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Surgical site infection following pancreaticoduodenectomy in a referral cancer center in Mexico

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Hepatobiliary & Pancreatic Diseases International 2024年第5期23卷 502-508页

作者： Rodrigo Villaseñor-Echavarri Javier Melchor-Ruan Mercedes Aranda-Audelo gabriela Arredondo-Saldaña Patricia Volkow-fernandez Maria del Carmen Manzano-Robleda Alejandro E Padilla-Rosciano Diana Vilar-Compte Department of Infectious Diseases Instituto Nacional de CancerologíaAv.San Fernando 22Belisario Domínguez Secc 16TlalpanMexico CityMexico School of Medicine Universidad PanamericanaAugusto Rodin No.498Insurgentes MixcoacBenito JuárezMexico CityMexico Department of Digestive Tube and Hepatopancreatobiliary Tumors Instituto Nacional de CancerologíaAv.San Fernando 22Belisario Domínguez Secc 16TlalpanMexico CityMexico Department of Infectious Diseases Hospital Manuel Gea GonzálezCalz.de Tlalpan 4800Belisario Domínguez Secc 16TlalpanMexico CityMexico Gastrointestinal and Endoscopy Department Instituto Nacional de CancerologíaAv.San Fernando 22Belisario Domínguez Secc 16TlalpanMexico CityMexico

Background: Pancreaticoduodenectomy is the standard treatment for resectable periampullary cancer. Surgical site infections(SSI) are common complications with increased morbidity. The study aimed to describe the prevalence, risk factors, microbiology, and outcomes of SSI among patients undergoing pancreaticoduodenectomy. Methods: We conducted a retrospective study in a referral cancer center between January 2015 and June 2021. We analyzed baseline patient characteristics and SSI occurrence. Culture results and susceptibility patterns were described. Multivariate logistic regression was used to determine risk factors, proportional hazards model to evaluate mortality, and Kaplan-Meier analysis to assess long-term survival. Results: A total of 219 patients were enrolled in the study;101(46%) developed SSI. Independent factors for SSI were diabetes mellitus, preoperative albumin level, biliary drainage, biliary prostheses, and clinically relevant postoperative pancreatic fistula. The main pathogens were Enterobacteria and Enterococci. Multidrug-resistance rate in SSI was high but not associated with increased mortality. Infected patients had higher odds of sepsis, longer hospital stay and intensive care unit stay, and readmission rate. Neither 30-day mortality nor long-term survival was significantly different between infected and non-infected patients. Conclusions: SSI prevalence among patients undergoing pancreaticoduodenectomy was high and largely caused by resistant microorganisms. Most risk factors were related to preoperative instrumentation of the biliary tree. SSI was associated with greater risk of unfavorable outcomes;however, survival was unaffected.

关键词： Surgical site infection Pancreaticoduodenectomy Pancreatic cancer Endoscopic biliary drainage Biliary prosthesis

Motivational and Methodological factors Involved in the Helping Behavior Test in Laboratory Rodents

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Journal of Behavioral and Brain Science 2024年第8期14卷 240-254页

作者： gabriela f. Marinho Jaqueline M. Wuo João Paulo Kurita Alvaro C. Lima Regina H. Silva Pharmacology Department Federal University of So Paulo So Paulo Brazil

Empathy allows humans and other animals to share the emotional state of another, adopting that individual’s perspective on a given situation. This ability is fundamental for species living in groups. Helping behavior in laboratory animals has been used to study empathy. In this test, subjects are exposed to a conspecific that is trapped and learn to open the cage to release the other animal. However, the interpretation of helping behavior as an emphatically motivated action is still controversial. Here we review the studies that use the helping behavioral test proposed by Ben-Ami Bartal and colleagues in 2011 to better understand motivational factors for this behavior. In addition, we compare methodological aspects of these studies. In conclusion, helping behavior can be driven by empathy, but other factors such as the desire for social contact and learning components cannot be ruled out as motivators. In addition, studies focused on evaluating neurobiological mechanisms underlying helping behavior in laboratory rodents can help elucidate the factors involved in releasing the trapped co-specific.

关键词： Animal Models Empathy Prosocial Behavior Rats

Improving the training abilities of ophthalmic educators: the Ophthalmology foundation’s initiatives

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Annals of Eye Science 2024年第1期9卷 1-3页

作者： Karl Golnik Yip Chee Chew gabriela Palis Meenakshi Swaminathan Department of Ophthalmology at the University of Cincinnati CincinnatiOHUSA. Department of Ophthalmology and Visual Sciences Khoo Teck Puat HospitalSingaporeSingapore Ophthalmology Department Hospital Italiano de Buenos AiresBuenos AiresArgentina Capstone Clinic ChennaiIndia Sri Ramachandra Medical College ChennaiIndia

Our goal as medical educators is for our students to learn what they need to know and competently perform ophthalmic *** addition,the students need to have good communication skills and behave professionally and ethically(1,2).Most medical educators are not taught how to teach but rather learn by role-modeling their *** can be good or bad depending on the mentor!In addition,the amount of knowledge and numbers of surgical procedures is ever increasing and yet,in most countries,the amount of time to train and become competent is not ***,our goal of creating competent ophthalmologists is ever more challenging.

关键词： Ophthalmology foundation teaching skills feedback

Association of donor hepatectomy time with liver transplantation outcomes: A multicenter retrospective study

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World Journal of Transplantation 2024年第1期14卷 130-140页

作者： Geisiane Custodio Andrew Maykon Massutti Aline Caramori Taynara Gonçalves Pereira Augusto Dalazen gabriela Scheidt Ludmilla Thomazini Cristiane Bauermann Leitão Tatiana Helena Rech Department of Intensive Care Unit Hospital Santa IsabelBlumenau-Santa Catarina CEP-89010906Brazil Transplant Division Hospital Santa IsabelBlumenau-Santa Catarina CEP-89010906Brazil School of Medicine Universidade Regional de Blumenau(FURB)Blumenau-Santa Catarina CEP-89010906Brazil School of Medicine Universidade Federal do Rio Grande do SulPorto Alegre 90035-903Brazil Departement of Endocrinology Hospital de Clínicas de Porto Alegre/Universidade Federal do Rio Grande do SulPorto Alegre 90035-903Rio Grande do SulBrazil Department of Internal Medicine Hospital de Clínicas de Porto AlegreDivision of Intensive Care MedicinePorto Alegre 90035-903Brazil

BACKGROUND Prolonged donor hepatectomy time may be implicated in early and late complications of liver *** To evaluate the impact of donor hepatectomy time on outcomes of liver transplant recipients,mainly early allograft *** This multicenter retrospective study included brain-dead donors and adult liver graft ***-recipient matching was obtained through a crossover *** and laboratory data were recorded for both donors and *** hepatectomy,cold ischemia,and warm ischemia times were *** outcome was early allograft *** outcomes included need for retransplantation,length of intensive care unit and hospital stay,and patient and graft survival at 12 *** from January 2019 to December 2021,a total of 243 patients underwent a liver transplant from a brain-dead *** these,57(25%)developed early allograft *** median donor hepatectomy time was 29(23–40)*** with early allograft dysfunction had a median hepatectomy time of 25(22–38)min,whereas those without it had a median time of 30(24–40)min(P=0.126).CONCLUSION Donor hepatectomy time was not associated with early allograft dysfunction,graft survival,or patient survival following liver transplantation.

关键词： Brain death Hepatectomy Liver transplantation Early allograft dysfunction Graft survival

Biliary complications associated with weight loss,cholelithiasis and choledocholithiasis

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2024年第4期15卷 1-8页

作者： Marcelo A Ribeiro Jr gabriela K Tebar Helena B Niero Leticia S Pacheco Department of Surgery Division of TraumaCritical Care and Acute Care SurgerySheikh Shakhbout Medical CityAbu Dhabi 11001United Arab Emirates Department of Surgery Pontifical Catholic University of São Paulo-Campus SorocabaSorocaba 18030070SPBrazil

Biliary complications like cholelithiasis and choledocholithiasis are more common in bariatric surgery patients due to obesity and rapid weight *** with a body mass index>40 face an eightfold risk of developing *** surgery,especially after laparoscopic Roux-en-Y gastric bypass(LRYGB),30%of patients develop biliary disease due to rapid weight *** aim of this review is to analyze the main biliary complications that occur after bariatric surgery and its management.A review of the literature was conducted mainly from 2010 up to 2023 with regard to biliary complications associated with bariatric patients in SciELO,PubMed,and *** undergoing LRYGB have a higher incidence(14.5%)of symptomatic calculi post-surgery compared to those undergoing laparoscopic sleeve gastrectomy at 4.1%.Key biliary complications within 6 to 12 months post-surgery include:Cholelithiasis:36%;Biliary colic/dyskinesia:3.86%;Acute cholecystitis:0.98%-18.1%;Chronic cholecystitis:70.2%;Choledocholithiasis:0.2%-5.7%and Pancreatitis:0.46%-9.4%.Surgeons need to be aware of these complications and consider surgical treatments based on patient symptoms to enhance their quality of life.

关键词： Bariatric surgery Complications Choledocholithiasis Cholelithiasis Acute cholecystitis

Analysis of Perinatal Outcomes of Twin Pregnancy in a Referral Hospital for High Risk

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Open Journal of Obstetrics and Gynecology 2024年第7期14卷 983-995页

作者： Eduarda Paim Pedro Lucas Carneiro ferreira Luciano Selistre fernanda Grossi José Mauro Madi gabriela françoes Rostirolla Mdica Residente do Programa de Residncia em Ginecologia e Obstetrcia Hospital Geral de Caxias do Sul Rio Grande do Sul Brasil faculdade de Medicina Universidade de Caxias do Sul Rio Grande do Sul Brasil Programa de Ps-Graduao Universidade de Caxias do Sul Rio Grande do Sul Brasil Servio de Ginecologia e Obstetrcia Hospital Geral de Caxias do Sul Rio Grande do Sul Brasil

Introduction: The incidence of twin pregnancies has increased significantly in recent decades. These pregnancies require more attention due to their worse outcomes than singleton pregnancies. Objective: To analyze the characteristics and perinatal outcomes of twin pregnancies at the Caxias do Sul General Hospital. Methods: This is a descriptive and retrospective study that included all births related to twin pregnancies between March 1998 and June 2018. Maternal and perinatal variables were analyzed. Descriptive analyses were carried out using measures of central tendency and dispersion for continuous variables (mean and standard deviation or median and interquartile range), according to a prior assessment of distribution using the Shapiro-Wilk test, and absolute (n) and relative (n%) frequencies for categorical variables. Results: 172 pairs of twins/21,972 births (0.8%) were identified. There was a high percentage of interpartum interval of less than 12 months, adherence and prenatal visits, body mass index, and need for neonatal intensive care. Stillbirth and neomortality rates were within acceptable parameters. Conclusion: The sample studied showed a percentage similar to that in the literature, a high rate of maternal and perinatal complications, characterizing it as a high-risk fetal pregnancy.

关键词： Pregnancy Twin Pregnancy High Risk Pregnancy Morbidity Perinatal Mortality Perinatal Results

A randomized,fellow eye,comparison of keratometry,aberrometry,tear film,axial length and the anterior chamber depth after eye rubbing in non-keratoconic eyes

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Eye and Vision 2017年第1期4卷 106-113页

作者： Jordan V.Chervenkoff Elizabeth Hawkes gabriela ortiz Deborah Horney Mayank A.Nanavaty Sussex Eye Hospital Brighton&Sussex University Hospitals NHS TrustEastern RoadBrighton BN25BFUK

Background:To investigate the effect of eye rubbing on keratometry(K),aberrometry,tear film break-up-time(TfBUT)and anterior chamber depth(ACD).Methods:Volunteers without any corneal pathology or dry eyes were randomised to rubbing in one eye and the fellow-eye was *** rubbing was performed for 2 *** outcomes studied were anterior and posterior K *** outcomes were changes in TfBUT,axial length(AL)&ACD,K changes in various zones,asphericity and *** and post rubbing K,aberrometry,ACD and TfBUT were assessed in a predetermined *** relationship of the above parameters to axial length(AL)was also *** was analysed using vector ***:Pre versus post rubbing,anterior flatter K further flattened(42.51±1.52 D vs.42.36±1.53 D,p=0.003)and the changes to J0 vector in central cornea(−0.16±0.26 D vs.-0.27±0.33 D,p=0.038)suggested change to against-the-rule(ATR)*** was significant change in Z^(+2)_(2) polynomial following *** found a positive correlation between axial length and change in posterior K(r=0.335,p=0.020).The TfBUT reduced following eye rubbing(15.3 s vs.13.9 s,p=0.0001).There was a positive correlation between AL and increase in ACD post rubbing(r=0.300,p=0.038).There was a positive correlation between ACD and change in mean posterior K(r=0.305,p=0.035).Conclusions:In healthy eyes,following eye rubbing,there is a significant change in TfBUT and central anterior K changes towards ATR *** eyes had more changes in posterior K and ***,eyes with deeper ACD showed more steepness of posterior K.

关键词： Eye rubbing Ectasia Tear film break up time Astigmatism Aberrations

Inflammasome links traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease

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Neural Regeneration Research 2025年第6期20卷 1644-1664页

作者： gabriela Seplovich Yazan Bouchi Juan Pablo de Rivero Vaccari Jennifer C.Munoz Pareja Andrew Reisner Laura Blackwell Yehia Mechref Kevin K.Wang J.Adrian Tyndall Binu Tharakan firas Kobeissy Department of Surgery Morehouse School of MedicineAtlantaGAUSA Department of Neurobiology Center for NeurotraumaMultiomics&Biomarkers(CNMB)Neuroscience InstituteMorehouse School of MedicineAtlantaGAUSA Department of Neurological Surgery and the Miami Project to Cure Paralysis University of Miami Miller School of MedicineMiamiFLUSA Division of Pediatric Critical Care Department of PediatricsUniversity of Miami Miller School of MedicineMiamiFLUSA Department of Pediatrics Emory UniversityAtlantaGAUSA Department of Neurosurgery Children’s Healthcare of AtlantaAtlantaGAUSA Department of Chemistry and Biochemistry Texas Tech UniversityLubbockTXUSA Morehouse School of Medicine AtlantaGAUSA

Traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease are three distinct neurological disorders that share common pathophysiological mechanisms involving neuroinflammation. One sequela of neuroinflammation includes the pathologic hyperphosphorylation of tau protein, an endogenous microtubule-associated protein that protects the integrity of neuronal cytoskeletons. Tau hyperphosphorylation results in protein misfolding and subsequent accumulation of tau tangles forming neurotoxic aggregates. These misfolded proteins are characteristic of traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease and can lead to downstream neuroinflammatory processes, including assembly and activation of the inflammasome complex. Inflammasomes refer to a family of multimeric protein units that, upon activation, release a cascade of signaling molecules resulting in caspase-induced cell death and inflammation mediated by the release of interleukin-1β cytokine. One specific inflammasome, the NOD-like receptor protein 3, has been proposed to be a key regulator of tau phosphorylation where it has been shown that prolonged NOD-like receptor protein 3 activation acts as a causal factor in pathological tau accumulation and spreading. This review begins by describing the epidemiology and pathophysiology of traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease. Next, we highlight neuroinflammation as an overriding theme and discuss the role of the NOD-like receptor protein 3 inflammasome in the formation of tau deposits and how such tauopathic entities spread throughout the brain. We then propose a novel framework linking traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease as inflammasomedependent pathologies that exist along a temporal continuum. finally, we discuss potential therapeutic targets that may intercept this pathway and ultimately minimize long-term neurological decline.

关键词： Alzheimer's disease caspase-1 chronic traumatic encephalopathy inflammasomes neurodegeneration neuroinflammation NLRP1 NLRP3 pyroptosis tauopathy traumatic brain injury

Malnutrition negatively impacts the quality of life of patients with cirrhosis: An observational study

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World Journal of Hepatology 2017年第5期9卷 263-269页

作者： gabriela Rojas-Loureiro Alfredo Servín-Caamano Elizabeth Pérez-Reyes Luis Servín-Abad fátima Higuerade la Tijera Liver Clinic Gastroenterology DepartmentHospital General de México“Dr.Eduardo Liceaga” Internal Medicine Department Hospital General de México“Dr.Eduardo Liceaga” Gastroenterologist at Lakeland Regional Medical Center

AIMTo verify how malnutrition is related to health-related quality of life (HRQL) impairment in patients with cirrhosis. METHODSData was retrospectively abstracted from medical records and obtained by direct interview. We included patients with cirrhosis from any etiology, evaluated at the Liver Clinic from Gastroenterology Department in a tertiary healthcare center, from June 2014 to June 2016. Child-Pugh score, data about complications, and demographic, clinical and anthropometric characteristics of patients were obtained. Nutritional status was evaluated by the Subjective Global Assessment (SGA). HRQL was evaluated through the Chronic Liver Disease Questionnaire. Patients were requested to assess their global HRQL with the following code: 0 = impairment of HRQL, when it was compared with other healthy subjects; 1 = good HRQL, if it was similar to the quality of life of other healthy subjects. To compare the primary outcome between malnourished and well-nourished groups, the χ2 test, fisher’s exact test or Student’s t-test were used, based on the variable type. Associations between predictor variables and deterioration of HRQL were determined by calculating the hazard ratio and 95% confidence interval using Cox proportional hazards regression. RESULTSA total of 127 patients with cirrhosis were included, and the mean age was 54.1 ± 12.3 years-old. According to Child-Pugh scoring, 25 (19.7%) were classified as A (compensated), 76 (59.8%) as B, and 26 (20.5%) as C (B/C = decompensated). According to SGA, 58 (45.7%) patients were classified as well-nourished. Sixty-nine patients identified HRQL as good, and 76 patients (59.8%) perceived impairment of their HRQL. Multivariate analysis to determine associations between predictor variables and self-perception of an impairment of HRQL found strong association with malnutrition (P P CONCLUSIONMalnutrition is a key factor related to impairment of HRQL in patients with cirrhosis.

关键词： Malnutrition Subjective global assessment Health-related quality of life Cirrhosis Chronic liver disease questionnaire