Predictive risk model of recurrence of acute diverticulitis after the first episode.

INTRODUCTION: The recurrence of acute diverticulitis (AD) of the colon is frequent and leads to hospital readmissions and the need for elective surgery in selected cases. It is important to individualize risk factors and develop predictive tools for their identification. MATERIALS AND METHODS: This prospective observational study included 368 patients who were diagnosed with AD between 2016 and 2021 in a tertiary general university hospital during their first episode and who had a good response to antibiotic, percutaneous, or peritoneal lavage treatment. Univariate and multivariate Cox regression analyses of the variables associated with recurrence were performed. Subsequently, a predictive risk score was developed and validated through survival studies. RESULTS: After a median follow-up of 50 months, there were 71 (19.3%) cases of recurrence out of a total of 368 patients. The mean time of recurrence was 15 months, and 73.3% of cases of recurrence occurred before 2 years of follow-up. Recurrence was independently associated with presentation with colonic perforation in the antimesenteric location (HR 3.67 95% CI [1.59-8.4]) and a CRP level greater than 100 mg/dl (HR 1.69 95% CI [1.04-2.77). A score with 5 variables was created that differentiated two risk groups: intermediate risk (0-3 points), with 19% recurrence and high risk (more than 3 points), with 42% recurrence. CONCLUSIONS: The risk of recurrence after the first episode of diverticulitis can be estimated using predictive scores. The detection of high-risk patients facilitates the individualization of follow-up and treatment.

The lymph node status as a prognostic factor in colon cancer: comparative population study of classifications using the logarithm of the ratio between metastatic and nonmetastatic nodes (LODDS) versus the pN-TNM classification and ganglion ratio systems.

BACKGROUND: pN stage in the TNM classification has been the "gold standard" for lymph node staging of colorectal carcinomas, but this system recommends collecting at least 12 lymph nodes for the staging to be reliable. However, new prognostic staging systems have been devised, such as the ganglion quotients or lymph node ratios and natural logarithms of the lymph node odds methods. The aim of this study was to establish and validate the predictive and prognostic ability of the lymph node ratios and natural logarithms of the lymph node odds staging systems and to compare them to the pN nodal classification of the TNM system in a population sample of patients with colon cancer. METHODS: A multicentric population study between January 2004 and December 2007. The inclusion criteria were that the patients were: diagnosed with colon cancer, undergoing surgery with curative intent, and had a complete anatomopathological report. We excluded patients with cancer of the rectum or caecal appendix with metastases at diagnosis. Survival analysis was performed using the Kaplan-Meier actuarial method and the Log-Rank test was implemented to estimate the differences between groups in terms of overall survival and disease-free survival. Multivariate survival analysis was performed using Cox regression. RESULTS: We analysed 548 patients. For the overall survival, the lymph node ratios and natural logarithms of the lymph node odds curves were easier to discriminate because their separation was clearer and more balanced. For disease-free survival, the discrimination between the pN0 and pN1 groups was poor, but this phenomenon was adequately corrected for the lymph node ratios and natural logarithms of the lymph node odds curves which could be sufficiently discriminated to be able to estimate the survival prognosis. CONCLUSIONS: Lymph node ratios and natural logarithms of the lymph node odds techniques can more precisely differentiate risk subgroups from within the pN groups. Of the three methods tested in this study, the natural logarithms of the lymph node odds was the most accurate for staging non-metastatic colon cancer. Thus helping to more precisely adjust and individualise the indication for adjuvant treatments in these patients.

Mortality and cardiovascular disease burden of uncontrolled diabetes in a registry-based cohort: the ESCARVAL-risk study.

BACKGROUND: Despite the epidemiological evidence about the relationship between diabetes, mortality and cardiovascular disease, information about the population impact of uncontrolled diabetes is scarce. We aimed to estimate the attributable risk associated with HbA1c levels for all-cause mortality and cardiovascular hospitalization. METHODS: Prospective study of subjects with diabetes mellitus using electronic health records from the universal public health system in the Valencian Community, Spain 2008-2012. We included 19,140 men and women aged 30 years or older with diabetes who underwent routine health examinations in primary care. RESULTS: A total of 11,003 (57%) patients had uncontrolled diabetes defined as HbA1c ≥6.5%, and, among those, 5325 participants had HbA1c ≥7.5%. During an average follow-up time of 3.3 years, 499 deaths, 912 hospitalizations for coronary heart disease (CHD) and 786 hospitalizations for stroke were recorded. We observed a linear and increasingly positive dose-response of HbA1c levels and CHD hospitalization. The relative risk for all-cause mortality and CHD and stroke hospitalization comparing patients with and without uncontrolled diabetes was 1.29 (95 CI 1.08,1.55), 1.38 (95 CI 1.20,1.59) and 1.05 (95 CI 0.91, 1.21), respectively. The population attributable risk (PAR) associated with uncontrolled diabetes was 13.6% (95% CI; 4.0-23.9) for all-cause mortality, 17.9% (95% CI; 10.5-25.2) for CHD and 2.7% (95% CI; - 5.5-10.8) for stroke hospitalization. CONCLUSIONS: In a large general-practice cohort of patients with diabetes, uncontrolled glucose levels were associated with a substantial mortality and cardiovascular disease burden.

CUSUM charts in the quality control of colon cancer lymph node analysis: a population-registry study.

BACKGROUND: The most important determinant of survival in patients with colon cancer is the presence or absence of regional lymph node metastases. This factor is consistently associated with long-term and disease-specific survival. Cumulative summation of differences (CUSUM) charts can help to discriminate abnormalities that cannot be explained by the general variability of a process. We used CUSUM charts to analyse the quality of nodal analysis in colon cancer and to use a population-registry cancer database to estimate the optimal number of lymph nodes for adequate prognostic analysis. METHODS: This was a multicentre population-registry cancer study from January 2004 to December 2007. We used these data to produce the different CUSUM curves, focusing on the main variables. To calculate survival, we used the Kaplan-Meier method. RESULTS: In this study, we examined 548 patients. The CUSUM curves were calculated for overall mortality, specific mortality, and recurrence according to (1) the number of lymph nodes analysed and affected and (2) compared the ratio of the number of lymph nodes affected to the number analysed. Finally, the lymph node ratio was compared to the overall survival CUSUM curve. DISCUSSION: This CUSUM control chart analysis reinforces the unquestionable importance of analysing at least 12 lymph nodes in patients with colon cancer in order to accurately estimate their prognosis. However, our findings indicate that the analysis of at least 20 lymph nodes is a more appropriate cutoff point for accomplishing the demanding objective of diagnosing a high-quality prognosis in colon cancer patients.

Primary esophageal melanoma: report of a case.

INTRODUCTION: Primary malignant melanoma of the esophagus is a rare tumor representing only 0.1-0.2% of esophageal malignancies. The goal of the study was to report on the management of a new case diagnosed and treated in our site. CASE REPORT: A 67-year-old patient presented with dysphagia to solids with no other remarkable history or associated skin lesions. He underwent gastroscopy, which revealed a polypoid mass suggestive of neoplasm in the distal third of the esophagus. Biopsy indicated melanoma with positive immunohistochemical markers S100 and HMB45, and negative cytokeratins and CEA. Computerized tomography (CT) and positron-emission tomography (PET) scans showed no local infiltration or distant metastases. An Ivor-Lewis esophagectomy procedure was performed with regional lymphadenectomy. Postoperative stay lasted for three weeks, and no remarkable postsurgical complications arose. The pathological study of the specimen confirmed the diagnosis of primary esophageal melanoma. DISCUSSION: Primary malignant melanoma of the esophagus has an unfortunate prognosis as it is an aggressive tumor usually diagnosed at an advanced stage, with local invasion and metastatic disease. Currently, surgery is the treatment of choice, with the remaining adjuvant therapies obtaining limited results.

[Diagnostic yield of pancreatic percutaneous puncture depending on the size of the lesion]. / Rentabilidad diagnóstica de la punción percutánea pancreática en función del tamaño de la lesión.

INTRODUCTION: The aim of the present study was to study the diagnostic efficacy of the percutaneous puncture of pancreatic tissue. MATERIAL AND METHODS: A retrospective study was conducted on patients with suspicion of pancreatic neoplasm, and with a percutaneous biopsy of pancreatic tissue, from 2000 to 2011. For the statistical comparative analysis, the sample was stratified by tumour size: ≤ 3cm and > 3cm. RESULTS: A total of 90 biopsies were performed. Pancreatic neoplasm diagnosis was made in 47 cases (52%), with 16 false negatives (18%), no false positives, and chronic pancreatitis in 24 cases (27%). The efficacy of the test results were: an overall sensitivity of 75% (95% CI: 62%-85%), a specificity of 100% (95% CI: 87%-100%), a positive predictive value of 100% (95% CI: 92%-100%), and a negative predictive value of 63% (95% CI: 46%-77%). For tumour sizes ≤ 3cm the sensitivity was 70% (95% CI: 45%-88%), with a specificity of 100% (95% CI 66%-100%), a positive predictive value of 100% (95% CI: 76%-100%, and a negative predictive value 60% (95% CI: 32%-83%). For tumours greater than 3cm, the sensitivity was 88% (95% CI: 70%-98%), the specificity was 100% (95% CI: 75%-100%), with a positive predictive value of 100% (95% CI: 85%-100%) and a negative predictive value of 81% (95% CI: 54%-96%). CONCLUSIONS: Pancreatic percutaneous biopsy efficacy was strongly determined by lesion size. For tumour sizes less than 3cm, the sensitivity and negative predictive value are unacceptably low, as negative results would not reliable.

On the catalytic oxidation of ascorbic acid at self-doping polyaniline films.

Ascorbic acid molecules in either acid or conjugate base forms have been oxidized on self-doping carboxylated polyaniline thin films. The kinetic model proposed by Bartlett et al. has been successfully applied to the catalytic reactions. Active sites in the polymer have been identified as the rings having quinoid character. The existence of significant electrostatic repulsions between ionogenic groups at the self-doping polymer and negatively charged ascorbate molecules has been established thanks to the analysis of the pH dependence of the Michaelis constant. It has been found that in contrast to inorganic conductors the regeneration of active sites in polyaniline-based materials is slower at higher potentials. Such a behavior can be satisfactorily correlated with the potential dependence of the polymer electronic conductivity.

The importance of a functional approach on benthic communities for aquaculture environmental assessment: Trophic groups - A polychaete view.

Polychaetes were studied to assess the effect of aquaculture activity on the seafloor. Very high biodiversity of species was recorded associated with aquaculture centres with Cirratulidae, Spionidae and Paraonidae families being the most diverse and abundant families. The spatial distribution of polychaete trophic groups was the best descriptor for detecting changes on the benthos. Surface and subsurface deposit-feeding species dominated the sites closest to the rafts cages, highlighting Capitella capitata and Cirratulus cirratus as opportunistic species. While replacement and species succession were observed with increasing presence of carnivores and omnivores in sites further away from the salmon cages and experiencing less impact. Analyses based on the distance of feeding modes and ecological groups from the disturbance source were better indicators of the impact that the traditional community approach or sediment biogeochemistry. Therefore, functional traits studies should always be considered on environmental assessments of benthic systems impacted by aquaculture.

Analysis of the impact of bariatric surgery on medium-term pharmacological expenditure.

INTRODUCTION: Obesity and associated diseases represent an important health and economic problem since pharmacological treatment for many of these pathologies needs lifelong subsidies. Theoretically, bariatric and metabolic surgery decreases the medication requirements of patients for these diseases but may result in other types of pharmacological needs. This study aims to demonstrate whether there is a real decrease in pharmacological expenditure after bariatric surgery. MATERIAL AND METHODS: Retrospective cross-sectional analysis of patients who were treated in our centre between 2012 and 2016, comparing different associated comorbidities and pharmacological expenses one month before and 2 years after surgery. RESULTS: 400 patients were operated. The results were presented, showing the differences between the resolution of the different comorbidities and the pharmacological savings generated for each of the surgical techniques studied. The most cost-effective comorbidity in the study was type 2 diabetes mellitus (DM2). The surgical technique with the best results was metabolic bypass, presenting a cost difference after surgery of 507 euros per month (P < 0.001). CONCLUSIONS: In a 2-year follow-up after bariatric surgery, a decreased prevalence of obesity-related diseases and associated pharmacological expenditure was observed, showing the efficiency of this intervention over the medium term.

Metastasis to the tunica vaginalis testis from a primary mucinous tumor of the cecum.

OBJECTIVES: We review the literature about secondary testicular tumors. METHODS: We present the case of a patient with a metastatic mucus-secreting testicular tumor who presented in the emergency room with symptoms of acute scrotum 10 months after surgery for a mixed tumor of the cecum. This type of tumor is rare, and the treatment of choice is orchiectomy; nevertheless, the prognosis of such metastasis remains poor. RESULTS: Because mucinous tumors can present late dissemination, long-term follow-up with assessment of the most common sites of metastasis is necessary. Our patient died 21 months after the initial diagnosis CONCLUSIONS: Testicular metastases and mucus-secreting intestinal tumor metastases are rare. These tumors occur in patients older than 60 years of age and young men. As in the case of primary tumors, the treatment is orchiectomy.

Effects of caffeine intake and exercise intensity on executive and arousal vigilance.

During physical efforts and sport practice, vigilance is responsible for maintaining an optimal state of activation, guaranteeing the ability to quickly respond and detect unexpected, but critical, stimuli over time. Caffeine and physical exercise are able to modulate the activation state, affecting vigilance performance. The aim of the present work was to assess the specific effects and modulations of caffeine intake and two physical intensities on vigilance components. Participants performed an attentional task (ANTI-Vea) to measure the executive and arousal components of vigilance, in six double-blinded counterbalanced sessions combining caffeine, placebo, or no-ingestion, with light vs. moderate cyclergometer exercise. Exercise at moderate intensity improved executive vigilance with faster overall reaction time (RT), without impairing error rates. Instead, caffeine intake generally improved arousal vigilance. In conclusion, caffeine and acute exercise seems to moderate executive and arousal vigilance in different ways.

Analysis of the impact of bariatric surgery on medium-term pharmacological expenditure. / Análisis del impacto de la cirugía bariátrica en el gasto farmacológico a medio plazo.

INTRODUCTION: Obesity and associated diseases represent an important health and economic problem since pharmacological treatment for many of these pathologies needs lifelong subsidies. Theoretically, bariatric and metabolic surgery decreases the medication requirements of patients for these diseases but may result in other types of pharmacological needs. This study aims to demonstrate whether there is a real decrease in pharmacological expenditure after bariatric surgery. MATERIAL AND METHODS: Retrospective cross-sectional analysis of patients who were treated in our centre between 2012 and 2016, comparing different associated comorbidities and pharmacological expenses one month before and 2years after surgery. RESULTS: 400 patients were operated. The results were presented, showing the differences between the resolution of the different comorbidities and the pharmacological savings generated for each of the surgical techniques studied. The most cost-effective comorbidity in the study was type2 diabetes mellitus (DM2). The surgical technique with the best results was metabolic bypass, presenting a cost difference after surgery of 507euros per month (P<.001). CONCLUSIONS: In a 2-year follow-up after bariatric surgery, a decreased prevalence of obesity-related diseases and associated pharmacological expenditure was observed, showing the efficiency of this intervention over the medium term.

Rare Site Hepatocellular Carcinoma Metastasis.

INTRODUCTION: Besides more common sites such as lung or peritoneum, hepatocellular carcinoma (HCC) can metastatize to rare sites. We report herein a new metastatic site of HCC: the nail-bed. We also review other recently reported rare site HCC metastases (RSHM). CASE REPORT: A 66-year-old woman with a 12-year history of resected-stage IA HCC who later presented lung, spleen and brain metastases treated with surgery, systemic therapies (sorafenib, sunitinib, capecitabine) and radiotherapy. The patient was referred to us because of a painful and rapidly evolving mass in the nail-bed of the left thumb. Biopsy confirmed nail-bed HCC metastasis, and the finger was amputated. The patient died few weeks later. CONCLUSION: This case was an opportunity for us to review RSHM. This type of metastasis seems to be an early event, in the context of advanced stage HCC with elevated protein induced by vitamin K absence-II (PIVKA II). The Lee nomogram is useful in detecting patients at high risk of developing RSHM. We would suggest insisting on systemic treatment in these metastatic patients although overall survival after RSHM diagnosis is poor.

Quality control techniques in surgery: Application of cumulative sum (CUSUM) charts. / Técnicas de control de calidad en cirugía. Aplicación de las gráficas de control cumulative sum.

Cumulative sum graphs are quality control charts that are possibly the most frequently used for monitoring clinical-care processes. One of their main advantages is the use in rare cases and in events with low incidence, where it would be necessary to obtain a large sample and a long follow-up time with conventional statistical methods, which is impossible in certain cases. This is also why they are useful for studying learning curves, the introduction of new technologies and, in general, for assessing the quality of care outcomes themselves, because their profile is sensitive to very subtle changes in trends (positive or negative), which would not be observed with other methods. On the other hand, their use can be expanded beyond quality control or monitoring, which is a new aspect in clinical research.

Modelling the probability of erroneous negative lymph node staging in patients with colon cancer.

BACKGROUND: Patients in who with insufficient number of analysed lymph nodes (LNs) are more likely to receive an incorrect LN staging. The ability to calculate the overall probability of undiagnosed LN involvement errors in these patients could be very useful for approximating the real patient prognosis and for giving possible indications for adjuvant treatments. The objective of this work was to establish the predictive capacity and prognostic discriminative ability of the final error probability (FEP) among patients with colon cancer and with a potentially incorrectly-staged LN-negative disease. METHODS: This was a retrospective multicentric population study carried out between January 2004 and December 2007. We used a mathematical model based on Bayes' theorem to calculate the probability of LN involvement given a FEP test result. Cumulative sum graphs were used to calculate risk groups and the survival rates were calculated, by month, using the Kaplan-Meier method. RESULTS: A total of 548 patients were analysed and classified into three risk groups according to their FEP score: low-risk (FEP < 2%), intermediate-risk (FEP 2%-15%), and high-risk (FEP > 15%). Patients with LN involvement had the lowest overall survival rate when compared to the three risk groups. This difference was statistically significant for the low- and intermediate-risk groups (P = 0.002 and P = 0.004, respectively), but high-risk group presented similar survival curves to pN+ group (P = 0.505). In terms of disease-free survival, the high-risk group presented similar curves to the intermediate-risk group until approximately 60 months' follow-up (P = 0.906). After 80 months' follow-up, the curve of high-risk group coincided with that of the pN+ group (P = 0.172). Finally, we summarized the FEP according to the number of analysed LNs and accompanied by a contour plot which represents its calculation graphically. CONCLUSIONS: The application of Bayes' theorem in the calculation of FEP is useful to delimit risk subgroups from among patients without LN involvement.

Using ankle-brachial index to detect peripheral arterial disease: prevalence and associated risk factors in a random population sample.

BACKGROUND AND AIM: The ankle-brachial index (ABI) is being used increasingly to diagnose peripheral arterial disease (PAD) that predicts cardiovascular morbidity and mortality. The aim of this study is to determine the prevalence of PAD and associated risk factors in a Spanish random population sample of age > or =40. METHODS AND RESULTS: PAD is defined as an ABI<0.9 in either leg. 784 participants of age > or =40 were randomly selected in a Spanish province. 55.4% of them were female. The prevalence of PAD in this sample was 10.5% (95% confidence interval (CI) 8.4-12.8); 9.7% in females and 11.4% in males. In logistic regression analyses, adjusted for age and gender, smoking per 10 pack-years (odds ratio (OR) 1.40, 95% CI 1.23-1.58), hypertension (OR 1.85, 95% CI 1.05-3.28), hypercholesterolemia (OR 1.76, 95% CI 1.04-2.98), and diabetes (OR 1.80, 95% CI 1.04-3.11) were positively associated with prevalent PAD. More than 91% of persons with PAD had one or more cardiovascular disease risk factors. CONCLUSIONS: We conclude that in our study hypertension, hypercholesterolemia, diabetes mellitus and smoking are associated with PAD. The majority of individuals with PAD had at least one important cardiovascular risk factor advanced enough to be considered eligible for an aggressive treatment.