Resolución quirúrgica de la colecistitis aguda. ¿Influye el tiempo de evolución?

ResumenIntroducciónLa colecistectomía laparoscópica precoz es nuestra conducta para el tratamiento de la colecistitis aguda; sin embargo, la consulta tardía y el tratamiento postergado por dificultades de acceso hacen que el tiempo de resolución muchas veces sobrepase los 7 días de iniciados los síntomas.Nuestro objetivo es comparar los resultados quirúrgicos entre los pacientes operados antes y después de este periodo.Material y métodosSerie de casos consecutivos de pacientes con diagnóstico de colecistitis aguda operados entre junio de 2013 y diciembre de 2014 en el Servicio de Cirugía del Hospital de Coquimbo. De 358 casos, se excluyen aquellos asociados a colangitis, pancreatitis aguda, ASA ≥4 y cuadro mayor de 30 días. Consecuentemente se incluyen 233 pacientes que se dividen en «grupo precoz» (GP), operados antes del séptimo día de iniciados los síntomas, y «grupo tardío» (GT), operados después de este periodo. Se analizan la presentación de la serie y la asociación entre variables cualitativas y cuantitativas mediante la prueba de χ2 y t de Student, respectivamente.ResultadosEl GP presenta una estadía hospitalaria de 3,9 (±2,0) días y el GT de 7,2 (±5,2), (p=0,0001); el periodo postoperatorio es de 1,9 (±1,6) y de 2,9 (±4,4) días, respectivamente (p=0,055). La tasa de conversión en el GP es del 2,1% y en el GT del 9,7% (p=0,027); la tasa global de complicaciones postoperatorias es del 3,2 y 10,7%, respectivamente (p=0,033).DiscusiónNuestros resultados respaldan la colecistectomía precoz en pacientes con colecistitis aguda. Se pone de manifiesto un problema de gestión, en que la postergación de la resolución quirúrgica empeora los resultados y conlleva mayor riesgo de complicaciones.AbstractIntroductionThe treatment for acute Cholecystitis should be an early Laparoscopic Cholecystectomy. However, this resolution often exceed 7 days after the clinical symptoms onset. Mainly, for delayed consultation of the patients, access difficulties and delayed surgical resolution in our hospital.The aim is compare the surgical outcomes of patients that have had a Cholecystectomy before 7 days after the clinical symptoms onset with those operated after this period.Material and methodsBetween June 2013 and December 2014, 358 patients were Cholecystectomy for acute Cholecystitis at the Hospital of Coquimbo. Those associated to Cholangitis, Acute Pancreatitis, ASA ≥4 and Gallbladder Cancer, were excluded; 233 patients were included. They were allocated into two groups according to the treatment timeframe: ‘Early Group’ (EG) for those operated before the seventh day of symptoms onset and ‘Late Group’ (LG) for those operated after this period. A retrospective study was used to collect data demographics, clinical and surgical outcomes. All these factors were compared between the two groups.ResultsThe EG had a hospital stay of 3.9 (±2.0) days and the LG 7.2 (±5.2) (P=.0001); the postoperative stay was 1.9 (±1.6) and 2.9 (±4.4) (P=.055) days, respectively. The conversion rate in the EG was 2.1% and 9.7% in the LT (P=.027); the overall rate of postoperative complications was 3.2% and 10.7% (P=.033), respectively.ConclusionsThe findings support an early Cholecystectomy in patients with acute cholecystitis. There is a management problem in terms of delayed surgical resolution which worsens surgical outcomes and increase morbidity

Synergy between medical informatics and bioinformatics: facilitating genomic medicine for future health care

Medical Informatics (MI) and Bioinformatics (BI) are two interdisciplinary areas located at the intersection between computer science and medicine and biology, respectively. Historically, they have been separated and only occasionally have researchers of both disciplines collaborated. The completion of the Human Genome Project has brought about in this post genomic era the need for a synergy of these two disciplines to further advance in the study of diseases by correlating essential genotypic information with expressed phenotypic information. Biomedical Informatics (BMI) is the emerging technology that aims to put these two worlds together in the new rising genomic medicine. In this regard, institutions such as the European Commission have recently launched several initiatives to support a new combined research agenda, based on the potential for synergism of both disciplines. In this paper we review the results the BIOINFOMED study one of these projects funded by the E

Revisiting the five-facet structure of mindfulness

The current study aimed to replicate the development of the Five-Facet Mindfulness Questionnaire (FFMQ) in a sample of 399 undergraduate students. We factor analyzed the Mindful Attention and Awareness Questionnaire (MAAS), the Freiburg Mindfulness Scale, the Southampton Mindfulness Questionnaire (SMQ), the Cognitive Affective Mindfulness Scale Revised (CAMS-R), and the Kentucky Inventory of Mindfulness Skills (KIMS), but also extended the analysis by including a conceptually related measure, the Philadelphia Mindfulness Scale (PHLMS), and a conceptually unrelated measure, the Langer Mindfulness Scale (LMS). Overall, we found a partial replication of the five-factor structure, with the exception of non-reacting and non-judging which formed a single factor. The PHLMS items loaded as expected with theoretically related factors, whereas the LMS items emerged as separate factor. Finally, we found a new factor that was mostly defined by negatively worded items indicating possible item wording artifacts within the FFMQ. Our conceptual validation study indicates that some facets of the FFMQ can be recovered, but item wording factors may threaten the stability of these facets. Additionally, measures such as the LMS appear to measure not only theoretically, but also empirically different constructs

Born to be green: new insights into the economics and management of green entrepreneurship

While the number of green start-ups has steadily increased around the world in response to the environmental problems demanding immediate solutions, there are several unresolved questions on the behaviour and performance of such ventures. The papers in this special issue shed light on these issues by underscoring the role of several factors, such as industry life cycles, knowledge spillovers, institutions, and availability of external finance, in shaping decision-making and firm behaviour in green start-ups. This paper highlights the state-of-the art developments in the literature, discusses the key contributions of the papers put together in this special issue and presents a future research agenda for scholars interested in green entrepreneurship

BUILDING BRIDGES FOR INNOVATION IN AGEING : SYNERGIES BETWEEN ACTION GROUPS OF THE EIP ON AHA

The Strategic Implementation Plan of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) proposed six Action Groups. After almost three years of activity, many achievements have been obtained through commitments or collaborative work of the Action Groups. However, they have often worked in silos and, consequently, synergies between Action Groups have been proposed to strengthen the triple win of the EIP on AHA. The paper presents the methodology and current status of the Task Force on EIP on AHA synergies. Synergies are in line with the Action Groups' new Renovated Action Plan (2016-2018) to ensure that their future objectives are coherent and fully connected. The outcomes and impact of synergies are using the Monitoring and Assessment Framework for the EIP on AHA (MAFEIP). Eight proposals for synergies have been approved by the Task Force: Five cross-cutting synergies which can be used for all current and future synergies as they consider overarching domains (appropriate polypharmacy, citizen empowerment, teaching and coaching on AHA, deployment of synergies to EU regions, Responsible Research and Innovation), and three cross-cutting synergies focussing on current Action Group activities (falls, frailty, integrated care and chronic respiratory diseases).Peer reviewe

Physiology and pathophysiology of the vasopressin-regulated renal water reabsorption

To prevent dehydration, terrestrial animals and humans have developed a sensitive and versatile system to maintain their water homeostasis. In states of hypernatremia or hypovolemia, the antidiuretic hormone vasopressin (AVP) is released from the pituitary and binds its type-2 receptor in renal principal cells. This triggers an intracellular cAMP signaling cascade, which phosphorylates aquaporin-2 (AQP2) and targets the channel to the apical plasma membrane. Driven by an osmotic gradient, pro-urinary water then passes the membrane through AQP2 and leaves the cell on the basolateral side via AQP3 and AQP4 water channels. When water homeostasis is restored, AVP levels decline, and AQP2 is internalized from the plasma membrane, leaving the plasma membrane watertight again. The action of AVP is counterbalanced by several hormones like prostaglandin E2, bradykinin, dopamine, endothelin-1, acetylcholine, epidermal growth factor, and purines. Moreover, AQP2 is strongly involved in the pathophysiology of disorders characterized by renal concentrating defects, as well as conditions associated with severe water retention. This review focuses on our recent increase in understanding of the molecular mechanisms underlying AVP-regulated renal water transport in both health and disease