Textbook outcome in distal pancreatectomy: A multicenter study.

BACKGROUND: Textbook outcome is an interesting quality metrics tool. Information on textbook outcomes in distal pancreatectomy is very scarce. In this study we determined textbook outcome in a distal pancreatectomy multicenter database and propose a specific definition of textbook outcome-distal pancreatectomy that includes pancreatic fistula. METHODS: Retrospective multicenter observational study of distal pancreatectomy performed at 8 hepatopancreatobiliary surgery units from January 1, 2008, to December 31, 2018. The inclusion criteria were any scheduled distal pancreatectomy performed for any diagnosis and age > 18 years. Specific textbook outcome-distal pancreatectomy was defined as hospital stay P < 75, no Clavien-Dindo complications (≥ III), no hospital mortality, and no readmission recorded at 90 days, and the absence of pancreatic fistula (B/C). RESULTS: Of the 450 patients included, 262 (58.2%) obtained textbook outcomes. Prolonged stay was the parameter most frequently associated with failure to achieve textbook outcomes. The textbook outcome group presented the following results. Preoperative: lower American Society of Anesthesiologists score < III, a lower percentage of smokers, and less frequent tumor invasion of neighboring organs or vascular invasion; operative: major laparoscopic approach, and less resection of neighboring organs and less operative transfusion; postoperative: lower percentage of delayed gastric emptying and pancreatic fistula B/C, and diagnosis other an adenocarcinoma. In the multivariate study, the American Society of Anesthesiologists score > II, resection of neighboring organs, B/C pancreatic fistula, and delayed gastric emptying were associated with failure to achieve textbook outcomes. CONCLUSION: The textbook outcome rate in our 450 pancreaticoduodenectomies was 58.2%. In the multivariate analysis, the causes of failure to achieve textbook outcomes were American Society of Anesthesiologists score > II, resection of neighboring organs, pancreatic fistula B/C, and delayed gastric emptying. We believe that pancreatic fistula should be added to the specific definition of textbook outcome-distal pancreatectomy because it is the most frequent complication of this procedure.

Propensity score matching analysis of laparoscopic surgery vs. open approach in 4 297 adult patients with acute appendicitis, acute cholecystitis or gastrointestinal tract perforation: a prospective multicentre study of nationwide outcomes.

BACKGROUND AND AIMS: Previous studies indicated that laparoscopic surgery could improve postoperative outcomes in acute appendicitis, acute cholecystitis, perforated gastroduodenal ulcer, or acute diverticulitis, but some reported opposite results or differences in the magnitude of improvement. A contemporary analysis using propensity score matching that compares outcomes is lacking. METHODS: Over a 6-month period, 38 centres (5% of all public hospitals) attending emergency general surgery patients on a 24 h, 7 days a week basis, enroled all consecutive adult patients who underwent laparoscopic surgery or open approach. RESULTS: The study included 2 645 patients with acute appendicitis [32 years (22-51), 44.3% women], 1 182 with acute cholecystitis [65 years (48-76); 46.7% women], and 470 with gastrointestinal tract perforation [65 years (50-76); 34% women]. After propensity score matching, hospital stays decreased in acute appendicitis [open, 2 days (2-4); lap, 2 days (1-4); P <0.001], acute cholecystitis [open, 7 days (4-12); lap, 4 days (3-6); P <0.001], and gastrointestinal tract perforation [open, 11 days (7-17); lap, 6 days (5-8.5); P <0.001]. A decrease in 30-day morbidity was observed in acute appendicitis (open, 15.7%; lap, 9.7%; P <0.001), acute cholecystitis (open, 41%; lap, 21.7%; P <0.001), and gastrointestinal tract perforation (open, 45.2%; lap, 23.5%; P <0.001). A decrease in 30-day mortality was found in acute cholecystitis (open, 8.8%; lap, 2.8%; P =0.013) and gastrointestinal tract perforation (open, 10.4%; lap, 1.7%; P =0.013). CONCLUSIONS: This clinically based, multicentre study suggests that an initial laparoscopic approach could be considered not only in patients with acute appendicitis or acute cholecystitis but also in patients with a perforation of the gastrointestinal tract.

Deciphering the mechanism of action of 089, a compound impairing the fungal cell cycle.

Fungal infections represent an increasingly relevant clinical problem, primarily because of the increased survival of severely immune-compromised patients. Despite the availability of active and selective drugs and of well-established prophylaxis, classical antifungals are often ineffective as resistance is frequently observed. The quest for anti-fungal drugs with novel mechanisms of action is thus important. Here we show that a new compound, 089, acts by arresting fungal cells in the G2 phase of the cell cycle through targeting of SWE1, a mechanism of action unexploited by current anti-fungal drugs. The cell cycle impairment also induces a modification of fungal cell morphology which makes fungal cells recognizable by immune cells. This new class of molecules holds promise to be a valuable source of novel antifungals, allowing the clearance of pathogenic fungi by both direct killing of the fungus and enhancing the recognition of the pathogen by the host immune system.

High-throughput annotation of full-length long noncoding RNAs with capture long-read sequencing.

Accurate annotation of genes and their transcripts is a foundation of genomics, but currently no annotation technique combines throughput and accuracy. As a result, reference gene collections remain incomplete-many gene models are fragmentary, and thousands more remain uncataloged, particularly for long noncoding RNAs (lncRNAs). To accelerate lncRNA annotation, the GENCODE consortium has developed RNA Capture Long Seq (CLS), which combines targeted RNA capture with third-generation long-read sequencing. Here we present an experimental reannotation of the GENCODE intergenic lncRNA populations in matched human and mouse tissues that resulted in novel transcript models for 3,574 and 561 gene loci, respectively. CLS approximately doubled the annotated complexity of targeted loci, outperforming existing short-read techniques. Full-length transcript models produced by CLS enabled us to definitively characterize the genomic features of lncRNAs, including promoter and gene structure, and protein-coding potential. Thus, CLS removes a long-standing bottleneck in transcriptome annotation and generates manual-quality full-length transcript models at high-throughput scales.

Tumor de Franz gigante / Giant Franz tumour

No disponible

Fístula arteriovenosa de territorio mesentérico inferior / Arteriovenous fistula in the inferior mesenteric territory

No disponible

Paniculitis mesentérica colónica / Mesenteric panniculitis of the colon

No disponible

Enseñanza de la Cirugía: nuevos tiempos, nuevos métodos / Teaching surgery: new times, new methods

Introducción La organización, seguimiento y calidad de la docencia postgrado es probablemente una asignatura pendiente en nuestro medio. Este proyecto se plantea un objetivo claro: utilizar una herramienta docente más práctica y eficaz que las disponibles hasta el momento. No solo nos planteamos evaluar al residente, sino aportar el material de estudio ya consensuado y revisado por sus responsables. Todo esto mediante un método fácil, accesible y gratuito que garantice su formación básica. Material y método Primeramente identificamos los problemas prácticos de la residencia de cirugía general en nuestro medio. Confeccionamos una encuesta y la enviamos por correo electrónico a todos los residentes a partir de segundo año de la Comunidad Autónoma del País Vasco. Con los resultados diseñamos un sistema de carpetas con Google Documents™ y lo comenzamos a aplicar en los de tercer y cuarto años. Resultados Los métodos tradicionales de la enseñanza de la Cirugía han quedado en parte obsoletos por el empuje tecnológico de las Ciencias de la Información. Las nuevas generaciones dominan de forma natural tanto la red como las aplicaciones informáticas más comunes. A nuestro alcance tenemos una serie de herramientas que por desconocimiento o falta de tiempo no utilizamos. Este trabajo pretende aportar una opción de trabajo que facilite la labor del tutor como figura docente, ya que la actividad asistencial frecuentemente no deja sitio para la interacción con el residente (AU)

Introduction The organisation, follow-up and quality of post-graduate teaching may be in need of appraisal in our area. This study sets out a clear objective: to use a more practical and effective teaching tool than we currently have available. Not only will it set out to assess the resident, but also provide material already approved and reviewed by their tutors. All this will be achieved using an easy, accessible and free method which ensures their basic training. Material and method Firstly, we identified the practical problems in the general surgery residency in our area. We prepared a questionnaire and sent it by e-mail to all second year and over residents of the Basque Country Autonomous Community. From the results obtained, we designed a file system with Google Documents™ and we started to apply it the third and fourth years. Results The teaching methods in Surgery have partly become obsolete due to the initiative of Information Sciences Technology. The new generations naturally dominate the Internet along with the more common computer applications. Within our reach we have a series of tools that, due to lack of knowledge or lack of time, we do not use. This article attempts to provide a working option that will help the job of the tutor as a teaching figure, since the health care activity often has no place for interaction with the resident (AU)

Evaluación del riesgo quirúrgico de 1.000 episodios consecutivos con el sistema POSSUM. Comparación entre cirugía gastrointestinal programada y urgente / Assessment of the surgical risk of 1, 000 consecutive episodes using the POSSUM system. Comparison between elective and emergency gastrointestinal surgery

Introducción El objetivo del presente estudio fue evaluar la capacidad predictiva del sistema POSSUM en nuestro medio y determinar su comportamiento en cirugía gastrointestinal programada y compararla con la urgente. Pacientes y método Se analizaron 1.000 episodios quirúrgicos correspondientes a 909 pacientes intervenidos con anestesia general o loco-regional, de forma programada (n=547 episodios) o urgente (n=453), que precisaron ingreso hospitalario. Resultados La morbilidad total fue 31,9% (32,9% en cirugía programada y 30,7% en cirugía urgente). La capacidad discriminativa de la escala POSSUM evaluada mediante curva ROC fue mayor para la mortalidad Portsmouth (área bajo la curva [ABC] =0,92) que para la morbilidad (ABC=0,74). La bondad de ajuste o grado de calibración entre los valores esperados usando la escala POSSUM y los observados fue reducida para la morbilidad (Hosmer-Lemeshow [H-L] =164,1; p<0,05). La escala POSSUM predijo un número considerablemente mayor de muertes a las observadas, aunque la variante Portsmouth predijo mejor la mortalidad. El grado de calibración de la morbilidad fue mejor para la cirugía gastrointestinal programada (H-L=27,7) que para la cirugía gastrointestinal urgente (H-L=177,3). Mediante análisis de regresión logística se identificó, además del riesgo estimado mediante la propia escala POSSUM, las variables complejidad quirúrgica, tipo de cirugía y edad del paciente como factores significativos predictivos de la aparición de morbilidad y mortalidad. Conclusiones En nuestro medio, el sistema POSSUM predice adecuadamente el riesgo de morbilidad de la cirugía gastrointestinal programada, y sobreestima el riesgo de morbilidad de la cirugía gastrointestinal urgente (AU)

Introduction The aim of the present study was to assess the predictive capacity of the POSSUM system in a Spanish university hospital, and to determine its behaviour in elective gastrointestinal surgery and compare it with emergency gastrointestinal surgery (operation < 24 hours).Patients and method A total of 1,000 surgical episodes corresponding to 909 patients who required hospital admission, operated on under general or loco-regional anaesthesia, either in the elective (n= 547 episodes) or the emergency setting (n= 453), were included in the study. Results The overall morbidity was 31.9% (32.8% in elective surgery; 30.7% in emergency surgery). The discriminatory capacity of the POSSUM scale, evaluated using receiver operating characteristic (ROC) curves, was higher for the Portsmouth variant of mortality (Area Under the Curve [AUC] = 0,92) than for morbidity (AUC= 0,74). The goodness of fit between the expected values using the POSSUM scale and those observed was reduced for morbidity (Hosmer-Lemeshow [H-L] = 164.1; p< 0.05). The POSSUM scale predicted a higher number of deaths than those observed, although the Portsmouth variant was better at predicting mortality. The goodness of fit for morbidity was better for elective gastrointestinal surgery (H-L= 27.7) than emergency gastrointestinal surgery (H-L= 177.3). The logistic regression analysis identified (besides the estimated risk using the POSSUM scale itself), surgical complexity, surgery type (elective, emergency), and age of patient, as significant predictive factors of morbidity and mortality. Conclusions In a Spanish university hospital, the POSSUM system adequately predicts morbidity risk in elective gastrointestinal surgery, and over-estimates morbidity risk in emergency gastrointestinal surgery (AU)

[Assessment of the surgical risk of 1,000 consecutive episodes using the POSSUM system. Comparison between elective and emergency gastrointestinal surgery]. / Evaluación del riesgo quirúrgico de 1.000 episodios consecutivos con el sistema POSSUM. Comparación entre cirugía gastrointestinal programada y urgente.

INTRODUCTION: The aim of the present study was to assess the predictive capacity of the POSSUM system in a Spanish university hospital, and to determine its behaviour in elective gastrointestinal surgery and compare it with emergency gastrointestinal surgery (operation < 24 hours). PATIENTS AND METHOD: A total of 1,000 surgical episodes corresponding to 909 patients who required hospital admission, operated on under general or loco-regional anaesthesia, either in the elective (n= 547 episodes) or the emergency setting (n= 453), were included in the study. RESULTS: The overall morbidity was 31.9% (32.8% in elective surgery; 30.7% in emergency surgery). The discriminatory capacity of the POSSUM scale, evaluated using receiver operating characteristic (ROC) curves, was higher for the Portsmouth variant of mortality (Area Under the Curve [AUC] = 0,92) than for morbidity (AUC= 0,74). The goodness of fit between the expected values using the POSSUM scale and those observed was reduced for morbidity (Hosmer-Lemeshow [H-L] = 164.1; p< 0.05). The POSSUM scale predicted a higher number of deaths than those observed, although the Portsmouth variant was better at predicting mortality. The goodness of fit for morbidity was better for elective gastrointestinal surgery (H-L= 27.7) than emergency gastrointestinal surgery (H-L= 177.3). The logistic regression analysis identified (besides the estimated risk using the POSSUM scale itself), surgical complexity, surgery type (elective, emergency), and age of patient, as significant predictive factors of morbidity and mortality. CONCLUSIONS: In a Spanish university hospital, the POSSUM system adequately predicts morbidity risk in elective gastrointestinal surgery, and over-estimates morbidity risk in emergency gastrointestinal surgery.

High-temperature gas chromatography-mass spectrometry with glass capillary columns for the screening of natural products.

High-temperature high resolution gas chromatography (HT-HRGC) and HT-HRGC coupled to mass spectrometry (HT-HRGC-MS) are powerful but relatively unexplored tools for the analysis of crude extracts and fractions of natural products. To illustrate the scope of the technique the direct characterization of several compounds, present in crude extracts of leaves and stems of Croton hemiargyreus Muell. Arg. var. hemiargyreus was undertaken, without derivatization or clean-up procedures. Both practical aspects and limitations of HT-HRGC and HT-HRGC-MS were evaluated resulting in a simple, straightforward and extremely powerful technique for the analysis of complex mixtures.