Ambulatory surgery in orthopedics: experience of over 10,000 patients

PurposeThe concept of day surgery is becoming an increasingly important part of elective surgery worldwide. Relentless pressure to cut costs may constrain clinical judgment regarding the most appropriate location for a patient’s surgical care. The aim of this study was to determine clinical and quality indicators relating to our experience in orthopedic day durgery, mainly in relation to unplanned overnight admission and readmission rates. Additionally, we focused on describing the main characteristics of the patients that experienced complications, and compared the patient satisfaction rates following ambulatory and non-ambulatory procedures.MethodsWe evaluated 10,032 patients who underwent surgical orthopedic procedures according to the protocols of our Ambulatory Surgery Unit. All complications that occurred were noted. A quality-of-life assessment (SF-36 test) was carried out both pre- and postoperatively. Ambulatory substitution rates and quality indicators for orthopedic procedures were also determined.ResultsThe major complication rate was minimal, with no mortal cases, and there was a high rate of ambulatory substitution for the procedures studied. Outcomes of the SF-36 questionnaire showed significant improvement postoperatively. An unplanned overnight admission rate of 0.14 % was achieved.ConclusionsOur institution has shown that it is possible to provide good-quality ambulatory orthopedic surgery. There still appears to be the potential to increase the proportion of these procedures. Surgeons and anesthesiologists must strongly adhere to strict patient selection criteria for ambulatory orthopedic surgery in order to reduce complications in the immediate postoperative term

High-resolution spectroscopic study of massive blue and red supergiants in Perseus OB1 - I. Definition of the sample, membership, and kinematics

Context. The Perseus OB1 association, including the h and χ Persei double cluster, is an interesting laboratory for the investigation of massive star evolution as it hosts one of the most populous groupings of blue and red supergiants (Sgs) in the Galaxy at a moderate distance and extinction. Aims. We discuss whether the massive O-type, and blue and red Sg stars located in the Per OB1 region are members of the same population, and examine their binary and runaway status. Methods. We gathered a total of 405 high-resolution spectra for 88 suitable candidates around 4.5 deg from the center of the association, and compiled astrometric information from Gaia DR2 for all of them. This was used to investigate membership and identify runaway stars. By obtaining high-precision radial velocity (RV) estimates for all available spectra, we investigated the RV distribution of the global sample (as well as different subsamples) and identified spectroscopic binaries (SBs). Results. Most of the investigated stars belong to a physically linked population located at d = 2.5 ± 0.4 kpc. We identify 79 confirmed or likely members, and 5 member candidates. No important differences are detected in the distribution of parallaxes when stars in h and χ Persei or the full sample are considered. In contrast, most O-type stars seem to be part of a differentiated population in terms of kinematical properties. In particular, the percentage of runaways among them (45%) is considerable higher than for the more evolved targets (which is lower than ∼5% in all cases). A similar tendency is also found for the percentage of clearly detected SBs, which already decreases from 15% to 10% when the O star and B Sg samples are compared, respectively, and practically vanishes in the cooler Sgs. Concerning this latter result, our study illustrates the importance of taking the effect of the ubiquitous presence of intrinsic variability in the blue-to-red Sg domain into account to avoid the spurious identification of pulsating stars as SBs. Conclusions. All but 4 stars in our working sample (including 10 O giants/Sgs, 36 B Sgs, 9 B giants, 11 A/F Sgs, and 18 red Sgs) can be considered as part of the same (interrelated) population. However, any further attempt to describe the empirical properties of this sample of massive stars in an evolutionary context must take into account that an important fraction of the O stars is or likely has been part of a binary/multiple system. In addition, some of the other more evolved targets may have also been affected by binary evolution. In this line of argument, it is also interesting to note that the percentage of spectroscopic binaries within the evolved population of massive stars in Per OB1 is lower by a factor 4−5 than in the case of dedicated surveys of O-type stars in other environments that include a much younger population of massive stars.We acknowledge funding from the Spanish Government Ministerio de Ciencia e Innovación through grants PGC-2018-091 3741-B-C211/C22, SEV 2015-0548, and CEX2019-000920-S and from the Canarian Agency for Research, Innovation and Information Society (ACIISI), of the Canary Islands Government, and the European Regional Development Fund (ERDF), under grant with reference ProID2017010115

Are the Stellar Winds in IC1613 stronger than expected?

In this poster we present the results of our analyses of three early massive stars in IC 1613, whose spectra have been observed with VIMOS and analyzed with CMFGEN and FASTWIND. One of the targets resulted a possible LBV and the other two are Of stars with unexpectedly strong winds. The Of stars seem to be strongly contaminated by CNO products. Our preliminary results may represent a challenge for the theory of stellar atmospheres, but they still have to be confirmed by the analysis of more objects and a more complete coverage of the parameter space.Comment: 2 pages. Poster contribution to the proceedings of the IAU272 "Active OB Stars: structure, evolution, mass loss and critical limits

Los Poyos del Molinillo (Frigiliana): new site of the Bronze Age in the East Axarquía (Málaga, Andalucía)

En este trabajo damos a conocer un nuevo yacimiento descubierto recientemente en el municipio de Frigiliana. La delimitación del área denominada Los Poyos del Molinillo permitió definir la existencia de un poblado y una covacha con restos de una inhumación. El estudio de los materiales arqueológicos, que incluye cerámica, piezas metálicas o elementos de molturación, o la datación AMS obtenida, permiten adscribir el yacimiento a la Edad del Bronce y ampliar el conocimiento de esta etapa en la Axarquía oriental (Málaga, Andalucía).In this work we present a new site recently discovered in the Frigiliana municipality (Málaga). The spatial delimitation of the so called Los Poyos del Molinillo area let us define a Bronze age settlement and an inhumation burial cave. The archaeological record includes ceramic, metallic items or grinding elements, all of them belonging to the Bronze Age, as well as an AMS Radiocarbon data. This site extends the knowledge about this period in the Eastern Axarquía (Málaga, Andalucía)

Near real-time surveillance of the SARS-CoV-2 epidemic with incomplete data

When responding to infectious disease outbreaks, rapid and accurate estimation of the epidemic trajectory is critical. However, two common data collection problems affect the reliability of the epidemiological data in real time: missing information on the time of first symptoms, and retrospective revision of historical information, including right censoring. Here, we propose an approach to construct epidemic curves in near real time that addresses these two challenges by 1) imputation of dates of symptom onset for reported cases using a dynamically-estimated "backward" reporting delay conditional distribution, and 2) adjustment for right censoring using the NobBS software package to nowcast cases by date of symptom onset. This process allows us to obtain an approximation of the time-varying reproduction number (Rt) in real time. We apply this approach to characterize the early SARS-CoV-2 outbreak in two Spanish regions between March and April 2020. We evaluate how these real-time estimates compare with more complete epidemiological data that became available later. We explore the impact of the different assumptions on the estimates, and compare our estimates with those obtained from commonly used surveillance approaches. Our framework can help improve accuracy, quantify uncertainty, and evaluate frequently unstated assumptions when recovering the epidemic curves from limited data obtained from public health systems in other locations.PMD was supported by the fellowship Ramón Areces Foundation. JAH was funded by the National Institute of General Medical Sciences, Award U54GM088558, and the National Institutes of Health Director’s Early Independence, Award DP5-OD028145. ML was supported by the Morris-Singer Fund and by a subcontract from the Carnegie Mellon University under an award from the US Centers for Disease Control and Prevention, Award U01IP001121). MS was supported by the National Institute Of General Medical Sciences, Award R01GM130668-02. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.S

The nature of the Cygnus extreme B supergiant 2MASS J20395358+4222505

2MASS J20395358+4222505 is an obscured early B supergiant near the massive OB star association Cygnus OB2. Despite its bright infrared magnitude (Ks = 5.82) it has remained largely ignored because of its dim optical magnitude (B = 16.63, V = 13.68). In a previous paper, we classified it as a highly reddened, potentially extremely luminous, early B-type supergiant. We obtained its spectrum in the U, B and R spectral bands during commissioning observations with the instrument MEGARA at the Gran Telescopio CANARIAS. It displays a particularly strong Hα emission for its spectral type, B1 Ia. The star seems to be in an intermediate phase between supergiant and hypergiant, a group that it will probably join in the near (astronomical) future. We observe a radial velocity difference between individual observations and determine the stellar parameters, obtaining Teff = 24 000 K and log gc = 2.88 ± 0.15. The rotational velocity found is large for a B supergiant, v sin i = 110 ± 25 kms−1⁠. The abundance pattern is consistent with solar, with a mild C underabundance (based on a single line). Assuming that J20395358+4222505 is at the distance of Cyg OB2, we derive the radius from infrared photometry, finding R = 41.2 ± 4.0 R⊙, log(L/L⊙) = 5.71 ± 0.04 and a spectroscopic mass of 46.5 ± 15.0 M⊙. The clumped mass-loss rate (clumping factor 10) is very high for the spectral type, M˙ = 2.4 × 10−6 M⊙ a−1. The high rotational velocity and mass-loss rate place the star at the hot side of the bi-stability jump. Together with the nearly solar CNO abundance pattern, they may also point to evolution in a binary system, J20395358+4222505 being the initial secondary.SS-D and AH acknowledge support from the Spanish Government Ministerio de Ciencia e Innovación through grants PGC-2018-091 3741-B-C22 and CEX2019-000920-S and from the Canarian Agency for Research, Innovation and Information Society (ACIISI), of the Canary Islands Government, and the European Regional Development Fund (ERDF), under grant with reference ProID2020010016. MG and FN acknowledge financial support through Spanish grant PID2019-105552RB-C41 (MINECO/MCIU/AEI/FEDER) and from the Spanish State Research Agency (AEI) through the Unidad de Excelencia ‘María de Maeztu’-Centro de Astrobiología (CSIC-INTA) project No. MDM-2017-0737. SRB acknowledges support by the Spanish Government under grants AYA2015-68012-C2-2-P and PGC2018-093741-B-C21/C22 (MICIU/AEI/FEDER, UE). SRA acknowledges funding support from the FONDECYT Iniciación project 11171025 and the FONDECYT Regular project 1201490. JIP acknowledges finantial support from projects Estallidos6 AYA2016-79724-C4 (Spanish Ministerio de Economia y Competitividad), Estallidos7 PID2019-107408GB-C44 (Spanish Ministerio de Ciencia e Innovacion), grant P18-FR-2664 (Junta de Andalucía), and grant SEV-2017-0709 ‘Centro de Excelencia Severo Ochoa Program’ (Spanish Science Ministry). AGP, SP, AG-M, JG and NC acknowledge support from the Spanish MCI through project RTI2018-096188-B-I00

Evaluation of prognostic factors among patients with chronic graft-versus-host disease

Background Chronic graft-versus-host disease (cGVHD) is a major complication after allogeneic stem cell transplantation with an adverse effect on both mortality and morbidity. In 2005, the National Institute of Health proposed new criteria for diagnosis and classification of chronic graft-versus-host disease for clinical trials. New sub-categories were recognized such as late onset acute graft-versus-host disease and overlap syndrome. Design and Methods We evaluated the prognostic impact of the new sub-categories as well as the clinical scoring system proposed by the National Institute of Health in a retrospective, multicenter study of 820 patients undergoing allogeneic stem cell transplantation between 2000 and 2006 at 3 different institutions. Patients were retrospectively categorized according to the National Institute of Health criteria from patients' medical histories. Results As far as the new sub-categories are concerned, in univariate analysis diagnosis of overlap syndrome adversely affected the outcome. Also, the number of organs involved for a cut-off value of 4 significantly influenced both cGVHD related mortality and survival. In multivariate analysis, in addition to NIH score, platelet count and performance score at the time of cGVHD diagnosis, plus gut involvement, significantly influenced outcome. These 3 variables allowed us to develop a simple score system which identifies 4 subgroups of patients with 84%, 64%, 43% and 0% overall survival at five years after cGVHD diagnosis (score 0: HR=15.96 (95% CI: 6.85-37.17), P<0.001; score 1: HR=5.47 (95% CI: 2.6-11.5), P<0.001; score 2: HR=2.8 (95% CI: 1.32-5.93), P=0.007). Conclusions In summary, we have identified a powerful and simple tool to discriminate different subgroups of patients in terms of chronic graft-versus-host disease related mortality and survival

Response to Novel Drugs before and after Allogeneic Stem Cell Transplantation in Patients with Relapsed Multiple Myeloma

Multiple myeloma (MM) remains as an incurable disease and, although allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative approach, most patients ultimately relapse, and their treatment remains challenging. Because allo-HSCT can modify not only the biology of the disease, but also the immune system and the microenvironment, it can potentially enhance the response to rescue therapies. Information on the efficacy and safety of novel drugs in patients relapsing after allo-HSCT is lacking, however. The objectives of this study were to evaluate the efficacy and toxicity of rescue therapies in patients with MM who relapsed after allo-HSCT, as well as to compare their efficacy before and after allo-HSCT. This retrospective multicenter study included 126 consecutive patients with MM who underwent allo-HSCT between 2000 and 2013 at 8 Spanish centers. All patients engrafted. The incidence of grade II-IV acute graft-versus-host disease (GVHD) was 47%, and nonrelapse mortality within the first 100 days post-transplantation was 13%. After a median follow-up of 92 months, overall survival (OS) was 51% at 2 years and 43% at 5 years. The median progression-free survival after allo-HSCT was 7 months, whereas the median OS after relapse was 33 months. Patients relapsing in the first 6 months after transplantation had a dismal prognosis compared with those who relapsed later (median OS, 11 months versus 120 months; P <.001). The absence of chronic GVHD was associated with reduced OS after relapse (hazard ratio, 3.44; P <.001). Most patients responded to rescue therapies, including proteasome inhibitors (PIs; 62%) and immunomodulatory drugs (IMiDs; 77%), with a good toxicity profile. An in-depth evaluation, including the type and intensity of PI- and IMiD-based combinations used before and after allo-HSCT, showed that the overall response rate and duration of response after allo-HSCT were similar to those seen in the pretransplantation period. Patients with MM who relapse after allo-HSCT should be considered candidates for therapy with new drugs, which can achieve similar response rates with similar durability as seen in the pretransplantation period. This pattern does not follow the usual course of the disease outside the transplantation setting, where response rates and time to progression decreases with each consecutive line of treatment

Impact of measurable residual disease by decentralized flow cytometry: a PETHEMA real-world study in 1076 patients with acute myeloid leukemia

The role of decentralized assessment of measurable residual disease (MRD) for risk stratification in acute myeloid leukemia (AML) remains largely unknown, and so it does which methodological aspects are critical to empower the evaluation of MRD with prognostic significance, particularly if using multiparameter flow cytometry (MFC). We analyzed 1076 AML patients in first remission after induction chemotherapy, in whom MRD was evaluated by MFC in local laboratories of 60 Hospitals participating in the PETHEMA registry. We also conducted a survey on technical aspects of MRD testing to determine the impact of methodological heterogeneity in the prognostic value of MFC. Our results confirmed the recommended cutoff of 0.1% to discriminate patients with significantly different cumulative-incidence of relapse (-CIR- HR:0.71, P < 0.001) and overall survival (HR: 0.73, P = 0.001), but uncovered the limited prognostic value of MFC based MRD in multivariate and recursive partitioning models including other clinical, genetic and treatment related factors. Virtually all aspects related with methodological, interpretation, and reporting of MFC based MRD testing impacted in its ability to discriminate patients with different CIR. Thus, this study demonstrated that “real-world” assessment of MRD using MFC is prognostic in patients at first remission, and urges greater standardization for improved risk-stratification toward clinical decisions in AML.This study was supported by the Centro de Investigación Biomédica en Red – Área de Oncología - del Instituto de Salud Carlos III (CIBERONC; CB16/12/00369, CB16/12/00233, CB16/12/00284 and CB16/12/00400), Instituto de Salud Carlos III/Subdirección General de Investigación Sanitaria (FIS No. PI16/01661, PI16/00517 and PI18/01946), Gerencia Regional de Salud de CyL (GRS 1346/A/16) and the Plan de Investigación de la Universidad de Navarra (PIUNA 2014-18). This study was supported internationally by the Cancer Research UK, FCAECC and AIRC under the Accelerator Award Program EDITOR