Core body temperatures of rats subjected to treadmill exercise to fatigue or exhaustion: The journal Temperature toolbox.

This study systematically reviewed the literature reporting the changes in rats' core body temperature (TCORE) induced by either incremental- or constant-speed running to fatigue or exhaustion. In addition, multiple linear regression analyses were used to determine the factors contributing to the TCORE values attained when exercise was interrupted. Four databases (EMBASE, PubMed, SPORTDiscus, and Web of Science) were searched in October 2021, and this search was updated in August 2022. Seventy-two studies (n = 1,538 rats) were included in the systematic review. These studies described heterogeneous experimental conditions; for example, the ambient temperature ranged from 5 to 40°C. The rats quit exercising with TCORE values varying more than 8°C among studies, with the lowest and highest values corresponding to 34.9°C and 43.4°C, respectively. Multiple linear regression analyses indicated that the ambient temperature (p < 0.001), initial TCORE (p < 0.001), distance traveled (p < 0.001; only incremental exercises), and running speed and duration (p < 0.001; only constant exercises) contributed significantly to explaining the variance in the TCORE at the end of the exercise. In conclusion, rats subjected to treadmill running exhibit heterogeneous TCORE when fatigued or exhausted. Moreover, it is not possible to determine a narrow range of TCORE associated with exercise cessation in hyperthermic rats. Ambient temperature, initial TCORE, and physical performance-related variables are the best predictors of TCORE at fatigue or exhaustion. From a broader perspective, this systematic review provides relevant information for selecting appropriate methods in future studies designed to investigate exercise thermoregulation in rats.

Sigmoid resection and primary anastomosis for perforated diverticulitis with peritonitis: To divert or not to divert-A systematic review and meta-analysis.

BACKGROUND: The role of proximal diversion in patients undergoing sigmoid resection and primary anastomosis for diverticulitis with generalized peritonitis is unclear. The aim of this study was to compare the clinical outcomes of sigmoid resection and primary anastomosis and sigmoid resection and primary anastomosis with a proximal diversion in perforated diverticulitis with diffuse peritonitis. METHOD: A systematic literature search on sigmoid resection and primary anastomosis and sigmoid resection and primary anastomosis with proximal diversion for diverticulitis with diffuse peritonitis was conducted in the Medline and EMBASE databases. Randomized clinical trials and observational studies reporting the primary outcome of interest (30-day mortality) were included. Secondary outcomes were major morbidity, anastomotic leak, reoperation, stoma nonreversal rates, and length of hospital stay. A meta-analysis of proportions and linear regression models were used to assess the effect of each procedure on the different outcomes. RESULTS: A total of 17 studies involving 544 patients (sigmoid resection and primary anastomosis: 287 versus sigmoid resection and primary anastomosis with proximal diversion: 257) were included. Thirty-day mortality (odds ratio 1.12, 95% confidence interval 0.53-2.40, P = .76), major morbidity (odds ratio 1.40, 95% confidence interval 0.80-2.44, P = .24), anastomotic leak (odds ratio 0.34, 95% confidence interval 0.099-1.20, P = .10), reoperation (odds ratio 0.49, 95% confidence interval 0.17-1.46, P = .20), and length of stay (sigmoid resection and primary anastomosis: 12.1 vs resection and primary anastomosis with diverting ileostomy: 15 days, P = .44) were similar between groups. The risk of definitive stoma was significantly lower after sigmoid resection and primary anastomosis (odds ratio 0.05, 95% confidence interval 0.006-0.35, P = .003). CONCLUSION: Sigmoid resection and primary anastomosis with or without proximal diversion have similar postoperative outcomes in selected patients with diverticulitis and diffuse peritonitis. However, further randomized controlled trials are needed to confirm these results.

Determinants of body core temperatures at fatigue in rats subjected to incremental-speed exercise: The prominent roles of ambient temperature, distance traveled, initial core temperature, and measurement site.

Understanding the factors that underlie the physical exercise-induced increase in body core temperature (TCORE) is essential to developing strategies to counteract hyperthermic fatigue and reduce the risk of exertional heatstroke. This study analyzed the contribution of six factors to TCORE attained at fatigue in Wistar rats (n = 218) subjected to incremental-speed treadmill running: ambient temperature (TAMB), distance traveled, initial TCORE, body mass, measurement site, and heat loss index (HLI). First, we ran hierarchical multiple linear regression analyses with data from different studies conducted in our laboratory (n = 353 recordings). We observed that TAMB, distance traveled, initial TCORE, and measurement site were the variables with predictive power. Next, regression analyses were conducted with data for each of the following TCORE indices: abdominal (TABD), brain cortex (TBRAIN), or colonic (TCOL) temperature. Our findings indicated that TAMB, distance traveled (i.e., an exercise performance-related variable), initial TCORE, and HLI predicted the three TCORE indices at fatigue. Most intriguingly, HLI was inversely related to TABD and TBRAIN but positively associated with TCOL. Lastly, we compared the temperature values at fatigue among these TCORE indices, and the following descendent order was noticed - TCOL, TABD, and TBRAIN - irrespective of TAMB where experiments were conducted. In conclusion, TCORE in rats exercised to fatigue depends primarily on environmental conditions, performance, pre-exercise TCORE, and measurement site. Moreover, the influence of cutaneous heat loss on TCOL is qualitatively different from the influence on TABD and TBRAIN, and the temperature values at fatigue are not homogenous within the body core.

Aprendizaje automático aplicado en área de la salud: parte 2 / Machine Learning In Healthcare: part 2

En el artículo anterior se introdujo el tema y se desarrolló cómo es la recolección y análisis de datos, la selección y entrenamiento de modelos de aprendizaje automático supervisados y los métodos de validación interna que permiten corroborar si el modelo arroja resultados similares a los de otros conjuntos de entrenamiento y de prueba. En este artículo continuaremos con la descripción de la evaluación del rendimiento, la selección del modelo más adecuado para identificar la característica que se va a evaluar y la validación externa del modelo. Además, el artículo resume los desafíos existentes en la implementación del Machine Learning desde la investigación al uso clínico. (AU)

In the previous article, we introduced topics such as data collection and analysis, selection and training of supervised machine learning models and methods of internal validation that allow to corroborate whether the model yields similar results to other training and test sets.In this article, we will continue with the description of the performance evaluation, selecting the most appropriate model to identify the characteristic to evaluate and the external validation of the model. In addition, the article summarizes the actual challenges in the implementation of machine learning from research to clinical use. (AU)

Indocyanine green (ICG) fluorescence imaging for prevention of anastomotic leak in totally minimally invasive Ivor Lewis esophagectomy: a systematic review and meta-analysis.

BACKGROUND: Indocyanine green (ICG) fluorescence imaging is an emerging technology that might help decreasing anastomotic leakage (AL) rates. The aim of this study was to determine the usefulness of ICG fluorescence imaging for the prevention of AL after minimally invasive esophagectomy with intrathoracic anastomosis. METHODS: A systematic literature review of the MEDLINE and Cochrane databases was performed to identify all articles on totally minimally invasive Ivor Lewis esophagectomy. Studies were then divided into two groups based on the use or not of ICG for perfusion assessment. Primary outcome was anastomotic leak. Secondary outcomes included operative time, ICG-related adverse reactions, and mortality rate. A meta-analysis was conducted to estimate the overall weighted proportion and its 95% confidence interval (CI) for main outcomes. RESULTS: A total of 3,171 patients were included for analysis: 381 (12%) with intraoperative ICG fluorescence imaging and 2,790 (88%) without ICG. Mean patients' age and proportion of males were similar between groups. Mean operative time was also similar between both groups (ICG: 354.8 vs. No-ICG: 354.1 minutes, P = 0.52). Mean ICG dose was 12 mg (5-21 mg). No ICG-related adverse reactions were reported. AL rate was 9% (95% CI, 5-17%) and 9% (95% CI, 7-12%) in the ICG and No-ICG groups, respectively. The risk of AL was similar between groups (odds ratio 0.85, 95% CI 0.53-1.28, P = 0.45). Mortality was 3% (95% CI, 1-9%) in patients with ICG and 2% (95% CI, 2-3%) in those without ICG. Median length of hospital stay was also similar between groups (ICG: 13.6 vs. No-ICG: 11.2 days, P = 0.29). CONCLUSION: The use of ICG fluorescence imaging for perfusion assessment does not seem to reduce AL rates in patients undergoing minimally invasive esophagectomy with intrathoracic anastomosis.

High-volume center analysis and systematic review of stump appendicitis: solving the pending issue.

PURPOSE: Stump appendicitis (SA) is a rare long-term complication after laparoscopic appendectomy (LA) that can be associated with high morbidity due to delayed diagnosis. We aimed to determine the incidence, risk factors, diagnosis, and management of SA by reviewing our large cohort of LA and performing a systematic review of the literature. METHODS: We retrospectively reviewed data of all patients who developed SA after LA between 2006 and 2020. Demographics, peri-operative variables, and postoperative outcomes were analyzed. A systematic review of the PubMed/MEDLINE, Embase and GoogleScholar bibliographic databases was also performed to identify publications regarding SA following LA. RESULTS: A total of 2,019 patients underwent LA; 5 (0.25%) developed SA after a median of 292 days. The most common symptom at presentation was right lower quadrant pain. Four SA (80%) occurred in patients with a history of complicated appendicitis at index operation. All patients were diagnosed with computed tomography and underwent completion stump appendectomy by laparoscopy. No postoperative complications were recorded. A total of 55 studies with 76 cases of SA after LA were identified in the systematic review. Most SA (98.7%) underwent surgery: 52% by laparoscopic approach and 36% through an open approach. Stump appendectomy was performed in 94.4% cases and an extended resection in 5.6%. CONCLUSION: Although SA is a rare complication after LA, a high index of clinical suspicious and imaging studies are key for early diagnosis and treatment. A laparoscopic resection of the inflamed appendiceal stump is feasible, safe, and highly effective. A minority of patients with severe cecum compromise may need extended resections or conversion to open surgery.

Aprendizaje automático aplicado en área de la salud: parte 1 / Machine learning in healthcare: part 1

Este será el primero de dos artículos donde se tratarán los pasos necesarios para desarrollar un proyecto de aplicación de técnicas de Machine Learning en Salud, que introduce nociones sobre la recolección y análisis de datos, la selección y entrenamiento de modelos de aprendizaje auto-mático de tipo supervisado y los métodos de validación interna para cada modelo. (AU)

This will be the first of two articles where the steps needed to apply machine learning methods in healthcare will be discussed. It will introduce fundamental notions about data collection, selection and training of supervised ML models as well as the methods of internal validation. In a second article, we will discuss about the performance evaluation to select the most appropriate model and its external validation. (AU)

Multifocal Nodular Fatty Infiltration of the Liver: A Rare Benign Disorder That Mimics Metastatic Liver Disease.

Fatty liver disease is a frequent diagnosis. Rarely, it adopts a multifocal nodular pattern mimicking multiple liver metastases. Multifocal nodular fatty infiltration of the liver entails a challenging problem that must be included as a differential diagnosis when dealing with healthy patients with an incidental finding of multiple liver lesions, even in the absence of obesity or metabolic syndrome. A complete clinical examination and high-quality imaging, including magnetic resonance imaging, might help to confirm diagnosis and to avoid unnecessary liver biopsies.

Laparoscopic resection and primary anastomosis for perforated diverticulitis: with or without loop ileostomy?

BACKGROUND: Evidence is growing about the benefits of laparoscopic resection with primary anastomosis (RPA) in perforated diverticulitis. However, the role of a diverting ileostomy in this setting is unclear. The aim of this study was to analyze the outcomes of laparoscopic RPA with or without a proximal diversion in Hinchey III diverticulitis. METHODS: This is a retrospective analysis of patients undergoing laparoscopic sigmoidectomy for perforated Hinchey III diverticulitis during the period 2000-2019. The sample was divided into two groups: RPA without diversion (G1) and RPA with protective ileostomy (G2). Primary outcomes of interest were 30-day overall morbidity, mortality, length of hospital stay (LOS), and urgent reoperation rates. Secondary outcomes of interest included operative time, readmission, and anastomotic leak rates. RESULTS: Laparoscopic RPA was performed in 94 patients: 76 without diversion (G1) and 18 with proximal loop ileostomy (G2). Mortality (G1: 1.3% vs. G2: 0%, p = 0.6), urgent reoperation (G1: 7.9% vs. G2: 5.6%, p = 0.73), and anastomotic leak rates (G1: 5.3% vs. G2: 0%, p = 0.32) were comparable between groups. Higher overall morbidity (G1: 27.6% vs. G2: 55.6%, p = 0.02) and readmission rates (G1: 1.3% vs. G2: 11.1%, p = 0.03), and longer LOS (G1: 6.3 vs. G2: 9.2 days, p = 0.02) and operative time (G1: 182.4 vs. G2: 230.2 min, p = 0.003) were found in patients with proximal diversion. CONCLUSION: Laparoscopic RPA had favorable outcomes in selected patients with Hinchey III diverticulitis. The addition of a proximal ileostomy resulted in increased morbidity, readmissions, and length of stay. Further investigation is needed to establish which patients might benefit from proximal diversion.

Long-term outcomes after bilateral transabdominal preperitoneal (TAPP) repair for asymptomatic contralateral inguinal hernia.

BACKGROUND: Surgical management of an asymptomatic inguinal hernia is controversial but given that most of the patients will develop symptoms, the hernioplasty seems to be a reasonable option. We aimed to compare postoperative outcomes after transabdominal preperitoneal (TAPP) repair between patients with symptomatic bilateral hernia (SBH) and patients with one symptomatic hernia and an asymptomatic contralateral hernia (ACH). METHODS: A consecutive series of patients undergoing bilateral laparoscopic TAPP from July 2014 to June 2018 were included. Symptomatic hernia was defined as a groin bulge associated to pain and altered patient's daily activities. Patients were divided into two groups, those with SBH and those with one symptomatic hernia in whom an ACH was diagnosed by physical examination or ultrasound when clinical assessment was inconclusive. Demographics, operative, and postoperative outcomes were compared. Quality of life (QoL) was assessed before and after surgery in both groups. RESULTS: A total of 305 bilateral TAPP repairs were included; 102 (33, 4%) patients had SBH and 203 (66, 6%) had ACH. There were no significant differences between groups regarding age, gender, body mass index, active smoking, and comorbidities. Operative time (SBH: 125 vs. ACH: 132 min, p = 0.13) and overall 30-day morbidity were similar between groups (SBH: 14, 7% vs. ACH: 13, 8%, p = 0.82). After a mean follow-up of 30 (10-48) months, the recurrence rate was 1, 4% and 2, 2% in SBH and ACH, respectively (p = 0.53). QoL after surgery improved significantly and similarly in both groups. CONCLUSION: Bilateral laparoscopic TAPP in the setting of an asymptomatic hernia did not increase morbidity and had similar outcomes when compared to patients with bilateral symptoms. A comprehensive preoperative evaluation of the contralateral groin should be routinely performed, mainly by physical examination, and a bilateral repair may be proposed if an asymptomatic contralateral hernia is detected.

Incidence and risk factors for umbilical trocar site hernia after laparoscopic TAPP repair. A single high-volume center experience.

BACKGROUND: Trocar site hernia (TSH) is often underestimated after minimally invasive surgery. Scarce information is available about the incidence of TSH in patients undergoing laparoscopic hernioplasty. We aimed to evaluate the incidence and risk factors of umbilical TSH after laparoscopic TAPP hernioplasty in patients with and without an associated umbilical hernia. METHODS: A retrospective analysis of a prospectively collected database of all patients who underwent laparoscopic inguinal TAPP repair during 2013-2018 was performed. After TAPP repair, the umbilical fascia was closed either by a figure-of-eight stitch with absorbable suture (G1) or by umbilical hernioplasty if it was present (G2). Multivariate logistic regression analysis was used to determine the TSH risk factors. Comparative evaluation regarding demographics, and operative and postoperative variables was performed. RESULTS: A total of 535 laparoscopic TAPP repairs were included. There were 359 (67.1%) patients in G1 and 176 in G2 (32.9%). Surgical site infection was higher in G2 (G1: 0.6% vs G2: 5.7%, p = 0.001). Overall TSH rate was 3.9% after a mean follow-up of 20 (12-41) months. Performing a concomitant umbilical repair significantly increased the risk of umbilical TSH (G1: 2.2% vs G2: 7.4%, p = 0.004). TSH rates in G2 were similar in patients with simple suture or mesh repairs (p = 0.88). Rectus abdominis diastasis (OR 37.8, 95% CI:8.22-174.0, p < 0.001) and inguinal recurrence (OR 13.5, 95% CI:2.04-89.5, p = 0.007) were independent risk factors for TSH. CONCLUSION: Although trocar site hernia after laparoscopic TAPP repair has a low incidence, its risk is significantly increased in patients with a concomitant umbilical hernia repair, rectus abdominis diastasis, and/or inguinal recurrence.

Laparoscopic Appendectomy Performed by Surgical Interns: Is it Too Early?

BACKGROUND: Laparoscopic appendectomy (LA) is a common procedure among surgical trainees. However, first-year residents' involvement in this procedure is scarcely studied. We aimed to determine the safety and outcomes of LA performed by surgical interns early in their first year of surgical training. MATERIALS AND METHODS: A retrospective review of all patients who underwent LA for acute appendicitis from 2006 to 2019 was performed. All patients operated by surgical interns were included. The sample was divided into 2 groups: LA performed during the first (G1) and last 3 months (G2) of their first year of residency. Demographics, operative variables, and postoperative outcomes were compared between groups. RESULTS: A total of 2009 LA were performed during the study period; 1647 (82%) were done by surgical interns. A total of 934 LA were performed at both ends of the year; 505 belonged to G1 and 429 to G2. Each surgical intern performed a mean of 40 LA. Demographics, complicated appendicitis rates, and presence of peritonitis were comparable between groups. Operative time was longer in G1 (G1: 61 vs. G2: 52 min, P<0.0001). Major morbidity (G1: 2.1% vs. G2: 3.4%, P=0.2), postoperative intra-abdominal abscess rates (G1: 2.8% vs. G2: 2.8%, P=0.66), median length of hospital stay (G1: 1.9 vs. G2: 1.8 d, P=0.59), and readmission rates (G1: 1.6% vs. G2: 2%, P=0.73) were similar between groups. There was no mortality in the series. CONCLUSIONS: LA can be safely performed by supervised surgical interns early in their training. Despite a longer operative time, postoperative outcomes were favorable and similar as those achieved at the end of surgical internship.

Risk Factors for Readmission After Short-Hospital-Stay Laparoscopic Appendectomy.

BACKGROUND: Single-day discharge is a common practice among patients undergoing laparoscopic appendectomy (LA). We aimed to determine risk factors associated with readmission in patients with short hospital stay after LA. METHODS: We performed a retrospective analysis of all patients who underwent LA during the period 2006-2019. Patients with length of hospital stay shorter than 24 h were included. Demographics, operative variables, and postoperative outcomes were analyzed. Multivariable logistic regression was performed to determine risk factors for readmission. RESULTS: A total of 2009 LA were performed during the study period; 1506 (75%) patients had short hospital stay and were included in the analysis. Median age was 31 (14-85) years, and 720 (48%) were female. Mild peritonitis was diagnosed in 423 (28%) patients, and 121 (8%) had gangrenous/perforated appendicitis. Mean surgical time was 51(14-180) min. Conversion rate was 0.4%. There were 143 (9%) postoperative complications, including 29 (1.9%) patients with postoperative intra-abdominal abscess. Nine patients (0.6%) underwent reoperation, and only 26 (1.7%) patients were readmitted. The mean time to hospital readmission was 6 (1-14) days. Although age >50 years, obesity, mild peritonitis, and complicated appendicitis were more frequent among patients readmitted, only age >50 years (OR 3.54 95% CI 1.51-8.30) and mild peritonitis (OR 6.16 95% CI 1.80-34.93) were found as independent risk factors for readmission. CONCLUSION: Most patients undergoing LA can be safely discharged within 24 h of admission. Patients over 50 years old and/or with localized peritonitis have significantly higher risk of readmission and therefore may need a closer postoperative follow-up.

Is the Clinician's Eye a Valid and Reproducible Tool for Diagnosing Patella Alta on a Lateral Knee Radiography?

INTRODUCTION: Validity and reproducibility of the clinician's eye (CE) to diagnose patella alta (PA) on a lateral knee radiography (radiograph) is unknown. METHODS: Cross-sectional study of 46 lateral knee x-rays. Three blind observers used CE, Insall-Salvati (IS), modified Insall-Salvati (mIS), and Caton-Deschamps (C-D) to determine patellar height. Sensitivity and specificity of each observer was compared with the musculoskeletal radiologist's C-D measurements. Intraobserver and interobserver agreement were assessed with intraclass correlation coefficient and Fleiss κ, respectively. Time needed to estimate patellar height for every method was recorded in seconds. Statistical differences between observers were calculated with a generalized estimating equation. Analysis of variance and post hoc Bonferroni test compared duration of each method (P < 0.05). Data were analyzed using Stata 15 (StataCorp). RESULTS: CE, IS, mIS, and C-D's sensitivity and specificity values are as follows: 77%, 92%; 94%, 52%; 67%, 58%; and 53%, 89%, respectively. Intraclass correlation coefficient and Fleiss κ of CE, IS, mIS, and C-D values are as follows: 0.66 and 0.43, 0.88 and 0.68, 0.54 and 0.09, and 0.68 and 0.59, respectively. CE was the second most sensitive and most specific method for diagnosis of PA, with moderate intraobserver and interobserver agreement. IS was the most sensitive method with good intraobserver and interobserver agreement. CE was significantly faster (P < 0.05) than all other conventional radiographic ratios. CONCLUSION: CE's sensitivity increases with observer's experience and is highly specific. If normal patellar height is diagnosed, no other ratios are necessary, even in the less experienced clinician. Intraobserver and interobserver reproducibilities were moderate and only inferior to the IS ratio. In case patellar height is uncertain with the CE, the IS ratio is the most sensitive and reproducible method to confirm the diagnosis of PA.

Management of paraesophageal hernia review of clinical studies: timing to surgery, mesh use, fundoplication, gastropexy and other controversies.

Despite paraesophageal hernias (PEH) being a common disorder, several aspects of their management remain elusive. Elective surgery in asymptomatic patients, management of acute presentation, and other technical aspects such as utilization of mesh, fundoplication or gastropexy are some of the debated issues. The aim of this study was to review the available evidence in an attempt to clarify current controversial topics. PEH repair in an asymptomatic patient may be reasonable in selected patients to avoid potential morbidity of an emergent operation. In acute presentation, gastric decompression and resuscitation could allow to improve the patient's condition and refer the repair to a more experienced surgical team. When surgical repair is decided, laparoscopy is the optimal approach in most of the cases. Mesh should be used in selected patients such as those with large PEH or redo operations. While a fundoplication is recommended in the majority of patients to prevent postoperative reflux, a gastropexy can be used in selected cases to facilitate postoperative care.