Immunization with a Mu-class glutathione transferase from Echinococcus granulosus induces efficient antibody responses and confers long-term protection against secondary cystic echinococcosis.

Cystic echinococcosis, a zoonosis caused by cestodes belonging to the Echinococcus granulosus sensu lato (s.l.) genetic complex, affects humans and diverse livestock species. Although a veterinary vaccine exhibiting high levels of antibody-mediated protection has successfully reached the market, the large genetic diversity among parasite isolates and their particular host preferences, makes still necessary the search for novel vaccine candidates. Glutathione transferases (GSTs) constitute attractive targets for immunoprophylaxis due to their outstanding relevance in helminth detoxification processes, against both exogenous and endogenous stressors. Among the six GSTs known to be expressed in E. granulosus s.l., EgGST1 (Mu-class), EgGST2 (Sigma-class), and EgGST3 (a still non-classifiable isoenzyme), show the highest proteomic expression. Therefore, their recombinant forms -rEgGST1, rEgGST2 and rEgGST3- were herein analyzed regarding their potential to induce long-term antiparasite protection in mice. Only immunization with rEgGST1 induced long-lasting protection; and accordingly, rEgGST1-specific antibodies enhanced the parasite killing through both the classical activation of the host complement system and the antibody-dependent cellular cytotoxicity by macrophages. These results support further testing of rEgGST1 as a vaccine candidate in diverse hosts due to the broad expression of EgGST1 in different parasite stages and tissues.

Mouse model of secondary cystic echinococcosis.

Cystic echinococcosis (CE) is a parasitic zoonosis caused by the larval stage of the cestode Echinococcus granulosus sensu lato (s. l.), a genetic complex composed of five species: E. granulosus sensu stricto (s. s.), E. equinus, E. ortleppi, E. canadensis, and E. felidis. The parasite requires two mammalian hosts to complete its life cycle: a definitive host (mainly dogs) harboring the adult parasite in its intestines, and an intermediate host (mostly farm and wild ungulates) where hydatid cysts develop mainly in the liver and lungs. Humans are accidental intermediate hosts, being susceptible to either primary or secondary forms of CE; the first one due to the ingestion of oncospheres, and the second one because of the spillage of protoscoleces (PSC) contained within a primary cyst. Secondary CE is a serious medical problem, and can be modeled in immunocompetent mice (a non-natural intermediate host) through the intraperitoneal inoculation of viable PSC from E. granulosus s. l. This model is useful to study not only the immunobiology of CE, but also to test new chemotherapeutics or therapeutical protocols, to explore novel vaccine candidates, and to evaluate alternative diagnostic and/or follow-up tools. The mouse model of secondary CE involves two sequential stages: an early stage of parasite pre-encystment (PSC develop into hydatid cysts in the peritoneal cavity of mice), and a late or chronic stage of parasite post-encystment (already differentiated cysts slowly grow during the whole host lifespan). This model is a time-consuming infection, whose outcome depends on several factors like the parasite infective dose, the mouse strain, and the parasite species/genotype. Thus, such variables should always be adjusted according to the research objectives. Herein, the general materials and procedures needed to establish secondary CE in mice are described, as well as several useful tips and recommendations.

Effects of microplastics pollution on the abundance and composition of interstitial meiofauna

Introduction: Pollution by microplastics is a global problem in marine environments, which impacts microorganisms and ecosystems at several spatial levels. Sandy beaches are depositional environments where microplastics tend to accumulate in large quantities. The co-occurrence of interstitial meiofauna and microplastics in sand grains raises the question on whether the accumulation of microplastics in the sediments affects the abundance and composition of the meiofaunal communities. Objective: To test the hypothesis that microplastics affect the meiofauna of urban sandy beaches. Methods: We studied the three main urban sandy beaches of Santa Marta, Colombia: El Rodadero, Santa Marta Bay, and Taganga. All are similar in morphology and external pressures, and differ from other beaches in the region. In April 2019 we collected 81 sand samples, equally distributed in the intertidal zone (upper, mid, and lower intertidal levels). We applied generalized linear models to abundance, and multivariate permutational tests to community composition. Results: We identified 17 taxonomic groups of meiofauna, and microplastic particles (mainly 45-500 micron fibres) evenly distributed across beaches and intertidal levels. There was more meiofauna at the mid intertidal level, and in fine and medium grain sediment. At the lower intertidal level, sites with more microplastics had less meiofauna. Abundance of microplastics explained 39 % of the variation in meiofaunal community composition at lower intertidal levels. Conclusions: The accumulation of microplastics might have a negative impact on these meiofaunal interstitial communities. This is not surprising: if microplastics occupy the same physical space as these animals, they might presumably modify the structure of sediments and the composition of interstitial water.

Introducción: La contaminación por microplásticos es un problema global en los ecosistemas marinos, con impacto sobre microorganismos y ecosistemas en varios niveles espaciales. Las playas arenosas son ambientes de deposición donde se tiende a acumular gran cantidad de microplásticos. La co-ocurrencia de meiofauna intersticial y microplásticos en granos de arena plantea la pregunta de que si la acumulación de microplásticos en sedimentos afecta la abundancia y composición de comunidades de meiofauna. Objetivo: Probar la hipótesis de que microplásticos afectan la meiofauna de playas arenosas urbanas. Métodos: Estudiamos las tres principales playas arenosas urbanas de Santa Marta, Colombia: El Rodadero, Bahía Santa Marta y Taganga. Estas son similares en morfología y presiones externas, y difieren de las otras playas de la región. En abril 2019 recolectamos 81 muestras de arena, distribuidas de manera equidistante en la zona intermareal (nivel intermareal superior, medio y bajo). Aplicamos modelos lineales generalizados de abundancia, y pruebas permutacionales multivariantes a la composición de comunidades. Resultados: Identificamos 17 grupos taxonómicos de meiofauna, y partículas de microplástico (principalmente fibras de 45-500 micras) distribuidos equitativamente a lo largo de las playas y niveles intermareales. Hubo más meiofauna en el nivel intermareal medio, y en sedimentos de grano mediano y fino. A niveles intermareales más bajos, sitios con más microplásticos tuvieron menos meiofauna. La abundancia de los microplásticos explicó el 39 % de la variación en comunidades de meiofauna a niveles intermareales bajos. Conclusión: La acumulación de microplásticos podría tener un impacto negativo sobre las comunidades de meiofauna intersticial. Esto no es de sorprender: si los microplásticos ocupan el mismo volumen físico que estos animales, estos podrían presuntamente modificar la estructura de sedimentos y la composición del agua intersticial.

Functional Food Components, Intestinal Permeability and Inflammatory Markers in Patients with Inflammatory Bowel Disease.

Inflammatory bowel diseases (IBD) are characterized by a chronic inflammatory process that affects the intestinal barrier structure. Recent evidence suggests that some food components can influence the integrity of the intestinal barrier and thus its permeability. We aimed at assessing the effect of food components on the intestinal permeability (IP) and on inflammatory markers in individuals with IBD by a single-blind randomized clinical study. Of the 53 individuals included, 47% (n = 25) had been diagnosed with IBD. The participants were divided into 4 groups. IBD patients were allocated to intervention group (n = 14) vs. no intervention group (n = 11), and the same happened with 28 control participants without disease (n = 14 in intervention group vs. n = 14 without intervention). Symptomatology, nutritional status, biochemical parameters (specifically serum zonulin (ZO) to measure IP) were evaluated on all individuals on an eight week period following a diet plan with/without potentially beneficial foods for the IP. At the beginning of the study, there were no significant differences in ZO values between individuals with and without IBD (p > 0.05). The effect of specific food components was inconclusive; however, a trend in the reduction of inflammatory parameters and on the prevalence of gastrointestinal symptomatology was observed. More controlled intervention studies with diet plans, including food components potentially beneficial for the integrity of the intestinal barrier, are of the utmost importance.

Realidad de los pacientes con hipertensión arterial de la costa del río Uruguay asistidos por especialistas en cardiología (Registro Río Uruguay I) / Reality of Hypertensive Patients from the Uruguay River Coast Assisted by Specialists in Cardiology (Río Uruguay Registry I)

RESUMEN Introducción: La hipertensión es uno de los principales factores que aumentan la "carga" de la enfermedad aterosclerótica. Objetivo: Analizar las características, el tratamiento y el grado de control en pacientes atendidos por cardiólogos en nuestra zona de influencia. Material y métodos: Se realizó un estudio transversal en 13 consultorios de cardiología donde se analizaron las características clínicas, tensión arterial y tratamiento farmacológico. Resultados: Se enrolaron 519 pacientes en 3 meses, hombres: 44,9%, edad: 61,5 años, tiempo de hipertensión: 11,2 años, enfermedad cardiovascular: 24%, tensión arterial promedio: 133/79,8 mmHg. Entre los pacientes sin enfermedad cardiovascular, el 73% tenían riesgo cardiovascular bajo (<10%). El 39,1% recibía dos drogas; el 26,8%, tres; el 24,7%, uno; el 7,9% cuatro; y el 1,35%, cinco drogas. Finalmente, el 60,5% de los pacientes estaba en el objetivo de tensión arterial (<140/90 mmHg). Conclusiones: Los pacientes con hipertensión evaluados en nuestra área geográfica presentaban bajo riesgo cardiovascular y alto uso de combinaciones farmacológicas. El 60% alcanzaban los objetivos de tensión arterial.

ABSTRACT Background: Hypertension is one of the main factors that increase the "burden" of atherosclerotic disease. Objective: The aim of this study was to analyze the characteristics, treatment and degree of control in patients treated by cardiologists in our area of influence. Material and methods: A cross-sectional study was carried out in 13 cardiology offices analyzing hypertensive patients' clinical characteristics, blood pressure and pharmacological treatment. Results: A total of 519 patients with the following characteristics were enrolled during a 3-month period: 44.9% were men, mean age was 61.5 years, the spell of hypertension was 11.2 years, 24% of patients had cardiovascular disease and mean blood pressure was 133/79.8 mmHg. Among patients without cardiovascular disease, 73% had low cardiovascular risk (<10%). Hypertensive treatment showed that 39.1% of patients were receiving two drugs, 26.8% three, 24.7% one, 7.9% four and 1.35% five drugs. Finally, 60.5% of patients was within the target blood pressure (<140/90 mmHg). Conclusions: Hypertensive patients evaluated in our geographical area presented low cardiovascular risk and high use of pharmacological combinations. Pressure targets were achieved in 60% of cases.

Adherence to antihypertensive drug treatment in Argentina: A multicenter study.

Adherence to antihypertensive medication is an important challenge that doctors often face in the treatment of hypertension. Good adherence is crucial to prevent cardiovascular complications. In consequence, the present study aimed at determining the prevalence of adherence to antihypertensive treatment and identifying associated clinical variables. A multicenter cross-sectional study was conducted in 12 cities of Argentina. A systematic sampling was performed in order to select patients with hypertension and under pharmacological treatment for at least 6 months. Physicians took three BP measurements, and the level of adherence was assessed using the self-administered Morisky questionnaire (MMAS-8). Participants were classified into three levels of adherence: high adherence-MMAS score of 8; medium adherence-MMAS scores of 6 to <8; and low adherence-MMAS scores of <6. A total of 1111 individuals (62 ± 12 years old, women 49.4%) were included in the present analysis; 159 (14.3%), 329 (29.6%) and 623 (56.1%) patients had low, medium, and high adherence, respectively. The prevalence of controlled hypertension increased only in high adherent patients: 42.8%, 42.2%, and 64.5% for low, medium, and high adherence groups, respectively. Similarly, systolic BP was lower only in the high adherence group. High educational level (OR 3.47, 95% CI 2.68-4.49) and diuretic treatment (OR 0.64, 95% CI 0.47-0.88) were independent predictors of high adherence. In conclusion, more than a half of treated hypertensive patients had a high level of adherence. These patients had lower BP values and higher control levels. A high educational level predicts high adherence.

Interstitial annelids from the Caribbean Coast of Colombia / Anélidos intersticiales de la costa Caribe de Colombia

Abstract A total of 298 species of polychaetes have been recorded from Colombia. However, only the family Protodrilidae has been reported from the marine interstitial realm. We here aim at identifying the interstitial annelids inhabiting the sandy beaches in Santa Marta region to the most accurate taxonomic level based on light microscopy examinations. Our samples, collected from the intertidal zone at three touristic beaches in the department of Magdalena (Santa Marta Bay, Rodadero Bay, and Taganga Bay), yielded a total of 83 specimens, which we assigned to five families, ten genera and nine species. From those, two families, eight genera, and the species Hesionides gohari, Neogyptis mediterranea, Neopetitia amphophthalma, Westheidesyllis gesae, and Syllis beneliahuae represent new records for the Colombian fauna. This survey should be considered as a first step towards a complete knowledge of the Colombian diversity of interstitial annelids, and our results significantly contribute to fill the gap of our current knowledge, suggesting a high diversity of species comparable to this in better-known areas of the Caribbean and the Atlantic coasts of Brazil. A brief diagnosis, comments on distribution and ecology, and remarks are provided for each record, in order to facilitate the re-identification of the species. Rev. Biol. Trop. 66(2): 658-673. Epub 2018 June 01.

Resumen Un total de 298 especies de poliquetos han sido registradas para Colombia. Sin embargo, solo la familia Protodrilidae ha sido reportada para el medio marino intersticial. El objetivo de este estudio fue identificar los anélidos intersticiales que habitan en playas arenosas de la región de Santa Marta hasta la categoría taxonómica más precisa, basados en observaciones al microscopio de luz. Las muestras fueron recolectadas en la zona intermareal de tres playas turísticas en el departamento del Magdalena (La bahía de Santa Marta, bahía de Rodadero y bahía de Taganga), resultando un total de 83 especímenes, los cuales fueron asignados a cinco familias, diez géneros y nueve especies. De estos, dos familias, ocho géneros y las especies Hesionides gohari, Neogyptis mediterranea, Neopetitia amphothalma, Westheidesyllis gesae y Syllis beneliahuae representan nuevos registros para la fauna de Colombia. Este trabajo debería ser considerado como el primer paso hacia el conocimiento de la diversidad de anélidos intersticiales en Colombia y los resultados contribuyen significativamente a llenar el vacío de información en el tema, sugiriendo una alta diversidad de especies comparable con la de áreas mejor conocidas del Caribe y de la costa atlántica de Brasil. En este trabajo se provee una breve diagnosis, comentarios sobre la distribución y ecología, y anotaciones para cada registro, con el propósito de facilitar la re-identificación de las especies.

Necesidad de tratamiento periodontal en adolescentes de 12 años de colegios municipalizados en Valdivia-Chile 2014: estudio transversal / Periodontal treatment needs in 12 year-old adolescents of municipal schools in Valdivia-Chile 2014: A cross-sectional study

Objetivo Determinar la necesidad de tratamiento periodontal de los adolescentes de 12 años de colegios municipalizados urbanos en la ciudad de Valdivia, Chile, en el año 2014. Material y métodos Estudio de corte transversal, donde se evaluó una muestra de 225 adolescentes de 12 años pertenecientes a colegios municipales de la ciudad de Valdivia, entre los meses de abril y mayo del año 2014. Para determinar la necesidad de tratamiento se utilizó el Índice de necesidad de tratamiento periodontal de la comunidad (CPITN). Resultados Los hallazgos revelaron que el 8% de los adolescentes examinados presentó un periodonto sano, un 40,9% sangrado al sondaje, un 47,6% cálculo y un 3,5% inspección a través de un periodontograma completo para determinar si existe periodontitis leve, moderada o grave. Conclusión Según los resultados obtenidos se evidencia que existe una alta necesidad de tratamiento periodontal en los adolescentes de 12 años pertenecientes a los colegios municipales urbanos de Valdivia. Con los datos obtenidos se puede incentivar el inicio de futuras investigaciones, y planificar programas odontológicos en la región que hagan énfasis en la prevención y tratamiento de las enfermedades periodontales desde el nivel primario de salud.

Objective To assess the periodontal treatment needs of 12 year-old adolescents of urban municipal schools in Valdivia, Chile. Materials and methods A cross-sectional, descriptive, observational study was carried out. A total of 225 adolescents of 12 years of age attending municipal schools in Valdivia between April and May, who met the inclusion criteria were evaluated. Treatment needs were determined using the Community Periodontal Index of Treatment Needs (CPITN). Results The findings revealed that 8% of the examined adolescents had a healthy periodontium, 40.9% had gingival bleeding on probing, 47.6% had calculus deposits, and 3.5% were examined using a periodontal chart to determine mild, moderate, or severe periodontitis. Conclusion According to the results it is evident that there is a high need for periodontal treatment by 12 year old adolescents attending urban municipal schools in Valdivia. The data of this study will help encourage additional research on the subject and in planning dental programs in the region, with emphasis on prevention and treatment of periodontal diseases from primary health care.

Myeloid sarcoma of gastrointestinal tract: a rare cause of obstruction

No disponible

The complete mitochondrial genome of Micrura ignea Schwartz & Norenburg 2005 (Nemertea: Heteronemertea) and comparative analysis with other nemertean mitogenomes.

We sequenced the complete mitochondrial genome of the Heteronemertea species, Micrura ignea. The genome was amplified with a combination of short and long PCRs that were subjected to 454 sequencing. The mitogenome of M. ignea is a circular molecule of 15,333bp in size and encodes the 37 genes typically found in metazoans, and one non-coding region. The order of the genes is the same as for all the other Heteronemerteans. All genes are encoded on the heavy strand except trnT and trnP. The phylogenetic analyses recovered M. ignea as a basal taxon in the Lineidae family, no differences were found in the topology of the phylogenetic trees in comparison with previous studies.

Evaluación clínica de los tejidos periodontales después del aumento de corona clínica / Clinical evaluation of periodontal tissue after crown lengthening surgery

INTRODUCCIÓN: La cirugía de aumento de corona clínica es un medio para facilitar los procedimientos de restauración con el objetivo de restablecer el ancho biológico periodontal. OBJETIVO: Registrar la evolución clínica de los tejidos periodontales de dientes sometidos a cirugía de aumento de corona clínica durante un período de cicatrización de 6 meses. Material y métodos: Se realizó un estudio observacional prospectivo, en el cual se evaluaron 25 pacientes; todos cumplieron con los criterios de inclusión y exclusión. Para evaluar la evolución de los dientes, se registró el índice gingival, índice de placa, índice PMA, recesión gingival, profundidad de sondaje y después de la cirugía, presencia de movilidad y lesión de área de furcación. Para medir la migración del margen gingival libre, se utilizó un dispositivo de acrílico. Se realizó el análisis estadístico de análisis de la varianza de un factor, margen de error del 5%, intervalo de confianza de 95%. RESULTADOS: El 84% de los pacientes fueron de género femenino, concentrándose el mayor porcentaje de pacientes entre los rangos de edad de 30 a 40 años (60%). Con respecto a los dientes intervenidos, el 76% fueron dientes posteriores, el diagnóstico más prevalente fue la categoría de diente con eliminación de caries subgingival (48%). A los 6 meses, existió ausencia total de inflamación gingival tanto en diente tratado como diente adyacente. Con respecto a la exposición coronal, medida a través de la distancia dispositivo-margen gingival libre, existió variación con la medición inicial de 4,26 mm en diente tratado y 3,90 mm en diente adyacente en relación con los 3 meses, 5,10 mm en diente tratado y 4,40 mm en diente adyacente, manteniéndose casi de forma similar a los 6 meses. CONCLUSIÓN: La evolución clínica de los tejidos periodontales posterior a la cirugía de aumento de corona clínica de nuestros pacientes demostró que a los 3 meses existe ausencia de inflamación gingival y en todos los casos se produjo retracción gingival de la encía comparada con los datos iniciales, consideración que debe tenerse presente en el momento de la rehabilitación final del diente

INTRODUCTION: Crown lengthening is a surgical procedure performed to re-establish the periodontal biological width of the tooth for its subsequent restoration. OBJECTIVE: To record the clinical outcomes of the periodontal tissues subjected to crown lengthening surgery, for a period of 6 months. Materials and methods: A prospective observational descriptive study was conducted on 25 patients who fulfilled the inclusion and exclusion criteria. The parameters evaluated were: gingival index, plaque index, Papillary-Marginal-Attachment (PMA) index, classification for gingival recessions probing depth and after surgery, classes of mobility and furcation classification. An acrylic device was used to measure the gingival margin migration. Statistical analysis was performed using one-way ANOVA, margin of error of 5%, and confidence level of 95%. RESULTS: Of the 25 patients, 84% were female, with the highest percentage of patients between the age ranges of 30 to 40 years (60%). As regards the teeth, 76% were back teeth, and the most prevalent diagnostic category was the removal of subgingival tooth decay (48%). At six months there was complete absence of gingival inflammation in the treated (TT) tooth, as well as in the adjacent (AD) tooth. With respect to the coronal exposure measured by the free gingival margin distance device, there was a difference between the initial measurement of 4.26 mm for the TT tooth and 3.90 mm for the AD tooth, and at three months, 5.10 mm for the TT tooth and 4.40 mm for the AD tooth, remaining almost the same at 6 months. CONCLUSION: The clinical outcome of periodontal tissues after crown lengthening surgery on our patients showed that there is absence of gingival inflammation after 3 months, and in all cases gingival gum recession, compared to the initial data. This should be taken into account when the final restoration of the tooth is considered

Necesidad de tratamiento periodontal e higiene oral en adolescentes de 12 años de Llanquihue / Periodontal treatment needsand oral hygiene in adolescents 12 years old of Llanquihue

OBJETIVO: Determinar la necesidad de tratamiento periodontal e higiene oral de los adolescentes de 12 años, de la ciudad de Llanquihue, Chile. MATERIAL Y MÉTODOS: Se realizó un estudio observacional descriptivo de corte transversal, en adolescentes de 12 años de la ciudad de Llanquihue, Chile, entre los meses de marzo y junio del año 2013. Se evaluó una muestra de 90 adolescentes, los cuales cumplieron con los criterios de inclusión. Para determinar la necesidad de tratamiento, se utilizó el índice de necesidad de tratamiento periodontal de la comunidad y se evaluó la higiene oral mediante el índice de higiene oral simplificado. Se aplicó el T-test, asumiendo un nivel de significancia estadística p < 0,05. RESULTADOS: Del total de adolescentes examinados, el 56,7% eran de género masculino. El valor promedio del índice de necesidad de tratamiento periodontal de la comunidad fue 1,1 ± 0,9 y el del índice de higiene oral simplificado fue de 0,7± 0,5. Los promedios de índice de necesidad de tratamiento periodontal de la comunidad e índice de higiene oral simplificado no tuvieron diferencias estadísticamente significativas entre géneros (p < 0,05). CONCLUSIÓN: El 33,3% de los adolescentes de 12 años pertenecientes a la ciudad de Llanquihue tienen necesidad de tratamiento periodontal. La detección de enfermedad periodontal debe ser una parte fundamental del examen dental integral de los niños y adolescentes

OBJECTIVE: To determine the periodontal treatment needs and oral hygiene among 12 years old teenagers, living in Llanquihue, Chile. MATERIALS AND METHODS: A cross-sectional, descriptive, observational study was performed. It evaluated 12 years old teenagers registered in the selected schools in Llanquihue, Chile 2013 between march and june. The sample consisted of 90 teenagers, who met the inclusion criteria. To determine the treatment needs periodontal it was used the Community Periodontal IndexofTreatment Needs(CPITN) and the oral hygiene was evaluated by using theSimplified Oral Hygiene Index(OHI-S).Test T was applied assuming a statistical significance level p < 0,05. RESULTS: Of the total sample, 56,7% of the participants were males. The average values for the CPITN and OHI-S, were 1,1 ± 0,9 and 0,7 ± 0,5, respectively. There were no statistically significant differences between both genders (p < 0,05). CONCLUSION: 33,3% of adolescents aged 12 yearsold belonging tothe town ofLlanquihue, need periodontal treatment. Periodontal disease detection must be considered as an important part of the integral dental examination in children and adolescents

Sustained relief of obstructive symptoms for the remaining life of patients following placement of an expandable metal stent for malignant colorectal obstruction.

BACKGROUND: self-expanding metal stents are currently being used as a definitive palliative treatment for malignant colorectal obstruction in patients with incurable disease. Few studies have followed large numbers of patients from stent placement until death, and those few have reported conflicting results in the long-term clinical outcome data. AIMS: this study evaluated the clinical effectiveness of stent placement for malignant colorectal obstruction throughout the patients lives and related factors affecting stent patency, clinical success and complications. METHODS: this was a multicentre, retrospective study of 89 consecutive patients who had undergone attempted expandable stent placement for symptomatic malignant colorectal obstruction during a 10-year period. Data were collected to analyse the sustained relief of obstructive symptoms throughout the patients lives, as well as the technical success, immediate clinical success, stent patency, complications, reinterventions, survival, prognostic factors associated with stent patency and long-term clinical efficacy and risk factors for complications. RESULTS: technical and immediate clinical success were achieved in 95.5% and 91.0% of patients, respectively. A total of 68 out of 89 patients (76.4%) maintained relief of obstruction from stent implantation until death without reintervention. Twenty patients (22.5%) had complications including perforation (n = 4; 4.5%), stent obstruction (n = 8; 9.0%), migration (n = 5; 5.6%) and haemorrhage (n = 3; 3.4%). Stent-related mortality was seen in 1 patient (1.1%). The estimated median survival and estimated mean stent patency were 87.0 and 322.7 days, respectively. In total, 12 of the initial 89 patients (13.5%) needed a colostomy for long-term relief of the obstructive symptoms. Univariate and multivariate analysis detected no significant prognostic factors associated with stent patency, long term clinical efficacy and risk factors for complications; however, the multivariate logistic model revealed a non-significant trend by which the use of chemotherapy was a risk factor for migration (OR = 11.89; p = 0.06). CONCLUSIONS: for palliation of incurable malignant colorectal obstruction, expandable stents can provide sustained relief of obstruction in approximately 75% of patients. The procedure is associated with acceptable morbidity, need for reintervention and minimal mortality.

Sustained relief of obstructive symptoms for the remaining life of patients following placement of an expandable metal stent for malignant colorectal obstruction / Mejoría mantenida durante el resto de la vida de los síntomas obstructivos en pacientes con obstrucciones malignas colorrectales trás la colocación de prótesis metálicas expandibles

Background: self-expanding metal stents are currently being used as a definitive palliative treatment for malignant colorectal obstruction in patients with incurable disease. Few studies have followed large numbers of patients from stent placement until death, and those few have reported conflicting results in the long-term clinical outcome data. Aims: this study evaluated the clinical effectiveness of stent placement for malignant colorectal obstruction throughout the patients’ lives and related factors affecting stent patency, clinical success and complications. Methods: this was a multicentre, retrospective study of 89 consecutive patients who had undergone attempted expandable stent placement for symptomatic malignant colorectal obstruction during a 10-year period. Data were collected to analyse the sustained relief of obstructive symptoms throughout the patients’ lives, as well as the technical success, immediate clinical success, stent patency, complications, reinterventions, survival, prognostic factors associated with stent patency and long-term clinical efficacy and risk factors for complications. Results: technical and immediate clinical success were achieved in 95.5% and 91.0% of patients, respectively. A total of 68 out of 89 patients (76.4%) maintained relief of obstruction from stent implantation until death without reintervention. Twenty patients (22.5%) had complications including perforation (n = 4; 4.5%), stent obstruction (n = 8; 9.0%), migration (n = 5; 5.6%) and haemorrhage (n = 3; 3.4%). Stent-related mortality was seen in 1 patient (1.1%). The estimated median survival and estimated mean stent patency were 87.0 and 322.7 days, respectively. In total, 12 of the initial 89 patients (13.5%) needed a colostomy for long-term relief of the obstructive symptoms. Univariate and multivariate analysis detected no significant prognostic factors associated with stent patency, longterm clinical efficacy and risk factors for complications; however, the multivariate logistic model revealed a non-significant trend by which the use of chemotherapy was a risk factor for migration (OR = 11.89; p = 0.06). Conclusions: for palliation of incurable malignant colorectal obstruction, expandable stents can provide sustained relief of obstruction in approximately 75% of patients. The procedure is associated with acceptable morbidity, need for reintervention and minimal mortality(AU)

Oral intake throughout the patients' lives after palliative metallic stent placement for malignant gastroduodenal obstruction: a retrospective multicentre study.

OBJECTIVES: Patients with inoperable malignant gastric outlet obstruction (GOO) have been managed with self-expandable metal stents to improve oral intake. Recent studies have shown conflicting results on the capacity of self-expandable metal stents to restore food intake in the long term. This study evaluated the clinical effectiveness of enteral stent placement for GOO throughout the patients' lives. METHODS: This was a multicentre, retrospective study with a long-term follow-up of 74 patients who underwent enteral stenting for symptomatic GOO. Data were collected to analyse improvements in oral intake for the patients' entire lives as assessed by the GOO scoring system (GOOSS), technical success, stent patency, complications, the need for reintervention, survival and the prognostic factors associated with stent patency. RESULTS: Technical and clinical success was achieved in 100 and 97.2% of the patients, respectively. A total of 71/74 patients (95.9%) continued oral intake for the rest of their lives and 58/74 patients (78.4%) needed no further intervention until death. Solid food intake (GOOSS 2-3) continued until death in 47/74 patients (63.5%). The GOOSS score improved (P<0.001) during the follow-up compared with the baseline. The median survival and the mean stent patency were 8 and 76.6 weeks, respectively. The complication rate was 18.9%. Malignant stent reobstruction was observed in 7/74 patients (9.5%). A Cox multivariate analysis showed that duodenal location of the obstruction was the only independent factor associated with stent patency (hazard ratio=5.28; 95% confidence interval=1.14-24.45; P=0.033). CONCLUSION: Enteral stenting in patients with unresectable GOO is safe and clinically effective. Ninety-five per cent of patients are able to resume oral intake for the rest of their lives, and the great majority remain free from further intervention. In approximately two-thirds of patients, solid food intake continues until death.