Bariatric Revisionary Surgery for Failed or Complicated Vertical Banded Gastroplasty (VBG): Comparison of VBG Reoperation (re-VBG) versus Roux-en-Y Gastric Bypass-on-VBG (RYGB-on-VBG)

Background. Revision of failed bariatric procedures is a significant challenge for bariatric surgeons, because of the increasing number of recurring morbid obesity or complications, especially in patients with a previous Vertical Banded Gastroplasty (VBG). Methods. Since November 1998, 109 patients with failed or complicated VBG were followed in a retrospective study. 49 patients underwent re-VBG and, since 2004, 60 underwent Roux-en-Y Gastric Bypass-on-Vertical Banded Gastroplasty (RYGB-on-VBG). Results. At 3 years follow-up, mean BMI decreased from 37.4 to 31.2 Kg/m2 in the first group, and from 35.0 to 28.4 Kg/m2 in the second. Early complications were 7 (14.3%) in the first group and 4 (6.5%) in the second; late complications were 33 (59.1%) and 11 (18.3%), respectively. Conclusion. Although both operations seem to be effective as bariatric revision procedures in terms of BMI, the mid-term outcomes of RYGB-on-VBG demonstrate the lowest rate of complications and better quality of life

Heme iron from meat and risk of colorectal cancer: a meta-analysis and a review of the mechanisms involved

Red meat and processed meat intake is associated with a risk of colorectal cancer, a major cause of death in affluent countries. Epidemiological and experimental evidence supports the hypothesis that heme iron present in meat promotes colorectal cancer. This meta-analysis of prospective cohort studies of colon cancer reporting heme intake included 566,607 individuals and 4,734 cases of colon cancer. The summary relative risk of colon cancer was 1.18 [95%C.I.: 1.06-1.32] for subjects in the highest category of heme iron intake compared with those in the lowest category. Epidemiological data thus show a suggestive association between dietary heme and risk of colon cancer. The analysis of experimental studies in rats with chemically-induced colon cancer showed that dietary hemoglobin and red meat consistently promote aberrant crypt foci, a putative pre-cancer lesion. The mechanism is not known, but heme iron has a catalytic effect on (i) the endogenous formation of carcinogenic N-nitroso compounds and (ii) the formation of cytotoxic and genotoxic aldehydes by lipoperoxidation. A review of evidence supporting these hypotheses suggests that both pathways are involved in heme iron toxicit

Hydrogen Supply for Steelmaking's Energy Transition: An IAM-based study on economic and environmental opportunities of fuel diversification under the threat of energy shocks

In the pursuit of low-carbon technologies and sustainable alternatives to fossil fuels essential to hand on to future generations a safe and livable planet, hydrogen has attracted engineering interest as a promising vector for storing and carrying clean energy that would help decarbonize society. Scientific research and technological trends indicate that heavy industries, especially steelmaking, might represent an excellent opportunity to consistently integrate the consumption of hydrogen into the manufacturing processes. This is likely to deliver substantial emissions savings as the steel industry, widely recognized to be a hard-to-abate sector, accounts for a large portion of the global pollution every year.Besides the heated debate on the technical and financial challenges related to deployment constraints and cost increases, the geopolitical risk of energy crises impacting the economic output of industries in energy-importing countries is neglected in the decision-making considerations, overlooking the critical implications of energy diversification on long-term planning.The aim of this study is thus to investigate the competition between hydrogen and natural gas for high-temperature heat generation in steel manufacturing while considering the potential impact of energy shocks on fuel expenditures. Addressing these dynamics would have significant consequences for the interplay between policymaking and industrial energy transition as it uncovers the relevance of sustainable energy resiliency to energy crises induced by geopolitical disruptions. \\To achieve the objectives of the project, an Integrated Assessment Model-based study has been conducted using the WITCH model, which required several improvements in the framework.The steel industry module was conceptualized and developed to describe the technology sets, the financial and technical constraints, the future projections of the steel market and the energy supply structure. Moreover, even though a prior version of the hydrogen supply was already in the model, the equations of the related module were modified to account for the consumption of hydrogen as a fuel in steel mills and to ensure compatibility with the expansion to the industrial sector. To allow for accurate integration of energy shocks in the model algorithm, the existing dynamics that describe the trajectories of fuel costs were then expanded and used to account for different shocks' intensities, time periods and the degree of energy dependency of the affected region. Finally, a scenario architecture suitable to capture the main variables of the analysis was designed to prepare a sensitivity analysis focused on the magnitude of the shock, the year of occurrence and the level of environmental commitment implemented.The outcome of the simulations shows that most of the production of steel will be located in energy-dependent countries, where energy shocks impact fuel expenditures on a national scale. The financial damages perceived by steelmakers are exacerbated by large magnitudes of the increase in price and by early shocks, which would strike the industry before the development of alternative sourcing of fuels. The regulatory push to support sustainable technologies has the potential to effectively dampen the impact of shocks and decarbonize the energy mix in steelmaking by accelerating investment cycles and promoting the deployment of low-carbon hydrogen. Further explorations of the correlation between preventive investments in hydrogen and perceived disruptions in industrial production have proven how large-scale investments for alternative and secure supply of hydrogen yield long-lasting resiliency to energy crises, while lagging intervention exposes the industry to the risk of wide costs of inaction.The results of the research have practical significance for both industrial and political decision-making. Risk-averse managers of steelmaking facilities might decide to allocate financial resources for early conversion from natural gas to hydrogen to guard against the possibility of energy shock backlash. Policymakers can produce long-term plans to stimulate the transition to green hydrogen with tailored carbon pricing, which would result in an expense transfer from the potential costs of the backlash of energy shock to the proactive development of secure and resilient hydrogen production. Besides the contribution to national environmental goals, this transformation would yield stabilization and permanent immunization of the industrial energy supply against the reoccurrence of shocks. This can safeguard not only the manufacturing sector but also the national economy overall, as the increased expenditures endured by steelmakers would translate into rising costs for infrastructural development in the country.Electrical Engineering | Sustainable Energy Technolog

Roux en-Y-Gastric Bypass on Vertical Banded Gastroplasty (variante Amenta-Cariani): risultati a 5 anni di follow-up

Premessa Per quanto riguarda il trattamento chirurgico dell\u2019obesit\ue0 patologica, l\u2019intervento di Roux-en-Y Gastric Bypass (RYGB) \ue8 una tecnica che, a fronte di un tasso accettabile di complicanze, fornisce ottimi risultati in termini di diminuzione ponderale, risoluzione delle comorbilit\ue0 legate all\u2019obesit\ue0 e qualit\ue0 di vita post-operatoria. Tuttavia emorragia, perforazione, occlusione e cancro nello stomaco escluso dopo RYGB sono complicanze serie che richiedono una diagnosi precoce. Nel 2002 abbiamo realizzato una procedura combinata, Roux en-Y-Gastric Bypass on Vertical Banded Gastroplasty (RYGB-on-VBG), con l\u2019obiettivo di realizzare un RYGB dove fosse possibile lo studio radiologico ed endoscopico tradizionale dello stomaco escluso e di ottenere un buon calo ponderale come per il RYGB standard. Scopo dello studio Lo scopo di questo studio clinico retrospettivo, condotto sui database prospettici dei pazienti sottoposti a RYGB-on-VBG, \ue8 quello di valutare i risultati fino a 5 anni di follow-up. Metodi Dal giugno 2002 al febbraio 2009, 268 pazienti, 68 uomini e 200 donne con una et\ue0 media di 41,8 \ub1 11,5 anni, Body Mass Index (BMI) medio di 48,0 \ub1 8,3 kg/m2, ed un Excess Body Weight (EBW)% medio di 113,4 \ub1 36,5 sono stati sottoposti a RYGB-on- VBG con tecnica open come prima procedura bariatrica. Le patologie preoperatorie concomitanti sono state: ipertensione in 112 pazienti (41,7%), iperlipidemia in 98 (36,5%), Obstructive Sleep Apnea Syndrome (OSAS) in 56 (20,8%) e diabete mellito di tipo 2 in 41 (15,2%). Il follow-up multidisciplinare, condotto a 6 e 12 mesi poi annualmente, ha incluso lo studio radiologico e, quando necessario, endoscopico del primo tratto del tubo digerente. Risultati Il tempo operatorio medio \ue8 stato di 180 minuti (range: 110- 305). La mortalit\ue0 operatoria \ue8 stata dello 0,7% (2/268) per cause non chirurgiche. Le complicanze precoci sono state il 3,3% e quelle tardive il 20,6%. La degenza media post-operatoria \ue8 stata di 8 giorni (range: 5-37). Il BMI medio \ue8 risultato 35,2 dopo 6 mesi e 32,4, 31,5, 32,0, 33,4 e 34,8 dopo 1, 2, 3, 4 e 5 anni, rispettivamente. La curva del calo ponderale e la risoluzione delle comorbilit\ue0 sono state simili a quelle che si ottengono con il RYGB standard. Conclusioni I risultati a 5 anni dimostrano che il RYGB-on-VBG \ue8 efficace come il RYGB standard e permette lo studio radiologico-endoscopico tradizionali dello stomaco funzionalmente escluso

LONG TERM RESULTS AFTER ROUX-EN-Y GASTRIC BYPASS ON VERTICAL BANDED GASTROPLASTY WITH EXPLORABLE REMNANT: DOES THE PRESENCE OF A GASTRO-GASTRIC OUTLET IMPACT ON FINAL OUTCOMES IN TERM OF METABOLIC EFFICACY AND WEIGHT LOSS?

Background. Functional RYGB have been abandoned in 2004 since a great rate of complication had been observed. Roux-en-Y Gastric Bypass on Vertical Banded Gastroplasty is a functional RYGB procedure wich demonstrated a low long term complication rate. Aim of the study is to verify the remission rate of most common comorbidities observed in obese patients and theweight loss at long term follow-up. Methods. Since June 2002 to December 2011 363 patients (90 males, 273 females) with mean age 41.8\ub110.9 years and mean preoperative BMI 47.56\ub18.4 Kg/m2 (EBW% 99\ub136.2) underwent RYGB. A 1.1 cm gastro-gastric outlet ad the edge of gastric pouch was left in place and reinforced with a gore-tex band. Among them, Type II DM was reported in 88 (24.2 %) cases, antihypertensive medications were necessary in 178 (49.0%), hypercholesterolemia was observed in 88 cases (24.2 %). Sleep apnea (OSAS) was observed in 97 patients (26.7 %). Postoperative follow-up was assessed with specific laboratory test, upper gastrointestinal series, and medical examination at 3-6-12 months, then annually. Results. Long term weigh loss was good according with success criteria of Christou, with mean EWL% (\ub1SD) 55.4(\ub116.8) after 6 months,67.4(\ub118.1) after 1 year,69.2\ub117.9 after 2 years, with few changes until 60.0(\ub120.5) after 10 years. Drop out rat was less than 10 %. Remission of diabetes was observed in 83 patients (94.3 %). Preoperative diabetic patients reached worse results than non-diabetics (5 years BMI 35.7\ub16.7 vs 31.6\ub15.9 Kg/m2). Remission of hypertension was observed in 156 patients (87.6 %). Preoperative blood glucose and Hb1Ac in diabetic patients were 157.0\ub144.3 mg/dl and 7.2\ub11.1%and dropped to 97.8\ub126.6 and 4.6\ub12.2 after 6months, and to 93.9\ub124.2 and 5.6\ub11.1 a 4 years (p<0.0001). Total cholesterol levels dropped from197.2\ub135.9 mg/dl preoperatively to 169.9\ub131.9 at 6 months, and assessed to 182.5\ub1 31.3 after 4 years. Remission of OSAS was observed in 95 patients (98.9 %). Discussion. The outcomes of this series are similar to those obtained after standard RYGB. Even if not inflatable, the small size of gastro-gastric outlet didn\u2019t allow the passage of big amount of chyme (confirmed at barium swallow) and didn\u2018t\u2019 determine such complications due to pathologic gastro-gastric fistula. Nonetheless the traditional endoscopy of gastric remnant was always possible when performed. Conclusions. An outlet for endoscopic study of gastric remnant doesn\u2019t compromise the metabolic effects of RYGB, neither in term of weight loss, or the impact on metabolic comorbidities