Reduction in Long-term Mortality After Sleeve Gastrectomy and Gastric Bypass Compared to Nonsurgical Patients With Severe Obesity.

OBJECTIVE: To separately compare the long-term risk of mortality among bariatric surgical patients undergoing either Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) to large, matched, population-based cohorts of patients with severe obesity who did not undergo surgery. BACKGROUND: Bariatric surgery has been associated with reduced long-term mortality compared to usual care for severe obesity which is particularly relevant in the COVID-19 era. Most prior studies involved the RYGB operation and there is less long-term data on the SG. METHODS: In this retrospective, matched cohort study, patients with a body mass index ≥35 kg/m 2 who underwent bariatric surgery from January 2005 to September 2015 in three integrated health systems in the United States were matched to nonsurgical patients on site, age, sex, body mass index, diabetes status, insulin use, race/ethnicity, combined Charlson/Elixhauser comorbidity score, and prior health care utilization, with follow-up through September 2015. Each procedure (RYGB, SG) was compared to its own control group and the two surgical procedures were not directly compared to each other. Multivariable-adjusted Cox regression analysis investigated time to all-cause mortality (primary outcome) comparing each of the bariatric procedures to usual care. Secondary outcomes separately examined the incidence of cardiovascular-related death, cancer related-death, and diabetes related-death. RESULTS: Among 13,900 SG, 17,258 RYGB, and 87,965 nonsurgical patients, the 5-year follow-up rate was 70.9%, 72.0%, and 64.5%, respectively. RYGB and SG were each associated with a significantly lower risk of all-cause mortality compared to nonsurgical patients at 5-years of follow-up (RYGB: HR = 0.43; 95% CI: 0.35,0.54; SG: HR = 0.28; 95% CI: 0.13,0.57) Similarly, RYGB was associated with a significantly lower 5-year risk of cardiovascular-(HR = 0.27; 95% CI: 0.20, 0.37), cancer- (HR = 0.54; 95% CI: 0.39, 0.76), and diabetes-related mortality (HR = 0.23; 95% CI:0.15, 0.36). There was not enough follow-up time to assess 5-year cause-specific mortality in SG patients, but at 3-years follow-up, there was significantly lower risk of cardiovascular- (HR = 0.33; 95% CI:0.19, 0.58), cancer- (HR = 0.26; 95% CI:0.11, 0.59), and diabetes-related (HR = 0.15; 95% CI:0.04, 0.53) mortality for SG patients. CONCLUSION: This study confirms and extends prior findings of an association with better survival following bariatric surgery in RYGB patients compared to controls and separately demonstrates that the SG operation also appears to be associated with lower mortality compared to matched control patients with severe obesity that received usual care. These results help to inform the tradeoffs between long-term benefits and risks of bariatric surgery.

Nitrogen dynamics of the aquatic system is an important driving force for efficient sewage purification in single pond natural treatment wetlands at East Kolkata Wetland.

At East Kolkata Wetlands, though the domestic city sewage is purified very rapidly, the mechanisms of treatment remains inadequately explored. In this context, the present study investigated nitrogen dynamics of the single pond treatment systems during purification and explored its potential role in sewage treatment. For this purpose the concentrations of different forms of nitrogen present both in water and soil at different time points of purification were measured. The organic nitrogen content decreased sharply, in the early phase, with an increase in ammonium concentration. Notably the reduction in organic nitrogen was significantly higher than the increase in NH4+ which can be attributed to the volatilization of NH4+ under alkaline pH. This volatilization results in reduced oxygen demand. The nitrate-N concentration decreased sharply from soil with a concomitant increase in water column. However the reduction of nitrate in soil was significantly higher than the increase in water column. It indicated the occurrence of denitrification under anoxic condition wherein nitrate serves as terminal electron acceptor. Additionally a part of the nitrate supported planktonic growth. Thus it describes another mechanism of reducing oxygen demand. The initial NH4+-N concentration in the soil was very low and it increased gradually during purification due to increasing soil cation exchange capacity. Thus by trapping NH4+ ion soil contributes towards preventing contamination of water. Thus at EKW, the cumulative activities in water and soil involved in nitrogen dynamics lead to overall reduction of the oxygen demand and contribute towards efficient sewage purification.

Investigation on the long-term storage and fate of arsenic obtained as a treatment residual: a case study.

In several places in India, activated alumina is used for effective removal of arsenic from contaminated ground water used for drinking purposes. Once exhausted, activated alumina is regenerated and reused for number of cycles. Regeneration of activated alumina generates treatment residuals containing arsenic, disposal of which needs care so as to avoid further pollution of the neighbouring environment. In the present study, a suitable stabilization and disposal method for the treatment residuals inside a well aerated coarse sand filter bed has been developed. Standard leaching tests carried out with the stabilized treatment residual indicated that the leaching of arsenic from the stabilized treatment residual was minimum, and was within the regulatory limit. Water quality data of all the wells located within 100 m from the sand filter were monitored for nearly four years and no adverse impact of disposal of arsenic-laden treatment residuals in the sand filter was observed.

A platelet-inspired paradigm for nanomedicine targeted to multiple diseases.

Platelets are megakaryocyte-derived anucleated cells found in the blood. They are mainly responsible for rendering hemostasis or clotting to prevent bleeding complications. Decreased platelet numbers or deficiencies in platelet functions can lead to various acute or chronic bleeding conditions and hemorrhage. On the other hand, dysregulated hyperactivity of the clotting process can lead to thrombosis and vascular occlusion. There is significant evidence that beyond hemostasis and thrombosis, platelets play crucial mechanistic roles in other disease scenarios such as inflammation, immune response and cancer metastasis by mediating several cell-cell and cell-matrix interactions, as well as aiding the disease microenvironment via secretion of multiple soluble factors. Therefore, elucidating these mechanistic functions of platelets can provide unique avenues for developing platelet-inspired nanomedicine strategies targeted to these diseases. To this end, the current review provides detailed mechanistic insight into platelets' disease-relevant functions and discusses how these mechanisms can be utilized to engineer targeted nanomedicine systems.

Well-head arsenic removal units in remote villages of Indian subcontinent: field results and performance evaluation.

Since 1997, over 135 well-head arsenic removal units have been installed in remote villages in the Indian state of West Bengal bordering Bangladesh. Every component of the arsenic removal treatment system including activated alumina sorbent is procured indigenously. Each unit serves approximately 200-300 households and contains about 100 L of activated alumina. No chemical addition, pH adjustment or electricity is required for operating these units. The arsenic concentration in the influent varies from around 100 microg/L to greater than 500 microg/L. In the treated water, arsenic concentration is consistently below 50 microg/L. The units are capable of removing both arsenites and arsenates from the contaminated groundwater for several months, often exceeding 10,000 bed volumes. In the top portion of the column, the dissolved iron present in ground water is oxidized by atmospheric oxygen into hydrated Fe(III) oxides or HFO particles which in turn selectively bind both As(III) and As(V). Upon exhaustion, these units are regenerated by caustic soda solution followed by acid wash. The arsenic-laden spent regenerant is converted into a small volume sludge (less than 500 g) and contained over a coarse sand filter in the same premise requiring no disposal. Many units have been operating for several years without any significant operational difficulty. The treated water is used for drinking and cooking. Most importantly, the villagers are responsible for the day to day operation and the upkeep of the units.

Treatment of chrome plating wastewater (Cr+6) using activated alumina.

Suitability of activated alumina for removal of hexavalent chromium from electroplating wastewater has been investigated. Activated alumina exhibited good sorption capacity for hexavalent chromium and pH has no pronounced effect on the sorption capacity. Both batch and column adsorption studies have been carried out and an adsorption column design indicated reasonable depth of column for practical application.