First evidence of a palaeo-nursery area of the great white shark.

Shark nurseries are essential habitats for shark survival. Notwithstanding the rich fossil record of the modern great white shark (Carcharodon carcharias, GWS), its use of nursery areas in the fossil record has never been assessed before. Here, we analysed the fossil record of the GWS from three South American Pliocene localities, assessed body size distributions and applied previously established criteria to identify palaeo-nurseries. We found that juveniles dominate the Coquimbo locality (Chile), whereas subadults and adults characterize Pisco (Peru) and Caldera (Chile), respectively. These results, summed to the paleontological and paleoenvironmental record of the region, suggest that Coquimbo represents the first nursery area for the GWS in the fossil record. Our findings demonstrate that one of the top predators in today's oceans has used nursery areas for millions of years, highlighting their importance as essential habitats for shark survival in deep time.

Endoscopic sutured gastroplasty: procedure evolution from first-in-man cases through current technique.

BACKGROUND: Endoscopic sutured gastroplasty (ESG) has evolved over time. With the advent of full-thickness endoscopic suturing, an efficient technique for ESG was developed and refined. METHODS: This prospective first-in-man trial started in April 2012 and represents the first use of full-thickness endoscopic suturing for primary obesity therapy. The trial focused on procedure development, reproducibility, safety, and short-term efficacy. The trial was performed at centers in five countries, in three phases. Phase I was evaluation of safety and technical feasibility of various procedure techniques; stitch patterns and sequences were assessed for efficiency, safety, and feasibility. Phase II entailed continued procedure refinement to establish a standardized technique. Phase III entailed evaluation of technical feasibility and weight loss outcomes in 77 patients; the procedure was performed using the standardized technique, and there was no procedure development. Data were prospectively collected into a registry. RESULTS: In Phase I, the procedure was created and modified to improve time efficiency. Safety and technical feasibility were established, and short-term weight loss was demonstrated. In Phase II, a number of stitch patterns were attempted, and the stitch pattern was modified and finalized. 22 patients were included, and 1-year total weight loss was 17.3 ± 2.6%. In Phase III, conformity with the final technique was high. 77 patients were included, with a mean BMI of 36.1 ± 0.6 kg/m2. Mean weight loss was 16.0 ± 0.8% at 6 months and 17.4 ± 1.2% at 12 months (n = 44). Postprocedural nausea, vomiting, and epigastric pain were frequently reported; there were no reported significant adverse events post-procedure or during the follow-up period. CONCLUSIONS: Following a methodical procedure development phase, ESG demonstrated safety and short-term efficacy in this trial. The procedure also achieved meaningful weight loss during the follow-up period.

Ileo biliar / Gallstone ileum

El Ileo Biliar es una patología descrita por primera vez por Bertholin en 1654, consistente en la obstrucción mécanica del instestino, causada por la impactación de uno o más cálculos dentro del lúmen intestinal. El paso del cálculo de la vesícula biliar a la vía digestiva se produce a través de una fístula siendo la más frecuente la fístula colecistoduodenal. El cuadro clínico del ileo biliar es idéntico al del resto de las obstrucciones abdominales. Sin embargo, el antecedente de una colelitiasis y los signos radiográficos descritos por Ringler, Borman y Noble que consisten en neumobilia, evidencias radiográficas de obstrucción intestinal y la visualización del cálculo en la luz intestinal; son los que nos permiten precisar el diagnóstico. Nuestro trabajo consiste en la revisión de esta patología y su incidencia en el Complejo Hospitalario Metropolitano de la Caja de Seguro Social entre 1980 y 1986, inclusive