Background
The Elipse™ intragastric balloon (EIGB) is a new swallowable balloon for weight loss (WL). Preserving metabolically active fat-free mass (FFM) and resting metabolic rate (RMR) during WL ...are crucial to maximize fat mass (FM) loss. After EIGB placement, a standard low-calorie diet (LCD) is generally prescribed. A low-calorie ketogenic diet (LCKD) has proven to be safe and effective in reducing FM while preserving FFM and RMR.
Objective
To prospectively compare the effects on WL, FM, FFM, and RMR in two groups of patients who were randomized to two different diets: LCKD and a standard LCD after EIGB placement.
Methods
WL, FM, FFM, and RMR were measured before EIGB and at 4 months in 48 patients who received either a LCKD (
n
= 24) or a standard LCD (
n
= 24). Compliance in following the prescribed diet was determined with food frequency questionnaires in all patients. The impact of LCKD and LCD on renal function was also evaluated.
Results
The LCKD group showed a significantly lower decrease in FFM and RMR when compared with the LCD group (3.55 vs 14.3%,
p
< 0.001; 9.79 vs 11.4%,
p
< 0.001, respectively). FM decreased more significantly with LCKD compared to LCD (41.6 vs 33.1%,
p
= 0.0606). Compliance in following the prescribed diets, without negative impact on renal function, was found.
Conclusion
Based on our findings, despite the small sample size, we were able to support the hypothesis that LCKD is associated with an increased FM loss while reducing the FFM loss and the RMR, without interfering with renal function after EIGB.
Neste trabalho, revisitamos o estudo de Ayres & Othero (2016), sobre o condicionamento de objetos nulos e pronomes em PB, na retomada anafórica de objeto direto de 3ª pessoa, na fala infantil, a ...partir das duas hipóteses consolidadas na literatura, a saber: a hipótese do conjunto de traços de animacidade e especificidade (cf. Cyrino, 1994/1997 e Casagrande, 2007, por exemplo), e a hipótese do gênero semântico (cf. Creus e Menuzzi, 2004, Othero et al., 2016, por exemplo). Como em seu estudo esses autores não distinguiram elipses de VP de objetos nulos, aqui nós separamos esses dois tipos de categoria vazia e as analisamos. Além disso, verificamos se o condicionamento dos objetos nulos e das elipses de VP ocorre em contextos semelhantes, tendo em vista que essas estruturas possuem formas superficialmente parecidas.
Anthropogenic climate change will disproportionately affect equatorial regions and closely adjacent areas, referred to here as the Fateful Ellipse. The vulnerability of these regions is exacerbated ...by a lack of capital for adaptive measures against the impacts of climate change. The increasing transference of capital from governmental control to private hands, and the increasing concentration of such capital into the hands of fewer individuals raises further concerns about capacity to mitigate or adapt to climate change. In addition, conflicts arise regarding the choice of climate change solutions. Ironically, the people of the Fateful Ellipse, who are most vulnerable to climate change, produce the lowest amount of carbon per capita. As a result of the colonial enterprise, including slavery, they also paid a heavy price toward the economic ascendency of Europe and North America and the Industrial Revolution that fueled the rise in greenhouse gas production. The discipline of geography itself owes some measure of its development and ascendency to colonialism and the exploitation of the Fateful Ellipse. As geographers we have the capacity, and a special responsibility, to contribute to the development of climate change solutions and global environmental justice.
Introducción: en la enseñanza de las matemáticas el uso de recursos tecnológicos ha tomado importancia en las prácticas docentes. No obstante, en algunas ocasiones la no profesionalización de ...profesores en las aulas les impide poder utilizar este tipo de herramientas de manera eficaz y acordes a las necesidades educativas de hoy día. Objetivo: caracterizar el conocimiento especializado del profesor de matemáticas que enseña de manera efectiva la modelación de la elipse a través de las mediaciones tecnológicas. Materiales y Métodos: el enfoque de esta investigación es de tipo cualitativo, con diseño y estudio de caso instrumental. La recolección de la información se llevó a cabo mediante 13 unidades de observación no participantes, diario de campo, cuestionario y una entrevista semiestructurada a un profesor con formación y experiencia en la enseñanza de la elipse haciendo uso de las TIC. Resultados: Se encontró relaciones entre el conocimiento especializado del profesor de los temas y de la enseñanza de las matemáticas, que contribuyen a la aproximación de la enseñanza de la modelación de la elipse mediante el software GeoGebra. Se Concluye que es indispensable que el profesor tenga conocimiento tanto disciplinar, didáctico pedagógico y del recurso tecnológico que utiliza para la enseñanza de un contenido específico de las matemáticas.
: Homozygous Familial Hypercholesterolemia (HoFH) is a very severe genetic form of hypercholesterolemia. Lacking LDL receptors in the liver, subjects with HoFH have raised plasma levels of LDL ...cholesterol, and up to 100 times higher risk of premature atherosclerotic cardiovascular disease than the general population.
: This evaluation is of a phase 3 trial of evinacumab; Evinacumab Lipid Studies in Patients with Homozygous Familial Hypercholesterolemia (ELIPSE HoFH). Evinacumab is a human monoclonal antibody inhibitor of angiopoietin-like protein 3 (ANGPTL3). In ELIPSE HoFH, evinacumab reduced LDL cholesterol by 47.1 ± 4.6%, HDL cholesterol by 30.4%, and triglycerides by 50.4 ± 7.7%.
: Evinacumab is not the ideal treatment for HoFH as it does not reduce LDL cholesterol levels to treatment targets while increasing HDL cholesterol. Although the incidence of adverse effects with evinacumab was low in ELIPSE HoFH, further studies are necessary to clarify its effects on liver enzymes and clinical cardiovascular outcomes. Evinacumab is a candidate to become the standard treatment for HoFH, as it may be better tolerated and/or more efficacious than the presently available specific treatment (lomitapide). However, the widespread use of evinacumab to treat high triglycerides or LDL cholesterol is unlikely due to evinacumab decreasing HDL cholesterol.
Purpose
The aim of this study was to evaluate the safety and efficacy of a new intragastric balloon (Elipse™ Balloon, Allurion Technologies, Natick, MA USA) not needing endoscopy.
Materials and ...Methods
The balloon was swallowed under fluoroscopy in 38 consecutive patients (F/M 28/10, mean age 46.4 ± 10.6 years, mean weight 109.7 ± 21.9 kg, and mean body mass index (BMI) 38.6 ± 6.7 kg/m
2
). After 4 months, the balloon spontaneously emptied and it was excreted through the digestive tract without upper endoscopy.
Results
There were no complications during balloon passage. After 16 weeks, the mean weight loss was 12.7 kg, mean percent excess weight loss was 26%, and mean BMI reduction was 4.2 kg/m
2
. Total body weight loss was 11.6%. There was a significant reduction in major co-morbidities related to metabolic syndrome: blood pressure (
p
< 0.02), waist circumference (
p
< 0.002), triglycerides (
p
< 0.0001), blood glucose (
p
< 0.001), and HOMA-IR index (
p
< 0.001). At the end of the treatment, 37 balloons were naturally excreted in the stool, and one balloon was endoscopically removed.
Conclusions
The results of this study on 38 consecutive patients demonstrate that the Elipse™ Balloon is safe, effective, and very well accepted by patients.
This work highlights the instrumental role of GeoGebra in the teaching / learning of Flat
Analytical Geometry and is intended for both students in the 1st year of the Degree in
Mathematics and the ...students in Secondary school in their extracurricular activities. The
theoretical approach and the presentation in GeoGebra are made with the purpose of
improving the understanding of the programmatic contents. The dynamism of the
Software allows: i) saving time in geometric constructions, ii) visualizing them step by
step and, iii) exploring their conjectures. Finally, we make some considerations and
recommendations for and in the use of GeoGebra in the teaching / learning of
Mathematics.
Este trabalho destaca o papel instrumental do GeoGebra no ensino/aprendizagem da Geometria Analítica plana e destina-se tanto aos estudantes do 1º ano do Curso de Licenciatura em Matemática, como aos alunos de Ensino Secundário nas suas atividades extracurriculares. A abordagem teórica e a apresentação no GeoGebra são feitas com o propósito de melhorar a compreensão dos conteúdos programáticos. O dinamismo do Software permite: i) economizar tempo nas construções geométricas, ii) visualizá-las passo a passo e, ainda, iii) explorar as suas conjeturas. Por fim, tecem-se algumas considerações e recomendações para e na utilização do GeoGebra no ensino/aprendizagem da Matemática.
Key Clinical Message
Gastric outlet obstruction can be a dangerous complication of intragastric balloons, as it can result in severe metabolic alkalosis. As weight loss procedures and medical tourism ...become more popular, physicians should have a high index of suspicion for complications of invasive procedures, particularly in returning travelers.
Intragastric balloons for weight loss have decreased in frequency in the United States. However, they are still frequent in low‐ and middle‐income countries. Severe complications occur in less than 3% of patients who undergo this procedure. Herein, we present a case of gastric outlet obstruction, severe metabolic alkalosis, and refeeding syndrome in a patient returning from the Dominican Republic. She presented with 2 weeks of emesis and obstipation, followed by a pre‐syncope and altered mental status. An intragastric mass was observed on computerized tomography, which was characterized as an intragastric balloon and retrieved endoscopically. All metabolic derangements were corrected, and the patient improved without sequelae. As weight loss procedures and medical tourism become more popular, physicians should have a high index of suspicion for complications of invasive procedures, particularly in returning travelers.
CT abdomen‐pelvis showing an obstructing mass occupying the patient's stomach.
•Elipse™ IGB is a novel procedureless device for weight loss.•We represent a successful laparoscopic management of a small bowel obstruction caused by Elipse™ IGB migration.•This is the first ...reported adverse event in literature regarding Elipse™ IGB device.
The Elipse™ intragastric balloon (IGB) for weight loss is a swallowable capsule that is filled with 550mL of fluid and resides in the stomach for four months before being excreted from the gastrointestinal tract. Although initial data showed that use of this device is safe and free from serious complications, we report for the first time the successful management of an Elipse™ IGB-related adverse event.
A 41-year-old woman presented to our emergency department following two days of abdominal pain, vomiting, and constipation. Her medical history included four caesarean sections and insertion of the Elipse™ IGB 16 weeks prior to presentation. The patient was vitally stable at presentation and abdominal examination revealed a mildly distended abdomen. Plain X-ray revealed a small bowel obstruction (SBO), and a double contrast computed tomography scan showed a dilated small bowel with mild free fluid proximal to a transition zone at the distal jejunum. Laparoscopic enterotomy was performed just proximal to the obstruction site, and the balloon was visualized and extracted after it had been incised and emptied. The enterotomy incision was closed with an intracorporeal continuous absorbable suture. The patient’s recovery was uneventful and she was discharged on postoperative day 4.
We discuss the possible etiologies of SBO following Elipse™ IGB insertion, and present a brief literature review regarding surgical and nonsurgical management options for such cases.
Although initial data showed the Elipse™ IGB to be safe, complications can occur and be managed successfully.
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