[Ambulatory laparoscopic cholecystectomy by minilaparoscopy versus traditional multiport ambulatory laparoscopic cholecystectomy. Prospective randomized trial]. / Colecistectomía laparoscópica ambulatoria por minilaparoscopia versus colecistectomía laparoscópica ambulatoria multipuerto tradicional. Estudio prospectivo aleatorizado.

OBJECTIVE: Difference analysis of ambulatorization rate, pain, analgesic requirements and daily activities recovery in patients undergoing laparoscopic cholecystectomy with standard multiport access (CLMP) versus a minilaparoscopic, 3mm size, technique. METHODS: Prospective randomized trial of 40 consecutive patients undergoing laparoscopic cholecystectomy. Comparison criteria included predictive ultrasound factors of difficult cholecystectomy, previous history of complicated biliary disease and demographics. Results are analyzed in terms of ambulatorization rate, pain, analgesic requirements, postoperative recovery, technical difficulty, hemorrhage intensity, overnight stay, readmission rate and total or partial conversion. RESULTS: Both procedures were similar in surgery time, technical score and hemorrhage score. MLC was associated with similar ambulatorization rate, 85%, and over-night stay 15%, with only 15% partial conversion rate. MLC showed less postoperative pain (P=.026), less analgesic consumption (P=.006) and similar DAR (P=.879). CONCLUSIONS: MLC is similar to CLMP in terms of ambulatorization with less postoperative pain and analgesic requirements without differences in postoperative recovery.

[The first experiences with colorectal laparoscopic surgery in Spain. Valencia, November 1991]. / Las primeras experiencias en cirugía laparoscópica de colon en España. Valencia, noviembre de 1991.

The development of laparoscopic colon surgery in Spain has spread quickly since its beginnings at the end of 1991. Colorectal Minimally Invasive Surgery is widely implemented and has changed the way we treat our patients, specially due to the short-term advantages such as lower morbidity with a better quality of life with the same oncological outcomes in the long term. A huge number of Spanish surgeons have contributed to the implementation of techniques and spreading the knowledge of these concepts by means of courses, controlled randomized studies, scientific papers, and books, and have obtained international recognition.

Forecasting the ecological footprint of G20 countries in the next 30 years.

The Ecological Footprint evaluates the difference between the availability of renewable resources and the extent of human consumption of these resources. Over the past few decades, historical records have shown an accelerated decline in the availability of resources. Based on national footprint and biocapacity accounts, this analysis aims to advance the forecasting of the G20 countries' ecological footprints over a 30-year time frame. We employed a time series forecasting approach implemented in Python, which included-modular regression (Prophet) and Autoregressive Integrated Moving Average (ARIMA & Auto-ARIMA) methods. We evaluated and combined the performance of these three methods. The results indicated that among the largest economies of the G20, only four countries are projected to have a positive ecological footprint balance by 2050. These countries share the common denominator of large land areas and a moderate population growth projection. However, the overall trend of the indicator suggests that it will continue to decline.

Diverse sources of fecal contamination in macroalgae wrack-affected environment adjacent to river outflow along the Baltic Sea coast.

We investigated the dynamics of feces-associated microorganisms in areas with wrack accumulation in the southeastern part of the Baltic Sea. Our study covered single-day (2021 ) and multi-day (2022) observations during the recreational season. We collected water, sand, and wrack samples and assessed the abundance of fecal indicator bacteria (FIB), as well metagenomic analysis was conducted to monitor changes in microbial composition. Based on metagenomic data we identified taxa associated with feces, sewage, and ruminant sources. Human-related fecal pollution based on genetic markers correlated with the presence of Lachnospiraceae, Prevotellaceae and Rickenellacea abundance. Higher abundance and diversity of feces-associated and ruminant-associated taxa and the presence of enteric pathogens were observed when wrack accumulated near the river outflow in 2021, suggesting a potential link with fecal pollution from the river. As a preventive measure, it is recommended to remove the wrack to reduce the risk of exposure to potential enteric pathogens if it is accumulated next to the river outflow.

Microbial Composition Dynamics in Peloids Used for Spa Procedures in Lithuania: Pilot Study.

Despite peloids' acknowledged therapeutic and cosmetic potential, there remains a limited understanding of their microbial diversity and dynamics, especially concerning beneficial and non-beneficial microorganisms under different heating conditions. Our study employs both cultivation and metagenomic methods to assess the microbiota of peloids, focusing on lake sapropel and peat under heating conditions recommended for external application and safety assurance. By applying microbial indicators specified in national regulatory documents, we found that all peloids reached thresholds for sulphite-reducing clostridia and colony-forming units. Each peloid exhibited a distinctive bacterial composition based on metagenomic analysis, and temperature-induced changes were observed in microbial diversity. We identified beneficial bacteria potentially contributing to the therapeutic properties of peloids. However, the same peloids indicated the presence of bacteria of human faecal origin, with a notably higher abundance of Escherichia coli, pointing to a potential source of contamination. Unfortunately, it remains unclear at which stage this contamination entered the peloids. The findings underscore the importance of monitoring and controlling microbial aspects in peloid applications, emphasising the need for measures to prevent and address contamination during their preparation and application processes.

[Evaluation of the gastrointestinal quality of life index as a system to prioritize patients on the waiting list for laparoscopic cholecystectomy]. / Evaluación del gastrointestinal quality of life index como sistema de selección para la priorización de pacientes en lista de espera de colecistectomía laparoscópica.

INTRODUCTION: We prospectively evaluated health-related quality of life (HRQoL) through the gastrointestinal quality of life index (GIQLI) as a system to prioritize patients on the waiting list for laparoscopic cholecystectomy (LC) and its correlation with a linear prioritization system developed in the General and Gastrointestinal Surgery Institute of Clínica Quirón in Valencia. MATERIAL AND METHODS: There were 100 consecutive patients who underwent elective outpatient LC. The main outcome measures consisted of: 1) assessment of the impact of the disease, measured through the GIQLI; 2) evaluation of an objective system based on technical scientific criteria; 3) evaluation of the utility of LC in improving HRQoL through the GIQLI by analyzing expected and obtained utility through the change ratio, and 4) analysis of the correlation between the objective linear system, HRQoL and utility. RESULTS: The GIQLI was useful in evaluating the impact of the disease. LC significantly improved HRQoL in both oligosymptomatic and symptomatic patients. The objective or clinical factors did not allow perceptions of the process to be evaluated or the impact on HRQoL to be measured or inferred. A prioritization system based on GIQLI scores allows patients to be selected according to the expected utility (worsening of HRQoL) and obtained utility (improvement in HRQoL) of CL. CONCLUSIONS: Prioritization systems should include utility to guarantee equity. The GIQLI shows the impact of the disease on the patient while the clinical/objective factors are unrelated to the expectation of prioritization. Prioritization systems should include both elements to maintain the balance between impact and appropriate indication.

[Ambulatory laparoscopic cholecystectomy. A cohort study of 1,600 consecutive cases]. / Colecistectomía laparoscópica ambulatoria. Estudio de cohortes de 1.600 casos consecutivos.

OBJECTIVE: A descriptive analysis of day-case laparoscopic cholecystectomy (ALC) in a cohort of 1,600 consecutive patients performed in Instituto de Cirugía y Aparato Digestivo (ICAD), Clínica Quirón de Valencia in the period 1997-2010. PATIENTS AND METHODS: Prospective observational study of 1,601 consecutive patients undergoing elective laparoscopic cholecystectomy (LC) provided by the regional health service and private health companies. MAIN MEASURES: Conversion rate, non-planned admissions, readmissions, surgery duration and demographics. RESULTS: ALC was successfully performed in 80.8% of cases. LC with over-night (ON) stay accounted for 13.4% of patients. Admission was necessary in 4.6%. Mortality was 0.13%, 0.08 in ALC and 0.5% in ON LC. Readmissions occurred in 2.1%, 1.6% in ALC group, 5.4% in ON stay and 4.2% in admission group. CONCLUSIONS: ALC is a reliable and safe procedure. Minimization of admission rates is the key for cost-effective optimization in the management of cholelithiasis. ALC should be considered as the reference standard in gallbladder stone disease treatment.

Responsible Leadership and Affective Organizational Commitment: The Mediating Effect of Corporate Social Responsibility.

Organizations and their leaders are challenged to assume a responsible behavior given the increase of corporate scandals and the deterioration of employee commitment. However, relatively few studies have investigated the impact of responsible leadership (RL) on employee commitment and the effect of corporate social responsibility (CSR) in this relationship. Using the social identity theory this article examined the mediating effect of CSR practices in the relationship between RL and affective organizational commitment (AOC). Data collection was done through a paper survey completed by 309 full-time Colombian employees. Structural equation modeling was used to analyze the data. The results showed that CSR fully mediated the influence of RL on AOC. Thus, RL is an effective mechanism to develop CSR practices that in turn increase the levels of AOC of employees.

[Pain, analgesic consumption and daily life activities recovery in patients undergoing ambulatory totally extra-peritoneal laparoscopic inguinal hernioplasty versus ambulatory Lichtenstein hernioplasty]. / Dolor percibido, consumo de analgésicos y recuperación de las actividades de la vida diaria en pacientes sometidos a hernioplastia inguinal ambulatoria laparoscópica tipo TEP versus hernioplastia Lichtenstein en régimen ambulatorio.

INTRODUCTION: Although the unique comparison standard of primary inguinal hernia repair is the Lichtenstein technique (LICH), totally extra-peritoneal (TEP) laparoscopic inguinal hernioplasty shows, although not systematically demonstrated, clear advantages as regards, perceived pain, analgesic use, and recovery of daily life activities. OBJECTIVE: To demonstrate the differences in perceived pain, analgesic use, and recovery of daily life activities between Lichtenstein hernioplasty and TEP laparoscopy. MATERIAL AND METHODS: A prospective, non-randomised observational study was conducted on 169 consecutive patients subjected to LICH vs TEP. The LICH was performed using local anaesthesia and sedation, and the TEP with general anaesthesia, both being performed as ambulatory surgery. The points of analysis included: analgesic use, level of perceived pain, and recovery of daily life activities. RESULTS: Analgesic use was less in the TEP group for post-operative day 4 and 5, similar to the perceived pain. As regards recovery of daily life activities, the significantly minimum differences were achieved on post-operative day 7 in favour of TEP. CONCLUSIONS: Our study shows a significant difference as regards perceived pain and analgesic use, as well as in the level of recovery of daily life activities, when comparing both groups. TEP hernioplasty should also be considered in the non-complicated primary unilateral inguinal hernia.

Domestic violence surveillance system: a model.

OBJECTIVE: To develop a domestic violence surveillance system. MATERIAL AND METHODS: The strategies included implementation of a standard digitalized reporting and analysis system along with advocacy with community decision makers, strengthening inter-institutional attention networks, consultation for constructing internal flow charts, sensitizing and training network teams in charge of providing health care in cases of domestic violence and supporting improved public policy prevention initiatives. RESULTS: A total of 6 893 cases were observed using 2004 and 2005 surveillance system data. The system reports that 80% of the affected were women, followed by 36% children under 14 years. The identified aggressors were mainly females' partners. The system was useful for improving victim services. CONCLUSIONS: Findings indicate that significant gains were made in facilitating the attention and treatment of victims of domestic violence, improving the procedural response process and enhancing the quality of information provided to policy-making bodies.

Identification of novel cryptic translocations involving IGH in B-cell non-Hodgkin's lymphomas.

Chromosomal rearrangements involving the immunoglobulin heavy chain gene (IGH) at 14q32 are observed in approximately 50% of patients with B-cell non-Hodgkin's lymphoma (NHL). The 5' end of the IGH gene is located within 8 kb of the telomeric repeats of 14q. Translocations involving the IGH locus and the telomeric band of a partner chromosome are difficult to identify, because most terminal bands of human chromosomes appear pale by conventional G-banding techniques. To determine whether there are cryptic translocations involving the IGH locus, we used dual-color fluorescence in situ hybridization (FISH) of 5' and 3' IGH genomic clones containing the variable sequences, or the J(H) and the 5' constant regions, respectively. We examined cells from 51 patients with B-cell NHL who had a normal karyotype (3 patients), clonal abnormalities not involving 14q32 (35 patients), or alterations of 14q32 other than recurring translocations, i.e., add(14)(q32) (13 patients). FISH detected 17 IGH translocations in 16 of 51 (31%) cases. Of the 13 cases with add(14)(q32), FISH identified the partner chromosome in 9 cases (69%; 3q27, 6 cases; 2p13, 19p13.3, and 18q21.3, 1 case each). Six of thirty-eight (16%) patients without visible alterations of 14q32 and 2 of 13 (15%) patients with an abnormality of one chromosome 14 had masked (5 patients) or cryptic IGH translocations (3 patients), involving 3q27 (3 patients), 5p15.3 (2 patients), 19p13.3 (3 patients), or 14q32 (1 patient; 1 patient had two rearrangements). We identified two novel, recurring, cryptic translocations: t(5;14)(p15.3;q32) (2 patients) and t(14;19)(q32;p13.3) (3 patients). In summary, FISH permitted the detection of cryptic or masked IGH rearrangements in approximately 20% of lymphoma cases without visible rearrangements of 14q32 analyzed retrospectively.

Identification of unstable sequences within the common fragile site at 3p14.2: implications for the mechanism of deletions within fragile histidine triad gene/common fragile site at 3p14.2 in tumors.

The FRA3B, at 3p14.2, lies within the fragile histidine triad (FHIT) gene and is the most highly expressed of the common fragile sites observed when DNA replication is perturbed by aphidicolin. Common fragile sites are highly unstable regions of the genome. Large intragenic deletions within FHIT, localized within the FRA3B sequences, have been identified in a variety of tumor cells. To characterize the FRA3B deletions in tumor cells and identify FRA3B sequences that are required for fragile site induction, we used microcell-mediated chromosome transfer to isolate hybrid cell clones that retain chromosome 3 homologues with various deletions within FRA3B. Detailed molecular mapping of the FHIT/FRA3B locus in the resultant hybrid cells revealed a complex pattern of instability within FRA3B. Each tumor cell line contained multiple chromosome 3 homologues with variable deletion patterns, often with discontinuous deletions, suggesting that the process of breakage and repair within FRA3B is an ongoing one. By comparing the approximate location of the breakpoints in the hybrid clones, we identified 11 recurring breakpoint/repair regions within the FRA3B. A comparison of the frequency of breaks/gaps within FRA3B in the hybrid clones with various deletions of FRA3B sequences revealed that the loss of FRA3B sequences does not reduce the overall rate of breakage and instability within the remaining FRA3B sequences. The majority of breaks occurred in the proximal portion of the FRA3B, in a 300-kb interval between exon 4 and the proximal 50 kb of intron 5. Our observations suggest that there is no single sequence within the FRA3B that influences breakage or recombination within this region; however, we cannot rule out the presence of multiple "hot spots" within the FHIT/FRA3B locus. Together, the results suggest that factors other than the DNA sequence per se are responsible for the formation of DNA breaks/gaps.

The learning curve in ambulatory laparoscopic cholecystectomy.

Whether laparoscopic cholecystectomy (LC) should be performed as an outpatient procedure is still under discussion. The aim of this study was to evaluate the influence of surgeon's experience in ambulatory management of LC. Three hundred eighty-one consecutive elective LCs were planned as outpatient procedures. An anesthetic protocol that includes free-opiates anesthesia, preemptive analgesia, and somatovisceral blockade was used. Percentages of ambulatory, overnight, and admitted patients were evaluated, and time series variation was also analyzed. Postoperative pain, nausea and vomiting incidence, postoperative recovery, and complications were examined. Two hundred ninety-one patients were strictly ambulatory (76.3%), 71 (18.6%) required overnight admission, and 19 (4.9%) were admitted. Percentage of ambulatory LC increased from 22% to 90% in 4 years of experience. Readmission rate was 0.01%. Free-opiates anesthetic techniques, preemptive analgesia, and somatovisceral blockade allowed us to obtain over 90% of ambulatory LC. The learning curve related to postoperative evaluation is crucial in obtaining those results.

[Surgical Complexity Classification Index (SCCI): a new patient classification system for clinical management of laparoscopic cholecystectomy]. / Indice de clasificación de complejidad quirúrgica (ICCQ): un nuevo sistema de clasificación de pacientes para la gestión clínica de la colecistectomía laparoscópica.

OBJECTIVE: To devise a classification system of patients subjected to elective laparoscopic cholecystectomy (LC) which will enable the degree of surgical difficulty and possible time in surgery to be correlated with clinical, ultrasound, associated comorbidity and age group variables. MATERIAL AND METHOD: A prospective observational study of 110 patients subjected to LC in which the SCCI (Surgical Complexity Classification Index) had been calculated. The SCCI was worked out from previous studies published on patient classification systems and complication predictive factors in patients subjected to LC. MAIN OUTCOME MEASURES: surgical technique difficulty score, length of surgical time, post-operative stay (ambulatory). RESULTS: The cut-off value that obtained a better classification of the patients was an SCCI > in whom the technique difficulty score was 13.2 +/- 3.6 and the duration of the surgery 51.9 +/- 31 compared with the SCCI < 5 subgroup, technical difficulty score 10.5 +/- 2.8 and the duration of the surgery 6.9 +/- 11.4 (p < 0.05). CONCLUSIONS: The SCCI enables the technical complexity of LC to be estimated and therefore appropriate risk management in the LC process together with improved clinical management of that process.