SADI-S with Extended Duodeno-Bulb Preservation: Case Report

Obesity has been growing in Brazil and in the world. It is reaching epidemic proportions, and bariatric surgery is the most effective treatment for patients with this disease. Among the procedures described in the literature, ileal surgeries such as biliopancreatic diversion with duodenal switch (BPD-DS) and single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) present better long-term results in terms of weight loss and comorbidities control. However, there are concerns regarding long term nutritional problems with these procedures. In this case report the aim is to demonstrate the technical feasibility of preserving an extended duodenal bulb segment, in the SADIS-S procedure, when there are difficulties in dissecting the retrobulbar region, as occurred here, due to fibrosis in this area. This assures the maintenance of the proposed surgical technique, in such a situation. The dissection and transection of the duodenum was done 7 cm distally to the pylorus, under endoscopic view, proximally to the papillae, where the tissue was normal. Additionally, due the importance of the duodenal mucosa on minerals and trace elements absorption and the release of important hormones in this region, this case report elicits the evaluation of the impact of this technical modification, which occurred casually, in the nutritional, hormonal and metabolic results, long term. In this case report, the extended duodenal length has demonstrated reasonable weight loss, adequate comorbidities control and good nutritional status, so far. These aspects must be evaluated in the long term, by clinical trials.info:eu-repo/semantics/publishedVersio

Sleeve Gastrectomy Associated with Antral Lesion Resection and Roux-en-Y Antrojejunal Reconstruction

Obesity has been growing worldwide, reaching epidemic proportions. Bariatric surgery is the most effective and durable treatment for severe obesity and related diseases. Roux-en-Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG) are the most frequently performed bariatric operations, with long-term good results, in terms of weight loss and comorbidities control. Gastroesophageal Reflux Disease (GERD) is commonly associated with obesity. In general, it precludes the indication of sleeve gastrectomy, since this technique has a refluxogenic potential, as shown in many studies. In such cases, RYGB is considered the best surgery, reaching good weight loss and gastroesophageal reflux disease control. The drawback of this technique is that it leaves the remnant stomach, the duodenum, and the proximal part of the jejunum inaccessible. Besides, RYGB makes transoral endoscopic access to the biliary tree impossible. For all these reasons, this bariatric technique is not indicated in cases of gastric polyposis, gastric dysplasia, or strong family history of cancer, among others. We report a case of a morbidly obese patient with intense GERD, for whom a RYGB was precluded due to her strong family history of cancer, even knowing that it would be the best choice for reflux disease control. Instead, SG was chosen, even knowing it could worsen the gastroesophageal reflux disease. The patient signed an informed consent, after being fully enlightened about the risks. During the surgery, a small subserosal whitish lesion was detected, near the pylorus, on the anterior wall of the antrum. Thinking in a Gastrointestinal Stromal Tumor (GIST), it was resected, with a 2 cm safety margin, leaving a 4 to 5 cm hole on the gastric wall. The decision to maintain the proposed sleeve gastrectomy was made, to avoid leaving a remnant stomach, in a patient with such a strong family history of cancer. In the area of the resected lesion, an intraoperative decision was made not to just close the big gastric hole, being afraid of causing some anatomic or functional disturbance in gastric emptying. Instead, we decided to use the gastric opening to construct a Roux-en-Y antrotrojejunal anastomosis, with a 50 cm alimentary limb and a 200 cm biliopancreatic limb. Accordingly, it was performed a sleeve gastrectomy, associated with an antrojejunostomy in a Roux-en-Y fashion. The patient had an uneventful postoperative course. In the second year, she achieved normal weight and good nutritional status, without gastroesophageal reflux symptoms complaints. Seriography study shows that most of the contrast material passes through the antrojejunal anastomosis, instead of the pylorus, while the duodenum is endoscopically patent. This case report shows an unexpected surgical finding that led to a tactic of adding a Roux-en-Y gastric bypass in the antrum, associated with a sleeve gastrectomy, a strategy that may be adopted in cases of morbidly obese patients with important GERD, for whom gastrointestinal exclusions are contraindicated. To confirm this hypothesis, controlled studies are needed.info:eu-repo/semantics/publishedVersio

Analysis of student´s proficiency evaluation model for adaptative testing / Analysis of student's proficiency evaluation model for adaptive testing

A evolução da Internet e sua adoção transformou e continua transformando cada vez mais o contexto humano e, a educação, também está inserida nessa situação. Devido a isso, há ferramentas de apoio ao estudante, como sistemas avaliativos online. Apresentaremos nesse trabalho os resultados da simulação de uma avaliação online feita por um aluno com dada proficiência, a fim de coletar todos os dados a respeito do desempenho deste aluno – sua nota final – utilizando a teoria de Resposta ao Item em duas abordagens para cômputo da nota final. Uma primeira abordagem usando a questão subsequente a uma respondida de um nível de dificuldade superior ou inferior dependendo do acerto da questão anterior. E uma segunda usando a questão subsequente a uma respondida de um nível de dificuldade entre a anterior e a do limite máximo ou mínimo dependendo do acerto da questão anterior. Foram analisados resultados de simulação para diferentes tamanhos de provas e para diferentes proficiências dos respondentes simulados. Após análise multivariada de clusterização dos resultados por K-means, verifica-se que ambas as abordagens são subótimas para situações diferentes de tamanhos de prova na busca da nota final mais próxima da proficiência simulada

Observation of pseudogap behavior in a strongly interacting Fermi gas

Ultracold atomic Fermi gases present an opportunity to study strongly interacting Fermi systems in a controlled and uncomplicated setting. The ability to tune attractive interactions has led to the discovery of superfluidity in these systems with an extremely high transition temperature, near T/T_F = 0.2. This superfluidity is the electrically neutral analog of superconductivity; however, superfluidity in atomic Fermi gases occurs in the limit of strong interactions and defies a conventional BCS description. For these strong interactions, it is predicted that the onset of pairing and superfluidity can occur at different temperatures. This gives rise to a pseudogap region where, for a range of temperatures, the system retains some of the characteristics of the superfluid phase, such as a BCS-like dispersion and a partially gapped density of states, but does not exhibit superfluidity. By making two independent measurements: the direct observation of pair condensation in momentum space and a measurement of the single-particle spectral function using an analog to photoemission spectroscopy, we directly probe the pseudogap phase. Our measurements reveal a BCS-like dispersion with back-bending near the Fermi wave vector k_F that persists well above the transition temperature for pair condensation

Maintaining a Linked Data Cloud and Data Service for Second World War History

One of the great promises of Linked Data is to provide a shared data infrastructure into which new data can be imported and aligned with, forming a sustainable, ever growing Linked Data Cloud (LDC). This paper studies and evaluates this idea in the context of the WarSampo LDC that provides a data infrastructure for Second World War related ontologies and data in Finland, including several mutually linked graphs, totaling ca 12 million triples. Two data integration case studies are presented, where the original WarSampo LDC and the related semantic portal were first extended by a dataset of hundreds of war cemeteries and thousands of photographs of them, and then by another dataset of over 4450 Finnish prisoners of war. As a conclusion, lessons learned are explicated, based on hands-on experience in maintaining the WarSampo LDC in a production environment.Peer reviewe

Perspectives on the Trypanosoma cruzi-host cell receptor interaction

Chagas disease is caused by the parasite Trypanosoma cruzi. The critical initial event is the interaction of the trypomastigote form of the parasite with host receptors. This review highlights recent observations concerning these interactions. Some of the key receptors considered are those for thromboxane, bradykinin, and for the nerve growth factor TrKA. Other important receptors such as galectin-3, thrombospondin, and laminin are also discussed. Investigation into the molecular biology and cell biology of host receptors for T. cruzi may provide novel therapeutic targets