Deep-sequencing reveals broad subtype-specific HCV resistance mutations associated with treatment failure

A percentage of hepatitis C virus (HCV)-infected patients fail direct acting antiviral (DAA)-based treatment regimens, often because of drug resistance-associated substitutions (RAS). The aim of this study was to characterize the resistance profile of a large cohort of patients failing DAA-based treatments, and investigate the relationship between HCV subtype and failure, as an aid to optimizing management of these patients. A new, standardized HCV-RAS testing protocol based on deep sequencing was designed and applied to 220 previously subtyped samples from patients failing DAA treatment, collected in 39 Spanish hospitals. The majority had received DAA-based interferon (IFN) a-free regimens; 79% had failed sofosbuvir-containing therapy. Genomic regions encoding the nonstructural protein (NS) 3, NS5A, and NS5B (DAA target regions) were analyzed using subtype-specific primers. Viral subtype distribution was as follows: genotype (G) 1, 62.7%; G3a, 21.4%; G4d, 12.3%; G2, 1.8%; and mixed infections 1.8%. Overall, 88.6% of patients carried at least 1 RAS, and 19% carried RAS at frequencies below 20% in the mutant spectrum. There were no differences in RAS selection between treatments with and without ribavirin. Regardless of the treatment received, each HCV subtype showed specific types of RAS. Of note, no RAS were detected in the target proteins of 18.6% of patients failing treatment, and 30.4% of patients had RAS in proteins that were not targets of the inhibitors they received. HCV patients failing DAA therapy showed a high diversity of RAS. Ribavirin use did not influence the type or number of RAS at failure. The subtype-specific pattern of RAS emergence underscores the importance of accurate HCV subtyping. The frequency of “extra-target” RAS suggests the need for RAS screening in all three DAA target regions

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Προσδιορισμός δεικτών κατανάλωσης ενέργειας στα αντλιοστάσια του Τμήμαατος Ανανπτύξεως Υδάτων

The purpose of this thesis is to define energy consumption indicators in irrigation and water pumping stations featuring Water Development Department (WDD). The identification of the indicators will be done after proper processing of data provided by the WDD. Initially a general reference to the pumping stations as part of the distribution systems and components of which consist of, and in basic functions that they perform. Then the concept of pumps and formulas presented those present and Directive 2009/125 / EC of the European Union to establish a framework for the setting of ecodesign requirements for energy related products. Then they are presented some examples from the literature which was similar study for the creation of indicators and then refer to the history of the department and water projects it has. Then it presents the pumping stations that dispose of that part in every province and made their categorization in irrigation and water pumping stations. The classification is made in the form of tables recorded their technical characteristics. The seventh chapter is an introduction to the concept of the index and energy consumption indicators and the various categories in which indicators are divided according to their use. Finally, in the form of charts, one for each indicator is the presentation of the results by province, and finally presents the conclusions reached by the end of the thesis.Σκοπός της παρούσας πτυχιακής εργασίας είναι ο προσδιορισμός δεικτών κατανάλωσης ενέργειας στα αντλιοστάσια άρδευσης και ύδρευσης που διαθέτει το Τμήμα Αναπτύξεως Υδάτων. Ο προσδιορισμός των δεικτών θα γίνει μετά από κατάλληλη επεξεργασία στοιχείων που δόθηκαν από το Τμήμα Αναπτύξεως Υδάτων (ΤΑΥ). Αρχικά γίνεται μια γενική αναφορά στα αντλιοστάσια ως μέρος των συστημάτων διανομής και τα συστατικά από τα οποία αποτελούνται καθώς και στις βασικές λειτουργίες που αυτά επιτελούν. Στην συνέχεια παρουσιάζεται η έννοια των αντλιών και οι τύποι αυτών που υπάρχουν καθώς και η οδηγία 2009/125/ΕΚ της Ευρωπαϊκής Ένωσης για την θέσπιση πλαισίου για τον καθορισμό των απαιτήσεων οικολογικού σχεδιασμού όσον αφορά τα συνδεόμενα με την ενέργεια προϊόντα. Έπειτα, παρουσιάζονται κάποια παραδείγματα από την βιβλιογραφία όπου έγινε παρόμοια μελέτη για την δημιουργία των δεικτών ενώ στην συνέχεια γίνεται αναφορά στο Ιστορικό του ΤΑΥ και στα υδατικά έργα που διαθέτει. Στην συνέχεια γίνεται παρουσίαση των αντλιοστασίων που διαθέτει το τμήμα σε κάθε επαρχία και γίνεται κατηγοριοποίηση τους σε αντλιοστάσια άρδευσης και ύδρευσης. Η κατηγοριοποίηση γίνεται υπό την μορφή πινάκων με καταγεγραμμένα τα τεχνικά χαρακτηριστικά τους (αριθμό αντλιών, τύπο αντλιών, παροχή αντλιών και μανομετρικό ύψος αντλιών). Στο έβδομο κεφάλαιο γίνεται μια εισαγωγή στην έννοια του δείκτη και στους δείκτες ενεργειακής κατανάλωσης καθώς και στις διάφορες κατηγορίες στις οποίες χωρίζονται οι δείκτες ανάλογα με την χρήση τους. Τέλος, υπό την μορφή διαγραμμάτων, ένα για κάθε δείκτη, γίνεται η παρουσίαση των αποτελεσμάτων ανά επαρχία και τέλος παρουσιάζονται τα συμπεράσματα που προέκυψαν με το πέρας της πτυχιακής εργασίας.Complete

Anales de Edafología y Agrobiología Tomo 37 Número 7-8

Mineralogía de las fracciones arenosas de suelos desarrollados sobre serpentinas en la Sierra de Carratraca (Málaga), por A. García y M. Delgado.-- Estudio sobre la infección y nodulación de Alnus glutinosa (L.) Gaertn. por su endofito simbionte, por C. Rodríguez-Barrueco, F. Bermúdez de Castro, A. Costa y C. Miguel.-- Efecto de la inoculación de un suelo con P, sobre la nutrición vegetal, por Mª D. Simón-Pujol, F. Congregado, Mª T. Felipe y A. Ramos-Cormenzana.-- Contribución al estudio de la «Enfermedad de Panamá en la platanera canaria. 1. Sustancias reguladoras del crecimiento aisladas de cultivos de Fusarium oxypomm cubense, por M. A. Rodríguez Raymond, C. Prendes, C. Dolores Lorenzo y A. Carlos Blesa.-- Mineralogía y génesis de suelos con horizonte B textura! sobre rocas calizas en el Sureste de España, por L. J. Alías y J. Albaladejo.-- Estudio comparativo de diversos métodos para la extracción conjunta de los óxidos libres de Fe, Al y Si en suelos, por J. Fernández, J. Aguilar, C. Dorronsoro y M. Pino.-- Contenido de L-Dopa y su precursor L-Tirosina en Vicia faba cultivada en el Norte de Navarra, por M. N. Cenarruzabeitia, A. Soria y J. Larralde.-- Cultivo de la lavanda: nutrición mineral. l. Primeros resultados, por S. Fernández Fábregas y E. Martín Ramírez.-- Notas sobre técnicas de investigación de sustancias húmicas. l. Aplicación de la respirometría, por J. F. Gallardo y M. I. M. González.-- Notas sobre técnicas de investigación de sustancias húmicas. II. Aplicación de la cromatografía en columna, por J. F. Gallardo y M. l. M. González.-- Cuantificación de fitohormonas en cultivos de Rhizobium spp. usados en fertilización biológica, por I. M. Sánchez-Calle, J. M. Barea y L. Recalde.-- Estudios sobre la resistencia de Lolium perenne L. al Dalapón. II. Experiencias de invernadero: tratamientos en postemergencia, por J. Segura, R. Fábregas y E. Vieitez.-- Suelos formados sobre materiales volcánicos (Islas Canarias). Aridisoles: Natrargids, Calciorthids. l. Características generales de estos suelos, por E. Fernández Caldas y C. M. Rodríguez Hernández.-- Vertisoles formados sobre materiales volcánicos (Islas Canarias). Typic Chromusterts. II. Características morfológicas, físico-químicas y mineralógicas, por E. Fernández Caldas y C. M. Rodríguez Hernández.-- Nota previa.-- El sistema Larsys Nuevo método para estudiar recursos naturales, por J. L. Labandero.-- Notas.-- Congreso de Ciencia del Suelo. Edmonton (Canadá).-- Presidentes y Vicepresidentes de Comisiones y Subcomisiones de la l. S. S. S. para el período 1978-82.-- Directivos de los nuevos Grupos de Trabajo de la l. S. S. S. 1978-82.-- Actividades Intercongresos de la l. S. S. S. propuestas para el período 1978-82.-- Declaraciones del Ministro de Educación y Ciencia sobre política científica.-- VII Curso Internacional de Fertilidad de Suelos y Nutrición Vegetal.-- Viaje del Profesor Hoyos a Méjico.-- II Reunión del grupo para el estudio del humus del C. S. l. C.-- Conferencias del Profesor Glinski.-- Conferencia del Profesor Jacquin.-- Conferencia del Ingeniero Donezar Díez de Ulzurrum.-- Actividades de la Jefe del Servicio de Documentación y Bibliotecas del Instituto de Edafología y Biología Vegetal.-- Primer Cursillo Nacional sobre Micromorfología de Suelos .-- Elecciones de representantes para la Comisión Científica del C. S. l. C.--Elecciones de representantes para la Comisión Económica del C. S. l. C.Peer reviewe

Safety and efficacy of intraperitoneal drain placement after emergency colorectal surgery. An international, prospective cohort study

Intraperitoneal drains are often placed during emergency colorectal surgery. However, there is a lack of evidence supporting their use. This study aimed to describe the efficacy and safety of intraperitoneal drain placement after emergency colorectal surgery. Method: COMPlicAted intra-abdominal collectionS after colorectal Surgery (COMPASS) is a prospective, international, cohort study into which consecutive adult patients undergoing emergency colorectal surgery were enrolled (from 3 February 2020 to 8 March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included rate and time-to-diagnosis of postoperative intraperitoneal collections, rate of surgical site infections (SSIs), time to discharge and 30-day major postoperative complications (Clavien-Dindo III-V). Multivariable logistic and Cox proportional hazards regressions were used to estimate the independent association of the outcomes with drain placement. Results: Some 725 patients (median age 68.0 years; 349 [48.1%] women) from 22 countries were included. The drain insertion rate was 53.7% (389 patients). Following multivariable adjustment, drains were not significantly associated with reduced rates (odds ratio [OR] = 1.56, 95% CI: 0.48-5.02, p = 0.457) or earlier detection (hazard ratio [HR] = 1.07, 95% CI: 0.61-1.90, p = 0.805) of collections. Drains were not significantly associated with worse major postoperative complications (OR = 1.26, 95% CI: 0.67-2.36, p = 0.478), delayed hospital discharge (HR = 1.11, 95% CI: 0.91-1.36, p = 0.303) or increased risk of SSIs (OR = 1.61, 95% CI: 0.87-2.99, p = 0.128). Conclusion: This is the first study investigating placement of intraperitoneal drains following emergency colorectal surgery. The safety and clinical benefit of drains remain uncertain. Equipoise exists for randomized trials to define the safety and efficacy of drains in emergency colorectal surgery