加味补肾壮筋汤颗粒剂对去卵巢骨质疏松大鼠血清NO、SOD及MDA的影响

目的探讨去卵巢骨质疏松大鼠血清中NO、SOD、MDA的变化及中药加味补肾壮筋汤颗粒剂对其的影响。方法选用6月龄清洁级Wistar雌性大鼠45只,随机分为正常对照组、模型组和中药组,每组15只。模型组和中药组行双侧卵巢切除术,术后正常对照组及模型组分别给予生理盐水67ml·kg-1·d-1,中药组给予加味补肾壮筋汤颗粒混悬液67ml·kg-1·d-1,分别于造模前及造模后3个月进行血清NO、SOD、MDA含量的测定。结果造模后3个月模型组血清中NO和SOD含量明显低于正常对照组,MDA含量明显高于正常对照组,且差异有统计学意义(P<005);而使用加味补肾壮筋汤颗粒剂3个月后血清中NO和SOD的含量明显升高,MDA含量明显降低,且差异与模型组比较有统计学意义(P<005)。结论血清中NO、SOD、MDA可能参与了绝经后骨质疏松症的病理进程,而加味补肾壮筋汤颗粒剂可以调节血清中NO、SOD、MDA含量,这可能是其防治骨质疏松症的机制之一。     

骨康冲剂对骨质疏松症BMD、BGP、PYD、E2、T的干预

目的 运用补肾健脾活血的代表方剂-骨康冲剂治疗原发性骨质疏松的疗效观察证明补肾健脾活血法的临床意义.方法 原发性骨质疏松症80例,随机分为骨康冲剂治疗组、强骨胶囊对照组对照观察.结果 骨康冲剂治疗组总有效率达96%,显效率达72%.治疗后比治疗前骨密度提高了,临床症状有明显改善、肾虚积分均有明显下降、但两组无明显差异,血清骨钙素（BGP）显著上升,尿吡啶酚（PYD）显著下降.以上指标两组均无差异.结论 骨康冲剂具有促进骨形成,抑制骨吸收的作用.对防治骨质疏松症有效,并说明补肾健脾活血法对防治骨质疏松症有实用价值.     

加味痛经汤治疗气滞血瘀型原发性痛经60例疗效分析

目的观察加味痛经汤治疗气滞血瘀型原发性痛经的临床疗效。方法将气滞血瘀型原发性痛经患者随机分成两组,治疗组30例予加味痛经汤口服,经净1周后口服补肾促排卵方加减;观察组30例予消炎痛口服。结果总有效率治疗组为90.00%,观察组为66.67%,两组比较差异有统计学意义（P〈0.05）;两组中医证候比较差异有统计学意义（P〈0.01）。结论加味痛经汤治疗气滞血瘀型原发性痛经有较好疗效,效果优于消炎痛。     

芪丹地黄冲剂治疗绝经后骨质疏松症的临床研究

目的观察芪丹地黄冲剂治疗绝经后骨质疏松症的临床疗效。方法将88例符合纳入标准的患者分为治疗组和对照组,治疗组应用芪丹地黄冲剂治疗,对照组应用强骨胶囊治疗,比较两组治疗前及治疗后3个月临床疗效、腰椎骨密度、肾阳虚症状积分以及相关骨代谢指标的改善情况。结果芪丹地黄冲剂治疗绝经后骨质疏松症,在临床疗效、骨密度、肾虚症状积分以及相关骨代谢指标的改善方面,与中药强骨胶囊具有类似的功用。结论芪丹地黄冲剂治疗绝经后骨质疏松症疗效确切又安全,值得临床推广使用。     

针药结合对原发性骨质疏松症患者骨密度的影响

目的探讨针药结合对原发性骨质疏松症的有效性。方法121例原发性骨质疏松症患者随机分为针药组85例和药物组36例，观察2组患者不同的干预方法治疗前后症状积分、骨密度的变化。结果针药组和药物组均能改善患者的临床症状，提高患者腰椎的骨密度，针药组的效果明显优于单纯药物治疗组。结论针灸疗法对原发性骨质疏松症有良好的治疗效果。     

骨疏康颗粒治疗骨质疏松症的临床观察(附300例分析)

我们运用中医肾主骨理论，以补肾益气活血为治则研制成骨疏康冲剂，对原发性骨质疏松症并肾虚兼气血不足的中医征候进行了３００例临床观察。其结果，骨疏康冲剂治疗骨质疏松症总有效率为９２．３％，其中显效率为７６．３％。对肾虚兼气血不足证疗效为７９．６％，明显优于对照组。在观察中，其骨密度值用药后明显升高，用药前后差异非常显著Ｐ＜０．０１。其骨密度值升高０．０６ｇ／ｃｍ２以上者为７６．３％。说明应用骨疏康冲剂有四分之三以上病例已疏松的骨质得以恢复。     

补肾壮筋汤对兔早期实验性膝骨关节炎软骨细胞凋亡及增殖细胞核抗原表达的影响

目的:探讨以补肝益肾为治疗手段的补肾壮筋汤对兔早期膝关节实验性OA的软骨细胞凋亡和增殖细胞核抗原(PCNA)表达的影响。方法:40只青紫蓝兔随机分为4组,每组10只,分别为中药组、假模组、模型组、正常组,参照Hulth法造成早期骨关节炎模型。术后第4周开始,中药组、假模组口服补肾壮筋汤,模型组、正常组口服生理盐水。7周末取兔膝关节软骨,肉眼、光镜、透射电镜观察形态学变化,用原位末端标记法(TUNEL法),免疫组化法分别观察软骨细胞凋亡和PCNA的表达。结果:中药组的软骨细胞凋亡指数小于模型组(P<0.05);而中药组的PCNA表达要高于其他各组(P<0.05)。结论:补肾壮筋汤减少兔早期膝关节实验性OA软骨细胞的凋亡,促进软骨细胞的增殖,对早期OA有治疗作用。     

加味麻黄附子细辛汤治疗太阳少阴合病腰椎间盘突出症队列研究分析

目的 探索加味麻黄附子细辛汤治疗腰椎间盘突出症疗效优势人群和和使用禁忌，凸显六经辨证特色和优势。方法 选取2019年3月～2020年3月就诊于上海市浦东新区中医医院骨伤门诊患者，采用队列研究分析将运用加味麻黄附子细辛汤结合中医综合治疗的腰椎间盘突出症与单纯采用中医综合治疗的腰椎间盘突出症患者分为暴露组和对照组，比较两组患者临床疗效，并将暴露组根据性别、年龄、二十四节气、体质量指数(body mass index, BMI)等因素进一步分亚组比较，探索麻黄附子细辛汤疗效优势人群和使用禁忌。结果 共收集204例患者，一般资料分析证实各项数据差异均有可比性。经统计分析，所有亚组均可改善腰椎间盘突出症症状；其中年龄>50岁、BMI<26.9 kg/m²、病程<3年、轻中劳动强度、冬春季组为加味麻黄附子细辛汤的疗效优势人群；回归分析显示，患者年龄越大，加味麻黄附子细辛汤疗效越好；病程越长，加味麻黄附子细辛汤疗效越差；高血压具有双向影响机制。结论 (1)加味麻黄附子细辛汤可改善太阳少阴合病腰椎间盘突出症患者的症状；(2)加味麻黄附子细辛汤具有特定的疗效优势人...     

利维爱及中药补肾法防治绝经后妇女骨质疏松症的临床对比研究

目的 观察利维爱及补肾中药对绝经后骨质疏松症的防治作用。方法 对35例绝经妇女每日顿服利维爱1．25mg，34例绝经妇女口服强骨胶囊1粒／次，3次／d。观察其治疗前后临床症状，骨密度及代谢生化指标及副作用。结果 服药前后两组临床症状均明显改善，骨密度有所上升。利维爱组尿Ca／Cr、尿HOP／Cr、血ca水平明显改善，补肾中药组骨代谢生化指标改善不明显，但利维爱组副作用较补肾中药组大。结论 直接应用性激素治疗组在防治绝经后骨质疏松方面效果更显著，补肾中药组在改善症状及维持骨量方面疗效显著且副作用小，对用性激素替代治疗有禁忌或顾虑及不能耐受其副作用的患者，是一种有效的治疗途径。     

二仙汤治疗男性更年期综合征临床研究

目的探讨二仙汤治疗肾虚证男性更年期综合征的疗效。方法采用Bosphorus心理系将症状量化的方法，对男性更年期综合征症状进行评分，将病人随机分为2组，Ⅰ组服用十一酸睾酮（安特尔），Ⅱ组经中医辨证为肾虚证服用二仙汤组。结果十一酸睾酮治疗组和二仙汤治疗组治疗后症状比治疗前均有明显的改善，应用安特尔治疗后血F-T明显升高（P〈0．01），而二仙汤服用3个月后F—T无明显改变（P〉0．05）。结论 二仙汤治疗男性更年期综合征，作用是补肾益气，调和阴阳平衡，特别适用于患有前列腺疾病的中老年人。     

青少年伴/不伴Arnold-Chiari畸形的脊髓空洞的影像学特征比较

目的探讨继发于Arnold-Chiari畸形的脊髓空洞(Arnold-Chiari malformation-associated syringomyelia,ACMS)与特发性脊髓空洞(idiopathic syringomyelia,IS)之间影像学特征的差异及其临床意义。方法对2006年6月~2013年6月在本院接受治疗并符合入选标准的132例(男70例,女62例)ACMS患儿及46例(男24例,女22例)IS患儿进行回顾性分析。在全脊髓MRI图像上评估2组患儿空洞的形态学特征,包括空洞与脊髓最大比值、空洞长度、空洞位置及形态。结果 ACMS组空洞与脊髓最大比值为0.61±0.18,空洞长度为9.01±4.88(2~20)个节段,均显著大于IS组(0.43±0.14,4.09±2.07),差异有统计学意义(P0.05)。ACMS组中82.57%空洞累及颈胸段,而IS组中50.00%空洞仅累及颈段。ACMS组中43.94%为膨胀型,而IS组中78.26%为局限型,差异有统计学意义(P0.05)。结论与IS相比,ACMS的空洞与脊髓最大比值更大,累及节段更长。     

Multiple somatic symptoms in employees participating in a randomized controlled trial associated with sickness absence because of nonspecific low back pain

Background contextThe prevalence of multiple somatic symptoms is high in primary and hospital outpatient populations. Multiple somatic symptoms may be present in patients sick-listed because of low back pain (LBP) and may be associated with increased risk of not returning to work (RTW).PurposeTo explore whether multiple somatic symptoms in a subset of patients with nonspecific LBP was associated with RTW, sickness absence (SA), or other social benefits.Study designThe study was a cohort study based on a randomized clinical trial with a prospective 2-year follow-up period. Patients were referred from general practices to the Spine Center, Regional Hospital Silkeborg, Denmark.Patient samplePatients were 285 sick-listed employees (4–12 weeks), with nonspecific LBP as their prime reason for SA. Exclusion criteria were unemployment, radiculopathy, LBP surgery within the past year, previous lumbar fusion, suspected cauda equina syndrome, progressive paresis or other serious back disease, pregnancy, known substance abuse, or primary psychiatric diagnosis.Outcome measuresSelf-reported health was assessed by the LBP rating scale and questions about pain and health in general. Disabilities were measured by the Roland Morris Questionnaire, the Short Form-36, and the Fear-Avoidance Beliefs Questionnaire. Work-related questions comprised expectations about RTW and risk of losing job because of SA. The Common Mental Disorder Questionnaire (subscale SCL-SOM) was used to assess multiple somatic symptoms (12 items). We categorized multiple somatic symptoms into four groups based on the SCL-SOM sum score: <6, 6 to 12, 13 to 18 and >18. Status of SA (>2 weeks) and RTW were gathered from a national database (DREAM).MethodsThe patients (N=285) were randomized into either multidisciplinary or brief intervention at the Spine Center (2004–2008). Both interventions comprised clinical examination and advice by a physiotherapist and a rheumatologist. Data were collected from questionnaires at baseline (inclusion) and 1 year after inclusion. Data on SA benefits were gathered from the DREAM database that contains data on all social transfer payments (such as sick leave benefits and other disability benefits) registered on a weekly basis.ResultsAll health factors, female gender, and poor work ability were significantly associated with a higher level of multiple somatic symptoms. The percentage of persons with SA increased significantly with the symptom score after 1 year, and the duration of SA remained significantly longer after 2 years of follow-up between the multiple somatic symptoms groups. The percentages with RTW after 1 and 2 years were negatively associated with a higher level of multiple somatic symptoms at baseline. We found no difference between the intervention groups.ConclusionsA higher level of multiple somatic symptoms was significantly associated with poor health and work ability at baseline and with longer duration of SA and unsuccessful RTW through a 2-year follow-up period.     

Patient-reported Quality of Life in Patients with Primary Metastatic Prostate Cancer Treated with Androgen Deprivation Therapy with and Without Concurrent Radiation Therapy to the Prostate in a Prospective Randomised Clinical Trial; Data from the HORRAD Trial

BackgroundA survival benefit was demonstrated for patients with low-volume metastatic prostate cancer (mPCa) when local radiotherapy was added to androgen deprivation therapy (ADT).ObjectiveTo determine the effect of ADT combined with external beam radiotherapy (EBRT) to the prostate on health-related quality of life (HRQoL) of patients with primary bone mPCa.Design, setting, and participantsThe HORRAD trial is a multicentre randomised controlled trial recruiting 432patients with primary bone mPCa between 2004 and 2014.InterventionPatients were randomised to ADT with EBRT or to ADT alone.Outcome measurements and statistical analysisPatients completed two validated HRQoL questionnaires (European Organization for Research and Treatment of Cancer [EORTC] Quality of Life Questionnaire Core Module (QLQ-C30) and EORTC Quality of Life Questionnaire Prostate Module [QLQ-PR25]) at baseline and at 3, 6, 12, and24 mo after the initiation of treatment. The effect of both treatments was evaluated based on mixed-effect models.Results and limitationsPatient characteristics and HRQoL scores at baseline were similar in both arms. At baseline, 98% of patients completed the questionnaires, compared with 58% at 24 mo. Patients reported significantly more diarrhoea (difference between the groups 10.8; 95% confidence interval [CI] 7.3–14.2), bowel symptoms (4.5; 95% CI 2.1–6.8), and urinary symptoms (11.9; 95% CI 8.9–14.8) after EBRT and ADT compared with ADT alone (all between-arm difference p < 0.001). Urinary complaints levelled at 6 mo. At 2 yr, only bowel symptom scores were significantly different (8.0; 95% CI 4.8–11.1, p ≤ 0.001), but 68% of patients in the radiotherapy group did not report clinically relevant worsening of their bowel symptom scores.ConclusionsPatients with bone mPCa reported temporary modest urinary and bowel symptoms after combined treatment with EBRT of the prostate and ADT compared with ADT alone. For some patients (22%), deterioration of bowel functions remains at 2 yr, whereas general HRQoL does not deteriorate..Patient summaryThis study investigated the effect of radiotherapy to the prostate added to hormonal therapy on patient-reported health-related quality of life (HRQoL) in patients with primary bone metastatic prostate cancer. Most patients reported only temporary urinary and bowel symptoms. In 22% of patients, bowel symptoms remained at 2 yr, whereas general HRQoL did not deteriorate.     

¿Es más efectivo el tratamiento combinado de electroestimulación transcutánea del nervio tibial y electroestimulación vaginal que el tratamiento en monoterapia de electroestimulación del nervio tibial para la vejiga hiperactiva? Un ensayo controlado aleatorizado

Introduction and objectivesOveractive bladder (OAB) is a prevalent disorder that increases with age and impairs patients’ quality of life. Guidelines recommend behavior modifications as the first-line treatment; however, physiotherapy has also been used with success, safety, and low cost. Transcutaneous tibial nerve electrical stimulation (TTNS) and vaginal electrical stimulation (VS) are being used in clinical physiotherapy practice. This study aimed to verify whether the addition of VS to TTNS is more beneficial than TTNS alone for women with OAB.Patients and methodsIn all, 106 women aged >18 years diagnosed with OAB or mixed urinary incontinence with prevalent OAB symptoms were randomly divided into 2 groups: Group 1: TTNS (n = 52); Group 2: TTNS + VS (n = 54). The 3 day voiding diary, pelvic floor muscle strength (Ortiz Scale), King's Health Questionnaire, and Overactive Bladder Questionnaire were assessed before and after treatment. Urinary frequency was considered the primary outcome, and a reduction of ≥ 3 micturitions/day was considered clinically relevant. Mixed linear models were used to compare the 2 groups.ResultsInitially, the groups were similar in age, body mass index, number of pregnancies, time of OAB onset, and prevalence of OAB symptoms. After treatment, a reduction in urinary frequency of 1.5 micturitions was observed in Group 2, which was not clinically relevant despite being statistically significant.ConclusionsThe addition of VS to TTNS for the treatment of OAB was not more effective than TTNS as a single therapy.     

推刮手法配合股四头肌功能锻炼治疗退行性膝关节炎的临床疗效观察

目的：探讨推刮手法配合股四头肌功能锻炼治疗退行性膝关节炎的临床疗效。方法：纳入符合退行性膝关节炎诊断标准病例48例（60膝），随机分为治疗组和对照组，治疗组采用推刮手法配合股四头肌功能锻炼的方法，10d为1个疗程，治疗3个疗程；对照组采用《推拿学》上治疗退行性膝关节炎的手法，10d为1个疗程，治疗3个疗程。分别于治疗前后观察患者疼痛、关节活动度、功能和肌力的情况，判定其疗效。结果：治疗后治疗组治愈7膝，好转21膝，无效2膝；对照组治愈8膝，好转19膝，无效3膝，组间比较差异无统计学意义。两种方法均能有效改善退行性膝关节炎的临床症状，患者治疗前后疼痛、关节活动度、功能、肌力均明显改善（P〈0．05）；两组间比较，治疗组对于膝关节功能和股四头肌肌力的改善优于对照组，差异有统计学意义（P〈0．05），而对疼痛和活动度的改善方面与对照组比较差异无统计学意义（P〉0．05）。结论：推刮手法配合股四头肌功能锻炼能有效改善退行性膝关节炎的临床症状和体征，提高患者的生活质量，减缓关节软骨的退变，防止病情进一步加重，疗效显著，值得临床推广。     

Impact of preoperative weakness and duration of symptoms on health-related quality-of-life outcomes following anterior cervical discectomy and fusion

BACKGROUND CONTEXTThe majority of patients with preoperative upper extremity weakness show improvements in motor function after anterior cervical discectomy and fusion (ACDF). Although numerous studies have examined both the extent and time course to which motor function can be expected to improve, few have shown that these improvements in motor function translate to improved health related quality of life (HRQOL) outcomes.PURPOSEThe purpose of this study was to examine the effect of preoperative weakness and duration of symptoms on HRQOL outcomes in patients who underwent ACDF.STUDY DESIGNRetrospective cohort study.PATIENT SAMPLEAdult patients who underwent an ACDF procedure at an academic hospital from January 2015 to December 2016 by a fellowship-trained spine surgeon.OUTCOME MEASURESThe primary outcomes of interest were HRQOL outcomes: Short Form-12 Physical/Mental Component Scores (SF-12 PCS/MCS), Neck Disability Index (NDI), and Visual Analog Scale Arm/Neck scores (VAS Arm/Neck).METHODSPatient demographics, surgical case characteristics, and motor strength exams were collected in patients who underwent ACDF over a 2-year period. Preoperative weakness was defined by a strength grade ≤3 (on a scale from 0 to 5) in at least one upper extremity muscle group. Multivariate linear regression analysis was performed to determine the effect of the preoperative weakness on HRQOL outcomes.RESULTSOf the 276 patients identified, 45 (16.3%) showed evidence of preoperative weakness, 44 (97.8%) of which showed subsequent postoperative motor improvements after ACDF. All patients reported significant improvements in all HRQOL outcome measures. Patients with preoperative weakness reported significantly worse preoperative VAS Arm (6.9 vs. 5.2; p=.01) and VAS Neck (6.1 vs. 4.8; p=.02) pain scores. Compared with patients without preoperative weakness, those with preoperative weakness reported significantly more improvement in NDI (β: −10.9; p=.001). Patients with symptoms greater than or equal to 12 months and preoperative weakness showed significantly less improvement in NDI (β: 14.8; p=.03).CONCLUSIONSPatients with preoperative weakness generally exhibited worse pain and HRQOL measures preoperatively, and showed greater potential for improvement after ACDF. Patients with a shorter duration of preoperative weakness had greater potential for improvement in HRQOL measures after ACDF compared with those with longer duration of symptoms. ACDF is an effective procedure to improve strength and HRQOL measures across all patient groups under appropriate indications.     

Evolution of Anxious-Depressive Symptomatology in Liver and Kidney Transplant Recipients: Hospitalization and 12-Month Post-Transplantation Phases

ObjectiveThe objective of this study was to compare the evolution (hospitalization in the transplantation unit and at 12 months post-transplantation) of anxious and depressive symptomatology in cadaveric transplant recipients as a function of type of organ implanted (liver or kidney).MethodsUsing a 2 × 2 mixed factorial design, 2 groups were selected: 34 liver transplant recipients and 41 kidney transplant recipients. Both groups were assessed in 2 phases: (1) in the transplantation unit after discharge from the intensive care unit; and (2) 12 months after discharge from the hospital following implantation surgery. The Hospital Anxiety and Depression Scale and the Scale for the Assessment of Social Support were administered. A mixed analysis of covariance was used to assess the influence on transplant recipients' anxious-depressive symptomatology of 2 independent factors: phase (hospitalization in the transplantation unit and at 12 months post-transplantation) and organ (liver and kidney). Perceived social support and age were included as covariates in the analyses. We also calculated d and w as effect size indexes.ResultsInteractive effects of the factors phase and organ were found in the variable anxiety (P = .005). Specifically, the following simple effects were significant: (1) kidney transplant recipients presented more anxious symptomatology while hospitalized in the transplantation unit than at 12 months post-transplantation (P = .001; d = 0.52; medium effect size); and (2) kidney transplant recipients presented more anxious symptomatology than liver transplant recipients while hospitalized in the transplantation unit (P = .013; d = ?0.59; medium effect size). No statistically significant effect was obtained for the variable depression.ConclusionWorse mental health (anxious symptoms) was associated with kidney transplant recipients but not with liver recipients while recovering from the implantation surgery in the transplantation unit.     

电针加穴位注射对腰椎间盘突出症镇痛效应的临床观察

目的：探讨电针加穴位注射治疗腰椎间盘突出症的临床疗效及对镇痛效果的影响。方法：将60例腰椎间盘突出症患者按入组先后随机数字表法分为电针结合穴位注射治疗组（A组）和单纯针刺组（B组）,每组30例。其中男31例,女29例,年龄35～62岁,平均48.3岁。A组于夹脊穴、秩边、环跳、阳陵泉、委中、昆仑予以电针针刺,1次/d,共10次,另配以穴位注射（当归注射液：1次/2d,共5次）;B组于夹脊穴、秩边、环跳、阳陵泉、委中、昆仑予以单纯针刺（1次/d,共10次）。经10d治疗后,通过目测类比定级法（VAS）比较治疗前后两组的平均疼痛分数,并根据疗效评定标准,从症状体征上比较两组的临床疗效。结果：两组在平均疼痛分数上差异具有统计学意义（t=7.18,P〈0.01）,A组的镇痛效果优于B组;两组的临床疗效比较,差异有统计学意义（u=2.91,P〈0.01）,A组优于B组。结论：电针加穴位注射治疗腰椎间盘突出症操作简单、疗效好,并能更好地缓解患者的疼痛,值得临床推广使用。     

Depression Treatment Is Not Associated With Improved Patient-Reported Outcomes Following Total Joint Arthroplasty

BackgroundThe objective of this study was to investigate if there were differences in disease-specific, overall health, and activity outcomes after total joint arthroplasty (TJA) between treated and untreated depressed patients.MethodsPatients who underwent primary, elective, unilateral TJA were divided into 3 groups based on self-reported history of depression and treatment at the time of surgery: 1) patients without depression, 2) patients with treated depression, and 3) patients with untreated depression. The primary outcomes were the differences in SF-12 PCS, SF-12 MCS, WOMAC, and UCLA activity rating scale up to 12 months postoperatively. A secondary outcome was the effect of depression treatment on patients’ perception of experiencing limitation in their activities due to depression. Univariate and mixed-effects model analyses were performed to control for potential confounding factors.ResultsThe prevalence of depression was 189/749 (25%). Compared to patients with treated depression, untreated patients had lower baseline SF-12 MCS (P < .001) and were more likely to have Medicaid insurance (P < .001). After controlling for potential confounding factors, there were no differences in either the absolute scores or net changes in any of the assessed outcomes at 12 months postoperatively among depressed patients regardless of treatment (P > .05). In addition, depression treatment did not affect patients’ perception of activity limitation (P = .412).ConclusionAlthough it is clear that depression adversely impacts patient outcomes in primary TJA, treatment does not appear to mitigate this negative effect. Depression treatment does not necessarily imply resolution of depressive symptoms. Future studies should explore alternative interventions to reduce the health-related consequences of depression to optimize the outcomes of TJA.     

Prevalence and impact of acid-related symptoms and diarrhea in patients undergoing Roux-en-Y gastric bypass,sleeve gastrectomy,and biliopancreatic diversion with duodenal switch

BackgroundGastrointestinal symptoms are common in the obese population.ObjectivesTo determine the prevalence and importance of acid-related symptoms and diarrhea in 3 different types of bariatric operations: Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and biliopancreatic diversion with duodenal switch (BPD/DS).SettingNational data from Sweden.MethodsA total of 58,823 primary bariatric procedures (RYGB: 87.5%, SG: 11.7%, and BPD/DS: .7%) performed from 2007 to 2017 were identified in the Scandinavian Obesity Surgery Registry. Associations between acid-related symptoms and diarrhea, both defined by continuous use of pharmacologic treatment, and predefined outcomes were studied in a multivariate model, adjusted for age, sex, body mass index, and year of surgery.ResultsAt baseline, acid-related symptoms were most common in RYGB (9.9%), while diarrhea was rare. In general, symptomatic patients were older, had more co-morbidities, and scored lower on quality of life compared with the remaining patients. In the multivariate analysis, RYGB patients with acid-related symptoms had reduced risk of prolonged operative time and length of stay, while postoperative complications and reoperations increased by 24% and 36%, respectively. In SG, both symptoms were associated with prolonged operative time and a doubled risk for complications. Symptomatic patients had reduced improvement in quality of life, while no association with the weight result was seen. Postoperatively, acid-related symptoms decreased in RYGB, while doubling in SG. Diarrhea increased 2- and 6-fold in RYGB and BPD/DS, respectively.ConclusionThe 2 gastrointestinal symptoms were associated with increased operative risks and reduced improvement in quality of life. Postoperatively, the respective anatomic alternations affected both gastrointestinal symptoms.