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La cirugía bariátrica es hasta el momento la mejor solución para el problema de obesidad y la diabetes, e incluso, influye en la mejoría de las enfermedades no transmisibles relacionadas con la nutrición. Sin embargo, no está exenta de complicaciones, entre las cuales son frecuentes las metabólicas y nutricionales que, afortunadamente, son predecibles, prevenibles y tratables. Es necesario que el médico, el equipo de salud y el paciente se encuentren conscientes de la importancia de la nutrición, no solamente antes de la cirugía e inmediatamente después de ella, sino el resto de la vida. Es fundamental cumplir diariamente con las necesidades de proteína del paciente, la cual debe seleccionarse en la forma más tolerable y absorbible, con el objeto de prevenir deficiencias nutricionales importantes que muchas veces se atribuyen equivocadamente a déficits de otros nutrientes. Finalmente, el cambio de estilo de vida debe incorporarse al tratamiento, para prevenir de esta manera la nueva ganancia de peso y las implicaciones que esto conlleva.Up to now, bariatric surgery has been the prime solution for obesity and diabetes, and even positively contributes to nutrition related non-transmissible diseases. However, bariatric surgery is not exempt from complications, most of which are metabolic or nutritionally related. Fortunately, these complications are preventable, predictable and treatable. It becomes necessary for the physician, patient and health team to be to be conscious not only of the importance of the needs not only before surgery and immediately following it, but in the context of the patient´s life span. It is fundamental to fulfill the patient's daily protein requirements by adhering to a protein diet that is both tolerable and absorbable in order to prevent important protein nutritional deficiencies, which sometimes are wrongly attributed to deficiencies of other nutrients. Finally, the patient´s change in life style must be incorporated in the treatment program so as to prevent new weight gain and its related effects.

Background. Actinomyces neuii is a Gram-positive bacillus rarely implicated in human infections. However, its occurrence is being increasingly recognized with the use of improved identification systems. Objective. To analyse A. neuii infections in Alberta, Canada, and review the literature regarding this unusual pathogen. Methods. Cases of A. neuii were identified in 2013-2014 in Alberta. Samples were cultured aerobically and anaerobically. A predominant catalase positive Gram-positive coryneform bacillus with no branching was isolated in each case. Testing was initially done with API-CORYNE® (bioMérieux) and isolates were sent to the Provincial Laboratory for Public Health for further testing. Isolates’ identities were confirmed by matrix-assisted laser desorption ionization time-of-flight mass spectrometry microbial identification system (MALDI-TOF MS MIS; bioMérieux) and/or DNA sequencing. Results. Six cases of A. neuii infection were identified. All patients had soft tissue infections; typically, incision and drainage were done followed by a course of antibiotics. Agents used included cephalexin, ertapenem, ciprofloxacin, and clindamycin. All had favourable outcomes. Conclusions. While A. neuii is infrequently recognized, it can cause a diverse array of infections. Increased use of MALDI-TOF MS MIS is leading to increased detection; thus, understanding the pathogenicity of this bacterium and its typical susceptibility profile will aid clinical decision-making.

Signal transducer and activator of transcription 3 (STAT3) is an oncogenic protein that is constitutively activated in numerous cancer cell lines and human cancers. Another STAT family member, STAT1, possesses cancer-inhibitory properties and can promote apoptosis in tumor cells upon activation. To better characterize these important cancer related genes, we tagged STAT3 and STAT1 loci with fluorescent protein (FP) sequences (RFP and GFP respectively) by targeted integration via zinc finger nuclease (ZFN)--mediated homologous recombination in A549 cells that express aberrantly activated STAT3. We inserted the FP transgenes at the N-terminus of the STAT3 locus and at the C-terminus of the STAT1 locus. The integration resulted in endogenous expression of fluorescent STAT3 and STAT1 chimeric fusion proteins. When stimulated with IL-6 or IFN-γ, the cells showed robust nuclear translocation of RFP-STAT3 or STAT1-GFP, respectively. Pre-incubation of cells with a known specific STAT3 inhibitor showed that IFN-γ-induced translocation of STAT1-GFP was not impaired. STAT3 activates multiple downstream targets such as genes involved in cell cycle progression - e.g. cyclin D1. To detect changes in expression of endogenous cyclin D1, we used ZFN technology to insert a secreted luciferase reporter behind the cyclin D1 promoter and separated the luciferase and cyclin D1 coding regions by a 2A sequence to induce a translational skip. The luciferase insertion was made in the RFP-STAT3/STAT1-GFP cell line to have all three reporters in a single cell line. Addition of a STAT3 inhibitor led to suppression of cyclin D1 promoter activity and cell growth arrest. The triple-modified cell line provides a simple and convenient method for high-content screening and pre-clinical testing of potential STAT3 inhibitors in live cells while ensuring that the STAT1 pathway is not affected. This approach of reporting endogenous gene activities using ZFN technology could be applied to other cancer targets.

With growing concern over bacterial resistance, the identification of new antimicrobial means is paramount. In the oral cavity microorganisms are essential to the development of periradicular diseases and are the major causative factors associated with endodontic treatment failure. As quaternary ammonium compounds have the ability to kill a wide array of bacteria through electrostatic interactions with multiple anionic targets on the bacterial surface, it is likely that they can overcome bacterial resistance. Melding these ideas, we investigated the potency of a novel endodontic sealer in limiting Enterococcus faecalis growth. We used a polyethyleneimine scaffold to synthesize nano-sized particles, optimized for incorporation into an epoxy-based endodontic sealer. The novel endodontic sealer was tested for its antimicrobial efficacy and evaluated for biocompatibility and physical eligibility. Our results show that the novel sealer foundation affixes the nanoparticles, achieving surface bactericidal properties, but at the same time impeding nanoparticle penetration into eukaryotic cells and thereby mitigating a possible toxic effect. Moreover, adequate physical properties are maintained. The nanosized quaternary amine particles interact within minutes with bacteria, triggering cell death across wide pH values. Throughout this study we demonstrate a new antibacterial perspective for endodontic sealers; a novel antibacterial, effective and safe antimicrobial means.

Icosahedral double-stranded DNA viruses use a single portal for genome delivery and packaging. The extensive structural similarity revealed by such portals in diverse viruses, as well as their invariable positioning at a unique icosahedral vertex, led to the consensus that a particular, highly conserved vertex-portal architecture is essential for viral DNA translocations. Here we present an exception to this paradigm by demonstrating that genome delivery and packaging in the virus Acanthamoeba polyphaga mimivirus occur through two distinct portals. By using high-resolution techniques, including electron tomography and cryo-scanning electron microscopy, we show that Mimivirus genome delivery entails a large-scale conformational change of the capsid, whereby five icosahedral faces open up. This opening, which occurs at a unique vertex of the capsid that we coined the "stargate", allows for the formation of a massive membrane conduit through which the viral DNA is released. A transient aperture centered at an icosahedral face distal to the DNA delivery site acts as a non-vertex DNA packaging portal. In conjunction with comparative genomic studies, our observations imply a viral packaging pathway akin to bacterial DNA segregation, which might be shared by diverse internal membrane-containing viruses.

Amino acid-based poly(ester urea)s (PEUs) are an emerging class of highly tunable, degradable polymers that have found utility in a wide scope of biomedical applications. PEUs possess three points of tunability at the amino acid side chain, diol length, and copolymer stoichiometric ratio, resulting in a broad range of chemical, thermal and mechanical properties. PEUs are interesting biologically because they degrade into naturally occurring amino acids, urea, oxidized products from the diols, and carbon dioxide, each of which can be metabolized or excreted. The diversity in structure, properties and biodegradation characteristics of PEUs have led to their exploration in a number of pre-clinical applications including hernia repair, adhesives, radiopaque implants, and drug delivery. In this review, we provide a thorough history of PEU synthesis methodology. The polymer properties arising from the various synthetic methods including mechanical, thermal, and biocompatibility properties are also summarized. This review concludes with an overview of progress in the primary applications of PEUs to date including hard and soft-tissue engineering, radiopaque biomaterials, adhesives, and drug delivery. [Display omitted] [ABSTRACT FROM AUTHOR]

Rationale: Saline nasal sprays are frequently used in the management of seasonal allergic rhinitis (SAR) for the cleansing and clearing of aeroallergens from the nasal cavity. Also using a drug-free approach, AM-301 nasal spray is forming a thin film barrier on the nasal mucosa to prevent contact with allergens, trap them, and facilitate their discharge. A clinical trial compared the efficacy, safety, and tolerability of AM-301 and saline spray in SAR., Methods: A total of 100 patients were randomized 1:1 to self-administer AM-301 or saline 3 × daily for 2 weeks. Primary efficacy endpoint: reduction in mean daily reflective Total Nasal Symptom Score (rTNSS). Secondary efficacy endpoints: reduction in mean instantaneous TNSS and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), global impression of efficacy. Safety and tolerability: adverse events, relief medication use, symptom-free days, global impression of tolerability., Results: AM-301-treated patients achieved a significantly lower rTNSS than the saline group (LS square means difference -1.1, 95% CI -1.959 to -0.241, p = .013) with improvement observed across all individual nasal symptoms. Likewise, all secondary endpoints showed statistical significance in favor of AM-301; for example, quality of life was significantly improved overall (p < .001) as well as for each individual RQLQ domain. Both treatments showed similarly good safety and tolerability. With AM-301, fewer patients used relief medication and more enjoyed symptom-free days compared to saline treatment., Conclusions: AM-301 was more effective than saline in improving SAR nasal symptoms and related quality of life while offering similar tolerability, demonstrating the benefits of a barrier approach., (© 2024 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

Background: Adults with intellectual disabilities have high rates of unemployment and underemployment. Despite benefits to employers and employees, some groups may be hesitant to implement inclusive employment programs due to lack of knowledge, absence of well-defined strategies, and limited exposure to successful examples., Objective: To address this gap, the Down Syndrome Program (DSP) in a New England tertiary pediatric hospital established an inclusive employment program that supports and trains young adults with Down syndrome in the development of foundational job skills within a hospital-based clinic., Methods: This case study examines strategies and lessons learned from the employment program's implementation and evolution., Results: Successful implementation required iterative, tailored approaches to meet diverse needs., Conclusion: The DSP developed a framework and collection of best practices for other organizations to adopt for successful employment of individuals with disabilities under an inclusive employment model.

Direct solvers are a common method for solving finite difference frequency domain (FDFD) systems that arise in numerical solutions of Maxwell's equations. In a direct solver, one factorizes the system matrix. Since the system matrix is typically very sparse, the fill-in of these factors is the single most important computational consideration in terms of time complexity and memory requirements. As a result, it is of great interest to determine ways in which this fill-in can be systematically reduced. In this paper, we show that in the context of commonly used perfectly matched boundary layer methods, the choice of boundary condition behind the perfectly matched boundary layer can be exploited to reduce fill-in incurred during the factorization, leading to significant gains of up to 40% in the efficiency of the factorization procedure. We illustrate our findings by solving linear systems and eigenvalue problems associated with the FDFD method.

Adjoint variable method in combination with gradient descent optimization has been widely used for the inverse design of nanophotonic devices. In many of such optimizations, the design region is only a small fraction of the total computational domain. Here we show that the adjoint variable method can be combined with the Schur complement domain decomposition method. With this combination, in each optimization step, the simulation only involves the degrees of freedom that are inside the design region. Our approach should significantly improve the computational efficiency of adjoint variable method based optimization of photonic structures.

Hepatitis E virus (HEV) is globally the most common cause of acute viral hepatitis. In industrialized countries, HEV infection can be seen in travelers returning from hyperendemic countries or in individuals at risk for autochthonous infection due to zoonotic exposure. Hepatitis E virus infection is often unrecognized and at times misdiagnosed because of nonspecific findings that can overlap with other causes of hepatitis, including autoimmune hepatitis (AIH). Although most cases of acute HEV infection resolve spontaneously and do not require treatment, life-threatening acute liver failure may occur in some cases. We discuss the case of an 8-year-old boy returning from Bangladesh with progressive acute liver injury and a clinical profile suggestive of AIH, who showed a favorable response to corticosteroid treatment before the diagnosis of an acute HEV infection could be established.

The use of degradable materials is required to address current performance and functionality shortcomings from biologically-derived tissues and non-resorbable synthetic materials used for hernia mesh repair applications. Herein a series of degradable l-valine-co-l-phenylalanine poly(ester urea) (PEU) copolymers were investigated for soft-tissue repair. Poly[(1-VAL-8) 0.7 -co-(1-PHE-6) 0.3 ] showed the highest uniaxial mechanical properties (332.5 ± 3.5 MPa). Additionally, l-valine-co-l-phenylalanine poly(ester urea)s were blade coated on small intestine submucosa extracellular matrix (SIS-ECM) and found to enhance the burst test mechanical properties of SIS-ECM in composite films (force at break between 102.6 ± 6.5-151.4 ± 11.3 N). Free standing films of l-valine-co-l-phenylalanine PEUs were found to have superior extension at break when compared to SIS-ECM (averages between 1.2 and 1.9 cm and 1.2 cm respectively). Fibroblast (L-929) spreading, proliferation, and improved attachment over control were observed without toxicity in vitro, while a reduced inflammatory response at both 7 and 14 days post-implant was observed for poly[(1-VAL-8)⁠ 0.7 -co-(1-PHE-6)⁠ 0.3 ] when compared to polypropylene in an in vivo rat hernia model. These results support the use of PEU copolymers as free-standing films or as composite materials in soft-tissue applications for hernia-repair., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

The use of catheters is ubiquitous in medicine and the incidence of infection remains unacceptably high despite numerous advances in functional surfaces and drug elution. Herein we report the use of a thermoplastic polyurethane containing an allyl ether side-chain functionality (allyl-TPU) that allows for rapid and convenient surface modification with antimicrobial reagents, post-processing. This post-processing functionalization affords the ability to target appropriate TPU properties and maintain the functional groups on the surface of the device where they do not affect bulk properties. A series of quaternary ammonium thiol compounds (Qx-SH) possessing various hydrocarbon tail lengths (8-14 carbons) were synthesized and attached to the surface using thiol-ene "click" chemistry. A quantitative assessment of the amount of Qx-SH available on the surface was determined using fluorescence spectroscopy and X-ray photoelectron spectroscopy (XPS). Contact-killing assays note the Q8-SH composition has the highest antimicrobial activity, and a live/dead fluorescence assay reveals rapid contact-killing of Staphylococcus aureus (>75% in 5 min) and Escherichia coli (90% in 10 min) inocula. Scale-up and extrusion of allyl-TPU provides catheter prototypes for biofilm formation testing with Pseudomonas aeruginosa, and surface-functionalized catheters modified with Q8-SH demonstrate their ability to reduce biofilm formation., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Hybrid halide perovskites exhibit nearly 20% power conversion efficiency, but the origin of their high efficiency is still unknown. Here, we compute the shift current, a dominant mechanism of the bulk photovoltaic (PV) effect for ferroelectric photovoltaics, in CH₃NH₃PbI₃ and CH₃NH₃PbI(3-x)Cl(x) from first-principles. We find that these materials give approximately three times larger shift current PV response to near-IR and visible light than the prototypical ferroelectric photovoltaic BiFeO₃. The molecular orientations of CH₃NH₃⁺ can strongly affect the corresponding PbI₃ inorganic frame so as to alter the magnitude of the shift current response. Specifically, configurations with dipole moments aligned in parallel distort the inorganic PbI₃ frame more significantly than configurations with near-net-zero dipole, yielding a larger shift current response. Furthermore, we explore the effect of Cl substitution on shift current and find that Cl substitution at the equatorial site induces a larger response than does substitution at the apical site.

N-hydroxysuccinimide (NHS) esters have been used for gas-phase conjugation reactions with peptides at nucleophilic sites, such as primary amines (N-terminus, ε-amine of lysine) or guanidines, by forming amide bonds through a nucleophilic attack on the carbonyl carbon. The carboxylate has recently been found to also be a reactive nucleophile capable of initiating a similar nucleophilic attack to form a labile anhydride bond. The fragile bond is easily cleaved, resulting in an oxygen transfer from the carboxylate-containing species to the reagent, nominally observed as a water transfer. This reactivity is shown for both peptides and non-peptidic species. Reagents isotopically labeled with O(18) were used to confirm reactivity. This constitutes an example of distinct differences in reactivity of carboxylates between the gas phase, where they are shown to be reactive, and the solution phase, where they are not regarded as reactive with NHS esters.

A comparison between solution and gas phase modification of primary amine sites in model peptide cations with N-hydroxysuccinimide (NHS) ester reagents is presented. In all peptides, the site of modification in solution was directed to the N-terminus by conducting reactions at pH=5, whereas for the same peptides, a lysine residue was preferentially modified in the gas phase. The difference in pKa values of the N-terminus and ε-amino group of the lysine allows for a degree of control over sites of protonation of the peptides in aqueous solution. With removal of the dielectric and multiple charging of the peptide ions in the gas phase, the accommodation of excess charge can affect the preferred sites of reaction. Interaction of the lone pair of the primary nitrogen with a proton reduces its nucleophilicity and, as a result, its reactivity towards NHS-esters. While no evidence for reaction of the N-terminus with sulfo-NHS-acetate was noted in the model peptide cations, a charge inversion experiment using bis[sulfosuccinimidyl] suberate, a cross-linking reagent with two sulfo-NHS-ester functionalities, showed modification of the N-terminus. Hence, an unprotonated N-terminus can serve as a nucleophile to displace NHS, which suggests that its lack of reactivity with the peptide cations is likely due to the participation of the N-terminus in solvating excess charge., (© American Society for Mass Spectrometry, 2011)

Background: Surgical quality measures have room for improvement in both large- and small-town hospitals., Methods: We sought concurrence of surgical specialists (general, orthopedic, gynecologic) to study accepted quality and safety parameters using a surgical time-out-based platform., Results: Surgeons and hospitalists participated promptly and actively and recorded enhanced performance measures compared with prior work and within the period of study. Practice patterns varied, and interchange among participating hospitals was helpful., Conclusions: Smaller institutions are more nimble than larger ones and developed interchangeable ideas for improvement. Surgical process measures improved such that all 4 hospitals are concerned about and committed to maintaining the gains., (Copyright (c) 2010 Elsevier Inc. All rights reserved.)

The fact that humans can execute accurate movements and generate precise muscle forces is very important for hand function. Target-tracking tasks or target-matching tasks are often executed under combined visual and somatosensory feedback. When visual feedback is removed, subjects have to depend on their perception of force. The objective of the present study was to estimate the effects of aging on the perception of a pinch force produced by the thumb and index finger. In a first set of trials, young (n = 12, age = 25.3 +/- 2.4 years) and elderly (n = 12, age = 71.5 +/- 3.3 years) healthy individuals were asked to reproduce pinch forces which were equivalent to 5%, 20%, and 40% of their maximal pinch force (MPF). Prior to the execution of these trials, the subjects were familiarized with the force levels by matching targets displayed on a screen. They were then asked to reproduce each of these forces without any visual or verbal feedback. The results showed a larger error in the reproduced force for the elderly subjects when compared with the young adults. However, this larger error was mainly due to an initial overshoot in the force to be reproduced, followed by a gradual decrease towards the appropriate force. This transient overshoot was rarely seen in the performance of the younger subjects. In a second set of trials, the same subjects were asked to produce a pinch force of 5%, 20%, and 40% of MPF with 1 hand using visual feedback. They were also instructed to simultaneously apply a comparable pinch force with the other hand (without any feedback). For both young and older adults, the pinch forces produced by the 2 hands were the same. In addition, in both blocks of trials, hand dominance had no effects on the performance for all subjects. These results suggest that normal aging affects the production of force based on sensorimotor memory rather more than it affects comparative outputs from central descending commands.