What is the Omega-Loop Gastric Bypass and Why is it Criticized?

The omega-loop gastric bypass (OLGBP), also called "mini-gastric bypass" or "single-anastomosis" gastric bypass is a form of gastric bypass where a long, narrow gastric pouch is created and anastomosed to the jejunum about 200- 250 cm from the angle of Treitz in an omega loop fashion, thereby avoiding a jejuno-jejunostomy.Proponents of the OLGBP claim that it is a safer and simpler operation than the traditional Roux-en-Y gastric bypass (RYGBP), easier to teach, that gives the same results in terms of weight loss than the RYGBP. One randomized study comparing the two techniques showed similar results after five years.The OLGBP is criticized because it creates an anastomosis between the gastric pouch and the jejunum where a large amount of biliopancreatic juices travel, thereby creating a situation where reflux of the latter into the stomach and distal esophagus is likely to develop. Such a situation has clearly been associated, in several animal studies, with an increased incidence of gastric cancer, especially at or close to the gastro-jejunostomy, and with an increased risk of lower esophageal cancer. In clinical practice, omega-loop gastrojejunostomies such as those used for reconstruction after gastric resection for benign disease or distal gastric cancer have been associated with the so called classical anastomotic cancer, linked to biliary reflux into the stomach, despite the fact that epidemiological studies about this do not show uniform results. Although no evidence at the present time links OLGBP to an increased risk of gastric cancer in the human, this possibility raises a concern among many bariatric surgeons, especially in the view that bariatric surgery is performed in relatively young patients with a long life expectancy, hence prone to develop cancer if indeed the risk is increased. Another arguments used against the OLGBP is that the jejuno-jejunostomy in the traditional RYGBP is easy to perform and associated with virtually no complication.Supporters of the OLGBP claim that the liquid that refluxes into the stomach after their procedure is not pure bile and pancreatic juice, but a combination of those with jejunal secretions, and that the latter is not as harmful. We would urge the proponents of the OLGBP to undertake the necessary animal studies to show that their assumption is indeed true before the procedure is performed widely, possibly leading to the development of hundreds of late gastric or esophageal carcinoma in the bariatric population. In the meantime, we strongly believe that RYGBP should remain the gold standard in gastric bypass surgery for morbid obesity.

Meta-análise da digestibilidade ileal de aminoácidos e minerais em suínos alimentados com dietas contendo enzimas

O objetivo deste trabalho foi avaliar, por meio da meta-análise, o efeito da fitase e da xilanase sobre a digestibilidade ileal aparente (DIa) de aminoácidos, cálcio e fósforo, em suínos em fase de crescimento. A base de dados consistiu de 21 artigos publicados entre 1998 e 2009, no total de 82 tratamentos e 644 suínos. A meta-análise foi realizada por análise gráfica, de correlação, de variância-covariância. As concentrações de fósforo fítico e as frações fibra em detergente neutro, fibra em detergente ácido e lignina em detergente ácido, nas dietas, apresentaram correlações baixas e negativas com a DIa do cálcio, fósforo e aminoácidos. A adição de fitase às dietas aumentou em 2% a DIa da arginina, em 14% a do cálcio e em 34% a do fósforo. A DIa da arginina, fenilalanina, isoleucina e lisina foi 3,3% superior em suínos alimentados com dietas com xilanase, em relação às dietas sem a enzima. O fósforo fítico e as fibras, nas dietas, reduzem a DIa do cálcio, do fósforo e dos aminoácidos essenciais. O uso de fitase e xilanase, nas dietas, melhora o aproveitamento de cálcio, fósforo e alguns aminoácidos. No entanto, o excesso de cálcio e fósforo nas dietas reduz a ação da fitase sobre a digestibilidade ileal dos nutrientes.

Percement de l'isthme de Suez. Notice géographique et historique et considérations sur le projet de percement d'un canal reliant la Méditerranée à la mer Rouge, par Maurice Bordot, d'après les travaux publiés par M. Ferdinand de Lesseps, précédée d'une lettre de M. Barthélemy-Saint-Hilaire

Comprend : Lettre

In vitro evaluation of the temperature increment at the external root surface after Er,Cr: YSGG laser irradiation of the root canal

Objectives: A study was made to determine the temperature increment at the dental root surface following Er,Cr:YSGG laser irradiation of the root canal. Design. Human canines and incisors previously instrumented to K file number ISO 30 were used. Irradiation was carried out with glass fiber endodontic tips measuring 200 μm in diameter and especially designed for insertion in the root canal. The teeth were irradiated at 1 and 2 W for 30 seconds, without water spraying or air, and applying a continuous circular movement (approximately 2 mm/sec.) in the apico-coronal direction. Results: At the 1 W power setting, the mean temperature increment was 3.84ºC versus 5.01ºC at 2 W. In all cases the difference in mean value obtained after irradiation versus the mean baseline temperature proved statistically significant (p< 0.05). Conclusions: Application of the Er,Cr:YSGG laser gives rise to a statistically significant temperature increment at the external root surface, though this increment is probably clinically irrelevant, since it would appear to damage the tissues (periodontal ligament and alveolar bone) in proximity to the treated tooth

Le [HMS] Calcutta [escortant le Renown sur lequel voyage le prince de Galles] dans le canal de Panama : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 59073

Le [HMS] Renown [à bord duquel voyage le prince de Galles] dans le canal de Panama : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 59074

Le [HMS] Renown [à bord duquel voyage le prince de Galles] dans le canal de Panama : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 59075

Le prince de Galles à bord du Renown dans le canal de Panama : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 59076

[Le] canal de Panama [franchi par le Renown à bord duquel voyage le prince de Galles] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 59077

Voyage du prince de Galles, le Renown dans le canal de Panama : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 59079

Reflexiones en torno a la "infantilización" del alumno universitario: el canal Youtube Officinalis.com

No son pocos los profesores que piensan que con la llegada de los planes de estudios adaptados a Bolonia ha bajado la exigencia personal frente a la propia responsabilidad de los estudiantes ante su aprendizaje. El uso, más o menos extendido, de materiales didácticos fácilmente 'digeribles'...

Reflexiones en torno a la "infantilización" del alumno universitario: el canal Youtube Officinalis.com

No son pocos los profesores que piensan que con la llegada de los planes de estudios adaptados a Bolonia ha bajado la exigencia personal frente a la propia responsabilidad de los estudiantes ante su aprendizaje. El uso, más o menos extendido, de materiales didácticos fácilmente 'digeribles'...

Proyecto de abastecimiento a las poblaciones de Térmens y Menàrguens desde el sistema del Canal de Piñana

Este proyecto resuelve el precario sistema de abastecimiento de agua potable actual de las poblaciones de Térmens y Menàrguens sustituyéndolo por otro nuevo, que utiliza aguas del sistema del canal de Piñana, en concreto de la tubería de abastecimiento a Lleida que actualmente se está ejecutando en su segunda fase. Se llega a la solución mediante dos tuberías de fundición dúctil una para cada localidad que llenan los depósitos ya existentes, además se ponen las bases del sistema de telegestión que deberá integrarse en la red general que se construirá en la fase que se está construyendo en la actualidad.