Biography:

I am a Digestive Surgeon who believes that patient care should be a physician's first priority. I am specializes in digestive surgery with most of the procedures do laparoscopically. My activity in laparoscopic surgery field: President of Indonesian Society of Endo-laparoscopic Surgeons ( ISES ), Former Vice President of Endoscopic Laparoscopic Surgeons of Asia (ELSA), Advisory Board Member of Indonesian Digestive Surgeons Association (IDSA), International Honorary Member of Japan Society for Endoscopic Surgery (JSES), Board Member of Asia Pacific Endo-Lap Surgery Group (APELS), Board Member of Asia Pacific Metabolic and Bariatric Surgery Society (APMBSS), and many more.

I am completed my medical degree at Padjadjaran University Bandung in 1983, continue my study in Department of Surgery University of Indonesia  1991 (graduated) , and completed as Digestive Surgeon in University of Indonesia 1997 . Now I work in Premier Bintaro Hospital and Mayapada Hospital Jakarta as a Digestive Surgeon.

Abstract:

Bariatric surgery, also called weight-loss surgery, is very effective for people who are not able to lose weight or maintain weight loss with diet and exercise alone. Most people can expect to lose between 35%-70% of their excess body weight one year after having bariatric surgery. Obesity, defined as a body mass index (BMI) ≥30 kg/m², has been associated with an elevated risk for the development of abdominal wall hernias (AWH). This risk is likely due to multiple factors, such as: increased visceral fat, intra-abdominal pressure, increased abdominal wall circumference, increase risk of surgical site infections (SSI).

The benefit for doing one stage laparoscopic sleeve gastrectomy and multiple hernia repair: the patient should not have reoperated for the other indication. This one stage laparoscopic procedure we can do it if we establish the patient safety criteria. Using a synthetic mesh in patient for hernia repair after sleeve gastrectomy considered this operation is clean. The ideal timing for hernia repair remains controversial, there are have scenarios: Hernia repair prior to bariatric surgery, bariatric surgery followed by hernia repair and simultaneous bariatric procedure and hernia repair. Each procedure can be done according to their respective criteria.

Biography:

Dr. Antara Banerjee is working as an Associate Professor at Faculty of Allied Health Sciences, Chettinad Academy of Research and Education, Chennai. She has done her Post-Doctoral research at University of Padova, Italy and University of Linkoping, Sweden for over 10 yrs. Her research areas includes Regenerative biology, Stem cell Biology and Oncology and Gastroenterology. She has published 55 high impact peer reviewed articles in International/ National Journals. She has been awarded with the Young Scientist Research grant award by Goverment of India and other Industry sponsered projects.  She is in the editorial board of several reputed journal and edited books from Springer nature and Elsevier.

Abstract:

Ulcerative colitis is a disease which involves inflammation and sores in the colonic lamina propria of large intestine. This results in the increased breakdown of extracellular matrix and interference of the mucosal barrier with imprudent production of inflammatory mediators which includes cytokines, reactive oxygen species, enzymes, growth factors, etc. Since mesenchymal stem cells are reported to be a potential candidate for cellular therapeutics, we hereby highlight the protective potential of exogenously administered human umbilical cord derived mesenchymal stem cells (UCMSCs) against Dextran Sulfate Sodium (DSS) induced acute colitis in immunodeficient NOD.CB₁₇-Prkdc^scid/J mice with specific response to endoplasmic reticulum (ER) stress.

To verify attenuation of DSS induced damage by UCMSCs, Disease Activity Index, colon length, histological changes, myeloperoxidase/catalase activities, chromosome aberrations (CA), sperm head anomalies, matrix metalloproteinase 2/9 expression and endoplasmic reticulum (ER) stress related proteins were evaluated. It is also been observed from the results that the ER stress induces chromatin changes, which can also facilitate cell survival.

There seemed to be a palpable increase in the frequencies of various types of CA level and significant downregulation of colonic tissue damage after administration of UCMSCs. The data validated that UCMSCs were able to prevent DSS-induced colitis in immunodeficient mice. The reduction of frequencies of chromosomal aberrations and sperm head anomaly suggests that the UCMSCs prevent the genotoxic damage rendered by DSS administration to the colon. Additionally we demonstrated a key function of MMPs and ER stress in the establishment of colitis suggesting them to be imminent therapeutic targets for treatment of Ulcerative colitis.

Keywords:

Dextran Sulphate sodium, Umbilical cord mesenchymal stem cells, genotoxicity, ER stress, matrix metalloproteinase.

Funding:

This work was supported by the grants sanctioned to Dr. Antara Banerjee (PI) from the SERB-DST Govt. of India with the sanction file no ECR/2017/001066 and Roberto Farini Association ONLUS, the Marina Minnaja Foundation ONLUS and COPEV (Comitato per la Prevenzione dell’Epatite Virale). The authors are thankful to Chettinad academy of Research and Education to provide infrastructural support.

Biography:

Dr. Anshoo Agarwal is currently working as Professor & Chairperson at Department of Pathology, Northern Border University, Arar Kingdom of Saudi Arabia. She received her Bachelor of Medicine & Bachelor of Surgery from King George's Medical College Lucknow. Dr. Anshoo Agarwal received her M.D in Pathology from LLRM Medical College / Ch. Charan Singh University. She is an Associate professor and Discipline Coordinator in University Technology MARA, Malaysia. Dr. Anshoo Agarwal has served on many scientific memberships like Life member of Indian Association of Pathology and Microbiology, Member of International Academy Pathology, Life member of Indian Society of Hematology & Transfusion Medicine, Emirates Medical Association Pathology Society. Dr. Anshoo Agarwal has more than 80 publications. Dr. Anshoo Agarwal is editorial member of 3 journals and has many reviewed publications. Dr. Anshoo Agarwal research interests include Advance Haematology & Immunohematology, Breast cancer and Anticancer vaccines.

Abstract:

Background:

The Indian Council of Medical Research in India has reflected that the occurrence of Gall bladder carcinoma (GBC) is predominantly higher in northern India. Reports from ICMR suggests that the incidence of GBC corresponds to 3.6 per million in males and 7.4 per million in females in Delhi, India, as compared to 1.13 per million in the US. The incidence is high in females and it represent almost three fourths of GBC victims and their highest incidence rate occur in this region, yet only few immunomarker studies are available from this high-predisposing region. GBC has also been reported to show a variable expression pattern among different ethnic groups.

GBC results via the dysplasia-metaplasia sequence and the 5-year survival rate for GBC is 32% and for the advanced stage it is only 10%. Current studies have focused on the importance of Cyclin D1, E-cadherin, EGFR, HER- 2, Ki67, and p53 immunomarkers in the development and prognosis of GBC. One of the most genetic aberrations is ascribed to be HER-2 in GBC. HER-2 and other immunomarkers Cyclin D1, E-cadherin, EGFR, Ki67, and p53 can be easily assessed by standard immunohistochemistry methods. However, concrete results have not been obtained due to a limited number of respectable GBC cases presented atthe hospitals. We, therefore, attempt to evaluate the immune-expression of these markers in GBC cases and determine their prognostic value in the selected GBC cohort.

Material and Methods

30 resected GBC cases were collected from the Gall bladder lesion cases. Histological type, and differentiation grading of all specimens was obtained from H&E-stained slides.Immunohistochemistry

Formalin-fixed (10%), paraffin-embedded GBC were sectioned (3–5 μm thick) and were treated with ready-to-use monoclonal antibodies Cyclin D1, E-cadherin, EGFR, HER- 2, Ki67, and p53 c-erbB-2 of (Dako^® Corporation, Carpinteria, Calif., USA) were used as the primary antibody. Scoring was based on the HerceptestTM (Dako) criteria; semi-quantitative analysis of the stain intensity was carried out.

The number of Immunomarker-stained cells in representative microscopic fields were counted and the percentage of positive cells was ad-judged as negative (0) or barely perceptible staining in <10% tumor cells (0), weak staining in <30% tumor cells (+1), strong, complete membranous staining in >30% cells (+2) while immunomarker positivity was established when more than 50% tumor cells exhibited complete nuclear staining (+3) . Statistics

Statistical analysis was performed using SPSS software 23.0. Statistical significance was set at p < 0.05.

Results

The average age of the patient cohort was 53 years, and 55% of them were females. 62% of cases had gallstones of different sizes and the average tumor size was 45 mm. All the cases were mostly histologically proved to be adenocarcinoma. About 11/30 of the patients showed staining for HER-2 , and 10/30 of the tumor cases showed positivity for p53,14/30  of the tumor cases showed positivity forCyclin D1,12 /30 of the tumor cases showed positivity for E-cadherin,113 /30 of the tumor cases showed positivity for EGFR, and 17 /30 of the tumor cases showed positivity for Ki67.Contingency table analysis by χ ² tests showed that HER-2,Cyclin D1, E-cadherin, EGFR, positivity showed significance with sex (p = 0.02). On the other hand, Ki67, and p53-positive cases did not show any significance with clinicopathological factors. HER-2, Cyclin D1, E-cadherin, EGFR, Ki67, and p53 showed statistical significance. Hence their expression is considered to be significant prognostic factors in the selected GBC cohort.

Conclusions

Consequently, it can be summed up that there is an important need to search for immuno- markers of GBC, which will not only diagnose and prognosticate the disease but also help in choosing the appropriate mode of therapy and may give us an opportunity to make our basic understanding of GBC pathology clearer. Furthermore, anprecise molecular categorization of GBC is necessary for the enrolment of patients in clinical trials in order to define which patient groups are likely to gain the most aimed therapy. Multiple cellular pathways influence the growth and metastatic potential of tumors creating the potential for tumors to overcome the signaling pathway blockade. Combining therapies that inhibit different intracellular signaling pathways have the potential to be more effective in overcoming tumor resistance. A new promise in gall-bladder treatment is the inhibition of the master heat shock protein 90, which has emerged as an exciting target for cancer therapy, which is a master regulator of the stability and activity of multiple oncoproteins such as HER-2, Cyclin D1, E-cadherin, EGFR, Ki67, and p53. Thus, our study assesses the expression of important immunomarkers involved in the pathogenesis of GBC, correlates it with clinicopathological parameters and establishes it as an independent prognostic factor in GBC.

Biography:

Abstract:

Objective:

To increase the efficiency of treatment of patients with NAFLD by individual correction of eating behavior (EB) based on the nutritional characteristics of the patients.

Materials and methods:

Fifty patients (46 men and 44 women) with NAFLD were examined. The control group consisted of 30 practically healthy patients reciprocating by sex and age. All patients studied the characteristics of EB (DEBQ questionnaire), anthropometric indicators, lipid and carbohydrate metabolism, the degree of liver steatosis, the area of visceral adipose tissue (CT scan), nutrigenetic features (definition of 5 polymorphisms: Pro12Ala of the PPARG2 gene (rs1801282), Gln27Glu of the ADRB2 gene (rs1042714), Arg16Gly of the ADRB2 gene (rs1042713), Trp64Arg of the ADRB3 gene (rs4994) and Thr54Ala of the FABP2 gene (rs1799883), associated with the risk of metabolic disorders. Patients were prescribed individual nutritional correction for 12 months, taking into account the identified polymorphisms associated with EB violation, namely: carriers of the Pro12Ala genotype of the polymorphism of the PPARG2 gene were prescribed a therapeutic diet with moderate fat intake of 1.1-1.2 g / kg / day and carbohydrate restriction of 2.5-3 g / kg / day, Pro12Pro genotype carriers - diet with restriction of fats up to 1.0 g / kg / day and moderate consumption of carbohydrates up to 3.5-4 g / kg / day.

Results:

After 12 months after individual correction, significant positive dynamics of the main anthropometric and laboratory-instrumental indicators were observed: a decrease in body mass index and waist circumference by a factor of 1.2 (p <0.05), a decrease in the level of total cholesterol and low-density lipoproteins of 1.5 and 1.3 times, respectively (p <0.001), the level of triglycerides, 2.1 times (p <0.001) and the increase in high-density lipoproteins by 1.4 times (p <0.001)), a decrease in HOMA-IR in 2.2 times (p <0.001)), liver samples (reduction of alanine aminotransferase 2.4 times and aspartate aminotransferase 2.5 times (p <0.05)), CT scan - signs of steatosis (35% increase in liver x-ray density (p <0.001)) and indicators of visceral obesity (a decrease of 2.1 times the area of visceral adipose tissue ((p <0.001). In addition, during the control questionnaire, normalization of EB was observed in 86% of patients and a decrease in the degree of eating disorders in 14% of patients compared with baseline indicators (p <0.001).

Conclusion:

Thus, the appointment of individual correction of EB taking into account nutritional features for at least 12 months contributes to a significant improvement in metabolic parameters associated with the risk of development and progression of NAFLD, the formation and stabilization of proper eating habits, which improves the effectiveness of treatment of patients with NAFLD.

Biography:

Dr. Anshoo Agarwal is currently working as Professor & Chairperson at Department of Pathology, Northern Border University, Arar Kingdom of Saudi Arabia. She received her Bachelor of Medicine & Bachelor of Surgery from King George's Medical College Lucknow. Dr. Anshoo Agarwal received her M.D in Pathology from LLRM Medical College / Ch. Charan Singh University. She is an Associate professor and Discipline Coordinator in University Technology MARA, Malaysia. Dr. Anshoo Agarwal has served on many scientific memberships like Life member of Indian Association of Pathology and Microbiology, Member of International Academy Pathology, Life member of Indian Society of Hematology & Transfusion Medicine, Emirates Medical Association Pathology Society. Dr. Anshoo Agarwal has more than 80 publications. Dr. Anshoo Agarwal is editorial member of 3 journals and has many reviewed publications. Dr. Anshoo Agarwal research interests include Advance Haematology & Immunohematology, Breast cancer and Anticancer vaccines.

Abstract:

Background:

Gall-Bladder Cancer (GBC) is a neoplasm common in certain parts of the world. The various studies reported vary due to geographical and racial differences. North India presents itself as a major center for this fatal cancer with a varied gene and protein expression profile. The pathogenesis of GBC is a much talked about phenomenon and often reports the immune-expression of Ki67 and HER-2. HER2 is an oncoprotein which is overexpressed in some malignancies including breast and GIT. HER2 and Ki67 are overexpressed in gallbladder cancer and in precancerous lesions. In our study, we have attempted to identify the immune-expression of HER-2 and Ki67 in Gall Bladder lesion (Non-neoplastic and pre-neoplastic) cases. The primary reasons for twisted results seen in the different studies can be credited to the source of antibodies used for immunohistochemistry, race of the patient cohort, and criteria used to adjudge positivity in the stained samples. A number of recent studies have identified  different  immunomarkers overexpression giving rise to their oncogenic potential  in non-neoplastic and preneoplastic lesions and has relation with GBC development and progression to Gall bladder carcinoma.

The present study was undertaken to assess pattern and level of expression of HER2 in metaplasia, dysplasia, and different type of gallbladder lesions, which would determine its suitability as a prognostic biomarker in neoplastic transformation of gallbladder epithelium. The study was undertaken to find the expression and significance of Ki-67 index and HER2 in these lesions.

Methods:

Fifty patients who underwent cholecystectomy comprised our study. Among them, 76% of specimens showing metaplasia, dysplasia, and various other lesions of Gall bladder lesions on routine histopathology were considered as cases. Chronic cholecystitis having non-metaplastic mucosa were considered as control. Immunohistochemistry (IHC) was performed for immunomarkers with HER2 and Ki-67. For HER2 interpretation ASCO/CAP guideline for breast cancer was followed. Chi-square test was used to find out the significance of HER2 expression in dysplasia/metaplasia/various other lesions of gall bladder. The ANOVA was used for determining the association of HER 2 and Ki-67 with malignant transformation.

Results:

Overexpression of HER2 was observed in 63 % of high-grade dysplasia, 53% of low-grade dysplasia, and 81% of intestinal metaplasia. Ki-67 index and HER 2-scoring increased as the precursor lesions progress toward higher grading. Hence, these markers might be used as a prognostic biomarker for gallbladder carcinoma and its precursor lesions and it may be considered as indication for aimed treatment aimed for gallbladder cancer and precancerous lesions.

Conclusions:

Our study conducted is an immunohistochemical study of non-neoplastic and preneoplastic lesions of Gall bladder lesions suggesting the prognostic role of Ki67 and HER2. We found Ki67 and HER-2 as an independent prognostic factor indicating progression in its severity. In the past, the treatment for all sorts of gall bladder lesions used to be identical. However, improvements in molecular techniques, has a unique molecular signature. It is therefore important for identifying the gall-bladder lesions which may transform into malignancies later. Therefore, our study may be critical to define prospective patient subsets that may be at risk of developing gall bladder carcinoma.

Biography:

Efren has completed his MD from the Autonomous University of Zacatecas and is now part of the first generation of a select group of doctors to carry out the Professional Master in Medical Consultation of Excellence by Harvard University. He has done multiple internships in general, maxillo-facial and plastic surgery in Italy and Mexico. Currently in the process of United States Medical Licensing and Homologation in Spain to continue post graduate studies and a fellowship in surgery. Recently with the pandemic he forms part of a medical network that provides distance consultation to patients in need of assistance in Mexico.

Abstract:

Introduction:

Intestinal Anastomosis is a surgical procedure that must be conducted correctly, with an optimal cicatrization, without morbidity, a rapid return to intestinal function, in order to prevent common clinical anastomosis leakage, dehiscence and adherence. Extracellular matrix is a tridimensional network that regenerates, protects and nurtures tissue. The objective of this study was to evaluate and compare the bursting strength of the intestinal anastomosis using the extracellular matrix.

Material and Methods:

In 12 Wistar rats, females of 12 to 16 weeks of age with a weight of 200-400 g, were anesthetized, posteriorly a trichotomy was realized and disinfection with iodine. To the control group an entero-entero anastomosis end to end was made. To the experimental group the same procedure and extracellular matrix was infiltrated. At 7 days euthanasia was realized in a CO2 chamber, afterwards the burst strength testing was done. A T student test was made with a confidence interval of 95% and a level of significance of 0.05% in SPSS.

Results:

In the control group the mean bursting pressure was 251.67 mmHg with a standard deviation of 40.702, in the experimental group the mean was 310 mmHg with a standard deviation of 10.954. with a statistical significance between both groups.

Conclusions:

The use of extracellular matrix as adjuvant in the intestinal anastomosis improves significantly the resistance in the burst strength test. Which could be a good option to use in surgical anastomosis and other future studies.

Biography:

Abstract:

The goal is to evaluate the effectiveness of various Anti-Helicobacter therapy (AHBT) regimens in Ukraine in order to select the most optimal treatment tactics.

Object of Study and Methods:

624 patients were examined, with an average age of (50.89 ± 14.17) years. Female (338, 54.1%), Male (286, 45.9%). The most common nosology was chronic atrophic gastritis associated with Helicobacter pylori (НР) (501, 78.9%). Non-Investigated Dyspepsia (1, 0.2%), Functional Dyspepsia (2, 0.3%), Duodenal Ulcer (117, 18.4%), Gastric Ulcer (14, 2.2%).  Most patients (449, 73.6%) did not receive primary therapy. Patients received different anti-Helicobacter therapy regimens: Dual (2, 0.3%), Triple (332, 52.2%), Quadruple (292, 45.9%), Sequential (0, 0.0%), Hybrid (0, 0.0%), Pylera (single capsule bismuth) (0, 0.0%), Other (10, 1.6%).

Results and discussion.

The most effective eradication scheme is Quadruple with the addition of Bismuth salts of tripotassium dicitrate (BTD) lasting 14 days (92.0%), as well as schemes with the inclusion of probiotics during AHBT with prolonged administration up to 4 weeks after the end of therapy (eradication efficiency is 90.6%). The effectiveness of Quadruple depending on the proton pump inhibitor (PPI) used was: Pantoprazole (92.0%), Esomeprazole (90.0%), Rabeprazole (89.9%), Omeprazole (78.6%) in therapeutic doses.

Conclusions:

Ways to increase the effectiveness of AHTB in Ukraine: adding BTC to therapy and duration of therapy for at least 10-14 days, using high doses of PPIs - Рantoprazole, adding probiotics to treatment regimens.

Biography:

Dr. Yury Marakhouski. approved as Professor of Clinical Medicine in 2005 year by the Higher Certification Commission of the Council of Ministers of the Republic of Belarus.  He is head of the Department Gastroenterology and Nutrition of the Byelorussian Medical Academy of Postgraduate Education. He has published more than 30 papers in reputed journals and serving as a member of the editorial board of several reputed journals (predominantly in Russia and Belarus). His Current Position is Head of Department of Gastroenterology and Nutrition, Byelorussian Medical Academy Postgraduate Education (BelMAPE).He is principal investigator on numerous clinical (18) and preclinical (6) studies and has been involved in the study of many medication including mesalazine, amino acids, anti-TNF.

Abstract:

Аim:

Evaluate threonine dipeptides [threonil-threonine(THL) and threonil-threonine-Zinc(ThL-Z)] efficacy and safty at the dextran sulfate sodium (DSS) model of experimental mouse and rats erosive colitis(DSS-EC).

Material and Methods:

This study consists of several phases.

Phase 1: Highly purified dipeptides synthesis.

Phase 2: Hypothesis confirmation that dipeptides THL and THL-Z have enteroprotective action. Phase 3: Toxicological screening by up-and-down (UDP) method with dose levels of 5, 50, 500, and 2000 mg/kg and calculate on ROC analysis, calculate No Observed Adverse Effect Level (NOAEL) and Lowest Observed Adverse Effect Level (LOAEL).

Phase 4: Dipeptides specific effect testing in mice and rats with DSS-EC model.

Phase 5: Complete standard toxicological assessment.

Phase 6: Рublications on dipeptides THL and THL-Z search and analysis.

Phase 7: Final assessment of the efficacy and safety of the substance containing an equal proportion of  the THL(10 mg) and THL-Z dipeptide (10 mg) [S-THL+THL-Z]. The study was conducted after approval by the local ethics committee. Data analysis and comparison was carried out using statistical processing software Statistica-6, version 6.1, series 1203d and Winpepi.

Results:

Synthesized dipeptides with 98.5% purity. Both dipeptides administration does not worsen the model-specific changes in the intestine, liver, kidnes and does not metabolic disorders, does not increase the general manifestations histological changes severity of bowel mucous membrane. It was found that mucous membrane excessive permeability is significantly more common at the DSS-EC: 49.8% versus 6.2% with Chi-square: p = 0.0027, Fisher coefficient (bilateral assessment) p = 0.01. Dipeptides THL and THL-Z have shown efficacy: decrease disease activity index (DAI) and istological activity index (HAI). Toxicological data have shown a high degree of safety without mortalities caused by the investigational product at dose 5000 mg/ kg body weight for both THL and THL-Z. NOEL and LOEL parameters allowed calculating the therapeutic dose were determined. Оn DSS chronic colitis (28 days, with adition increased mucosal damage by rectal administration of 30% ethyl alcohol) treatment  with S-THL+THL-Z give the following data: positive response Odds Ratio (OR) was 59.18, in the absence of signivicants adverse reactions (benefit 59 times the risk); complete remission came by the 2nd week according to DAI, and persisted by the 4th week; excessive permeability is significantly redused.

Conclusion:

This study first time clearly demonstrated that threonine’s dipeptides has positive efficacy at the experimental induced colitis and it may be very promising as a new medication for Inflammatory Bowel Disease.

Biography:

Abstract:

Statement of the Problem:

Pancreatic metastases (PM) from other tumors are rare and they account for approximately 1-2 % of all pancreatic malignancies.PM represent a therapeutic challenge: most patients present at diagnosis with a widespread disease while the finding of an isolated pancreatic lesion is far more uncommon. Even if in recent years a growing number of studies have reported successful pancreatic resection for PM, the role of surgery in this context remains undefined. The purpose of this study is to investigate the safety and efficacy of surgical resection in patients affected by PM.

Methodology & Theoretical Orientation:

We reviewed all patients with PM between January 1980 and December 2020 from a prospectively collected database. All enrolled patients had a histological diagnosis of PM. The following data were analyzed: basic demographics, characteristics of primary tumor, time interval between primary and secondary PM, symptoms, presence of extra pancreatic disease, surgical strategy, morbidity, mortality, length of ICU and hospital stay, neoadjuvant and adjuvant treatment, follow-up, disease-free survival and overall survival.  

Findings:

In the considered time-interval, 44 patients were observed in our Center for PM (M/F 22/22; median age 66 years, range 41-78). Renal cell carcinoma represented the most frequent primary tumor (n=19), followed by colorectal cancer (n=12), sarcoma (n=4), melanoma (n=4, lung cancer (n=2), schwannoma (n=1), gastric cancer (n=1), small bowel carcinoid tumor (n=1). Thirty-seven patients underwent surgery and pancreatic resection was feasible in 35 cases. Overall morbidity and mortality rates were 36% and 2%, respectively. Median OS and DSF survival were significantly longer for patients with PM from renal cancer when compared to other patients (p=0.008). At univariate and multivariate analysis, the renal origin of PM was the only independent prognostic factors for survival.

Conclusions:

Surgery for PM is safe and effective, especially for PM of renal origin.

Biography:

Prof. Renato Vilella is a physical therapist and has completed three specializations (Pain, Neuroscience, and Acupuncture) by 23 years old. He is also a professor for the Centro Universitário de Lavras – UNILAVRAS, and a researcher with 23 articles published in indexed journals and two books published. Currently, the professor works as a Management Editor for the Iberoamerican Journal of Medicine and as a reviewer for International Scientific Journals and does his research with a focus on Pain, Manual Therapy, Neurosciences, and Physical Therapy.

Abstract:

The Manipulation of Connective Tissue System has been developed by Professor Renato Vilella to create a new and integrative approach to the human body, a capacity of clinical reasoning connecting all structures to finally result in effective non-invasive treatment. The Gastrointestinal system has its functions, but also has connections to many different structures such as the diaphragm, the costal arch, abdominal and lumbar muscles, the pelvis, and nervous system – both peripheral and autonomous.

When we understand these connections, we can see what is going on with our patient’s body, and after this investigation, treat in the right way and resolve the cause, not the symptoms or the consequences. The beauty of the Connective System Manipulation is the possibility to know that the problem’s cause may be in a different, and even far away, the location from the consequences. In my speech, I will teach you all of these mentioned connections, and the incredible possibilities of non-invasive treatment for the most common gastrointestinal system dysfunctions.

Biography:

Raffaele Pilla, Pharm.D., Ph.D., Doctor Europaeus, received his Master’s degree in Pharmacy at G. d’Annunzio University in Chieti-Pescara, Italy in 2005, where he also served internships at the Cell Physiology Laboratory and Molecular Biology Laboratory. Prior, he was an Erasmus Student at Faculté de Pharmacie de Reims in Reims, France. He received his Doctor Europaeus in 2010 from Pitié-Salpétrière Institute in Paris, France. Also, in 2010, he received his Ph.D. in Biochemistry, Physiology, and Pathology of Muscle at G. d’Annunzio University in Chieti-Pescara, Italy. He was hired as a Postdoctoral Scholar in the Department of Pharmacology and Physiology at the University of South Florida in Tampa, on two research grants funded by the Office of Naval Research (US Navy) and Divers’ Alert Network. He has written and lectured widely worldwide. He has been involved in ongoing research at the University of South Florida with the use of ketone esters.

Abstract:

It has been recently shown that nutritional ketosis is effective against seizure disorders and various acute/chronic neurological disorders. Physiologically, glucose is the primary metabolic fuel for cells. However, many neurodegenerative disorders have been associated with impaired glucose transport/metabolism and with mitochondrial dysfunction, such as Alzheimer’s/Parkinson’s disease, general seizure disorders, and traumatic brain injury. Ketone bodies and tricarboxylic acid cycle intermediates represent alternative fuels for the brain and can bypass the rate- limiting steps associated with impaired neuronal glucose metabolism.

Therefore, therapeutic ketosis can be considered as a metabolic therapy by providing alternative energy substrates. It has been estimated that the brain derives over 60% of its total energy from ketones when glucose availability is limited. In fact, after prolonged periods of fasting or ketogenic diet (KD), the body utilizes energy obtained from free fatty acids (FFAs) released from adipose tissue. Because the brain is unable to derive significant energy from FFAs, hepatic ketogenesis converts FFAs into ketone bodies-hydroxybutyrate (BHB) and acetoacetate (AcAc)-while a percentage of AcAc spontaneously decarboxylates to acetone.

Large quantities of ketone bodies accumulate in the blood through this mechanism. This represents a state of normal physiological ketosis and can be therapeutic. Ketone bodies are transported across the blood-brain barrier by monocarboxylic acid transporters to fuel brain function. Starvation or nutritional ketosis is an essential survival mechanism that ensures metabolic flexibility during prolonged fasting or lack of carbohydrate ingestion.

Therapeutic ketosis leads to metabolic adaptations that may improve brain metabolism, restore mitochondrial ATP production, decrease reactive oxygen species production, reduce inflammation, and increase neurotrophic factors’ function. It has been shown that KD mimics the effects of fasting and the lack of glucose/insulin signaling, promoting a metabolic shift towards fatty acid utilization. In this work, the author reports a number of successful case reports treated through metabolic ketosis.