Efecto de tratamientos enzim?tico, microondas y ultrasonido en la extracci?n de grasa de semilla de mango (Mangifera Indica L.)

73 P?ginasSe evalu? el efecto de los tratamientos de ultrasonido, microondas y enzim?tico como procesamiento previo al m?todo por prensado para aumentar el rendimiento de extracci?n de la grasa de semilla de mango. Se trabajaron dos variedades de mango Kala Alphonso y Mariquita. Las muestras fueron expuestas a ultrasonido durante 1 h, con una amplitud de 100 % y ciclo de 1 s. El tratamiento con microondas se evalu? a una potencia de 100 W durante 15 y 30 min con intervalos de 5 min evitando la evaporaci?n del agua destilada. En el tratamiento con enzimas se incub? la muestra a 45?C durante 4 h. Los rendimientos se calcularon con base al contenido inicial de aceite determinados por el m?todo Soxhlet para cada variedad 12,0 % para Kala Alphonso y 11,35 % Mariquita. Los resultados mostraron que la semilla Kala Alphonso tratada con enzima present? mayor rendimiento de extracci?n con 33,36 % en comparaci?n con Mariquita (25,99 %). Con el tratamiento de ultrasonido, la variedad Kala Alphonso obtuvo el mayor rendimiento de extracci?n (16,02 %). En el tratamiento con microondas no se logr? obtener unas condiciones de procesamiento donde la exposici?n a la energ?a electromagn?tica no afectara la estructura de la semilla y se pudiera extraer grasa de semilla de mango. De igual forma se realizaron pruebas de extracci?n de componentes grasos por el m?todo de extrusi?n, donde no se obtuvo la separaci?n de la grasa de la semilla, por lo anterior puede explicarse en que este tipo de procesamiento es m?s eficaz cuando se trabaja con semillas con mayor contenido de aceite. Las pruebas de calidad determinaron que la grasa extra?da presenta caracter?sticas similares a grasas industriales, lo que permitir?a su posible futura aplicaci?n en diferentes industrias.ABSTRACT It was evaluated the ultrasound, microwaves and enzymatic treatment effects as previous processing to the press method in order to increase mango seed fat extraction performance. Two varieties of mango, Kala Alphonso and Mariquita, were subjected to different treatments. The samples were exposed to ultrasound waves during 1 h, with 100 % amplitude and 1 s cycle. The microwave treatment was evaluated at minimal power (100 W) during 15 and 30 min with 5 min intervals for avoiding distilled water evaporation. In the treatment with enzymes, the sample was incubated at 45?C during 4 h. The yield was analyzed based on the initial oil content measured by Soxhlet method, 12,0 % for Kala Alphonso and 11,35 % for Mariquita. The results showed that Kala Alphonso seed treated with enzyme had a higher yield with 33,36 % compared to Mariquita with 25,99 %. In the ultrasound treatment, the Kala Alphonso variety had the higher extraction performance (16,02 %). In the microwave treatment was not possible to obtain processing conditions that exposure to electromagnetic energy will not affect the seed structure and the extraction of fat mango kernel. It was also made fat extraction tests by the extrusion method, however it was not possible to obtain fat separation, this can be explained that extrusion processing is most effective with higher oil content seeds. The quality results showed that fat mango seed presented characteristics similar to other industrial fats, so it is possible used in different industries considering its high unsaturated fatty acid content. The mechanical press extraction is an efficient process for obtaining mango seed fat but it is required previous treatments, however this is a real possibility in order to add value to an industrial sub-product.INTRODUCCI?N 12 1. PLANTEAMIENTO DEL PROBLEMA 15 2. JUSTIFICACI?N 16 3. OBJETIVOS 17 3.1 GENERAL 17 3.2 ESPECIFICOS 17 4. MARCO TE?RICO 18 4.1 GENERALIDADES DEL MANGO 18 4.1.1 Producci?n y Comercializaci?n del Mango 18 4.1.2 Subproductos del Procesamiento del Mango 20 4.2 COMPOSICI?N DE LA SEMILLA 21 4.2.1 Compuestos Grasos de la Semilla de Mango 21 4.3 M?TODOS DE EXTRACCI?N 25 4.3.1 M?todos Soxhlet o con Disolventes 25 4.3.2 M?todo de Extracci?n por Prensado 25 4.3.3 Extracci?n Asistida por Microondas 25 4.3.4 Extracci?n Asistida con Ultrasonido 26 4.3.5 Actividad Enzim?tica 26 4.4 ESTADO DEL ARTE 26 5. METODOLOG?A 32 5.1 CARACTERIZACION DE LA SEMILLA DE MANGO 32 5 5.1.1 M?todo de Extracci?n por Soxhlet 34 5.2 PRUEBAS DE HIDRATACI?N DE LA SEMILLA DE MANGO 35 5.2.1 Hidrataci?n con Vapor de Agua 36 5.2.2 Hidrataci?n Semillas en Remojo 36 5.2.3 Hidrataci?n con Vapor en Autoclave 36 5.3 TRATAMIENTOS PREVIOS DE EXTRACCI?N 37 5.3.1 Tratamiento por Microondas 37 5.3.2 Tratamiento por Ultrasonido 37 5.3.3 Tratamiento Enzim?tico 38 5.4 M?TODOS DE EXTRACCI?N 39 5.4.1 M?todo de Extracci?n por Prensado 39 5.4.2. M?todo de Extracci?n por Extrusi?n 41 5.5 DETERMINACI?N DE LA CALIDAD 42 5.6 DISE?O EXPERIMENTAL 42 5.6.1 An?lisis de Resultados 43 6. RESULTADOS Y DISCUSI?N 44 6.1 RENDIMIENTO DE EXTRACCION POR SOXHLET 44 6.1.1 An?lisis Proximal 44 6.1.2 Perfil de ?cidos Grasos 45 6.2 PRUEBAS DE HIDRATACI?N DE LA SEMILLA DE MANGO 46 6.3 TRATAMIENTOS PREVIOS DE EXTRACCI?N POR PRENSADO 48 6.3.1 Tratamiento por Microondas 48 6.3.2 Tratamiento con Ultrasonido y Enzima 49 6.4 DETERMINACI?N DE LA CALIDAD 52 6.5 RENDIMIENTO DE EXTRACCI?N POR EXTRUSI?N 56 7. CONCLUSIONES 58 RECOMENDACIONES 60 6 REFERENCIAS 6

Captura de carbono en ra?ces finas y estructurales en bosques alto-andinos y sistemas agroforestales en asocio con ?rboles dispersos y cultivos en Santa Isabel, Tolima

75 p. Recurso Electr?nicoLas ra?ces finas (di?metro < 2 mm) se han caracterizado por ser un componente radicular importante dentro de la absorci?n de nutrientes y din?mica del carbono. Se evalu? la captura de carbono en ra?ces finas mediante un dise?o completamente al azar con tres tratamientos (bosques, cultivos y pasturas); del mismo modo se utiliz? un dise?o con arreglo en franjas (profundidad: 0-10, 10-20, 20-30, 30-40, 40-50 cm) y cinco repeticiones. Se colectaron bloques de 10 x 10 x 10 cm que fueron lavados y tamizados para separar las ra?ces finas y secadas hasta peso constante. La biomasa de ra?ces estructurales se estim? con la ecuaci?n desarrollada por Cairns et al. (1997). Se encontraron diferencias estad?sticas (p<0,05) en la acumulaci?n de carbono entre sistemas: mayor en bosques que en pasturas y cultivos (ra?ces finas: 4,2 ? 0,6 vs 2,1 ? 0,4 vs 0,6 ? 0,25 t/ha, y estructurales: 26 ? 2,8 vs 10 ? 0,9 t/ha, respectivamente). La profundidad tiene un efecto significativo (p<0,05) en la acumulaci?n de carbono en ra?ces finas, siendo mayor en las primeras capas y reduci?ndose en las profundas: 55% del carbono se encuentra en los primeros 20 cm del suelo y 12% entre 40-50 cm. Los agentes fisicoqu?micos que caracterizan la cobertura del suelo determinan el crecimiento y desarrollo de las ra?ces. La conservaci?n de bosques nativos implica la retenci?n de cantidades importantes de carbono que al reportar un cambio de uso del suelo podr?a generar un incremento en las concentraciones de CO2 a la atm?sfera. Palabras claves: Almacenamiento de carbono, Biodiversidad, Biomasa, Servicios ambientales.Fine roots (diameter < 2 mm) has been characterized as a mean root component in nutrient absorption and carbon dynamics. Carbon sequestration was evaluated inside fine roots through a completely random design with three treatments such as forests; crops and pastures. Similarly, It was applied a design with pursuant slots (depth: 0-10; 10-20; 20-30; 30-40; 40-50 cm) and five repetitions. Blocks were collected of 10 x 10 x 10 cm in dimension which were washed and sifted in order to separate the fine roots and dried them until constant weight. Structural root?s Biomass was estimated with the equation developed by Cairns et al. (1997). It was found statistic differences (p<0,05) on the accumulation of carbon between systems: higher in forests than pastures and crops (fine roots : 4,2 ? 0,6 vs 2,1 ? 0,4 vs 0,6 ? 0,25 t/ha and structural ones: 26 ? 2,8 vs 10 ? 0,9 t/ha, respectively). Depth has a significant effect (p<0,05) on the increasing of carbon at fine roots being higher on the first layers and decreasing at the last ones: 55% of carbon is found in the first 20 cm of the soil and 12% between 40-50 cm. Physicochemical agents that characterize the soil coverage determine the growth and development of roots. Consequently, native forests preservation implies retention of important amounts of carbon since it shows a change on the use of soil could produce an increase on the concentrations of CO2 at the atmosphere. Keywords: Carbon storage, Biodiversity, Biomass, Environmental service

Captura de carbono en ra?ces finas y estructurales en bosques alto-andinos y sistemas agroforestales en asocio con ?rboles dispersos y cultivos en Santa Isabel, Tolima

75 p. Recurso Electr?nicoLas ra?ces finas (di?metro < 2 mm) se han caracterizado por ser un componente radicular importante dentro de la absorci?n de nutrientes y din?mica del carbono. Se evalu? la captura de carbono en ra?ces finas mediante un dise?o completamente al azar con tres tratamientos (bosques, cultivos y pasturas); del mismo modo se utiliz? un dise?o con arreglo en franjas (profundidad: 0-10, 10-20, 20-30, 30-40, 40-50 cm) y cinco repeticiones. Se colectaron bloques de 10 x 10 x 10 cm que fueron lavados y tamizados para separar las ra?ces finas y secadas hasta peso constante. La biomasa de ra?ces estructurales se estim? con la ecuaci?n desarrollada por Cairns et al. (1997). Se encontraron diferencias estad?sticas (p<0,05) en la acumulaci?n de carbono entre sistemas: mayor en bosques que en pasturas y cultivos (ra?ces finas: 4,2 ? 0,6 vs 2,1 ? 0,4 vs 0,6 ? 0,25 t/ha, y estructurales: 26 ? 2,8 vs 10 ? 0,9 t/ha, respectivamente). La profundidad tiene un efecto significativo (p<0,05) en la acumulaci?n de carbono en ra?ces finas, siendo mayor en las primeras capas y reduci?ndose en las profundas: 55% del carbono se encuentra en los primeros 20 cm del suelo y 12% entre 40-50 cm. Los agentes fisicoqu?micos que caracterizan la cobertura del suelo determinan el crecimiento y desarrollo de las ra?ces. La conservaci?n de bosques nativos implica la retenci?n de cantidades importantes de carbono que al reportar un cambio de uso del suelo podr?a generar un incremento en las concentraciones de CO2 a la atm?sfera. Palabras claves: Almacenamiento de carbono, Biodiversidad, Biomasa, Servicios ambientalesFine roots (diameter < 2 mm) has been characterized as a mean root component in nutrient absorption and carbon dynamics. Carbon sequestration was evaluated inside fine roots through a completely random design with three treatments such as forests; crops and pastures. Similarly, It was applied a design with pursuant slots (depth: 0-10; 10-20; 20-30; 30-40; 40-50 cm) and five repetitions. Blocks were collected of 10 x 10 x 10 cm in dimension which were washed and sifted in order to separate the fine roots and dried them until constant weight. Structural root?s Biomass was estimated with the equation developed by Cairns et al. (1997). It was found statistic differences (p<0,05) on the accumulation of carbon between systems: higher in forests than pastures and crops (fine roots : 4,2 ? 0,6 vs 2,1 ? 0,4 vs 0,6 ? 0,25 t/ha and structural ones: 26 ? 2,8 vs 10 ? 0,9 t/ha, respectively). Depth has a significant effect (p<0,05) on the increasing of carbon at fine roots being higher on the first layers and decreasing at the last ones: 55% of carbon is found in the first 20 cm of the soil and 12% between 40-50 cm. Physicochemical agents that characterize the soil coverage determine the growth and development of roots. Consequently, native forests preservation implies retention of important amounts of carbon since it shows a change on the use of soil could produce an increase on the concentrations of CO2 at the atmosphere. Keywords: Carbon storage, Biodiversity, Biomass, Environmental service

Incidencia de la evaluaci?n formativa en el desarrollo de la competencia textual en los estudiantes del grado 5? de la instituci?n educativa t?cnica industrial Sim?n Bol?var sede Santa Ana del Guamo - Tolima

135 p. Recurso Electr?nicoInvestigaci?n titulada ?Incidencia de la evaluaci?n formativa en el desarrollo de la competencia textual en los estudiantes del grado 5? de la Instituci?n Educativa T?cnica Industrial Sim?n Bol?var Sede Santa Ana, del Guamo ?Tolima?, pretende observar y analizar el proceso ense?anza- aprendizaje en el desarrollo de la competencia textual por parte de los estudiantes antes mencionados, as? como la pertinencia de la evaluaci?n formativa en los procesos acad?micos que se llevan a cabo en la educaci?n de nuestro pa?s. Para esto se opt? por un enfoque cualitativo descriptivo mediante el cual se identificaron las falencias de los estudiantes sujetos de estudio para la elaboraci?n de textos escritos, por medio de una r?brica que permiti? analizar su desempe?o de forma gradual de acuerdo a los ejercicios realizados para tal fin. Palabras clave: evaluaci?n formativa, ense?anza, aprendizaje, competencia textual.The present investigation entitled ?Incidencia de la evaluaci?n formativa en el desarrollo de la competencia textual en los estudiantes del grado 5? de la Instituci?n Educativa T?cnica Industrial Sim?n Bol?var Sede Santa Ana, del Guamo ?Tolima?, aims to observe and analyze the teaching-learning process in the development of textual competence by the aforementioned students, as well as the relevance of the formative evaluation in such processes. For this, a qualitative descriptive approach was chosen, through which the flaws of the students? subject of study in the elaboration of written texts were identified, by means of instruments elaborated for that purpose. Keywords: formative evaluation, teaching, learning, textual competence

La ODA como estrategia pedag?gica para fortalecer la comprensi?n lectora, en los estudiantes de grado s?ptimo de la instituci?n educativa departamental Gustavo Uribe Ram?rez, ubicada en el municipio de Granada Cundinamarca

184 p. Recurso Electr?nicoEl presente proyecto de intervenci?n tiene como objetivo utilizar el subg?nero l?rico de la Oda como estrategia pedag?gica para fortalecer la comprensi?n lectora en estudiantes del grado s?ptimo de la INSTITUCI?N EDUCATIVA DEPARTAMENTAL GUSTAVO URIBE RAM?REZ, ubicada en el municipio de Granada Cundinamarca. Esta l?nea de acci?n surge de la observaci?n y an?lisis realizado, donde se identific? como problem?tica principal que el estudianteno entiende lo que lee, en consecuencia, no es capaz de comprender la tem?tica del texto, adem?s las estrategias del docente son poco llamativas. Metodol?gicamente esta investigaci?n se enmarca dentro del paradigma cualitativo, teniendo como base la IAP (investigaci?n acci?n participativa), debido a que el proceso ense?anza aprendizaje de la lectura significa el hecho de intercambiar y capturar experiencias en el lenguaje de los propios individuos, cu?les son susintereses y qu? implica el comprender la situaci?n y las condiciones del investigado. Para determinar la problem?tica y siguiendo la metodolog?a investigativa se llev? un proceso secuencial que permiti? obtener informaci?n: el Diario de campo dio vista global, el estudio de caso estableci? problem?ticas generales, la entrevista ampli? la magnitud del problema y el grupo focal determin? la falencia a fortalecer. El uso del subg?nero l?rico de la Oda es unametodolog?a innovadora; es un tipo de texto que requiere de una lectura inferencial para determinar el verdadero sentido de lo que est? plasmado, adem?s por su gran variedad de tem?ticas, contextos y estilos, permite el trabajo din?mico mediante nuevas estrategias que logran captar la atenci?n del estudiante. Palabras clave:Oda, poes?a, comprensi?n lectora, l?rica, pedagog?a, IAP, intervenci?n, interacci?n, comunicaci?n, lectura, educaci?n, estrategia.The present project of intervention has as aim use the lyric subkind of the Ode as pedagogic strategy to strengthen the reading comprehension in students of the seventh degree of the EDUCATIONAL DEPARTMENTAL INSTITUTION GUSTAVO URIBE RAMIREZ, located in the municipality of Granada Cundinamarca. This line of action arises from the observation and realized analysis, where there was identified as principal problematic that the student does not understand what he reads, in consequence, is not capable of understanding the subject matter of the text, in addition the slightly showy strategies of the educational sound. Methodologically this investigation places inside the qualitative paradigm, having as base the IAP (investigation participative action), due to the fact that the process education learning of the reading means the fact of exchanging and capturing experiences in the language of the own individuals, which are his interests and what implies understanding the situation and the conditions of the investigated one. To determine the problematic and following the methodology investigative one took a sequential process that allowed obtaining information: the Field diary gave global sight, the study of case established problematic personal details, the interview extended the magnitude of the problem and the focal group determined the failing to strengthen The use of the lyric subkind of the Ode is an innovative methodology; it is a type of text that it needs of a reading inferential to determine the real sense of what is formed, in addition for his great variety of subject matters, contexts and styles, allows the dynamic work by means of new strategies that manage to catch the attention of the student. Keywords: Ode, poetry, reading, lyric comprehension, pedagogy, IAP, intervention, interaction, communication, reading, education, strategy

Plan de negocios para la implementaci?n de un servicio de hospitalizaci?n domicilaria en el ?mbito de Lima Metropolitana

La creaci?n de HaD (Hospitalizaci?n a Domicilio) es un modelo de negocio innovador y pionero en nuestro pa?s, contribuyendo a solucionar un problema serio en el sector salud, como es una alta demanda de camas hospitalarias y un d?ficit de las mismas. El presente plan de negocios demuestra que nuestra empresa es viable, de acuerdo a las oportunidades del entorno y la propuesta del servicio, generando ventajas competitivas para satisfacer la demanda actual de los pacientes en Lima. El estudio de mercado realizado ha determinado que 60% de los encuestados tomar?a el servicio, la principal preocupaci?n de los encuestados es la seguridad y el punto cr?tico y de mayor preocupaci?n para los prestadores es el servicio de emergencia. Se opt? por la estrategia de operaciones de diferenciaci?n del Servicio, considerando los siguientes atributos: Seguridad en la atenci?n de salud de la hospitalizaci?n a domicilio, calidad en la atenci?n, servicio oportuno de hospitalizaci?n a domicilio versus la hospitalizaci?n convencional los cuales buscan garantizar la posici?n corporativa de la empresa. En cuanto a los costos en relaci?n a la hospitalizaci?n convencional supone un ahorro para el pagador del 30% s?lo en hoteler?a y servicios m?dicos, lo cual le supone una ventaja frente a la hospitalizaci?n convencional. La estrategia de Marketing ser? B2B, y se desarrollar?n estrategias conforme el servicio se posicione en el mercado. La propaganda se entregar? fundamentalmente de forma directa a los clientes y se realizar? reuniones de trabajo y venta del servicio con las IAFAS

Bacterial behavior on coated porous titanium substrates for biomedical applications

In this work, bacterial behavior on dense and porous titanium substrates is discussed. Porous titanium was fabricated by a space holder technique using 50 vol , NH4HCO3 with particle sizes between 250 and 355 amp; 956;m . These substrates were coated by sulfonated PEEK termed SPEEK . Characterization of the porous substrate was carried out using the Archimedes Method, Image Analysis, and three dimensional X ray Micro Computed Tomography including total and interconnected porosity, equivalent diameter, and pore shape factor , as well as mechanical characterization specifically stiffness and yield strength . A detailed study was performed here to investigate the influence of substrate porosity on the adhesion and proliferation of E. coli, MRSA, and P. aeruginosa common causes of orthopedic device associated infections . Bacterial colonization was examined in terms of the initial bacterial concentration, as well as bacterial adherence to and growth on the surface and inside the pores. Results suggest that fully dense titanium supported the least bacterial colonization, while the porous titanium promoted bacterial growth in the medium and inside the cavities. Furthermore, the SPEEK coating deposited onto the samples inhibited bacteria growth inside the porous materials. In this manner, this study showed for the first time that SPEEK could have potential antibacterial properties to offset the increase in bacteria growth commonly observed in porous material

Anti-tumour necrosis factor discontinuation in inflammatory bowel disease patients in remission: study protocol of a prospective, multicentre, randomized clinical trial

Background: Patients with inflammatory bowel disease who achieve remission with anti-tumour necrosis factor (anti-TNF) drugs may have treatment withdrawn due to safety concerns and cost considerations, but there is a lack of prospective, controlled data investigating this strategy. The primary study aim is to compare the rates of clinical remission at 1?year in patients who discontinue anti-TNF treatment versus those who continue treatment. Methods: This is an ongoing, prospective, double-blind, multicentre, randomized, placebo-controlled study in patients with Crohn?s disease or ulcerative colitis who have achieved clinical remission for ?6?months with an anti-TNF treatment and an immunosuppressant. Patients are being randomized 1:1 to discontinue anti-TNF therapy or continue therapy. Randomization stratifies patients by the type of inflammatory bowel disease and drug (infliximab versus adalimumab) at study inclusion. The primary endpoint of the study is sustained clinical remission at 1?year. Other endpoints include endoscopic and radiological activity, patient-reported outcomes (quality of life, work productivity), safety and predictive factors for relapse. The required sample size is 194 patients. In addition to the main analysis (discontinuation versus continuation), subanalyses will include stratification by type of inflammatory bowel disease, phenotype and previous treatment. Biological samples will be obtained to identify factors predictive of relapse after treatment withdrawal. Results: Enrolment began in 2016, and the study is expected to end in 2020. Conclusions: This study will contribute prospective, controlled data on outcomes and predictors of relapse in patients with inflammatory bowel disease after withdrawal of anti-TNF agents following achievement of clinical remission. Clinical trial reference number: EudraCT 2015-001410-1

Preliminary safety and efficacy of first-line pertuzumab combined with trastuzumab and taxane therapy for HER2-positive locally recurrent or metastatic breast cancer (PERUSE).

BACKGROUND: Pertuzumab combined with trastuzumab and docetaxel is the standard first-line therapy for HER2-positive metastatic breast cancer, based on results from the phase III CLEOPATRA trial. PERUSE was designed to assess the safety and efficacy of investigator-selected taxane with pertuzumab and trastuzumab in this setting. PATIENTS AND METHODS: In the ongoing multicentre single-arm phase IIIb PERUSE study, patients with inoperable HER2-positive advanced breast cancer (locally recurrent/metastatic) (LR/MBC) and no prior systemic therapy for LR/MBC (except endocrine therapy) received docetaxel, paclitaxel or nab-paclitaxel with trastuzumab [8\u2009mg/kg loading dose, then 6\u2009mg/kg every 3\u2009weeks (q3w)] and pertuzumab (840\u2009mg loading dose, then 420\u2009mg q3w) until disease progression or unacceptable toxicity. The primary end point was safety. Secondary end points included overall response rate (ORR) and progression-free survival (PFS). RESULTS: Overall, 1436 patients received at least one treatment dose (initially docetaxel in 775 patients, paclitaxel in 589, nab-paclitaxel in 65; 7 discontinued before starting taxane). Median age was 54\u2009years; 29% had received prior trastuzumab. Median treatment duration was 16\u2009months for pertuzumab and trastuzumab and 4\u2009months for taxane. Compared with docetaxel-containing therapy, paclitaxel-containing therapy was associated with more neuropathy (all-grade peripheral neuropathy 31% versus 16%) but less febrile neutropenia (1% versus 11%) and mucositis (14% versus 25%). At this preliminary analysis (52 months' median follow-up), median PFS was 20.6 [95% confidence interval (CI) 18.9-22.7] months overall (19.6, 23.0 and 18.1\u2009months with docetaxel, paclitaxel and nab-paclitaxel, respectively). ORR was 80% (95% CI 78%-82%) overall (docetaxel 79%, paclitaxel 83%, nab-paclitaxel 77%). CONCLUSIONS: Preliminary findings from PERUSE suggest that the safety and efficacy of first-line pertuzumab, trastuzumab and taxane for HER2-positive LR/MBC are consistent with results from CLEOPATRA. Paclitaxel appears to be a valid alternative taxane backbone to docetaxel, offering similar PFS and ORR with a predictable safety profile. CLINICALTRIALS.GOV: NCT01572038

Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND: The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. METHODS: Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. RESULTS: Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). CONCLUSION: Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery