escassez de estudos específicos acerca da Qualidade de Vida (QV) de pessoas com Úlceras Venosas Crônicas (UVC) motivou-nos a realizar este estudo, que objetivou: verificar as propriedades psicométricas do Índice de Qualidade de Vida de Ferrans e Powers (IQVFP); descrever as características sócio-demográficas (CSD) e às das úlceras venosas (CUVC); analisar os escores de QV segundo às CSD e as CUVC. O estudo é descritivo, exploratório, correlacional, de campo e transversal, realizado através de entrevistas junto a 89 pessoas com UVC em 3 ambulatórios públicos, utilizando-se a versão genérica do IQVFP. Este instrumento é compsoto por 68 itens e dividido em 4 domínios: Saúde/Funcionamento (DSF), Sócio-Econômico (DSE), Psicológico/Espiritual (DPE) e Família (Dfa). Atestou-se ao IQVFP a confiabilidade - alfa de 0,09 no IQV Total; a validade concorrente e a validade discriminante. No entanto, nesta última apenas para o IQV Total (p=0,029 e DSF )p=0,005). Houve predomínio de: mulheres (68,54%); idade média de 53,44 anos; católicos (65,86%), profissões que exigem ortostatismo anterior e posteriomente à UVC (90,36% e 89,78%) respectivamente. A respeito das CUVC constatou-se: média de 1,54 úlceras, 71,95% da amostra tiveram novas UVC após a primeira ulceração; 67,045% têm a ferida há menos de 5 anos e com 69,74% está com UVC atual localizadas na perna esquerda. Acerca da QV obteve-se: escore médio de 22,27% (DP= 5,05) para o IQVT e correlação dos domínios com o IQVT. Não houve correlação entre a idade, número de filhos, número de úlceras, tempo de ocorrência da primeira UVC e tempo com a UVC atual e os DSF, DSE e o IQVT. Houve correlação: negativa entre o DPE e número de UVC (r=-0,19) e entre o DFa e tempo com a UVC atual (r=-0,19); positiva entre o IQVT e seus domínios e os católicos, não confirmados na comparação para o DSF; positiva entre os DSF, DPE, DFa e o IQVT e ortostatismo antes da primeira UVC, confirmada na comparação nos DSF e DFa. Os pacientes sem companheiros tiveram melhor QV no DFa, evidenciado na correlação (r=-0,28; p=0,004) e comparação (p < 0,006) Em conclusão, constatou-se: o IQVFP é adequado para a população alvo; pessoas com baixo nível sócio-econômico e educacional e com boa qualidade de vida / The shortage of specific studies about Quality of Life (QOL) of people with Chronic Venous Ulcers (CVU) motivated us to accomplish this study, which aimed at verifying the psychometric properties of the Ferrans and Powers quality of Life Index (FPQOL); described to the socio-demographic characteristics (SDC) and the venous ulcers characteristics (CVUC); analyze the QLI scores based on the SDC and the CVUC. It is a descriptive, exploratory, co-related, field and transversal study performed through interviews with 89 people who had CVU, treated on 3 public ambulatories using the generic version of thje FPQLI. This scale consists of 68 items that are divided into 4 domais: Health/Functioning (HFD), Social and Economic (SED), Psychological/Spiritual (PSD) and Family (FaD). It was attested to the FPQLI the reliability (alpha of 0.99 to overall QOL); the concurring, validity and the discriminating validity, the last one only for the Overall QOL (p=0.029) and HFD (p=0.005). There was a higher number of women (68.54%); mean age of 53.44; catholics (65.86%) and standing professionals before and after the CVU (90,36 e 89,79%, respectively). About CVUC there was mean of 1.54 ulcers; 71.95% of the sample developed new CVU after the first ulceration; 67.04% people have had the wound for less than 5 years and 69.74% of the CVU is located on the left leg. About QOL, it was obtained the mean score of 22.27 (pd=5.05) ro Overall and correlation of all domains with the QLI. There was no correlation among age, number of children, number of ulcers, time of occurence of first CVU, time with today\'s CVU and the HFD, SED and Overall QOL. There was correlation: negative - between the PSD and the number of CVU (r=-0.19) and between the DaD and the time with today\'s CVU (r=-0.19); positive - among the Overall QOL and its domains and the cotholics, it was not confirmed in the HFD comparision; positive - among the HFD, PED, FaD and the QOL and standing position before the first CVU, confirmed in the HFD and Fad comparision. The patients without companions had better QOL in the FaD, shown crearly in the correlation (r=0.28, p=0.004) and comparision (p,0.006). In conclusion, it was attested to FPQOL is suitable for the target population; are people with low social-economic and educational level and show good QOL

The number of operations for morbid obesity is rising fast. We have examined aspects of postoperative physiology and results after bariatric surgery. The pH in the proximal pouch after Roux-en-Y gastric bypass (RYGBP) was investigated with catheter-based and wire-less technique. Gastric emptying, PYY-levels in the fasting state and after a standardized meal was evaluated after biliopancreatic diversion with duodenal switch (DS). A clinical trial was undertaken, comparing DS to RYGBP in patients with BMI&gt;48. Main outcome variables were safety and long-term weight results as well as abdominal symptoms and laboratory results. Patients with stomal ulcer had significantly lower pH in their proximal gastric pouch as compared to asymptomatic control subjects. Long-time pH measurements with the wire-less BRAVO-system were feasible and demonstrated pH&lt;4 in median 10.5% of the time in asymptomatic post-RYGBP patients. After DS, the T50 of gastric emptying was 28±16 minutes. PYY-levels were higher after DS than in age-matched control subjects. BMI-reduction was greater after DS (24 BMI-units) than after RYGBP (17 BMI-units) in median 3.5 (2.0-5.3) years after surgery (p&lt;0.001). Fasting glucose and HbA1c levels were lower one and three years after DS as compared to RYGBP. On the other hand, DS-patients reported having more diarrhea and malodorous flatus. This thesis has resulted in deepened knowledge. Acid produced in the proximal pouch is an important pathogenetic factor in the development of stomal ulcer after RYGBP. However, symptom-free patients have an acidic environment in the proximal Roux-limb as well. After DS, gastric emptying is fast, but not instantaneous, and PYY-levels are high. DS results in superior weight reduction and better glucose control as compared to RYGBP in patients with BMI&gt;48. We believe that DS has a place in surgical treatment of the super-obese, even though symptoms of diarrhea and malodorous flatus are more common after DS.

escassez de estudos específicos acerca da Qualidade de Vida (QV) de pessoas com Úlceras Venosas Crônicas (UVC) motivou-nos a realizar este estudo, que objetivou: verificar as propriedades psicométricas do Índice de Qualidade de Vida de Ferrans e Powers (IQVFP); descrever as características sócio-demográficas (CSD) e às das úlceras venosas (CUVC); analisar os escores de QV segundo às CSD e as CUVC. O estudo é descritivo, exploratório, correlacional, de campo e transversal, realizado através de entrevistas junto a 89 pessoas com UVC em 3 ambulatórios públicos, utilizando-se a versão genérica do IQVFP. Este instrumento é compsoto por 68 itens e dividido em 4 domínios: Saúde/Funcionamento (DSF), Sócio-Econômico (DSE), Psicológico/Espiritual (DPE) e Família (Dfa). Atestou-se ao IQVFP a confiabilidade - alfa de 0,09 no IQV Total; a validade concorrente e a validade discriminante. No entanto, nesta última apenas para o IQV Total (p=0,029 e DSF )p=0,005). Houve predomínio de: mulheres (68,54%); idade média de 53,44 anos; católicos (65,86%), profissões que exigem ortostatismo anterior e posteriomente à UVC (90,36% e 89,78%) respectivamente. A respeito das CUVC constatou-se: média de 1,54 úlceras, 71,95% da amostra tiveram novas UVC após a primeira ulceração; 67,045% têm a ferida há menos de 5 anos e com 69,74% está com UVC atual localizadas na perna esquerda. Acerca da QV obteve-se: escore médio de 22,27% (DP= 5,05) para o IQVT e correlação dos domínios com o IQVT. Não houve correlação entre a idade, número de filhos, número de úlceras, tempo de ocorrência da primeira UVC e tempo com a UVC atual e os DSF, DSE e o IQVT. Houve correlação: negativa entre o DPE e número de UVC (r=-0,19) e entre o DFa e tempo com a UVC atual (r=-0,19); positiva entre o IQVT e seus domínios e os católicos, não confirmados na comparação para o DSF; positiva entre os DSF, DPE, DFa e o IQVT e ortostatismo antes da primeira UVC, confirmada na comparação nos DSF e DFa. Os pacientes sem companheiros tiveram melhor QV no DFa, evidenciado na correlação (r=-0,28; p=0,004) e comparação (p < 0,006) Em conclusão, constatou-se: o IQVFP é adequado para a população alvo; pessoas com baixo nível sócio-econômico e educacional e com boa qualidade de vida / The shortage of specific studies about Quality of Life (QOL) of people with Chronic Venous Ulcers (CVU) motivated us to accomplish this study, which aimed at verifying the psychometric properties of the Ferrans and Powers quality of Life Index (FPQOL); described to the socio-demographic characteristics (SDC) and the venous ulcers characteristics (CVUC); analyze the QLI scores based on the SDC and the CVUC. It is a descriptive, exploratory, co-related, field and transversal study performed through interviews with 89 people who had CVU, treated on 3 public ambulatories using the generic version of thje FPQLI. This scale consists of 68 items that are divided into 4 domais: Health/Functioning (HFD), Social and Economic (SED), Psychological/Spiritual (PSD) and Family (FaD). It was attested to the FPQLI the reliability (alpha of 0.99 to overall QOL); the concurring, validity and the discriminating validity, the last one only for the Overall QOL (p=0.029) and HFD (p=0.005). There was a higher number of women (68.54%); mean age of 53.44; catholics (65.86%) and standing professionals before and after the CVU (90,36 e 89,79%, respectively). About CVUC there was mean of 1.54 ulcers; 71.95% of the sample developed new CVU after the first ulceration; 67.04% people have had the wound for less than 5 years and 69.74% of the CVU is located on the left leg. About QOL, it was obtained the mean score of 22.27 (pd=5.05) ro Overall and correlation of all domains with the QLI. There was no correlation among age, number of children, number of ulcers, time of occurence of first CVU, time with today\'s CVU and the HFD, SED and Overall QOL. There was correlation: negative - between the PSD and the number of CVU (r=-0.19) and between the DaD and the time with today\'s CVU (r=-0.19); positive - among the Overall QOL and its domains and the cotholics, it was not confirmed in the HFD comparision; positive - among the HFD, PED, FaD and the QOL and standing position before the first CVU, confirmed in the HFD and Fad comparision. The patients without companions had better QOL in the FaD, shown crearly in the correlation (r=0.28, p=0.004) and comparision (p,0.006). In conclusion, it was attested to FPQOL is suitable for the target population; are people with low social-economic and educational level and show good QOL

Les bones morphogenetic protein (Bmp) sont des morphogènes qui jouent des rôles sur la prolifération et la différenciation cellulaire. La perte de signalisation dans cette voie est associée à la polypose juvénile familiale et à un risque accru de cancer gastrique. Elle est aussi associée avec l’inflammation et la guérison des tissus. Il est montré qu’au niveau de l’estomac, les ligands et les récepteurs de la signalisation des Bmp sont exprimés dans les compartiments épithéliaux et mésenchymateux. Les différents modèles animaux développés ont confirmé l’importance de cette signalisation dans la carcinogenèse gastrique. Cependant, ces modèles causent une perte de signalisation dans l’ensemble de la muqueuse gastrique et ne réussissent pas à montrer un mécanisme. Parallèlement, notre laboratoire a montré qu’une perte de signalisation de la voie des Bmp, exclusivement dans le compartiment épithélial, ne développe pas les phénotypes associés à la progression du cancer gastrique. Ce résultat suggère que les cellules mésenchymateuses pourraient être la clé de l’importance de la signalisation des Bmp dans l’estomac. Afin de mettre en lumière le rôle de la signalisation des Bmp dans le compartiment mésenchymateux, des souris qui perdent de façon spécifique le récepteur de type 1a des Bmp dans ce compartiment ont été généré (Bmpr1aMES). Il semble que la perte de signalisation des Bmp induit au niveau du mésenchyme une modification du comportement et une activation des fibroblastes en myofibroblastes. Cette modification produit également un microenvironnement (matrices, facteurs de croissance, cytokines, interleukines) propice au développement du cancer et induire des modifications importantes de l’épithélium et un appel de cellules immunitaires. Cet environnement semble être suffisant pour réduire de façon importante le nombre de cellules endocriniennes et de cellules pariétales dans l’épithélium gastrique. Il semble que la perte mésenchymateuse de signalisation des Bmp au niveau gastrique entraîne le développement d’une métaplasie au niveau de l’estomac des souris, une hyperplasie atypique qui évolue jusqu'à une dysplasie accompagnée d’une desmoplasie importante. Mes travaux ont également démontré que, dans ce contexte, une mutation oncogénique, comme la perte de Trp53, pourrait devenir maligne. En conclusion, au sein du mésenchyme, la signalisation des Bmp est importante pour le maintien de celui-ci dans un état sain. Il est probable qu’elle joue un rôle important dans le retour à l’état normal suivant les gastrites. Sa perte rend l’estomac des souris fragile au développement d’adénomes. / Abstract : Bone morphogenetic proteins (Bmp) play roles in the proliferation and differentiation. It is also associated with inflammation and tissue repair. Disruption of signaling in this pathway is associated with familial juvenile polyposis and an increase risk of gastric cancer. It has been shown that in the stomach, Bmp signaling is bidirectional. Meaning that ligands and receptors are expressed in both the epithelial and stromal compartments. Gastric abrogation animal models of the Bmp signaling pathway have confirmed the importance of this signaling in gastric carcinogenesis. However these models cause a loss of signaling in both compartments of the gastric mucosa, and the mechanism of action for this has yet been undefined. Previous work by a student in our laboratory provided a model of loss of the Bmp signaling pathway exclusively in the epithelial compartment. This model does not develop phenotypes associated with the progression of gastric cancer, suggesting, that the stromal compartment is the key in tumorigenesis by Bmp signaling in the stomach. To further test this hypothesis, we generated mice with a stromal compartment-specific loss of type1a BMP receptor (Bmpr1aMES). It appears that this deletion in the stroma induced behavior alteration with activation of fibroblasts into myofibroblasts. This change also produces a microenvironment (matrix, growth factors, cytokines, and interleukins) that is conducive to the development of cancer and induces significant modifications of the epithelium as well as a recruitment of immune cells. This microenvironment seems to be sufficient to significantly reduce the number of endocrine cells and parietal cells in the gastric epithelium. It seems that the loss of stromal Bmp signaling in the mice’s stomachs causes development of metaplasia; atypical hyperplasia that progresses to dysplasia accompanied by a significant desmoplasia. My work also shows that in this environment an oncogenic mutation such as the loss of Trp53 may become malignant. In conclusion, in the stromal compartment, Bmp signaling is important for maintaining a healthy state. It is probably involved in the return to the normal state following gastritis, and its loss makes the mouse stomach susceptible to adenoma development.