Is staple line oversewing in patients on chronic anticoagulation during laparoscopic sleeve gastrectomy necessary? Propensity score matching analysis using the 2015-2018 MBSAQIP.

BACKGROUND: There is an increased incidence of post-operative bleeding in patients on chronic anticoagulation (CAC). This incited some surgeons to oversew the sleeve staple line as a potentially preventive measure for post-operative bleeding. However, there is no clear evidence to assess the effectiveness of staple line oversewing during laparoscopic sleeve gastrectomy (LSG) in patients with CAC. METHODS: Using the 2015-2018 metabolic and bariatric surgery accreditation and quality improvement program database, patients between ages 18 and 65 who underwent LSG were included. To investigate the role of CAC, we performed 1:1 propensity score matching (PSM) between the CAC and non-CAC patients. Then, to explore the impact of oversewing, we focused on the CAC patients and divided them into 2 subgroups: oversewing versus non-oversewing. PSM was also performed to compare both subgroups. To avoid confounders, both PSM analyses were performed using 22 preoperative characteristics. 30-day postoperative outcomes including bleeding and blood transfusion requirement were assessed. RESULTS: 402,826 patients underwent LSG. 9148 patients (2.3%) were on CAC. In the CAC cohort (8843 matched cases), the anticoagulated patients showed significant increase in postoperative bleeding (1.2% vs. 0.5%; P < 0.001), blood transfusion requirements (1.7% vs. 0.7%; P < 0.001), unplanned ICU admissions (2.0% vs. 1.3%; P = 0.001), interventions (2.0% vs. 1.5%; P = 0.015), and readmissions (6.2% vs. 4.7%; P < 0.001). 1939 (21.2%) patients on CAC underwent oversewing during the LSG. The operative time was significantly longer in these patients (87.11 ± 40 vs. 76.19 ± 37; P < 0.001). Patients who underwent oversewing showed similar results in 30-day outcomes as those who did not, with no statistical difference, including postoperative bleeding (1.0% vs. 0.9%; P = 0.8) and blood transfusion requirements (1.4% vs. 1.8%; P = 0.9). CONCLUSION: Incidences of post-operative bleeding and blood transfusion requirements are higher in patients on CAC during the LSG. Oversewing the sleeve staple line leads to longer operative times without additional benefit in 30-day outcomes.

Innovaciones internacionales en robótica médica para mejorar el manejo del paciente en Perú / International innovations in medical robotics to improve the patient management in Peru

Surgical Engineering Society realizó una investigación, la primera revisión como pioneros en LATAM, desde el año 2015, que desarrolla el tema de las últimas tecnologías de robótica médica creadas en América del Norte, Europa y Asia, que se importan para aplicarlas en el sistema de salud de Perú y América Latina Los sistemas robóticos para cirugía, rehabilitación y asistencia se presentan cubriendo la descripción del diseño del control y las especificaciones técnicas. Además, el manejo del paciente mediante robots se analiza con herramientas de diagnóstico, pronóstico y tratamiento. El proceso para evaluar los nuevos inventos de los dispositivos robóticos y llevarlo al mercado se introduce donde en las tres etapas que se muestran a continuación: innovación, asuntos regulatorios y aplicación biomédica. Además, hay un alto porcentaje de población con discapacidad en América Latina, por lo tanto, es necesario que más científicos biomédicos se especialicen en robótica para comenzar a desarrollar nuevas ideas y mejorar el manejo del paciente. Finalmente, las nuevas tecnologías creadas en América Latina deben ser asequibles, simples y eficientes para apoyar la situación económica de la atención médica en el continente y brindar los mejores estándares de calidad para mejorar los resultados del tratamiento en los pacientes.

Surgical Engineering Society conducted a research, the First Review as the pioneers in LATAM, since year 2015, which develops the topic of the latest Medical Robotics technologies created in North América, Europe and Asia, which are imported to apply in the Healthcare System of Peru and Latin America. The robotic systems for surgery, rehabilitation and assistance are presented covering the description of control design and technical specifications. Besides, the patient management using robots is analyzed with diagnosis, prognosis and treatment tools. The process to evaluate the new inventions of robotic devices and bring to the market is introduced where three stages are shown as the following: innovation, regulatory affairs and biomedical application. Moreover, there is a high percentage of population with disability in Latin America, therefore, it is necessary that more biomedical scientists be specialized in robotics to start developing new ideas to improve the patient management. Finally, the new technologies created in Latin America must be affordable, simply and effcient in order to support the healthcare economic situation in the continent and give the best quality standards to improve treatment outcomes on patients.

Manifestaciones clínicas y cambios en la química sérica y tisular en ratas tratadas con vitamina D3 (calciferol) / Clinical signs and changes in serum and tissue chemistry in rats treated with vitamin D3 (calciferol)

En el presente trabajo se estudió el efecto de la administración subcutánea de 250, 500 y 750 μg (10.000, 20.000 y 30.000 UI, respectivamente) de vitamina D3 (calciferol)/día durante 8 días, sobre las concentraciones séricas de vitamina D3 y de 25-hidroxivitamina D3 (25-OH-D3) y sobre las concentraciones séricas y tisulares de Ca, Zn, Cu y Fe en 45 ratas macho Wistar, de 12 semanas de edad y con pesos entre 180 y 200 gramos. El grupo control estuvo integrado por 15 ratas Wistar sanas, con género, edad y peso similares a los animales tratados. La administración del calciferol a dosis altas produjo una hipervitaminosis D que se caracterizo por un aumento en el contenido sérico de la vitamina D3 y de 25-OH-D3, diversos signos clínicos (por ejemplo, anorexia, pérdida marcada de peso, diarreas sanguinolentas, conjuntivitis bilateral y muerte), hipercalcemia, hipocincemia, hipercupremia, hipoferremia y una alteración en la distribución tisular de Ca, Zn, Cu y Fe en comparación con los controles no tratados. La hipercalcemia y la inflamación son un hallazgo prominente en la hipervitaminosis D. La inflamación o la infección inducen cambios sistémicos, conocidos colectivamente como la respuesta de fase aguda. Entre las variadas alteraciones que produce esta respuesta encontramos hipoferremia, hipocincemia e hipercupremia. Es probable que estas respuestas estén mediadas, en parte, por la producción y liberación de citocinas como la interleucina 1, interferones (IFN-alfa), la interleucina 6 (Il-6) y el factor de necrosis tumoral (TNF). El desarrollo de la hipoferremia durante la inflamación requiere de hepcidina, un péptido rico en enlaces disulfuro, regulador del metabolismo del hierro, sintetizado en el hígado en respuesta a la liberación de Il-6 durante la inflamación/infección. En conclusión, nuestros resultados proporcionan evidencias que la administración de altas dosis de vitamina D, a corto plazo, determina diversos signos clínicos, produce un marcado aumento de las concentraciones séricas de la vitamina D3 y de 25-OH-D3 y una marcada alteración en las concentraciones séricas y tisulares de Ca, Zn, Cu y Fe, que dependen de las dosis inyectadas de vitamina D.

In the present work the effect of subcutaneous administration of 250, 500 and 750 ìg (10.000, 20.000 and 30.000 IU, respectively) of vitamin D3 (calciferol) daily for eight days, on serum concentrations of vitamin D3 and 25- hydroxyvitamin D3 (25-OH-D3) and on serum and tissue concentrations of Ca, Zn, Cu and Fe in 45 white male Wistar rats, aged 12 weeks and weighing 180-200 g, have been studied. The group control was integrated by 15 healthy rats with similar characteristics (strain, gender, age and weight) that treated animals. Administration of high doses of calciferol produced a hypervitaminosis D characterized by a significant (p3 and 25-OH-D3, diverse clinical signs (such as, anorexia, marked loss of body weight, bloody diarrhea, bilateral conjunctivitis, and death), hypercalcemia, hypozincaemia, hypercupremia, hypoferraemia and an alteration in the tissue distribution of Ca, Zn, Cu and Fe as compared with untreated controls. Hypercalcemia and inflammation are prominent findings in hypervitaminosis D. Inflammation or infection induce systemic changes, collectively known as the acute phase response. Among the varied alterations that together produce this response are hypoferraemia, hypozincaemia and hypercupremia. It is likely that these responses are mediated, in part, by production and release of cytokines such as interleukin 1, interferons (IFN-alpha), interleukin 6 (Il-6) and tumor necrosis factor (TNF). The development of hypoferraemia during inflammation requires hepcidin, an iron regulatory hormone, a disulfide-rich peptide, produced in the liver in response to the release of Il-6 during inflammation/ infection. In conclusion, our results provide evidence that short-term administration of high doses of vitamin D determined diverse clinical signs and produced a marked increase of serum vitamin D3 and 25-OH-D3 and a marked alteration in the serum and tissue concentrations of Ca, Zn, Cu, and Fe. These changes depend on the doses given of vitamin D.

[Clinical signs and changes in serum and tissue chemistry in rats treated with vitamin D3 (calciferol)]. / Manifestaciones clínicas y cambios en la química sérica y tisular en ratas tratadas con vitamina D3 (calciferol).

In the present work the effect of subcutaneous administration of 250, 500 and 750 microg (10.000, 20.000 and 30.000 IU, respectively) of vitamin D3 (calciferol) daily for eight days, on serum concentrations of vitamin D3 and 25-hydroxyvitamin D3 (25-OH-D3) and on serum and tissue concentrations of Ca, Zn, Cu and Fe in 45 white male Wistar rats, aged 12 weeks and weighing 180-200 g, have been studied. The group control was integrated by 15 healthy rats with similar characteristics (strain, gender, age and weight) that treated animals. Administration of high doses of calciferol produced a hypervitaminosis D characterized by a significant (p < 0.05) increase in serum vitamin D3 and 25-OH-D3, diverse clinical signs (such as, anorexia, marked loss of body weight, bloody diarrhea, bilateral conjunctivitis, and death), hypercalcemia, hypozincaemia, hypercupremia, hypoferraemia and an alteration in the tissue distribution of Ca, Zn, Cu and Fe as compared with untreated controls. Hypercalcemia and inflammation are prominent findings in hypervitaminosis D. Inflammation or infection induce systemic changes, collectively known as the acute phase response. Among the varied alterations that together produce this response are hypoferraemia, hypozincaemia and hypercupremia. It is likely that these responses are mediated, in part, by production and release of cytokines such as interleukin 1, interferons (IFN-alpha), interleukin 6 (11-6) and tumor necrosis factor (TNF). The development of hypoferraemia during inflammation requires hepcidin, an iron regulatory hormone, a disulfide-rich peptide, produced in the liver in response to the release of I1-6 during inflammation/infection. In conclusion, our results provide evidence that short-term administration of high doses of vitamin D determined diverse clinical signs and produced a marked increase of serum vitamin D3 and 25-OH-D3 and a marked alteration in the serum and tissue concentrations of Ca, Zn, Cu, and Fe. These changes depend on the doses given of vitamin D.

Analysis of photorefractive optical damage in lithium niobate: application to planar waveguides.

Photorefractive optical damage of single beams in LiNbO(3) crystals is analyzed within a framework of two photoactive centres (Fe(2+)/Fe(3+) and Nb(Li) (4+)/Nb(Li) (5+)). It compares model simulations and significant experimental measurements in LiNbO(3) waveguides. A good agreement is found in the performed comparisons: photovoltaic currents, refractive index changes and, especially relevant, in degraded beam-profiles. The progress of the degraded wavefront has been simulated by implementing a finite-difference beam-propagating method which includes the model equations. These results, together with previous ones on grating recording, provide a comprehensive, satisfactory explanation of most important questions on photorefractive optical damage.

Correlation between photorefractive index changes and optical damage thresholds in z-cut proton-exchanged-LiNbO(3) waveguides.

An interferometric Mach-Zehnder technique very recently developed has been applied to measure photorefractive index changes in different types of z-cut proton-exchanged planar waveguides in LiNbO(3). These measurements are complemented by determining the intensitythreshold for the onset of optical damage with a standard single-beam setup. In the intensity region just below the threshold-intensity obtained in the single-beam experiment the refractive index change is found to saturate at values around1x10(-4). Furthermore, we measure the dark conductivities of proton-exchanged waveguides by monitoring the decay of the light-induced index changes. Via the time constant of the decay we obtain dark conductivities of the order of about 5x10(-16) Omega (-1) cm (-1), that are negligible compared with the photoconductivity within the light intensity range used. The results of the measurements compare well with the predictions of a recent work, that uses a two-center model to explain the optical damage.

Prospective evaluation of aminopeptidase activities in plasma and peripheral organs of streptozotocin-induced diabetic rats.

The cleavage of peptides by aminopeptidase enzyme types could be among the mechanisms related to certain disruptions on mediator and modulatory functions in diabetes mellitus. In order to examine this hypothesis, we measured representative aminopeptidase activities in tissues of peripheral organs of control and streptozotocin-diabetic rats. None of the examined aminopeptidase activities differed between diabetics and controls in plasma, ileum, stomach or lung. Soluble and membrane-associated alanyl, and membrane-associated cystyl aminopeptidase activities were higher in the kidney of diabetics. Decreased activity was observed in soluble and membrane-associated aspartyl and soluble dipeptidyl-peptidase IV, while increased activity was observed in soluble alanyl, arginyl, and cystyl aminopeptidases in the pancreas of diabetics. In the jejunum, soluble cystyl aminopeptidase increased in diabetics. Soluble arginyl and type-1-pyroglutamyl aminopeptidase and membrane-associated dipeptidyl-peptidase IV activities increased in the liver of diabetics. Membrane-associated dipeptidyl-peptidase IV and alanyl aminopeptidase activities in the spleen were higher in diabetics than in controls. Membrane-associated alanyl aminopeptidase activity also increased in the heart of diabetics. All these changes in streptozotocin-treated rats were avoided by the administration of insulin. Our comparative analysis of a diverse array of aminopeptidase activities supported the proposal that the regulation of peptide cleavage by these enzyme types is associated with the effects of streptozotocin-diabetes mellitus on peripheral organs.

Understanding light intensity thresholds for catastrophic optical damage in LiNbO3.

The appearance of light intensity thresholds for catastrophic optical damage in LiNbO3 is satisfactorily explained by using a photorefractive model based on the Fe(2+)?Fe(3+) and NbLi(4+)?NbLi(5+) defect pairs. Model simulations of the photorefractive amplification gain as a function of the light intensity present sharp threshold behavior. A similar behavior is shown by the saturating refractive index change. In agreement with experiments, predicted thresholds appear shifted towards higher intensities (up to a 10(4) factor) when the Nb(Li) concentration is decreased or the temperature is increased. The model also explains very recent data on the threshold enhancement with the Fe(2+)/Fe(3+) ratio in optical waveguides.

Polimorfismos del transportador de serotonina y efecto de fluoxetina sobre la impulsividad y agresividad en el trastorno límite de personalidad / Serotonin transporter polymorphism and fluoxetine effect on impulsiveness and aggression in borderline personality disorder

Introducción. La impulsividad y agresividad son características del trastorno límite de personalidad y están asociadas a una disfunción del sistema serotoninérgico. Polimorfismos del transportador de serotonina han sido vinculados a las conductas agresivas e impulsivas. En depresión el alelo corto (S) se asocia a peor respuesta a los inhibidores selectivos de la recaptación de serotonina (ISRS). El objetivo de este trabajo es estudiar estos polimorfismos para predecir la respuesta de las conductas agresivas e impulsivas a los ISRS en el trastorno límite de personalidad. Método. Cincuenta y nueve pacientes con trastorno límite de personalidad del DSM-IV de acuerdo al International Personality Disorder Examination (IPDE) y sin patología del eje I fueron tratados con fluoxetina en dosis flexibles durante 12 semanas. Los pacientes fueron evaluados mediante la Overt Aggression Scale Modified (OAS-M) al inicio y a las 2, 4, 8 y 12 semanas de tratamiento. Se determinó los polimorfismos L y S de la región promotora del transportador de serotonina. Se comparó la respuesta a fluoxetina de los portadores de LL frente a los portadores de S (LS + SS). Resultados. Los portadores de LL tuvieron mejor respuesta que los portadores de S en reducir las puntuaciones del OAS-M total y en los componentes agresividad e irritabilidad del OAS-M. Conclusiones. Los portadores del alelo L responden mejor a fluoxetina que los portadores de S, de modo similar que en depresión. El alelo S puede representar un factor común de mala respuesta a los ISRS en las patologías asociadas a disfunción del sistema serotoninérgico

Introduction. Impulsiveness and aggressiveness are characteristics of borderline personality disorder and are associated to a serotoninergic system dysfunction. Serotonin transporter polymorphisms have been linked to aggressive and impulsive behaviors. The short allele (S) in depression is associated to a worse response to selective serotonin reuptake inhibitors (SSRI). This study aims to study these polymorphisms to predict the response of aggressive and impulsive behaviors to SSRIs in borderline personality disorder. Method. Fifty-nine patients with DSM-IV borderline personality disorder in accordance with the International Personality Disorder Examination (IPDE) and without axis 1 disease were treated with flexible doses of fluoxetine for 12 weeks. The patients were evaluated with the Overt Aggression Scale Modified (OAS-M) at the beginning and at 2, 4, 8 and 12 weeks of treatment. Polymorphisms L and S of the serotonin transporter promoter region were determined. Response to fluoxetine of the LL carriers versus the S carriers (LS+SS) was compared. Results. LL carriers had a better response than S carriers in the reduction of total OAS-M scores and on the aggressiveness and irritability components of the OAS-M. Conclusions. L-allele carriers responded better to fluoxetine than S carriers, in a similar way as in depression. The S allele may represent a common factor of bad response to SSRI in diseases associated to serotoninergic system dysfunction

Serotonin transporter polymorphism and fluoxetine effect on impulsiveness and aggression in borderline personality disorder.

INTRODUCTION: Impulsiveness and aggressiveness are characteristics of borderline personality disorder and are associated to a serotoninergic system dysfunction. Serotonin transporter polymorphisms have been linked to aggressive and impulsive behaviors. The short allele (S) in depression is associated to a worse response to selective serotonin reuptake inhibitors (SSRI). This study aims to study these polymorphisms to predict the response of aggressive and impulsive behaviors to SSRIs in borderline personality disorder. METHOD: Fifty-nine patients with DSM-IV borderline personality disorder in accordance with the International Personality Disorder Examination (IPDE) and without axis 1 disease were treated with flexible doses of fluoxetine for 12 weeks. The patients were evaluated with the Overt Aggression Scale Modified (OAS-M) at the beginning and at 2, 4, 8 and 12 weeks of treatment. Polymorphisms L and S of the serotonin transporter promoter region were determined. Response to fluoxetine of the LL carriers versus the S carriers (LS+SS) was compared. RESULTS: LL carriers had a better response than S carriers in the reduction of total OAS-M scores and on the aggressiveness and irritability components of the OAS-M. CONCLUSIONS: L-allele carriers responded better to fluoxetine than S carriers, in a similar way as in depression. The S allele may represent a common factor of bad response to SSRI in diseases associated to serotoninergic system dysfunction.

Optimal designs for radiation retention with poisson correlated response.

In this paper we describe a non-linear model with correlated observations which accounts for the elimination rate of radiation in the lung of individuals who have been exposed to an accidental intake at some time. The response is then modelled as a conditional Poisson distribution. When the leak is moderate or the size of the particles is large a theoretical justification of this assumption is given and D-optimal designs are computed.

Identificación de una variante genética de triptófano hidroxilasa 2 en población chilena / Identification of a genetic variant of tryptophan hydroxylase 2 in the Chilenan population

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Molecular epidemiology of human rotaviruses in Santiago, Chile.

BACKGROUND: Protective immunity against rotavirus infection is directed against antigenic epitopes on the outer capsid proteins VP7 and VP4. Our aim was to characterize the epidemiology of rotavirus antigenic types over time in Santiago, Chile. METHODS: We prospectively obtained 2097 stool samples for rotavirus testing, VP7 (G1 to G4) and VP4 (P4, P6, P8, P9) typing from children with diarrhea evaluated in emergency rooms of 5 base hospitals of Santiago. In addition 256 rotavirus-positive samples collected between 1985 and 1987 in the north health care area of Santiago were studied. RESULTS: Of 995 rotavirus-positive samples obtained 825 (82%) were typable for 1 or more VP7 types. G1 represented 81% of the G-typed samples during 1993 through 1995 and 77% during 1985 through 1987, predominating in all health care areas. G2 was next most common in all 5 areas, representing 6 to 23% of typed samples, with 1 area, the Southeast concentrating a significantly higher number of G2 infections. G2 declined from 35% of rotavirus-positive samples in 1993 to 0% in 1995 (P < 0.001), and from 25% to 2% in the north health care area from 1985 to 1987 (P < 0.001). G4 was uncommon and significantly more prevalent in 1985 through 1987 than in 1993 through 1995 (7% vs. 3%, P = 0.015). G3 was not detected. G1P8 (53%) and G2P4 (16%) combinations were by far the most commonly detected G-P associations. CONCLUSIONS: In Santiago, Chile, rotavirus antigenic type G1P8 has been highly prevalent and G2P4 has circulated in cycles. Differences in epidemiology of rotavirus antigenic types worldwide may prove to be relevant in efficacy of rotavirus vaccines.

Evaluating current methods for determination of the susceptibility of mycobacteria to pyrazinamide, conventional, radiometric Bactec and two methods of pyrazinamidase testing.

The authors compared conventional and Bactec determinations of pyrazinamide susceptibility with pyrazinamidase activity determined using either standard Dubos Oleic agar or Middlebrooks 7H9 agar. Of the 26 Mycobacterium tuberculosis tested, Bactec found 16 strains susceptible and 10 resistant, conventional methods found six susceptible and 20 resistant. Dubos identified 13 and Middlebrooks 10 strains as producing pyrazinamidase (susceptible). Of the 11 strains susceptible in Bactec and resistant by conventional methods, eight produced pyrazinamidase. All mycobacteria other than tuberculosis (6) and Mycobacterium bovis (2) were resistant by all methods. Bactec results gave a better correlation with pyrazinamidase results than conventional tests.

[Antigenic types of circulating rotavirus in children with acute diarrhea in Santiago de Chile]. / Tipos antigénicos de rotavirus circulantes en niños con diarrea aguda en Santiago de Chile.

Protective immunity against rotavirus infection is directed against antigenic epitopes on the outer capsid proteins VP7 and VP4. The aim of this study was to characterize the VP7 and VP4 antigenic types circulating in different hospital areas of Santiago, Chile, over different time periods. Between April 1993 and April 1994 a total of 1206 stool samples were obtained from children consulting for acute no bloody diarrhea in 5 hospitals representative of the 5 major health areas of Santiago. In addition, 256 rotavirus positive samples, obtained from children with acute diarrhea consulting in the north health area of Santiago between 1985-1987 were studied. All samples were processed for rotavirus by an ELISA and all rotavirus positive samples were VP7 typed (types G1-G4) by a monoclonal antibody based ELISA. 50 rotavirus positive samples were selected for VP4 typing by PCR (types P1-P4). A total of 782 rotavirus positive samples were obtained of which 618 (79%) were typable for one specific VP7 type. VP7 type G1 represented 63% of the rotavirus positive samples and predominated in all areas evaluated throughout the entire period of observation. VP7 type G2 represented 13% of rotavirus samples, following G1 in predominance. G2 types decreased progressively in all areas in both study periods. G4 types were detected mainly during 1985-1987, and G3 types have so far not been detected. Preliminary analysis of VP4 types suggests that P1 types are predominant and closely associated with VP7 G1 type. These results are relevant for the adoption of appropriate preventive strategies for rotavirus infection, specifically aimed to the development of effective vaccines.

Capacitación de monitores en contaminación fecal en una localidad rural / Monitors training on faecal contamination in rural locality

Se presenta el programa de extensión contaminación fecal y saneamiento ambiental en el medio rural, que lleva a cabo la unidad docente asociada de parasitología de la Universidad. En este programa se evalúan las condiciones sanitarias de la localidad y se insta a sus habitantes a participar activamente en la solución de sus problemas de saneamiento ambiental. Posteriormente se capacita a los profesores y personal de salud de la comuna, quienes actúan como monitores que mantienen la acción educativa y promueven proyectos locales de saneamiento ambiental. En 1991 se integra al programa la localidad de Sagrada Familia de la Vll Región de Chile, en donde se desarrolla un curso-taller para profesores y personal de salud, en el que se capacitan 36 monitores en 21 horas lectivas. Es organizado y realizado por un equipo multidisciplinario de estudiantes de la Universidad con el apoyo de docentes y del municipio local. Los contenidos son analizados con apoyo de material escrito, audiovisual y técnicas de educación participativa