Results of medium seventeen years' follow-up after laparoscopic choledochotomy for ductal stones

INTRODUCTION: In a previously published article the authors reported the long-term follow-up results in 138 consecutive patients with gallstones and common bile duct (CBD) stones who underwent laparoscopic transverse choledochotomy (TC) with T-tube biliary drainage and laparoscopic cholecystectomy (LC). Aim of this study is to evaluate the results at up to 23 years of follow-up in the same series. METHODS: One hundred twenty-one patients are the object of the present study. Patients were evaluated by clinical visit, blood assay, and abdominal ultrasound. Symptomatic patients underwent cholangio-MRI, followed by endoscopic retrograde cholangiopancreatography (ERCP) as required. RESULTS: Out of 121 patients, 61 elderly patients died from unrelated causes. Fourteen patients were lost to follow-up. In the 46 remaining patients, ductal stone recurrence occurred in one case (2,1%) successfully managed by ERCP with endoscopic sphincterotomy. At a mean follow-up of 17.1 years no other patients showed signs of bile stasis and no patient showed any imaging evidence of CBD stricture at the site of choledochotomy. CONCLUSIONS: Laparoscopic transverse choledochotomy with routine T-tube biliary drainage during LC has proven to be safe and effective at up to 23 years of follow-up, with no evidence of CBD stricture when the procedure is performed with a correct technique

Evolution and Therapy of Brain by Foods Containing Unsaturated Fatty Acids

About 6 million years ago, our ancestors had experienced a tremendous brain growth, widely viewed as a “major adaptive shift” in human evolution. Half of human brain composition is fat and 20% of its dry weight is long‐chain polyunsaturated fatty acids (LCPUFA). Consequently, improvements in consumption of dietary fat were necessary condition for promoting encephalization. Dietary fat quantity and quality have been subjected to tremendous change over the past 10,000 years with the introduction of industrially produced trans fatty acids and reduced intakes of ω‐3 fatty acids. The absolute human brain size reached its peak of approximately 90,000 years ago and has decreased by 11% since 35,000 years ago, most of it (8%) coming in the last 10,000 years. The shortfall in consumption of animal foods since the late Paleolithic and mainly consequent shortfall in consumption of preformed LCPUFA would be the plausible hypothesis for the brain size decreasing. Genetically, we are still adapted to the East African ecosystem on which our genome evolved, with some adaptations since the Out‐of‐Africa Diaspora. Dietary fat quantity and quality change has caused a conflict with our slowly adapting genome and this mismatch is likely to be at the basis of “typically Western” diseases. Many recommendations for the intakes of EPA + DHA have been issued, notably for prevention. However, the ultimate goal might be to return to the fat quality of our ancient diet on which our genes have evolved during the past million years of evolution

OPEN SOURCE COMO ALTERNATIVA NA PROTEÇÃO DO MEIO AMBIENTE: BREVES CONSIDERAÇÕES TEÓRICAS

O trabalho aborda a possibilidade de utilização de Open Source como forma de reduzir descartes de computadores no meio ambiente, dando sobrevida a equipamentos que ainda poderão ser utilizados, utilizando distribuições Linux como forma de manter softwares atualizados em pleno 2023, reduzindo o descartes de eletrônicos ao meio ambiente. Abordará os consórcios que recolhem lixos eletrônicos que estejam inutilizáveis.&nbsp

Active fixation coronary sinus lead in a patient with persistence of left superior vena cava

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Association between neutropenia and response to ramucirumab and paclitaxel in patients with metastatic gastric cancer

PURPOSE: The aim of this study was to evaluate if the occurrence of neutropenia is correlated with response to ramucirumab plus paclitaxel for metastatic gastric cancer.METHODS: This is a retrospective study of patients treated with ramucirumab plus paclitaxel.RESULTS: Fifty-three patients were evaluated. Among these, 10 patients (26.5%) developed grade ≥3 neutropenia. Patients with grade ≥3 neutropenia reported a progression-free survival of 6.6 months (95% confidence interval 3.3-8.4) and overall survival of 11 months (95% confidence interval 5.9-13.1) vs. 4.4 months (95% confidence interval 3.9-5.2) and 8.7 months (95% confidence interval 7.8-10.1) respectively in patients' group with lower grade events.CONCLUSION: Our analysis seems to suggest that the occurrence of neutropenia predicts response to treatment with ramucirumab and paclitaxel.</p

Análise quali-quantitativa e espacial de poluição por microplástico ao longo da praia Tupi, Praia Grande – SP, Brasil: Quali-quantitative and spatial analysis of plastic pollution along praia Tupi, Praia Grande – SP, Brazil

A poluição marinha por plástico se tornou uma ameaça global para animais aquáticos e terrestres. Fragmentos desse material podem viajar pelas correntes oceânicas e chegar a lugares remotos ou parar no fundo dos oceanos, causando desequilíbrios aos ecossistemas e a vida. A magnitude desse problema serviu de inspiração para a realização do presente trabalho que buscou identificar a presença de pequenas partículas de plástico, denominadas micro e mesoplástico, e outros resíduos presentes na areia da Praia Tupi, no município de Praia Grande, em São Paulo. Foram coletadas amostras de areia em três faixas da praia com 30 metros de distância entre elas, sendo o início na face da praia (faixa mais próxima ao mar), na crista do berma (faixa intermediária entre o mar e a avenida) e no berma (mais próxima à avenida). As 21 amostras foram analisadas em laboratório com auxílio de uma peneira para identificação de pequenos fragmentos plásticos. No total foram encontrados 396 microplásticos, 51 mesoplásticos e 17 macroplásticos. A maior quantidade de microplásticos foi encontrada na face da praia, na linha da maré alta. Os macroplásticos concentraram-se no berma, onde há elevada concentração de visitantes. Dentre os microplásticos, 22 eram pellets, cuja presença indica que há fontes de resíduos que não sejam o turismo. Como resultado da ocorrência do plástico na praia foram identificados potenciais impactos ambientais, sociais e econômicos, alguns de caráter irreversível

Metabolic syndrome and dietary components are associated with coronary artery disease risk score in free-living adults: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Coronary artery disease (CAD) is among the main causes of death in developed countries, and diet and lifestyle can influence CAD incidence.</p> <p>Objective</p> <p>To evaluate the association of coronary artery disease risk score with dietary, anthropometric and biochemical components in adults clinically selected for a lifestyle modification program.</p> <p>Methods</p> <p>362 adults (96 men, 266 women, 53.9 ± 9.4 years) fulfilled the inclusion criteria by presenting all the required data. The Framingham score was calculated and the IV Brazilian Guideline on Dyslipidemia and Prevention of Atherosclerosis was adopted for classification of the CAD risks. Anthropometric assessments included waist circumference (WC), body fat and calculated BMI (kg/m²) and muscle-mass index (MMI kg/m²). Dietary intake was estimated through 24 h dietary recall. Fasting blood was used for biochemical analysis. Metabolic Syndrome (MS) was diagnosed using NCEP-ATPIII (2001) criteria. Logistic regression was used to determine the odds of CAD risks according to the altered components of MS, dietary, anthropometric, and biochemical components.</p> <p>Results</p> <p>For a sample with a BMI 28.5 ± 5.0 kg/m²the association with lower risk (<10% CAD) were lower age (<60 years old), and plasma values of uric acid. The presence of MS within low, intermediary, and high CAD risk categories was 30.8%, 55.5%, and 69.8%, respectively. The independent risk factors associated with CAD risk score was MS and uric acid, and the protective factors were recommended intake of saturated fat and fiber and muscle mass index.</p> <p>Conclusion</p> <p>Recommended intake of saturated fat and dietary fiber, together with proper muscle mass, are inversely associated with CAD risk score. On the other hand, the presence of MS and high plasma uric acid are associated with CAD risk score.</p

Shallow geophysics of the Asinara Island Marine Reserve Area (NW Sardinia, Italy)

We present a high-resolution swath bathymetric and backscatter map of the entire sector of the Marine Reserve Area (MRA) of the Asinara Island, along with a geological and sediment thickness map derived from the interpretation of a large set of high-resolution seismic profiles, and an airborne-derived hyperspectral image of the Asinara Island. Acquired data show that most of the eastern marine sector of the Asinara Island is characterized by quite gentle bathymetric gradients, whereas the western coastline appears to be very indented, with an articulated and rough morphology of the seafloor, which deepens sharply towards the open sea. The maps presented in this study at the 1:50.000 scale do not only provide the first, high-resolution bathymetry of the MRA of the Asinara Island but also may furnish the base for the creation of a benthic habitat map and a more comprehensive maritime spatial planning of this protected area

Soluble RAGE Plasma Levels in Patients with Coronary Artery Disease and Peripheral Artery Disease

The objective of the present study was define in a relatively large patient population with coronary artery disease (CAD) whether the concomitant presence of peripheral artery disease (PAD), which is known to convey additional cardiovascular risk, was associated with different circulating levels of sRAGE with respect to CAD alone and control subjects. Clinical and laboratory parameters including the ankle brachial index (ABI) and sRAGE (enzyme-linked immunosorbent assay kit) were investigated in 544 patients with angiographically documented CAD and 328 control subjects. 213/554 CAD patients (39%) showed an ABI <0.9 associated with typical symptoms (group CAD + PAD), whereas 331 patients were free from PAD. The concentration of plasma sRAGE was significantly lower (P < 0.0001) in CAD population, with and without PAD, than in control subjects. Among CAD patients, those with PAD showed lower levels of sRAGE. The distribution of the three groups (CAD, CAD + PAD, and controls) according to sRAGE tertiles showed that lower levels were more frequent in patients with CAD and CAD + PAD, whereas higher levels were more frequently found in controls. CAD patients presenting with PAD have lower sRAGE levels than CAD patients without peripheral atherosclerosis showing that stable atherosclerotic lesions in different vascular districts are inversely related to soluble decoy receptor sRAGE

Metabolic signature of Mycobacterium avium subsp. paratuberculosis infected and infectious dairy cattle by integrating nuclear magnetic resonance analysis and blood indices

The early diagnosis of Mycobacterium avium subsp. paratuberculosis (MAP) is one of the current challenges of farmers and veterinarians. This work aimed to investigate the changes in metabolic levels associated with natural MAP infection in infected and infectious dairy cattle. The study included sera from 23 infectious/seropositive, 10 infected but non-infectious/seronegative, and 26 negative Holstein Fresian cattle. The samples were selected from a collection of samples gathered during a prospective study. The samples were analyzed by quantitative nuclear magnetic resonance (NMR) spectroscopy and routine blood chemistry. The blood indices and the 1H NMR data were concatenated by low-level data fusion, resulting in a unique global fingerprint. Afterwards, the merged dataset was statistically analyzed by the least absolute shrinkage and selection operator (LASSO), which is a shrinkage and selection method for supervised learning. Finally, pathways analysis was performed to get more insights on the possible dysregulated metabolic pathways. The LASSO model achieved, in a 10 time repeated 5-fold cross-validation, an overall accuracy of 91.5% with high values of sensitivity and specificity in classifying correctly the negative, infected, and infectious animals. The pathway analysis revealed MAP-infected cattle have increased tyrosine metabolism and enhanced phenylalanine, tyrosine and tryptophan biosynthesis. The enhanced synthesis and degradation of ketone bodies was observed both in infected and infectious cattle. In conclusion, fusing data from multiple sources has proved to be useful in exploring the altered metabolic pathways in MAP infection and potentially diagnosing negative animals within paratuberculosis-infected herds