[Management of chronic non-oncologic pain by multicomponent programs using non-pharmacologic therapies: A systematic review of the literature]. / Manejo del dolor crónico no oncológico con programas multicomponentes de terapias no farmacológicas: revisión sistemática de la literatura.

Chronic pain is a public health problem suffered by 20% of the world's population. Pharmacological approaches are insufficient, so a multi-therapeutic approach that also includes non-pharmacological therapies (psychological therapies, meditation, physical exercise, healthy habits, etc.) is proposed. The aim of this review was to review the existing scientific evidence on the effect of multicomponent programs with non-pharmacological therapies in people with chronic non-oncologic pain. To this end, a search for scientific articles was carried out in three databases (PubMed, Web of Science and PsycINFO) and 17 articles were selected, following the PRISMA recommendations. The patients who participated in these programs were mostly women, aged 18 to 80years, working or on sick leave due to pain, with secondary education or less and married. The most frequent pain was musculoskeletal, mainly low back pain. All the articles studied the effectiveness of two or more therapies, highlighting psychological therapies, physical exercise and education. Positive results were obtained in the reduction of different variables such as pain, pain catastrophizing, anxiety and depression, in addition to improving functionality and quality of life. It has also been shown that patients' prior expectations regarding the intervention influence its effectiveness. Although throughout the review there was great heterogeneity in the interventions, in the evaluation methods and in the results themselves, it can be concluded that multicomponent programs show positive results in the management of chronic pain, and should therefore be incorporated as a routine therapeutic treatment.

[Impact of a multicomponent program with nonpharmacological therapies for patients with chronic pain]. / Impacto de un programa multicomponente con terapias no farmacológicas para pacientes con dolor crónico.

INTRODUCTION: 25.9% of Spanish people suffer from chronic pain. An integrated, interdisciplinary approach is recommended, with pharmacological and non-pharmacological therapies, involving patients in their self-care. OBJECTIVE: To evaluate the effectiveness and impact on resources of a program with non-pharmacological therapies in the control of non-oncological chronic pain in the short and medium term. MATERIAL AND METHODS: Quasi-experimental before-after study, follow-up 3-6 months, measuring: pain, well-being, quality of life, self-esteem, resilience, anxiety/depression (validated scales); patient-reported outcomes of workshop impact on pain management, habits and mood; ED and office visits; drug consumption and employment status. RESULTS: One hundred and forty-two patients completed the program; 131 (92.3%) were women, age: 56.0. Decreased: pain (scale 0-10) (start: 6.0; end of workshop: 4.0; 3 months: 5.0); anxiety (12.9; 10.4; 8.8) and depression (12.3; 7.23; 6.47) (scales 0-21). They increased: well-being (scale 0-10) (4.0; 6.0; 4.0); quality of life (scale 0-1) (0.418; 0.580; 0.536); health status (scale 0-100) (47.5; 60.0; 60.0); self-esteem (scale 9-36) (24.1; 27.5; 26.7); resilience (scale 6-30) (14.8; 17.4; 18.6). Patient-reported outcomes were performed by 136 patients at the end of the workshop and 79 at 3 months: pain decreased (end of program: 104, 76.5%; 3 months: 66, 83.5%); medication decreased (96, 76.2%; 60, 78.9%); habits improved (112, 88.2%; 69, 90.8%). Forty patients (37.4%) reduced visits to the emergency room, 40 (37.4%) reduced scheduled visits. Overall satisfaction: 9.8 out of 10. CONCLUSIONS: Patients learn to mitigate their pain, participate in their self-care and improve their quality of life, self-esteem and emotional state. The effects remained for 3-6 months.

Utilidad de la fluorescencia cercana al infrarrojo para la identificación del bronquio segmentario en segmentectomías mínimamente invasivas / Usefulness of near-infrared fluorescence for identifying the segmental bronchus in minimally invasive segmentectomy

Las resecciones sublobares anatómicas mínimamente invasivas han ganado relevancia durante los últimos años gracias al avance de las técnicas de imagen, los programas de cribado y el aumento de segundas neoplasias. La identificación precisa del bronquio segmentario o subsegmentario objeto de resección es vital para obtener resultados óptimos en segmentectomías y subsegmentectomías. Dada la complejidad y la posibilidad de variaciones anatómicas, varios autores han publicado distintos métodos para identificar el bronquio objetivo de la resección. Sin embargo, estos métodos tienen ciertas limitaciones. El presente artículo describe una nueva técnica rápida, efectiva, con bajo riesgo de complicaciones y sin coste adicional para la identificación de los bronquios segmentarios en segmentectomías mínimamente invasivas. (AU)

Minimally invasive anatomical sublobar resections have gained relevance in recent years mainly due to advances in imaging techniques, screening programs and the increase in second neoplasms. Accurate identification of the segmental or subsegmental bronchus is vital to guarantee optimal results in segmentectomies and subsegmentectomies. Given the complexity and the possibility of anatomical variations, several authors have published different methods to identify the target bronchus. However, these methods have certain limitations. This article describes a new rapid and effective technique, with a low risk of complications and without additional cost, for the identification of segmental bronchi in minimally invasive segmentectomies. (AU)

Utilidad de la fluorescencia cercana al infrarrojo para la identificación del bronquio segmentario en segmentectomías mínimamente invasivas / Usefulness of near-infrared fluorescence for identifying the segmental bronchus in minimally invasive segmentectomy

Las resecciones sublobares anatómicas mínimamente invasivas han ganado relevancia durante los últimos años gracias al avance de las técnicas de imagen, los programas de cribado y el aumento de segundas neoplasias. La identificación precisa del bronquio segmentario o subsegmentario objeto de resección es vital para obtener resultados óptimos en segmentectomías y subsegmentectomías. Dada la complejidad y la posibilidad de variaciones anatómicas, varios autores han publicado distintos métodos para identificar el bronquio objetivo de la resección. Sin embargo, estos métodos tienen ciertas limitaciones. El presente artículo describe una nueva técnica rápida, efectiva, con bajo riesgo de complicaciones y sin coste adicional para la identificación de los bronquios segmentarios en segmentectomías mínimamente invasivas. (AU)

Minimally invasive anatomical sublobar resections have gained relevance in recent years mainly due to advances in imaging techniques, screening programs and the increase in second neoplasms. Accurate identification of the segmental or subsegmental bronchus is vital to guarantee optimal results in segmentectomies and subsegmentectomies. Given the complexity and the possibility of anatomical variations, several authors have published different methods to identify the target bronchus. However, these methods have certain limitations. This article describes a new rapid and effective technique, with a low risk of complications and without additional cost, for the identification of segmental bronchi in minimally invasive segmentectomies. (AU)

Usefulness of near-infrared fluorescence for identifying the segmental bronchus in minimally invasive segmentectomy.

Minimally invasive anatomical sublobar resections have gained relevance in recent years mainly due to advances in imaging techniques, screening programs and the increase in second neoplasms. Accurate identification of the segmental or subsegmental bronchus is vital to guarantee optimal results in segmentectomies and subsegmentectomies. Given the complexity and the possibility of anatomical variations, several authors have published different methods to identify the target bronchus. However, these methods have certain limitations. This article describes a new rapid and effective technique, with a low risk of complications and without additional cost, for the identification of segmental bronchi in minimally invasive segmentectomies.

Similar outcomes after newly implemented rats approach compared to standard vats for anatomical lung resection. A propensity-score matched analysis / Resultados similares de un abordaje robótico (RATS) recientemente implementado comparado con un abordaje VATS convencional para resecciones pulmonares anatómicas: análisis de datos emparejados por puntuación de propensión

Introduction Outcomes after the introduction of surgical innovations can be impaired by learning periods. The aim of this study is to compare the short-term outcomes of a recently implemented RATS approach to a standard VATS program for anatomical lung resections. Methods Retrospective review of consecutive patients undergoing pulmonary anatomical resection through a minimally invasive approach since RATS approach was applied in our department (June 01, 2018, to November 30, 2019). Propensity score matching was performed according to patients’ age, gender, ppoFEV1, cardiac comorbidity, type of malignancy, and type of resection. Outcome evaluation includes: overall morbidity, significant complications (cardiac arrhythmia, pneumonia, prolonged air leak, and reoperation), 30-day mortality, and length of hospital stay. Data were compared by two-sided chi-square or Fisher's exact test for categorical and Mann–Whitney U test for continuous variables. Results A total of 273 patients (206 VATS, 67 RATS) were included in the study. After propensity score matching, data of 132 patients were analyzed. The thirty-days mortality was nil. Overall morbidity (RATS: 22.4%, VATS: 29.2%; p=0.369), major complications (RATS: 9% vs VATS: 9.2%; p=0.956) and the rates of specific major complications (cardiac arrhythmia RATS: 4.5%, VATS: 4.6%, p=1; pneumonia RATS:0%, VATS:4.6%, p=0.117; prolonged air leak RATS: 7.5%; VATS: 4.6%, p=0.718) and reoperation (RATS: 3%, VATS: 1.5%, p=1) were comparable between both groups. The median length of stay was 3 days in both groups (p=0.101) (AU)

Introducción La introducción de innovaciones quirúrgicas se asocia con períodos de aprendizaje que pueden afectar a los resultados. El objetivo de este estudio es comparar los resultados postoperatorios de un abordaje RATS para resecciones pulmonares anatómicas implementado recientemente frente a los de un abordaje VATS convencional. Métodos Revisión retrospectiva de los pacientes sometidos a resección pulmonar anatómica mediante un abordaje mínimamente invasivo en nuestro centro desde el inicio del programa de cirugía RATS (junio de 2018) hasta noviembre de 2019. Los pacientes fueron emparejados por puntuación de propensión según variables de riesgo. Los resultados analizados fueron: morbilidad global, complicaciones (mayores, arritmia, neumonía, fuga aérea prolongada y reintervención), mortalidad a los 30 días y estancia hospitalaria. Los datos se compararon mediante la prueba de chi-cuadrado o la exacta de Fisher para variables categóricas y la prueba de U de Mann-Whitney para variables continuas. Resultados Se incluyeron en el estudio 273 pacientes (206 VATS, 67 RATS). Tras el emparejamiento, se analizaron los datos de 132 pacientes. La mortalidad a los 30 días fue nula. La morbilidad global (RATS: 22,4%, VATS: 29,2%; p=0,369), complicaciones mayores (RATS: 9%, VATS: 9,2%; p=0,956), arritmia (RATS: 4,5%, VATS: 4,6%, p=1); neumonía (RATS: 0%, VATS: 4,6%, p=0,117); fuga aérea prolongada (RATS: 7,5%; VATS: 4,6%, p=0,718) y reintervención (RATS: 3%, VATS: 1,5%, p=1) fueron comparables entre ambos grupos. La mediana de la estancia hospitalaria fue de 3 días en ambos grupos (p=0,101). Conclusiones Un programa RATS para resecciones pulmonares anatómicas puede implementarse de manera segura por cirujanos experimentados en VATS sin aumentar los índices de morbilidad (AU)

Factores predictores de respuesta completa patológica tras inducción (ypT0N0M0) en cáncer de pulmón no microcítico y resultados a corto plazo: resultados del Grupo Español de Cirugía Torácica Videoasistida (GE-VATS) / Predictive factors of pathological complete response after induction (ypT0N0M0) in non-small cell lung cancer and short-term outcomes: results of the Spanish Group of Video-assisted Thoracic Surgery (GE-VATS)

Introducción Analizar los factores predictores de respuesta patológica completa (RCp) en pacientes con cáncer de pulmón no microcítico (CPNM) sometidos a resección pulmonar anatómica tras terapia de inducción y evaluar los resultados postoperatorios de estos pacientes. Métodos Se incluyeron en el estudio todos los pacientes registrados de forma prospectiva en la base de datos del grupo de trabajo GE-VATS reclutados entre el 20 de diciembre de 2106 y el 20 de marzo de 2018, sometidos a resección pulmonar anatómica por CPNM tras tratamiento de inducción. La población se dividió en dos grupos: pacientes que obtuvieron respuesta completa patológica tras inducción (RCp) y pacientes que no obtuvieron una respuesta patológica completa tras inducción (no-RCp). Se realizó un análisis multivariante mediante una regresión logística binaria para determinar los factores predictores de RCp y se analizaron los resultados postoperatorios de los pacientes. Resultados De los 241 pacientes analizados, 36 pacientes (14,9%) alcanzaron RCp. Los factores predictores de RCp fueron el sexo masculino (OR 2,814, IC 95% 1,015-7,806), la histología de carcinoma escamoso (OR 3,065, IC 95% 1,233-7,619) u otra distinta de adenocarcinoma (ADC) (OR 5788, IC 95% 1,878-17,733), la terapia de inducción que incluye radioterapia (OR 4,096, IC 95% 1,785-9,401) y terapias dirigidas (OR 7,625, IC 95% 2,147-27,077). La ocurrencia de complicaciones respiratorias postoperatorias fue superior en los pacientes que recibieron quimio-radioterapia de inducción (p = 0,032). Conclusiones El sexo masculino, la histología de carcinoma escamoso o diferente de ADC y la terapia de inducción que incluye radioterapia o terapia dirigida son factores predictores positivos para la obtención de RCp. La quimio-radioterapia de inducción se asocia con un mayor riesgo de complicaciones respiratorias postoperatorias (AU)

Introduction To analyze the predictors of pathological complete response (pCR) in not small cells lung carcinoma (NSCLC) patients who underwent anatomical lung resection after induction therapy and to evaluate the postoperative results of these patients. Methods All patients prospectively registered in the database of the GE-VATS working group undergone anatomic lung resection by NSCLC after induction treatment and recruited between December 20th 2016, and March 20th 2018, were included in the study. The population was divided into two groups: patients who obtained a complete pathological response after induction (pCR) and patients who did not obtain a complete pathological response after induction (non-pCR). A multivariate analysis was performed using a binary logistic regression to determine the predictors of pCR and the postoperative results of patients were analyzed. Results Of the 241 patients analyzed, 36 patients (14.9%) achieved pCR. Predictive factors for pCR are male sex (OR 2.814, 95% CI 1.015-7.806), histology of squamous carcinoma (OR 3.065, 95% CI 1.233-7.619) or other than adenocarcinoma (ADC) (OR 5.788, 95% CI 1.878-17.733) and induction therapy that includes radiation therapy (OR 4.096, 95% CI 1.785-9.401) and targeted therapies (OR 7.625, 95% CI 2.147-27.077). Prevalence of postoperative pulmonary complications was higher in patients treated with neoadjuvant chemo-radiotherapy (p = 0.032). Conclusions Male sex, histology of squamous carcinoma or other than ADC, and induction therapy that includes radiotherapy or targeted therapy are positive predictors for obtaining pCR. Induction chemo-radiotherapy is associated with a higher risk of postoperative pulmonary complications (AU)

Hallazgo intraoperatorio inesperado de un trombo tumoral en vena pulmonar durante una lobectomía robótica / Unexpected Intraoperative Finding of a Pulmonary Vein Tumor Thrombus During a Robotic Lobectomy

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[Translated article] Unexpected Intraoperative Finding of a Pulmonary Vein Tumor Thrombus During a Robotic Lobectomy / Hallazgo intraoperatorio inesperado de un trombo tumoral en vena pulmonar durante una lobectomía robótica

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Effective discrimination of gas-phase peptide conformers using TIMS-ECD-ToF MS/MS.

In the present work, four, well-studied, model peptides (e.g., substance P, bradykinin, angiotensin I and AT-Hook 3) were used to correlate structural information provided by ion mobility and ECD/CID fragmentation in a TIMS-q-EMS-ToF MS/MS platform, incorporporating an electromagnetostatic cell (EMS). The structural heterogeneity of the model peptides was observed by (i) multi-component ion mobility profiles (high ion mobility resolving power, R ∼115-145), and (ii) fast online characteristic ECD fragmentation patterns per ion mobility band (∼0.2 min). Particularly, it was demonstrated that all investigated species were probably conformers, involving cis/trans-isomerizations at X-Pro peptide bond, following the same protonation schemes, in good agreement with previous ion mobility and single point mutation experiments. The comparison between ion mobility selected ECD spectra and traditional FT-ICR ECD MS/MS spectra showed comparable ECD fragmentation efficiencies but differences in the ratio of radical (˙)/prime (') fragment species (H˙ transfer), which were associated with the differences in detection time after the electron capture event. The analysis of model peptides using online TIMS-q-EMSToF MS/MS provided complementary structural information on the intramolecular interactions that stabilize the different gas-phase conformations to those obtained by ion mobility or ECD alone.

Mortality predictors in complicated patients after anatomical lung resection / Variables predictivas de muerte en pacientes complicados tras resección pulmonar anatómica

Introduction: Failure to rescue (FTR), defined as the mortality rate among patients suffering from postoperative complications, is considered an indicator of the quality of surgical care. The aim of this study was to investigate the risk factors associated with FTR after anatomical lung resections.Method: Patients undergoing anatomical lung resection at our center between 1994 and 2018 were included in the study. Postoperative complications were classified as minor (grade I and II) and major (grade IIIA to V), according to the standardized classification of postoperative morbidity. Patients who died after a major complication were considered FTR. A stepwise logistic regression model was created to identify FTR predictors. Independent variables included in the multivariate analysis were age, body mass index, cardiac, renal, and cerebrovascular comorbidity, ppoFEV1%, VATS approach, extended resection, pneumonectomy, and reintervention. A non-parametric ROC curve was constructed to estimate the predictive capacity of the model.Results: A total of 2.569 patients were included, of which 223 (8.9%) had major complications and 49 (22%) could not be rescued. Variables associated with FTR were: age (OR: 1.07), history of cerebrovascular accident (OR: 3.53), pneumonectomy (OR: 6.67), and reintervention (OR: 12.26). The area under the ROC curve was 0.82 (95% CI: 0.77–0.88).Conclusions: Overall, 22% of patients with major complications following anatomical lung resection in this series did not survive until discharge. Pneumonectomy and reintervention are the most significant risk factors for FTR. (AU)

Introducción: El fallo en el rescate (FTR) definido como la tasa de fallecimientos entre los pacientes que sufren una complicación postoperatoria, es considerado un indicador de la calidad de los cuidados quirúrgicos. El objetivo de este estudio es investigar los factores de riesgo asociados al FTR después de resecciones pulmonares anatómicas.Método: Se incluyeron en el estudio pacientes sometidos a resección pulmonar anatómica en nuestro centro entre 1994 y 2018. Las complicaciones postoperatorias se clasificaron en menores (grados I y II) y mayores (grados IIIa a V) según la clasificación estandarizada de morbilidad postoperatoria. Los casos que fallecieron tras una complicación mayor fueron considerados FTR. Se creó un modelo de regresión logística por pasos para identificar los factores predictores de FTR. Se consideraron variables independientes en el análisis multivariante la edad, índice de masa corporal, comorbilidad cardiaca, renal, cerebrovascular, VEF1ppo%, abordaje VATS, resección extendida, neumonectomía y reintervención. Se construyó una curva ROC no paramétrica para estimar la capacidad predictiva del modelo.Resultados: Se analizaron 2.569 pacientes. En total, 223 casos (8,9%) tuvieron complicaciones mayores y 49 (22%) no pudieron ser rescatados. Las variables asociadas con FTR fueron: edad (OR: 1,07), antecedente de ACV (OR: 3,53), neumonectomía (OR: 6,67) y reintervención (OR: 12,26). El área bajo la curva de la curva ROC fue 0,82 (IC 95%: 0,77–0,88).Conclusiones: 22% de los pacientes que presentan complicaciones mayores tras la resección pulmonar anatómica en esta serie no sobreviven al alta. La neumonectomía y la reintervención son los factores de riesgo más potentes para FTR. (AU)

Resecciones pulmonares anatómicas por vía robótica: análisis de la curva de aprendizaje / Robotic anatomical lung resections: Analysis of the learning curve

Introducción: La cirugía robótica se ha convertido en una vía de abordaje segura y efectiva para el tratamiento de la patología quirúrgica pulmonar. Sin embargo, la adopción de nuevas técnicas quirúrgicas requiere de la evaluación de la curva de aprendizaje. El objetivo de este estudio es analizar la curva de aprendizaje de las resecciones pulmonares anatómicas por vía robótica. Métodos: Análisis retrospectivo de todas las resecciones pulmonares anatómicas por vía robótica realizadas por un mismo cirujano entre junio de 2018 y marzo de 2020. La curva de aprendizaje se evaluó utilizando gráficas CUSUM para estimar los cambios en la tendencia del tiempo y los fallos quirúrgicos y la aparición de complicaciones cardiorrespiratorias postoperatorias a lo largo de la secuencia de casos. Resultados: El estudio incluyó un total de 73 casos. La mediana de duración de todas las intervenciones fue de 120min (rango intercuartílico: 90-150min), la prevalencia de fallo quirúrgico fue del 23,29%, mientras que 4/73 pacientes presentaron alguna complicación cardiorrespiratoria postoperatoria. Con base en el análisis CUSUM, la curva de aprendizaje fue dividida en 3 fases diferentes: fase i (desde la primera hasta la 14.a intervención), fase ii (entre la 15.a y la 30.a intervención) y fase iii (a partir de la 31.a intervención). Conclusiones: La curva de aprendizaje para las resecciones pulmonares anatómicas por vía robótica puede dividirse en 3 fases. La competencia técnica que asegura resultados perioperatorios satisfactorios se consiguió en la fase iii, a partir de la 31.a intervención. (AU)

Introduction: Robotic surgery has become a safe and effective approach for the treatment of pulmonary surgical pathology. However, the adoption of new surgical techniques requires the evaluation of the learning curve. The objective of this study is to analyze the learning curve of robotic anatomical lung resections. Methods: Retrospective analysis of all robotic anatomical lung resections performed by the same surgeon between June 2018 and March 2020. The learning curve was evaluated using CUSUM charts to estimate trend changes in surgical time, surgical failure and the occurrence of post-operative cardiorespiratory complications throughout the sequence of cases. Results: The study included a total of 73 cases. The median duration of all complications was 120min (interquartile range: 90-150min), the prevalence of surgical failure was 23.29%, while 4/73 patients had any postoperative cardiorespiratory complication. Based on the CUSUM analysis, the learning curve was divided into 3 different phases: phase i (from the first to the 14th intervention), phase ii (between the 15th and 30th intervention) and phase iii (from the 31st intervention). Conclusions: The learning curve for robotic anatomical lung resections can be divided into 3 phases. The technical competence that guarantees satisfactory perioperative outcomes was achived in phase iii from the 31st intervention. (AU)

Robotic anatomical lung resections: Analysis of the learning curve.

INTRODUCTION: Robotic surgery has become a safe and effective approach for the treatment of pulmonary surgical pathology. However, the adoption of new surgical techniques requires the evaluation of the learning curve. The objective of this study is to analyze the learning curve of robotic anatomical lung resections. METHODS: Retrospective analysis of all robotic anatomical lung resections performed by the same surgeon between June 2018 and March 2020. The learning curve was evaluated using CUSUM charts to estimate trend changes in surgical time, surgical failure and the occurrence of post-operative cardiorespiratory complications throughout the sequence of cases. RESULTS: The study included a total of 73 cases. The median duration of all complications was 120 min (interquartile range: 90-150 min), the prevalence of surgical failure was 23.29%, while 4/73 patients had any postoperative cardiorespiratory complication. Based on the CUSUM analysis, the learning curve was divided into 3 different phases: phase i (from the first to the 14th intervention), phase ii (between the 15th and 30th intervention) and phase iii (from the 31st intervention). CONCLUSIONS: The learning curve for robotic anatomical lung resections can be divided into 3 phases. The technical competence that guarantees satisfactory perioperative outcomes was achived in phase iii from the 31st intervention.

Hematoma espontáneo gigante de pared torácica en paciente anticoagulada por COVID-19 / Giant Spontaneous Hematoma of the Chest Wall in a Patient Receiving Anticoagulation for COVID-19

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A distinguishing profile of chemokines, cytokines and biomarkers in the saliva of children with Sjögren's syndrome.

OBJECTIVE: SS is an autoimmune disease most commonly diagnosed in adults but can occur in children. Our objective was to assess the presence of chemokines, cytokines and biomarkers (CCBMs) in saliva from these children that were associated with lymphocyte and mononuclear cell functions. METHODS: Saliva was collected from 11 children diagnosed with SS prior to age 18 years and 16 normal healthy children. A total of 105 CCBMs were detected in multiplex microparticle-based immunoassays. ANOVA and t test (0.05 level) were used to detect differences. Ingenuity Pathway Analysis (IPA) was used to assess whether elevated CCBMs were in annotations associated with immune system diseases and select leukocyte activities and functions. Machine learning methods were used to evaluate the predictive power of these CCBMs for SS and were measured by receiver operating characteristic (ROC) curve and area under curve (AUC). RESULTS: Of the 105 CCBMs detected, 43 (40.9%) differed in children with SS from those in healthy study controls (P < 0.05) and could differentiate the two groups (P < 0.05). Elevated CCBMs in IPA annotations were associated with autoimmune diseases and with leukocyte chemotaxis, migration, proliferation, and regulation of T cell activation. The best AUC value in ROC analysis was 0.93, indicating that there are small numbers of CCBMs that may be useful for diagnosis of SS. CONCLUSION: While 35 of these 43 CCBMs have been previously reported in SS, 8 CCBMs had not. Additional studies focusing on these CCBMs may provide further insight into disease pathogenesis and may contribute to diagnosis of SS in children.

Mortality predictors in complicated patients after anatomical lung resection.

INTRODUCTION: Failure to rescue (FTR), defined as the mortality rate among patients suffering from postoperative complications, is considered an indicator of the quality of surgical care. The aim of this study was to investigate the risk factors associated with FTR after anatomical lung resections. METHOD: Patients undergoing anatomical lung resection at our center between 1994 and 2018 were included in the study. Postoperative complications were classified as minor (grade I and II) and major (grade IIIA to V), according to the standardized classification of postoperative morbidity. Patients who died after a major complication were considered FTR. A stepwise logistic regression model was created to identify FTR predictors. Independent variables included in the multivariate analysis were age, body mass index, cardiac, renal, and cerebrovascular comorbidity, ppoFEV1%, VATS approach, extended resection, pneumonectomy, and reintervention. A non-parametric ROC curve was constructed to estimate the predictive capacity of the model. RESULTS: A total of 2.569 patients were included, of which 223 (8.9%) had major complications and 49 (22%) could not be rescued. Variables associated with FTR were: age (OR: 1.07), history of cerebrovascular accident (OR: 3.53), pneumonectomy (OR: 6.67), and reintervention (OR: 12.26). The area under the ROC curve was 0.82 (95% CI: 0.77-0.88). CONCLUSIONS: Overall, 22% of patients with major complications following anatomical lung resection in this series did not survive until discharge. Pneumonectomy and reintervention are the most significant risk factors for FTR.