Utilizing bougie ≥40 Fr may decrease leak without impacting %EWL up to 3 years. Distance from the pylorus does not impact leak or weight loss. Buttressing does not seem to impact leak; however, if surgeons desire to buttress, bioabsorbable material is the most common type used. Longer-term studies are needed to definitively determine the effect of bougie size on weight loss after LSG.

No abstract

The authors have demonstrated that high-quality MR images can be obtained in the operating room within reasonable time constraints. Procedures can be conducted without compromising or altering traditional neurosurgical, nursing, or anesthetic techniques. It is feasible that within the next decade intraoperative MR imaging may become the standard of care in neurosurgery.

. Can. J. Chem. 59, 1105 (1981).Several isomeric compounds derived from the spiro systems 5 to 9 (Scheme 4) were obtained from the acid cyclization of the appropriate dihydroxy ketone precursor.The configuration and the conformation of the products obtained was determined by I3C nmr analysis and equilibration studies. The experimental results can be rationalized by taking into account the anomeric and the exo-anomeric effects and the usual steric interactions.PIERRE DESLONGCHAMPS, DARYL D. ROWAN, NORMAND POTHIER, TILLES SAUVE et JOHN K. SAUNDERS. Can. J. Chem. 59, 1105 (1981).Plusieurs composes isomeres derives des systemes spiranniques 5 a 9 (Schema 4) furent obtenus par cyclisation en milieu acide des precurseurs dihydroxycetoniques appropries.La configuration et la conformation des produits obtenus ont ete dkterminees par la rmn du I3C et par des etudes d'equilibration. Les resultats exptrimentaux sont expliques en tenant compte de I'effet anomere, de I'effet exo-anomtre et des interactions steriques habituelles.Stereoelectronic effects have been recognized for a long time to influence the configuration and the conformation of acetals, particularly in carbohydrates where these effects were first discovered and discussed in terms of the anomeric and exoanomeric effects (I).,,, a-And P-glycosides can theoretically take conformations A , , A,, A, and E,, E,, E, respectively (Scheme 1). The relative proportions of these various conformers in a and P-glycosides should be influenced by the usual steric interactions and by stereoelectronic effects. For instance, if stereoelectronic effects (anomeric and exo-anomeric effects) are important, the following predictions can be made: (a) conformer A, has only one anomeric effect and conformers A , and A, have two each,4 and since A, must be eliminated because of strong 'This work has been presented at the 8th Natural Products Symposium, University of West Indies, Mona, Jamaica, January 1980, and at the 1st International Symposium on Stereoelectronic Effects, University of St. Andrews, Scotland, July 1980.2The preference for an alkoxy group to be axially oriented is due to the anomeric effect, whereas the preference for the R group of the side chain at the anomeric center to be in the A , or the E, conformation in a and P-glycosides respectively is due to the exo-anomeric effect (Scheme 1).3The anomeric (or the exo-anomeric) effect is considered to be a stabilizing effect which occurs when an electron pair of an oxygen atom is oriented antiperiplanar to a C-OR bond. The stabilization would be gained through an electronic delocalization due to the overlap of an electron lone pair orbital of an oxygen with the antibonding orbital of a C-OR sigma bond (2, 3).41n this article, we use the term anomeric effect to describe either an anomeric or an exo-anomeric effect, assuming that both effects are of the same order of magnitude. steric interactions, A , must correspond to the most stable conformer of an a-glycoside; (b) conformer E, has no anomeric effect whereas El and E, have ...

Structured Abstract Objective To compare bariatric surgery vs. intensive medical weight management (MWM) in patients with type 2 diabetes (T2DM) who do not meet current NIH criteria for bariatric surgery. To assess whether the soluble form of receptor for advanced glycation endproducts (sRAGE) is a biomarker to identify patients most likely to benefit from surgery. Summary Background Data There are few studies comparing surgery to MWM for patients with T2DM and BMI < 35. Methods 57 patients with T2DM and BMI 30–35 who otherwise met criteria for bariatric surgery were randomized to MWM vs. surgery (bypass, sleeve or band, based on patient preference). The primary outcomes assessed at 6 months were change in insulin resistance (HOMA-IR) and diabetes remission. Secondary outcomes included changes in HbA1c, weight, and sRAGE. Results The surgery group had improved HOMA-IR (−4.6 vs. +1.6; p=0.0004) and higher diabetes remission (65% vs. 0%, p<0.0001) than the MWM group at 6 months. Compared to MWM, the surgery group had lower HbA1c (6.2 vs. 7.8, p=0.002), lower fasting glucose (99.5 vs. 157; p=0.0068) and fewer T2DM medication requirements (20% vs. 88%; p<0.0001) at 6 months. The surgery group lost more weight (7.0 BMI decrease vs. 1.0 BMI decrease, p<0.0001). Higher baseline sRAGE was associated with better weight loss outcomes (r=−0.641; p=0.046). There were no mortalities. Conclusions Surgery was very effective short-term in patients with T2DM and BMI 30–35. Baseline sRAGE may predict patients most likely to benefit from surgery. These findings need to be confirmed with larger studies. ClinicalTrials.gov ID: NCT01423877