***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose The aim of this study was to assess the pharmacokinetics and protein binding of  cefazolin in morbidly obese patients undergoing bariatric surgery , to study the influence of bodyweight measures and age on pharmacokinetic parameters and to evaluate unbound cefazolin concentrations over time in this population . Methods Twenty morbidly obese patients ( bodyweight 112–260 kg , body mass index 38–79 kg m−2 ) were studied following the administration of cefazolin 2 g at induction of anaesthesia . Blood sample s were collected up to 4 h post-dosing to determine total and unbound plasma cefazolin concentrations . Non-compartmental pharmacokinetic data analysis was performed . Results Cefazolin clearance was 4.2 ± 1.0 L h−1 ( mean ± st and ard deviation ) and showed a negative correlation with age ( p = 0.003 ) but not with bodyweight measures ( p > 0.05 ) . Volume of distribution was 13.0 ± 3.1 L and correlated positively with bodyweight measures ( p ≤ 0.001 ) . Saturable protein binding was observed with a median protein binding of 79 % ( interquartile range 74–82 ) , which proved similar to reported protein binding in non-obese patients . In all patients , unbound cefazolin concentrations remained above 1 mg L−1 ( minimal inhibitory concentration for 90 % ( MIC90 ) of methicillin-sensitive isolates of Staphylococcus aureus in Europe ) until 4 h post-dosing . Conclusions Younger age— and not bodyweight — was significantly associated with higher cefazolin clearance . However , as in all patients with bodyweights up to 260 kg , unbound plasma cefazolin concentrations remained above 1 mg L−1 until 4 h after the intravenous administration of a 2-g dose . As such , re-dosing within 4 h or dosing with another antibiotic class should only be considered in the case of a higher MIC90 of the local isolates Cross-sectional studies have found that obesity is associated with low intellectual ability and neuroimaging abnormalities in adolescence and adulthood . Some have interpreted these associations to suggest that obesity causes intellectual decline in the first half of the life course . We analyzed data from a prospect i ve longitudinal study to test whether becoming obese was associated with intellectual decline from childhood to midlife . We used data from the ongoing Dunedin Multidisciplinary Health and Development Study , a population -representative birth cohort study of 1,037 children in New Zeal and who were followed prospect ively from birth ( 1972 - 1973 ) through their fourth decade of life with a 95 % retention rate .  Intelligence quotient ( IQ ) was measured in childhood and adulthood . Anthropometric measurements  were taken at birth and at 12 subsequent in-person assessment s. As expected , cohort members who became obese had lower adulthood IQ scores . However , obese cohort members exhibited no excess decline in IQ . Instead , these cohort members had lower IQ scores since childhood . This pattern remained consistent when we accounted for children 's birth weights and growth during the first years of life , as well as for childhood-onset obesity . Lower IQ scores among children who later developed obesity were present as early as 3 years of age . We observed no evidence that obesity contributed to a decline in IQ , even among obese individuals who displayed evidence of the metabolic syndrome and /or elevated systemic inflammation In this study , we evaluated the reliability of a newly developed method for pain assessment , which is based on perceptual matching by Pain Matcher ® , Cefar Medical AB , Lund , Sweden , during minor gynecological surgery . In addition , the responsiveness to two different anesthetic methods —electro-acupuncture or a fast-acting opiate , alfentanil , both in combination with a paracervical block — was estimated by using Pain Matcher and visual analog scale ( VAS ) assessment s before and 2 h after surgery . Two hundred-twenty-three women ( aged 22–38 yr ) participated . The results show that Pain Matcher is a reliable method for pain assessment s , with lack of r and om individual disagreement and with no statistical evidence of systematic disagreement in position or in concentration . The augmented rank-order coefficient ( ra ) values were excellent ( 0.95–1.00 ) . When scales were used to detect true changes over time , there was no clear indication of responsiveness , mostly because of statistically significant r and om individual changes . However , the individual changes were much smaller for magnitude matching than for VAS . In conclusion , we would recommend the use of perceptual matching by Pain Matcher for pain assessment , because in this study it was a reliable and powerful in test-retest situations and had smaller individual changes than VAS after intervention . The Pain Matcher procedure was well accepted by the patients , and the results suggest that it may be useful when evaluating acute pre- and postoperative pain Background : Treatment of  post‐operative pain  is still a significant problem . Recently , interest has focused on pre‐operative identification of patients who may experience severe post‐operative pain in order to offer a more aggressive analgesic treatment . The nociceptive stimulation methods have included heat injury and pressure algometry . A simple method , Pain Matcher ® ( PM ) , using electrical stimulation , is vali date d for pain assessment , but has not been evaluated as a tool for prediction of post‐operative pain . Our aim was to assess the predictive value of pre‐caesarean section pain threshold on intensity of post‐caesarean section pain using the PM CONTEXT Obesity is a major health problem in the United States , but the number of obesity-attributable deaths has not been rigorously estimated . OBJECTIVE To estimate the number of deaths , annually , attributable to obesity among US adults . DESIGN Data from 5 prospect i ve cohort studies ( the Alameda Community Health Study , the Framingham Heart Study , the Tecumseh Community Health Study , the American Cancer Society Cancer Prevention Study I , and the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study ) and 1 published study ( the Nurses ' Health Study ) in conjunction with 1991 national statistics on body mass index distributions , population size , and overall deaths . SUBJECTS Adults , 18 years or older in 1991 , classified by body mass index ( kg/m2 ) as overweight ( 25 - 30 ) , obese ( 30 - 35 ) , and severely obese ( > 35 ) . MAIN OUTCOME MEASURE Relative hazard ratio ( HR ) of death for obese or overweight persons . RESULTS The estimated number of annual deaths attributable to obesity varied with the cohort used to calculate the HRs , but findings were consistent overall . More than 80 % of the estimated obesity-attributable deaths occurred among individuals with a body mass index of more than 30 kg/m2 . When HRs were estimated for all eligible subjects from all 6 studies , the mean estimate of deaths attributable to obesity in the United States was 280184 ( range , 236111 - 341153 ) . Hazard ratios also were calculated from data for nonsmokers or never-smokers only . When these HRs were applied to the entire population ( assuming the HR applied to all individuals ) , the mean estimate for obesity-attributable death was 324 940 ( range , 262541 - 383410 ) . CONCLUSIONS The estimated number of annual deaths attributable to obesity among US adults is approximately 280000 based on HRs from all subjects and 325000 based on HRs from only nonsmokers and never-smokers 
    Output:
    
Weight loss after surgery was not identified as a factor for higher pain thresholds in obese subjects .
From the available literature , there is a tendency towards higher pain thresholds in obese subjects .
Neither substantial weight loss , nor gender , were factors explaining difference in threshold .