Wernicke encephalopathy after sleeve gastrectomy

The article describes the case of a patient with Wernicke encephalopathy, which developed 3 months after the sleeve gastrectomy. An MRI of the brain was performed to verify the diagnosis, which revealed a symmetrical non-uniform increase in the MR signal on T2-WI and Tirm from the medial part of the thalamus, mastoid bodies and gray matter around the aqueduct of Sylvius. Thiamine infusion was promptly initiated as therapy. During treatment, acute neurological symptoms almost regressed, the patient was discharged in a satisfactory condition with preservation of vertical nystagmus under the supervision of specialists at the place of residence. Wernicke–Korsakoff syndrome more often occurs as a complication of alcoholism and arising from thiamine deficiency. However, the fact that this condition also occurs under the influence of other etiopathogenetic factors is often ignored by clinicians. In the management of patients after bariatric interventions, this condition is much more common in malabsorptive operations. However, a combination of certain factors can be described in patients after restrictive types of bariatric surgeries

Evaluation of the effectiveness of weight loss and the return of lost weight after sleeve gastrectomy in the long term follow-up period

Sleeve gastrectomy, originally proposed as part of a two-stage operation, more than 15 years ago, is recognized as an independent, effective intervention for the treatment of obesity. The purpose of this review was to evaluate the effectiveness of sleeve gastrectomy based on data on long-term follow-up of patients. A search was performed in two databases, 33 literary sources were selected based on the results of the selection. In this review, the authors evaluated some parameters characterizing the effectiveness of sleeve gastrectomy in the long term after surgery. The percentage of follow-up of patients in the long-term period (follow up, %) varied from 5,6% to 97%, the expected decrease in % follow up over time did not occur. The authors have suggested similar results due to the heterogeneity of the data of the analyzed sources. By the five-year period, the detected average % of follow-up did not correspond to the optimal recommended level of follow-up for operated patients by this time. The most common criterion for assessing the return of weight is an increase in body weight by more than 10 kg from the lowest achieved. The prevalence of this phenomenon ranged from 26.3% to 44%. Among the reasons predisposing to weight loss are the initial high BMI, old age, dilatation of the formed stomach. In the absence of a universal definition of various terms (follow up, unsatisfactory result of surgery, weight loss, etc.), the results among the same patients when using different definitions will differ, there is a need to adopt standards when describing these phenomena. Despite the likelihood of weight loss after longitudinal resection, this operation is relatively simple from a technical point of view, safer, it can be used to improve the course of concomitant pathology (diabetes mellitus, hypertension), improve the quality and increase the life expectancy of patients

Fungal endophthalmitis

The article presents a clinical case of fungal endophthalmitis, the causative agent of which was Paecilomyces lilacinum. Patient M., female, 1947 year of birth was operated on for complicated cataract of the right eye. Two weeks later, she complained of decreased vision. A local anti-inflammatory therapy of the exudative reaction in the anterior chamber was carried out, therefore an improvement was achieved. Two weeks later, the patient again complained of visual impairment. Лечение было продолжено со сменой фунгицидных средств, обладающих большим Systemic and local anti-inflammatory and antibacterial therapy of exudative uveitis with the course of fluconazole for 15 days was carried out. Extended clinical and laboratory studies did not reveal any chronic inflammatory and immune diseases in the female patient. In connection with the further progression of the process, vitrectomy was performed with the removal of IOL and washing of the vitreous cavity with a solution of vancomycin. The achieved stabilization lasted short. There were appeared signs indicating a fungal etiology of the inflammatory process. Taking into account the previous long-term antibiotic therapy, yeast contamination was suggested. Despite the active treatment, there was a further deterioration of the eye. No pathogenic and conditionally pathogenic microflora growth was revealed as a result of seeding. Confocal microscopy revealed a filamentous structure of the mycelium in the thickness of the corneal stroma, which indicated infection with mold, not yeast fungi. Treatment was continued with a change of fungicidal agents with a large spectrum of action, as well as a silicone oil tamponade. The obtained culture was aimed at identification of the species and determination of sensitivity to fungicides in the medical scientific and practical center for tuberculosis control, Moscow. Cultural studies identified pathogenic microflora – Paecilomyces lilacinum, sensitive to ketoconazole. In connection with the spread of infection to the periorbital tissues, with the subsequent probability of systemic damage, an emergency enucleation of the eyeball was decided. This example indicates the need for increased alertness for fungal infection in cases of atypical flow of intraocular inflammation, the search for methods for early detection of the pathogen

УБМ-критерии безопасности фемтосопровождения в хирургии катаракты после ранее выполненной микроинвазивной непроникающей глубокой склерэктомии

PURPOSE: To evaluate the safety criteria of femtolaser impact during femtosecond laser–assisted cataract phacoemulsification on the filtration zone after microinvasive non-penetrating deep sclerotomy based on ultrasound bio- microscopy data.MATERIALS AND METHODS: 12 patients (15 eyes) with operated primary open-angle glaucoma, 7 women and 5 men, were kept under observation. The average age of the patients was 64±11 years. Femtosecond laser–assisted cataract phacoemulsification was performed 6-12 months after microinvasive non-penetrating deep sclerectomy. In addition to standard research methods all patients underwent ultrasound biomicroscopy prior to surgery. The femtolaser stage of the surgery was performed using FEMTO LDV Z8 device («Ziemer», Switzerland). Ultrasonic cataract phacoemulsification was performed using Centurion VisionSystem («Alcon», USA) according to the standard phaco-chop technique. Ultrasonic biomicroscopy follow-up was performed 1 day and 1 month after the operation.RESULTS: Study results indicate the need to include ultrasound biomicroscopy into the list of mandatory diag nostic research methods for patients with previously operated glaucoma prior to femtosecond laser–assisted cataract surgery. To ensure a safe performing of femtolaser cataract surgery in patients after microinvasive non-penetrating deep sclerectomy, one has to take into account a combination of such features as the preservation of the linear profile of the trabeculodecemetic membrane, the absence of its dense adhesions with surrounding tissues, and the presence of an intrascleral cavity with a height of 0.25 mm and above. Failure to respect these conditions when using femtosecond laser technology can lead to adverse changes of the newly formed drainage system.CONCLUSION: Femtosecond laser–assisted cataract surgery for patients who previously underwent microinvasive non-penetrating deep sclerotomy (MNSE) is a safe and effective technology when performed after a preliminary selection of patients based on filtration zone ultrasound biomicroscopy (UBM).ЦЕЛЬ: Выявить критерии безопасности фемтолазерного воздействия на фильтрационную зону в ходе факоэмульсификации катаракты (ФЭК) после микроинвазивной непроникающей глубокой склерэктомии (МНГСЭ) на основании данных ультразвуковой биомикроскопии (УБМ). МАТЕРИАЛЫ И МЕТОДЫ. Под наблюдением находились 12 пациентов (7 женщин, 5 мужчин; 15 глаз) с оперированной первичной открытоугольной глаукомой. Средний возраст пациентов составил 64±11 лет. ФЭК с фемтолазерным сопровождением выполнялась через 6-12 месяцев после ранее проведенной МНГСЭ. В предоперационном периоде помимо стандартных методов исследования всем пациентам дополнительно проводили УБМ. Фемтолазерный этап операции выполняли на приборе FEMTO LDV Z8 («Ziemer», Швейцария). Ультразвуковую ФЭК проводили на системе Centurion VisionSystem («Alcon», США) по стандартной методике «phaco-chop». УБМ в динамике осуществляли в 1-е сутки и через 1 месяц после операции.РЕЗУЛЬТАТЫ.Результаты исследования указывают на необходимость включения ультразвуковой биомикроскопии в перечень обязательных методов исследования для пациентов с ранее оперированной глаукомой на этапе диагностики перед хирургией катаракты с фемтосопровождением. Для обеспечения безопасного проведения фемтолазерной хирургии катаракты у пациентов после МНГСЭ следует учитывать совокупность таких признаков, как сохранность линейного профиля трабекулодесцеметовой мембраны, отсутствие ее плотных сращений с окружающими тканями, наличие интрасклеральной полости с высотой от 0,25 мм и выше. Применение фемтолазерной технологии при несоблюдении данных условий может спровоцировать неблагоприятные изменения в сформированной дренажной системе. ЗАКЛЮЧЕНИЕ. Фемтолазерная хирургия катаракты, выполняемая при наличии показаний и на основе предварительного отбора пациентов с учетом данных УБМ фильтрационной зоны после МНГСЭ, является безопасной и эффективной технологией у пациентов с оперированной ранее глаукомой

Retinoic Acid Functions as a Key GABAergic Differentiation Signal in the Basal Ganglia

Retinoic acid (RA) is essential for the generation of GABAergic inhibitory neurons in the mouse forebrain, and RA treatment of embryonic stem cells induces the production of GABAergic neurons

Consequences of Lineage-Specific Gene Loss on Functional Evolution of Surviving Paralogs: ALDH1A and Retinoic Acid Signaling in Vertebrate Genomes

Genome duplications increase genetic diversity and may facilitate the evolution of gene subfunctions. Little attention, however, has focused on the evolutionary impact of lineage-specific gene loss. Here, we show that identifying lineage-specific gene loss after genome duplication is important for understanding the evolution of gene subfunctions in surviving paralogs and for improving functional connectivity among human and model organism genomes. We examine the general principles of gene loss following duplication, coupled with expression analysis of the retinaldehyde dehydrogenase Aldh1a gene family during retinoic acid signaling in eye development as a case study. Humans have three ALDH1A genes, but teleosts have just one or two. We used comparative genomics and conserved syntenies to identify loss of ohnologs (paralogs derived from genome duplication) and to clarify uncertain phylogenies. Analysis showed that Aldh1a1 and Aldh1a2 form a clade that is sister to Aldh1a3-related genes. Genome comparisons showed secondarily loss of aldh1a1 in teleosts, revealing that Aldh1a1 is not a tetrapod innovation and that aldh1a3 was recently lost in medaka, making it the first known vertebrate with a single aldh1a gene. Interestingly, results revealed asymmetric distribution of surviving ohnologs between co-orthologous teleost chromosome segments, suggesting that local genome architecture can influence ohnolog survival. We propose a model that reconstructs the chromosomal history of the Aldh1a family in the ancestral vertebrate genome, coupled with the evolution of gene functions in surviving Aldh1a ohnologs after R1, R2, and R3 genome duplications. Results provide evidence for early subfunctionalization and late subfunction-partitioning and suggest a mechanistic model based on altered regulation leading to heterochronic gene expression to explain the acquisition or modification of subfunctions by surviving ohnologs that preserve unaltered ancestral developmental programs in the face of gene loss

Retinoic Acid-Dependent Signaling Pathways and Lineage Events in the Developing Mouse Spinal Cord

Studies in avian models have demonstrated an involvement of retinoid signaling in early neural tube patterning. The roles of this signaling pathway at later stages of spinal cord development are only partly characterized. Here we use Raldh2-null mouse mutants rescued from early embryonic lethality to study the consequences of lack of endogenous retinoic acid (RA) in the differentiating spinal cord. Mid-gestation RA deficiency produces prominent structural and molecular deficiencies in dorsal regions of the spinal cord. While targets of Wnt signaling in the dorsal neuronal lineage are unaltered, reductions in Fibroblast Growth Factor (FGF) and Notch signaling are clearly observed. We further provide evidence that endogenous RA is capable of driving stem cell differentiation. Raldh2 deficiency results in a decreased number of spinal cord derived neurospheres, which exhibit a reduced differentiation potential. Raldh2-null neurospheres have a decreased number of cells expressing the neuronal marker β-III-tubulin, while the nestin-positive cell population is increased. Hence, in vivo retinoid deficiency impaired neural stem cell growth. We propose that RA has separable functions in the developing spinal cord to (i) maintain high levels of FGF and Notch signaling and (ii) drive stem cell differentiation, thus restricting both the numbers and the pluripotent character of neural stem cells

Prospects for the use of mobile learning in the preparation of specialists in the field of commerce

Рассматриваются социально-экономические условия становления специалиста сферы коммерции в вузе и формирования его профессиональной культуры на основе компетентностного подхода с использованием современных информационных технологий. Приведены возможности внедрения мобильных технологий обучения в образовательный процесс при подготовке специалистов сферы коммерции в высшей школе. Анализируются достоинства мобильного обучения, даются практические советы для организации изучения курса товароведения с применением современных средств свзязи, таких как смартфоны и планшетные компьютеры. Описываются недостатки и сложности внедрения мобильной технологии, а также возможные пути решения возникающих проблем.We consider the socio-economic conditions of development of the specialist areas of commerce in high school and the formation of its professional culture based on competence-based approach with the use of modern information technology. Given the possibility of the introduction of mobile learning technologies in the educational process in the preparation of specialists in the sphere of commerce in high school. Analyzes the advantages of mobile learning, practical advice for the organization of the study course of merchandising with the use of modern svzyazi such as smartphones and tablet computers. Describes the pitfalls and difficulties of implementation of mobile techno-logy, as well as possible solutions to problems

PROBABILISTIC ZONING OF ADJACENT CATCHMENTS BY PHYSICAL MODELING

Now the probabilistic zoning of avalanche sites is being made either on the basis of the available field data, or using the mathematical and physical modeling of avalanche dynamics processes. The work purpose consisted in research of interaction and compiling probabilistic zoning maps of two adjacent avalanche sites by a physical modeling method. For the two adjacent sites № 9 and 10 on the slope of northern exposition ofTchegetMountain(Elbrus region,Caucasus) the model of this slope with the scale of 1: 2 500 was created. The model dimension is 0,82 × 1,1 ×0,57 m. This model was produced using the 4-mm plywood sheets imposed against each other. The model horizontals correspond to the10 mnatural ones. The model slope was also surfaced by thin gypsum lay and then varnished. The fine-grained sawdust (0.1 mm) with a natural friction angle of 43º has been chosen as the loose material modeling snow. A series of experiments on modeling avalanche releases from the two sites were carried out resulted in the measurements of avalanche deposit parameters such as run-out distance and length, width and thickness of deposits. The similarity criteria were used during the experiments. The morphometric features of adjacent sites interaction are revealed. The basic result of the carried out work will consist in the probabilistic zoning map of two adjacent sites № 9 and 10