Robotic transversus abdominis release using HUGO RAS system: our initial experience.

BACKGROUND: Transversus abdominis release (TAR) is an effective technique for treating large midline and off-midline hernias. Recent studies have demonstrated that robotic TAR (rTAR) is technically feasible and associated with improved outcomes compared to open surgery. There is no published experience to date describing abdominal wall reconstruction using the novel robotic platform HUGO RAS System (Medtronic®). METHODS: All consecutive patients who underwent a rTAR in our institution were included. Three of the four arm carts of the HUGO RAS System were used at any given time. Each arm configuration was defined by our team in conjunction with Medtronic® personnel. rTAR was performed as previously described. Upon completion of the TAR on one side, a redocking process with different, mirrored arms angles was performed to continue with the contralateral TAR. Operative variables and early morbidity were recorded. RESULTS: Ten patients were included in this study. The median BMI was 31 (21-40.6) kg/m2. The median height was 1.6 m (1.5-1.89 m). A trend of decreased operative time, console time, and redocking time was seen in these consecutive cases. No intraoperative events nor postoperative morbidity was reported. The median length of stay was 3 (1-6) days. CONCLUSION: Robotic TAR utilizing the HUGO RAS system is a feasible and safe procedure. The adoption of this procedure on this novel platform for the treatment of complex abdominal wall hernias has been successful for our team.

[Trauma Injuries Associated with Rope Bullfights in the Azores: A Cross-Sectional Study]. / Trauma Associado às Touradas à Corda nos Açores: Um Estudo Transversal.

INTRODUCTION: The aim of the study was to describe trauma injuries associated with rope bullfights in the Azores, Portugal, regarding the cause of the incident, trauma mechanism, most affected anatomical areas, and injury severity. METHODS: Two-year cross-sectional study in the local hospital with prospective data collection. Patients who were consecutively admitted to the local hospital's emergency department with trauma injuries from the bull's direct impact or from falls either during the bull's escape or when handling the rope, were included. Data on general demographics, lesion characteristics, treatments, need for hospitalization and mortality were collected. RESULTS: Fifty-six incidents and 80 trauma injuries were identified. The main cause of trauma was the bull's direct impact (37; 66.07%) and the mechanism of injury was blunt trauma in all patients (100%; 56). Head and neck injuries (27; 33.75%) were the most common. The median Injury Severity Score at the emergency department admission was 4. Major trauma was noted in five patients (8.92%). Ten patients (17.85%) needed hospitalization with a median hospital stay of seven days. Three of the 10 hospitalized patients (30%) were previously admitted to the intensive care unit. Surgery was performed in six patients (10.71%). CONCLUSION: The main cause of trauma was the bull's direct impact, and the mechanism of injury was blunt trauma. The most affected anatomical areas were the head and neck. These findings are a wake-up call to the impact of these events regarding the economic costs they entail, the costs for the health of the local population, the safety measures currently implemented and the availability of the necessary means to treat these patients.

Introdução: O objetivo deste estudo foi caracterizar as lesões traumáticas tauromáquicas ocorridas nas touradas à corda nos Açores no que diz respeito à causa do incidente, mecanismo de trauma, área anatómica mais afetada e gravidade das lesões. Métodos: Estudo unicêntrico, transversal, com a colheita prospetiva de dados realizada durante dois anos. Foram incluídos os doentes que consecutivamente recorreram ao serviço de urgência do hospital local por lesões traumáticas ocorridas por trauma direto com o animal ou quedas aquando da fuga ou manuseio da corda. Foram colhidos dados demográficos gerais, características da lesão, tratamentos efetuados, necessidade de internamento hospitalar e mortalidade. Foi realizada uma análise estatística descritiva com recurso ao software estatístico SPSS. Resultados: Registaram-se 56 admissões hospitalares e 80 lesões traumáticas. A principal causa de traumatismo foi o trauma direto com o animal (37; 66,07%) e o mecanismo de lesão foi o trauma fechado (56; 100%). As áreas anatómicas mais afetadas foram a cabeça e pescoço (27; 33,75%). A mediana de Injury Severity Score foi de 4 à admissão hospitalar. Cinco doentes (8,92%) apresentaram trauma major. Dez doentes (17,85%) necessitaram de internamento hospitalar com uma mediana de dias de internamento de sete (IIQ 4,5 dias). Três (30%) dos doentes internados necessitaram de internamento em unidade de cuidados intensivos. Seis doentes (10,71%) foram submetidos a cirurgia. Conclusão: A principal causa de traumatismo foi o trauma direto com o animal e o mecanismo de lesão foi o trauma fechado. As áreas anatómicas mais afetadas foram a cabeça e pescoço. Estes dados constituem um alerta para o impacto destes eventos no que diz respeito aos custos económicos que acarretam, aos custos para a saúde da população local, às medidas de segurança atualmente implementadas e à disponibilidade dos meios necessários para tratar estes doentes.

Chemical composition and antifungal activity of the essential oil from the Hymenaea stigonocarpa Mart. Ex Hayne (jatobá-do-cerrado) fruit peel.

This study investigated the chemical composition and the antifungal activity of the essential oil extracted from the Hymenaea stigonocarpa fruit peel (HSFPEO) against Botrytis cinerea, Sclerotinia sclerotiorum, Aspergillus flavus and Colletotrichum truncatum. The HSFPEO obtained through hydrodistillation was analyzed with gas chromatography coupled to mass spectrometry. The antifungal activity was determined by the mean mycelial growth inhibition of the fungus treated with essential oils and growth control. The major constituents of HSFPEO were spathulenol (25.19%) and caryophyllene oxide (13.33%). HSFPEO demonstrated antifungal activity against all fungi tested in all concentrations evaluated in a dose-dependent behavior. The best results were observed against B. cinerea and A. flavus, in which the lowest concentration tested inhibited more than 70% of mycelial growth. Based on the current knowledge, this study describes for the first time the chemical composition and the antifungal activity of HSFPEO against the phytopathogenic fungi B. cinerea and C. truncatum.

GALLBLADDER POLYPS: CORRELATION AND AGREEMENT BETWEEN ULTRASONOGRAPHIC AND HISTOPATHOLOGICAL FINDINGS IN A POPULATION WITH HIGH INCIDENCE OF GALLBLADDER CANCER.

BACKGROUND: Gallbladder polyps are becoming a common finding in ultrasound. The management has to consider the potential risk of malignant lesions. AIMS: The aim of this study was to analyze the ultrasound findings in patients undergoing cholecystectomy due to gallbladder polyps and compare them for histopathological findings (HPs). METHODS: Patients with an ultrasonographic diagnosis of gallbladder polyp and who underwent cholecystectomy from 2007 to 2020 were included in the study. RESULTS: A total of 447 patients were included, of whom 58% were women. The mean age was 45±12 years. The mean size of polyps in US was 7.9±3.6 mm. Notably, 9% of polyps were greater than 10 mm, and single polyps were significantly larger than the multiple ones (p=0.003). Histopathological findings confirmed the presence of polyps in 88.4%, with a mean size of 4.8±3.4 mm. In all, 16 cases were neoplastic polyps (4.1%), 4 of them being malignancies, and all were single and larger than 10 mm. We found a significant correlation between ultrasound and histopathological findings polyp size determination (r=0.44; p<0.001). The Bland-Altman analysis obtained an overestimation of the US size of 3.26 mm. The receiver operating characteristic (ROC) curve analysis between both measures obtained an area under the receiver operating characteristic curve (AUC) of 0.77 (95%CI 0.74-0.81). Ultrasound polyps size larger than 10 mm had an odds ratio (OR) of 8.147 (95%CI 2.56-23.40) for the presence of adenoma and malignancy, with a likelihood ratio of 2.78. CONCLUSIONS: There is a positive correlation and appropriate diagnostic accuracy between ultrasound size of gallbladder polyps compared to histopathological records, with a trend to overestimate the size by about 3 mm. Neoplastic polyps are uncommon, and it correlates with size. Polyps larger than 10 mm were associated with adenoma and malignancy.

Remote and asynchronous training network: from a SAGES grant to an eight-country remote laparoscopic simulation training program.

BACKGROUND: Limitations in surgical simulation training include lack of access to validated training programs with continuous year-round training and lack of experts' ongoing availability for feedback. A model of simulation training was developed to address these limitations. It incorporated basic and advanced laparoscopic skills curricula from a previously validated program and provided instruction through a digital platform. The platform allowed for remote and asynchronous feedback from a few trained instructors. The instructors were continuously available and provided personalized feedback using a variety of different media. We describe the upscaling of this model to teach trainees at fourteen centers in eight countries. METHODS: Institutions with surgical programs lacking robust simulation curricula and needing instructors for ongoing education were identified. The simulation centers ("skills labs") at these sites were equipped with necessary simulation training hardware. A remote training-the-administrators (TTA) program was developed where personnel were trained in how to manage the skills lab, schedule trainees, set up training stations, and use the platform. A train-the-trainers (TTT) program was created to establish a network of trained instructors, who provided objective feedback through the platform remotely and asynchronously. RESULTS: Between 2019 and 2022, seven institutions in Chile and one in each of the USA, Bolivia, Brazil, Ecuador, El Salvador, México, and Perú implemented a digital platform-based remote simulation curriculum. Most administrators were not physicians (19/33). Eight Instructors were trained with the TTT program and became active proctors. The platform has been used by 369 learners, of whom 57% were general surgeons and general surgery residents. A total of 6729 videos, 28,711 feedback inputs, and 233.7 and 510.2 training hours in the basic and advanced programs, respectively, were registered. CONCLUSION: A remote and asynchronous method of giving instruction and feedback through a digital platform has been effectively employed in the creation of a robust network of continuous year-round simulation-based training in laparoscopy. Training centers were successfully run only with trained administrators to assist in logistics and setup, and no on-site instructors were necessary.

Gallbladder polyps: correlation and agreement between ultrasonographic and histopathological findings in a population with high incidence of gallbladder cancer / Pólipos da vesícula biliar: correlação e concordância entre achados ultrassonográficos e histopatológicos em uma população com alta incidência de câncer de vesícula biliar

ABSTRACT BACKGROUND: Gallbladder polyps are becoming a common finding in ultrasound. The management has to consider the potential risk of malignant lesions. AIMS: The aim of this study was to analyze the ultrasound findings in patients undergoing cholecystectomy due to gallbladder polyps and compare them for histopathological findings (HPs). METHODS: Patients with an ultrasonographic diagnosis of gallbladder polyp and who underwent cholecystectomy from 2007 to 2020 were included in the study. RESULTS: A total of 447 patients were included, of whom 58% were women. The mean age was 45±12 years. The mean size of polyps in US was 7.9±3.6 mm. Notably, 9% of polyps were greater than 10 mm, and single polyps were significantly larger than the multiple ones (p=0.003). Histopathological findings confirmed the presence of polyps in 88.4%, with a mean size of 4.8±3.4 mm. In all, 16 cases were neoplastic polyps (4.1%), 4 of them being malignancies, and all were single and larger than 10 mm. We found a significant correlation between ultrasound and histopathological findings polyp size determination (r=0.44; p<0.001). The Bland-Altman analysis obtained an overestimation of the US size of 3.26 mm. The receiver operating characteristic (ROC) curve analysis between both measures obtained an area under the receiver operating characteristic curve (AUC) of 0.77 (95%CI 0.74-0.81). Ultrasound polyps size larger than 10 mm had an odds ratio (OR) of 8.147 (95%CI 2.56-23.40) for the presence of adenoma and malignancy, with a likelihood ratio of 2.78. CONCLUSIONS: There is a positive correlation and appropriate diagnostic accuracy between ultrasound size of gallbladder polyps compared to histopathological records, with a trend to overestimate the size by about 3 mm. Neoplastic polyps are uncommon, and it correlates with size. Polyps larger than 10 mm were associated with adenoma and malignancy.

RESUMO RACIONAL: Os pólipos da vesícula biliar estão se tornando um achado comum na ultrassonografia (US). O manejo deve levar em consideração o risco de lesões malignas. OBJETIVOS: Analisar os achados da ultrassonografia em pacientes submetidos à colecistectomia por pólipos vesicais e compará-los com os achados histopatológicos. MÉTODOS: Foram revisados os prontuários médicos dos pacientes com diagnóstico ultrassonográfico de pólipo vesicular e submetidos à colecistectomia no período de 2007 a 2020. RESULTADOS: Foram incluídos no estudo 447 pacientes. A média de idade foi 45±12anos, sendo 58% mulheres. O tamanho médio dos pólipos na US foide 7,9±3,6mm. Nove por cento foram maiores que 10 mm, e os pólipos únicos encontrados foram maiores do que os múltiplos (p=0,003). A HP confirmou a presença de pólipos em 88,4%, tamanho médio 4,8±3,4mm. Dezesseis eram pólipos neoplásicos (4,1%) e quatro deles malignos, únicos e maiores que 10 mm. Foi encontrado correlação significativa entre a determinação do tamanho do pólipo ao ultrassonografia e histopatológicos (r=0,44; p<0,001). A análise de Bland-Altman obteve uma superestimação do tamanho do pólipo ao US em 3,26 mm. A análise da curva da característica de operação do receptor entre as duas medidas obteve uma área sob a curva curva da característica de operação do receptor (AUC) de 0,77 (IC95% 0,74-0,81). Pólipos ao ultrassonografia maiores que 10 mm apresentaram razão de chance (OR) de 8,147 (IC95% 2,56-23,40) para presença de adenoma e malignidade, com razão de verossimilhança de 2,78. CONCLUSÕES: Há uma correlação positiva e acurácia diagnóstica apropriada entre o tamanho dos pólipos da vesícula biliar por ultrassonografia em comparação com os achados histopatológicos, com uma tendência de superestimar o tamanho em cerca de 3 mm. Pólipos maiores que 10 mm foram associados a adenoma e malignidade.

Perfil, evolução e distribuição espacial dos óbitos por suicídio em idosos na região Nordeste, Brasil / Profile, evolution and spatial distribution of deaths from suicide in the elderly in the Northeast region, Brazil / Perfil, evolución y distribución espacial de las muertes por suicidio en ancianos en la región Nordeste, Brasil

O suicídio está entre as vinte principais causas de morte no mundo e, com o processo de envelhecimento populacional, há uma tendência de aumento desses óbitos entre os idosos. Assim, este trabalho teve como objetivo analisar o perfil, a evolução e a distribuição espacial dos óbitos por suicídio em idosos na região Nordeste no período de 2009 a 2018. Para isso, foi realizado um estudo ecológico, com base no Sistema de Informação sobre Mortalidade. Verificou-se o perfil dos óbitos por suicídio nos quinquênios 2009-2013 e 2014-2018. Para estudar a evolução do coeficiente de mortalidade por suicídio em idosos ao longo dos anos, por estado do Nordeste, realizou-se a análise de regressão linear. Por fim, a análise espacial foi utilizada para verificar agrupamentos de municípios com maior risco de morte por esse agravo. Os resultados mostraram que os mais acometidos foram os indivíduos do sexo masculino, pardos, casados e com idades entre 60 e 69 anos, sendo a principal causa o enforcamento. Foi evidenciada redução dos óbitos na faixa etária de 80 anos ou mais, redução entre os casados e aumento entre os idosos separados judicialmente, redução dos óbitos por autointoxicação e aumento dos óbitos por precipitação de locais elevados. Aumento significativo do coeficiente de mortalidade foi observado nos estados do Piauí, Maranhão, Ceará, Paraíba, Bahia e Pernambuco. A análise espacial demonstrou uma maior concentração de municípios com indicadores mais elevados nos estados do Piauí e do Rio Grande do Norte, evidenciando a necessidade de maiores esforços em saúde para essa população.

The suicide is among the twenty leading causes of death in the world, and, with the population aging process, these deaths tend to increase among the elderly. Thus this study aimed to analyze the profile, evolution, and spatial distribution of deaths by suicide in the elderly in the Northeast region in the period from 2009 to 2018. For this, an ecological study was carried out based on the Mortality Information System. The profile of deaths by suicide in the five-year periods of 2009-2013 and 2014-2018 was verified. To study the evolution of the suicide mortality rate in the elderly over the years, by state in the Northeast, a linear regression analysis was performed. Finally, spatial analysis was used to verify clusters of municipalities with a higher risk of death from this cause. The results showed that the most affected individuals were male, mixed race, married, and aged between 60 and 69 years, with hanging as the main cause. A reduction in deaths in the age group of 80 years and over, a reduction among married people and an increase among the elderly legally separated, a reduction in deaths due to self-intoxication and an increase in deaths due to precipitation from high places were evidenced. A significant increase in the mortality rate was observed in the states of Piauí, Maranhão, Ceará, Paraíba, Bahia, and Pernambuco. The spatial analysis showed a greater concentration of municipalities with higher indicators in the states of Piauí and Rio Grande do Norte, highlighting the need for greater efforts in health for this population.

Entre las veinte principales causas de muerte en el mundo se destaca el suicidio que tiene una tendencia a incrementarse entre los ancianos dado el proceso de envejecimiento de la población. Por tanto, este estudio tuvo como objetivo analizar el perfil, la evolución y la distribución espacial de las muertes por suicidio en ancianos de la región Nordeste de Brasil en el período de 2009 a 2018. Para ello, se realizó un estudio ecológico, basado en el Sistema de Información de Mortalidad. Se determinó el perfil de muertes por suicidio en el quinquenio 2009-2013 y 2014-2018. Para estudiar la evolución de la tasa de mortalidad por suicidio en ancianos a lo largo de los años, por estados en el Nordeste, se realizó un análisis de regresión lineal. Por último, se utilizó el análisis espacial para verificar los conglomerados de municipios con mayor riesgo de muerte por esta condición. Los resultados mostraron que los individuos más afectados fueron los hombres, pardos, casados ​​y con edades entre los 60 y los 69 años, con el ahorcamiento como principal causa. Se evidenció una reducción de las muertes en el grupo de edad de más de 80 años, una reducción entre las personas casadas, un aumento entre los ancianos legalmente separados, una reducción de las muertes por autointoxicación y un aumento de las muertes por precipitación de lugares altos. Se observó un aumento significativo en la tasa de mortalidad en los estados de Piauí, Maranhão, Ceará, Paraíba, Bahía y Pernambuco. El análisis espacial mostró una mayor concentración de municipios con los indicadores más altos en los estados de Piauí y Rio Grande do Norte, lo que apunta a la necesidad de mayores esfuerzos en salud orientados hacia esta población.

Recidiva intestinal única de melanoma cutáneo maligno: reporte de un caso / Intestinal relapse of a cutaneous melanoma: report of one case

Digestive tract primary melanoma is uncommon. However, metastatic lesions are more frequent and occur mainly in the small intestine. We report a 69-year-old male patient who consulted for a hyperpigmented skin lesion on the left thigh associated with multiple subcutaneous nodules. The biopsy was compatible with melanoma and PET/CT was positive for metastases in nodules and in an inguinal lymph node. Radiotherapy and chemotherapy with pembrolizumab were performed with good response, associated with posterior resection of the inguinal lymph node and melanocytic lesions. At three years of follow-up, a new hypermetabolic focus in the proximal jejunum was found in a control PET/CT. An endoscopic biopsy confirmed that it was a recurrence of the melanoma. Laparoscopic resection with primary anastomosis was performed with good clinical evolution. The definitive biopsy showed a melanoma metastasis with two of three lymph nodes positive for metastasis and a non-mutated BRAF gene. In conclusion, a single intestinal recurrence of melanoma is rare and requires an active search, since it can be resected using minimally invasive techniques.

Management of Biliopancreatic Limb Bleeding after Roux-en-Y Gastric Bypass: A Case Report.

The Roux-en-Y gastric bypass is one of the most extensive surgical treatments for obesity. The treatment of upper gastrointestinal bleeding after Roux-en-Y gastric bypass is complex due to the difficulty of accessing the excluded gastric antrum and duodenal bulb. There is no consensus regarding the management of this complication. While various techniques have been described to access the biliopancreatic limb, double-balloon enteroscopy is the most commonly used. If double-balloon enteroscopy is unavailable, a pediatric colonoscope may be used as an alternative; however, its use in such cases has not been described. We report the case of a 50-year-old male patient who underwent gastric bypass 13 years ago and was admitted for a second episode of upper gastrointestinal bleeding. The initial approach using upper endoscopy, colonoscopy, and abdominal computed tomography angiography did not reveal the cause of gastrointestinal hemorrhage; therefore, an endoscopic study of the biliopancreatic limb was performed using a pediatric colonoscope. A Forrest Ib ulcer was found in the duodenal bulb, and endoscopic therapy was administered. The evolution was found to be satisfactory.

[Intestinal relapse of a cutaneous melanoma. Report of one case]. / Recidiva intestinal única de melanoma cutáneo maligno: reporte de un caso.

Digestive tract primary melanoma is uncommon. However, metastatic lesions are more frequent and occur mainly in the small intestine. We report a 69-year-old male patient who consulted for a hyperpigmented skin lesion on the left thigh associated with multiple subcutaneous nodules. The biopsy was compatible with melanoma and PET/CT was positive for metastases in nodules and in an inguinal lymph node. Radiotherapy and chemotherapy with pembrolizumab were performed with good response, associated with posterior resection of the inguinal lymph node and melanocytic lesions. At three years of follow-up, a new hypermetabolic focus in the proximal jejunum was found in a control PET/CT. An endoscopic biopsy confirmed that it was a recurrence of the melanoma. Laparoscopic resection with primary anastomosis was performed with good clinical evolution. The definitive biopsy showed a melanoma metastasis with two of three lymph nodes positive for metastasis and a non-mutated BRAF gene. In conclusion, a single intestinal recurrence of melanoma is rare and requires an active search, since it can be resected using minimally invasive techniques.

Greater osteoblast densities due to the addition of amphiphilic peptide nanoparticles to nano hydroxyapatite coatings.

BACKGROUND: In vitro and in vivo studies have shown that metallic implants coated with nano hydroxyapatite (HA) reduce the time needed for complete osseointegration compared to metallic implants coated with conventional or micron-sized HA. Moreover, due to their biologically inspired nanometer dimensions, amphiphilic peptide nanoparticles (APNPs) can also promote osteoblast attachment and enhance other cell functions if used as a coating material. Coatings made of HA and APNPs could improve osteoblast functions, but have never been tested. PURPOSE: The objective of this study was to prepare coatings of nanocrystalline HA and APNPs on poly(2-hydroxyethyl methacrylate) (pHEMA) coatings in order to improve osteoblast (bone-forming cells) adhesion and cell density. METHODS: HA was synthesized by a wet chemical process. Coatings were synthesized with different conditions and components. RESULTS: X-ray diffraction infrared spectroscopy, transmission electron microscopy, and electron diffraction showed that nanocrystalline HA was synthesized with an expected nano size and shape distribution but with low impurities. pHEMA hydrogels with HA and APNPs increased osteoblast densities after 3 days compared to controls. CONCLUSION: Since cell proliferation is a prerequisite function for bone formation, these results imply that the current materials should be tested for a wide range of orthopedic applications.

Can sexual transmission support the enzootic cycle of Trypanosoma cruzi?

BACKGROUND Trypanosoma cruzi circulates in sylvatic habitats, mainly through blood-feeding triatomines, although other routes also contribute to its dispersion. Sexual transmission of T. cruzi is an understudied topic, especially among wild mammals. Because of the difficulties inherent to field work, experimentally infected mice are frequently used to evaluate the transmission of T. cruzi. OBJECTIVE This study aimed to evaluate the sexual transmission of T. cruzi in acutely infected mice. METHODS Male and female mice in the acute phase of Chagas disease were mated with naïve partners. Then, parasitological tests, immunohistochemistry, serological assays, and polymerase chain reaction (PCR) assays were used to detect infection. FINDINGS Parasitological analysis showed trypomastigotes in the blood of 20% of the naïve mice after mating with infected partners. Serological assays detected anti-T. cruzi antibodies in all naïve females mated with infected males and in 60% of naïve males mated with infected females. PCR showed T. cruzi nDNA bands for all naïve mice mated with infected partners. The possibility of sexual transmission was also confirmed by visualisation of amastigotes in the testes. MAIN CONCLUSIONS Our results demonstrate that sexual transmission of T. cruzi is an ordinary event that may contribute to maintenance of the parasite's enzootic cycle.

Safety and efficacy of the endoscopic duodenal-jejunal bypass liner prototype in severe or morbidly obese subjects implanted for up to 3 years.

BACKGROUND: The duodenal-jejunal bypass liner (DJBL) is an endoscopic device that mimics the duodenal-jejunal exclusion component of the Roux-en-Y gastric bypass. Previous studies assessing the efficacy of the DJBL have shown 10-40% excess weight loss (%EWL) and improvements in obesity-associated comorbidities. The aim of this study was to evaluate the safety and efficacy of a new DJBL prototype over a 3-year period. METHODS: Morbidly obese subjects were enrolled in a single-arm, open-label, prospective trial. The subjects were offered the opportunity to continue with the trial annually and signed a new consent form. The primary endpoint was safety. The secondary endpoints were changes in weight and biochemical parameters from baseline. RESULTS: The DJBL was implanted endoscopically in 80 subjects (age: 35±10 years; 69% female; weight: 109±17 kg; BMI: 42±5.4 kg/m2). Seventy-two severe adverse events (AEs) were observed in 55 patients (68%), of which nine subjects required a prolonged hospital stay and three subjects required major interventions. Overall, 23 subjects (29%) underwent early device removal due to AEs. Additionally, 95% of the patients experienced mild AEs that mainly consisted of abdominal pain. The severe AEs included a liver abscess (3), upper GI bleeding (4), cholangitis (1), and acute pancreatitis (1) and mostly occurred after 12 months of follow-up. Two patients presented a short esophageal perforation during explantation. These perforations were successfully managed with endoscopic closure in one subject and medical treatment in the other subject. In the completer population at 52 weeks (71 patients), 104 weeks (40 patients), and 156 weeks (11 patients), the mean %EWL were 44 ± 16, 40 ± 22, and 39 ± 20, respectively (p < 0.001). CONCLUSION: This study shows significant and sustained weight loss after 3 years of treatment with the new DJBL. However, the high frequency and severity of AEs preclude the use of this prototype for periods longer than 1 year.

Distinct patterns in the gut microbiota after surgical or medical therapy in obese patients.

Bariatric surgery is highly successful in improving health compared to conventional dietary treatments. It has been suggested that the gut microbiota is a relevant factor in weight loss after bariatric surgery. Considering that bariatric procedures cause different rearrangements of the digestive tract, they probably have different effects on the gut microbiota. In this study, we compared the impact of medical treatment, sleeve gastrectomy and Roux-en-Y gastric bypass on the gut microbiota from obese subjects. Anthropometric and clinical parameters were registered before, 6 and 12 months after treatment. Fecal samples were collected and microbiota composition was studied before and six months post treatment using 16S rRNA gene sequencing and qPCR. In comparison to dietary treatment, changes in intestinal microbiota were more pronounced in patients subjected to surgery, observing a bloom in Proteobacteria. Interestingly, Bacteroidetes abundance was largely different after six months of each surgical procedure. Furthermore, changes in weight and BMI, or glucose metabolism, correlated positively with changes in these two phyla in these surgical procedures. These results indicate that distinct surgical procedures alter the gut microbiota differently, and changes in gut microbiota might contribute to health improvement. This study contributes to our understanding of the impact of weight loss surgery on the gut microbiota, and could be used to replicate this effect using targeted therapies.

Primary leiomyosarcoma of the greater omentum: a case report.

INTRODUCTION: Greater omentum leiomyosarcomas are rare tumors with only a few cases reported in literature. PRESENTATION OF CASE: We report the case of a 68-year-old man who consulted complaining of diffuse abdominal pain without a palpable mass at physical examination. Imaging studies revealed a solid-cystic lesion in the right lower quadrant. Surgical resection was performed and the tumor was diagnosed as a leiomyoscarcoma by histological and immunohistochemical examinations. DISCUSSION: Surgical resection of all lesions seems to be a reasonable therapeutic approach if resection is feasible. Chemotherapy may be used in selected cases. CONCLUSION: More cases are needed to define the best treatment approach of this disease.

Laparoscopy-Assisted Trans-Gastric Rendez-vous for the Treatment of Common Bile Duct Stones in Patients with Prior Roux-en-Y Gastric Bypass.

BACKGROUND: Common bile duct (CBD) stones in a Roux-en-Y gastric bypass (RYGB) represent a major challenge for ERCP due to long-limb anatomy. Trans-gastric approach has been proposed but entails high ERCP-related risks. Laparoscopy assisted trans-gastric rendez-vous (LATG-RV) is a one-step procedure that may lower the risks of these patients. METHODS: We describe our initial experience in four patients with past history of RYGB and CBD stones. RESULTS: All patients underwent LATG-RV and had successful CBD stone clearance. Postoperative course was uneventful with normal amylase levels. Average procedure time was 105 min and postoperative stay 2 days. CONCLUSION: LATG-RV is a safe and effective procedure for the clearance of CBD stones in RYGB patients. It may have fewer complications and shorter operative time than regular trans-gastric ERCP.

[Endoscopic submucosal dissection in early gastric cancer: Experience in 16 patients]. / Disección submucosa endoscópica en cáncer gástrico incipiente: experiencia inicial en el Hospital Clínico de la Pontificia Universidad Católica de Chile.

BACKGROUND: Endoscopic submucosal dissection (ESD) is a minimally invasive procedure that allows curative treatment of early gastric cancer (EGC) in selected patients. AIM: To report our initial experience with ESD. MATERIAL AND METHODS: Analysis of prospective data from 16 patients aged 61 to 84 years, who underwent ESD between December 2011 and June 2014. Tumor type, operative time, hospitalization length, oncologic outcomes, complications and short-term follow up were registered. RESULTS: En-block resection was achieved in all cases. The median operative time was 135 min (range: 50-320 min). Specimens' median size was 3.5 cm (range: 3-10). All the resections were R0. In 14 patients ESD was considered curative. In two patients, ESD was considered potentially non-curative due to the presence pathological risk factors for lymph-node metastases in the biopsy specimen. Both patients underwent laparoscopic gastrectomy with lymph-node dissection. There was one case of gastric wall perforation that was repaired by laparoscopic suture. There was no mortality. The median follow-up time was 15 months (range: 2-30 months). CONCLUSIONS: ESD is a feasible and safe procedure in our institution with good results in this initial experience.

Experiência de ócio como possibilidade de prevenção à Sindrome de Burnout / Leisure experience as prevention for Burnout Syndrome

O presente artigo tem como objetivo pensar na experiência de ócio como uma possibilidade de ação preventiva e/ou curativa para os indivíduos acometidos pela síndrome de burnout. Esta reflexão parte de uma compreensão baseada no contexto contemporâneo, marcado pelo signo da pressa, da imediatez e da cultura do consumo, onde se manifesta o burnout, considerado como um dos novos modos de subjetivação na realidade hipermoderna. Partindo do questionamento sobre a experiência do ócio como possibilidade para prevenir ou amenizar os efeitos da síndrome de burnout, procura-se argumentar a partir de evidências trazidas por autores e estudiosos sobre os benefícios do ócio.

This article has the aim of acknowledging the leisure experience as a possibility of preventive and/or healing action for individuals afflicted by burnout syndrome. This reflection begins with an understanding based on the contemporary trait of haste, consumerism and immediatism. In this context, burnout manifests itself as one of the new ways of subjectivation in hypermodern reality. Starting with the question about the leisure experience as a way to prevent or mitigate the effects of the burnout syndrome, the paper is based on evidence brought about by authors and scholars on the benefits of leisure.