Pancreatic metastases from renal cell carcinoma. Postoperative outcome after surgical treatment in a Spanish multicenter study (PANMEKID)

Background: Renal Cell Carcinoma (RCC) occasionally spreads to the pancreas. The purpose of our study is to evaluate the short and long-term results of a multicenter series in order to determine the effect of surgical treatment on the prognosis of these patients. Methods: Multicenter retrospective study of patients undergoing surgery for RCC pancreatic metastases, from January 2010 to May 2020. Variables related to the primary tumor, demographics, clinical characteristics of metastasis, location in the pancreas, type of pancreatic resection performed and data on short and long-term evolution after pancreatic resection were collected. Results: The study included 116 patients. The mean time between nephrectomy and pancreatic metastases' resection was 87.35 months (ICR: 1.51-332.55). Distal pancreatectomy was the most performed technique employed (50 %). Postoperative morbidity was observed in 60.9 % of cases (Clavien-Dindo greater than IIIa in 14 %). The median follow-up time was 43 months (13-78). Overall survival (OS) rates at 1, 3, and 5 years were 96 %, 88 %, and 83 %, respectively. The disease-free survival (DFS) rate at 1, 3, and 5 years was 73 %, 49 %, and 35 %, respectively. Significant prognostic factors of relapse were a disease free interval of less than 10 years (2.05 [1.13-3.72], p 0.02) and a history of previous extrapancreatic metastasis (2.44 [1.22-4.86], p 0.01). Conclusions: Pancreatic resection if metastatic RCC is found in the pancreas is warranted to achieve higher overall survival and disease-free survival, even if extrapancreatic metastases were previously removed. The existence of intrapancreatic multifocal compromise does not always warrant the performance of a total pancreatectomy in order to improve survival

Pancreatic metastases from renal cell carcinoma. Postoperative outcome after surgical treatment in a Spanish multicenter study (PANMEKID)

Background: Renal Cell Carcinoma (RCC) occasionally spreads to the pancreas. The purpose of our study is to evaluate the short and long-term results of a multicenter series in order to determine the effect of surgical treatment on the prognosis of these patients. Methods: Multicenter retrospective study of patients undergoing surgery for RCC pancreatic metastases, from January 2010 to May 2020. Variables related to the primary tumor, demographics, clinical characteristics of metastasis, location in the pancreas, type of pancreatic resection performed and data on short and long-term evolution after pancreatic resection were collected. Results: The study included 116 patients. The mean time between nephrectomy and pancreatic metastases' resection was 87.35 months (ICR: 1.51-332.55). Distal pancreatectomy was the most performed technique employed (50 %). Postoperative morbidity was observed in 60.9 % of cases (Clavien-Dindo greater than IIIa in 14 %). The median follow-up time was 43 months (13-78). Overall survival (OS) rates at 1, 3, and 5 years were 96 %, 88 %, and 83 %, respectively. The disease-free survival (DFS) rate at 1, 3, and 5 years was 73 %, 49 %, and 35 %, respectively. Significant prognostic factors of relapse were a disease free interval of less than 10 years (2.05 [1.13-3.72], p 0.02) and a history of previous extrapancreatic metastasis (2.44 [1.22-4.86], p 0.01). Conclusions: Pancreatic resection if metastatic RCC is found in the pancreas is warranted to achieve higher overall survival and disease-free survival, even if extrapancreatic metastases were previously removed. The existence of intrapancreatic multifocal compromise does not always warrant the performance of a total pancreatectomy in order to improve survival. (C) 2021 The Authors. Published by Elsevier Ltd

European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome, in the right population.

In clinical practice and for scientific purposes, cardiologists and primary care physicians perform risk assessment in patients with cardiac diseases or conditions with high risk of developing such. The European Heart Rhythm Association (EHRA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), and the Latin American Heart Rhythm Society (LAHRS) set down this expert consensus statement task force to summarize the consensus regarding risk assessment in cardiac arrhythmias. Objectives were to raise awareness of using the right risk assessment tool for a given outcome in a given population, and to provide physicians with practical proposals that may lead to rational and evidence-based risk assessment and improvement of patient care in this regard. A large variety of methods are used for risk assessment and choosing the best methods and tools hereof in a given situation is not simple. Even though parameters and test results found associated with increased risk of one outcome (e.g. death) may also be associated with higher risk of other adverse outcomes, specific risk assessment strategies should be used only for the purposes for which they are validated. The work of this task force is summarized in a row of consensus statement tables

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Detección de apoptosis en enfermedades cardiovasculares mediante las imágenes SPECT de cardiología nuclear

La apoptosis es un proceso biológico de muerte o suicidio celular presente en todas las células de los metazoarios. Mantiene un equilibrio entre la regeneración de las células pluripotenciales o células madre y la eliminación de células que ya han servido su propósito, que se han reproducido en exceso, o en las que existe daño genético irreparable. La activación de la apoptosis en cardiomiocitos es un problema común en una gran variedad de cardiopatías y se ha sugerido que contribuye de manera importante a la dilatación ventricular y al aumento del tamaño del infarto en pacientes con insuficiencia cardíaca y con enfermedad cardiovascular. El diagnóstico clínico de la apoptosis es una realidad en la ciencia médica, cuya aplicación en diferentes facetas de la Cardiología, incluye desde la cardiopatía coronaria hasta los trastornos del ritmo. En este sentido, el uso de la imagenología no-invasiva, puede ser de gran utilidad para la detección in vivo de este tipo de muerte celular, en pacientes con necrosis miocárdica, con isquemia miocárdica aguda, con rechazo agudo del trasplante cardíaco, con miocarditis, con tumores malignos intracardíacos, así como en casos de cardiotoxicidad y de otras cardiomiopatías. Particularmente la unión de la Anexina V, marcada con Tc99m produce imágenes gammagráficas que permiten la identificación de células apoptóticas in vivo, en sistemas con el SPECT y SestaMiBi. En resumen, la utilización de estas técnicas será invaluable en un futuro próximo para la terapia e intervención anti-apoptosis en la rutina de la Cardiología diaria

Western blot analyses of the enzymes involved in lipid accumulation.

<p>Cells were exposed to Cu²⁺ (10, 50 μM), Fe²⁺ overload (1 mM), the combination of both metals or its vehicle for 24 h. Cell lysates were prepared for Western blot as described in “Material and Methods” and (A) DGAT 1 expression levels, (B) FAS expression levels and (C) LPAAT-θ expression levels were assessed. Western blot in each case is representative of three different experiments. Bands of proteins were quantified using scanning densitometry. Data in the graphs above each blot represent the ratio between cellular protein expression and Actin, expressed as a percentage of the corresponding control condition (mean ± SD of three different experiments). *p < 0.05 for each condition with respect to the control; one-way ANOVA and Tukey’s <i>post hoc</i> test.</p

Effect of metal-induced injury on TAG content and formation of LD.

<p>(A) RT-qPCR analysis for <i>Plin-2</i> transcripts in N27 cells after incubation for 5 h with 1 mM Fe²⁺, 50 μM Cu²⁺, the combination of these metals or the vehicle. Data was normalized to <i>Tbp</i> as internal reference gen using the 2^-ΔΔCt method (n = 3). (B) Fluorescence images of dopaminergic neurons exposed to 1 mM Fe²⁺, or the vehicle for 24 hours, stained with Nile Red to detect LD. Representative images from three different experiments are shown. (C) TAG content in N27 incubated in the presence of 1 mM Fe²⁺, 50 μM Cu²⁺, the combination of these metals or the vehicle for 24 hours. Results are expressed as a percentage of the control and represent mean ± SD (n = 3). (D) Cholesterol content in N27 incubated in the presence of 1 mM Fe²⁺, 50 μM Cu²⁺, the combination of these metals or the vehicle for 24 hours. Results are expressed as a percentage of the control and represent mean ± SD (n = 3). *p < 0.05 for each condition with respect to the control; one-way ANOVA and Tukey’s <i>post hoc</i> test.</p