| 1. |
- Arner, Peter, et al.
(författare)
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Variations in the size of the major omentum are primarily determined by fat cell number
- 2013
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Ingår i: Journal of Clinical Endocrinology and Metabolism. - : The Endocrine Society. - 0021-972X .- 1945-7197. ; 98:5, s. E897-E901
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Accumulation of visceral adipose tissue (VAT) is strongly linked to insulin resistance. Variations in the size of any adipose depot are determined by alterations in adipocyte volume and/or number. The individual contribution of each of the latter factors was determined in the major omentum, a fully resectable VAT depot.SUBJECTS: Total removal of the major omentum (omentectomy) was performed in conjunction with bariatric surgery in 55 obese patients. Tissue weight as well as mean adipocyte size and number in the omentum were determined. In subgroups, total VAT was estimated by computerized tomography (n = 17) or dual-energy x-ray absorptiometry (n = 34).RESULTS: The weight of the major omentum (on average 0.6 kg) correlated significantly with total VAT mass estimated by computerized tomography or dual-energy x-ray absorptiometry (r = 0.48-0.7; P < .01). Omental weight in relation to total body fat correlated with several features of the metabolic syndrome and inversely with serum-leptin (P < .001). Mean adipocyte size and total adipocyte number correlated strongly with omental weight (r = 0.6-0.8; P < .0001), irrespective of body mass index and total body fat mass, and accounted almost in total for interindividual variations in omental size. However, stepwise regression analysis demonstrated that adipocyte number was significantly (P < .0001) more important (62%) than adipocyte size (35%).CONCLUSION: The size of the major omentum is representative for VAT mass and correlates with a pernicious metabolic profile. Variations in omental weight are primarily determined by adipocyte number and to a lesser degree by adipocyte size, suggesting that increased VAT mass in obesity is predominantly dependent on adipocyte proliferation.
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| 2. |
- Ahlqvist, Margary, et al.
(författare)
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A new reliable tool (PVC assess) for assessment of peripheral venous catheters
- 2010
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Ingår i: Journal of Evaluation In Clinical Practice. - : Wiley. - 1356-1294 .- 1365-2753. ; 16:6, s. 1108-1115
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Tidskriftsartikel (refereegranskat)abstract
- Rationale and aims To evaluate the extensive use of peripheral venous catheters (PVCs), including catheter-related complications, a reliable tool for PVC assessment is needed. The aim of this study was to develop such a tool to evaluate PVCs in relation to management, documentation and signs and symptoms of thrombophlebitis (TH), as well as to determine its inter-rater and test-retest reliability. Method The tool development included confirmation of content and face validity. Two groups of registered nurses used the new tool (PVC assess) to assess PVC management and signs of TH independently. Group A (n = 3) assessed 26 items in 67 PVCs bedside (inter-rater reliability). Group B (n = 3) assessed photographs (67 PVCs, 21 items) of the same PVCs as those in Group A with a 4-week interval (test-retest reliability). Proportion of agreement P(A) and Cohen's kappa were calculated to evaluate inter-rater and test-retest reliability. Results Among nurses assessing PVCs at bedside, the P(A) was good to excellent (0.80-1) in 96% of the items in PVC assess. In 80% of the items kappa was substantial to almost perfect (0.61-1). TH sign erythema fell into the fair range (kappa = 0.40). In test-retest reliability analysis the P(A) was within the good and excellent range (0.80-1.0) and kappa varied from moderate to almost perfect (0.41-1.0) in 95% of the items. One item 'outer dressing is clean' was in fair range (0.21-0.40). Conclusions The PVC assess instrument shows satisfactory inter-rater and test-retest reliability. Reliability tests on reviewing documentation remain to be performed.
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| 3. |
- Andersson, Daniel P., et al.
(författare)
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Omentectomy in addition to gastric bypass surgery and influence on insulin sensitivity : A randomized double blind controlled trial
- 2014
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Ingår i: Clinical Nutrition. - : Elsevier BV. - 0261-5614 .- 1532-1983. ; 33:6, s. 991-996
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Tidskriftsartikel (refereegranskat)abstract
- Background & aims: Accumulation of visceral adipose tissue is associated with insulin resistance and cardio-vascular disease. The aim of this study was to elucidate whether removal of a large amount of visceral fat by omentectomy in conjunction with Roux en-Y gastric bypass operation (RYGB) results in enhanced improvement of insulin sensitivity compared to gastric bypass surgery alone. Methods: Eighty-one obese women scheduled for RYGB were included in the study. They were randomized to RYGB or RYGB in conjunction with omentectomy. Insulin sensitivity was measured by hyperinsulinemic euglycemic clamp before operation and sixty-two women were also reexamined 2 years post-operatively. The primary outcome measure was insulin sensitivity and secondary outcome measures included cardio-metabolic risk factors. Results: Two-year weight loss was profound but unaffected by omentectomy. Before intervention, there were no clinical or metabolic differences between the two groups. The difference in primary outcome measure, insulin sensitivity, was not significant between the non-omentectomy (6.7 +/- 1.6 mg/kg body weight/minute) and omentectomy groups (6.6 +/- 1.5 mg/kg body weight/minute) after 2 years. Nor did any of the cardio-metabolic risk factors that were secondary outcome measures differ significantly. Conclusion: Addition of omentectomy to gastric bypass operation does not give an incremental effect on long term insulin sensitivity or cardio-metabolic risk factors. The clinical usefulness of omentectomy in addition to gastric bypass operation is highly questionable.
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| 4. |
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| 5. |
- Bonn, Stephanie Erika, et al.
(författare)
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App Technology to Support Physical Activity and Intake of Vitamins and Minerals After Bariatric Surgery (the PromMera Study): Protocol of a Randomized Controlled Clinical Trial
- 2020
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Ingår i: JMIR Research Protocols. - : JMIR PUBLICATIONS, INC. - 1929-0748. ; 9:8
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Tidskriftsartikel (refereegranskat)abstract
- Background: To optimize postoperative outcomes after bariatric surgery, lifestyle changes including increased physical activity are needed. Micronutrient deficiency after surgery is also common and daily supplementation is recommended. Objective: The aim of the PromMera study is to evaluate the effects of a 12-week smartphone app intervention on promotion of physical activity (primary outcome) and adherence to postsurgery vitamin and mineral supplementation, as well as on other lifestyle factors and overall health in patients undergoing bariatric surgery. Methods: The PromMera study is a two-arm, randomized controlled trial comprising patients undergoing bariatric surgery. Participants are randomized postsurgery 1:1 to either the intervention group (ie, use of the PromMera app for 12 weeks) or the control group receiving only standard care. Clinical and lifestyle variables are assessed pre- and postsurgery after 18 weeks (postintervention assessment), 6 months, 1 year, and 2 years. Assessments include body composition using Tanita or BOD POD analyzers, muscle function using handgrip, biomarkers in blood, and an extensive questionnaire on lifestyle factors. Physical activity is objectively measured using the ActiGraph wGT3X-BT triaxial accelerometer. Results: A total of 154 participants have been enrolled in the study. The last study participant was recruited in May 2019. Data collection will be complete in May 2021. Conclusions: Implementing lifestyle changes are crucial after bariatric surgery and new ways to reach patients and support such changes are needed. An app-based intervention is easily delivered at any time and can be a key factor in the adoption of healthier behavioral patterns in this rapidly growing group of patients.
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| 6. |
- Bonn, Stephanieb E. E., et al.
(författare)
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Effect of a Smartphone Application on Physical Activity and Weight Loss After Bariatric Surgery-Results from a Randomized Controlled Trial
- 2023
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Ingår i: Obesity Surgery. - : SPRINGER. - 0960-8923 .- 1708-0428. ; 33:9, s. 2841-2850
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Tidskriftsartikel (refereegranskat)abstract
- Purpose Ways to motivate and support patients in being physically active after bariatric surgery are needed. This trial was aimed at evaluating the effect of using a smartphone application targeting physical activity during 12 weeks on moderate-to-vigorous physical activity (MVPA, primary outcome) and secondary outcomes of inactivity, light physical activity (LPA), body mass index (BMI), and percent total weight loss (%TWL) after bariatric surgery.Materials and Methods Data from a randomized controlled trial comprising 146 patients (79.5% women) undergoing bariatric surgery was analyzed. Mean age and BMI pre-surgery were 40.9 years and 40.5 kg/m(2), respectively. Participants were randomized 1:1 to an intervention or a control group. Physical activity and body weight were objectively measured at baseline pre-surgery and post-surgery follow-ups after 6 weeks (weight only), 18 weeks, 6 months, and 1 year. Linear mixed models were fitted to assess longitudinal differences in outcomes between the groups.Results A significant effect of the intervention (group-by-time interaction 16.2, 95% CI 3.5 to 28.9) was seen for MVPA at 18 weeks; the intervention group had increased their MVPA since baseline, while the control group had decreased their MVPA. The control group had lowered their BMI approximately 1 kg/m(2) more than the intervention group at follow-up after 18 weeks and 12 months, yet, mean BMI did not differ between the groups. No intervention effect was seen on inactivity, LPA, or %TWL.ConclusionOur results indicate that use of a smartphone application targeting physical activity may have the potential to promote short-term MVPA post bariatric surgery.
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| 7. |
- Ganda Mall, John-Peter, 1988-
(författare)
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Non-digestible Polysaccharides and Intestinal Barrier Function : specific focus on its efficacy in elderly and patients with Crohn’s disease
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A large number of elderly suffer from gastrointestinal (GI) symptoms such as constipation and diarrhoea. The underlying mechanisms of age-acquired GI symptoms are not well studied but are necessary to clarify in order to recommend the right treatment. Non-digestible polysaccharides (NPS) are dietary fibres that could have beneficial effects on the intestinal immune system and barrier function, although their efficacy needs to be evaluated. Paper I showed that elderly with GI symptoms have significantly higher small intestinal permeability than a general elderly population, along with a stronger association to psychological distress. In Paper II we performed a randomised controlled trial with a general population of elderly that consumed either placebo, the NPS’s arabinoxylan or oat β-glucan for a period of 6 weeks. No protective effects were observed related to indomethacin-induced intestinal hyperpermeability, inflammatory markers, or self-reported health if compared to placebo. Paper III showed that stimulation with a yeast-derived β-glucan significantly attenuated Compound (C) 48/80-induced hyperpermeability in colonic biopsies from elderly with GI symptoms mounted in Ussing chambers, but not in young healthy adults. Arabinoxylan attenuated only C48/80-induced transcellular permeability in elderly but both paracellular and transcellular permeability in young healthy adults. Paper IV showed that the same yeast-derived β-glucan from paper III could cross the epithelium of ileal tissues from patients with Crohn’s disease (CD) and non-CD controls, mounted in Ussing chambers, and attenuate C48/80-induced hyperpermeability. In conclusion, we found that elderly with GI symptoms display a deteriorated barrier function and that administration of selective NPS can have beneficial effect on intestinal permeability in selective populations.
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| 8. |
- Hedberg, Suzanne, et al.
(författare)
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BEST: Bypass equipoise sleeve trial; rationale and design of a randomized, registry-based, multicenter trial comparing Roux-en-Y gastric bypass with sleeve gastrectomy
- 2019
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Ingår i: Contemporary Clinical Trials. - : Elsevier BV. - 1551-7144 .- 1559-2030. ; 84
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Tidskriftsartikel (refereegranskat)abstract
- Background: Laparoscopic gastric bypass (LGBP) is a well-documented surgical intervention for severe obesity. Recently, laparoscopic sleeve gastrectomy (LSG) has gained increased popularity. Short-term follow-up in limited-sized randomized trials comparing LGBP and LSG show no major differences in weight-loss, adverse events, or effect on comorbidities; however, there is a lack of sufficiently powered, pragmatic, randomized controlled trials comparing the mid- and long-term results of the two methods. Method: BEST is a randomized, registry-based, multicenter trial comparing LGBP and LSG. The trial has two primary outcomes; rates of substantial complications (SC) and total body weight loss. We hypothesize that patients treated with LSG will experience 35% fewer substantial complications during the 5-year follow-up compared to patients treated with LGBP, and that the efficacy of LSG will remain within a non-inferiority margin of 5% in terms of weight loss. Our sample size calculation, using data from the Scandinavian Obesity Surgery Registry (SOReg), shows a power of 80% for SC and > 95% for weight loss at p < .025 with a total of 2100 included patients. The design of the trial will also enable comparisons within several relevant patient subgroups. Conclusions: As a large-sized, pragmatic, randomized trial, BEST will provide robust data comparing LGBP with LSG by generating long-term results on weight loss and SC's, as well as secondary outcomes and comparisons within patient subgroups. The use of a well-established registry for registration of all data facilitates a large multicenter trial, and combines the strengths of registry studies with those of a randomized trial. Clinical Trials registry: NCT 02767505. © 2019 Elsevier Inc.
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| 9. |
- Hedberg, Suzanne, et al.
(författare)
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Comparison of Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass : A Randomized Clinical Trial
- 2024
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Ingår i: JAMA Network Open. - : American Medical Association (AMA). - 2574-3805. ; 7:1
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE: Laparoscopic sleeve gastrectomy (SG) and laparoscopic Roux-en-Y gastric bypass (RYGB) are widely used bariatric procedures for which comparative efficacy and safety remain unclear.OBJECTIVE: To compare perioperative outcomes in SG and RYGB.DESIGN, SETTING, AND PARTICIPANTS: In this registry-based, multicenter randomized clinical trial (Bypass Equipoise Sleeve Trial), baseline and perioperative data for patients undergoing bariatric surgery from October 6, 2015, to March 31, 2022, were analyzed. Patients were from university, regional, county, and private hospitals in Sweden (n = 20) and Norway (n = 3). Adults (aged ≥18 years) eligible for bariatric surgery with body mass indexes (BMIs; calculated as weight in kilograms divided by height in meters squared) of 35 to 50 were studied.INTERVENTIONS: Laparoscopic SG or RYGB.MAIN OUTCOMES AND MEASURES: Perioperative complications were analyzed as all adverse events and serious adverse events (Clavien-Dindo grade >IIIb). Ninety-day mortality was also assessed.RESULTS: A total of 1735 of 14 182 eligible patients (12%; 1282 [73.9%] female; mean (SD) age, 42.9 [11.1] years; mean [SD] BMI, 40.8 [3.7]) were included in the study. Patients were randomized and underwent SG (n = 878) or RYGB (n = 857). The mean (SD) operating time was shorter in those undergoing SG vs RYGB (47 [18] vs 68 [25] minutes; P < .001). The median (IQR) postoperative hospital stay was 1 (1-1) day in both groups. The 30-day readmission rate was 3.1% after SG and 4.0% after RYGB (P = .33). There was no 90-day mortality. The 30-day incidence of any adverse event was 40 (4.6%) and 54 (6.3%) in the SG and RYGB groups, respectively (odds ratio, 0.71; 95% CI, 0.47-1.08; P = .11). Corresponding figures for serious adverse events were 15 (1.7%) for the SG group and 23 (2.7%) for the RYGB group (odds ratio, 0.63; 95% CI, 0.33-1.22; P = .19).CONCLUSIONS AND RELEVANCE: This randomized clinical trial of 1735 patients undergoing primary bariatric surgery found that both SG and RYGB were performed with a low perioperative risk without clinically significant differences between groups.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02767505.
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| 10. |
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| 11. |
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| 12. |
- Kald, Anders, et al.
(författare)
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Laparoscopic hernia repair in patients with bilateral groin hernias
- 2000
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Ingår i: European Journal of Surgery. - 1102-4151 .- 1741-9271. ; 166:3, s. 210-212
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare outcome of unilateral and bilateral laparoscopic hernia repair. Design: Prospective consecutive trial. Setting: University hospital, Sweden. Subjects: 380 patients who had unilateral hernias repaired laparoscopically and 64 patients who had bilateral hernias repaired. The median (range) age in the two groups was 56 (21-86) and 61 (30-85) years, respectively and the median (range) follow-up was 42 (24-58) months. Main outcome measures: Operating time, hospital stay, complications, and time to recovery. Results: The median (range) operating time was 70 (25-240) minutes in the unilateral and in the bilateral group 113 (55-330) minutes. The complication rate, recurrence rate, and time to full recovery did not differ between the groups. Conclusion: The laparoscopic approach seems to be a good option for patients with bilateral inguinal hernias.
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| 13. |
- Laurenius, Anna, et al.
(författare)
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Nordiska riktlinjer för kosttillskott och uppföljning efter obesitaskirurgi - Monitorering och supplementering med vitaminer och mineraler
- 2018
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 115
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Forskningsöversikt (refereegranskat)abstract
- Each year 6,800 bariatric operations are performed in Sweden. Bariatric surgery involves both a reduced intake and a reduced absorption of vitamins and minerals. There has been debate about whose responsibility long-term follow-up is, particularly regarding monitoring vitamin and mineral status. The Swedish Society for Bariatric Surgery and the Norwegian Association for Bariatric Surgery, who oversee their respective national quality registers, have appointed an expert group to develop guidelines for postoperative supplementation and nutritional monitoring of vitamins and minerals, along with a schedule for routine follow-up. Several existing international guidelines have served as the basis for the development of this guidance. The Finnish Association for Metabolic Surgery and The Danish Association for the Study of Obesity have also decided to adopt the recommendations. The care of the patient group with severe obesity is a common responsibility of primary care and hospitals, as patients are heavily affected by obesity-related morbidity, which, even without surgery, requires major health care efforts, not least from primary care. After surgery, a large proportion of these efforts can be reduced, but focus changes.
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| 14. |
- Laurenius, Anna, et al.
(författare)
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Nordiska riktlinjer för kosttillskott och uppföljning efter obesitaskirurgi - Monitorering och supplementering med vitaminer och mineraler. : Nordiska riktlinjer för kosttillskott och uppföljning efter obesitaskirurgi - Monitorering och supplementering med vitaminer och mineraler.
- 2018
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Ingår i: Lakartidningen. - 1652-7518. ; 115
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Tidskriftsartikel (refereegranskat)abstract
- Each year 6,800 bariatric operations are performed in Sweden. Bariatric surgery involves both a reduced intake and a reduced absorption of vitamins and minerals. There has been debate about whose responsibility long-term follow-up is, particularly regarding monitoring vitamin and mineral status. The Swedish Society for Bariatric Surgery and the Norwegian Association for Bariatric Surgery, who oversee their respective national quality registers, have appointed an expert group to develop guidelines for postoperative supplementation and nutritional monitoring of vitamins and minerals, along with a schedule for routine follow-up. Several existing international guidelines have served as the basis for the development of this guidance. The Finnish Association for Metabolic Surgery and The Danish Association for the Study of Obesity have also decided to adopt the recommendations. The care of the patient group with severe obesity is a common responsibility of primary care and hospitals, as patients are heavily affected by obesity-related morbidity, which, even without surgery, requires major health care efforts, not least from primary care. After surgery, a large proportion of these efforts can be reduced, but focus changes.
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| 15. |
- Malmgren A, Anna, et al.
(författare)
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Indications for percultaneous endoscopic gastrostomy and survival in old adults
- 2011
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Ingår i: Food & Nutrition Research. - : SNF Swedish Nutrition Foundation. - 1654-6628 .- 1654-661X. ; 55, s. 6037-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Many diseases striking old adults result in eating difficulties. Indications for selecting individuals for percutaneous endoscopic gastrostomy (PEG) are unclear and everybody may not benefit from the procedure.OBJECTIVE:The aim of this study was to evaluate indications for and survival after PEG insertion in patients older than 65 years.DESIGN AND METHODS:A retrospective analysis including age, gender, diagnosis, indication, and date of death was made in 201 consecutive individuals, 94 male, mean age 79±7 years, who received a nutritional gastrostomy.RESULTS:Dysphagia was present in 86% of the patients and stroke was the most common diagnosis (49%). Overall median survival was 123 days and 30-day mortality was 22%. Patients with dementia and Mb Parkinson had the longest survival (i.e. 244 and 233 days), while those with other neurological diseases, and head and neck malignancy had the shortest (i.e. 75 and 106 days). There was no difference in mortality in patients older or younger than 80 years, except in patients with dementia.CONCLUSIONS:Old age should not be a contraindication for PEG. A high 30-day mortality indicates that there is a need of better criteria for selection and timing of PEG insertion in the elderly.
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| 16. |
- Paul, Rebecca, et al.
(författare)
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Health-Related Quality of Life, Sexuality and Hormone Status after Laparoscopic Roux-En-Y Gastric Bypass in Women
- 2020
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Ingår i: Obesity Surgery. - : Springer-Verlag New York. - 0960-8923 .- 1708-0428. ; 30, s. 493-500
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveFew studies have been carried out concerning the influence of bariatric surgery on female sexuality and hormones, particularly utilizing hormone-based questionnaires. The effect of bariatric surgery on sex hormone levels, sexual function and health-related quality of life (HRQL) in women was analyzed in this study. Participants were included in a single-center study at a regional hospital in Sweden, with a duration of one-year follow-up.MethodsOne hundred non-smoking women, undergoing laparoscopic Roux-en-Y gastric bypass, were included in the study. Blood assay for sex-hormone binding globulin (SHBG), testosterone, estrogen, progesterone, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) was analyzed. Participants completed the Female Sexual Function Index (FSFI), Women’s Health Questionnaire (WHQ) and Psychological General Well-being Inventory (PGWB) parallel to lab testing.ResultsAt one-year follow-up, several significant results were found concerning hormones and questionnaires. Testosterone decreased and SHBG increased, N = 68/100. Desire, arousal, orgasm, satisfaction and total score domains for the FSFI increased after one year, N = 53/100. WHQ domains concerning depressed mood, somatic symptoms, memory, anxiety, sexual behavior and attractiveness improved after one year, N = 47/100. All domains in the PGWB (N = 52), including anxiety, depressed mood, positive well-being, self-control, general health, vitality and total score improved at follow-up. Spearman’s Rho coefficient analysis found correlation between testosterone/WHQ-sexual problems (0.3), SHBG/WHQ-general health (0.3) and SHBG/FSFI-arousal (−0.3).ConclusionsBariatric surgery normalizes levels of sex-hormones in women, and results in improved sexual function, health-related quality of life and psychological well-being.
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| 17. |
- Paul, Rebecca, 1978-
(författare)
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Obesity and Effects of Bariatric Surgery - with a Certain Focus on Women's Health
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Severe obesity influences sex hormone levels in women, which may result in subfertility, menstrual disturbances, anovulation and hyperandrogenism as well as increased risk for complications during pregnancy and birthing. Bariatric surgery leads to long-term weight loss and resolution of several comorbidities including hormone imbalance. However, the impact of altered sex hormones in women with obesity is insufficiently understood. Little is known concerning potential influences of changed sex hormone levels on women's function and quality of life following bariatric surgery and subsequent weight loss. This thesis aims to understand sex hormone balance in women with severe obesity and after bariatric surgery and to explore women’s experiences of changes in life after bariatric surgery and weight loss. Study I included 100 women and utilized blood assay to investigate changes in serum sex- hormone levels and questionnaires concerning sexual function and health-related quality of life (HRQoL) in women with severe obesity before and one year after bariatric surgery. Findings from Study I indicated that testosterone and sex hormone binding globulin normalized, and questionnaires showed improvements in several domains of sexual function, psychological well-being and general health in women one year after surgery. Study II used a qualitative method, specifically thematic analysis, to explore women's pre- and postoperative experiences, indicating that increased fertility and achieved motherhood were motivating factors to undergo bariatric surgery. Fourteen women were interviewed, and the themes of “Experiencing Motherhood and Femininity” and “Achieving a Normal Life” emerged from the data. Study III applied the qualitative method with Gadamer’s hermeneutic analysis to understand the lived experiences of premenopausal women with obesity before and after having undergone bariatric surgery. A focus was on influences of altered sex hormones and potential restoration of levels after surgery. Ten women were included, and analysis of the horizons created the fusions of “Recognition of Unhealthy Body Weight”, “Dealing with Other People’s Opinions and Society’s Norms”, “Life has Changed in a Positive Way” and “Accepting Inner Self and Bodily Changes”. Finally, to elaborate on previous studies' findings and better understand the current knowledge base, a systematic review and interpretative meta-synthesis of published literature involving qualitative methods concerning women’s experiences of womanliness related to changes after undergoing bariatric surgery was conducted in study IV. Ten relevant studies were included, and a meta-synthesis, according to Gadamer’s hermeneutics, created the fusions of “Womanliness,” “A Healthy and Functioning Body,” and “Mind and Body Connection.” This thesis provides a clearer understanding of the experiences of living with obesity that motivate premenopausal women to seek bariatric surgery. The importance of postoperative benefits such as restored function, health and womanliness are illustrated as well as clarifying difficulties involving adaptations to life after surgery. These findings may inform potential bariatric surgery candidates and healthcare professionals of the experiences of women living with obesity, as well as expectations, postoperative experiences and challenges. These findings promote patient-centred guidance prior to surgery and during postoperative follow-up.
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| 18. |
- Scerri, Paul, et al.
(författare)
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Headless Chickens III
- 2000
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Ingår i: RoboCup-99. - : Springer Berlin/Heidelberg. - 9783540410430 - 9783540453277 - 3540410430 ; , s. 576-579
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Bokkapitel (refereegranskat)abstract
- The development of the Headless Chickens III emphasized a high level team specification environment, called the Strategy Editor, that was intended for use by endusers, rather than computer programmers[2]. Using the strategy editor consisted of placing players on a image of the ground and indicating the direction(s) the player should kick and/or dribble when they get the ball. Different player formations and passing/dribbling patterns could be specified for different game situations. The designer could also specify the style of play for each of the players, e.g. defensive or inclined to shoot or dribble.
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| 19. |
- Sima, Eduardo, 1975-
(författare)
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Gastric bypass : Technical aspects and long-term results
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Roux-en-Y gastric bypass (RYGBP) achieves superior short- and long-term weight loss compared to other weight loss modalities. Different operative techniques have been developed to technically facilitate the surgical procedure, with consequences in the form of an array of postoperative complications and gastrointestinal symptoms. Furthermore, as our follow-up on operated patients extends beyond the first postoperative years, it becomes apparent that a significant number of patients experience unsatisfactory weight result. Current research is just starting to chart factors associated with postoperative long-term weight regain with the ultimate goal of preventing it.In Paper I it is found that the linear stapled technique for the gastrojejunostomy in laparoscopic RYGBP is associated with shorter operative time, in-hospital stay and a lower incidence of surgical site infections and anastomotic strictures compared to the circular stapled technique. Paper II demonstrates that, despite no differences in weight result, the 21-mm circular stapled technique for the gastrojejunostomy is associated with a higher incidence of vomiting and endoscopic anastomotic dilatations compared to the 25-mm circular stapled technique and the linear stapled technique in the long-term after RYGBP. Paper III shows that despite differences in body composition, long-term weight responders and non-responders after RYGBP did not differ in resting, glucose-induced or activity-related energy expenditure. Lastly Paper IV shows long-term weight result is associated with fasting levels of leptin and ghrelin, and that the response of these hormones to a glucose load might contribute to perpetuate obesity.
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| 20. |
- Söderholm, Johan D, 1958-, et al.
(författare)
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Augmented increase in tight junction permeability by luminal stimuli in the non-inflamed ileum of crohn's disease
- 2002
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Ingår i: Gut. - : BMJ. - 0017-5749 .- 1468-3288. ; 50:3, s. 307-313
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Tidskriftsartikel (refereegranskat)abstract
- Background: Crohn's disease is associated with deranged intestinal permeability in vivo, suggesting dysfunction of tight junctions. The luminal contents are important for development of neoinflammation following resection. Regulation of tight junctions by luminal factors has not previously been studied in Crohn's disease. Aims: The aim of the study was to investigate the effects of a luminal stimulus, known to affect tight junctions, on the distal ileum in patients with Crohn's disease. Patients: Surgical specimens from the distal ileum of patients with Crohn's disease (n=l 2) were studied, and ileal specimens from colon cancer patients (n=l 3) served as controls. Methods: Mucosal permeability to 51Cr-EDTA and electrical resistance were studied in Ussing chambers during luminal exposure to sodium caprate (a constituent of milk fat, affecting tight junctions) or to buffer only. The mechanisms involved were studied by mucosal ATP levels, and by electron and confocal microscopy. Results: Baseline permeability was the same in non-inflamed ileum of Crohn's disease and controls. Sodium caprate induced a rapid increase in paracellular permeability - that is, increased permeation of 51Cr-EDTA and decreased electrical resistance - which was more pronounced in non-inflamed ileum of Crohn's disease, and electron microscopy showed dilatations within the tight junctions. Moreover, sodium caprate induced disassembly of perijunctional filamentous actin was more pronounced in Crohn's disease mucosa. Mucosal permeability changes were accompanied by mitochondrial swelling and a fall in epithelial ATP content, suggesting uncoupling of oxidative phosphorylation. Conclusions: The tight junctions in the non-inflamed distal ileum of Crohn's disease were more reactive to luminal stimuli, possibly mediated via disturbed cytoskeletal contractility. This could contribute to the development of mucosal neoinflammation in Crohn's disease.
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