Minimally Invasive Approach of a Retrocaval Ureter

The retrocaval ureter is a rare congenital entity, classically managed with open pyeloplasty techniques. The experience obtained with the laparoscopic approach of other more frequent causes of ureteropelvic junction (UPJ) obstruction has opened the method for the minimally invasive approach of the retrocaval ureter. In our paper, we describe a clinical case of a right retrocaval ureter managed successfully with laparoscopic dismembered pyeloplasty. The main standpoints of the procedure are described. Our results were similar to others published by other urologic centers, which demonstrates the safety and feasibility of the procedure for this condition.

Minimally invasive repair of Morgagni hernia - A multicenter case series

Children may benefit from minimally invasive surgery (MIS) in the correction of Morgagni hernia (MH). The present study aims to evaluate the outcome of MIS through a multicenter study. National institutions that use MIS in the treatment of MH were included. Demographic, clinical and operative data were analyzed. Thirteen patients with MH (6 males) were operated using similar MIS technique (percutaneous stitches) at a mean age of 22.2±18.3 months. Six patients had chromosomopathies (46%), five with Down syndrome (39%). Respiratory complaints were the most common presentation (54%). Surgery lasted 95±23min. In none of the patients was the hernia sac removed; prosthesis was never used. In the immediate post-operative period, 4 patients (36%) were admitted to intensive care unit (all with Down syndrome); all patients started enteral feeds within the first 24h. With a mean follow-up of 56±16.6 months, there were two recurrences (18%) at the same institution, one of which was repaired with an absorbable suture; both with Down syndrome. The application of MIS in the MH repair is effective even in the presence of comorbidities such as Down syndrome; the latter influences the immediate postoperative recovery and possibly the recurrence rate. Removal of hernia sac does not seem necessary. Non-absorbable sutures may be more appropriate.

Survivorship and Clinical Outcome of the Minimally Invasive Uniglide Medial Fixed Bearing, All-polyethylene Tibia, Unicompartmental Knee Arthroplasty at a Mean Follow-up of 7.3 Years

Background: Medial UKA performed in England and Wales represents 7 to 11% of all knee arthroplasty procedures, and is most commonly performed using mobile-bearing designs. Fixed bearing eliminates the risk of bearing dislocation, however some studies have shown higher revision rates for all-polyethylene tibial components compared to those that utilize metal-backed implants. The aim of the study is to analyse survivorship and maximum 8-year clinical outcome of medial fixed bearing, Uniglide unicompartmental knee arthroplasty performed using an all-polyethylene tibial component with a minimal invasive approach. Methods: Between 2002 and 2009, 270 medial fixed UKAs were performed in our unit. Patients were reviewed pre-operatively, 5 and 8 years post-operatively. Clinical and radiographic reviews were carried out. Patients’ outcome scores (Oxford, WOMAC and American Knee Score) were documented in our database and analysed. Results: Survival and clinical outcome data of 236 knees with a mean 7.3 years follow-up are reported. Every patient with less than 4.93 years follow-up underwent a revision. The patients’ average age at the time of surgery was 69.5 years. The American Knee Society Pain and Function scores, the Oxford Knee Score and the WOMAC score all improved significantly. The 5 years survival rate was 94.1% with implant revision surgery as an end point. The estimated 10 years survival rate is 91.3%. 14 patients were revised before the 5 year follow-up. Conclusion: Fixed bearing Uniglide UKA with an all-polyethylene tibial component is a valuable tool in the management of a medial compartment osteoarthritis, affording good short term survivorship.

Virtuous Activity Is Sufficient for Happiness and Some Minimally Favorable Circumstances Are Necessary for Virtuous Activity

Thesis (Ph.D.)--University of Washington, 2016-08

Minimally invasive video-assisted thyroid surgery: how can we improve the learning curve?

Objective. Minimally invasive video-assisted thyroidectomy (MIVAT) is a technically demanding procedure and requires a surgical team skilled in both endocrine and endoscopic surgery. A time consuming learning and training period is mandatory at the beginning of the experience. The aim of our report is to focus some aspects of the learning curve of the surgeon who practices video-assisted thyroid procedures for the first time, through the analysis of our preliminary series of 36 cases. Patients and methods. From September 2004 to April 2005 we selected 36 patients for minimally invasive video-assisted surgery of the thyroid. The patients were considered eligible if they presented with a nodule not exceeding 35mm in maximum diameter; total thyroid volume within normal range; absence of biochemical and echographic signs of thyroiditis. We analyzed surgical results, conversion rate, operating time, post-operative complications, hospital stay, cosmetic outcome of the series. Results. We performed 36 total thyroidectomy. The procedure was successfully carried out in 33/36 cases. Post-operative complications included 3 transient recurrent nerve palsies and 2 transient hypocalcemias; no definitive hypoparathyroidism was registered. All patients were discharged 2 days after operation. The cosmetic result was considered excellent by most patients. Conclusions. Advances in skills and technology have enabled surgeons to reproduce most open surgical techniques with video-assistance or laparoscopically. Training is essential to acquire any new surgical technique and it should be organized in detail to exploit it completely.

Lipid oxidation kinetics of ozone-processed shrimp during iced storage using peroxide value measurements

In this research, in situ generated ozone exposure/wash cycles of 1, 3, and 5 min applied to shrimp samples either before (BIS) or during iced storage (DIS) has been used to study the lipid oxidation kinetics using the peroxide values (PV). The induction period (IP) as well as PV at end of the IP (PVIP) have been obtained. The rate constants (k) as well as half-lives (t1/2) of hydroperoxides formation for different oxidation stages were calculated. The results showed that both IP and PVIP were lower with BIS (IP between 4.35±0.09 and 5.08±0.23 days; PVIP between 2.92±0.06 and 3.40±0.18 mEq kg−1) compared with DIS (IP between 5.92±0.12 and 6.14±0.09 days; PVIP between 4.49±0.17 and 4.56±0.10 mEq kg−1). The k value for DIS seemed to be the greater compared to BIS. In addition, whilst decreases and increases in t1/2 were found at propagation, respectively, for BIS and DIS, decreases and increases were only found at the induction of oxidation stage(s) for BIS. Further, the PV of ozone-processed samples would fit first order lipid oxidation kinetics independent of duration of ozone exposures. For the first time, PV measurements and fundamental kinetic principles have been used to describe how increasing ozone exposures positively affects the different oxidation stages responsible for the formation of hydroperoxides in ozone-processed shrimp.

Evaluation of processed groundnut (Arachis hypogaea) cake meals in the feeding of Clariid catfish, Clarias gariepinus, fingerlings

Groundnut cake (GNC) meal is an important source of dietary protein for domestic animals with a cost advantage over the conventional animal protein sources used in aquaculture feed production. It would be useful to evaluate the effects of GNC processing methods on the density and nutritional values of processed GNC meals. The use of processed GNC meals in the diets of Clarias gariepinus fingerlings was evaluated. Seven iso-proteic and iso-caloric diets were formulated, replacing fish meal with roasted and boiled GNC meals, each at three inclusion levels of 30%, 35%, and 40%. Diet I is 100% fishmeal, Diet II is 30% roasted GNC meal, Diet III is 35% roasted GNC meal, Diet IV is 40% roasted GNC meal, Diet V is 30% boiled GNC meal, Diet VI is 35% boiled GNC meal and Diet VII is 40% boiled GNC meal. Results showed that the crude protein content of GNC meals was 40.5% and 40.8% in boiled and roasted GNC meals respectively; the lower protein content for processed GNC meals might be due to heat denaturation of the seed protein, with boiled GNC meal being more adversely affected. The mean weight gain of fingerlings fed roasted GNC meals ranged between 5.29 – 5.64 while for boiled GNC meals, it was between 4.60 – 5.22. Generally, fish performed better when fed diets containing roasted GNC meals, than boiled GNC meals, and compared favorably with fish fed fish meal based diet. Body mass increase, total feed increase, protein efficiency ratio and specific growth rate by C. gariepinus fingerlings in all diets, showed no significant differences, suggesting that processed GNC meals could partially replace diets for C. gariepinus fingerlings without adverse consequences. This study showed that processed GNC meals could partially replace fish meal up to 30% without significantly influencing fingerling growth and health. It is recommended that the use of fish meal as the main basal ingredient for fingerlings could be discontinued, since GNC meal was a cheaper alternative, and could replace fish meal up to 35%, without any significant adverse effects on the fingerling performance. KEYWORDS: Clarias gariepinus, Fingerlings, Groundnut cake meal, Nutrient utilization, Performance.

Minimally invasive repair of Morgagni hernia - A multicenter case series

Children may benefit from minimally invasive surgery (MIS) in the correction of Morgagni hernia (MH). The present study aims to evaluate the outcome of MIS through a multicenter study. National institutions that use MIS in the treatment of MH were included. Demographic, clinical and operative data were analyzed. Thirteen patients with MH (6 males) were operated using similar MIS technique (percutaneous stitches) at a mean age of 22.2±18.3 months. Six patients had chromosomopathies (46%), five with Down syndrome (39%). Respiratory complaints were the most common presentation (54%). Surgery lasted 95±23min. In none of the patients was the hernia sac removed; prosthesis was never used. In the immediate post-operative period, 4 patients (36%) were admitted to intensive care unit (all with Down syndrome); all patients started enteral feeds within the first 24h. With a mean follow-up of 56±16.6 months, there were two recurrences (18%) at the same institution, one of which was repaired with an absorbable suture; both with Down syndrome. The application of MIS in the MH repair is effective even in the presence of comorbidities such as Down syndrome; the latter influences the immediate postoperative recovery and possibly the recurrence rate. Removal of hernia sac does not seem necessary. Non-absorbable sutures may be more appropriate.

The use of animal processed proteins and fat on the growth performance of rainbow trout (Onchorynchus mykiss)

Hoje em dia a industria da aquacultura enfrenta novos desafios para manter a sustentabilidade econômica de uma forma responsável para o meio ambiente e consumidores. Um dos maiores desafios que apresenta hoje em dia, é o aumento do preço da farinha e óleo de peixe que são os constituintes maioritários da alimentação para os peixes de aquacultura. As PAP’s e gorduras de animais terrestres parecem ser uma alternativa viável, sustentável e menos problemática do que as farinhas e óleos vegetais para substituir a farinha e óleo de peixe. Por esta razão neste trabalho nos procuramos substituir uma pequena parte da farinha e óleo de peixe por alguns produtos provenientes de animais terrestres. Este estudo foi um teste de crescimento para a truta arco-íris (Oncorhynchus mykiss). Inicialmente foram formuladas 4 dietas (CTRL, PAP2, PAP3 and PAP4). Exceptuando o dieta controlo (CTRL) que foi uma dieta comercial, os outros alimentos foram desenhados para substituir a farinha de peixe e outras farinhas vegetais por PAP’s (proteína animal processada) como hidrolisado de farinha de penas, farinha de sangue de suíno e gordura animal processadas como a gordura de aves. O teste foi feito ao longo de 112 dias com checkpoints no dia (30, 60 e 112), onde os peixes eram pesados com excepção do dia 112 onde foram também amostrados para composição corporal e índice hepatossomático. O peso inicial médio dos peixes dos grupos foi 219,7g e o peso médio final foi 488,7g. Não existiram alterações comportamentais nem preferência por nenhuma ração testada e não foram verificadas diferenças estatisticamente significativas (P>0,05) no consumo de ração, crescimento e outros parâmetros de crescimento com a exceção da taxa de eficiência proteica. Foram também verificadas diferenças estatísticas significativas para alguns aspectos da composição corporal, ganhos e retenções. Os resultados demonstram que as substituições feitas não tiveram impacto no crescimentos da truta arco íris mas sim na composição corporal. Apesar disso os resultados não sugerem nenhum problema importante relacionado com o uso de PAP’s na formulação de ração para peixes.

Application of mathematical models to mycotoxins children risk assessment: a case study of Portuguese children exposure to co-occurring mycotoxins in processed cereal-based foods

People, animals and the environment can be exposed to multiple chemicals at once from a variety of sources, but current risk assessment is usually carried out based on one chemical substance at a time. In human health risk assessment, ingestion of food is considered a major route of exposure to many contaminants, namely mycotoxins, a wide group of fungal secondary metabolites that are known to potentially cause toxicity and carcinogenic outcomes. Mycotoxins are commonly found in a variety of foods including those intended for consumption by infants and young children and have been found in processed cereal-based foods available in the Portuguese market. The use of mathematical models, including probabilistic approaches using Monte Carlo simulations, constitutes a prominent issue in human health risk assessment in general and in mycotoxins exposure assessment in particular. The present study aims to characterize, for the first time, the risk associated with the exposure of Portuguese children to single and multiple mycotoxins present in processed cereal-based foods (CBF). Portuguese children (0-3 years old) food consumption data (n=103) were collected using a 3 days food diary. Contamination data concerned the quantification of 12 mycotoxins (aflatoxins, ochratoxin A, fumonisins and trichothecenes) were evaluated in 20 CBF samples marketed in 2014 and 2015 in Lisbon; samples were analyzed by HPLC-FLD, LC-MS/MS and GC-MS. Daily exposure of children to mycotoxins was performed using deterministic and probabilistic approaches. Different strategies were used to treat the left censored data. For aflatoxins, as carcinogenic compounds, the margin of exposure (MoE) was calculated as a ratio of BMDL (benchmark dose lower confidence limit) to the aflatoxin exposure. The magnitude of the MoE gives an indication of the risk level. For the remaining mycotoxins, the output of exposure was compared to the dose reference values (TDI) in order to calculate the hazard quotients (ratio between exposure and a reference dose, HQ). For the cumulative risk assessment of multiple mycotoxins, the concentration addition (CA) concept was used. The combined margin of exposure (MoET) and the hazard index (HI) were calculated for aflatoxins and the remaining mycotoxins, respectively. 71% of CBF analyzed samples were contaminated with mycotoxins (with values below the legal limits) and approximately 56% of the studied children consumed CBF at least once in these 3 days. Preliminary results showed that children exposure to single mycotoxins present in CBF were below the TDI. Aflatoxins MoE and MoET revealed a reduced potential risk by exposure through consumption of CBF (with values around 10000 or more). HQ and HI values for the remaining mycotoxins were below 1. Children are a particularly vulnerable population group to food contaminants and the present results point out an urgent need to establish legal limits and control strategies regarding the presence of multiple mycotoxins in children foods in order to protect their health. The development of packaging materials with antifungal properties is a possible solution to control the growth of moulds and consequently to reduce mycotoxin production, contributing to guarantee the quality and safety of foods intended for children consumption.

Salt content of processed foods available in the Portuguese market

Evidence suggests that current levels of salt consumption across Europe are linked with several chronic diseases. In recent decades, high blood pressure has increased, together with the consumption of processed foods. World Health Organization (WHO) recommends a salt intake of less than 5 g/day for the prevention of cardiovascular disease. The aim of this study was to evaluate the salt content of processed foods available in the Portuguese market and to compare the determined values with the recommended daily intake established by WHO. Categories of processed foods that contribute to a higher intake of salt were identified: pastry, bakery, fast-food, snacks, ready-to-eat meals, nuts, seeds, soups, cereals, sauces, patties, among others. Between 2013 and 2015, 267 processed food samples were acquired in food chains and restaurants from Lisbon region (Portugal) and the salt content was quantified using Charpentier-Volhard method. High amounts of salt were quantified in the analysed processed foods, namely snacks, fast-food, patties, meals and bakery products. If we consider one portion of a curd cheese pie (193 g), the intake of salt can reach 45% of the recommended value. For snacks, regular portion size is 35 g. One portion of a salty snack can contribute with 31% of the salt recommended daily intake. Up to now food industry has developed efforts to decrease the salt content of some food products, namely bread. However, there still exist foods with high salt content and from a nutritional point of view this should be a priority area of intervention. The obtained results are an effective assessment of current salt content in foods which will be important for further reformulation strategies and to monitor progress in the next years.