Deep versus shallow decompression stops: illustration of different decompression strategies used in technical diving

IMPULSE OSCILLOMETRY IDENTIFIES DISTINCT ASTHMA PHENOTYPES ON CLUSTER ANALYSIS

Dive computers for mixed gas diving and PC software for decompression calculations are often considered as ‘black boxes’ to the diver: they perform part of their function – the calculation of a decompression schedule – but leave the user in a somewhat nebulous state about the relative safety of this schedule. This is because, in reality, the technology, underlying algorithms and utilised constants are not clearly documented, especially if the so-called gradient factors come into play. Gradient factors are sometimes praised as safety knobs for the decompression schedules, or as a unique selling proposition for these black boxes. This paper discusses the impact of gradient factors on the calculation of decompression times, as well as how the different implementations of dive profi le data can infl uence these calculations. With one inert gas in the breathing mixture, the analytical expression for the decompression time is td. However, if there is more than one inert gas present, the decompression time must be calculated numerically. Therefore 480 square diveprofi les were analysed in the technical/recreational diving range using one freeware, two commercially available software packages and one private software with numerical methods. There are signifi cant differences in the calculation of the decompression times with trimix gases, depending on the helium percentage. In the present analysis, these differences do not come from variations in the decompression algorithms but rather from different implementations of these numerical methods. Presently, a defi nitive answer cannot be given about the origin of these variations but the user should be aware that these exist.

Introduction: Cervical spine is the most mobile part of the human spine, thus making it the most vulnerable compared to all the other vertebral structures. Surgical procedures are usually performed within the first 24 hours, or 4-6 weeks after trauma in order to prevent any secondary trauma. The research was conducted to evaluate the amount of time of the surgical procedure towards the effectivity and improvement of the neurological status in the cervical injury or acute spinal cord injury (ASCI).Methods: A meta-analysis research which evaluate the effectivity of surgical procedure on cervical trauma/ASCI, with the database procured from PubMed, Embase, and Cochrane. The main parameter is the decompression procedure and the clinical outcome which were categorized. The time of surgery or decompression are categorized into “<24 hours” and “>24 hours”, the neurological outcome is categorized into “improvement” and “no improvement”. The data was presented in odd ratio (OR) and confidence interval (CI) and were further analyzed by forest plot.Results: From PubMed, there were 353 articles, Embase 2 articles, and Cochrane 594 articles, but only 3 articles which fulfilled the inclusion criteria. The comparison between the surgical procedure in the cervical <24 hours with the surgical procedure >24 hours was identified for this research. Statistically, there was a significant difference on the neurological status (OR=1,85; 95%CI=1,21-2,84; p<0,01).Conclusion: With meta-analysis background, early decompressive procedure <24 hours for cervical trauma patients produced a significantly better result in improving the neurological status compared to the late decompressive procedure >24 hours.

Previous studies have explored people's perceptions of weight-related terminology; however, to date, limited data has explored the emotional response to weight-related terms used by healthcare professionals (HCPs). This study explored the preferences and emotional responses of terms used by HCPs to describe body weight and of parents to describe their children's weight. A total of 2911 adults completed an online cross-sectional survey, with 1693 living with overweight or obesity (mean age 49.2 years [SD 12.5], female (96%), median body mass index (BMI) 31.4kg/m2 [28.1, 36.5]). The survey explored preferences of 22 weight-related terms using a 5-point Likert scale and their emotional response to these terms (using 7-core emotions). Parents also indicated preferences and emotional responses to terms used to describe their children's weight. Respondents completed the modified weight bias internalization scale to examine how this may impacted preferences. 'Weight', "unhealthy weight" and "overweight" were the three preferred terms, while "super obese", "chubby", and "extra-large" were least preferred in people living with overweight and obesity. Parents preferred 'weight', "unhealthy weight" and "body mass index", and least preferred "fat", "extra-large" and "extremely obese" when describing their children's weight. All terms elicited a negative emotional response. The most commonly emotion was sadness for terms to describe adult's bodyweight, and anger for terms used to describe children's weight. All BMI categories reported disgust with terms incorporating "obese". Our results offer novel insight into the preferred terminology and emotional responses to terminology used by HCPs for both adults and parents to describe their children's weight.

Obesity does not impact clinical outcome but affects cervical sagittal alignment and adjacent segment degeneration in short term follow-up after an anterior cervical decompression and fusion

Attendees of 15 health centers in urban and rural areas in the Riyadh region were screened for obesity during May and June 1994. Systemic selection yielded 1580 Saudi males for analysis. The mean age was 33.6 +/- 13.5 years and body mass index (BMI) was 26.9 +/- 5.7 kg/m(2). Only 36.6% of subjects were their ideal weight (BMI < 25 kg/m(2)), while 34.8% were overweight (BMI 25-29.9 kg/m(2)), 26.9% were moderately obese (BMI 30-40 kg/m(2)) and 1.7% were morbidly obese (BMI > 40 kg/m(2)). Middle age, lower education and joblessness predicted a higher risk for obesity. Patients living in a rural areas had greater BMIs than those living in urban areas (P <0.01). Forty percent of overweight participants did not think they were so. The high prevalence of obesity and the lack of awareness among those afflicted emphasizes the need for community-based programs for preventing and reducing obesity, since weight control is effective in ameliorating most of the disorders associated with obesity, such as Type II non-insulin-depedent diabetis mellitus, hypertension, stroke, heart disease, sleep apnea syndrome and osteoarthritis of the knees. Young parents who are at risk of developing obesity and who play a central role in perpetuating it in their offspring should be the target of obesity-prevention programs.

A comprehensive comparison of two commonly used BMI thresholds for non-communicable diseases and multimorbidity in the Chinese population.

Suprasellar meningiomas often invade the optic canals (OCs). The feasibility of removing these tumors through a minimal-access endonasal route has been demonstrated, but the importance, safety, and timing of OC exploration and decompression are not well described. To create a simple decision-tree algorithm for OC exploration and decompression in the endonasal endoscopic surgery for planum sphenoidale and tuberculum sella meningiomas. We identified a consecutive series of 8 planum sphenoidale and tuberculum sella meningiomas resected endonasally. "Late" OC exploration and decompression was performed in 4 of 8 patients. The extent of resection, visual outcome, and complications were recorded. Five patients had OC invasion on magnetic resonance imaging. Endoscopic inspection did not reveal additional OC invasion. The OC was opened bilaterally in 2 patients and unilaterally in 2 patients. Gross total resection was achieved in 6 of 7 patients in whom it was the goal. Vision improved in 3 patients (3 of 3 OCs opened) and was stable in 4 (1 of 4 OCs opened). In 1 patient, the bitemporal hemianopsia improved, but there was unilateral deterioration (no OC invasion) because the tumor was extremely adherent to 1 optic nerve. After an average follow-up of 20.9 months, all patients had an Glasgow Outcome Scale score of 5, and there were no cerebrospinal fluid leaks. Exploration and decompression of the OC are feasible, safe, and important to optimize visual outcome and to minimize recurrence in planum sphenoidale and tuberculum sella meningiomas resected endonasally. It may not be important to open the canal early during surgery because tumor debulking can be performed without manipulating the optic nerves. Early decompression, however, is technically feasible.

This study aims to evaluate a potential selection effect caused by exclusion of children with non-identifiable infancy peak (IP) and adiposity rebound (AR) when estimating associations between age and body mass index (BMI) at IP and AR and later weight status. In 4744 children with at least 4 repeated measurements of height and weight in the age interval from 0 to 8 years (37 998 measurements) participating in the IDEFICS (Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants)/I.Family cohort study, fractional polynomial multilevel models were used to derive individual BMI trajectories. Based on these trajectories, age and BMI at IP and AR, BMI values and growth velocities at selected ages as well as the area under the BMI curve were estimated. The BMI growth measures were standardized and related to later BMI z-scores (mean age at outcome assessment: 9.2 years). Age and BMI at IP and AR were not identifiable in 5.4% and 7.8% of the children, respectively. These groups of children showed a significantly higher BMI growth during infancy and childhood. In the remaining sample, BMI at IP correlated almost perfectly (r⩾0.99) with BMI at ages 0.5, 1 and 1.5 years, whereas BMI at AR correlated perfectly with BMI at ages 4-6 years (r⩾0.98). In the total study group, BMI values in infancy and childhood were positively associated with later BMI z-scores where associations increased with age. Associations between BMI velocities and later BMI z-scores were largest at ages 5 and 6 years. Results differed for children with non-identifiable IP and AR, demonstrating a selection effect. IP and AR may not be estimable in children with higher-than-average BMI growth. Excluding these children from analyses may result in a selection bias that distorts effect estimates. BMI values at ages 1 and 5 years might be more appropriate to use as predictors for later weight status instead.

Study question Does Body Mass Index (BMI) affect the semen parameter outcome after microsurgical varicocelectomy in infertile men? Summary answer BMI significantly affects the quality of semen parameters of infertile men with varicocele. However, it does not influence the outcome of varicocele repair. What is known already Varicocele is the most common correctable cause for male infertility. It has been proven that varicocele affects different semen parameters which can be corrected by varicocelectomy, thus restoring male fertility potential. Obesity is another well-known risk factor for male infertility. Both varicocele and obesity can affect semen parameters through similar pathophysiological mechanisms including hyperthermia and increased seminal oxidative stress. Although, varicocele was found to be negatively correlated with BMI, the effect of BMI on varicocele management was not investigated. Study design, size, duration This retrospective study of 1170 patients presenting with male factor infertility to a tertiary medical center over a period of 8 years. The inclusion criteria were patients who underwent microsurgical varicocelectomy for infertility. Patients with a genetic abnormality, history of chemotherapy or radiotherapy or leukocytospermia were excluded. Participants/materials, setting, methods 813 patients were recruited and grouped according to BMI international score into Group A (n = 251patients, BMI &amp;lt; 25kg/m2), Group B (n = 289patients, BMI 25-29.9kg/m2), Group C (n = 183patients, BMI 30-34.9kg/m2 ) and Group D (n = 90patients, BMI&amp;gt;34.9kg/m2) Semen analysis, sperm DNA fragmentation(SDF), hormonal profile were collected pre-and 3 months post-operatively. Chi-squared test, Spearman correlations and Mann-Whitney test were used for statistical analysis of the study data. p-value &amp;lt;0.05 was considered significant. Main results and the role of chance The patients’ mean age was 35.87±8.17 years. High-grade varicocele (II and III) was significantly more prevalent in the lower BMI groups (group A and B, p &amp;lt; 0.001). BMI showed significant negative correlation with sperm concentration (r=-196, p &amp;lt; 0.0001), total motility (r=-117, p = 0.001) and progressive motility (r=-107, p = 0.002). The basal pre-operative investigations showed significant difference between the obesity groups as regards sperm concentration (p &amp;lt; 0.001), total motility (p = 0.003) and progressive motility (p = 0.037). The more obese groups (Groups C and D) showed the poorest semen parameters. Postoperatively, all groups showed significant improvement in sperm concentration (A:p=0.03, B:0.01, C:&amp;lt;0.001, D:0.01). Total and progressive motility were only significant in Groups A (p = 0.06, &amp;lt;0.0001 respectively), B (p &amp;lt; 0.0001, 0.03 respectively) and C (p &amp;lt; 0.0001, &amp;lt;0.0001 repectively) while in Group D, total motility was improved clinically but did reach statistical significance (p = 0.07) and progressive motility didn’t show improvement. Morphology was significantly improved in only Group B (p = 0.02). There was no significant difference between the 4 groups as regards the median improvement of semen parameters postoperatively except for morphology which improved significantly more in the less obese patients (p = 0.002). Limitations, reasons for caution The main limitation is the retrospective design of the study. Wider implications of the findings In infertile patients with varicocele, obesity is an additional factor that leads to worse semen parameters, thus weight reduction may help in these cases. Clinicians should not be discouraged to go for varicocelectomy in obese patients based on the improvement in semen parameters post-varicocelectomy in all obesity groups. Trial registration number Not applicable

Ovine plasma dipalmitoylphosphatidylcholine does not predict decompression bubbling

BACKGROUNDOverweight children exhibit a higher prevalence of functional gastrointestinal disorders compared with their normal-weight peers, yet the underlying reasons remain unclear. Gastrointestinal motility, a key pathophysiological factor in functional gastrointestinal disorders, may be influenced by body mass index (BMI).AIMTo evaluate the impact of BMI on gastric motility parameters in children with functional abdominal pain disorders (FAPDs).METHODSWe assessed gastric motility in 176 children with FAPDs (61.4% females, mean age 7.94 years, SD 1.96 years) and 63 healthy controls (57.1% females, mean age 9.17 years, SD 1.90 years) at the Gastroenterology Research Laboratory, University of Kelaniya, Sri Lanka. FAPDs were diagnosed and subtyped using the Rome IV criteria: Functional abdominal pain 97 patients; irritable bowel syndrome 39 patients, functional dyspepsia (FD) 25 patients; and abdominal migraine 15 patients. Gastric motility was measured using a validated ultrasound method. Weight and height were measured using sensitive standard scales.RESULTSThe BMIs of children with FAPDs and controls were 15.04 and 15.46 kg/m², respectively (P = 0.33). Fasting antral area (FAA) and antral area at 1 min (AA1) and 15 min (AA15) were significantly greater in patients with FAPD with a higher BMI (2.71 cm², 12.57 cm², and 7.19 cm², respectively) compared with those with a lower BMI (2.12 cm², 10.68 cm², and 6.13 cm², respectively) (P < 0.01). BMI positively correlated with FAA and AA15 (r = 0.18 and r = 0.19, respectively) (P < 0.01) in those with FAPDs. In controls, only AA1 was greater in the higher BMI group (12.51 cm² vs 9.93 cm²) and had a positive correlation (r = 0.33) (P ≤ 0.01). Subgroup analysis revealed that in patients with FD, BMI negatively correlated with gastric emptying rate (GER) (r = -0.59) and antral motility index (MI) (r = -0.49), while in functional abdominal pain, MI positively correlated (r = 0.25) with BMI (P ≤ 0.01).CONCLUSIONIn children with FAPDs, higher BMI was associated with increased gastric antral distention during fasting and postprandial periods (as indicated by FAA, AA1, and AA15) but not with contractility and transit (MI, GER). However, in the FD subgroup, high BMI correlated with reduced GER and MI. This indicates the possible role of BMI in gastric hypomotility and the pathophysiology of FD. These findings underscore the importance of lifestyle and dietary interventions aimed at optimizing BMI in the management of FAPDs, particularly FD.

Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies

Predictors of disease-free survival in colorectal cancer with microsatellite instability: An AGEO multicentre study

SAT0049 Obesity is Associated with Reduced Improvement in Functional Disability After 1 Year of Treatment: Results from an Inception Early Rheumatoid Arthritis Cohort