Introduction and Validation of a Novel Acute Pancreatitis Digital Tool: Interrogating Large Pooled Data From 2 Prospectively Ascertained Cohorts

Objectives: Acute pancreatitis (AP) is a sudden onset, rapidly evolving inflammatory response with systemic inflammation and multiorgan failure (MOF) in a subset of patients. New highly accurate clinical decision support tools are needed to allow local doctors to provide expert care. Methods: Ariel Dynamic Acute Pancreatitis Tracker (ADAPT) is a digital tool to guide physicians in ordering standard tests, evaluate test results and model progression using available data, propose emergent therapies. The accuracy of the severity score calculators was tested using 2 prospectively ascertained Acute Pancreatitis Patient Registry to Examine Novel Therapies in Clinical Experience cohorts (pilot University of Pittsburgh Medical Center, n = 163; international, n = 1544). Results: The ADAPT and post hoc expert-calculated AP severity scores were 100% concordant in both pilot and international cohorts. High-risk criteria of all 4 severity scores at admission were associated with moderately-severe or severe AP and MOF (both P < 0.0001) and prediction of no MOF was 97.8% to 98.9%. The positive predictive value for MOF was 7.5% to 14.9%. Conclusions: The ADAPT tool showed 100% accuracy with AP predictive metrics. Prospective evaluation of ADAPT features is needed to determine if additional data can accurately predict and mitigate severe AP and MOF

Outcomes of elective liver surgery worldwide: a global, prospective, multicenter, cross-sectional study

Background: The outcomes of liver surgery worldwide remain unknown. The true population-based outcomes are likely different to those vastly reported that reflect the activity of highly specialized academic centers. The aim of this study was to measure the true worldwide practice of liver surgery and associated outcomes by recruiting from centers across the globe. The geographic distribution of liver surgery activity and complexity was also evaluated to further understand variations in outcomes. Methods: LiverGroup.org was an international, prospective, multicenter, cross-sectional study following the Global Surgery Collaborative Snapshot Research approach with a 3-month prospective, consecutive patient enrollment within January–December 2019. Each patient was followed up for 90 days postoperatively. All patients undergoing liver surgery at their respective centers were eligible for study inclusion. Basic demographics, patient and operation characteristics were collected. Morbidity was recorded according to the Clavien–Dindo Classification of Surgical Complications. Country-based and hospital-based data were collected, including the Human Development Index (HDI). (NCT03768141). Results: A total of 2159 patients were included from six continents. Surgery was performed for cancer in 1785 (83%) patients. Of all patients, 912 (42%) experienced a postoperative complication of any severity, while the major complication rate was 16% (341/2159). The overall 90-day mortality rate after liver surgery was 3.8% (82/2,159). The overall failure to rescue rate was 11% (82/ 722) ranging from 5 to 35% among the higher and lower HDI groups, respectively. Conclusions: This is the first to our knowledge global surgery study specifically designed and conducted for specialized liver surgery. The authors identified failure to rescue as a significant potentially modifiable factor for mortality after liver surgery, mostly related to lower Human Development Index countries. Members of the LiverGroup.org network could now work together to develop quality improvement collaboratives

Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study.

Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay

Necesidad y conveniencia de la consagración legal de potestades discrecionales a favor de la administración

<p><span>Discrecionalidad y Estado de Derecho. Relación entre discrecionalidad y desviación de poder. Dificultades en la configuración de la desviación de poder. Indicios relevantes en la jurisprudencia. Conclusiones</span></p><p>El tema impone precisar que el mismo debe analizarse desde una óptica desvestida de prejuicios: tiendo a pensar que en el ámbito del Derecho Administrativo, la discrecionalidad administrativa es vista como un fenómeno negativo, como una debilidad del Estado de Derecho y – por lo tanto – como un aspecto de la actividad administrativa que se debe intentar reducir a su mínima expresión, no comparto una posición situada en ese extremo.<br />La consagración de potestades discrecionales forma parte necesaria e ineludible del ejercicio de la función administrativa y todo Estado de Derecho debe garantizar el ejercicio eficiente y eficaz de la función administrativa como garantía del cumplimiento de los cometidos estatales.</p

The Preparation, Characterization, X-ray Structural Analysis, and Thermogravimetric Analysis of Tetrakis[1,3-Dimethyl-2(3H)-Imidazolethione]Zinc(II) Nitrate and Tetrafluoroborate

Two new compds., [Zn(dmit) 4][BF4]2 (1) and [Zn(dmit)4][NO3]2 (2), were synthesized and characterized via std. solid and soln. state methods including single crystal x-ray crystallog. (dmit = 1,3-dimethyl-2(3H)-imidazolethione). [Zn(dmit)4][BF4]2 crystallizes in space group Pbcn with a 11.954(2), b 21.260(4), c 12.749(3) Å, Z = 4. [Zn(dmit)4][NO3]2 crystallizes in space group I41/a with a = b 11.091(4), c 22.713(5) Å, Z = 4. Both structures display a compressed tetrahedral geometry in the zinc coordination sphere similar to previously reported iso-Pr and Bu analogs. The degree of distortion is closer to that noted for the recently reported Me iso-Pr analog than to the Me Bu complex. There are no significant differences between the nitrate and tetrafluoroborate coordination spheres, and the source of distortion appears to be close intramol. contacts. TGA results suggest that both complexes decomp. to yield ZnS2 instead of ZnS

CCDC 704290: Experimental Crystal Structure Determination

An entry from the Cambridge Structural Database, the world’s repository for small molecule crystal structures. The entry contains experimental data from a crystal diffraction study. The deposited dataset for this entry is freely available from the CCDC and typically includes 3D coordinates, cell parameters, space group, experimental conditions and quality measures.,Related Article: D.J.Williams, K.A.Arrowood, L.M.Bloodworth, A.L.Carmack, D.Gulla, M.W.Gray, I.Maasen, F.Rizvi, S.L.Rosenbaum, K.P.Gwaltney, D.VanDerveer|2010|J.Chem.Cryst.|40|1074|doi:10.1007/s10870-010-9797-

CCDC 621659: Experimental Crystal Structure Determination

An entry from the Cambridge Structural Database, the world’s repository for small molecule crystal structures. The entry contains experimental data from a crystal diffraction study. The deposited dataset for this entry is freely available from the CCDC and typically includes 3D coordinates, cell parameters, space group, experimental conditions and quality measures.,Related Article: D.J.Williams, K.A.Arrowood, L.M.Bloodworth, A.L.Carmack, D.Gulla, M.W.Gray, I.Maasen, F.Rizvi, S.L.Rosenbaum, K.P.Gwaltney, D.VanDerveer|2010|J.Chem.Cryst.|40|1074|doi:10.1007/s10870-010-9797-

The Preparation, Characterization and X-ray Structural Analysis of Tetrakis[1-Methyl-3-(2-Propyl)-2(3H)-Imidazolethione]Cadmium(II) Hexafluorophosphate

A new compd., [Cd(mipit)4][PF6]2 was synthesized and characterized via std. solid and soln. state methods including single crystal x-ray crystallog. (mipit = 1-methyl-3-(2-propyl)-2(3H)-imidazolethione). The title compd. crystallizes in tetragonal space group I41/a with a 12.478(2), b 12.478(2), c 28.806(6) Å, and Z = 4. The complex is a high melting, colorless solid that has a distorted tetrahedral CdS4 coordination geometry. TGA results for the title compd. as well as for another potential CdS synthon and two potential CdSe synthons are reported

CCDC 742462: Experimental Crystal Structure Determination

An entry from the Cambridge Structural Database, the world’s repository for small molecule crystal structures. The entry contains experimental data from a crystal diffraction study. The deposited dataset for this entry is freely available from the CCDC and typically includes 3D coordinates, cell parameters, space group, experimental conditions and quality measures.,Related Article: D.J.Williams, D.Gulla, K.A.Arrowood, L.M.Bloodworth, A.L.Carmack, T.J.Evers, M.S.Wilson, J.J.Concepcion, C.A.S.Brevett, B.E.Huck, D.VanDerveer|2009|J.Chem.Cryst.|39|581|doi:10.1007/s10870-009-9528-