Fugas de sutura en anastomosis ileocólicas. Análisis de una serie institucional y metaanálisis comparativo entre anastomosis manuales y mecánicas

Objetivo: Evaluar la técnica quirúrgica (manual frente a mecánica) como factor de riesgo de fuga anastomótica (FA) ileocólica en una serie institucional, así como en el conjunto de la literatura científica publicada sobre el tema hasta el momento mediante un metaanálisis. Métodos: Análisis retrospectivo de 477 pacientes con anastomosis ileocólicas realizadas desde noviembre de 2010 a septiembre de 2016 en un hospital terciario. Las anastomosis se realizaron mediante técnicas estandarizadas. Se evaluaron los factores de riesgo independientes para FA, las complicaciones y la mortalidad. Las FA fueron divididas en menores o mayores según la necesidad de tratamiento médico o tratamiento invasivo con drenaje percutáneo o reintervención. La revisión sistemática y metaanálisis fue llevada a cabo según la metodología PRISMA (Prefered Reporting Items for Systematic reviews and MetaAnalysis). Se realizó una revisión bibliográfica de la literatura mediante la búsqueda en bases de datos electrónicas (PubMed, Ovid, Cochrane Library database y ClinicalTrials.gov) hasta enero de 2019, sin restricciones de idioma. Se completó la búsqueda revisando manualmente las listas de referencias de los artículos incluidos y mediante la búsqueda de conferencias de congresos, cartas y editoriales. Las palabras clave en dicha búsqueda fueron: “ileocolic”, “right colectomy”, “anastomosis”, “leak”. Resultados: En la serie institucional con 477 pacientes, el 53,7% de las anastomosis fueron manuales y el 46,3% mecánicas. La anastomosis latero-lateral fue la configuración más frecuente (93,3%). La FA se diagnosticó en el 8,8% de los pacientes y 36 se clasificaron como FA mayor (7,5%). En el análisis multivariante, el sexo masculino (p = 0,014, OR 2,9), la hipertensión arterial (p = 0,048, OR 2,29) y las transfusiones perioperatorias (p <0,001, OR 2,4 por litro) fueron factores de riesgo independientes para FA mayor. La tasa global de complicaciones a los 60 días fue del 27,3%. El sexo masculino (31,3% vs. femenino 22,3%, p=0,02, OR 1,7), la diabetes (p = 0,03 OR 2,0), hábito de fumar (p = 0,04 OR 1,8) y las 7 transfusiones perioperatorias (p <0,001, OR 3,3 por litro ) fueron factores de riesgo independientes para la morbilidad postoperatoria. La tasa de mortalidad a los 60 días fue del 3,1% y no se identificaron factores de riesgo significativos. En el metaanálisis, se halló una tasa de FA global de 4,4% (incluyendo FA mayor y menor) con OR 1,12 [IC95% 0,69, 1,81] a favor de la anastomosis manual. En el subanálisis de los estudios de los últimos 10 años y a los 5 años se obtuvo OR 1,27 [IC95% 0,85, 1,91] y OR 1,37 [IC95% 0,93, 2,02] respectivamente a favor de la anastomosis manual. En el análisis por patología, los pacientes con cáncer presentaron una menor tasa de FA en la anastomosis manual (OR 1,18 [IC95% 0,75, 1,87] y los pacientes con EII una menor tasa con anastomosis mecánica (OR 0,52 [IC95% 0,28, 0,97]). En el análisis de la mortalidad, la morbilidad y la estancia hospitalaria se observaron mejores resultados en las anastomosis mecánicas (mortalidad: OR 0,96 [IC95% 0,60, 1,53], morbilidad: OR de 0,80 [IC95% 0,51, 1,26]; estancia: OR 0,72 [IC95% 0,41, 1,26] aunque sin diferencias estadísticamente significativas Conclusiones: La incidencia de FA en la anastomosis ileocólicas en el presente trabajo sobre una serie unicéntrica alcanza el 8,8%, con una tasa de FA mayor de 7,5%. El tipo de anastomosis mecánica muestra una mayor tendencia a la FA con un intervalo de confianza que certifica su validez. Las variables pronósticas independientes como factores de riesgo de FA en el presente estudio son: sexo masculino, hipertensión arterial y transfusiones perioperatorias. El metaanálisis sobre el tema identifica una tasa global de FA de 4,4%, con esta misma tendencia a una mayor tasa de FA en anastomosis mecánicas. En el subanálisis de los pacientes intervenidos por cáncer se observó una menor tasa de FA con las anastomosis manuales y en subanálisis de enfermedad inflamatoria intestinal se observa una menor tasa de FA con las anastomosis mecánicas.Objective: To evaluate the surgical technique (manual versus mechanical) as a risk factor for ileocolic anastomotic leakage (AF) in an institutional series, as well as in the set of scientific literature published on the subject so far through a meta-analysis. Methods: Retrospective analysis of 477 patients with ileocolic anastomosis performed from November 2010 to September 2016 in a tertiary hospital. Anastomoses are used by standardized techniques. Independent risk factors for AF, complications and mortality were evaluated. AFs were divided into minor or major according to the need for medical treatment or invasive treatment with percutaneous drainage or reintervention. The systematic review and meta-analysis was carried out according to the PRISMA methodology (Elements of preferred reports for systematic reviews and MetaAnalysis). A literature review of the literature was performed by searching electronic databases (PubMed, Ovid, Cochrane Library database and ClinicalTrials.gov) until January 2019, without language restrictions. The search is completed by manually reviewing the reference lists of the included articles and by searching for conference conferences, letters and editorials. The keywords in this search were: "ileocolic", "right colectomy", "anastomosis", "leakage". Results: In the institutional series with 477 patients, 53.7% of the anastomoses were manual and 46.3% mechanical. Laterolateral anastomosis was the most frequent configuration (93.3%). AF was diagnosed in 8.8% of the patients and 36 was classified as major AF (7.5%). In the multivariate analysis, male sex (p = 0.014, OR 2.9), arterial hypertension (p = 0.048, OR 2.29) and perioperative transfusions (p <0.001, OR 2.4 per liter) were factors independent risk for major AF. The overall complication rate at 60 days was 27.3%. The male sex (31.3% vs. 22.3% female, p = 0.02, OR 1.7), diabetes (p = 0.03 OR 2.0), smoking (p = 0.04 OR 1.8) and 7 Perioperative transfusions (p <0.001, OR 3.3 per liter) were independent risk factors for postoperative morbidity. The 60-day mortality rate was 3.1% and no critical risk factors were identified. In the meta-analysis, a global AF rate of 4.4% (including major and minor AF) was found with OR 1.12 [95% CI 0.69, 1.81] in favor of manual anastomosis. In the sub-analysis of the studies of the last 10 years and 5 years, OR 1.27 [95% CI 0.85, 1.91] and OR 1.37 [95% CI 0.93, 2.02] respectively were obtained at favor of manual anastomosis. In the pathology analysis, cancer patients have a lower rate of AF in manual anastomosis (OR 1.18 [95% CI 0.75, 1.87] and patients with IBD a lower rate with mechanical anastomosis (OR 0 , 52 [95% CI 0.28, 0.97]) In the analysis of mortality, morbidity and hospital stay, better results were observed in mechanical anastomoses (mortality: OR 0.96 [95% CI 0.60, 1.53], morbidity: OR of 0.80 [95% CI 0.51, 1.26]; stay: OR 0.72 [95% CI 0.41, 1.26] although without statistically significant differences Conclusions: The incidence of AF in the ileocolic anastomosis in the present study on a single-center series reaches 8.8%, with an AF rate greater than 7.5%. The type of mechanical anastomosis shows a greater tendency to AF with a confidence interval that certifies its validity. The independent prognostic variables as risk factors for AF in the present study are: male sex, arterial hypertension and perioperative transfusions. The meta-analysis on the subject identifies an overall AF rate of 4.4%, with this same trend at a higher AF rate in mechanical anastomosis. A lower rate of AF with manual anastomoses is observed in the subanalysis of patients intervened for cancer and in a subanalysis of inflammatory bowel disease a lower rate of AF is observed with mechanical anastomoses

Estudio comparativo del blanqueo de las lanas no tratadas, clorada y Hercosett con soluciones de peróxido de hidrógeno.

Se ha procedido a la realización de experiencias de blanqueo de lana según un plan central giratorio de tres variables (concentración de peróxido de hidrógeno, temperatura y tiempo de blanqueo) sobre: 1) una lana no tratada, 2) la misma lana después de haber experimentado el tratamiento de clorado en medio ácido que precede a la aplicación de la resina Hercosett, y 3) la misma lana después de haber recibido el tratamiento completo. A partir de las ecuaciones de respuesta que relacionan un parámeiro determinado con las condiciones de blanqueo ha sido posible comparar el comportamiento de las tres lanas en la operación de blanqueo con peróxido de hidrógeno. A este respecto cabe indicar que el valor de W de la lana clorada es similar o superior al de la lana tratada, según que las condiciones de blanqueo sean más o menos benignas. Por su (parte, el valor W de la lana Hercosett es mayor que el de la lana no tratada, siendo la diferencia tanto más acusada cuanto más severas son las condiciones de blanqueo. Se ha observado que la lana Hercosett se blanquea algo menos y tarda más tiempo en blanquearse que la lana no tratada. En cuanto a los parámetros químicos y mecánicos se ha observado que la lana Hercosett posee solubilidades en álcali, contenidos de ácido cisteico algo menores y resistencias a la tracción en húmedomayores que las correspondientes a la lana no tratada blanqueada en las mismas condiciones.Peer Reviewe

Performance of default-risk measures: the sample matters

This paper examines the predictive power of the main default-risk measures used by both academics and practitioners, including accounting measures, market-price-based measures and the credit rating. Given that some measures are unavailable for some firm types, pair wise comparisons are made between the various measures, using same-size samples in every case. The results show the superiority of market-based measures, although their accuracy depends on the prediction horizon and the type of default events considered. Furthermore, examination shows that the effect of within-sample firm characteristics varies across measures. The overall finding is of poorer goodness of fit for accurate default prediction in samples characterised by high book-to-market ratios and/or high asset intangibility, both of which suggest pricing difficulty. In the case of large-firm samples, goodness of fit is in general negatively related to size, possibly because of the 'too-big-to-fail' effect.This paper has been possible thanks to the SANFI Research Grant for Young Researchers Edition 2015, the financial support from the Spanish Ministry of Economy, Industry and Competitiveness (ECO2016-77631-R (AEI/FEDER, UE)) and the Spanish Ministry of Science and Innovation (PID2019-104304GB-I00/AEI/10.13039/501100011033). Ana González Urteaga particularly acknowledges financial support from the Spanish Ministry of Science, Innovation and Universities through grant PGC2018-095072-B-I00

Assessing university students’ perception of academic quality using machine learning

Purpose – The aim of this research is to assess the influence of the underlying service quality variable, usually related to university students’ perception of the educational experience. Another aspect analysed in this work is the development of a procedure to determinewhich variables are more significant to assess students’ satisfaction. Design/methodology/approach – In order to achieve both goals, a twofold methodology was approached. In the first phase of research, an assessment of the service quality was performed with data gathered from 580 students in a process involving the adaptation of the SERVQUAL scale through a multi-objective optimization methodology. In the second phase of research, results obtained from students were compared with those obtained from the teaching staff at the university. Findings – Results from the analysis revealed the most significant service quality dimensions from the students’ viewpoint according to the scores that they provided. Comparison of the results with the teaching staff showed noticeable differences when assessing academic quality. Originality/value – Significant conclusions can be drawn from the theoretical review of the empirical evidences obtained through this study helping with the practical design and implementation of quality strategies in higher education especially in regard to university education.Spanish Ministry of Economy and Competitiveness (MINECO) #1 under Grant RTI2018-101674-B-I00European Regional Development Fund (ERDF) #2 under Grant FPA2017-85197-PERDF #3 under Grant B-SEJ-209-UGR1

Simulating use cases for the UAH autonomous electric car

2019 IEEE Intelligent Transportation Systems Conference (ITSC), Auckland, New Zealand, 27-30 Oct. 2019This paper presents the simulation use cases for the UAH Autonomous Electric Car, related with typical driving scenarios in urban environments, focusing on the use of hierarchical interpreted binary Petri nets in order to implement the decision making framework of an autonomous electric vehicle. First, we describe our proposal of autonomous system architecture, which is based on the open source Robot Operating System (ROS) framework that allows the fusion of multiple sensors and the real-time processing and communication of multiple processes in different embedded processors. Then, the paper focuses on the study of some of the most interesting driving scenarios such as: stop, pedestrian crossing, Adaptive Cruise Control (ACC) and overtaking, illustrating both the executive module that carries out each behaviour based on Petri nets and the trajectory and linear velocity that allows to quantify the accuracy and robustness of the architecture proposal for environment perception, navigation and planning on a university Campus.Ministerio de Economía y CompetitividadComunidad de Madri

UAV Detection of sinapis arvensis infestation in alfalfa plots using simple vegetation indices from conventional digital cameras

Producción CientíficaUnmanned Aerial Vehicles (UAVs) offer excellent survey capabilities at low cost to provide farmers with information about the type and distribution of weeds in their fields. In this study, the problem of detecting the infestation of a typical weed (charlock mustard) in an alfalfa crop has been addressed using conventional digital cameras installed on a lightweight UAV to compare RGB-based indices with the widely used Normalized Difference Vegetation Index (NDVI) index. The simple (R−B)/(R+B) and (R−B)/(R+B+G) vegetation indices allowed one to easily discern the yellow weed from the green crop. Moreover, they avoided the potential confusion of weeds with soil observed for the NDVI index. The small overestimation detected in the weed identification when the RGB indices were used could be easily reduced by using them in conjunction with NDVI. The proposed methodology may be used in the generation of weed cover maps for alfalfa, which may then be translated into site-specific herbicide treatment maps.Unión Europea (project LIFE11 ENV/ES/000535

Inteligencia emocional y esquemas tempranos desadaptativosen futuros educadores: ampliando fronteras

The main objective of the present work is the identification of the Early Maladaptive Schemes in educators in training and their scores in Perceived Emotional Intelligence (TMMS-24) to then explore possible relationships between them and establish differences by gender and degree taken. The sample is from Madrid university students of the Degrees in Infant, Primary and Social Education (N = 713), with an average age of 18.8 years. After the application of the Spanish adaptation of the SQ-SF (Cid, Tejero y Torrubia, 1997) and the TMMS-24 (Fernández Berrocal, Extremera and Ramos, 2004), we found that the schemes that reached highest scores were Self-sacrifice (18,28), Unreachable Goals (16,45) and Abandonment (14,13), obtaining significant differences in some of the schemes between the different levels of the factors considered. On the other hand, the results found in Perceived Emotional Intelligence showed average scores of 27.22 in Attention to Feelings, 25.57 in Emotional Clarity and 26.57 for Emotional Regulation, also with some significant differences between diferent variables. Finally, statistically significant negative correlations were found between the total scheme score and the dimensions of Emotional Clarity and Emotional Regulation, and positive with Attention to Feelings.El objetivo principal del presente trabajo es llevar a cabo la identificación de los Esquemas Desadaptativos Tempranos en educadores en formación y a sus puntuaciones en Inteligencia Emocional Percibida para, a continuación, explorar posibles relaciones entre ellos y establecer diferencias en virtud del género y de la titulación cursada. La muestra es de estudiantes universitarios madrileños de los Grados de Maestro en Educación Infantil, Primaria y Educación Social (N=713), con una media de edad de 18,8 años. Tras la aplicación de la adaptación española del SQ-SF (Cid, Tejero y Torrubia, 1997) y del TMMS-24 (Fernández Berrocal, Extremera y Ramos, 2004), encontramos que los esquemas que alcanzaron mayor puntuación fueron Autosacrificio (18,28), Metas Inalcanzables (16,45) y Abandono (14,13), obteniéndose diferencias significativas en algunos de los esquemas entre las diferentes variables consideradas. Por su parte, los resultados encontrados en Inteligencia Emocional Percibida mostraron puntuaciones medias de 27,22 en Atención a los Sentimientos, de 25,57 en Claridad Emocional y de 26,57 para la Regulación Emocional, también con algunas diferencias significativas entre géneros y titulación. Finalmente se encontraron correlaciones negativas estadísticamente significativas entre la puntuación total de esquemas y las dimensiones de Claridad Emocional y Regulación emocional y positiva con Atención a los sentimientos

Long-term Evaluation of Fistulotomy and Immediate Sphincteroplasty as a Treatment for Complex Anal Fistula

Background: Fistulotomy with immediate sphincteroplasty is a technique that can heal fistulas and decrease fecal incontinence more effectively than fistulotomy alone, in selected patients. Objective: We aimed to perform a long-term evaluation of fecal incontinence after fistulotomy and immediate sphincteroplasty in patients with complex anal fistula. Design: This prospective study included patients undergoing fistulotomy and immediate sphincteroplasty for complex anal fistula from January 2000 to December 2010. Settings: The study was conducted by 2 colorectal surgeons in the coloproctology unit of the General Hospital of Elche. Patients: We included patients aged ≥18 years with complex anal fistulas of cryptoglandular origin. Main outcome measures: Main outcomes were recurrence and continence after fistulotomy and immediate sphincteroplasty, according to fistula tract height and preoperative continence status. Results: A total of 107 patients were included; 68.2% were men, with a mean age of 48 years and mean fistula duration of 12.8 months. The range and median follow-up period were 84 to 204 and 96 months. Thirty-seven fistulas were not primary. The overall healing rate was 84.1%. Primary fistulas healed by the end of follow-up in 58 (82.9%) of 70 patients; recurrent fistulas healed in 32 (86.5%) of 37; high tracts healed in 31 (83.8%) of 37, and nonhigh fistulas healed in 59 (84.3%) of 70. Male sex (OR = 0.66 (95% CI, 0.20-2.13); p > 0.05) and recurrent fistulas (OR = 0.43 (95% CI, 0.11-1.68); p > 0.05) could have a protective effect against postoperative fecal incontinence; however, more studies with larger sample sizes are necessary to confirm this result, whereas high fistulas showed a 4-fold increased risk of incontinence (range, 1.22-13.06; p < 0.01). One in 5 high-tracts patients experienced continence deterioration. Limitations: This was a prospective study, and randomized clinical trials with more patients and longer follow-up are needed to compare fistulotomy and immediate sphincteroplasty with other sphincter-preserving techniques. Conclusions: Fistulotomy and immediate sphincteroplasty are good options for treating complex anal fistulas, especially for recurrent fistulas, men, and patients with nonhigh tracts, with acceptable recurrence and incontinence rates. See Video Abstract at http://links.lww.com/DCR/B498

Photodynamic Therapy for the Treatment of Complex Anal Fistula

Background and objectives: To validate and analyze the results of intralesional photodynamic therapy in the treatment of complex anal fistula. Study design/materials and methods: This prospective multicentric observational study enrolled patients treated for complex anal fistula who underwent intralesional photodynamic therapy (i-PDT). The included patients were treated from January 2016 to December 2018 with a minimum follow-up of 1 year to evaluate recurrence, continence and postoperative morbidity. Intralesional 5-aminolevulinic acid (ALA) gel (2%) was injected directly into the fistula. The internal and external orifices were closed. After an incubation period of 2 hours, the fistula was irradiated using an optical fiber connected to a red laser (Multidiode 630 PDT) operating at 1 W/cm for 3 minutes (180 J). Results: In total, 49 patients were included (61.2% male). The mean age was 48 years, and the mean duration of fistula was 13 months. Of the fistulas included, 75.5% were medium transphincteric, and 24.5% were high transphincteric. The median fistula length was 4 ± 1,14 cm (range: 3-5). A total of 41 patients (83.7%) had a previous history of fistula surgery. Preoperatively, some degree of anal incontinence was found in 5 patients (10.2%). No center reported any other procedure-related complications intraoperatively. Phototoxicity was found in one patient. In the first 48 hours after the procedure, fever was reported in 2 patients (4%). At the end of follow-up, total healing was observed in 32/49 patients (65.3%). No patient reported new incontinence postoperatively. Conclusion: i-PDT could be considered a good choice in patients with complex anal fistulas to avoid surgery and its complications. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc

Efectividad de 5-fluoruracilo y vinorelbina en pacientes multitratadas por cáncer de mama metastásico

Objetivo. Evaluar la actividad y toxicidad de fluoruracilo en infusión continua y vinorelbina en segunda o tercera línea de tratamiento del cáncer de mama metastásico (CMM). Método y pacientes. En este estudio fase II se incluyeron 24 pacientes que habían recibido doxorrubicina y/o paclitaxel. Se administró 5-fluoruracilo a 1g/m2/día en infusión continua por 3 días y vinorelbina a 30 mg/m2 D1 cada 21 días por 6 ciclos. Resultados. Las respuestas globales observadas fueron del 37,5% (12,5% respuestas completas). El período libre de enfermedad se calculó una media de 6,33 ± 8,12 meses (IC 95% de 3,43 meses). Se observó toxicidad en el 12,5% de las pacientes y no se registró toxicidad grave ni muertes relacionadas a tratamiento. Conclusión. El 5-fluoruracilo/vinorelbina a las dosis administradas es un esquema efectivo en pacientes con CMM multitratadas, con un bajo perfil de toxicidad y costo