Small bowel enteroscopy - A joint clinical guideline from the spanish and portuguese small bowel study groups

The present evidence-based guidelines are focused on the use of device-assisted enteroscopy in the management of small-bowel diseases. A panel of experts selected by the Spanish and Portuguese small bowel study groups reviewed the available evidence focusing on the main indications of this technique, its role in the management algorithm of each indication and on its diagnostic and therapeutic yields. A set of recommendations were issued accordingly.Estas recomendações baseadas na evidência detalham o uso da enteroscopia assistida por dispositivo no manejo clínico das doenças do intestino delgado. Um conjunto de Gastrenterologistas diferenciados em patologia do intestino delgado foi selecionado pelos grupos de estudos Espanhol e Português de intestino delgado para rever a evidência disponível sobre as principais indicações desta técnica, o seu papel nos algoritmos de manejo de cada indicação e sobre o seu rendimento diagnóstico e terapêutico. Foi gerado um conjunto de recomendações pelos autores

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Small Bowel Enteroscopy - A Joint Clinical Guideline by the Spanish and Portuguese Small-Bowel Study Groups

The present evidence-based guidelines are focused on the use of device-assisted enteroscopy in the management of small-bowel diseases. A panel of experts selected by the Spanish and Portuguese small-bowel study groups reviewed the available evidence focusing on the main indications of this technique, its role in the management algorithm of each indication, and its diagnostic and therapeutic yield. A set of recommendations was issued accordingly.info:eu-repo/semantics/publishedVersio

Small bowel enteroscopy - A joint clinical guideline from the spanish and portuguese small bowel study groups

The present evidence-based guidelines are focused on the use of device-assisted enteroscopy in the management of small-bowel diseases. A panel of experts selected by the Spanish and Portuguese small bowel study groups reviewed the available evidence focusing on the main indications of this technique, its role in the management algorithm of each indication and on its diagnostic and therapeutic yields. A set of recommendations were issued accordingly.Estas recomendações baseadas na evidência detalham o uso da enteroscopia assistida por dispositivo no manejo clínico das doenças do intestino delgado. Um conjunto de Gastrenterologistas diferenciados em patologia do intestino delgado foi selecionado pelos grupos de estudos Espanhol e Português de intestino delgado para rever a evidência disponível sobre as principais indicações desta técnica, o seu papel nos algoritmos de manejo de cada indicação e sobre o seu rendimento diagnóstico e terapêutico. Foi gerado um conjunto de recomendações pelos autores

Anales de Edafología y Agrobiología Tomo 48 Número 5-12

A comparative study of the effect of soil boron on yield, yield attributes and nutrient uptake by susceptible and tolerant varieties of wheat. Por B. R. Chhipa and P. Lal.-- Suelos y vegetación de las Peñas de Aya (Navarra y Guipúzcoa. Por J. Peralta, J. Íñiguez y J. C. Bascones.-- Presencia de horizonte plácico en Ñadis (Placaquands) y Trumaos (Placudands) en el sur de Chile. Por W. Luzio, C. Barros, M. Aroncibia y S. Alcayaga.-- Retención de 0,0-Dimetil, S-(Z, Metilamino- 2, Oxoetil -Ditiofosfato (Dimetoato) por Vermiculitas homoionicas. l.-cinética del proceso. Por C. Valenzuela Calahorro, A. García Rodríguez y A. Bernalte García.-- Estudio edafogenético en suelo~ de Rañas. Distribución de hierro y aluminio. Por Mª P. García Rodr(guez, J. Forteza Bonnin, y L. F. Lorenzo Martín.-- Water retention equations and their relationship with particle size distribution and bulk density for undisturbed samples. Por A. Andriulo, N. Amiotti y C. Pecorari.-- Evolución regresiva de diversos parámetros edáficos en agroecosistemas (Cafetales, cañaverales) derivados del bosque mesófilo de montaña (México). Por N. García Calderón, F. Velasco y N. Aguilera.-- Micronutrients distribution in grown soils (Fe and Zn) prediction equations of contenta. Por A. Ruiz-Nieto, E. Barahona, S. Jaime, F. Huertas, A. Aguilar and J. Linares.-- Contenido de azufre total en muestras superficiales de suelos de la provincia de la Coruña. Por A. Merino García, C. Monterroso Martínez y E. García -Rodeja G.-- Aspectos termodinámicos de la adsorción de Clorprofan por suelos. Por G. Dios Cancela, J. A. Guillén Alfara y S. González García.-- Consideraciones acerca de las interralaciones entre suelos. Vegetación y paleoprocesos morfogenéticos en el Macizo de Ayllón y la Sierra de Alto Rey (Sector oriental del Sistema Central). Por J. J. Ibáñez Martín, F. Fernández González y A. García Alvarez.--Composición Geoquímica de unas ferricretas en el entorno de un monte isla de Ciudad Real. Por R. Jiménez Ballesta, A. M. Alvarez González, A. Gutiérrez Maroto y E. Redondo.--Relación entre algunas propiedades físico-químicas y las fracciones de fósforo en suelos naturales de Galicia (NW España). Por Mª C. Trasar Cepeda, F. Gil Sotres y F. Guitián Ojea.-- Respuesta del cultivo de tomate en enarenado y condiciones salinas a diferentes programas de fertilización fosfórica. Por M. J. Sarro, A. Saa, C. Cadahía y A. Masaguer.-- Distribución del fósforo en perfiles de suelos de Galicia (NW Spain). Por M. a C. Trasar Cepeda, F. Gil Sotres y F. Guitián Ojea.-- Influencia de la dilución en la desorción de cationes en Andosoles y suelos ándicos. Por C. D. Arbelo, J. E. García-Hernández y J. M. Hernández Moreno.-- Las marismas del Guadalquivir, reserva biogenética de plantas tolerantes a la salinidad. Por T. Marañón, L. V. García, J. M. Murillo y L. Clemente.-- Efectos del Abonado N/K sobre el contenido, interacciones y evolución del N, K, Ca y Mg en varias etapas del desarrollo de la patata. Por M. J. Lema Gesto y A. M. Cortizas.-- Estabilidad estructural de suelos afectados por sales: Revisión bibliográfica. Por E. Amezketa y R. Aragües.-- Descomposición de rastrojo de trigo, respiracion y biomasa microbiana bajo labranza convencional y siembra directa. Por O. J. Santanatoglia, R. Alvarez, P. E. Daniel, G. M. Brazzola y R. García.-- Factores formadores y características generales de los Luvisoles desarrollados sobre materiales calizos y su distribución en la provincia de Valencia. Por Mª D. Soriano Soto.-- Propiedades de intercambio iónico en tobas sálicas pumíticas del sur de la Isla de Tenerife. Por J. E. García Hernández, J. S. Notario del Pino y M. González Martín.-- Las reacciones lentas del fósforo en suelos gallegos: III. Experiencias de incubación: b) Comparación de las técnicas Bray II, Olsen y electroultrafiltración (EUF) para reflejar las variaciones con el tiempo en la extracción de fósforo. Por E. de Blas Varela, F. Gil Sotres y F. Guitián.-- Crecimiento y producción de genotipos procedentes de Haploides de Nicotiana tabacum L. seleccionados en cámara de bajo contenido en C02. Por E. Delgado y H. Medrano.-- Características foliares de genotipos de Nicotiana tabacum L. obtenidos a partir de Haploides seleccionados por supervivencia a bajas concentraciones de C02. Por E. Delgado y H. Medrano.-- Efecto de las poliaminas sobre la actividad fosfatasa ácida y ribonucleasa soluble en semillas de Garbanzo (Cicerarietinum L.). Por E. Merlo, T. Angosto y A. J. Matilla.-- Efectos de la 6-Bencil- aminopurina y el ácido Indol-3-Butfrico en cultivos in vitro de explantos de Hipocotilo-Epicotilo de Pinus canariensis Chr. Sm. ex DC. Por J. F. Pérez Francés, A. Bueno Marrero, V. M. García Díaz y R. Martín.-- Factores abióticos definitorios del área ocupada por Cytisus multiflorus (L 'Her) Sweet en España. Por E. V. Martínez Ropero, J. M. Gómez Gutiérrez y P. Galindo Villardon.-- Índice de satisfacción de los requerimientos hídricos de los cereales de invierno para una región marginal de secano. Por J. D. Paoloni.-- Effect of qualities of irrigation water and NPK fertilizars on grain and straw yield of wheat. Por R. Lal and P.Lal.-- Efecto de la concentración y tipo de agente solidificante del medio de cultivo en la vitrificación de brotes adventicios de Pinus canariensis. Por C. Martínez Pulido.-- Evolución de constituyentes químicos y de la emisión de etileno durante el desarrollo y maduración del albaricoque (Prunus armemízca, L. cv. Búlida). Por A. Amaros, M. Serrano, F. Riquelme y F. Romojaro.-- Cambio varietal en melocotoneros improductivos. Por J. Egea CaballeroPeer reviewe

Stoma-free Survival After Rectal Cancer Resection With Anastomotic Leakage: Development and Validation of a Prediction Model in a Large International Cohort.

Objective:To develop and validate a prediction model (STOMA score) for 1-year stoma-free survival in patients with rectal cancer (RC) with anastomotic leakage (AL).Background:AL after RC resection often results in a permanent stoma.Methods:This international retrospective cohort study (TENTACLE-Rectum) encompassed 216 participating centres and included patients who developed AL after RC surgery between 2014 and 2018. Clinically relevant predictors for 1-year stoma-free survival were included in uni and multivariable logistic regression models. The STOMA score was developed and internally validated in a cohort of patients operated between 2014 and 2017, with subsequent temporal validation in a 2018 cohort. The discriminative power and calibration of the models' performance were evaluated.Results:This study included 2499 patients with AL, 1954 in the development cohort and 545 in the validation cohort. Baseline characteristics were comparable. One-year stoma-free survival was 45.0% in the development cohort and 43.7% in the validation cohort. The following predictors were included in the STOMA score: sex, age, American Society of Anestesiologist classification, body mass index, clinical M-disease, neoadjuvant therapy, abdominal and transanal approach, primary defunctioning stoma, multivisceral resection, clinical setting in which AL was diagnosed, postoperative day of AL diagnosis, abdominal contamination, anastomotic defect circumference, bowel wall ischemia, anastomotic fistula, retraction, and reactivation leakage. The STOMA score showed good discrimination and calibration (c-index: 0.71, 95% CI: 0.66-0.76).Conclusions:The STOMA score consists of 18 clinically relevant factors and estimates the individual risk for 1-year stoma-free survival in patients with AL after RC surgery, which may improve patient counseling and give guidance when analyzing the efficacy of different treatment strategies in future studies

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AimThe SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery.MethodsThis was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin.ResultsOverall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P ConclusionOne in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Stoma-free survival after anastomotic leak following rectal cancer resection: worldwide cohort of 2470 patients

Background: The optimal treatment of anastomotic leak after rectal cancer resection is unclear. This worldwide cohort study aimed to provide an overview of four treatment strategies applied. Methods: Patients from 216 centres and 45 countries with anastomotic leak after rectal cancer resection between 2014 and 2018 were included. Treatment was categorized as salvage surgery, faecal diversion with passive or active (vacuum) drainage, and no primary/secondary faecal diversion. The primary outcome was 1-year stoma-free survival. In addition, passive and active drainage were compared using propensity score matching (2: 1). Results: Of 2470 evaluable patients, 388 (16.0 per cent) underwent salvage surgery, 1524 (62.0 per cent) passive drainage, 278 (11.0 per cent) active drainage, and 280 (11.0 per cent) had no faecal diversion. One-year stoma-free survival rates were 13.7, 48.3, 48.2, and 65.4 per cent respectively. Propensity score matching resulted in 556 patients with passive and 278 with active drainage. There was no statistically significant difference between these groups in 1-year stoma-free survival (OR 0.95, 95 per cent c.i. 0.66 to 1.33), with a risk difference of -1.1 (95 per cent c.i. -9.0 to 7.0) per cent. After active drainage, more patients required secondary salvage surgery (OR 2.32, 1.49 to 3.59), prolonged hospital admission (an additional 6 (95 per cent c.i. 2 to 10) days), and ICU admission (OR 1.41, 1.02 to 1.94). Mean duration of leak healing did not differ significantly (an additional 12 (-28 to 52) days). Conclusion: Primary salvage surgery or omission of faecal diversion likely correspond to the most severe and least severe leaks respectively. In patients with diverted leaks, stoma-free survival did not differ statistically between passive and active drainage, although the increased risk of secondary salvage surgery and ICU admission suggests residual confounding