The Helicobacter pylori Genome Project : insights into H. pylori population structure from analysis of a worldwide collection of complete genomes

Helicobacter pylori, a dominant member of the gastric microbiota, shares co-evolutionary history with humans. This has led to the development of genetically distinct H. pylori subpopulations associated with the geographic origin of the host and with differential gastric disease risk. Here, we provide insights into H. pylori population structure as a part of the Helicobacter pylori Genome Project (HpGP), a multi-disciplinary initiative aimed at elucidating H. pylori pathogenesis and identifying new therapeutic targets. We collected 1011 well-characterized clinical strains from 50 countries and generated high-quality genome sequences. We analysed core genome diversity and population structure of the HpGP dataset and 255 worldwide reference genomes to outline the ancestral contribution to Eurasian, African, and American populations. We found evidence of substantial contribution of population hpNorthAsia and subpopulation hspUral in Northern European H. pylori. The genomes of H. pylori isolated from northern and southern Indigenous Americans differed in that bacteria isolated in northern Indigenous communities were more similar to North Asian H. pylori while the southern had higher relatedness to hpEastAsia. Notably, we also found a highly clonal yet geographically dispersed North American subpopulation, which is negative for the cag pathogenicity island, and present in 7% of sequenced US genomes. We expect the HpGP dataset and the corresponding strains to become a major asset for H. pylori genomics

Tecnología lúdica para la rehabilitación de miembro superior en jóvenes

El proyecto de investigación consistió en el diseño de una tecnología lúdica utilizada como instrumento de rehabilitación en una actividad de juego, enfocada al restablecimiento de la función motriz del miembro superior, el cual está involucrado en la realización de actividades de la vida diaria (actividades como: aseo personal, sostener objetos, apoyarse, entre otras). El juego propuesto considera a la persona en su conjunto de sistemas físicos, intelectuales y psicosociales. El prototipo fue caracterizado con pruebas realizadas a 50 jóvenes de edades entre 16 y 22 años, aparentemente sanos, quienes decidieron participar de manera voluntaria de la actividad de juego. El juguete constó de: un brazalete electrónico (control remoto) y un carro de juguete que tenía la función de moverse simultáneamente con los movimientos que efectuaba el jugador con su extremidad superior. El juguete se moviliza en medio de una pista dividida por tres niveles de dificultad. Se constató que la actividad lúdica propuesta cumplió con los requerimientos de una actividad en el marco de la rehabilitación, puesto que se tiene en cuenta la estabilidad y realización de movimientos desde la articulación proximal del hombro, siguiendo por codo y muñeca, además se pueden obtener beneficios adyacentes, a nivel cognitivo, debido a que el jugador debe entender e identificar el espacio en el que se desarrolla el juego, de tal manera que el jugador plantea una estrategia de juego basado en secuencias lógicas, acciones y consecuencias, y en ciertas actitudes sociales, evidenciadas en la apreciación que genera el juego en el participante, evaluado a través de una encuesta en factores como: dversión, atención, presión, sentido de competencia y esfuerzo

Tecnología lúdica para la rehabilitación de miembro superior en jóvenes

This research project consisted in the design of a playful technology, used as a rehabilitation instrument in a game activity, focused on the restoration of the motor function in the upper limbs. The game conside red the person as a whole of physical, intellectual and psychosocial systems. The upper limbs are involved in daily-life activities (personal hygiene, holding objects, supporting, among others). The prototype was designed with tests performed on 50 young people between the ages of 16 and 22, apparently healthy, who decided to participate voluntarily in the game. The toy consisted of an electronic bracelet (remote control) and a toy car that had the function of displacing simultaneously with the movements made by the player with his upper extremity. The toy moves in the middle of a track divided by three levels of difficulty. It was found that the recreational activity was carried out with the requirement of an activity within the framework of the rehabilitation, because the construction and realization of movements are articulated, from the proximal joint of a shoulder, following the elbow and the wrist. It also carried adjacent benefits, at a cognitive level, because the player must understand and identify the space in which the game is developed, in such a way that the player presents a game strategy based on strategic actions, actions and consequences, and certain social attitudes, evidenced in the appreciation that the game generates in the participant, identified through an evaluation in factors such as: fun, attention, pressure, sense of competence and effort.El proyecto de investigación consistió en el diseño de una tecnología lúdica utilizada como instrumento de rehabilitación en una actividad de juego, enfocada al restablecimiento de la función motriz del miembro superior, el cual está involucrado en la realización de actividades de la vida diaria (actividades como: aseo personal, sostener objetos, apoyarse, entre otras). El juego propuesto considera a la persona en su conjunto de sistemas físicos, intelectuales y psicosociales. El prototipo fue caracterizado con pruebas realizadas a 50 jóvenes de edades entre 16 y 22 años, aparentemente sanos, quienes decidieron participar de manera voluntaria de la actividad de juego. El juguete constó de: un brazalete electrónico (control remoto) y un carro de juguete que tenía la función de moverse simultáneamente con los movimientos que efectuaba el jugador con su extremidad superior. El juguete se moviliza en medio de una pista dividida por tres niveles de dificultad. Se constató que la actividad lúdica propuesta cumplió con los requerimientos de una actividad en el marco de la rehabilitación, puesto que se tiene en cuenta la estabilidad y realización de movimientos desde la articulación proximal del hombro, siguiendo por codo y muñeca, además se pueden obtener beneficios adyacentes, a nivel cognitivo, debido a que el jugador debe entender e identificar el espacio en el que se desarrolla el juego, de tal manera que el jugador plantea una estrategia de juego basado en secuencias lógicas, acciones y consecuencias, y en ciertas actitudes sociales, evidenciadas en la apreciación que genera el juego en el participante, evaluado a través de una encuesta en factores como: dversión, atención, presión, sentido de competencia y esfuerzo

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research