P10 25. ¿Aumenta la extracción endoscópica de vena safena las complicaciones inmediatas en los pacientes coronarios?

ObjetivoEn 2009 se ha empleado en nuestro centro la extracción endoscópica de vena safena (EEVS). Analizamos si tiene un impacto inmediato en infarto perioperatorio y supervivencia.Material y métodosSe han analizado todos los pacientes coronarios aislados intervenidos en 2009. Se emplearon el Vasoview 6 y Hemopro.La duración de la intervención, estancia en unidad de cuidados intensivos (UCI), troponina postoperatoria y necesidad de aminas fueron comparadas en ambos grupos.ResultadosFueron intervenidos 291 pacientes de revascularización coronaria aislada, con un 28,5% de EEVS.Edad media 67,38 (36-83), varones 79,4%. El 47,6% fue cirugía sin bomba extracorpórea. Mortalidad global del 2,9%. Se realizaron una media de 2,64 (desviación estándar [DE] 0,904) injertos/paciente, con un tiempo total medio de quirófano de 5,83 h (DE 1,18).No precisó soporte inotrópico el 65%, y a dosis bajas en el 25,6%. Troponina máxima 0,701 (0,1-12,5). Estancia mediana en UCI 1 día (1-30).La duración de la intervención fue significativamente mayor en los pacientes con EEVS (5,68 h vs 6,41 h; p = 0,005).La troponina máxima fue ligeramente superior en el grupo de extracción convencional (0,73 vs 0,65; p = 0,667), no significativa. No hubo diferencias significativas en duración media del ingreso en UCI, ni en necesidad de soporte inotrópico.ConclusiónLa EEVS no produce repercusión precoz en cuanto a infarto perioperatorio/duración de UCI, aunque se precisa seguimiento para estimar diferencias a largo plazo.La EEVS prolonga la duración de la intervención dada su mayor complejidad técnica

Exchange of functional domains between a bacterial conjugative relaxase and the integrase of the human adeno-associated virus

Endonucleases of the HUH family are specialized in processing single-stranded DNA in a variety of evolutionarily highly conserved biological processes related to mobile genetic elements. They share a structurally defined catalytic domain for site-specific nicking and strand-transfer reactions, which is often linked to the activities of additional functional domains, contributing to their overall versatility. To assess if these HUH domains could be interchanged, we created a chimeric protein from two distantly related HUH endonucleases, containing the N-terminal HUH domain of the bacterial conjugative relaxase TrwC and the C-terminal DNA helicase domain of the human adeno-associated virus (AAV) replicase and site-specific integrase. The purified chimeric protein retained oligomerization properties and DNA helicase activities similar to Rep68, while its DNA binding specificity and cleaving-joining activity at oriT was similar to TrwC. Interestingly, the chimeric protein could catalyse site-specific integration in bacteria with an efficiency comparable to that of TrwC, while the HUH domain of TrwC alone was unable to catalyze this reaction, implying that the Rep68 C-terminal helicase domain is complementing the TrwC HUH domain to achieve site-specific integration into TrwC targets in bacteria. Our results illustrate how HUH domains could have acquired through evolution other domains in order to attain new roles, contributing to the functional flexibility observed in this protein superfamily.This work was supported by the Medical Research Council (MRC) grant MR/N022890/1 to EH and grant 1001764 to RML; National Institutes of Health (NIH) grant RO1-GM09285 to CRE; Spanish Ministry of Economy and competitiveness (MINECO) grant BIO2013-46414-P to ML and AFM is supported by a Doc.Mobility fellowship from the Swiss National Science Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

ZERO: probabilistic routing for deploy and forget wireless sensor networks

As Wireless Sensor Networks are being adopted by industry and agriculture for large-scale and unattended deployments, the need for reliable and energy-conservative protocols become critical. Physical and Link layer efforts for energy conservation are not mostly considered by routing protocols that put their efforts on maintaining reliability and throughput. Gradient-based routing protocols route data through most reliable links aiming to ensure 99% packet delivery. However, they suffer from the so-called ”hot spot” problem. Most reliable routes waste their energy fast, thus partitioning the network and reducing the area monitored. To cope with this ”hot spot” problem we propose ZERO a combined approach at Network and Link layers to increase network lifespan while conserving reliability levels by means of probabilistic load balancing techniques.Peer Reviewe

Safety and efficacy of intraperitoneal drain placement after emergency colorectal surgery. An international, prospective cohort study

Intraperitoneal drains are often placed during emergency colorectal surgery. However, there is a lack of evidence supporting their use. This study aimed to describe the efficacy and safety of intraperitoneal drain placement after emergency colorectal surgery. Method: COMPlicAted intra-abdominal collectionS after colorectal Surgery (COMPASS) is a prospective, international, cohort study into which consecutive adult patients undergoing emergency colorectal surgery were enrolled (from 3 February 2020 to 8 March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included rate and time-to-diagnosis of postoperative intraperitoneal collections, rate of surgical site infections (SSIs), time to discharge and 30-day major postoperative complications (Clavien-Dindo III-V). Multivariable logistic and Cox proportional hazards regressions were used to estimate the independent association of the outcomes with drain placement. Results: Some 725 patients (median age 68.0 years; 349 [48.1%] women) from 22 countries were included. The drain insertion rate was 53.7% (389 patients). Following multivariable adjustment, drains were not significantly associated with reduced rates (odds ratio [OR] = 1.56, 95% CI: 0.48-5.02, p = 0.457) or earlier detection (hazard ratio [HR] = 1.07, 95% CI: 0.61-1.90, p = 0.805) of collections. Drains were not significantly associated with worse major postoperative complications (OR = 1.26, 95% CI: 0.67-2.36, p = 0.478), delayed hospital discharge (HR = 1.11, 95% CI: 0.91-1.36, p = 0.303) or increased risk of SSIs (OR = 1.61, 95% CI: 0.87-2.99, p = 0.128). Conclusion: This is the first study investigating placement of intraperitoneal drains following emergency colorectal surgery. The safety and clinical benefit of drains remain uncertain. Equipoise exists for randomized trials to define the safety and efficacy of drains in emergency colorectal surgery