Bile Leak following Laparoscopic Cholecystectomy due to Perforated Duodenal Ulcer in Patient with Roux-en-Y Gastric Bypass

Background and Aims. Screening for gastric diseases in symptomatic outpatients with conventional esophagogastroduodenoscopy (C-EGD) is expensive and has poor compliance. We aimed to explore the efficiency and safety of magnetic-controlled capsule gastroscopy (MCCG) in symptomatic outpatients who refused C-EGD. Methods. We performed a retrospective study of 76794 consecutive symptomatic outpatients from January 2014 to October 2019. A total of 2318 adults () in the MCCG group who refused C-EGD were matched with adults in the C-EGD group using propensity-score matching (PSM). The detection rates of abnormalities were analyzed to explore the application of MCCG in symptomatic patients. Results. Our study demonstrated a prevalence of gastric ulcers (GUs) in patients with functional dyspepsia- (FD-) like symptoms of 8.14%. The detection rate of esophagitis and Barrett’s esophagus was higher in patients with typical gastroesophageal reflux disease (GERD) symptoms than in patients in the other four groups (). The detection rates of gastric ulcers in the five groups (abdominal pain, bloating, heartburn, follow-up, and bleeding) were significantly different (). The total detection rate of gastric ulcers in symptomatic patients was 9.7%. A total of 7 advanced carcinomas were detected by MCCG and confirmed by endoscopic or surgical biopsy. The advanced gastric cancer detection rate was not significantly different between the MCCG group and the C-EGD matched group in terms of nonhematemesis GI bleeding (2 vs. 2, ). In addition, the overall focal lesion detection rate in the MCCG group was superior to that in the C-EGD matched group (224 vs. 184, ). MCCG gained a clinically meaningful small bowel diagnostic yield of 54.8% (17/31) out of 31 cases of suspected small bowel bleeding. No patient reported capsule retention at the two-week follow-up. Conclusion. MCCG is well tolerated, safe, and technically feasible and has a considerable diagnostic yield. The overall gastric diagnostic yield of gastric focal lesions with MCCG was comparable to that with C-EGD. MCCG offered a supplementary diagnosis in patients who had a previously undiagnostic C-EGD, indicating that MCCG could play an important role in the routine monitoring and follow-up of outpatient. MCCG shows its safety and efficiency in symptomatic outpatient applications

Dinâmicas de identificação na trajetória profissional em transição

Tese (doutorado)—Universidade de Brasília, Instituto de Psicologia, Programa de Pós-graduação em Processos de Desenvolvimento Humano e Saúde, 2018.Esta pesquisa teve como objetivo analisar as dinâmicas de identificação na trajetória profissional em transição de três profissionais de uma instituição pública brasileira. Em perspectiva culturalista, a Psicologia do Desenvolvimento está interessada em momentos de crise e de ruptura. Os participantes são de diferentes faixas etárias, possuem entre 5 a 10 anos de trabalho, e que participaram de cursos de formação continuada em serviço. Optamos pelo uso de multimétodos em estudo longitudinal, havendo aproximação de campo com a Teoria Fundamentada (TF). O estudo ocorreu em três Etapas, a primeira fase de coleta foi realizada durante o mestrado, e a segunda e terceira fases foram realizadas no segundo e quarto ano de doutorado. Os multimétodos possibilitaram a triangulação produzida na sequência de entrevistas individuais, com narrativa aberta seguida por entrevista episódica mediada por objetos e/ou imagens. Finalizamos a coleta de cada Etapa com a escrita de cartas o que possibilitou a expressão de interpretação pessoal e o deslocamento de posicionamentos pelos participantes. Utilizamos a análise dialógica temática e análise pragmática do discurso. Os resultados indicaram que nas trajetórias profissionais dos participantes haviam pontos de mudança materializados por crises e rupturas que produziram reflexividade e transformações na atuação profissional. As mudanças geraram momentos de instabilidade nas trajetórias profissionais provocando processos dinamogênicos em ambivalências, produzindo novas agencialidades. Na dinâmica do posicionamento, as ações foram energizadas por emoções e se qualificaram, atualizando nas três Etapas de coleta os sentidos do fazer profissional. Na Etapa 1, a instituição passara por mudanças em sua educação corporativa com a introdução de novas ferramentas nos cursos na UC. A inovação provocou impacto nesses profissionais produzindo tensão, a qual foi direcionada para mobilização do participante em atuar profissionalmente, filiando o aspecto pessoal ao profissional (profissional-pessoal). Na Etapa 2, identificamos ênfase no buscar conhecimento para desempenhar atividades cotidianas, atuando em nível profissional com orientações pessoais, visando equilíbrio pessoal-profissional. Na Etapa 3, as tomadas de decisão sobre produção de conhecimento e ascensão na carreira atuam na regulação das experiências pessoais, filiando o profissional ao pessoal (pessoal-profissional). Concluímos que as dinâmicas de identificação foram tecidas na produção de significados em interações e reflexividades no presente, energizando ações orientadas por sentidos que atualizam os significados sobre práticas pessoais em formação continuada em serviço em dinâmicas de irisação identitária, no jogo de aproximação e distanciamento em intersubjetividades.This research aims at analyzing the dynamics of identification in the professional trajectory in transition of three professionals of a Brazilian public institution. From a cultural perspective, Developmental Psychology is interested in times of crisis and rupture. The participants are of different age groups, with 5 to 10 years working experience, and have attended continuing education courses in their workplace. We opted for the use of multimethods in a longitudinal study, with field approximation with Grounded Theory (GT). The study took place in three stages, the first phase of data collection was carried out during the author's master's degree, and the second and third phases were carried out in the second and fourth year of her doctorate. The use of multimethods enabled the triangulation produced in the sequence of individual interviews, with open narrative followed by episodic interview mediated by objects and / or images. We finished the data collection of each stage with the writing of letters which enabled the expression of personal interpretation and the displacement of positions by the participants. We use thematic dialogic analysis and pragmatic discourse analysis. The results indicated that in the professional trajectories of the participants there were points of change materialized by crises and ruptures that produced reflexivity and changes in the professional performance. The changes generated moments of instability in the professional trajectories provoking dynamogenic processes in ambivalences, producing new agencies. In the dynamics of the positioning, the actions were energized by emotions and qualified, updating in the three stages of data collection the senses of professional doing. In stage 1, the institution had undergone changes in its corporate education with the introduction of new tools in the courses at the CU. Innovation has had an impact on these professionals producing tension, which was directed to the mobilization of the participant in acting professionally, linking the personal aspects to the professional (professional-personal). In step 2, we identified an emphasis on seeking knowledge to perform daily activities, acting on a professional level with personal orientations, aiming at personal-professional balance. In step 3, decision making on knowledge production and career advancement regulate personal experiences, linking the professional to the personal (professional-personal). We conclude that the dynamics of identification were woven into the production of meanings in interactions and reflexivities in the present, energizing actions oriented by senses that update the meanings about personal practices in continued formation in service in dynamics of identity irisation, in the game of approximation and distance in intersubjectivities

Comparativo de orçamentos de uma obra pública modelada em bim através dos bancos de dados deinfra e sinapi

TCC (graduação) - Universidade Federal de Santa Catarina. Centro Tecnológico. Engenharia Civil.Dentro do processo licitatório de obras públicas, a orçamentação é uma etapa de suma importância, tanto para as empresas participantes quanto para o órgão fiscalizador. A qualidade tanto dos projetos quanto do banco de dados de serviços utilizado pode comprometer a precisão do orçamento. Assim, essa pesquisa tem como objetivo principal a adequação do orçamento, feito a partir da tabela de referência DEINFRA, de uma obra pública modelada em BIM, o Centro de Referência de Assistência Social (CRAS), para o banco de dados SINAPI. A metodologia utilizada envolveu análise documental tanto dos projetos e memoriais descritivos da obra escolhida quanto das tabelas DEINFRA e SINAPI para realizar a conversão dos serviços do orçamento do CRAS, além do levantamento de quantitativos a partir do modelo BIM. Após finalizada a etapa de conversão também foi traçada a curva ABC para ambos orçamentos. Os resultados obtidos foram o orçamento convertido, que apresentou um aumento no custo total em relação ao orçamento básico de 8,5%, as curvas ABC e uma classificação dos problemas encontrados durante o processo de conversão. A partir da análise desses resultados foi possível determinar algumas das causas de variações tanto dos orçamentos quanto das curvas, que são a característica genérica e pouco específica das composições DEINFRA e o alto grau de especificação apresentado pelos serviços SINAPI.Within the public works bidding process, budgeting is a very important step for both the participating companies and the supervisory body. The quality of both projects and the service database used may compromise budget accuracy. Thus, this research has as its main objective in the adequacy of the budget, made from the DEINFRA (State Department of Infrastructure) reference table, of a public work modeled in BIM, the Reference Center for Social Assistance (CRAS), for the SINAPI database. The methodology used involves analysis of both projects and descriptive memorials of the chosen work as well as the tables DEINFRA and SINAPI (National Budgeting System for Bidding Process) to perform the conversion of the budget services of CRAS, as well as the quantitative extracted from the BIM model. After the conversion step was completed, the ABC analysis was also made for both budgets. The results obtained were the converted budget, which showed an increase in the total cost in comparison with the basic budget of 8,5%, a classification of the problems encountered during the conversion process and the ABC analysis. From the analysis of these results it was possible to determine some of the causes of variations in both budgets and curves, which are the generic and unspecific characteristic of DEINFRA compositions and the high degree of specification presented by SINAPI services

Posicionamentos em formação profissional continuada: um estudo multimétodo longitudinal

This article presents a longitudinal case study aimed at analyzing the production of meanings in positions of a professional in service continued education. Qualitative multi methods were applied in 3 annual sets with 3 interviews ”“ open, mediated by object or image and episodic, and the writing of letters. Data were submitted to dialogic-thematic. Results indicated she organized herself, studied and applied knowledge, acting as part of a team with dedication and responsibility and oriented towards the future. Interpretations of herself, the other and situations were actualized in qualified contextualized dynamogenic actions.El estudio de caso longitudinal tuvo como objetivo analizar la producción de significados de una profesional en formación continuada en el trabajo. Multimétodos cualitativos fueron aplicados en tres bloques anuales con entrevista abierta, mediada por objeto o imagen y episódica, y escritura de cartas. Los datos fueran sometidos a análisis dialógico-temático y pragmático discursivo. Los resultados indicaron que se organiza, estudia y aplica conocimientos, actuando en equipo con dedicación y responsabilidad, con la orientación direccionada hacia el futuro. Las interpretaciones de sí, del otro y de situaciones se actualizaron en acciones cualificadas y contextualizadas dinamogénicas.Este estudo de caso longitudinal teve por objetivo analisar a produção de significados em posicionamentos de profissional em formação continuada em serviço. Utilizou-se multimétodos qualitativos aplicados em 3 blocos anuais com entrevista aberta, mediada por objeto ou imagem e episódica, e escrita de cartas, submetidos às análises dialógico-temática. Os resultados indicaram que o participante se organiza, estuda e aplica conhecimentos, atuando em equipe, com dedicação e responsabilidade, direcionada para o futuro. As interpretações de si, do outro e das situações são atualizadas em ações dinamogênicas qualificadas contextualizadas

Protoporphyrin IX Fluorescence Photobleaching Increases with the Use of Fractionated Irradiation in the Esophagus

Fluorescence measurements have been used to track the dosimetry of photodynamic therapy (PDT) for many years, and this approach can be especially important for treatments with aminolevulinic-acid-induced protoporphyrin IX (ALA-PpIX). PpIX photobleaches rapidly, and the bleaching is known to be oxygen dependent, and at the same time, fractionation or reduced irradiance treatments have been shown to significantly increase efficacy. Thus, in vivo measurement of either the bleaching rate and/or the total bleaching yield could be used to track the deposited dose in tissue and determine the optimal treatment plans. Fluorescence in rat esophagus and human Barrett\u27s esophagus are measured during PDT in both continuous and fractionated light delivery treatment, and the bleaching is quantified. Reducing the optical irradiance from 50 to 25 mW/cm did not significantly alter photobleaching in rat esophagus, but fractionation of the light at 1-min on and off intervals did increase photobleaching up to 10% more (p value=0.02) and up to 25% more in the human Barrett\u27s tissue (p value\u3c0.001). While two different tissues and two different dosimetry systems are used, the data support the overall hypothesis that light fractionation in ALA-PpIX PDT esophageal treatments should have a beneficial effect on the total treatment effect

Cerebral Hemodynamic Influences in Task-Related Functional Magnetic Resonance Imaging and Near-Infrared Spectroscopy in Acute Sport-Related Concussion::A Review

One of the challenges of managing athletes with sport-related concussion (SRC) is guiding them to a safe return to play. A potential biomarker for use in the clinical assessment of recovery is the analysis of brain activation patterns during task-related functional Magnetic Resonance Imaging (fMRI). However, fMRI studies have provided conflicting results regarding what is pathological. An element that can contribute to this disagreement are hemodynamic impairments of the brain that follow a concussion. A functional neuroimaging technique based on the optical properties of brain tissue—called functional near-infrared spectroscopy (fNIRS)—can be used to evaluate SRC athletes, partially taking into consideration these brain hemodynamic impairments. However, so far, fNIRS has not been extensively used in concussion. In this critical review, there is a description of the main fMRI results involving the neocortex in acutely concussed patients, the influences of hemodynamic impairments on fMRI and fNIRS and the advantages and disadvantages of fNIRS to limit this influence

The value of KRAS mutation testing with CEA for the diagnosis of pancreatic mucinous cysts

BACKGROUND AND AIMS: Pancreatic cyst fluid (PCF) CEA has been shown to be the most accurate preoperative test for detection of cystic mucinous neoplasms (CMNs). This study aimed to assess the added value of PCF KRAS mutational analysis to CEA for diagnosis of CMNs. PATIENTS AND METHODS: This is a retrospective study of prospectively collected endoscopic ultrasonography (EUS) fine-needle aspiration (FNA) data. KRAS mutation was determined by direct sequencing or equivalent methods. Cysts were classified histologically (surgical cohort) or by clinical (EUS or FNA) findings (clinical cohort). Performance characteristics of KRAS, CEA and their combination for detection of a cystic mucinous neoplasm (CMN) and malignancy were calculated. RESULTS: The study cohort consisted of 943 patients: 147 in the surgical cohort and 796 in the clinical cohort. Overall, KRAS and CEA each had high specificity (100 % and 93.2 %), but low sensitivity (48.3 % and 56.3 %) for the diagnosis of a CMN. The positivity of KRAS or CEA increased the diagnostic accuracy (80.8 %) and AUC (0.84) significantly compared to KRAS (65.3 % and 0.74) or CEA (65.8 % and 0.74) alone, but only in the clinical cohort (P < 0.0001 for both). KRAS mutation was significantly more frequent in malignant CMNs compared to histologically confirmed non-malignant CMNs (73 % vs. 37 %, P = 0.001). The negative predictive value of KRAS mutation was 77.6 % in differentiating non-malignant cysts. CONCLUSIONS: The detection of a KRAS mutation in PCF is a highly specific test for mucinous cysts. It outperforms CEA for sensitivity in mucinous cyst diagnosis, but the data does not support its routine use

Post-intubation tracheal lacerations: Risk-stratification and treatment protocol according to morphological classification

BackgroundPost-intubation tracheal laceration (PITL) is a rare condition (0.005% of intubations). The treatment of choice has traditionally been surgical repair. Following our first report in 2010 of treatment protocol tailored to a risk-stratified morphological classification there is now clear evidence that conservative therapy represents the gold standard in the majority of patients. In this paper we aim to validate our risk-stratified treatment protocol through the largest ever reported series of patients. MethodsThis retrospective analysis is based on a prospectively collected series (2003-2020) of 62 patients with PITL, staged and treated according to our revised morphological classification. ResultsFifty-five patients with Level I (#8), II (#36) and IIIA (#11) PITL were successfully treated conservatively. Six patients with Level IIIB injury and 1 patient with Level IV underwent a surgical repair of the trachea. No mortality was reported. Bronchoscopy confirmed complete healing in all patients by day 30. Statistical analysis showed age only to be a risk factor for PITL severity. ConclusionsOur previously proposed risk-stratified morphological classification has been validated as the major tool for defining the type of treatment in PITL