Respuesta a la endotelina-I en arterias humanas de tumores de colon y recto

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Fisiología. Fecha de lectura: 20 de Febrero de 200

Structural and dielectric properties of ultra-fast microwave-processed La_0.3Ca_0.7Fe_0.7Cr_0.3O3-delta ceramics

Perovskite La_0.3Ca_0.7Fe_0.7Cr_0.3O_(3-delta) (LCFCr) is a mixed ionic and electronic conductor (MIEC) that can be employed as an electrode material in reversible solid oxide fuel cells (RSOFCs). In this work, an ultra-fast (15 min) one-step microwave (MW)-assisted combustion synthesis route has been developed to obtain phase pure and highly crystalline LCFCr powder. The synthesized powders exhibited a sponge-like microstructure with increased electrochemical reaction sites. Neutron thermodiffraction analysis revealed a structural transition above 500 degrees C from the room temperature (RT) orthorhombic Pnma to a rhombohedral R3c perovskite phase. The oxygen vacancy concentration was found to increase from delta = 0.272(7) at RT to delta = 0.333(5) at 900 degrees C. Furthermore, a 3-dimensional G-type antiferromagnetic structure was detected at RT. MW-sintering of pressed green ceramic pellets was carried out at 950 degrees C for 1 h, using a MW-transparent quartz fiber crucible or alternatively a SiC crucible acting as a MW-absorber. Impedance spectroscopy data on sintered ceramic pellets revealed electronic inhomogeneity as demonstrated by the occurrence of three dielectric relaxation processes associated with two grain boundary (GB)-like contributions and one bulk. The dielectric inhomogeneity encountered may be restricted to the extrinsic GB areas, which may be rather thin. More homogeneous dielectric properties of the GBs were found in the pellet that was sintered in the SiC crucible

Management of acute diverticulitis with pericolic free gas (ADIFAS). an international multicenter observational study

Background: There are no specific recommendations regarding the optimal management of this group of patients. The World Society of Emergency Surgery suggested a nonoperative strategy with antibiotic therapy, but this was a weak recommendation. This study aims to identify the optimal management of patients with acute diverticulitis (AD) presenting with pericolic free air with or without pericolic fluid. Methods: A multicenter, prospective, international study of patients diagnosed with AD and pericolic-free air with or without pericolic free fluid at a computed tomography (CT) scan between May 2020 and June 2021 was included. Patients were excluded if they had intra-abdominal distant free air, an abscess, generalized peritonitis, or less than a 1-year follow-up. The primary outcome was the rate of failure of nonoperative management within the index admission. Secondary outcomes included the rate of failure of nonoperative management within the first year and risk factors for failure. Results: A total of 810 patients were recruited across 69 European and South American centers; 744 patients (92%) were treated nonoperatively, and 66 (8%) underwent immediate surgery. Baseline characteristics were similar between groups. Hinchey II-IV on diagnostic imaging was the only independent risk factor for surgical intervention during index admission (odds ratios: 12.5, 95% CI: 2.4-64, P =0.003). Among patients treated nonoperatively, at index admission, 697 (94%) patients were discharged without any complications, 35 (4.7%) required emergency surgery, and 12 (1.6%) percutaneous drainage. Free pericolic fluid on CT scan was associated with a higher risk of failure of nonoperative management (odds ratios: 4.9, 95% CI: 1.2-19.9, P =0.023), with 88% of success compared to 96% without free fluid ( P <0.001). The rate of treatment failure with nonoperative management during the first year of follow-up was 16.5%. Conclusion: Patients with AD presenting with pericolic free gas can be successfully managed nonoperatively in the vast majority of cases. Patients with both free pericolic gas and free pericolic fluid on a CT scan are at a higher risk of failing nonoperative management and require closer observation

Outcomes of initially nonoperative management of diverticulits with abscess formation in inmunosuppressed patients. DIPLICAB study COLLABORATIVE group

Aim: Management of diverticulitis with abscess formation in immunosuppressed patients (IMS) remains unclear. The main objective of the study was to assess short- and long-term outcomes between IMS and immunocompetent patients (IC). The secondary aim was to identify risk factors for emergency surgery. Methods: A nationwide retrospective cohort study was performed at 29 Spanish referral centres between 2015–2019 including consecutive patients with first episode of diverticulitis classified as modified Hinchey Ib or II. IMS included immunosuppressive therapy, biologic therapy, malignant neoplasm with active chemotherapy and chronic steroid therapy. A multivariate analysis was performed to identify independent risk factors to emergency surgery in IMS. Results: A total of 1395 patients were included; 118 IMS and 1277 IC. There were no significant differences in emergency surgery between IMS and IC (19.5% and 13.5%, p = 0.075) but IMS was associated with higher mortality (15.1% vs. 0.6%, p < 0.001). Similar recurrent episodes were found between IMS and IC (28% vs. 28.2%, p = 0.963). Following multivariate analysis, immunosuppressive treatment, p = 0.002; OR: 3.35 (1.57–7.15), free gas bubbles, p < 0.001; OR: 2.91 (2.01–4.21), Hinchey II, p = 0.002; OR: 1.88 (1.26–2.83), use of morphine, p < 0.001; OR: 3.08 (1.98–4.80), abscess size ≥5 cm, p = 0.001; OR: 1.97 (1.33–2.93) and leucocytosis at third day, p < 0.001; OR: 1.001 (1.001–1.002) were independently associated with emergency surgery in IMS. Conclusion: Nonoperative management in IMS has been shown to be safe with similar treatment failure than IC. IMS presented higher mortality in emergency surgery and similar rate of recurrent diverticulitis than IC. Identifying risk factors to emergency surgery may anticipate emergency surgery.Depto. de CirugíaFac. de MedicinaTRUEpu

C-protein reactive as a marker of surgical stress reduction with an ERAS protocol (enhanced recovery after surgery) in colorectal surgery: a proxpective cohort study.

Background: The aim of this study is to evaluate the effectiveness of an Enhanced Recovery After Surgery Protocol (ERAS) in relation to reduce the Systemic Inflammatory Response (SIR) to surgery using C-reactive protein (CRP) in the first (POD1), second (POD2) and third (POD3) postoperative day. Methods: We enrolled 121 patients (ERAS group) that underwent elective colorectal surgery with ERAS, and compared them with 135 patients (preERAS group) that had undergone surgery prior to the implementation. We made a univariate analysis to compare the CRP values in POD1, POD2, and POD3 between preERAS/ERAS group, laparoscopic/open surgery and the presence or not of Clavien Dindo complications. Multivariable lineal regression was used to assess if the ERAS had a decreasing effect on the CRP in POD1, POD2, and POD3, and was adjusted by age, male sex, use of laparoscopy, and complications. Results: The presence of complications was independently associated with an increase in CRP values ​​in POD1, POD2, and POD3. Laparoscopy in POD1 and POD2, and ERAS in POD2 was independently associated with a decrease in CRP values. Conclusion: The analysis shows an increase in SIR measured as a CRP value in those patients that had complications. The SIR decreased with laparoscopy in POD1 and POD2 and with ERAS in POD2.Depto. de CirugíaFac. de MedicinaTRUEpu

Implementation of an Enhanced Recovery After Surgery program in elective colorectal surgery: a prospective cohort study

Objective: To evaluate the results of an Enhanced Recovery After Surgery (ERAS) protocol in elective colorectal surgery compared to the historical cohort of this hospital with standard care, in terms of hospital Length Of Stay (LOS), 30 days readmissions rate and 3–5 Clavien–Dindo Complications (CDC). Methodology: Data were collected from consecutive patients during 2 time periods, before (135 patients from hospital database) and after implementation of an ERAS protocol (121 with prospective follow up). Multivariate lineal or logistic regressions were used to assess the impact of ERAS program, adjusting by gender, age, laparoscopy and 3–5 CDC. Results: The two groups were homogeneous in terms of demographic and surgery details, with the exception of the operative approach, with increased use of laparoscopy in the ERAS group. The ERAS protocol decreased LOS (9.8 ± 3.7 vs. 11 ± 3.8, p = 0.018) without increasing 30 days readmission rate or the number of severe CDC. In a multivariate analysis, age and 3–5 CDC were independently associated with a longer LOS while male gender, ERAS protocol and laparoscopic surgery with a decreased LOS. 3–5 CDC increased readmissions (OR = 3.5, 95% CI 1.2–10.2) while laparoscopic surgery decreased them (OR = 0.2, 95% CI 0.1–0.8). ERAS improved compliance with secondary variables in a statistically significant way: more laparoscopic surgery; more regional analgesia in the intraoperative period; earlier adherence to ambulation; faster onset of oral liquid diet and analgesia by mouth; and lower requirements of opioids. Conclusions: ERAS protocol and laparoscopic surgery decreased LOS without increasing 30 days readmission rate. Severe CDC increased LOS and readmissions. Resumo: Objetivo: Avaliar os resultados de um protocolo de recuperação aprimorada após a cirurgia (enhanced recovery after surgery [ERAS]) em cirurgia colorretal eletiva em comparação com a coorte histórica deste hospital, que recebeu o tratamento padrão, em termos de hospitalização, taxa de readmissão de 30 dias e graus 3 a 5 na escala de complicações cirúrgicas de Clavien-Dindo (CCD). Metodologia: Os dados foram coletados de pacientes consecutivos em dois períodos de tempo: antes (135 pacientes do banco de dados do hospital) e depois da implementação de um protocolo ERAS (121 pacientes com acompanhamento prospectivo). Regressões lineares ou logísticas multivariadas foram usadas para avaliar o impacto do protocolo ERAS, ajustando por sexo, idade, uso de laparoscopia e graus 3 a 5 na escala CCD. Resultados: Os dois grupos foram homogêneos em termos de características demográficas e cirúrgicas, com exceção da abordagem operatória, com o aumento do uso de laparoscopia no grupo ERAS. O protocolo ERAS diminuiu o tempo de internação (9,8 ± 3,7 vs. 11 ± 3,8; p = 0,018) sem aumentar a taxa de readmissão de 30 dias ou a severidade na escala CCD. Na análise multivariada, a idade e os graus 3 a 5 na escala CCD foram independentemente associados a uma hospitalização mais longa, enquanto o sexo masculino, o protocolo ERAS e a cirurgia laparoscópica foram independentemente associados a uma hospitalização mais curta. Graus 3 a 5 na escala CCD foram associados a um aumento nas readmissões (OR = 3,5; IC 95%: 1,2–10,2), enquanto a cirurgia laparoscópica foi associada a uma diminuição nesse número (OR = 0,2; IC 95%: 0,1–0,8). O ERAS melhorou a adesão às variáveis secundárias de uma forma estatisticamente significativa: aumento no número de cirurgias laparoscópicas; maior uso de analgesia regional no período intraoperatório; adesão precoce à deambulação; início mais rápido da dieta líquida oral e analgesia por via oral; finalmente, menor uso de opioides. Conclusões: O protocolo ERAS e a cirurgia laparoscópica diminuíram o tempo de internação sem aumentar a taxa de readmissão de 30 dias. Um grau severo na escala CCD aumentou a hospitalização e readmissões. Keywords: Colorectal surgery, Enhanced recovery after surgery, Laparoscopy, Palavras-chave: Cirurgia colorretal, Recuperação aprimorada após a cirurgia, Laparoscopi

Can physiological stimulation prior to ileostomy closure reduce postoperative ileus: a prospective multicenter pilot study

Background The aim of this study was to assess the impact of ileostomy closure following preoperative physiological stimulation (PPS) on postoperative ileus (POI) in patients with loop ileostomy after low anterior resection for rectal cancer. Methods Patients who underwent ileostomy closure between January 2017 and February 2020 in two tertiary referral centers were prospectively included. PPS stimulation was compared to standard treatment. Stimulation was carried out daily during the 15 days prior to ileostomy closure by the patient's self-instillation of 200 ml of fecal contents from the ileostomy bag via the efferent loop, using a rectal catheter. Standard treatment (ST) consisted of observation. Outcomes measures were POI, morbidity, stimulation feasibility, and predictors to ileus. Results A total of 58 patients were included [42 males and 16 females, median age 67 (43–85) years]. PPS was used in 24 patients, who completed the entire stimulation process, and ST in 34 patients. No differences in preoperative factors were found between the two groups. POI was significantly lower in the PPS group (4.2%) vs the ST group (32.4%); p < 0.01, OR: 0.05 (CI 95% 0.01–0.65). The PPS group had a shorter time to restoration of bowel function (1 day vs 3 days) p = 0.02 and a shorter time to tolerance of liquids (1 day vs 2 days), p = 0.04. Age (p = 0.01), open approach at index surgery, p = 0.03, adjuvant capecitabine (p = 0.01). and previous abdominal surgeries (p = 0.02) were associated with POI in the multivariate analysis. C-reactive-protein values on the 3rd (p = 0.02) and 5th (p < 0.01) postoperative day were also associated with POI. Conclusions PPS for patients who underwent ileostomy closure after low anterior resection for rectal cancer is feasible and might reduce POI.Depto. de CirugíaFac. de MedicinaTRUEpu

Encuesta de satisfacción tras aplicación de un protocolo de recuperación intensificada ERAS (Enhanced Recovery After Surgery) en cirugía electiva colorrectal en mayores de 70 años

Introduction: Enhanced Recovery After Surgery (ERAS) programs have been shown to reduce hospital stay, without increasing the rate of complications or readmissions 30 days after discharge; however, there is limited information about patient satisfaction. Objective: To determine the satisfaction of our patients following the implementation of an ERAS protocol in elective colorectal surgery. Materials and methods: A period of 4 days after discharge, a telephone survey was conducted based on the enhanced recovery in abdominal surgery clinical survey of the first 55 patients aged 70 years or older, who underwent elective colorectal surgery according to an ERAS protocol at the Hospital Universitario de Guadalajara, Spain. This is a cross-sectional analytical study. Results: Most of our patients are very satisfied with the care and the way they were treated by the health staff during their hospitalization, and they would be willing to undergo surgery again following this protocol. Most of them consider that the information received in the pre-anesthesia and surgery consultation is very good, and they value this consultation as one of the most positive aspects of the protocol. More than half of the patients did not experience any nausea or vomiting and rated their pain as ≤3 (minimum 0 and maximum 10). Most considered the introduction of oral feeding and ambulation as on time or somewhat early. Conclusion: Elderly patients undergoing elective colorectal surgery according to an ERAS protocol are highly pleased with the care received. Standardized surveys are required to be able to contrast outcomes.Introducción: los programas de recuperación intensificada postoperatoria (Enhanced Recovery After Surgery (ERAS)) reducen la estancia hospitalaria, sin aumentar la tasa de complicaciones ni de reingresos a los 30 días tras el alta, pero hay poca información acerca del grado de satisfacción de los pacientes. Objetivo: conocer la satisfacción de nuestros pacientes tras la aplicación de un protocolo ERAS en cirugía electiva colorrectal. Materiales y métodos: cuatro días tras el alta, se realizó una encuesta telefónica basada en la encuesta de la guía clínica RICA (Recuperación Intensificada en Cirugía Abdominal) a los 55 primeros pacientes con edad mayor o igual a 70 años operados de cirugía electiva colorrectal según un protocolo ERAS. Es un estudio analítico transversal. Resultados: la mayor parte de nuestros pacientes están muy satisfechos con la asistencia y con el trato recibido por el personal sanitario durante su ingreso hospitalario, y se volverían a operar siguiendo este protocolo. La mayoría consideran que la información recibida en la consulta de pre-anestesia y cirugía es muy buena, y valoran esta consulta como uno de los aspectos más positivos del protocolo. Más de la mitad de los pacientes no tuvieron náuseas ni vómitos y calificaron su dolor como ≤3 (mínimo 0 y máximo 10). La mayoría consideraron el inicio de tolerancia oral y deambulación como a tiempo o algo pronto. Conclusiones: Los pacientes ancianos operados de cirugía electiva colorrectal según un protocolo ERAS están muy satisfechos con la asistencia prestada. Se necesitan encuestas estandarizadas para poder comparar resultados.Depto. de CirugíaFac. de MedicinaTRUEpu

Step-by-step right colectomy and intracorporeal stapled side-to-side ileocolic anastomosis – a video vignette

Depto. de CirugíaFac. de MedicinaTRUEpu

Absence of allelic imbalance involving EMSY, CAPNS, and PAK1 genes in papillary thyroid carcinoma

Papillary thyroid cancer (PTC) accounts for 80% of all thyroid malignancies, and genetic alterations associated to its etiology remain largely unknown. Chromosomal band 11q13 seems to be one of the most frequently amplified regions in human cancer, providing several candidate genes that need detailed characterization. The aim of our study was to investigate the existence of allelic imbalance at EMSY, CAPN5, and PAK1, as candidate genes within 11q13.5-q14 region using a single nucleotide polymorphism-based analysis. We selected a panel of 9 polymorphisms that were analyzed in 41 thyroid carcinoma samples, their contralateral non-pathological tissue and 178 controls from the general population. We did not detect allelic imbalance at these loci in our series. However, we observed a difference in the EMSY-haplotype distribution among PTC patients when compared to controls (odds ratio=2.00; p=0.02). We conclude that 11q13.5-q14 is not imbalanced in PTC, but there is evidence suggesting that EMSY might be of relevance in PTC etiology.Fundación de Investigación Biomédica Mutua Madrileña AutomovilistaMinisterio de Ciencia y TecnologíaDepto. de CirugíaFac. de MedicinaTRUEpu