Tube-in-tube endoscopic vacuum therapy for treatment of colorectal anastomotic leaks: A low-cost, patient-friendly, feasible and efficient technical modification of sponge-based endoscopic vacuum therapy.

BACKGROUND AND AIMS: Colorectal endoscopic vacuum therapy (CR EVT) is usually performed using sponges passed through the anus. It may be associated with patient discomfort and displacement of the aspiration tube. METHODS: With the tube-in-tube endoscopic vacuum therapy modification (CR TT-EVT), it is possible to position the aspiration tube in the pelvic cavity through the abdominal wall. In addition, it allows frequent cleaning of the fistula, eliminates the need for programmed device changes, and enables a standardized approach to such a wide variety of fistulas, leaks, and perforations. RESULTS: Here is a technical note on how to perform CR TT-EVT, while we are at the early phase of our case series we have reached 100% of technical success.

Cost-effective modified endoscopic vacuum therapy for the treatment of gastrointestinal transmural defects: step-by-step process of manufacturing and its advantages.

Video 1Cost-effective modified endoscopic vacuum therapy for GI transmural defects. Step-by-step process of manufacturing and potential advantages.1.Cut half gauze to the ideal size to cover only the fenestrated portion of the nasogastric tube (NGT).2.Wrap the gauze around the fenestrated portion of the NGT. The assistance of another person is important in this process.3.Cut the antimicrobial incise drape to match the size of the fenestrated portion of the NGT. Note that the incise drape is a very strong adhesive; therefore, 3 people are usually required to assemble it properly.4.Next, the suture is used to fix the gauze and drape to the NGT. Perform fixation of the modified sponge in 3 places. The first knot is in the proximal portion, just below the last fenestra of the NGT, as a marker of where the vacuum system starts. The second knot is at the distal end, to avoid migration of the modified sponge. The third knot is in the middle of the modified sponge, which is essential to serve as a guide during endoscopic placement. For example, in cases of defects without collection in which the sponge will be placed in an intraluminal position, it is ideal to place the vacuum system in the middle of the defect; in cases of intracavitary placement, it will work as a guide to how much of the modified sponge will be inside the collection.5.Finally, use a needle to make innumerable punctures in the modified sponge system to obtain adequate aspiration. An 18G needle is recommended because, in addition to having an adequate diameter, it is very sharp, which facilitates perforation of the modified sponge system.6.After creation of the modified endoscopic vacuum therapy, the functionality test is performed. Turn on the wall suction system, connect the distal end of the NGT to the tube of the canister connected on the wall, and place the NGT inside a bowl with a liquid solution. The aspiration of a large amount of liquid indicates proper functioning of the modified endoscopic vacuum therapy system.7.The device is then ready to be positioned endoscopically in the patient. After proper positioning, connect the NGT to the suction tube to avoid migration of the device upon removal of the scope.8.In addition to the cost-effective device as described, in our practice we also use wall suction to reduce costs associated with the use of the vacuum machine.9.Use the antimicrobial incise drape to seal the connection between the NGT and the suction tube to avoid leakage within the connection.10.Last, owing to instability of the negative wall pressure, a 20F intravenous catheter is connected to the tube to maintain a negative pressure between -75 and -150 mmHg, as confirmed by laboratory studies performed by our group.

Endoscopic vacuum therapy versus endoscopic stenting for upper gastrointestinal transmural defects: Systematic review and meta-analysis.

BACKGROUND: Upper gastrointestinal fistulas, leaks, and perforations represent a high cost burden to health systems worldwide, with high morbidity and mortality rates for affected patients. Management of these transmural defects remains therapeutically challenging. OBJECTIVES: The aim of this study is to perform a systematic review and meta-analysis to investigate the efficacy and safety of self-expanding metal stents (SEMS) versus endoscopic vacuum therapy (EVT) for treatment of upper gastrointestinal transmural defects. METHODS: Searches were performed on MEDLINE, EMBASE, Central Cochrane, Latin American and Caribbean Health (LILACS), and gray literature, as well as a manual search to identify studies comparing SEMS versus EVT to treat upper gastrointestinal transmural defects. Evaluated outcomes were: rates of successful closure, mortality, length of hospital stay, duration of treatment, and adverse events. RESULTS: Five studies with a total of 274 patients were included. There was a 21% increase in successful fistula closure attributed to EVT compared with the SEMS group (RD 0.21, CI 0.10-0.32; P = 0.0003). EVT demonstrated a 12% reduction in mortality compared to stenting (RD 0.12, CI 0.03-0.21; P = 0.006) and an average reduction of 14.22 days in duration of treatment (CI 8.38-20.07; P < 0.00001). There was a 24% reduction in adverse events (RD 0.24, CI 0.13-0.35; P = 0.0001. There were no statistical differences between the studied therapies regarding the length of hospital stay. CONCLUSION: Endoscopic vacuum therapy proves to be superior in successful defect closure, mortality, adverse events and duration of treatment.

Avaliação do vocabulário em crianças brasileiras: revisão sistemática de estudos com três instrumentos / Vocabulary assessment in Brazilian children: a systematic review with three instruments

RESUMO Objetivo: investigar, por meio de revisão sistemática, como três instrumentos de avaliação do vocabulário infantil (Teste de Linguagem Infantil ABFW, Expressive Vocabulary Test - EVT - e Peabody Picture Vocabulary Test - PPVT) têm sido utilizados nas pesquisas brasileiras, verificando seus propósitos de usos e os principais resultados encontrados. Estratégia de pesquisa: a revisão foi organizada em dois estudos. O Estudo 1 referiu-se ao procedimento de busca a priori, e o Estudo 2, ao procedimento de busca a posteriori. Foram consultadas três bases de dados nacionais (CAPES, SciELO e PePSIC). Critérios de seleção: para o Estudo 1, foram selecionados artigos empíricos contendo resultados de pesquisas em um dos testes de interesse, em amostra de crianças com desenvolvimento típico em idade escolar (7-10 anos). Para o Estudo 2, foi ampliada a busca para crianças em idade pré-escolar e com algum tipo de transtorno do desenvolvimento. Análise dos dados: os artigos selecionados foram lidos na íntegra e sintetizados em uma tabela contendo objetivo do estudo, faixa etária da amostra, instrumento, delineamento, principais resultados e periódico de publicação. Resultados: foram encontrados 24 estudos, a maioria na área da Fonoaudiologia. Os resultados indicam predominância de pesquisas transversais e observacionais, que buscaram traçar perfil cognitivo de crianças com algum transtorno do desenvolvimento, utilizando ou não grupos de controle. Nenhuma pesquisa tratou da investigação psicométrica dos instrumentos. Conclusão: mostra-se necessária a condução de pesquisas no Brasil que enfoquem na investigação psicométrica de instrumentos de avaliação do vocabulário em crianças pré-escolares e em idade escolar.

ABSTRACT Purpose: To investigate, through a systematic review, how three assessment instruments for children's vocabulary (Test of Childhood language ABFW, Expressive Vocabulary Test - EVT, and Peabody Picture Vocabulary Test - PPVT) have been used in Brazilian research, verifying its purposes of uses and the main results of the researches. Research strategy: This review was organized in three studies. Study 1 referred to the process of a priori search and Study 2 referred to the a posteriori search. We searched for three Brazilian's database (CAPES, SciELO, and PePSIC). Selection criteria: For Study 1, we selected empirical studies containing research data with one of the three-targeted tests, using typically developing school children (7 to 10 years old). For Study 2, we enlarged the age range for pre-school and extended the search to non-typically developing children. Data analysis: The selected articles were fully read and synthesized in a table containing the study's aims, the age range of the sample, instrument, research design, main results, and journal. Results: We found out 24 articles, most of which from the speech-language therapy area. The results indicated the predominance of cross-sectional and observational studies, aiming to delineate the cognitive profile of children with some developmental disturbance, with or without control groups. None of the researches conducted a psychometric inquiry of the instruments. Conclusion: In Brazil, it is necessary to carry out research focusing on the psychometric inquiry of instruments for evaluating the vocabulary in pre-school and school-age children.

Osmotic stress induces apoptosis in extravillous trophoblast cells. Role of TRPV-1.

In different tissues hyperosmolarity induces cell differentiation. Nevertheless an exacerbated hyperosmolar stress alters the normal cellular development. The transient receptor potential vanilloid 1 (TRPV-1) is a non-selective cation channel that is activated by hyperosmolarity and participates in many cellular processes. TPRV-1 is expressed in human placenta at term. Here, we evaluated the expression of TRPV-1 in first trimester extravillous trophoblast cells and its participation in the survival of these cells exposed to hyperosmolar stress. Our results showed that hyperosmolar stress up-regulates the expression of TRPV-1 and induces the apoptosis in Swan 71 cells. In addition, the inhibition of TRPV-1 abrogates the apoptotic events.