Long-Term Improvements in Pulmonary Function 5 Years After Bariatric Surgery

Background

Obesity is associated with reduced pulmonary function. We evaluated pulmonary function and status of asthma and obstructive sleep apnoea syndrome (OSAS) before and 5 years after bariatric surgery.

Methods

Spirometry was performed at baseline and 5 years postoperatively. Information of asthma and OSAS were recorded. Of 113 patients included, 101 had undergone gastric bypass, 10 duodenal switch and 2 sleeve gastrectomy.

Results

Eighty (71 %) patients were women, mean preoperative age was 40 years and preoperative weight was 133 kg in women and 158 kg in men. Five years postoperatively, weight reduction was 31 % (42 kg; p?<?0.001) in women and 24 % (38 kg; p?<?0.001) in men. Forced expiratory volume in 1 s (FEV1) increased 4.1 % (116 ml; p?<?0.001) in women and 6.7 % (238 ml; p?=?0.003) in men. Forced vital capacity (FVC) increased 5.8 % (209 ml; p?<?0.001) in women and 7.6 % (349 ml; p?<?0.001) in men. Gender and weight loss were independently associated with the improvements in FEV1 and FVC. At follow-up, FEV1 had increased 36 % of the difference towards the estimated normal FEV1, and there was a corresponding 70 % recovery of FVC. These improvements occurred despite an expected decline in pulmonary function by age during the study period. Of the asthmatics and OSAS patients, 48 and 80 %, respectively, were without symptoms 5 years postoperatively.

Conclusions

Pulmonary function measured with spirometry was significantly improved 5 years after bariatric surgery, despite an expected age-related decline during this period. Symptoms of asthma and OSAS also improved.     

A review of mercury exposure among artisanal small-scale gold miners in developing countries

Purpose

Extraction of gold using mercury has been a way out of poverty for millions of people in developing countries. Artisanal small-scale gold mining (ASGM) has expanded during the last decades and is often carried out under primitive conditions. Thus, workers in this industry may be exposed to high levels of mercury and suffer from toxic effects from mercury exposure. The objective of this review was to provide an outline of the studies available on elemental mercury exposure among artisanal small-scale gold miners.

Methods

Searching the PubMed and Embase databases, 26 studies with a total of 3,005 exposed subjects and 442 controls across 14 different developing countries were found. Urine mercury levels were used as biomarkers of exposure.

Results

In general, the urine mercury levels were elevated and a considerable proportion of workers had urine mercury levels above existing guidelines. Exposed subjects were stratified into residents, miners, millers, smelters, and refiners, who by work task content were expected to be increasingly exposed to mercury. This group order did show a clear trend of increasing mercury levels. Mercury levels differed substantially between studies. Possible explanations include dissimilarities in gold extraction methods, use of protective devices, and selection of participants.

Conclusions

This review provides evidence that artisanal gold miners and residents of the mining sites are exposed to mercury vapour to an extent where acute and long-term toxic effects of mercury are likely. Interventions aimed at reducing exposure and emission of mercury from ASGM are needed.     

Towards understanding of electrolyte degradation in lithium-mediated non-aqueous electrochemical ammonia synthesis with gas chromatography-mass spectrometry

Lithium-mediated electrochemical ammonia synthesis (LiMEAS) in non-aqueous media is a promising technique for efficient and green ammonia synthesis. Compared to the widely used Haber–Bosch process, the method reduces CO₂ emissions to zero due to the application of green hydrogen. However, the non-aqueous medium encounters the alkali metal lithium and organic components at high negative potentials of electrolysis, which leads to formation of byproducts. To assess the environmental risk of this synthesis method, standardized analytical methods towards understanding of the degradation level and consequences are needed. Here we report on the implementation of an approach to analyze the liquid electrolytes after electrochemical ammonia synthesis via high-resolution gas chromatography-mass spectrometry (GCMS). To characterize the molecular species formed after electrolysis, electron ionization high-resolution mass spectrometry (EI-MS) was applied. The fragmentation patterns enabled the elucidation of the mechanisms of byproduct formation. Several organic electrolytes were analyzed and compared both qualitatively and quantitatively to ascertain molecular composition and degradation products. It was found that the organic solvent in contact with metallic electrodeposited lithium induces solvent degradation, and the extent of this decomposition to different organic molecules depends on the organic solvent used. Our results show GCMS as a suitable technique for monitoring non-aqueous electrochemical ammonia synthesis in different organic electrolytes.

Lithium-mediated non-aqueous electrochemical ammonia synthesis (LiMEAS) as an efficient and green ammonia production way was studied by GCMS in different organic electrolytes to evaluate the stability of electrochemical systems.     

Healthcare practices that increase the quality of care in cancer trajectories from a general practice perspective: a scoping review

ObjectiveGeneral practice plays an important role in cancer trajectories, and cancer patients request the continuous involvement of general practice. The objective of this scoping review was to identify healthcare practices that increase the quality of care in cancer trajectories from a general practice perspective.Design, setting, and subjectsA scoping review of the literature published in Danish or English from 2010 to 2020 was conducted. Data was collected using identified keywords and indexed terms in several databases (PubMed, MEDLINE, EBSCO CINAHL, Scopus, and ProQuest), contacting key experts, searching through reference lists, and reports from selected health political, research- and interest organizations’ websites.Main outcome measuresWe identified healthcare practices in cancer trajectories that increase quality care. Identified healthcare practices were grouped into four contextual domains and allocated to defined phases in the cancer trajectory. The results are presented according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR).ResultsA total of 45 peer-reviewed and six non-peer-reviewed articles and reports were included. Quality of care increases in all phases of the cancer trajectory when GPs listen carefully to the full story and use action plans. After diagnosis, quality of care increases when GPs and practice staff have a proactive care approach, act as interpreters of diagnosis, treatment options, and its consequences, and engage in care coordination with specialists in secondary care involving the patient.ConclusionThis scoping review identified healthcare practices that increase the quality of care in cancer trajectories from a general practice perspective. The results support general practice in investigating own healthcare practices and identifying possibilities for quality improvement.

KEY POINTS

• Identified healthcare practices in general practice that increase the quality of care in cancer trajectories:
• Listen carefully to the full story
• Use action plans and time-out-consultations
• Plan and provide proactive care
• Act as an interpreter of diagnosis, treatment options, and its consequences for the patient
• Coordinate care with specialists, patients, and caregivers with mutual respect
• Identified barriers for quality of care in cancer trajectories are:
• Time constraints in consultations
• Limited accessibility for patients and caregivers
• Health practices to increase the quality of care should be effective, safe, people-centered, timely, equitable, integrated, and efficient. These distinctions of quality of care, support general practice in investigating and improving quality of care in cancer trajectories.

     

Small-scale purification and mass spectrometry analysis reveal a third aquaporin-4 protein isoform of 36kDa in rat brain

Aquaporin-4 (AQP4) is known to have two main isoforms M1 and M23 in the brain. Immunoblot analyses have provided evidence of additional AQP4 immunopositive bands, suggesting that the repertoire of AQP4 isoforms is broader than previously assumed. As isoforms beyond M1 and M23 are not observed in recombinant systems, investigation of novel isoforms requires the use of a native source. Here we report purification of AQP4 to three silver-stained proteins on SDS-PAGE. This was achieved by organelle separation, alkaline stripping of cellular membranes, detergent solubilization and multiple chromatographic steps. The three proteins that co-purified were identified as AQP4 by mass spectrometry. These results represent the first purification of AQP4 from a native source and demonstrate by mass spectrometry the presence of a third AQP4 isoform of 36kDa in the rat brain. Immunoblots revealed that the same isoform is present in the mouse, pig, and human brain.     

Relations between background,process and outcome in the first semester of a new,problem-based medical curriculum

The authors investigated the relations between students' background (gender, age, study experience), learning process (learning approach, independent study time) and outcome (examination results, satisfaction) in the first semester of a new, integrated undergraduate medical curriculum, combining PBL and conventional learning methods. Data were obtained from official records and from a questionnaire answered by 113 students (response rate 92%). Variables were subjected to multivariate analyses. Significantly more males than females reported a strategic learning approach, and these students were less satisfied and more prone to fail on the exam. Time used on independent study did not predict examination results. The authors suggest that in a problem-based curriculum, the strategic males should be identified and supervised to improve the qualitative aspects of their study behaviour.