Commercially available activity monitors such as the fitbit charge and apple watch show poor validity in patients with gait aids after total knee arthroplasty.

PURPOSE: The aim of this study is to determine the validity of consumer grade step counter devices during the early recovery period after knee replacement surgery. METHODS: Twenty-three participants wore a Fitbit Charge or Apple Watch Series 4 smart watch and performed a walking test along a 50-metre hallway. There were 9 males and 14 females included in the study with an average age of 68.5 years and BMI of 32. Each patient wore both the Fitbit Charge and Apple Watch while completing the walking test and an observer counted the ground truth value using a thumb-push tally counter. This test was repeated pre-operatively with no gait aid, immediately post operatively with a walker, at 6 weeks follow up with a cane and at 6 months with no gait aid. Bland-Altman plots were performed for all walking tests to compare the agreement between measurement techniques. RESULTS: Mean overall agreement of step count for pre-operative and at 6 months for subjects walking without gait aids was excellent for both the Apple Watch vs. actual and Fitbit vs. actual with bias values ranging from - 0.87 to 1.36 with limits of agreement (LOA) ranging between - 10.82 and 15.91. While using a walker both devices showed extremely little agreement with the actual step count with bias values between 22.5 and 24.37 with LOA between 11.7 and 33.3. At 6 weeks post-op while using a cane, both the Apple Watch and Fitbit devices had a range of bias values between - 2.8 and 5.73 with LOA between - 13.51 and 24.97. CONCLUSIONS: These devices show poor validity in the early post operative setting, especially with the use of gait aids, and therefore results should be interpreted with caution.

Additive and synergistic antifungal effects of copper and phenolic extracts from grape cane and apples.

BACKGROUND: Organic viticulture seeks sustainable alternatives for eco-toxic copper fungicides to control downy mildew caused by Plasmopara viticola. (Poly)phenol-rich extracts of agricultural byproducts are known to possess antifungal activity, but high production costs often limit their actual implementation. RESULTS: We developed and produced novel ligninsulfonate-based grape cane extract (GCE) formulations and an apple extract on a pilot plant scale, including a detailed (poly)phenol characterization by high-performance liquid chromatography photodiode array mass spectrometry (HPLC-PDA-MS). Our GCE formulations alone reduced downy mildew disease severity in greenhouse trials by 29%-69% in a dose-dependent manner, whereas a standard application of the copper-based agent alone reached ~56%. When applied together, disease severity was diminished by 78%-92%, revealing a synergistic effect that depended on the mixture ratio. Combining GCE formulations with the apple extract, additive effects were found (80% disease severity reduction). CONCLUSION: The studied plant extracts are proposed to both substitute for and synergistically reinforce copper fungicides in grapevine downy mildew control. © 2023 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Thyroid carcinosarcoma masquerading as a paraesophageal abscess in a Cane Corso dog.

A 12-year-old castrated male Cane Corso dog was presented with cervical swelling, lethargy, anorexia, and cough. An extensive neck mass with necrotic cysts was observed, severely adherent to surrounding tissues. Based on diagnostic imaging including ultrasound, computed tomography, and fine-needle aspiration cytology, paraesophageal abscess was tentatively diagnosed. However, after the mass was surgically removed, a diagnosis of thyroid carcinosarcoma composed of neoplastic cell populations with epithelial and mesenchymal origins was made via histopathology and immunohistochemistry. The dog died of a recurrent mass with pulmonary metastasis 105 d after surgery. This report describes a rare type of canine thyroid cancer, thyroid carcinosarcoma, preoperatively masquerading as an abscess and postoperatively confirmed by histopathology. Key clinical message: Thyroid carcinosarcoma, despite its rarity in dogs, should be included in the differential diagnoses of cervical mass especially with an aggressive progression.

Carcinosarcome thyroïdien déguisé en abcès paraoesophagien chez un chien Cane Corso. Un chien Cane Corso mâle castré de 12 ans a été présenté avec de l'enflure cervicale, de la léthargie, de l'anorexie et une toux. Une masse étendue du cou avec des kystes nécrotiques a été observée, adhérente fortement aux tissus environnants. Sur la base de l'imagerie diagnostique comprenant l'échographie, la tomodensitométrie et la cytologie par aspiration à l'aiguille fine, un abcès paraoesophagien a été provisoirement diagnostiqué. Cependant, après l'ablation chirurgicale de la masse, un diagnostic de carcinosarcome thyroïdien composé de populations de cellules néoplasiques d'origine épithéliale et mésenchymateuse a été posé par histopathologie et immunohistochimie. Le chien est décédé d'une masse récurrente avec métastase pulmonaire 105 jours après la chirurgie. Ce rapport décrit un type rare de cancer de la thyroïde canine, le carcinosarcome thyroïdien, se faisant passer pour un abcès en préopératoire et confirmé en postopératoire par histopathologie.Message clinique clé:Le carcinosarcome thyroïdien, malgré sa rareté chez le chien, doit être inclus dans les diagnostics différentiels de masse cervicale surtout à évolution agressive.(Traduit par Dr Serge Messier).

Exploring the acceptability of the 'smart cane' to support mobility in older cancer survivors and older adults: A mixed methods study.

INTRODUCTION: Approximately 25% of older cancer survivors (i.e., ≥ 65 years, with cancer history) use ≥1 mobility device, surpassing usage by other older adults. Few tools exist for older "survivors" to regain function or follow lifestyle recommendations. Our goal was to explore opportunities to leverage technology-enabled mobility devices, such as the "smart cane," to support mobility goals in these survivors. The research objective was to assess perceptions related to acceptability, usability and preferences of participants regarding technology-enabled mobility devices in everyday life. MATERIALS AND METHODS: We used a convergent mixed-methods design, analyzing quantitative data followed by qualitative focus groups. A pre-survey derived from the Senior Technology Acceptance Model assessed the acceptability of technology-enabled devices among participants, who also participated in one of three focus groups delivered via Zoom. The Zoom sessions included facilitated 90-min discussions and video demonstration of the smart cane. Focus group sessions were recorded and transcribed verbatim and thematic content analysis was conducted. RESULTS: We recruited 12 older US survivors. Participants were 58% female, aged 68-86, and 16% non-White. From a pre-survey of participants, 83% said that they liked the idea of technology-enhanced mobility device and 100% said they thought they could be skillful at using a technology-enabled device if training was provided. Though participants were enthusiastic about the smart cane overall and felt the smart cane supported independence for older adults, the themes revealed concerns about safety, accessibility and technology support, as well as the concern for negative impact on self-image due to use of a mobility device. There was a strong preference for working with clinical professionals as the most trusted sources for referrals, if a smart cane was suggested. DISCUSSION: Older survivors in our sample found the smart cane very acceptable, and supportive of independence for older adults with cancer and other conditions. Participants also provided many insights that revealed additional research needed to support access, safety and usability for older adults, older survivors and caregivers, especially by partnering with clinical professionals.

Temperature and light conditions affect stability of phenolic compounds of stored grape cane extracts.

This study aimed to determine the stability of PCs in grape canes extracts stored at different temperatures and light conditions. The PCs composition was monitored every-two weeks during three months by liquid chromatography coupled to diode array and fluorescence detectors (LC-DAD-FLD). Initially, stilbenes represented 87 % of total PCs. Storage at -20 and 5 °C reduced PCs 8 and 6 %, respectively. When extracts were exposed to 25 and 40 °C, the degradation of (+)-catechin and (-)-epicatechin was faster than under lower temperatures, and light accelerated the degradation kinetics. trans-piceatannol showed particularly sensitive to temperature increase, being mostly degraded after two weeks stored at 40 °C. Conversely, degradation of trans-resveratrol and ε-viniferin was mostly catalyzed by light, since nearly 70 % of them were degraded at 40 °C under light, in comparison with a 23 % reduction of trans-resveratrol and no changes of ε-viniferin at 40 °C in darkness.

Action of silicon on the activity of antioxidant enzymes and on physiological mechanisms mitigates water deficit in sugarcane and energy cane plants.

Production of sugarcane and more recently of energy cane strengthen renewable bioenergy production capacity. However, droughts resulting from climate change have limited the production of these crops. One of the strategies to attenuate water deficit damage in these crops is the use of silicate, which contributes to plant physiology. This strategy is likely to increase water use efficiency, thus promoting crop sustainability. Notwithstanding, studies on this issue are still incipient. This study assesses whether Si applied via fertigation and foliar spraying in the seedling production phase and as a complement after seedling transplanting to the soil is efficient in attenuating water deficit in sugarcane and energy cane. The study further elucidates physiological and biochemical mechanisms involved in this process. For this, the authors conducted two experiments: one with sugarcane and the other with energy cane. Treatments were arranged in randomized blocks with 5 replications, in a 2 × 2 factorial scheme. Factors consisted of the absence (-Si) and presence of Si (+ Si) applied via fertigation and foliar spraying; and two water regimes: 70% (without water deficit) and 30% (severe water deficit) of the soil water retention capacity. Silicon was supplied during the formation phase of presprouted seedlings and during the transplanting of seedlings to pots filled with samples of Entisol (Quartzipsamment). In these pots, water regimes were induced from 7 to 160 days after transplanting. Severe water deficit reduced the water content and water potential of plants. This situation induced oxidative stress and impaired gas exchange and photosynthetic water use efficiency, reducing plant growth. Silicon supply via fertigation in association with foliar spraying in the seedling formation phase with complementation after transplanting was efficient in increasing Si accumulation in the plants. Silicon was effective in attenuating severe water deficit damage up to initial culm formation through mechanisms that maintain water and physiological balance by favoring the antioxidant defense system in sugarcane and energy cane plants.

Magnet and wire remodeling for the treatment of candy cane syndrome: first case series of a new approach (with video).

BACKGROUND AND AIMS: Candy cane syndrome (CCS) is an adverse event (AE) from gastrectomy or gastric bypass and end-to-side anastomosis to a jejunal loop. Preferential passage of food to the blind loop induces early satiety, pain, and regurgitation. An endoscopic device that combines 2 magnets and a self-retractable wire was designed to perform progressive septotomy with marsupialization. We evaluated the clinical safety and efficacy of this treatment in CCS. METHODS: Consecutive patients presenting with symptoms associated with CCS after gastrectomy or Roux-en-Y gastric bypass were treated with the MAGUS (Magnetic Gastrointestinal Universal Septotome) system. Weight, dysphagia, pain scores, 12-item Short Form Survey quality of life physical and mental scores, GERD Health-Related Quality of Life, and Eckardt score were measured at baseline and 1 and 3 months postprocedure. Satisfaction with therapy and AEs were monitored during follow-up. RESULTS: Fourteen consecutive patients with CCS were enrolled in the study. Thirteen MAGUS systems migrated within 28 days after achieving uneventful complete septotomy. In 1 patient the magnet had to be collected from the right-sided colon after 1 month. Treatment was completed in a single endoscopy session. Dysphagia score (2 [1-3] vs 1 [1-1], P = .02), pain score (7 [6-8] vs 1 [0-1], P = .002), Eckardt score (5 [3-8] vs 1 [0-2], P = .002), GERD Health-Related Quality of Life score (37 [29-45] vs 8 [6-23], P = .002), and quality of life physical and mental scores were all significantly improved at 3 months. No device or procedure-related serious AEs were observed. One patient died during follow-up from evolution of oncologic disease. CONCLUSIONS: Endoluminal septotomy using a retractable wire and magnet system in CCS is feasible and safe, with rapid improvement of symptoms. (Clinical trial registration number: NCT04480216.).

Successful treatment of "candy cane" syndrome through endoscopic gastrojejunal anastomosis revision.

Candy cane syndrome is an underappreciated complication reported in bariatric patients following Roux-en-Y gastric bypass. It results from an excessively long blind afferent Roux limb at the gastrojejunostomy that can lead to food accumulation. Patients often present with nausea, vomiting, food intolerance, acid reflux, and abdominal pain. Many patients remain undiagnosed due to vague gastrointestinal symptoms, delayed presentation, and physician unawareness. Here, we present the case of a 40-year-old female who presented for a third opinion on the cause of intractable acid reflux and nausea. Workup revealed her symptoms stemmed from an excessively long afferent Roux limb. Traditionally, treatment would include laparoscopic or open surgical removal of the blind limb. Although effective, surgical intervention is invasive, may not be an option in high-risk patients, and can lead to further complications. We were able to successfully address this patient's candy cane syndrome by utilizing a novel endoscopic approach to revise the gastrojejunal anastomosis, which led to full resolution of her symptoms. Endoscopic therapy of candy cane syndrome may provide a minimally invasive approach that exposes patients to decreased procedural risk while potentially producing similar treatment results as more invasive surgical approaches.

Occurrence of pesticides and environmental contaminants in vineyards: Case study of Portuguese grapevine canes.

Every year, after grape harvesting, high quantities of vine-canes are generated. Due to the high amount of bioactive compounds present in this woody material, several studies reported their potential to be used in different sustainable applications. However, before employing vine-canes in this kind of products, their safety needs to be assessed. A robust method for identification and quantification of 30 environmental contaminants (12 organochloride pesticides (OCPs), 6 organophosphorus pesticides (OPPs), 5 polychlorinated biphenyls (PCBs) and 7 brominated flame retardants (BFRs)) in vine-canes was developed. For that, the extraction and clean-up procedures were optimized, namely the vine-canes size, the QuEChERS (quick, easy, cheap, effective, rugged and safe) composition and the amount of carbon used in the dispersive-solid phase extraction (d-SPE). Suitable analytical parameters were obtained: linearity (r2) >0.99 for all the studied compounds and for the solvent and matrix-matched standards; relative standard deviation (RSD) below 14%; and mean recoveries for two spiking levels (10 and 20 µg/kg) between 75 and 103%, excepting for the PCBs that ranged between 59 and 105%. The limit of detection (LOD) and quantification (LOQ) ranged between 0.38 and 1.09 and 1.26 to 3.64 µg/kg, respectively. Regarding the analysis of 19 vine-cane samples, corresponding to four different varieties (Touriga Nacional, Tinta Roriz, Alvarinho, and Loureiro) collected in four different years in the North of Portugal, five contaminants (aldrin, 2,2-bis(4-chlorophenyl)-1,1-dichloroethylene (p,p'-DDE), α-hexachlorocyclohexane (α-HCH), 2,4,4'-trichlorobiphenyl (PCB28), and 2,2',4,5,5'-pentachlorobiphenyl (PCB101)) were detected. However, only α-HCH (5.85 ± 0.32 to 5.99 ± 0.25 µg/kg) and aldrin (2.44 ± 0.15 µg/kg) were quantified above the LOQ. The screening of environmental contaminants in vine-canes is essential to waste valorization, especially if the goal is to apply them in products for human consumption.

Pilot-plant scale extraction of phenolic compounds from grape canes: Comprehensive characterization by LC-ESI-LTQ-Orbitrap-MS.

Grape canes, also named vine shoots, are well-known viticultural byproducts containing high levels of phenolic compounds, which are associated with a broad range of health benefits. In this work, grape canes (Vitis vinifera cv. Pinot noir) were extracted in a 750 L pilot-plant reactor under the following conditions: temperature 80 °C, time 100 min, solid/liquid ratio 1:10. The comprehensive characterization of grape cane phenolic compounds was performed by liquid chromatography coupled to high-resolution/accurate mass measurement LTQ-Orbitrap mass spectrometry. A total of 44 compounds were identified and, 26 of them also quantified, consisting of phenolic acids and aldehydes (17), flavonoids (12), and stilbenoids (15). The most abundant class of phenolics were stilbenoids, among which (E)-ε-viniferin predominated. The phenolic profile of grape canes obtained using pilot plant extraction differed significantly from the results of laboratory-scale studies obtained previously. Additionally, we observed a high antioxidant capacity of grape cane pilot-plant extract measured by the radical antioxidant scavenging potential (ABTS+) (2209 ± 125 µmol TE/g DW) and oxygen radical absorbance capacity using fluorescein (ORAC-FL) (4612 ± 155 µmol TE/g DW). Grape cane pilot-plant extract for their phenolic profile may be used as a by-product for the development of novel nutraceutical and pharmaceutical products, improving the value and the sustainability of these residues.

Factores intrínsecos y extrínsecos asociados con caídas en adultos mayores: estudio de casos y controles en México / Intrinsic and extrinsic factors associated with falls in older adults: a case-control study in Mexico

Resumen Antecedentes: Las caídas tienen un origen multifactorial. Objetivo: Estimar el riesgo de caídas y su asociación con algunos factores intrínsecos y extrínsecos en adultos mayores. Métodos: Estudio de casos y controles que incluyó pacientes de ambos sexos con edades ≥ 60 años. Los casos fueron pacientes que ingresaron al servicio de urgencias de un hospital de segundo nivel, con diagnóstico de lesión o fractura secundaria a una caída; los controles fueron pacientes que acudieron a unidades de medicina familiar. El análisis estadístico que se realizó fue descriptivo, bivariante y multivariante. Se utilizó el programa SPSS versión 22.0. Resultados: Se incluyeron 342 pacientes (171 casos y 171 controles). La edad promedio fue 76.1 ± 8.8 años, el 66 % fueron mujeres y por autorreporte el 97.1 % tenían enfermedades crónicas. Se observaron diferencias en el índice de masa corporal, en la proporción de casos con deterioro cognitivo, uso de dispositivos para caminar y dependencia para realizar actividades básicas e instrumentales de la vida diaria. El análisis multivariante ajustado reveló asociación entre el evento caída con deterioro cognitivo y dependencia para realizar actividades instrumentales de la vida diaria. Conclusiones: El deterioro cognitivo y la dependencia para realizar actividades instrumentales de la vida diaria se asociaron al riesgo de caer.

Abstract Background: Falls have a multifactorial origin. Objective: To estimate the risk of falls and their association with some intrinsic and extrinsic factors in elderly. Methods: Case-control study that included individuals of both genders aged ≥ 60 years. Cases were patients who were admitted to the emergency department of a secondary care hospital diagnosed with injury or fracture secondary to a fall; the controls were patients who attended family medicine units. Descriptive, bivariate and multivariate statistical analysis was carried out. The SPSS program, version 22.0, was used. Results: Three-hundred and forty-two patients were included (171 cases and 171 controls). Mean age was 76.1 ± 8.8 years, 66 % were women and 97.1 % had self-reported chronic diseases. Differences were observed in body mass index, in the proportion of cases with cognitive impairment, use of walking devices and dependence to perform basic and instrumental activities of daily living. Adjusted multivariate analysis revealed an association between the fall event and cognitive impairment and dependence to perform instrumental activities of daily living. Conclusions: Cognitive impairment and dependence to perform instrumental activities of daily living were associated with the risk of falling.

Revision of a Previous Capella Bypass due to dysphagia, GERD and Candy Cane Syndrome.

BACKGROUND: Capella ringed gastric bypass is a technical variant of gastric bypass which seeks to improve long-term outcomes with a greater restriction. Frequent complications are due to the band, due to its inclusion or slippage, without being able to reject others. Our purpose is to present the video of a revisional bariatric surgery made by laparoscopic approach in a patient with a previous open retrogastric retrocolic Capella gastric bypass. MATERIALS AND METHODS: The patient presents dysphagia, gastroesophagic reflux disease (GERD), and pain, with a BMI of 36 kg/m2. Her supplementary tests show a hiatal hernia, GERD, and a Candy Cane Syndrome. The surgery was difficult due to multiple adhesions. Hiatal hernia was repaired and pillars were closed. The band was visualized intraoperatively close to the gastrojejunal anastomosis, although the high endoscopy did not detect neither stenosis nor difficulty of passage to the gastric pouch. It showed the retrogastric gastrojejunal anastomosis with a normal food loop and a 15-cm widened blind loop (Candy Cane Syndrome), which was resected. RESULTS: She had a left pneumonia and damage in left hepatic lobe (LHL). She was discharged after antibiotic treatment for 7 days. The patient has improved clinically, without dysphagia nor GERD. Her current BMI is 29.8 kg/m2. CONCLUSIONS: In conclusion, bariatric revisional surgery can lead to serious complications, but it is justified in patients with poor quality of life. A ringed retrocolic retrogastric bypass poses more difficulties in revisional procedures. It is mandatory to know which technique was performed before. The duration of the procedure can result in more complications like liver damage.

Type IV dermoid sinus, intramedullary dermoid cyst and spina bifida in a Cane Corso.

A 1-year-old male Cane Corso was presented for progressive hindlimb neurologic deficits, with a history of suspected recurrent meningitis. Physical examination and advanced diagnostic imaging findings were suggestive of a thoracic dermoid sinus extending into the dura mater, and spina bifida. After initial medical treatment, the lesion was surgically excised, and the presence of an intramedullary cyst in continuation with the dermoid sinus was confirmed, requiring partial durectomy and myelotomy for removal. Histopathological examination of the excised tissue confirmed the diagnosis of a dermoid sinus associated with an intramedullary dermoid cyst. After surgery, the dog temporarily declined neurologically but then showed progressive neurological improvement. This report describes presentation and successful surgical treatment of a type IVa dermoid sinus associated with an intramedullary dermoid cyst and spina bifida in a dog.

Alterações cardiorrespiratórias em indivíduos hemiparéticos crônicos pós-acidente vascular cerebral / Cardiorespiratory changes in chronic post-stroke hemiparetic patients

Objetivo: Analisar a função cardiorrespiratória em pacientes he- miparéticos crônicos pós-acidente vascular cerebral. Métodos: Estudo retrospectivo, por meio da análise de dados de prontuários de pacientes submetidos ao teste de caminhada de 6 minutos e manovacuometria em uma clínica de fisioterapia de um centro universitário. Foram analisados os dados de sete prontuários. Re- sultados: A média de metros percorridos pelos participantes no teste de caminhada de 6 minutos foi de 199,5. Os valores percentuais da manovacuometria foram de -41,34 na pressão inspiratória máxima e de 57,85 na pressão expiratória máxima. Conclusão: Os dados desta pesquisa sugerem que indivíduos hemiparéticos crônicos apresentam fadiga respiratória e muscular, diminuição da capacidade funcional durante a marcha e fraqueza dos músculos respiratórios.

Objective: To analyze the cardiorespiratory function in chronic post-stroke hemiparetic patients. Methods: This is a retrospective study, through data analysis of medical records from patients who underwent the 6-minute walk test and manovacuometry, in a physical therapy clinic of a university center. Results: The mean number of meters walked by participants in the 6-minut walk test was 199.5 meters. The percentage values of manovacuometry were -41,34 in the maximun inspiratory pressure and 57.85 in the maximun expiratory pressure. Conclusion: The data from this survey suggest that chronic hemiparetic individuals have respiratory and muscle fatigue, decreased functional capacity during gait, and respiratory muscle weakness.

Paciente con amputación transfemoral derecha, clavo gamma y síndrome hemimotor derecho: valoración y manejo del proceso de protetización / Patient with a right transfemoral amputation, gamma nail, and right Hemi-motor syndrome: assessment and management of the prosthetic fitting

Introducción: la decisión de protetizar a un paciente amputado depende de: la etiología, nivel de amputación, uni o bilateralidad, comorbilidades, soporte sociofamiliar, capacidad funcional y motivación del paciente. Observación clínica: varón, 83 años, diabético, cardiopatía isquémica, accidente cerebrovascular con paresia braquial derecha residual en año 2000. Clavo gamma por fractura pertro-cantérea derecha en 2012 y amputación transfemoral derecha en 2018 de causa vascular. Se protetiza mediante encaje de contención isquiática CAT-CAM, sistema de suspensión tipo Kiss, rodilla de bloqueo a la extensión con adaptación del sistema de desbloqueo en porción antero-interna del encaje y pie Sach. Tras tratamiento fisioterápico, consigue deambulación autónoma con ayuda de un bastón y tercera persona por dificultad para agarre de MSD. Conclusión: los médicos rehabilitadores debemos apostar por dotar a nuestros pacientes de autonomía y funcionalidad, siempre que sea viable.

Introduction: prosthesis, an amputee patient, depends on etiology, level, uni or bilaterality, comorbidities, socio-family support, functional capacity, and motivation of the patient. Clinical observation: male, 83 years old, diabetic, ischemic heart disease, stroke with residual upper right limb (URL) paresis in 2000. Gamma nail due to the right trochanteric fracture in 2012, and right transfemoral amputation in 2018 of vascular cause. Prosthetic fitting CAD-CAM socket/interface, Kiss type suspension system, extension locking knee with an adaptation of the unlocking system in the antero-internal portion of the socket, and Sach foot. After physiotherapeutic treatment, he achieves independent walking with the help of 1 cane and third-person due to difficulty in the URL grip. Conclusion: rehabilitation doctors must bet on providing our patients with independency, and better function, whenever it is viable.

König's Syndrome After Roux-en-Y Gastric Bypass: Candy Cane Twist.

BACKGROUND: A König's syndrome is referred to abdominal pain in relation to meals with constipation alternated with diarrhea, meteorism, and abdominal distension. A postoperative long-term complication after Roux-en-Y gastric bypass could be the appearance of chronic abdominal pain associated with vomiting, dysphagia, and nausea. CASE REPORT: A 43-year-old female patient was submitted for a Roux-en-Y gastric bypass for morbid obesity with an initial body mass index (BMI) of 36 kg/m2 (weight 100 kg, height 168 cm). At the 5-year follow-up, the patient's BMI was 22.3 kg/m2 with a weight loss of 40 kg. In the last month, the patient has undergone a further weight loss of 8 kg (BMI 18.4 kg/m2) with the presence of chronic abdominal pain, dyspepsia, and dysphagia and abdominal distension. Any vasomotor problems (hot flushing, sweating, palpitations, and diarrhea) were described. The computer tomography (CT) with oral contrast shows the presence of a blind afferent Roux limb at the gastrojejunostomy, explaining a possible König's syndrome. RESULTS: The patient was submitted for a diagnostic laparoscopy, which revealed the presence of a twisted candy cane that was identified and resected. The postoperative stages were uneventful and the patient was discharged on the second postoperative day. CONCLUSION: Candy cane syndrome is a rare and challenging complication reported in bariatric patients following Roux-en-Y gastric bypass and is best investigated with a barium swallow or oesophago-gastro-duodenoscopy (OGD). This means that this kind of pathology could be avoided by not leaving such a long blind loop during the primary gastric bypass operation. An explorative laparoscopy could be performed in the event of abdominal pain, nausea, and vomiting at a long-term follow-up after gastric bypass. Even if there are little data regarding the efficacy of surgical treatment, if present, "candy cane" surgical revision seems to be the best treatment for the majority of the patients with long-term symptomatic relief.

Efficient repeated batch production of androstenedione using untreated cane molasses by Mycobacterium neoaurum driven by ATP futile cycle.

The biotransformation of phytosterol to androstenedione (AD) by mycobacteria is a unique process accompanied by energy-producing. However, high intracellular ATP content can severely inhibit the efficient production of AD. In this study, a novel citrate-based ATP futile cycle (AFC) and pyruvate-based AFC were constructed for the first time. Application of AFCs reduced intracellular ATP and propionyl-CoA levels and increased NAD+/NADH ratios and cell viability. The forced consumption of ATP promotes the transcription of critical genes in propionyl-CoA metabolism. The synergistic effect of enhanced propionyl-CoA metabolism and AFC increased AD conversion yield from 60.6% to 97.3%. The AD productivity was further improved by repeated batch fermentation using untreated cane molasses. The maximum productivity was 181% higher than that of the original strain. Therefore, the strategy of combining AFC and repeated batch fermentation is a valuable tool for the efficient and low-cost production of AD and other steroidal pharmaceutical precursors.

Intussusception, a Plausible Cause of the Candy Cane Syndrome (Roux Syndrome): Known for a Century-Still a Frequently Missed Cause of Pain After Roux-en-Y Gastric Bypass.

BACKGROUND: Candy cane syndrome (CCS), which is also called Roux syndrome, is a rarely reported and neglected complication of proximal Roux-en-Y gastric bypass (RYGB) surgery. METHODS: Forty-seven cases of CCS that underwent candy cane (CC) resection were analyzed retrospectively for pain remission to determine whether intussusception is a possible underlying mechanism. RESULTS: Forty-three patients (89.6%) benefited from laparoscopic CC resection (p < 0.001). The highly sensitive diagnostic tests were upper gastrointestinal series (91%) and gastroscopy (96%). Intussusception of the CC into the gastric pouch was demonstrated in most cases and was postulated as the trigger for CCS. In some cases, retroperistaltic intussusception led to nonspecific upper gastrointestinal bleeding. CONCLUSION: A vast majority of CCS cases benefited significantly from CC resection. The long-described retroperistaltic intussusception of the CC was suggested as an important underlying mechanism of the symptoms. Although CC resection remains a stopgap, evidence on its clinical significance has been shown for a century. Building on this wealth of experience and the already vast storage of practical knowledge, awareness of this underestimated complication after RYGB should be raised.

Uso de bastones contralaterales en artrosis de rodilla / Contralateral canes for knee osteoarthritis

INTRODUCCIÓN La artrosis de rodilla es un problema de salud relevante dada su alta prevalencia y discapacidad asociada. Dentro de las alternativas de manejo no farmacológico se ha planteado el uso de bastones, sin embargo no existe consenso en la literatura respecto a su indicación. MÉTODOS Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis, preparamos tablas de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos tres revisiones sistemáticas que en conjunto incluyeron cuatro estudios primarios, de los cuales, uno es ensayo aleatorizado. Concluimos que el uso de bastón contralateral en pacientes con artrosis de rodilla probablemente disminuye el dolor. Además, podría aumentar levemente la funcionalidad, pero la certeza de la evidencia es baja.

INTRODUCTION Knee osteoarthritis is a relevant health problem given its high prevalence and associated disability. Within the non-pharmacological management alternatives, the use of canes has been proposed, however, there is no consensus in the literature regarding its indication. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified three systematic reviews including four studies overall, of which one was randomized trials. We conclude that the use of a contralateral cane in patients with knee osteoarthritis probably reduces pain. In addition, it could slightly increase function, but the certainty of the evidence is low.