Nonsurgical Control Group Research Articles

Post-operative cognitive dysfunction at 3 months in adults after non-cardiac surgery: a qualitative systematic review.

Post-operative cognitive dysfunction is defined as a decline in cognitive functions that occurs after surgery, but different diagnostic criteria and incidences have been reported in medical literature. Our aim was to determine incidence of post-operative cognitive dysfunction 3 months after non-cardiac surgery in adults. A systematic review of available evidence was performed by PRISMA guidelines. A search was done in May-July 2015 on PubMed, EMBASE, CINAHL, LILACS, Scielo, Clinical Trials, and Grey Literature Reports. Inclusion criteria were prospective design studies with patients over 18 years old, surgery under general or regional anesthesia, follow-up for 3 months, and use of a neurocognitive battery for diagnosis. We excluded studies made on cardiac or brain surgery patients. Risk of bias was assessed using tools from National Heart Lung and Blood Institute. We selected 24 studies. Average age was 68 years. Only five studies reported incidence of cognitive decline for a non-surgical control group. Median number of tests used was 5 (range 3-13). Pooled incidence of post-operative cognitive dysfunction at 3 months was 11.7% [95% CI 10.9-12.5] but with several methodological differences between studies. Increasing age was the most consistent risk factor identified (seven studies). Post-operative cognitive dysfunction in patients is frequent, especially in patients over 60 years old. Limitations include methodological differences in studies. Efforts must be made to reach a consensus in definition and diagnosis for future research.

Changes in knee joint load indices from before to 12 months after arthroscopic partial meniscectomy: a prospective cohort study

Patients undergoing arthroscopic partial meniscectomy (APM) are at increased risk of knee osteoarthritis (OA). Meniscal damage and/or surgery may alter knee joint loading to increase OA risk. We investigated changes in knee joint loading following medial APM surgery, compared with the contra-lateral leg. We estimated indices of knee joint loading (external peak knee adduction moment (KAM), KAM impulse and peak knee flexion moment (KFM)) normalized to body size (i.e., body mass (BM) and height (HT)) using 3D gait analysis in 23 patients (17 men, mean (SD) 46.2 (6.4) years, BMI 25.8 (3.4)kg/m(2)) without radiographic knee OA before and 12 months after medial APM. Static alignment was assessed by radiography and self-reported outcomes by Knee injury and Osteoarthritis Outcome Score (KOOS). Peak KAM and KAM impulse increased in the APM leg compared to the contra-lateral leg from before to 12 months after surgery (change difference: 0.38Nm/BM*HT% 95% CI 0.01 to 0.76 (P=0.049) and 0.20 Nm*s/BM*HT% 95% CI 0.10 to 0.30 (P<0.001)). Patients self-reported improvements on all KOOS subscales (KOOS pain improvement: 22.8 95% CI 14.5 to 31.0 (P<0.01)). A relative increase in indices of medial compartment loading was observed in the leg undergoing APM compared with the contra-lateral leg from before to 12 months after surgery. This increase may contribute to the elevated risk of knee OA in these patients. Randomized trials including a non-surgical control group are needed to determine if changes in joint loading following APM are caused by surgery or by changes in symptoms.

Relationship Between Bariatric Surgery and Bone Mineral Density: a Meta-analysis.

A meta-analysis regarding bone loss after bariatric surgery, designed to compare surgical and nonsurgical groups, has not yet been performed. Therefore, we performed a meta-analysis to compare the differences between bariatric surgical groups and nonoperated controls with regard to bone mineral density. In March 2015, we performed a review of the literature using PubMed, EMBASE, and the Cochrane Library. The search focused on retrospective and prospective studies, including but not limited to randomized studies published in English. Among 1299 studies that were initially screened, ten met the selection criteria. For all types of bariatric surgery, bone density at the femoral neck was lower in the surgical group than in the nonsurgical control group (mean difference [MD] -0.05g/cm(2); 95% confidence interval [CI], -0.07 to -0.02; p = 0.001); no difference in bone density was found between the two groups at the lumbar spine (MD -0.01g/cm(2); 95% CI -0.07 to 0.05; p = 0.661). The analysis of Roux-en-Y gastric bypass showed similar results. Bone density at the femoral neck decreased after bariatric surgery, compared to that in nonsurgical controls, whereas bone density at the lumbar spine did not show a difference between groups. Further larger scale studies with comparative nonsurgical controls are warranted to overcome the heterogeneity among studies in this analysis and to add evidence of possible bone loss subsequent to bariatric surgical procedures.

Rapid review: sinonasal surgery vs. medical therapy for asthma in patients with chronic rhinosinusitis with or without nasal polyps.

The objective of the study was to compare the effect of sinonasal surgery vs. medical treatment on asthma in patients with chronic rhinosinusitis with or without nasal polyps. We executed a PRISMA guidelines-based systematic search of the following databases: PubMed, CENTRAL, Embase, Scopus and CINAHL. The search ran from database inception until 26 Feb 2014. We included controlled clinical trials comparing surgical intervention with medical intervention in patients with chronic rhinosinusitis with or without nasal polyps. We included only English papers. We used a pre-defined data collection form. Two authors independently assessed study quality. We assessed directness of evidence and risk of bias using pre-defined criteria. Our search yielded 2004 original articles, six of which satisfied our inclusion criteria. One article was excluded from further review because no comparison could be made of the subgroup of operated asthmatic patients versus the non-surgical control group. Only one study used objective pulmonary function measurements in asthmatics undergoing sinonasal surgery and therefore had the highest directness of evidence. Also it had a low risk of bias. Patient characteristics, treatments and outcome measures varied across studies, as did the observed effect. Risk of bias was high in most studies. Patient characteristics, treatment and outcome measurement differed across studies, making a comparison of the effects difficult. There is a risk of publication language bias. There is insufficient evidence either for or against sinonasal surgery for asthma control as compared to medical treatment.

Quality of Life After Sphincter-Preserving Rectal Cancer Resection

BackgroundWith an increasing number of cancer survivors quality of life (QoL) becomes more and more important in the treatment of rectal cancer (RC). QoL after sphincter-preserving anterior resection (AR), however, was found nonsuperior to abdominoperineal resection. The aim of our study was to evaluate QoL after AR compared with colon cancer patients after right hemicolectomy (CC) and healthy lay persons without history of cancer (HL) in long-term follow-up. Patients and MethodsConsecutive alive RC patients (n = 293) who received an AR between 1998 and 2008 were included. CC patients (n = 201) and HL of the same age were used as a surgical and a nonsurgical control group, respectively. QoL was assessed using European Organization of Research and Treatment of Cancer questionnaires QLQ-C 30 and -CR 38. ResultsQuestionnaires from 116 RC patients, 105 CC patients, and 103 HL were evaluable with a median time after surgery of 5 years. The global health status did not differ. Social functioning, future perspectives, and financial difficulties tended to poorer scores in the cancer groups. Physical functioning was better in RC and CC patients compared with HL. Defecation problems and diarrhea were more frequent in RC patients (P < .05). An additional open question revealed a median stool frequency of 3, 2, and 1 per day for RC, CC, and HL, respectively. Defecation problems were more frequent in RC patients who received radiation therapy (P < .05). ConclusionDiarrhea and defecation problems impaired QoL after AR for RC, which was worsened after radiation therapy. To improve QoL of RC patients in the future, physicians have to focus on minimization of gastrointestinal side effects while optimizing surgical reconstruction.

Incidence and risk factors for postoperative cognitive dysfunction in older adults undergoing major noncardiac surgery: A prospective study.

Background & Aims:Postoperative cognitive dysfunction (POCD) is a decline in cognitive function that occurs after surgery. The purpose of this study was to estimate the incidence and identify potential risk factors of POCD in older adults undergoing major noncardiac surgery.Materials and Methods:A total of 69 patients aged 65 years or older undergoing major noncardiac surgery were enrolled. Patients’ cognitive function was assessed before and 3 months after surgery using a computerized neurocognitive battery. A nonsurgical control group of 54 older adults was recruited to adjust for learning effects from repeated administration of neurocognitive tests. Data about potential risk factors for POCD were collected before, during, and after surgery, including patient, medication, and surgery factors. The incidence of POCD was calculated using the Z-score method. A multivariable logistic regression model was used to identify risk factors for POCD.Results:POCD was present in eleven patients (15.9%, 95% confidence interval [CI] = 7.3-24.6) 3 months after major noncardiac surgery. Carrying the apolipoprotein E4 (APOE4) genotype (odds ratio [OR] = 4.74, 95% CI = 1.09-22.19), using one or more highly anticholinergic or sedative-hypnotic drugs at home prior to surgery (OR = 5.64, 95% CI = 1.35-30.22), and receiving sevoflurane for anesthesia (OR = 6.43, 95% CI = 1.49-34.66) were associated with the development of POCD.Conclusions:POCD was observed in 15.9% of older adults after major noncardiac surgery. Risk factors for POCD in these patients were carrying the APOE4 genotype, using one or more highly anticholinergic or sedative-hypnotic drugs prior to surgery, and receiving sevoflurane for anesthesia.

Vitamin K1 monitoring in pregnancies after bariatric surgery: a prospective cohort study

BackgroundNeonatal intracranial bleedings and birth defects have been reported, possibly related to maternal vitamin K1 deficiency during pregnancy after bariatric surgery. The objective of this study was to investigate the effects of screening and supplementation on K1 serum levels in pregnant women with bariatric surgery, and to compare K1 levels and prothrombin time (PT %) in the first trimester with pregnant women without bariatric surgery. MethodsA prospective cohort study including 49 pregnant women with bariatric surgery. Nutritional deficiencies were prospectively screened. In case of observed low K1 serum levels, supplementation was provided. K1 serum levels and PT (%) during the first trimester were compared with a nonsurgical control group of 27 women. ResultsDuring the first trimester, most women had low K1 serum levels (<0.8 nmol/l). Mean vitamin K1 levels were significantly lower in the surgical group compared to the nonsurgical control group (.44 versus .64 nmol/l; P = .016). PT (%) remained in the normal range, The surgery group showed a higher mean PT compared to the controls (111.3 versus 98.9%; P<.001) Mean K1 serum levels in the study group were higher during the third than during the first trimester (P = .014). PT (%) was significantly higher during the second and third than during the first trimester (P = .004). Most of the coagulation factors, including II, V, VII, IX, and X, remained within normal ranges. ConclusionLow circulating K1 appears to be common in pregnant women with and without bariatric surgery. Supplementation during pregnancy can restore vitamin K1 in women with bariatric surgery, potentially protecting the fetus and newborn against intracranial hemorrhage.

Chronic complaints after ankle sprains: a systematic review on effectiveness of treatments.

Systematic review. Objective To determine the effectiveness of treatments for patients with chronic complaints after ankle sprain. Though most people recover completely after a lateral inversion ankle injury, a considerable percentage have persistent complaints. Currently, it is still unclear which treatment options are best for these patients. Major databases, including PubMed, Embase, CINAHL, and PEDro, were searched for randomized controlled trials and controlled clinical trials conducted from 1966 to October 2012. Due to clinical heterogeneity, the data were analyzed using a best-evidence synthesis. A total of 20 randomized controlled trials and 1 controlled clinical trial were included in the analysis. The included studies compared different treatments (training programs, physiotherapy, chiropractic/manual therapy, surgery, postoperative training, and functional treatment). For pain and function outcomes, limited to moderate evidence was found for effectiveness of a training program compared to conservative treatment. Two studies found a decrease of recurrences after a proprioceptive training program. Four studies showed good results for different surgical methods but did not include a nonsurgical control group for comparison. Limited evidence was found for the effectiveness of an early mobilization program after surgery. In chronic ankle complaints after an ankle sprain, a training program gives better results for pain and function, and a decrease of recurrent ankle sprains, than a wait-and-see policy. There was insufficient evidence to determine the most effective surgical treatment, but limited evidence suggests that postoperative, early mobilization was more effective than a plaster cast. Therapy, level 1a-.

Effects on Cognition of Conventional and Robotically Assisted Cardiac Valve Operation

The effect of valve surgical procedures on cognition was investigated in patients undergoing conventional or robotically assisted techniques. The confounding factors of surgical procedure, mood state, preexisting cognitive impairment, and repeated experience with cognitive tests were controlled for. Patients undergoing conventional valve procedures (n = 15), robotically assisted valve procedures (n = 15), and thoracic surgical procedures (n = 15), along with a nonsurgical control group (n = 15) were tested preoperatively, 1 week after operation, and 8 weeks after operation by use of a battery of cognitive tests and a mood state assessment. Surgical group data were normalized against data from the nonsurgical control group before statistical analysis. Patients undergoing conventional valve procedures performed worse than those undergoing robotically assisted valve procedures on every subtest before operation, and this disadvantage persisted after operation. Age and premorbid intelligence quotient were significantly associated with performance on several cognitive subtests. Anxiety, depression, and stress were not associated with impaired cognitive performance in the surgical groups after operation. A week after operation, patients undergoing conventional valve procedures performed worse on the cognitive tests that had a motor component, which may reflect discomfort caused by the sternotomy. Patients undergoing robotically assisted valve procedures were significantly less impaired on information processing tasks 1 week after operation when compared with those undergoing conventional valve procedures. The majority of patients who were impaired 1 week after operation recovered to preoperation levels within 8 weeks. The robotically assisted valve surgical procedure results in more rapid recovery of performance on cognitive tests. However, regardless of the type of surgical intervention, the prospect of a recovery of cognitive performance to preoperative levels is high.

A Comparison of Duloxetine Plasma Levels in Postbariatric Surgery Patients Versus Matched Nonsurgical Control Subjects

Bariatric surgery such as the Roux-en-Y gastric bypass (RYGB) is currently used as a treatment for severe obesity. Alteration of the gastrointestinal tract by this procedure suggests a potential for clinically significant alterations in the bioavailability of ingested medications including antidepressants. The purpose of this trial was to determine to what extent the RYGB procedure alters the area under the plasma concentration/time curve (AUC(0-infinity)) of the antidepressant, duloxetine. Ten subjects who were 1 year post-RYGB where compared with healthy control subjects matched for body mass index, age, and sex. Ultrarapid or poor metabolizers for cytochrome P450 2D6 were excluded from the study. Subjects received a single dose of 60 mg of duloxetine. Nineteen plasma samples were obtained during 72 hours to characterize the plasma level profile. The mean AUC(0-infinity) was significantly smaller for the postbariatric surgery (PBS) group (646.74 ng × h/mL [SD, 79.70; range, 539.57-791.62], P = 0.017) compared to the nonsurgical control group (1119.91 ng × h/mL [SD, 593.40; range, 415.5-2426.56]). The Tmax was also significantly shorter for the PBS group (2.2 hours) compared to the nonsurgical control group (6 hours; P = 0.005). No significant difference in Cmax or half-life was identified. To our knowledge, this is the first reported study exploring duloxetine pharmacokinetics PBS. This trial found that the bariatric surgery group was exposed to only 57.7% of duloxetine as compared to the nonsurgery group. This finding suggests that clinicians need to monitor patients closely after bariatric surgery and that further exploration of the effects of bariatric surgery on antidepressant pharmacokinetic parameters is warranted.

Serum Levels of Intravitreal Bevacizumab After Vitrectomy, Lensectomy and Non-Surgical Controls

Purpose: To determine serum level differences of intravitreally-placed bevacizumab after vitrectomy and lensectomy-vitrectomy and to compare these with non-operated eyes in a rabbit model.Methods: Five Dutch-belted rabbits underwent pars plana vitrectomy (PPV), five rabbits underwent pars plana lensectomy (PPL) and five rabbits served as non-surgical controls. Twelve days following the surgical procedures, each operated eye underwent an intravitreal injection consisting of 1.25 mg/0.05 mL bevacizumab. Serum levels from each rabbit were drawn on days 2, 4, 7, 10, 14, 21, 28 and 35 and were measured with ELISA immunoassay.Results: The average peak serum concentration (Cmax) was highest for the PPL group (11.33 μg ± 3.48 mL), and was similar between the PPV (5.35 μg ± 2.69 mL) and non-surgical control groups (5.35 μg ± 0.69 mL). The average time to maximal plasma concentration (Tmax) in days was earliest for the PPL group (2.8 ± 0.47), followed by the PPV (5.6 ± 0.84) and non-surgical control groups (6.4 ± 0.71). The PPL group had higher serum levels than the other two groups until day 7 that was significant only at day 2 (p < 0.0001). After day 4, there were no significant differences or trends between any of the three groups. The half-life (T1/2) was fastest for the PPL group (1.41 ± 0.21 d) followed by the PPV (2.80 ± 3.35 d) and non-surgical control groups (6.69 ± 10.4 d).Conclusions: Serum bevacizumab levels were initially elevated following lensectomy and vitrectomy compared to non-surgical eyes following intravitreal injection. The half-life of bevacizumab was prolonged in non-surgical eyes presumably due to a slower release from the vitreous cavity.

Recovery of Cognitive Function After Coronary Artery Bypass Graft Operations

The effect of coronary artery bypass grafting (CABG) operations on cognition was examined after controlling for the operation, emotional state, preexisting cognitive impairment, and repeated experience with cognitive tests. On-pump CABG patients (n=16), thoracic surgical patients (n=15), and a nonsurgical control group (n=15) were tested preoperatively, and at 1 and 8 weeks postoperatively, using a battery of cognitive tests and an emotional state assessment. Patient groups were similar in age, sex, level of education, and premorbid intelligence quotient score. Surgical group data were normalized against data from the nonsurgical control group before statistical analysis. CABG patients performed worse on every subtest before the operation, and this disadvantage persisted after the operation. Anxiety, depression, and stress were associated with impaired cognitive performance in the surgical groups 1 week after the operation: 44% of CABG patients and 33% of surgical control patients were significantly impaired; yet, by 8 weeks, nearly all patients had recovered to preoperative levels, with 25% of CABG and 13% of surgical control patients improving beyond their preoperative performance. Stress, anxiety, and depression impair cognitive performance in association with CABG and thoracic operations. Most patients recover to, or exceed, preoperative levels of cognition within 8 weeks. Thus, after controlling for nonsurgical factors, the prospects of a tangible improvement in cognition after CABG are high.

Vitamin status after gastric bypass and lifestyle intervention: a comparative prospective study

BackgroundBariatric surgery can lead to vitamin deficiencies. We aimed to assess the changes in blood vitamin concentrations in patients who were taking predefined supplements after gastric bypass surgery. MethodsA total of 29 patients underwent gastric bypass and 24 unmatched controls underwent lifestyle intervention in a prospective, nonrandomized trial. The patients in the surgical group received multivitamin, iron, calcium, vitamin D, and vitamin B12 supplements. No supplements were prescribed to the lifestyle group. The median body mass index decreased from 46 to 32 kg/m2 after surgery and from 40 to 39 kg/m2 after lifestyle intervention. ResultsOf the 53 included patients, 50 completed the 1-year follow-up examination (94%). Compared with the lifestyle patients, the surgical patients had increased vitamin B6, folic acid, vitamin B12, and lipid-adjusted vitamin E (P <.02 for each) concentrations but decreased vitamin A concentrations (P <.01) during follow-up. No significant difference between the 2 groups was found for vitamin B1, vitamin C, or 25-hydroxyvitamin D. Most surgical patients reported taking their supplements. ConclusionGastric bypass patients adhering to a set of dietary supplements had mostly stable or increased vitamin concentrations compared with both their baseline values and the changes in a nonsurgical control group.

HGF inhibits TGF-β1-induced myofibroblast differentiation and ECM deposition via MMP-2 in Achilles tendon in rat

Both myofibroblast differentiation and extracellular matrix (ECM) deposition are essential components of scar formation in tendons, and hepatocyte growth factor (HGF) is reported to prevent fibrogenic responses in tendons. Matrix metalloproteinases-2(MMP-2) is also involved in the healing process in tendons. Whether HGF protects healed Achilles tendons from injury-induced scar formation and the mechanisms are unknown. Daily for 2 weeks after wounding, except for the non-surgical control group, the Achilles tendons in rats were locally injected with HGF (100 ng 50 μl(-1) per mouse) or phosphate-buffered saline (PBS). Histological examination showed HGF ameliorated disorganized collagen fibers caused by surgical incisions in rats. After transforming growth factor beta-1 (TGF-β1) induced fibrogenic responses in primary Achilles tendon fibroblasts in rats, HGF treatment for 24 h reduced α-smooth muscle actin (α-SMA) (0.60 ± 0.07-fold, P < 0.05) and type III collagen expression (0.39 ± 0.07-fold, P < 0.05). Moreover, HGF elevated MMP-2 expression (1.23 ± 0.11-fold, P < 0.05). The MMP-2 inhibitor, tissue inhibitors of metalloproteinase-1 (TIMP-1), partially blocked the inhibitory effects of HGF on α-SMA expression (from 0.60 ± 0.07-fold to 0.83 ± 0.07-fold, P < 0.05) and type III collagen expression (from 0.39 ± 0.06-fold to 0.86 ± 0.08-fold, P < 0.05). These results indicate HGF attenuates TGF-β1-induced fibrogenic responses in Achilles tendon, which was mediated by MMP-2. These results will aid in developing effective therapeutic approaches for the dysfunctional repair in Achilles tendons.

Preliminary comparison of sertraline levels in postbariatric surgery patients versus matched nonsurgical cohort

Background Roux-en- Y gastric bypass (RYGB) is the most frequent bariatric procedure performed in the United States, with thousands performed. Because of the changes to the gastrointestinal tract, the potential exists for clinically significant alterations in the absorption/bioavailability of ingested medications. The purpose of the present pilot trial was to determine to what extent RYGB alters the area under the plasma concentration/time curve (AUC 0–10.5) of the antidepressant, sertraline at a community research center. Methods After an overnight fast, 5 postbariatric surgery and 5 nonsurgical control subjects matched for body mass index, age, and gender received 100 mg of sertraline. Plasma samples were obtained for 10.5 hours. The mean AUC 0–10.5, maximal plasma concentration, and the interval to the peak plasma level were obtained for both groups. Results The mean AUC 0–10.5 was significantly smaller for the postbariatric surgery group (124.4 ± 55.5 ng-hr/mL, range 62.0–198.1; P = .043) compared with the nonsurgical control group (314.8 ± 129.6 ng-hr/mL, range 194.8–508.7). The maximal plasma concentration was also significantly smaller for the postbariatric surgery group than for the nonsurgical control group ( P = .043). Conclusion To our knowledge, this is the first reported study exploring antidepressant pharmacokinetics after bariatric surgery. In the present trial, the AUC 0–10.5 and maximal plasma concentration were significantly smaller in the subjects who had undergone RYGB than in the matched subjects who had not. Additional investigation of the effects of bariatric surgery (RYGB, sleeve gastrectomy, and gastric banding) on the antidepressant pharmacokinetic parameters is warranted.

Postoperative Cognitive Decline: The Unsubstantiated Phenotype

Postoperative Cognitive Decline: The Unsubstantiated Phenotype

Methods and madness: agitation, delirium, and postoperative cognitive dysfunction

Over the past decade, disorders of cognition in adult surgical patients have attracted the attention of perioperative physicians. As our surgical population ages and lengths of hospital stay decrease, postoperative cognitive deficits present a barrier to efficient discharge and return to function in the community. Physicians are aware that treatment of delirium adds $2,500 US to hospital stays of patients [ 65 yr of age, costing Medicare approximately $6.9 billion US annually. Similarly, we know that patients with postoperative cognitive dysfunction (POCD) one week following surgery are more likely to leave employment, while those with POCD persisting three months postoperatively suffer an increased risk of mortality in the subsequent five years. In this month’s issue of the Journal, Yu et al. present an observational cohort study of 2,000 patients undergoing general anesthesia. Their study results indicate that [ 20% of adult subjects experienced postanesthetic agitation. Delirium, POCD, agitation—the variety of cognitive disorders studied in the perioperative period can be...well...rather confusing. Often the terms are defined poorly and sometimes they are used interchangeably. Is agitation in the postanesthesia care unit synonymous with delirium? Is emergence agitation, like delirium, associated with significant adverse outcomes? While emergence agitation may not be representative of normal cognition, is it POCD? What is the busy clinician to make of all this? Perhaps a good beginning would be to takee the advice of management expert, W. Edwards Deming, and describe the process under discussion. Only one of the conditions mentioned in the preceding paragraph is a diagnosable psychiatric disorder. The Diagnostic and Statistical Manual of Mental Disorders defines delirium as a transient, fluctuating disturbance of consciousness, attention, cognition, and perception. The Confusion Assessment Method (CAM) operationalizes the diagnosis of delirium using four clinical features: 1) acute onset and fluctuating course; 2) inattention; 3) disorganized thinking; and 4) altered level of consciousness. Diagnosis is based on the presence of features 1 and 2 plus one of either 3 or 4. The CAM has been used extensively, and its sensitivity and specificity both exceed 90%. On the other hand, POCD is a more subtle condition and more difficult to quantify. While inherently challenging, POCD research has been hampered further by the large number of cognitive tests employed and the widely disparate definitions of an abnormal test result. An operating definition of POCD has emerged based on a decade of research by the International Study of Postoperative Cognitive Dysfunction (ISPOCD). The ISPOCD research group employs a battery of four individual neuropsychometric tests given before and after surgery and standardizes interval changes in test scores using data from a non-surgical control group. While the deficits in attention, concentration, executive function, verbal memory, visuospatial abstraction, and psychomotor speed are both real and quantifiable, POCD as a disorder is

Dynamics of Change in Total and Regional Body Composition After Gastric Bypass in Obese Patients

Little is known on patterns of change over time in body composition, especially lean body mass (LBM), during massive weight loss after Roux-en-Y gastric bypass (RYGB) in obese patients. We performed sequential measurements of total and regional body composition in patients after RYGB, and we compared a subsample of patients after surgery to a nonsurgical control group of similar age and body fatness. We used dual-energy X-ray absorptiometry (DXA) before and at 3, 6, and 12 months after RYGB in 42 obese women (before surgery: age 39.5 +/- 11.6 years; BMI 44.6 +/- 6.1 kg/m(2); mean +/- s.d.) and in 48 control obese women referred for nonsurgical weight management, before weight loss. During 1-year follow-up after RYGB, there was a continuous decrease in body weight (-36.0 +/- 12.5 kg at 1 year), total fat mass (FM) (-26.0 +/- 9.1 kg), as well as in trunk and appendicular FM. In contrast, the decrease in total LBM (-9.8 +/- 4.8 kg at 1 year), as well as in trunk and appendicular LBM, plateaued after 3-6 months. Rates of loss in weight, FM, and LBM were highest during the first 3-month period after RYGB (6.4 +/- 1.8, 4.1 +/- 1.7, and 2.3 +/- 1.2 kg/month, respectively), then decreased continuously for FM but plateaued for LBM. There was no evidence of a decrease in total, trunk, or appendicular LBM in weight-reduced subjects compared to the control group. In conclusion, follow-up of these obese women revealed a differential pattern of change in FM and LBM after RYGB. Despite an important loss in LBM, especially during the 3-6 months of initial period, LBM appears to be spared thereafter.

Psychological Profile of Taiwanese Female Cosmetic Surgery Candidates: Understanding Their Motivation for Cosmetic Surgery

Psychological processes consisting of body image and self-esteem are considered key to the motivation for cosmetic surgery (CS). The current study aimed to investigate such processes as well as social support, perception of other people's opinion, and sex life satisfaction of Taiwanese female CS candidates. Further analyses were conducted to identify which processes predicted motivation for CS. Questionnaires comprising subscales of the Multidimensional Body-Self Relations Questionnaire, the Rosenberg Self-Esteem Scale, the Perception of Other Peoples' Opinion Scale, and social support and sex life questions were completed by Taiwanese female CS candidates (n = 85) preoperatively. The results were compared with those for a sex-matched nonsurgical control group (n = 105) as well as previously published data and reference norms. Correlation and multiple regression analysis also was conducted to identify any relationship between variables as well as which variable best predicted the likelihood of a patient having surgery. A total of 29 CS candidates (34.1%) reported before their surgical consultation that they would "very likely" or "likely" have CS, and 54 (63.5%) received support from all three social groups, namely, family, friends, and partner. The body image (appearance evaluation, orientation, and body area satisfaction) of the CS candidates was not significantly different from that of the control group. The former had significantly higher self-esteem and perception of other people's opinion scores. Self-esteem was positively correlated with appearance evaluation (r = 0.484; p < 0.01) and body area satisfaction (r = 0.494; p < 0.01). Body area satisfaction had a fair degree of negative correlation with the likelihood of having CS (r = -0.413; p < 0.01). Regression analysis indicated that only body area dissatisfaction predicted the likelihood of having CS, accounting for 29.4% of the total variance. The results of this study indicate that the Taiwanese female CS candidates did not have higher body image dissatisfaction or greater body image investment than the control group. However, body area dissatisfaction was the only significant predictor for the likelihood of having CS, a feature not previously recognized in Asian CS candidates. The higher self-esteem of the CS candidates opposes the view that low self-esteem is a principal motivating factor for CS.

Neuropsychological Function 5 Years after Cardiac Surgery and the Effect of Psychological Distress

Research has shown conflicting results with regard to the influence of depression and anxiety on neuropsychological performance following coronary artery bypass graft (CABG) surgery. Notably, the independent effects of depression and anxiety have not been examined among CABG candidates in the longer term where it is has been suggested that these patients show marked cognitive deterioration. A neuropsychological test battery and measures of psychological distress were completed by 86 CABG patients and 50 nonsurgical control participants at baseline and 6 months, whereas 75 patients and 36 controls, respectively, completed a 5-year follow-up. In CABG patients, cognitive and affective depressive symptoms were independently associated with lower and worse performance on the Boston Naming Test, Purdue Peg Board, and Digit Symbol Coding 6 months after surgery, whereas at 5-year follow-up an effect for Digit Symbol persisted, and an association was also observed for the Trail Making Test (TMT). On average, CABG patients performed worse on TMT and Digit Symbol at 6 months, whereas at 5-year follow-up their performance was worse on short-term delayed verbal recall. The results among the CABG patients did not show a consistent pattern of association between psychological distress and those neuropsychological domains that were on average significantly lower than a nonsurgical control group. The results here also support the use of nonbiased statistical methodology to document dysfunction among heterogeneous cognitive domains after CABG surgery.