Endoscopic sleeve gastroplasty in class Ⅲ obesity:Efficacy, safety, and durability outcomes in 404 consecutive patients

BACKGROUND Endoscopic sleeve gastroplasty(ESG) is an effective therapy for class Ⅰ-Ⅱ obesity, but there are knowledge gaps in the published literature about its implementation in patients with class Ⅲ obesity [body mass index(BMI) ≥ 40 kg/m2].AIM To evaluate the safety, clinical efficacy, and durability of ESG in adults with class Ⅲ obesity.METHODS This was a retrospective cohort study that used prospectively collected data on adults with BMI ≥ 40 kg/m2who underwent ESG and longitudinal lifestyle counseling at two centers with expertise in endobariatric therapies from May 2018-March 2022. The primary outcome was total body weight loss(TBWL) at 12 mo. Secondary outcomes included changes in TBWL, excess weight loss(EWL) and BMI at various time points up to 36 mo, clinical responder rates at 12 and 24 mo, and comorbidity improvement. Safety outcomes were reported through the study duration. One-way ANOVA test was performed with multiple Tukey pairwise comparisons for TBWL, EWL, and BMI over the study duration.RESULTS 404 consecutive patients(78.5% female, mean age 42.9 years, mean BMI 44.8 ± 4.7 kg/m2) were enrolled. ESGs were performed using an average of 7 sutures, over 42 ± 9 min, and with 100% technical success. TBWL was 20.9 ± 6.2% at 12 mo, 20.5 ± 6.9% at 24 mo, and 20.3 ± 9.5% at 36 mo. EWL was 49.6 ± 15.1% at 12 mo, 49.4 ± 16.7% at 24 mo, and 47.1 ± 23.5% at 36 mo. There was no difference in TBWL at 12, 15, 24, and 36 mo from ESG. TBWL exceeding 10%, 15%, and 20% was achieved by 96.7%, 87.4%, and 55.6% of the cohort at 12 mo, respectively. Of the cohort with the relevant comorbidity at time of ESG, 66.1% had improvement in hypertension, 61.7% had improvement in type Ⅱ diabetes, and 45.1% had improvement in hyperlipidemia over study duration. There was one instance of dehydration requiring hospitalization(0.2% serious adverse event rate).CONCLUSION When combined with longitudinal nutritional support, ESG induces effective and durable weight loss in adults with class Ⅲ obesity, with improvement in comorbidities and an acceptable safety profile.

Ethanol steam reforming over Ni/ZSM-5 nanosheet for hydrogen production

Compared to reforming reactions using hydrocarbons,ethanol steam reforming(ESR)is a sustainable alternative for hydrogen(H_(2))production since ethanol can be produced sustainably using biomass.This work explores the catalyst design strategies for preparing the Ni supported on ZSM-5 zeolite catalysts to promote ESR.Specifically,two-dimensional ZSM-5 nanosheet and conventional ZSM-5 crystal were used as the catalyst carriers and two synthesis strategies,i.e.,in situ encapsulation and wet impregnation method,were employed to prepare the catalysts.Based on the comparative characterization of the catalysts and comparative catalytic assessments,it was found that the combination of the in situ encapsulation synthesis and the ZSM-5 nanosheet carrier was the effective strategy to develop catalysts for promoting H_(2) production via ESR due to the improved mass transfer(through the 2-D structure of ZSM-5 nanosheet)and formation of confined small Ni nanoparticles(resulted via the in situ encapsulation synthesis).In addition,the resulting ZSM-5 nanosheet supported Ni catalyst also showed high Ni dispersion and high accessibility to Ni sites by the reactants,being able to improve the activity and stability of catalysts and suppress metal sintering and coking during ESR at high reaction temperatures.Thus,the Ni supported on ZSM-5 nanosheet catalyst prepared by encapsulation showed the stable performance with~88% ethanol conversion and~65% H_(2) yield achieved during a 48-h longevity test at 550-C.

Transoral outlet reduction:Outcomes of endoscopic Roux-en-Y gastric bypass revision in 284 patients at a community practice

BACKGROUND Transoral outlet reduction(TORe)is a minimally invasive endoscopic revision of Roux-en-Y gastric bypass(RYGB)for weight recurrence;however,little has been published on its clinical implementation in the community setting.AIM To characterize the safety and efficacy of TORe in the community setting for adults with weight recurrence after RYGB.METHODS This is a retrospective cohort study of argon plasma coagulation and purse-string suturing for gastric outlet reduction in consecutive adults with weight recurrence after RYGB at a single community center from September 2020 to September 2022.Patients were provided longitudinal nutritional support via virtual visits.The primary outcome was total body weight loss(TBWL)at twelve months from TORe.Secondary outcomes included TBWL at three months and six months;excess weight loss(EWL)at three,six,and twelve months;twelve-month TBWL by obesity class;predictors of twelve-month TBWL;rates of post-TORe stenosis;and serious adverse events(SAE).Outcomes were reported with descriptive statistics.RESULTS Two hundred eighty-four adults(91.9%female,age 51.3 years,body mass index 39.3 kg/m^(2))underwent TORe an average of 13.3 years after RYGB.Median pre-and post-TORe outlet diameter was 35 mm and 8 mm,respectively.TBWL was 11.7%±4.6%at three months,14.3%±6.3%at six months,and 17.3%±7.9%at twelve months.EWL was 38.4%±28.2%at three months,46.5%±35.4%at six months,and 53.5%±39.2%at twelve months.The number of follow-up visits attended was the strongest predictor of TBWL at twelve months(R^(2)=0.0139,P=0.0005).Outlet stenosis occurred in 11 patients(3.9%)and was successfully managed with endoscopic dilation.There was one instance of post-procedural nausea requiring overnight observation(SAE rate 0.4%).CONCLUSION When performed by an experienced endoscopist and combined with longitudinal nutritional support,purse-string TORe is safe and effective in the community setting for adults with weight recurrence after RYGB.

船用低速二冲程柴油机燃烧与排放数值模拟研究

使用CFD软件对一台船用低速二冲程柴油机额定工况点缸内喷雾、燃料着火和燃烧过程、排放物NOx浓度分布及生成总量进行了数值模拟研究。模拟所得压缩压力和最高燃烧压力与实测值基本一致。在额定工况点运行时,柴油机预混合燃烧比例很小,基本呈现单峰状的扩散燃烧特征;燃烧放热初始时刻在上止点附近,整个燃烧持续期约为45℃A。同时,计算所得的NOx生成总量与实测值存在19.15%的偏差。

Numerical Modeling of One-Dimensional Binary Solidification with a Mushy Layer Evolution

The numerical modeling of a binary solidification with a mushy layer mechanism is considered in this manuscript.The nonlinear coupled system of equations describes the heat and mass diffusions of a one-dimensional spatial variable in the semiinfinite interval.Also formulated is a transformed system in a finite interval.We propose numerical methods for solving the nonlinear system using a threshold strategy based on fixed computation-domain approach.Our calculated results and those from the LeadEx field experiment are well-matched in their tendencies.

Staged endovascular reconstruction of complex traumatic intracranial carotid artery dissection

Case presenTaTion A 32-year old woman presented with traumatic facial injuries from a horseback riding incident.She was found to have a Glasgow Coma Score of 3T,left eyelid ptosis with a fixed-dilated pupil and a flaccid right upper extremity.CT angiogram of the head showed complex craniofacial injuries,including a transverse fracture transecting the clivus and the left petrous temporal bone,with SAH in the suprasellar cistern.There was a bilateral engorgement of the superior ophthalmic veins,suggestive of bilateral CCF formations.Digital subtraction angiography(DSA)showed a left petrocavernous internal carotid artery dissection(ICAD).MRI of the brain demonstrated multiple embolic infarcts in the left middle cerebral artery(MCA)territory,despite therapeutic anticoagulation with heparin.

Efficient Photocatalytic Reduction of CO_(2)Catalyzed by the Metal–Organic Framework MFM-300(Ga)

Photocatalytic reduction of CO_(2)to carbon fuels is an important target but highly challenging to achieve.Here,we report the efficient photoconversion of CO_(2)into formic acid over a Ga(Ⅲ)-based metal–organic framework(MOF)material using triethanolamine as the sacrificial agent.Under light irradiation and at room temperature,photoreduction of CO_(2) over MFM-300(Ga)yields formic acid with a selectivity of 100%.

安全使用含浓缩钾药物的最佳实践

改善患者安全性的建议往往是在实践指南及很多专家或机构的建议基础上提出的, 但并未得到证实,尤其是那些有关如何使用含钾药品安全性方面的建议即使是目前已得到广泛认可的含钾溶液安全使用常规,也缺乏表示支持或否定的确凿证据或经验性证据当务之急是开展医疗卫生系统整体评估医疗保健系统的研究。