Use of sponge-assisted endoluminal vacuum therapy for the treatment of colorectal anastomotic leaks: expert panel consensus

Colorectal anastomotic leaks; Endoluminal vacuum therapyFugas anastomóticas colorrectales; Terapia de vacío endoluminalFuites anastomòtiques colorectals; Teràpia de buit endoluminalBackground Anastomotic leaks represent one of the most significant complications of colorectal surgery and are the primary cause of postoperative mortality and morbidity. Sponge-assisted endoluminal vacuum therapy (EVT) has emerged as a minimally invasive technique for the management of anastomotic leaks; however, there are questions regarding patient selection due to the heterogeneous nature of anastomotic leaks and the application of sponge-assisted EVT by surgeons. Method Seven colorectal surgical experts participated in a modified nominal group technique to establish consensus regarding key questions that arose from existing gaps in scientific evidence and the variability in clinical practice. After a bibliographic search to identify the available evidence and sequential meetings with participants, a series of recommendations and statements were formulated and agreed upon. Results Thirty-seven recommendations and statements on the optimal use of sponge-assisted EVT were elaborated on and unanimously agreed upon by the group of experts. The statements and recommendations answer 10 key questions about the indications, benefits, and definition of the success rate of sponge-assisted EVT for the management of anastomotic leaks. Conclusion Although further research is needed to resolve clinical and technical issues associated with sponge-assisted EVT, the recommendations and statements produced from this project summarize critical aspects to consider when using sponge-assisted EVT and to assist those involved in the management of patients with colorectal anastomotic leaks.This project was supported by B. Braun Surgical SAU

Machine learning to predict major bleeding during anticoagulation for venous thromboembolism: possibilities and limitations

Predictive tools for major bleeding (MB) using machine learning (ML) might be advantageous over traditional methods. We used data from the Registro Informatizado de Enfermedad TromboEmbólica (RIETE) to develop ML algorithms to identify patients with venous thromboembolism (VTE) at increased risk of MB during the first 3 months of anticoagulation. A total of 55 baseline variables were used as predictors. New data prospectively collected from the RIETE were used for further validation. The RIETE and VTE-BLEED scores were used for comparisons. External validation was performed with the COMMAND-VTE database. Learning was carried out with data from 49 587 patients, of whom 873 (1.8%) had MB. The best performing ML method was XGBoost. In the prospective validation cohort the sensitivity, specificity, positive predictive value and F1 score were: 33.2%, 93%, 10%, and 15.4% respectively. F1 value for the RIETE and VTE-BLEED scores were 8.6% and 6.4% respectively. In the external validation cohort the metrics were 10.3%, 87.6%, 3.5% and 5.2% respectively. In that cohort, the F1 value for the RIETE score was 17.3% and for the VTE-BLEED score 9.75%. The performance of the XGBoost algorithm was better than that from the RIETE and VTE-BLEED scores only in the prospective validation cohort, but not in the external validation cohort

Real-life disease monitoring in follicular lymphoma patients using liquid biopsy ultra-deep sequencing and PET/CT

In the present study, we screened 84 Follicular Lymphoma patients for somatic mutations suitable as liquid biopsy MRD biomarkers using a targeted next-generation sequencing (NGS) panel. We found trackable mutations in 95% of the lymph node samples and 80% of the liquid biopsy baseline samples. Then, we used an ultra-deep sequencing approach with 2 · 10−4 sensitivity (LiqBio-MRD) to track those mutations on 151 follow-up liquid biopsy samples from 54 treated patients. Positive LiqBio-MRD at first-line therapy correlated with a higher risk of progression both at the interim evaluation (HRINT 11.0, 95% CI 2.10–57.7, p = 0.005) and at the end of treatment (HREOT, HR 19.1, 95% CI 4.10–89.4, p < 0.001). Similar results were observed by PET/CT Deauville score, with a median PFS of 19 months vs. NR (p < 0.001) at the interim and 13 months vs. NR (p < 0.001) at EOT. LiqBio-MRD and PET/CT combined identified the patients that progressed in less than two years with 88% sensitivity and 100% specificity. Our results demonstrate that LiqBio-MRD is a robust and non-invasive approach, complementary to metabolic imaging, for identifying FL patients at high risk of failure during the treatment and should be considered in future response-adapted clinical trials.This study has been funded by Instituto de Salud Carlos III (ISCIII) and co-funded by the European Union through the projects PI21/00314, PI19/01430, PI19/01518 and PI18/00295, PTQ2020-011372, CP19/00140, CP22/00082, Doctorado industrial CAM IND2020/TIC-17402 and CRIS cancer foundation

Women with psychotic episodes during pregnancy show increased markers of placental damage with Tenney-Parker changes

y. Psychosis is a hazardous and functionally disruptive psychiatric condition which may affect women in pregnancy, entailing negative consequences for maternofetal well-being. The precise pathophysiological basis and consequences of a psychotic episode in pregnancy remain to be further elucidated. The placenta is a pivotal tissue with many functions in the gestational period, critically influencing the fate and development of pregnancy. Although detrimental alterations have been observed in women undergoing severe psychiatric disorders in pregnancy, there are little studies evaluating the consequences of suffering from a psychotic episode in the placental tissue In this work, we have evaluated the histopathological consequences of a first episode of psychosis in pregnancy (FE-PW; N=22) and compare them with healthy pregnant women (HC-PW; N=20) by using histological, immunohistochemical and gene expression techniques. Our results define that the placental tissue of FE-PW display an increase in the number of placental villi, bridges, syncytial knots and syncytial knots/villi. Besides, we have also observed an enhanced gene and protein expression in FE-PW of the hypoxic marker HIF-1α, together with the apoptotic markers BAX and Bcl-2. To our knowledge, this is the first study demonstrating significant histopathological changes in the placenta of women suffering a new-onset psychotic episode in pregnancy. Further studies should be aimed at deepening the knowledge about the pernicious effects of psychosis in the maternofetal tissues, as well as the potential implications of these alterations

Aplicación metodología cualitativa para el estudio del impacto de la pandemia COVID-19 en titulaciones de Ciencias de la Salud, Terapia Ocupacional y Fisioterapia

[EN] The COVID-19 pandemic forced a sudden adaptation of higher education to a complex and changing reality, by incorporating new technologies for teaching. The Health Sciences degrees have adapted their curriculum to this new reality, where the teaching and learning process has been modified by incorporating new technologies, distance learning and limitation of clinical practices in health centers. It is necessary to analyze dimensions such as the teaching and learning process, the modification of the material used, the integration of theoretical and practical content, and the participation of students in the development of educational material. The objective of this work is to present 6 qualitative research proposals that help to understand the adaptation of professors and students to this new reality, together with the teaching and learning process and the incorporation of new tools and teaching methods (e-learning) during the pandemic.[ES] La educación superior ha precisado adaptarse a una nueva realidad compleja debido a la pandemia del COVID-19. Esto ha obligado incorporar nuevas tecnologías para la enseñanza superior. Como consecuencia, las titulaciones universitarias, como las de las ciencias de la salud, han ido realizando modificaciones y adaptándose incorporando nuevas tecnologías y metodología de enseñanza. Pero existen dimensiones como las prácticas clínicas en centros sanitarios que siguen planteando retos dentro del proceso de enseñanza y aprendizaje en estas titulaciones. Es preciso analizar en Ciencias de la Salud, dimensiones como el proceso de enseñanza y aprendizaje, la modificación del material docente utilizado, la integración de los contenidos teóricos y prácticos, y la participación de los estudiantes en el desarrollo de material docente. El objetivo de esta comunicación es presentar 6 propuestas de investigación cualitativa, que ayuden a desarrollar y elaborar estudios que analicen y profundicen en la perspectiva de los profesores y estudiantes en esta nueva realidad, junto al proceso de enseñanza e incorporación de métodos de enseñanza (e-learning) durante la pandemia.Moro, P.; Palacios-Ceña, D.; Lima Florencio, L.; Perez Corrales, J.; Gueita Rodriguez, J.; Martinez Piedrola, R.; Perez De Heredia, M.... (2021). Aplicación metodología cualitativa para el estudio del impacto de la pandemia COVID-19 en titulaciones de Ciencias de la Salud, Terapia Ocupacional y Fisioterapia. En IN-RED 2021: VII Congreso de Innovación Edicativa y Docencia en Red. Editorial Universitat Politècnica de València. 970-982. https://doi.org/10.4995/INRED2021.2021.13743OCS97098

The INTEGRAL/IBIS AGN catalogue I: X-ray absorption properties versus optical classification

In this work we present the most comprehensive INTEGRAL AGN sample which lists 272 objects. Here we mainly use this sample to study the absorption properties of active galaxies, to probe new AGN classes and to test the AGN unification scheme. We find that half (48%) of the sample is absorbed while the fraction of Compton thick AGN is small (~7%). In line with our previous analysis, we have however shown that when the bias towards heavily absorbed objects which are lost if weak and at large distance is removed, as it is possible in the local Universe, the above fractions increase to become 80% and 17%. We also find that absorption is a function of source luminosity, which implies some evolution in the obscuration properties of AGN. Few peculiar classes, so far poorly studied in the hard X-ray band, have been detected and studied for the first time such as 5 XBONG, 5 type 2 QSOs and 11 LINERs. In terms of optical classification, our sample contains 57% of type 1 and 43% of type 2 AGN; this subdivision is similar to that found in X-rays if unabsorbed versus absorbed objects are considered, suggesting that the match between optical and X-ray classification is overall good. Only a small percentage of sources (12%) does not fulfill the expectation of the unified theory as we find 22 type 1 AGN which are absorbed and 10 type 2 AGN which are unabsorbed. Studying in depth these outliers we found that most of the absorbed type 1 AGN have X-ray spectra characterized by either complex or warm/ionized absorption more likely due to ionized gas located in an accretion disk wind or in the biconical structure associated to the central nucleus, therefore unrelated to the toroidal structure. Among 10 type 2 AGN which resulted to be unabsorbed, at most 3-4% is still eligible to be classified as a "true" type 2 AGN.Comment: 21 pages, 6 figures, 5 tables. Accepted for publication on MNRAS. arXiv admin note: text overlap with arXiv:0709.2077 by other author

Risks of dengue secondary infective biting associated with aedes aegypti in home environments in Monterrey, Mexico

Abstract. Secondary dengue virus infections are a major risk for developing dengue hemorrhagic fever. Recent exposure to infectious bites of Aedes aegypti (L.) females in previously diagnosed dengue cases fulfills the epidemiological model of dengue hemorrhagic fever. A study was comprised of 357 (89.2%) dengue and 43 (10.8%) dengue hemorrhagic fever cases confirmed by laboratory tests and clinical manifestations. An entomological survey was done in homes and backyards. Concurrently, a questionnaire was used to assess the impact of healthpromotion campaigns through knowledge of the vector and its epidemiological role. Seventy-six (28.4%) of the 268 (67.0%) total wet or dry oviposition sites were positive for the presence of larvae or pupae, while adult Ae. aegypti were found in 32 (8.0%). One hundred thirty-two (33%) householders who formerly had dengue fever or dengue hemorrhagic fever had knowledge of either larval or adult dengue vector stages. According to gender distribution, 145 (36.2%) and 14 (3.5%) of the males confirmed with cases of dengue and dengue hemorrhagic fever lived in houses with 17.9 and 2% of the Ae. aegypti larval and pupal habitats. Houses with females who had dengue and dengue hemorrhagic fever were 212 (53%) and 29 (7.3%), with containers with immature Ae. aegypti in 19.4 and 7%, respectively. Lack of sustainability of government-targeted health education campaigns is the major problem for involving communities in prevention and control of dengu

Influence of IL28B Polymorphisms on Response to a Lower-Than-Standard Dose peg-IFN-α 2a for Genotype 3 Chronic Hepatitis C in HIV-Coinfected Patients

Background: Data on which to base definitive recommendations on the doses and duration of therapy for genotype 3 HCV/HIV-coinfected patients are scarce. We evaluated the efficacy of a lower peginterferon-α 2a dose and a shorter duration of therapy than the current standard of care in genotype 3 HCV/HIV-coinfected patients. Methods and Findings: Pilot, open-label, single arm clinical trial which involved 58 Caucasian HCV/HIV-coinfected patients who received weekly 135 μg peginterferon-α 2a plus ribavirin 400 mg twice daily during 20 weeks after attaining undetectable viremia. The relationships between baseline patient-related variables, including IL28B genotype, plasma HCV-RNA, ribavirin dose/kg, peginterferon-α 2a and ribavirin levels with virological responses were analyzed. Only 4 patients showed lack of response and 5 patients dropped out due to adverse events related to the study medication. Overall, sustained virologic response (SVR) rates were 58.3% by intention-to-treat and 71.4% by per protocol analysis, respectively. Among patients with rapid virologic response (RVR), SVR and relapses rates were 92.6% and 7.4%, respectively. No relationships were observed between viral responses and ribavirin dose/kg, peginterferon-α 2a concentrations, ribavirin levels or rs129679860 genotype. Conclusions: Weekly 135 μg pegIFN-α 2a could be as effective as the standard 180 μg dose, with a very low incidence of severe adverse events. A 24-week treatment duration appears to be appropriate in patients achieving RVR, but extending treatment up to just 20 weeks beyond negativization of viremia is associated with a high relapse rate in those patients not achieving RVR. There was no influence of IL28B genotype on the virological responses. © 2012 López-Cortés et al.Funding provided by Fundación Pública Andaluza para la gestión de la Investigación en Salud de Sevilla. Hospitales Universitarios Virgen del Rocío. Seville, Spain. The enzyme-linked immunosorbent assay Hu-INF-α kits for determination of pegIFN-α-2a were financed by Roche Pharma, S.A. (Spain).Peer Reviewe