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China Institute of Sport Science ,China
Time : 10:00 - 10:40
Mei Wang is a expert in national physical fitness surveillance ,exercise and the health promotion the health behavior of adolescent and exercise prescription in China. She has completed her postdoctoral studies from Beijing Sports University of Sport Physiology in China. She is the director of Mass Sports Research Center, in China Institute of Sport Science in Beijing, She has published more than 5 papers in reputed journals and has been serving as an editorial board member of repute.
Regular physical activity helps maintain general health and aids in preventing chronic diseases such as obesity diabetes, and cardiovascular disease. The economic environment is one of the most significant macro-level factors. Based on the 2014 survey of physical activity and physical fitness data of 20 − 69 year old Chinese, this study aims to investigate the relationship between economic development and people’s physical activity in China.
Methods: A total of 43,389 adults from 30 different regions in mainland China were recruited. The GDP per capita of the 30 regions were determined based on the 2013 annual statistical report released by the national bureau of statistics of China and provincial level statistics bureaus. A questionnaire was used to determine the participants’ exercise frequency, duration, and intensity. Results: For the 30 regions surveyed, the correlation coefficients between GDP per capita and weekly activity were 0. 23 for men and 0.15 for women. The correlation coefficients between GDP per capita and obesity rates were 0.52 for men and 0.39 for women.
Conclusions: Although people in economically advanced regions in China currently engage in more physical activities than those in less economically developed regions, overweight and obesity persist as serious problems.
Nicklaus Children’s Hospital ,USA
Time : 10:50 - 11:30
Christopher Tirotta has been an active member of Nicklaus Children’s Hospital medical staff since 1991, practicing with the Department of Anesthesiology; he has served as the Director of Cardiac Anesthesia since 2002. He has served as Chief of the Department of Anesthesia since July 2017. He also has a clinical appointment with the Department of Anesthesiology at The University of Miami School of Medicine. Tirotta received his BA from Cornell University in 1982 and his MD from New York University School of Medicine in 1986. He also received an MBA degree from Columbia University in 1999. Tirotta completed his internship in Internal Medicine at SUNY at Stony Brook in 1987. He completed his residency training in anesthesiology at the University of Miami/Jackson Memorial Hospital in 1990; he sub-specialized in pediatric and cardiovascular anesthesia, including heart transplantation.
Post-operative pain control continues to be a problem in surgical patients. A novel formulation of an ultra-long acting local anesthetic is now available in the US: Exparel or liposomal bupivacaine. Liposomal bupivacaine is made up of microscopic polyhedral particles. The liposomes encapsulate the drug, bupivacaine hydrochloride, without altering molecular structure. This provides the reliable low dose release of the bupivacaine over time, providing long-lasting, post-surgical pain relief over the course of 2-3 days. This eliminates the need for titration of a single dose or the need for external devices or pumps to prolong analgesia.
Plasma bupivacaine levels may persist for 96 hours after injection. Peak plasma concentrations are lower in magnitude and occur later in time than after a similar injection with bupivacaine HCl. Plasma bupivacaine concentrations are not correlated with local efficacy.
Safety profile was evaluated in 10 clinical trials in patients undergoing a variety of surgical procedures. Most common adverse events were nausea, constipation and vomiting. Exparel demonstrated a favorable cardiac profile. There was no cardiac toxicity and no QTc prolongation, even supra-therapeutic doses. Rate of absorption is dependent on total dose administered, route of administration and vascularity of the surgical site. Efficacy has been established. Multiple trials demonstrated a significant reduction if pain intensity scores and a reduction if overall opioid consumption compared to placebo.Liposomal bupivacaine is a safe and effective novel drug to treat post-surgical pain.
Charles University ,Czech Republic
Time : 11:45 - 12:25
Jaroslav Macasek is currently an assistanct Professor and Vicehead of 4th Department of Internal Medicine at Charles University. He has completed his Ph.D. thesis in biochemistry and patobiochemistry (1st Faculty of Medicine, Prague). He is the Vicehead of 4th Department of Internal Medicine in Teaching Hospital, Prague. He has published more than 6 papers in reputed journals and has been co-investigator of research projects in lipidology focused on fatty acids.
Fatty acids (FA) are substantial components of lipids - one of the three major components of biological matter (along with proteins and carbohydrates). They are synthesized from two-carbon precursor; their degradation by β-oxidation in mitochondria is accompanied by energy-release.
Fatty acids in mammalian organism reach chain-length 12-24 carbon atoms, with 0-6 double bonds. Their composition is tissue specific. Endogenous acids can be desaturated up to Δ9 position, desaturation to other position is possible only from exogenous (essential) acids - linoleic (n-6 series) and α-linolenic (n-3 series).
Circulating lipids (in form of lipoproteins) consist of cholesteryl esters and triglycerides in nonpolar core and phosphatidylcholine and sphingomyeline in the polar envelope of lipoproteins. Nonesterified fatty acids (product of lipolysis and source for lipid synthesis) are bound to plasma albumin.
Membrane lipids, which ensure its fluidity and other functions, consist of phosphatidylcholine, phosphatidylethanolamine, sphingomyeline and some other (minor) phospholipids. Unsaturated fatty acids with 18-20 carbon atoms are precursors of prostaglandins, leucotrienes and thromboxanes, which have a broad scale of autocrine as well as paracrine effects. Fatty acids are ligands of several nuclear receptors, which take part in a number of metabolic pathways. Covalent modification of proteins by acylation enables their incorporation into membranes.
Many pathological stages are accompanied with changes in FA composition, often expressed as decreased content of polyunsaturated FA (PUFA) and increased content of saturated (SFA) and monounsaturated FA (MUFA) - dyslipidemia, malnutrition, inflammation, oxidative stress, inherited diseases, common metabolic abnormalities (metabolic syndrome, diabetes mellitus type 2). Content of individual FA depends (apart from other factors) on the activity of desaturation and elongation enzymes of their metabolic cascade.
In our studies we have proved the mentioned changes in patients with metabolic syndrome, cardiovascular diseases, diabetes mellitus type 2, anorexia nervosa, protein-energetic malnutrition, pancreatic carcinoma, chronic and acute pancreatitis and sepsis – statistically significant increase of SFA and MUFA (P < 0.05-0.001) and decrease of PUFA n-6 (P < 0.01-0.001). Increase in SFA and MUFA content was on the account of palmitic, palmitoleic and oleic acids connected with increased Δ9-desaturase activity of palmitic and stearic acids. Decrease in PUFA n-6 content was on the account of linoleic acid. Decreased content of PUFA n-3 was observed in the placental triacylglycerol fraction of mothers with gestational diabetes and diabetes type 1 (P < 0.001-0.0001).
Policlinico San Marco , Italy
Time : 12:25 - 12:55
This study is a retrospective analysis of a cohort of obese patients who underwent laparoscopic sleeve gastrectomy (LSG) from January 2008 to October 2016 at our Centre. The aim of the study was to search for predictive factors for proximal leakage, which is the main complication affecting LSG.
1738 patients were analyzed. The correlation between postoperative leakage and both preoperative and operative variables was analyzed. The experience of the surgeons was calculated in the number of LSGs performed. The surgical materials considered were stapler, cartridges, and reinforcement of the suture.
Proximal leakage was observed in 45 patients out of 1738 (2.6%). No correlation was found between leakage and the preoperative variables analyzed. The operative variables that were found to be associated with lower incidence of leakage at the multivariate analysis (p < 0.05) were the reinforcement of the staple line (or overriding suture or buttressing materials) and the experience of the surgeons. A distance of less than 2 cm from the pylorus resulted to be significantly related to a higher incidence of fistula at the univariate analysis.
In this large consecutive cohort study of LSG, proximal staple line reinforcement (buttress material or suture) reduced the risk of a leak. The risk of a proximal leak was much higher in the surgeons first 100 cases, which has implications for training and supervision during this "learning curve" period.
São Paulo State University , Brazil
Time : 12:55 - 13:25
Helga Verena Leoni Maffei, MD, PhD, Professor of Pediatric Gastroenterology, Prof. Emeritus of UNESP-São Paulo State University, Brazil. Graduation/residency training at the Medical Faculty, USP-University of São Paulo. Research Fellow/Honorary Consultant at the Gastroenterology Unit-Central Middlesex Hospital (Medical Research Council), London/UK, 1975-6. Active at Botucatu Medical School/UNESP, from 1966-2005, she organized/was responsible for the residency/post-graduation courses in Pediatric Gastroenterology. Papers in reputed journals and book chapters. Past president of São Paulo’s and Latin-America SPGHAN. Assessor of Funding Research Society FAPESP and scientific journals. Award from the National Academy of Sciences/BR. Actual research activities at Children’s Hospital ‘Menino Jesus’, São Paulo City
Childhood functional constipation is highly prevalent worldwide, therefore a public health problem. Also ‘occult’ constipation is frequent and goes unrecognized. In addition, children submitted to surgery need special attention, because of prolonged fasting, special diets, and postoperative ileus. Physiopathology is multi factorial, dietary fiber (DF) being one of the involved factors. Most studies depict a lower DF intake in children with constipation than in those without. Also, population surveys show a DF intake mostly below what is recommended. Thus, adequate DF intake could possibly prevent constipation. Onset around weaning from breast milk – protective against constipation - is frequent, but guidelines do not contemplate DF in this vulnerable period. Many complications ensue along time, thus early diagnosis and treatment are desirable, trying to avoid evolution to so called ‘intractable constipation’ and to surgical interventions, in an originally functional disorder. But, prevailing guidelines do hamper an early diagnosis. DF-dense diet is recommended for treatment, after adequate bowel washout procedures, but no emphasis is placed on it in the guidelines. Proposals to approximate the prevailing guidelines to everyday practice and a summary of studies evaluating dietary treatment of constipation with emphasis on supplements with DF/wheat bran will be presented. More studies are necessary to recommend DF supplements. In spite of this, DF treatment of constipation should not be neglected, since in general, studies show its beneficial effects.
China Institute of Sport Science , China
Time : 14:25 - 14:55
Chaoqun Fan has completed her PhD at the age of 28 years from Beijing Sports University of Sport Physiology in China. She is the assistant researcher of Mass Sports Research Center of China Institute of Sport Science.
Exercise has been confirmed to play an important role in weight loss, but menopausal women movement that also need to pay attention to a very important problem, that is osteoporosis, to avoid the happening of fracture. This research will explore effect of different exercises on bone density (BMD) in postmenopausal osteoporosis women.
Methods: The research recruit 53 postmenopausal osteoporosis women in intervention groups and 39 participants finished the intervention. Participants were assigned into three training groups: Body weight exercise training group , Jumping group, Brisk walking group. Control group included participants that did not receive training. Training groups exercise with monitor 2 times a week, and one family-based exercise a week. Every time lasted for 1 hour, and the whole intervention lasted for 3 months. Use DXA (GE LUANER) to measure BMD of L2-L4, hip and femoral neck. Use ELISA to measure bone metabolic indicators including PINP and CTX1.
Koç University School of Medicine , Turkey
Time : 14:55 - 15:25
Demet Demirkol has completed her pediatric intensive care fellowship education from Istanbul Faculty of Medicine and to be a professor of Pediatrics at 2013. She is the director of Koç University Pediatric Intensive Care Unit. She has published more than 30 papers in reputed journals and has been serving as an editorial board member of repute.
Differential lung ventilation (DLV) is a rare ventilation technique for patients with severe unilateral or asymmetric lung diseases who have failed with conventional mechanical ventilation strategies. During mechanical ventilation, the gas flow delivered by mechanical ventilator is mostly directed towards the less affected lung resulting in over-inflation, dead spaces and parenchymal damage in the less affected lung. Compensatory regional vasoconstriction and shunts occur in the capillaries of the affected lung. In most cases of unilateral or asymmetric lung diseases, conventional bilateral mechanical ventilation strategies might further deteriorate ventilation perfusion mismatching, thus mechanical ventilation management becomes difficult. To provide adequate oxygenation and ventilation, ventilator modes and parameters should be selected according to the different characteristics of each lung, like compliance, resistance and blood flow. DLV allows for different ventilator settings to be used for each lung.
A variety of techniques for performing DLV have been described, the main method is using double lumen endotracheal or tracheotomy tubes in adult patients. Pediatric double lumen tubes are suitable for patients older than 1 year; in small sizes these tubes are neither practical nor available. In small children and infants DLV must be performed by using alternative techniques such as combination of a laryngeal mask airway and a long tracheal tube or two single lumen tracheal tubes.In our case, we used an alternative technique for performing DLV. In this technique two single lumen, cuffed endotracheal tubes were inserted into the main bronchus of each lung through tracheotomy under bronchoscopy guidance. The tracheal tubes were attached to different ventilators, each providing support to a lung. This technique that proved to be efficient and simple has not been previously reported in pediatric patients
University Miguel Hernández , Spain
Time : 15:25 - 15:55
Manuel Moya has completed his PhD at the age of 24 years from the Universidad de Valencia, Bachelor’s Degree with Extraordinary Award. Postdoctoral studies at the Faculty of Medicine in the same University. Full Professor of Pediatrics and Head, Medical School at the University Miguel Hernandez / Hospital Universitario S. Juan de Alicante. He has published more than 200 papers in reputed journals and has been serving as an editorial board member of Anales de Pediatria and is regular referee of more than 10 International journals. Editor in Chief of the International Pediatric Association Newsletter.
Obesity is global problem because of its growing trend, even in the low- and middle-income countries, and because of the well-known consequences being the most indicative of which is the present reduction of life expectancy appearing in some high-income countries. There is a wide consensus that prevention should start at the earliest possible time. Pediatrics is the best time to initiate it because of the increased prevalence in childhood, the clinical burden (comorbidities already present in obese children), tracking and poor therapeutic results. It is worth analyzing why these four issues exist and the way to counteract them. In this general approach it is also necessary to stress the importance of the homogenization of anthropometric measures and their evaluation (Z-score for body mass index and waist circumference), with a general method (Cole) without neglecting the screening methods (centiles). The next general consideration is a consequence of the poor treatment results, which have given way to shamanic therapeutic responses that must be analyzed under the evidence grading score.
Preventive trajectories are initiated from global and or national directions and actions that later on fork into social/ environmental milieu and child and family lifestyle.
Types of prevention: The three levels of prevention, i.e primary (before the disease), secondary (latent disease) and tertiary (for disease consequences) plus the fourth holistic level, when carried out in practice fall on the classical questions: What, When and How, issued by WHO Population Health Promotion. What kind of prevention? The answer would be general and individual. The general approach is crowded by a great extent of plans and guidelines; therefore the evidence based policies are and will be applied to clear the overlapping and sometimes confusing panorama. Who is the recipient of prevention? This has been changed because of the notion that earliest prevention should start preconceptionally, going on from pregnancy and into the newborn period. The negative consequences of high birthweight are clearly demonstrated. Even the classical age to start prevention (4-6 years) is receding in favour of the early rebound of BMI. How prevention is carried out? The present ways should be based on demonstrated plans, but a lot of very varied norms appear and these seem unable to solve the problem. New interventions for pediatric population are analyzed and the common points of action are: Reduction of energy intake, Increase of energy expenditure, Involvement of parents/ family and provision of appropriate information to child or adolescent.
For this occasion a non-systematic revision of 56 preventive plans has been made and it can be concluded that adult models are of value for early prevention, results about efficiency are scanty, individual approaches are almost absent. In fact there is no great variation to the plans of 50 years ago. In this panorama of some good prevention programs yet increased prevalence trends of obesity in the world it is clear that something new must be done but it has not been defined yet. In the meantime this succinct analysis of positive facts and negative issues, will perhaps contribute step by step to improve the obesity prevention future.
Hamad General Hospital , Qatar
Time : 16:15 - 16:45
Tamer Saafan is currently a general surgery specialist who joined Hamad General Hospital as a resident in September 2012. Hamad General Hospital (HGH) is well known and one of the most advanced tertiary hospitals in the Middle East. During his residency, he showed significant improvement in his academic career and surgical skills that qualified him to be the general surgery academic chief resident between July 2015-July 2016. As an academic chief resident, he helped in restructuring the educational activities of his department which included arranging lectures, conferences and interdepartmental meetings. Tamer Saafan has two published articles in a well reputed journal. He has given multiple national and international presentations about different topics, including laparoscopy, bariatric surgery, endocrine surgery and acute care surgery. Currently Tamer Saafan is working on multiple research projects in bariatric, endocrine and general surgery.
Background: Controversy exists as to whether routine preoperative esophagogastroduodenoscopy (p-OGD) in bariatric surgery should be routinely undertaken or undertaken selectively based on patients’ symptoms. As very few studies have focused on the role of p-OGD prior to the increasingly common laparoscopic sleeve gastrectomy (LSG), we assessed the role/impact of p-OGD in LSG patients.
Methods: Retrospective review of records of all LSG patients operated upon at Hamad General Hospital, Qatar (2011–2014, n = 1555). All patients were screened by p-OGD. Patient characteristics were analyzed, and p-OGD findings were categorized into four groups employing Sharaf et al.’s classification. We assessed the impact of p-OGD findings on any change in surgical management or lack thereof.
Results: p-OGD findings indicated that 89.5% of our patients had normal or mild findings and were asymptomatic (groups 0 and 1, not necessitating any change in surgical management), and no patients had gastric cancer or varices (group 3). A total of 10.5% of our sample were categorized as group 2 patients who, according to Sharaf et al. might have their surgical approach changed. All patients diagnosed preoperatively with hiatal hernia (HH) had LSG with crucial repair and their symptoms resolved postoperatively.
Conclusion: Due to effectiveness and best utilization of resources, routine p-OGD screening in patients scheduled for LSG may require further justification for asymptomatic patients especially in regions with low upper GI cancers. p- OGD findings had low impact on the management of asymptomatic patients. Crural repair plus LSG was effective for hiatal hernia.
University of Athens School of Medicine , Greece
Time : 16:45 - 17:15
Both HPV-positive and negative cervical cancers are associated with cell cycle disruption; however, the actual processes affected, remain elusive. To this end, we employed both in vitro and in vivo cell models of cervical cancer, by investigating the genomic and transcriptomic effects of the presence or absence of HPV in three distinct and informative cervical cell lines vs. a normal one, and further validating these transcriptomic patterns in clinical samples. Whole exome sequencing and RNA sequencing were performed in a normal cervical cell line (HCK1T), one HPV (–) C33A, and in two HPV (+) cell lines, HeLa [HPV18+] and SiHa [HPV16+], and in 12 clinical samples of normal, CIN3 and cancer stages. RNA-sequencing documented the main integration sites of HPV18 and HPV16 in chromosomes 8 and 13, respectively. Furthermore, a total of 212 genes (85 upregulated and 127 downregulated) were differentially expressed in HeLa and SiHa only. The majority of the downregulated genes, such as integrin alpha 6 and cadherin 3, are involved in processes and pathways including cell adhesion, cell-cell signaling and differentiation, and development-related processes. The upregulated genes are involved in embryonic morphogenesis, apoptosis, cell cycle and in positive regulation of transcription, including factors HOXA13, EBF1, and NR4A1. Whole exome sequencing revealed 1,257 genes mutated in HeLa and SiHa cells only, affecting processes regulating cell adhesion and development. Sixteen of these mutated genes were also differentially expressed between HPV [+] and HPV [-] cells. We further expanded and validated these data in clinical samples from normal, CIN3 and cervical cancer tissues (n=12). The data documented that the CIN3 and cervical cancer transcriptomes exhibited minimal similarities. With more than 2,000 transcripts differentially expressed among CIN3, cervical cancer and normal tissues, <400 genes showed similar expression patterns. Chemotaxis and immune-related processes were downregulated in CIN3 patients, while cell cycle and mitosis were upregulated only in cervical cancer patients. In concordance with this, most of the transcriptional regulators controlling the immune and defense response, such as IL1b, IL1a, several cytokines (CCL5, CXCL1, CXCL8) and interferon regulatory factors (IRF1, IRF7) were downregulated, while in cervical cancer, regulators such as E2F1 and CDKN2A controlling cell cycle progression, were upregulated. Interestingly many pluripotency-related genes displayed elevated gene expression only in CIN3, suggesting the establishment of a transient pluripotency-like phenotype, which could eventually lead to cervical cancer. These combined data imply that the presence of HPV in cervical cancer cells initially leads to aberrant expression of genes controlling cell-cell signaling and cell adhesion, while distinct genes, processes and pathways are deregulated during the transition from CIN3 to cervical cancer.