Otro escenario descolonizador: luchas nacionalistas en Panamá durante la Segunda Guerra Mundial y los inicios de la Guerra Fría. (1939-1953).

The Panamanian post-World War II reality, the attempts by the United States to prolong its military presence at the defense  sites granted in the Fábrega-Wilson convention, highlighting the participation of the Panamanian popular movement that gave effect to the rejection of the Philos-Hines agreement. The political reality and the oligarchical contradictions and the rol of National Police, turned into the arbiter of them. The events following Domingo Díaz’s rise and death; the role of subsequent governments in the development of anti-communist policy, a macartist period, promoted by the United States. In Panama, the rise to the presidency of Colonel Remón  was the fundamental instrument for persecution; a reflux of the Panamanian popular movement occurs that will achieve a subsequent upsurge after the physical disappearance of José Remón Cantera. The glorious pages written in the sovereignty operation, the May 58 feast, the 1959 flag planting, the Cerro Tute armed uprising, the march of hunger and despair, the banana plantation workers strike in Chiriquí and Bocas del Toro and, finally, the anti-Cuban policy promoted by the United States and directed to the oligarchical sectors from Roberto Chiari’s government, will find obstacles in the popular movement.La realidad panameña posterior a la Segunda Guerra Mundial, los intentos de los Estados Unidos de prolongar su presencia militar en los sitios de defensas concedidos en el convenio Fábrega-Wilson, destacándose la participación del movimiento popular panameño que hizo efectivo el rechazo del acuerdo Filos-Hines; seguidamente se explica la realidad política y las contradicciones oligárquicas y el rol de la Policía Nacional, convertida en árbitro de las mismas; los acontecimientos suscitados luego del ascenso y muerte de Domingo Díaz, el papel de los gobiernos subsiguientes en el desarrollo de la política anticomunista, periodo macartista, impulsada por los Estados Unidos.  En Panamá, el ascenso a la presidencia de la Republica del coronel Remón fue el instrumento fundamental para la persecución; ocurre un reflujo del movimiento popular panameño que logrará un posterior repunte luego de la desaparición física de José Remón Cantera. Las páginas gloriosas escritas en la operación soberanía, la gesta de mayo del 58, la siembra de bandera de 1959, el alzamiento armado de Cerro Tute, la marcha del hambre y desesperación, la huelga de los trabajadores del banano en Chiriquí y Bocas del Toro y, por último, la política anticubana promovida por los Estados Unidos dictada a los sectores oligárquicos del gobierno del presidente Roberto Chiari, encontrará un valladar en el movimiento popular

Stoma-free Survival After Rectal Cancer Resection With Anastomotic Leakage: Development and Validation of a Prediction Model in a Large International Cohort.

Objective:To develop and validate a prediction model (STOMA score) for 1-year stoma-free survival in patients with rectal cancer (RC) with anastomotic leakage (AL).Background:AL after RC resection often results in a permanent stoma.Methods:This international retrospective cohort study (TENTACLE-Rectum) encompassed 216 participating centres and included patients who developed AL after RC surgery between 2014 and 2018. Clinically relevant predictors for 1-year stoma-free survival were included in uni and multivariable logistic regression models. The STOMA score was developed and internally validated in a cohort of patients operated between 2014 and 2017, with subsequent temporal validation in a 2018 cohort. The discriminative power and calibration of the models' performance were evaluated.Results:This study included 2499 patients with AL, 1954 in the development cohort and 545 in the validation cohort. Baseline characteristics were comparable. One-year stoma-free survival was 45.0% in the development cohort and 43.7% in the validation cohort. The following predictors were included in the STOMA score: sex, age, American Society of Anestesiologist classification, body mass index, clinical M-disease, neoadjuvant therapy, abdominal and transanal approach, primary defunctioning stoma, multivisceral resection, clinical setting in which AL was diagnosed, postoperative day of AL diagnosis, abdominal contamination, anastomotic defect circumference, bowel wall ischemia, anastomotic fistula, retraction, and reactivation leakage. The STOMA score showed good discrimination and calibration (c-index: 0.71, 95% CI: 0.66-0.76).Conclusions:The STOMA score consists of 18 clinically relevant factors and estimates the individual risk for 1-year stoma-free survival in patients with AL after RC surgery, which may improve patient counseling and give guidance when analyzing the efficacy of different treatment strategies in future studies

Stoma-free survival after anastomotic leak following rectal cancer resection: worldwide cohort of 2470 patients

Background: The optimal treatment of anastomotic leak after rectal cancer resection is unclear. This worldwide cohort study aimed to provide an overview of four treatment strategies applied. Methods: Patients from 216 centres and 45 countries with anastomotic leak after rectal cancer resection between 2014 and 2018 were included. Treatment was categorized as salvage surgery, faecal diversion with passive or active (vacuum) drainage, and no primary/secondary faecal diversion. The primary outcome was 1-year stoma-free survival. In addition, passive and active drainage were compared using propensity score matching (2: 1). Results: Of 2470 evaluable patients, 388 (16.0 per cent) underwent salvage surgery, 1524 (62.0 per cent) passive drainage, 278 (11.0 per cent) active drainage, and 280 (11.0 per cent) had no faecal diversion. One-year stoma-free survival rates were 13.7, 48.3, 48.2, and 65.4 per cent respectively. Propensity score matching resulted in 556 patients with passive and 278 with active drainage. There was no statistically significant difference between these groups in 1-year stoma-free survival (OR 0.95, 95 per cent c.i. 0.66 to 1.33), with a risk difference of -1.1 (95 per cent c.i. -9.0 to 7.0) per cent. After active drainage, more patients required secondary salvage surgery (OR 2.32, 1.49 to 3.59), prolonged hospital admission (an additional 6 (95 per cent c.i. 2 to 10) days), and ICU admission (OR 1.41, 1.02 to 1.94). Mean duration of leak healing did not differ significantly (an additional 12 (-28 to 52) days). Conclusion: Primary salvage surgery or omission of faecal diversion likely correspond to the most severe and least severe leaks respectively. In patients with diverted leaks, stoma-free survival did not differ statistically between passive and active drainage, although the increased risk of secondary salvage surgery and ICU admission suggests residual confounding