Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Gestión del conocimiento: perspectiva multidisciplinaria. Volumen 13

El libro “Gestión del Conocimiento. Perspectiva Multidisciplinaria”, Volumen 13 de la Colección Unión Global, es resultado de investigaciones. Los capítulos del libro, son resultados de investigaciones desarrolladas por sus autores. El libro es una publicación internacional, seriada, continua, arbitrada, de acceso abierto a todas las áreas del conocimiento, orientada a contribuir con procesos de gestión del conocimiento científico, tecnológico y humanístico. Con esta colección, se aspira contribuir con el cultivo, la comprensión, la recopilación y la apropiación social del conocimiento en cuanto a patrimonio intangible de la humanidad, con el propósito de hacer aportes con la transformación de las relaciones socioculturales que sustentan la construcción social de los saberes y su reconocimiento como bien público. El libro “Gestión del Conocimiento. Perspectiva Multidisciplinaria”, Volumen 13, de la Colección Unión Global, es resultado de investigaciones. Los capítulos del libro, son resultados de investigaciones desarrolladas por sus autores. El libro cuenta con el apoyo de los grupos de investigación: Universidad Sur del Lago “Jesús María Semprúm” (UNESUR) - Zulia – Venezuela; Universidad Politécnica Territorial de Falcón Alonso Gamero (UPTFAG) - Falcón – Venezuela; Universidad Politécnica Territorial de Mérida Kléber Ramírez (UPTM) - Mérida - Venezuela; Universidad Guanajuato (UG) - Campus Celaya - Salvatierra - Cuerpo Académico de Biodesarrollo y Bioeconomía en las Organizaciones y Políticas Públicas (CABBOPP) - Guanajuato – México; Centro de Altos Estudios de Venezuela (CEALEVE) - Zulia – Venezuela, Centro Integral de Formación Educativa Especializada del Sur (CIFE - SUR) - Zulia – Venezuela; Centro de Investigaciones Internacionales SAS (CEDINTER) - Antioquia – Colombia y diferentes grupos de investigación del ámbito nacional e internacional que hoy se unen para estrechar vínculos investigativos, para que sus aportes científicos formen parte de los libros que se publiquen en formatos digital e impreso

Optimization by Central Composite Experimental Design of the Synthesis of Physically Crosslinked Chitosan Spheres

Chitosan (CS) has special properties such as biocompatibility, biodegradability, antibacterial, and biological activity which make this material is currently studied in various applications, including tissue engineering. There are different methods to modify the morphology of CS. Most use chemical crosslinking agents, however, those methods have disadvantages such as low polymer degradability and unwanted side effects. The objective of this research was to obtain CS spheres through the physical crosslinking of commercial CS without using crosslinking agents through a simple coacervation method. A central composite experimental design was used to optimize the synthesis of the CS spheres and by the response surface methodology it was possible to obtain CS spheres with the smallest diameter and the most regular morphology. With the optimal formulation (CS solution 1.8% (w/v), acetic acid (AAC) solution 1% (w/v), sodium hydroxide (NaOH) solution 13% (w/v), relative humidity of (10%) and needle diameter of 0.6 mm), a final sphere diameter of 1 mm was obtained. Spheres were characterized by physical, chemical, thermal, and biological properties in simulated body fluid (SBF). The results obtained allowed us to understand the effect of the studied variables on the spheres&rsquo; diameter. An optimized condition facilitated the change in the morphology of the CS while maintaining its desirable properties for use in tissue engineering

Influence of the chitosan morphology on the properties of acrylic cements and their biocompatibility

Acrylic bone cements (ABC) are materials widely used in orthopedics and biomedical applications. Several active compounds have been introduced to ABC formulations to improve their mechanical properties and bifunctionality. In this research, we studied the effect of the addition of chitosan (CS) microspheres and chitosan sheets on ABC formulations. For mechanical performance optimization, the compression strength was taken as a response variable using an extreme vertices mixing design with fraction by weight of CS and poly(methyl methacrylate) (PMMA) as the variable factors. According to the statistical analysis, the control samples (without CS), samples with 7% (wt.) of CS sheets, and samples with 17% (wt.) of CS spheres presented the best compression properties: 90.6 MPa and 95.6 MPa, respectively. The study of these formulations confirmed that CS spheres allow a higher amount of loading on the formulation, maintaining comparable compression strength. By 1H-NMR, it was observed that the residual monomer was similar in all wording. The hydrolytic degradation assay in simulated body fluid (SBF) determined that the sphere incorporation increased by 50% and 35% for the water uptake and weight loss values, respectively, when compared with the reported values with CS sheets. By morphological analysis via SEM, it was observed that the porosity increased considerably in the presence of CS spheres throughout the immersion time in SBF. The subdermal implant results demonstrated excellent compatibility between the cement studied and the biological environment.Author Mayra Eliana Valencia Zapata thanks MinCiencias for funding her doctoral studies. Author Luis Rojo is a member of the SusPlast platform from the Spanish National Research Council (CSIC)

Cancer-associated differences in the acetylcholinesterase activity in bronchial aspirates of lung cancer patients

International audienceIn non-neuronal contexts, acetylcholine is thought to be involved in the regulation of vital cell functions such as proliferation, differentiation, apoptosis and cell-cell interaction. In airways most cells express the non-neuronal cholinergic system each containing a specific set of components required for synthesis, signal transduction and acetylcholine hydrolysis. Our aim was determine the expression of cholinergic system components in bronchial aspirates from controls and lung cancer patients. We conducted an analysis of cholinergic components in stored soluble and cellular fraction of bronchial aspirates from non-cancerous patients and diagnosed lung cancer patients. This study presents data proving that the fluid secreted by human lung cells contains enough acetylcholinesterase activity to control acetylcholine level. Thus, these data demonstrate that: (a) Acetylcholinesterase activity is significantly lower in aspirates from squamous cell carcinomas; (b) The molecular distribution of acetylcholinesterase in both bronchial cells and fluids consisted of amphiphilic monomers and dimers; (c) choline acetyltransferase, nicotinic receptors and cholinesterases are expressed in cultured human lung cells, as demonstrated by RT-PCR. It appears that the non-neuronal cholinergic system is involved in lung physiology and lung cancer. The physiological consequences of the presence of non-neuronal ACh will depend on the particular cholinergic signalling network of each cell type. Clarifying the pathophysiological actions of acetylcholine remains an essential task and warrants further investigation