Impact of comorbidities on hospital mortality in patients with acute pancreatitis : a population-based study of 110,021 patients

The impact of pre-existing comorbidities on acute pancreatitis (AP) mortality is not clearly defined. Our study aims to determine the trend in AP hospital mortality and the role of comorbidities as a predictor of hospital mortality. We analyzed patients aged ≥ 18 years hospitalized with AP diagnosis between 2016 and 2019. The data have been extracted from the Spanish National Hospital Discharge Database of the Spanish Ministry of Health. We performed a univariate and multivariable analysis of the association of age, sex, and comorbidities with hospital mortality in patients with AP. The role of the Charlson and Elixhauser comorbidity indices as predictors of mortality was evaluated. A total of 110,021 patients diagnosed with AP were hospitalized during the analyzed period. Hospital mortality was 3.8%, with a progressive decrease observed in the years evaluated. In multivariable analysis, age ≥ 65 years (OR: 4.11, p 1.5 (OR: 2.03, p 1.5 (OR: 2.71, p < 0.001) comorbidity indices were also independently associated with mortality, and ROC curve analysis showed that they are useful for predicting hospital mortality. Advanced age, heart disease, renal disease, moderate-severe liver disease, peripheral vascular disease, and cerebrovascular disease before admission were independently associated with hospital mortality. The Charlson and Elixhauser comorbidity indices are useful for predicting hospital mortality in AP patients. The online version contains supplementary material available at 10.1186/s12876-023-02730-6

Incorporació de dades 3D en visors web : desenvolupament d'una app corporativa per al Consorci del Besòs

Aquest projecte final ha consistit en la creació d'un primer prototip d'una App webmapping que permet visualitzar i consultar un model urbà 3D dels edificis de l'àmbit territorial del Consorci del Besòs, així com també visualitzar l'àmbit dels projectes del consorci i els directoris que contenen la documentació. Tant el buscador de projectes com el model 3D són anteriors a aquesta aplicació, fruit de 2 Treballs Finals de Màster posteriorment explicats amb més detall. Es tracta d'una aplicació pensada per a ser utilitzada a nivell intern dins el Consorci, essent una eina que permeti als tècnics poder situar els projectes en un entorn molt més ric i comprensible, com és el 3D. Durant el desenvolupament de l'app s'han fet anar diverses tecnologies, triant finalment utilitzar una aplicació web basada en HTML, CSS i les llibreries Cesium.js. i Sheet.js. Cesium és una biblioteca de codi obert de JavaScript que proporciona per defecte un visor amb globus 3D i multitud de capes cartogràfiques. Permet continguts tant dinàmics com estàtics i suporta multitud de formats com KML, JSON o 3D TILES. Partint d'un model Multipatch d'ESRI (.SHP), s'ha convertit a 3D TILES i a través d'aquesta llibreria s'ha carregat, situant-lo en un entorn cartogràfic 3D, simbolitzant-lo i fent-lo consultable. També s'han carregat els àmbits dels projectes i l'àmbit que avarca consorci. La llibreria Sheet.js permet llegir arxius d'Excel com una variable JSON. El consorci emmagatzema tota la informació en una unitat de xarxa interna de l'oficina, i en una taula d'Excel es registren tots els projectes, amb el nom, l'ID o municipi, però també amb les rutes URL cap a cada directori de la xarxa interna on hi ha les fotos, la documentació tècnica o l'estat del treball. Quan es troba un projecte, apareix una sèrie d'icones que permeten accedir a diferent documentació o visualitzar l'àmbit en el mapa. En aquesta part del projecte s'ha modificat el buscador per a que l'àmbit sigui compatible amb el nou mapa de Cesium. En aquest projecte, les principals dificultats han residit en adaptar el treball previ per assolir els objectiu propis d'aquesta aplicació. Aprendre com fer compatible el model Multipatch d'ESRI a Cesium.js, o adaptar el buscador per a que pugui treballar amb el mapa de Cesium.js han estat les tasques que han ocupat més temps. També Cesium.js en sí -tractant-se d'una llibreria relativament jove i amb una documentació a vegades discreta- ha portat alguns problemes d'execució més endavant explicatsEste proyecto final ha consistido en la creación de un primer prototipo de una App webmapping que permite visualizar y consultar un modelo urbano 3D de los edificios del ámbito territorial del Consorcio del Besòs, así como también visualizar el ámbito de los proyectos del consorcio y los directorios que contienen la documentación. Tanto el buscador de proyectos como el modelo 3D son anteriores a esta aplicación, fruto de 2 Trabajos Finales de Máster posteriormente explicados con más detalle. Se trata de una aplicación pensada para ser utilizada a nivel interno dentro del Consorcio, siendo una herramienta que permita a los técnicos poder situar los proyectos en un entorno mucho más rico y comprensible, como es el 3D. Durante el desarrollo de la app se han utilizado diferentes tecnologías, eligiendo finalmente utilizar una aplicación web basada en HTML, CSS y las librerías Cesium.js. y Sheet.js. Cesium es una biblioteca de código abierto de JavaScript que proporciona por defecto un visor con globo 3D y multitud de capas cartográficas. Permite contenidos tanto dinámicos como estáticos y soporta multitud de formatos como KML, JSON o 3D TILES. Partiendo de un modelo Multipatch de ESRI (.shp), se ha convertido a 3D TILES y a través de esta librería se ha cargado, situándose en un entorno cartográfico 3D, simbolizándolo y haciéndolo consultable. También se han cargado los ámbitos de los proyectos y el ámbito que abarca el consorcio. La librería Sheet.js permite leer archivos de Excel como una variable JSON. El consorcio almacena toda la información en una unidad de red interna de la oficina, y en una tabla de Excel se registran todos los proyectos, con el nombre, el ID o municipio, pero también con las rutas URL hacia cada directorio de la red interna donde están las fotos, la documentación técnica o el estado del trabajo. Cuando se encuentra un proyecto, aparece una serie de iconos que permiten acceder a diferente documentación o visualizar el ámbito en el mapa. En esta parte del proyecto se ha modificado el buscador para que el ámbito sea compatible con el nuevo mapa de Cesium. En este proyecto, las principales dificultades han residido en adaptar el trabajo previo para alcanzar los objetivos de esta aplicación. Aprender cómo hacer compatible el modelo Multipatch de ESRI a Cesium.js, o adaptar el buscador para que pueda trabajar con el mapa de Cesium.js han sido las tareas que han ocupado más tiempo. También Cesium.js en sí -tratando de una librería relativamente joven y con una documentación a veces discreta- ha llevado a algunos problemas de ejecución más adelante explicadosThis end-of-master project consisted in the creation of a first prototype of a webmapping application that allows visualizing and consulting a 3D urban model of the buildings belonging to the territorial scope of the Besòs Consortium, as well as visualizing the scope of the consortium's projects and also the directories that contain all project's documentation. Both the project search engine and the 3d model are prior to this application, being the result of 2 Master's Thesis later explained in more detail. It is an application designed to be used internally within the Consortium, being a tool that allows technicians to place projects in a much richer and understandable environment, such as 3D. During the development of the application several technologies have been tested, finally choosing an application based on HTML, CSS and the Cesium.js libraries and Sheet.js. Cesium is an open-source JavaScript library that offers by default a3D globe map and a multitude of cartographic layers. The contents, both dynamic and static, support a multitude of formats such as KML, JSON or 3D TILES. Starting from a Multipatch model of ESRI (.shp), it has been converted into 3D TILES and through this library it has been loaded, situating itself in a 3D cartographic environment, symbolizing what can be consulted. The scope of the projects and the consortium scope have also been loaded. The Sheet.js library allows you to read Excel files as a JSON variable. The consortium stores all the information in an internal network unit of the office, and in an Excel table all the projects are registered, with the name, ID or municipality, but also with the URL routes to each directory of the internal network where are the photos, the technical documentation or the status of the work. When a project is found, a series of icons appears that allow the access to different documentation or visualize the scope on the map. In this part of the project the search engine has been modified so that the scope appears on the new Cesium map. In this project, the main difficulties have been to adapt the previous work in order to achieve the objectives of this application. Learn how to make the Multipatch ESRI model compatible with Cesium.js, or adapt the search engine so that you can work with the Cesium.js map have been the tasks that have taken up most of the time. Also, Cesium.js itself - being a relatively young library and having a lack of documentation in some cases- has led to some execution problems later explaine

The role of clinically relevant intra-abdominal collections after pancreaticoduodenectomy

Pancreatectomy complications; Pancreatic fistula; Postoperative collectionsComplicaciones de pancreatectomía; Fístula pancreática; Colecciones postoperatoriasComplicacions de pancreatectomia; Fístula pancreàtica; Col·leccions postoperatòriesBackground There is controversial evidence regarding the impact of clinically relevant postoperative intra-abdominal collections (CR-IC) on the clinical course after pancreaticoduodenectomy. C-reactive Protein (CRP) has been validated as a predictor of postoperative pancreatic fistula (POPF). Still, its role in predicting CR-IC has not been studied. Methods A retrospective analysis was conducted on patients who underwent PD at a tertiary hospital between October 2012 and October 2017. The incidence of CR-IC, clinically relevant POPF and other complications, as well as mortality and length of hospitalisation, was retrieved. The impact of CR-IR on mortality and major complications was analysed. The serum CRP levels were retrieved on the third and fifth postoperative days (POD3 and POD5), followed by an analysis of sensitivity, specificity, and area under the curve to predict CR-IC using CRP. Results One hundred forty patients were enrolled following inclusion and exclusion criteria. The mean age was 66.5 years (15–83). The incidence of CR-IC was 33.7% (47), and CR-POPF was 24.3%. Pancreatic duct diameter ≤ 4 mm was identified as a risk factor related to CR-IC occurrence. The group of patients who developed CR-IC after PD exhibited a higher rate of complications Clavien-Dindo ≥ III compared to patients without CR-IC (40.4% vs 7.5%, p  III: OR = 10.6 (95% CI: 3.90–28.7). No differences in mortality were reported between the CR-IC group and non-CR-IC group. CRP at postoperative day 3 (POD3) > 17.55 mg/dl and CRP at postoperative day 5 (POD5) > 13.46 mg/dl were predictors of CR-IC (AUC: 0.731 and AUC:0.821, respectively). Conclusions CR-IC has a significant impact after pancreaticoduodenectomy and is associated with a higher incidence of Clavien-Dindo ≥ III complications. Additionally, CRP levels at POD3 and POD5 play a role in predicting CR-IC. Prospective studies are essential to explore strategies for mitigating the occurrence of CR-IC after PD.Open Access Funding provided by Universitat Autonoma de Barcelona

Motores alternativos de combustión interna

Motores alternativos de combustión interna ha sido concebido para proporcionar al lector una visión general de las diferentes partes y subsistemas de los motores alternativos de combustión interna, tanto de aplicación a plantas de tracción motriz para vehículos como a plantas estacionarias para generación de energía eléctrica. Su objetivo básico es cubrir las necesidades bibliográficas para el seguimiento de las asignaturas Ingeniería y Máquinas Térmicas y Ampliación de Motores Térmicos, que se imparten en las escuelas de ingeniería industrial. Asimismo, pretende ofrecer una visión horizontal de las diferentes partes y subsistemas que conforman la máquina alternativa de combustión interna. Los tres primeros capítulos introducen al lector en la problemática de la transformación de energía desde una fuente primaria hasta su forma final en trabajo mecánico en un eje de rotación. En los capítulos siguientes, se analizan los aspectos concretos de la máquina alternativa que nos ocupa, que, dado su funcionamiento pulsante, se estructuran en una fase cerrada, en la que el volumen del cilindro está cerrado al exterior y se desarrollan los procesos para la generación de trabajo (compresión, aportación de calor y expansión), y una fase abierta, en la que el volumen del cilindro está abierto al exterior para realizar los procesos de renovación de la carga; ambas fases se dan tanto en los motores de encendido por compresión (MEC) como en los de encendido por chispa (MEP). Los capítulos finales ofrecen una visión mecánica del mecanismo transformador utilizado en los que se describe su arquitectura mecánica y el detalle de su funcionamiento

Pancreatic cancer risk in relation to lifetime smoking patterns, tobacco type, and dose-response relationships.

BACKGROUND: Despite smoking being a well-established risk factor for pancreatic cancer (PC), there is a need to further characterize PC risk according to lifespan smoking patterns and other smoking features. Our aim was to deeply investigate them within a large European case-control study. METHODS: Tobacco smoking habits and other relevant information was obtained from 2,009 cases and 1,532 controls recruited in the PanGenEU study using standardized tools. Multivariate logistic regression analysis was performed to evaluate PC risk by smoking characteristics and interactions with other PC risk factors. Fractional polynomials and restricted cubic splines were used to test for non-linearity of the dose-response relationships and to analyse their shape. RESULTS: Relative to never-smokers, current smokers (OR=1.72, 95%CI: 1.39-2.12), those inhaling into the throat (OR=1.48, 95%CI: 1.11-1.99), chest (OR=1.33, 95%CI: 1.12-1.58), or using non-filtered cigarettes (OR=1.69, 95%CI: 1.10-2.61), were all at an increased PC risk. PC risk was highest in current black tobacco smokers (OR=2.09, 95%CI: 1.31-3.41), followed by blond tobacco smokers (OR=1.43, 95%CI: 1.01-2.04). Childhood exposure to tobacco smoke relative to parental smoking was also associated with increased PC risk (OR=1.24, 95%CI: 1.03-1.49). Dose-response relationships for smoking duration, intensity, cumulative dose, and smoking cessation were non-linear and showed different shapes by tobacco type. Effect modification by family history of PC and diabetes was likely. CONCLUSIONS: This study reveals differences in PC risk by tobacco type and other habit characteristics, as well as non-linear risk associations. IMPACT: This characterization of smoking-related PC risk profiles may help in defining PC high-risk populations

A multilayered post-GWAS assessment on genetic susceptibility to pancreatic cancer

Funder: Fundación Científica Asociación Española Contra el Cáncer (ES)Funder: Cancer Focus Northern Ireland and Department for Employment and LearningFunder: Intramural Research Program of the Division of Cancer Epidemiology and Genetics, National Cancer Institute, USAAbstract: Background: Pancreatic cancer (PC) is a complex disease in which both non-genetic and genetic factors interplay. To date, 40 GWAS hits have been associated with PC risk in individuals of European descent, explaining 4.1% of the phenotypic variance. Methods: We complemented a new conventional PC GWAS (1D) with genome spatial autocorrelation analysis (2D) permitting to prioritize low frequency variants not detected by GWAS. These were further expanded via Hi-C map (3D) interactions to gain additional insight into the inherited basis of PC. In silico functional analysis of public genomic information allowed prioritization of potentially relevant candidate variants. Results: We identified several new variants located in genes for which there is experimental evidence of their implication in the biology and function of pancreatic acinar cells. Among them is a novel independent variant in NR5A2 (rs3790840) with a meta-analysis p value = 5.91E−06 in 1D approach and a Local Moran’s Index (LMI) = 7.76 in 2D approach. We also identified a multi-hit region in CASC8—a lncRNA associated with pancreatic carcinogenesis—with a lowest p value = 6.91E−05. Importantly, two new PC loci were identified both by 2D and 3D approaches: SIAH3 (LMI = 18.24), CTRB2/BCAR1 (LMI = 6.03), in addition to a chromatin interacting region in XBP1—a major regulator of the ER stress and unfolded protein responses in acinar cells—identified by 3D; all of them with a strong in silico functional support. Conclusions: This multi-step strategy, combined with an in-depth in silico functional analysis, offers a comprehensive approach to advance the study of PC genetic susceptibility and could be applied to other diseases

Cerimònia d'investidura de doctor 'honoris causa' a Peter J. Balsells

Acte acadèmic d’investidura del Dr. Peter J. Balsells com el 23è doctor honoris causa de la UdG, acte presidit pel rector de la UdG, Sergi Bonet. El director de l’Escola Politècnica Superior i padrí del doctorand, Joaquim Salvi, va elogiar la figura de Balsells i va desgranar tots els detalls de la seva intensa biografia que l’han fet mereixedor del màxim reconeixement acadèmic de la institució universitària. El secretari general en funcions, Ricard Rigall, i la presidenta del Consell Social de la UdG també vàren participar en la cerimònia acadèmica. En els seu discurs, el rector ha destacat el compromís amb la societat del Dr. Balsells i que “els somnis només es fan realitat quan passió i professionalitat van lligades”. El Dr. Balsells, d’altra banda, s’ha mostrat “profundament agraït” pel reconeixement i ha declarat viure “un dia de somni”. La concessió del Doctorat Honoris Causa a Pere Balsells i Jofre va ser aprovada pel Consell de Govern a proposta de la Comissió de Govern de l’Escola Politècnica Superior, per la seva contribució al progrés de la tecnologia, pel seu mestratge en els camps de la seva especialitat, pel seu generós mecenatge a la Universitat de Girona i pels seus valors d’humanitat, humilitat i estima envers el nostre paí

The role of high serum triglyceride levels on pancreatic necrosis development and related complications

The relevance of elevated serum triglyceride (TG) levels in the early stages of acute pancreatitis (AP) not induced by hypertriglyceridemia (HTG) remains unclear. Our study aims to determine the role of elevated serum TG levels at admission in developing pancreatic necrosis. We analyzed the clinical data collected prospectively from patients with AP. According to TG levels measured in the first 24 h after admission, we stratified patients into four groups: Normal TG (< 150 mg/dL), Borderline-high TG (150-199 mg/dL), High TG (200-499 mg/dL) and Very high TG (≥ 500 mg/dL). We analyzed the association of TG levels and other risk factors with the development of pancreatic necrosis. A total of 211 patients were included. In the Normal TG group: 122, in Borderline-high TG group: 38, in High TG group: 44, and in Very high TG group: 7. Pancreatic necrosis developed in 29.5% of the patients in the Normal TG group, 26.3% in the Borderline-high TG group, 52.3% in the High TG group, and 85.7% in the Very high TG group. The trend analysis observed a significant association between higher TG levels and pancreatic necrosis (p = 0.001). A multivariable analysis using logistic regression showed that elevated TG levels ≥ 200 mg/dL (High TG and Very high TG groups) were independently associated with pancreatic necrosis (OR: 3.27, 95% CI − 6.27, p < 0.001). An elevated TG level at admission ≥ 200 mg/dl is independently associated with the development of pancreatic necrosis. The incidence of pancreatic necrosis increases proportionally with the severity of HTG. The online version contains supplementary material available at 10.1186/s12876-023-02684-

Liquid biopsy after resection of pancreatic adenocarcinoma and its relation to oncological outcomes. : Systematic review and meta-analysis

It has been hypothesised that manipulation during surgery releases tumoral components into circulation. We investigate the effect of surgery on plasma-borne DNA biomarkers and the oncological outcomes in resectable pancreatic ductal adenocarcinoma (PDAC). We also compare non-touch isolation techniques (NTIT) with standard techniques. We performed a systematic review and a meta-analysis of studies analysing liquid biopsy as circulating tumour DNA (ctDNA), circulating tumour cells (CTCs), and messenger RNA (mRNA) in resectable PDAC patients who underwent surgery and its association with overall survival (OS) and disease-free survival (DFS). Research in EMBASE, Web of Science and PubMed was performed. The ctDNA shift negative-to-positive (ctDNA -/+) or ctDNA shift positive-to-negative (ctDNA +/-) before and after surgery was evaluated. Twelve studies comprising 413 patients were included. Shorter OS and DFS were identified in patients with positive ctDNA status before (HR = 2.28, p = 0.005 and HR = 2.16, p = 0.006) or after surgery (HR = 3.88, p < 0.0001 and HR = 3.81, p = 0.03), respectively. Surgical resection increased the rate of ctDNA +/-. There were no differences in OS or DFS in the ctDNA +/- group compared with ctDNA +/+ or ctDNA -/+. However, there was a trend to shorter OS in the ctDNA -/+ group (HR = 5.00, p = 0.09). No differences between NTIT and standard techniques on liquid biopsy status were found. Positive ctDNA in the perioperative period is associated with a worse prognosis. Surgical resection has a role in the negativisation of liquid biopsy status. More studies are needed to assess the potential of minimally invasive techniques on ctDNA dynamics