The different types of internal hernia after laparoscopic Roux-En-Y gastric by-bass for morbid obesity : MDCT features : P5

Purpose: 1. To provide an overview of the different types of internal hernia (IH) occurring after laparoscopic Roux-en-Y gastric bypass (LRYGBP) performed for morbid obesity. 2. To describe the correspondent MDCT features in relation with the underlying anatomical landmarks in order to differentiate their localisation and to direct the surgeon during following laparoscopic closure of mesenteric defects. Methods and materials: LRYGBP performed for morbid obesity is associated with less perioperative complications, shorter hospital stay and a more rapid recovery compared with the open surgical procedure. However, a relatively high incidence of IH is seen that may be due to the laparoscopic approach, but also caused by rapid weight loss with consecutive loosening of the mesenteric sutures. Results: After briefly reviewing the surgical procedure of LRYGBP (ante- versus retrocolic) we describe the exact anatomical landmarks of the different types of IH occurring at any time after operation: They are caused by surgical defects either at the level of the transverse colon mesentery, at the Petersen's space, which represents an opening between the mesocolon and jejunal mesentery, or at the enteroenterostomy site. Typical MDCT features of each IH type in axial and coronal plane as well as targeted vascular reconstructions are demonstrated. Conclusion: Exact knowledge about underlying pathophysiology and anatomical landmarks is essential for distinguishing the different types of IH occurring after LRYGBP on MDCT, since radiological features are difficult to recognize and may even overlap. The radiologist should be aware of the potential anatomic sites to ensure subsequent straightforward laparoscopic exploration.

Un protocole de nutrition suffit-il à garantir des pratiques "evidence based" (EBM) - réalité clinique et propositions : P5

Le support nutritionnel en soins intensifs est désormais basé sur des études de niveau A et B. La participation du SMIA au «Nutrition Day 2008» avait mis en évidence des déviations par rapport aux recommandations. Cette étude a pour objectif de réaliser une analyse approfondie sur un mois. Méthodes: Analyse des patients sortis ayant séjourné plus de 3 jours en mars 2008 dans un service de 32 lits bénéficiant d'une diététicienne à 60% et du Protocole NUTSIA depuis 2006. Extraction de la database: variables démographiques, nutrition risk score (NRS), jours de démarrage et voie de nutrition, bilan calorique cumulé. Résultats: 69 patients âgés de 60 ± 17 ans ont séjourné 9 ± 10 jours. Le NRS est réalisé tardivement dans 29% des cas. A 48h, le support nutritionnel est défini chez 67% des patients avec 43% de nutrition artificielle, une prédominance de NE (73%) sur PN (27%). Seuls 3 patients ont un bilan cumulé < -10000 kcal. La couverture des séjours par la diététicienne est de 50%. Conclusion: Comparé à l'EBM, les pratiques nutritionnelles sont globalement satisfaisantes, mais l'évaluation systématique est insuffisante. L'introduction de la NE est tardive et sa progression trop lente comparé au protocole. Les remèdes proposés sont une administration de NE par défaut, une augmentation de la présence de la diététicienne et son «empowerment» sur la prescription.

Workshop1 P5 Professional organisations

Key Animation

Workshop3 p5 Summative or formative scales

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Aprender a leer y escribir en P5 de manera significativa.

El fin de esta experiencia es que los niños y las niñas se sientan motivados para hacer las convivencias y participen en ellas, para ello se implica a los alumnos teniendo que ser ellos los que la organicen.

P5 y la familia.

En la escuela infantil se dedica un espacio y un tiempo a la conversación mientras están sentados por lo general en círculo para que puedan verse todos las caras. Cada día se trata un tema diferente en función de los acontecimientos o inquietudes que tengas los niños y niñas. Las intervenciones suelen hacer referencia a familiares de su entorno cercano, ya que son quienes les acompañan en su experiencia vivida. La familia es su columna, es el desencadenante de vivencias y representa todos aquellos recuerdos que construyen su aprendizaje. La importancia de compartir con los niños y niñas sus experiencias y explicarlas ayuda acrecer, a entender el mundo de los adultos, a sentirse implicados y partícipes de lo que sucede a su alrededor. Compartir experiencias con los demás ayuda a hacerse responsables y capaces de entender y poder resolver, y saber enfrentarse a las pequeñas dificultades que la vida ajusta a cada edad.

Stable triple helices formed by oligonucleotide N3'-->P5' phosphoramidates inhibit transcription elongation.

Oligonucleotide analogs with N3'-->P5' phosphoramidate linkages bind to the major groove of double-helical DNA at specific oligopurine.oligopyrimidine sequences. These triple-helical complexes are much more stable than those formed by oligonucleotides with natural phosphodiester linkages. Oligonucleotide phosphoramidates containing thymine and cytosine or thymine, cytosine, and guanine bind strongly to the polypurine tract of human immunodeficiency virus proviral DNA under physiological conditions. Site-specific cleavage by the Dra I restriction enzyme at the 5' end of the polypurine sequence was inhibited by triplex formation. A eukaryotic transcription assay was used to investigate the effect of oligophosphoramidate binding to the polypurine tract sequence on transcription of the type 1 human immunodeficiency virus nef gene under the control of a cytomegalovirus promoter. An efficient arrest of RNA polymerase II was observed at the specific triplex site at submicromolar concentrations.

Oligonucleotide N3'-->P5' phosphoramidates.

Synthetic oligonucleotides and their analogs have attracted considerable interest recently. These compounds may lead to highly specific therapeutic agents, as well as to powerful diagnostic tools. Here, we present the synthesis of uniformly modified oligodeoxyribonucleotide N3'-->P5' phosphoramidates containing 3'-NHP(O)(O-)O-5' internucleoside linkages and the study of their hybridization properties. Thermal dissociation experiments show that these compounds form very stable duplexes with single-stranded DNA, RNA, and with themselves following Watson-Crick base pairing. The duplex thermal stability was enhanced by 2.2-2.6 degrees C per modified linkage compared with phosphodiesters. The structure of complexes formed by phosphoramidates closely resembles that of RNA oligomers and corresponds to an A form, as judged by CD spectroscopy. N3'-->P5' phosphoramidates also form stable triplexes with double-stranded DNA under near-physiological conditions when natural phosphodiesters fail to do so. Physicochemical characteristics of the amidates are similar to those of RNA oligomers, even though they are composed of 2'-deoxyfuranose-based nucleosides.

Implementación de una API para la interacción del guante P5 con entornos de realidad virtual desarrollados en Java y Java 3D

Este artículo presenta el proceso de implementación de una API (Application Programming Interface) que permite la interacción del guante P5 de Essential Reality1 con un entorno virtual desarrollado en el lenguaje de programación Java y su librería Java 3D.2 Por otra parte, se describe un ejemplo implementado, haciendo uso de la API en cuestión. Con base en este ejemplo se presentan los resultados de la ejecución de pruebas de requerimientos de recursos físicos como la CPU y memoria física. Finalmente, se especifican las conclusiones y resultados obtenidos.

Pyrimidine-5'-nucleotidase Campinas, A New Mutation (p.r56g) In The Nt5c3 Gene Associated With Pyrimidine-5'-nucleotidase Type I Deficiency And Influence Of Gilbert's Syndrome On Clinical Expression.

Pyrimidine-5'-nucleotidase type I (P5'NI) deficiency is an autosomal recessive condition that causes nonspherocytic hemolytic anemia, characterized by marked basophilic stippling and pyrimidine nucleotide accumulation in erythrocytes. We herein present two African descendant patients, father and daughter, with P5'N deficiency, both born from first cousins. Investigation of the promoter polymorphism of the uridine diphospho glucuronosyl transferase 1A (UGT1A) gene revealed that the father was homozygous for the allele (TA7) and the daughter heterozygous (TA6/TA7). P5'NI gene (NT5C3) gene sequencing revealed a further change in homozygosity at amino acid position 56 (p.R56G), located in a highly conserved region. Both patients developed gallstones; however the father, who had undergone surgery for the removal of stones, had extremely severe intrahepatic cholestasis and, liver biopsy revealed fibrosis and siderosis grade III, leading us to believe that the homozygosity of the UGT1A polymorphism was responsible for the more severe clinical features in the father. Moreover, our results show how the clinical expression of hemolytic anemia is influenced by epistatic factors and we describe a new mutation in the P5'N gene associated with enzyme deficiency, iron overload, and severe gallstone formation. To our knowledge, this is the first description of P5'N deficiency in South Americans.

Adaptações musculares ao treinamento de força com sobrecargas excentricas

Universidade Estadual de Campinas . Faculdade de Educação Física