¿Es complejo reparar la hernia inguinal del prostatectomizado por vía retropúbica mediante el abordaje preperitoneal posterior abierto tipo Nyhus «corto» (técnica de Dávila)?

ResumenIntroducciónEstudio de pacientes prostatectomizados por vía retropúbica que presentan una hernia inguinal que ha sido reparada por la técnica tipo Nyhus «corto» o «técnica de Dávila».Material y métodoEstudio prospectivo de 85 pacientes prostatectomizados (84 por vía retropúbica y uno laparoscópica) con 93 reparaciones por la vía modificada de Nyhus, seleccionados de una serie global de 3 078 reparaciones preperitoneales con la misma técnica en 2863 pacientes, en 27 años. Media de edad de 69.2±7.4 años (42-86 años). No hubo selección de pacientes. La técnica se realizó a través de un espacio preperitoneal con adherencias posprostatectomía, y en todos los casos se colocó una malla de polipropileno de baja densidad macroporosa o una autoadhesiva Parietene ProGrip®.ResultadosEn 92 reparaciones el espacio preperitoneal fue abordable con pocas dificultades, pero el único prostatectomizado por laparoscopia presentó un alto nivel de dificultad, resuelto sin incidencias. El tiempo operatorio medio fue de 24.0±5.7min, y de 17.4±4.4min en los pacientes con malla autoadhesiva. La morbilidad hallada fue de 15 hematomas, 16 seromas y 4 hematomas escrotales. No hubo infección ni dolor inguinal crónico o recidivas en el seguimiento de 64 pacientes (75.3%) entre 1-26 años.ConclusionesLa supuesta complejidad y peligrosidad del abordaje preperitoneal abierto en el paciente prostatectomizado, para tratarle una hernia inguinal por vía preperitoneal posterior abierta mediante la técnica de Nyhus modificada (Nyhus «corto» o «técnica de Dávila»), no se ha constatado en esta serie, con buenos resultados a corto y muy largo plazo.AbstractIntroductionStudy of patients who underwent a retropubic prostatectomy and developed an inguinal hernia that has been repaired with the «short» Nyhus technique or «Dr. Davila's technique».Material and methodProspective study: 85 prostatectomized patients (84 retropubic route and one laparoscopic) with 93 repairs using the modified Nyhus technique were selected out of a global series of 3 078 preperitoneal repairs using the same technique on 2863 patients, over the course of 27 years. Mean age: 69.2±7.4 years (42-86 years). There were no criteria to select patients. Technique was performed by means of a preperitoneal space with adhesions post-prostatectomy, and in all cases a low density macroporous polypropylene mesh or a self-fixating Parietene ProGrip® was placed.ResultsIn 92 of the repairs the preperitoneal space was treatable with few difficulties; however, the only laparoscopic prostatectomy showed a great degree of difficulty that was resolved without any incidents. The mean operating time was 24.0±5.7min and 17.4±4.4min on those patients with a self-fixating mesh. Morbidity results: 15 hematomas, 16 seromas, 4 scrotal hematomas. There were no infections, no chronic inguinal pain or relapses during the follow-up process of 64 patients (75.3%) between 1-26 years of age.ConclusionsThere has been no evidence of the alleged complexity and risk of the open preperitoneal approach in the prostatectomized patient in order to treat an inguinal hernia with an open posterior preperitoneal approach by means of the modified Nyhus («short» Nyhus or «Dr. Davila's technique»). Both short and long-term results have been successful

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Taking the pulse of Earth's tropical forests using networks of highly distributed plots

Tropical forests are the most diverse and productive ecosystems on Earth. While better understanding of these forests is critical for our collective future, until quite recently efforts to measure and monitor them have been largely disconnected. Networking is essential to discover the answers to questions that transcend borders and the horizons of funding agencies. Here we show how a global community is responding to the challenges of tropical ecosystem research with diverse teams measuring forests tree-by-tree in thousands of long-term plots. We review the major scientific discoveries of this work and show how this process is changing tropical forest science. Our core approach involves linking long-term grassroots initiatives with standardized protocols and data management to generate robust scaled-up results. By connecting tropical researchers and elevating their status, our Social Research Network model recognises the key role of the data originator in scientific discovery. Conceived in 1999 with RAINFOR (South America), our permanent plot networks have been adapted to Africa (AfriTRON) and Southeast Asia (T-FORCES) and widely emulated worldwide. Now these multiple initiatives are integrated via ForestPlots.net cyber-infrastructure, linking colleagues from 54 countries across 24 plot networks. Collectively these are transforming understanding of tropical forests and their biospheric role. Together we have discovered how, where and why forest carbon and biodiversity are responding to climate change, and how they feedback on it. This long-term pan-tropical collaboration has revealed a large long-term carbon sink and its trends, as well as making clear which drivers are most important, which forest processes are affected, where they are changing, what the lags are, and the likely future responses of tropical forests as the climate continues to change. By leveraging a remarkably old technology, plot networks are sparking a very modern revolution in tropical forest science. In the future, humanity can benefit greatly by nurturing the grassroots communities now collectively capable of generating unique, long-term understanding of Earth's most precious forests.Additional co-authors: Susan Laurance, William Laurance, Francoise Yoko Ishida, Andrew Marshall, Catherine Waite, Hannsjoerg Woell, Jean-Francois Bastin, Marijn Bauters, Hans Beeckman, Pfascal Boeckx, Jan Bogaert, Charles De Canniere, Thales de Haulleville, Jean-Louis Doucet, Olivier Hardy, Wannes Hubau, Elizabeth Kearsley, Hans Verbeeck, Jason Vleminckx, Steven W. Brewer, Alfredo Alarcón, Alejandro Araujo-Murakami, Eric Arets, Luzmila Arroyo, Ezequiel Chavez, Todd Fredericksen, René Guillén Villaroel, Gloria Gutierrez Sibauty, Timothy Killeen, Juan Carlos Licona, John Lleigue, Casimiro Mendoza, Samaria Murakami, Alexander Parada Gutierrez, Guido Pardo, Marielos Peña-Claros, Lourens Poorter, Marisol Toledo, Jeanneth Villalobos Cayo, Laura Jessica Viscarra, Vincent Vos, Jorge Ahumada, Everton Almeida, Jarcilene Almeida, Edmar Almeida de Oliveira, Wesley Alves da Cruz, Atila Alves de Oliveira, Fabrício Alvim Carvalho, Flávio Amorim Obermuller, Ana Andrade, Fernanda Antunes Carvalho, Simone Aparecida Vieira, Ana Carla Aquino, Luiz Aragão, Ana Claudia Araújo, Marco Antonio Assis, Jose Ataliba Mantelli Aboin Gomes, Fabrício Baccaro, Plínio Barbosa de Camargo, Paulo Barni, Jorcely Barroso, Luis Carlos Bernacci, Kauane Bordin, Marcelo Brilhante de Medeiros, Igor Broggio, José Luís Camargo, Domingos Cardoso, Maria Antonia Carniello, Andre Luis Casarin Rochelle, Carolina Castilho, Antonio Alberto Jorge Farias Castro, Wendeson Castro, Sabina Cerruto Ribeiro, Flávia Costa, Rodrigo Costa de Oliveira, Italo Coutinho, John Cunha, Lola da Costa, Lucia da Costa Ferreira, Richarlly da Costa Silva, Marta da Graça Zacarias Simbine, Vitor de Andrade Kamimura, Haroldo Cavalcante de Lima, Lia de Oliveira Melo, Luciano de Queiroz, José Romualdo de Sousa Lima, Mário do Espírito Santo, Tomas Domingues, Nayane Cristina dos Santos Prestes, Steffan Eduardo Silva Carneiro, Fernando Elias, Gabriel Eliseu, Thaise Emilio, Camila Laís Farrapo, Letícia Fernandes, Gustavo Ferreira, Joice Ferreira, Leandro Ferreira, Socorro Ferreira, Marcelo Fragomeni Simon, Maria Aparecida Freitas, Queila S. García, Angelo Gilberto Manzatto, Paulo Graça, Frederico Guilherme, Eduardo Hase, Niro Higuchi, Mariana Iguatemy, Reinaldo Imbrozio Barbosa, Margarita Jaramillo, Carlos Joly, Joice Klipel, Iêda Leão do Amaral, Carolina Levis, Antonio S. Lima, Maurício Lima Dan, Aline Lopes, Herison Madeiros, William E. Magnusson, Rubens Manoel dos Santos, Beatriz Marimon, Ben Hur Marimon Junior, Roberta Marotti Martelletti Grillo, Luiz Martinelli, Simone Matias Reis, Salomão Medeiros, Milton Meira-Junior, Thiago Metzker, Paulo Morandi, Natanael Moreira do Nascimento, Magna Moura, Sandra Cristina Müller, Laszlo Nagy, Henrique Nascimento, Marcelo Nascimento, Adriano Nogueira Lima, Raimunda Oliveira de Araújo, Jhonathan Oliveira Silva, Marcelo Pansonato, Gabriel Pavan Sabino, Karla Maria Pedra de Abreu, Pablo José Francisco Pena Rodrigues, Maria Piedade, Domingos Rodrigues, José Roberto Rodrigues Pinto, Carlos Quesada, Eliana Ramos, Rafael Ramos, Priscyla Rodrigues, Thaiane Rodrigues de Sousa, Rafael Salomão, Flávia Santana, Marcos Scaranello, Rodrigo Scarton Bergamin, Juliana Schietti, Jochen Schöngart, Gustavo Schwartz, Natalino Silva, Marcos Silveira, Cristiana Simão Seixas, Marta Simbine, Ana Claudia Souza, Priscila Souza, Rodolfo Souza, Tereza Sposito, Edson Stefani Junior, Julio Daniel do Vale, Ima Célia Guimarães Vieira, Dora Villela, Marcos Vital, Haron Xaud, Katia Zanini, Charles Eugene Zartman, Nur Khalish Hafizhah Ideris, Faizah binti Hj Metali, Kamariah Abu Salim, Muhd Shahruney Saparudin, Rafizah Mat Serudin, Rahayu Sukmaria Sukri, Serge Begne, George Chuyong, Marie Noel Djuikouo, Christelle Gonmadje, Murielle Simo-Droissart, Bonaventure Sonké, Hermann Taedoumg, Lise Zemagho, Sean Thomas, Fidèle Baya, Gustavo Saiz, Javier Silva Espejo, Dexiang Chen, Alan Hamilton, Yide Li, Tushou Luo, Shukui Niu, Han Xu, Zhang Zhou, Esteban Álvarez-Dávila, Juan Carlos Andrés Escobar, Henry Arellano-Peña, Jaime Cabezas Duarte, Jhon Calderón, Lina Maria Corrales Bravo, Borish Cuadrado, Hermes Cuadros, Alvaro Duque, Luisa Fernanda Duque, Sandra Milena Espinosa, Rebeca Franke-Ante, Hernando García, Alejandro Gómez, Roy González-M., Álvaro Idárraga-Piedrahíta, Eliana Jimenez, Rubén Jurado, Wilmar López Oviedo, René López-Camacho, Omar Aurelio Melo Cruz, Irina Mendoza Polo, Edwin Paky, Karen Pérez, Angel Pijachi, Camila Pizano, Adriana Prieto, Laura Ramos, Zorayda Restrepo Correa, James Richardson, Elkin Rodríguez, Gina M. Rodriguez M., Agustín Rudas, Pablo Stevenson, Markéta Chudomelová, Martin Dancak, Radim Hédl, Stanislav Lhota, Martin Svatek, Jacques Mukinzi, Corneille Ewango, Terese Hart, Emmanuel Kasongo Yakusu, Janvier Lisingo, Jean-Remy Makana, Faustin Mbayu, Benjamin Toirambe, John Tshibamba Mukendi, Lars Kvist, Gustav Nebel, Selene Báez, Carlos Céron, Daniel M. Griffith, Juan Ernesto Guevara Andino, David Neill, Walter Palacios, Maria Cristina Peñuela-Mora, Gonzalo Rivas-Torres, Gorky Villa, Sheleme Demissie, Tadesse Gole, Techane Gonfa, Kalle Ruokolainen, Michel Baisie, Fabrice Bénédet, Wemo Betian, Vincent Bezard, Damien Bonal, Jerôme Chave, Vincent Droissart, Sylvie Gourlet-Fleury, Annette Hladik, Nicolas Labrière, Pétrus Naisso, Maxime Réjou-Méchain, Plinio Sist, Lilian Blanc, Benoit Burban, Géraldine Derroire, Aurélie Dourdain, Clement Stahl, Natacha Nssi Bengone, Eric Chezeaux, Fidèle Evouna Ondo, Vincent Medjibe, Vianet Mihindou, Lee White, Heike Culmsee, Cristabel Durán Rangel, Viviana Horna, Florian Wittmann, Stephen Adu-Bredu, Kofi Affum-Baffoe, Ernest Foli, Michael Balinga, Anand Roopsind, James Singh, Raquel Thomas, Roderick Zagt, Indu K. Murthy, Kuswata Kartawinata, Edi Mirmanto, Hari Priyadi, Ismayadi Samsoedin, Terry Sunderland, Ishak Yassir, Francesco Rovero, Barbara Vinceti, Bruno Hérault, Shin-Ichiro Aiba, Kanehiro Kitayama, Armandu Daniels, Darlington Tuagben, John T. Woods, Muhammad Fitriadi, Alexander Karolus, Kho Lip Khoon, Noreen Majalap, Colin Maycock, Reuben Nilus, Sylvester Tan, Almeida Sitoe, Indiana Coronado G., Lucas Ojo, Rafael de Assis, Axel Dalberg Poulsen, Douglas Sheil, Karen Arévalo Pezo, Hans Buttgenbach Verde, Victor Chama Moscoso, Jimmy Cesar Cordova Oroche, Fernando Cornejo Valverde, Massiel Corrales Medina, Nallaret Davila Cardozo, Jano de Rutte Corzo, Jhon del Aguila Pasquel, Gerardo Flores Llampazo, Luis Freitas, Darcy Galiano Cabrera, Roosevelt García Villacorta, Karina Garcia Cabrera, Diego García Soria, Leticia Gatica Saboya, Julio Miguel Grandez Rios, Gabriel Hidalgo Pizango, Eurídice Honorio Coronado, Isau Huamantupa-Chuquimaco, Walter Huaraca Huasco, Yuri Tomas Huillca Aedo, Jose Luis Marcelo Peña, Abel Monteagudo Mendoza, Vanesa Moreano Rodriguez, Percy Núñez Vargas, Sonia Cesarina Palacios Ramos, Nadir Pallqui Camacho, Antonio Peña Cruz, Freddy Ramirez Arevalo, José Reyna Huaymacari, Carlos Reynel Rodriguez, Marcos Antonio Ríos Paredes, Lily Rodriguez Bayona, Rocio del Pilar Rojas Gonzales, Maria Elena Rojas Peña, Norma Salinas Revilla, Yahn Carlos Soto Shareva, Raul Tupayachi Trujillo, Luis Valenzuela Gamarra, Rodolfo Vasquez Martinez, Jim Vega Arenas, Christian Amani, Suspense Averti Ifo, Yannick Bocko, Patrick Boundja, Romeo Ekoungoulou, Mireille Hockemba, Donatien Nzala, Alusine Fofanah, David Taylor, Guillermo Bañares-de Dios, Luis Cayuela, Íñigo Granzow-de la Cerda, Manuel Macía, Juliana Stropp, Maureen Playfair, Verginia Wortel, Toby Gardner, Robert Muscarella, Hari Priyadi, Ervan Rutishauser, Kuo-Jung Chao, Pantaleo Munishi, Olaf Bánki, Frans Bongers, Rene Boot, Gabriella Fredriksson, Jan Reitsma, Hans ter Steege, Tinde van Andel, Peter van de Meer, Peter van der Hout, Mark van Nieuwstadt, Bert van Ulft, Elmar Veenendaal, Ronald Vernimmen, Pieter Zuidema, Joeri Zwerts, Perpetra Akite, Robert Bitariho, Colin Chapman, Eilu Gerald, Miguel Leal, Patrick Mucunguzi, Miguel Alexiades, Timothy R. Baker, Karina Banda, Lindsay Banin, Jos Barlow, Amy Bennett, Erika Berenguer, Nicholas Berry, Neil M. Bird, George A. Blackburn, Francis Brearley, Roel Brienen, David Burslem, Lidiany Carvalho, Percival Cho, Fernanda Coelho, Murray Collins, David Coomes, Aida Cuni-Sanchez, Greta Dargie, Kyle Dexter, Mat Disney, Freddie Draper, Muying Duan, Adriane Esquivel-Muelbert, Robert Ewers, Belen Fadrique, Sophie Fauset, Ted R. Feldpausch, Filipe França, David Galbraith, Martin Gilpin, Emanuel Gloor, John Grace, Keith Hamer, David Harris, Tommaso Jucker, Michelle Kalamandeen, Bente Klitgaard, Aurora Levesley, Simon L. Lewis, Jeremy Lindsell, Gabriela Lopez-Gonzalez, Jon Lovett, Yadvinder Malhi, Toby Marthews, Emma McIntosh, Karina Melgaço, William Milliken, Edward Mitchard, Peter Moonlight, Sam Moore, Alexandra Morel, Julie Peacock, Kelvin Peh, Colin Pendry, R. Toby Pennington, Luciana de Oliveira Pereira, Carlos Peres, Oliver L. Phillips, Georgia Pickavance, Thomas Pugh, Lan Qie, Terhi Riutta, Katherine Roucoux, Casey Ryan, Tiina Sarkinen, Camila Silva Valeria, Dominick Spracklen, Suzanne Stas, Martin Sullivan, Michael Swaine, Joey Talbot, James Taplin, Geertje van der Heijden, Laura Vedovato, Simon Willcock, Mathew Williams, Luciana Alves, Patricia Alvarez Loayza, Gabriel Arellano, Cheryl Asa, Peter Ashton, Gregory Asner, Terry Brncic, Foster Brown, Robyn Burnham, Connie Clark, James Comiskey, Gabriel Damasco, Stuart Davies, Tony Di Fiore, Terry Erwin, William Farfan-Rios, Jefferson Hall, David Kenfack, Thomas Lovejoy, Roberta Martin, Olga Martha Montiel, John Pipoly, Nigel Pitman, John Poulsen, Richard Primack, Miles Silman, Marc Steininger, Varun Swamy, John Terborgh, Duncan Thomas, Peter Umunay, Maria Uriarte, Emilio Vilanova Torre, Ophelia Wang, Kenneth Young, Gerardo A. Aymard C., Lionel Hernández, Rafael Herrera Fernández, Hirma Ramírez-Angulo, Pedro Salcedo, Elio Sanoja, Julio Serrano, Armando Torres-Lezama, Tinh Cong Le, Trai Trong Le, Hieu Dang Tra

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Increased recovery in coarse-root secondary growth improves resilience to drought in transition forests

Interaction of global change drivers affects forest resilience. Land-use changes (land abandonment) and climate change (a higher frequency and intensity of droughts) are interacting in the Mediterranean Region. Components of resilience in secondary stem growth have been widely studied but, despite the importance of root systems in forest functionality and resilience, non-previous studies have assessed them in coarse roots. In this study, we use Juniperus thurifera tree-ring chronologies in coarse roots and stems to assess biomass allometry and tree resilience to drought events comparing two stages of a forest expansion gradient (mature forests and transition zone) in Alto Tajo Natural Park. We extracted cores of stems and coarse roots in 48 trees distributed in different developmental stages and calculated cross-sectional area increments, root-stem allometric relationship and resilience components for both organs in each individual for two drought events (2005 and 2012). Stem and root growth as well as its allometric exponent were higher in the transition zone than in mature forests. Both organs exhibited a trade-off between resistance and recovery in mature forests but maintenance of higher values in the transition zone. Resilience did not show differences between organs being higher in the transition zone than in mature forests. However, relative resilience in roots in the transition zone was higher than in mature forests, without differences in stems between stages. Finally, the 2012 drought event showed a higher impact on the components of resilience than the 2005 drought event. This study extends the knowledge of root response to drought events and highlights the potential of land-use legacies to reduce the negative impact of climate change by promoting increased root recovery after drought events in trees established in past agricultural lands.This study was supported by the Spanish Ministry of Economy and Competitiveness (MINECO) grant: COMEDIAS (CGL2017-83170-R), FPI fellowship to BAM (PRE2018-083584) and Comunidad de Madrid grant: REMEDINAL TE (Ref. TE-CM.S2018/EMT-4338,2019-2023-Comunidad de Madrid).Peer reviewe

European Conference on Technology Enhanced Learning, EC-TEL 2021 (16º. 2021. Bolzano, Italy)

Producción CientíficaEducawood is a socio-semantic annotation system intended for environmental learning in Secondary and Higher Education. It can be used to socially annotate trees and other ecosystem structures such as dead wood. Furthermore, Educawood allows the exploration of existing semantic datasets of land cover maps and forestry inventories as well as social tree annotations (all released as Linked Open Data). Teachers can browse these data to propose contextualized environmental education activities, e.g. finding and annotating singular trees. Students can go on a field trip and use Educawood with their mobile devices to submit tree annotations. Follow-up activities can exploit socially-created tree annotations, for example in virtual field trips.Junta de Castilla y León - Fondo Europeo de Desarrollo Regional (project VA257P18)Agencia Estatal de Investigación - Fondo Europeo de Desarrollo Regional (project TIN2017-85179-C3-2-R)Cross-Forest (project CEF 2017-EU-IA-0140)VirtualForests (project Erasmus+ 2020-1-ES01- KA226-HE-095836)Universidad de Valladolid (project UVA-PID2020-015

¿He vivido en vano? Mesa Redonda sobre Todas las Sangres, 23 de junio de 1965

"Se ilustra sobre los cambios que las personas y las ideas sobre la creación y la investigación han seguido en el Perú. Se analiza la novela de Arguedas, que es entendida desde un punto de vista literario y desde un punto de vista sociológico; y así confluyen distintos ángulos para juzgar el texto de Todas las sangres". ― Introducción

Evaluación de la terapia con presión negativa tópica en la cicatrización de heridas agudas y úlceras cutáneas tratadas en un hospital valenciano

To evaluate the effectiveness of negative pressure wound therapy (NPWT) in the healing of acute wounds, diabetic foot ulcers, venous ulcers, and prpressure ulcers (PU). Methods: Prospective observational analytic study from January to December 2014 Sample of 57 patients Consortium General Hospital Universitario de Valencia (CHGUV) treated with TPNt (Vivano™). Using FEDPALLA, EVA, scales and planimetric and dimensional calculation of each lesion. Evaluation and monitoring by nominal grgroup. Descriptive and inferential statistical analysis using SPSS v.21. Results: The mean age of participants was 63.6 ± 21.6 years, 54.3% were women (n=32) and 27.3% were smokers. 26 acute wounds, 13 vascular ulcers, neuropathic ulcers 9 and 9 prpressure sores: 4 grgroups of lesions with subsequent prprospective follow-up were classified. The prpre-study mean dimensions were 4.4 x 8.2 x 1.3 cm and a volume of 17.6 cm3. Post-study: 2.4 x 5.3 x 0.6 cm and a volume of 3.8 cm3. The average age of injury was 79 days and the order for 16 days. Conclusions: All evaluated cases have been favored by the TPNt (reducing the size and site prpreparation for epithelialization); prproving to be a convenient therapy for the patient, useful for nurses (better time management of direct care) and management savings by decreasing the costs of hospitalization (ambulatory monitoring).Objetivo: Evaluar la eficacia de la Terapia de Presión Negativa tópica (TPNt) en la cicatrización de las heridas agudas, las ulceras de pie diabético, las ulceras venosas, y las úlceras por presión (UPP). Método: Estudio analítico observacional prospectivo desde enero a diciembre de 2014. Muestra de 57 pacientes del Consorcio del Hospital General Universitario de Valencia (CHGUV) en tratamiento con TPNt (Vivano™). Uso de las escalas FEDPALLA, EVA, y cálculo planimétrico y dimensional de cada lesión. Evaluación y seguimiento por grupo nominal. Análisis estadístico descriptivo e inferencial con SPSS v.21 Resultados: La media de edad de los participantes fue de 63,6 ± 21,6 años, un 54,3% eran mujeres (n=32) y un 27,3% fumadores. Se clasificaron 4 grupos de lesiones con su posterior seguimiento prospectivo: 26 heridas agudas, 13 úlceras vasculares, 9 úlceras neuropáticas y 9 úlceras por presión. Las dimensiones medias pre-estudio fueron 4,4 x 8,2 x 1,3 cm y un volumen de 17,6 cm3. Post-estudio: 2,4 x 5,3 x 0,6 cm y un volumen de 3,8 cm3. La antigüedad media de la lesión fue de 79 días y su resolución de 16 días. Conclusiones: Todos los casos evaluados se han visto favorecidos por la TPNt (reducción de las dimensiones y preparación del lecho para su epitelización); resultando ser una terapia cómoda para el paciente, útil para los profesionales de enfermería (mejor gestión de los tiempos de cuidados directos), y de ahorro para la administración por la disminución de los costes de hospitalización (seguimiento ambulatorio)

Evaluation of the therapy with topical negative pressure in the healing of acute wounds and skin ulcers treateded in a valencian hospital

Objetivo: Evaluar la eficacia de la Terapia de Presión Negativa tópica (TPNt) en la cicatrización de las heridas agudas, las ulceras de pie diabético, las ulceras venosas, y las úlceras por presión (UPP).Método: Estudio analítico observacional prospectivo desde enero a diciembre de 2014. Muestra de 57 pacientes del Consorcio del Hospital General Universitario de Valencia (CHGUV) en tratamiento con TPNt (Vivano™). Uso de las escalas FEDPALLA, EVA, y cálculo planimétrico y dimensional de cada lesión. Evaluación y seguimiento por grupo nominal. Análisis estadístico descriptivo e inferencial con SPSS v.21 Resultados: La media de edad de los participantes fue de 63,6 ± 21,6 años, un 54,3% eran mujeres (n=32) y un 27,3% fumadores. Se clasificaron 4 grupos de lesiones con su posterior seguimiento prospectivo: 26 heridas agudas, 13 úlceras vasculares, 9 úlceras neuropáticas y 9 úlceras por presión. Las dimensiones medias preestudio fueron 4,4 x 8,2 x 1,3 cm y un volumen de 17,6 cm3. Postestudio: 2,4 x 5,3 x 0,6 cm y un volumen de 3,8 cm3. La antigüedad media de la lesión fue de 79 días y su resolución de 16 días. Conclusiones: Todos los casos evaluados se han visto favorecidos por la TPNt (reducción de las dimensiones y preparación del lecho para su epitelización); resultando ser una terapia cómoda para el paciente, útil para los profesionales de enfermería (mejor gestión de los tiempos de cuidados directos), y de ahorro para la administración por la disminución de los costes de hospitalización (seguimiento ambulatorio).To evaluate the effectiveness of negative pressure wound therapy (NPWT) in the healing of acute wounds, diabetic foot ulcers, venous ulcers, and prpressure ulcers (PU). Methods: Prospective observational analytic study from January to December 2014 Sample of 57 patients Consortium General Hospital Universitario de Valencia (CHGUV) treated with TPNt (Vivano™). Using FEDPALLA, EVA, scales and planimetric and dimensional calculation of each lesion. Evaluation and monitoring by nominal grgroup. Descriptive and inferential statistical analysis using SPSS v.21. Results: The mean age of participants was 63.6 ± 21.6 years, 54.3% were women (n=32) and 27.3% were smokers. 26 acute wounds, 13 vascular ulcers, neuropathic ulcers 9 and 9 prpressure sores: 4 grgroups of lesions with subsequent prprospective follow-up were classified. The prpre-study mean dimensions were 4.4 x 8.2 x 1.3 cm and a volume of 17.6 cm3. Post-study: 2.4 x 5.3 x 0.6 cm and a volume of 3.8 cm3. The average age of injury was 79 days and the order for 16 days. Conclusions: All evaluated cases have been favored by the TPNt (reducing the size and site prpreparation for epithelialization); prproving to be a convenient therapy for the patient, useful for nurses (better time management of direct care) and management savings by decreasing the costs of hospitalization (ambulatory monitoring).Enfermerí