Comparative Effectiveness of Roux-en Y Gastric Bypass Versus Vertical Sleeve Gastrectomy for Sustained Remission of Type 2 Diabetes Mellitus.

BACKGROUND: Bariatric surgery results in rapid weight loss and resolution of comorbidities such as type 2 diabetes mellitus (T2DM). We aimed to determine whether the type of surgical procedure-vertical sleeve gastrectomy (VSG) versus Roux-en-Y gastric bypass (RYGB)-was associated with sustained remission from T2DM, and to identify other independent predictors of sustained remission. METHODS: Using the IBM MarketScan database of privately insured patients in the United States, we performed a retrospective cohort study on individuals aged 18-65 y with T2DM on hypoglycemic medication, who underwent either VSG or RYGB from 2010 to 2016. Remission was defined as no refill of antidiabetic medication 180 d after a patient's medication was expected to run out and recurrence as medication refill after at least 180 d of remission. RESULTS: Of 5119 patients in our cohort, 4127 (81%) experienced remission of T2DM, and 816 (19.8%) of the 4127 patients experienced recurrence. Patients who underwent RYGB had a 24% (HR = 1.24, 95% CI: 1.16, 1.32) increased probability of achieving remission compared with VSG. RYGB had a 36% (HR = 0.64, 95% CI: 0.55, 0.74) decreased risk of recurrence compared with VSG. A higher number of diabetic medications at the time of surgery and a higher Charlson index score were associated with decreased probability of remission and an increased risk of recurrence of T2DM. CONCLUSIONS: While both procedures are initially effective, RYGB may be better than VSG at providing lasting remission of T2DM.

Accumbal TRH is downstream of the effects of isolation stress on hedonic food intake in rats.

Emotional stress, through elevating corticosterone (CORT) levels may reduce feeding in rodents however when offered palatable food, stressed animals ingest more food compared to non-stressed controls. Nucleus accumbens (NAc) is part of the mesocorticolimbic system and participates in processing rewarding characteristics of food modulating palatable food intake, mainly when glucocorticoids are elevated. A possible mediator of CORT effects is accumbal thyrotropin-releasing hormone (TRH), which reduces chow intake in rats when administered into the NAc. We aimed to study the TRH role in hedonic feeding in stressed rats. For 14 days, animals with ad libitum access to chow or chow plus chocolate milk were either group-housed or singly-housed to induce stress. Rats with access to chocolate milk showed hyperphagia and decreased accumbal TRH mRNA levels, which were potentiated by stress. Results suggest that TRH downregulation was permissive of the increased palatable food intake. TRH injections into NAc of singly-housed animals with palatable food access reduced their food intake and increased serum CORT levels. The accumbal injections of a glucocorticoid receptor antagonist (mifepristone) in stressed rats with palatable food access, reduced only palatable food intake and increased accumbal TRH expression and serum CORT levels. This modulation of TRH mRNA when CORT signaling is modified suggests that accumbal TRH is downstream of glucocorticoids activity, which specifically increase palatable food intake. Our results strengthen the TRH involvement in regulating emotional aspects of hedonic feeding in stressed animals. Finding new therapies directed towards increasing TRHergic activity in NAc may be protective against overeating.

Validation of a Hybrid Exoskeleton for Upper Limb Rehabilitation. A Preliminary Study.

Recovery of therapeutic or functional ambulatory capacity in patients with rotator cuff injury is a primary goal of rehabilitation. Wearable powered exoskeletons allow patients to perform repetitive practice with large movements to maximize recovery, even immediately after the acute event. The aim of this paper is to describe the usability, acceptability and acceptance of a hybrid exoskeleton for upper-limb passive rehabilitation using the System Usability Scale (SUS) questionnaire. This equipment, called ExoFlex, is defined as a hybrid exoskeleton since it is made up of rigid and soft components. The exoskeleton mechanical description is presented along with its control system and the way motion is structured in rehabilitation sessions. Seven patients (six women and one man) have participated in the evaluation of this equipment, which are in the range of 50 to 79 years old. Preliminary evidence of the acceptance and usability by both patients and clinicians are very promising, obtaining an average score of 80.71 in the SUS test, as well as good results in a questionnaire that evaluates the clinicians' perceived usability of ExoFlex.

Efficient Upper Limb Position Estimation Based on Angular Displacement Sensors for Wearable Devices.

Motion tracking techniques have been extensively studied in recent years. However, capturing movements of the upper limbs is a challenging task. This document presents the estimation of arm orientation and elbow and wrist position using wearable flexible sensors (WFSs). A study was developed to obtain the highest range of motion (ROM) of the shoulder with as few sensors as possible, and a method for estimating arm length and a calibration procedure was proposed. Performance was verified by comparing measurement of the shoulder joint angles obtained from commercial two-axis soft angular displacement sensors (sADS) from Bend Labs and from the ground truth system (GTS) OptiTrack. The global root-mean-square error (RMSE) for the shoulder angle is 2.93 degrees and 37.5 mm for the position estimation of the wrist in cyclical movements; this measure of RMSE was improved to 13.6 mm by implementing a gesture classifier.

Acoustic interactions for robot audition: A corpus of real auditory scenes.

The Acoustic Interactions for Robot Audition corpus is introduced for research on sound source localization and separation, and for multi-user speech recognition. Its aim is to evaluate and train Robot Audition techniques, as well as Auditory Scene Analysis in general. It was recorded in six real-life environments with different noise presence and reverberation time, using two array configurations: an equilateral triangle, and a three-dimensional 16-microphone array set over a hollow plastic body. It includes clean speech data for static sources and tracking information for mobile sources. It is freely available at https://aira.iimas.unam.mx/.

Absence of the Nonextension Sign as a Marker for Endoscopic Submucosal Dissection Suitability.

Early gastric cancer is defined as gastric cancer confined to the mucosa or submucosa, irrespective of lymph node metastasis. Endoscopic submucosal dissection is a standard treatment of early gastric cancer. The nonextension sign consists of a protrusion of the surrounding mucosa into the lumen, resembling a trapezoidal shape. This phenomenon occurs when massive submucosal invasion by a cancer increases the thickness and rigidity of the gastric wall and may be useful to differentiate between mucosal or microinvasive submucosal and invasive submucosal cancers. Our case demonstrates the usefulness of the absence of the conventional endoscopic nonextension sign as a marker to decide the adequate approach for mucosal lesions.

Buerger disease (thromboangiitis obliterans): a clinical diagnosis.

Thromboangiitis obliterans, or Buerger disease, is a debilitating vascular disease with a well-known pronounced link to cigarette smoking and, more specifically, to the nicotine component of tobacco inhalation. Buerger disease is an inflammatory occlusive disorder that primarily affects the medium and small vessels of the extremities. In the present case report, a 46-year-old man, nonforthcoming smoker, presented to the authors' clinic with a deep ulcer at the head of the second metatarsal. Evidently, although the patient continued to smoke, the ulcer responded to therapy but regressed. Once the history was elaborated, the patient stopped smoking, and the ulcer healed completely within 2 months. Follow-up appointments proved to be unremarkable and to the authors' knowledge, there has not been a reoccurrence, and the patient remains tobacco-free.

Factors associated with locoregional recurrence in penile cancer: a case-control study.

PURPOSE: Surgical excision of the primary tumor in penile cancer (PC) has shown good local control with a risk of locoregional recurrence (LR) of 4-8%. The magnitude of such risk and the characteristics that distinguish patients who develop LR from those who do not is controversial. Our goal was to estimate, clinical and oncological characteristics, and outcome of LR in a cohort of patients with PC. MATERIALS AND METHODS: A retrospective, case-control study of ten patients with LR of PC and ten controls. Using a multivariate analysis for clinical and oncological characteristics was evaluated to determine their association with LR. RESULTS: Cases and controls were similar in regards to the prevalence of diabetes, age, grade of differentiation, presence of lymphovascular invasion (LVI), and positive margins. In our multiple logistic regression analysis clinical stage (CS), LVI and positive margins were associated with LR. Time to LR had a median of 15 months. CONCLUSIONS: Our study confirms that patients with advanced CS, LVI and positive margins after surgical excision of the primary tumor could have higher risk of LR. We believe that a close oncological follow-up should be done in patients with adverse oncological characteristics.

OBJETIVO: La escisión quirúrgica del tumor primario en cáncer de pene (PC) ha demostrado un buen control local con un riesgo de recurrencia locorregional (LR) del 4-8%. La magnitud del riesgo y las características que distinguen a los pacientes con recurrencia locorregional de los que no la presentan son motivo de controversia. Nuestro objetivo fue analizar características clínicas y oncológicas para establecer su relación LR en una cohorte de pacientes con PC. MATERIAL Y MÉTODOS: Estudio retrospectivo de casos y controles de 10 pacientes con LR de PC y 10 controles. Mediante un análisis multivariado se analizaron características clínicas y oncológicas y se determinó su asociación con LR. RESULTADOS: Los casos y controles fueron similares en cuanto a prevalencia de diabetes, edad, grado de diferenciación, invasión linfovascular y márgenes positivos. En nuestro análisis de regresión logística múltiple, el estadio clínico (CS), la invasión linfovascular y los márgenes positivos se asociaron con LR. El tiempo a la LR tuvo una mediana de 15 meses. CONCLUSIONES: Nuestro estudio confirma que los pacientes con CS avanzado, invasión linfovascular y márgenes positivos podrían tener mayor riesgo de LR. Creemos que debe realizarse un seguimiento oncológico estrecho en pacientes con características oncológicas adversas.

Efficient Multiaxial Shoulder-Motion Tracking Based on Flexible Resistive Sensors Applied to Exosuits.

This article describes the performance of a flexible resistive sensor network to track shoulder motion. This system monitors every gesture of the human shoulder in its range of motion except rotations around the longitudinal axis of the arm. In this regard, the design considers the movement of the glenohumeral, acromioclavicular, sternoclavicular, and scapulothoracic joints. The solution presented in this work considers several sensor configurations and compares its performance with a set of inertial measurement units (IMUs). These devices have been put together in a shoulder suit with Optitrack visual markers in order to be used as pose ground truth. Optimal configurations of flexible resistive sensors, in terms of accuracy requirements and number of sensors, have been obtained by applying principal component analysis techniques. The data provided by each configuration are then mapped onto the shoulder pose by using neural network algorithms. According to the results shown in this article, a set of flexible resistive sensors can be an adequate alternative to IMUs for multiaxial shoulder pose tracking in open spaces. Furthermore, the system presented can be easily embedded in fabric or wearable devices without obstructing the user's motion.

Laccase production by Pycnoporus sanguineus under different culture conditions.

Pycnoporus sanguineus is a white-rot fungus that produces ligninolytic enzymes such as laccases. These enzymes can endure temperatures as high as 60 degrees C and are useful for pulp bleaching, dye decolorization and phenolic degradation.Laccase production by fungi depends not only on the carbon and nitrogen sources but also on the nitrogen concentration of the culture medium. In this work, we examined the effect of four carbon sources (maltose, glucose, fructose and sucrose) and four nitrogen sources (ammonium tartrate, sodium nitrate, asparagine and yeast extract) on the activity of laccase from Pycnoporus sanguineus. All carbon and nitrogen sources exhibited a strong influence on laccase activity, a sucrose-asparagine medium providing the best results (320 mU/ml). Moreover, using an asparagine concentration 5 times higher than the reference level increased laccase activity to 820 mU/ml. Higher asparagine concentrations, however, resulted in no further increase in activity.Consistent with previous results, the carbon and nitrogen sources, and the nitrogen concentration, had a strong impact on laccase activity, the optimum conditions depending on the particular fungus. The conditions of the culture medium had a marked effect on laccase activity, which increased up to 820 mU/ml.

Melanoidin-containing wastewaters induce selective laccase gene expression in the white-rot fungus Trametes sp. I-62.

Wastewaters generated from the production of ethanol from sugar cane molasses may have detrimental effects on the environment due to their high chemical oxygen demand and dark brown color. The color is mainly associated with the presence of melanoidins, which are highly recalcitrant to biodegradation. We report here the induction of laccases by molasses wastewaters and molasses melanoidins in the basidiomycetous fungus Trametes sp. I-62. The time course of effluent decolorization and laccase activity in the culture supernatant of the fungus were correlated. The expression of laccase genes lcc1 and lcc2 increased as a result of the addition of complete molasses wastewater and its high molecular weight fraction to fungal cultures. This is the first time differential laccase gene expression has been reported to occur upon exposure of fungal cultures to molasses wastewaters and their melanoidins.

Both the Suprachiasmatic Nucleus and the Superior Ovarian Nerve Contribute to the Processes of Ovulation and Steroid Hormone Secretion on Proestrus.

The aims of the present study were to analyze if the superior ovarian nerve (SON) plays a role in the neural signals from suprachiasmatic nucleus (SCN) that lead to ovulation and ovarian steroids secretion on proestrus day. Rats on proestrus day were treated at 11.00 to 11.30 or 17.00 to 17.30 hours with 1 of the 3 experimental procedures (1) unilateral or bilateral SON sectioning, (2) unilateral or bilateral injury to the SCN, or (3) unilateral injury to the SCN followed by unilateral sectioning of the SON ipsilateral to the treated SCN. Treatments were evaluated 24 hours after surgical procedures. Compared to laparotomized animals, right or bilateral SON sectioning treatment at 17.00 hours resulted in lower ovulation rates and number of ova shed by the right ovary. The ovaries of nonovulating animals showed early follicular luteinization signs and trapped ova. Bilateral SCN injury treatment at 11.00 hours resulted in anovulation; whereas right SCN injury treatment, with or without right SON sectioning, resulted in a lower number of ova shed. Injecting luteinizing hormone-releasing hormone to animals with bilateral SCN injury restored ovulation. In rats with unilateral or bilateral SON sectioning, or with injury to the SCN with or without unilateral sectioning of the SON, the effects on hormone levels depended of the hormone studied and the time of day treatment was performed. The present results suggest that on proestrus day, the role of the right or both SON in ovulation and steroid hormone secretion regulation takes place through different neuroendocrine mechanisms from SCN.

The white-rot fungus Pleurotus ostreatus secretes laccase isozymes with different substrate specificities.

Four laccase isozymes (LCC1, LCC2, LCC3 and LCC4) synthesized by Pleurotus ostreatus strain V-184 were purified and characterized. LCC1 and LCC2 have molecular masses of about 60 and 65 kDa and exhibited the same pI value (3.0). Their N termini were sequenced, revealing the same amino acid sequence and homology with laccases from other microorganisms. Laccases LCC3 and LCC4 were characterized by SDS-PAGE, estimating their molecular masses around 80 and 82 kDa, respectively. By native isoelectrofocusing, their pI values were 4.7 and 4.5, respectively. When staining with ABTS and guaiacol in native polyacrilamide gels, different specificities were observed for LCC1/LCC2 and LCC3/LCC4 isozymes.

Representaciones sociales del empleo y desempleo de población del Páis Vasco / Social representations of employment and unemployment from the Basque Country population

Con la base teórico metodológica de las representaciones sociales (RS) se analizan los conceptos de empleo y desempleo en dos grupos poblacionales del País Vasco: jóvenes de 20 y menos años y adultos mayores de 21 años y más. Se utiliza la técnica asociativa de listados libres para conocer el contenido y estructura de las RS, así como la identificación del núcleo central y los elementos periféricos. Para los participantes el empleo es una ocupación que implica acceso al dinero, favorece la satisfacción de necesidades, genera felicidad. Para los mayores de 21 años es un medio para obtener dignidad, realización y futuro. El desempleo implica la falta de dinero, crisis y pobreza, genera desesperanza, depresión y agobio. Para los mayores de 21 años genera problemas, deudas, depresión y angustia, favorece la marginación y culpan a los políticos y al gobierno de su existencia. Se concluye con propuestas de afrontamiento ante el desempleo por parte de participantes

With the theoretical methodological basis of social representations (SR), concepts of employment and unemployment were analyzed in two population groups from the Basque Country: people 20 years old and under and adults over 21 years old. The associative technique of free listings was used in order to know the content and structure of SR, as well as the identification of the central nucleus and the peripheral elements. For the participants employment is an occupation that implies earning money, allows the needs’ satisfaction, and generates happiness. For the group that was 21 years old or older it means, obtaining dignity, to be satisfied and a sure future. Unemployment leads to a lack of money, crisis and poverty, causes hopelessness, depression and overwhelms the person. For the participants over 21 it generates problems, debts, depression, anguish, marginalization and the politicians and the government are blamed for its existence. We conclude with proposals from participants for coping with unemployment

Photocatalytic elimination of indoor air biological and chemical pollution in realistic conditions.

The photocatalytic elimination of microorganisms from indoor air in realistic conditions and the feasibility of simultaneous elimination of chemical contaminants have been studied at laboratory scale. Transparent polymeric monoliths have been coated with sol-gel TiO(2) films and used as photocatalyst to treat real indoor air in a laboratory-scale single-step annular photocatalytic reactor. The analytical techniques used to characterize the air quality and analyze the results of the photocatalytic tests were: colony counting, microscopy and PCR with subsequent sequencing for microbial quantification and identification; automated thermal desorption coupled to gas chromatography with mass spectrometry detection for chemical analysis. The first experiments performed proved that photocatalysis based on UVA-irradiated TiO(2) for the reduction of the concentration of bacteria in the air could compete with the conventional photolytic treatment with UVC radiation, more expensive and hazardous. Simultaneously to the disinfection, the concentration of volatile organic compounds was greatly reduced, which adds value to this technology for real applications. The fungal colony number was not apparently modified.

Conocimientos sobre reanimación cardiopulmonar básica y avanzada de adultos de médicos residentes de un hospital de tercer nivel en Paraguay / Knowledge of adult basic and advanced cardiopulmonary resuscitation of medical residents at a third level in Paraguay

El objetivo de este trabajo consistió en determinar el nivel de conocimiento que tienen los médicos residentes del Hospital Nacional de Itauguá sobre reanimación cardiopulmonar básica y avanzada en adultos. Estudio observacional, descriptivo, de corte transverso, con muestreo no probabilístico de casos consecutivos que incluyó a médicos residentes del Hospital Nacional de Itauguá, de distintas especialidades. Los participantes completaron un cuestionario de 20 preguntas seleccionadas del banco de preguntas de las guías de Soporte Vital Básico para profesionales de la salud (BLS) y Soporte Vital Avanzado en Adultos (ACLS) de la American Heart Association, actualización del 2010. Participaron del estudio 135 médicos, de los cuales 76 (56,3%) fueron del sexo masculino y 59 (43,7%) del sexo femenino. La edad media de los participantes fue de 27,57 ± 4 años, estando 92 (68,1%) médicos con edades comprendidas entre los 26 y 31 años. En cuanto al conocimiento de los participantes sobre la reanimación cardiopulmonar de adultos, 113 (83,7%) presentaron un nivel no satisfactorio, al responder menos de 17 preguntas del cuestionario de manera correcta. La evidente deficiencia que mostraron los médicos residentes participantes de este estudio en sus conocimientos sobre reanimación cardiopulmonar, nos hace plantear la necesidad de insistir que todas las Facultades de Medicina del país incorporen un mejor y mayor enfoque teórico y práctico de los contenidos sobre reanimación cardiopulmonar dentro de sus planes de estudio e implementen estrategias de capacitación continua en esta área

The objective of this study was to determine the level of knowledge of adult basic and advanced cardiopulmonary resuscitation of medical residents at the National Hospital of Itauguá. Observational, descriptive and cross-sectional study with a nonprobabilistic sampling of consecutive cases. The study participants were medical residents of the National Hospital of Itauguá, from different specialties, who completed a questionnaire of 20 questions selected from the Basic Life Support for Health Professionals (BLS) and Advanced Cardiovascular Life Support in Adults (ACLS) of the American Heart Association guides, 2010 update. The study included 135 physicians, of which 76 (56.3%) were men and 59 (43.7%) were women. The mean age of participants was 27.57 ± 4 years and 92 (68.1%) were physicians between 26 and 31 years of age. Regarding the participants' knowledge about cardiopulmonary resuscitation, 113 (83.7%) presented an unsatisfactory level, by answering less than 17 questions of the questionnaire correctly. The evident deficiency shown by the medical residents in their knowledge of cardiopulmonary resuscitation makes it necessary to insist on incorporating a better and greater theoretical and practical approach of the contents on cardiopulmonary resuscitation within the curricula of all the Medical Schools of the country, and they should implement continuous training strategies in this area.

Complications of the Weil osteotomy.

Introduction. The Weil osteotomy is commonly used for multiple forefoot pathologies yielding metatarsalgia. Despite its common use, the Weil osteotomy is associated with a high complication rate. Methods. A literature review was undertaken with predetermined criteria. To maximize the articles for review, prospective and retrospective studies were considered as well as multiple indications. Seventeen articles qualified for analysis, and study format, patient demographics, surgical indication, and complication rates were documented. The data obtained were totaled and evaluated for trends. Results. Details of 1131 Weil osteotomies are reported. The most commonly reported complication of the Weil osteotomy was floating toe, reported in 233 cases, with an overall occurrence of 36%. Recurrence was reported in 15% of the cases. Transfer metatarsalgia was reported in 7% of the cases, whereas delayed union, non-union, and malunion were collectively reported in 3% of the cases. Discussion. There is no consensus regarding utilization of the Weil osteotomy with prophylactic surgery, plantar plate repair, and adjunctive interphalangeal arthrodesis. These variables may alter complication rates and provide new avenues for research.

Cultural conceptions of HIV/AIDS among teenagers in Bolivia, Chile and Mexico.

OBJECTIVE: To understand the cultural dimensions of HIV/AIDS among adolescent students. METHODS: A cognitive anthropological study was undertaken in Cochabamba (Bolivia), Talca (Chile) and Guadalajara (Mexico), during 2007 and 2008. A total of 184 teenagers (from 14 to 19 years old) were selected by purposeful sampling at secondary schools in each country. Free association lists and pile sorts were utilized. Terms associated with the concept of HIV/AIDS and groups of conceptual dimensions were investigated. Subsequently, consensus analysis was performed using factorial principal components and dimensional analysis through hierarchical clusters and multidimensional scales. RESULTS: The differences between the country contexts were in the degree of consensus in relation to the term HIV/AIDS, which was greater in Cochabamba. In Talca and Guadalajara the youths mentioned metaphors of fighting against HIV/AIDS, while in Cochabamba participants talked about help, support and love that infected people should receive. The similarities among conceptions by youth from the three countries were: the risk factors (unprotected sexual practice and contact with specific population groups), the consequences (physical and social death, being the latter understood as social rejection of people living with HIV/AIDS) and the prevention of illness (based on information and condom use). CONCLUSIONS: For adolescent students, HIV/AIDS is a disease caused by sexual practices and drug use and involves harm, pain and death. HIV/AIDS prevention programs for adolescents should promote science based information on the topic and not concentrate only on the emotional and social consequences of HIV/AIDS.

Concepciones culturales del VIH/Sida de adolescentes de Bolivia, Chile y México / Cultural conceptions of HIV/AIDS among teenagers in Bolivia, Chile and Mexico

OBJETIVO: Comprender las dimensiones culturales del VIH/Sida de estudiantes adolescentes. MÉTODOS: Estudio antropológico cognitivo. Realizado en Cochabamba (Bolivia), Talca (Chile) y Guadalajara (México) entre 2007 y 2008. Un total de 184 jóvenes (de 14 y 19 años de edad) fueron seleccionados por muestreo propositivo en centros de estudios de educación media superior de cada país. Fueron utilizadas las técnicas de listados libres y el sorteo de montones. Se indagaron términos asociados al concepto VIH/Sida y grupos de dimensiones conceptuales. Posteriormente se aplicó análisis de consenso mediante factorización de componentes principales y análisis dimensional mediante conglomerados jerárquicos y escalas multidimensionales. RESULTADOS: Las diferencias entre los contextos fueron en el grado de consenso en relación al término de VIH/Sida, ya que fue mayor en Cochabamba. En Talca y Guadalajara los jóvenes mencionaron metáforas de lucha frente a la enfermedad, mientras en Cochabamba se refirieron a la ayuda, apoyo y amor que las personas infectadas deberían recibir. Las coincidencias entre las conceptualizaciones de los jóvenes de los tres países fueron: los riesgos (las prácticas sexuales desprotegidas y el contacto con algunos grupos poblacionales específicos), las consecuencias (muerte física y social, entendida ésta última como el rechazo de la sociedad hacia los enfermos) y la prevención de la enfermedad (con base en la información así como uso del condón). CONCLUSIONES: Para los estudiantes adolescentes el VIH/Sida es una enfermedad causada por prácticas sexuales y consumo de drogas que implica daño, dolor y muerte. Los programas preventivos del VIH/Sida para los adolescentes deben promover la búsqueda de información sobre el tema con bases científicas, y no centrarse en las consecuencias emocionales y sociales de la enfermedad.