Laparoscopic and open gastrectomy for locally advanced gastric cancer: a retrospective analysis in Colombia.

INTRODUCTION: Radical gastrectomy has traditionally been the pillar treatment with curative intent for malignant tumors of the stomach. The safety of the laparoscopic approach for advanced gastric cancer (AGC) is still under debate. In our institution, laparoscopic gastrectomy is the most performed approach. OBJECTIVE: Our aim is to describe the experience of a high-volume center in the treatment of AGC in Colombia and to analyze the short-term results and the overall survival rate at 1, 3, and 5 years comparing the open and laparoscopic approaches. METHODS: A cross-sectional retrospective study of patients who underwent gastrectomy for advanced gastric cancer by open or laparoscopic approaches were performed. A Will-Coxon Mann Whitney test was performed in terms of lymph node status and surgical approach. Survival analysis was performed using the Kaplan-Meier method for overall survival at 1, 3, and 5 years. An initial log-rank test was performed to test the relationships between the operative variables and overall survival, the statistical value was accepted if p < 0.20. Data with an initial statistical relationship in the log-rank test were included in a secondary analysis using multivariate Cox proportional regression, variables with a value of p < 0.05 were considered statistically significant. RESULTS: 310 patients met the inclusion criteria. 89% underwent laparoscopic gastrectomy and 10.9% open gastrectomy. The resection margins were negative at 93.5% and the In terms of lymph node dissection, the median lymph nodes extracted was 20 (12;37), with statistically significant differences between the approaches in favor of the laparoscopic approach (Median 21 vs 12; z = - 2.19, p = 0.02). The survival rate was at 1, 3, and 5 years of 84.04%, 66.9%, and 65.47% respectively. The presence of complications and the ICU requirement have a negative impact on survival at 1 year (p 0.00). CONCLUSION: A laparoscopic approach is safe with acceptable morbidity and mortality rates for treating gastric cancer. D2 Lymphadenectomy could be performed successfully in a laparoscopic approach in a high-volume center and a properly standardized technique. Major postoperative morbidity with intensive care unit requirement seems to influence overall survival rates.

Agrochemical pesticide production, trade, and hazard: Narrowing the information gap in Colombia.

Pesticides are a major tool for the intensification of agriculture, and helped to increase food, feed and biofuel production. Yet, there are persistent concerns about the negative effects of pesticides in human health and the environment, particularly in low and middle income countries (LMICs). Given the lack of information on pesticide exposure and hazard, Colombia exemplifies the need to narrow the information gap on pesticide risk in LMICs. We assessed pesticide hazard in Colombia based on the official toxicity categorization, compared it to more integral international standards, and identified main actions to narrow this information gap. Results showed that Colombia has been a relevant regional actor in pesticide production and trade, reaching almost 75 million kilogrammes and liters sold in 2016. Based on acute toxicity for humans, a quarter of the amount of pesticides sales and imports, and a third of the exports in 2016 ranged from moderately to extremenly toxic. The top-selling agrochemicals in 2016 (glyphosate with 14% of the total sales, chlorpyrifos 7.5% and mancozeb 6.9%) are also commonly used in other countries, reflecting a homogenized global industry. Compared to integral international categorizations, we found that for that year 63% of the pesticides sold with slightly acute toxicity are actually considered highly hazardous pesticides (HHP) for humans or the environment, evidencing the need to use a more integral hazard categorization in the country. Narrowing the information gap in pesticide use and associated risks demands a transparent process of knowledge creation and sharing, including funtional information and monitoring systems. This should be part of an integral assessment and regulation that better defines HHP, their production and trade to reduce pesticide risk while informing a transition towards sustainable food systems.

Climate smart agriculture, farm household typologies and food security: An ex-ante assessment from Eastern India.

One of the great challenges in agricultural development and sustainable intensification is the assurance of social equity in food security oriented interventions. Development practitioners, researchers, and policy makers alike could benefit from prior insight into what interventions or environmental shocks might differentially affect farmers' food security status, in order to move towards more informed and equitable development. We examined the food security status and livelihood activities of 269 smallholder farm households (HHs) in Bihar, India. Proceeding with a four-step analysis, we first applied a multivariate statistical methodology to differentiate five primary farming system types. We next applied an indicator of food security in the form of HH potential food availability (PFA), and examined the contribution of crop, livestock, and on- and off-farm income generation to PFA within each farm HH type. Lastly, we applied scenario analysis to examine the potential impact of the adoption of 'climate smart' agricultural (CSA) practices in the form of conservation agriculture (CA) and improved livestock husbandry, and environmental shocks on HH PFA. Our results indicate that compared to livestock interventions, CA may hold considerable potential to boost HH PFA, though primarily for wealthier and medium-scale cereal farmers. These farm HH types were however considerably more vulnerable to food insecurity risks resulting from simulated drought, while part-time farmers and resource-poor agricultural laborers generating income from off-farm pursuits were comparatively less vulnerable, due in part to their more diversified income sources and potential to migrate in search of work. Our results underscore the importance of prior planning for development initiatives aimed at increasing smallholder food security while maintaining social equity, while providing a robust methodology to vet the implications of agricultural interventions on an ex ante basis.

Case Report: Laparoscopic Management of Acute Appendicitis Resulting from Ascaris lumbricoides.

Appendicitis is one of the most common conditions that leads to an acute abdomen. Surgical management is the gold standard for therapy. The main cause of appendicitis is an obstruction in the appendicular lumen. Intestinal ascariasis infection is undoubtedly one of the least frequent. We present a female patient with acute appendicitis resulting from Ascaris lumbricoides as an incidental intraoperative diagnosis.

An agent-based approach to explore the effect of voluntary mechanisms on land use change: a case in rural Queensland, Australia.

In rural regions, land use changes (LUC) are often the result of the decision-making of individual farmers. To influence this decision-making, compulsory and voluntary mechanisms are implemented. However, farmers' decision-making is a heterogeneous process that depends on their ability and willingness to take certain decisions. Discrepancies between farmers' ability and willingness and the design of voluntary mechanisms occur frequently. This makes it necessary to understand how farmers' participation in these mechanisms can affect LUC. The aim of this paper was to demonstrate an agent-based approach to analyse and explore how voluntary mechanisms can influence LUC processes in rural regions. This approach was applied to a rural region in Australia, where clearing of native vegetation has occurred for agricultural development. Historical land cover data and semi-structured interviews were used to parameterise an agent-based model. Factors that influence farmers' ability and willingness to participate in these mechanisms were identified. Three scenarios were simulated with the model to explore how the implementation of different voluntary mechanisms can affect the landscape structure of the region. This paper identifies how the diversity of farmers' decision-making can influence the landscape structure in the region. The advantages and limitations of an agent-based approach in relation to LUC research and policy are discussed.

Pediatric Prevention: Teaching Safety Skills.

Serious threats to child safety are infrequent and unpredictable but can lead to serious injury and death. To stay safe, children must identify and avoid contact with a safety threat, escape from it, and report it to an adult so the adult can remove the threat. Research shows that active learning approaches are effective for teaching children to engage in these safety skills. Passive learning approaches are not effective. Active learning approaches require children to practice the skills in the presence of simulated threats with feedback to reinforce correct responses and promote generalization of skills to the natural environment.

Response to bullying (RTB): Behavioral skills and in situ training for individuals diagnosed with intellectual disabilities.

This study evaluated behavioral skills training (BST) and in situ training (IST) to teach a response to bullying (RtB) to four adults with intellectual disabilities who were victims of bullying. The RtB consisted of refraining from retaliating, stating disapproval, walking away, and telling a staff member. In situ assessments were conducted in the natural setting to assess the effects of BST and IST. BST alone was successful in teaching the RtB to two participants. When BST did not result in the use of the RtB, IST was effective for one participant, and IST plus an incentive was effective for the other participant. The results of this study are consistent with previous BST and IST research.

Protocolo de recuperación mejorada después de cirugía (ERAS) atenúa el estrés y acelera la recuperación en pacientes después de resección radical por cáncer colorrectal: Experiencia en la Clínica Universitaria Colombia / Enhanced Recovery After Surgery (ERAS) protocol attenuates stress and accelerates recovery in patients after radical resection for colorectal cancer: Experience at Clínica Universitaria Colombia

Introducción. El conjunto de estrategias de recuperación mejorada después de la cirugía (ERAS, por sus siglas en inglés) constituye un enfoque de atención multimodal y multidisciplinario, cuyo propósito es reducir el estrés perioperatorio de la cirugía, disminuir la morbilidad y acortar la estancia hospitalaria. Este estudio tuvo como objetivo describir los resultados clínicos de pacientes sometidos a cirugía por cáncer colorrectal, identificando las complicaciones principales y los factores perioperatorios relacionados con el alta temprana. Métodos. Se analizaron los pacientes consecutivos sometidos a cirugía colorrectal entre los años 2020 y 2023, todos los cuales siguieron el protocolo ERAS institucional. Se evaluaron las características clínicas, los factores perioperatorios, los desenlaces postoperatorios y la tasa global de adherencia al protocolo. Resultados. Un total de 456 pacientes fueron sometidos a cirugía colorrectal, 51% de sexo masculino, con edad media de 60 años. La mayoría de las intervenciones se realizaron por laparoscopia (78 %), con una tasa de conversión del 14,5 %. Las complicaciones postoperatorias incluyeron fuga anastomótica (4,6 %), sangrado, infección intraabdominal y obstrucción intestinal. La estancia hospitalaria promedio fue de 4 días y la mortalidad del 2,8 %. La tasa global de adherencia al protocolo ERAS fue del 84,7 %. Conclusiones. El enfoque combinado de cirugía laparoscópica y protocolo ERAS es factible, seguro y se asocia con una estancia hospitalaria más corta. La implementación y adherencia al protocolo ERAS no solo mejora los resultados postoperatorios, sino que también resalta la importancia de acceder a datos sólidos, permitiendo mejorar la atención perioperatoria local.

Introduction. The Enhanced Recovery After Surgery (ERAS) protocol is a multimodal, multidisciplinary approach to care, the purpose of which is to reduce the perioperative stress of surgery, decrease morbidity, and shorten hospital stay. This study aimed to describe the clinical outcomes of patients undergoing surgery for colorectal cancer, identifying the main complications and perioperative factors related to early discharge. Methods. Consecutive patients undergoing colorectal surgery between 2020 and 2023 were analyzed, who followed the institutional ERAS protocol. Clinical characteristics, perioperative factors, postoperative outcomes, and overall protocol adherence rate were evaluated. Results. A total of 456 patients underwent colorectal surgery, 51% male, with a mean age of 60 years. Most interventions were performed laparoscopically (78%), with a conversion rate of 14.5%. Postoperative complications included anastomotic leak (4.6%), followed by bleeding, intra-abdominal infection, and intestinal obstruction. The average hospital stay was 4 days and mortality was 2.8%. The overall adherence rate to the ERAS protocol was 84.7%. Conclusions. The combined approach of laparoscopic surgery and ERAS protocol is feasible, safe, and associated with a shorter hospital stay. Implementation and adherence to the ERAS protocol not only improves postoperative outcomes, but also highlights the importance of accessing solid data, allowing for improved local perioperative care.

Data presentation options to manage variability in physical activity research.

This paper presents seven tactics for managing the variability evident in some physical activity data. High levels of variability in daily step-count data from pedometers or accelerometers can make typical visual inspection difficult. Therefore, the purpose of the current paper is to discuss several strategies that might facilitate the visual interpretation of highly variable data. The seven strategies discussed in this paper are phase mean and median lines, daily average per week, weekly cumulative, proportion of baseline, 7-day moving average, change point detection, and confidence intervals. We apply each strategy to a data set and discuss the advantages and disadvantages.

Effects of student pairing and public review on physical activity during school recess.

The purpose of this study was to evaluate the effects of student pairing and feedback during recess on children's step counts. During baseline, participants wore a sealed pedometer during recess. During intervention, we paired participants with higher step counts with participants with lower step counts. We encouraged teams to compete for the highest step count each day and provided feedback on their performance during each recess session. Results showed a large mean increase in step count from baseline to intervention. These results suggest that children's steps during recess can be increased with a simple and cost-effective intervention.

Using token reinforcement to increase walking for adults with intellectual disabilities.

The purpose of this study was to evaluate the effectiveness of token reinforcement, using an ABAB reversal design, for increasing distance walked for adults with mild to moderate intellectual disabilities at an adult day-training center. Five participants earned tokens for walking 50-m laps and exchanged tokens for back-up reinforcers that had been identified through preference assessments. Token reinforcement resulted in a substantial increase from baseline in laps walked for 4 participants.

Male contest investment changes with male body size but not female quality in the spider Nephila clavipes.

Animals use rules to adjust their level of investment in a contest. We evaluate male strategies during contests over females in the golden orb-web spider Nephila clavipes. We tested whether male behaviour changes with female value, and found that contests were similar in intensity and outcome whether the female was a juvenile or adult, virgin or non-virgin, or whether one male had invested sperm in the female. We found evidence that males use a self-assessment strategy when deciding to withdraw from a contest. Loser body size and contestant size difference were correlated with a higher frequency of contest escalation, and fights involving two large males were more likely to escalate than a fight in which one male was small. A multiple regression showed that loser body size had a stronger effect on contest escalation than contestant body size difference. More importantly, the size of the winning male had no effect on contest escalation, a key prediction of a self-assessment strategy. In N. clavipes, body size is the primary factor that determines the outcome of male contests, and males do not appear to assess their opponent or the quality of the resource when deciding to withdraw from the fight.

Efecto de la edad y la hora de la aspiración sobre la calidad oocitaria y el desarrollo in vitro en hembras bovinas prepúberes / Effect of age and coasting period on oocytes quality and their in vitro development from prepubertal cattle

Objective. This study evaluated the effect of age and coasting period over oocyte quality and their posterior development under in vitro conditions from prepubertal Bos indicus crossbred donors. Material and methods. Donors females received a norgestomet implant and estradiol benzoate. Four days later a unique dosage of 150 IU of eCG was administered. Three coasting periods (24, 48, and 56 h) and four ages (3, 6, 10, and 12 months) were proved. All antral follicles were aspirated and an in vitro culture proceed was done. Results. 439 follicles were aspirated, of which 385 (87.7%) were 2-5 mm, 41 (9.33%) were 5-10 mm, and 13 (2.3%) were ›10 mm. After aspiration, a total of 373 oocytes (84.9%) were recovered, finding differences (p<0.05) between averages of 6 (9.3) and 10 months old animals (32.3). 285 (76.4 %) recovered oocytes were subjected to in vitro process. Cleavage values were significantly higher (p<0.05) in 10 (27.1%) and 12 months animals (26.8%). Although the number of transferable embryos was low, there were differences between ages (p<0.05) obtaining a higher percentage in age 3 (12.6%). Conclusions. A coasting period higher than 24 h has a negative effect on oocyte quality. Some oocytes from 3 months old calves were competent for in vitro embryo development; however, higher numbers of embryos were produced from 10 and 12 months of age prepuber females, indicating they have higher competency in vitro.