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Gastric Bypass with Long Pouch and Transit Bipartition for Endoscopic Access to the Remaining Stomach

Surgical Science 2022年第8期13卷 353-366页

作者： Paulo Reis Esselin de Melo Marcella Giovana Gava-Brandolis Thonya Cruz Braga danilo Fossalussa Minari ricardo augusto martins bueno da costa Jose Geraldo Moraes Sampaio Neto Louise Flores Silva José Humberto Cardoso Resende Hospital Estadual Alberto Rassi Surgical Skills Coordinator Goi&#226nia Brazil UNIFAN Research Coordinator Aparecida de Goi&#226nia Brazil

Introduction: obesity has a complex and multifactorial etiology, difficult treatment and increasing incidence rates in recent decades. The treatment involves clinical and pharmacological approaches and, in case of lack of results, surgical interventions. Roux-en-Y gastric bypass (RYGB) is one of these surgical interventions in which the stomach is divided, creating a small pouch, and the remaining portion of the stomach become excluded and left without endoscopic access. Objective: to evaluate the results of modified RYGB with long pouch and endoscopic access to the remaining stomach. Materials and Methods: prospective clinical trial with sample selected among patients seen at the Alberto Rassi General State Hospital of Goiânia (HGG) and indicated for bariatric and metabolic surgery confirmed by the medical and multidisciplinary team. The study was conducted from January 2020 to August 2021. Clinical history and laboratory test results of the selected patients were collected through consultations with the medical and multidisciplinary team. Results: twelve participants were included in the study. Of these, 11 (91.7%) were women and the mean age was 46.3 years. The weight before surgery was 112.17 kg (92.00 - 150.00) and the Body Mass Index (BMI) was 44.89 (35.06 - 74.39). After 18 months of surgery, the mean weight was 80.77 kg (±11.92) and the mean BMI was 29.46 (±11.00), showing a significant reduction in both (p = 0.003 and p = 0.002, respectively). All patients underwent endoscopic evaluation of the pouch, remaining stomach and duodenum at 12 months postoperatively. The mean percentage of lost excess weight loss was 68.21%. Conclusion: We conclude that the proposed changes in RYGB (GBLP + GIB – Roux-en-Y gastric bypass with long pouch and gastrointestinal bipartition) did not compromise weight loss or control of type 2 diabetes and other comorbidities and proved to be a safe and effective alternative without gastroduodenal exclusion, enabling a better postop

关键词： Obesity Bariatric Surgery Metabolic Surgery Roux-En-Y Gastric Bypass

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Gastric Bypass with Long Pouch and Transit Bipartition for Endoscopic Access to the Remaining Stomach

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Surgical Science（外科学） 2022年第8期

作者： paulo reis esselin de melo marcella giovana gava-brandolis thonya cruz braga danilo fossalussa minari ricardo augusto martins bueno da costa jose geraldo moraes sampaio neto louise flores silva josé humberto cardoso resende

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Technical Evaluation of Hybrid Clones of Corymbia spp. to Produce Market Pulp

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Paper And Biomaterials 2022年第3期7卷 1-6页

作者： Marcelo Moreira da costa ricardo de Carvalho Bittencourt Thales augusto Pinto Coelho Nogueira Larissa Soares Silva Weslley Henrique martins da Silva Sebastião Renato Valverde Gleison augusto Dos Santos daniel Alexander Fernandes Coelho Claudilene Aparecida Alves Pena Department of Forest Sciences Federal University of VicosaVicosaMinas Gerais36570900Brazil Aperam BioEnergia Co. CapelinhaMinas Gerais39680000Brazil

This study presents hybrid clones of Corymbia *** by Aperam BioEnergia as potential substitutes for Eucalyptus wood in the pulp *** biomass of Eucalyptus *** compared with that of Corymbia *** performing modified kraft pulping and basic density *** were made by analyzing their respective mean annual increments of cellulose(MAI_(cel))and specific wood consumption(SWC),estimated using a kappa number of(19±1).The results showed that one of the hybrid clones(Corymbia citriodora×Corymbia torelliana,ID 4)had higher basic wood density,higher screened yield,better MAI_(cel#k19),and lower SWC than the other samples,reaching values of 0.608 t/m^(3),54.1%,24.6 ADt/ha/year(i.e.,air dry ton/hectare/year),and 2.74 m^(3)/ADt,***,clone ID 4 had the highest MAI_(cel)/SWC ratio score(8.98).Given its high forest productivity and low industrial cost compared with other samples,as well as its advantages over Eucalyptus ***,we concluded that clone ID 4 has great potential as an alternative biomass for pulp production.

关键词： Corymbia hybrids modified kraft pulping mean annual increments of cellulose(MAIcel) specific wood consumption(SWC)

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Hepatobiliary phases in magnetic resonance imaging using liverspecific contrast for focal lesions in clinical practice

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World Journal of Hepatology 2022年第7期14卷 1459-1469页

作者： daniel Alvarenga Fernandes Eduardo Andreazza dal Lago Felipe Aguera Oliver Bruna Melo Coelho Loureiro daniel Lahan martins Thiago José Penachim ricardo Hoelz de Oliveira Barros José de ArimatéiaBatista Araújo Filho Larissa Bastos Eloy da costa Áurea Maria Oliveira da Silva Elaine Cristina de Ataíde Ilka de Fátima Santana Ferreira Boin Nelson Marcio Gomes Caserta Department of Radiology School of Medical SciencesUniversity of Campinas-UNICAMPCampinas 13083-888São PauloBrazi Department of Radiology Medical SchoolSão Paulo State University-UNESPBotucatu 18618-970São PauloBrazil Instituto de Radiologia Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo-InRad/HC-FMUSPSão Paulo 05403-010SPBrazil Department of Radiology Sírio-Libanês HospitalSão Paulo 05652-900SPBrazil Department of Pathology School of Medical SciencesUniversity of Campinas-UNICAMPCampinas 13083-888São PauloBrazil Liver Transplant Unit Department of SurgerySchool of Medical SciencesUniversity of Campinas-UNICAMPCampinas 13083-888São PauloBrazil

BACKGROUND Challenging lesions,difficult to diagnose through non-invasive methods,constitute an important emotional burden for each patient regarding a still uncertain diagnosis(malignant x benign).In addition,from a therapeutic and prognostic point of view,delay in a definitive diagnosis can lead to worse *** of the main innovative trends currently is the use of molecular and functional methods to *** liver-specific contrast agents havebeen developed and studied in recent years to improve the performance of liver magnetic resonance imaging(MRI).More recently,one of the contrast agents introduced in clinical practice is gadoxetic acid(gadoxetate disodium).AIM To demonstrate the value of the hepatobiliary phases using gadoxetic acid in MRI for the characterization of focal liver lesions(FLL)in clinical *** Overall,302 Lesions were studied in 136 patients who underwent MRI exams using gadoxetic acid for the assessment of *** radiologists independently reviewed the MRI exams using four stages,and categorized them on a 6-point scale,from 0(lesion not detected)to 5(definitely malignant).The stages were:stage 1-images without contrast,stage 2-addition of dynamic phases after contrast(analogous to usual extracellular contrasts),stage 3-addition of hepatobiliary phase after 10 min(HBP 10’),stage 4-hepatobiliary phase after 20 min(HBP 20’)in addition to stage *** The interobserver agreement was high(weighted Kappa coefficient:0.81-1)at all stages in the characterization of benign and malignant *** diagnostic weighted accuracy(Az)was 0.80 in stage 1 and was increased to 0.90 in stage *** of the hepatobiliary phase increased Az to 0.98 in stage 3,which was also 0.98 in stage *** The hepatobiliary sequences improve diagnostic *** growing potential in the era of precision medicine,the improvement and dissemination of the method among medical specialties can bring benefits in the management of patients w

关键词： Liver Liver neoplasms Liver transplantation Medical oncology Diagnostic imaging Magnetic resonance imaging

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Endoscopic management and prevention of migrated esophageal stents

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World Journal of Gastrointestinal Endoscopy 2014年第2期6卷 49-54页

作者： Bruno da costa martins Felipe Alves Retes Bruno Frederico Medrado Marcelo Simas de Lima Caterina Maria Pia Simione Pennacchi Fabio Shiguehissa Kawaguti Adriana Vaz Safatle-Ribeiro ricardo Sato Uemura Fauze Maluf-Filho Department of Gastroenterology Endoscopy DivisionCancer Institute of the University of So Paulo

The use of self-expandable metallic stents has increased recently to palliate inoperable esophageal neoplasia and also in the management of benign strictures. Migration is one of the most common complications after stent placement and the endoscopist should be able to recognize and manage this situation. Several techniques for managing migrated stents have been described, as well as new techniques for preventing stent migration. Most stents have a "lasso" at the upper flange which facilitates stent repositioning or removal. An overtube, endoloop and large polypectomy snare may be useful for the retrieval of stents migrated into the stomach. External fixation of the stent with Shim's technique is efficient in preventing stent migration. Suturing the stent to the esophageal wall, new stent designs with larger flanges and double-layered stents are promising techniques to prevent stent migration but they warrant validation in a larger cohort of patients.

关键词： Endoscopy Stents Esophageal cancer Benign strictures Complications

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Neuromuscular Electrical Stimulation in Intensive Care Unit Patients:Integrative Review

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Modern Research in Inflammation 2019年第2期8卷 11-27页

作者： Miriam Viviane Baron Marcus Vinicius de Mello Pinto Janine Koepp Cristine Brandenburg Paulo ricardo martins Amanda Correa dos Santos daniela Moraes Carolina Goncalves Pinheiro Nathália Ken Pereira Iketani Bartira Ercilia Pinheiro da costa Nephrology Laboratory Department of Postgraduate of Medicine and Health SciencesSchool of MedicinePontifical Catholic University of Rio Grande do SulPorto AlegreBrazil Celulare Institute Rio de JaneiroBrazil Nursing Course Department of Nursing and DentistryUniversity of Santa Cruz do SulSanta Cruz do SulBrazil Postgraduate Program in Brazilian Education Department of Fundamentals of EducationFederal University of CearáFortalezaBrazil School of Medicine Pontifical Catholic University of Rio Grande do SulPorto AlegreBrazil Physiotherapy Course Department of PhysiotherapyVale do Salgado FacultyIcóBrazil Department of Physiotherapy Dom Luiz I Hospital-Portuguese Beneficent of BelemParaBrazil

Intensive care units’ acquired muscle weakness is present in approximately 50% of the patients. Although active muscle training can attenuate weakness, a large proportion of critical patients cannot participate in any active mobilization. Neuromuscular electrical stimulation may be an alternative strategy to reverse muscle weakness. The objective of the study was to review the scientific publications on the use of neuromuscular electrical stimulation and its parameters and the main results in patients hospitalized in intensive care units. This is an integrative review surveying studies in online databases. The studies were selected from the following descriptors: neuromuscular electrical stimulation AND parameters AND intensive care units AND muscle weakness. The inclusion criteria included articles that addressed the topic of neuromuscular electrical stimulation and the parameters used in patients admitted to intensive care units, aged 18 years or older. Exclusion criteria were studies involving animals, case reports, letters to the editor and book chapters. The search comprised articles in the Portuguese, English and Spanish languages from January 2013 to March 2019. Of the 185 articles identified, nine met the eligibility criteria. The studies were evaluated assessing the level of evidence, and the relevant information was presented in the table and discussed. The parameters of the neuromuscular electrical stimulation employed in the studies showed positive results for the maintenance of strength and muscle mass. There was evidence of benefits in the local and systemic microcirculation, potentially mobilizing endothelial stem cells, to prevent atrophy, to reduce mechanical ventilation time and stay in intensive care unit;and when incorporated into the usual physiotherapy care, proved to be more effective than usual care. Its use is safe and viable in critically ill patients.

关键词： Muscle Weakness Critical Illness Polyneuropathy Sepsis Electric Stimulation Therapy Physical Therapy Modalities

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Risk factors associated with inflammatory bowel disease: A multicenter case-control study in Brazil

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World Journal of Gastroenterology 2020年第25期26卷 3611-3624页

作者： Valéria Cristina Loureiro Salgado Ronir Raggio Luiz Neio Lucio Fernandes Boéchat Isabella Sued Leao Bianca do Carmo Schorr JoséMiguel Luz Parente daniela Calado Lima Eduardo Santos Silveira Júnior Genoile Oliveira Santana Silva Neogélia Pereira Almeida Andrea Vieira Maria Luiza Queiroz de bueno Júlio Maria Chebli érika Ruback Bertges Luísa martins da costa Brugnara Columbano Junqueira Neto Stefania Burjack Gabriel Campbell Luana Letiza Discacciati Joao Paulo Silva Cézar Tiago Nunes Gilaad G Kaplan Cyrla Zaltman Division of Gastroenterology Department of Internal MedicineClementino Fraga Filho HospitalFederal University of Rio de JaneiroRio de Janeiro 21940-230Brazil Institute for Studies in Public Health Federal University of Rio de JaneiroRio de Janeiro 21940-230Brazil Multidisciplinary Research Laboratory Clementino Fraga Filho HospitalInstitute of Thoracic DiseasesFaculty of MedicineFederal University of Rio de JaneiroRio de Janeiro 21940-230Brazil Division of Gastroenterology Department of Internal MedicineHospital UniversityFaculty of MedicineFederal University of PiauíPiauí64049-550Brazil Almeida Division of GastroenterologyInflammatory Bowel Disease Outpatient ClinicRoberto Santos General Hospital(HGRS)of the Bahia State Department of HealthBahia 40110-060Brazil Division of Gastroenterology Inflammatory Bowel Disease Outpatient ClinicIrmandade Santa Casa da Misericórdia of São PauloSão Paulo 01221020Brazil Division of Gastroenterology Department of Internal MedicineHospital UniversityFaculty of MedicineFederal University of Juiz de ForaMinas Gerais 36036-247Brazil Division of Gastroenterology Inflammatory Bowel Disease Outpatient ClinicFederal District Base HospitalBrasília 70330-150Brazil Gastrointestinal Physiology Institute of Nutritional ScienceNestle Research CenterLausanne 1000Switzerland Departments of Medicine and Community Health Sciences University of CalgaryCalgary T2N4Z6Canada

BACKGROUND The etiology of inflammatory bowel disease(IBD)is unknown,but it is believed to be *** hygiene hypothesis proposes that better hygiene conditions would lead to less infectious disease during childhood and favor the development of immune-mediated *** To test the hygiene hypothesis in IBD by assessing the environmental risk factors associated with IBD development in different regions of Brazil with diverse socioeconomic development *** A multicenter case-control study was carried out with 548 Crohn’s disease(CD)and 492 ulcerative colitis(UC)outpatients and 416 healthy controls,from six IBD centers within different Brazilian states at diverse socioeconomic development stages.A semi-structured questionnaire with 87 socioeconomic and environmental questions was *** regression model was created to assess the odds ratio(OR)with P value and 95%confidence intervals(CI).RESULTS Predictive variables for both diseases(CD and UC)were women[odd ratios(OR)=1.31;OR=1.69],low monthly family income(OR=1.78;OR=1.57),lower number of cohabitants(OR=1.70;OR=1.60),absence of vaccination(OR=3.11;OR=2.51),previous history of bowel infections(OR=1.78;OR=1.49),and family history of IBD(OR=5.26;OR=3.33).Associated risk factors for CD were age(18-39 years)(OR=1.73),higher educational level(OR=2.22),absence of infectious childhood diseases(OR=1.99).The UC predictive variables were living in an urban area(OR=1.62),inadequate living conditions(OR=1.48)and former smokers(OR=3.36).Appendectomy was a risk factor for CD(OR=1.58)with inverse association with UC(OR=4.79).Consumption of treated and untreated water was associated with risk of CD(OR=1.38)and UC(OR=1.53),*** This is the first examining environmental exposures as risk factors for inflammatory bowel disease in *** of the variables associated with disease risk support the role of the hygiene hypothesis in IBD development.

关键词： Crohn’s disease Ulcerative colitis Risk factors Environmental factors Hygiene hypothesis

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Approach to Paroxysmal Atrial Fibrillation Type Arrhythmia in a Cardiology Service:A Case Report

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Modern Research in Inflammation 2020年第2期9卷 9-17页

作者： Miriam Viviane Baron Luis Manuel Ley Dominguez Carolina Paz Mohamad Isa Gabriela Di Lorenzo Garcia Scherer Michele Paula dos Santos Vitoria Pereira Itaquy Talia Guimaraes dos Santos Julia Braga da Silveira Paulo ricardo martins Amanda Correa dos Santos Marcus Vinicius de Mello Pinto Janine Koepp daiana Klein Weber Carissimi Joice Nedel Ott Carolina Goncalves Pinheiro Nathalia Ken Pereira Iketani Gabriela Feltez Bartira Ercília Pinheiro da costa Postgraduate Program in Medicine and Health Sciences of the Pontifical Catholic University of Rio Grande do Sul(PUC/RS) Porto AlegreBrazil Improvement of Higher Education Personnel Brazil(CAPES)Distrito FederalBrazil School of Medicine of the Pontifical Catholic University of Rio Grande do Sul(PUC/RS) Porto AlegreBrazil School of Health and Life Sciences of the Pontifical Catholic University of Rio Grande do Sul(PUC/RS) Porto AlegreBrazil Celulare Institute PetrópolisBrazil Undergraduate Nursing Course of the University of Santa Cruz do Sul(UNISC) Santa Cruz do SulBrazil Postgraduate Program in Health Sciences of the Faculty of Medicine of ABC(FMABC) Sao PauloBrazil Undergraduate Physiotherapy Course of the Vale do Salgado Faculty(FVS) CearáBrazil Physiotherapy of the Hospital Beneficiente Portuguesa of Belém ParáBrazil Rehabilitation Sciences of the Federal University of Health Sciences of Porto Alegre Porto AlegreBrazil Postgraduate Program in Medicine and Health Sciences School of Medicine of the Pontifical Catholic University of Rio Grande do Sul(PUC/RS)Porto AlegreBrazil

Atrial fibrillation is a cardiac arrhythmia of high prevalence in the population, especially in the elderly. Its main electrical characteristics are the interval between two successive irregular R waves, absence of P waves and presence of f waves between QRS complexes. The most common symptoms of atrial fibrillation are irregular palpitations associated with dyspnea, dizziness, feeling tired, fatigue and general malaise, but not all patients have any symptoms. The present report presents the history of an elderly patient who arrived at the hospital’s emergency department with irregular heart rhythm and palpitations. The patient’s symptoms, associated with the electrocardiogram results, indicated paroxysmal atrial fibrillation. Electrical cardioversion was performed, and after, cardiac ablation via the femoral vein at the hospital’s cardiology service. There were no complications during the procedure. As a routine imaging exam after ablation, control esophagogastroduodenoscopy was requested to verify that there was no formation of atrio-esophageal fistula developed by the invasive ablation procedure and electrocardiogram, which showed normal sinus rhythm. The patient remained in the cardiac intensive care unit for observation for 24 hours. After the electrical cardioversion and catheter ablation procedures, the patient improved his clinical picture of atrial fibrillation and was discharged after 24 hours of hospitalization. He received treatment to perform at home, to reduce acid reflux into the esophagus and to prevent thrombosis. He did not present pulmonary thromboembolism after hospital discharge. It is believed, therefore, that this form of treatment and management of paroxysmal atrial fibrillation is effective for the solution of the proposed problem and can also serve as a reference for other professionals within the cardiology service.

关键词： Atrial Fibrillation Electrical Cardioversion Catheter Ablation Hypertension Obstructive Sleep Apnea Syndrome

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Association between mucosal surface pattern under near focus technology and Helicobacter pylori infection

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World Journal of Gastrointestinal Endoscopy 2021年第10期13卷 518-528页

作者： Felipe Fiuza Fauze Maluf-Filho Edson Ide Carlos Kiyoshi Furuya Jr Sonia Nadia Fylyk Jennifer Nakamura Ruas Luciana Stabach Gabriela Albuquerque Araujo Sergio Eiji Matuguma ricardo Sato Uemura Christiano Makoto Sakai Kendi Yamazaki Sergio Shiguetoshi Ueda Paulo Sakai Bruno costa martins Department of Endoscopy Hospital Alemão Oswaldo CruzSão Paulo 01323-020Brazil

BACKGROUND Many studies evaluated magnification endoscopy(ME)to correlate changes on the gastric mucosal surface with Helicobacter pylori(***)***,few studies validated these concepts with high-definition endoscopy without *** To access the association between mucosal surface pattern under near focus technology and *** infection status in a western *** Cross-sectional study including all patients referred to routine upper *** exams were performed using standard high definition(S-HD)followed by near focus(NF-HD)*** of erythema,erosion,atrophy,and nodularity were recorded during S-HD,and surface mucosal pattern was classified using NF-HD in the gastric *** were taken for rapid urease test and *** One hundred and eighty-seven patients were analyzed from August to November *** those,47(25.1%)were ***+,and 42(22.5%)had a previous *** *** the examination with S-HD,erythema had the best sensitivity for *** detection(80.9%).Exudate(99.3%),nodularity(97.1%),and atrophy(95.7%)demonstrated better specificity values,but with low sensitivity(6.4%-19.1%).On the other hand,the absence of erythema was strongly associated with ***-(negative predictive value=92%).With NF-HD,56.2%of patients presented type 1 pattern(regular arrangement of collecting venules,RAC),and only 5.7%of RAC+patients were ***+.The loss of RAC presented 87.2%sensitivity for *** detection,70.7%specificity,50%positive predictive value,and 94.3%negative predictive value,indicating that loss of RAC was suboptimal to confirm *** infection,but when RAC was seen,*** infection was *** The presence of RAC at the NF-HD exam and the absence of erythema at S-HD were highly predictive of *** negative *** the other hand,the loss of RAC had a suboptimal correlation with the presence of ***.

关键词： Diagnosis Endoscopy Gastric infection Gastritis Helicobacter pylori Sensitivity and specificity

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Technical Evaluation of Hybrid Clones of Corymbia spp. to Produce Market Pulp

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造纸与生物质材料（英文版） 2022年第3期

作者： Marcelo Moreira da costa ricardo de Carvalho Bittencourt Thales augusto Pinto Coelho Nogueira Larissa Soares Silva Weslley Henrique martins da Silva Sebasti?o Renato Valverde Gleison augusto Dos Santos daniel Alexander Fernandes Coelho Claudilene Aparecida Alves Pena

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