¿Día o noche? El momento ideal para realizar la colecistectomía / Day or night? The right time to perform cholecystectomy

Introducción. La frecuencia de complicaciones postquirúrgicas de la colecistectomía realizada en la noche es un tema de controversia, siendo que se ha reportado una frecuencia mayor durante el horario nocturno. El objetivo de este estudio fue analizar la presentación de colecistectomía difícil dependiendo de la hora en que se realizó la cirugía, además de otras complicaciones, estancia intrahospitalaria postquirúrgica, reingreso a 30 días y reintervención. Métodos. Se realizó un estudio retrospectivo, observacional, analítico y transversal, comparando la presentación de colecistectomía difícil y su frecuencia en horario diurno (8:00 am a 7:59 pm) y nocturno (8:00 pm a 7:59 am), además de seroma, absceso, hematoma, fuga biliar, biloma, estancia intrahospitalaria postquirúrgica, reingreso a 30 días y reintervención. Resultados. Se incluyeron en el estudio 228 pacientes, 117 operados durante el día (52 %) y 111 durante la noche (48 %). La colecistectomía difícil se presentó 26 % vs 34 % de los casos intervenidos en el día y la noche, respectivamente. La complicación más frecuente fue seroma (14 %). La estancia hospitalaria media fue de 2,7 días en cirugías diurnas y de 2,5 en cirugías nocturnas; hubo 3 % de reintervenciones y 6 %, respectivamente. También hubo 2 % de reingresos a los 30 días entre los pacientes operados en el día y 3 % entre los operados en la noche. Conclusiones. La frecuencia de colecistectomía difícil y las complicaciones, la estancia intrahospitalaria postquirúrgica, el reingreso a 30 días y la necesidad de reintervención, no tuvieron diferencias significativas respecto al horario de la cirugía.

Introduction. The frequency of post-surgical complications of cholecystectomy performed overnight is a matter of controversy, and a higher rate has been reported during the night shift. The objective of this study was to analyze the presentation of difficult cholecystectomy depending on the time the surgery was performed, in addition to other complications, postoperative hospital stay, 30-day readmission, and reintervention. Methods. A retrospective, observational, analytical and cross-sectional study was carried out, comparing the presentation of difficult cholecystectomy and its frequency during daytime (8:00 am to 7:59 pm) and at night (8:00 pm to 7:59 am), in addition of seroma, abscess, bile leak, biloma, hematoma, post-surgical hospital stay, 30-day readmission, and reintervention.Results. A total of 228 patients were included in the study, 117 patients operated during the day (52%), and 111 at night (48%). Difficult cholecystectomy occurred in 26% vs. 34% of the cases operated on during the day and at night, respectively. The most frequent complication was seroma (14%). The mean hospital stay was 2.7 days in day surgeries and 2.5 in night surgeries; there were also 2% readmission at 30 days among patients operated during the day and 3% among those operated on at night. Conclusions. The frequency of difficult cholecystectomy and complications, postoperative hospital stay, 30-day readmission, and the need of reintervention, did not have significant differences with respect to the time of surgery.

Critical view of the myopectineal orifice: a scoring system to objectively evaluate transabdominal preperitoneal inguinal hernia repair.

BACKGROUND: More than 20 million inguinal hernia repair (IHR) procedures are performed worldwide every year. The critical view of the myopectineal orifice (CV of the MPO) is a stepwise guide to the achievement and standardization of minimally invasive IHR (MI IHR). We propose a scoring system as an objective method for fulfillment of the CV of the MPO. METHODS: The scoring system was employed for evaluation of the transabdominal preperitoneal (TAPP) technique in 15 video-recorded procedures. Two variants of the score were used: the simple CV of the MPO score (s-CVMPO score) and the extended CV of the MPO score (e-CVMPO score). The inter-rater agreement and internal consistency for both scores and the correlation between the two scores were assessed. RESULTS: Inter-rater agreement with respect to satisfactory/unsatisfactory achievement of the CV of the MPO was high for both the s-CVMPO and e-CVMPO scores (κ = 1, p < 0.001). The Finn coefficient for inter-rater agreement was 0.97 for the s-CVMPO score and 0.99 for the e-CVMPO score (p < 0.001 for both). Both the s-CVMPO and e-CVMPO scores showed internal consistency with Cronbach's α of 0.89 and 0.87, respectively. The correlation coefficient between the two scores for the average score of each procedure was ρ = 0.96 (p < 0.001). CONCLUSION: The CVMPO score is a reliable tool for expert evaluation of TAPP repair. Implementing the CVMPO score facilitates objective assessment of the safety and quality of the procedure.

Influence of laboratory procedures on postthawing cell viability and hematopoietic engraftment after autologous peripheral blood stem cell transplantation.

BACKGROUND: The kinetics of hematopoietic recovery after autologous stem cell transplantation (ASCT) may be affected by laboratory procedures. The aim of this study was to evaluate the influence of characteristics of the cryopreserved units of peripheral blood stem cells (PBSC) on postthawing cell viability and engraftment outcomes after ASCT. STUDY DESIGN AND METHODS: This was a retrospective cohort study including individuals referred for ASCT. Cryopreservation was conducted at a single processing facility between 2014 and 2019, and patients received clinical care at six transplant centers. Covariates and outcome data were retrieved from participants' records. RESULTS: The study population comprised 619 patients (345 [55.7%] male). Median age was 53 years. Multiple myeloma was the most common diagnosis (62.7%). Higher preapheresis CD34+ cell count, lower nucleated cell (NC) concentration per cryobag, and composition of the cryoprotectant solution (5% dimethyl sulfoxide [DMSO] and 6% hydroxyethyl starch) were statistically significantly associated with higher postthawing cell viability. The linear regression model for time to neutrophil and platelet engraftment included the infused CD34+ cell dose and the composition of the cryoprotectant solution. Patients who had PBSC cryopreserved using 10% DMSO solution presented six times higher odds (odds ratio [OR] = 6.9; 95% confidence interval [CI]: 2.2-21.1; p = .001) of delayed neutrophil engraftment (>14 days) and two times higher odds (OR = 2.3, 95%CI: 1.4-3.7; p = .001) of prolonged hospitalization (>18 days). DISCUSSION: The study showed that mobilization efficacy, NC concentration, and the composition of the cryoprotectant solution significantly affected postthawing cell viability. In addition, the composition of the cryoprotectant solution significantly impacted engraftment outcomes and time of hospitalization after ASCT.

Assessing the toxic effects of magnetic particles used for lake restoration on phytoplankton: A community-based approach.

Inactivation by adding different phosphorus (P) adsorbents is one of the most frequently used methods for combating inland water eutrophication. The aim of this work was to assess the toxic effects of novel P adsorbents (magnetic particles, MPs) on the phytoplankton community. An outdoor microcosm experiment, containing lake water and surface sediment from a hypertrophic Mediterranean lake, was carried out following a factorial design (n = 5) with three different treatments: control (C), where no MPs were added; Treatment-Water (T-W) and Treatment-Sediment (T-S). In T-W and T-S treatments, MPs were added on the surface water layer and on the sediment, respectively, to obtain a final concentration of 1.4 g MP L-1. This concentration was based on both the sedimentary mobile P concentration of the study site and the maximum P adsorption capacity of the MPs, obtained from the literature. After 24 h of contact time, the MPs were removed using a magnetic rake. Physicochemical measurements and biological samples were taken after 24 h of exposure to the MPs and at different time points after such exposure (day 2, 7, 21, 35 and 70). Changes in phytoplankton community such as abundance (biovolume and Chla), species composition and taxonomic groups were assessed, as well as changes in the Shannon-Wiener diversity index. Additionally, the eutrophic metric Algae Group Index (AGI), one of the metrics proposed in the Water Framework Directive, was also calculated. Our results indicate that there is no strong evidence to infer that MPs caused an effect on the phytoplankton community, since no significant differences (GLM test; p > 0.05) were found between controls and treatments in any of the studied variables (phytoplankton taxonomic groups, AGI, Chla concentration, biovolume, diversity and community responses). Accordingly, MPs did not cause any toxic effects on the phytoplankton community of the lake, encouraging the use of MPs in a future whole-lake restoration strategy. However, if the final goal of the restoration plan is to combat nuisance cyanobacteria blooms, higher initial MPs doses or repeated MPs applications are required to achieve a reduction in P concentrations below biological thresholds in order to prevent algal blooms.

Evaluation of dried amorphous ferric hydroxide CFH-12® as agent for binding bioavailable phosphorus in lake sediments.

Metal hydroxides formed from aluminum (Al) and iron (Fe) salts can be used as phosphorus (P) adsorbents in lake restoration, but the application entails problems in low-alkaline lakes due to acid producing hydrolysis and potential formation of toxic metal ions. Therefore, we tested the potential of applying CFH-12® (Kemira) - a dried, amorphous Fe-oxide with no pH effect - in lake restoration. Since Fe3+ may become reduced in lake sediments and release both Fe2+ and any associated P we also evaluated the redox sensitivity of CFH-12® in comparison with freshly formed Fe(OH)3. CFH-12® was added to undisturbed sediment cores from three Danish lakes relative to the size of their mobile P pool (molar Fe:PMobile dose ratio of ~10:1), and P and Fe fluxes across the sediment-water interface were compared with those from untreated cores and cores treated with freshly formed Fe(OH)3. Under anoxic conditions, we found that CFH-12® significantly reduced the P efflux from the sediments (by 43% in Lake Sønderby, 70% in Lake Hampen and 60% in Lake Hostrup) while the Fe2+ efflux remained unchanged relative to the untreated cores. Cores treated with freshly formed Fe(OH)3 retained more P, but released significantly more Fe2+, indicating continued Fe3+ reduction. Finally, experiments with pure phases showed that CFH-12® adsorbed less P than freshly formed Fe(OH)3 in the short term, but was capable of adsorbing up to 70% of P adsorbed by Fe(OH)3 over 3months. With product costs only 30% higher than Al salts we find that CFH-12® has potential for use in restoration of low-alkaline lakes.