Gallbladder stones in bariatrics and management of choledocholithiasis after gastric bypass

Mariano Palermo,Manoel Galvao Neto 소화기인터벤션의학회 2019 Gastrointestinal Intervention Vol.8 No.1

It is known that the rapid weight loss is a predisposing factor to develop biliary lithiasis. The physiopathology is related with an oversaturation of bile with cholesterol, bile stasis, and increase in mucin concentration in bile. The incidence of cholelithiasis post gastric bypass is estimated around 37%. Almost 50% developed disease in the first year of monitoring, and 60% in the first 6 months. Meanwhile the patients undergoing sleeve gas-trectomy have an incidence of cholelithiasis of 27%. Diverse kinds of protocols exist: prophylactic surgery (simultaneous cholecystectomy and gastric bypass in every patients, whether they have or not cholelithiasis), elective (simultaneous cholecystectomy with conventional gastric bypass in the patients with asymptomatic cholelithiasis), and conventional cholecystectomy only in the presence of cholelithiasis with symptoms. Which way to go is still a topic of discussion among surgeons but the majority agree that prophylactic surgery shouldn’t be an option because the number of patients that will develop symptomatic cholelithiasis is low (around 6% to 8% of them) and this leads to an elevated number of patients exposed to an unnecessary procedure with potential complications. The presence of gallstones in the common bile duct (CBD) although is a rare complica-tion after Roux-en-Y gastric bypass (around 0.2% of the bariatric patients) represents an important challenge due to the anatomical modifications of the gastrointestinal tract. This leads to having to pursue other methods to reach the papillae for the resolution of choledocholithiasis: laparoscopy-assisted transgastric endoscopic retrograde cholangiopancreatography (ERCP), balloon enteroscopy assisted ERCP, percutaneous biliary drainage with subsequent trans fistula treatment and laparoscopic exploration of CBD. Which of these methods should we choose must be based on the surgeon experience, the equipment available and the location of the stone. But whatever the method, a special training is needed on endoscopy, percutaneous surgery and laparoscopy.

Gallbladder stones in bariatrics and management of choledocholithiasis after gastric bypass

Mariano Palermo,Manoel Galvao Neto 소화기인터벤션의학회 2019 International journal of gastrointestinal interven Vol.8 No.1

It is known that the rapid weight loss is a predisposing factor to develop biliary lithiasis. The physiopathology is related with an oversaturation of bile with cholesterol, bile stasis, and increase in mucin concentration in bile. The incidence of cholelithiasis post gastric bypass is estimated around 37%. Almost 50% developed disease in the first year of monitoring, and 60% in the first 6 months. Meanwhile the patients undergoing sleeve gas-trectomy have an incidence of cholelithiasis of 27%. Diverse kinds of protocols exist: prophylactic surgery (simultaneous cholecystectomy and gastric bypass in every patients, whether they have or not cholelithiasis), elective (simultaneous cholecystectomy with conventional gastric bypass in the patients with asymptomatic cholelithiasis), and conventional cholecystectomy only in the presence of cholelithiasis with symptoms. Which way to go is still a topic of discussion among surgeons but the majority agree that prophylactic surgery shouldn’t be an option because the number of patients that will develop symptomatic cholelithiasis is low (around 6% to 8% of them) and this leads to an elevated number of patients exposed to an unnecessary procedure with potential complications. The presence of gallstones in the common bile duct (CBD) although is a rare complica-tion after Roux-en-Y gastric bypass (around 0.2% of the bariatric patients) represents an important challenge due to the anatomical modifications of the gastrointestinal tract. This leads to having to pursue other methods to reach the papillae for the resolution of choledocholithiasis: laparoscopy-assisted transgastric endoscopic retrograde cholangiopancreatography (ERCP), balloon enteroscopy assisted ERCP, percutaneous biliary drainage with subsequent trans fistula treatment and laparoscopic exploration of CBD. Which of these methods should we choose must be based on the surgeon experience, the equipment available and the location of the stone. But whatever the method, a special training is needed on endoscopy, percutaneous surgery and laparoscopy.

Sediment Transport on Block Ramp: Filling and Energy Recovery

Stefano Pagliara,Michele Palermo,Ilaria Lotti 대한토목학회 2009 KSCE JOURNAL OF CIVIL ENGINEERING Vol.13 No.2

The effect of sediment transport on both morphology and energy dissipation in presence of non conventional stream rehabilitation structures, such as block ramps or rock chutes, is a not well explored topic on hydraulic engineering. Namely, in normal functioning conditions, these types of structures are generally located in mountain rivers, which are characterized by an elevated sediment transport which can be deposited and trapped between the rocks constituting the ramp. This causes a change in the bed roughness and in the energy dissipation process that is present on a block ramp. This occurrence was experimentally investigated at the Hydraulic Laboratory of the University of Pisa. Different experimental conditions were tested and the main hydraulic and geometric parameters controlling the filling phenomenon and its effects were highlighted. Namely, it was experimentally proved that both the median diameters of the filling material and of the ramp blocks, the ramp slope and the discharge are the most relevant parameters governing the ramp filling. Thus, experimental formulae were derived to foresee the ramp morphological changes and the interaction between the filling process and the geometric and hydraulic parameters. Moreover a comparison of the energy dissipation on block ramp was conducted and the energy recovery in presence and absence of filling material was compared. The effect of sediment transport on both morphology and energy dissipation in presence of non conventional stream rehabilitation structures, such as block ramps or rock chutes, is a not well explored topic on hydraulic engineering. Namely, in normal functioning conditions, these types of structures are generally located in mountain rivers, which are characterized by an elevated sediment transport which can be deposited and trapped between the rocks constituting the ramp. This causes a change in the bed roughness and in the energy dissipation process that is present on a block ramp. This occurrence was experimentally investigated at the Hydraulic Laboratory of the University of Pisa. Different experimental conditions were tested and the main hydraulic and geometric parameters controlling the filling phenomenon and its effects were highlighted. Namely, it was experimentally proved that both the median diameters of the filling material and of the ramp blocks, the ramp slope and the discharge are the most relevant parameters governing the ramp filling. Thus, experimental formulae were derived to foresee the ramp morphological changes and the interaction between the filling process and the geometric and hydraulic parameters. Moreover a comparison of the energy dissipation on block ramp was conducted and the energy recovery in presence and absence of filling material was compared.

Restorative Justice and Chinese Traditional Legal Culture in the Context of Contemporary Chinese Criminal Justice Reform

Jianhong Liu,George B. Palermo 아시아경찰학회 2009 Asia Pacific Journal of Police & Criminal Justice Vol.7 No.1

The restorative justice movement of recent decades has largely developed in Western countries (Van Ness 2002). The present study examines the Chinese Confucian traditional philosophy and legal cultural values that are compatible with the philosophy and principles of restorative justice and analyzes the specific principles of the Confucian traditional legal culture that were conducive to restorative justice practices. It explicates several major Chinese contemporary programs and practices which are compatible with modern restorative justice and explains how the Chinese Confucian traditional legal cultural principles continue to influence criminal justice policy within the context of contemporary Chinese criminal justice reforms. The study suggests that unlike the typical Western restorative justice movement, which is a response to the problems of justice system, the main impetus for the development of China's restorative justice is its Confucian traditional legal culture.

Histamine and spontaneously released mast cell granulesaffect the cell growth of human hepatocellular carcinoma cells

Nadia Lampiasi,Antonina Azzolina,Giuseppe Montalto,di Palermo),Melchiorre Cervello 생화학분자생물학회 2007 Experimental and molecular medicine Vol.39 No.3

The role of mast cells in tumor growth is still controversial. In this study we analyzed the effects spontaneously released by mast cells on the growth of two human hepatocellular carcinoma cell lines, HA22T/VGH and HuH-6, with different characteri-stics of differentiation, biological behavior and genetic defects. We showed that total mast cell releasate, exocytosed granules (granule remnants) and histamine reduced cell viability and proliferation in HuH-6 cells. In contrast, in HA22T/VGH cells granule remnants and histamine induced a weak but significant increase in cell growth. We showed that both cell lines expressed histamine receptors H1 and H2 and that the selective H1 antagonist terfenadine reverted the histamine-induced inhibition of HuH-6 cell growth, whereas the selective H2 antagonist growth of HA22T/VGH cells. We demonstrated that histamine down-regulated the expression of β-ca-tenin, COX-2 and survivin in HuH-6 cells and that this was associated with caspase-3 activation and PARP cleavage. On the contrary, in HA22T/VGH cells expression of survivin and β-catenin increased after treatment with granule remnants and histamine. Overall, our results suggest that mediators stored in mast cell granules and histamine may affect the growth of liver cancer cells. However, mast cells and histamine may play different roles depending on the tumor cell features. Finally, these data suggest that histamine and histamine receptor agonists/ antagonists might be c onsidered as new thera-peutic drugs to inhibit liver tumor growth.

Combined hysteroscopy-laparoscopy approach for excision of pelvic nitinol fragment from Essure contraceptive device: Role of intraoperative fluoroscopy for uterine conservation

( E. Scott Sills ),( Gianpiero D. Palermo ) 대한산부인과학회 2016 Obstetrics & Gynecology Science Vol.59 No.4

We describe the successful removal of a pelvic contraceptive coil in a symptomatic 46-year-old patient who had Essure devices for four years, using a combined hysteroscopy-laparoscopy-fluoroscopy approach. Following normal hysteroscopy, at laparoscopy the right Essure implant was disrupted and its outer nitinol coil had perforated the fallopian tube. However, the inner rod (containing polyethylene terephthalate) had migrated to an extrapelvic location, near the proximal colon. In contrast, the left implant was situated within the corresponding tube. Intraoperative fluoroscopy was used to confirm complete removal of the device, which was further verified by postoperative computed tomography. The patient’s condition improved after surgery and she continues to do well. This is the first report to describe this technique in managing Essure complications remote from time of insertion. Our case highlights the value and limitations of preoperative and intraoperative imaging to map Essure fragment location before surgery.

Modelling seismically repaired and retrofitted reinforced concrete shear walls

W. Leonardo Cortés-Puentes,Dan Palermo 사단법인 한국계산역학회 2011 Computers and Concrete, An International Journal Vol.8 No.5

The Finite Element Method (FEM) was employed to demonstrate that accurate simulations of seismically repaired and retrofitted reinforced concrete shear walls can be achieved provided a good analysis program with comprehensive models for material and structural behaviour is used. Furthermore, the analysis tool should have the capability to retain residual damage experienced by the original structure and carry it forward in the repaired and retrofitted structure. The focus herein is to provide quick, simple,but reliable modelling procedures for repair and retrofitting strategies such as concrete replacement, addition of diagonal reinforcing bars, bolting of external steel plates, and bonding of external steel plates and fibre reinforced polymer sheets, thus illustrating versatility in the modelling. Slender, squat, and slender-squat shear walls were investigated. The modelling utilized simple rectangular membrane elements for the concrete, truss bar elements for the steel and FRP retrofitting materials, and bond-link elements for the bonding interface between steel or FRP to concrete. The analyses satisfactorily simulated seismic behaviour, including lateral load capacity, displacement capacity, energy dissipation, hysteretic response, and failure mode.

Systematic Review on Cancer Care Teams in Adolescents and Young Adult Patients with Cancer: How Multidisciplinary Teams Influence the Quality of Care

Hyewon Shin,Angela Kabbe,Olivia Palermo,Molly Yost 한국간호과학회 2021 한국간호과학회 학술대회 Vol.2021 No.10

Aim(s): The use of multidisciplinary teamwork has been found to result in effective care for patients with cancer in general but there is a lack of research surrounding teamwork in adolescent and young adult patients with cancer. This integrative review examines the teamwork among health care providers determining the plan of care for this population. Method(s): The preferred reporting items for systematic reviews and meta-analysis guidelines informed this review of studies that were conducted from 2000 to 2020. Eligible studies involved health care providers caring for a young patient diagnosed with cancer between 15-39 years of age, encompassed at least one phase of the cancer care continuum (cancer diagnosis to survivorship), and included multidisciplinary teamwork among health care providers. Result(s): Ten articles met inclusion criteria. Four themes were identified: 1) unique features of multidisciplinary teams in adolescent and young adult cancer care; 2) components of the multidisciplinary team effort; 3) how multidisciplinary teams were implemented, and ; 4) the impact of the multidisciplinary teams. These populations have psychosocial and informational needs related to their developmental stages. Multidisciplinary team efforts varied and included education and care delivery foci. Medicine, nursing, and social work were the commonly included disciplines on multidisciplinary teams. Communication and team member cooperation were deemed important to multidisciplinary team processes. Conclusion(s): Multidisciplinary team efforts demonstrated positive impacts on adolescent and young adult cancer care and improved outcomes. Emerging evidence indicates multidisciplinary teams have positive impacts on the experience and outcomes of this population. Further research focused on evaluating existing multidisciplinary team efforts for adolescent and young adult patients with cancer are needed. The development of comprehensive cancer care programs utilizing multidisciplinary teams should be considered.

Kinetics for the biodiesel production from lauric acid over Keggin heteropolyacid loaded in silica framework

Luis A. Gallego-Villada,Edwin A. Alarcón,Valeria Palermo,Patricia G. Vázquez,Gustavo P. Romanelli 한국공업화학회 2020 Journal of Industrial and Engineering Chemistry Vol.92 No.-

Kinetic models were developed to describe the esterification reaction of lauric acid and ethanol overheterogeneous catalysts, which is a reaction of special interest in the biodiesel production. VanadiumKeggin heteropolyacid was included on a silica framework by sol–gel procedure, using different loadings. The synthesized materials were characterized by FT-IR, XRD, SEM, nitrogen adsorption/desorptionisotherms, and potentiometric titration, and tested as solid catalysts in the esterification of lauric acid. Best performance was achieved with SiO2@20PMoV, which was used in the esterification of others fattyacid and alcohols. The reuse was successfully tested infive consecutive runs. Kinetic data usingSiO2@20PMoV were obtained at different temperatures (48–78 C), fatty acid:alcohol molar ratios(4 mmol of lauric acid and 2.5, 5, 10 and 15 mL of ethanol), and catalyst amounts (12.5, 25 and 50 mg). Thebest heterogeneous models were LH3 (surface reaction as rate-limiting step) and ER3 (desorption of ethyllaurate as rate-limiting step when the adsorbed reactant is lauric acid). The activation energies were56.1 kJ mol 1 and 64.8 kJ mol 1, and the reaction rate constants at 78 C were 0.2791 mol g 1 h 1 and0.0768 mol g 1 h 1 for LH3 and ER3, respectively.

Science and technology roadmap for graphene, related two-dimensional crystals, and hybrid systems

Ferrari, Andrea C.,Bonaccorso, Francesco,Fal'ko, Vladimir,Novoselov, Konstantin S.,Roche, Stephan,Bøggild, Peter,Borini, Stefano,Koppens, Frank H. L.,Palermo, Vincenzo,Pugno, Nicola,Garrido, Jos&eacut The Royal Society of Chemistry 2015 Nanoscale Vol.7 No.11

<P>We present the science and technology roadmap for graphene, related two-dimensional crystals, and hybrid systems, targeting an evolution in technology, that might lead to impacts and benefits reaching into most areas of society. This roadmap was developed within the framework of the European Graphene Flagship and outlines the main targets and research areas as best understood at the start of this ambitious project. We provide an overview of the key aspects of graphene and related materials (GRMs), ranging from fundamental research challenges to a variety of applications in a large number of sectors, highlighting the steps necessary to take GRMs from a state of raw potential to a point where they might revolutionize multiple industries. We also define an extensive list of acronyms in an effort to standardize the nomenclature in this emerging field.</P>