysis and self modeling curve resolution were used to confirm the number of the species and the resolution of the system, respectively. Sets of 3.3×10-4 and 3.3×10-5 mol L-1 Cr(VI) solutions, respectively, were analyzed in the pH range from 1 to 12. Two factors were identified, which were related to the chromate ion (CrO4(2-)) and bichromate ion (HCrO4-). The pK of the equilibrium was estimated as 5.8.

Nuorten koherenssin tunne: mittaaminen, ennustavat tekijät, seuraukset

Sense of coherence in adolescence: measuring, predictive factors, consequences The aim of this study was to explore the stability of sense of coherence (SOC) in adolescence and the associations between childhood psychological symptoms and SOC in adolescence. Furthermore, the aim of this study was to explore whether the 13-item SOC scale for adults is applicable to adolescents 12 years of age and to determine which factors are associated with perceived health and SOC. Data relating to SOC and factors associated with perceived health and SOC were collected in class in a cross-sectional setting by self-administered questionnaires in all publicly funded elementary schools (N=35) of Turku. A total of 1 231 (83%) of 1 481 12-year-old schoolchildren participated in the study. The data was, with appropriated authority consent, anonymously completed with marks in mathematics, native and first foreign language at the end of sixth class. The examination of stability of SOC in adolescence and the associations between childhood psychological symptoms and SOC was based on data of a prospective population-based mail survey. The source population originated in 11 health authority areas of the Province of Turku and Pori. The study was carried out by using questionnaires at child’s ages of 3, 12, 15, and 18 years. Acceptably completed questionnaires were returned by 1 086 (84%) parents at the child’s age of 3, at the age of 12 by 70% adolescents and parents, at the age of 15, by 66% adolescents and 58% parents, and at the age of 18, by 61.5% adolescents and 61% parents. The results of the study showed that childhood behavioural problems from the age of 3 years predicted poor SOC at the age of 18 years. A poor SOC was associated with psychological symptoms and behavioural problems in adolescence. Contrary to assumptions in Antonovsky’s theory, there was no significant change in SOC between the ages of 15 to 18 years, and the stability of SOC did not depend on initial SOC. Slight fluctuation in SOC scores was seen at the individual level. When studied cross-sectionally, in 12-year-old schoolchildren, insufficient physical exercise, less than excellent marks in mathematics, weak SOC, insufficient social support from teachers, and perceived various problems in class climate associated with perception of poor health. Identification of behavioural problems in early childhood helps to identify the children at risk of ill-being and poor SOC in adolescence since problems seem to persist unchanged until adolescence. The 13-item SOC scale aimed at adults is applicable to adolescents of 12 years of age or older and the SOC scale is a useful tool in identifying adolescents in need of supportive interventions.

Antenatal inflammation and brain pathology in preterm infants

Chorioamnionitis is known to be an important risk factor underlying preterm delivery, and it has also been suggested to associate with brain lesions and deviant neurological development in both preterm and term infants. Cytokines are believed to be the link causing the deleterious effects of inflammation to the nervous system. Their genetic regulation has also been suggested to play a role, as interleukin (IL)-6 -174 and -572 genotypes, which partly regulate IL-6 synthesis responses, have been connected with deviant neurological development in preterm infants. We evaluated the association of histological chorioamnionitis with brain lesions, regional brain volumes, and the functioning of the auditory pathway in very low birth weight/very low gestational age (VLBW/VLGA) infants. In addition, we investigated the association between IL-6 -174 and -572 genotypes and histological chorioamnionitis, neonatal infections, and brain lesions and regional brain volumes in VLBW/VLGA infants. This study is a part of a larger multidisciplinary project PIPARI (Development and Functioning of Very Low Birth Weight Infants from Infancy to School Age), in which the survivors of a 6-year cohort of VLBW/VLGA infants (n=274) are being followed until school age in Turku University Central Hospital, Finland. Placental samples were collected in the delivery room, and were analyzed for histological inflammatory findings. Blood samples from the infants were collected and DNA was genotyped for IL-6-174 and -572 polymorphisms (GG/GC/CC). Brain ultrasound examinations were performed repeatedly in the neonatal intensive care unit and at term age, and were analysed for structural brain lesions. Brain magnetic resonance imaging was performed at term age, and was analysed for regional brain volumes. In addition, diffusion tensor imaging was performed at term, and was used to analyse fractional anisotrophy and the apparent diffusion coefficient of inferior colliculus. The brainstem auditory evoked potential recordings were carried out according to the routine clinical procedure at median age of 30 days after term age. In our study, we found that histological chorioamnionitis was not an independent risk factor for brain lesions, reduced regional brain volumes or abnormal functioning of the auditory pathway in VLBW/VLGA infants. In addition, we found that IL-6 -174 GG and -572 GC genotypes were associated with a higher incidence of histological chorioamnionitis, and that -174 CC genotype associated with higher incidence of septicaemia. The analysed IL-6 genotypes were not associated with other brain lesions, but a reduced volume of basal ganglia and thalami was associated with IL-6 -174 CC and -572 GG genotypes. In conclusion, our findings suggest that histological chorioamnionitis is not an independent risk factor for the brain development of VLBW/VLGA infants, or that the risk caused by inflammation does not exceed the risks attributed to other underlying pathologies behind preterm deliveries. In addition, our findings give reason to propose that IL-6 promoter genotypes have a role in the defence against serious infections and in the brain development of VLBW/VLGA infants.

Konstruktionistista ja realistista ikääntymistutkimusta

Ikääntyminen, hyvinvointi ja teknologia -tutkijakoulun, Ikäinstituutin sekä Kasvun ja vanhenemisen tutkijat ry:n yhteisseminaari Helsingissä 1.-2.12.2008.

UV determination of epinephrine, uric acid, and acetaminophen in pharmaceutical formulations and some human body fluids using multivariate calibration

In this work, a spectrophotometric methodology was applied in order to determine epinephrine (EP), uric acid (UA), and acetaminophen (AC) in pharmaceutical formulations and spiked human serum, plasma, and urine by using a multivariate approach. Multivariate calibration methods such as partial least squares (PLS) methods and its derivates were used to obtain a model for simultaneous determination of EP, UA and AC with good figures of merit and mixture design was in the range of 1.8 - 35.3, 1.7 - 16.8, and 1.5 - 12.1 µg mL-1. The 2nd derivate PLS showed recoveries of 95.3 - 103.3, 93.3 - 104.0, and 94.0 - 105.5 µg mL-1 for EP, UA, and AC, respectively.

MICROESTRUTURA E PROPRIEDADES DE FILMES DE AMIDO-ÁLCOOL POLIVINÍLICO-ALGINATO ADICIONADOS DE ÓLEOS ESSENCIAIS DE COPAÍBA E CAPIM LIMÃO

AbstractFilms obtained by blends between starch and other polymers and films developed with the addition of an oil can show higher water vapor barriers and improved mechanical properties. Films with starch/PVOH/alginate were obtained by adding copaiba and lemongrass essential oils (EOs). Films without oil served as the control. The microstructure, water vapor permeability (PVA), mechanical properties, and antifungal activity were determined for the films. The effects of the addition of the EOs on the properties of the films were dependent of the concentration and type of oil. The films with 0.5% lemongrass EO were similar to the control films. These films showed a 2.02 × 10-12 g s-1Pa m-1 PVA, 11.43 MPa tensile stress, 13.23% elongation, and 247.95 MPa/mm resistance at perforation. The addition of 1% of copaiba EO increased the PVA from 0.5 × 10-12 to 12.1 × 10-12 g s-1 Pa m-1 and the diffusion coefficient from 0.17 × 10-8 to 7.15 × 10-8m2/day. Films with quantities of EOs displayed fissures and micropores; the control films developed micropores with smaller diameters than films with EOs. The addition of EOs did not change the resulting infrared spectrum of the films. The films with oil displayed a diminished development of the Fusarium sp. culture, and the film without EOs did not display notable differences in the development of the culture. The starch/PVOH/alginate films with 0.5% lemongrass EO were the most suited for the development of a packaging active system.

Survival and Quality of Life among Patients with Severe Lower Extremity Peripheral Arterial Disease

Lower extremity peripheral arterial disease (PAD) is associated with decreased functional status, diminished quality of life (QoL), amputation, myocardial infarction, stroke, and death. Nevertheless, public awareness of PAD as a morbid and mortal disease is low. The aim of this study was to assess the incidence of major lower extremity amputation due to PAD, the extent of reamputations, and survival after major lower extremity amputation (LEA) in a population based PAD patient cohort. Furthermore, the aim was to assess the functional capacity in patients with LEA, and the QoL after lower extremity revascularization and major amputation. All 210 amputees due to PAD in 1998–2002 and all 519 revascularized patients in 1998–2003 were explored. 59 amputees alive in 2004 were interviewed using a structured questionnaire of QoL. Two of each amputee age-, gender- and domicile-matched controls filled in and returned postal self-administered QoL questionnaire as well as 231 revascularized PAD patients (the amount of these patients who engaged themselves to the study), and one control person for each patient completed postal self-administered QoL questionnaire. The incidence rate of major LEA was 24.1/100 000 person-years and it was considerably high during the years studied. The one-month mortality rate was 21%, 52% at one-year, and the overall mortality rate was 80%. When comparing the one-year mortality risk of amputees, LEAs were associated with a 7.4-fold annual mortality risk compared with the reference population in Turku. Twenty-two patients (10%) had ipsilateral transversions from BK to AK amputation. Fifty patients (24%) ended up with a contralateral major LEA within two to four amputation operations. Three bilateral amputations were performed at the first major LEA operation. Of the 51 survivors returning home after their first major LEA, 36 (71%) received a prosthesis; (16/36, 44%) and were able to walk both in- and outdoors. Of the 68 patients who were discharged to institutional care, three (4%) had a prosthesis one year after LEA. Both amputees and revascularized patients had poor physical functioning and significantly more depressive symptoms than their controls. Depressive symptoms were more common in the institutionalized amputees than the home-dwelling amputees. The surviving amputees and their controls had similar life satisfaction. The amputees felt themselves satisfied and contented, whether or not they lived in long-term care or at home. PAD patients who had undergone revascularizations had poorer QoL than their controls. The revascularized patients’ responses on their perceived physical functioning gave an impression that these patients are in a declining life cycle and that revascularizations, even when successful, may not be sufficient to improve the overall function. It is possible that addressing rehabilitation issues earlier in the care may produce a more positive functional outcome. Depressive symptoms should be recognized and thoroughly considered at the same time the patients are recovering from their revascularization operation. Also primary care should develop proper follow-up, and community organizations should have exercise groups for those who are able to return home, since they very often live alone. In rehabilitation programs we should consider not only physical disability assessment but also QoL.

Determinação direta e simultânea de Al, As, Fe, Mn e Ni em cachaça por espectrometria de absorção atômica em forno de grafite

Este trabalho propõe um método simples, rápido e confiável para determinação direta e simultânea de Al, As, Fe, Mn e Ni em cachaça por espectrometria de absorção atômica em forno de grafite (GFAAS). A superfície superior da plataforma do tubo de grafite foi revestida com filme à base de tungstênio (WxCyOz).O programa de aquecimento otimizado (temperatura, tempo de rampa, tempo de patamar) foi o seguinte: secagem 1 (100ºC, 5 s, 5 s); secagem 2 (120ºC, 5 s, 5 s); pirólise (1300ºC, 10 s, 30 s); atomização (2200ºC, 1 s, 6 s) e limpeza (2550ºC, 1 s, 3s). Os desvios padrões relativos (n=3) foram < 4,4%, < 0,7%, < 11%, < 6,0%, < 1,2% para os elementos Al, As, Fe, Mn e Ni, respectivamente. A exatidão foi avaliada por meio de testes de adição e recuperação dos analitos em 8 amostras de cachaças comerciais, e as recuperações situaram-se nos seguintes intervalos: 80 - 105% (Al), 81 - 92% (As), 82 - 108% (Fe), 83 - 106% (Mn), 83 - 108% (Ni). Os limites de detecção calculados foram 9,7 µg L-1 Al, 2,3 µg L-1 As, 12 µg L-1 Fe, 14 µg L-1 Mn e 0,8 µg L-1 Ni.