Obesity is one of the most important public health conditions worldwide. Bariatric surgery for severe obesity is an effective treatment that results in the improvement and remission of many ...obesity-related comorbidities, as well as providing sustained weight loss and improvement in quality of life. Contemporary bariatric operations include Roux-en-Y gastric bypass, sleeve gastrectomy, adjustable gastric band and the duodenal switch. The vast majority of these procedures are now performed using laparoscopic technique, the main advantages of which include rapid recovery, the reduction of postoperative pain and the reduction of wound-related complications, compared with open surgery. Contemporary bariatric surgery is now safe, with a mortality of three in 1,000 patients; however, all bariatric operations are associated with their own unique short-term and long-term nutritional and procedural-related complications. Type 2 diabetes mellitus (T2DM) is the most studied metabolic disorder associated with obesity, with data demonstrating that improvement and remission of T2DM in patients with obesity is superior after bariatric surgery compared with conventional medical therapy. Bariatric surgery is now a part of some treatment algorithms for the medical management of patients with T2DM and severe obesity. New, minimally invasive and endoscopic devices for the treatment of obesity have now been approved in the USA, which will expand the treatment options for individuals with obesity.
Analysis of a recent single state bariatric surgery registry revealed that laparoscopic sleeve gastrectomy was the most common bariatric procedure starting in 2012. The objective of this study was to ...examine the trend in utilization of laparoscopic sleeve gastrectomy performed at academic medical centers in the United States.
Using ICD-9 diagnosis and procedure codes, clinical data obtained from the University HealthSystem Consortium database for all bariatric procedures performed for the treatment of severe obesity between October 1, 2011, and June 30, 2014. Quarterly trends in utilization for the 4 most commonly performed bariatric operations were examined, and comparisons between procedures were performed.
A total of 54,953 bariatric procedures were performed. Utilization of laparoscopic sleeve gastrectomy increased from 23.7% of all bariatric procedures during the fourth quarter of 2011 to 60.7% during the second quarter of 2014 while laparoscopic gastric bypass decreased from 62.2% to 37.0%, respectively. Utilization of laparoscopic sleeve gastrectomy surpassed that of laparoscopic gastric bypass in the second quarter of 2013 (50.6% versus 45.8%). During the same time period, utilization of open gastric bypass fell from 6.6% to 1.5%, and the use of laparoscopic adjustable gastric banding decreased from 7.5% to .8%.
Within the context of U.S. academic medical centers, there has been a significant increase in the utilization of laparoscopic sleeve gastrectomy, which has surpassed laparoscopic gastric bypass utilization since 2013. Laparoscopic sleeve gastrectomy is now the most commonly performed bariatric procedure at the national level within academic centers.
The prevalence of obesity and outcomes of bariatric surgery are well established. However, analyses of the surgery impact have not been updated and comprehensively investigated since 2003.
To examine ...the effectiveness and risks of bariatric surgery using up-to-date, comprehensive data and appropriate meta-analytic techniques.
Literature searches of Medline, Embase, Scopus, Current Contents, Cochrane Library, and Clinicaltrials.gov between 2003 and 2012 were performed.
Exclusion criteria included publication of abstracts only, case reports, letters, comments, or reviews; animal studies; languages other than English; duplicate studies; no surgical intervention; and no population of interest. Inclusion criteria were a report of surgical procedure performed and at least 1 outcome of interest resulting from the studied surgery was reported: comorbidities, mortality, complications, reoperations, or weight loss. Of the 25,060 initially identified articles, 24,023 studies met the exclusion criteria, and 259 met the inclusion criteria.
A review protocol was followed throughout. Three reviewers independently reviewed studies, abstracted data, and resolved disagreements by consensus. Studies were evaluated for quality.
Mortality, complications, reoperations, weight loss, and remission of obesity-related diseases.
A total of 164 studies were included (37 randomized clinical trials and 127 observational studies). Analyses included 161,756 patients with a mean age of 44.56 years and body mass index of 45.62. We conducted random-effects and fixed-effect meta-analyses and meta-regression. In randomized clinical trials, the mortality rate within 30 days was 0.08% (95% CI, 0.01%-0.24%); the mortality rate after 30 days was 0.31% (95% CI, 0.01%-0.75%). Body mass index loss at 5 years postsurgery was 12 to 17. The complication rate was 17% (95% CI, 11%-23%), and the reoperation rate was 7% (95% CI, 3%-12%). Gastric bypass was more effective in weight loss but associated with more complications. Adjustable gastric banding had lower mortality and complication rates; yet, the reoperation rate was higher and weight loss was less substantial than gastric bypass. Sleeve gastrectomy appeared to be more effective in weight loss than adjustable gastric banding and comparable with gastric bypass.
Bariatric surgery provides substantial and sustained effects on weight loss and ameliorates obesity-attributable comorbidities in the majority of bariatric patients, although risks of complication, reoperation, and death exist. Death rates were lower than those reported in previous meta-analyses.
In this paper, we present a method to describe (functionally) free algebras in some subvarieties of BL-algebras. Particularly, we give a description of free algebras in subvarieties of the subvariety ...MG, where MG is the subvariety of BL generated by the algebra 0,1MV⊕0,1G.
A novel computational method is proposed in this work for use in discovering reaction mechanisms and solving the kinetics of transition metal-catalyzed reactions. The method does not rely on either ...chemical intuition or assumed
mechanisms, and it works in a fully automated fashion. Its core is a procedure, recently developed by one of the authors, that combines accelerated direct dynamics with an efficient geometry-based post-processing algorithm to find transition states (Martinez-Nunez, E.,
,
, 222-234). In the present work, several auxiliary tools have been added to deal with the specific features of transition metal catalytic reactions. As a test case, we chose the cobalt-catalyzed hydroformylation of ethylene because of its well-established mechanism, and the fact that it has already been used in previous automated computational studies. Besides the generally accepted mechanism of Heck and Breslow, several side reactions, such as hydrogenation of the alkene, emerged from our calculations. Additionally, the calculated rate law for the hydroformylation reaction agrees reasonably well with those obtained in previous experimental and theoretical studies.
Industrial scale-up of microalgal cultures is often a protracted step prone to culture collapse and the occurrence of unwanted contaminants. To solve this problem, a two-stage scale-up process was ...developed - heterotrophically Chlorella vulgaris cells grown in fermenters (1
stage) were used to directly inoculate an outdoor industrial autotrophic microalgal production unit (2
stage). A preliminary pilot-scale trial revealed that C. vulgaris cells grown heterotrophically adapted readily to outdoor autotrophic growth conditions (1-m
photobioreactors) without any measurable difference as compared to conventional autotrophic inocula. Biomass concentration of 174.5 g L
, the highest value ever reported for this microalga, was achieved in a 5-L fermenter during scale-up using the heterotrophic route. Inocula grown in 0.2- and 5-m
industrial fermenters with mean productivity of 27.54 ± 5.07 and 31.86 ± 2.87 g L
d
, respectively, were later used to seed several outdoor 100-m
tubular photobioreactors. Overall, all photobioreactor cultures seeded from the heterotrophic route reached standard protein and chlorophyll contents of 52.18 ± 1.30% of DW and 23.98 ± 1.57 mg g
DW, respectively. In addition to providing reproducible, high-quality inocula, this two-stage approach led to a 5-fold and 12-fold decrease in scale-up time and occupancy area used for industrial scale-up, respectively.
The star formation activity in cosmic voids Ricciardelli, E; Cava, A; Varela, J ...
Monthly notices of the Royal Astronomical Society,
12/2014, Letnik:
445, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Using a sample of cosmic voids identified in the Sloan Digital Sky Survey Data Release 7, we study the star formation activity of void galaxies. The properties of galaxies living in voids are ...compared with those of galaxies living in the void shells and with a control sample, representing the general galaxy population. Void galaxies appear to form stars more efficiently than shell galaxies and the control sample. This result cannot be interpreted as a consequence of the bias towards low masses in underdense regions, as void galaxy subsamples with the same mass distribution as the control sample also show statistically different specific star formation rates. This highlights the fact that galaxy evolution in voids is slower with respect to the evolution of the general population. Nevertheless, when only the star-forming galaxies are considered, we find that the star formation rate is insensitive to the environment, as the main sequence is remarkably constant in the three samples under consideration. This fact implies that environmental effects manifest themselves as fast quenching mechanisms, while leaving the non-quenched galaxies almost unaffected, as their star formation activity is largely regulated by the mass of their halo. We also analyse galaxy properties as a function of void-centric distance and find that the enhancement in the star formation activity with respect to the control sample is observable up to a radial distance 1.5R
void. This result can be used as a suitable definition of void shells. Finally, we find that larger voids show an enhanced star formation activity in the shells with respect to their smaller counterparts, which could be related to the different dynamical evolution experienced by voids of different sizes.
Aim: To disentangle the effects of environmental and geographical processes driving phylogenetic distances among clades of maritime pine (Pinus pinaster). To assess the implications for conservation ...management of combining molecular information with species distribution models (SDMs; which predict species distribution based on known occurrence records and on environmental variables). Location: Western Mediterranean Basin and European Atlantic coast. Methods: We undertook two cluster analyses for eight genetically defined pine clades based on climatic niche and genetic similarities. We assessed niche similarity by means of a principal component analysis and Schoener's D metric. To calculate genetic similarity, we used the unweighted pair group method with arithmetic mean based on Nei's distance using 266 single nucleotide polymorphisms. We then assessed the contribution of environmental and geographical distances to phylogenetic distance by means of Mantel regression with variance partitioning. Finally, we compared the projection obtained from SDMs fitted from the species level (SDMsp) and composed from the eight clade-level models (SDMcm). Results: Genetically and environmentally defined clusters were identical. Environmental and geographical distances explained 12.6% of the phylogenetic distance variation and, overall, geographical and environmental overlap among clades was low. Large differences were detected between SDMsp and SDMcm (57.75% of disagreement in the areas predicted as suitable). Main conclusions: The genetic structure within the maritime pine subspecies complex is primarily a consequence of its demographic history, as seen by the high proportion of unexplained variation in phylogenetic distances. Nevertheless, our results highlight the contribution of local environmental adaptation in shaping the lower-order, phylogeographical distribution patterns and spatial genetic structure of maritime pine: (1) genetically and environmentally defined clusters are consistent, and (2) environment, rather than geography, explained a higher proportion of variation in phylogenetic distance. SDMs, key tools in conservation management, better characterize the fundamental niche of the species when they include molecular information.
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► Lactic acid, biosurfactants, xylitol or ethanol may be obtained from wine residues. ► By-products valorization turns wine wastes into products with industrial applications. ► The ...costs of waste disposal enhances the search of economically viable solutions for valorizing residues.
Wine production generates huge amounts of waste. Before the 1990s, the most economical option for waste removal was the payment of a disposal fee usually being of around 3000 Euros. However, in recent years the disposal fee and fines for unauthorized discharges have increased considerably, often reaching 30,000–40,000 Euros, and a prison sentence is sometimes also imposed. Some environmental friendly technologies have been proposed for the valorization of winery waste products. Fermentation of grape marc, trimming vine shoot or vinification lees has been reported to produce lactic acid, biosurfactants, xylitol, ethanol and other compounds. Furthermore, grape marc and seeds are rich in phenolic compounds, which have antioxidants properties, and vinasse contains tartaric acid that can be extracted and commercialized. Companies must therefore invest in new technologies to decrease the impact of agro-industrial residues on the environment and to establish new processes that will provide additional sources of income.
On the universality of void density profiles Ricciardelli, E; Quilis, V; Varela, J
Monthly notices of the Royal Astronomical Society,
05/2014, Letnik:
440, Številka:
1
Journal Article
Recenzirano
Odprti dostop
The massive exploitation of cosmic voids for precision cosmology in the upcoming dark energy experiments requires a robust understanding of their internal structure, particularly of their density ...profile. We show that the void density profile is insensitive to the void radius both in a catalogue of observed voids and in voids from a large cosmological simulation. However, the observed and simulated voids display remarkably different profile shapes, with the former having much steeper profiles than the latter. Sparsity cannot be the main reason for this discrepancy, as we demonstrate that the profile can be recovered with reasonable accuracy even with very sparse samples of tracers. On the other hand, the observed profile shows a significant dependence on the galaxy sample used to trace the matter distribution. Samples including low-mass galaxies lead to shallower profiles with respect to the samples where only massive galaxies are used, as faint galaxies live closer to the void centre. We argue that galaxies are biased tracers when used to probe the matter distribution within voids.
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