Search

While gamma-ray bursts (GRBs) have the potential to shed light on the astrophysics of jets, compact objects, and cosmology, a major set back in their use as probes of these phenomena stems from our incomplete knowledge surrounding their prompt emission. There are numerous models that can account for various observations of GRBs in the gamma-ray and X-ray energy ranges, due to the flexibility in the number of parameters that can be tuned to increase agreement with data. Furthermore, these models lack predictive power that can test future spectropolarimetric observations of GRBs across the electromagnetic spectrum. In this work, we use the MCRaT radiative transfer code to calculate the X-ray spectropolarimetric signatures expected from the photospheric model for two unique hydrodynamic simulations of long GRBs. We make time-resolved and time-integrated comparisons between the X-ray and gamma-ray mock observations, shedding light on the information that can be obtained from X-ray prompt emission signatures. Our results show that the T 90 derived from the X-ray light curve is the best diagnostic for the time that the central engine is active. We also find that our simulations reproduce the observed characteristics of the Einstein Probe–detected GRB 240315C. Based on our simulations, we are also able to make predictions for future X-ray spectropolarimetric measurements. Our results show the importance of conducting global radiative transfer calculations of GRB jets to better contextualize the prompt emission observations and constrain the mechanisms that produce the prompt emission. [ABSTRACT FROM AUTHOR]

Background: Caries experience in Argentine children is quite high and no national data are present. Aim: This cross-sectional observational survey aimed to assess the oral health status of schoolchildren in Buenos Aires (CABA) using CTNI and to evaluate the ecological association between health inequalities and caries prevalence. Design: Data were collected, via a clustered procedure, during the 2016–2018 school years. Children were examined at school to determine dental status according to the CTNI performed under standardized conditions, using light, dental mirrors, WHO probes and magnification (2.5×). Secondary sources were used to acquire socio-demographic and epidemiological data. A hierarchical cluster analysis was carried out with the municipalities of the CABA as the dependent variable and the socio-demographic factors. Results: The study population consisted of 62,904 schoolchildren, 43,571 of whom were enrolled into the study. Total caries prevalence was 67.78% while severe caries prevalence was 28.29%, which was statistically associated with the year of the survey (p < 0.01). Four territorial conglomerates from a socio-epidemiological standpoint outline homogeneous areas of social risk; cluster 1 had the highest social risk. The prevalence of severe caries (CTNI 7–14) was highest in cluster 1 (44.7–53.2% of the population). Conclusion: The social inequalities between municipalities of the CABA were statistically associated with high inequalities in oral health needs. [ABSTRACT FROM AUTHOR]

The merger of two magnetized compact objects, such as neutron stars, forms a compact object which may launch a relativistic and collimated jet. Numerical simulations of the process show that a dense and highly magnetized medium surrounds the system. This study presents a semi-analytical model that models the effects that a static magnetized medium with a tangled field produces in relativistic, collimated, and non-magnetized jets. The model is a first approximation that addresses the magnetic field present in the medium and is based on pressure equilibrium principles between the jet, cocoon, and external medium. A fraction of the ambient medium field is allowed to be entrained in the cocoon. We find that the jet and cocoon properties may be affected by high magnetic fields (≳ 1015 G) and mixing. The evolution of the system may vary up to |$\sim 10{{\ \rm per\ cent}}$| (compared to the non-magnetized case). Low-mixing may produce a slower broader jet with a broader and more energetic cocoon would be produced. On the other hand, high-mixing could produce a faster narrower jet with a narrow and less-energetic cocoon. Two-dimensional hydrodynamical simulations are used to validate the model and to constrain the mixing parameter. Although the magnetic field and mixing have a limited effect, our semi-analytic model captures the general trend consistent with numerical results. For high magnetization, the results were found to be more consistent with the low mixing case in our semi-analytic model. [ABSTRACT FROM AUTHOR]

Aim: Some patients with inflammatory bowel disease (IBD) require subtotal colectomy (STC) with ileostomy. The recent literature reports a significant number of patients who do not undergo subsequent surgery and are resigned to living with a definitive stoma. The aim of this work was to analyse the rate of definitive stoma and the cumulative incidence of secondary reconstructive surgery after STC for IBD in a large national cohort study. Method: A national retrospective study (2013–2021) was conducted on prospectively collected data from the French Medical Information System Database (PMSI). All patients undergoing STC in France were included. The association between definitive stoma and potential risk factors was studied using univariate and multivariate analyses. Results: A total of 1860 patients were included (age 45 ± 9 years; median follow‐up 30 months). Of these, 77% (n = 1442) presented with ulcerative colitis. Mortality and morbidity at 90 days after STC were 5% (n = 100) and 47% (n = 868), respectively. Reconstructive surgery was identified in 1255 patients (67%) at a mean interval of 7 months from STC. Seveny‐four per cent (n = 932) underwent a completion proctectomy with ileal pouch anal anastomosis and 26% (n = 323) an ileorectal anastomosis. Six hundred and five (33%) patients with a definitive stoma had an abdominoperineal resection (n = 114; 19%) or did not have any further surgical procedure (n = 491; 81%). Independent risk factors for definitive stoma identified in multivariate analysis were older age, Crohn's disease, colorectal neoplasia, postoperative complication after STC, laparotomy and a low‐volume hospital. Conclusion: We found that 33% of patients undergoing STC with ileostomy for IBD had definitive stoma. Modifiable risk factors for definitive stoma were laparotomy and a low‐volume hospital. [ABSTRACT FROM AUTHOR]

Long-duration gamma-ray bursts (LGRBs), thought to be produced during core-collapse supernovae, may have a prominent neutron component in the outflow material. If present, neutrons can change how photons scatter in the outflow by reducing its opacity, thereby allowing the photons to decouple sooner than if there were no neutrons present. Understanding the details of this process could therefore allow us to probe the central engine of LGRBs, which is otherwise hidden. Here, we present results of the photospheric emission from an LGRB jet, using a combination of relativistic hydrodynamic simulations and radiative transfer postprocessing using Monte Carlo radiation transfer code. We control the size of the neutron component in the jet material by varying the equilibrium electron fraction Y e , and we find that the presence of neutrons in the GRB fireball affects the Band parameters α and E 0, while the picture with the β parameter is less clear. In particular, the break energy E 0 is shifted to higher energies. Additionally, we find that increasing the size of the neutron component also increases the total radiated energy of the outflow across multiple viewing angles. Our results not only shed light on LGRBs but are also relevant to short-duration gamma-ray bursts associated with binary neutron star mergers due to the likelihood of a prominent neutron component in such systems. [ABSTRACT FROM AUTHOR]

Introduction: Contradictions remain on the impact of interhospital competition on the quality of care, mainly the mortality. The aim of the study is to evaluate the impact of interhospital competition on postoperative mortality after surgery for colorectal cancer in France. Methods: We conducted a retrospective cross-sectional study from 2015 to 2019. Data were collected from a National Health Database. Patients operated on for colorectal cancer in a hospital in mainland France were included. Competition was measured using number of competitors by distance-based approach. A mixed-effect model was carried out to test the link between competition and mortality. Results: Ninety-five percent (n = 152,235) of the 160,909 people operated on for colorectal cancer were included in our study. The mean age of patients was 70.4 ±12.2 years old, and female were more represented (55%). A total of 726 hospitals met the criteria for inclusion in our study. Mortality at 30 days was 3.6% and we found that the mortality decreases with increasing of the hospital activity. Using the number of competitors per distance method, our study showed that a "highly competitive" and "moderately competitive" markets decreased mortality by 31% [OR: 0.69 (0.59, 0.80); p<0.001] and by 12% respectively [OR: 0.88 (0.79, 0.99); p<0.03], compared to the "non-competitive" market. High hospital volume (100> per year) was also associated to lower mortality rate [OR: 0.74 (0.63, 0.86); p<0.001]. Conclusions: The results of our studies show that increasing hospital competition independently decreases the 30-day mortality rate after colorectal cancer surgery. Hospital caseload, patients' characteristics and age also impact the post-operative mortality. [ABSTRACT FROM AUTHOR]

Acute chest syndrome (ACS) is a life-threatening complication of sickle cell disease (SCD). Although respiratory pathogens are frequently detected in children with ACS, their respective role in triggering the disease is still unclear. We hypothesized that the incidence of ACS followed the unprecedented population-level changes in respiratory pathogen dynamics after COVID-19-related nonpharmaceutical interventions (NPIs). What is the respective role of respiratory pathogens in ACS epidemiology? This study was an interrupted time series analysis of patient records from a national hospital-based surveillance system. All children aged < 18 years with SCD hospitalized for ACS in France between January 2015 and May 2022 were included. The monthly incidence of ACS per 1,000 children with SCD over time was analyzed by using a quasi-Poisson regression model. The circulation of 12 respiratory pathogens in the general pediatric population over the same period was included in the model to assess the fraction of ACS potentially attributable to each respiratory pathogen. Among the 55,941 hospitalizations of children with SCD, 2,306 episodes of ACS were included (median [interquartile range] age, 9 [5-13] years). A significant decrease was observed in ACS incidence after NPI implementation in March 2020 (–29.5%; 95% CI, –46.8 to –12.2; P =.001) and a significant increase after lifting of the NPIs in April 2021 (24.4%; 95% CI, 7.2 to 41.6; P =.007). Using population-level incidence of several respiratory pathogens, Streptococcus pneumoniae accounted for 30.9% (95% CI, 4.9 to 56.9; P =.02) of ACS incidence over the study period and influenza 6.8% (95% CI, 2.3 to 11.3; P =.004); other respiratory pathogens had only a minor role. NPIs were associated with significant changes in ACS incidence concomitantly with major changes in the circulation of several respiratory pathogens in the general population. This unique epidemiologic situation allowed determination of the contribution of these respiratory pathogens, in particular S pneumoniae and influenza, to the burden of childhood ACS, highlighting the potential benefit of vaccine prevention in this vulnerable population. [Display omitted] [ABSTRACT FROM AUTHOR]

Background and Objectives: Dental caries is still a dramatic public health problem. The effectiveness of an alternative technique using acidulated phosphate fluoride (APF) gel pH 3.5 was evaluated and compared with conventional treatments in reducing dental caries incidence. Materials and Methods: A double-blind randomized controlled trial was conducted, involving 180 children aged 4–11 years. Three groups were formed: NaF varnish (NaFV), APF in tray (APFt), and APF in toothbrush (APFtbru). Clinical examinations were performed using standardized criteria and the ICDAS Index was assessed. The Caries Treatment Needs Index (CTNI) was calculated. Dental examinations were conducted at baseline, 12 months, and 24 months. Results: At baseline, 16,719 dental surfaces were included, with 15,434 surfaces being sound. After 24 months, the Kaplan–Meier analysis showed significant differences between the APFtbru group and the other two groups (p = 0.03). Cox regression analysis revealed that the surfaces treated with NaF varnish had the lowest survival rates (HR = 0.51 95%CI = 0.33/0.81). Occlusal surfaces had the lowest cumulative survival, while other tooth surfaces showed similar performance. Conclusions: The alternative technique of APF gel application with a toothbrush resulted in maintaining dental health over 24 months. This technique can be cost-effective and may offer advantages over traditional fluoride varnish application. [ABSTRACT FROM AUTHOR]

Background: Preoperative attrition is highly prevalent in patients referred for bariatric surgery. Little information is available neither on reasons reported by patients for attrition in knowledge nor costs of attrition in a publicly funded health system. Objectives: To assess the reasons for the attrition of bariatric candidates and calculate its economic impact on a population with obesity in a public hospital in France. Methods: This is a retrospective study including all bariatric surgery candidates between 2014 and 2018 in our Center of Excellence in Obesity Care. Data were extracted from the hospital information system, and patient-related outcomes were collected via a standardized questionnaire. Economic analysis was performed. Primary outcome was to analyze the rate of preoperative attrition. Secondary outcome was reasons for discontinuation and their economic impact. Results: In total, 1360 patients were referred for bariatric surgery at our hospital, and 1225 were included in the study. Attrition rate in preoperative phase was 46.8%. Three factors were significantly associated with follow-up fragmentation risk: unemployment (OR 0.52, 95% CI 0.29–0.7, p < 0.001), active smoking (OR 2.24, 95% CI 1.53–5.15, p < 0.001), and body mass index (OR 0.98, 95% CI 0.97–1.00, p = 0.036). Average cost to the healthcare system was €792 for each patient who dropped out. Conclusions: We identified predictors and patient-reported factors that seem to be beyond the possibility of removal by health professionals. We should consider and address preventable factors, through the development of care pathways tailored to the individual profile of a patient. [ABSTRACT FROM AUTHOR]

Both long and short gamma-ray bursts (GRBs) are expected to occur in the dense environments of active galactic nucleus (AGN) accretion discs. As these bursts propagate through the discs they live in, they photoionize the medium causing time-dependent opacity that results in transients with unique spectral evolution. In this paper, we use a line-of-sight radiation transfer code coupling metal and dust evolution to simulate the time-dependent absorption that occurs in the case of both long and short GRBs. Through these simulations, we investigate the parameter space in which dense environments leave a potentially observable imprint on the bursts. Our numerical investigation reveals that time-dependent spectral evolution is expected for central supermassive black hole masses between 105 and 5 × 107 solar masses in the case of long GRBs, and between 104 and 107 solar masses in the case of short GRBs. Our findings can lead to the identification of bursts exploding in AGN disc environments through their unique spectral evolution coupled with a central location. In addition, the study of the time-dependent evolution would allow for studying the disc structure, once the identification with an AGN has been established. Finally, our findings lead to insight into whether GRBs contribute to the AGN emission, and which kind, thus helping to answer the question of whether GRBs can be the cause of some of the as-of-yet unexplained AGN time variability. [ABSTRACT FROM AUTHOR]

The merger of two neutron stars (NSs) produces the emission of gravitational waves, the formation of a compact object surrounded by a dense and magnetized environment. If the binary undergoes delayed collapse a collimated and relativistic jet, which will eventually produce a short gamma-ray burst (SGRB), may be launched. The interaction of the jet with the environment has been shown to play a major role in shaping the structure of the outflow that eventually powers the gamma-ray emission. In this paper, we present a set of 2.5D RMHD simulations that follow the evolution of a relativistic non-magnetized jet through a medium with different magnetization levels, as produced after the merger of two NSs. We find that the predominant consequence of a magnetized ambient medium is that of suppressing instabilities within the jet and preventing the formation of a series of collimation shocks. One implication of this is that internal shocks lose efficiency, causing bursts with low-luminosity prompt emission. On the other hand, the jet-head velocity and the induced magnetization within the jet are fairly independent of the magnetization of the ambient medium. Future numerical studies with a larger domain are necessary to obtain light curves and spectra in order to better understand the role of magnetized media. [ABSTRACT FROM AUTHOR]

Background: Persistent müllerian duct syndrome (PMDS) is characterized by the persistence of müllerian duct derivatives in otherwise normally virilized 46,XY males. Biallelic mutations of the anti-müllerian hormone (AMH) and AMH receptor type 2 (AMHR2) genes lead to PMDS type 1 and 2, respectively. Aim: The aims of the study were to report the clinical, hormonal, and genetic findings in a patient with PMDS and discuss surgical strategies to achieve successful orchidopexy. Results: A 4-year-old boy was evaluated after the incidental finding of müllerian derivates during laparoscopy for nonpalpable gonads. Karyotype was 46,XY and laboratory tests revealed normal serum gonadotropin and androgen levels but undetectable serum AMH levels. PMDS was suspected. Molecular analysis revealed a novel variant c.902_929del in exon 5 and a previously reported mutation (c.367C>T) in exon 1 of the AMH gene. Successful orchidopexy was performed in two sequential surgeries in which the müllerian duct structure was preserved and divided to protect the vascular supply to the gonads. Histological evaluation of the testicular biopsy showed mild signs of dysgenesis. Doppler ultrasound showed blood flow in both testes positioned in the scrotum 1.5 years after surgery. Conclusion: PMDS is a rare entity that requires a high index of suspicion (from surgeons) when evaluating a patient with bilateral cryptorchidism. Surgical treatment is challenging and long-term follow-up is essential. Histological evaluation of the testis deserves further investigation. [ABSTRACT FROM AUTHOR]

Recent reports indicate an increase in Leydig cell tumor (LCT) incidence. Radical orchiectomy is the standard therapy in children and adults, although it entails physical and psychosocial side effects. Testis-sparing surgery can be a consideration for benign LCT of 2.5 cm or less in size. Malignant LCTs respond poorly to conventional chemotherapy, so new treatment modalities are needed. In this study, we observed increased histidine decarboxylase expression and pro-angiogenic potential in LCT surgically resected from pediatric patients (fetal to pubertal) vs control samples from patients without endocrine or metabolic disorders which were collected at necropsy. We, therefore, evaluated for the first time the antitumor efficacy of two histidine decarboxylase inhibitors (a-methyl-dl-histidine dihydrochloride (a-MHD) and epigallocatechin gallate (EGCG)), alone and combined with carboplatin, in two preclinical models of LCT. MA-10 and R2C Leydig tumor cells, re presenting two different LCT subtypes, were used to generate syngeneic and xenograft mouse LCT models, respectively. In the syngeneic model, monotherapy with a-MHD effectively reduced tumor growth and angiogenesis. In the xenografts, which showed co-expression of histidine decarboxylase and CYP19, the combination of EGCG plus carboplatin was the most effective therapy, leading to LCT growth arrest and undetectable levels of plasmatic estradiol. Testicular and body weights remained unaltered. On the basis of this study, histidine decarboxylase may emerge as a novel pharmacological target for LCT treatment. [ABSTRACT FROM AUTHOR]

GW170817 is the first binary neutron star (NS) merger detected in gravitational waves (GWs) and photons, and so far remains the only GW event of its class with a definitive electromagnetic counterpart. Radio emission from the structured jet associated with GW170817 has faded below the sensitivity achievable via deep radio observations with the most sensitive radio arrays currently in operation. Hence, we now have the opportunity to probe the radio re-brightening that some models predict, which should emerge at late times from the interaction of the dynamically stripped merger ejecta with the interstellar medium. Here we present the latest results from our deep radio observations of the GW170817 field with the Karl G. Jansky Very Large Array (VLA), 4.5 yr after the merger. Our new data at 3 GHz do not show any compelling evidence for emission in excess to the tail of the jet afterglow (<3.3 ÎĽ Jy), confirming our previous results. We thus set new constraints on the dynamical ejecta afterglow models. These constraints favor single-speed ejecta with energies ≲1050 erg (for an ejecta speed of β 0 = 0.5), or steeper energyâ€"speed distributions of the kilonova ejecta. Our results also suggest larger values of the cold, nonrotating maximum NS mass in equal-mass scenarios. However, without a detection of the dynamical ejecta afterglow, obtaining precise constraints on the NS equation of state remains challenging. [ABSTRACT FROM AUTHOR]

The association of GRB170817A with a binary neutron star (BNS) merger has revealed that BNSs produce at least a fraction of short gamma-ray bursts (SGRBs). As gravitational wave (GW) detectors push their horizons, it is important to assess coupled electromagnetic (EM)/GW probabilities and maximize observational prospects. Here, we perform BNS population synthesis calculations with the code mobse , seeding the binaries in galaxies at three representative redshifts, |$z$|  = 0.01, 0.1, and 1 of the Illustris TNG50 simulation. The binaries are evolved and their locations numerically tracked in the host galactic potentials until merger. Adopting the microphysics parameters of GRB170817A, we numerically compute the broad-band light curves of jets from BNS mergers, with the afterglow brightness dependent on the local medium density at the merger site. We perform Monte Carlo simulations of the resulting EM population assuming either a random viewing angle with respect to the jet, or a jet aligned with the orbital angular momentum of the binary, which biases the viewing angle probability for GW-triggered events. We find a gamma-ray detection probability of |$\sim\!2{{\rm per\ cent}},10{{\rm per\ cent}},\mathrm{and}\ 40{{\rm per\ cent}}$| for BNSs at |$z$|  = 1, 0.1, and 0.01, respectively, for the random case, rising to |$\sim\!75{{\rm per\ cent}}$| for the |$z$|  = 0.01, GW-triggered aligned case. Afterglow detection probabilities of GW-triggered BNS mergers vary in the range of |$\sim \! 0.3 \!-\! 0.5{{\rm per\ cent}}$|⁠ , with higher values for aligned jets, and are comparable across the high- and low-energy bands, unlike gamma-ray-triggered events (cosmological SGRBs) which are significantly brighter at higher energies. We further quantify observational biases with respect to host galaxy masses. [ABSTRACT FROM AUTHOR]

Background: The impact of weight loss induced by bariatric surgery on cancer occurrence is controversial. To study the causal effect of bariatric surgery on cancer risk from an observational database, a target-trial emulation technique was used to mimic an RCT. Methods: Data on patients admitted between 2010 and 2019 with a diagnosis of obesity were extracted from a national hospital discharge database. Criteria for inclusion included eligibility criteria for bariatric surgery and the absence of cancer in the 2 years following inclusion. The intervention arms were bariatric surgery versus no surgery. Outcomes were the occurrence of any cancer and obesity-related cancer; cancers not related to obesity were used as negative controls. Results: A total of 1 140 347 patients eligible for bariatric surgery were included in the study. Some 288 604 patients (25.3 per cent) underwent bariatric surgery. A total of 48 411 cancers were identified, including 4483 in surgical patients and 43 928 among patients who did not receive bariatric surgery. Bariatric surgery was associated with a decrease in the risk of obesity-related cancer (hazard ratio (HR) 0.89, 95 per cent c.i. 0.83 to 0.95), whereas no significant effect of surgery was identified with regard to cancers not related to obesity (HR 0.96, 0.91 to 1.01). Conclusion: When emulating a target trial from observational data, a reduction of 11 per cent in obesity-related cancer was found after bariatric surgery. [ABSTRACT FROM AUTHOR]

Purpose: The present study aims to determine the impact of previous bariatric surgery (BS) on the length of hospital stay; the incidence of mortality, re-transplantation, and re-hospitalization after LT; and the related economic costs, through the analysis of the French National Health Insurance Information System. Materials and Methods: All patients aged > 18 years who underwent LT in France in the period from 2010 to 2019 were included. Thirty-nine patients with a history of BS (study group) were compared with 1798 obese patients without previous BS (control group). Results: At the time of LT, patients with a history of BS were significantly younger than those of the control group and had lower Charlson comorbidity index. Female sex was significantly more represented in the study group. No significant differences were detected between the two groups regarding the postoperative mortality rate after LT (10.3% in the study group versus 8.0% in the control group), long-term mortality (0.038 versus 0.029 person-year of follow-up, respectively), re-transplantation (adjusted hazard ratio (HR) = 2.15, p = 0.2437), re-hospitalization (adjusted analysis, IRR = 0.93, p = 0.7517), and costs of LT hospitalization (73,515 € in the study group versus 65,878 € in the control group). After 1:2 propensity score matching, the duration of the LT hospital stay was significantly longer in the study group (58.3 versus 33.4 days, p = 0.0172). Conclusion: No significant differences were detected between patients with previous BS versus obese patients without history of BS undergoing LT concerning the rates of mortality, re-LT, re-hospitalization after LT, and costs of hospitalization and re-hospitalizations. [ABSTRACT FROM AUTHOR]

Purpose Several strategies are suggested for ventral hernia repair (VHR) in bariatric candidates, in terms of timing and technique. The aim was to describe practices in VHR in bariatric patients on a nationwide scale in France. Materials and Methods We used the prospective national hospital discharge summaries database system to conduct a retrospective cohort study. We included patients operated once for sleeve or bypass, between 2007 and 2018, and who had VHR concomitant with bariatric surgery (BS) or within 2 years before or after. Results Among 11,680 eligible patients, 2039 underwent VHR in the 2 years before BS, 3388 had concomitant BS and VHR, and 6260 patients had VHR within 2 years after BS. Patients who underwent a concomitant surgery presented a higher suture repair rate (86.1% versus 37.1% and 44.0%, P < 0.001). Overall recurrence of VH at 10 years was 23.3% and was higher for patients who underwent VHR first (36.2%) than patients who underwent BS first (24.5%) and the concomitant group (18.6%), P < 0.001. Major complication rate was 11.1%, 7.8%, and 16.9% (P < 0.001) for VHR-first, concomitant, and BS-first groups, respectively. Mesh infection was found in 0.6% (13/2039) of patients in the VHR-first group, in 0.6% (20/3388) in the concomitant group, and in 1.1% (68/6260) in the BS-first group (P < 0.001). Conclusion About one-quarter of bariatric patients undergoing VHR will be reoperated for an anterior hernia. VHR before BS entailed a higher risk of reoperation for recurrence and should be avoided. A concomitant repair entailed the lowest rate of recurrence. [ABSTRACT FROM AUTHOR]

Purpose: Several strategies are suggested for ventral hernia repair (VHR) in bariatric candidates, in terms of timing and technique. The aim was to describe practices in VHR in bariatric patients on a nationwide scale in France. Materials and Methods: We used the prospective national hospital discharge summaries database system to conduct a retrospective cohort study. We included patients operated once for sleeve or bypass, between 2007 and 2018, and who had VHR concomitant with bariatric surgery (BS) or within 2 years before or after. Results: Among 11,680 eligible patients, 2039 underwent VHR in the 2 years before BS, 3388 had concomitant BS and VHR, and 6260 patients had VHR within 2 years after BS. Patients who underwent a concomitant surgery presented a higher suture repair rate (86.1% versus 37.1% and 44.0%, P < 0.001). Overall recurrence of VH at 10 years was 23.3% and was higher for patients who underwent VHR first (36.2%) than patients who underwent BS first (24.5%) and the concomitant group (18.6%), P < 0.001. Major complication rate was 11.1%, 7.8%, and 16.9% (P < 0.001) for VHR-first, concomitant, and BS-first groups, respectively. Mesh infection was found in 0.6% (13/2039) of patients in the VHR-first group, in 0.6% (20/3388) in the concomitant group, and in 1.1% (68/6260) in the BS-first group (P < 0.001). Conclusion: About one-quarter of bariatric patients undergoing VHR will be reoperated for an anterior hernia. VHR before BS entailed a higher risk of reoperation for recurrence and should be avoided. A concomitant repair entailed the lowest rate of recurrence. [ABSTRACT FROM AUTHOR]

Background: Diverticular disease is a common disorder. Several guidelines report on its optimal management. The aim of this study was to describe the evolution of the prevalence of this disease, the treatment strategies, and the mortality rate on a national level. Methods: We conducted a retrospective study on prospective data using a nationwide database. All consecutive adult patients diagnosed with diverticular disease and admitted via the emergency department from 2009 to 2018 were included in the study. We performed a descriptive analysis for epidemiologic data, diagnosis, and treatment. Results: During the data collection period, 233,386 patients were included in the study. The number of admissions for emergent diverticular disease increased by 65.8%, from 16,754 in 2009 to 27,781 in 2018, for both uncomplicated and complicated diverticular disease. Among these patients, 19,350 (8.3%) were operated on. The rate of surgical treatment progressively decreased from 9.7% in 2009 to 7.6% in 2018. The three main interventions were Hartmann's procedure (HP, n = 9111, 47.1%), resection with primary anastomosis (RPA, n = 4335, 22.4%), and peritoneal lavage (PL, n = 4836, 25%). We observed a progressive annual increase in HPs (n = 716 in 2009 and n = 1055 in 2018) as well as a decline in PLs since 2015, while the number of RPAs remained stable. Conclusions: Although admissions for emergent diverticular disease have increased during the study period, the rate of surgical treatment has decreased, suggesting an evolution toward more conservative management of this pathology. [ABSTRACT FROM AUTHOR]

Purpose: Follow-up is a cornerstone of the success of bariatric surgery. However, adherence to monitoring decreases over time. The reasons for non-compliance with follow-up still remain unclear. Materials and Methods: This is a retrospective, single-center, cohort study, including all patients undergoing bariatric surgery between 2014 and 2017. Patients lost to follow-up were called back and questioned about the reasons of non-adherence. Patients followed and lost to follow-up were compared in terms of weight loss. Results: Overall, 29.7% of patients were lost to follow-up. After a callback, we obtained information on 89.9% of patients. The first reason of non-attendance was considering follow-up as unnecessary (29.5%). Almost a quarter of patients (24%) discontinued follow-up due to geographic distance, while 23.3%, 18.6%, and 14.0% of patients explained the lack of follow-up due to family, professional, or health problems. Only 7.0% declared to renounce to follow-up because of poor weight loss. Percentage of excess weight loss at 3 and 5 years after surgery was respectively 73.6% and 81.2% in attendant patients, and 70.7% and 68.4% in non-adherent patients (p = ns). Despite a greater weight loss in the group of patients regularly followed, the difference with patients lost to follow-up remained not significant in multivariate analysis. Conclusions: Follow-up is of crucial importance in the management of bariatric patients. Follow-up disruption is associated to individual patient choice and external constraints. In order to improve the quality of long-term care, care providers will probably need to adapt to these constraints, diversifying the offer of care. [ABSTRACT FROM AUTHOR]

Purpose: One anastomosis gastric bypass (OAGB) is now recognized as a mainstream bariatric procedure, nonetheless concerns about the risk of nutritional deficiencies and biliary reflux persist, and the ideal length of the biliopancreatic limb (BPL) is debated. Materials and Methods: Data of patients who underwent OAGB between May 2010 and December 2010 were collected prospectively and analyzed retrospectively. At an 8-year follow-up, a complete evaluation included clinical examination, blood tests, upper gastrointestinal endoscopy, and quality of life (QoL) assessed through the BAROS score. Results: Overall, 115 patients underwent OAGB with a BPL of 150 cm. Thirty-six (31%) were lost at the 8-year follow-up. Mean preoperative weight was 117 ± 20.8 kg and mean BMI 43.2 ± 5.8 kg/m2. At 8 years, weight was 76.5 ± 17.3 kg, BMI 28.3 ± 5.8, %TWL 34.8 ± 10.7, and %EWL 84.8 ± 27.1. No patients were readmitted for nutritional complications or underwent revisional surgery for malnutrition; 6 patients were converted to Roux-en-Y gastric bypass for intractable reflux. High rates of vitamin D and A deficiencies and secondary hyperparathyroidism were found at 8 years. The BAROS score was > 3 at 8 years for 93% of patients. Upper gastrointestinal endoscopy was available for 46 patients and found esophagitis in 6.5% of cases but no cases of Barrett's esophagus. Conclusion: OAGB performed with a 150-cm BPL is an effective bariatric procedure, associated with good long-term outcomes in relation to weight loss, QoL, resolution of comorbidities, and a very low rate of protein-calorie malnutrition. Fat-soluble vitamin deficiencies represent the main long-term concern. Endoscopic findings at 8 years are reassuring. [ABSTRACT FROM AUTHOR]

Introduction: In the last two decades, an impressive increase in the number of surgical interventions was recorded in bariatric surgery. Similarly, several bibliometric studies reported an increasing trend for scientific production. This study aims to compare these two trends. Methods: This study focused on the period 2003–2016 and included the following procedures: adjustable gastric banding (AGB), bilio-pancreatic deviation (BPD), one-anastomosis gastric bypass (OAGB), Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and vertical banded gastroplasty (VBG). We retrieved the data on intervention from International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) surveys and data from publications from the Web of Science database. An analysis of the global trend and the trend per continent was performed. Results: Over the study period, the most common procedure to be performed was RYGB (47.1%) followed by SG (33.5%) and AGB (14.8%). The percentage of publications was similar, with 48.3% studies on RYGB, 18.5% on AGB, and 18.4% on SG. In terms of evolution, SG has become the most common procedure to be performed in every continent but Latin America, while RYGB remains the most frequently discussed in scientific publications. Asia has the highest rate of publications per 1000 interventions (4.7), followed by Europe (3.0), the Pacific (2.0), and North America (1.6). Conclusion: This study found many similarities in the trend of publications and interventions in bariatric surgery: in particular with an important growth rate in the last 15 years and the progressive polarization toward two procedures (SG and RYGB). Nevertheless some important differences persist at a national level. [ABSTRACT FROM AUTHOR]

GRB 170817A was a subluminous short gamma-ray burst detected about 1.74 s after the gravitational wave signal GW170817 from a binary neutron star (BNS) merger. It is now understood as an off-axis event powered by the cocoon of a relativistic jet pointing 15°–30° away from the direction of observation. The cocoon was energized by the interaction of the incipient jet with the non-relativistic baryon wind from the merger remnant, resulting in a structured outflow with a narrow core and broad wings. In this paper, we couple the observational constraints on the structured outflow with a model for the jet–wind interaction to constrain the intrinsic properties with which the jet was launched by the central engine, including its time delay from the merger event. Using wind prescriptions inspired by magnetized BNS merger simulations, we find that the jet was launched within about 0.4 s from the merger, implying that the 1.74 s observed delay was dominated by the fireball propagation up to the photospheric radius. We also constrain, for the first time for any gamma-ray burst, the jet opening angle at injection and set a lower limit to its asymptotic Lorentz factor. These findings suggest an initially Poynting-flux dominated jet, launched via electromagnetic processes. If the jet was powered by an accreting black hole, they also provide a significant constraint on the survival time of the metastable neutron star remnant. [ABSTRACT FROM AUTHOR]

A comprehensive understanding of gamma-ray bursts (GRBs) has been elusive due to the variety of questions surrounding the radiation mechanism at play in these events. Polarization measurements of GRBs can heavily constrain the relevant radiation mechanisms and the structure of the GRB jet; however, there is a limited number of theoretical predictions that observed GRB polarizations can be compared against. Here, we conduct radiative transfer calculations of a set of two-dimensional relativistic hydrodynamic long GRB (LGRB) jet simulations, of a constant and a variable jet, using the Monte Carlo Radiation Transport (MCRaT) code. MCRaT has been enhanced by the inclusion of polarization; it has been first verified by reproducing a variety of results in the literature and then used to obtain the time-integrated and time-resolved polarization degrees and angles of the synthetic LGRBs. While the obtained time-integrated polarization degrees (≲1%) are consistent with the constraints from the POLAR experiment, they are lower than other theoretical studies due to the lack of strong gradients in the model jet profiles that we use. The time-resolved results suggests that GRBs with wide jets observed on axis will have small polarization degrees (≲2%) and constant polarization angles, during the brightest portion of the light curve. GRBs observed off-axis will have larger polarization degrees and polarization angles that change with the temporal structure of radiating shells in the outflow. We then place our results in the context of GRB prompt emission models and future LEAP and POLAR-2 GRB polarimetry detections. [ABSTRACT FROM AUTHOR]

Context: The 30-day readmission rate after bariatric surgery is considered an important metric of the quality of hospital care. However, readmission rate beyond 30 days is rarely reported and does not provide any information about trajectories of care which would be of great interest for healthcare planning. The aim of this study was to analyze trajectories of care during the first year after bariatric surgery on a nationwide basis using data mining methods. Method: This was a retrospective descriptive study on the trajectories of care within the first year after bariatric surgery. Data were extracted from a national administrative claims database (the PMSI database) and trajectories were defined as principal diagnosis of successive readmissions. Formal Concept Analysis was performed to find common concepts of trajectories of care. Results: We included for analysis 198,389 bariatric procedures performed on 196,323 patients. Twelve main concepts were selected. About one third of patients (32.4%) were readmitted in the first year after surgery. Most common trajectories were as follows: regular follow-up (14.9%), cholelithiasis (2.2%), abdominal pain (1.9%), and abdominal sepsis (1.3%). Important differences were found in trajectories among different bariatric procedures: 1.8% of gastric banding patients had pregnancy-related events (delivery or medical abortion), while we observed a readmission rate for abdominal sepsis in 2.7% and 5.1% of patients operated of gastric bypass and sleeve gastrectomy respectively. Conclusion: Administrative claim data can be analyzed through Formal Concept Analysis in order to classify trajectories of care. This approach permits to quantify expected postoperative complications and to identify unexpected events. [ABSTRACT FROM AUTHOR]

Background: Readmission rate is considered an indicator of quality of care, which is already used in some countries to impose financial penalties on hospital with readmissions in excess of the national average. Nevertheless, this indicator presents some controversial drawbacks. The objective of this study was the assessment of readmission rate after bariatric surgery. Methods: This is a retrospective observational study on a national administrative claims database, the Information Systems Medicalization Program, PMSI, which is a nationwide billing tool collecting information on all hospital discharges in France. All adult patients operated of bariatric surgery from January 1, 2013, through December 31, 2016, were included. The main outcome was unplanned 30-day readmission rate. Secondary outcome was the analysis of reasons for readmission. Results: During the study period, out of 187,000 bariatric interventions, the unplanned readmission rate was 4.7%. A significant difference was found between bariatric procedures (gastric banding 3.1%, sleeve gastrectomy 4.5%, gastric bypass 5.7%, p < 0.001). The most important risk factors are the Charlson comorbidity index, the occurrence of a complication after the initial intervention, and the bariatric technique type itself. The main causes of return to the hospital are abdominal pain, peritonitis, nausea/vomiting, and bleeding. After adjustment for confounders, the rate of rehospitalization varies between 1.0% and 16.0% among all French hospitals. Conclusions: Approximately 5 % of patients undergoing bariatric surgery suffered a readmission within 30 days. We identified common causes and identified patients at high risk for such an event. These information could be useful for developing strategies to improve in- and outpatient care in bariatric population. [ABSTRACT FROM AUTHOR]

Background: Aromatase deficiency is a rare autosomal recessive disorder. 46,XY-affected patients often remain undiagnosed until late puberty. Only 2 pediatric cases have been reported. Data on pubertal development in affected males are scarce. Aim: To report the clinical phenotype and hormonal studies of an aromatase-deficient boy during the prepubertal and early pubertal period. Results: The patient was the older brother of a 46,XX girl with aromatase deficiency. Molecular analysis revealed a previously reported homozygous mutation (Arg192Cys) in the CYP19A1 gene. Pubertal onset was at 9.8 years. At 11.3 years of age, signs of rapidly progressive puberty were seen. Laboratory tests revealed normal pubertal basal and GnRH-stimulated gonadotropin levels, normal Sertoli cell markers, and increased testosterone. The prepubertal lumbar spine bone mineral density (BMD) was normal but pubertal bone mineral accrual was incomplete, leading to osteopenia. Conclusion: Estrogen restraint on gonadotropin secretion has been demonstrated in animal and human models. Interestingly, our patient presented with accelerated puberty and apparently normal pituitary gonadal function. These findings suggest that aromatase activity may be required to define pubertal progression in boys. Estrogen deficiency due to aromatase deficiency is responsible for insufficient bone mineral accrual during puberty. [ABSTRACT FROM AUTHOR]

This study is a review on the management of ventral hernia during bariatric surgery. The main outcomes are the recurrence rate after ventral hernia repair and the incidence of prosthetic infection. Eleven studies were included. Ventral hernias were treated by simple suture (n = 191), synthetic mesh (n = 186), and biological mesh (n = 72). Mean defect size was 18 cm2. Recurrence rate was 25.7% in the suture group, 14.3% in the biomesh group, and 1.1% in the synthetic mesh group (p < 0.05). Mesh infection rate was not different between the groups. No significant difference was observed in 30-day reoperation. Concomitant treatment of small hernia defect is feasible and safe during bariatric surgery. Synthetic mesh provides a significantly lower recurrence rate without any increase in 30-day wound morbidity. [ABSTRACT FROM AUTHOR]

Abstract: We propose a dynamic version of the dividend discount model, solve it in closed form, and assess its empirical validity. The valuation method is tractable and can be easily implemented. We find that our model produces equity value forecasts that are very close to market prices, and explains a large proportion of the observed variation in share prices. Moreover, we show that a simple portfolio strategy based on the difference between market and estimated values earns considerably positive returns. These returns cannot be simply explained either by the Fama‐French three‐factor model (even after adding a momentum factor) or the Fama‐French five‐factor model. [ABSTRACT FROM AUTHOR]

Purpose: The epidemic of obesity has determined an important rise in popularity for bariatric surgery (BS) in France. The role of general practitioners (GPs) in the decision-making process of candidates to BS as well as in their life-long follow-up after surgery is therefore destined to grow up. The aim of this survey was to provide a picture of the actual knowledge of GPs about BS.Methods: The link to an e-questionnaire composed of 20 multiple choice questions was sent to all the 101 Departmental Councils of the French Medical Board, accompanied by a letter explaining the objectives of the study. Councils were asked to distribute the e-questionnaire to GPs in their department.Results: A total of 2224 GPs were solicited by e-mail in six departments and 288 surveys were completed, representing a 12.9% response rate. A proportion as high as 97.2% of GPs reported taking care of at least one patient operated on for BS and 88.5% declared having referred at least one patient for BS. Nevertheless, a considerable proportion of GPs declared not to have sufficient knowledge to manage BS patients. Moreover, 86.1% wished to receive more education and 83.7% declared to be available for participating in follow-up.Conclusion: Academic institutions, scientific societies, and all physicians involved in obesity care should actively participate in the correction of the educational gap of GPs in order to obtain an effective help in the complex challenge of facing the obesity epidemic. [ABSTRACT FROM AUTHOR]

We present a novel Dynamic Monte Carlo code (DynaMo code) that self-consistently simulates the Compton-scattering-driven dynamic evolution of a plasma. We use the DynaMo code to investigate the time-dependent expansion and acceleration of dissipationless gamma-ray burst fireballs by varying their initial opacities and baryonic content. We study the opacity and energy density evolution of an initially optically thick, radiation-dominated fireball across its entire phase space - in particular during the Rph < Rsat regime. Our results reveal new phases of fireball evolution: a transition phase with a radial extent of several orders of magnitude - the fireball transitions from Γ ∝ R to Γ ∝ R0, a post-photospheric acceleration phase - where fireballs accelerate beyond the photosphere and a Thomson-dominated acceleration phase - characterized by slow acceleration of optically thick, matter-dominated fireballs due to Thomson scattering. We quantify the new phases by providing analytical expressions of Lorentz factor evolution, which will be useful for deriving jet parameters. [ABSTRACT FROM AUTHOR]

Backgroud The risk of esophageal cancer after bariatric surgery is a matter of debate. Several studies have reported that bariatric surgery patients have a lower risk of cancer. However, esophageal cancer is associated with gastroesophageal reflux disease, which may increase after bariatric surgery and in particular after sleeve gastrectomy. Objectives The objective of this study is to evaluate the risk of esophageal cancer after two bariatric procedures: sleeve gastrectomy (SG) and gastric bypass (GBP). Methods Data from patients operated on for bariatric surgery between 2007 and 2020 in France were extracted from a national discharge database (PMSI). Adult patients operated on for SG or GBP were included and followed up until December 2020. Patients were divided into two groups according to the procedure initially performed. The endpoints were the occurrence of esophageal and cardia cancers. To assess the effect of the type of bariatric procedure on the development of cancer, a multivariate analysis was performed using a marginal Cox model after matching on propensity score (PS). In the sensitivity analysis, we used different models: standard Cox regression, Cox regression adjusted on propensity score, and Cox model with adjustment for inverse probability of treatment weighting. Results Of the 367,169 patients included, 68.7% were SGs and 31.3% were GBPs. The two groups differed at inclusion in terms of age, sex, BMI, and comorbidities. Median follow-up was 6.0 years (IQR 3.0–8.0 years) for the entire cohort, and approximately 35,000 patients were followed for at least 10 years. A total of 88 esophageal cancers were identified, including 64 after SG and 24 after GBP. In multivariate analysis, no significant difference was found between SG and GBP on cancer incidence (HR 1.6, 95%CI 0.9–2.7, p = 0.09 for OS versus GBP). No differences were found in sensitivity analyses. Conclusion In this large national cohort of bariatric surgery patients, no significant differences were found in the incidence of esophageal and cardia cancer between OS and GBP. [ABSTRACT FROM AUTHOR]

Background: Knowledge regarding the feasibility and safety of sleeve gastrectomy (SG) in obese liver transplant recipients is scarce. We report our experience of sleeve gastrectomy following liver transplantation (LT). Methods: All patients who had undergone LT and subsequently underwent SG at our institution were retrospectively reviewed. Surgical outcomes, liver and kidney function tests, outcomes of obesity-related comorbidities, and excess weight loss were analyzed. Results: Between May 2008 and February 2015, six consecutive patients underwent SG after LT. Three procedures (50%) were performed totally by laparoscopy, and three by upfront laparotomy for concomitant incisional hernia complex repair. Within the first 30 days, one complication occurred: early gastric fistula that required multiple endoscopic procedures and re-intervention, followed by death 19 months after SG due to multi-organ failure. Another patient had one late complication: chronic infection on a parietal mesh successfully controlled by mesh removal. Excess weight loss averaged 76% at 2 years with a median BMI of 28 (21-39) kg/m. Median follow-up was 37.2 months (range 13-101 months). Median length of stay was 9 days (range: 6-81 days). Conclusions: SG is technically feasible after LT and resulted in weight loss without adversely affecting graft function and immunosuppression. However, morbidity and mortality are high. [ABSTRACT FROM AUTHOR]

Copyright of Italian Journal of Nursing (IJN) / Giornale Italiano di Infermieristica is the property of Collegio IPASVI MI-LO-MB - Ordine Professioni Infermieristiche MI-LO-MB and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)