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BackgroundDuodenal switch and single anastomosis modifications continue to gain greater interest among bariatric surgeons. Limiting factors to adoption include concerns around the nutritional management, patient compliance and follow-up, and the technical challenge of the operation. The majority of techniques offered currently use a hand-sewn duodenoileostomy. This approach is limited by the steep learning curve as well as longer operating times.ObjectivesWe present a video demonstrating the fully stapled technique for duodenoileostomy and ileileostomy. We offer technical pearls around the technique, specifically focused on maintaining a widely patent anastomosis, open biliopancreatic limb, safe duodenal dissection, and correct loop orientation.MethodsLaparoscopic fully stapled duodenoileostomy for duodenal switch and single anastomosis modification.SettingCommunity hospital, single institution, 3 surgeons.ConclusionTriple staple offers a reproducible and safe technique for the duodenoileostomy and specifically for construction of a Roux or loop anastomosis in duodenal switch.  相似文献   
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ObjectiveTo evaluate the effectiveness of an intervention with dual task based on trail making test on gait, cognition and daily activities execution in individuals with Parkinson's disease.DesignRandomized controlled trial.Methodology10 individuals with Parkinson's Disease (PD) were divided into dual task group (DTG) and control group (CG). Were realized 16 dual task (DT) training sessions based on the Trail Making Test (TMT) for DTG and a conventional training protocol for CG. Pre and post intervention assessments used the 6 minute walk test (T6), TMT, Katz Index and Falls Efficacy Scale (FES).ResultsComparing the difference between pre and post intervention values between groups, there was no significant difference for T6 (p=0,36). In TMT there was a significant difference (p=0,03), showing shorter times for DTG. The tests used for time values in the Katz index tasks showed an important difference for the DTG (P=0,02). As for the results of the FES, they did not show pre and post changes in the DTG (0,45) and in the CG (p= 0,29) and not even between the groups (p=0,45).ConclusionThe proposed intervention was able to promote improvements in the performance of daily life activities, learning adaptations and retention of motor and cognitive aspects, which may reflect positively in the daily lives of patients with PD and, consequently, greater autonomy to perform these types of activities.  相似文献   
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Background

The dilated cardiomyopathy with ataxia syndrome (DCMA) is a rare mitochondrial disorder characterized by progressive cardiomyopathy, prolonged QT interval and early death in childhood related to intractable heart failure. We present a case series of 9 children with DCMA who demonstrated functional improvement and favourable left ventricular remodeling only after digoxin was added to their medical therapy.

Methods

A retrospective review of 46 patients with DCMA followed at the Alberta Children’s Hospital from 2005 to 2017 identified 9 patients who were treated with digoxin and had serial echocardiography data. For each subject, we calculated the difference between baseline and follow-up for left ventricular ejection fraction (LVEF), end-diastolic dimension (LVEDD), and end-systolic dimension (LVESD) as determined by echocardiography.

Results

Patients were on average 45.6 ± 59 months of age when digoxin was started with a mean LVEF of 40% ± 11% when digoxin was started. Seven patients were on angiotensin-converting enzyme inhibitors (ACEIs) at the time of initiation of digoxin, and all were on β-receptor antagonists (BB). After being on digoxin for a mean of 11.7 ± 10.9 months, average LVEF improved to 55% ± 10% (P = 0.0005), and there were significant decreases in the Z-scores for LVEDD (+2.1 ± 1.9 to +0.65 ± 1.4, P = 0.02) and LVESD (+3.83 ± 2.07 to +1.79 ± 1.76, P = 0.01).

Conclusions

In children with DCMA, we report that digoxin seems to have additive beneficial properties when combined with ACEI and BB therapy. This novel observation may have implications for the medical treatment of mitochondrial cardiomyopathies.  相似文献   
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Background/Objectives

The Trail‐Making Test (TMT), which is commonly used to measure executive function, consists of two components (TMT‐A and TMTB). There is a lack of normative TMT data for Chinese elderly adults. This study aimed to evaluate the validity of the TMT in screening for cognitive impairment.

Design

2,294 Chinese‐speaking adults aged 50 to 85: 1,026 with normal cognition (NC), 462 with mild cognitive impairment (MCI), 108 with Alzheimer's disease (AD), 113 with vascular mild cognitive impairment (VaMCI), 121 with vascular dementia (VaD), 282 with uncertain types of dementia, and 15 with mixed dementia. Receiver operating characteristic curve analysis was performed to test the ability of TMT scores to differentiate between NC and cognitive impairment.

Results

Age, education, and sex were significantly associated with TMT completion time. The TMT‐A exhibited sensitivity of 77.8% and specificity of 92.0% with cut‐off value of 98.5 seconds for discriminating AD from NC. The TMT‐B had sensitivity of 83.3% and specificity of 91.8% with a cut‐off value of 188.5 seconds for discriminating AD from NC. The TMT‐A had sensitivity of 85.7% and specificity of 81.6% for discriminating NC from VaD with a cut‐off value of 77.5 seconds, and the TMT‐s had sensitivity of 81.6% and specificity of 83.9% with a cut‐off value of 147.5 seconds. The TMT had less sensitivity distinguishing MCI from NC.

Conclusion

The Chinese version of the TMT is reliable for detecting AD or VaD but poor at distinguishing MCI from NC.  相似文献   
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There is a possible association between infectious agents and psychiatric disorders. Previous studies in the US provided evidence for cognitive impairment correlated with Herpes simplex virus type 1 (HSV-1) infection. For a replication study in Europe we chosed individuals diagnosed with bipolar disorder to analyse the correlation with HSV-1 infection. Antibody prevalence was analyzed by using solid phase immunoassay techniques. Cognitive functioning was tested with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Form A, the Trail Making Test A&B, and two subtests from the WAIS III: the Letter Number Sequencing Task and the subtest on information. History and psychopathology was assessed using structured interviews and validated rating scales (SCID, HRSD-21, YMRS, PANSS). Additionally, we investigated social functioning and quality of life using self-assessment-scales (SAS, LQLP). Prevalence rates of antibodies against diverse infectious agents did not differ significantly between patients and controls. We found a significant correlation between cognitive impairment in patients with bipolar disorder and the prevalence of antibodies directed against HSV-1. Cognitive functions were significantly impaired including language, attention, and immediate memory.The results of this study confirm previous findings suggesting that HSV-1 affects cognitive functions in patients with bipolar disorder. This may also result in more impaired functioning, less quality of life and difficulties in social adjustment.  相似文献   
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