Autologous adipose-derived stem cells for the treatment of complex cryptoglandular perianal fistula: A randomized clinical trial with long-term follow-up.

The aim of this clinical trial (ID Number NCT01803347) was to determine the safety and efficacy of autologous adipose-derived stem cells (ASCs) for treatment of cryptoglandular fistula. This research was conducted following an analysis of the mistakes of a same previous phase III clinical trial. We designed a multicenter, randomized, single-blind clinical trial, recruiting 57 patients. Forty-four patients were categorized as belonging to the intent-to-treat group. Of these, 23 patients received 100 million ASCs plus intralesional fibrin glue (group A) and 21 received intralesional fibrin glue (group B), both after a deeper curettage of tracks and closure of internal openings. Fistula healing was defined as complete re-epithelialization of external openings. Those patients in whom the fistula had not healed after 16 weeks were eligible for retreatment. Patients were evaluated at 1, 4, 16, 36, and 52 weeks and 2 years after treatment. Results were assessed by an evaluator blinded to the type of treatment. After 16 weeks, the healing rate was 30.4% in group A and 42.8% in group B, rising to 55.0% and 63.1%, respectively, at 52 weeks. At the end of the study (2 years after treatment), the healing rate remained at 50.0% in group A and had reduced to 26.3% in group B. The safety of the cellular treatment was confirmed and no impact on fecal continence was detected. The main conclusion was that autologous ASCs for the treatment of cryptoglandular perianal fistula is safe and can favor long-term and sustained fistula healing.

Altered interphase fluorescence in situ hybridization profiles of chromosomes 4, 8q24, and 9q34 in pancreatic ductal adenocarcinoma are associated with a poorer patient outcome.

Most patients with pancreatic ductal adenocarcinoma (PDAC) die within 6 months of diagnosis. However, 20% to 25% patients undergoing total tumor resection remain alive and disease-free 5 years after diagnostic surgery. Few studies on tumor markers have predicted patient prognosis and/or survival. We evaluated the effect of tumor cytogenetic copy number changes detected by interphase fluorescence in situ hybridization on overall survival (OS) of 55 PDAC patients. The prognostic value of copy number changes showing an effect on OS was validated in an external cohort of 44 surgically resected PDAC patients by comparative genomic hybridization arrays, and the genes coded in altered chromosomes with prognostic value were identified by high-density single-nucleotide polymorphism arrays in 20 cases. Copy number changes of chromosomes 4 and 9q34 with gains of 8q24 were independently associated with shorter OS. On the basis of these three chromosomal alterations, a score is proposed that identifies patients with significantly different (P < 0.001) 5-year OS rates: 60% ± 20%, 16% ± 8%, and 0% ± 0%, respectively. Our results show an association between tumor cytogenetics and OS of PDAC patients and provide the basis for further prognostic stratification of patients undergoing complete tumor resection. Further studies to identify specific genes coded in these chromosomes and their functional consequences are necessary to understand the clinical effect of these changes.

Formación quirúrgica en España: resultados de una encuesta nacional / Surgical training in Spain: Results of a national survey

Introducción: El objetivo del estudio intenta realizar una aproximación al estado de la formación quirúrgica en España y analizar su adecuación a los objetivos del programa. Material y métodos: Se presentan y se analizan los resultados de dos encuestas realizadas por la Asociación Española de Cirujanos a los residentes y a los tutores de Cirugía General basadas en las conclusiones del XXVII Congreso Nacional de Cirugía. Las cuestiones formuladas hacían referencia a aspectos generales del servicio y particulares en relación con el acceso, la actividad docente, la actividad quirúrgica, la actividad investigadora y las perspectivas personales. Las respuestas fueron definidas, adaptadas y categorizadas como variables cuantitativas y cualitativas. Se utilizó un programa estadístico G Stat 2.0 para el procesamiento y la presentación descriptiva de los resultados. Resultados: El número de residentes y tutores a quienes se enviaron las encuestas fue de 626 y 142. Fueron respondidas el 19% de las encuestas de residentes y el 29% de las encuestas de tutores. Según el año de residencia, predominaron las de residentes de primer año (32%) frente a los de años ulteriores, siendo el índice de respuesta de los R5 del 7,2%. El 91% conocía bien el programa de la especialidad y el 76% estaba satisfecho con la formación recibida. Conclusiones: Los resultados obtenidos en cuanto a actividad quirúrgica concuerdan con los previstos en el programa tanto en el número de procedimientos como en su progresión a lo largo de la residencia, aunque no es posible asegurar su uniformidad. Las funciones y la acreditación de los tutores que constituyen uno de los pilares fundamentales del proceso formativo están pendientes de regulación específica (AU)

Introduction: The aim of the study is to try and find out the state of surgical training in Spain and to determine whether it meets the objectives of the Program. Material and methods: The results of two surveys carried out on Residents and General Surgery Tutors by the Spanish Surgeons Association, based on the conclusions of the XXVII Congreso Nacional de Cirugía. The questions formulated referred to general aspects of the Service and specific ones related to access, teaching activity, surgery, research and personal perspectives. The responses were defined, adjusted and categorised as quantitative and qualitative variables. The statistics program G Stat 2.0 was used for processing and the descriptive presentation of the results. Results: The surveys were sent to 626 Residents and 142 Tutors, with a response rate of 19% and 29%, respectively. First year residents predominated (32%) compared to later years, with an R-5 response index of 7.2%. A total of 91% knew the speciality Program well, and 76% were satisfied with the training received. Conclusions: The results obtained as regards surgical activity agree with those established in the Program, both in the number of procedures and in their progression throughout the Residency, although it is not possible to ensure its uniformity. The functions and accreditation of the Tutors which are one of the main foundations of the training process are pending specific regulations (AU)

[Surgical training in Spain: results of a national survey]. / Formación quirúrgica en España: resultados de una encuesta nacional.

INTRODUCTION: The aim of the study is to try and find out the state of surgical training in Spain and to determine whether it meets the objectives of the Program. MATERIAL AND METHODS: The results of two surveys carried out on Residents and General Surgery Tutors by the Spanish Surgeons Association, based on the conclusions of the XXVII Congreso Nacional de Cirugía. The questions formulated referred to general aspects of the Service and specific ones related to access, teaching activity, surgery, research and personal perspectives. The responses were defined, adjusted and categorised as quantitative and qualitative variables. The statistics program G Stat 2.0 was used for processing and the descriptive presentation of the results. RESULTS: The surveys were sent to 626 Residents and 142 Tutors, with a response rate of 19% and 29%, respectively. First year residents predominated (32%) compared to later years, with an R-5 response index of 7.2%. A total of 91% knew the speciality Program well, and 76% were satisfied with the training received. CONCLUSIONS: The results obtained as regards surgical activity agree with those established in the Program, both in the number of procedures and in their progression throughout the Residency, although it is not possible to ensure its uniformity. The functions and accreditation of the Tutors which are one of the main foundations of the training process are pending specific regulations.

Evaluación de un curso de formación en cirugía menor para médicos de atención primaria / Evaluation of a training course in minor surgery for primary health care physicians

Objetivos. Evaluar los conocimientos adquiridos y conocer la opinión sobre el curso de los alumnos participantes en un curso de formación en cirugía menor realizado por médicos de atención primaria. Diseño. Los conocimientos teóricos adquiridos por los participantes se han evaluado mediante un diseño casi experimental del tipo antes y después a través de un test de 20 preguntas de similar grado de dificultad realizado al comienzo y al final de la realización del curso. Los resultados se analizan mediante el test de Wilcoxon. La opinión de los alumnos sobre el curso se conoció a través de un cuestionario que los alumnos realizaron al final del curso. Participantes y métodos. El curso fue realizado por 24 médicos que trabajan en los centros de salud de Salamanca y provincia y consta de seminarios, talleres y asistencia y participación en quirófanos de cirugía menor. Resultados y discusión. Se produjo un aumento de los conocimientos teóricos con incremento significativo en el número de aciertos y disminución en el número de respuestas erróneas (p = 0,0001). La opinión de los alumnos sobre el curso puede considerarse buena (oscilando entre 3,92 y 4,23 sobre un máximo de 5). Los alumnos valoraron negativamente la no inclusión de determinados contenidos que deberán ser incorporados en sucesivos cursos (AU)