Higher Weight Loss Rate Research Articles

Distal gastric bypass: 2-m biliopancreatic limb construction with varying lengths of common channel

BackgroundLong-term durability after Roux-en-Y gastric bypass is challenging in the super-obese population. Although lengthening of biliopancreatic limb (BPL) is associated with higher rates of weight loss, shortening of common limb (CL) is related to higher risk of malabsorption. ObjectivesIn this study, we aimed at evaluating the importance of the total alimentary limb length by creating a 2-m BPL diversion with varying CL lengths. SettingHigh-volume bariatric center, Norway. MethodsThree groups of patients (N = 187) with different limb lengths were included in this retrospective cohort-analysis as follows: group 1 (n = 69; Roux limb = 150 cm, BPL = 60 cm), group 2 (n = 88; BPL = 200 cm, CL = 150 cm), and group 3 (n = 30; BPL = 200 cm, CL = 200 cm). Weight loss, regain, and failure were analyzed along with malabsorption issues. ResultsPreoperative body mass index (BMI) was higher in group 2 (58.5, P < .001) and 3 (57.4) versus group 1 (54.6, P = .011). No other clinically significant differences between the groups were noted. Follow-up rate was 95% at year 2, 74% at year 5, and 52% at year 10. At 10-year follow-up, excess weight loss and total weight loss was higher in group 2 (70.4%; 40.3%) and 3 (64.0%; 35.9%) compared with group 1 (55.9%; 29.2%). Excess weight loss failure was higher in group 1 versus 2 (30% versus 8.3%, P < .001). No difference in short- or long-term complications was seen except higher occurrence of internal hernia in distal Roux-en-Y gastric bypass groups (11.4%, 6.7%). Vitamin and mineral deficiencies occurred more frequently the shorter the CL was. ConclusionSustainable weight loss in a long-term follow-up is achieved by shortening the total alimentary limb length with a 2-m BPL diversion that should not be attached <200 cm from the ileocecal junction owing to higher rates of internal hernia and vitamin and mineral deficiencies.

Evaluation of the Rapid Weight Loss Practices of Taekwando Athletes and Their Effects

This study was conducted to determine the physiological and psychological effects of the weight loss by determining the weight loss methods commonly used by taekwondo athletes. Of the questionnaires evaluated, 107 belonged to female taekwondo athletes and 195 belonged to male taekwondo athletes. The arithmetic average, standard deviation and percent frequency (%) distributions of the obtained data were calculated. It was determined that the; first weight loss age for the competition is 15,66±3,84(kg) in males and 15,95±3,16(kg) in females; the highest weight loss rate before the competition is 4,52±2,77 (kg) in males and 4,40±5,36 (kg) in females. It was stated that 30.3% of male athletes and 41.1% of female athletes start to lose weight 3-4 weeks before the competition, that male and female athletes prefer the diet method most frequently as a rapid weight loss method and 21.5% of athletes who use the weight loss method with fluid loss prefer to run with raincoat. The athletes do not use ergogenic aids and the frequency percentage of physiological (muscle cramps, body temperature increase, heart throb, dyspnea, injury) and psychological (excessive nervousness, low performance due to high fatigue, stress) adverse effects of fast weight loss is very low.Conclusion: Unlike other martial athletes, it has been determined that Taekwondo athletes do not start to lose weight at an early age and that the majority of them try to reach the weight they want by applying the diet method among rapid weight loss methods in a very short time before the competition.

Using within-day hive weight changes to measure environmental effects on honey bee colonies.

Patterns in within-day hive weight data from two independent datasets in Arizona and California were modeled using piecewise regression, and analyzed with respect to honey bee colony behavior and landscape effects. The regression analysis yielded information on the start and finish of a colony’s daily activity cycle, hive weight change at night, hive weight loss due to departing foragers and weight gain due to returning foragers. Assumptions about the meaning of the timing and size of the morning weight changes were tested in a third study by delaying the forager departure times from one to three hours using screen entrance gates. A regression of planned vs. observed departure delays showed that the initial hive weight loss around dawn was largely due to foragers. In a similar experiment in Australia, hive weight loss due to departing foragers in the morning was correlated with net bee traffic (difference between the number of departing bees and the number of arriving bees) and from those data the payload of the arriving bees was estimated to be 0.02 g. The piecewise regression approach was then used to analyze a fifth study involving hives with and without access to natural forage. The analysis showed that, during a commercial pollination event, hives with previous access to forage had a significantly higher rate of weight gain as the foragers returned in the afternoon, and, in the weeks after the pollination event, a significantly higher rate of weight loss in the morning, as foragers departed. This combination of continuous weight data and piecewise regression proved effective in detecting treatment differences in foraging activity that other methods failed to detect.

Body Mass Index, Weight Loss, and Cause-Specific Mortality in Rheumatoid Arthritis.

To examine associations of body mass index (BMI) and weight loss with cause-specific mortality in rheumatoid arthritis (RA). A cohort of US veterans with RA was followed until death or through 2013. BMI was categorized as underweight, normal, overweight, and obese. Weight loss was calculated as the 1) annualized rate of change over the preceding 13 months, and 2) cumulative percent. Vital status and cause of death were obtained from the National Death Index. Multivariable competing-risks regression models were utilized to assess the time-varying associations of BMI and weight loss with cause-specific mortality. Among 1,600 participants and 5,789 patient-years of followup, 303 deaths occurred (95 cardiovascular, 74 cancer, and 46 respiratory). The highest weight-loss rate and weight-loss percent were associated with a higher risk of cardiovascular mortality (rate: subdistribution hazard ratio [sHR] 2.27 [95% confidence interval (95% CI) 1.61-3.19]; percent: sHR 2.31 [95% CI 1.06-5.01]) and cancer mortality (rate: sHR 2.36 [95% CI 1.11-5.01]; percent: sHR 1.90 [95% CI 1.00-3.62]). Overweight BMI was protective of cardiovascular mortality (sHR 0.59 [95% CI 0.38-0.91]), while underweight BMI was associated with a near 3-fold increased risk of respiratory mortality (sHR 2.93 [95% CI 1.28-6.67]). Incorporation of time-varying BMI and weight loss in the same models did not substantially alter individual associations for cardiovascular and cancer mortality, but an association between weight-loss percentage and respiratory mortality was attenuated after BMI adjustment. Both BMI and weight loss are predictors of cause-specific mortality in RA. Weight loss is a strong predictor of cardiovascular and cancer mortality, while underweight BMI is a stronger predictor of respiratory mortality.

Low weight gain at the start of a family-based intervention for adolescent girls with restrictive eating disorders predicted emergency hospital admission.

This study examined predictors of emergency hospitalisation of adolescent girls with restrictive eating disorders and weight loss treated by a family-based intervention programme. We studied 339 girls aged 10-17years treated in a specialist unit at Uppsala University Children's Hospital, Sweden, from August 2010 to December 2015. Historical weight data were obtained from school health services, and other weight data were determined at presentation. Weight controlling behaviour was recorded, and patients were evaluated using the Eating Disorder Examination Questionnaire. A family-based intervention started after assessment and the early weight gain after one week, one month and three months was assessed. There were 17 emergency admissions of 15 patients for refusing food, progressive weight loss and medical instability. Logistic regression analysis showed that emergency admissions were predicted by a low body mass index standard deviation score at presentation (odds ratio 2.57), a high rate of weight loss before presentation (odds ratio 4.38) and a low rate of weight gain at the start of treatment (odds ratio 4.59). Poor weight gain at the start of a family-based intervention for adolescent girls with restrictive eating disorders predicted emergency hospital admission.

Analysis of pyrolysis characteristics and kinetics of Euphausia superba shell waste using TG-FTIR and distributed activation energy model

Pyrolysis of Euphausia superba shell waste (ESW) was investigated by using a thermogravimetric analyzer coupled with a Fourier transform infrared spectrometer (TG-FTIR). The kinetic parameters of pyrolysis reactions were obtained via the distributed activation energy model (DAEM). Experimental results showed that the temperature at which the highest weight loss rate occurred increased from 280 to 315 °C as the heating rate increased from 5 to 30 °C min−1. Almost all the volatiles were evolved between 300 and 350 °C, while CH4 and aliphatic C–H were also produced at higher-temperature regions. A large amount of CO2 was generated above 650 °C by the decomposition of carbonates, and it can be further reduced to CO by ESW char. CO2 was the main non-condensable product, and ketones were the dominating condensable products. The activation energy of pyrolysis reactions increased from 79 to 392 kJ mol−1 for conversion rates 0.13 to 0.54. The linear relationship between the natural logarithm of the frequency factor and activation energy was also established. The activation energy approximately followed Gaussian distribution, and the mean activation energy was 162 kJ mol−1.

Wood injury characteristics of fungi isolated from printing woodblocks of the Tripitaka Koreana in the Haeinsa Temple at Hapcheon, Republic of Korea

We investigated the wood-damaging characteristics of microorganisms by conducting decay tests on the surface of woodblocks made from the wood of Prunus sargentii, with the aim of identifying ways to preserve the woodblocks. The microorganisms were classified into 29 types of fungi and 6 types of bacteria. Among them 11 types of fungi showed high wood-degrading enzyme activity, and hence classified under risk levels 2–3. We also found that the anti-mold effect of P. sargentii was low, based on the finding that surface contaminants such as Eupenicillium rubidurum and Penicillium oxalicum grew on the P. sargentii specimen. In addition, these strains were grew on the surface of a lacquered P. sargentii specimen, and the anti-mold effect of the lacquer did not seem to correlate with the number of lacquer applications. The P. sargentii specimen was found to have a higher weight loss rate than a Pinus densiflora specimen, which indicated that the preservative effect of P. sargentii against Coprinellus radians was low. However, the weight loss rate of the lacquered P. sargentii specimen was low, and mycelium was not observed in the wood tissue. In conclusion, we believe that lacquer exerts a preservative effect on P. sargentii specimens.

Assessing the role of weight suppression (WS) and weight loss rate (WLR) in eating disorders

Introduction and aimsIn this study, we aim to assess the role of weight suppression (WS) in eating disorders, not only from a quantitative point of view but also assessing the speed of the weight loss by using a new parameter: the weight loss rate (WLR). We analysed the role of these two indexes in different eating disorders domains, considering both eating behaviours and outcome profiles.MethodsThe sample consisted of 414 patients, including 62 with AN binge purge subtype (ANBP), 146 with AN restrictive subtype (ANR) and 206 with bulimia nervosa (BN). Data about response to treatment were available for a subsample of 201 patients. A cross-sectional design was used for the clinical symptoms detected during the initial assessment and a longitudinal design was adopted for the response to treatment analysis.ResultsNo significant relationship emerged between both WS and WLR and variables collected at baseline assessment. We observed, on the contrary, a significant association between WS and weight gain at the end of treatment. High WLR predicted remission of binge eating and compensatory behavior in BN patients. We further analyzed our data to identify threshold values of both WS and WLR of clinical utility.ConclusionsThe role of WS and WLR as predictive factors in the outcome of eating disorders is of great interest and these initial results remark the usefulness of collecting these data during the initial assessment in order to plan a tailored therapeutic intervention.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Pyrolysis Characteristics of Vitrinites in Coking Coals with Different Coal Ranks

ABSTRACTThe vitrinite-rich concentrates were produced from five coking coals with different ranks (Donghuantuo gas coal, Tangshan 1/3 coking coal, Zhongliu fat coal, Hongsheng coking coal, and Lvjiatuo coking coal) by float-sink separation under centrifugal force. The relationships of the pyrolysis characteristics of raw coals (RC) and vitrinite-rich concentrates (VC) with the coal rank and elemental composition were studied by thermogravimetric analysis and ultimate analysis. The results show that vitrinite-rich concentrate have greater weight loss and a higher weight-loss rate than the corresponding raw coals. Also, VCs have higher H, C, and N content and lower O and S content. With an increase of coal rank, the weight-loss rate (ΔTG) and maximum weight-loss rate (DTGmax) of VC decreases, and the temperature with DTGmax (Tmax) of VC increases, and the C/H ratio of VC also increases. The analysis of thermogravimetric parameters and elemental composition of VC shows that the ΔTG and DTGmax decrease linearly with the C/H ratio, and Tmax increases linearly with the C/H ratio.

Effect of Ternary Eutectic Salt on the Calcium Sulfate Oxygen Carrier for Chemical Looping Combustion of Coal Char

AbstractThe effect of a ternary eutectic salt (43.5 % Li2CO3–31.5 % Na2CO3–25 % K2CO3) on the CaSO4 oxygen carrier for chemical looping combustion (CLC) of coal char is experimentally investigated in a bench‐scale fluidized‐bed reactor with steam as the gasification agent at atmospheric pressure and 925 °C. The ternary eutectic catalyst is added to the CaSO4 oxygen carrier by physical mixing and impregnation, respectively. The enhanced carbon conversion and shortened reaction time in the fluidized bed reactor, coupled with the high weight loss rate of CaSO4 reduction with CO in the thermogravimetric analyzer (TGA), suggest that the reactions of coal char gasification and CaSO4 reduction are synergistically catalyzed in the presence of the ternary eutectic salt. The modified oxygen carriers prepared by physical mixing and impregnation show no significant difference in carbon conversion and gasification rates according to the experimental results. The sample with catalyst impregnated into the mixture of anhydrite and coal char gives higher activity compared to the samples with catalyst impregnated into the coal char or anhydrite solely, due to the more uniform distribution of the catalyst.

Non-isothermal pyrolysis of de-oiled microalgal biomass: Kinetics and evolved gas analysis

Non-isothermal (β=5, 10, 20, 35°C/min) pyrolysis of de-oiled microalgal biomass (DMB) of Chlorella variabilis was investigated by TGA-MS (30–900°C, Argon atmosphere) to understand thermal decomposition and evolved gas analysis (EGA). The results showed that three-stage thermal decomposition and three volatilization zone (100–400°C, 400–550°C and 600–750°C) of organic matters during pyrolysis. The highest rate of weight-loss is 8.91%/min at 302°C for 35°C/min heating-rate. Kinetics of pyrolysis were investigated by iso-conversional (KAS, FWO) and model-fitting (Coats-Redfern) method. For Zone-1and3, similar activation energy (Ea) is found in between KAS (α=0.4), FWO (α=0.4) and Avrami–Erofe’ev (n=4) model. Using the best-fitted kinetic model Avrami–Erofe’ev (n=4), Ea values (R2=>0.96) are 171.12 (Zone-1), 404.65 (Zone-2) and 691.42kJ/mol (Zone-3). EGA indicate the abundance of most gases observed consequently between 200–300°C and 400–500°C. The pyrolysis of DMB involved multi-step reaction mechanisms for solid-state reactions having different Ea values.

Bariatric Surgery for Patients With Early-Onset vs Late-Onset Type 2 Diabetes

The prevalence of early-onset type 2 diabetes mellitus (T2DM), which responds poorly to medical treatment, is increasing. Bariatric surgery has been well recognized for its effectiveness in the remission of T2DM, but its effectiveness and durability in the remission of early-onset T2DM has not yet been explored. To compare the short- and long-term outcomes of bariatric surgery with a specific focus on the rate of remission of T2DM in patients with early-onset (age <40 years) and late-onset (age ≥40 years) T2DM. In this cohort study, 558 Taiwanese patients (339 with early-onset T2DM and 219 with late-onset T2DM) with a body mass index (calculated as weight in kilograms divided by height in meters squared) above 25 underwent bariatric surgery to ameliorate T2DM between January 1, 2007, and December 31, 2013. Patients were followed up for at least 1 year. Preoperative, perioperative, and postoperative clinical and laboratory data were prospectively collected and compared between the 2 groups. Rate of remission of T2DM (hemoglobin A1C <6.0% without antiglycemic medication) was the primary outcome measure. Of the 558 patients (345 women) in the study, mean (SD) ages were 33.5 (7.5) for those with early-onset T2DM and 50.6 (6.5) with late onset T2DM. Those with early-onset T2DM had higher mean (SD) preoperative BMI and hemoglobin A1C values (39.4 [8.5] and 8.7% [3.8%] of total hemoglobin [to convert hemoglobin to a proportion of total hemoglobin, multiply by 0.01], respectively) than did patients with late-onset T2DM (36.7 [7.5] and 8.2% [1.6%], respectively). Distribution of surgical procedures and major complications were similar between the 2 groups. At 1 year, patients with early-onset T2DM achieved greater weight loss than those with late-onset T2DM, although the difference was not statistically significant. A higher rate of complete remission of T2DM was observed in patients with early-onset T2DM than in those with late-onset disease (193 [56.9%] vs 110 [50.2%]; P = .02). At 5 years, patients with early-onset T2DM still maintained a higher rate of weight loss (mean [SD], 30.4% [11.8%] vs 21.6% [11.7%]; P = .002) and higher rate of remission (47 of 72 [65.3%] vs 26 of 48 [54.2%]; P = .04) than did those with late-onset disease. Age at bariatric surgery, duration of T2DM, and preoperative C-peptide level were independent predictors of remission. The remission rate was directly related to extent of weight loss. Multivariate analysis confirmed the higher rate of remission in the group with early-onset T2DM. This article describes the largest long-term study examining bariatric surgery for patients with early-onset T2DM. Bariatric surgery may achieve better and more long-lasting glycemic control in select patients with early-onset T2DM than in those with late-onset T2DM.

Intensive lifestyle intervention provides rapid reduction of serum fatty acid levels in women with severe obesity without lowering omega-3 to unhealthy levels.

SummarySerum fatty acid (FA) levels were monitored in women with severe obesity during intensive lifestyle intervention. At baseline, total FA levels and most individual FAs were elevated compared to a matching cohort of normal and overweight women (healthy controls). After 3 weeks of intensive lifestyle intervention, total level was only 11–12% higher than in the healthy controls and with almost all FAs being significantly lower than at baseline, but with levels of omega‐3 being similar to the healthy controls. This is contrary to observations for patients subjected to bariatric surgery where omega‐3 levels dropped to levels significantly lower than in the lifestyle patients and healthy controls. During the next 3 weeks of treatment, the FA levels in lifestyle patients were unchanged, while the weight loss continued at almost the same rate as in the first 3 weeks. Multivariate analysis revealed that weight loss and change of serum FA patterns were unrelated outcomes of the intervention for lifestyle patients. For bariatric patients, these processes were associated probably due to reduced dietary input and increased input from the patients’ own fat deposits, causing a higher rate of weight loss and simultaneous reduction of the ratio of serum eicosapentaenoic to arachidonic acid.

Onion (Allium cepaL.) bulbs are most sensitive to base plate impacts

Although onion bulbs have one of the highest storage potentials under ambient conditions of any vegetable, physical impacts to bulbs during mechanical postharvest handling can reduce this capacity. This presents a significant challenge in production systems that rely on mechanised harvesting and handling operations to remain economically competitive. In this study, the respiration rate of onions sampled immediately after travelling over a commercial packing and grading line was elevated compared with pre-graded samples. Elevated respiration rate was linked to a higher rate of weight loss and reduced storage potential. Controlled impacts applied to individual bulbs also increased the rate of bulb respiration and internal sprout growth. Bulbs were more sensitive to impacts to the base plate than to impacts to the equator or neck. Environmental scanning electron microscopy revealed intra-cellular disruption within the scales where bulbs were impacted on the equator. No physical damage could be distinguished in bulbs impacted on the base plate. Minimising postharvest respiration rate of mature bulbs is recommended for long-term storage. Furthermore, it is recommended that the design of handling equipment consider both impact magnitude and position.

Long term oxidation behavior of micro- and nano-crystalline CVD diamond foils

Nano- and micro-crystalline diamond foils with a thickness of at least 30μm are manufactured by hot-filament chemical vapor deposition (HFCVD) in an industrial coating machine. Some of them are doped with trimethylborate. The diamond foils are exposed to air at 450°C and 500°C and oxidized for up to 738h. At these temperatures all investigated diamond foils exhibit a substantial weight loss, which is measured with a high precision balance. Nanocrystalline diamond foils show a high weight loss rate compared to microcrystalline diamond foils. At 500°C the weight loss rate is two to seven times higher than that at 450°C. Grain boundaries and small diamond crystals are etched much faster than larger diamond crystal. The incorporation of boron does not significantly affect the oxidation of the diamond foils.

Alkaline hydrolysis and pretreatment of trilobal high dimethyl 5-sulfoisophthalate sodium cationic dyeable polyester

Lower glass transition temperature and crystallinity degree of trilobal high dimethyl 5-sulfoisophthalate sodium cationic dyeable polyester (THCDP) led to its more sensitivity to strong alkali and high temperature than regular Poly(ethylene terephthalate) (PET). The kinetic behaviors of alkaline hydrolysis of THCDP and PET were further explored, and the kinetics equations determined by regression analysis manifested that THCDP with high content of dimethyl 5-sulfoisophthalate sodium salt (SIP) was more prone to alkali hydrolysis and had higher weight loss rate. A comparatively lower power consumption pretreatment process of THCDP knitted fabrics benefited from the synergistic effect of various additives was applied in this study by response surface methodology and the optimum process with less auxiliaries, especially with less caustic treatment avoided large strength loss of fabric, as well as lower manufacturing cost in an environmentally friendly way.

Association of browning in ‘Thompson Seedless’ table grapes with cracking enhanced by application of organophosphate insecticides

Sporadic occurrences of symptoms termed ‘streak browning’ (SB) in ‘Thompson Seedless’ grapes have been observed for years in the Lachish region of Israel. It was not until 2010 and 2011 that this issue became a threat to ‘Thompson’ growers, with damage soaring to 50% in some vineyards. The damage was mainly superficial and characterized by elongated parallel brown streaks, which reduced the value of the fruit to below commercial value. The first symptoms usually were seen after véraison, and they intensified during fruit ripening. Microscope observations revealed superficial microcracking at the center of each streak, suggesting that these cracks were responsible for the SB. A survey of over 100 ‘Thompson’ vineyards in the affected region showed correlation between the level of SB and poor air movement and/or light penetration. Spatial distribution of clusters with SB within the vineyard was non-random. Several lines of evidence suggested that high berry firmness was an important precondition for formation of SB, and such berries also were found to have higher soluble solids than undamaged ones. Among detached berries those with SB suffered higher rates of weight loss. Another important observation was that there was more damage in the back and bottom parts of the cluster. This pattern led to the hypothesis that SB was aggravated by foliar sprays which are slower to dry in the back part of the clusters. Dipping detached berries in solutions of organophosphate insecticides showed that they enhanced the cracking, suggesting that they have the potential to damage to the skin during repeated exposures. Spraying clusters with two organophosphate insecticides enhanced SB formation, but so also did the water control, albeit to a lower extent. The results suggest that SB can be formed on firm berries and that commercial formulations of organophosphate insecticides applied after véraison might induce microcracking and subsequent SB symptoms.

Increased P-wave dispersion a risk for atrial fibrillation in adolescents with anorexia nervosa

ABSTRACTStudies have shown that a prolonged P-wave dispersion is a risk factor for the development of atrial fibrillation. The aim of this study was to evaluate P-wave dispersion in adolescents with anorexia nervosa at diagnosis. We evaluated electrocardiographic findings, particularly the P-wave dispersion, at initial assessment in 47 adolescents with anorexia nervosa. Comparison of P-wave dispersion between adolescents with anorexia nervosa and controls showed a statistically significant higher P-wave dispersion in patients with anorexia nervosa (72 ± 16.3 msec) when compared to the control group (43.8 ± 9.5 msec). Percent of body weight lost, lower body mass index, and higher weight loss rate in the patients with anorexia nervosa had no effect on P-wave dispersion. Due to the fact that anorexia nervosa has a high mortality rate we believe that cardiac pathologies such as atrial fibrillation must also be considered in the medical evaluation.

Thermogravimetric and Kinetics of Thermal Degradation of Powdered Laboratory Examination Gloves: 2. Analysis of Isotherm and Thermal Scan Traces from 307-455⁰C

The kinetics of pyrolysis of powdered laboratory safety examination gloves (PLEG) by the thermogravimetric analysis (TGA) was studied and the corresponding parameters were evaluated. Original Research Article Hamidi et al.; BJAST, 6(4): 316-334, 2015; Article no.BJAST.2015.091 317 The goal was to look for approaches to save the condensed energy within the PLEG wastes in order to reduce the environmental pollution caused by an ever increasing amount of laboratory safety examination gloves (LEG) in the landfills. The study was conducted in the Department of Biological and Physical Sciences at South Carolina State University (SCSU), Orangeburg, SC, USA, during the spring and summer of 2014. Twelve TGA experiments were performed on twelve samples of PLEG under three distinct conditions. From the thermal scans and isotherms, the highest rate of weight loss, the temperature at the maximum weight loss, the apparent order of reaction (wlo), the apparent rate constant (k) and the apparent activation energy of weight loss (Ea) were estimated. The experimental results confirmed keeping the PLEG in temperatures near to 340°C for a period of 30 min resulted in production of new materials with more thermal stability than the original PLEG.

The Impact of Medical Comorbidities in MPN-Related Fatigue

Background:Philadelphia chromosome negative myeloproliferative neoplasms (MPN) include myelofibrosis (MF), polycythemia vera (PV), and essential thrombocythemia (ET). Pertinent to these disorders is the high persistence, prevalence, and severity of fatigue. Overall, excessive fatigue compared to age and gender matched controls occurs in greater than 95% of MPN patients (Blood. 2011;118(2):401-8). Physiologic etiologies of fatigue in these patients include cytokine dysregulation and impaired hematopoiesis, however to date no one has investigated the impact that cofounding medical illnesses have on MPN fatigue burden.Methods:A 70-item internet-based survey was developed by a team of MPN investigators, patient advocates from MPN Forum, and hosted by the Mayo Clinic Survey Research Center. The survey was promoted online via multiple MPN-related webpages including the MPN Forum, MPN Net, MPN Research Foundation, and MPN Voice during late February to March of 2014. Surveyed data included disease demographics such as splenomegaly, thrombosis, hemorrhage transfusions, medications, and phlebotomies. The MPN-SAF (including the MPN 10) was utilized including the 10-item brief fatigue inventory was used to assess disease burden (Blood. 2011 Jul 14;118(2):401-8). Comorbid conditions were assessed, including hypothyroidism, anemias, sleep disturbances, obesity, and heart and lung disorders.Data:Demographics. Overall 1788 MPN patients participated in the survey. Of these, 1676 consented to participate and provided additional data (i.e., completed at least 10 questions). Of these, 555 (33%) patients had ET, 651 (39.0%) had PV, and 417 (25.0%) had MF. Among MF patients, 44.1% had primary MF, 29.7% had post-PV MF, and 26.2% had post-ET MF. Respondents were 68% female with a mean age of 59. Overall brief fatigue inventory score had a mean of 4.4 (range 0-10). MPN-10 score average was 28.4 (range 0-83).Medical Comorbidities. Overall, many patients endorsed having comorbid medical diseases that could contribute to overall fatigue (Table1). Overall 20.2% of patients endorsed having low thyroid function, with 10% indicating they obtained this diagnosis in the last six months. Twenty three percent endorsed having a new sleep disturbance in the last six months. On average, patients tended to have an average to above average BMI (mean =26.3, median = 25.0). However, many patients also experienced a high rate of unintended weight loss (11.8% with >11lb weight loss in the last 6 months). Cytopenias were also frequently encountered, with 14.7% of participants having required previous transfusions. Among these, 46% required transfusions in the last 6 months. Thrombosis (18.3%), hemorrhage (14.7%), and anemia (48.0%) were relatively common. In the last six months, 11.1% of patients required iron supplementation and 2.2% required erythropoietin injections. Many patients also endorsed the use of medications that could contribute to overall fatigue.Correlations. Items significantly correlated with worsened fatigue score (BFI greater than or equal to four) included female gender (<0.001), age (p=0.0047), lower education level (<0.001) and lower BMI (<0.001). Current use of alcohol and tobacco was also significantly associated with greater burden of fatigue (<0.001 and 0.0025, respectively). Items not significantly associated with fatigue included DIPSS (MF only), IPSET (ET only) or PV risk scoring.ConclusionsOverall patients with MPN experience an exclusive pattern of disabling fatigue. Many fatigue-related medications and medical comorbidities may contribute to the debilitating fatigue seen among MPN patients, although no specific comorbidities could account for the high prevalence of fatigue. Rates of comorbid disease burden varied widely compared to the general population. For some diseases including diabetes, rates among MPN populations were less than the general population (National Diabetes Statistics Report, 2014), however the rates of other comorbidities, such as hypothyroidism, were higher (J Clin Endocrinol Metab 2002;87:489–99). Similar to our previous studies, females tended to suffer from a higher mean fatigue burden than males (Geyer ASH 2014). Clinical and research-related determination of fatigue should take into account cofounding comorbid medical conditions that can contribute to overall fatigue burden. [Display omitted] DisclosuresHarrison:Novartis: Consultancy, Honoraria, Research Funding, Speakers Bureau; Sanofi: Honoraria, Speakers Bureau; Shire: Speakers Bureau; CTI: Consultancy; YM Bioscience: Consultancy; Gilead: Consultancy; SBio: Consultancy. Mesa:Incyte: Research Funding; Novartis: Consultancy; Gilead: Research Funding; Genentech: Research Funding; Promedior: Research Funding; Ns Pharma: Research Funding; Celgene: Research Funding; Lilly: Research Funding; Cti: Research Funding.