Single Anastomosis Duodenal Switch: 1-Year Outcomes.

INTRODUCTION: Single-anastomosis duodenal switch has been suggested to be an effective bariatric procedure that offers excellent weight loss and by lengthening the common channel the potential to reduce micronutrient deficiencies. PURPOSE: To evaluate the weight loss, comorbidity resolution and the 1-year nutritional outcomes of the single-anastomosis duodenal switch (SADS) procedure. SETTING: Multiple US Hospitals. METHODS: From October 2014 to January 2017, 120 patients were enrolled at six sites across the USA and underwent the SADS procedure. Weight loss, comorbidities, quality of life, and adverse events were followed post-procedure for 12 months. RESULTS: At 1, 6, and 12 months, 98.3%, 85.5%, and 77.1% of the patients were available for assessment, respectively. At 12 months, patients showed significantly reduced body mass index when compared to baseline (46.8 ± 5.8 vs 29.8 ± 4.4, P < 0.001 respectively). Sixty-five patients had type 2 diabetes at baseline; however, 11 patients lost to follow-up. Of the available data (54 patients), 96.3% of the patients had a resolution of type 2 diabetes by 12 months with a mean A1C reduction from 7.8 ± 1.6 to 5.3 ± 0.7. Additionally, there were reductions in hyperlipidemia, sleep apnea, and hypertension at 12 months. Patient gastroesophageal reflux disease satisfaction and quality of life (SF-36) scores were significantly higher at 12 months post-procedure (P < 0.001 in all cases) while 12-month protein levels remained at normal values. There were abnormalities of parathyroid hormone and vitamin D at 1 year with all other nutritional markers being not significantly different at 1 year from baseline. There were 10, IIIb, or greater complications according to the Clavien-Dindo scoring system during the study period, not all of which were related to the surgery. CONCLUSIONS: SADS is a highly efficacious weight loss procedure with significant comorbidity reduction at 1 year. At 1 year, complications and vitamin and mineral deficits appear to be consistent with other malabsorption operations. Long-term follow-up is needed, especially around complications and vitamin deficiencies.

Coordination copolymerization of severely encumbered isoalkenes with ethylene: enhanced enchainment mediated by binuclear catalysts and cocatalysts.

This contribution describes the implementation of the binuclear organotitanium "constrained geometry catalysts" (CGCs), (mu-CH(2)CH(2)-3,3'){(eta(5)-indenyl)[1-Me(2)Si((t)()BuN)](TiMe(2))}(2)[EBICGC(TiMe(2))(2); Ti(2)] and (mu-CH(2)-3,3'){(eta(5)-indenyl)[1-Me(2)Si((t)BuN)](TiMe(2))}(2)[MBICGC(TiMe(2))(2); C1-Ti(2)], in combination with the bifunctional bisborane activator 1,4-(C(6)F(5))(2)BC(6)F(4)B(C(6)F(5))(2) (BN(2)) in ethylene + olefin copolymerization processes. Specifically examined are the classically poorly responsive 1,1-disubstituted comonomers, methylenecyclopentane (C), methylenecyclohexane (D), 1,1,2-trisubstituted 2-methyl-2-butene (E), and isobutene (F). For the first three comonomers, this represents the first report of their incorporation into a polyethylene backbone via a coordination polymerization process. C and D are incorporated via a ring-unopened pathway, and E is incorporated via a novel pathway involving 2-methyl-1-butene enchainment in the copolymer backbone. In ethylene copolymerization, Ti(2) + BN(2) enchains approximately 2.5 times more C, approximately 2.5 times more D, and approximately 2.3 times more E than the mononuclear catalyst analogue [1-Me(2)Si(3-ethylindenyl)((t)BuN)]TiMe(2) (Ti(1)) + B(C(6)F(5))(3) (BN) under identical polymerization conditions. Polar solvents are found to weaken the catalyst-cocatalyst ion pairing, thus influencing the comonomer enchainment selectivity.

The conserved Xanthomonas campestris pv. vesicatoria effector protein XopX is a virulence factor and suppresses host defense in Nicotiana benthamiana.

Nicotiana benthamiana leaves display a visible plant cell death response when infiltrated with a high titer inoculum of the non-host pathogen, Xanthomonas campestris pv. vesicatoria (Xcv). This visual phenotype was used to identify overlapping cosmid clones from a genomic cosmid library constructed from the Xcv strain, GM98-38. Individual cosmid clones from the Xcv library were conjugated into X. campestris pv. campestris (Xcc) and exconjugants were scored for an altered visual high titer inoculation response in N. benthamiana. The molecular characterization of the cosmid clones revealed that they contained a novel gene, xopX, that encodes a 74-kDa type III secretion system (TTSS) effector protein. Agrobacterium-mediated transient expression of XopX in N. benthamiana did not elicit the plant cell death response although detectable XopX protein was produced. Interestingly, the plant cell death response occurred when the xopX Agrobacterium-mediated transient expression construct was co-inoculated with strains of either XcvDeltaxopX or Xcc, both lacking xopX. The co-inoculation complementation of the plant cell death response also depends on whether the Xanthomonas strains contain an active TTSS. Transgenic 35S-xopX-expressing N. benthamiana plants also have the visible plant cell death response when inoculated with the non-xopX-expressing strains XcvDeltaxopX and Xcc. Unexpectedly, transgenic 35S-xopX N. benthamiana plants displayed enhanced susceptibility to bacterial growth of Xcc as well as other non-xopX-expressing Xanthomonas and Pseudomonas strains. This result is also consistent with the increase in bacterial growth on wild type N. benthamiana plants observed for Xcc when XopX is expressed in trans. Furthermore, XopX contributes to the virulence of Xcv on host pepper (Capsicum annuum) and tomato (Lycopersicum esculentum) plants. We propose that the XopX bacterial effector protein targets basic innate immunity in plants, resulting in enhanced plant disease susceptibility.

Natural history of carotid artery stenosis contralateral to endarterectomy: results from two randomized prospective trials.

PURPOSE: A few nonrandomized studies have reported the natural history of carotid artery stenosis (CAS) contralateral to carotid endarterectomy (CEA). This study analyzed this condition with data from two randomized prospective trials. METHODS: The contralateral carotid arteries in 534 patients from two randomized trials that compared CEA with primary closure versus patching were followed up clinically and with duplex ultrasound scanning at 1 month and then every 6 months. CAS was classified as less than 50%, 50% to 79%, 80% to 99%, and occlusion. Late contralateral CEA was performed to treat significant CAS. Progression was defined as progress to a higher category of stenosis. Kaplan-Meier life table analysis was used to estimate freedom from progression of CAS. The correlation of risk factors and CAS progression was also analyzed. RESULTS: Of 534 patients, 61 had initial contralateral CEA and 53 had contralateral occlusion. Overall, CAS progressed in 109 of 420 patients (26%) at mean follow-up of 41 months. Progression of CAS was noted in 5 of 162 patients (3%) with baseline normal carotid arteries. CAS progressed in 56 of 157 patients (36%) with less than 50% stenosis versus 45 of 95 patients (47%) with 50% to 79% stenosis (P =.003). Median time to progression was 24 months for less than 50% CAS, and 12 months for 50% to 79% CAS (P =.035). At 1, 2, 3, 4, and 5 years, freedom from disease progression in patients with baseline CAS <50% was 95%, 78%, 69%, 61%, 48%, respectively, and in patients with 50% to 79% CAS was 75%, 61%, 51%, 43%, and 33%, respectively (P =.003). Freedom from progression in patients with baseline normal carotid arteries at 1 through 5 years was 99%, 98%, 96%, 96%, and 94%, respectively. Late neurologic events referable to the CCA were infrequent (28 of 420 [6.7%] in the entire series; 28 of 258 [10.9%] patients with contralateral CAS), and included 10 strokes (2.4%) and 18 transient ischemic attacks (4.3%). However, late contralateral CEA was performed in 62 patients (62 of 420 [15%] in the entire series; 62 of 258 [24%] patients with contralateral CAS). Survival rates were 96%, 92%, 90%, 87%, and 82%, respectively, at 1 through 5 years. CONCLUSIONS: Progression of CCA stenosis was noted in a significant number of patients with baseline contralateral CAS. Serial clinical studies and duplex ultrasound scanning every 6 to 12 months in patients with 50% to 79% CAS, and every 12 to 24 months in patients with 50% or less CAS is adequate.

Natural history of > or =60% asymptomatic carotid stenosis in patients with contralateral carotid occlusion.

OBJECTIVE: Although the Asymptomatic Carotid Atherosclerosis Study (ACAS) reported that carotid endarterectomy (CEA) is beneficial for patients with asymptomatic > or =60% carotid stenosis (ACS), several other studies have reported mixed results. Our prospective study analyzed the natural history of > or =60% ACS in patients with contralateral carotid occlusion (CCO). PATIENT POPULATION AND METHODS: During a 10-year period, patients with 60-<70% ACS with CCO were entered into a protocol of clinical examination and duplex surveillance every 6 months. All patients underwent maximum medical therapy. Late CEAs were considered if lesions became symptomatic or progressed to > or =70% stenosis. A Kaplan-Meier lifetable analysis was performed to estimate the freedom from both ipsilateral strokes and all strokes. RESULTS: Eighty-two patients were enrolled with a mean follow-up of 59.5 months (range, 7-141 months). Late strokes were noted in 27 of 82 patients (33%); 19 (23%) were ipsilateral and 8 (10%) were contralateral (side of CCO). Late transient ischemic attacks (TIAs) were noted in 22 of 82 (27%, 7 ipsilateral and 15 contralateral). The combined neurologic event (TIA/stroke) rate was 60% (49 of 82, 32% ipsilateral and 28% contralateral). Kaplan-Meier lifetable analysis showed that the rates of freedom from ipsilateral strokes, all strokes, and progression to > or =70% stenosis at 1, 2, 3, 4, and 5 years were 94%, 90%, 85%, 80%, 73%; 94%, 89%, 84%, 77%, 67%; and 99%, 96%, 92%, 86%, and 82%, respectively. The ipsilateral stroke-free survival rates at l, 2, 3, 4, and 5 years were 94%, 88%, 78%, 70%, and 63%. Twenty-one late CEAs were performed with no perioperative stroke/deaths (5 for ipsilateral TIAs, 9 for ipsilateral strokes, and 7 for > or =70% ACS). Overall, 20 (24%, 11 with symptoms and 9 asymptomatic) progressed to > or =70% stenosis. CONCLUSIONS: Patients with 60-<70% ACS and CCO with maximal medical therapy carry a higher incidence of ipsilateral strokes and all strokes than what was reported by the ACAS study; therefore, prophylactic CEA may be justified in these patients.