Perioperative outcomes and long-term quality of life after total pancreatectomy.

BACKGROUND: Total pancreatectomy is required to treat diseases involving the entire pancreas, and is characterized by high morbidity rates and impaired long-term quality of life (QoL). To date, risk factors associated with perioperative and long-term outcomes have not been determined fully. METHODS: Data from patients undergoing total pancreatectomy between 2000 and 2014 at two high-volume centres were analysed retrospectively to assess risk factors for major surgical complications. Short Form (SF) 36, European Organisation for Research and Treatment of Cancer QLQ-PAN26 and Audit of Diabetes Dependent questionnaires, as well as an original survey were used to investigate factors influencing QoL. RESULTS: A total of 329 consecutive patients underwent total pancreatectomy in the two centres. Overall, total pancreatectomy was associated with a morbidity rate of 59·3 per cent and a 30-day mortality rate of 2·1 per cent. Age over 65 years and long duration of surgery (more than 420 min) were independently associated with major complications (at least Clavien-Dindo grade III). QoL analysis was available for 94 patients (28·6 per cent) with a median follow-up of 63 (i.q.r. 20-109) months; the most common indication for total pancreatectomy in these patients was intraductal papillary mucinous neoplasms (46 per cent). Both physical (PCS) and mental (MCS) component summary scores of SF-36® were lower after total pancreatectomy compared with scores for a normative population (P = 0·020 and P < 0·001 respectively). Linear regression analysis showed that young age, abdominal pain and worse perception of body image were negatively associated with the PCS, whereas diabetes, sexual satisfaction and perception of body image affected MCS. CONCLUSION: Total pancreatectomy can be performed with acceptable morbidity and mortality rates. Older patients had a higher risk of postoperative complications but reported better QoL than younger patients.

ANTECEDENTES: La pancreatectomía total es una cirugía necesaria para tratar enfermedades que afectan a la totalidad el páncreas y se caracteriza por una alta morbilidad y una disminución de la calidad de vida (QoL) a largo plazo. Hasta la fecha, los factores de riesgo asociados a los resultados perioperatorios y a largo plazo no han sido completamente determinados. MÉTODOS: Los datos de los pacientes que se sometieron a una pancreatectomía total desde el año 2000 al 2015 en dos centros de alto volumen se analizaron retrospectivamente para evaluar los factores de riesgo de las complicaciones quirúrgicas mayores. Se utilizaron el SF-36, el EORTC-PAN-26, los cuestionarios ADD-QoL y una encuesta original para investigar los factores que afectan la QoL. RESULTADOS: Un total de 329 pacientes consecutivos se sometieron a una pancreatectomía total en los dos centros. En general, la pancreatectomía total se asoció a un 59,3% de morbilidad y un 2,1% de mortalidad a los 30 días. La edad > 65 años y el tiempo operatorio prolongado (> 420 minutos) se asociaron de forma independiente a las complicaciones Clavien-Dindo ≥ III. El análisis de QoL estuvo disponible en 94 (28,6%) de los pacientes con una mediana de seguimiento de 63 meses (rango intercuartílico 20-109) y la indicación más común fue una neoplasia papilar mucinosa intraductal (IPMN) (45,7%). Las puntuaciones del SF-36 fueron más bajas en ambos componentes sumatorios físico (PCS) y mental (MCS) (P = 0,002; P < 0,001) en comparación con una población normal. El modelo de regresión lineal mostró que la edad joven, el dolor abdominal y la peor percepción de la imagen corporal se asociaron negativamente con el PCS; mientras que la diabetes, la satisfacción sexual y la percepción de la imagen corporal afectaron al MCS. CONCLUSIÓN: Se puede realizar una pancreatectomía total con morbilidad y mortalidad aceptables. Los pacientes de mayor edad tienen un riesgo más elevado de complicaciones postoperatorias, pero presentaron mejor QoL que los pacientes más jóvenes.

Prognostic impact and implications of extracapsular lymph node involvement in colorectal cancer: a systematic review with meta-analysis.

BACKGROUND: The extranodal extension (ENE) of nodal metastasis (i.e. the extension of tumor cells through the nodal capsule into the perinodal adipose tissue) has recently emerged as an important prognostic factor in different types of malignancies. However, the tumor-node-metastasis (TNM) staging system for colorectal cancer does not consider it as a prognostic parameter. Therefore, we conducted a systematic review and meta-analysis to determine the prognostic role of ENE in patients with lymph node-positive colorectal cancer. MATERIALS AND METHODS: Two independent authors searched PubMed and SCOPUS until 7 January 2015 without language restrictions. Prospective studies reporting data on prognostic parameters in subjects with colorectal cancer, comparing participants with the presence of ENE (ENE+) versus only intranodal extension (ENE-) were eligible. Data were summarized using risk ratios (RRs) for the number of deaths/recurrences and hazard ratios (HRs) together with 95% confidence intervals (CIs) for time-dependent risk related to ENE+, adjusted for potential confounders. RESULTS: Thirteen studies including 1336 patients were identified with a median follow-up of 4.7 years. ENE was associated with a higher T stage and tumor grading. In addition, ENE was associated with a significantly increased risk of all-cause mortality (RR = 1.75; 95% CI 1.42-2.16, P < 0.0001, I(2) = 60%; HR = 1.69, 95% CI 1.32-2.17, P < 0.0001, I(2) = 46%) and of recurrence of disease (RR = 2.07, 95% CI 1.65-2.61, P < 0.0001, I(2) = 47%; HR = 2.31, 95% CI 1.54-3.44, P < 0.0001, I(2) = 48%). CONCLUSIONS: Based of these results, in colorectal cancer, ENE should be considered from the gross sampling to the pathology report, as well as in future oncologic staging systems.

Limited English Proficiency, Postoperative Complications, and Interpreter Use in Vascular Surgery Patients in Hawai'i.

A retrospective cohort analysis of inpatient and outpatient vascular surgery cases from 2014 to 2018 was conducted to analyze the relationship between limited English proficiency (LEP) and undesirable postoperative outcomes, and to evaluate interpreter use as part of culturally and linguistically appropriate services (CLAS). Propensity score matching and logistic regression models were used to examine the association of English proficiency with postoperative outcomes and chart review was done to examine CLAS provision. Of the 959 cases, 57 (6%) were LEP and had noticeably worse health status before surgery than non-LEP. The 57 cases include 51 patients who had a single vascular surgery and 3 patients who had 2 vascular surgeries (different medical encounter/visit). There was no statistically significant difference in postoperative outcomes between patients with LEP and without LEP. Males with LEP were significantly less likely than females to receive CLAS (P=.008). On the day of vascular surgery and/or the day informed surgical consent was obtained, 16% of patients with LEP received access to interpreters; 25% had no documentation about interpreter provision, and 59% had mixed language access (family, staff, or interpreter). The provision of interpreters might be influenced by providers' perceived ability to communicate with patients with LEP without an interpreter, ease of obtaining an interpreter, availability of family or ad-hoc interpreters, and patients' preferences. Future research should examine reasons for frequent use of untrained individuals and inform strategies to implement language services in line with national standards.

Assessment of Interaction of Human OCT 1-3 Proteins and Metformin Using Silico Analyses.

Metformin, a drug frequently used by diabetic patients as the first-line treatment worldwide, is positively charged and is transported into the cell through human organic cation transporter (hOCT 1-3) proteins. We aimed to mimic the cellular uptake of metformin by hOCT1-3 with various bioinformatics methods and tools. 3D structure of OCT1-3 proteins was predicted by considering the structures and function of these proteins. We predicted functional regions (active and ligand binding sites) of OCT1-3 and performed comparative bioinformatics analysis. The predicted structure of hOCT1-3 was then analyzed in the Blind Docking server and the results were confirmed with predicted binding site residues and conserved domain regions. We simulated the OCT1-3 and metformin docking and also validated the docking procedure with other substrates of HOCT1-3 proteins. We selected the best poses of metformin docking simulations as per binding energy (-5.27 to -4.60 kcal/mol). Lastly, we validated the static description of protein-ligand (OCT-Metformin) interactions by performing molecular dynamics simulation. Eventually, we obtained stable simulation of OCT-metformin interaction.

Extra-nodal extension of sentinel lymph node metastasis is a marker of poor prognosis in breast cancer patients: A systematic review and an exploratory meta-analysis.

Invasive breast cancer is the most common malignancy in women. Its most common site of metastasis is represented by the lymph nodes of axilla, and the sentinel lymph node (SLN) is the first station of nodal metastasis. Axillary SLN biopsy accurately predicts axillary lymph node status and has been accepted as standard of care for nodal staging in breast cancer. To date, the morphologic aspects of SLN metastasis have not been considered by the oncologic staging system. Extranodal extension (ENE) of nodal metastasis, defined as extension of neoplastic cells through the nodal capsule into the peri-nodal adipose tissue, has recently emerged as an important prognostic factor in several types of malignancies. It has also been considered as a possible predictor of non-sentinel node tumor burden in SLN-positive breast cancer patients. We sought out to clarify the prognostic role of ENE in SLN-positive breast cancer patients in terms of overall and disease-free survival by conducting a systematic review and meta-analysis. Among 172 screened articles, 5 were eligible for the meta-analysis; they globally include 624 patients (163 ENE+ and 461 ENE-) with a median follow-up of 58 months. ENE was associated with a higher risk of both mortality (RR = 2.51; 95% CI: 1.66-3.79, p < 0.0001, I(2) = 0%) and recurrence of disease (RR = 2.07, 95% CI: 1.38-3.10, p < 0.0001, I(2) = 0%). These findings recommend the consideration of ENE from the gross sampling to the histopathological evaluation, in perspectives to be validated and included in the oncologic staging.

Modificaciones de la curvatura posterior corneal después de la cirugía refractiva láser / Modifications in the corneal posterior curve after laser refractive surgery

OBJETIVO: Describir las modificaciones de la curvatura posterior corneal en pacientes sometidos a cirugía refractiva láser en el Instituto Cubano de Oftalmología Ramón Pando Ferrer en el período de mayo a octubre de 2010. MÉTODOS: Se realizó un estudio descriptivo, longitudinal y prospectivo, con un universo de 257 pacientes (504 ojos) sometidos a cirugía refractiva láser. La muestra quedó conformada por 31 pacientes (59 ojos). Se analizaron variables como edad, sexo, equivalente esférico, paquimetría preoperatoria, cantidad de ablación, estroma residual y diferencia de elevación posterior corneal, esta última obtenida del mapa de diferencia del topógrafo Galilei, con medición preoperatoria al mes y a los tres meses de la cirugía. Mediante análisis de regresión múltiple fueron valorados dichos cambios de la paquimetría, la cantidad de ablación y el estroma residual. RESULTADOS: El equivalente esférico, la paquimetría, la cantidad de ablación y el estroma residual se encontraron dentro de los parámetros de seguridad establecidos. La diferencia promedio de la elevación corneal posterior fue de 15,62 Ám al mes y de 11,78 Ám a los tres meses, con disminución significativa con el tiempo (p= 0,000). Se observó asociación con la paquimetría preoperatoria y el estroma residual, y se encontró una correlación inversa entre este último y la elevación corneal posterior a los tres meses. CONCLUSIONES: La cirugía refractiva láser induce un aumento precoz en la elevación corneal posterior, con disminución progresiva hacia el tercer mes. Los factores que más influyeron en estos cambios fueron el estroma residual y la paquimetría preoperatoria

OBJECTIVES: To describe the modifications in the corneal posterior curve in patients underwent laser refractive surgery in the Ramón Pando Ferrer Cuban Institute of Ophthalmology from May to October, 2020. METHODS: A prospective, longitudinal and descriptive study was conducted in an universe of 257 patients (504 eyes) underwent to laser refractive surgery. Sample included 31 patients (59 eyes). Variables analyzed were: age, sex, spherical equivalent, preoperative pachymetry, ablation amount, residual stroma and difference of corneal posterior elevation, this latter achieved from the difference map of Galilei topography, with preoperative measurement at month and at three months after surgery. By multiple regression analysis the changes of pachymetry, the ablation amount and the residual stroma were assessed. RESULTS: The spherical equivalent, the pachymetry, the ablation amount and the residual stroma were within the established safety parameters. The mean difference of posterior corneal elevation was of 15,62 ?m at three months, with a significant decrease in time (p= 0,000). There was association with preoperative pachymetry and the residual stroma and also an inverse correlation between this latter and the posterior corneal elevation at three months. CONCLUSIONS: The laser refractive surgery produces an early increase in the posterior corneal elevation with a progressive decrease at third month. The factors that more influenced in such changes were the residual stroma and the preoperative pachymetry

Diversidad genética en poblaciones humanas de dos regiones colombianas / Genetic diversity in human populations of two regions from Colombia

Introducción: Estudios preliminares han mostrado la existencia de relaciones genéticas entre las poblaciones humanas del sur-occidente y las de la región andina colombiana, teniendo esto implicaciones en el grado de miscegenación de estas comunidades. No obstante el reconocimiento de este amplio proceso de mestizaje, no se tiene suficiente información que permita establecer la estructura y el grado de diversidad genética para cada región en particular y de la población colombiana en general. Objetivo: Determinar la estructura y diversidad genética presente en grupos poblacionales del centro y sur-occidente colombiano. Metodología: Se analizaron las frecuencias alélicas de 12 sistemas de microsatélites autosómicos y el tipo y frecuencia de RFLPÆs de mtDNA presentes en 472 individuos de tres grupos étnicos: mestizos, indígenas y afroamericanos. Resultados: La caracterización de haplotipos de mtDNA en individuos afrodescendientes presentó 15% de marcadores típicos amerindios y 43% de africanos. El anßlisis de la diversidad genética mostró un índice de 0.72 en individuos Pijaos, valor cercano al índice de diversidad de la población mestiza de Cali (0.75). El analisis molecular de varianza (AMOVA) a partir de los 12 STRÆs, mostró que la estructuración genética no es significativa (FST de 0.032); adicionalmente se evidenció alta endogamia en la muestra mestiza de Caldas (0.43) y en la muestra indígena Coyaima (0.34).Conclusiones: Con los marcadores moleculares estudiados se estableció la estructura genética de poblaciones del sur-occidente colombiano confirmandose adicionalmente el grado de miscegenación y el flujo genético ocurrido entre diferentes grupos étnicos del centro y sur-occidente colombiano.

Introduction: Preliminary studies have showed close relations among southwest human populations and Andean region leaving it consequences in ethnic admixe process. However, this wide process of racial admixture today it is not exist sufficient information to define structure and genetic diversity for each region and Colombian population in general. Objectives: The principal goal from this study was to determinate the genetic structure and diversity present into human populations from Andean and Southwest Colombia regions. Methods: This study was realized by characterization allelic frequencies of 12 autosomal STRÆs and six RFLPÆs of mtDNA presents in 472 individuals from three ethnics groups: Caucasoids, Afroamericans and Amerindians. Results: mtDNA haplotypes presents in Afrodescends sample was 15% and 43% typical Amerindian and African markers respectively; the genetics diversity analysis shows a value of 0.72 in Pijao indigenous, these values are close to diversity index of mestizos from Cali (0.75). AMOVA of allelic frequencies from 12 STRÆs shows that genetic structures donÆt was significatively different (FST de 0.032); in addition itÆs to exhibit high endogamy in mestizos from Caldas sample (0.43) and Coyaima indigenous (0.34). Conclusions: was established genetic structure for southwest Colombian population. Additionally, the results confirm the mixing process and the genetics flow among many populations groups from Andean and southwest Colombia regions.

Tratamiento de la braquimetatarsia mediante elongación ósea con minifijador externo RALCA® / Treatment of brachymetatarsia through bone lengthening with RALCA® external mini-fixator

Se presentan los resultados de la elongación ósea con minifijador externo RALCA en una serie de 6 pacientes afectados de braquimetatarsia. Los pacientes fueron tratados en el Complejo Científico Ortopédico Internacional Frank País durante los años 2003 al 2007 (ambos inclusive). En 5 pacientes la afección fue bilateral por lo cual se trataron un total de 11 pies. En todos los casos la anomalía se localizó en el IV metatarsiano. Todos los pacientes pertenecen al sexo femenino y la edad promedio en el momento de la cirugía fue de 13,2 años. El alargamiento promedio logrado fue de 16 mm (12-21). El tiempo promedio de consolidación fue de 2,2 meses por cm de hueso elongado. En tres pies se presentaron complicaciones: retardo de consolidación, infección superficial en el trayecto de los alambres y contractura en flexión a nivel de la articulación metatarsofalángica del dedo correspondiente.

This paper presented the results of bone lengthening with RALCA external mini-fixator in a series of 6 cases with brachymetatarsia. The patients were treated at Frank País International Scientific Orthopedic Complex from 2003 to 2007. Five patients suffered from bilateral brachymetatarsia, so 11 feet were treated; the anomaly was located in the fourth metatarsal. All the patients were females aged 13,2 years as average at the time of surgery. The average lengthening was 16 mm (12-21). The average time of consolidation was 2,2 months per lengthened bone cm. Three feet presented with complications such as retardation in consolidation, surface infection in the wiring path and contracture on flexion at the corresponding toe´s metatarsal-phalangeal joint.

Les résultats de l'allongement osseux par mini-fixateur externe RALCA dans une série de 6 patients atteints de brachymétatarsie sont présentés dans ce travail. Les patients ont été traités au Complexe scientifique international d'orthopédie Frank Pais entre 2003 et 2007 (tous les deux années y compris). Cinq patients sur six étaient atteints de brachymétatarsie bilatérale, étant localisée dans tous les cas au niveau du 4ème métatarsien. Tous les patients ont été du sexe féminin, et l'âge moyen au moment de la chirurgie a été de 13,2 ans. L'allongement moyen a été de 16 mm (12-21). Le temps de consolidation moyen a été de 2,2 mois par cm. Il y a eu des complications chez trois patients: retard de la consolidation, infection légère sur le trajet des fils, et contracture en flexion au niveau de l'articulation métatarso-phalangienne du doigt concerné.

Prevalência e incidência de dor lombar entre bailarinos da Escola de Dança da Universidade Federal da Bahia / Prevalence and incidence of low back pain between dancers of the School of Dance at the Federal University of Bahia

A prevalência de dor lombar (DL) na população geral tem sido estudada por vßrios autores, porém estes estudos não são freqüentes na área de arte e esportes. O objetivo do presente estudo foi estabelecer evidências da freqüência da dor lombar entre dançarinos da Escola da Dança da UFBA. A metodologia empregada contemplou um estudo transversal prospectivo para determinar a prevalência de DL, e um estudo de coorte para estabelecer a incidência de DL. Para estabelecer a prevalência, foram avaliadas quatro amostras consecutivas e, para o estudo de incidência, uma coorte de n=27 alunos foi acompanhada durante três anos. Os resultados revelaram que, de acordo com o estimador intervalar e com uma confiabilidade de 95 por cento, a prevalência de DL máxima foi de 47 por cento. A incidência oscilou entre 30,4 por cento e 40,7 por cento. Conclui-se que a prevalência de DL entre dançarinos parece não ser maior do que a da população geral. Os índices de incidência de DL indicariam uma freqüência endêmica leve a moderada de DL nesta população de dançarinos.

Aspectos moleculares de la resistencia a pirazinamida en M. tuberculosis: implicancias para el desarrollo de nuevos métodos de diagnóstico y terapéutica / Molecular aspects of the resistance to pirazinamida in M. tuberculosis: implications for the development of new methods of diagnosis and therapeutics

Objetivo: Deseamos entender el polimorfismo del gen pirazinamidasa de M.tuberculosis en la población /peruana, y su correlación con las características ®estructura-función¼ de la enzima que codifica, para establecer los fundamentos moleculares del uso de técnicas de ADN para el diagnóstico de resistencia a PZA. Asimismo deseamos estudiar el efecto de altas concentraciones de Fe y Zn en la actividad enzimßtica de pncA como potenciadores de la terapia antituberculosa. Material y métodos: Hemos empleado la prueba MABA como la prueba referencia para comparar la técnica SSCP en la medición de la sus-ceptibilidada PZA. Adicionalmente hemos secuenciado el gen de pirazinamidasa de 20 cepas de M. tuberculosis y hemos determinado la actividad enzimßtica pirazinamidasa utilizando la prueba de Wayne. Para medir el efecto de los iones en la actividad enzimßtica, utilizamos la prueba de Wayne cuantitativa. Resultados: Hemos estudiado el polimorfismo del gen pncA utilizando secuenciamiento y el SSCP. Esta última técnica, sorprendentemente mostró unaimportante sensibilidad (92.9 por ciento y especificidad y un valor predictivo positivo de 93 por ciento para diagnosticar resistencia a PZA. Diversas mutaciones en el gen fueron detectadas en cepas resistentes a PZA,produciendo cambios de aminoßcidos asociados al sitio catalítico pero mayormente al sitio de coordinación del Zn, siendo la mutación D49N aparentemente la mßs prevalerte dentro de la población VIH positivos. Conclusiones: Las mutaciones mßs frecuentes asociadas a resistencia a PZA parecen afectar fundamentalmente la coordinación del Zn, frente a lo cual altas concentraciones de este ión, estimula la actividad pirazinamidasa, repotenciando el efecto de la PZA.

Pontas de diamantes-CVD / CVD diamond stones

Neste trabalho mostra-se através de testes rigorosos a grande superioridade de pontas de diamante-CVD em comparação com pontas de diamantes convencionais. As pontas de diamante CVD, um produto inédito, são obtidas através de uma nova tecnologia, que surgiu na última década, para a produção artificial de diamante. A tecnologia de disposição química a partir da fase vapor (CVD - Chemical Vapor Deposition) permite a deposição de diamante com granulação completamente coalescente, em substratos de diferentes formatos. A caracterização de pontas para uso odontológico se deu com uma granulação adequada, proporcionando um melhor desempenho. Testes de desgastes, para caracterização das pontas diamantadas, foram realizados em lâminas de vidro, makor e dentina. Mediu-se a velocidade do corte em função do tempo de vida das pontas. As técnicas de microscopia óptica e de microscopia eletrônica de varredura, foram utilizadas na determinação do desempenho global destes dispositivos. Foram, também, realizadas medidas de variação da temperatura in vitro, no interior da câmara pulpar em função do tempo de desgaste, tanto para as pontas de diamante-CVD como para as pontas diamantadas convencionais. Os resultados mostram uma durabilidade muito maior, uma melhor qualidade no acabamento, uma melhor limpeza da ponta e é garantido o contato do dente apenas com o diamante. Isto abre novas perspectivas na operacionalidade e na qualidade do trabalho