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Objective: The aim of this study was to assess the precision of a web-based tool in measuring visual acuity (VA) in ophthalmic patients, comparing it to the traditional in-clinic evaluation using a Snellen chart, considered the gold standard., Methods: We conducted a prospective and in-clinic validation comparing the Eyecare Visual Acuity Test® to the standard Snellen chart, with patients undergoing both tests sequentially. Patients wore their standard spectacles as needed for both tests. Inclusion criteria involved individuals above 18 years with VA equal to or better than +1 logMar (20/200) in each eye. VA measurements were converted from Snellen to logMAR, and statistical analyses included Bland-Altman and descriptive statistics., Results: The study, encompassing 322 patients and 644 eyes, compared Eyecare Visual Acuity Test® to conventional methods, revealing a statistically insignificant mean difference (0.01 logMAR, P  = 0.1517). Bland-Altman analysis showed a narrow 95% limit of agreement (0.22 to -0.23 logMAR), indicating concordance, supported by a significant Pearson correlation (r = 0.61, P  < 0.001) between the two assessments., Conclusion: The Eyecare Visual Acuity Test® demonstrates accuracy and reliability, with the potential to facilitate home monitoring, triage, and remote consultation. In future research, it is important to validate the Eyecare Visual Acuity Test® accuracy across varied age cohorts, including pediatric and geriatric populations, as well as among individuals presenting with specific comorbidities like cataract, uveitis, keratoconus, age-related macular disease, and amblyopia., Competing Interests: Declaration of conflicting interestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Mauro Gobira and Glauco Aquino are medical advisors at Eyecare Health Company, São Paulo. Marco Antonio Negreiros and Ariadne Dias are founders at Eyecare Health Company, São Paulo. Mauro Gobira, Glauco Aquino, Marco Antonio Negreiros, and Ariadne Dias did not participate in the data collection. The other authors do not have affiliations with the Eyecare Health Company.

Soil ecosystem service (SES) approaches evidence the importance of soil for human well-being, contribute to improving dialogue between science and decision-making and encourage the translation of scientific results into public policies. Herein, through systematic review, we assess the state of the art of SES approaches in tropical regions. Through this review, 41 publications were identified; while most of these studies considered SES, a lack of a consistent framework to define SES was apparent. Most studies measured soil natural capital and processes, while only three studies undertook monetary valuation. Although the number of publications increased (from 1 to 41), between 2001 and 2019, the total number of publications for tropical regions is still small. Countries with the largest number of publications were Brazil ( n = 8), Colombia ( n = 6) and Mexico ( n = 4). This observation emphasizes an important knowledge gap pertaining to SES approaches and their link to tropical regions. With global momentum behind SES approaches, there is an opportunity to integrate SES approaches into policy and practice in tropical regions. The use of SES evaluation tools in tropical regions could transform how land use decisions are informed, mitigating soil degradation and protecting the ecosystems that soil underpins., (© 2021 The Authors.)

Considering scenarios of future changes in land use have the potential to support policy-makers in drafting environmental laws to reconcile the demands of multiple land uses. The Pantanal, one of the largest wetlands in the world, has been undergoing rapid land use changes, and does not yet have any integrated environmental legislation on Legal Reserve for entire region (LR - minimum percentage of native vegetation required within private properties). The aim of this paper was to generate future vegetation loss scenarios for the Pantanal based on four LR values: (i) BAU: Business as usual, which considers existing laws: Native Vegetation Protection Law and State Decree; (ii) LRE: LR elimination owing to a bill recently proposed; (iii) LR50: which considers the bill proposing 50% of LR for the Pantanal; and (iv) LR80: our proposed levels of 80% of LR for the lowlands and 35% for the plateau (following values in the Amazon). Based on native vegetation loss from each scenario, we estimated the soil loss and sediment yield to rivers. Our results show that LRE would increase native vegetation loss in the Pantanal by as much as 139% when compared to the BAU, whereas increasing LR levels would reduce conversion values by 29% (LR80). Elimination of the LR would increase soil erosion and sediment production by up to 7% and 10%, respectively, compared to BAU. Based on native vegetation loss from each scenario, we estimated the soil loss and sediment yield to rivers with our data showing more than 90% of the sediment transported to the lowland originating from the plateau. The LR80 indicates a reduction in soil nutrient replacement costs of 10% compared to BAU, while in the LR50 these costs decrease by 1.5%, and in the LRE would increase of 8%. Our results show that abolishing current protections would have substantial impacts on avulsion processes, on several economic activities (tourism, fishery, cattle raising, etc.) and negative impacts for biodiversity conservation and would bring losses to agriculture in the Pantanal. Hence, our study brings clearly evidence of LR importance and need to expand it in this sensitive wetland., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Sleeve gastrectomy is a well-standardized surgical treatment for obesity. However, rates of weight regain after sleeve gastrectomy in long-term follow-up are relatively high. This multicenter study is the first to evaluate the use of an endoscopic sleeve gastroplasty (ESG) technique for the management of this population., Methods: This was a multicenter retrospective study, including patients with weight regain following sleeve gastrectomy who underwent ESG for weight loss. Primary outcomes included absolute weight loss, percent total weight loss (%TWL), change in body mass index (BMI), percent excess weight loss (%EWL) at 6 and 12 months, and safety profile. Clinical success was defined as achieving ≥ 25 % EWL at 1 year, ≤ 5 % serious adverse event (SAE) rate following society-recommended thresholds, and %TWL ≥ 10 %., Results: 34 patients underwent ESG after sleeve gastrectomy. Technical success was 100 %. At 1 year, 82.4 % and 100 % of patients achieved ≥ 10 %TWL and ≥ 25 % EWL, respectively. Mean (SD) %TWL was 13.2 % (3.9) and 18.3 % (5.5), and %EWL was 51.9 % (19.1) and 69.9 % (29.9) at 6 months and 1 year, respectively. Mean (SD) %TWL was 14.2 % (12.5), 19.3 % (5.3), 17.5 % (5.2), and 20.4 % (3.3), and %EWL was 88.5 % (52.8), 84.4 % (22.4), 55.4 % (14.8), and 47.8 % (11.2) for BMI categories of overweight and obesity class I, II, and III, respectively, at 1 year. No predictors of success were identified in the multivariable regression analysis. No SAEs were reported., Conclusion: ESG appears to be safe and effective in the management of weight regain following sleeve gastrectomy., Competing Interests: Dr. E. G. H. de Moura is a consultant (with nonfinancial support) for Boston Scientific and Olympus. Dr. Galvão Neto has received grants and personal fees from Fractyl Labs, GI dynamics, GI windows, Apollo Endosurgery, Olympus, Medtronic, and M.I. Tech. Dr. Thompson has received grants from Apollo Endosurgery and Olympus, and personal fees from Medtronic, Boston Scientific, Apollo Endosurgery, and Olympus., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Roux-en-Y gastric bypass (RYGBP) controls obesity and comorbidities. However, there is no consensus on ring placement due to its complications. Surgical ring removal has been the standard approach, despite its inherent morbidity risks. Endoscopic dilation with achalasia balloon is a novel and minimally invasive option. We aimed to evaluate safety and efficacy of aggressive dilation as an outpatient procedure to treat food intolerance after banded RYGBP without stenosis; we also analyzed long-term weight regain., Methods: This prospective study included 63 patients presenting with more than four vomiting episodes per week. Therapeutic endoscopy with a 30-mm balloon (Rigiflex®) was performed with radioscopic guidance in the first 16 patients (25.4 %). Four dilation sessions were performed in 12 patients (19 %), three in 14 (22.2 %), two in 24 (38 %), and one in 13 (20.6 %)., Results: Complete symptom improvement was achieved in 59 patients (93.6 %), partial improvement in 2 (3.2 %), and failure in 2, leading to ring removal by laparotomy. Complications rate was 9.5 %, including three cases of bleeding, two intragastric ring erosions, and one pneumoperitoneum; all treated clinically with no need for reintervention. Mean preoperative body mass index (BMI) was 42.4 kg/m(2) and postoperative (before endoscopic treatment) BMI was 25.3 kg/m(2). At a mean follow-up of 46.1 months after endoscopic intervention, mean BMI was 27.8 kg/m(2)., Conclusions: Aggressive endoscopic dilation for food intolerance is a safe and minimally invasive method that promotes symptom improvement. It avoided reoperation in 96.8 % of patients and led to a low rate of weight regain.

After much debate, there is an emerging consensus that the composition of many ecological communities is determined both by species traits, as proposed by niche theory, as well as by chance events. A critical question for ecology is, therefore, which attributes of species predict the dominance of deterministic or stochastic processes. We outline two hypotheses by which organism size could determine which processes structure ecological communities, and we test these hypotheses by comparing the community structure in bromeliad phytotelmata of three groups of organisms (bacteria, zooplankton, and macroinvertebrates) that encompass a 10 000-fold gradient in body size, but live in the same habitat. Bacteria had no habitat associations, as would be expected from trait-neutral stochastic processes, but still showed exclusion among species pairs, as would be expected from niche-based processes. Macroinvertebrates had strong habitat and species associations, indicating niche-based processes. Zooplankton, with body size between bacteria and macroinvertebrates, showed intermediate habitat associations. We concluded that a key niche process, habitat filtering, strengthened with organism size, possibly because larger organisms are both less plastic in their fundamental niches and more able to be selective in dispersal. These results suggest that the relative importance of deterministic and stochastic processes may be predictable from organism size.

Gastrobronchial fistula (GBF) is a serious complication following bariatric surgery, whose treatment by thoracotomy and/or laparotomy involves a high morbidity rate. We present the outcomes of endoscopic management for GBF as a helpful technique for its healing process. This is a multicenter retrospective study of 15 patients who underwent gastric bypass (n = 10) and sleeve gastrectomy (n = 5) and presented GBF postoperatively (mean of 6.7 months). Ten patients developed lung abscess and were treated by antibiotic therapy (n = 10) and thoracotomy (n = 3). Abdominal reoperation was performed in nine patients for abscess drainage (n = 9) and/or ring removal (n = 4) and/or nutritional access (n = 6). The source of the GBF was at the angle of His (n = 14). Furthermore, 14 patients presented a narrowing of the gastric pouch treated by 20 or 30 mm aggressive balloon dilation (n = 11), stricturotomy or septoplasty (n = 10) and/or stent (n = 7). Fibrin glue was used in one patient. We performed, on average, 4.5 endoscopic sessions per patient. Endotherapy led to a 93.3% (14 out of 15) success rate in GBF closure with an average healing time of 4.4 months (range, 1-10 months), being shorter in the stent group (2.5 × 9.5 months). There was no recurrence during the average 27.3-month follow-up. A patient persisted with GBF, despite the fibrin glue application, and decided to discontinue it. GBF is a highly morbid complication, which usually arises late in the postoperative period. Endotherapy through different strategies is a highly effective therapeutic option and should be implemented early in order to shorten leakage healing time.