On-line breath analysis of volatile organic compounds as a method for colorectal cancer detection

Background: Analysis of exhaled volatile organic compounds (VOCs) in breath is an emerging approach for cancer diagnosis, but little is known about its potential use as a biomarker for colorectal cancer (CRC). We investigated whether a combination of VOCs could distinct CRC patients from healthy volunteers. Methods: In a pilot study, we prospectively analyzed breath exhalations of 38 CRC patient and 43 healthy controls all scheduled for colonoscopy, older than 50 in the average-risk category. The samples were ionized and analyzed using a Secondary ElectroSpray Ionization (SESI) coupled with a Time-of-Flight Mass Spectrometer (SESI-MS). After a minimum of 2 hours fasting, volunteers deeply exhaled into the system. Each test requires three soft exhalations and takes less than ten minutes. No breath condensate or collection are required and VOCs masses are detected in real time, also allowing for a spirometric profile to be analyzed along with the VOCs. A new sampling system precludes ambient air from entering the system, so background contamination is reduced by an overall factor of ten. Potential confounding variables from the patient or the environment that could interfere with results were analyzed. Results: 255 VOCs, with masses ranging from 30 to 431 Dalton have been identified in the exhaled breath. Using a classification technique based on the ROC curve for each VOC, a set of 9 biomarkers discriminating the presence of CRC from healthy volunteers was obtained, showing an average recognition rate of 81.94%, a sensitivity of 87.04% and specificity of 76.85%. Conclusions: A combination of cualitative and cuantitative analysis of VOCs in the exhaled breath could be a powerful diagnostic tool for average-risk CRC population. These results should be taken with precaution, as many endogenous or exogenous contaminants could interfere as confounding variables. On-line analysis with SESI-MS is less time-consuming and doesn’t need sample preparation. We are recruiting in a new pilot study including breath cleaning procedures and spirometric analysis incorporated into the postprocessing algorithms, to better control for confounding variables

Predictive Power of the "Trigger Tool" for the detection of adverse events in general surgery: a multicenter observational validation study

Background In spite of the global implementation of standardized surgical safety checklists and evidence-based practices, general surgery remains associated with a high residual risk of preventable perioperative complications and adverse events. This study was designed to validate the hypothesis that a new “Trigger Tool” represents a sensitive predictor of adverse events in general surgery. Methods An observational multicenter validation study was performed among 31 hospitals in Spain. The previously described “Trigger Tool” based on 40 specific triggers was applied to validate the predictive power of predicting adverse events in the perioperative care of surgical patients. A prediction model was used by means of a binary logistic regression analysis. Results The prevalence of adverse events among a total of 1,132 surgical cases included in this study was 31.53%. The “Trigger Tool” had a sensitivity and specificity of 86.27% and 79.55% respectively for predicting these adverse events. A total of 12 selected triggers of overall 40 triggers were identified for optimizing the predictive power of the “Trigger Tool”. Conclusions The “Trigger Tool” has a high predictive capacity for predicting adverse events in surgical procedures. We recommend a revision of the original 40 triggers to 12 selected triggers to optimize the predictive power of this tool, which will have to be validated in future studies

Famílies botàniques de plantes medicinals

Facultat de Farmàcia, Universitat de Barcelona. Ensenyament: Grau de Farmàcia, Assignatura: Botànica Farmacèutica, Curs: 2013-2014, Coordinadors: Joan Simon, Cèsar Blanché i Maria Bosch.Els materials que aquí es presenten són els recull de 175 treballs d’una família botànica d’interès medicinal realitzats de manera individual. Els treballs han estat realitzat per la totalitat dels estudiants dels grups M-2 i M-3 de l’assignatura Botànica Farmacèutica durant els mesos d’abril i maig del curs 2013-14. Tots els treballs s’han dut a terme a través de la plataforma de GoogleDocs i han estat tutoritzats pel professor de l’assignatura i revisats i finalment co-avaluats entre els propis estudiants. L’objectiu principal de l’activitat ha estat fomentar l’aprenentatge autònom i col·laboratiu en Botànica farmacèutica

Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Towards two-dimensional organo-metallic molecular architecture via interface chemistry

Contrairement aux matériaux bidimensionnels inorganiques (e.g. graphene, dichalcogénures de métaux de transition), les matériaux bidimensionnels organiques sont synthétique, et présentent une structure plus complexe héritée de leur briques de construction. Une gamme plus riche de propriétés est attendue pour cette raison, et leur production devrait être à bas coût.Dans ce manuscrit de thèse nous présentons nos résultats obtenus selon deux stratégies visant la formation de telles couches organiques bi-dimensionnelles, ou au moins ultraminces. Ces deux stratégies exploitent une chimie interfaciale. La première stratégie s'appuie sur des outils de science des surfaces (microscopie à effet tunnel, spectroscopies de photoémission et de seuil d'absorption par rayons X, théorie de la fonctionnelle de la densité) et se concentre sur une molécule dérivée du triphénylène et ses modifications sur la surface (111) bien définie du cuivre. Si nous ne sommes pas parvenus à élaborer un matériaux bidimensionnel étendu, nous avons découvert que les molécules sont catalytiquement oxydées et dans le même temps changent de structure, d'organisation sur la surface, et d'interaction avec le substrat. Les molécules totalement oxydées se révèlent être d'excellents accepteurs électroniques, meilleurs que la plupart des molécules connues. La seconde stratégie est basée sur une synthèse en solution et des caractérisations plus versatiles (spectroscopies UV-visible et Raman, microscopies optique et électroniques). Elle exploite la chimie dynamique des liaisons imines, avec comme monomère un composé arène(ruthenium), conduisant à la formation d'une nanocouche organométallique polymérique, qui peut être manipulée facilement pour être par exemple reportée sur une membrane suspendue.Compared to inorganic two-dimensional materials (e.g. graphene, transition metal dichalcogenides), organic two-dimensional materials are all synthetic materials, that additionally have a more complex structure inherited from their building blocks. A richer set of properties is for this reason expected from them, and their production should be unexpensive.In this thesis manuscript we present our work on two strategies toward the formation of such organic two-dimensional, or at list ultrathin organic sheet materials. These strategies rely on interfacial chemistry, on one hand at the vacuum/solid interface, and on the other hand the liquid/liquid interface. The first strategy is based on surface science tools (scanning tunneling microscopy, X-ray photoemision and absorption near-edge spectroscopies, density functional theory) and addressed triphenylene derivative molecules experiencing chemical modifications on the well-defined (111) surface of copper. Although we did not yet manage to prepare an extended two-dimensional material in this system, we discovered that the molecules get catalytically oxidized and concomitantly change in shape, surface organization, and interaction with the substrate. We establish that the fully-oxidized molecules are stronger electron acceptor than most known molecules. The second strategy is based on in-solution synthesis and more versatile characterization (UV-visible and Raman spectroscopies, optical and electron microscopies). It exploits dynamic imine bond chemistry starting from ruthenium(arene) monomers, to form polymeric organometallic nanosheets that are conveniently manipulated and can for instance be suspended across membrane

Vers une architecture moléculaire organométallique bidimensionnelle par chimie d'interface

Compared to inorganic two-dimensional materials (e.g. graphene, transition metal dichalcogenides), organic two-dimensional materials are all synthetic materials, that additionally have a more complex structure inherited from their building blocks. A richer set of properties is for this reason expected from them, and their production should be unexpensive.In this thesis manuscript we present our work on two strategies toward the formation of such organic two-dimensional, or at list ultrathin organic sheet materials. These strategies rely on interfacial chemistry, on one hand at the vacuum/solid interface, and on the other hand the liquid/liquid interface. The first strategy is based on surface science tools (scanning tunneling microscopy, X-ray photoemision and absorption near-edge spectroscopies, density functional theory) and addressed triphenylene derivative molecules experiencing chemical modifications on the well-defined (111) surface of copper. Although we did not yet manage to prepare an extended two-dimensional material in this system, we discovered that the molecules get catalytically oxidized and concomitantly change in shape, surface organization, and interaction with the substrate. We establish that the fully-oxidized molecules are stronger electron acceptor than most known molecules. The second strategy is based on in-solution synthesis and more versatile characterization (UV-visible and Raman spectroscopies, optical and electron microscopies). It exploits dynamic imine bond chemistry starting from ruthenium(arene) monomers, to form polymeric organometallic nanosheets that are conveniently manipulated and can for instance be suspended across membrane.Contrairement aux matériaux bidimensionnels inorganiques (e.g. graphene, dichalcogénures de métaux de transition), les matériaux bidimensionnels organiques sont synthétique, et présentent une structure plus complexe héritée de leur briques de construction. Une gamme plus riche de propriétés est attendue pour cette raison, et leur production devrait être à bas coût.Dans ce manuscrit de thèse nous présentons nos résultats obtenus selon deux stratégies visant la formation de telles couches organiques bi-dimensionnelles, ou au moins ultraminces. Ces deux stratégies exploitent une chimie interfaciale. La première stratégie s'appuie sur des outils de science des surfaces (microscopie à effet tunnel, spectroscopies de photoémission et de seuil d'absorption par rayons X, théorie de la fonctionnelle de la densité) et se concentre sur une molécule dérivée du triphénylène et ses modifications sur la surface (111) bien définie du cuivre. Si nous ne sommes pas parvenus à élaborer un matériaux bidimensionnel étendu, nous avons découvert que les molécules sont catalytiquement oxydées et dans le même temps changent de structure, d'organisation sur la surface, et d'interaction avec le substrat. Les molécules totalement oxydées se révèlent être d'excellents accepteurs électroniques, meilleurs que la plupart des molécules connues. La seconde stratégie est basée sur une synthèse en solution et des caractérisations plus versatiles (spectroscopies UV-visible et Raman, microscopies optique et électroniques). Elle exploite la chimie dynamique des liaisons imines, avec comme monomère un composé arène(ruthenium), conduisant à la formation d'une nanocouche organométallique polymérique, qui peut être manipulée facilement pour être par exemple reportée sur une membrane suspendue

Nano-sheets of two-dimensional polymers with dinuclear (arene)ruthenium nodes, synthesised at a liquid/liquid interface

International audienceWe developed a new class of mono- or few-layered two-dimensional polymers based on dinuclear (arene)ruthenium nodes, obtained by combining the imine condensation with an interfacial chemistry process, and use a modified Langmuir–Schaefer method to transfer them onto solid surfaces. Robust nano-sheets of two-dimensional polymers including dinuclear complexes of heavy ruthenium atoms as nodes were synthesised. These nano-sheets, whose thickness is of a few tens of nanometers, were suspended onto solid porous membranes. Then, they were thoroughly characterised with a combination of local probes, including Raman spectroscopy, Fourier transform infrared spectroscopy and transmission electron microscopy in imaging and diffraction mode