Process Development of a Macrocyclic Peptide Inhibitor of PD-L1.

This article outlines the process development leading to the manufacture of 800 g of BMS-986189, a macrocyclic peptide active pharmaceutical ingredient. Multiple N-methylated unnatural amino acids posed challenges to manufacturing due to the lability of the peptide to cleavage during global side chain deprotection and precipitation steps. These issues were exacerbated upon scale-up, resulting in severe yield loss and necessitating careful impurity identification, understanding the root cause of impurity formation, and process optimization to deliver a scalable synthesis. A systematic study of macrocyclization with its dependence on concentration and pH is presented. In addition, a side chain protected peptide synthesis is discussed where the macrocyclic protected peptide is extremely labile to hydrolysis. A computational study explains the root cause of the increased lability of macrocyclic peptide over linear peptide to hydrolysis. A process solution involving the use of labile protecting groups is discussed. Overall, the article highlights the advancements achieved to enable scalable synthesis of an unusually labile macrocyclic peptide by solid-phase peptide synthesis. The sustainability metric indicates the final preparative chromatography drives a significant fraction of a high process mass intensity (PMI).

High biosorption of cationic dye onto a novel material based on paper mill sludge.

The valorization of paper mill sludge (PMS) is the main goal of this study. The emissions of PMS continue to increase at global scale, especially from packaging paper and board sectors. The raw sludge was used to prepare an adsorbent to remove toxic pollutants from wastewater, the methylene blue (MB), an organic dye. Firstly, the physico-chemical characterization of PMS was done determining the crystalline phases of PMS fibers, the content of main elements, and the pH zero point charge, which was determined at around pH 7. The adsorption of MB on PMS powder was studied at 18 °C with an agitation of 200 rpm, being the best operating conditions 30 min of contact time, 250 mg L-1 of initial MB concentration and 0.05 g in 25 mL of adsorbent dose. Experimental data of MB adsorption was fitted to Langmuir and Freundlich isotherm equations. The Langmuir model was more accurate for the equilibrium data of MB adsorption at pH 5.1. The PFOM and PSOM were adjusted to experimental adsorption kinetics data, being PSOM, which describes better the MB adsorption by PMS powder. This was confirmed by calculating the maximum adsorption capacity with PSOM, which was 42.7 mg g-1, being nearly similar of the experimental value of 43.5 mg g-1. The analysis of adsorption thermodynamics showed that the MB was adsorbed exothermically with a ΔH0 = - 20.78 kJ mol-1, and spontaneously with ΔG0 from - 0.99 to - 6.38 kJ mol-1 in the range of temperature from 291 to 363 K, respectively. These results confirm that the sludge from paper industry can be used as biosorbent with remarkable adsorption capacity and low cost for the treatment of wastewater. PMS can be applied in the future for the depollution of the effluents from the textile industry, which are highly charged with dyes.

Heart transplant in a Sars-CoV-2 positive recipient: Management protocol of the world's first case.

The advent of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in China at the end of 2019 has developed into a global outbreak, and COVID- 19 is an ongoing major public health issue. During the pandemic, transplant programs had to devise strategies to deal with the possibility of COVID-19-positive donors and recipients. We describe the case of a heart transplant recipient who tested positive with the SARS- CoV2 swab upon admission to our Unit of Cardiac Surgery when a suitable donor became available. Given his clinical status of end-stage heart failure and the absence of imaging and clinical signs suggestive of COVID-19, and his having been vaccinated with three doses, we decided to proceed with the transplant.

Dental care and risk of developing severe COVID-19 / Atención odontológica y el riesgo de complicación por COVID-19

RESUMEN Durante la pandemia por la COVID-19 la atención odontológica fue recomendada solo en casos de urgencia y dolor. La reducción de citas dentales puede afectar la economía de los dentistas, principalmente la de aquellos que no cuentan con seguridad financiera. Los odontólogos por necesidades económicas requieren brindar atención a pesar del riesgo de ser infectados por SARS-COV-2. Objetivo : Describir la frecuencia de la atención odontológica y el riesgo de complicación por COVID-19 en odontólogos de Ixtlahuaca, Estado de México, México. Material y métodos : Estudio transversal, muestreo no probabilístico desarrollado desde agosto hasta septiembre de 2020. Se aplicó un cuestionario por redes sociales para identificar la frecuencia de la atención odontológica. Resultados: La muestra estuvo conformada por 121 odontólogos; el promedio de edad fue de 32,3 años. La mayor parte de la muestra estuvo conformada por mujeres (74,4 %). Los odontólogos mostraron un riesgo medio a desarrollar complicaciones por COVID-19 (92,5 %). Los odontólogos de práctica privada realizaron más tratamientos no urgentes durante el semáforo epidemiológico rojo y naranja, mostrando diferencias estadísticamente significativas (p ≤ 0,05). El 30 % de la muestra presentó un peso no saludable. Conclusiones : Los odontólogos tienen un riesgo medio a enfermar gravemente por COVID-19. El riesgo se encuentra asociado al peso no saludable. Los odontólogos realizaron tratamientos no urgentes a pesar de las recomendaciones gubernamentales. Los profesionales de práctica privada realizaron una mayor cantidad de tratamientos no urgentes. Los dentistas brindan atención a pesar del riesgo epidemiológico por COVID-19 debido a las necesidades económicas.

ABSTRACT During the COVID-19 pandemic, dental care was recommended only in urgent and severe pain cases. Reduced dental appointments may affect the financial situation of dentists, especially those who are not financially secure. Due to economic necessity, dentists are required to provide care despite the risk of being infected with SARS-COV-2. Objective: To describe the frequency of dental care and the risk of complications due to COVID-19 among dentists in Ixtlahuaca, State of Mexico, Mexico. Material and methods: Cross-sectional study, non-probabilistic sampling carried out from August to September 2020. A survey was carried out through social networks to identify the frequency of dental care. Results: The sample consisted of 121 dentists with an average age of 32.3 years. Women comprised most of the sample (74.4%). Dentists had a medium risk of suffering complications due to COVID-19 (92.5%). Private practice dentists performed more non-urgent treatments during the red and orange epidemiological risk periods, showing statistically significant differences (p≤0.05). Unhealthy weight was present in 30% of the sample. Conclusions: Dentists have a medium risk of becoming seriously ill from COVID-19. The risk is associated with unhealthy weight. Dentists performed non-urgent treatments despite government recommendations. Private practitioners performed a greater number of non-urgent treatments. Dentists provide care despite epidemiological risk related to COVID-19 due to economic necessity.

Augmentation in the repair of traumatic patellar tendon ruptures. A novel mechanical and biological construct: Technical note.

Patellar tendon ruptures are infrequent and potentially disabling injuries. These injuries are usually repaired with transosseous suture tunnels. However, this technique can produce a significant gap formation and prolonged postoperative immobilization. Although several techniques have been described to improve the integrity of the repair, the surgical technique of choice is a matter of debate especially when there is tissue loss due to high-energy trauma. This study aims to evaluate the clinical outcomes of patients with acute patellar tendon ruptures due to high-energy trauma treated with a novel construct configuration that includes a suture anchor and a figure-of-eight augmentation with hamstring autograft with medial and lateral reinforcement. To determine the clinical outcomes the International Knee Documentation Committee (IKDC) score was obtained pre-surgery and at 12 months of follow-up. A total of six patients were recruited, with a median age of 27.5 years, five of these were male. Three lesions were in the proximal pole of the tendon, two were mid-substance and one was in the junction with tibial tuberosity. The IKDC clinical score significantly increased from pre-surgery to the 12-month follow-up with a median difference of 32.8 (95% CI, 19.5-42.6, p = 0.0313). Likewise, the patients presented a post-surgery quadriceps strength level with a median of 5/5. All patients had full active knee extension with a median of 0-120°. There was no statistical difference in the range of motion comparing the surgical knee to the contralateral knee (p = 0.6883). No patient presented any type of reintervention or complication during the follow-up period. The configuration of the construct presented in the technique had not been reported before in the literature and combines the advantages of the use of suture anchors and biological augmentation with lateral and medial reinforcement. This technique may be useful in patients with traumatic injuries with and without loss of tissue. Although it is a small series with concomitant injuries, satisfactory clinical results were presented during follow-up.

Quadricuspid aortic valve repair with a modified-tricuspidization technique.

INTRODUCTION: Quadricuspid aortic valve (QAV) is an extremely rare developmental abnormality with an incidence of 0.006%. QAV is an incidental finding that in some patients (23%) may determine aortic regurgitation (AR). Altogether 16% of patients indeed require surgery with AR being the most frequent indication. METHODS AND RESULTS: We describe a case report of a 46 year-old female affected by severe aortic regurgitation due to QAV successfully treated with a  modified-tricuspidization technique associated with cusp extension, prolapsing commissure suturing, and sub-commissural annuloplasty. DISCUSSION: QAV repair represents an attractive perspective to overcome the drawbacks of either mechanical or biological prosthesis.

The best is the enemy of the good, a simple technique to treat a complex disease: Calamari procedure.

Infective endocarditis is a life-threatening condition and despite advances in antibiotic therapy, about one-third of patients require surgical treatment. The choice of the most appropriate surgical treatment is crucial. The study by Asen Petrov et al. paves the way for a new, safe, simple, and useful Calamari technique for the treatment of aortic valve endocarditis complicated by aortic root abscess (ARA). This technique was initially described in a series of five patients. The most interesting part of the study is that the procedure was effective (only one patient died 30 days after surgery) and fast (mean cardiopulmonary bypass time 90 ± 10.30 min; mean cross-clamp time 73.6 ± 12.12 min). As reported by Leontyev et al., the procedure of choice in ARA is represented by a wide range of procedures ranging from aortic valve replacement with debridement of the abscess to reconstruction of the intervalvular fibrous body and replacement of both the mitral valve and the aortic root. Alternatively, pericardial patch reconstruction is required in approximately one-third of cases. Radicality is key but a fast procedure is very important. In this scenario, the Calamari procedure is very useful, especially for its rapid execution (short cardiopulmonary bypass and cross-clamp time) which is associated with a reduction in mortality. A simple procedure to treat complex diseases. However, this procedure needs to be performed on more patients and its outcomes should be compared in trials with the other available techniques for the treatment of ARA.

Primary malignant cardiac tumors: Sex-related therapy and multidisciplinary approach as a new challenge for the future.

Primary malignant cardiac tumors represent (PMCTs) a very rare disease with an incidence of 0.009%1 (up to 10% of primary cardiac neoplasms) and are related to a very poor prognosis. The study by Mohamed Rahouma tries to give us information on sex differences in PMCTs, their incidence, behavior, and outcomes. Females were significantly older and had a lower stage of cancer. Males are known to have a more aggressive course and present at an earlier age. Sarcoma is the most common type of PMCTs in both males and females. There was no gender disparity in late mortality and patients who underwent surgery had a better prognosis than those who did not undergo surgery. Significant predictors of late mortality were found to be patients' high comorbidity index, angiosarcoma histology, and Stage III/IV. A challenge for cardiac surgeons is to improve survival in patients with cardiac malignancies, involving a multidisciplinary approach with oncologists, cardiologists, and radiologists. To pave the way for a significant improvement in survival in the future, more advanced sex-specific medical therapies for cancer such as novel chemotherapy agents, targeted immune therapies, genetic engineering need to be standardized to PMCTs and combined with radiological therapies such as gamma-knife and very advanced surgery to effectively treat even very aggressive forms of malignant tumors, with a significant impact on the patient's quality of life and survival.

Prosthetic Shoulder Joint Infection by Cutibacterium acnes: Does Rifampin Improve Prognosis? A Retrospective, Multicenter, Observational Study.

This retrospective, multicenter observational study aimed to describe the outcomes of surgical and medical treatment of C. acnes-related prosthetic joint infection (PJI) and the potential benefit of rifampin-based therapies. Patients with C. acnes-related PJI who were diagnosed and treated between January 2003 and December 2016 were included. We analyzed 44 patients with C. acnes-related PJI (median age, 67.5 years (IQR, 57.3-75.8)); 75% were men. The majority (61.4%) had late chronic infection according to the Tsukayama classification. All patients received surgical treatment, and most antibiotic regimens (43.2%) included ß-lactam. Thirty-four patients (87.17%) were cured; five showed relapse. The final outcome (cure vs. relapse) showed a nonsignificant trend toward higher failure frequency among patients with previous prosthesis (OR: 6.89; 95% CI: 0.80-58.90) or prior surgery and infection (OR: 10.67; 95% IC: 1.08-105.28) in the same joint. Patients treated with clindamycin alone had a higher recurrence rate (40.0% vs. 8.8%). Rifampin treatment did not decrease recurrence in patients treated with ß-lactams. Prior prosthesis, surgery, or infection in the same joint might be related to recurrence, and rifampin-based combinations do not seem to improve prognosis. Debridement and implant retention appear a safe option for surgical treatment of early PJI.

Serine-Selective Bioconjugation.

This Communication reports the first general method for rapid, chemoselective, and modular functionalization of serine residues in native polypeptides, which uses a reagent platform based on the P(V) oxidation state. This redox-economical approach can be used to append nearly any kind of cargo onto serine, generating a stable, benign, and hydrophilic phosphorothioate linkage. The method tolerates all other known nucleophilic functional groups of naturally occurring proteinogenic amino acids. A variety of applications can be envisaged by this expansion of the toolbox of site-selective bioconjugation methods.

Human Aging Alters the Spatial Organization between CD34+ Hematopoietic Cells and Adipocytes in Bone Marrow.

Age-related clonal hematopoiesis is a major risk factor for myeloid malignancy and myeloid skewing is a hallmark of aging. However, while it is known that non-cell-autonomous components of the microenvironment can also influence this risk, there have been few studies of how the spatial architecture of human bone marrow (BM) changes with aging. Here, we show that BM adiposity increases with age, which correlates with increased density of maturing myeloid cells and CD34+ hematopoietic stem/progenitor cells (HSPCs) and an increased proportion of HSPCs adjacent to adipocytes. However, NGFR+ bone marrow stromal cell (NGFR+ BMSC) density and distance to HSPCs and vessels remained stable. Interestingly, we found that, upon aging, maturing myeloid cell density increases in hematopoietic areas surrounding adipocytes. We propose that increased adjacency to adipocytes in the BM microenvironment may influence myeloid skewing of aging HSPCs, contributing to age-related risk of myeloid malignancies.

Indicadores cineantropométricos y nutricionales para el control saludable de la condición física / Kineanthropometric and nutritional indicators for healthy control of physical condition

Introducción: La calidad de vida es un concepto que abarca numerosas variables influyentes, que incluye la condición física como requisito influyente en numerosas enfermedades no trasmisibles. La comunidad estudiantil universitaria de educación básica necesita presentar buenos indicadores cineantropométricos y nutricionales para su futuro egreso, siendo esta una condición exigida para el ejercicio profesional. Objetivo: Determinar indicadores cineantropométricos y nutricionales para el control saludable de la condición física en estudiantes de Educación de la Universidad Técnica de Manabí. Métodos: Se estudió una muestra aleatoria representativa de 50 estudiantes en Educación Básica en la Facultad de Filosofía Letras y Ciencias de la Educación de la Universidad Técnica de Manabí. Se investigaron parámetros relacionados con el índice de masa corporal, el porcentaje de grasa en cintura-cadera, el gasto calórico total, el registro de la ingesta calórica diaria y el balance energético. Resultados: El 50 por ciento de los estudiantes estuvieron sobrepeso u obesos, manifestando además un índice de actividad física bajo. El 24 por ciento tuvieron una relación peso-talla normal, pero con elevado índice cintura-cadera, lo cual reflejó acumulación de tejido adiposo en la región abdominal. Además 23 (46 por ciento) manifestaron un balance energético positivo a favor de la ingesta, incluyendo los dos que clasifican con un Índice de Masa Corporal de tipo delgados o bajo peso. Conclusiones: Los resultados demuestran que los estudiantes evaluados con el Índice de Masa Corporal, el Índice Cintura-Cadera y el Índice de Actividad Física están en correspondencia con un balance energético positivo, lo que refleja una tendencia a un estilo de vida no saludable incongruente con sus funciones de futuros educadores (AU)

Introduction: Quality of life is a concept encompassing a large number of influential variables, including physical condition as a determining factor in many non-communicable diseases. The basic education university student community needs to exhibit good kineanthropometric and nutritional indicators for their eventual graduation, this being a condition required for professional practice. Objective: Determine kineanthropometric and nutritional indicators for the healthy control of physical condition among Education students from the Technical University of Manabí. Methods: A study was conducted of a representative random sample of 50 Basic Education students from the School of Philosophy, Humanities and Education Sciences (FFLCE) of the Technical University of Manabí. The parameters analyzed were body mass index, waist-hip fat percentage, total energy expenditure, daily calorie intake, and energy balance. Results: 50 percent of the students were either overweight or obese, with a low physical activity index. 24 percent had a normal weight-height ratio, but with a high hip-waist index, reflecting an accumulation of adipose tissue in the abdominal region. Additionally, 23 (46 percent) exhibited a positive energy balance toward the intake, including two classed as slim or underweight according to their BMI. Conclusions: Results show that the students evaluated for body mass, waist-hip and physical activity indices are in correspondence with a positive energy balance, pointing to a trend toward an unhealthy lifestyle inconsistent with their functions as future educators (AU)

Análisis de conocimientos durante sesiones educativas de sensibilización para el alivio del dolor, en el marco del proceso de acreditación: lecciones aprendidas / Knowledge Analysis During Educational Awareness Sessions for Pain Relief, In the Framework of an Accreditation Process: Lessons Learned

Introducción: Los vacíos de conocimiento del personal de salud pueden generar resultados negativos en la detección, valoración y manejo integral para el alivio del dolor. Este trabajo los pone en evidencia y muestra cómo un proceso de acreditación en salud diagnostica problemas y genera planes de mejoramiento. Objetivo: Analizar los conocimientos respecto al alivio del dolor en el personal de salud durante un proceso de acreditación, para lograr estándares de calidad. Materiales y métodos: Se realizó un estudio observacional con 358 encuestas al personal de salud de un hospital de alta complejidad, donde se evaluó la percepción sobre la importancia, seguimiento y tratamiento para el alivio del dolor. Resultados: En congruencia con la literatura mundial, el 61,9% de los participantes percibe que hay un inadecuado tratamiento del dolor intrahospitalario. Al detectarlo, el 55,3% de las veces se toma una conducta para aliviarlo. Un 22% piensa que los opioides son solo de uso por clínica de dolor, y el 33%, que todos los pacientes con dolor deberían ser evaluados por clínica de dolor. Conclusión: Aunque el alivio del dolor se percibe como un elemento importante, se diagnostican vacíos en el conocimiento que son susceptibles de intervención para optimizar la calidad de la atención.

Background: Knowledge gaps in the health personnel can generate negative results in the detection, assessment and management for pain relief. This work puts them in evidence and shows how a health accreditation process can diagnose problems and generate plans for improvement. Objective: Analyze knowledge regarding pain relief in the health personnel during an accreditation process to achieve quality standards. Methods: An observational study was conducted with 358 surveys for the health personnel of a hospital, where the perception about the importance, follow-up and treatment for pain relief was evaluated. Results: In congruence with the literature, 61.9% of the participants perceived that there is an inadequate intrahospitalary pain treatment. When detected 55.3% of the times a behavior is taken to alleviate it. 22% think that opioids are only to be used by pain clinics, and 33% considered that all patients should be evaluated by pain clinics. Conclusion: Although pain relief is perceived as an important element, gaps in knowledge are diagnosed, and these are amenable for intervention to optimize care quality.

Ultrasonido gástrico "point-of-care" en tricobezoar: Reporte de caso / Point-of-care gastric ultrasound in trichobezoar: case report

Abstract Introduction: Trichobezoar is a rare entity that consists of a mass of hair particles in the gastrointestinal tract. The treatment of trichobezoar is basically surgical; however, alterations in gastric emptying represent a challenge for anesthesia because of the risk of bronchoaspiration during induction. Ultrasonography as a perioperative tool is helpful to guide decision-making and to plan the anesthetic technique to evaluate the gastric contents. Clinical findings, diagnostic evaluation, and interventions: This is a case of an emergent surgical correction due to trichobezoar. The ultrasound findings of the gastric evaluation allowed for the identification of a patient at risk of regurgitation and guided the decision about the induction of anesthesia. Conclusion: Currently, the opinion of the anesthesiologist based on the medical record and the physical examination determines the approach to the induction of anesthesia. The qualitative evaluation of the gastric contents using ultrasound, in addition to the physical examination, is extremely useful in case of a surgical emergency or in the absence of more sophisticated diagnostic images, when suspecting conditions with a full stomach and high risk of bronchoaspiration.

Resumen Introducción: El tricobezoar es una entidad poco frecuente, que consiste en la concentración de partículas de pelo en el tracto gastrointestinal. Su tratamiento es esencialmente quirúrgico y por la alteración en el vaciamiento gástrico, representa un reto anestésico por el riesgo de broncoaspiración durante la inducción anestésica. La ultrasonografía como herramienta perioperatoria es útil en la orientación de toma de decisiones y en el planeamiento de la técnica anestésica dado que nos permite realizar una evaluación del contenido gástrico. Hallazgos clínicos, evaluación diagnóstica e intervenciones: Presentamos un caso de corrección quirúrgica por tricobezoar de emergencia. Los hallazgos ecográficos de la evaluación gástrica y como estos permitieron identificar a una paciente con riesgo de regurgitación, orientando así la toma de decisiones en la inducción anestésica. Conclusión: En la actualidad el criterio del anestesiólogo basado en la historia clínica y el examen físico determinan la conducta durante la inducción anestésica. La evaluación cualitativa del contenido gástrico con ultrasonido como extensión del examen físico, resulta de inmensa utilidad frente a una urgencia quirúrgica o ausencia de imágenes diagnosticas de mayor complejidad, si se sospecha entidades con estómago lleno y alto riesgo de broncoaspiración.

Intubación selectiva evaluada con ecografía en neonato pretérmino llevado a corrección de atresia esofágica tipo C. Reporte de caso / Ultrasound-guided selective intubation in a preterm neonate undergoing type-C esophageal athresia correction. Case report

Abstract Introduction: Neonatal patients presenting with tracheoesophageal fistula represent a challenge to the anesthesiologist due to the multiple difficulties this pathology involves for airway management. Case discussion: Following is a description of a case of a neonate undergoing tracheoesophageal fistula repair using ultrasound-guided orotracheal intubation as an adjunct to selective intubation. Conclusion: Perioperative ultrasound is a promising tool for airway management of the pediatric patient. Further studies to assess the possibility to position the technique as a standard of care are needed.

Resumen Introducción: Los pacientes neonatales con fístula traqueoesofágica representan un reto para el anestesiólogo dadas las dificultades en el manejo de la vía aérea que esta patología supone. Presentación del caso: A continuación se expone un caso de un neonato llevado a corrección de fístula traqueoesofágica con intubación orotraqueal guiada por ultrasonido como técnica adjuvante a la intubación selectiva. Conclusion: La ultrasonografía perioperatoria en el manejo de la vía aérea del paciente pediático constituye una herramienta prometedora que requiere de estudios adicionales para evaluar la posibilidad de posicionarla como un estándar de cuidado.

Stress During Development of Experimental Endometriosis Influences Nerve Growth and Disease Progression.

PURPOSE: We have previously shown that stress prior to induction worsens clinical presentation and inflammatory parameters in a rat model of endometriosis. This study was designed to examine whether stress during the development of endometriosis can affect the growth of endometriotic implants through nerve growth and immune alterations. METHODS: Endometriosis was surgically induced in female Sprague-Dawley rats by suturing uterine horn implants onto the small intestine mesentery. Two weeks later, one group of rats (endo-stress) was subjected to a 10-day swim stress protocol. Controls had no stress (endo-no stress) or sutures only and stress (sham-stress). On day 60, all rats were killed and examined for the presence of endometriotic vesicles. The size of each vesicle was measured. The uterus and colon were removed and assessed for damage, cell infiltration, and expression of nerve growth factor (NGF), its receptors (p75 and Tropomyosin receptor kinase A (Trk-A)/pTrk-A), and calcitonin gene-related peptide, a sensory fiber marker. A differential analysis of peritoneal fluid white blood cell count was performed. RESULTS: Stress significantly increased endometriotic vesicle size but not colonic damage and increased infiltration of mast cells. Significantly increased expression of NGF and its receptors was found in the uterus of animals with endometriosis receiving stress. CONCLUSIONS: Stress stimulates the development of ectopic endometrial vesicles in an animal model of endometriosis and increases inflammatory cell recruitment to the peritoneum. In addition, stress promotes nerve fiber growth in the uterus.

Experiencia inicial con esofagectomia mínimamente invasiva transtorácica en posición semiprono por cáncer esofágico / Initial experience with minimally invasive transtoraxic esophagectomy in semiprone position for esophageal cancer

Resumen Introducción El tratamiento quirúrgico del cáncer esofágico se asocia a una alta morbimortalidad. El abordaje mínimamente invasivo se ha introducido con el objetivo de disminuir la morbilidad postoperatoria. Objetivo Describir la técnica y los resultados de la esofagectomía mínimamente invasiva (EMI) transtorácica en posición semiprono. Métodos Estudio de cohorte descriptivo. Se incluyeron pacientes con una EMI electiva por cáncer entre abril de 2013 y mayo de 2017. Se registraron variables demográficas, perioperatorias, anatomía patológica y la sobrevida. Resultados Incluimos 33 pacientes (24 hombres, edad 69 años, 91% con comorbilidades). La ubicación predominante del tumor fue en los tercios medio e inferior del esófago (90%). Quince (45%) pacientes recibieron neoadyuvancia. No existieron casos de conversión a toracotomías. La reconstrucción se realizó con estómago en un 93%. Se realizó anastomosis cervical en 66% y torácica en 30%. El tiempo operatorio fue de 420 (330-570) minutos y el sangrado de 200 (20-700) cc. La mortalidad a 90 días fue de 0%. La morbilidad global fue de 78%, se registró un 15% de neumonía y un 9% requirió una reoperación. La estadía hospitalaria fue de 23 (11-81) días. La histología fue carcinoma escamoso en 51% y adenocarcinoma en 45%. Los márgenes fueron RO en 87%. El recuento ganglionar alcanzó 30 (9-45) ganglios. La sobrevida global a 2 años es 68%. Conclusión Los resultados preliminares de esta técnica son favorables; sin ningún caso de mortalidad postoperatoria. Los resultados oncológicos demuestran un alto porcentaje de cirugía RO y adecuado recuento ganglionar.

Introduction Surgical treatment of esophageal cancer is associated with high morbidity and mortality. The minimally invasive approach has been introduced with the aim of reducing postoperative morbidity. Aim To describe the surgical technique and the results of transthoracic minimally invasive esophagectomy (MIE) in semiprone position. Material and Methods Descriptive cohort study. Patients with an elective MIE for cancer were included between April 2013 and May 2017. Demographic, perioperative, pathology and survival variables were recorded. Results We included 33 patients (24 men, age 69 years, 91% with comorbidities). The predominant location of the tumor was in the middle and lower thirds of the esophagus (90%). Fifteen (45%) patients received neoadjuvant treatment. There were no cases of conversion to thoracotomy. The reconstruction was performed with stomach in 93%. Cervical anastomosis was performed in 66% and thoracic anastomosis in 30%. The operative time was 420 (330-570) minutes and bleeding 200 (20-700) cc. The 90-day mortality rate was 0%. Overall morbidity was 78%, there was a 15% occurrence of pneumonia and 9% required a reoperation. The hospital stay was 23 (11-81) days. The histology was squamous carcinoma in 51% and adenocarcinoma in 45%. Margins were RO at 87%. The lymph node count reached 30 (9-45) lymph nodes. Overall 2-year survival is 68%. Conclusion The preliminary results of this technique are favorable, without any case of postoperative mortality. The oncological results demonstrate a high percentage of RO surgery and adequate lymph node count.

¿3 o 4 años de residencia en anestesiología?: cómo plantear la discusión en términos de educación basada en co / 3 or 4 years for Anesthesia Residency Program? How to approach the discussion in terms of competency-based education

Abstract Faced with the dilemma of extending the anesthesiology residency from 3 to 4 years, there have been several arguments for and against. However, the starting point of the discussion must be redesigning the national program curricula to move away from a fixed-time training and variable competencies, to a competency-based model; i.e., fixed competencies and variable time frames.

Ante la disyuntiva de prolongar la duración de la residencia en anestesiología de 3 a 4 años se han esgrimido varias razones de lado y lado. Sin embargo, la discusión debe partir de un rediseño curricular de los programas nacionales para dar el paso de un entrenamiento de tiempo fijo y competencias variables a el paradigma de educación basada en competencias, es decir, competencias fijas y tiempo variable.