Complicações respiratórias pós-operatórias em cirurgia bariátrica: revisão da literatura

Obesidade é um problema de saúde pública mundial com altos índices de morbi-mortalidade. A cirurgia bariátrica tem sido o tratamento mais usado e desperta atenção para seu desenvolvimento e resultados. Porém, até o momento, não há revisão sobre a incidência de complicações respiratórias nesta população. O objetivo deste estudo foi revisar a literatura sobre as complicações respiratórias após cirurgias bariátricas convencionais com a utilização das bases de dados PubMed, Cochrane e Scielo buscando os termos: complicações, pulmonar, pós-operatório e cirurgia bariátrica. Os limites foram os últimos dez anos, adultos, inglês e espanhol. Encontramos 69 artigos e utilizamos 21. As complicações respiratórias mais observadas em cirurgia bariátrica são: embolia pulmonar, atelectasias e pneumonia, estando relacionadas à idade e à hipoventilação. A obesidade mórbida está associada a disfunções respiratórias, incluindo diminuição da resistência cardiorrespiratória e dispneia, sendo as alterações mais comuns: diminuição da ventilação e da complacência torácica, taquipneia e aumento do trabalho muscular respiratório, com altos índices de hipoxemia e fadiga respiratória. Nossos resultados mostram que embolia pulmonar, atelectasias e pneumonias são as complicações respiratórias mais incidentes em cirurgias bariátricas convencionais, sendo os idosos ou portadores de síndrome da hipoventilação e apneia obstrutiva do sono os que apresentam maior risco de desenvolvê-las.Obesity is a public health problem worldwide because of the high rates of morbimortality. Bariatric surgery has been the most often treatment and attracts attention on its development and results. However, there is no review about the incidence of respiratory complications in this population. The aim of this study was to review the literature on respiratory complications in conventional bariatric surgery utilizing the databases PubMed, Scielo and Cochrane. The terms searched were complications, pulmonary, postoperative care and bariatric surgery, and the limits, the last ten years, adults, English and Spanish. We found 69 articles, and used 21, showing that the most common respiratory complications in bariatric surgery are pulmonary embolism, atelectasis and pneumonia, being related to age and the presence of hypoventilation. Morbid obesity is associated with respiratory dysfunction, including decreased cardiorespiratory endurance and dyspnea, being the most common changes: the decrease in ventilation and chest wall compliance, and tachypnea and respiratory muscle workload, with high rates of hypoxemia and respiratory fatigue. Our results suggest that pulmonary embolism, atelectasis and pneumonia are the pulmonary complications with the highest incidences in conventional bariatric surgery, and elderly and patients with hypoventilation or syndrome and obstructive sleep apnea have higher risk of developing postoperative pulmonary complications

Is there just one dyslexic reader? Evidence for the existence of distinct dyslexic sub-groups.

Purpose of Review. It is generally agreed that there are individual differences in the severity of the reading deficit in dyslexia. The purpose of this review is to discuss whether recent research strengthens claims that there are also qualitative differences in the type of reading impairment that individual dyslexic children experience. Recent Findings. Recent research suggests that surface dyslexia exists in larger numbers than has previously been assumed and that different subtypes of surface dyslexia exist in English as well as in Hebrew. Bilinguals with surface dyslexia in English also show the hallmarks of surface dyslexia when reading a more transparent orthography. The developmental reading impairments that have been observed in children with phonological dyslexia and in children with letter position dyslexia can also be found in several different orthographies and are quite distinct from those seen in surface dyslexia. Summary. Surface dyslexia, phonological dyslexia and letter position dyslexia represent qualitatively different types of developmental reading impairments and can all be seen in both opaque and more transparent alphabetic orthographies

Sensor response and radiation damage effects for 3D pixels in the ATLAS IBL Detector

Abstract Pixel sensors in 3D technology equip the outer ends of the staves of the Insertable B Layer (IBL), the innermost layer of the ATLAS Pixel Detector, which was installed before the start of LHC Run 2 in 2015. 3D pixel sensors are expected to exhibit more tolerance to radiation damage and are the technology of choice for the innermost layer in the ATLAS tracker upgrade for the HL-LHC programme. While the LHC has delivered an integrated luminosity of  ≃ 235 fb-1 since the start of Run 2, the 3D sensors have received a non-ionising energy deposition corresponding to a fluence of ≃ 8.5 × 1014 1 MeV neutron-equivalent cm-2 averaged over the sensor area. This paper presents results of measurements of the 3D pixel sensors' response during Run 2 and the first two years of Run 3, with predictions of its evolution until the end of Run 3 in 2025. Data are compared with radiation damage simulations, based on detailed maps of the electric field in the Si substrate, at various fluence levels and bias voltage values. These results illustrate the potential of 3D technology for pixel applications in high-radiation environments.</jats:p

Sensor response and radiation damage effects for 3D pixels in the ATLAS IBL Detector

Abstract Pixel sensors in 3D technology equip the outer ends of the staves of the Insertable B Layer (IBL), the innermost layer of the ATLAS Pixel Detector, which was installed before the start of LHC Run 2 in 2015. 3D pixel sensors are expected to exhibit more tolerance to radiation damage and are the technology of choice for the innermost layer in the ATLAS tracker upgrade for the HL-LHC programme. While the LHC has delivered an integrated luminosity of  ≃ 235 fb-1 since the start of Run 2, the 3D sensors have received a non-ionising energy deposition corresponding to a fluence of ≃ 8.5 × 1014 1 MeV neutron-equivalent cm-2 averaged over the sensor area. This paper presents results of measurements of the 3D pixel sensors' response during Run 2 and the first two years of Run 3, with predictions of its evolution until the end of Run 3 in 2025. Data are compared with radiation damage simulations, based on detailed maps of the electric field in the Si substrate, at various fluence levels and bias voltage values. These results illustrate the potential of 3D technology for pixel applications in high-radiation environments.</jats:p