Bariatric Revisionary Surgery for Failed or Complicated Vertical Banded Gastroplasty (VBG): Comparison of VBG Reoperation (re-VBG) versus Roux-en-Y Gastric Bypass-on-VBG (RYGB-on-VBG)

Background. Revision of failed bariatric procedures is a significant challenge for bariatric surgeons, because of the increasing number of recurring morbid obesity or complications, especially in patients with a previous Vertical Banded Gastroplasty (VBG). Methods. Since November 1998, 109 patients with failed or complicated VBG were followed in a retrospective study. 49 patients underwent re-VBG and, since 2004, 60 underwent Roux-en-Y Gastric Bypass-on-Vertical Banded Gastroplasty (RYGB-on-VBG). Results. At 3 years follow-up, mean BMI decreased from 37.4 to 31.2 Kg/m2 in the first group, and from 35.0 to 28.4 Kg/m2 in the second. Early complications were 7 (14.3%) in the first group and 4 (6.5%) in the second; late complications were 33 (59.1%) and 11 (18.3%), respectively. Conclusion. Although both operations seem to be effective as bariatric revision procedures in terms of BMI, the mid-term outcomes of RYGB-on-VBG demonstrate the lowest rate of complications and better quality of life

Serum Albumin Is Inversely Associated With Portal Vein Thrombosis in Cirrhosis

We analyzed whether serum albumin is independently associated with portal vein thrombosis (PVT) in liver cirrhosis (LC) and if a biologic plausibility exists. This study was divided into three parts. In part 1 (retrospective analysis), 753 consecutive patients with LC with ultrasound-detected PVT were retrospectively analyzed. In part 2, 112 patients with LC and 56 matched controls were entered in the cross-sectional study. In part 3, 5 patients with cirrhosis were entered in the in vivo study and 4 healthy subjects (HSs) were entered in the in vitro study to explore if albumin may affect platelet activation by modulating oxidative stress. In the 753 patients with LC, the prevalence of PVT was 16.7%; logistic analysis showed that only age (odds ratio [OR], 1.024; P = 0.012) and serum albumin (OR, -0.422; P = 0.0001) significantly predicted patients with PVT. Analyzing the 112 patients with LC and controls, soluble clusters of differentiation (CD)40-ligand (P = 0.0238), soluble Nox2-derived peptide (sNox2-dp; P < 0.0001), and urinary excretion of isoprostanes (P = 0.0078) were higher in patients with LC. In LC, albumin was correlated with sCD4OL (Spearman's rank correlation coefficient [r(s)], -0.33; P < 0.001), sNox2-dp (r(s), -0.57; P < 0.0001), and urinary excretion of isoprostanes (r(s), -0.48; P < 0.0001) levels. The in vivo study showed a progressive decrease in platelet aggregation, sNox2-dp, and urinary 8-iso prostaglandin F2 alpha-III formation 2 hours and 3 days after albumin infusion. Finally, platelet aggregation, sNox2-dp, and isoprostane formation significantly decreased in platelets from HSs incubated with scalar concentrations of albumin. Conclusion: Low serum albumin in LC is associated with PVT, suggesting that albumin could be a modulator of the hemostatic system through interference with mechanisms regulating platelet activation

Reasoning with Goal Models

Over the past decade, goal models have been used in Computer Science in order to represent software requirements, business objectives and design qualities. Such models extend traditional AI planning techniques for representing goals by allowing for partially defined and possibly inconsistent goals. This paper presents a formal framework for reasoning with such goal models. In particular, the paper proposes a qualitative and a numerical axiomatization for goal modeling primitives and introduces label propagation algorithms that are shown to be sound and complete with respect to their respective axiomatizations. In addition, the paper reports on preliminary experimental results on the label propagation algorithms applied to a goal model for a North America car manufacturer

Reasoning with Goal Models

Abstract. Over the past decade, goal models have been used in Computer Science in order to represent software requirements, business objectives and design qualities. Such models extend traditional AI planning techniques for representing goals by allowing for partially defined and possibly inconsistent goals. This paper presents a formal framework for reasoning with such goal models. In particular, the paper proposes a qualitative and a numerical axiomatization for goal modeling primitives and introduces label propagation algorithms that are shown to be sound and complete with respect to their respective axiomatizations. In addition, the paper reports on preliminary experimental results on the propagation algorithms applied to a goal model for a US car manufacturer.

Il Bypass Gastrico: evoluzione di una tecnica

Riportiamo l'evoluzione della nostra esperienza in chirurgia bariatrica con l'evoluzione da tecniche tradizionali di Bypass Gastrico su ansa alla Roux a nuove soluzioni per consentire lo studio endoscopico e radiologico dello stomaco esclus