Laparoscopic Hartmann's reversal has better clinical outcomes compared to open surgery: An international multicenter cohort study involving 502 patients.

Background: Hartmann's procedure (HP) is used in surgical emergencies such as colonic perforation and colonic obstruction. "Temporary" colostomy performed during HP is not always reversed in part due to potential morbidity and mortality associated with reversal. There are several contributing factors for patients requiring a permanent colostomy following HP. Therefore, there is still some discussion about which technique to use. The aim of this study was to evaluate perioperative variables of patients undergoing Hartmann's reversal using a laparoscopic and open approach. Methods: The multicenter retrospective cohort study was done between January 2009 and December 2019 at 14 institutions globally. Patients who underwent Hartmann's reversal laparoscopic (LS) and open (OS) approaches were evaluated and compared. Sociodemographic, preoperative, intraoperative variables, and surgical outcomes were analyzed. The main outcomes evaluated were 30-day mortality, length of stay, complications, and postoperative outcomes. Results: Five hundred and two patients (264 in the LS and 238 in the OS group) were included. The most prevalent sex was male in 53.7%, the most common indication was complicated diverticular disease in 69.9%, and 85% were American Society of Anesthesiologist (ASA) II-III. Intraoperative complications were noted in 5.3% and 3.4% in the LS and OS groups, respectively. Small bowel injuries were the most common intraoperative injury in 8.3%, with a higher incidence in the OS group compared with the LS group (12.2% vs. 4.9%, p < 0.5). Inadvertent injuries were more common in the small bowel (3%) in the LS group. A total of 17.2% in the OS versus 13.3% in the LS group required intensive care unit (ICU) admission (p = 0.2). The most frequent postoperative complication was ileus (12.6% in OS vs. 9.8% in LS group, p = 0.4)). Reintervention was required mainly in the OS group (15.5% vs. 5.3% in LS group, p < 0.5); mortality rate was 1%. Conclusions: Laparoscopic Hartmann's reversal is safe and feasible, associated with superior clinical outcomes compared with open surgery.

Simultaneous cross-evaluation of heterogeneous E. coli datasets via mechanistic simulation.

The extensive heterogeneity of biological data poses challenges to analysis and interpretation. Construction of a large-scale mechanistic model of Escherichia coli enabled us to integrate and cross-evaluate a massive, heterogeneous dataset based on measurements reported by various groups over decades. We identified inconsistencies with functional consequences across the data, including that the total output of the ribosomes and RNA polymerases described by data are not sufficient for a cell to reproduce measured doubling times, that measured metabolic parameters are neither fully compatible with each other nor with overall growth, and that essential proteins are absent during the cell cycle-and the cell is robust to this absence. Finally, considering these data as a whole leads to successful predictions of new experimental outcomes, in this case protein half-lives.

Modulation of Intracellular O2 Concentration in Escherichia coli Strains Using Oxygen Consuming Devices.

The use of cell factories for the production of bulk and value-added compounds is nowadays an advantageous alternative to the traditional petrochemical methods. Nevertheless, the efficiency and productivity of several of these processes can improve with the implementation of micro-oxic or anoxic conditions. In the industrial setting, laccases are appealing catalysts that can oxidize a wide range of substrates and reduce O2 to H2O. In this work, several laccase-based devices were designed and constructed to modulate the intracellular oxygen concentration in bacterial chassis. These oxygen consuming devices (OCDs) included Escherichia coli's native laccase (CueO) and three variants of this protein obtained by directed evolution. The OCDs were initially characterized in vitro using E. coli DH5α protein extracts and subsequently using extracts obtained from other E. coli strains and in vivo. Upon induction of the OCDs, no major effect on growth was observed in four of the strains tested, and analysis of the cell extract protein profiles revealed increased levels of laccase. Moreover, oxygen consumption associated with the OCDs occurred under all of the conditions tested, but the performance of the devices was shown to be strain-dependent, highlighting the importance of the genetic background even in closely related strains. One of the laccase variants showed 13- and 5-fold increases in oxidase activity and O2 consumption rate, respectively. Furthermore, it was also possible to demonstrate O2 consumption in vivo using l-DOPA as the substrate, which represents a proof of concept that these OCDs generate an intracellular oxygen sink, thereby manipulating the redox status of the cells. In addition, the modularity and orthogonality principles used for the development of these devices allow easy reassembly and fine-tuning, foreseeing their introduction into other chassis/systems.

Síndrome confusional en paciente octogenaria con implante reciente de marcapasos / Confusional state in an octogenarian patient with a recent implantation of pacemaker

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Ortogeriatría: primer registro multicéntrico autonómico de fracturas de cadera en Castilla y León (España) / Orthogeriatrics: The First multicentre regional register of hip fractures in Castilla y León (Spain)

Objetivo: El objetivo de este trabajo es describir las características de los pacientes con fractura de cadera en los hospitales públicos de Castilla y León recogidos durante un periodo de tiempo de 3 meses (noviembre del 2014 y octubre y noviembre del 2015). Material y método: El grupo de trabajo de Ortogeriatría de Castilla y León elabora un registro común para recoger datos de las fracturas de cadera. Se incluyen mayores de 74 años ingresados por fractura de cadera, en 13 hospitales públicos de la comunidad, los meses de noviembre del 2014 y octubre-noviembre del 2015. Es un estudio multicéntrico, prospectivo y observacional en el que se recogieron variables clínicas, funcionales, sociales y mortalidad intrahospitalaria. Resultados: Se analizaron 776 pacientes, con una edad media de 86,6±6 años. La demora quirúrgica fue de 4±2,8 días y la estancia media hospitalaria de 10±4,7 días. El riesgo anestésico fue ASA 3±0,6. El 66,5% de los pacientes tuvieron complicaciones médicas intrahospitalarias y precisaron transfusión el 55,5%. Fallecieron durante la hospitalización un 4,6%. La estancia media prequirúrgica se relacionó con la estancia global, con p<0,001. Conclusiones: Los registros de fractura de cadera son una herramienta esencial para evaluar el proceso y mejorar la calidad asistencial de estos pacientes. Este es el primer registro multicéntrico de fracturas de cadera en ancianos realizado en una región de España y puede ser un buen precedente de referencia ante el futuro registro nacional (AU)

Objective: The objective of this study is to describe the characteristics of the patients with hip fracture admitted to the Public Hospitals of Castilla y León during three monthly periods (November 2014, and October and November 2015). Material and method: The Castilla y León orthogeriatrics work group created a common register to collect data on hip fractures. The study included patients 75 years-old and over hospitalised with hip fractures in the 13 public hospitals in the community during November 2014, and October and November 2015. A multicentre, prospective, and observational study was conducted, in which clinical, functional, and social variables, as well as in-hospital mortality, were collected. Results: The analysis included data from a total of 776 patients with a mean age of 86 (±6) years. The surgical delay was 4±2.8 days, and the mean hospital stay was 10±4.7 days. The anaesthesia risk was ASA 3±0.6. Around two-thirds (66.5%) of the patients had medical complications while in hospital, and 55.5% required a transfusion. In-hospital mortality was 4.6%. The mean pre-surgical stay was related to the overall stay: P<.001. Conclusions: Hip fracture registers are an essential tool for evaluating the process and for improving the treatment quality of these patients. This is the first multicentre register of hip fracture in the elderly created in a Spanish region, and could be a good precedent reference for a future national register (AU)

[Orthogeriatrics: The First multicentre regional register of hip fractures in Castilla y León (Spain)]. / Ortogeriatría: primer registro multicéntrico autonómico de fracturas de cadera en Castilla y León (España).

OBJECTIVE: The objective of this study is to describe the characteristics of the patients with hip fracture admitted to the Public Hospitals of Castilla y León during three monthly periods (November 2014, and October and November 2015). MATERIAL AND METHOD: The Castilla y León orthogeriatrics work group created a common register to collect data on hip fractures. The study included patients 75 years-old and over hospitalised with hip fractures in the 13 public hospitals in the community during November 2014, and October and November 2015. A multicentre, prospective, and observational study was conducted, in which clinical, functional, and social variables, as well as in-hospital mortality, were collected. RESULTS: The analysis included data from a total of 776 patients with a mean age of 86 (±6) years. The surgical delay was 4±2.8 days, and the mean hospital stay was 10±4.7 days. The anaesthesia risk was ASA 3±0.6. Around two-thirds (66.5%) of the patients had medical complications while in hospital, and 55.5% required a transfusion. In-hospital mortality was 4.6%. The mean pre-surgical stay was related to the overall stay: P<.001. CONCLUSIONS: Hip fracture registers are an essential tool for evaluating the process and for improving the treatment quality of these patients. This is the first multicentre register of hip fracture in the elderly created in a Spanish region, and could be a good precedent reference for a future national register.

El glaucoma maligno / Malignant glaucoma

El glaucoma maligno es una forma rara de glaucoma, que suele seguir a la cirugía en pacientes con ángulo cerrado y glaucoma primario de ángulo cerrado. En esta revisión bibliográfica se discuten las características clínicas, la clasificación, la patogenia y el manejo de esta afección. La revisión bibliográfica la efectuamos a partir de una búsqueda en Medline (los principales artículos de PubMed y en Internet) y bases Cochrane (The Cochrane Library). Las imágenes aportadas son propias y las hemos efectuado con tomografía de coherencia óptica SS-1000 de segmento anterior CASIA de Tomey ®. El objetivo de la revisión es revisar las evidencias sobre una afección rara y actualizar los protocolos diagnósticos y terapéuticos con las nuevas técnicas a nuestro alcance. Consideramos que el nombre de glaucoma maligno para esta patología debería evitarse, ya que actualmente con los medios disponibles el pronóstico es relativamente bueno. Es por esto, que preferimos nombres como el síndrome de misdirección del humor acuoso, o glaucoma por bloqueo ciliar(AU)

Malignant glaucoma is a rare form of glaucoma that typically follows surgery in patients with primary angle closure and primary angle-closure glaucoma. In this bibliographic review we discuss the clinical characteristics, classification, pathogenesis, and management. The literature review is based on a search in Medline (the main articles of PubMed, Internet) and Cochrane databases (The Cochrane Library). The images provided we have done them with SS-1000 Optical Coherence Tomography CASIA of Tomey ®. The aim of the review is to review the evidence for a rare condition and update the diagnostic and therapeutic protocols with the new techniques. In addition, the review authors thought that the name of malignant glaucoma for this pathology should be avoided, because of prognosis is relatively good. This is the reason, we prefer names such as misdirected aqueous humor syndrome, or ciliary blockage glaucoma(AU)

El glaucoma maligno / Malignant glaucoma

El glaucoma maligno es una forma rara de glaucoma, que suele seguir a la cirugía en pacientes con ángulo cerrado y glaucoma primario de ángulo cerrado. En esta revisión bibliográfica se discuten las características clínicas, la clasificación, la patogenia y el manejo de esta afección. La revisión bibliográfica la efectuamos a partir de una búsqueda en Medline (los principales artículos de PubMed y en Internet) y bases Cochrane (The Cochrane Library). Las imágenes aportadas son propias y las hemos efectuado con tomografía de coherencia óptica SS-1000 de segmento anterior CASIA de Tomey ®. El objetivo de la revisión es revisar las evidencias sobre una afección rara y actualizar los protocolos diagnósticos y terapéuticos con las nuevas técnicas a nuestro alcance. Consideramos que el nombre de glaucoma maligno para esta patología debería evitarse, ya que actualmente con los medios disponibles el pronóstico es relativamente bueno. Es por esto, que preferimos nombres como el síndrome de misdirección del humor acuoso, o glaucoma por bloqueo ciliar(AU)

Malignant glaucoma is a rare form of glaucoma that typically follows surgery in patients with primary angle closure and primary angle-closure glaucoma. In this bibliographic review we discuss the clinical characteristics, classification, pathogenesis, and management. The literature review is based on a search in Medline (the main articles of PubMed, Internet) and Cochrane databases (The Cochrane Library). The images provided we have done them with SS-1000 Optical Coherence Tomography CASIA of Tomey ®. The aim of the review is to review the evidence for a rare condition and update the diagnostic and therapeutic protocols with the new techniques. In addition, the review authors thought that the name of malignant glaucoma for this pathology should be avoided, because of prognosis is relatively good. This is the reason, we prefer names such as misdirected aqueous humor syndrome, or ciliary blockage glaucoma(AU)

Why Build Whole-Cell Models?

Our ability to build computational models that account for all known gene functions in a cell has increased dramatically. But why build whole-cell models, and how can they best be used? In this forum, we enumerate several areas in which whole-cell modeling can significantly impact research and technology.

An integrative, multi-scale, genome-wide model reveals the phenotypic landscape of Escherichia coli.

Given the vast behavioral repertoire and biological complexity of even the simplest organisms, accurately predicting phenotypes in novel environments and unveiling their biological organization is a challenging endeavor. Here, we present an integrative modeling methodology that unifies under a common framework the various biological processes and their interactions across multiple layers. We trained this methodology on an extensive normalized compendium for the gram-negative bacterium Escherichia coli, which incorporates gene expression data for genetic and environmental perturbations, transcriptional regulation, signal transduction, and metabolic pathways, as well as growth measurements. Comparison with measured growth and high-throughput data demonstrates the enhanced ability of the integrative model to predict phenotypic outcomes in various environmental and genetic conditions, even in cases where their underlying functions are under-represented in the training set. This work paves the way toward integrative techniques that extract knowledge from a variety of biological data to achieve more than the sum of their parts in the context of prediction, analysis, and redesign of biological systems.

Actividad ortogeriátrica en los hospitales públicos de Castilla y León: descripción y revisión de la literatura / Orthogeriatric activity in public hospitals of Castilla y León: Description and review of the literature

El beneficio de la colaboración entre traumatología y geriatría en la atención del anciano que ingresa por fractura de cadera está ampliamente demostrado. Para conocer las características de colaboración entre Traumatología y Geriatría en los hospitales públicos de Castilla y León se realizó una encuesta a todos los geriatras de la comunidad, interrogándoles sobre el tipo de colaboración que mantenían con Traumatología para la atención del anciano que ingresa con fractura de cadera y detalles sobre el tratamiento de las complicaciones. Los resultados más relevantes fueron que la mayoría de los hospitales mantienen una colaboración ortogeriátrica con alto grado de implicación por parte de Geriatría y el geriatra atiende las complicaciones médicas de estos pacientes. La estancia media hospitalaria es de 10 d y la estancia prequirúrgica de 3 d. En este artículo se detallan cómo se manejan los problemas clínicos más frecuentes en nuestra comunidad, comparándolo con las recomendaciones actuales de las guías de práctica clínica y de las últimas publicaciones (AU)

The benefits of the collaboration between orthopaedics and geriatrics in the management and care of elderly patients admitted with hip fracture have been widely demonstrated. A questionnaire was sent to all hospital geriatricians of Castilla y León in order to determine the characteristics this collaboration between orthopaedics and geriatrics in the public hospitals of Castilla y León. They were asked about the type of collaboration with orthopaedics in the care of the elderly patient admitted with hip fracture and details of the treatment of the complications. Most of the hospitals maintain a high level of orthogeriatric collaboration with geriatricians, and the geriatrician attends to most of the medical complications of these patients. The average hospital stay is 10 days, with a surgical delay of 3 days. Management of the most frequent clinical problems in hospitals of Castilla y León are detailed in this article, comparing them with the latest articles and current recommendations from clinical practice guides (AU)

[Orthogeriatric activity in public hospitals of Castilla y León: description and review of the literature]. / Actividad ortogeriátrica en los hospitales públicos de Castilla y León: descripción y revisión de la literatura.

The benefits of the collaboration between orthopaedics and geriatrics in the management and care of elderly patients admitted with hip fracture have been widely demonstrated. A questionnaire was sent to all hospital geriatricians of Castilla y León in order to determine the characteristics this collaboration between orthopaedics and geriatrics in the public hospitals of Castilla y León. They were asked about the type of collaboration with orthopaedics in the care of the elderly patient admitted with hip fracture and details of the treatment of the complications. Most of the hospitals maintain a high level of orthogeriatric collaboration with geriatricians, and the geriatrician attends to most of the medical complications of these patients. The average hospital stay is 10 days, with a surgical delay of 3 days. Management of the most frequent clinical problems in hospitals of Castilla y León are detailed in this article, comparing them with the latest articles and current recommendations from clinical practice guides.

Automated design of bacterial genome sequences.

BACKGROUND: Organisms have evolved ways of regulating transcription to better adapt to varying environments. Could the current functional genomics data and models support the possibility of engineering a genome with completely rearranged gene organization while the cell maintains its behavior under environmental challenges? How would we proceed to design a full nucleotide sequence for such genomes? RESULTS: As a first step towards answering such questions, recent work showed that it is possible to design alternative transcriptomic models showing the same behavior under environmental variations than the wild-type model. A second step would require providing evidence that it is possible to provide a nucleotide sequence for a genome encoding such transcriptional model. We used computational design techniques to design a rewired global transcriptional regulation of Escherichia coli, yet showing a similar transcriptomic response than the wild-type. Afterwards, we "compiled" the transcriptional networks into nucleotide sequences to obtain the final genome sequence. Our computational evolution procedure ensures that we can maintain the genotype-phenotype mapping during the rewiring of the regulatory network. We found that it is theoretically possible to reorganize E. coli genome into 86% fewer regulated operons. Such refactored genomes are constituted by operons that contain sets of genes sharing around the 60% of their biological functions and, if evolved under highly variable environmental conditions, have regulatory networks, which turn out to respond more than 20% faster to multiple external perturbations. CONCLUSIONS: This work provides the first algorithm for producing a genome sequence encoding a rewired transcriptional regulation with wild-type behavior under alternative environments.

Computational design of host transcription-factors sets whose misregulation mimics the transcriptomic effect of viral infections.

The molecular mechanisms underlying viral pathogenesis are yet poorly understood owed to the large number of factors involved and the complexity of their interactions. Could we identify a minimal set of host transcription factors (TF) whose misregulation would result in the transcriptional profile characteristic of infected cells in absence of the virus? How many of such sets exist? Are all orthogonal or share critical TFs involved in specific biological functions? We have developed a computational methodology that uses a quantitative model of the transcriptional regulatory network (TRN) of Arabidopsis thaliana to explore the landscape of all possible re-engineered TRNs whose transcriptomic profiles mimic those observed in infected plants. We found core sets containing between six and 34 TFs, depending on the virus, whose in silico knockout or overexpression in the TRN resulted in transcriptional profiles that minimally deviate from those observed in infected plants.

Computational design of genomic transcriptional networks with adaptation to varying environments.

Transcriptional profiling has been widely used as a tool for unveiling the coregulations of genes in response to genetic and environmental perturbations. These coregulations have been used, in a few instances, to infer global transcriptional regulatory models. Here, using the large amount of transcriptomic information available for the bacterium Escherichia coli, we seek to understand the design principles determining the regulation of its transcriptome. Combining transcriptomic and signaling data, we develop an evolutionary computational procedure that allows obtaining alternative genomic transcriptional regulatory network (GTRN) that still maintains its adaptability to dynamic environments. We apply our methodology to an E. coli GTRN and show that it could be rewired to simpler transcriptional regulatory structures. These rewired GTRNs still maintain the global physiological response to fluctuating environments. Rewired GTRNs contain 73% fewer regulated operons. Genes with similar functions and coordinated patterns of expression across environments are clustered into longer regulated operons. These synthetic GTRNs are more sensitive and show a more robust response to challenging environments. This result illustrates that the natural configuration of E. coli GTRN does not necessarily result from selection for robustness to environmental perturbations, but that evolutionary contingencies may have been important as well. We also discuss the limitations of our methodology in the context of the demand theory. Our procedure will be useful as a novel way to analyze global transcription regulation networks and in synthetic biology for the de novo design of genomes.

A meta-analysis reveals the commonalities and differences in Arabidopsis thaliana response to different viral pathogens.

Understanding the mechanisms by which plants trigger host defenses in response to viruses has been a challenging problem owing to the multiplicity of factors and complexity of interactions involved. The advent of genomic techniques, however, has opened the possibility to grasp a global picture of the interaction. Here, we used Arabidopsis thaliana to identify and compare genes that are differentially regulated upon infection with seven distinct (+)ssRNA and one ssDNA plant viruses. In the first approach, we established lists of genes differentially affected by each virus and compared their involvement in biological functions and metabolic processes. We found that phylogenetically related viruses significantly alter the expression of similar genes and that viruses naturally infecting Brassicaceae display a greater overlap in the plant response. In the second approach, virus-regulated genes were contextualized using models of transcriptional and protein-protein interaction networks of A. thaliana. Our results confirm that host cells undergo significant reprogramming of their transcriptome during infection, which is possibly a central requirement for the mounting of host defenses. We uncovered a general mode of action in which perturbations preferentially affect genes that are highly connected, central and organized in modules.