A standardized stepwise approach to minimally invasive ileocolic anastomosis: Tips and tricks for laparoscopic and robotic surgery

Aim Intracorporeal anastomosis has been associated with earlier recovery of postoperative bowel function, shorter length of stay and lower surgical site infection rates. The aim of this work is to describe a step-by-step standardized technique for intracorporeal ileocolic and ileosigmoid anastomosis suitable for laparoscopic and robotic colectomy. Method Each step of the technique is illustrated using a composite collection of three operative patient videos. Two procedures were performed robotically and one was laparoscopic. Tips are provided to construct a two-layer anastomosis (both posteriorly and anteriorly). The procedures are presented in stepwise fashion, discussing the advantages and feasibility of the technique. Results The standardized technique described herein was used in three patients for this report, of whom two underwent right colectomy and one subtotal colectomy for cancer. The median operating time was 255 (206-333) min. There were no intraoperative complications. No major postoperative complications or 30-day readmissions occurred. The median length of stay was 4 (3-5) days. Conclusion The described technique of a two-layer anastomosis can be used with any available minimally invasive approach. It is safe and feasible. Using a standardized approach, the technique can be easily taught and mastered, optimizing operating times and reducing adverse events

Leveraging a nationwide infection surveillance program to implement a colorectal surgical site infection reduction bundle: a pragmatic, prospective and multicentre cohort study

Background: Bundled interventions usually reduce surgical site infection (SSI) when implemented at single hospitals, but the feasibility of their implementation at nationwide level and their clinical results are not well established. Materials and methods: Pragmatic interventional study to analyse the implementation and outcomes of a colorectal surgery care bundle within a nationwide quality improvement program. The bundle consisted of: antibiotic prophylaxis, oral antibiotic prophylaxis (OAP), mechanical bowel preparation (MBP), laparoscopy, normothermia, and a wound retractor. Control (CG) and Intervention (IG) groups were compared. Overall SSI, superficial (S-SSI), deep (D-SSI) and organ/space (O/S-SSI) rates were analysed. Secondary endpoints included microbiology, 30-day mortality and hospital stay (LOS). Results: A total of 37,849 procedures were included, 19,655 in the CG and 18,194 in the IG. In all, 5,462 SSIs (14.43%) were detected: 1,767 S-SSI (4.67%), 847 D-SSI (2.24%) and 2,838 O/S-SSI (7.5%). Overall SSI fell from 18.38% (CG) to 10.17% (IG), OR 0.503, [0.473-0.524]. O/S-SSI rates were 9.15% (CG) and 5.72% (IG), OR 0.602, [0.556-0.652]. The overall SSI rate was 16.71% when no measure was applied and 6.23% when all six were used. Bundle implementation reduced the probability of overall SSI (OR 0.331; CI95 0.242, 0.453), and also O/S-SSI rate (OR 0.643; CI95 0.416, 0.919). In the univariate analysis, all measures except normothermia were associated with a reduction in overall SSI, while only laparoscopy, OAP, and MBP were related with a decrease in O/S-SSI. Laparoscopy, wound retractor and OAP decreased overall SSI and O/S-SSI in the multivariate analysis. Conclusions: In this cohort study, the application of a specific care bundle within a nationwide nosocomial infection surveillance system proved feasible, and resulted in a significant reduction in overall and O/S-SSI rates in elective colon and rectal surgery. The OR for SSI fell between 1.5 and 3 times after the implementation of the bundle

Multicentre, randomised, single-blind, parallel group trial to compare the effectiveness of a Holter for Parkinson's symptoms against other clinical monitoring methods: study protocol

Introduction In recent years, multiple studies have aimed to develop and validate portable technological devices capable of monitoring the motor complications of Parkinson's disease patients (Parkinson's Holter). The effectiveness of these monitoring devices for improving clinical control is not known. Methods and analysis This is a single-blind, cluster-randomised controlled clinical trial. Neurologists from Spanish health centres will be randomly assigned to one of three study arms (1:1:1): (a) therapeutic adjustment using information from a Parkinson?s Holter that will be worn by their patients for 7 days, (b) therapeutic adjustment using information from a diary of motor fluctuations that will be completed by their patients for 7 days and (c) therapeutic adjustment using clinical information collected during consultation. It is expected that 162 consecutive patients will be included over a period of 6 months. The primary outcome is the efficiency of the Parkinson?s Holter compared with traditional clinical practice in terms of Off time reduction with respect to the baseline (recorded through a diary of motor fluctuations, which will be completed by all patients). As secondary outcomes, changes in variables related to other motor complications (dyskinesia and freezing of gait), quality of life, autonomy in activities of daily living, adherence to the monitoring system and number of doctor?patient contacts will be analysed. The noninferiority of the Parkinson's Holter against the diary of motor fluctuations in terms of Off time reduction will be studied as the exploratory objective. Ethics and dissemination approval for this study has been obtained from the Hospital Universitari de Bellvitge Ethics Committee. The results of this study will inform the practical utility of the objective information provided by a Parkinson's Holter and, therefore, the convenience of adopting this technology in clinical practice and in future clinical trials. We expect public dissemination of the results in 2022.Funding This work is supported by AbbVie S.L.U, the Instituto de Salud Carlos III [DTS17/00195] and the European Fund for Regional Development, 'A way to make Europe'

Healthcare workers hospitalized due to COVID-19 have no higher risk of death than general population. Data from the Spanish SEMI-COVID-19 Registry

Aim To determine whether healthcare workers (HCW) hospitalized in Spain due to COVID-19 have a worse prognosis than non-healthcare workers (NHCW). Methods Observational cohort study based on the SEMI-COVID-19 Registry, a nationwide registry that collects sociodemographic, clinical, laboratory, and treatment data on patients hospitalised with COVID-19 in Spain. Patients aged 20-65 years were selected. A multivariate logistic regression model was performed to identify factors associated with mortality. Results As of 22 May 2020, 4393 patients were included, of whom 419 (9.5%) were HCW. Median (interquartile range) age of HCW was 52 (15) years and 62.4% were women. Prevalence of comorbidities and severe radiological findings upon admission were less frequent in HCW. There were no difference in need of respiratory support and admission to intensive care unit, but occurrence of sepsis and in-hospital mortality was lower in HCW (1.7% vs. 3.9%; p = 0.024 and 0.7% vs. 4.8%; p<0.001 respectively). Age, male sex and comorbidity, were independently associated with higher in-hospital mortality and healthcare working with lower mortality (OR 0.211, 95%CI 0.067-0.667, p = 0.008). 30-days survival was higher in HCW (0.968 vs. 0.851 p<0.001). Conclusions Hospitalized COVID-19 HCW had fewer comorbidities and a better prognosis than NHCW. Our results suggest that professional exposure to COVID-19 in HCW does not carry more clinical severity nor mortality

Ciencia Odontológica 2.0

Libro que muestra avances de la Investigación Odontológica en MéxicoEs para los integrantes de la Red de Investigación en Estomatología (RIE) una enorme alegría presentar el segundo de una serie de 6 libros sobre casos clínicos, revisiones de la literatura e investigaciones. La RIE está integrada por cuerpos académicos de la UAEH, UAEM, UAC y UdeG

Profilaxis antibiótica endovenosa frente a oral más endovenosa en cirugía colónica : ensayo clínico prospectivo, aleatorizado, controlado y multicéntrico

Estudis previs han trobat que la preparació intestinal mecànica amb antibiòtics orals pot reduir la incidència d'infeccions de el lloc quirúrgic, però cap assaig controlat aleatoritzat ha avaluat els antibiòtics orals sols sense preparació intestinal mecànica. L'objectiu d'aquest estudi va ser determinar si la profilaxi amb antibiòtics orals el dia abans de la cirurgia electiva de còlon afecta la incidència d'infeccions postoperatòries de el lloc quirúrgic. En aquest assaig controlat aleatoritzat, pragmàtic i multicèntric, es va reclutar a pacients sotmesos a cirurgia de còlon de cinc grans hospitals d'Espanya i van participar 47 cirurgians colorectals d'aquests hospitals. Els pacients van ser elegibles per a la inclusió si se'ls va diagnosticar neoplàsia o malaltia diverticular i si estava indicada una resecció parcial de l'còlon o un colectomia total. Els participants van ser assignats a l'atzar (1: 1) mitjançant taules d'assignació a l'atzar en línia per a ja sigui l'administració d'antibiòtics orals el dia abans de la cirurgia (grup experimental) o la no administració d'antibiòtics orals abans de la cirurgia (grup de control). Per al grup experimental, es va administrar ciprofloxacina 750 mg cada 12 h (dues dosis a les 12 h i 00 h) i metronidazol 250 mg cada 8 h (tres dosis a les 12h, 18h i 00 h) el dia abans de la cirurgia. Tots els pacients van rebre cefuroxima 1 · 5 g i metronidazole 1 g per via intravenosa en el moment de la inducció anestèsica. El resultat primari va ser la incidència d'infeccions de el lloc quirúrgic. Els pacients van ser seguits durant 1 mes després de la cirurgia i es van registrar totes les complicacions postquirúrgiques. Entre el 2 de maig de 2015 i el 15 d'abril de 2017, avaluem 582 pacients per determinar la seva elegibilitat, dels quals 565 van ser elegibles i assignats a l'atzar per no rebre antibiòtics orals (n = 282) o rebre antibiòtics orals (n = 282) abans de la cirurgia. Posteriorment es van excloure 13 participants del grup de control i 16 de el grup experimental; 269 participants en el grup de control i 267 en el grup experimental van rebre la seva intervenció assignada. La incidència d'infeccions de el lloc quirúrgic en el grup control (30 [11%] de 269) va ser significativament més gran que en el grup experimental (13 [5%] de 267; prova de χ² p = 0 · 013). Els antibiòtics orals es van associar amb una reducció significativa en el risc d'infeccions de el lloc quirúrgic en comparació amb cap antibiòtic oral (odds ratio 0 · 41, IC de el 95%: 0 · 20-0 · 80; p = 0 · 008). Es van observar més complicacions (incloses infeccions de el lloc quirúrgic) en el grup de control que en el grup experimental (76 [el 28%] enfront de 51 [19%]; p = 0,017), tot i que no hi va haver diferències en la gravetat segons l'avaluació de puntuació de Clavien-Dindo. No es van observar diferències entre els grups en termes de complicacions locals, complicacions quirúrgiques o complicacions mèdiques que no estiguessin relacionades amb complicacions sèptiques. L'administració d'antibiòtics orals com a profilaxi el dia abans de la cirurgia de còlon redueix significativament la incidència d'infeccions de el lloc quirúrgic sense preparació mecànica de l'intestí i s'ha d'adoptar de forma rutinària abans de la cirurgia de còlon electiva.Estudios previos han encontrado que la preparación intestinal mecánica con antibióticos orales puede reducir la incidencia de infecciones del sitio quirúrgico, pero ningún ensayo controlado aleatorizado ha evaluado los antibióticos orales solos sin preparación intestinal mecánica. El objetivo de este estudio fue determinar si la profilaxis con antibióticos orales el día antes de la cirugía electiva de colon afecta la incidencia de infecciones posoperatorias del sitio quirúrgico. En este ensayo controlado aleatorizado, pragmático y multicéntrico, se reclutó a pacientes sometidos a cirugía de colon de cinco grandes hospitales de España y participaron 47 cirujanos colorrectales de estos hospitales. Los pacientes fueron elegibles para la inclusión si se les diagnosticó neoplasia o enfermedad diverticular y si estaba indicada una resección parcial del colon o una colectomía total. Los participantes fueron asignados al azar (1: 1) mediante tablas de asignación al azar en línea para ya sea la administración de antibióticos orales el día antes de la cirugía (grupo experimental) o la no administración de antibióticos orales antes de la cirugía (grupo de control). Para el grupo experimental, se administró ciprofloxacino 750 mg cada 12 h (dos dosis a las 12 h y 00 h) y metronidazol 250 mg cada 8 h (tres dosis a las 12h, 18 h y 00 h) el día antes de la cirugía. Todos los pacientes recibieron cefuroxima 1·5 g y metronidazol 1 g por vía intravenosa en el momento de la inducción anestésica. El resultado primario fue la incidencia de infecciones del sitio quirúrgico. Los pacientes fueron seguidos durante 1 mes después de la cirugía y se registraron todas las complicaciones posquirúrgicas. Entre el 2 de mayo de 2015 y el 15 de abril de 2017, evaluamos 582 pacientes para determinar su elegibilidad, de los cuales 565 fueron elegibles y asignados al azar para no recibir antibióticos orales (n = 282) o recibir antibióticos orales (n = 282) antes de la cirugía. Posteriormente se excluyeron 13 participantes del grupo de control y 16 del grupo experimental; 269 participantes en el grupo de control y 267 en el grupo experimental recibieron su intervención asignada. La incidencia de infecciones del sitio quirúrgico en el grupo control (30 [11%] de 269) fue significativamente mayor que en el grupo experimental (13 [5%] de 267; prueba de χ² p = 0 · 013). Los antibióticos orales se asociaron con una reducción significativa en el riesgo de infecciones del sitio quirúrgico en comparación con ningún antibiótico oral (odds ratio 0·41, IC del 95%: 0 · 20-0 · 80; p = 0 · 008). Se observaron más complicaciones (incluidas infecciones del sitio quirúrgico) en el grupo de control que en el grupo experimental (76 [28%] frente a 51 [19%]; p = 0,017), aunque no hubo diferencias en la gravedad según la evaluación de puntuación de Clavien-Dindo. No se observaron diferencias entre los grupos en términos de complicaciones locales, complicaciones quirúrgicas o complicaciones médicas que no estuvieran relacionadas con complicaciones sépticas. La administración de antibióticos orales como profilaxis el día antes de la cirugía de colon reduce significativamente la incidencia de infecciones del sitio quirúrgico sin preparación mecánica del intestino y debe adoptarse de forma rutinaria antes de la cirugía de colon electiva.Previous studies have found that mechanical bowel preparation with oral antibiotics can reduce the incidence of surgical-site infections, but no randomised controlled trial has assessed oral antibiotics alone without mechanical bowel preparation. The aim of this study was to determine whether prophylaxis with oral antibiotics the day before elective colon surgery affects the incidence of postoperative surgical-site infections. In this multicentre, pragmatic, randomised controlled trial, patients undergoing colon surgery were recruited from five major hospitals in Spain and 47 colorectal surgeons at these hospitals participated. Patients were eligible for inclusion if they were diagnosed with neoplasia or diverticular disease and if a partial colon resection or total colectomy was indicated. Participants were randomly assigned (1:1) using online randomisation tables to either administration of oral antibiotics the day before surgery (experimental group) or no administration of oral antibiotics before surgery (control group). For the experimental group, ciprofloxacin 750 mg was given every 12 h (two doses at 1200 h and 0000 h) and metronidazole 250 mg every 8 h (three doses at 1200 h, 1800 h, and 0000 h) the day before surgery. All patients were given intravenous cefuroxime 1·5 g and metronidazole 1 g at the time of anaesthetic induction. The primary outcome was incidence of surgical-site infections. Patients were followed up for 1 month after surgery and all postsurgical complications were registered. Between May 2, 2015, and April 15, 2017, we assessed 582 patients for eligibility, of whom 565 were eligible and randomly assigned to receive either no oral antibiotics (n=282) or oral antibiotics (n=282) before surgery. 13 participants in the control group and 16 in the experimental group were subsequently excluded; 269 participants in the control group and 267 in the experimental group received their assigned intervention. The incidence of surgical-site infections in the control group (30 [11%] of 269) was significantly higher than in the experimental group (13 [5%] of 267; χ² test p=0·013). Oral antibiotics were associated with a significant reduction in the risk of surgical-site infections compared with no oral antibiotics (odds ratio 0·41, 95% CI 0·20-0·80; p=0·008). More complications (including surgical-site infections) were observed in the control group than in the experimental group (76 [28%] vs 51 [19%]; p=0·017), although there was no difference in severity as assessed by Clavien-Dindo score. No differences were noted between groups in terms of local complications, surgical complications, or medical complications that were not related to septic complications. The administration of oral antibiotics as prophylaxis the day before colon surgery significantly reduces the incidence of surgical-site infections without mechanical bowel preparation and should be routinely adopted before elective colon surgery

Preoperative oral antibiotics with versus without mechanical bowel preparation to reduce surgical site infections following colonic resection: Protocol for an international randomized controlled trial (ORALEV2)

Surgical site infections (SSIs) are common after colonic surgery. SSIs can cause relevant morbidity and increase costs of care. Preoperative oral antibiotics can reduce the incidence of SSIs after resection of the colon, but the role of mechanical bowel preparation (MBP) is debated. This study aims to assess the impact of a combined regimen of oral antibiotics and MBP on SSIs after colonic surgery

Índice de velocidad de emergencia en líneas de maíz

The purpose of this study was to define a classification on the vigor of seeds, using the maize line emergence and germination speed rates, using four sample sizes. The experiment was carried out in the seeds laboratory of the Plant Breeding Department of the Chapingo Autonomous University. Line and hybrid maize seeds were used, provided by the Seeds Production Program of the Valley of Mexico Experimental Center, of the National Forestry, Agriculture and Livestock Institute. Emergence in sand, standard germination and accelerated aging were tested, using a complete cluster design at random, with four repetitions of 25, 50, 75 and 100 seeds. In each test, the germination and emergence were evaluated, along with length, dry weight of the aerial and radicle sections, and percent age of germination and emergence. A variation analysis, Tukey test for comparing averages (p¿ 0.05) and Pearson correlation test were carried out. To identify the maize lines with higher vigor using the estimated sample sizes, values above 3, 6, 10 and 13 are suggested as emergence rates in the sand test, in the standard germination and acceleration tests, values above 7, 14, 21 and 28 are suggested, and as germination rates, values of 9, 18, 31 and 42.El objetivo del presente estudio fue establecer una clasificación sobre el vigor de semillas mediante los í­ndices de velocidad de emergencia y germinación en lí­neas de maí­z, utilizando cuatro tamaños de muestra. El experimento se realizó en el laboratorio de semillas del Departamento de Fitotecnia de la Universidad Autónoma Chapingo. Se utilizaron semillas de lí­neas de maí­z proporcionados por el programa de producción de semillas del Campo Experimental Valle de México del Instituto Nacional de Investigaciones Forestales, Agrí­colas y Pecuarias. Se efectuaron pruebas de emergencia en arena, germinación estándar y envejecimiento acelerado bajo un diseño experimental de bloques completos al azar con cuatro repeticiones de 25, 50, 75 y 100 semillas. En cada prueba se evaluó el í­ndice de velocidad de germinación y emergencia, longitud, peso seco de la parte aérea y radí­cula, porcentaje de germinación y emergencia. Se hizo análisis de varianza, comparación de medias Tukey (p? 0.05) y prueba de correlación de Pearson. Para la identificación de líneas de maíz con alto vigor, con los tamaños de muestra estimados, en la prueba de arena se proponen como índices de velocidad de emergencia valores superiores a 3, 6, 10 y 13; en la prueba de germinación estándar y de envejecimiento acelerado, se proponen valores superiores a 7, 14, 21 y 28, y como índices de velocidad de germinación valores de 9, 18, 31 y 4

ELEMENTOS TEÓRICOS DE LA MEDICIÓN DEL CAPITAL INTELECTUAL. ¿CUADRO DE MANDO INTEGRAL?

En la actualidad las Organizaciones buscan cada vez con mayor necesidad formas de gestionar sus Recursos Humanos a través de vías más efectivas con el fin de perfeccionar la gestión de los mismos a tono con las exigencias del mundo de hoy. Los planteamientos resumidos en el informe del Massachusetts Institute of Technology, titulado “Retos gerenciales para los años 90”; indica que los directivos de las empresas estarían ciegos si no entendieran que el mensaje más importante de los años 90 es que el desafío más significativo está relacionado con las personas y no con la tecnología.Gestión del Conocimiento, Capital Intelectual, Cuadro de Mando Integral

Comparison of analytical methods for measuring proanthocyanidins in wines and their relationship with perceived astringency

Artículo de publicación ISIThe concentration of proanthocyanidins from twenty red wines from cv. Cabernet Sauvignon, five ros e wines from cv. Cabernet Sauvignon and five white wines from cv. Sauvignon Blanc was quantified using four analytical methodologies, and their relationship with the perceived astringency was investigated. Proanthocyanidin concentrations were determined by a methylcellulose precipitation assay, a protein precipitation assay and two colourimetric methods (Bate-Smith and vanillin assay). The four methodologies showed high repeatability but differed widely in proanthocyanidin concentrations. The methylcellulose and protein precipitation assays could not quantify proanthocyanidins in ros e and white wines. The protein precipitation assay gave the lowest concentration of proanthocyanidins in all of the red wines. The methylcellulose precipitation assay (r = 0.7725; r2 = 0.59) and the protein precipitation assay (r = 0.6828; r2 = 0.47) showed a strong correlation with the perceived astringency compared with the colourimetric methods. The strong correlation of the methylcellulose precipitation method with the perceived astringency could be a useful tool to estimate red wine astringency