Five-year follow-up after biliopancreatic diversion with duodenal switch

BACKGROUND: Only limited data are available for assessing the medium and long-term outcomes after bariatric surgery. We report our own long-term results after biliopancreatic diversion with duodenal switch (BPD-DS). METHODS: The data from 51 patients with a theoretical >/=5-year follow-up were reviewed after BPD-DS performed from February 2002 to October 2004. The patients were assessed every 3 months during their first postoperative year, every 6 months during the second year, and annually thereafter. RESULTS: The preoperative body mass index (BMI) was 47 +/- 6.1 kg/m(2). The first 23 patients had undergone open BPD-DS. The same procedure was used (150-mL sleeve, 150-cm alimentary limb, and 100-cm common channel) for the 28 laparoscopic BPD-DS procedures, although 15 patients underwent conversion to laparotomy at the beginning of our experience. No patients died postoperatively. Of the 51 patients, 7 were not available for follow-up: 2 patients had died 9 months after BPD-DS (1 of myocardial infarction and 1 after ventral hernia repair), 1 underwent reversal, 1 refused follow-up after a complicated postoperative course, and contact was lost with 3 patients (7.8% lost to follow-up). The 5-year BMI was 31 +/- 4.5 kg/m(2), with a mean excess weight loss of 71.9% +/- 20.6%. Of the 44 patients, 7 (15.9%) had an excess weight loss of <50%; 4 of these unsatisfactory results occurred after revision BPD-DS. After primary BPD-DS, excess weight loss of 75.8% +/- 18.0% was observed. Biologic data were obtained for 85% of the patients at 5 years. The main vitamin and micronutrients parameters remained stable over time. However, a trend was seen toward an increase in the parathormone levels and difficulties in maintaining a normal vitamin D level despite updated vitamin supplementation. CONCLUSION: The results of our study have shown that BPD-DS achieves sustainable significant weight loss with >5 years of follow-up, with unsatisfactory results in <20% of cases. Although not statistically significant, revision surgery more often resulted in lesser weight loss, although this difference had almost vanished when the initial BMI was taken as a reference compared with the BMI before BPD-DS

Molecular clips and tweezers hosting neutral guests

Intense current interest in supramolecular chemistry is devoted to the construction of molecular assemblies displaying controlled molecular motion associated to recognition. On this ground, molecular clips and tweezers have focused an increasing attention. This tutorial review points out the recent advances in the construction of always more sophisticated molecular clips and tweezers, illustrating their remarkably broad structural variety and focusing on their binding ability towards neutral guests. A particular attention is brought to recent findings in dynamic molecular tweezers whose recognition ability can be regulated by external stimuli. Porphyrin-based systems will not be covered here as this very active field has been recently reviewed

Varied nanostructures from a single multifunctional molecular material

The control of the morphology of nanostructures formed from a single component molecular material incorporating electron accepting and donating moieties is shown, from both solution and gel states. The compound comprises one tetrathiafulvalene (TTF) and two pyrene units which act as the [small pi]-electron rich and deficient units, respectively, and which are united by amide-containing linkers whose additional role is to aide aggregation by hydrogen bonding. This role was demonstrated by IR and NMR spectroscopy. The gels were deposited onto surfaces and the solvent allowed to evaporate, leaving films formed by meshes of fibres with different morphologies in accord with the different solvents used to form the materials. Doping of these xerogels with iodine vapour afforded conducting films whose characteristics were probed with current sensing atomic force microscopy (CS-AFM), providing current maps and I-V curves which show how dramatically the processing solvent can influence the electronic properties of these xerogel-derived materials

Rapid and MR-Independent IK1 activation by aldosterone during ischemia-reperfusion

In ST elevation myocardial infarction (STEMI) context, clinical studies have shown the deleterious effect of high aldosterone levels on ventricular arrhythmia occurrence and cardiac mortality. Previous in vitro reports showed that during ischemia-reperfusion, aldosterone modulates K+ currents involved in the holding of the resting membrane potential (RMP). The aim of this study was to assess the electrophysiological impact of aldosterone on IK1 current during myocardial ischemia-reperfusion. We used an in vitro model of “border zone” using right rabbit ventricle and standard microelectrode technique followed by cell-attached recordings from freshly isolated rabbit ventricular cardiomyocytes. In microelectrode experiments, aldosterone (10 and 100 nmol/L, n=7 respectively) increased the action potential duration (APD) dispersion at 90% between ischemic and normoxic zones (from 95±4ms to 116±6 ms and 127±5 ms respectively, P<0.05) and reperfusion-induced sustained premature ventricular contractions occurrence (from 2/12 to 5/7 preparations, P<0.05). Conversely, potassium canrenoate 100 nmol/L and RU 28318 1 μmol/l alone did not affect AP parameters and premature ventricular contractions occurrence (except Vmax which was decreased by potassium canrenoate during simulated-ischemia). Furthermore, aldosterone induced a RMP hyperpolarization, evoking an implication of a K+ current involved in the holding of the RMP. Cell-attached recordings showed that aldosterone 10 nmol/L quickly activated (within 6.2±0.4 min) a 30 pS K+-selective current, inward rectifier, with pharmacological and biophysical properties consistent with the IK1 current (NPo =1.9±0.4 in control vs NPo=3.0±0.4, n=10, P<0.05). These deleterious effects persisted in presence of RU 28318, a specific MR antagonist, and were successfully prevented by potassium canrenoate, a non specific MR antagonist, in both microelectrode and patch-clamp recordings, thus indicating a MR-independent IK1 activation. In this ischemia-reperfusion context, aldosterone induced rapid and MR-independent deleterious effects including an arrhythmia substrate (increased APD90 dispersion) and triggered activities (increased premature ventricular contractions occurrence on reperfusion) possibly related to direct IK1 activation

Kinks in the Hartree approximation

The topological defects of the lambda phi^4 theory, kink and antikink, are studied in the Hartree approximation. This allows us to discuss quantum effects on the defects in both stationary and dynamical systems. The kink mass is calculated for a number of parameters, and compared to classical, one loop and Monte Carlo results known from the literature. We discuss the thermalization of the system after a kink antikink collision. A classical result, the existence of a critical speed, is rederived and shown for the first time in the quantum theory. We also use kink antikink collisions as a very simple toy model for heavy ion collisions and discuss the differences and similarities, for example in the pressure. Finally, using the Hartree Ensemble Approximation allows us to study kink antikink nucleation starting from a thermal (Bose Einstein) distribution. In general our results indicate that on a qualitative level there are few differences with the classical results, but on a quantitative level there are some import ones.Comment: 20 pages REVTeX 4, 17 Figures. Uses amsmath.sty and subfigure.sty. Final version, fixed typo in published versio

Étude pharmacologique et anatomo-pathologique d’un insecticide : le thiophosphate de di-éthyle et de paranitrophényle

Valade Paul, Salle J. Étude pharmacologique et anatomo-pathologique d’un insecticide : le tiopliosphate de di-éthyle et de paranitrophényle. In: Bulletin de l'Académie Vétérinaire de France tome 103 n°5, 1950. pp. 255-262

A practical approach to estimate resting energy expenditure in frail elderly people

Objectives: Some prediction equations of resting energy expenditure (REE) are available and can be used in clinical wards to determine energy requirements of patients. The aim of the present study was to assess the accuracy of those equations in sick elderly patients, using the Bland &amp; Altman methods with our database of 187 REE measurements.Design: The 3 equations tested were Harris &amp; Benedict equation of 1919, WHO/FAO/UNU equation of 1985 and Fredrix et al. equation of 1990. In addition, three models developed from the present data were tested.Results: The present study shows that the Fredrix et al equation gave an accurate prediction of REE without significant bias along the whole range of REE. It also shows that under-weight sick elderly patients (BMI ≤ 21 kg/m2) had a greater weight-adjusted REE than their normal weight counterparts.Conclusion: A simple formula using a factor multiplying body weight, i.e. 22 kcal/kg/d in under-weight and 19 kcal/kg/d in normal weight sick elderly was accurate to predicting REE and bias was not influenced by the level of REE. This model included half of the group in the range of ±10% of the difference between predicted REE and measured REE, but the confidence interval of the bias was ±400 kcal/d. Conversely, the Harris &amp; Benedict and WHO formulae did accurately predict REE

Prevalence of sarcopenia in the French senior population

Introduction A muscle mass normalized for height2 (MMI) or for body weight (SMI) below 2SD under the mean for a young population defines sarcopenia. This study aimed at setting the cutoffs and the prevalence of sarcopenia in the French elderly population. Another objective was to compare the results obtained with SMI and MMI.Methods: Muscle mass was assessed by bioelectrical impedance analysis in 782 healthy adults (&lt;40 years) to determine skeletal mass index (SMI, muscle mass*100/weight) and muscle mass index (MMI, muscle mass/height2). Prevalence was estimated in 888 middle aged (40–59 years) and 218 seniors (60–78 years). All were healthy people.Results: For women mean-2SD were 6.2 kg/m2 (MMI) and 26.6% (SMI); for men limits were 8.6 kg/m2 (MMI) and 34.4% (SMI). In middle aged persons a small number of them were identified as sarcopenic. In healthy seniors, 2.8% of women and 3.6% of men were sarcopenic (MMI). The prevalence was 23.6% in women and 12.5% in men with SMI. MMI and SMI identified different sarcopenic populations, leaner subjects for MMI while fatter subjects for SMI.Conclusion: Cutoff values for the French population were defined. Prevalence of sarcopenia was different from that in the US population

Call-by-value non-determinism in a linear logic type discipline

We consider the call-by-value lambda-calculus extended with a may-convergent non-deterministic choice and a must-convergent parallel composition. Inspired by recent works on the relational semantics of linear logic and non-idempotent intersection types, we endow this calculus with a type system based on the so-called Girard's second translation of intuitionistic logic into linear logic. We prove that a term is typable if and only if it is converging, and that its typing tree carries enough information to give a bound on the length of its lazy call-by-value reduction. Moreover, when the typing tree is minimal, such a bound becomes the exact length of the reduction

Is a Failure to Recognize an Increase in Food Intake a Key to Understanding Insulin-Induced Weight Gain?

The present study aimed to assess the contribution of energy intake to positive energy balance and weight gain with insulin therapy. Changes in energy intake (self-report and weighed food intake), dietary behavior (auto-questionnaires), resting energy expenditure (REE) (indirect calorimetry), physical activity (accelerometry), and glucosuria were monitored over the first 6 months of insulin therapy in 46 diabetic adults. No change in REE, activity, or glucosuria could explain weight gain in the type 1 (4.1 ± 0.6 kg, P &lt; 0.0001) or type 2 (1.8 ± 0.8 kg, P = 0.02) diabetic groups. An increase in energy intake provides the most likely explanation for weight gain with insulin. However, it is not being recognized because of significant underestimation of self-reported food intake, which appears to be associated with increased dietary restraint