Combined Charlson comorbidity/C-Reactive Protein Index Is a Novel Predictor in Renal Cell Carcinoma: Analysis of the International Marker Consortium for Renal Cancer (INMARC) Registry.

OBJECTIVE: To evaluate predictive ability of a novel combined index, Charlson comorbidity index and C-reactive protein (CCI-CRP), for outcomes in renal cell carcinoma (RCC), and compare predictive outcomes with of CCI-CRP to its separate components and to the UCLA integrated staging system (UISS). PATIENTS AND METHODS: We retrospectively analyzed INMARC registry of RCC patients. Receiver Operator Characteristics (ROC) analysis was fitted to identify threshold defining low-CRP (LCRP) and high-CRP (HCRP). Patients were stratified according to CCI [low-CCI ≤ 3 (LCCI); intermediate-CCI 4-6 (ICCI); high-CCI > 6 (HCCI)] and CRP level. Kaplan-Meier analysis (KMA) was conducted for overall (OS) and cancer-specific survival (CSS). Based on survival analysis distribution we proposed a new stratification: CCI-CRP. Model performance was assessed with ROC/area under the curve (AUC) analysis and compared to CCI and CRP alone, and UISS. RESULTS: We analyzed 2,890 patients (median follow-up 30 months). ROC identified maximum product sensitivity and specificity for CRP at 3.5 mg/L. KMA revealed 5-year OS of 95.6% for LCRP/LCCI, 83% LCRP/ICCI, 73.3% LCRP/HCCI, 62.6% HCRP/LCCI, 51.6% HCRP/ICCI and 40.5% HCRP/HCCI (P < .001). From this distribution, new CCI-CRP is proposed: low CCI-CRP (LCRP/LCCI and LCRP/ICCI), intermediate CCI-CRP (LCRP/HCCI and HCRP/LCCI), and high CCI-CRP (HCRP/ICCI and HCRP/HCCI). AUC for CCI-CRP showed improved performance for predicting OS/CSS vs. CCI alone (0.73 vs. 0.63/0.77 vs. 0.60), CRP alone (0.73 vs. 0.71/0.77 vs. 0.74) and UISS (0.73 vs 0.67/0.77 vs 0.73). CONCLUSIONS: CCI-CRP, exhibits increased prognostic performance for survival outcomes in RCC compared to CCI and CRP alone, and UISS. Further investigation is requisite.

Evaluation of potency and metabolic stability of diphyllin-derived Vacuolar-ATPase inhibitors.

Diphyllin is a naturally occurring lignan comprised of an aryl naphthalene lactone scaffold that demonstrates beneficial biological activities in disease models of cancer, obesity, and viral infection. A target of diphyllin and naturally occurring derivatives is the vacuolar ATPase (V-ATPase) complex. Although diphyllin-related natural products are active with in vitro models for viral entry, the potencies and unknown pharmacokinetic properties limit well-designed in vivo evaluations. Previous studies demonstrated that diphyllin derivatives have the utility of blocking the Ebola virus cell entry pathway. However, diphyllin shows limited potency and poor oral bioavailability in mice. An avenue to improve the potency was used in a new library of synthetic derivatives of diphyllin. Diphyllin derivatives exploiting ether linkages at the 4-position with one-to-three carbon spacers to an oxygen or nitrogen atom provided compounds with EC50 values ranging from 7 to 600 nM potency and selectivity up to >500 against Ebola virus in infection assays. These relative potencies are reflected in the Ebola virus infection of primary macrophages, a cell type involved in early pathogenesis. A target engagement study reveals that reducing the ATPV0a2 protein expression enhanced the potency of diphyllin derivatives to block EBOV entry, consistent with effects on the endosomal V-ATPase function. Despite the substantial enhancement of antiviral potencies, limitations were identified, including rapid clearance predicted by in vitro microsome stability assays. However, compounds with similar or improved half-lives relative to diphyllin demonstrated improved pharmacokinetic profiles in vivo. Importantly, these derivatives displayed suitable plasma levels using oral administration, establishing the feasibility of in vivo antiviral testing.

Association of Elevated C-Reactive Protein with Worsened Outcomes in Different Histologies of Renal Cortical Tumors: Analysis of the INMARC Registry.

BACKGROUND: To evaluate relationship between histological subtypes of renal cell carcinoma (RCC) and preoperative c-reactive protein (CRP). PATIENTS AND METHODS: We queried the International Marker Consortium for Renal Cancer database for patients affected by RCC. Patients were classified according to their histology: benign tumors, clear cell (cc) RCC, chromophobe (ch) RCC, papillary (p) RCC, and variant histology (vh) RCC; and according to CRP (mg/L): low CRP ≤5 and high CRP >5. Primary outcome was all-cause mortality (ACM). Secondary outcomes were cancer-specific mortality (CSM), recurrence and association between CRP and histology. Multivariable analysis (MVA) via Cox regression and multivariable logistic regression were fitted to elucidate predictors of outcomes. RESULTS: Total 3902 patients (high CRP n = 1266) were analyzed; median follow up 51 (IQR 20-91) months. On MVA elevated CRP was an independent risk factor associated with increased risk of ACM in benign tumors (HR 5.98, P < .001), ccRCC (HR 2.69, P < .001), chRCC (HR 3.99, P < .001), pRCC (HR 1.76, P = .009) and vhRCC (HR 2.97, P =.007). MVA for CSM showed CRP as risk factor in ccRCC (HR 2.77, P < .001), chRCC (HR 6.16, P = .003) and pRCC (HR 2.29, P = .011), while in vhRCC was not (P = .27). MVA for recurrence reported CRP as risk factor for ccRCC (HR 1.30, P = .013), while in chRCC (P = .33), pRCC (P = .34) and vhRCC (P = .52) was not. On multivariable logistic regression CRP was a predictor of pRCC (OR 1.003, P = .002), while decreasing CRP was associated with benign tumors (OR 0.994, P = .048). CONCLUSION: Elevated CRP was a robust predictor of worsened ACM in all renal cortical neoplasms. While most frequently observed in pRCC patients, elevated CRP was independently associated with worsened CSM in non-vhRCC. Conversely, elevated CRP was least likely to be noted in benign tumors, and elevation in this subgroup of patients should prompt further consideration for surveillance given increased risk of ACM. Further investigation is requisite.

Effect of periprocedural furosemide-induced diuresis with matched isotonic intravenous hydration in patients with chronic kidney disease undergoing transcatheter aortic valve implantation.

BACKGROUND: Acute kidney injury (AKI) after transcatheter aortic valve implantation (TAVI) is a serious complication which is associated with increased mortality. The RenalGuard system was developed to reduce the risk of AKI after contrast media exposition by furosemide-induced diuresis with matched isotonic intravenous hydration. The aim of this study was to examine the effect of the RenalGuard system on the occurrence of AKI after TAVI in patients with chronic kidney disease. METHODS: The present study is a single-center randomized trial including patients with severe aortic valve stenosis undergoing TAVI. Overall, a total of 100 patients treated by TAVI between January 2017 and August 2018 were randomly assigned to a periprocedural treatment with the RenalGuard system or standard treatment by pre- and postprocedural intravenous hydration. Primary endpoint was the occurrence of AKI after TAVI, and secondary endpoints were assessed according to valve academic research consortium 2 criteria. RESULTS: Overall, the prevalence of AKI was 18.4% (n = 18). The majority of these patients developed mild AKI according to stage 1. Comparing RenalGuard to standard therapy, no significant differences were observed in the occurrence of AKI (RenalGuard: 21.3%; control group: 15.7%; p = 0.651). In addition, there were no differences between the groups with regard to 30-day and 12-month mortality and procedure-associated complication rates. CONCLUSION: In this randomized trial, we did not detect a reduction in AKI after TAVI by using the RenalGuard system. A substantial number of patients with chronic kidney disease developed AKI after TAVI, whereas the majority presented with mild AKI according to stage 1 (ClinicalTrials.gov number NCT04537325).

Organizing pneumonia due to anti-synthetase syndrome: Presentation of a clinical case

Introduction: Organizing pneumonia is a rare clinico-pathological syndrome. This crypto-genic or secondary condition is of unknown origin, and may be infectious, or associated with autoimmune diseases, cancer, drugs, or radiation. Case description: The case is presented of a 52-year-old patient who was diagnosed with organizing pneumonia secondary to anti-synthetase syndrome. Discussion: It is intended to make known that not all pulmonary consolidative clinical pictures correspond to infectious processes. In this case, an organizing pneumonia secondary to anti-synthetase syndrome is documented. Despite being a disorder that is classified as an idiopathic inflammatory myopathy, it manifests as an interstitial lung disease with predominantly respiratory symptoms.

Introducción: La neumonía organizativa es un síndrome clínico-patológico poco frecuente, dentro del cual se desconoce la etiología de la denominada neumonía criptogénica o secundaria, que puede ser infecciosa o asociada con enfermedades autoinmunes, cáncer, fármacos o radiación. Descripción del caso: Se presenta el caso de una paciente de 52 arios a quien se le diagnostica neumonía organizativa secundaria a síndrome antisintetasa. Discusión: Se busca dar a conocer que no todos los cuadros clínicos de consolidación pulmonar corresponden a procesos infecciosos. En este caso se documentó una neumonía organizativa secundaria a síndrome antisintetasa, la cual a pesar de ser una patología que se cataloga como una miopatía inflamatoria idiopática, se manifestó como una enfermedad pulmonar intersticial con síntomas predominantemente respiratorios.

A Catastrophic Complication of Thoracic Endovascular Aortic Repair: Aortoesophageal Fistula.

A 62-year-old man was admitted to the hospital due to sepsis secondary to a hemodialysis catheter-related infection that, upon diagnostic evaluation, demonstrated to be caused by P. aeruginosa and was treated with meropenem. Eradication of the infectious episode was confirmed by blood workup, including cultures. One month after the initial episode, the patient was readmitted due to a symptomatic penetrating aortic ulcer, which was classified as a cardiovascular emergency. The patient underwent an aortic stent-graft placement. Four weeks later, he presented to the emergency department with a 2-hour onset of thoracic pain and massive hematemesis. The esophagus and aortic segment with aortic stent graft were resected en bloc after an aortoesophageal fistula was diagnosed.

What is the mission of innovation?-Lexical structure, sentiment analysis, and cosine similarity of mission statements of research-knowledge intensive institutions.

Mission statements (henceforth: missions) are strategic planning communication tools used by all types of organizations worldwide. Missions communicate an organization's purpose, values, standards, and strategy. Research on missions has been prolific over the past 30 years, nevertheless several empirical gaps remain, such as single sector or country studies and restricted mission samples. In this article, we identify similarities and differences in the content of missions from government, private, higher education, and health research-knowledge intensive institutions in a sample of 1,900+ institutions from 89 countries through the deployment of sentiment analysis, readability, and lexical diversity; semantic networks; and a similarity computation between document corpus. We found that missions of research-knowledge intensive institutions are challenging to read texts with lower lexical diversity that favors positive rather than negative words. In stark contrast to this, the non-profit sector is consonant in multiple dimensions in its use of Corporate Social Responsibility jargon. The lexical appearance of 'research' in the missions varies according to mission sectorial context, and each sector has a cluster-specific focus. Utilizing the mission as a strategic planning tool in higher-income regions might serve to explain corpora similarities shared by sectors and continents. Furthermore, our open-access dataset on missions worldwide can be used as a source for further replication, triangulation, or crowdsourcing-data studies. Also, practitioners could use our open-access dataset and insights to facilitate strategic planning activities in organizations from multiple sectors.

Winners and runners-up alike?-a comparison between awardees and special mention recipients of the most reputable science award in Colombia via a composite citation indicator.

The research agenda on global academic elites (e.g., those awarded the Nobel Prize) has overlooked academic awards and elites from developing countries and the public symbolic recognition of scientific elites by research awards. In this study, we examine the bibliometric features of individual researcher profiles of those participants who received a special mention in Colombia's most prestigious prize in the sciences: the Alejandro Ángel Escobar Prize (AAEP). First, we chart the citation per article trend of Colombia's most prolific researchers before and after receiving the special mention and the AAEP. We then compare the special mention group with those awarded the AAEP, using a composite citation indicator of six scientific impact and productivity indices to estimate (1) bulk impact (number of citations and h index) and (2) authorship order adjusted impact (Schreiber hm index; total citations for articles of which the scientist is the single author; total citations for articles of which the scientist is the single or first author; and total citations for articles of which the scientist is the single, first, or last author). Results show that there is no overall halo effect in citation per article after receiving the special mention or the AAEP. Such recognition comes after an academically productive career marked by multiple citations per article peaks. There is no clear-cut division between the composite citation indicator of those awarded a special mention and those awarded the AAEP. Findings place the profile of local authors in an adjusted and inclusive framework that takes full cognisance of the scientific elites in developing countries.

The Colombian scientific elite-Science mapping and a comparison with Nobel Prize laureates using a composite citation indicator.

A well-established agenda on the research output, impact, and structure of global scientific elites such as Nobel Prize laureates has generated interest in the scientific elites from developing countries. However, this topic has not been investigated in detail. This study, first, deploys science mapping techniques to provide a comprehensive analysis of the output, impact, and structure of the Colombian scientific elite, i.e., researchers awarded with the Alejandro Ángel Escobar Foundation National Prize 1990-2020, known locally as the Colombian Nobel. Second, we conducted a productivity and impact comparison between the Colombian scientific elite and Nobel Prize laureates in science and economics by means of a stratified random sample 1990-2020 via the composite citation indicator proposed by Ioannidis et al. Findings showed that the Colombian scientific elite has a broader agenda than indexing titles in internationally renowned bibliographic databases. The Colombian scientific elite also showed positive growth, which is an inverse trend compared with the sample of Nobel laureate productivity. There were no noticeable changes in productivity/impact before and after receiving the Alejandro Ángel Escobar Foundation National Prize. Institutional collaboration within the Colombian scientific elite displayed the highest betweenness (brokerage) role of world/local top-tier universities. However, only two Colombian scientific elite members published an article with two Nobel Prize laureates. Most of the research profiles reflected the national output priorities, but were found to diverge from the national focus in respect of strategic research capacities. The interleaving of the Colombian scientific elite and Nobel Prize laureates-particularly between the 3rd and 2nd quartiles-enabled a more nuanced analysis of the local impact in the global scientific landscape. Our findings also contrast with previous findings on the lower research impact of authors from Latin America, despite their involvement as contributors to reputable journals, and also shed light on the research performance-impact standards and agenda between the global North and South and provide an in-context assessment of outstanding local research.

Industry 4.0 Technologies Applied to Inland Waterway Transport: Systematic Literature Review.

The focus of this article is inland waterway transport. Different problems in this domain have been studied due to the increase in waterway traffic globally. Industry 4.0 technologies have become an alternative for the possible solution of these problems. For this reason, this paper aims to answer the following research questions: (1) What are the main problems in transporting cargo by inland waterway? (2) What technological strategies are being studied to solve these problems? (3) What technologies from Industry 4.0 are used within the technological strategies to solve the exposed problems? This study adopts a Systematic Literature Review (SLR) approach. For this work, were recovered 645 articles, 88 of which were eligible, from which we could identify five domains corresponding to (1) traffic monitoring, (2) smart navigation, (3) emission reduction, (4) analytics with big data, and (5) cybersecurity. The strategies currently being considered combine navigation technologies, such as AIS (Automatic Identification System), which offers a large amount of data, with Industry 4.0 tools and mainly machine learning techniques, to take advantage of data collected over a long time. This study is, to our knowledge, one of the first to show how Industry 4.0 technologies are currently being used to tackle inland waterway transport problems and current application trends in the scientific community, which is a first step for the development of future studies and more advanced solutions.

Industry 4.0 Technologies Applied to the Rail Transportation Industry: A Systematic Review.

BACKGROUND: Industry 4.0 technologies have been widely used in the railway industry, focusing mainly on maintenance and control tasks necessary in the railway infrastructure. Given the great potential that these technologies offer, the scientific community has come to use them in varied ways to solve a wide range of problems such as train failures, train station security, rail system control and communication in hard-to-reach areas, among others. For this reason, this paper aims to answer the following research questions: what are the main issues in the railway transport industry, what are the technologic strategies that are currently being used to solve these issues and what are the technologies from industry 4.0 that are used in the railway transport industry to solve the aforementioned issues? METHODS: This study adopts a systematic literature review approach. We searched the Science Direct and Web of Science database inception from January 2017 to November 2021. Studies published in conferences or journals written in English or Spanish were included for initial process evaluation. The initial included papers were analyzed by authors and selected based on whether they helped answer the proposed research questions or not. RESULTS: Of the recovered 515 articles, 109 were eligible, from which we could identify three main application domains in the railway industry: monitoring, decision and planification techniques, and communication and security. Regarding industry 4.0 technologies, we identified 9 different technologies applied in reviewed studies: Artificial Intelligence (AI), Internet of Things (IoT), Cloud Computing, Big Data, Cybersecurity, Modelling and Simulation, Smart Decision Support Systems (SDSS), Computer Vision and Virtual Reality (VR). This study is, to our knowledge, one of the first to show how industry 4.0 technologies are currently being used to tackle railway industry problems and current application trends in the scientific community, which is highly useful for the development of future studies and more advanced solutions. FUNDING: Colombian national organizations Minciencias and the Mining-Energy Planning Unit.

Innovation for sustainability in the Global South: bibliometric findings from management & business and STEM (science, technology, engineering and mathematics) fields in developing countries.

Research on innovation and sustainability is prolific but fragmented. This study integrates the research on innovation in management and business and STEM fields for sustainability in a unified framework for the case of developing countries (i.e., the Global South). It presents and discusses the output, impact, and structure of such research based on a sample of 14,000 + articles and conference proceedings extracted from the bibliographic database Scopus. The findings reveal research output inflections after global announcements such as UN-Earth Summits. The study also reveals the indisputable leadership of China in overall output and research agenda-setting. Nonetheless, countries such as India, Mexico, and Nigeria are either more efficient or impactful. GS research published in highly reputable journals is still scarce but increasing modestly. Central topic clusters (e.g., knowledge management) remain peripheral to the global Sustainable Development Goals (SDGs) research landscape. Finally, academic-corporate collaboration is in its infancy and limited to particular economic sectors: energy, pharmaceuticals, and high-tech.

Economic impact of digital dermatitis, foot rot, and bovine respiratory disease in feedlot cattle.

Digital dermatitis (DD) has emerged in North American feedlots, although production and economic impacts are not fully understood. Objectives of this study were to: (1) estimate the economic impact of a single case of DD, foot rot (FR), and bovine respiratory disease (BRD) in feedlot cattle and (2) determine its impact on average daily gain (ADG). Feedlot cattle health and production records were available from two feedlots for a 3-yr interval. The dataset consisted of 77,115 animal records, with 19.3% (14,900) diagnosed with a disease. Diseased animals were categorized into five groups: DD, FR, BRD, other diseases (OT), and two or more diseases (TM), with a treatment cumulative incidence of 6.0%, 59.1%, 10.7%, 12.7%, and 11.5%, respectively. FR was the disease with the highest cumulative incidence in both heifers and steers (58.8% and 59.6%, respectively). Of all fall-placed cattle diagnosed with any disease, 48.1% of the cases were FR. DD affected the partial budget in five out of the eight groups of cattle, with the highest impact of DD seen in grass yearling heifers and grass yearling steers: $-98 and $-96 CAD, respectively, relative to their healthier counterparts. Healthy cattle had a significantly higher ADG when compared with DD cattle in five of the eight categories, ranging from 0.11 kg/d in winter-placed heifers to 0.17 kg/d in fall-placed steers. In the economic analysis, it was concluded that on an individual animal basis, BRD was the most impactful of all analyzed diseases, whereas DD was second, marking the importance of controlling and mitigating this foot condition. Identifying differential effects of diseases on a partial budget analysis and ADG of the types of cattle stratified by sex enables feedlot producers to focus control and mitigation strategies on specific groups.

Risk factors of digital dermatitis in feedlot cattle.

Digital dermatitis (DD) has been reported in North American feedlots, although risk factors are not well characterized. Our objectives were to analyze: (1) foot and leg conformation and (2) pen hygiene, as potential variables that predispose feedlot cattle to DD. Production parameters in DD-affected cattle were compared with healthy cattle and with those diagnosed with more commonly known infectious lesion foot rot (FR). In total, 2,854 feedlot cattle in 11 pens in 2 feedlots were assessed (bi-weekly pen walks) throughout the feeding cycle. Pen condition was categorized as: "dry," "mud present but has good bedding," "more mud than bedding," and "excessive mud." Gait scoring was competed and cattle with abnormal gait or evident foot lesions (i.e., DD or FR) were restrained in a cattle chute for a close foot inspection (n=280), including scoring of foot angle and claw set and hind and side views of rear feet and legs. Cumulative incidence of DD (present or absent) and FR was 2.5% (71/2,854) and 11.6% (331/2,854), respectively. Foot and leg conformation was not significantly different between left and right sides or between cattle with (n=71) and without DD (n=209). Lameness was diagnosed in only 22% of cattle with DD. Cattle with DD gained 0.27 kg/d less compared with healthy cattle (mean ± SD: 1.29 ± 0.29 vs. 1.56 ± 0.27, P<0.05) and 0.4 kg/d less compared with FR (1.29 ± 0.29 vs. 1.69 ± 0.25). Presence of DD was not significantly different between pens with "dry" and "mud present but has good bedding," but for pens with "more mud than bedding" or "excessive mud," the risk of cattle having DD cases increased significantly [odds ratio (OR)=8.55, confidence interval (CI): 4.0-18.4 and OR=14.1, CI: 5.9-33.8, respectively]. In conclusion, it is important to keep good pen conditions to reduce the risk of DD, which can be managed through proper stocking density and strategic bedding, irrespective of foot and leg conformation.

Embolia pulmonar tumoral: una manifestación inicial infrecuente del cáncer / Pulmonary tumour embolism: An infrequent initial manifestation of cancer

Resumen Generalmente la embolia pulmonar puede ser resultado de una trombosis, sin embargo, existen otros tipos de embolismos pulmonares. Se describe el caso de una paciente de 44 años de edad con artritis reumatoide, uso de terapia biológica y sin diagnóstico previo de cáncer, que presentó embolismo pulmonar en el contexto de trombosis venosa en miembros inferiores sin respuesta a la anticoagulación por lo que se estudiaron otras posibles etiologías, documentando finalmente embolismo tumoral por adenocarcinoma de origen desconocido posiblemente de mama. La posibilidad de embolia pulmonar tumoral se debe considerar ante la no respuesta al tratamiento con anticoagulación.

Abstract Pulmonary embolism is usually caused by thrombosis; however there are other types of pulmonary embolisms. The case is presented of a 44 year-old patient with rheumatoid arthritis on biological therapy, with no previous diagnosis of cancer. The patient had a pulmonary embolism in the context of venous thrombosis in the lower limbs, with no response to anticoagulation treatment. It was finally documented as a tumour embolism due to adenocarcinoma of unknown origin, possibly of the breast. The possibility of a pulmonary tumour embolism should be considered in the absence of a response to anticoagulation therapy.

Complications of surgery for infectious lung cavities.

Background Infectious lung cavities are a common entity for the respiratory physician. Sometimes these lesions require surgical treatment, but surgery is challenging, and complications are common. Methods Patients with infectious lung cavities amenable to surgical treatment were included in a case-control study. The control group included patients with no complications. The cases group comprised patients with any of the following complications up to 90 days after surgery: death, persistence of hemoptysis, empyema, operative blood loss > 500 mL, vascular lesion requiring repair, massive transfusion (>5 units of packed red blood cells per 48 h) or reoperation for bleeding, postoperative mechanical ventilation, intensive care unit stay > 48 h, prolonged air leak, and persistent atelectasis. The potential risk factors for complications analyzed were demographic data, exposure to contaminants, comorbidities, preoperative embolization, surgical indication, spirometry results, and sputum test positive for Mycobacterium tuberculosis. Results Forty-five patients were included in the study and divided into 24 cases and 21 controls. We found a significant difference in the time to removal of chest tubes in favor of the noncomplicated cases (6.45 vs. 4.05 days, p = 0.030), and persistent active infection at the time of surgery tended to be a risk factor for complications (odds ratio = 6.6, 95% confidence interval: 0.7-60, p = 0.061). Conclusion The presence of persistent active infection at the time of surgery could be a risk factor for complications in resection surgery for infectious lung cavities.

Modified Ravitch Procedure for Left Poland Syndrome Combined With Pectus Excavatum.

Poland Syndrome is a rare disease with an incidence of 1 in 30,000. This disease is characterized by agenesis of the pectoralis major, hypoplasia of mammarian tissue and the nipple complex, and limb abnormalities. The severe form of this disease can be associated with rib and sternal malformations like pectus excavatum. A 19-year-old man with severe Poland syndrome with cardiac extrasystoles and restrictive ventilation as shown by a spirometry test is presented. A total sternal reconstruction with partial osteotomies and bilateral resection of cartilage was performed. The sternum was stabilized with underlying titanium bars and clips. The cosmetic result was satisfactory.

[The benefits of digital chest drainage in pleural decortication in thoracic empyema. Prospective, randomized, control trial]. / Beneficios del drenaje torácico digital en pleurodecorticación por empiema. Estudio prospectivo, comparativo aleatorizado.

BACKGROUND: Prolonged air leak after pleural decortication is one of the most frequent complications. OBJECTIVE: The aim of this study is to compare the effects of prolonged air leak between the digital chest drainage (DCD) system and the classic drainage system in patients with empyema class IIB or III (American Thoracic Society classification) in pleural decortication patients. MATERIAL AND METHODS: A total of 37 patients were enrolled in a prospective randomized control trial over one year, consisting of 2blinded groups, comparing prolonged air leak as a main outcome, the number of days until removal of chest drain, length of hospital stay and complications as secondary outcomes. RESULTS: The percentage of prolonged air leak was 11% in the DCD group and 5% in the classic group (P=0.581); the mean number of days of air leak was 2.5±1.8 and 2.4±2.2, respectively (P=0.966). The mean number of days until chest tube removal was 4.5±1.8 and 5.1±2.5 (P=0.41), the length of hospital stay was 7.8±3.7 and 8.9±4.0 (P=0.441) and the complication percentages were 4 (22%) and 7 (36%), respectively (P=0.227). DISCUSSION: In this study, no significant difference was observed when the DCD was compared with the classic system. This was the first randomized clinical trial for this indication; thus, future complementing studies are warranted.