Pregnancy after Gastric Banding for the Treatment of Morbid Obesity

Obesity is known to have a negative impact on pregnancy outcome, as it is associated with an increase in the incidence of gestational diabetes, hypertension, preeclampsia, neural tube defects, macrosomia, and late fetal death. Gastric banding is considered an appropriate intervention for morbid obesity when other weight-loss measures are unsuccessful, and this treatment has been shown to be effective in causing a sustainable weight loss. Some women will become pregnant after bariatric surgery, and the nutritional and metabolic challenges brought by gastric banding may have a profound impact on maternal health and pregnancy outcome. The authors report the case of a 27 year old pregnant woman, with a past medical history of gastric banding surgery for morbid obesity. At 18 weeks of gestation, the patient started complaining of severe nausea and vomiting, The situation deteriorated three weeks later when she rapidly developed severe desnutrition, dehydration and early signs of liver and renal failure. Migration of the gastric band was diagnosed, and laparoscopy conducted to remove it. In the day following surgery the patient complained of absent fetal movements, and an intrauterine demise was diagnosed on ultrasound. Pathological examination of the fetus and placenta failed to reveal the cause of death, but no growth restriction was documented, suggesting the occurrence of an acute event

Cirurgia do Timo num Serviço de Cirurgia Geral

AIMS: Evaluation of thymectomy cases between 1990-2003, in a General Surgery Department. Evaluation of the therapeutic efficacy in Miastenia Gravis patients. PATIENTS AND METHODS: Retrospective study based on evaluation of data from Serviço de Cirurgia, Neurologia and Consult de Neurology processes, between 1990-2003, of 15 patients submitted to total thymectomy. RESULTS: 15 patients, aged 17 to 72, 11 female and 4 male. Miastenia Gravis was the main indication for surgery, for uncontrollable symptoms or suspicion of thymoma. In patients with myasthenia, surgery was accomplish after compensation of symptoms. There weren't post-surgery complications. Pathology were divided in thymic hyperplasia and thymoma. Miastenia patients have there symptoms diminished or stable with reduction or cessation of medical therapy. CONCLUSIONS: Miastenia was the most frequent indication for thymectomy. Surgery was good results, with low morbimortality, as long as the protocols are respected

Adaptação e teste de aceitabilidade do colete de vibração Expector® em equinos

The project is based on a test of a thoracic vibration vest prototype, adapted to equines by the Expector® vest’s company, on healthy animals. Ten (10) equines were used in the project, male or female, adults, healthy, belonging to FMVZUSP or private owners. Each animal went through two phases: A and B. Phase A consisted of the placement of the vest without turning on the vibrators, evaluating the animal’s acceptability, facility, adaptation to the animal’s body, and discomfort due to the vest’s use. Phase B included the placement of the vest and turning on the vibrators, evaluating the animal’s acceptability, reaction to the vibrators, and, if present, to which velocity/type of vibration, and the presence of adverse effects. Both phases were done three times on separate days. The behavioral parameters: “placement facility” and “adaptation to the animal’s body” were observed. In phase B, the response to the vibration was classified from 0 to 5. The answer was evaluated on low and high intensities for the four vibration types. The heart rate (HR) and respiratory rate (RR) were also evaluated at the beginning and end of each repetition. The animals’ HR was kept on normal, except for one animal on one day of the test. Concerning the RR, most animals presented moments of tachypnea. On the experiment’s first day, 100% of grade Great to “facility of placement” and “adaptation to the animal’s body” was obtained, but on days 2 and 3 this value dropped to 90% due to alterations in one animal’s responses. Regarding vibration’s responses, 77.3% were evaluated as no discomfort (grade 0), 17.1% little discomfort (grade 1), 3.3% medium discomfort (grade 2), 0.4% great discomfort (grade 3), 0.21% extreme discomfort (grade 4), and 1.6% non-acceptance of the vest (grade 5). Some possible changes on the prototype were also verified to be suggested to the manufacturer, such as the change of the buckle and the use of wireless control. Vest use appears promising for equine respiratory physiotherapy, considering the acceptability was good, and its efficiency on the expectoration of diseased animals must be tested.O projeto consistiu no teste de um protótipo de colete de vibração torácica, adaptado aos equinos pela empresa do colete Expector®, em animais saudáveis. Foram utilizados 10 equinos, machos ou fêmeas, adultos, saudáveis, pertencentes à FMVZ- USP e a proprietários particulares. Cada animal passou por duas fases: A e B. A Fase A consistiu na colocação do colete sem ligar os vibradores, avaliando-se a aceitabilidade do animal; facilidade; adaptação ao corpo do animal e incômodo do mesmo à sua presença. Já a Fase B contava com a colocação do colete e funcionamento dos vibradores, avaliando-se a aceitabilidade do animal; reação aos vibradores e, se presente, a qual velocidade/tipo de vibração; presença de reações ou efeitos adversos. As duas fases foram realizadas em triplicata em dias separados. Foram observados os parâmetros comportamentais “facilidade de colocação” e “adaptação ao corpo do animal”. Na fase B, a resposta à vibração foi classificada de 0 a 5. A resposta foi avaliada nas intensidades baixa e alta para os quatro diferentes tipos de vibração. Foram avaliadas também as frequências cardíaca (FC) e respiratória (FR) no início e final de cada repetição. A FC dos animais se manteve dentro do intervalo de normalidade, com exceção de um animal em um dia de avaliação. Em relação à FR, a maioria apresentou momentos de taquipneia. No primeiro dia de experimento obteve-se 100% de avaliação Ótima para “facilidade de colocação” e “adaptação ao corpo do animal”, mas nos dias 2 e 3 esse valor caiu para 90% devido à alteração na resposta de um animal. Em relação à resposta à vibração, 77,3% das respostas foram avaliadas como nenhum incômodo (nota 0), 17,1% pouco incômodo (nota 1), 3,3% médio incômodo (nota 2), 0,4% muito incômodo (nota 3), 0,21% incômodo extremo (nota 4) e 1,6% não aceitação do colete (nota 5). Foram também verificadas algumas possíveis mudanças no protótipo  a serem sugeridas ao fabricante, como mudança do tipo de fivela e uso de controle sem fio. A utilização do colete parece ser muito promissora para a fisioterapia respiratória em equinos, visto que a aceitabilidade foi muito boa, devendo-se agora realizar a avaliação de sua eficácia na expectoração de animais enfermos.

Severe neonatal air leak syndrome – Answer

Air leak syndromes include pulmonary inter­stitial emphysema, pneumomediastinum, pneumo­thorax, pneumopericardium, pneumo­peritoneum, subcutaneous emphysema and systemic air embolism. These syndromes are more common and severe among neonates with underlying lung disease, especially those with low birth weight and respiratory distress syndrome. Antenatal steroids and early surfactant administration can prevent and improve their outcome. In the case reported, pneumopericardium was the first air leak presentation. Pericardial drainage was postponed due to cardiorespiratory stability on aminergic support. Air dissection into the pleural space led to tension pneumothorax, with gradual clinical improvement after thoracocentesis and chest tube placement. The thoracic drain was removed after 3 days with elective extubation on the 7th day of life. She was discharged home at 36 weeks of postmenstrual age without any respiratory dysfunction

8-Amide and 8-carbamate substitution patterns as modulators of 7-hydroxy-4-methylcoumarin's antidepressant profile: Synthesis, biological evaluation and docking studies

Psychiatric and neurological disorders affect millions of people worldwide. Currently available treatments may help to improve symptoms, but they cannot cure the diseases. Therefore, there is an urgent need for potent and safe therapeutic solutions. 8-Amide and 8-carbamatecoumarins were synthetized and evaluated as human monoamine oxidase A and B (hMAO-A and hMAO-B) inhibitors. Comparison between both scaffolds has been established, and we hypothesized that the introduction of different substituents can modulate hMAO activity and selectivity. N-(7-Hydroxy-4-methylcoumarin-8-yl)-4-methylbenzamide (9) and ethyl N-(7-hydroxy-4-methylcoumarin-8-yl)carbamate (20) proved to be the most active and selective hMAO-A inhibitors (IC = 15.0 nM and IC = 22.0 nM, respectively), being compound 9 an irreversible hMAO-A inhibitor twenty-four times more active in vitro than moclobemide, a drug used in the treatment of depression and anxiety. Based on PAMPA assay results, both compounds proved to be good candidates to cross the blood-brain barrier. In addition, these compounds showed non-significant cytotoxicity on neuronal viability assays. Also, the best compound proved to have a t of 6.84 min, an intrinsic clearance of 195.63 μL min mg protein, and to be chemically stable at pH 3.0, 7.4 and 10.0. Docking studies were performed to better understand the binding affinities and selectivity profiles for both hMAO isoforms. Finally, theoretical drug-like properties calculations corroborate the potential of both scaffolds on the search for new therapeutic solutions for psychiatric disorders as depression.This research was funded by Consellería de Cultura, Educacion ´ e Ordenacion ´ Universitaria (EM2014/016), Ministerio de Ciencia e Innovacion ´ (PID2020-116076RJ-I00/AEI/10.13039/501100011033) and Fundaçao ˜ para a Ciˆencia e Tecnologia (PTDC/ASP-PES/28397/ 2017, CEECIND/02423/2018, UIDB/00081/2020, LA/P/0056/2020 and EXPL/BIA-BQM/0492/2021). Financial support from the Xunta de Galicia (Centro de investigacion ´ de Galicia accreditation 2019–2022) and the European Union (European Regional Development Fund - ERDF), is also gratefully acknowledged. M.I.R.-F. acknowledges the economic support from the Spanish Ministry of Science, Innovation and Universities; Spanish Research Agency; and European Regional Development Funds (grant PID2021-122650OB-I00) and from CSIC (PIE202080E118)

Robotic4all project: Results of a hands-on robotic surgery training program

Objective: Although robotic surgery adoption and its indications are growing worldwide, for multiple factors, including costs, there is a lack of training and experience. Our aim was to study the impact of a robotic introduction training program on gesture performance, such as suturing, in robot-naive individuals. Methods: Using the DaVinci robot, a 2-hour program was based on virtual reality and anatomical model exercises. All participants performed 3 repetitions of virtual reality exercises on the virtual simulator, and then performed and were assessed on 2 tests, ie robot and laparoscopic training box. After the course, the participants were surveyed for this training program. Results: Twenty-seven residents and surgeons were enrolled in the training program. With only 2 hours of training, all of the participants were able to complete the training program, thus learning generic and specific skills in robotic surgery. In virtual reality exercise, the scores of the 3 exercises increased significantly with every repetition (p < 0.001) and the size of the increase was large. The completion time on the robot platform was 2.6 times faster (169.33 ± 28.28 s vs. 447.96 ± 156.55 s, p < 0.001) than that in the laparoscopic box, and the difference between both types of tests was large (p h 2 ¼ 0.797). The centralization and passage of the needle were significantly better on the robot platform (5 vs. 3, p < 0.001, r ¼ 0.47; 5 vs. 4, p < 0.001, r ¼ 0.59) than in the laparoscopic box. For the intracorporeal stitchþknot test, every participant was able to perform the exercise on the robot but only 85.2% (23/27) in the laparoscopic box. Twenty-one participants answered the survey, and 13 (61.9%) of them consid- ered robotic performance independent of laparoscopic experience. Conclusions: Surgeons are interested and seek training in robotic surgery. We implemented the first hands-on robotic surgery training program in Portugal and participants considered it was important and adequate for its purpose. All participants, even without robotic experience, learned quicker, performed better, faster and more precisely on the robot over laparoscopy

8-Amide and 8-carbamate substitution patterns as modulators of 7-hydroxy-4-methylcoumarin's antidepressant profile: Synthesis, biological evaluation and docking studies

Psychiatric and neurological disorders affect millions of people worldwide. Currently available treatments may help to improve symptoms, but they cannot cure the diseases. Therefore, there is an urgent need for potent and safe therapeutic solutions. 8-Amide and 8-carbamatecoumarins were synthetized and evaluated as human monoamine oxidase A and B (hMAO-A and hMAO-B) inhibitors. Comparison between both scaffolds has been established, and we hypothesized that the introduction of different substituents can modulate hMAO activity and selectivity. N-(7-Hydroxy-4-methylcoumarin-8-yl)-4-methylbenzamide (9) and ethyl N-(7-hydroxy-4-methylcoumarin-8-yl)carbamate (20) proved to be the most active and selective hMAO-A inhibitors (IC50 = 15.0 nM and IC50 = 22.0 nM, respectively), being compound 9 an irreversible hMAO-A inhibitor twenty-four times more active in vitro than moclobemide, a drug used in the treatment of depression and anxiety. Based on PAMPA assay results, both compounds proved to be good candidates to cross the blood-brain barrier. In addition, these compounds showed non-significant cytotoxicity on neuronal viability assays. Also, the best compound proved to have a t1/2 of 6.84 min, an intrinsic clearance of 195.63 μL min−1 mg−1 protein, and to be chemically stable at pH 3.0, 7.4 and 10.0. Docking studies were performed to better understand the binding affinities and selectivity profiles for both hMAO isoforms. Finally, theoretical drug-like properties calculations corroborate the potential of both scaffolds on the search for new therapeutic solutions for psychiatric disorders as depressionThis research was funded by Consellería de Cultura, Educación e Ordenación Universitaria (EM2014/016), Ministerio de Ciencia e Innovación (PID2020-116076RJ-I00/AEI/10.13039/501100011033) and Fundação para a Ciência e Tecnologia (PTDC/ASP-PES/28397/2017, CEECIND/02423/2018, UIDB/00081/2020, LA/P/0056/2020 and EXPL/BIA-BQM/0492/2021). Financial support from the Xunta de Galicia (Centro de investigación de Galicia accreditation 2019–2022) and the European Union (European Regional Development Fund - ERDF), is also gratefully acknowledged. M.I.R.-F. acknowledges the economic support from the Spanish Ministry of Science, Innovation and Universities; Spanish Research Agency; and European Regional Development Funds (grant PID2021-122650OB-I00) and from CSIC (PIE-202080E118)S

Rarity of monodominance in hyperdiverse Amazonian forests.

Tropical forests are known for their high diversity. Yet, forest patches do occur in the tropics where a single tree species is dominant. Such "monodominant" forests are known from all of the main tropical regions. For Amazonia, we sampled the occurrence of monodominance in a massive, basin-wide database of forest-inventory plots from the Amazon Tree Diversity Network (ATDN). Utilizing a simple defining metric of at least half of the trees ≥ 10 cm diameter belonging to one species, we found only a few occurrences of monodominance in Amazonia, and the phenomenon was not significantly linked to previously hypothesized life history traits such wood density, seed mass, ectomycorrhizal associations, or Rhizobium nodulation. In our analysis, coppicing (the formation of sprouts at the base of the tree or on roots) was the only trait significantly linked to monodominance. While at specific locales coppicing or ectomycorrhizal associations may confer a considerable advantage to a tree species and lead to its monodominance, very few species have these traits. Mining of the ATDN dataset suggests that monodominance is quite rare in Amazonia, and may be linked primarily to edaphic factors

Unraveling Amazon tree community assembly using Maximum Information Entropy: a quantitative analysis of tropical forest ecology

In a time of rapid global change, the question of what determines patterns in species abundance distribution remains a priority for understanding the complex dynamics of ecosystems. The constrained maximization of information entropy provides a framework for the understanding of such complex systems dynamics by a quantitative analysis of important constraints via predictions using least biased probability distributions. We apply it to over two thousand hectares of Amazonian tree inventories across seven forest types and thirteen functional traits, representing major global axes of plant strategies. Results show that constraints formed by regional relative abundances of genera explain eight times more of local relative abundances than constraints based on directional selection for specific functional traits, although the latter does show clear signals of environmental dependency. These results provide a quantitative insight by inference from large-scale data using cross-disciplinary methods, furthering our understanding of ecological dynamics

Geographic patterns of tree dispersal modes in Amazonia and their ecological correlates

Unidad de excelencia María de Maeztu CEX2019-000940-MAim: To investigate the geographic patterns and ecological correlates in the geographic distribution of the most common tree dispersal modes in Amazonia (endozoochory, synzoochory, anemochory and hydrochory). We examined if the proportional abundance of these dispersal modes could be explained by the availability of dispersal agents (disperser-availability hypothesis) and/or the availability of resources for constructing zoochorous fruits (resource-availability hypothesis). Time period: Tree-inventory plots established between 1934 and 2019. Major taxa studied: Trees with a diameter at breast height (DBH) ≥ 9.55 cm. Location: Amazonia, here defined as the lowland rain forests of the Amazon River basin and the Guiana Shield. Methods: We assigned dispersal modes to a total of 5433 species and morphospecies within 1877 tree-inventory plots across terra-firme, seasonally flooded, and permanently flooded forests. We investigated geographic patterns in the proportional abundance of dispersal modes. We performed an abundance-weighted mean pairwise distance (MPD) test and fit generalized linear models (GLMs) to explain the geographic distribution of dispersal modes. Results: Anemochory was significantly, positively associated with mean annual wind speed, and hydrochory was significantly higher in flooded forests. Dispersal modes did not consistently show significant associations with the availability of resources for constructing zoochorous fruits. A lower dissimilarity in dispersal modes, resulting from a higher dominance of endozoochory, occurred in terra-firme forests (excluding podzols) compared to flooded forests. Main conclusions: The disperser-availability hypothesis was well supported for abiotic dispersal modes (anemochory and hydrochory). The availability of resources for constructing zoochorous fruits seems an unlikely explanation for the distribution of dispersal modes in Amazonia. The association between frugivores and the proportional abundance of zoochory requires further research, as tree recruitment not only depends on dispersal vectors but also on conditions that favour or limit seedling recruitment across forest types