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Research background: The outbreak of COVID-19 has disrupted and shaken all economic and financial sectors. In this scenario, crowdfunding has emerged as a new relevant financing mechanism alongside more traditional funding channels by attracting investors through an internet-based method of fundraising to support ventures. In recent years, many crowdfunding platforms, specialized in green projects rose, allowing start-ups to raise funds for their campaigns. The literature on the use of crowdfunding in the sustainable sector is quite limited. Purpose of the article: We use a hand-collected dataset of 350 equity crowdfunding campaigns, gathered from the Italian platforms over the period January 2016-June 2020, to analyze the impact of COVID-19 outbreak on the success of green equity crowdfunding projects. We also test the greater attractiveness of the projects sustainability-oriented than other types of campaigns and if growth in the number of “green” projects is linked to the increase of local environmental performance. Methods: We measure the probability of success of pitched projects, both in terms of the total amount raised and the number of investors. We run a negative-binomial-regression for the number of investors and a Tobit-regression for the amount of capital raised. Findings & Value added: Coherently with our hypotheses, we find that COVID-19 has reduced the probability of success and that campaigns with a sustainability orientation are more likely to reach the funding target because investors give more importance to a sustainable future. Finally, our search provides that the leading countries in environmental performance have a positive effect on the green crowdfunding projects, by aspiring to move toward a sustainable future.

Objective: This study examines the potential role of candidate genes in moderating treatment effects of methylphenidate (MPH) in attention-deficit/hyperactivity disorder (ADHD).Method: Eighty-two subjects with ADHD aged 6 to 17 years participated in a prospective, double-blind, placebo-controlled, multiple-dose, crossover titration trial of immediate release MPH three times daily. The subjects were assessed on a variety of parent and clinician ratings and a laboratory math test. Data reduction based on principal components analysis identified statistically derived efficacy and side effect outcomes.Results: Attention-deficit/hyperactivity disorder symptom response was predicted by polymorphisms at the serotonin transporter (SLC6A4) intron 2 VNTR (p = .01), with a suggested trend for catechol-O-methyltransferase (COMT) (p = .04). Gene × dose interactions were noted on math test outcomes for the dopamine D4 receptor (DRD4) promoter (p = .008), DRD4 exon 3 VNTR (p = .006), and SLC6A4 promoter insertion/deletion polymorphism (5HTTLPR) (p = .02). Irritability was predicted by COMT (p = .02). Vegetative symptoms were predicted by 5HTTLPR (p = .003). No significant effects were noted for the dopamine transporter (SLC6A3) or synaptosomal-associated protein 25 (SNAP25).Conclusions: This article confirms and expands previous studies suggesting that genes moderate ADHD treatment response. The ADHD outcomes are not unitary but reflect both behavioral and learning domains that are likely influenced by different genes. Future research should emphasize candidate gene and genome-wide association studies in larger samples, symptom reduction as well as side effects outcomes, and responses over full therapeutic dose ranges to assess differences in both gene and gene × dose interactive effects. [ABSTRACT FROM AUTHOR]

Background: Left bundle branch (LBB) pacing (LBBP) has gained rapid adoption. Evidence for direct LBB capture has varied from 30%-95% depending on the criteria., Objective: The purpose of this study was to assess the feasibility and efficacy of intraprocedural transthoracic echocardiographic guidance to achieve LBB capture., Methods: This was a prospective, nonrandomized, case-control study (ClinicalTrials.gov Identifier: NCT05646251). The pectoral region including echocardiographic windows were sterile-draped using Ioban. The lead was placed in the right ventricular septum and sheath orientation adjusted under echocardiography. The lead was advanced under echocardiographic visualization until the tip reached the left ventricular subendocardium. LBB capture was strictly defined: transition from nonselective to selective/left ventricular septal capture; LBB potential with injury current; and Delta (HBP-LBBP) V 6 RWPT ≥10., Results: Thirty patients underwent echocardiography-guided left bundle branch pacing (EC-LBBP) and compared with 30 patients (standard approach): mean age 74.4 ± 10 years; female 45%; hypertension 92%; cardiomyopathy 43%; atrioventricular block/atrioventricular nodal ablation 75%. Total procedural and fluoroscopy durations were similar. Left bundle branch area pacing (LBBAP or left ventricular septal pacing) was successful in all patients in both groups. EC-LBBP was 97% successful in achieving LBB capture vs 70% (P = .02) with LBB potentials (LB-V 23 ± 6 ms) in 95% vs 77% (22 ± 6 ms). Morphology transition confirming LBB capture was seen in 87% vs 67% (P = .02). Lead tip was visualized at the left ventricular subendocardium in 100% of patients in EC-LBBP., Conclusion: EC-LBBP was 97% successful in achieving LBB capture using strict criteria. LBBP lead was subendocardial in all patients. EC-LBBP is practical, feasible, safe, and highly effective in achieving LBB capture., Competing Interests: Disclosures Medtronic grant. Dr Vijayaraman reports speaker, consultant, research, and fellowship support from Medtronic; is a consultant for Abbott, Biotronik, and Boston Scientific; and reports a patent for the HBP delivery tool. Elliot Schmidt is an employee of Medtronic. All other authors have no conflicts to disclose., (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Background: His-Purkinje conduction system pacing (HPCSP) using His bundle pacing (HBP) or left bundle branch pacing (LBBP) has emerged as an alternative to biventricular pacing (BVP) in patients requiring cardiac resynchronization therapy (CRT)., Objectives: The aim of the study was to compare the feasibility and clinical efficacy of HOT-CRT (His-Purkinje conduction system pacing Optimized Trial of Cardiac Resynchronization Therapy) with BVP in patients with heart failure, reduced ejection fraction, and indication for CRT., Methods: This was a prospective, randomized, controlled trial of HOT-CRT and BVP in patients with LVEF <50% and indications for CRT. If HPCSP resulted in incomplete electrical resynchronization, a coronary sinus (CS) lead was added. The primary outcome was the change in left ventricular ejection fraction (LVEF) at 6 months. The primary safety endpoint was freedom from major complications., Results: A total of 100 patients (female 31%, aged 70 ± 12 years, LVEF 31.5% ± 9.0%) were randomized. HOT-CRT was successful in 48 of 50 (96%) and BVP-CRT in 41 of 50 (82%) patients (P = 0.03). QRS duration significantly decreased from 164 ± 26 ms to 137 ± 20 ms with HOT-CRT and 166 ± 28 ms to 141 ± 19 ms with BVP. Fluoroscopy results (18.8 ± 12.4 min vs 23.8 ± 12.4 min, P = 0.05) and procedure duration (119 ± 42 min vs 114 ± 36 min, P = 0.5) were similar. The primary outcome of change in LVEF at 6 months was greater in HOT-CRT than in BVP (12.4% ± 7.3% vs 8.0% ± 10.1%, P = 0.02). The primary safety endpoint was similar (98% vs 94%, P = 0.62). Echocardiographic response of improvement in LVEF >5% occurred in 80% vs 61% (P = 0.06). Complications occurred in 3 (6%) in HOT-CRT vs 10 (20%) in BVP (P = 0.03)., Conclusions: HPCSP-guided CRT resulted in greater change in LVEF compared with BVP. Randomized clinical trials with long-term follow-up are necessary. (His-Purkinje Conduction System Pacing Optimized Trial of Cardiac Resynchronization Therapy [HOT-CRT]; NCT04561778)., Competing Interests: Funding Support and Author Disclosures This work was funded by a Geisinger Foundation internal grant. Dr Vijayaraman has been a consultant for, and the recipient of honoraria, research support, and fellowship support from Medtronic; a consultant for Abbott; the recipient of honoraria from Biotronik and Boston Scientific; and the holder of a patent on the HBP delivery tool. Dr Subzposh has been the recipient of honoraria from Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess the incidence of axillary lymphadenopathy over established time ranges after COVID-19 vaccination and lymph node pathologic features (i.e. size increase and qualitative characteristics) in subjects undergoing axillary evaluation during a breast imaging examination., Methods and Materials: The institutional review board approved this prospective study., Inclusion Criteria: women undergoing mammography and breast ultrasound between July and October 2021; information about the COVID-19 vaccine and infection, if any., Exclusion Criteria: known metastatic lymphadenopathy. Participants were divided into 5 subgroups according to time between vaccine and imaging: < 6 weeks; 7-8 weeks; 9-10 weeks; 11-12 weeks; > 12 weeks. Evaluation of axillary lymph nodes was performed with ultrasound. Descriptive statistical analysis was performed. p < 0.05 was considered significant., Results: A total of 285 women were included. Most of the patients underwent Moderna vaccine (n = 175, 61.4%). 63/285 patients had a previous history of breast cancer (22.1%). 13/17 (76.5%) patients with previous COVID-19 infection had no previous history of cancer, whereas 4/17 had a previous history of cancer (p < .001). 41/285 (14.4%) women showed lymphadenopathy, and they were significantly younger (46.9 ± 11.6 years) than women with borderline (54.0 ± 11.9 years) or no lymphadenopathy (57.3 ± 11.9 years) (p < .001). Lymphadenopathy and borderline lymphadenopathy were more frequently observed in the Moderna-vaccinated women and in the subgroup of patients evaluated < 6 weeks after vaccination (p < 0.001). The most common pathologic feature was cortical thickening, followed by complete or partial effacement of fatty hilum., Conclusion: A lymphadenopathy within 12 weeks after vaccination is a common finding particularly in younger women and after Moderna vaccine and no further assessment should be required., (© 2023. Italian Society of Medical Radiology.)

Background: Left bundle branch area pacing (LBBAP) is a novel therapeutic option for bradycardia and heart failure patients. ECG belt is a novel technology for assessment of ventricular electrical heterogeneity (VEH) using multi-electrode ECG. A metric of overall VEH based on standard deviation of activation times (SDAT) from all electrodes in the ECG belt has been previously shown to predict cardiac resynchronization therapy (CRT) response. The aim of the study is to evaluate non-invasive assessment of VEH using ECG belt to optimize LBBAP., Methods: VEH from a 40-electrode ECG belt was characterized in 20 patients (male 15, EF 33 ± 13%, NYHA class 3.05 ± 0.6; CRT indication 18) during LBBAP (20) and LBBAP-Optimized CRT (LOT-CRT-7), anodal capture (16), NS-LBBP (18), S-LBBP (5), LVSP (9). In addition to SDAT, regional (LV/RV) VEH was assessed with average left ventricular activation times (LVAT), SDAT of left-sided (LV dispersion) and right-sided (RV dispersion) electrodes. Optimal LBBAP was determined based on maximal SDAT and QRS duration (d) change., Results: All metrics were significantly reduced (p < 0.0001 for ECG belt metrics, p = 0.0027 for QRSd) during LBBAP and LOT-CRT compared to intrinsic. QRSd, SDAT, LVAT, and LV and RV dispersion during optimal LBBAP were significantly lower (133 ± 20/157 ± 24; 20.5 ± 7.5/38.6 ± 9; 44.4 ± 14.3/61.4 ± 21; 11.6 ± 11.6/29.5 ± 15; 21.1 ± 7.8/42.5 ± 9.3; p < 0.0001) compared to intrinsic rhythm. However, they were not significantly different among selective, non-selective, anodal, and LV septal captures. EF and NYHA class improved to 46 ± 11% and 1.9 ± 0.6 (p < 0.001)., Conclusions: LBBAP significantly reduced overall and regional (RV/LV) VEH, irrespective of the mechanism of capture. Detailed assessment of electrical heterogeneity using ECG belt may add valuable insights on effects of LBBAP., Trial Registration: ClinicalTrials.gov Identifier: NCT04583709., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background and Aims: Highly sensitive technologies are available for the molecular characterization of solid tumors, including digital PCR (dPCR). Liquid biopsy, based on the analysis of cell-free DNA (cfDNA), is often used to assess EGFR or RAS alterations in lung and colorectal cancers. Our study aimed to compare the results of two different dPCR platforms for the detection of mutations in cfDNA., Methods: Plasma samples from lung and colorectal cancer patients collected as per routine procedures have been tested. cfDNA Was extracted from plasma, and samples were screened on the droplet digital PCR (ddPCR, BioRad) and solid dPCR QIAcuity (Qiagen)., Results: A total of 42 samples were analyzed, obtained from 20 Non-Small Cell Lung Cancer (NSCLC) patients carrying an EGFR or a KRAS mutation on tissue at diagnosis, and from 22 samples of colorectal cancer (CRC) patients, 10 of which presenting a KRAS mutation. EGFR mutation detection was 58.8% for ddPCR and 100% for dPCR (κ = 0.54; 95% CI, 0.37-0.71), compared to tissue results. The detection rate for RAS mutations was 72.7% for ddPCR and 86.4% for dPCR (κ = 0.34; 95% CI, 0.01-0.68), compared to tissue results., Conclusions: This study showed moderate agreement between dPCR and ddPCR. Sampling effect or threshold settings may potentially explain the differences in the cfDNA data between the two different platforms., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: MDR consultant/speaker: Astellas, Astra Zeneca, Celgene, Novartis, Pfizer, Bio-Rad, Janssen, Sanofi-Aventis, Roche, Lilly, MSD and Ipsen. C.C. reports personal fees from Roche, Amgen, Bayer, and Sevier; research founding from Merck Serono; and consulting/advisory role with Roche, Bayer, Amgen. SF received support for travel expenses from Novartis, Teva, Roche, BMS, Lilly and Ipsen. RD consultant/speaker: Ipsen, Novartis, Pfizer, Sanofi Genzyme, AstraZeneca, Janssen, Gilead, Lilly, and EUSA Pharma. All other authors report no competing interests., (Copyright © 2023 Elsevier B.V. All rights reserved.)

This study sought to develop basic robotic surgical skills among surgical trainees across multiple specialties using a VR-based curriculum and provided objective, on-demand, automated assessments using the Intuitive Learning platform. This curriculum was developed using the Da Vinci Skills Simulator and included 24 exercises. A pre-test and post-test were required for completion of the curriculum. Scores > 90 on individual exercises and the post-test were required for successful completion. The Intuitive learning platform provided automated performance metrics and tracked trainee progression. The curriculum was implemented and data collected over a 12-month period. 21 trainees completed the entire curriculum. Post-test scores were significantly higher than pre-test scores and trainees reported improvement in their robotic skills after curriculum completion. A comparison based on training level revealed that junior residents had significantly lower number of attempts per exercise, fewer penalties, and higher completion scores when compared to senior residents and fellows. Individual exercise analysis demonstrated that exercises, such as 'Three-Arm Relay' and 'Ring Rollercoaster', required the longest time and most attempts to achieve a passing score. The 'Energy Pedals' and 'Knot Tying' skills were the least-utilized skills addressed in the curriculum. Virtual reality-based curriculums using the Intuitive Learning platform can be standardized across multiple specialties allowing for the development of basic robotic skills, shared interdisciplinary surgical education, and provides powerful objective and automated performance metrics of trainees., (© 2022. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Management of blunt scrotal trauma is classically centered upon evaluation of potential testicular ruptures to that expedient surgical intervention can be employed. We present a unique case of blunt scrotal trauma causing bilateral testes rupture in order to illustrate the rationale for societal guidelines. We additionally offer discussion of potential sequelae of afflicted patients and a sparingly used technique to salvage a severely injured testis., (© 2019 The Authors.)

Background: The All of Us Research Program is building a national longitudinal cohort and collecting data from multiple information sources (e.g., biospecimens, electronic health records, and mobile/wearable technologies) to advance precision medicine. Participant-provided information, collected via surveys, will complement and augment these information sources. We report the process used to develop and refine the initial three surveys for this program., Methods: The All of Us survey development process included: (1) prioritization of domains for scientific needs, (2) examination of existing validated instruments, (3) content creation, (4) evaluation and refinement via cognitive interviews and online testing, (5) content review by key stakeholders, and (6) launch in the All of Us electronic participant portal. All content was translated into Spanish., Results: We conducted cognitive interviews in English and Spanish with 169 participants, and 573 individuals completed online testing. Feedback led to over 40 item content changes. Lessons learned included: (1) validated survey instruments performed well in diverse populations reflective of All of Us; (2) parallel evaluation of multiple languages can ensure optimal survey deployment; (3) recruitment challenges in diverse populations required multiple strategies; and (4) key stakeholders improved integration of surveys into larger Program context., Conclusions: This efficient, iterative process led to successful testing, refinement, and launch of three All of Us surveys. Reuse of All of Us surveys, available at http://researchallofus.org, may facilitate large consortia targeting diverse populations in English and Spanish to capture participant-provided information to supplement other data, such as genetic, physical measurements, or data from electronic health records.

A 67-year-old male patient presented with right scrotal swelling and underwent a right hydrocelectomy. A 1 cm paratesticular lesion was found within the hydrocele sac after entering the tunica vaginalis. Local excision grossly removed this in its entirety. Pathology returned as well differentiated papillary mesothelioma of the tunica vaginalis. Pathologic features and management options are discussed.

Background: Understanding the role that urologic disease plays within central Haiti could lead to the development of sustainable and regionally appropriate urologic care. We aim to document the prevalence of urologic surgical disease presenting for treatment in central Haiti., Methods: The present study is based on a retrospective review of surgical case logs at five Partners in Health and Zanmi Lasante hospitals in central Haiti. Data were collected from June 30, 2009, through July 29, 2010, and included patient demographics, disease processes, interventions required, surgeon name, and surgeon training (urologic trained versus non-urologic trained)., Results: Urologic surgical disease comprised 498/5,539 (9.0 %) of all surgical cases in central Haiti from July 2009-July 2010. A total of 492 diagnoses and 498 urologic procedures on 469 patients were recorded. Most common diagnoses included hydrocele (33.3 %), phimosis (23.0 %), benign prostatic hyperplasia (10.8 %), and cryptorchidism (7.3 %). Hydrocelectomy was the most commonly performed procedure (160/498, 32.1 %), followed by circumcision (117/498, 23.4 %) and open prostatectomy (38/498, 7.6 %). Surgeon training (urologic versus non-urologic) was determined for 360/498 (72.3 %) of surgical cases. Urologic trained surgeons performed 55/360 (15.3 %) of all surgical procedures. Among patients who underwent prostatectomy, urology surgeons performed 14/31 (45.2 %) of open prostatectomies, and non-urology surgeons performed 17/31 (54.8 %). Urologists performed all transurethral resections of the prostate (9 vs. 0; p = 0.0051)., Conclusions: Urologic surgical diseases comprise a substantial source of morbidity for patients in central Haiti. Understanding the scale and scope of urologic disease is important in developing health systems to adequately address the regional burden of surgical disease in limited-resource settings.

Purpose: V-Loc™180 (Covidien Healthcare, Mansfield, MA) is a new unidirectional barbed suture that may reduce loss of tension during a running closure. We evaluated the use of the barbed suture for urethrovesical anastomosis (UVA) during robotic assisted laparoscopic prostatectomy (RALP). Time to completion of UVA, post-operative anastomotic leak rate, and urinary incontinence were compared in patients undergoing UVA with 3-0 unidirectional-barbed suture vs. 3-0 Monocryl™ (Ethicon, Somerville, NJ)., Materials and Methods: Data were prospectively collected for 70 consecutive patients undergoing RALP for prostate cancer between November 2009 and October 2010. In the first 35 patients, the UVA was performed using a modified running van Velthoven anastomosis technique using two separate 3-0 monofilament sutures. In the subsequent 35 patients, the UVA was performed using two running novel unidirectional barbed sutures. At 7-12 days postoperatively, all patients were evaluated with a cystogram to determine anastomotic integrity. Urinary incontinence was assessed at two months and five months by total daily pad usage. Clinical symptoms suggestive of bladder neck contracture were elicited., Results: Age, PSA, Gleason score, prostate size, estimated blood loss, body mass index, and clinical and pathologic stage between the 2 groups were similar. Comparing the monofilament group and V-Loc™180 cohorts, average time to complete the anastomosis was similar (27.4 vs. 26.4 minutes, p = 0.73) as was the rate of urinary extravasation on cystogram (5.7 % vs. 8.6%, p = 0.65). There were no symptomatic bladder neck contractures noted at 5 months of follow-up. At 2 months, the percentage of patients using 2 or more pads per day was lower in the V-Loc™180 cohort (24% vs. 44%, p < 0.02). At 5 months, this difference was no longer evident., Conclusions: Time to complete the UVA was similar in the intervention and control groups. Rates of urine leak were also comparable. While the V-Loc™180 was associated with improved early continence, this difference was transient.

Background/aims: The total mesorectal excision (TME) for rectal tumours was introduced in 1982 by Heald et al. and has led both to a 5% de crease of local recurrences 5 and 10 years after the operation when compared with cases treated with conventional surgery, and to an increase of survival up to five years estimated in 80% of all cases. In Italy TME was firstly introduced for distal rectal carcinomas about 20 years ago, and has shown the same rate of local recurrences reported by Heald. The aim of our work is to highlight TME advantages and demonstrate how this more demanding and longer lasting method has an acceptable risk for the surgery of rectal tumours., Methodology: We have compared two groups of patients operated for rectal carcinoma; the first, "historical control group" (no TME, including 46 patients) was treated with the standard surgery technique, while the second group (TME, 47 patients) underwent the total mesorectal excision technique. 14 of non TME patients belonged to Dukes stage A, 20 to stage B and 12 to C; whereas in the TME group 16 patients belonged to Dukes stage A, 23 to B and 8 to C. The patients of both groups undergone the exams of follow up (blood test, hepatic ultrasonography, abdominal CT, thorax Ro); the follow up pattern included periodic controls with a check-up every three and six months, from one to five years., Results: Postoperative complications in both groups do not show important differences in rates, although, the first group (no TME) had 11 cases with postoperative complications confronted with the 8 cases of the second group (TME). The complications taken into consideration were: anastomotic bleeding (3 patients no TME, 6% vs 1 patients TME, 2%), intestinal obstruction (1 patient no TME, 2% vs 1 patient TME, 2%), parietal infection (4 patients no TME, 9% vs 3 patients TME, 6%), anastomotic fistulae (2 patients no TME, 4% vs 2 patients TME, 4%), retention of urine and vesicular disorder (1 patient no TME, 2% vs 1 patient TME, 2%). Tumours closer to the anus have shown more complications compared with tumours at higher levels. As a matter of fact, 9 cases of no TME and TME patients with low located tumours have undergone complications compared with the 3 cases of no TME and TME patients with tumours being more distant from the anus; the rest 7 cases belonged to the middle rectum. A higher rate of local recurrences was noticed in the no TME group: 6 (13%) compared with the TME group: 3 (6%). Other tardy complications taken into consideration were: hepatic metastasis (5 patients no TME, 11% vs 4 patients TME, 8%), pulmonary metastasis (3, 6% of the no TME vs 2, 4% of the TME), anastomotic stenosis (4, 9% of the no TME vs 2, 4% of the TME), impotence (2, 4% of the no TME vs 1, 2% of the TME). We also noticed that most of the tardy complications in the TME group belonged to Dukes stage C., Conclusion: From our experience, we concluded that, in TME patients, complications are lower than in no TME patients; the site of the tumour affects the appearance of complications which are more frequently in distal localizations. An important result is the minor incidence of local recurrences after TME, which brings us to the conclusion that TME can be considered a valid method with an acceptable risk for the surgery of rectal tumour.

Background: A small percentage of patients undergoing laparoscopic adjustable gastric banding (LAGB) experience band slippage that might require subsequent surgical intervention. We present our experience with band slippage in 660 consecutive LAGBs performed since November 2001 in order to determine the optimal management for slipped gastric bands., Methods: The treatment options for patients with slipped bands include band removal, gastric reduction and reapplication of the original band, and band replacement. Data from electronic medical records, as well as telephone interviews, were collected and tabulated. The original weight and body mass index, weight and body mass index before the revisional procedure, and the most recent weight, body mass index, and percentage of excess weight loss are presented., Results: Of the 660 LAGB patients, 34 (5%) experienced band slippage and required 40 subsequent operative procedures. Of the 34 patients, 6 underwent multiple procedures for their slipped band. Overall, 10 removals, 13 gastric reductions, and 17 replacements were performed (40 total procedures). Of the 34 patients, 28 (82%) were available for follow-up. This group of 28 patients underwent 34 operative procedures (7 removals, 11 gastric reductions, and 16 replacements). No complications were associated with these 34 operations. Of the 11 patients with gastric reduction, 6 (55%) had subsequent recurrence of band slippage, resulting in 6 additional operations (5 replacements and 1 removal)., Conclusion: After band slippage, all 3 management options result in maintenance of most of the lost weight. However, because a large number of patients who undergo gastric reduction experience repeated slippage and require additional surgical intervention, gastric reduction should not be routinely performed in this population. Given the overall experience with revisional surgery after band slippage, additional investigation of the etiology of band slippage and its prevention is warranted.

The effect of 1-alpha-OHD3 on the rate of decline of renal function was studied in 18 patients with predialytic chronic renal failure. 9 patients with serum creatinine 4.19 +/- 1.63 mg/dl, were treated with 1-alpha-OHD3 0.4 +/- 0.11 micrograms/day and a low phosphate diet and 9 patients, with serum creatinine 3.69 +/- 1.24 mg/dl, received the low phosphate diet alone. In the first group retrospectively in 8 patients up to 3-44 months and prospectively in all patients reciprocal values of serum creatinine levels fell linearly with time. Comparison of the slopes of the regression lines before and following the start of treatment did not show statistical differences in 6 cases, in 1 case the decline of renal function improved significantly and in 1 case it became positive. Serum calcium increased significantly (p less than 0.025), alkaline phosphatase decreased (p less than 0.005) and serum iPTH decreased in 6 of 8 cases. In the low phosphate diet group, serum calcium, alkaline phosphatase did not change while iPTH increased in 8 of 9 cases. The rate of decline of renal function before treatment in 3 cases did not improve after the institution of the diet. In conclusion improvement or prevention of secondary hyperparathyroidism in predialytic chronic renal failure can be achieved with daily doses of less than or equal to 0.5 micrograms 1-alpha OHD and a low phosphate diet. The small increment in serum calcium levels induced by the treatment did not accelerate the deterioration of renal function while showing a better control of alkaline phosphatase and serum iPTH than the low phosphate diet alone.