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Role of endoscopic vacuum therapy in the management of gastrointestinal transmural defects

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World Journal of Gastrointestinal Endoscopy 2019年第5期11卷 329-344页

作者： Diogo Turiani Hourneaux de Moura Bruna Furia Buzetti Hourneaux de Moura Michael A Manfredi Kelly E Hathorn Ahmad N Bazarbashi Igor braga Ribeiro eduardo Guimaraes Hourneaux de Moura Christopher C Thompson Division of Gastroenterology Hepatology and EndoscopyBrigham and Women’s Hospital-Harvard Medical School Department of Endoscopy of Clinics Hospital of Sao Paulo University Esophageal and Airway Atresia Treatment Center Boston Children's Hospital-Harvard Medical School

A gastrointestinal(GI) transmural defect is defined as total rupture of the GI wall,and these defects can be divided into three categories: perforations,leaks,and fistulas. Surgical management of these defects is usually challenging and may be associated with high morbidity and mortality rates. Recently,several novel endoscopic techniques have been developed,and endoscopy has become a firstline approach for therapy of these conditions. The use of endoscopic vacuum therapy(EVT) is increasing with favorable results. This technique involves endoscopic placement of a sponge connected to a nasogastric tube into the defect cavity or lumen. This promotes healing via five mechanisms,including macrodeformation,microdeformation,changes in perfusion,exudate control,and bacterial clearance,which is similar to the mechanisms in which skin wounds are treated with commonly employed wound vacuums. EVT can be used in the upper GI tract,small bowel,biliopancreatic regions,and lower GI tract,with variable success rates and a satisfactory safety profile. In this article,we review and discuss the mechanism of action,materials,techniques,efficacy,and safety of EVT in the management of patients with GI transmural defects.

关键词： Gastrointestinal Endoscopy Endoscopic vacuum therapy Negative pressure therapy Fistula Leak Perforation Defect

Propofol vs midazolam sedation for elective endoscopy in patients with cirrhosis:A systematic review and meta-analysis of randomized controlled trials

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World Journal of Gastrointestinal Endoscopy 2020年第8期12卷 241-255页

作者： John Alexander Lata Guacho Diogo Turiani Hourneaux de Moura Igor braga Ribeiro Alberto Machado da Ponte Neto Shailendra Singh Marina Gammaro Baldavira Tucci Wanderley Marques Bernardo eduardo Guimarães Hourneaux de Moura Gastrointestinal Endoscopy Unit Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão Paulo 05403-010Brazil Division of Gastroenterology Department of Internal MedicineWest Virginia UniversityCharlestonWV 25304United States

BACKGROUND Patients with cirrhosis frequently require sedation for elective endoscopic *** sedation protocols are available,but choosing an appropriate sedative in patients with cirrhosis is *** To conduct a systematic review and meta-analysis to compare propofol and midazolam for sedation in patients with cirrhosis during elective endoscopic procedures in an attempt to understand the best *** This systematic review and meta-analysis was conducted using the PRISMA *** searches were performed using MEDLINE,EMBASE,Central Cochrane,LILACS *** randomized control trials(RCTs)were *** outcomes studied were procedure time,recovery time,discharge time,and adverse events(bradycardia,hypotension,and hypoxemia).The risk of bias assessment was performed using the Revised Cochrane Risk-of-Bias tool for randomized trials(RoB-2).Quality of evidence was evaluated by *** meta-analysis was performed using Review *** The search yielded 3,576 *** of these,8 RCTs with a total of 596 patients(302 in the propofol group and 294 in the midazolam group)were included for the final *** time was similar between midazolam and propofol groups(MD:0.25,95%CI:-0.64 to 1.13,P=0.59).Recovery time(MD:-8.19,95%CI:-10.59 to-5.79,P<0.00001).and discharge time were significantly less in the propofol group(MD:-12.98,95%CI:-18.46 to-7.50,P<0.00001).Adverse events were similar in both groups(RD:0.02,95%CI:0-0.04,P=0.58).Moreover,no significant difference was found for bradycardia(RD:0.03,95%CI:-0.01 to 0.07,P=0.16),hypotension(RD:0.03,95%CI:-0.01 to 0.07,P=0.17),and hypoxemia(RD:0.00,95%CI:-0.04 to 0.04,P=0.93).Five studies had low risk of bias,two demonstrated some concerns,and one presented high *** quality of the evidence was very low for procedure time,recovery time,and adverse events;while low for discharge *** This systematic review and meta-analysis based on RCTs sh

关键词： Sedation Midazolam Propofol Cirrhosis Endoscopic Endoscopy Metaanalysis

Hybrid Duodenal Transit Bipartition: An Endoscopic and Laparoscopic Metabolic Procedure

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Surgical Science 2024年第10期15卷 547-564页

作者： Paulo Reis Rizzo Esselin de Melo Anna Carolina Hoff Ricardo Zorron Victor Ramos Mussa Dib Carlos Augusto Scussel Madalosso Rui Ribeiro Thonya Cruz braga Fernando Reis Esselin Melo Paula Volpe Carlos eduardo Domene Antonio Torres Paulo Reis Institute Goinia Brazil Alfredo Nasser University Center (UNIFAN) Goinia Brazil Angioskope International Interventional Endoscopy Training Center So Paulo Brazil Department of Bariatric and Metabolic Surgery CUF Descobertas Hospital Lisbon Portugal Victor Dib Institute Manaus Brazil Gastrobese Clinic Passo Fundo Brazil Lusadas Amadora Hospital Lisboa Portugal Clianest Group Renaissance Hospital Goinia Brazil IOM-Intraoperative Medical Services Paulo Reis Institute Braslia Brazil Integrated Center for Advanced Medicine (CIMAMED) So Paulo Brazil Department of Surgery Hospital Clnico San Carlos Madrid Spain Department of Surgery School of Medicine Complutense University Madrid Spain San Carlos Health Research Institute (IdISSC) Madrid Spain

Obesity has been increasing significantly in Brazil and worldwide, becoming a major public health issue. Traditional prevention and treatment strategies, including behavioral interventions, nutritional modifications, physical activity, pharmacotherapy, and metabolic/bariatric procedures, have proven insufficient to reverse this trend. Bariatric surgery is recognized as the most effective treatment for obesity and its comorbidities, but it carries potential long-term risks. Hybrid Duodenal Transit Bipartition is proposed as a minimally invasive “endobariatric” procedure combining endoscopic sleeve gastroplasty (ESG) with laparoscopic duodenoileal or distal duodenojejunal anastomosis. The main objective of this study is to demonstrate the importance of the intestinal metabolic component of hybrid duodenal transit bipartition. This intestinal component is responsible for optimizing and attempting to maintain weight loss and control comorbidities from an ESG through the incretin stimulus generated by the early arrival of food in the ileum or distal jejunum (duodenoileal or distal duodenojejunal anastomosis). Additionally, it is a minimally invasive procedure that preserves the entire digestive system and does not involve gastrointestinal exclusion, allowing for endoscopic and nutritional access. To date, only one patient has undergone the hybrid duodenal bipartition procedure, with satisfactory early postoperative results at 60 days and weight loss exceeding the scientific literature on patients who underwent isolated endoscopic sleeve gastroplasty. Further studies are needed to validate these results and assess the long-term metabolic benefits of this new approach.

关键词： Duodenal Switch Duodenal Transit Bipartition Bariatric Surgery Metabolic Surgery Endoscopic Gastroplasty Endobariatric

Sodium picosulphate or polyethylene glycol before elective colonoscopy in outpatients?A systematic review and meta-analysis

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World Journal of Gastrointestinal Endoscopy 2018年第12期10卷 422-441页

作者： Rodrigo Silva de Paula Rocha Igor braga Ribeiro Diogo Turiani Hourneaux de Moura Wanderley Marques Bernardo Maurício Kazuyoshi Minata Flávio Hiroshi Ananias Morita Júlio Cesar Martins Aquino Elisa Ryoka Baba Nelson Tomio Miyajima eduardo Guimaraes Hourneaux de Moura Gastrointestinal Endoscopy Unit Hospital das Cliicas da Faculdade de Medicina da Universidade de Sao PauloSao Paulo 05403-010Brazil Division of Gastroenterology Hepatology and EndoscopyBrigham and Women’s HospitalHarvard Medical SchoolBostonMA 02115United States

AIM To determine the best option for bowel preparation [sodium picosulphate or polyethylene glycol(PEG)] for elective colonoscopy in adult *** A systematic review of the literature following the PRISMA guidelines was performed using Medline, Scopus, EMBASE, Central, Cinahl and Lilacs. No restrictions were placed for country, year of publication or language. The last search in the literature was performed on November 20th, 2017. Only randomized clinical trials with full texts published were included. The subjects included were adult outpatients who underwent bowel cleansing for elective colonoscopy. The included studies compared sodium picosulphate with magnesium citrate(SPMC)and PEG for bowel preparation. Exclusion criteria were the inclusion of inpatients or groups with specific conditions, failure to mention patient status(outpatient or inpatient) or dietary restrictions, and permission to have unrestricted diet on the day prior to the exam. Primary outcomes were bowel cleaning success and/or tolerability of colon preparation. Secondary outcomes were adverse events, polyp and adenoma detection rates. Data on intention-totreat were extracted by two independent authors and risk of bias assessed through the Jadad scale. Funnel plots, Egger's test, Higgins' test(I2) and sensitivity analyses were used to assess reporting bias and heterogeneity. The meta-analysis was performed by computing risk difference(RD) using MantelHaenszel(MH) method with fixed-effects(FE) and random-effects(RE) *** Manager 5(RevMan 5) version 6.1(The Cochrane Collaboration) was the software chosen to perform the ***662 records were identified but only 16 trials with 6200 subjects were included for the meta-analysis. High heterogeneity among studies was found and sensitivity analysis was needed and performed to interpret data. In the pooled analysis,SPMC was better for bowel cleaning [MH FE, RD 0.03, IC(0.01, 0.05), P = 0.003, I2= 33%, NNT 34], for tole

关键词： Sodium picosulphate Polyethylene glycol Bowel cleaning success Tolerability Colonoscopy Randomized clinical trials Meta-analysis

Regeneration of critical-sized defects, in a goat model, using a dextrin-based hydrogel associated with granular synthetic bone substitute

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Regenerative Biomaterials 2021年第1期8卷 73-82页

作者： Isabel Pereira Jose eduardo Pereira Luis Maltez Alexandra Rodrigues Catarina Rodrigues Manuela Oliveira Dina MSilva Ana Rita Caseiro Justina Prada Ana Colette Mauricio Jose Domingos Santos Miguel Gama CEB Centre of Biological EngineeingUniversity of MinhoCampus de GualtarBraga 4710-057Portugal CECAV Animal and Veterinary Research CentreUniversity of Trias-os-Montes e Alto DouroVila Real 5001-801Portugal Department of Veterinary Sciences University of Tras-os-Montes e Alto DouroVila Real 5001-801Portugal Bios ckin Molecular and Cell Therapies S.A.Laboratorio CriovidaTecMaiaRua Engenheiro Frederico Ulrich 2650Moreira da Maia 4470-605Portugal Departamento de Clinicas Veterinarias Instituto de Ciencias Biomedicas de Abel Salazar(ICBAS)Universidade do Porto(UP)Rua de Jorge Viterbo Ferreiran°228Porto 4050-313Portugal Centro de Estudos de Ciencia Animal(CECA) Instituto de CienciasTecnologias e Agroambiente da Universidade do Porto(ICETA)Rua D.Manuel IApartado 55142Porto 4051-401 Portugal Centro de Investigaqao Vasco da Gama(CIVG)/Escola Universitaria Vasco da Gama(EUVG) Avenida Jose R.Sousa Femandesn°197 LordemaoCoimbra 3020-210Portugal REQUIMTE/LAQV Departamento de Engenharia Metalurgica e MateriaisFaculdade de EngenhariaUniversidade do PortoRua Dr Roberto FriasPorto 4200-495Portugal

The development of injectable bone substitutes(IBS)have obtained great importance in the bone re-generation field,as a strategy to reach hardly accessible defects using minimally invasive techniques and able to fit to irregular *** this scenario,the association of injectable hydrogels and bone graft granules is emerging as a well-established ***,in situ forming hydrogels have arisen as a new IBS *** in situ forming and injectable dextrin-based hydrogel(HG)was developed,aiming to act as a carrier of granular bone substitutes and bioactive *** this work,the HG was associated to a granular bone substitute(Bonelike)and implanted in goat critical-sized calvarial defects(14mm)for 3,6 and *** results showed that HG improved the han-dling properties of the Bonelike granules and did not affect its osteoconductive features,neither impairing the bone regener ation *** multipotent mesenchymal stromal cells from the umbilical cord,extracellular matrix hydrolysates and the pro-angiogenic peptide LLKKK18 were also combined with the *** bioactive agents did not enhance the new bone formation significantly under the conditions tested,according to micro-computed tomography and histological analysis.

关键词： polysaccharide injec table hydrogel granular ceramics Bonelike' bone regen eration calvarial defect

Relationship between Fusobacterium nucleatum,inflammatory mediators and microRNAs in colorectal carcinogenesis

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World Journal of Gastroenterology 2018年第47期24卷 5351-5365页

作者： Marcela Alcantara Proenca Joice Matos Biselli Maysa Succi Fábio eduardo Severino Gustavo Noriz Berardinelli Alaor Caetano Rui Manuel Reis David J Hughes Ana Elizabete Silva Department of Biology UNESPUniv. Estadual PaulistaCampus of Sao Jose do Rio PretoSao Jose do Rio PretoSao Paulo 15054-000Brazil Department of Surgery and Orthopedics Faculty of MedicineUNESPUniv. Estadual PaulistaCampus of BotucatuBotucatuSao Paulo 18618-687Brazil Endoscopy Center of Rio Preto Sao Jose do Rio PretoSao Paulo 15015-700Brazil Molecular Oncology Research Center Barretos Cancer HospitalBarretosSao Paulo 14784-400Brazil Life and Health Sciences Research Institute University of MinhoCampus GualtarBraga 4710-057Portugal ICVS/3B’s-PT Government Associate Laboratory Campus GualtarBraga 4710-057Portugal Cancer Biology and Therapeutics Group UCD Conway InstituteUniversity College DublinDublin D04 V1W8Ireland

AIM To examine the effect of Fusobacterium nucleatum(F. nucleatum) on the microenvironment of colonic neoplasms and the expression of inflammatory mediators and microRNAs(miRNAs).METHODS Levels of F. nucleatum DNA, cytokine gene mRNA(TLR2, TLR4, NFKB1, TNF, IL1 B, IL6 and IL8), and potentially interacting miRNAs(miR-21-3p, miR-22-3p, mi R-28-5p, miR-34a-5p, miR-135b-5p) were measured by quantitative polymerase chain reaction(qPCR) TaqMan? assays in DNA and/or RNA extracted from the disease and adjacent normal fresh tissues of 27 colorectal adenoma(CRA) and 43 colorectal cancer(CRC) patients. KRAS mutations were detected by direct sequencing and microsatellite instability(MSI) status by multiplex PCR. Cytoscape v3.1.1 was used to construct the postulated miRNA:mRNA interaction *** Overabundance of F. nucleatum in neoplastic tissue compared to matched normal tissue was detected in CRA(51.8%) and more markedly in CRC(72.1%). We observed significantly greater expression of TLR4, IL1 B, IL8, and miR-135 b in CRA lesions and TLR2, IL1 B, IL6, IL8, mi R-34 a and miR-135 b in CRC tumours compared to their respective normal tissues. Only two transcripts for miR-22 and miR-28 were exclusively downregulated in CRC tumour samples. The mRNA expression of IL1 B, IL6, IL8 and miR-22 was positively correlated with F. nucleatum quantification in CRC tumours. The mRNA expression of miR-135 b and TNF was inversely correlated. The miRNA:mRNA interaction network suggested that the upregulation of miR-34 a in CRC proceeds via a TLR2/TLR4-dependent response to F. nucleatum. Finally, KRAS mutations were more frequently observed in CRC samples infected with F. nucleatum and were associated with greater expression of miR-21 in CRA, while IL8 was upregulated in MSI-high *** Our findings indicate that F. nucleatum is a risk factor for CRC by increasing the expression of inflammatory mediators through a possible mi RNA-mediated activation of TLR2/TLR4.

关键词： Colorectal cancer Colorectal adenoma Fusobacterium nucleatum Inflammation Cytokines MicroRNAs

Updates in the Diagnosis of Gestational Trophoblast Disease

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Health 2023年第1期15卷 48-58页

作者： Maira de Lima Oliveira Mota Marcela Curvêllo Beltrão Elizabeth Bacha eduardo Fonseca Mascarenhas Filho Maísa Mendonça de Jesus Nelson Henriky Felix Mascarenhas Tallys Leandro Barbosa da Silva Maria Fernanda Telles Pires de Souza Victoria de Oliveira Carmo Borges Séfora Maria Fragoso braga Centro Universitário Tiradentes (UNIT) Maceió Brasil Estácio de Juazeiro do Norte (FMJ) Ceará Brasil Universidade Federal de Alagoas (UFAL) Maceió Brasil Sã o Leopoldo Mandic Campinas Brasil Hospital Regional de Arapiraca Arapiraca Brasil

GTD (Gestational Trophoblastic Disease) is a pathology that encompasses benign and malignant clinical forms, affects women of childbearing age, has a variable incidence and is more frequent in developing or underdeveloped countries, colliding with the economic barrier. The frequent absence of clear protocols and guidelines for the correct diagnosis of the pathology results in inadequate classification, imprecise treatment and failed post-therapeutic observation, increasing the risk of relapses, morbidity and mortality. The present study aims to point out updated national and international practice protocols of diagnosis of GTD, through an integrative review. Seven articles were selected and it was observed that the main international reference centers are agreed with the management suggested by the IFGO (International Federation of Gynecology and Obstetrics), being the conduct in the Hydatidiform Mole (HM): evacuation by suction and curettage under ultrasound guidance, followed by hCG monitoring every 1 - 2 weeks until normalized (usually one month for Partial Hydatidiform Mole six months for Complete Hydatidiform Mole and one year for Gestational Trophoblastic Neoplasia). Unfortunately, regarding the diagnosis of MH, the guidelines of some countries show the absence or difficulty of access to the karyotype test and ploid p57 or pelvic ultrasound accompanying the uterine curettage, contrary to what is proposed by the IFGO guideline. Establishing and complying with consistent guidelines can improve patient care, with early diagnosis of the pathology and its complications, reducing the rate of recurrence, morbidity and mortality, especially in less developed countries.

关键词： Diagnosis Gestational Trophoblastic Disease Updates

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Jardim Edite社会性住宅综合体

新建筑 2015年第6期 90-90页

作者： Marta Moreira Milton braga Fernando de Mello Franco eduardo Ferroni Pablo Hereú 王玺 MMBB建筑师事务所 H+F建筑师事务所华中科技大学建筑与城市规划学院

Jardim Edite社会性住宅综合体项目是受托安置圣保罗城市内一个近来显著发展的商业金融区内的贫民。为了确保能整合该住宅综合体和富裕的周边环境,该项目将住宅功能竖向地安排在建筑上层,而地面部分完全用于公共设施。公共设施既可供居... 详细信息

Jardim Edite社会性住宅综合体项目是受托安置圣保罗城市内一个近来显著发展的商业金融区内的贫民。为了确保能整合该住宅综合体和富裕的周边环境,该项目将住宅功能竖向地安排在建筑上层,而地面部分完全用于公共设施。公共设施既可供居住社区使用也可服务于周边的城市群体,给该区域的经济活动和日常生活提供了综合设施。

关键词：住宅功能综合体社会性公共设施周边环境居住社区经济活动城市