Early postoperative complications after gastric bypass revisional surgery in patients with previous sleeve gastrectomy versus primary gastric bypass.

BACKGROUND: Revisional bariatric surgery (RS) is indicated if there is weight regain or insufficient weight loss, no improvement or reappearance of co-morbidities, or previous bariatric surgery complications. It has been associated with higher postoperative morbidity. OBJECTIVE: To evaluate the early postoperative complications (<30 d) of Roux-en-Y gastric bypass RS (RYGB-RS) after primary sleeve gastrectomy (SG-1) compared with primary RYGB (RYGB-1) at a bariatric surgery referral center. SETTING: Department of General and Digestive Surgery of General Universitary Hospital of Alicante, Spain. METHODS: Retrospective cohort study comparing RYGB-RS after SG-1 and RYGB-1 between January 2008 and March 2021. Postoperative complications, hospital stay, mortality, and readmissions were analyzed. RESULTS: Six hundred and twenty-eight RYGB surgeries (48 RYGB-RS, 580 RYGB-1) were studied. The mean age of patients undergoing RYGB-RS was 50 years, compared with 46 years in the RYGB-1 group (P = .017). Mean initial body mass index was 44.2 kg/m2 (RYGB-RS) versus 47.6 kg/m2 (RYGB-1; P = .004). Cardiovascular risk factors were higher in the RYGB-1 group (P < .05). Indications for RS were weight regain or insufficient weight loss (72.9%), weight regain or insufficient weight loss plus gastroesophageal reflux disease (14.6%), and gastroesophageal reflux disease (12.5%). There were no differences in the frequency of complications (RYGB-RS 22.9% vs RYGB-1 20.5%) or in their severity (Clavien-Dindo ≥IIIa; RYGB-RS 10.4% vs RYGB-1 6.4%; P > .05). There were no differences in emergency room visits (RYGB-RS at 12.5% vs RYGB-1 at 14.9%) or in readmissions (RYGB-RS at 12.5% vs RYGB-1 at 9.4%). CONCLUSION: No differences were observed between primary RYGB and revisional RYGB in early morbidity, mortality, emergencies, or readmissions. Revisional bariatric surgery is a safe procedure at referral centers and must be done by expert hands.

Selective directed forgetting is mediated by the lateral prefrontal cortex: Preliminary evidence with transcranial direct current stimulation.

Recent research has shown that providing a cue to selectively forget one subset of previously learned facts may result in specific forgetting of this information. Behavioral evidence suggests that this selective directed forgetting effect relies on executive control and is a direct consequence of active, rather than passive, mechanisms. To date, however, no previous research has addressed the neural underpinnings of selective directed forgetting. Since the lateral prefrontal cortex is thought to mediate motivated forgetting by exerting top-down control over the brain structures that underpin memory representations, the present study aimed to test the hypothesis that selective directed forgetting is prefrontally driven. Specifically, we used transcranial direct current stimulation to disrupt activity in the dorsolateral prefrontal cortex, using a stimulation protocol that has already been shown to be effective in this regard. Our results reveal that, in contrast to sham stimulation, real stimulation abolished selective directed forgetting. Additionally, real stimulation hindered performance in an updating working memory task thought to recruit the lateral prefrontal cortex. These findings, complementing others obtained with a variety of memory control tasks, support the hypothesis that memory downregulation is achieved by control processes mediated by the right lateral prefrontal cortex.

[Predictors of kidney function in a cohortof Mexican adults]. / Predictores de la función renal en una cohorte de adultos mexicanos.

OBJECTIVE: Our aim was to examine prospectively predictors of subclinical renal alterations among adults without chronic kidney disease. MATERIALS AND METHODS: We analyzed data from a cohort of Mexican adults (n=757). Kidney function (2010) was assessed with the estimated glomerular filtration rate (eGFR-Cr), serum creatinine and uric acid. Predictors of each kidney function marker (2004) were identified with linear and logistic regression models. RESULTS: 33% had an eGFR-Cr 40 years old and users of antihypertensive medication; and higher among those with a high protein intake. Serum creatinine predictors were similar to those observed for eGFR-Cr. Uric acid decreased in men, among those with obesity, hypertension and high cholesterol. CONCLUSIONS: Conventional kidney function biomarkers are useful to identify subclinical alterations. Some predictors of kidney function are potentially modifiable, therefore susceptible for intervention among high-risk groups.

OBJETIVO: Examinar prospectivamente los predictores de alteraciones subclínicas de la función renal en adultos sin diagnóstico previo de enfermedad renal crónica. MATERIAL Y MÉTODOS: Se analizaron datos de una cohorte de adultos mexicanos (n=757). La función renal (2010) se midió mediante la tasa de filtración glomerular estimada (TFGECr), creatinina y ácido úrico séricos. Los predictores (2004) se identificaron con modelos de regresión lineal y logística. RESULTADOS: Se clasificó 33% con TFGE-Cr disminuida.La TFGE-Cr fue menor en hombres, en >40 años y en usuarios de antihipertensivos; y fue mayor en aquellos con consumo proteico alto. Los predictores de la creatinina fueron similares a los de la TFGE-Cr. El ácido úrico disminuyó en participantes hombres, con obesidad, hipertensión e hipercolesterolemia. CONCLUSIONES: Los biomarcadores séricos convencionales son útiles para identificar alteraciones subclínicas de la función renal. Algunos predictores de la función renal son potencialmente modificables, por tanto susceptibles de intervención.

Predictores de la función renal en una cohorte de adultos mexicanos / Predictors of kidney function in a cohort of Mexican adults

Resumen: Objetivo: Examinar prospectivamente los predictores de alteraciones subclínicas de la función renal en adultos sin diagnóstico previo de enfermedad renal crónica. Material y métodos: Se analizaron datos de una cohorte de adultos mexicanos (n=757). La función renal (2010) se midió mediante la tasa de filtración glomerular estimada (TFGE-Cr), creatinina y ácido úrico séricos. Los predictores (2004) se identificaron con modelos de regresión lineal y logística. Resultados: Se clasificó 33% con TFGE-Cr disminuida. La TFGE-Cr fue menor en hombres, en >40 años y en usuarios de antihipertensivos; y fue mayor en aquellos con consumo proteico alto. Los predictores de la creatinina fueron similares a los de la TFGE-Cr. El ácido úrico disminuyó en participantes hombres, con obesidad, hipertensión e hipercolesterolemia. Conclusión. Los biomarcadores séricos convencionales son útiles para identificar alteraciones subclínicas de la función renal. Algunos predictores de la función renal son potencialmente modificables, por tanto susceptibles de intervención.

Abstract: Objectives: Our aim was to examine prospectively predictors of subclinical renal alterations among adults without chronic kidney disease. Materials and methods: We analyzed data from a cohort of Mexican adults (n=757). Kidney function (2010) was assessed with the estimated glomerular filtration rate (eGFR-Cr), serum creatinine and uric acid. Predictors of each kidney function marker (2004) were identified with linear and logistic regression models. Results: 33% had an eGFR-Cr <90 ml/min/1.73 m2. eGFR-Cr was lower among men, those >40 years old and users of antihypertensive medication; and higher among those with a high protein intake. Serum creatinine predictors were similar to those observed for eGFR-Cr. Uric acid decreased in men, among those with obesity, hypertension and high cholesterol. Conclusion: Conventional kidney function biomarkers are useful to identify subclinical alterations. Some predictors of kidney function are potentially modifiable, therefore susceptible for intervention among high-risk groups.

Selective directed forgetting: Eliminating output order and demand characteristics explanations.

Previous research has shown that giving an instruction to forget part of a studied list of items impairs the subsequent retrieval of these items compared with those not cued to be forgotten. This selective directed forgetting (SDF) effect has been found with slightly different procedures and in adolescents and young adults. While recent research has suggested that executive control might underlie SDF, alternative explanations that rely on procedural issues still have not been investigated. Specifically, SDF might essentially reflect output interference from the items cued to be remembered, so that the earlier recalled items interfere with the later recalled items. The effect could also result from demand characteristics: Participants might withhold the to-be-forgotten items to comply with the experimenter's implicit goals or might not be willing to engage in the effort of retrieving all studied information. The results from two experiments showed that (1) the to-be-forgotten items were less accessible and were not influenced by output interference from to-be-remembered items (Experiment 1), and (2) SDF was still present when participants were offered monetary reward for retrieving as many items as possible (Experiment 2). Hence, the findings do not provide support to explanations of SDF based on output interference and demand characteristics.

Exploring Mechanisms of Selective Directed Forgetting.

While some studies have shown that providing a cue to selectively forget one subset of previously learned facts may cause specific forgetting of this information, little is known about the mechanisms underlying this memory phenomenon. In three experiments, we aimed to better understand the nature of the selective directed forgetting (SDF) effect. Participants studied a List 1 consisting of 18 sentences regarding two (or three) different characters and a List 2 consisting of sentences regarding an additional character. In Experiment 1, we explored the role of rehearsal as the mechanism producing SDF by examining the effect of articulatory suppression after List 1 and during List 2 presentation. In Experiments 2 and 3, we explored the role of attentional control mechanisms by introducing a concurrent updating task after List 1 and during List 2 (Experiment 2) and by manipulating the number of characters to be selectively forgotten (1 out of 3 vs. 2 out of 3). Results from the three experiments suggest that neither rehearsal nor context change seem to be the mechanisms underlying SDF, while the pattern of results is consistent with an inhibitory account. In addition, whatever the responsible mechanism is, SDF seems to rely on the available attentional resources and the demands of the task. Our results join other findings to show that SDF is a robust phenomenon and suggest boundary conditions for the effect to be observed.

Disfunción familiar en gestantes adolescentes de un área de salud / Family dysfunction in pregnant adolescents from a health area

Se realizó un estudio descriptivo, observacional, de corte transversal, de las 58 gestantes menores de 20 años, pertenecientes al área de salud del Policlínico Universitario Josué País García de Santiago de Cuba, de enero a diciembre del 2013, con vistas a determinar la relación entre la disfunción familiar y la presentación del embarazo en ellas, para lo cual se aplicó el instrumento de evaluación Faces III. Al efectuar el análisis estadístico se evidenció un predominio del grupo etario de 15-18 años, de la vinculación a los diferentes niveles de enseñanza en correspondencia con la edad, así como de la disfuncionalidad familiar y el tipo de familia extensa; estos 2 últimos resultados constituyeron factores predisponentes en el desarrollo de conductas de riesgo, como el embarazo precoz(AU)

A descriptive, observational, cross-sectional study of the 58 pregnant adolescents under 20 years, belonging to the health area of Josué País García University Polyclinic in Santiago de Cuba, was carried out from January to December, 2013, aimed at determining the relation between family dysfunctions and their pregnancies, for which the evaluation instrument Faces III was applied. During the statistical analysis a prevalence of the age group 15-18 years, a link to the different teaching levels in correspondence to age were evidenced, as well as of the family dysfunctionality and the numerous members family; these 2 last results constituted predisposing factors in the development of risky behaviors, as early pregnancy(AU)

Disfunción familiar en gestantes adolescentes de un área de salud / Family dysfunction in pregnant adolescents from a health area

Se realizó un estudio descriptivo, observacional, de corte transversal, de las 58 gestantes menores de 20 años, pertenecientes al área de salud del Policlínico Universitario "Josué País García" de Santiago de Cuba, de enero a diciembre del 2013, con vistas a determinar la relación entre la disfunción familiar y la presentación del embarazo en ellas, para lo cual se aplicó el instrumento de evaluación Faces III. Al efectuar el análisis estadístico se evidenció un predominio del grupo etario de 15-18 años, de la vinculación a los diferentes niveles de enseñanza en correspondencia con la edad, así como de la disfuncionalidad familiar y el tipo de familia extensa; estos 2 últimos resultados constituyeron factores predisponentes en el desarrollo de conductas de riesgo, como el embarazo precoz.

A descriptive, observational, cross-sectional study of the 58 pregnant adolescents under 20 years, belonging to the health area of "Josué País García" University Polyclinic in Santiago de Cuba, was carried out from January to December, 2013, aimed at determining the relation between family dysfunctions and their pregnancies, for which the evaluation instrument Faces III was applied. During the statistical analysis a prevalence of the age group 15-18 years, a link to the different teaching levels in correspondence to age were evidenced, as well as of the family dysfunctionality and the numerous members family; these 2 last results constituted predisposing factors in the development of risky behaviors, as early pregnancy.

Selective voluntary forgetting in young and older adults.

Aging is thought to involve a decline in executive-control capacities, although evidence regarding this claim is not always clear. Thus, although studies exist that suggest impoverished inhibitory memory control in older adults relative to younger adults, experiments with the list-method direct forgetting procedure have mostly failed to show adult-age differences in voluntary forgetting. In the present study we aimed to further study this issue by comparing young-old and young adults' performance with the selective directed forgetting (SDF) procedure, which we assumed to involve higher demands of executive control than the standard nonselective procedure. Thus, on the basis of previous studies showing that a critical factor in finding adult-age differences in executive-control tasks is the overall challenge posed by the tasks, we predicted less SDF in older adults than in younger adults. Supporting our hypothesis, across three experiments we show evidence of older adults' impoverished capacity to voluntarily forget episodic memories, although only when the task requires selective forgetting. Ours join other findings to suggest that sensitiveness to detect adult-age differences in cognitive control may strongly depend on the executive-control demands imposed by tasks.

Different sorption behaviors for wine polyphenols in contact with oak wood.

The evolution of polyphenols of enological interest- monomeric anthocyanins, (+)-catechin, (-)-epicatechin, gallic acid, and trans-resveratrol-in the presence of oak wood was investigated in aging-model conditions. Disappearance kinetics showed that, except for gallic acid, all of the wine polyphenols tend to disappear from the model wine in presence of oak wood, to reach an equilibrium after 20 days of contact. At equilibrium, the higher disappearance rates were obtained for monomeric anthocyanins and trans-resveratrol with values of 20 and 50%, respectively. For monomeric anthocyanins, the rate of disappearance seemed to be independent of their nature. In order to evaluate the contribution of sorption to oak wood in the disappearance phenomena, sorption kinetics were determined for trans-resveratrol and malvidin-3-glucoside through the extraction and the quantification of the fraction sorbed to wood. These curves showed that the wood intake of trans-resveratrol and malvidin-3-glucoside followed a two-step behavior, with a higher rate during the first 2 days, likely due to a surface sorption mechanism, and then a slower rate to reach the equilibrium, which could be related to a diffusion mechanism. The comparison of disappeared and sorbed amounts at equilibrium showed that a minor part of the disappeared monomeric anthocyanins were sorbed by wood. In contrast, half of the concentration decrease of trans-resveratrol in wine finds its origin in a sorption mechanism by oak wood. Results in real wine show similar sorption kinetics.

Un futuro mejor es posible con el uso de la ciencia y la técnica en la Atención Primaria de Salud / With the use of science and technique in the primary health care, a better future is possible

Con la ejecución de las actividades cientificotécnicas se pretende modificar favorablemente los indicadores de salud que afectan a la comunidad perteneciente al Policlínico Facultad “Josué País García” de Santiago de Cuba, entre ellos el incremento de las enfermedades crónicas no transmisibles, las infecciones respiratorias agudas en los niños, el bajo peso al nacer, el riesgo maternoperinatal y otros, mediante la ejecución de proyectos y la colaboración de instituciones, organismos y organizaciones, empeñados conjuntamente en garantizar la continuidad de las investigaciones emprendidas y mejorar la calidad de vida de la población del territorio

Un futuro mejor es posible con el uso de la ciencia y la técnica en la Atención Primaria de Salud / With the use of science and technique in the primary health care, a better future is possible

Con la ejecución de las actividades cientificotécnicas se pretende modificar favorablemente los indicadores de salud que afectan a la comunidad perteneciente al Policlínico Facultad “Josué País García” de Santiago de Cuba, entre ellos el incremento de las enfermedades crónicas no transmisibles, las infecciones respiratorias agudas en los niños, el bajo peso al nacer, el riesgo maternoperinatal y otros, mediante la ejecución de proyectos y la colaboración de instituciones, organismos y organizaciones, empeñados conjuntamente en garantizar la continuidad de las investigaciones emprendidas y mejorar la calidad de vida de la población del territorio(AU)

Cuidados del enfermo en fase terminal y atención a su familia / Taken care of of the patient in final stage and attention to its family

Presenta un análisis de la medicina paliativa en enfermos incurables. Aborda planteamientos éticos en relación a los cuidados, atención y preparación de los pacientes para una muerte digna...