A Risk-Based Screening Approach to Patients Needing Surgery During the De-Escalation Phase of COVID-19 Pandemic

Since the outbreak of COVID-19 pandemic, many national and international surgical societies have produced guidelines regarding the management of surgical patients. During the mitigation phase of the pandemic, most documents suggested to consider postponing elective procedures, unless this might have impacted the life expectancy of patients. As awareness and knowledge about COVID-19 are gradually increasing, and as we enter a phase when surgical services are resuming their activities, surgical strategies have to adapt to this rapidly evolving scenario. This is particularly relevant when considering screening policies and the associated findings. We herein describe a risk-based approach to the management of patients with surgical diseases, which might be useful in order to limit the risks for healthcare workers and patients, while allowing for resuming elective surgical practice safely

CXCR7 expression in diffuse large B-cell lymphoma identifies a subgroup of CXCR4+ patients with good prognosis

© 2018 Moreno et al.The CXCR4/CXCL12 axis has been extensively associated with different types of cancer correlating with higher aggressiveness and metastasis. In diffuse large B-cell lymphoma (DLBCL), the expression of the chemokine receptor CXCR4 is involved in the dissemination of malignant B cells and is a marker of poor prognosis. CXCR7 is a chemokine receptor that binds to the same ligand as CXCR4 and regulates de CXCR4-CXCL12 axis. These findings together with the report of CXCR7 prognostic value in several tumor types, led us to evaluate the expression of CXCR7 in diffuse large B-cell lymphoma biopsies. Here, we describe that CXCR7 receptor is an independent prognostic factor that associates with good clinical outcome. Moreover, the expression of CXCR7 associates with increased survival in CXCR4+ but not in CXCR4- DLBCL patients. Thus, the combined immunohistochemical evaluation of both CXCR7 and CXCR4 expression in DLBCL biopsies may improve their prognostic value as single markers. Finally, we show that CXCR7 overexpression in vitro is able to diminish DLBCL cell survival and increase their sensitivity to antitumor drugs. Hence, further studies on the CXCR7 receptor may establish its role in DLBCL and the molecular mechanisms that modulate CXCR4 activity.This work was supported by Instituto de Salud Carlos III (co-founding from FEDER) [ FIS PI11/00872, RD12/0036/0071, FIS PI14/00450 to J.S., FIS PI15/00378 to R.M., PIE15/00028 to R.M. and J.S., RD12/0036/0069, PS09/01382 to M.G.D, PI15/01393 to M.A, CD13/00074 to V.P.]; Centro de Investigación Biomédica en Red (CIBER) [CB06/01/1031 and Nanomets3 to R.M. and CB16/12/00233 to M.G.D.]; Agència de Gestió d'Ajuts Universitaris i de Recerca (AGAUR) [2014-SGR-1041, 2014PROD0005 to R.M and 2014-SGR-1281 to J.S]; Fundació La Marató TV3 [416/C/2013-2030 to R.M, 100830/31/32 to J.S and M.G.D.]; Josep Carreras Leukaemia Research Institute [P/AG 2014 to R.M.]; the Health Council of Castilla y León (BIO/SA56/13 and BIO/SA78/15 to M.A.); Agència de Gestió d’Ajuts Universitaris i de Recerca (AGAUR) [2017FI_B00680 to A.F.]

Impact of comorbidities on hospital mortality in patients with acute pancreatitis: a population-based study of 110,021 patients

Acute pancreatitis; Comorbidity; Hospital mortalityPancreatitis aguda; Comorbilidad; Mortalidad hospitalariaPancreatitis aguda; Comorbilitat; Mortalitat hospitalàriaBackground The impact of pre-existing comorbidities on acute pancreatitis (AP) mortality is not clearly defined. Our study aims to determine the trend in AP hospital mortality and the role of comorbidities as a predictor of hospital mortality. Methods We analyzed patients aged ≥ 18 years hospitalized with AP diagnosis between 2016 and 2019. The data have been extracted from the Spanish National Hospital Discharge Database of the Spanish Ministry of Health. We performed a univariate and multivariable analysis of the association of age, sex, and comorbidities with hospital mortality in patients with AP. The role of the Charlson and Elixhauser comorbidity indices as predictors of mortality was evaluated. Results A total of 110,021 patients diagnosed with AP were hospitalized during the analyzed period. Hospital mortality was 3.8%, with a progressive decrease observed in the years evaluated. In multivariable analysis, age ≥ 65 years (OR: 4.11, p  1.5 (OR: 2.03, p  1.5 (OR: 2.71, p < 0.001) comorbidity indices were also independently associated with mortality, and ROC curve analysis showed that they are useful for predicting hospital mortality. Conclusions Advanced age, heart disease, renal disease, moderate-severe liver disease, peripheral vascular disease, and cerebrovascular disease before admission were independently associated with hospital mortality. The Charlson and Elixhauser comorbidity indices are useful for predicting hospital mortality in AP patients. Peer Review reports Background Acute pancreatitis (AP) is a prevalent acute inflammatory disease that affects the pancreas, with an increased incidence in recent years [1, 2]. Most cases are mild with a self-limited course [3]. However, patients with severe acute pancreatitis have a high mortality rate (20–50%) [4,5,6]. For this reason, many efforts have been made to find predictors of severity and mortality in patients with AP [7,8,9,10,11] to identify patients who need admission to an intensive care unit or specific treatment. In clinical practice, systems such as the Ranson score, the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, the Computed Tomography Severity Index (CTSI), the Bedside Index for Severity in Acute Pancreatitis (BISAP), and various biochemical markers are used to predict severe AP and mortality [3, 12,13,14,15,16]. However, hospital mortality in AP could also be related to intrinsic patient characteristics, such as individual comorbidities. Most classic scores do not consider comorbidities before admission, except for APACHE II, but are restricted to severe chronic diseases. According to some previous studies, patients with certain comorbidities, such as obesity [17], hypertriglyceridemia [18], chronic renal failure [19], diabetes [20, 21], and systemic lupus erythematosus [22], are associated with a higher risk of AP severity and mortality. However, few studies currently evaluate the impact of comorbidities on AP severity and mortality. Our study aimed to determine the relevance of comorbidities and their indexes (Charlson and Elixhauser) as predictors of hospital mortality in patients with AP

Ecología y distribución de Senecio pterophorus (Compositae) en la Península Ibérica

Field survey in Catalonia (Spain) has increased the known distribution and the number of populations of the South African daisy Senecio pterophorus DC. in the Iberian Peninsula and mainland Europe. The species colonizes relatively disturbed habitats such as river beds, road borders and disturbed helm-oak communities with no limitation in light and water. The analysis of population structure related to habitat type has revealed that in riparian and ruderal areas populations are large and well-established, with a large number of members per age class. However, in disturbed forests populations have only a few scattered adults. Senecio pterophorus also shows great morphological plasticity related with habitat type: in open environments plants are shorter, adopt a spherical habit, and have smaller leaves than in forests, where they are taller and have leaves twice in size. This species may be considered as invasive in the Iberian Peninsula and mainland Europe, where it has rapidly spread in recent years. Furthermore, we suggest that S. pterophorus may be a threat to native species and habitat diversity as occurs in Australia, where the species displaces the native plants and hybridizes with some native Senecio species.En este trabajo se describen el área de distribución y el número de poblaciones de la especie sudafricana Senecio pterophorus DC. en Cataluña, única área de la Europa continental de donde hasta ahora se conoce. Esta especie coloniza ambientes perturbados, como lechos de ríos, márgenes de carreteras y áreas forestales perturbadas, siempre que no haya limitación por la luz y la humedad. En los hábitats riparios y ruderales las poblaciones son más estables y densas, con un gran número de individuos de diversas clases de edad, mientras que en ambientes forestales las poblaciones suelen contar con pocos individuos adultos distribuidos de forma dispersa. Senecio pterophorus presenta, además, una acusada plasticidad morfológica en relación con el hábitat, de modo que en ambientes riparios y ruderales los individuos desarrollan un porte esférico, de menor tamaño, y unas hojas más pequeñas que en ambientes forestales, donde el porte de las plantas es más alargado y el tamaño de las hojas mucho mayor. Esta especie, en creciente expansión, debe ser considerada una planta invasora en la Península Ibérica, ya que ha aumentado considerablemente el número de sus poblaciones en un período relativamente corto. Además, se sugiere que S. pterophorus puede llegar a ser una amenaza para la conservación de la diversidad de especies y de hábitats naturales autóctonos, como ocurre en Australia, donde desplaza a las especies nativas e incluso se hibrida con otras especies de Senecio

The role of high serum triglyceride levels on pancreatic necrosis development and related complications

Acute pancreatitis; Pancreatic necrosis; TriglyceridePancreatitis aguda; Necrosi pancreàtica; TriglicèridsPancreatitis aguda; Necrosis pancreática; TriglicéridosBackground The relevance of elevated serum triglyceride (TG) levels in the early stages of acute pancreatitis (AP) not induced by hypertriglyceridemia (HTG) remains unclear. Our study aims to determine the role of elevated serum TG levels at admission in developing pancreatic necrosis. Methods We analyzed the clinical data collected prospectively from patients with AP. According to TG levels measured in the first 24 h after admission, we stratified patients into four groups: Normal TG (< 150 mg/dL), Borderline-high TG (150–199 mg/dL), High TG (200–499 mg/dL) and Very high TG (≥ 500 mg/dL). We analyzed the association of TG levels and other risk factors with the development of pancreatic necrosis. Results A total of 211 patients were included. In the Normal TG group: 122, in Borderline-high TG group: 38, in High TG group: 44, and in Very high TG group: 7. Pancreatic necrosis developed in 29.5% of the patients in the Normal TG group, 26.3% in the Borderline-high TG group, 52.3% in the High TG group, and 85.7% in the Very high TG group. The trend analysis observed a significant association between higher TG levels and pancreatic necrosis (p = 0.001). A multivariable analysis using logistic regression showed that elevated TG levels ≥ 200 mg/dL (High TG and Very high TG groups) were independently associated with pancreatic necrosis (OR: 3.27, 95% CI − 6.27, p < 0.001). Conclusions An elevated TG level at admission ≥ 200 mg/dl is independently associated with the development of pancreatic necrosis. The incidence of pancreatic necrosis increases proportionally with the severity of HTG

MYC directly transactivates CR2/CD21, the receptor of the Epstein-Barr virus, enhancing the viral infection of Burkitt lymphoma cells.

MYC is an oncogenic transcription factor dysregulated in about half of total human tumors. While transcriptomic studies reveal more than 1000 genes regulated by MYC, a much smaller fraction of genes is directly transactivated by MYC. Virtually all Burkitt lymphoma (BL) carry chromosomal translocations involving MYC oncogene. Most endemic BL and a fraction of sporadic BL are associated with Epstein-Barr virus (EBV) infection. The currently accepted mechanism is that EBV is the BL-causing agent inducing MYC translocation. Herein we show that the EBV receptor, CR2 (also called CD21), is a direct MYC target gene. This is based on several pieces of evidence: MYC induces CR2 expression in both proliferating and arrested cells and in the absence of protein synthesis, binds the CR2 promoter and transactivates CR2 in an E-box-dependent manner. Moreover, using mice with conditional MYC ablation we show that MYC induces CR2 in primary B cells. Importantly, modulation of MYC levels directly correlates with EBV's ability of infection in BL cells. Altogether, in contrast to the widely accepted hypothesis for the correlation between EBV and BL, we propose an alternative hypothesis in which MYC dysregulation could be the first event leading to the subsequent EBV infection.S

Ecologia y distribucion de Senecio pterophorus (Compositae) en la Peninsula Iberica.

En este trabajo se describen el área de distribución y el número de poblaciones de la especie sudafricana Senecio pterophorus DC. en Cataluña, única área de la Europa continental de donde hasta ahora se conoce. Esta especie coloniza ambientes perturbados, como lechos de ríos, márgenes de carreteras y áreas forestales perturbadas, siempre que no haya limitación por la luz y la humedad. En los hábitats riparios y ruderales las poblaciones son más estables y densas, con un gran número de individuos de diversas clases de edad, mientras que en ambientes forestales las poblaciones suelen contar con pocos individuos adultos distribuidos de forma dispersa. Senecio pterophorus presenta, además, una acusada plasticidad morfológica en relación con el hábitat, de modo que en ambientes riparios y ruderales los individuos desarrollan un porte esférico, de menor tamaño, y unas hojas más pequeñas que en ambientes forestales, donde el porte de las plantas es más alargado y el tamaño de las hojas mucho mayor. Esta especie, en creciente expansión, debe ser considerada una planta invasora en la Península Ibérica, ya que ha aumentado considerablemente el número de sus poblaciones en un período relativamente corto. Además, se sugiere que S. pterophorus puede llegar a ser una amenaza para la conservación de la diversidad de especies y de hábitats naturales autóctonos, como ocurre en Australia, donde desplaza a las especies nativas e incluso se hibrida con otras especies de Senecio

Elevated Serum Triglyceride Levels in Acute Pancreatitis: A Parameter to be Measured and Considered Early

Triglicéridos séricos; Pancreatitis agudaTriglicèrids sèrics; Pancreatitis agudaAcute pancreatitis; Serum triglycerideBackground The value of serum triglycerides (TGs) related to complications and the severity of acute pancreatitis (AP) has not been clearly defined. Our study aimed to analyze the association of elevated levels of TG with complications and the severity of AP. Methods The demographic and clinical data of patients with AP were prospectively analyzed. TG levels were measured in the first 24 h of admission. Patients were divided into two groups: one with TG values of<200 mg/dL and another with TG≥200 mg/dL. Data on the outcomes of AP were collected. Results From January 2016 to December 2019, 247 cases were included: 200 with TG<200 mg/dL and 47 with TG≥200 mg/dL. Triglyceride levels≥200 mg/dL were associated with respiratory failure (21.3 vs. 10%, p=0.033), renal failure (23.4 vs. 12%, p=0.044), cardiovascular failure (19.1 vs. 7.5%, p=0.025), organ failure (34 vs. 18.5%, p=0.02), persistent organ failure (27.7 vs. 9.5%, p=0.001), multiple organ failure (19.1 vs. 8%, p=0.031), moderately severe and severe AP (68.1 vs. 40.5%, p=0.001), pancreatic necrosis (63.8 vs. 34%, p<0.001), and admission to the intensive care unit (27.7 vs. 9.5%, p=0.003). In the multivariable analysis, a TG level of≥200 mg/dL was independently associated with respiratory, renal, and cardiovascular failure, organ failure, persistent organ failure, multiple organ failure, pancreatic necrosis, severe pancreatitis, and admission to the intensive care unit (p<0.05). Conclusions In our cohort, TG≥200 mg/dL was related to local and systemic complications. Early determinations of TG levels in AP could help identify patients at risk of complications.Open Access Funding provided by Universitat Autonoma de Barcelona

Early impairment of lung mechanics in a murine model of Marfan syndrome

Early morbidity and mortality in patients with Marfan syndrome (MFS) -a connective tissue disease caused by mutations in fibrillin-1 gene- are mainly caused by aorta aneurysm and rupture. However, the increase in the life expectancy of MFS patients recently achieved by reparatory surgery promotes clinical manifestations in other organs. Although some studies have reported respiratory alterations in MFS, our knowledge of how this connective tissue disease modifies lung mechanics is scarce. Hence, we assessed whether the stiffness of the whole lung and of its extracellular matrix (ECM) is affected in a well-characterized MFS mouse model (FBN1 C1039G/+ ). The stiffness of the whole lung and of its ECM were mea- sured by conventional mechanical ventilation and atomic force microscopy, respectively. We studied 5-week and 9-month old mice, whose ages are representative of early and late stages of the disease. At both ages, the lungs of MFS mice were significantly more compli- ant than in wild type (WT) mice. By contrast, no significant differences were found in local lung ECM stiffness. Moreover, histopathological lung evaluation showed a clear emphyse- matous-like pattern in MFS mice since alveolar space enlargement was significantly increased compared with WT mice. These data suggest that the mechanism explaining the increased lung compliance in MFS is not a direct consequence of reduced ECM stiffness, but an emphysema-like alteration in the 3D structural organization of the lung. Since lung alterations in MFS are almost fully manifested at an early age, it is suggested that respira- tory monitoring could provide early biomarkers for diagnosis and/or follow-up of patients with the Marfan syndrom