Study of risk factors for delayed gastric emptying after partial pancretoduodenectomy.

INTRODUCTION: Delayed gastric emptying is one of the most frequent complications after pancreatoduodenectomy. METHODS: We performed an analysis of risk factors for delayed gastric emptying on a prospective database of 390 patients operated on between 2013 and 2021. A comparative retrospective study was carried out between patients with and without delayed gastric emptying and subsequently a study of risk factors for delayed gastric emptying using univariate and multivariate logistic regression models. RESULTS: The incidence of delayed gastric emptying in the overall series was 28%. The morbidity of the group was 63%, and postoperative mortality was 3.1%. Focusing on delayed gastric emptying, the median age (73 years vs 68 years, P < 0.001) and preoperative creatinine (75 vs 65.5, P < 0.001) were higher in the group with this complication. The study of risk factors showed that age over 60 years (P = 0.002) and pancreatic fistula (P < 0.001) were risk factors for delayed gastric emptying. CONCLUSION: The presence of pancreatic fistula is confirmed as a risk factor for slow gastric emptying after pancreaticoduodenectomy. In addition, age over 60 years is shown to be a risk factor for slow gastric emptying.

Delayed gastric emptying after classical Whipple or pylorus-preserving pancreatoduodenectomy: a randomized clinical trial (QUANUPAD).

PURPOSE: Pylorus-preserving pancreatoduodenectomy (PPPD) has been the gold standard for pancreatic head lesion resection for several years. Some studies have noted that it involves more delayed gastric emptying (DGE) than classical Whipple (i.e., pancreatoduodenectomy with antrectomy). Our working hypothesis was that the classical Whipple has a lower incidence of DGE. We aimed to compare the incidence of DGE among pancreatoduodenectomy techniques. METHODS: This pragmatic, randomized, open-label, single-center clinical trial involved patients who underwent classical Whipple (study group) or PPPD (control group). Gastric emptying was clinically evaluated using scintigraphy. DGE was defined according to the International Study Group of Pancreatic Surgery (ISGPS) criteria. The secondary endpoints were postoperative morbidity, length of hospital stay, anthropometric measurements, and nutritional status. RESULTS: A total of 84 patients were randomized (42 per group). DGE incidence was 50% (20/40, 95% confidence interval (95% CI): 35-65%) in the study group and 62% (24/39, 95% CI: 46-75%) in the control group (p = 0.260). No differences were observed between both groups regarding postoperative morbidity or length of hospital stay. Anthropometric measurements at 6 months post-surgery: triceps fold measurements were 12 mm and 16 mm (p = 0.021). At 5 weeks post-surgery, triceps fold measurements were 13 mm and 16 mm (p = 0.020) and upper arm circumferences were 26 cm and 28 cm (p = 0.030). No significant differences were observed in nutritional status. CONCLUSION: DGE incidence and severity did not differ between classical Whipple and PPPD. Some anthropometric measurements may indicate a better recovery with PPPD. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03984734.

SO2 measurements in a clean coastal environment of the southwestern Europe: Sources, transport and influence in the formation of secondary aerosols.

Two years of SO2 measurements at El Arenosillo observatory located in the Gulf of Cadiz (Atlantic Ocean) were investigated. Annual hourly averages of 1.9 ± 1.5 µg m-3 and p95 between 3 and 4.4 µg m-3 were recorded, showing clean and background environments. Monthly means vary between 1.5 and 2.4 µg m-3, a monthly evolution was not found. SO2 fields from the MERRA2 model were used to identify SO2 sources and its transport, which could be affecting the studied region. Although SO2 records were low, major conductive for SO2 increases were observed in specific periods. A selection methodology was applied to extract these events, which showed a mean of ~11 µg m-3. Surface meteorological observations and ERA5 meteorological fields from the ECMWF model were used to assess the weather conditions. SO2 increases, in cold months occurred under conditions governed by synoptic-scale. Two types of transport scenarios were identified: SO2 transport defined as direct impact, which is the sum of the plumes from Portugal and the Huelva area; and indirect impact, where SO2 and sulphate particle emissions from Portugal were transported and accumulated in the Gulf of Cadiz and then carried inland, where new particle formation were observed. Episodes with high SO2 concentrations were also reported in warm periods associated with pure sea-land breezes. The SO2 peaks under sea-land breezes were associated with the transport of SO2 from the south of Portugal to the Gulf of Cadiz, whereas SO2 from the east of the Iberian Peninsula and north of Africa reached the Mediterranean Sea and were then transported to the Atlantic Ocean following the Strait of Gibraltar. Blocking of the airflows from the Mediterranean Sea to the Atlantic Ocean turns the Gulf of Cadiz into a chemical reservoir, where chemical species such as SO2 can accumulate, triggering new particle formation processes.

Unusual winter Saharan dust intrusions at Northwest Spain: Air quality, radiative and health impacts.

Saharan air masses can transport high amounts of mineral dust particles and biological material to the Iberian Peninsula. During winter, this kind of events is not very frequent and usually does not reach the northwest of the Peninsula. However, between 21 and 22 February 2016 and between 22 and 23 February 2017, two exceptional events were registered in León (Spain), which severely affected air quality. An integrative approach including: i) typical synoptic conditions; ii) aerosol chemical composition; iii) particle size distributions; iv) pollen concentration; v) aerosol optical depth (AOD); vi) radiative forcing and vii) estimation of the impact of aerosols in the respiratory tract, was carried out. In the global characterization of these events, the exceedance of the PM10 daily limit value, an increase in the coarse mode and a rise in the iron concentration were observed. On the 2016 event, an AOD and extinction-related Ångström exponent clearly characteristic of desert aerosol (1.1 and 0.05, respectively) were registered. Furthermore, pollen grains not typical of flowering plants in this period were identified. The chemical analysis of the aerosol from the 2017 event allowed us to confirm the presence of the main elements associated with mineral sources (aluminum, calcium, and silica concentrations). An increase in the SO42-, NO3- and Cl- concentrations during the Saharan dust intrusion was also noted. However, in this event, there was no presence of atypical pollen types. The estimated dust radiative forcing traduced a cooling effect for surface and atmosphere during both events, corroborated by trends of radiative flux measurements. The estimated impact on the respiratory tract regions of the high levels of particulate matter during both Saharan dust intrusions showed high levels for the respirable fraction.

Study of the exceptional meteorological conditions, trace gases and particulate matter measured during the 2017 forest fire in Doñana Natural Park, Spain.

In late June 2017, a forest fire occurred in Doñana Natural Park, which is located in southwestern Europe. Many animal and plant species, some of which are threatened, suffered from the impact of this fire, and important ecosystems in the European Union were seriously affected. This forest fire occurred under exceptional weather conditions. The meteorological situation was studied at both the synoptic scale and the local scale using meteorological fields in the ERA-Interim global model from ECMWF (European Centre for Medium Range Weather Forecasts), the WRF (Weather Research and Forecasting) mesoscale model and ground observations collected at El Arenosillo observatory. Anomalies were obtained using records (observations and simulations) over the last two decades (1996-2016). An anticyclonic system dominated the synoptic meteorological conditions, but a strong pressure gradient was present; positive high pressure anomalies and negative low pressure anomalies resulted in intense NW flows. At the surface, wind gusts of 80 km h-1, temperatures up to 35 °C and relative humidity values <20% were observed. In terms of anomalies, these observations corresponded to positive temperature anomalies (differences of 12 °C), positive wind speed anomalies (>29 km h-1) and negative relative humidity anomalies (differences of 40%). The forest fire reached El Arenosillo observatory approximately 8 h after it began. When the fire started, record-setting maximum values were measured for all gases monitored at this site (specifically, peaks of 99,995 µg m-3 for CO, 951 µg m-3 for O3, 478 µg m-3 for NO2, 116 µg m-3 for SO2 and 1000 µg m-3 for PM10). According to the temporal evolution patterns of these species, the atmosphere over a burnt area can recover to initial atmospheric levels between 48 and 96 h after an event. The impact of the Doñana plume was studied using hourly forward trajectories computed with the HYSPLIT (Hybrid Single-Particle Lagrangian Integrated Trajectory) model to analyse the emission source for the burnt area. The Doñana fire plume affected large metropolitan areas near the Mediterranean coast. Air quality stations located in the cities of Seville and Cadiz registered the arrival of the plume based on increases in CO and PM10. Using CO as a tracer, measurements from the AIRS and MOPITT instruments allowed us to observe the transport of the Doñana plume from the Strait of Gibraltar to the Mediterranean. Finally, after two days, the Doñana forest fire plume reached the western Mediterranean basin.

An anomalous African dust event and its impact on aerosol radiative forcing on the Southwest Atlantic coast of Europe in February 2016.

A desert dust (DD) event that had its origin in North Africa occurred on the 20th-23rd of February 2016. The dust transport phenomenon was exceptional because of its unusual intensity during the coldest season. A historical dataset (2006-2015) of February meteorological scenarios using ECMWF fields, meteorological parameters, aerosol optical properties, surface O3 and AOD retrieved from MODIS at the El Arenosillo observatory (southwestern Spain) were analysed and compared with the levels during the DD event to highlight its exceptionality. Associated with a low-pressure system in western North Africa, flows transported air from the Sahel to Algeria and consequently increased temperatures from the surface to 700hPa by up to 7-9°C relative to the last decade. These conditions favoured the formation of a Saharan air layer. Dust was transported to the north and reached the Western Mediterranean Basin and the Iberian Peninsula. The arrival of the DD event at El Arenosillo did not affect the surface weather conditions or ozone but did impact the aerosol radiative forcing at the top of atmosphere (RFTOA). Aerosol radiative properties did not change relative to historical; however, the particle size and the amount of the aerosol were significantly higher. The DD event caused an increase (in absolute terms) of the mean aerosol RFTOA to a value of -8.1Wm-2 (long-term climatological value ~-1.5Wm-2). The aerosol RFTOA was not very large relative other DD episodes; however, our analysis of the historical data concluded that the importance of this DD event lay in the month of occurrence. European phenological datasets related to extreme atmospheric events predominantly reflect changes that are probably associated with climate change. This work is an example of this phenomenon, showing an event that occurred in a hotspot, the Saharan desert, and its impact two thousand km away.

A long-term study of new particle formation in a coastal environment: meteorology, gas phase and solar radiation implications.

New particle formation (NPF) was investigated at a coastal background site in Southwest Spain over a four-year period using a Scanning Particle Mobility Sizer (SMPS). The goals of the study were to characterise the NPF and to investigate their relationship to meteorology, gas phase (O3, SO2, CO and NO2) and solar radiation (UVA, UVB and global). A methodology for identifying and classifying the NPF was implemented using the wind direction and modal concentrations as inputs. NPF events showed a frequency of 24% of the total days analysed. The mean duration was 9.2±4.2 h. Contrary to previous studies conducted in other locations, the NPF frequency reached its maximum during cold seasons for approximately 30% of the days. The lowest frequency took place in July with 10%, and the seasonal wind pattern was found to be the most important parameter influencing the NPF frequency. The mean formation rate was 2.2±1.7 cm(-3) s(-1), with a maximum in the spring and early autumn and a minimum during the summer and winter. The mean growth rate was 3.8±2.4 nm h(-1) with higher values occurring from spring to autumn. The mean and seasonal formation and growth rates are in agreement with previous observations from continental sites in the Northern Hemisphere. NPF classification of different classes was conducted to explore the effect of synoptic and regional-scale patterns on NPF and growth. The results show that under a breeze regime, the temperature indirectly affects NPF events. Higher temperatures increase the strength of the breeze recirculation, favouring gas accumulation and subsequent NPF appearance. Additionally, the role of high relative humidity in inhibiting the NPF was evinced during synoptic scenarios. The remaining meteorological variables (RH), trace gases (CO and NO), solar radiation, PM10 and condensation sink, showed a moderate or high connection with both formation and growth rates.

Utilidad de los marcadores tumorales como cribado de neoplasia oculta en enfermedad tromboembólica / Role of tumour markers for occult neoplasia screening in thromboembolic disease

Objetivo: Evaluar la eficacia de los marcadores tumorales (MT) dentro del cribado avanzado para la detección de neoplasia oculta, en pacientes que han presentado enfermedad tromboembólica (ETE). Material y métodos: Estudio retrospectivo entre enero 2007 y diciembre de 2008 diagnosticados de ETE en nuestro centro. Se evaluaron los siguientes marcadores tumorales: antígeno carcinoso 19.9 (Ca 19.9), antígeno carcinoso 125 (Ca 125), antígeno carcinoso 15.3 (Ca 15.3), antígeno carcinoma embrionario (CEA), alfafetoproteína(AFP) y antígeno específico de próstata (PSA), tomando una determinación dentro del mes siguiente del diagnóstico de ETE. Criterios de inclusión: TVP de MMSS o MMII, TEP diagnosticados por prueba de imagen, clínica aguda. Criterios de exclusión: neoplasia previa conocida, TVP no idiopática, imposibilidad de seguimiento. Resultados: El 63,4% eran hombres, el 36,6% mujeres, con edad media de 62,8 años. El análisis estadístico se hizo en función de 122 pacientes, de los 199 iniciales, con un seguimiento medio de 38 meses. Al finalizar el estudio no se encontraron diferencias significativas en cuanto a la incidencia posterior de neoplasia respecto a los pacientes con valores de MT positivos de los negativos (Ca 125: p=0,161; Ca 15.3: p=0,930; CEA: p=0,703; PSA: p=0,382; AFP: 100% pacientes con valores negativos). Exceptuando el Ca 19.9 (p<0,000). Conclusiones: Como conclusión a nuestro estudio, el uso de MT como cribado de cáncer oculto posterior a un evento trombótico, no ha permitido la detección de los pacientes que desarrollaron una neoplasia durante el seguimiento (AU)

Objective: To evaluate the use of the tumour markers (TM) as part the advanced screening of occult neoplasia, in patients with thromboembolic disease (TED). Material and methods: A retrospective study was conducted between January 2007 and December 2008 on patients diagnosed with TED in our centre. The sample included 63.4% males, and 36.6% females, with a mean age of 62.8 years. The following TM were evaluated in a blood sample taken within one month after the diagnosis of TED: cancer antigen 19.9 (Ca 19.9), cancer antigen 125 (Ca 125), cancer antigen 15.3 (Ca 15.3), embryonic carcinoma antigen (CEA), alpha fetoprotein (AFP), and prostate specific antigen (PSA). The inclusion criteria were, DVT of lower and upper limbs, TEP diagnosed by imaging technique, acute clinic signs. Exclusion criteria: previous known neoplasia, non-idiopathic DVT, impossibility of follow-up. Results: The statistical analysis was performed on the basis of 122 patients out of 199 initially included, with an average follow-up of 38 months. At the end of the study no significant differences were found as regards the subsequent finding of a neoplasia in patients with positive TM values compared with those with negative values (Ca 125: P=0.161; Ca 15.3: P=0.930; CEA: P=0.703; PSA: P=0.382; AFP: 100% patients with negative values). Exempting the Ca 19.9 (P<0.000). Conclusions: As a conclusion of our study, TM as extensive screening of early stages of cancer after TED, is not useful for detecting an occult neoplasia during follow-up (AU)

Radioactive impact of Fukushima accident on the Iberian Peninsula: evolution and plume previous pathway.

High activity concentrations of several man-made radionuclides (such as (131)I, (132)I, (132)Te, (134)Cs and (137)Cs) have been detected along the Iberian Peninsula from March 28th to April 7th 2011. The analysis of back-trajectories of air masses allowed us to demonstrate that the levels of manmade radionuclide activity concentrations in the southwest of the Iberian Peninsula come from the accident produced in the nuclear power plant of Fukushima. The pathway followed by the radioactive plume from Fukushima into Huelva (southwest of the Iberian Peninsula) was deduced through back-trajectories analysis, and this fact was also verified by the activity concentrations measured of those radionuclides reported in places crossed by this radioactive cloud. In fact, activity concentrations reported by E.P.A., and by IAEA, in several places of Japan, Pacific Ocean and United States of America are according to the expected ones from the air mass trajectory arriving at Huelva province.

Characterization of a long range transport pollution episode affecting PM in SW Spain.

A multidisciplinary study on aerosol characterization was performed at the regional background monitoring station of El Arenosillo, in SW Spain, between 28 June and 5 July 2006. The main aim of the Arenosillo aerosol measurement campaign 2006 was to compare the results of aerosol characterization obtained by different groups by measuring physical and chemical parameters using optical methods and in situ sampling. The campaign coincided with a long-range transport episode from Western Iberia, passing through the Gulf of Cadiz and the Straits of Gibraltar towards the study area. The results of the variability of PM levels and chemical composition of PM10, PM2.5 and PM1 at El Arenosillo and at three nearby regional and urban background sites were interpreted. Mean levels measured during the campaign reached 23, 15 and 12 microg m(-3) for PM10, PM2.5 and PM1, respectively, at El Arenosillo. PM during the Arenosillo campaign 2006 was dominated by the secondary inorganic aerosols (SIA, 24, 38 and 39% of PM10, PM2.5 and PM1 mass), carbonaceous aerosols (17, 21 and 23% of the mass), crustal material (13, 9 and 4%), and sea spray (10, 5 and 1%). These values are within the usual range of regional background sites of Southern Spain with the exception of the relatively low crustal load and the high SIA levels. Two major PM episodes were differentiated. The first one was characterized by high levels of Bi, As, Pb, Se, P and Zn, which are the main tracers of the industrial emissions near the town of Huelva. High concentrations of these elements were also recorded at the nearby sites. In the second episode, maximum levels of SO4(2-), V and coarse Cu as well as the bulk mass of PM1 were determined, tracing the polluted air mass transport from Western Iberia through the Straits of Gibraltar. These results underline the importance of the influence of long-range transport of pollutants on the levels and composition of regional background PM in SW Iberia, where local emissions may also play a role.