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Background Cardiovascular procedural volumes can serve as metrics of hospital infrastructure and quality, and are the basis for thresholds for initiating transcatheter mitral valve repair (TMVr) programs. Whether hospital volumes of TMVr, surgical mitral valve replacement or repair (SMVRr), and percutaneous coronary intervention (PCI) are indicators of TMVr quality of care is not known. Methods We used the 2017 Nationwide Readmissions Database to identify hospitals that performed at least 5 TMVr procedures. Hospitals were divided into quartiles of TMVr volume. Associations of hospital TMVr, SMVRr, and PCI volumes, as well as SMVRr and PCI outcomes with TMVr outcomes were examined. Outcomes studied were risk-standardized in-hospital mortality rate (RSMR) and 30-day readmission rate (RSRR). Results The study included 3404 TMVr procedures performed across 150 hospitals in the US. The median hospital TMVr volume was 17 (IQR 10, 28). The mean hospital-level RSMR and RSRR for TMVr were 3.0% (95% CI 2.5%, 3.4%) and 14.8% (95% CI 14.5%, 15.0%), respectively. There was no significant association between hospital TMVr volume (as quartiles or as a continuous variable) and TMVr RSMR or RSRR (P > 0.05). Similarly, there was weak or no correlation between hospital SMVRr and PCI volumes and outcomes with TMVr RSMR or RSRR (Pearson correlation coefficients, r = −0.199 to 0.269). Conclusion In this study, we found no relationship between hospital TMVr, SMVRr, and PCI volume and TMVr outcomes. Further studies are needed to determine more appropriate structure and process measures to assess the performance of established and new TMVr centers. more...

Background The increase in obesity has become a major public health concern. Morbid obesity is associated with co-morbidities, reduced quality-of-life, and death. Metabolic surgery (MS) is the most effective treatment for obesity. Objectives The aim of this study was to evaluate the costs and outcomes of MS compared with no surgery in patients with a body mass index ≥30 kg/m2. Setting Health care system, Austria Methods A total of 177 patients who underwent MS were documented retrospectively, based on the hospital records of 2 specialized centers in Austria, over a 1-year period. At baseline 26.0% of patients exhibited type 2 diabetes (T2D), 52.5% cardiovascular disease (CVD), 23.2% hyperlipidemia, and 23.7% depression. Following the observation period, a Markov chain simulation model was developed to analyze the long-term consequences of T2D, including diabetic complications, CVD, hyperlipidemia, depression, non-alcoholic steatohepatitis (NASH), myocardial infarction, and stroke, over a total of 20 years. Direct medical costs were expressed in 2017 euros from the payer’s perspective. Quality-adjusted life years (QALYs), life years (LYs), and costs were discounted. Results MS led to costs of €40,427 and 9.58 QALYs (15.58 LYs) per patient over 20 years. No MS was associated with €64,819 and 6.33 QALYs (13.92 LYs). Total cost-savings amounted to €24,392, which offset the cost of the procedure including re-operations. Over 20 years MS saved –6.7 patient-years per patient with T2D, –5.8 patient-years with CVD, –1.5 patient-years with hyperlipidemia, –1.8 patient-years with depression, and –3.8 patient-years with NASH. Conclusion MS is associated with substantial savings in long-term costs, expected health benefits, and reduced onset of complications. MS significantly increases quality of life. more...

BackgroundObesity is one of the most important health-related problems of the twenty-first century. Data on its prevalence in Austria remain scarce. Aim of this study was to determine current trends of overweight and obesity, associated comorbidities and socioeconomic status in all 18-year-old male Austrian citizens, and its potential impact on the demand for bariatric surgery in the future.MethodsData from compulsory military conscription examinations in all 18-year-old males from 2003 to 2018 were obtained from the Federal ministry of Defense’s database. Measurements of height, weight, and subsequent body mass index (BMI) calculations in 874, 220 adolescents were subdivided into yearly cohorts. Comorbidities, educational status, and nicotine abuse were evaluated.ResultsMean BMI increased from 22.0 ± 3.95 kg/m2in 2003 to 22.8 ± 4.69 kg/m2in 2018 (p p p p ConclusionsBMI and cardiovascular risk steadily increased over the last 15 years in Austrian male adolescents. A significant shift from normal weight to overweight was observed, while higher obesity classes doubled over this observational period. This study also revealed a significant association of BMI and lower educational status.Graphical AbstractTrends of overweight and obesity in male adolescents: prevalence, socio-economic status and impact on cardiovascular risk in a central European country more...

Purpose Sleeve gastrectomy (SG) is the commonest bariatric procedure worldwide but there is also a high conversion rate mainly due to weight regain and gastroesophageal reflux disease (GERD) reported in studies with long-term follow-up. The aim of this study is to highlight benefits and limitations of converting SG patients to Roux-en-Y gastric bypass (RYGB) and one-anastomosis gastric bypass (OAGB). Setting Retrospective cross-sectional-study, medical university clinic setting. Methods This study includes all patients converted from primary SG to RYGB or OAGB by 12/2018 at the Medical University of Vienna. Patients were examined using gastroscopy, esophageal manometry, 24-h pH-metry, and questionnaires. Results Fifty-eight patients were converted from SG to RYGB (n = 45) or OAGB (n = 13). Total weight loss of patients converted to RYGB and OAGB was 41.5% and 44.8%, respectively, at nadir. Six patients had Barrett’s esophagus (BE) after SG. In four out of these six patients, a complete remission of BE after conversion to RYGB was observed; nevertheless, two patients after RYGB and one after OABG newly developed BE. Clinical GERD improved at a higher rate after RYGB than after OAGB. Both revisional procedures improved associated medical problems. Conclusion Conversion to RYGB is probably the best option for patients with GERD after SG. OAGB has shown a low potential to cure patients from GERD symptoms after SG. In terms of additional weight loss and remission of associated medical problems, both procedures studied were equal. Surveillance gastroscopies every 5 years after SG revisions are recommended. Graphical abstract more...

We report on photoelectron spectra of SiO2 nanoparticles (d = 157 ± 6 nm) above the Si 2p threshold in the photon energy range 118–248 eV with electron kinetic energy 10–140 eV and analyze the photoelectron yield as a function of photon energy. more...

Obesity is associated with increasing cardiometabolic morbidity and mortality rates worldwide. Not everyone with obesity, however, develops metabolic complications. Brown adipose tissue (BAT) has been suggested to be a promoter of leanness and metabolic health. To date, little is known about the prevalence and metabolic function of BAT in people with severe obesity, a population at high cardiometabolic risk. In this cross-sectional study, we included 40 individuals with World Health Organization class II-III obesity (BMI ≥35 kg/m2). Using a 150-min personalized cooling protocol and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography, cold-activated BAT was detectable in 14 of the participants (35%). Cold-induced thermogenesis was significantly higher in participants with detectable BAT compared with those without. Notably, individuals with obesity and active BAT had 28.8% lower visceral fat mass despite slightly higher total fat mass compared with those without detectable BAT 18F-FDG uptake. The lower amount of visceral fat mass was accompanied by lower insulin resistance and systemic inflammation and improved nonalcoholic fatty liver disease parameters, all adjusted for age, sex, and percent body fat. Contrary to previous assumptions, we show here that a significant fraction of individuals with severe obesity has active BAT. We found that decreased BAT 18F-FDG uptake was not associated with adiposity per se but with higher visceral fat mass. In summary, active BAT is linked to a healthier metabolic phenotype in obesity. more...

Laparoscopic Roux-en-Y Gastric Bypass (RYGB) is a commonly used method in bariatric surgery that leads to sufficient long-term weight loss and consequently to improvement or resolution of obesity-associated diseases. The nadir weight is commonly reached between six months and two years after surgery. Despite this initially good weight loss, weight regain is observed in up to 20% of the patients. Besides intensive dietological evaluation, bariatric re-operation can be an option in these cases. Before the surgical reintervention, an intensive evaluation of the esophagus, pouch, anastomosis, and adjacent small bowel using upper GI-endoscopy and radiological examinations (X-ray and/or 3D-CT volumetry) is mandatory. In patients with a dilated pouch, pouch-resizing with a MiniMIZER® Gastric Ring (Bariatric Solutions GmbH, Stein am Rhein, Switzerland) could be an option to reestablish restriction in the long term. Currently, there is no gold standard for the choice of the weight regain procedure or for the technique used in the procedure itself. This article focuses on the standardized procedure of pouch resizing with implantation of a MiniMIZER® Gastric Ring for the surgical therapy of weight regain due to pouch dilatation and/or dilatation of the gastrojejunostomy and the adjacent small bowel (usually approximately the first 20cm), resulting in a huge neo-stomach after RYGB, as performed at the Medical University of Vienna. Further, indications for revisional surgery for weight regain, mandatory examinations, and recommended conservative therapy options prior to surgery will be described. Next, the fast-track concept and its advantages are explained. Lastly, the surgical procedure, including positioning of the patient, placement of trocars, the intraoperative process, and special advice, is presented. Exact planning of the procedure and postoperative follow-up are indispensable for a further long-term success after weight regain surgery. In conclusion, pouch-resizing and implantation of the MiniMIZER® Gastric Ring represent a practical and effective solution in patients with dilated pouch/anastomosis/adjacent small bowel with weight regain after RYGB, if conservative therapy, including dietitian counseling and new drugs (e.g., Semaglutide), has failed. more...

Multiple system atrophy (MSA) is a fatal neurodegenerative disease of unknown etiology characterized by widespread aggregation of the protein alpha-synuclein in neurons and glia. Its orphan status, biological relationship to Parkinson’s disease (PD), and rapid progression have sparked interest in drug development. One significant obstacle to therapeutics is disease heterogeneity. Here, we share our process of developing a clinical trial-ready cohort of MSA patients (69 patients in 2 years) within an outpatient clinical setting, and recruiting 20 of these patients into a longitudinal “n-of-few” clinical trial paradigm. First, we deeply phenotype our patients with clinical scales (UMSARS, BARS, MoCA, NMSS, and UPSIT) and tests designed to establish early differential diagnosis (including volumetric MRI, FDG-PET, MIBG scan, polysomnography, genetic testing, autonomic function tests, skin biopsy) or disease activity (PBR06-TSPO). Second, we longitudinally collect biospecimens (blood, CSF, stool) and clinical, biometric, and imaging data to generate antecedent disease-progression scores. Third, in our Mass General Brigham SCiN study (stemcellsinneurodegeneration), we generate induced pluripotent stem cell (iPSC) models from our patients, matched to biospecimens, including postmortem brain. We present 38 iPSC lines derived from MSA patients and relevant disease controls (spinocerebellar ataxia and PD, including alpha-synuclein triplication cases), 22 matched to whole-genome sequenced postmortem brain. iPSC models may facilitate matching patients to appropriate therapies, particularly in heterogeneous diseases for which patient-specific biology may elude animal models. We anticipate that deeply phenotyped and genotyped patient cohorts matched to cellular models will increase the likelihood of success in clinical trials for MSA. more...

The diagnosis of bacterial infections at deep body sites benefits from noninvasive imaging of molecular probes that can be traced by positron emission tomography (PET). We specifically labeled bacteria by targeting their iron transport system with artificial siderophores. The cyclen-based probes contain different binding sites for iron and the PET nuclide gallium-68. A panel of 11 siderophores with different iron coordination numbers and geometries was synthesized in up to 8 steps, and candidates with the best siderophore potential were selected by a growth recovery assay. The probes [68Ga]7 and [68Ga]15 were found to be suitable for PET imaging based on their radiochemical yield, radiochemical purity, and complex stability in vitro and in vivo. Both showed significant uptake in mice infected with Escherichia coli and were able to discern infection from lipopolysaccharide-triggered, sterile inflammation. The study qualifies cyclen-based artificial siderophores as readily accessible scaffolds for the in vivo imaging of bacteria. more...

Purpose Since 2014, sleeve gastrectomy (SG) has been the most frequently performed bariatric-metabolic operation worldwide (2018: 386,096). There are only a few studies reporting a long-term follow-up (up to 11 years) available today. The aim of this study was to evaluate the long-term outcome of SG with a follow-up of at least 15 years regarding weight loss, remission of associated medical problems (AMP), conversions, and quality of life (QOL). Setting Multicenter cross-sectional study; university hospital. Methods This study includes all patients who had SG before 2005 at the participating bariatric centers. History of weight, AMP, conversions, and QOL were evaluated by interview at our bariatric center. Results Fifty-three patients met the inclusion criteria of a minimal follow-up of 15 years. Weight and body mass index at the time of the SG were 136.8kg and 48.7kg/m2. Twenty-six patients (49.1%) were converted to Roux-en-Y gastric bypass (RYGB) for weight regain and gastroesophageal reflux within the follow-up period. Total weight loss after 15 years was 31.5% in the non-converted group and 32.9% in the converted group. Remission rates of AMP and QOL were stable over the follow-up period. Conclusion Fifteen years after SG, a stable postoperative weight was observed at the cost of a high conversion rate. Patients converted to RYGB were able to achieve further weight loss and preserve good remission rates of AMP. SG in patients without the need of a conversion to another bariatric-metabolic procedure may be considered effective. Careful preoperative patient selection is mandatory when performing SG. Graphical abstract more...

We provide a contemporary consideration of long-term outcomes and trends of induction therapy use following lung transplantation in the United States.We reviewed the United Network for Organ Sharing registry from 2006 to 2018 for first-time, adult, lung-only transplant recipients. Long-term survival was compared between induction classes (Interleukin-2 inhibitors, monoclonal or polyclonal cell-depleting agents, and no induction therapy). A 1:1 propensity score match was performed, pairing patients who received basiliximab with similar risk recipients who did not receive induction therapy. Outcomes in matched populations were compared using Cox, Kaplan-Meier and Logistic regression modeling.22 025 recipients were identified; 8003 (36.34%) were treated with no induction therapy, 11 045 (50.15%) with basiliximab, 1556 (7.06%) with alemtuzumab and 1421 (6.45%) with anti-thymocyte globulin. Compared with those who received no induction, patients receiving basiliximab, alemtuzumab or anti-thymocyte globulin were found on multivariable Cox-regression analyses to have lower long-term mortality (all p .05). Following propensity score matching of basiliximab and no induction populations, analyses demonstrated a statistically significant association between basiliximab use and long- term survival (p .001). Basiliximab was also associated with a lower risk of acute rejection (p .001) and renal failure (p = .002).Induction therapy for lung transplant recipients-specifically basiliximab-is associated with improved long-term survival and a lower risk of renal failure or acute rejection. more...

Studying how novel phenotypes originate and evolve is fundamental to the field of evolutionary biology as it allows us to understand how organismal diversity is generated and maintained. However, determining the basis of novel phenotypes is challenging as it involves orchestrated changes at multiple biological levels. Here, we aim to overcome this challenge by using a comparative species framework combining behavioral, gene expression, and genomic analyses to understand the evolutionary novel egg-laying substrate-choice behavior of the invasive pest species Drosophila suzukii. First, we used egg-laying behavioral assays to understand the evolution of ripe fruit oviposition preference in D.suzukii compared with closely related species D.subpulchrella and D.biarmipes as well as D.melanogaster. We show that D.subpulchrella and D.biarmipes lay eggs on both ripe and rotten fruits, suggesting that the transition to ripe fruit preference was gradual. Second, using two-choice oviposition assays, we studied how D.suzukii, D.subpulchrella, D.biarmipes, and D.melanogaster differentially process key sensory cues distinguishing ripe from rotten fruit during egg-laying. We found that D.suzukii's preference for ripe fruit is in part mediated through a species-specific preference for stiff substrates. Last, we sequenced and annotated a high-quality genome for D. subpulchrella. Using comparative genomic approaches, we identified candidate genes involved in D.suzukii's ability to seek out and target ripe fruits. Our results provide detail to the stepwise evolution of pest activity in D.suzukii, indicating important cues used by this species when finding a host, and the molecular mechanisms potentially underlying their adaptation to a new ecological niche. more...

Resume Objectifs Des etudes internationales ont montre que la prise en charge perinatale active aux âges gestationnels les plus faibles s’accompagnait d’une amelioration de la survie sans augmentation des handicaps graves par rapport a une prise en charge moins active. Un travail mene par les societes savantes (SFMP, SFN et CNGOF) a permis d’elaborer de nouvelles propositions pour une prise en charge plus optimaledes enfants extremement prematures en France. Methode Ce groupe a ete constitue en 2015 a l’initiative des societes savantes et en lien avec les associations de parents et d’usagers. Le travail s’est appuye sur la revue de la litterature sur le pronostic des enfants extremement prematures, ainsi que sur les recommandations emises par des societes savantes europeennes. Sur la base de ces informations, un texte a ete produit, soumis a l’ensemble des membres du groupe de travail et definitivement accepte par les societes savantes en avril 2019. Resultats Ce texte propose une aide a la decision dans la prise en charge de ces naissances. Il pose comme principes : l’administration de la corticotherapie independamment de la prise en charge (reanimation ou soins de confort) ; une evaluation pronostique et une decision collegiale, hors contexte de l’urgence ; un consensus sur l’information a delivrer aux parents avant de les informer et de recueillir leur avis. Cette demarche suppose une coherence de la prise en charge avant, pendant et apres la naissance et elle s’appuie sur une etroite collaboration obstetrico-pediatrique. Conclusion Ces propositions doivent permettre de faire evoluer la prise en charge perinatale de l’extreme prematurite en France. more...

Purpose Long-term follow-up after sleeve gastrectomy (SG) revealed a high incidence of gastroesophageal reflux disease (GERD) frequently caused by preoperative silent pathologic reflux. We aimed to evaluate prevalence and phenotypes of GERD in asymptomatic patients with morbid obesity prior to metabolic surgery according to modern objective testing. Material and Methods Prospective collection of data including consecutive patients with morbid obesity (body mass index (BMI) ≥ 35 kg/m2) prior to metabolic surgery was applied for this study between 2014 and 2019. Patients underwent clinical examinations, endoscopy, pH metry, and high-resolution manometry and were analyzed according to the Lyon consensus. Results Of 1379 patients undergoing metabolic surgery, 177 (12.8%, females = 105) asymptomatic individuals with a median age of 42.6 (33.8; 51.6) years and a median BMI of 44.6 (41.3; 50.8) kg/m2 completed objective testing and were included during the study period. GERD was diagnosed in 55 (31.1%), whereas criteria of borderline GERD were met in another 78 (44.1%). GERD was mediated by a structural defective lower esophageal sphincter (p = 0.004) and highlighted by acidic (p = 0.004) and non-acidic (p = 0.022) reflux episodes. Esophageal motility disorders were diagnosed in 35.6% (n = 63) of individuals with a novel hypercontractile disorder found in 7.9% (n = 14) of patients. Conclusion GERD affects a majority of asymptomatic patients with morbid obesity prior to primary bariatric surgery. Future longitudinal trials will have to reveal the clinical significance of esophageal motility disorders in patients with morbid obesity. more...

Currently, 4.8% of bariatric operations worldwide are one-anastomosis gastric bypass (OAGB) procedures. If a hiatal hernia is detected in a preoperative gastroscopy, OAGB can be combined with hiatoplasty. Intrathoracic pouch migration (ITM) is common after bypass procedures because the fundus, a natural abutment, is separated from the pouch.The aim of this study was to find out whether OAGB or OAGB combined with hiatoplasty carries a higher risk of ITM and, therefore, also gastroesophageal reflux disease (GERD).University hospital.Fifty patients (group 1: 25× primary OAGB; group 2: 25× primary OAGB with hiatoplasty) were included in this study. History of weight, GERD, and quality of life were recorded in patient interviews and pouch volume and ITM were evaluated using 3-dimensional-computed tomography volumetry.There were no differences in terms of patient characteristics, history of weight, pouch volume, or quality of life between both groups. ITM was found in group 1 in 60% (n = 15) and group 2 in 76% (n = 19) of all patients (P = .152). The ITM mean length was significantly lower in group 1 with .9 ± 1.1 cm than in group 2 with 1.8 ± 1.2 cm (P = .007). Regarding GERD, there was no difference between both groups; nevertheless, significantly more patients with ITM (38.2%; n = 13) had GERD compared with patients without ITM (6.3%; n = 1).In primary OAGB, an additional hiatoplasty was not associated with higher rates of ITM or GERD; nevertheless, the length of ITM was higher after hiatoplasty. If ITM occurs, patients have a risk of developing GERD. more...

Laparoscopic Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) is a bariatric/metabolic procedure that has been gaining popularity in recent years. SADI-S strongly affects the secretion of various gut hormones, adipocytokines and incretins. From a mechanistic point of view, the operation combines malabsorption and restriction, and has been shown to have a long-lasting and significant impact on weight loss and remission of comorbidities. With regard to the technique, first, a Sleeve is created and then the duodenum is tran-sected approximately 3-4cm after the pylorus at the level of the gastroduodenal artery (GDA). Next, 250-300cm of small bowel is measured from the caecum and a hand-sewn duo-deno-ileal anastomosis is performed. The length of the biliopancreatic limb is variable in this procedure. Because of the standardized common limb length in all patients, weight loss is very precise within a low range. Nevertheless, due to the complex hand-sewn anastomosis and the delicacy necessary when handling the duodenum, this procedure should be reserved for experienced bariatric surgeons in specialized centers. This article provides an overview of the standard surgical technique at the Department of Visceral Surgery at the Medical University of Vienna, as well as information about patient selection and pre- and postoperative care. more...

Empruntant aux notions th��oriques de la force du droit de Pierre Bourdieu, cette th��se remet en question le succ��s de la r��forme de la proc��dure p��nale au Chili. Elle applique une approche critique diff��rente de celle qui est traditionnellement utilis��e dans ce domaine, qui limite souvent la critique au champ juridique, sans consid��rer comment ce domaine s���inscrit dans un contexte social plus large. L���hypoth��se de la recherche est que les int��r��ts des acteurs du syst��me de justice p��nale (procureurs, d��fenseurs, demandeurs et juges) et diverses formes de capitaux influencent la sentence avant m��me que la sentence finale soit rendue par le tribunal. Si l���hypoth��se se r��v��lait exacte, cela affecterait la l��gitimit�� du syst��me de justice p��nale au Chili, puisque des facteurs qui vont au-del�� du droit p��nal affectent la fa��on dont ce droit est appliqu��. Pour tester l���hypoth��se, en 2016, l���auteur a observ�� des n��gociations entre des acteurs judiciaires au Chili. Les observations se sont principalement concentr��es sur la ��proc��dure abr��g��e��, une proc��dure alternative sommaire au proc��s p��nal ordinaire introduite avec les r��formes du droit p��nal chilien. L���analyse des donn��es recueillies confirme l���hypoth��se: diverses limitations et contraintes non juridiques, et parfois d���ordre juridique, influent sur l���acc��s �� la proc��dure abr��g��e et sur son r��sultat pour les accus��s (et les victimes) �� qui cette derni��re s���applique. Certaines de ces limites et contraintes sont bien connues dans la litt��rature, particuli��rement nord- am��ricaine, par exemple sur les accords n��goci��s et la n��gociation de plaidoyer. Mais la th��se d��montre aussi un ��tiquetage r��current, souvent subtil, des et parfois par les accus��s xiii selon un syst��me inconscient de diff��renciation sociale et ��conomique. C���est cet ��tiquetage qui limite et contraint la l��gitimit�� de la proc��dure abr��g��e. Cette th��se propose une application de la Th��orie de la force du droit de Pierre Bourdieu. Elle invite ��galement les acteurs du syst��me p��nal, et ceux qui ont le pouvoir, �� assumer la responsabilit�� des normes sociales inconscientes qu���ils reproduisent, �� travers le syst��me de justice p��nale, et qui peuvent affecter sa l��gitimit��. more...

Background: Children���s active transportation (AT) and independent mobility (IM) are associated with higher physical activity. COVID-19 restrictions have drastically reduced opportunities for physical activity, but their effects on AT and IM remain unknown. Purpose: Using two national surveys of parents across Canada conducted by separate survey firms in October and December 2020, we examined changes in AT and IM since the COVID-19 pandemic. We assessed potential disparities in changes by gender, household income, and disability status. Methods: Survey 1 included 1,568 parents of 5- to 17-year-olds and Survey 2 included 2,291 parents of 7- to 12-year-olds. We assessed changes associated with COVID-19 retrospectively on 5-point scales ranging from a lot less to a lot more. Changes in IM were only assessed in survey 2. We summarized changes in AT and IM with descriptive statistics and examined disparities with linear regression models. Results: In surveys 1 and 2 respectively, 33.4 and 37.5% of parents reported a decline in AT, 48.9 and 48.4% reported no change, and 16.8 and 14.0% reported an increase. 32.8% of parents reported a decline in IM, 56.5% reported no change and 10.7% reported an increase. In both surveys, decreases in AT were significantly larger among children from households earning CAD$ 20,000-79,999 versus >$100,000 with no disparities related to gender or disabilities (p>0.05). We obtained similar results for IM in survey 2. Conclusions: These findings emphasize the need for public health authorities and policymakers to promote AT and IM as activities that can comply with physical distancing requirements. Funding: Study 1 was funded by Dalhousie University, the Province of Nova Scotia, and ParticipACTION. Study 2 was funded by the Heart and Stroke Foundation of Canada (grant # G-19-0026216)., The Health & Fitness Journal of Canada, Vol. 14 No. 3 (2021): Proceedings from the 8th International Society for Physical Activity and Health Congress more...

International audience; Objective To describe and compare the characteristics of women with placenta accreta spectrum (PAS) and their pregnancy outcomes according to the presence of placenta praevia and a prior caesarean section.Design Prospective population-based study.Setting All 176 maternity hospitals of eight French regions.Population Two hundred and forty-nine women with PAS, from a source population of 520 114 deliveries.Methods Women with PAS were classified into two risk-profile groups, with or without the high-risk combination of placenta praevia (or an anterior low-lying placenta) and at least one prior caesarean. These two groups were described and compared.Main outcome measures Population-based incidence of PAS, characteristics of women, pregnancies, deliveries and pregnancy outcomes.Results The PAS population-based incidence was 4.8/10 000 (95% CI 4.2-5.4/10 000). After exclusion of women lost to follow up from the analysis, the group with placenta praevia and a prior caesarean included 115 (48%) women and the group without this combination included 127 (52%). In the group with both factors, PAS was more often suspected antenatally (77% versus 17%; P < 0.001) and more often percreta (38% versus 5%; P < 0.001). This group also had more hysterectomies (53% versus 21%, P < 0.001) and higher rates of blood product transfusions, maternal complications, preterm births and neonatal intensive care unit admissions. Sensitivity analysis showed similar results after exclusion of women who delivered vaginally.Conclusion More than half the cases of PAS occurred in women without the combination of placenta praevia and a prior caesarean delivery, and these women had better maternal and neonatal outcomes. We cannot completely rule out that some of the women who delivered vaginally had placental retention rather than PAS; however, we found similar results among women who delivered by caesarean.Tweetable abstract Half the women with PAS do not have both placenta praevia and a prior caesarean delivery, and they have better maternal outcomes. more...

The implementation of high-resolution manometry (HRM) and the Lyon Consensus statement facilitate evaluation of gastroesophageal reflux disease and motility disorders in morbidly obese patients. Therefore, we aimed to investigate prevalence and phenotype of (borderline) GERD and esophageal motility disorders in this population. Consecutive morbidly obese (BMI ≥ 35 kg/m2) patients were offered evaluation by means of HRM, ambulatory 24-h pH impedance monitoring, endoscopy, and a clinical examination at our tertiary academic center. Data were collected prospectively. Out of 448 eligible individuals, 147 patients (females = 75, 51%) with a median age of 41.6 (33.4; 52.3) years and a BMI of 44 (40.9; 49.4) kg/m2 were included during the study period. The Chicago Classification revealed motility disorders in 50 (34%) patients, dominated by outflow obstruction (18.4%, n = 27) and a novel disorder (7.5%, n = 11), nicknamed jackhammer esophagus (JE). According to the Lyon Consensus, 52 (35.4%) patients had evidence of true GERD, whereas borderline GERD was noted in another 60 (40.8%). Hypersensitive esophagus was observed in 6.8% (n = 10). Sensitivity and specificity of symptoms for GERD were 53.8% and 68.4%, respectively. The current gold standard of assessment revealed that the prevalence of esophageal motility disorders and (borderline) GERD is high in the morbidly obese population. Further longitudinal data are needed to delineate the natural course of novel motility disorders like JE in obesity and to identify risk factors for adverse outcomes following bariatric surgery. more...

Despite the rapid growth of aortic valve replacement (AVR) for aortic stenosis (AS), limited data suggest symptomatic severe AS remains undertreated.This study sought to investigate temporal trends in AVR utilization among patients with a clinical indication for AVR.Patients with severe AS (aortic valve area 1 cmOf 10,795 patients, 6,150 (57%) had an indication or potential indication for AVR, of whom 2,977 (48%) received AVR. The frequency of AVR varied by AS subtype with LG groups less likely to receive an AVR (HG-NEF: 70%, HG-LEF: 53%, LG-NEF: 32%, LG-LEF: 38%, P 0.001). AVR volumes grew over the 18-year study period but were paralleled by comparable growth in the number of patients with an indication for AVR. In patients with a Class I indication, younger age, coronary artery disease, smoking history, higher hematocrit, outpatient index transthoracic echocardiogram, and LVEF ≥0.5 were independently associated with an increased likelihood of receiving an AVR. AVR was associated with improved survival in each AS-subgroup.Over an 18-year period, the proportion of patients with an indication for AVR who did not receive AVR has remained substantial despite the rapid growth of AVR volumes. more...

The diagnosis of bacterial infections at deep body sites benefits from noninvasive imaging of molecular probes that can be traced by positron emission tomography (PET). We specifically labeled bacteria by targeting their iron transport system with artificial siderophores. The cyclen-based probes contain different binding sites for iron and the PET nuclide gallium-68. A panel of 11 siderophores with different iron coordination numbers and geometries was synthesized in up to 8 steps, and candidates with the best siderophore potential were selected by a growth recovery assay. The probes more...

Laparoscopic diverted one-anastomosis gastric bypass (D-OAGB) is a bariatric procedure combining the principles of restriction, malabsorption, and other factors to induce weight loss. It is achieved by creating a narrow, long gastric pouch and bypassing a part of the small bowel (biliopancreatic limb). D-OAGB was first described by Dr. Ribero in 2013 and is technically a variation of the very heterogeneous group of Roux-en-Y gastric bypass operations. There are different technical variants to perform D-OAGB and to organize pre- and postoperative care. The following article is based on the approach to bariatric surgery as taken at the Department of General Surgery at the Medical University of Vienna. This article focuses on patient preparation before bariatric/metabolic surgery with mandatory and optional preoperative examinations to find the surgical procedure best suited for each individual patient and to decrease the patient’s risk. The surgical technique of D-OAGB itself, including positioning of the patient and related technical highlights, as well as the specifics of the postoperative course, are described. D-OAGB is an effective procedure for patients with symptomatic gastroesophageal reflux for adequate weight loss and remission of comorbidities with a low risk of malnutrition. For D-OAGB to be successful, important technical steps, such as creating a narrow, long pouch, exact length of the biliopancreatic and alimentary limb, and additional hiatoplasty (if necessary), should be taken. In terms of the postoperative course, regular checkups are vital to ensure desirable outcome in the long-term follow up and early detection of adverse developments. more...

Background One-anastomosis gastric bypass (OAGB) is a well-established treatment method in patients with morbid obesity. Its long-term impact on de novo reflux, anastomotic complications, and malnutrition needs further evaluation. Roux-en-Y gastric bypass (RYGB) is a technically feasible procedure in revisional bariatric surgery. This study presents our institutional data on conversion from OAGB to RYGB. Objective To determine the reasons for conversion, preoperative endoscopic findings, and feasibility of revisional bariatric surgery after OAGB. Setting University hospital in Austria METHODS: Retrospective analysis of a prospectively fed database. All patients undergoing OAGB between January 2012 and December 2019 were included. Screening was carried out for all patients needing conversion to RYGB. Percent total weight loss, percent excess weight loss, time to conversion, postoperative complications, and reasons for conversion were assessed. Results Eighty-two of 1,025 patients who underwent OAGB were converted laparoscopically to RYGB. Seven patients were converted early because of anastomotic/gastric tube leakage. Median time to late conversion was 29.1 ± 24.3 months, mean percent excess weight loss was 86.6% ± 33.1% and percent total weight loss was 35.1% ± 13.5%. Forty-two patients were converted because of reflux, 11 because of persistent marginal ulcers, 10 because of anastomotic stenosis, 9 because of malnutrition, and 3 because of weight regain. Seven patients showed Barrett's metaplasia in biopsies at the gastroesophageal junction before conversion. Conclusion Laparoscopic conversion from OAGB to RYGB is technically feasible with a moderate rate of postoperative complications. Severe (bile) reflux is a serious long-term complication after OAGB, with 4.1% of patients needing conversion to RYGB. Endoscopy after OAGB in patients showing clinical symptoms of gastroesophageal reflux disease is strongly advised to detect underlying pathologic changes. more...

Background Direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) has encouraged lung transplantation with HCV positive donors. Early trials have been promising; however, nationwide data have not been previously examined. Methods The United Network for Organ Sharing registry was queried for adult patients receiving lung transplants from 2016 to 2019. We excluded multiorgan transplants, incomplete data, and loss to follow-up. Nucleic acid testing (NAT) determined HCV status. Propensity matching was performed for comparison of outcomes.. Results Hepatitis C virus NAT-positive lungs were transplanted in 189 patients, compared with 9511 recipients of NAT-negative lungs. The HCV NAT-positive donors were younger (mean 33 vs 35 years, P = .017) with higher rates of Pa o 2/Fi o 2 greater than 300 (83.6% vs 76.5%, P = .029). Recipients of NAT-positive lungs had lower lung allocation scores (mean 39.3 vs 42.4, P = .009). Distance traveled was significantly further for HCV viremic donor lungs (mean 416 vs 206 miles, P .999), or reintubation (P = .304). At mean follow-up of 395 days, 63 recipients of NAT-positive lungs (40%) seroconverted, 14 with viremia. One-year mortality rates among seroconverted patients was 6% and did not differ significantly from 14% in nonseroconverted patients or 13.2% in recipients of HCV-negative lungs. Conclusions Short-term outcomes of lung transplantation from HCV viremic donors are promising, with no difference in early complications or survival. The effects of seroconversion and long-term outcomes including chronic rejection and infection need to be further explored. more...