Estudio comparativo de casos y controles concurrentes entre hernioplastia intraperitoneal laparoscópica y hernioplastia intraperitoneal abierta

ResumenIntroducciónLa hernioplastia incisional laparoscópica en casos seleccionados presenta evidentes ventajas en términos de recuperación posoperatoria y complicaciones, y es comparable en términos de recurrencia; sin embargo, esta técnica no constituye la técnica de elección en la reparación de las hernias incisionales. En el presente estudio proponemos la hernioplastia laparoscópica como la técnica de elección en hernias incisionales primarias de la línea media supraumbilical con un anillo herniario no mayor de 10cm sin pérdida de domicilio.Pacientes y métodoEstudio prospectivo descriptivo de casos y controles consecutivos seleccionados de pacientes operados de hernia incisional mediante técnica laparoscópica y técnica abierta, en cuyo seguimiento y evaluación se aplicaron instrumentos de medición de resultados y complicaciones, previamente descritos y validados, sin intervención directa en los resultados quirúrgicos de la muestra en estudio.ResultadosSe estudiaron 112 pacientes con hernias incisionales de tipo M2, de los cuales 28 fueron operados con cirugía laparoscópica y 84 con cirugía abierta. Ambos grupos fueron comparables en términos de características generales de los pacientes y de sus hernias. Las complicaciones fueron más frecuentes en el grupo de pacientes operados mediante la técnica abierta, y las relacionadas con piel fueron las más importantes. Todos los pacientes cumplieron con el seguimiento de 2 años. En este periodo se midieron los resultados con el instrumento disponible. Se evidenciaron como mejores resultados los de la técnica laparoscópica.ConclusionesLos resultados de la hernioplastia laparoscópica en hernias incisionales seleccionadas de la línea media supraumbilical demuestran la superioridad de esta técnica sobre la hernioplastia intraperitoneal abierta.AbstractIntroductionLaparoscopic incisional hernioplasty has demonstrated advantages in selected cases in terms of postoperative recuperation and complications, and it is comparable in recurrence to open incisional hernioplasty; however, this technique does not constitute the gold standard for incisional hernia repair. We recommend that laparoscopic incisional hernioplasty should be considered the gold standard technique to repair upper midline incisional hernias with rings of less than 10cm and without loss of domain.Patients and methodsProspective case-control study of patients operated for incisional hernia with laparoscopic and open techniques that were followed-up with previously validated instruments for the measurement of incisional hernia outcomes and postoperative complications, without direct intervention over the study population.ResultsOne-hundred twelve patients with M2 incisional hernia were included, of them 28 were submitted to laparoscopic surgery and 84 to open surgery. Both groups of patients were comparable in their general and hernia characteristics. Complications were more common in patients submitted to open surgery, being skin-related complications the most frequent. All patients complied with the two-year follow-up. During this period, outcomes were measured with the available instrument, evidencing the better outcomes of the laparoscopic technique.ConclusionsThe outcomes of laparoscopic incisional hernioplasty in selected upper midline hernias showed the superiority of this technique compared with the open technique

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Fil: Zappettini, E.O. Servicio Geológico Minero Argentino; Argentina.Fil: Prieto Rincón, G.; ColombiaFil: Amezcua, Natalia; México.Fil: Muñoz Tapia, Santiago; República Dominicana.Fil: Sepúlveda Ospina, Janeth; Colombia.Fil: Celada Arango, Marlos Mario; Colombia.Fil: Jara, David; Costa Rica.Fil: Cazañas Díaz, Xiomara; Cuba.Fil: Torres Zafra, Jorge Luis; Cuba.Fil: Cobiella Reguera, Jorge Luis; Cuba.Fil: Zurcher, Lukas; Estados Unidos de América.Fil: Orris, Greta; Estados Unidos de América.Fil: Gray, Floyd; Estados Unidos de América.Fil: Maldonado Díaz, Carolina; Guatemala.Fil: Rodriguez, Noé; Honduras.Fil: Mérida Montiel, Ramón; México.Fil: Zarruk, Carlos; Nicaragua.La Asociación de Servicios Geológicos y Mineros de Iberoamérica (ASGMI), bajo los auspicios de la Comisión de la Carta Geológica del Mundo (CCGM) preparó la primera versión del Mapa Metalogénico de América Central y el Caribe. La coordinación general estuvo a cargo del Servicio Geológico Minero Argentino (SEGEMAR), con tres coordinaciones regionales: América Central a cargo del Servicio Geológico Mexicano (SGM), las islas del Caribe a cargo del Servicio Geológico Nacional de la República Dominicana y el norte de América del Sur a cargo del Servicio Geológico Colombiano. Participaron además los Servicios Geológicos, Direcciones de Minería u organismos equivalentes de los países involucrados, que designaron Coordinadores Nacionales. El proyecto fue presentado y aprobado en ocasión de la Asamblea de ASGMI realizada en La Habana (Cuba) en 2017. Posteriormente fue presentado ante la Comisión de la Carta Geológica del Mundo (CCGM) en París en 2018. Los objetivos, criterios metodológicos y cronograma de trabajo fueron así establecidos. En los años 2018 y 2019 se realizaron dos reuniones de los participantes, una en Santo Domingo, República Dominicana, y otra en Tegucigalpa, Honduras. Los avances del mapa fueron presentados durante la Reunión Santo Domingo de 2018 y en ocasión del XV Simposio IAGOD, celebrado en Salta (Argentina) ese mismo año. El mapa fue generado digitalmente a partir del Mapa Estructural del Caribe (Bouysse et al., 2020), provisto por la Comisión de la Carta Geológica del Mundo, realizándose una actualización de la información geológica, a partir de la bibliografía citada en el texto. Los polígonos fueron reclasifi cados y reagrupados en orden a defi nir unidades tectonoestratigráfi cas y mejor refl ejar la metalogénesis de la región. El proyecto en SIG creado es también mostrado en la página WEB de ASGMI (www.asgmi.org.es) con el fi n de facilitar la difusión de los datos del mapa creado. Su formato digital y su disponibilidad en la WEB aseguran un fácil acceso para actualizar la información y hacerlo accesible a los usuarios

Impact of interstitial lung disease on the survival of systemic sclerosis with pulmonary arterial hypertension

To assess severity markers and outcomes of patients with systemic sclerosis (SSc) with or without pulmonary arterial hypertension (PAH-SSc/non-PAH-SSc), and the impact of interstitial lung disease (ILD) on PAH-SSc. Non-PAH-SSc patients from the Spanish SSc registry and PAH-SSc patients from the Spanish PAH registry were included. A total of 364 PAH-SSc and 1589 non-PAH-SSc patients were included. PAH-SSc patients had worse NYHA-functional class (NYHA-FC), worse forced vital capacity (FVC) (81.2 +/- 20.6% vs 93.6 +/- 20.6%, P < 0.001), worse tricuspid annular plane systolic excursion (TAPSE) (17.4 +/- 5.2 mm vs 19.9 +/- 6.7 mm, P < 0.001), higher incidence of pericardial effusion (30% vs 5.2%, P < 0.001) and similar prevalence of ILD (41.8% vs. 44.9%). In individuals with PAH-SSc, ILD was associated with worse hemodynamics and pulmonary function tests (PFT). Up-front combination therapy was used in 59.8% and 61.7% of patients with and without ILD, respectively. Five-year transplant-free survival rate was 41.1% in PAH-SSc patients and 93.9% in non-PAH-SSc patients (P < 0.001). Global survival of PAH-SSc patients was not affected by ILD regardless its severity. The multivariate survival analysis in PAH-SSc patients confirmed age at diagnosis, worse NYHA-FC, increased PVR, reduced DLCO, and lower management with up-front combination therapy as major risk factors. In conclusion, in PAH-SSc cohort risk of death was greatly increased by clinical, PFT, and hemodynamic factors, whereas it was decreased by up-front combination therapy. Concomitant ILD worsened hemodynamics and PFT in PAH-SSc but not survival regardless of FVC impairment

Impact of interstitial lung disease on the survival of systemic sclerosis with pulmonary arterial hypertension

To assess severity markers and outcomes of patients with systemic sclerosis (SSc) with or without pulmonary arterial hypertension (PAH-SSc/non-PAH-SSc), and the impact of interstitial lung disease (ILD) on PAH-SSc. Non-PAH-SSc patients from the Spanish SSc registry and PAH-SSc patients from the Spanish PAH registry were included. A total of 364 PAH-SSc and 1589 non-PAH-SSc patients were included. PAH-SSc patients had worse NYHA-functional class (NYHA-FC), worse forced vital capacity (FVC) (81.2 ± 20.6% vs 93.6 ± 20.6%, P &lt; 0.001), worse tricuspid annular plane systolic excursion (TAPSE) (17.4 ± 5.2 mm vs 19.9 ± 6.7 mm, P &lt; 0.001), higher incidence of pericardial effusion (30% vs 5.2%, P &lt; 0.001) and similar prevalence of ILD (41.8% vs. 44.9%). In individuals with PAH-SSc, ILD was associated with worse hemodynamics and pulmonary function tests (PFT). Up-front combination therapy was used in 59.8% and 61.7% of patients with and without ILD, respectively. Five-year transplant-free survival rate was 41.1% in PAH-SSc patients and 93.9% in non-PAH-SSc patients (P &lt; 0.001). Global survival of PAH-SSc patients was not affected by ILD regardless its severity. The multivariate survival analysis in PAH-SSc patients confirmed age at diagnosis, worse NYHA-FC, increased PVR, reduced DLCO, and lower management with up-front combination therapy as major risk factors. In conclusion, in PAH-SSc cohort risk of death was greatly increased by clinical, PFT, and hemodynamic factors, whereas it was decreased by up-front combination therapy. Concomitant ILD worsened hemodynamics and PFT in PAH-SSc but not survival regardless of FVC impairment

Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.info:eu-repo/semantics/publishedVersio

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Public regulation and passengers importance in port infrastructure costs

Because ports are conceived and designed mainly to be the transfer point of various types of freight, passengers tend to be forgotten in the analysis of port costs. In this paper first we investigate the importance of passengers in port infrastructure costs by means of a multi-output cost function estimated from 20 annual observations (1986-2005) for 26 Spanish Port Authorities. Results show that, although a passenger weights on average less than one tenth of a ton, he or she represents as much as two tons of solid bulk and about three tons of containerized general cargo in terms of marginal costs. Secondly, we compare the marginal costs of different cargoes with their price caps established by law. Results suggest that some type of second best pricing is induced by present regulation.Spanish ports Regulation Marginal costs Cost function

Transcriptional changes and oxidative stress associated with the synergistic interaction between Potato virus X and Potato virus Y and their relationship with symptom expresión

14 páginas, 7 figuras, 2 tablas -- PAGS nros. 1431-1444Many virus diseases of economic importance to agriculture result from mixtures of different pathogens invading the host at a given time. This contrasts with the latively scarce studies available on the molecular events associated with virus---host interactions in mixed infections. Compared with single infections, co-infection of Nicotiana benthamiana with Potato virus X (PVX) and Potato virus Y (PVY) resulted in increased systemic symptoms (synergism) that led to necrosis of the newly emerging leaves and death of the plant. A comparative transcriptional analysis was undertaken to identify quantitative and qualitative differences in gene expression during this synergistic infection and correlate these changes with the severe symptoms it caused. Global transcription rofiles of doubly infected leaves were compared with those from singly infected leaves using gene ontology enrichment analysis and metabolic pathway annotator software. Functional gene categories altered by the double infection comprise suites of genes regulated coordinately, which are associated with chloroplast functions (downregulated), protein synthesis and degradation (upregulated), carbohydrate metabolism (upregulated), and response to biotic stimulus and stress (upregulated). The expressions of reactive oxygen species–generating enzymes as well as several mitogen-activated protein kinases were also significantly induced. Accordingly, synergistic infection induced a severe oxidative stress in N. benthamiana leaves, as judged by increases in lipid peroxidation and by the generation of superoxide radicals in chloroplasts, which correlated with the misregulation of antioxidative genes in microarray data. Interestingly, expression of genes encoding oxylipin biosynthesis was uniquely upregulated by the synergistic infection. Virus-induced gene silencing of α-dioxygenase1 delayed cell death during PVX–PVY infectionThis work was supported by grant BIO2006-10944 from the Ministerio Educacione y Ciencia and by grant 200540M109 from the Comunidad Autónoma de MadridPeer reviewe