Resultados del uso de prótesis endoscópica colorrectal. 15 años de experiencia

Objetivo: Describir morbimortalidad asociada al uso de prótesis colorrectales (PC) e identificar factores asociados a sus complicaciones durante los años 2007 a 2022 en Clínica INDISA. Material y Método: Estudio transversal retrospectivo basado en registro clínico. Resultados: Se instalaron 49 PC con un 100% de éxito de desobstrucción. El 87,8% en colon izquierdo. La etiología principal fue la patología maligna 91,8% y el 85,7% de ellos fueron primarios colorrectales. Se instalaron 34 como tratamiento paliativo (TP), 12 como puente a cirugía electiva (PCE) y 3 por patología benigna. La tasa de complicaciones fue de 26,5% (7 estenosis, 4 perforaciones y 2 migraciones). La mortalidad asociada fue de 4,1% (2 pacientes). El grupo de complicados fue más joven, con etapas oncológicas más avanzadas y con estenosis en rectosigmoides(p < 0,005). Los menores de 50 años tuvieron 5 veces más riesgo de alguna complicación (OR = 5,0;IC95%:1,09-23,0; p = 0,039). Discusión: El uso de PC tiene baja morbimortalidad. Su uso principal es como TP o PCE en obstrucción colorrectal maligna, con alta tasa de desobstrucción. Está asociado con menor morbilidad que la cirugía de urgencia, menor tasa de ostomía y mayor cosecha ganglionar. La instalación como puente se asocia además a mayor tasa de anastomosis primaria. Nuestra serie mostró mayor tasa de complicación en aquellos con tumores avanzados y más jóvenes. Conclusión: El uso de PC es seguro y con baja morbimortalidad. La principal indicación es en neoplasia colorrectal obstructiva como TP. Tienen mayor riesgo de complicación los pacientes jóvenes y los tumores colorrectales avanzados con ganglios peri tumorales.

Objective: To describe morbidity and mortality associated with colorectal prostheses (CP) and identify factors associated with their complications during the 2007 to 2022 at INDISA Clinic. Material and Method: Retrospective cross-sectional study based on clinical registry. Results: 49 CPs were installed with 100% clearing success. 87.8% in left colon. The main etiology was malignant 91.8% and 85.7% were primary colorectal. 34 were installed with palliative intention, 12 as a bridge to elective surgery (BTS) and 3 for benign pathology. There were 13 (26.5%) patients with adverse effects (7 strictures, 4 perforations and 2 migrations). Associated mortality was 4.1% (2 patients). The complicated group was younger, with more advanced oncological stages and rectosigmoid stenosis (p < 0.005). Those under 50 years of age had 5 times higher risk of some complication (OR = 5.0; 95% CI: 1.09-23.0; p = 0.039). Discussion: The use of CPs has low short-term morbidity and mortality. Its main use is as palliative treatment or BTS in malignant colorectal obstruction. It's a high clearance rate. It is associated with less morbidity than emergency surgery, a lower ostomy rate, and a higher lymph node harvest. Installation as a bridge is also associated with a higher rate of primary anastomosis. Our group showed a higher complication rate in those with advanced and younger tumors. Conclusion: The use of CPs is safe, with low morbidity and mortality. The main indication is in obstructive colorectal neoplasia as palliative treatment. Young patients and advanced colorectal tumors with peritumoral nodes have a higher risk of complications.

Resultados de cirugía resectiva colorrectal por Endometriosis Infiltrante Profunda: 6 años de experiencia

Objetivo: Describir los resultados tempranos de la cirugía resectiva colorrectal por Endometriosis Infiltrante Profunda (EIP) en mujeres intervenidas en centro clínico privado, durante los últimos 6 años. Material y Método Estudio transversal que muestra la evolución clínica de pacientes intervenidas quirúrgicamente con resecciones colorrectales por diagnóstico de (EIP), entre los años 2016-2022 en Clínica Indisa. Se agruparon en resecciones discoidales (Grupo I) y segmentarias (Grupo II) Resultados: De los pacientes operados por (EIP) entre los años 2016 al 2022, 160 pacientes fueron sometidas a resecciones colorrectales, 56 en el Grupo I y 104 en el grupo II. Las características demográficas de ambos grupos fueron similares, con excepción del hábito tabáquico que mostró un predominio en el Grupo II. El análisis de las variables quirúrgicas (tipo de abordaje, tasa de conversión, altura de la anastomosis y ostomía de protección) mostró una distribución similar en ambos grupos. En relación a la evolución postoperatoria, el Grupo I presentó una disminución significativa en el tiempo de realimentación con sólidos de 2 vs 3 días (p = 0,001). El inicio del tránsito intestinal, días de hospitalización y presencia de complicaciones Clavien-Dindo > = 3, no presentó diferencias significativas entre ambos grupos. Discusión: La endometriosis afecta, significativamente, a mujeres en todo el mundo, existiendo escasa evidencia que reporte los resultados de las cirugías colorrectales que comparen ambas técnicas, demostrando que el manejo en centros especializados tiene mejores resultados. Conclusión: Al comparar estas dos técnicas de resección colorrectal en DIE, concluimos que los pacientes operados por resección discoidal tienen una realimentación más temprana sin diferencias significativas en el resto de las variables estudiadas.

Objective: To describe the early outcomes of resective colorectal surgery for Deep Infiltrating Endometriosis (DIE) in women treated at private center over the past 6 years. Materials and Methods: This cross-sectional study presents the clinical evolution of surgically treated patients with colorectal resections for DIE diagnosis between 2016 and 2022 at Clínica INDISA. They were grouped into discoid resections (Group I) and segmental resections (Group II). Results: Of patients operated for DIE between 2016 and 2022, 160 underwent colorectal resections, with 56 in Group I and 104 in Group II. The demographic characteristics of both groups were similar, except for smoking habits, which showed a predominance in Group II. The analysis of surgical variables (approach type, conversion rate, anastomotic height, and protective ostomy) showed a similar distribution in both groups. Regarding postoperative outcomes, Group I showed a significant decrease in solid food resumption time, 2 vs 3 days (p = 0.001). The initiation of intestinal transit, hospitalization days, and presence of Clavien-Dindo complications >= 3 did not present significant differences between both groups. Discussion: Endometriosis significantly affects women worldwide, with limited evidence reporting colorectal surgery outcomes comparing both techniques, demonstrating that management in specialized centers yields better results. Conclusion: When comparing these two techniques of colorectal resection in DIE, we conclude that patients undergoing discoid resection have an earlier resumption of solid food intake without significant differences in the remaining studied variables.

[Translated article] Immobilisation with compression bandage vs. antebraquial splint in distal radius fractures operated by open reduction and locking plate. Randomised clinical trial.

INTRODUCTION: Currently, there is a lack of prospective studies to unify criteria about type and time for postoperative immobilisation in surgical distal radius fractures. The aim of this study is to compare functional and radiological results in two groups of distal radius fractures treated with internal fixation with locking plate, and immobilised with antebrachial splint or compression bandage for 3 weeks. MATERIAL AND METHOD: A randomised clinical trial was carried out with two parallel groups with 3, 6, and 12 weeks of follow-up. Main and secondary functional variables were measured, such as pain on VAS scale, values on PRWE, DASH and MRS scale, range of motion in flexion-extension, complications, etc. In addition, some radiological variables were measured at preoperative period and one week after surgery, such as union time, dorsal displacement, shortening, ulnar variance, etc. RESULTS: A total of 62 patients were evaluated: 27 immobilised with bandage and 35 with splint. Analysis of the results obtained showed significant differences in both groups for almost all radiological variables from pre to postoperative period, and for all functional variables from 3 to 12 weeks after surgery. No significant differences were found between the two groups for any of the radiological and functional variables evaluated (VAS 3-12 weeks: p=.584; PWRE 3-12 weeks: p=.248; flexion range of motion 3-12 weeks: p=.959; extension range of motion: p=.50; union time: p=.89). CONCLUSIONS: We do not find clinical or radiological differences between immobilisation with antebrachial splint or compression bandage for distal radius fractures operated with locking plate. A greater number of patients and follow-up are necessary to extrapolate the results to the general population and to establish criteria for good postoperative management of these fractures.

Immobilization with compression bandage vs antebraquial splint in distal radius fractures operated by open reduction and locking plate. Randomized clinical trial. / Inmovilización con vendaje compresivo vs férula antebraquial en fracturas de radio distal intervenidas mediante reducción abierta y placa bloqueada. Ensayo clínico aleatorizado.

INTRODUCTION: Currently, there is a lack of prospective studies to unify criteria about type and time for postoperative immobilization in surgical distal radius fractures. The aim of this study is to compare functional and radiological results in two groups of distal radius fractures treated with internal fixation with locking plate, and immobilized with antebrachial splint or compression bandage for 3weeks. MATERIAL AND METHOD: A randomized clinical trial was carried out with two parallel groups with 3, 6, and 12weeks of follow-up. Main and secondary functional variables were measured, such as pain on VAS scale, values on PRWE, DASH and MRS scale, range of motion in flexion-extension, complications, etc. In addition, some radiological variables were measured at preoperative period and one week after surgery, such as union time, dorsal displacement, shortening, ulnar variance, etc. RESULTS: A total of 62 patients were evaluated: 27 immobilized with bandage and 35 with splint. Analysis of the results obtained showed significant differences in both groups for almost all radiological variables from pre to postoperative period, and for all functional variables from 3 to 12weeks after surgery. No significant differences were found between the two groups for any of the radiological and functional variables evaluated (VAS 3-12weeks: P=.584; PWRE 3-12weeks: P=.248; flexion range of motion 3-12weeks: P=.959; extension range of motion: P=.50; union time: P=.89). CONCLUSIONS: We do not find clinical or radiological differences between immobilization with antebrachial splint or compression bandage for distal radius fractures operated with locking plate. A greater number of patients and follow-up are necessary to extrapolate the results to the general population and to establish criteria for good postoperative management of these fractures.

Lenalidomide in combination with R-ESHAP in patients with relapsed or refractory diffuse large B-cell lymphoma: A phase 2 study from GELTAMO.

Diffuse large B-cell lymphoma (DLBCL) patients with relapsed or refractory (RR) disease have poor outcomes with current salvage regimens. We conducted a phase 2 trial to analyse the safety and efficacy of adding lenalidomide to R-ESHAP (LR-ESHAP) in patients with RR DLBCL. Subjects received 3 cycles of lenalidomide 10 mg/day on days 1-14 of every 21-day cycle, in combination with R-ESHAP at standard doses. Responding patients underwent autologous stem-cell transplantation (ASCT). The primary endpoint was the overall response rate (ORR) after 3 cycles. Centralized cell-of-origin (COO) classification was performed. Forty-six patients were included. The ORR after LR-ESHAP was 67% (35% of patients achieved complete remission). Patients with primary refractory disease (n = 26) had significantly worse ORR than patients with non-refractory disease (54% vs. 85%, p = 0.031). No differences in response rates according to the COO were observed. Twenty-eight patients (61%) underwent ASCT. At a median follow-up of 41 months, the estimated 3-year PFS and OS were 42% and 48%, respectively. The most common grade ≥3 adverse events were thrombocytopenia (70% of patients), neutropenia (67%) and anaemia (35%). There were no treatment-related deaths during LR-ESHAP cycles. In conclusion, LR-ESHAP is a feasible salvage regimen with promising efficacy results for patients with RR DLBCL.

Tratamiento quirúrgico de la enfermedad pilonidal sacrocoxígea. Experiencia de un centro en los últimos 4 años

Objetivo: Evaluar los resultados a largo plazo en el tratamiento quirúrgico de la enfermedad pilonidal sacrocoxígea (EPS), comparando las diferentes técnicas quirúrgicas utilizadas, complicaciones, tiempo de cicatrización y recidiva. Material y Método: Estudio trasversal retrospectivo. Se revisaron las fichas de los pacientes intervenidos por EPS entre enero 2017 hasta agosto 2021. Para el seguimiento se obtuvo la información desde los registros de los controles periódicos en nuestro centro y aquellos que no continuaron con estos controles se contactaron telefónicamente. Resultados: Se recopilaron 309 casos, con una media de seguimiento de 15,6 meses. Las técnicas más utilizadas para la fase crónica de EPS fueron marsupialización y Karydakis, con tiempo de cicatrización completa de 54,5 y 18,2 días, respectivamente. La presencia de complicaciones prolongó el tiempo de cicatrización en 46,5 días en Karydakis, con mínimo impacto en marsupialización. La tasa de recidiva fue menor en Karydakis y en etapa aguda cuando se realiza destechamiento y legrado. La profilaxis antibiótica no afectó el riesgo de complicaciones postoperatorias. Discusión: El desarrollo de complicaciones postoperatorias tiene mayor impacto en la cicatrización de la técnica cerrada que en la abierta, siendo esta última más tolerante en cuanto a la cicatrización frente a complicaciones. Conclusión: La intervención con técnica de Karydakis logra la cicatrización de la herida operatorio en menor tiempo que la marsupialización, sin embargo, al desarrollar complicaciones, este tiempo aumenta 3,5 veces más. La recurrencia fue menor en Karydakis. En absceso se recomienda el desteche y legrado por sobre el drenaje exclusivo

Aim: To evaluate long-term results in the surgical treatment of sacrococcygeal pilonidal disease (SPD) comparing the different surgical techniques used, complications, healing time and recurrence. Material and Method: Retrospective cross-sectional study. The files of the patients operated on for EPS between January 2017 and August 2021 were reviewed. For follow-up, information was obtained from the records of the periodic controls in our center; those who did not continue with these controls were contacted by telephone. Results: 309 cases were collected, with a mean follow-up of 15.6 months. The most used techniques for the chronic phase of EPS were marsupialization and Karydakis, achieving complete wound healing in 54.5 and 18.2 days, respectively. The presence of complications prolonged the healing time by 46.5 days in Karydakis, with minimal impact on marsupialization. The recurrence rate was lower in Karydakis and in the acute stage when unroofing and curettage were performed. Antibiotic prophylaxis did not increase the risk of postoperative complications. Discussion: The development of postoperative complications has a greater impact on the healing of the closed technique than in the open technique, the last one seems to be more tolerant in terms of healing in the presence of complications. Conclusion: The intervention with the Karydakis technique achieves healing of the surgical wound in less time than marsupialization, however, when complications develop, this time increases 3.5 times more. Recurrence was lower in Karydakis. In abscess weaning and curettage is recommended over the exclusive drainage.

Foliar application of methyl jasmonate and methyl jasmonate supported on nanoparticles: Incidence on grape phenolic composition over two seasons.

Tools to address the mismatch between technological and phenolic maturity of grapes are needed. Application of elicitors could be an effective alternative. This work compares the effect of the application of methyl jasmonate (MeJ) in conventional form and, as a novelty, in the form of MeJ-doped nanoparticles (ACP-MeJ) on the phenolic composition of Tempranillo grapes. Results showed that, regardless of season, both treatments increased the grape total phenols content. In 2019, most of the anthocyanins, and to a lesser extent the flavanols, increased with the application of MeJ, and several hydroxycinnamic acids increased in the grapes treated with ACP-MeJ, with dose 10 times lower than those of the MeJ conventional. In 2020, anthocyanins were not affected by the treatments, but total flavanols, flavonols, hydroxybenzoic acid, and stilbenes increased after ACP-MeJ application. Thus, foliar application of ACP-MeJ could serve to increase grape phenolic composition, reducing maturity decoupling and the environmental impact.

[Epidemiology and Outcomes of Soft Tissue Sarcomas: Insights from a Decade of Head and Neck Surgery at Sótero del Río Hospital, Santiago, Chile]. / Sarcomas de partes blandas: Análisis de la experiencia de diez años del equipo de cirugía de cabeza y cuello en el Hospital Sótero del Río.

BACKGROUND: Soft tissue sarcomas (STS) are rare malignant tumors of mesenchymal origin. They are associated with genetic and environmental risk factors. Their clinical manifestations are nonspecific, requiring a high level of suspicion. The first-line treatment is surgical. Positive margins are the only independent predictor of local recurrence and worse survival rates. Strict follow-up is recommended due to its high recurrence rate. AIM: Analyze the casuistry of STS treated with curative intent by the head and neck surgery team at the Sótero del Río Hospital (HSR) at Santiago, Chile between 2013 and 2023. METHODS: A retrospective, descriptive study of patients with STS managed by the HSR head and neck surgery team. Clinical presentation, diagnostic and therapeutic tools, and oncological results are analyzed. RESULTS: 26 patients were included, 84.6% female, with an average age of 61.7 years. Only 30.8% presented identifiable risk factors. The most common histology was undifferentiated pleomorphic sarcoma (26.9%), and the predominant location was extremities (46.2%). 77.8% of head and neck sarcomas and 58.8% of trunk and extremity sarcomas occurred in advanced stages. Disease-free survival was 66.6%; 68.2% in patients with negative surgical margins, and 60.0% in positive margins at five years. CONCLUSIONS: STS is an infrequent pathology. This study corresponds to the first retrospective research on STS in Chile. We require establishing a specialized multidisciplinary team to optimize the management and follow-up of STS patients.

Quiste pilonidal. Preferencias en su manejo de los cirujanos/as colorrectales de Latinoamérica

Objetivo: Caracterizar las preferencias y frecuencia de las técnicas quirúrgicas para la resolución de la enfermedad pilonidal (EPS) en los cirujanos/as colorrectales de Latinoamérica. Material y Método: Estudio transversal descriptivo analítico mediante encuesta electrónica validada por pares expertos. Distribuida entre los cirujanos/as colorrectales de Latinoamérica. Fueron excluidos los cirujanos/as no subespecialistas en cirugía colorrectal. Resultados: Se obtuvieron 372 respuestas de 15 países latinoamericanos, con media de 18,9 ± 12,5 años como subespecialistas. El 66,7% utiliza técnicas abiertas para EPS crónica, las técnicas más usadas son marsupialización (31,5%), destechamiento (27,7%) y resección con técnica de Karydakis (17,7%), colgajo de Limberg (6,1%), Bascom (5,4%), plastias en Z o V-Y (4%), McFee (3,8%) y Epsit (3,8%). La intervención más utilizada para la resolución de la EPS aguda es el drenaje bajo anestesia formal con curetaje y/o marsupialización (51,1%). El 45,3% de los cirujanos/as cambia de técnica durante su carrera. Discusión: Gracias a la amplia distribución y representatividad de los encuestados se logró plasmar la preferencia de manera realista acerca de las inclinaciones en el manejo de la EPS por parte de los subespecialistas del continente, aportando información de la que no se tiene precedente. Conclusión: Las técnicas abiertas son las preferidas para la resolución de la EPS crónica, las técnicas más utilizadas son marsupialización, destechamiento y Karydakis. Es frecuente el cambio de técnica quirúrgica preferente dentro de los subespecialistas, existiendo una relación entre escoger técnicas abiertas en la medida que los cirujanos/as tienen más años de experiencia.

Aim: To characterize the preferences and frequency of surgical techniques for the resolution of pilonidal disease (PSD) in colorectal surgeons of Latin America. Materials and Method: Cross-sectional descriptive and analytical study using an electronic survey validated by expert peers. Distributed among colorectal surgeons in Latin America. Surgeons who were not subspecialists in colorectal surgery were excluded. Results: 372 responses were obtained from subspecialist surgeons in colorectal surgery from 15 Latin American countries, with a mean of 18.9 ± 12.5 years as subspecialists. 66.7% use open techniques for chronic PSD, the most used techniques: marsupialization (31.5%), unroofing (27.7%) and resection with the Karydakis technique (17.7%), Limberg flap (6, 1%), Bascom (5.4%), Z or VY plasties (4%), McFee (3.8%) and Epsit (3.8%). The most used intervention for the resolution of acute PSD is drainage under formal anesthesia with curettage and/or marsupialization (51.1%). 45.3% of surgeons change techniques during their career. Discussion: Due to the wide distribution and representativeness of the respondents, it was possible to capture the preference in a realistic way about the management of the PSD by the subspecialists of the continent, contributing with information with which there is no precedent. Conclusion: Open techniques are preferred for the resolution of chronic PSD, marsupialization, unroofing and Karydakis were used the most. The change of surgical technique within subspecialists is frequent, there is a relationship between preferring open techniques to the extent that surgeons have more years of experience.

Redox Cycling Dioxonaphthoimidazoliums Disrupt Iron Homeostasis in Mycobacterium bovis Bacillus Calmette-Guérin.

The dioxonaphthoimidazolium scaffold is a novel, highly bactericidal redox cycling antituberculosis chemotype that is reliant on the respiratory enzyme Type II NADH dehydrogenase (NDH2) for the generation of reactive oxygen species (ROS). Here, we employed Mycobacterium bovis Bacillus Calmette-Guérin (M. bovis BCG) reporter strains to show that ROS generated by the redox cycler SA23 simulated an iron deficient state in the bacteria, which led to a compensatory increase in the expression of the iron acquisition mbtB gene while collaterally reducing the expression of the iron storage bfrB gene. Exacerbating the iron deficiency via the inclusion of an iron chelator or aggravating oxidative stress by deploying a catalase (KatG) loss-of-function mutant strain enhanced the activity of SA23, whereas a combined approach of treating the katG mutant strain with an iron chelator led to even greater gains in activity. Our results support the notion that the activity of SA23 pivots on a vicious cycle of events that involve the derailment of iron homeostasis toward greater acquisition of the metal, overwhelmed oxidative stress defenses due to enhanced Fenton reactivity, and, ultimately, self-inflicted death. Hence, we posit that redox cyclers that concurrently perturb the iron equilibrium and cellular respiration are well-positioned to be potent next-generation anti-tubercular drugs. IMPORTANCE Cellular respiration in mycobacteria is a potentially rich target space for the discovery of novel drug entities. Here, we show that a redox cycling bactericidal small molecule that selectively activates a respiratory complex in mycobacteria has the surprising effect of disrupting iron homeostasis. Our results support the notion that the disruption of cellular respiration is a potent driver of reactive oxygen species (ROS) generation by the redox cycling molecule. Mycobacteria respond by acquiring iron to restore the levels depleted by the prevailing oxidizing conditions, which inadvertently trigger the compensatory acquisition of the metal. This leads to overwhelmed oxidative stress defenses and yet more iron depletion. For organisms that are unable to break out of this pernicious cycle of events, cell death is the inevitable outcome. Hence, aberrant ROS production by a redox cycling bactericidal agent inflicts a plethora of damaging effects on mycobacteria, including the derailment of iron homeostasis.

The Iron Response of Mycobacterium tuberculosis and Its Implications for Tuberculosis Pathogenesis and Novel Therapeutics.

Most pathogenic bacteria require iron for growth. However, this metal is not freely available in the mammalian host. Due to its poor solubility and propensity to catalyze the generation of reactive oxygen species, host iron is kept in solution bound to specialized iron binding proteins. Access to iron is an important factor in the outcome of bacterial infections; iron limitation frequently induces virulence and drives pathogenic interactions with host cells. Here, we review the response of Mycobacterium tuberculosis to changes in iron availability, the relevance of this response to TB pathogenesis, and its potential for the design of new therapeutic interventions.

Estudio comparativo en pacientes sometidos a cirugía colorrectal con preparación mecánica exclusiva y preparación mecánica con antibióticos orales / Complications and postoperative clinical evolution in patients undergoing colorectal surgery with mechanical preparation alone and mechanical preparation with oral antibiotics

Objetivo: Evaluar las complicaciones posoperatorias y la evolución clínica en pacientes sometidos a colectomías y anastomosis con dos estrategias preoperatorias, preparación mecánica (PMC) y preparación mecánica con antibióticos orales (PMC+AO). Materiales y Método: Estudio retrospectivo, con un total de 216 pacientes, 149 fueron del grupo PMC y 67 del PMC+AO. Variables estudiadas: características demográficas, intervención quirúrgica, localización anastomótica, fuga anastomótica (FA), infección del sitio operatorio (ISO), tránsito intestinal posoperatorio, infección por Clostridium difficile (CD) y estadía hospitalaria. Para el análisis estadístico se realizaron modelos bivariados y multivariados. Resultados: La FA fue más frecuente en el grupo PMC (7,38% vs. 0%, p = 0,011). En colectomías del lado izquierdo, la diferencia más marcada en las FA de ambos grupos fue en anastomosis del recto medio, sin casos en el grupo PMC+AO (0% vs. 50%, p = 0,019). En colectomías derechas, la FA fue similar para ambos grupos. Hubo más ISO en el grupo PMC (4,7% vs. 0%, p = 0,037). La recuperación del tránsito intestinal fue más rápida para el grupo PMC+AO, determinando menor estadía hospitalaria (3,98 días vs. 6,39 días, p = 0,001). El grupo PMC+AO se asoció a mayor tasa de colitis por CD (4,48% vs. 0,67%, p = 0,008). Discusión y Conclusión: El uso de la preparación intestinal con antibióticos orales podría ayudar a prevenir la FA en las colectomías izquierdas y evitar las ISO, favoreciendo la recuperación del tránsito intestinal, reduciendo la estadía hospitalaria. La asociación a CD debe examinarse en estudios más amplios.

Aim: To evaluate postoperative complications and clinical evolution in patients undergoing colectomies and anastomosis with two preoperative strategies, mechanical bowel preparation alone (MBP) and mechanical bowel preparation with oral antibiotics (MBP+OA). Materials and Method: Retrospective study, with defined inclusion and exclusion criteria. Variables studied: preoperative demographic characteristics, surgical intervention, anastomotic location, anastomotic leakage (AL), surgical site infection (SSI), postoperative intestinal transit, Clostridium difficile (CD) infection and hospital stay. Statistical analysis, bivariate and multivariate models were performed. Results: 216 patients studied, 149 were MBP group and 67 MBP+OA group. The group MBP had higher rates of AL (7.38% vs. 0%, p = 0.011). For left-sided colectomies, AL rate in both groups had a higher difference in the middle rectum, with no cases in the MBP+OA group (0% vs. 50%, p = 0.019). For right colectomies, the AL rates were similar in both groups. SSI was higher in MBP group (4.7% vs. 0%, p = 0.037). The bowel transit recovery was faster for MBP+OA group, determining less hospital stay (3.98 days vs. 6.39 days, p = 0.001). The group MBP+OA had a higher rate of CD colitis, 4.48% (p = 0.008). Discussion and Conclusion: These results suggest that preoperative oral antibiotic with mechanical bowel preparation could help to prevent anastomotic leaks in left-sided colectomies, also avoid surgical site infection, favoring the recovery of postoperative bowel transit, reducing hospital stay. The association to CD should be examined in larger studies.

Abordaje quirúrgico y evolución posoperatoria en reintervenciones de complicaciones en cirugía colorrectal laparoscópica, 15 años de experiencia / Surgical approach and postoperative clinical course in reinterventions for complications following laparoscopic colorectal surgery: 15 years of experience

Resumen Objetivo: Comparar tres abordajes quirúrgicos (abierto, laparoscópico y laparoscópico convertido) para el manejo de complicaciones posoperatorias en cirugía colorrectal electiva realizadas primariamente por vía laparoscópica. Materiales y Método: Este estudio de cohorte retrospectivo incluyó pacientes reoperados después de una cirugía colorrectal laparoscópica electiva, agrupándose según la vía de abordaje de reoperación: abierta (RVA), laparoscópica (RVL) y laparoscópica convertida (RVLC). Las variables estudiadas fueron: preoperatorias (edad, sexo, puntuación ASA, IMC, comorbilidades e historia quirúrgica); operatorias (causa de reoperación, latencia para reoperación, tiempo operatorio, cirugía realizada y causa de conversión); y posoperatorias (tránsito intestinal, días de hospitalización, días de UCI, complicaciones médicas, infección del sitio quirúrgico, evisceración, transfusión y mortalidad a los 30 días). Resultados: Sin diferencias significativas para las variables preoperatorias y operatorias. En cuanto a las variables posoperatorias, el grupo de reoperaciones por vía laparoscópica, tuvo menos días de hospitalización (p = 0,012), menos días de UCI (p = 0,001) y un tránsito intestinal más rápido para reaparición de gases, heces y retorno a dieta sólida (p = 0,008, p = 0,029, p = 0,030, respectivamente). No hubo diferencias significativas en la infección del sitio quirúrgico, la evisceración, las complicaciones médicas, la transfusión y la mortalidad. Discusión y Conclusión: Este estudio reveló una mejor evolución clínica posoperatoria en el grupo de reoperación laparoscópica, con menor estancia hospitalaria y en UCI, y reducción del íleo posoperatorio, sin aumento de la morbimortalidad. Por lo tanto, la reoperación laparoscópica en cirugía colorrectal podría ser el abordaje más adecuado en pacientes debidamente seleccionados.

Aim: To compare three approaches (laparoscopic, open, and conversion of laparoscopic approach) for the management of intra-abdominal surgical complications after elective laparoscopic colorectal surgery. Materials and Method: This was a retrospective cohort study including patients who required reoperation due to an intra-abdominal surgical complication after initial elective laparoscopic colorectal surgery. Patients were grouped according to the reoperation approach-laparoscopic reoperation, laparoscopic reoperation that required conversion to open surgery, and open reoperation. Pre-operative variables (age, gender, ASA score, BMI, comorbidities, and surgical history), operative variables (cause of reoperation, latency for reoperation, operative time, surgery performed, and cause of conversion), and post-operative variables (intestinal transit, hospital days, ICU days, medical complications, surgical site infection, evisceration, transfusion and 30-day mortality), were compared between groups. Results: There were no significant differences between groups among the pre-operative and operative variables. In terms of post-operative variables, the laparoscopic reoperation group, had fewer hospital days (p = 0.012), fewer ICU days (p = 0.001), and faster intestinal transit regarding gas, stool and return to solid diet (p = 0.008, p = 0.029 and p = 0.030, respectively). However, there were no significant differences in surgical site infection, evisceration, medical complications, transfusion, and mortality. Discussion and Conclusión: This study revealed better post-operative clinical course in the laparoscopic reoperation group, with shorter hospital and ICU stay, and reduced postoperative ileus, without increased morbidity or mortality. Laparoscopic reoperation for complications after elective laparoscopic colorectal surgery may therefore be the preferred approach.

Efecto perjudicial de la pandemia por SARS-CoV-2 en la sintomatología digestiva en pacientes con síndrome de intestino irritable / Detrimental impact of SARS-CoV-2 pandemic in the symptomatology of patients with irritable bowel syndrome

Irritable Bowel Syndrome (IBS) is a more frequent disorder in the brain-gut axis interaction in the world. COVID-19 has affected the population's mental health, and its impact on clinical severity in patients with IBS is unknown. Objective: To evaluate the effect of psychosocial stress produced by the pandemic on the severity of gastrointestinal symptoms. Methodology: 54 women and three men with IBS were interviewed by telephone. Factors associated with quality of life, comorbidities, IBS subtype, and COVID-19 diagnosis were asked. Calls were developed between June 2020 to January 2021. Results: 75% had Diarrheal IBS (IBS-D), 67% had comorbidities, 47% with busy work, and 70% in person, five patients (9%) were diagnosed with COVID-19. Of the total, 88% referred to change in gastrointestinal symptoms, 56% increased abdominal pain, and 95% bloating. Abdominal pain was negatively associated with quality of life (p < 0.036), and the incomplete evacuation's sensation positively with difficulty sleeping (p < 0.034). Conclusion: In this study, IBS patients interviewed by telephone reported higher abdominal pain and subjective bloating associated with the pandemic by SARS-CoV-2. Keywords: Irritable

El Síndrome de Intestino Irritable (SII) es uno de los trastornos en la interacción cerebrointestino más frecuentes en el mundo. La pandemia COVID-19 ha afectado la salud mental de la población, siendo desconocido su impacto en la severidad clínica en pacientes con SII. Objetivo: Evaluar el efecto del estrés psicosocial producido por la pandemia en la severidad de síntomas gastrointestinales de pacientes con SII. Metodología: 54 mujeres y 3 hombres con SII fueron entrevistados vía telefónica. Se preguntó por factores asociados a calidad de vida, comorbilidades, subtipo de SII y diagnóstico de COVID-19. Las llamadas se realizaron entre junio de 2020 hasta enero de 2021. Resultados: Un 75% presentó SII Diarreico (SII-D), el 67% comorbilidades, el 47% con trabajo activo y 70% presencial, 5 pacientes (9%) diagnosticados COVID-19. Del total, 88% refirió cambio en síntomas gastrointestinales, 56% aumentó el dolor abdominal y 95% la distensión abdominal. El dolor abdominal se asoció negativamente con la calidad de vida (p < 0,036), y la sensación de evacuación incompleta positivamente con la dificultad para dormir (p < 0,034). Conclusión: En este estudio, los pacientes con SII entrevistados vía telefónica reportaron mayor dolor y distensión abdominal subjetiva asociado a la pandemia por SARS-CoV-2.

Mejoramiento de la calidad del fruto por la incorporación de genes de especies silvestres en el tomate (Solanum lycopersicum L.) / Fruit quality improvement through the incorporation of wild species genes in the tomato (Solanum lycopersicum L.)

RESUMEN En el mejoramiento del tomate (Solanum lycopersicum L.) se ha logrado un incremento significativo para el rendimiento y otras características productivas en un período corto de tiempo. Como consecuencia se redujo notablemente la diversidad genética. Si bien el germoplasma silvestre se ha utilizado principalmente como fuente de genes de resistencia para enfermedades y plagas, nuestro grupo inició en la década de 1990, un programa de mejoramiento genético en tomate para mejorar la calidad del fruto con especial énfasis en incrementar la vida poscosecha y también ampliar la variabilidad genética con la incorporación de estos genes al gran cultivo. Hemos desarrollado diferentes poblaciones a partir del cruzamiento interespecífico entre el cultivar argentino Caimanta de S. lycopersicum y la accesión LA0722 de S. pimpinellifolium L. Mediante la generación de cruzamientos entre estos padres selectos y el posterior avance generacional de la selección se ha tratado de dilucidar las bases genéticas que definen la calidad del fruto. Para ello se integraron al programa de mejoramiento información obtenida de datos genómicos, posgenómicos y bioinformáticos. Al mismo tiempo hemos desarrollado cuatro nuevos cultivares con características de calidad de fruto superiores al ser comparados con híbridos comerciales. Para conservar y estudiar la diversidad del cultivo también estamos desarrollado una colección de germoplasma que en la actualidad cuenta con 162 genotipos de tomate de diferentes especies y orígenes. Además, se ha iniciado la transferencia directa de plantines a huertas urbanas y periurbanas para favorecer el acceso a semillas de estos cultivares desarrollados en instituciones públicas.

ABSTRACT The genetic improvement of tomato (Solanum lycopersicum L.) has achieved an increase for yield and other agronomic traits in a short period of time. As a consequence, genetic diversity has been notably reduced. Wild germplasm has been mostly used as a source of resistance genes for diseases and pests. Our group started in the 1990' a breeding program in tomato for improving fruit quality, with special emphasis on increasing fruit shelf life and broadening the genetic variability with the incorporation of wild genes. We have developed different populations from the interspecific cross between the Argentine cultivar Caimanta of S. lycopersicum and the accession LA0722 of S. pimpinellifolium L. Through crosses between these selected parents and the subsequent generational selection advance, we attempted to elucidate the genetic bases that underlie tomato fruit quality. To do that, we use state-of-the-art technology available in the field of genetics and breeding programs, including genomic, post-genomic and bioinformatic data. At the same time, we have developed four new cultivars with improved fruit quality traits compared to commercial hybrids. To conserve and study the tomato diversity, we have developed a germplasm collection that currently contains 162 tomato genotypes from different species and origins. In addition, we have started a direct transfer of our cultivars to urban and peri-urban community orchards to facilitate them the access to genotypes that were developed in Argentine public institutions.

Resección por videotoracoscopía de nódulos pulmonares marcados con lipiodol: experiencia en dos centros universitarios / Videotoracoscopy resection of pulmonary nodules marked with lipiodol: experience in two university centers

INTRODUCCIÓN: Para facilitar la localización intraoperatoria de los nódulos pulmonares existe la alternativa de marcarlos previamente con lipiodol. OBJETIVO: Describir los resultados quirúrgicos de los pacientes sometidos a resección por videotoracoscopía de nódulos pulmonares marcados previamente con lipiodol. MATERIAL Y MÉTODOS: Estudio descriptivo. Se incluyeron los pacientes que fueron sometidos a resección por videotoracoscopía de nódulos pulmonares marcados con lipiodol, en Clínica Las Condes e Instituto Nacional del Tórax, entre junio de 2012 y junio de 2019. Se consideraron variables demográficas, radiológicas, quirúrgicas e histológicas. RESULTADOS: Se estudió un total de 93 pacientes. La edad promedio fue 63,5 (± 11,9) años. El tamaño promedio de los nódulos fue de 10,7 (± 5,8) mm. Se identificó y extrajo el 100% de los nódulos marcados. Los días de hospitalización promedio fueron 4,7 (± 6,9). Solo se registró un fallecimiento de causa no quirúrgica. CONCLUSIONES: La resección videotoracoscópica de nódulos pulmonares marcados previamente con lipiodol, es una técnica segura y eficaz.

BACKGROUND: To facilitate the intraoperative location of lung nodules there is the alternative of pre-marking them with lipiodol. OBJECTIVE: To describe the surgical results of patients undergoing videotoracoscopy resection of pulmonary nodules previously marked with lipiodol. MATERIAL AND METHODS: Descriptive study. Patients who underwent videotorcoscopy resection of pulmonary nodules marked with lipiodol were included at Clínica Las Condes and Instituto Nacional del Tórax between June 2012 and June 2019. Demographic, radiological, surgical and histological variables were considered. RESULTS: A total of 93 patients were studied. The average age was 63,5 (± 11.9) years. The average size of the nodules was 10.7 (± 5.8) mm. 100% of the marked nodules were identified and extracted. The average hospitalization days were 4.7 (± 6.9). Only one death of non-surgical cause was recorded. CONCLUSIONS: Videotoracoscopic resection of pulmonary nodules previously marked with lipiodol is a safe and effective technique.

Sticholysin II shows similar immunostimulatory properties to LLO stimulating dendritic cells and MHC-I restricted T cell responses of heterologous antigen.

Induction of CD8+ T cell responses against tumor cells and intracellular pathogens is an important goal of modern vaccinology. One approach of translational interest is the use of liposomes encapsulating pore-forming proteins (PFPs), such as Listeriolysin O (LLO), which has shown efficacy at priming strong and sustained CD8+ T cell responses. Recently, we have demonstrated that Sticholysin II (StII), a PFP from the sea anemone Stichodactyla helianthus, co-encapsulated into liposomes with ovalbumin (OVA) was able to stimulate, antigen presenting cells, antigen-specific CD8+ T cells and anti-tumor activity in mice. In the present study, we aimed to compare StII and LLO in terms of their abilities to stimulate dendritic cells and to induce major histocompatibility complex (MHC) class I restricted T cell responses against OVA. Interestingly, StII exhibited similar abilities to LLO in vitro of inducing dendritic cells maturation, as measured by increased expression of CD40, CD80, CD86 and MHC-class II molecules, and of stimulating OVA cross-presentation to a CD8+ T cell line. Remarkably, using an ex vivo Enzyme-Linked ImmunoSpot Assay (ELISPOT) to monitor gamma interferon (INF-γ) producing effector memory CD8+ T cells, liposomal formulations containing either StII or LLO induced comparable frequencies of OVA-specific INF-γ producing CD8+ T cells in mice that were sustained in time. However, StII-containing liposomes stimulated antigen-specific memory CD8+ T cells with a higher potential to secrete IFN-γ than liposomes encapsulating LLO. This StII immunostimulatory property further supports its use for the rational design of T cell vaccines against cancers and intracellular pathogens. In summary, this study indicates that StII has immunostimulatory properties similar to LLO, despite being evolutionarily distant PFPs.