Riesgo quirúrgico tras resección pulmonar anatómica en cirugía torácica. Modelo predictivo a partir de una base de datos nacional multicéntrica

Introduction: the aim of this study was to develop a surgical risk prediction model in patients undergoing anatomic lung resections from the registry of the Spanish Video-Assisted Thoracic Surgery Group (GEVATS). Methods: data were collected from 3,533 patients undergoing anatomic lung resection for any diagnosis between December 20, 2016 and March 20, 2018. We defined a combined outcome variable: death or Clavien Dindo grade IV complication at 90 days after surgery. Univariate and multivariate analyses were performed by logistic regression. Internal validation of the model was performed using resampling techniques. Results: the incidence of the outcome variable was 4.29% (95% CI 3.6-4.9). The variables remaining in the final logistic model were: age, sex, previous lung cancer resection, dyspnea (mMRC), right pneumonectomy, and ppo DLCO. The performance parameters of the model adjusted by resampling were: C-statistic 0.712 (95% CI 0.648-0.750), Brier score 0.042 and bootstrap shrinkage 0.854. Conclusions: the risk prediction model obtained from the GEVATS database is a simple, valid, and reliable model that is a useful tool for establishing the risk of a patient undergoing anatomic lung resection

Grupo español de cirugía torácica asistida por videoimagen: método, auditoría y resultados iniciales de una cohorte nacional prospectiva de pacientes tratados con resecciones anatómicas del pulmón

Introduction: our study sought to know the current implementation of video-assisted thoracoscopic surgery (VATS) for anatomical lung resections in Spain. We present our initial results and describe the auditing systems developed by the Spanish VATS Group (GEVATS). Methods: we conducted a prospective multicentre cohort study that included patients receiving anatomical lung resections between 12/20/2016 and 03/20/2018. The main quality controls consisted of determining the recruitment rate of each centre and the accuracy of the perioperative data collected based on six key variables. The implications of a low recruitment rate were analysed for '90-day mortality' and 'Grade IIIb-V complications'. Results: the series was composed of 3533 cases (1917 VATS; 54.3%) across 33 departments. The centres' median recruitment rate was 99% (25-75th:76-100%), with an overall recruitment rate of 83% and a data accuracy of 98%. We were unable to demonstrate a significant association between the recruitment rate and the risk of morbidity/mortality, but a trend was found in the unadjusted analysis for those centres with recruitment rates lower than 80% (centres with 95-100% rates as reference): grade IIIb-V OR=0.61 (p=0.081), 90-day mortality OR=0.46 (p=0.051). Conclusions: more than half of the anatomical lung resections in Spain are performed via VATS. According to our results, the centre's recruitment rate and its potential implications due to selection bias, should deserve further attention by the main voluntary multicentre studies of our speciality. The high representativeness as well as the reliability of the GEVATS data constitute a fundamental point of departure for this nationwide cohort

Evaluation of the mini-nutritional assessment short-form (MNA-SF) among institutionalized older patients in Spain Evaluación del test corto de valoración nutricional (MNA-SF) en ancianos institucionalizados en España

Introduction: In the present study, we evaluated a short form version of MNA test in a multicenter study and the relationship of different biochemical markers with MNASF scores. Material and methods: This was a cross-sectional survey covering a sample of representative of the older institutionalized Spanish population aged above 65 years (n = 873). A Mini nutritional assessment short form test (MNA-SF) was used. Results: The number of patients classified as well nouri shed (42.1%) was larger in the 65-74 (52.6%) range than in the 75-84 (40.2%), 85-94 (43.8%) and > 95 (24%) age ranges. Risk of undernutrition occurred in a total of 506 patients (57.9%), risk of undernutrition was larger in > 95 (76%) range than in 65-74 (47.4%), 75-84 (59.8%) and 85-94 range (56.2%). No differences were detected between males and females at risk of undernutrition (odds ratio: 0.85 CI 95%: 0.64-1.12). Conclusion: In this multicenter study, institutionalized patients have a high prevalence of at risk of malnutrition assessed by MNA-SF test.Introducción: En el presente estudio, se evaluó una versión corta del test MNA en un estudio multicéntrico y se valoro la relación de los marcadores bioquímicos con el test MNA-SF. Material y métodos: Se realizó un estudio transversal de una muestra representativa de la población anciana institucionalizada española de más de 65 años (n = 873). Se utilizó en todos los pacientes el test de valoración nutricional en su versión corta (MNA-SF). Resultados: El número de pacientes clasificados como bien nutridos (42,1%) fue mayor en los ancianos de 65-74 años (52,6%) que en el rango de edad entre 75 a 84 (40,2%), 85-94 años (43,8%) y > 95 años (24%). La situación de riesgo de desnutrición se produjo en un total de 506 pacientes (57,9%), este riesgo de desnutrición fue mayor en los ancianos mayores de 95 años (76%) que en el rango de edad de 65 a 74 años (47,4%), de 75 a 84 años (59,8%) y de 85-94 años (56,2%). No se detectaron diferencias entre hombres y mujeres en riesgo de desnutrición (OR: 0,85 IC 95% : 0.64-1.12). Conclusión: En este estudio multicéntrico, los pacientes ancianos institucionalizados tienen una alta prevalencia de riesgo de desnutrición evaluada por el test MNA-SF

Rapid ligand-regulated gating kinetics of single inositol 1,4,5-trisphosphate receptor Ca2+ release channels

The ubiquitous inositol 1,4,5-trisphosphate receptor (InsP3R) intracellular Ca2+ release channel is engaged by thousands of plasma membrane receptors to generate Ca2+ signals in all cells. Understanding how complex Ca2+ signals are generated has been hindered by a lack of information on the kinetic responses of the channel to its primary ligands, InsP3 and Ca2+, which activate and inhibit channel gating. Here, we describe the kinetic responses of single InsP3R channels in native endoplasmic reticulum membrane to rapid ligand concentration changes with millisecond resolution, using a new patch-clamp configuration. The kinetics of channel activation and deactivation showed novel Ca2+ regulation and unexpected ligand cooperativity. The kinetics of Ca2+-mediated channel inhibition showed the single-channel bases for fundamental Ca2+ release events and Ca2+ release refractory periods. These results provide new insights into the channel regulatory mechanisms that contribute to complex spatial and temporal features of intracellular Ca2+ signals