Fuzzy logic as a decision-making support system for the indication of bariatric surgery based on an index (OBESINDEX) generated by the association between body fat and body mass index

Background: A Fuzzy Obesity Index (OBESINDEX) for use as an alternative in bariatric surgery indication (BSI) is presented. The search for a more accurate method to evaluate obesity and to indicate a better treatment is important in the world health context. BMI (body mass index) is considered the main criteria for obesity treatment and BSI. Nevertheless, the fat excess related to the percentage of Body Fat (%BF) is actually the principal harmful factor in obesity disease that is usually neglected. This paper presents a new fuzzy mechanism for evaluating obesity by associating BMI with %BF that yields a fuzzy obesity index for obesity evaluation and treatment and allows building up a Fuzzy Decision Support System (FDSS) for BSI.

Methods: Seventy-two patients were evaluated for both BMI and %BF. These data are modified and treated as fuzzy sets. Afterwards, the BMI and %BF classes are aggregated yielding a new index (OBESINDEX) for input linguistic variable are considered the BMI and %BF, and as output linguistic variable is employed the OBESINDEX, an obesity classification with entirely new classes of obesity in the fuzzy context as well is used for BSI.

Results: There is a gradual, smooth obesity classification and BSI when using the proposed fuzzy obesity index when compared with other traditional methods for dealing with obesity.

Conclusion: The BMI is not adequate for surgical indication in all the conditions and fuzzy logic becomes an alternative for decision making in bariatric surgery indication based on the OBESINDEX

Fuzzy logic as a decision-making support system for the indication of bariatric surgery based on an index (MAFOI) generated by the association between body fat and body mass index.

Background: A fuzzy obesity index (MAFOI) for use as an alternative to bariatric surgery indication (BSI) is presented. The search for a more accurate method to evaluate obesity and to indicate a better treatment is important in the world health context. BMI (body mass index) is considered the main criteria for obesity treatment and BSI. Nevertheless, the fat excess related to the percentage of Body Fat (%BF) is actually the principal harmful factor in obesity disease that is usually neglected. This paper presents a new fuzzy mechanism for evaluating obesity by associating BMI with %BF that yields a fuzzy obesity index for obesity evaluation and treatment and allows building up a Fuzzy Decision Support System (FDSS) for BSI. Methods: Seventy-two patients were evaluated for both BMI and %BF. These data are modified and treated as fuzzy sets. Afterwards, the BMI and %BF classes are aggregated yielding a new index (MAFOI) for input linguistic variable are considered the BMI and %BF, and as output linguistic variable is employed the MAFOI, an obesity classification with entirely new classes of obesity in the fuzzy context as well as is used for BSI. Results: There is gradual, smooth obesity classification and BSI when using the proposed fuzzy obesity index when compared with other traditional methods for dealing with obesity.
Conclusion: The BMI is not adequate for surgical indication in all the conditions and fuzzy logic becomes an alternative for decision making in bariatric surgery indication based on the MAFOI

Laparoscopy Pneumoperitoneum Fuzzy Modeling

Abstract: Gas volume to intra-peritoneal pressure fuzzy modeling for evaluating pneumoperitoneum in videolaparoscopic surgery is proposed in this paper. The proposed approach innovates in using fuzzy logic and fuzzy set theory for evaluating the accuracy of the prognosis value in order to minimize or avoid iatrogenic injuries due to the blind needle puncture. In so doing, it demonstrates the feasibility of fuzzy analysis to contribute to medicine and health care. Fuzzy systems is employed here in synergy with artificial neural network based on backpropaga tion, multilayer perceptron architecture for building up numerical functions. Experimental data employed for analysis were collected in the accomplishment of the pneumoperitoneum in a random population of patients submitted to videolaparoscopic surgeries. Numerical results indicate that the proposed fuzzy mapping for describing the relation from the intra peritoneal pressure measures as function injected gas volumes succeeded in determinining a fuzzy model for this nonlinear system when compared to the statistical model

Isolated ileal interposition in enteroendocrine L cells differentiation

INTRODUCTION: 
Due to the progressive nature of type 2 diabetes, its complexity and drug treatment perpetuity, there is currently a search for surgical procedures that can promote euglycemia also in non-obese patients. Diabetic patients glycemic control can be achieved by increasing the blood concentration of GLP-1, a hormone produced by L cells that are more densely concentrated in the terminal ileum. Early and extended improvement of diabetes in patients submitted to bariatric surgeries awakened the necessity of investigating the isolated ileal interposition as a surgical alternative for the treatment of diabetes. The interposition of this ileal segment to a more anterior region (proximal jejunum) can promote a greater stimulation of the L cells by poorly digested food, increasing the production of GLP-1 and reflecting on glycemic control. However, in order to consolidate the ileal interposition as a surgical treatment of diabetes it is necessary that the interposed ileum keep the same differentiation rate into L cells for a long period to justify the intervention.

AIMS: 
To investigate the isolated ileal interposition influence on the differentiation of intestinal precursor cells into enteroendocrine L cells over time.

METHODS: 
Twelve 12-week-old male Wistar rats (Rattus norvegicus albinus) of the WAB strain (heterogeneous) will be used. All animals will receive a high-calorie, high-fat diet for 16 weeks or more until they develop glucose dysmetabolism confirmed by glycemic test. They will be divided into two groups of 10 animals each: the isolated ileal interposition group (GI) and the control group (GC), comprising animals that will not be submitted to any surgical intervention. Blood samples will be collected under anesthesia at the weeks 12, 26, 36 and 44 for the determination of serum levels of glucose, insulin, GLP-1, glucagon, C-peptide and glycosilated hemoglobin. The insulin tolerance test will be performed and insulin resistance will be calculated. For the comparative analysis of the ileal precursor cells differentiation into enteroendocrine cells among the two groups, the following intestinal fragments will be collected after euthanasia: interposed ileum and remaining ileum from GI, jejunum and ileum from GC. These fragments will be analyzed by imunofluorescence and also by Real Time PCR using PCR Arrays for target genes including the main ones related to stem cell, stem cell signaling, diabetes, Wnt and Notch signaling pathways and other genes and pathways involved in the differentiation of intestinal precursor cells into enteroendocrine cells, especially GLP-1-producing L cells that play important role in euglycemia

Organic consequences of ileal transposition in rats with diet-induced obesity

INTRODUCTION: The clinical management of metabolic syndrome - especially diabetes mellitus type 2 - is notoriously complex due to the progressive nature of this disease. At present, there is a need for a surgical procedure that is effective for the treatment of diabetes mellitus type 2, even in non-obese individuals. The isolated ileal transposition theory could lead to an effective alternative therapy. This intervention has not yet been performed in humans, and there are no reports of its use in an experimental model of diet-induced metabolic syndrome.
 OBJECTIVES: The objective of this study is to evaluate the physiological effects of ileal transposition in rats with diet-induced metabolic syndrome. The effects of this procedure on glucose and lipid metabolism will be assessed. 
METHODS: Forty 12-week-old male rats (albino Rattus norvegicus, Wistar, 2BAW, heterogeneous) will be divided into four groups of 10 animals each: the ileal transposition group (TG) comprising animals on a hypercaloric-hyperlipidic diet; the sham group (SG) containing animals that receive the same diet and undergo the sham surgery; control group 1 (CG1), which will receive a hypercaloric-hyperlipidic diet and will not undergo surgery; and control group 2 (CG2), which will consume standard feed and will not undergo surgery. The surgeries will be performed in 20-week-old animals. Blood samples for laboratory testing will be collected from 12-week-old animals on the day of surgery and after eight postoperative weeks, following determination of the weights of the animals and the administration of anesthesia. The levels of serum glucose, insulin, triglycerides, total cholesterol and fractions, glucagon-like peptide-1, C-peptide and glycated hemoglobin will be assessed in all of the animals. The insulin tolerance test will be performed using PRISMA software, and insulin resistance will be calculated by the HOMA-IR indirect test. On specific days, two 20-week-old rats will be separated and randomly distributed in TG and SG. These animals will be followed until the eighth postoperative week. Subsequently, they will be euthanized, and the retroperitoneal and periepididymal fat deposits will be collected and weighed using a precision scale. In addition, the pancreas, liver and intestinal segments will be sent for pathological and immunohistochemical studies.
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Poor glycaemic control in Brazilian patients with type 2 diabetes attending the public healthcare system a cross-sectional study

Objectives: To describe the clinical profile of Brazilian patients with type 2 diabetes attending the public healthcare system and identify factors associated with poor glycaemic control.Design: Cross-sectional study.Setting: 14 centres in five regions of Brazil, including primary care units and outpatient clinics of University Hospitals.Participants: Patients with type 2 diabetes attending outpatient clinics of public healthcare system.Main outcome measured: Glycated haemoglobin (HbA1c), centrally measured by high-performance liquid chromatography (National Glycohemoglobin Standardization Program certified).Results: A total of 5750 patients aged 61 10 years, with 11 8 years of diabetes duration (66% women, 56% nonwhite, body mass index: 28.0 5.3 kg/m(2)) were analysed. Mean HbA1c was 8.6 +/- 2.2%, and median HbA1c was 8.1% (6.9% to 9.9%). HbA1c 8%.Conclusions: the majority of Brazilian patients with type 2 diabetes attending the public healthcare system had HbA1c levels above recommended targets. the recognition of Northeast residents and non-white patients as vulnerable populations should guide future policies and actions to prevent and control diabetes.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundo de Incentivo a Pesquisa (FIPE) of Hospital de Clinicas de Porto Alegre (HCPA)Pfizer PharmaceuticalHosp Clin Porto Alegre, Endocrine Div, Porto Alegre, RS, BrazilUniv Fed Rio Grande do Sul, Porto Alegre, RS, BrazilHosp Getulio Vargas, Endocrine Div, Manaus, Amazonas, BrazilUniv Fed Amazonas, Manaus, Amazonas, BrazilFed Univ Para, BR-66059 Belem, Para, BrazilUniversidade Federal de São Paulo, Endocrine Div, São Paulo, BrazilUniversidade Federal de São Paulo, Endocrine Div, São Paulo, BrazilWeb of Scienc

Assessment of numerical simulations of deep circulation and variability in the Gulf of Mexico using recent observations

Author Posting. © American Meteorological Society, 2020. This article is posted here by permission of American Meteorological Society for personal use, not for redistribution. The definitive version was published in Journal of Physical Oceanography 50(4), (2020): 1045-1064, doi:10.1175/JPO-D-19-0137.1.Three simulations of the circulation in the Gulf of Mexico (the “Gulf”) using different numerical general circulation models are compared with results of recent large-scale observational campaigns conducted throughout the deep (>1500 m) Gulf. Analyses of these observations have provided new understanding of large-scale mean circulation features and variability throughout the deep Gulf. Important features include cyclonic flow along the continental slope, deep cyclonic circulation in the western Gulf, a counterrotating pair of cells under the Loop Current region, and a cyclonic cell to the south of this pair. These dominant circulation features are represented in each of the ocean model simulations, although with some obvious differences. A striking difference between all the models and the observations is that the simulated deep eddy kinetic energy under the Loop Current region is generally less than one-half of that computed from observations. A multidecadal integration of one of these numerical simulations is used to evaluate the uncertainty of estimates of velocity statistics in the deep Gulf computed from limited-length (4 years) observational or model records. This analysis shows that the main deep circulation features identified from the observational studies appear to be robust and are not substantially impacted by variability on time scales longer than the observational records. Differences in strengths and structures of the circulation features are identified, however, and quantified through standard error analysis of the statistical estimates using the model solutions.This work was supported by the Gulf Research Program of the National Academy of Sciences under Awards 2000006422 and 2000009966. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Gulf Research Program or the National Academy of Sciences. The authors acknowledge the GLORYS project for providing the ocean reanalysis data used in the ROMS simulation. GLORYS is jointly conducted by MERCATOR OCEAN, CORIOLIS, and CNRS/INSU. Installation, recovery, data acquisition, and processing of the CANEK group current-meter moorings were possible because of CICESE-PetróleosMexicanos Grant PEP-CICESE 428229851 and the dedicated work of the crew of the B/O Justo Sierra and scientists of the CANEK group. The authors thank Dr. Aljaz Maslo, CICESE, for assistance with analysis of model data. The Bureau of Ocean Energy Management (BOEM), U.S. Dept. of the Interior, provided funding for the Lagrangian Study of the Deep Circulation in the Gulf of Mexico and the Observations and Dynamics of the Loop Current study. HYCOM simulation data are available from the HYCOM data server (https://www.hycom.org/data/goml0pt04/expt-02pt2), MITgcm data are available from the ECCO data server (http://ecco.ucsd.edu/gom_results2.html), and the ROMS simulation data are available from GRIIDC (NA.x837.000:0001)

Museums and cradles of diversity are geographically coincident for narrowly distributed Neotropical snakes

Factors driving the spatial configuration of centres of endemism have long been a topic of broad interest and debate. Due to different eco-evolutionary processes, these highly biodiverse areas may harbour different amounts of ancient and recently diverged organisms (paleo- and neo-endemism, respectively). Patterns of endemism still need to be measured at distinct phylogenetic levels for most clades and, consequently, little is known about the distribution, the age and the causes of such patterns. Here we tested for the presence of centres with high phylogenetic endemism (PE) in the highly diverse Neotropical snakes, testing the age of these patterns (paleo- or neo-endemism), and the presence of PE centres with distinct phylogenetic composition. We then tested whether PE is predicted by topography, by climate (seasonality, stability, buffering and relictualness), or biome size. We found that most areas of high PE for Neotropical snakes present a combination of both ancient and recently diverged diversity, which is distributed mostly in the Caribbean region, Central America, the Andes, the Atlantic Forest and on scattered highlands in central Brazil. Turnover of lineages is higher across Central America, resulting in more phylogenetically distinct PE centres compared to South America, which presents a more phylogenetically uniform snake fauna. Finally, we found that elevational range (topographic roughness) is the main predictor of PE, especially for paleo-endemism, whereas low paleo-endemism levels coincide with areas of high climatic seasonality. Our study highlights the importance of mountain systems to both ancient and recent narrowly distributed diversity. Mountains are both museums and cradles of snake diversity in the Neotropics, which has important implications for conservation in this region.Fil: Azevedo, Josué Anderson Rêgo. University Goteborg; Suecia. Gothenburg Global Biodiversity Centre; SueciaFil: Guedes, Thaís B.. University Goteborg; Suecia. Gothenburg Global Biodiversity Centre; Suecia. Universidade Estadual do Maranhão. Centro de Estudos Superiores de Caxias. Programa de Pós-graduação em Biodiversidade, Ambiente e Saúde; PortugalFil: Nogueira, Cristiano de Campos. Universidade de Sao Paulo; BrasilFil: Passos, Paulo. Universidade Federal do Rio de Janeiro; BrasilFil: Sawaya, Ricardo. Universidad Federal do Abc; BrasilFil: Prudente, Ana. Museu Paraense Emílio Goeldi; BrasilFil: Barbo, Fausto Erritto. Governo do Estado de Sao Paulo. Secretaria da Saude. Instituto Butantan; BrasilFil: Strüssmann, Christine. Universidade Federal do Mato Grosso do Sul; BrasilFil: Franco, Francisco L.. Governo do Estado de Sao Paulo. Secretaria da Saude. Instituto Butantan; BrasilFil: Arzamendia, Vanesa. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Instituto Nacional de Limnología. Universidad Nacional del Litoral. Instituto Nacional de Limnología; ArgentinaFil: Giraudo, Alejandro Raul. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Instituto Nacional de Limnología. Universidad Nacional del Litoral. Instituto Nacional de Limnología; ArgentinaFil: Argolo, Antonio. Universidade Estadual de Santa Cruz; BrasilFil: Jansen, Martin. Senckenberg Research Institute and Nature Museum; AlemaniaFil: Zaher, Hussam. Universidade de Sao Paulo; BrasilFil: Tonini, Joao Filipe Riva. Centre National de la Recherche Scientifique; Francia. Muséum National d'Histoire Naturelle; Francia. Sorbonne University; Francia. Harvard University; Estados UnidosFil: Faurby, Søren. University Goteborg; SueciaFil: Antonelli, Alexandre. University Goteborg; Sueci

Determinants of intensive insulin therapeutic regimens in patients with type 1 diabetes: data from a nationwide multicenter survey in Brazil

Background: To evaluate the determinants of intensive insulin regimens (ITs) in patients with type 1 diabetes (T1D).Methods: This multicenter study was conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. Data were obtained from 3,591 patients (56.0% female, 57.1% Caucasian). Insulin regimens were classified as follows: group 1, conventional therapy (CT) (intermediate human insulin, one to two injections daily); group 2 (three or more insulin injections of intermediate plus regular human insulin); group 3 (three or more insulin injections of intermediate human insulin plus short-acting insulin analogues); group 4, basal-bolus (one or two insulin injections of long-acting plus short-acting insulin analogues or regular insulin); and group 5, basal-bolus with continuous subcutaneous insulin infusion (CSII). Groups 2 to 5 were considered IT groups.Results: We obtained complete data from 2,961 patients. Combined intermediate plus regular human insulin was the most used therapeutic regimen. CSII was used by 37 (1.2%) patients and IT by 2,669 (90.2%) patients. More patients on IT performed self-monitoring of blood glucose and were treated at the tertiary care level compared to CT patients (p < 0.001). the majority of patients from all groups had HbA1c levels above the target. Overweight or obesity was not associated with insulin regimen. Logistic regression analysis showed that economic status, age, ethnicity, and level of care were associated with IT (p < 0.001).Conclusions: Given the prevalence of intensive treatment for T1D in Brazil, more effective therapeutic strategies are needed for long term-health benefits.Farmanguinhos/Fundacao Oswaldo Cruz/National Health MinistryBrazilian Diabetes SocietyFundacao do Amparo a Pesquisa do Estado do Rio de JaneiroConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Univ Estado Rio de Janeiro, Unit Diabet, BR-20551030 Rio de Janeiro, BrazilBaurus Diabet Assoc, São Paulo, BrazilFed Univ São Paulo State, Diabet Unit, São Paulo, BrazilFed Univ Hosp Porto Alegre, Porto Alegre, BrazilUniv Hosp São Paulo, Diabet Unit, São Paulo, BrazilUniv Fed Rio de Janeiro, Rio de Janeiro, BrazilUniv Fed Ceara, Fortaleza, Ceara, BrazilSanta Casa Misericordia, Belo Horizonte, MG, BrazilSanta Casa Misericordia São Paulo, São Paulo, BrazilUniv Fed Amazonas, Manaus, Amazonas, BrazilHosp Geral de Bonsucesso, Rio de Janeiro, BrazilHosp Univ Clementino Fraga Filho IPPMG, Rio de Janeiro, BrazilUniv Hosp São Paulo, São Paulo, BrazilFac Ciencias Med Santa Casa São Paulo, São Paulo, BrazilUniv São Paulo, Inst Crianca, Hosp Clin, São Paulo, BrazilUniv São Paulo, Fac Med Ribeirao Preto, Hosp Clin, Ribeirao Preto, BrazilAmbulatorio Fac Estadual Med Sao Jose Rio Preto, Ribeirao Preto, BrazilEscola Paulista Med, Ctr Diabet, Ribeirao Preto, BrazilClin Endocrinol Santa Casa Belo Horizonte, Belo Horizonte, MG, BrazilUniv Estadual Londrina, Londrina, BrazilUniv Fed Parana, Hosp Clin, Porto Alegre, RS, BrazilInst Crianca Com Diabet Rio Grande Sul, Rio Grande Do Sul, RS, BrazilGrp Hosp Conceicao, Inst Crianca Com Diabet, Porto Alegre, RS, BrazilHosp Univ Santa Catarina, Florianopolis, SC, BrazilInst Diabet Endocrinol Joinville, Joinville, BrazilHosp Reg Taguatinga, Brasilia, DF, BrazilHosp Geral Goiania, Goiania, Go, BrazilCtr Diabet & Endocrinol Estado Bahia, Goiania, Go, BrazilUniv Fed Maranhao, Sao Luis, BrazilCtr Integrado Diabet & Hipertensao Ceara, Fortaleza, Ceara, BrazilUniv Fed Sergipe, Aracaju, BrazilHosp Univ Alcides Carneiro, Campina Grande, BrazilHosp Univ Joao de Barros Barreto, Belem, Para, BrazilFed Univ São Paulo State, Diabet Unit, São Paulo, BrazilUniv Hosp São Paulo, Diabet Unit, São Paulo, BrazilUniv Hosp São Paulo, São Paulo, BrazilEscola Paulista Med, Ctr Diabet, Ribeirao Preto, BrazilWeb of Scienc