Nb-Based Catalysts for the Valorization of Furfural into Valuable Product through in One-Pot Reaction.

Nb-based catalysts supported on porous silica with different textural properties have been synthesized, characterized, and tested in the one-pot reaction of furfural to obtain valuable chemicals. The catalytic results reveal that the presence of fluoride in the synthesis, which limits the growing of the porous silica, limits diffusional problems of the porous silica, obtaining higher conversion values at shorter reaction times. On the other hand, the incorporation of NbOx species in the porous silica provides Lewis acid sites and a small proportion of Brönsted acid sites, in such a way that the main products are alkyl furfuryl ethers, which can be used as fuel additives.

Real-world clinical, psychosocial and economic burden of atopic dermatitis: Results from a multicountry study.

BACKGROUND: Atopic dermatitis (AD), a relapsing, inflammatory skin disease, is associated with pruritus that can negatively affect patients' quality of life. Understanding the burden of AD is critical for informing and tailoring treatment and disease management to improve patient outcomes. This study characterized global treatment patterns and the clinical, psychosocial and economic burden of moderate-to-severe AD. METHODS: MEASURE-AD was a cross-sectional 28-country study in patients with physician-confirmed moderate-to-severe AD who were either receiving or eligible for systemic therapy for AD. Patients ≥12 years were enrolled between December 2019 and December 2020 while attending routine office or clinic visit. Primary outcomes included Worst Pruritus Numeric Rating Scale (WP-NRS; range: 0-10) and Dermatology Life Quality Index (DLQI; range: 0-30) and Children's DLQI (CDLQI; range: 0-30). Secondary outcomes included physician- and patient-reported clinical, psychosocial and economic burden. RESULTS: Of the 1591 patients enrolled, 1558 (1434 adults and 124 adolescents) fulfilled all patient selection criteria and were included in this analysis. Almost all patients (98.4%) in the total population were using AD medications and more than half (56%) were receiving systemic medication (15% systemic monotherapy). The most used systemic therapies were dupilumab (56.3%), systemic glucocorticoids (18.1%) and methotrexate (16.2%). Mean WP-NRS was 5.3 in the total population, and most patients (≥55%) reported moderate-to-severe pruritus (WP-NRS ≥4). Mean DLQI was 10.8 and mean CDLQI was 9.6. Secondary endpoints demonstrated substantial clinical, psychosocial, and economic burden of disease. Subgroup analysis demonstrated that patients receiving systemic therapy had lower disease burden than those not taking systemic medications. CONCLUSIONS: While systemic therapy lowers overall disease burden, patients with moderate-to-severe AD continue to have substantial multidimensional disease burden and uncontrolled disease. Overall, there is a need for effective disease management, including effective treatments that improve patients' psychosocial outcomes and reduce the economic burden of AD.

Terminal efficiency, Lag and dropout in cohorts from 2007 to 2014 of dental students at the University of Costa Rica / Eficiencia terminal, rezago y abandono en las cohortes del 2007 al 2014 de estudiantes de Odontología de la Universidad de Costa Rica

Abstract Determine the terminal efficiency, lag and dropout in the cohorts of students who entered the dentistry career at the Faculty of Dentistry at University of Costa Rica in the lapse 2007 to 2014. Data from 736 files were collected. The variables considered were sex, admission age, nationality, marital status, children, admission note, domicile and high school. The data was collected from the Student Application System, the physical files, and the data base from the Supreme Court of Elections of Costa Rica. Descriptive statistics, bivariate and multivariate analysis were made, which were implemented from two logistic regression models. 98% of the students were Costa Rican, 68% women, 79% entered according to the admission note, 43% entered with an age of 18 years or less, 50% came from a public school, 77% resided in the Greater Metropolitan Area and 95% were single and remained without children. The average terminal efficiency was 6%; 46% of students have graduated with lag, 16% are still enrolled and 32% dropped out. Sex, age, admission note, and motherhood are sociodemographic variables that are associated with terminal efficiency and dropout. The average terminal efficiency in the cohorts from 2007 to 2014 in the courses at the Faculty of Dentistry University of Costa Rica was very low, almost half of the students graduated with lag and about a third dropped out the studies. The grade from the admission note seems to be a predictor of students'academic behavior, higher grade had more chances of graduating and less likely to dropout.

Resumen Determinar la eficiencia terminal, el rezago y el abandono en las cohortes de los estudiantes que ingresaron a la carrera de Odontología de la Facultad de Odontología UCR en el período 2007 al 2014. Se recopilaron los datos de 736 expedientes. Las variables consideradas fueron: sexo, edad de ingreso, nacionalidad, estado civil, hijos, lugar y colegio de procedencia, y nota de examen de admisión. Los datos se recopilaron del Sistema de Aplicaciones Estudiantiles, los expedientes físicos y del Tribunal Supremo de Elecciones de Costa Rica. Se realizó estadística descriptiva, análisis bivariado y multivariado que se implementó a partir de dos modelos de regresión logística. El 98% de los estudiantes fueron costarricenses, el 68% mujeres, el 79% ingresó según la nota de admisión, el 43% ingresó con una edad de 18 años o menos, el 50% provenía de un colegio público, el 77% residía en la gran área Metropolitana y el 95% eran solteros y permanecieron sin hijos. La eficiencia terminal en promedio fue de 6%; el 46% de los estudiantes se han graduado con rezago, el 16% continúan matriculados y el 32% hizo abandono de los estudios. El sexo, la edad, la nota del examen de admisión y la maternidad son variables sociodemográficas que se asocian con la eficiencia terminal y el abandono. El promedio de la eficiencia terminal en las cohortes del 2007 al 2014 en la carrera de Odontología de la Facultad de Odontología UCR fue muy bajo, casi la mitad de los estudiantes se han graduado con rezago y cerca de un tercio hizo abandono de los estudios. La nota del examen de admisión parece ser un predictor en el comportamiento académico de los estudiantes: a mayor nota más posibilidades de graduarse y menos de abandonar la carrera.

Sociodemographic and academic characteristics of the admission profile of students, faculty of dentistry, University of Costa Rica 2007-2014 / Características sociodemográficas y académicas del perfil de ingreso de estudiantes de la Facultad de Odontología de la Universidad de Costa Rica 2007-2014

The objective of this research was to determine some of the sociodemographic and academic characteristics of the students who entered the Dentistry career in the period 2007 to 2014. Data was collected from 673 student files. The variables considered were sex, admission age, marital status, children, nationality, place of origin, high school of origin, and admission exam score. The data was obtained from the database of the Student Applications System, the physical files, and the Supreme Electoral Tribunal of Costa Rica. Descriptive statistics were performed, establishing the absolute and relative frequency of the variables. The Mann-Whitney test was used to determine if there were statistically significant differences between the admission exam and the established sociodemographic variables (p<0,05, IC 95%). 68,4% of the students are female. The average age was 18.4 years (SD=2,41). 99,0% of the students are from Costa Rica. 99,3% were single and only 0,9% had children. The largest number of students entered through an admission exam (78.9%) and 50.7% studied at a public high school. Regarding the address, 77.9% of the subjects resided in the Greater Metropolitan Area. The average grade of the admission exam was 613,8 (SD=49,95). There was a statistically significant difference between the entrance exam grade and the different types of high schools of origin. The group of students who entered to train as Dentists at the University of Costa Rica from 2007 to 2014 was a population with an average age of entry of 18,4 years, Costa Rican, predominantly female, single, without children, from geographic areas within the Greater Metropolitan Area (GMA), graduated from public schools with an average admission exam grade of 612,2.

El objetivo de esta investigación fue determinar algunas de las características sociodemográficas y académicas de los estudiantes que ingresaron a la carrera de Odontología en el período 2007 al 2014. Se recopilaron los datos de 673 expedientes de los estudiantes. Las variables consideradas fueron: sexo, edad de ingreso, estado civil, hijos, nacionalidad, lugar de procedencia, colegio de procedencia y nota de examen de admisión. Los datos se obtuvieron de la base de datos del Sistema de Aplicaciones Estudiantiles (SAE), los expedientes físicos y del Tribunal Supremo de Elecciones de Costa Rica. Se realizó estadística descriptiva estableciendo la frecuencia absoluta y relativa de las variables. Se empleó el test de Mann Whitney para determinar si existían diferencias estadísticamente significativas entre el examen de admisión y las variables sociodemográficas establecidas (p<0,05, IC 95%). El 68,4% de los estudiantes pertenecen al sexo femenino. La edad promedio fue de 18,4 años (DS=2,41). El 99,0% de los discentes son de nacionalidad costarricense. El 99,3% eran solteros y sólo el 0,9% tenían hijos. La mayor cantidad de estudiantes ingresaron por examen de admisión (78,9%) y el 50,7% cursó sus estudios en un colegio público. Respecto al domicilio, el 77,9% de los sujetos residían en el Gran Área Metropolitana. El promedio de nota del examen de admisión fue de 613,8 (DS=49,95). Hubo una diferencia estadísticamente significativa entre la nota del examen de admisión y los diferentes tipos de colegios de procedencia. El grupo de estudiantes que ingresaron a formarse como Odontólogos en la Universidad de Costa Rica en el periodo de 2007 al 2014 fue una población con un promedio una edad de ingreso de 18,4 años predominantemente femenina, costarricense, soltera, sin hijos, proveniente de áreas geográficas dentro del Gran Área Metropolitana (GAM), egresadas de colegios públicos con un promedio de nota de examen de admisión de 612,2.

The Role of Copper in the Hydrogenation of Furfural and Levulinic Acid.

Currently, there is a great interest in the development of sustainable and green technologies for production of biofuels and chemicals. In this sense, much attention is being paid to lignocellulosic biomass as feedstock, as alternative to fossil-based resources, inasmuch as its fractions can be transformed into value-added chemicals. Two important platform molecules derived from lignocellulosic sugars are furfural and levulinic acid, which can be transformed into a large spectrum of chemicals, by hydrogenation, oxidation, or condensation, with applications as solvents, agrochemicals, fragrances, pharmaceuticals, among others. However, in many cases, noble metal-based catalysts, scarce and expensive, are used. Therefore, an important effort is performed to search the most abundant, readily available, and cheap transition-metal-based catalysts. Among these, copper-based catalysts have been proposed, and the present review deals with the hydrogenation of furfural and levulinic acid, with Cu-based catalysts, into several relevant chemicals: furfuryl alcohol, 2-methylfuran, and cyclopentanone from FUR, and γ-valerolactone and 2-methyltetrahydrofuran from LA. Special emphasis has been placed on catalytic processes used (gas- and liquid-phase, catalytic transfer hydrogenation), under heterogeneous catalysis. Moreover, the effect of addition of other metal to Cu-based catalysts has been considered, as well as the issue related to catalyst stability in reusing studies.

Utility of Differential White Cell Count and Cell Population Data for Ruling Out COVID-19 Infection in Patients With Community-Acquired Pneumonia

Introduction: The main aim of this study was to assess the utility of differential white cell count and cell population data (CPD) for the detection of COVID-19 in patients admitted for community-acquired pneumonia (CAP) of different etiologies. Methods: This was a multicenter, observational, prospective study of adults aged ≥18 years admitted to three teaching hospitals in Spain from November 2019 to November 2021 with a diagnosis of CAP. At baseline, a Sysmex XN-20 analyzer was used to obtain detailed information related to the activation status and functional activity of white cells. Results: The sample was split into derivation and validation cohorts of 1065 and 717 patients, respectively. In the derivation cohort, COVID-19 was confirmed in 791 patients and ruled out in 274 patients, with mean ages of 62.13 (14.37) and 65.42 (16.62) years, respectively (p<0.001). There were significant differences in all CPD parameters except MO-Y. The multivariate prediction model showed that lower NE-X, NE-WY, LY-Z, LY-WY, MO-WX, MO-WY, and MO-Z values and neutrophil-to-lymphocyte ratio were related to COVID-19 etiology with an AUC of 0.819 (0.790, 0.846). No significant differences were found comparing this model to another including biomarkers (p=0.18). Conclusions: Abnormalities in white blood cell morphology based on a few cell population data values as well as NLR were able to accurately identify COVID-19 etiology. Moreover, systemic inflammation biomarkers currently used were unable to improve the predictive ability. We conclude that new peripheral blood biomarkers can help determine the etiology of CAP fast and inexpensively. (AU)

Utility of Differential White Cell Count and Cell Population Data for Ruling Out COVID-19 Infection in Patients With Community-Acquired Pneumonia.

INTRODUCTION: The main aim of this study was to assess the utility of differential white cell count and cell population data (CPD) for the detection of COVID-19 in patients admitted for community-acquired pneumonia (CAP) of different etiologies. METHODS: This was a multicenter, observational, prospective study of adults aged ≥18 years admitted to three teaching hospitals in Spain from November 2019 to November 2021 with a diagnosis of CAP. At baseline, a Sysmex XN-20 analyzer was used to obtain detailed information related to the activation status and functional activity of white cells. RESULTS: The sample was split into derivation and validation cohorts of 1065 and 717 patients, respectively. In the derivation cohort, COVID-19 was confirmed in 791 patients and ruled out in 274 patients, with mean ages of 62.13 (14.37) and 65.42 (16.62) years, respectively (p<0.001). There were significant differences in all CPD parameters except MO-Y. The multivariate prediction model showed that lower NE-X, NE-WY, LY-Z, LY-WY, MO-WX, MO-WY, and MO-Z values and neutrophil-to-lymphocyte ratio were related to COVID-19 etiology with an AUC of 0.819 (0.790, 0.846). No significant differences were found comparing this model to another including biomarkers (p=0.18). CONCLUSIONS: Abnormalities in white blood cell morphology based on a few cell population data values as well as NLR were able to accurately identify COVID-19 etiology. Moreover, systemic inflammation biomarkers currently used were unable to improve the predictive ability. We conclude that new peripheral blood biomarkers can help determine the etiology of CAP fast and inexpensively.

Genitourinary Lesions Due to Monkeypox.

BACKGROUND: Since May 2022, 31 000 cases of monkeypox infection have been reported in nonendemic areas. OBJECTIVE: To describe a series of cases of monkeypox with genitourinary involvement. DESIGN, SETTING, AND PARTICIPANTS: This was a prospective observational study of men diagnosed with monkeypox disease with genitourinary involvement. RESULTS AND LIMITATIONS: A total of 14 patients were recruited. The median age was 42 yr. Of these patients, 43% sought a consultation for genitourinary symptomatology, and 71% had engaged in sex with other men. Eight patients (57%) were positive for human immunodeficiency virus, one diagnosed synchronously; the remainder had a median CD4 count of 663/µl. Six patients (43%) had a different sexually transmitted disease. Penile oedema was present in 43% of patients and two patients required surgical exploration. CONCLUSIONS: Genitourinary involvement is frequent in monkeypox disease and is often the reason for the consultation visit. PATIENTS SUMMARY: In this report we looked at how monkeypox disease can affect the genitourinary area, causing swelling of the penis or skin lesions.

Porous SiO2 Nanospheres Modified with ZrO2 and Their Use in One-Pot Catalytic Processes to Obtain Value-Added Chemicals from Furfural.

Porous SiO2 nanospheres were modified with different loadings of ZrO2 to obtain catalysts with a Si/Zr molar ratio from 2.5 to 30. These materials were characterized by X-ray diffraction, transmission and scanning electron microscopies, N2 adsorption-desorption at -196 °C, X-ray photoelectron spectroscopy and pyridine and 2-6-dimethylpyridine thermoprogrammed desorption. The characterization of these catalysts has revealed that a high proportion of Zr favors the formation of Lewis acid sites, which are implied in catalytic transfer hydrogenation processes, whereas the low Brönsted acidity promotes a dehydration reaction, being possible to give rise to a large variety of products from furfural through consecutive reactions, such as furfuryl alcohol, i-propyl furfuryl ether, i-propyl levulinate, and γ-valerolactone, in a range of temperature of 110-170 °C and 1-6 h of reaction.

Lignin Depolymerization to BTXs.

Lignin, one of the main components of lignocellulosic biomass, is the largest renewable source of aromatics on the planet and presents an extraordinary opportunity for being used in the production of bio-based products. It can be transformed for the substitution of aromatic chemical-derived petrol as BTXs. The wide range of applications that it can be obtained from BTXs building blocks makes the selective depolymerization of lignin a great scientific challenge. This review emphasizes the different strategies for the fragmentation of lignin to monomers or aromatics hydrocarbons. Thus, a by-product traditionally discarded or used for energy generation, it could be valorized into high added-value products.

Influence of Structure-modifying Agents in the Synthesis of Zr-doped SBA-15 Silica and Their Use as Catalysts in the Furfural Hydrogenation to Obtain High Value-added Products through the Meerwein-Ponndorf-Verley Reduction.

Zr-doped mesoporous silicas with different textural parameters have been synthesized in the presence of structure-modifying agents, and then characterized by X-ray diffraction (XRD), transmission electron microscopy (TEM), N2 adsorption-desorption at -196 °C, NH3 thermoprogrammed desorption (NH3⁻TPD), CO2 thermoprogrammed desorption (CO2⁻TPD), and X-ray photoelectron spectroscopy (XPS). These porous materials were evaluated in the furfural hydrogenation through the Meerwein-Ponndorf-Verley (MPV) reaction. The catalytic results indicate that the catalyst synthesized under hydrothermal conditions and adding a pore expander agent is more active and selective to furfuryl alcohol. However, the Zr-doped porous silica catalysts that were synthesized at room temperature, which possess narrow pore sizes, tend to form i-propyl furfuryl and difurfuryl ethers, coming from etherification between furfuryl alcohol (FOL) and isopropanol molecules (used as H-donor) by a SN2 mechanism.

Porous Silicon-Based Catalysts for the Dehydration of Glycerol to High Value-Added Products.

Increasing worldwide biodiesel production has led to the generation of an important glycerol surplus, which needs to be valorized in order to improve the economic and environmental sustainability of the biodiesel industry. In this context, glycerol dehydration to acrolein by acid catalysis appears to be a potential route of glycerol valorization, since acrolein is an important intermediate for many chemical industries. The main drawback of this catalytic process is catalyst deactivation. Different alternatives have been proposed for overcoming it, such as the use of mesoporous materials in order to facilitate the diffusion of glycerol and reaction products, thus minimizing deactivation. This review compiles the main achievements of the use of mesoporous silica-containing materials that have been deployed either as a catalyst or for support in glycerol dehydration to acrolein. Thus, the effect of mesoporosity on both catalytic performance and deactivation will be discussed, as well as the blocking of pores by coke deposition.

Dehydration of xylose to furfural over MCM-41-supported niobium-oxide catalysts.

A series of silica-based MCM-41-supported niobium-oxide catalysts are prepared, characterized by using XRD, N2 adsorption-desorption, X-ray photoelectron spectroscopy, Raman spectroscopy, and pyridine adsorption coupled to FTIR spectroscopy, and tested for the dehydration of D-xylose to furfural. Under the operating conditions used all materials are active in the dehydration of xylose to furfural (excluding the MCM-41 silica support). The xylose conversion increases with increasing Nb2 O5 content. At a loading of 16 wt % Nb2 O5 , 74.5 % conversion and a furfural yield of 36.5 % is achieved at 170 °C, after 180 min reaction time. Moreover, xylose conversion and furfural yield increase with the reaction time and temperature, attaining 82.8 and 46.2 %, respectively, at 190 °C and after 100 min reaction time. Notably, the presence of NaCl in the reaction medium further increases the furfural yield (59.9 % at 170 °C after 180 min reaction time). Moreover, catalyst reutilization is demonstrated by performing at least three runs with no loss of catalytic activity and without the requirement for an intermediate regeneration step. No significant niobium leaching is observed, and a relationship between the structure of the catalyst and the activity is proposed.

Frequency of FRAX risk factors in osteopenic postmenopausal women with and without history of fragility fracture.

OBJECTIVE: Fractures associated with bone fragility represent a major public health concern. Although the risk of bone fracture is higher among patients with osteoporosis, the number of fractures is usually higher among patients with osteopenia due to its higher prevalence. METHODS: This is an observational case series study that compares the frequencies of nonskeletal risk factors for osteoporotic fractures in osteopenic postmenopausal women with previous clinical fragility fractures (FFs) and osteopenic postmenopausal women without previous FF. Risk factors included in the FRAX algorithm and other selected risk factors, including asymptomatic vertebral fractures, were evaluated. RESULTS: A total of 735 (50.3% with prior FF and 49.7% without prior FF) postmenopausal women were evaluated (median age, 60 y; mean bone mineral density [BMD] femoral neck T score of -1.67). The frequency of the following risk factors was significantly higher among women with FF-FRAX algorithm: age, use of corticosteroids, and BMD femoral neck T score; other factors: Hispanic ethnicity, falls during the last year, and BMD lumbar T score. In addition, the frequency of previously undetected asymptomatic vertebral fractures was four times higher among women with a history of FF. CONCLUSIONS: The results of the present study support the need to assess the presence of asymptomatic vertebral fractures and BMD T scores in osteopenic postmenopausal women. The risk evaluation of this subpopulation can be accomplished by using some of the risk factors included in the FRAX algorithm combined with other conventional risk factors.

[Cocaine-induced ischemic colitis in a high-risk patient treated conservatively]. / Colitis isquémica inducida por cocaína en un paciente de riesgo, tratada de forma conservadora.

Drug consumption is among the non-occlusive causes of ischemic colitis. We report a case of cocaine-induced ischemic colitis in a 34-year-old man who had undergone sigmoid resection and loop colostomy due to abdominal-pelvic injury 3 months previously. The patient presented with abdominal pain associated with diarrhea and slight transient fever of doubtful etiology and reported intranasal cocaine consumption. He was hemodynamically stable and showed no peritoneal irritation. Traces of blood were found in the colostomy bag. Colonoscopy showed ulcers and necrosis proximal to the stoma. Computed tomography angiography scan showed no abnormalities except filiform inferior mesenteric artery. The symptoms were self-limiting and the patient was discharged 3 days after admission. Subsequently the colostomy was closed without complications. A high degree of suspicion is required in young patients with abdominal pain not identified by conventional methods and a recent history of drug consumption.

Colitis isquémica inducida por cocaína en un paciente de riesgo, tratada de forma conservadora / Cocaine-induced ischemic colitis in a high-risk patient treated conservatively

Entre las causas no oclusivas de isquemia cólica están las inducidas farmacológicamente. Presentamos un caso de colitis isquémica provocada por consumo de cocaína en un paciente de 34 años de edad con antecedentes de traumatismo abdomino-pélvico tres meses antes, en el que se efectuó resección de sigma y colostomía en asa. Consultó por dolor abdominal asociado a diarrea y febrícula, y refería consumo de cocaína intranasal. Estaba hemodinámicamente estable y sin peritonismo, evidenciándose restos hemáticos en la bolsa de colostomía. Una colonoscopia objetivó úlceras y necrosis proximales al estoma y la angiotomografía no mostró hallazgos patológicos a excepción de una arteria mesentérica inferior filiforme. El cuadro fue autolimitado, y el paciente dado de al tercer día. Más adelante se reconstruyó el tránsito intestinal sin complicaciones. Debe existir un elevado grado de sospecha ante un dolor abdominal no filiado en pacientes jóvenes con antecedentes de consumo reciente de la droga (AU)

Drug consumption is among the non-occlusive causes of ischemic colitis. We report a case of cocaine-induced ischemic colitis in a 34-year-old man who had undergone sigmoid resection and loop colostomy due to abdominal-pelvic injury 3 months previously. The patient presented with abdominal pain associated with diarrhea and slight transient fever of doubtful etiology and reported intranasal cocaine consumption. He was hemodynamically stable and showed no peritoneal irritation. Traces of blood were found in the colostomy bag. Colonoscopy showed ulcers and necrosis proximal to the stoma. Computed tomography angiography scan showed no abnormalities except filiform inferior mesenteric artery. The symptoms were self-limiting and the patient was discharged 3 days after admission. Subsequently the colostomy was closed without complications. A high degree of suspicion is required in young patients with abdominal pain not identified by conventional methods and a recent history of drug consumption (AU)

Autoevaluación de una vía clínica para mejora del proceso quirúrgico carcinoma de recto / Self-evaluation of a clinical pathway to improve the results of rectal cancer

Objetivo Analizar si la autoevaluación de una vía clínica mejora los resultados del tratamiento del cáncer de recto (CR).Pacientes y método Pacientes intervenidos de CR divididos en 3 grupos según modificaciones bianuales de una vía clínica analizando diversos indicadores. Resultados Ciento sesenta y seis pacientes: grupo A: 2002–2003, n=50; B: 2004–2005, n=53 y C: 2006–2007, n=63; sin diferencias en edad, sexo o comorbilidad. El estudio preoperatorio mejoró con la introducción de TC toracoabdominopélvico: un 76% en el grupo C frente a un 6% del A (p<0,001). Todos los tumores del grupo C fueron estadificados mediante RM, ECO rectal o ambas, frente a un 84% del A (p<0,001). La tasa de amputaciones de recto pasó del 42% en el grupo A, al 17% en el C (p=0,007). Un 48% de cirujanos del grupo A frente al 94% en el C (p<0,001) tenían dedicación específica a la coloproctología. La media de adenopatías analizadas fue: grupo A: 6,2±4,5 frente a 13±6,5 en el C (p<0,001) y se informó del margen circunferencial en un 24% del grupo A frente al 76% en el C (p<0,001). Parámetros como la transfusión perioperatoria de hemoderivados, ingreso en UCI, uso de sonda nasogástrica, tolerancia precoz o analgesia epidural también mejoraron progresivamente. La mortalidad operatoria descendió de forma no significativa hasta el 4,7% y las dehiscencias anastomóticas del 24% al 9,5%, reduciéndose la estancia postoperatoria de 15–11 días (p=0,029).Conclusiones Se han mejorado múltiples indicadores de forma significativa en un período relativamente corto al efectuar autoevaluaciones del proceso (AU)

Objectives To analyse whether the self-evaluation of a clinical pathway improves the results of rectal cancer (RC) treatment. Patients and method Patients operated on for RC were divided into 3 groups according to biannual modifications of a clinical pathway analysing several indicators.Results166 patients: Group A: 2002–3 n=50, B: 2004–5 n=53 and C: 2006–7 n=63, without any differences in age, gender or comorbidity. Preoperative study improved with the introduction of CT scan: 76% in Group C vs. 6% in Group A (P<0.001). All Group C tumours were staged using MR, rectal ultrasound or both, compared to 84% in Group A (P<0.001). The rate of abdominal-perineal resections was reduced from 42% (Group A) to 17% (Group C); (P=0.007) and about 48% of surgeons in Group A vs. 94% in the C had a specific activity in coloproctology (P<0.001). The average lymph node count was: Group A=6.2±4.5 vs. 13±6.5 in the C and circumferential margin analysis was reported in 24% of Group A vs. 76% in Group C (P<0.001). Parameters such as perioperative blood transfusion, ICU admission, use of nasogastric tube, early feeding or epidural analgesia also improved progressively. Operative mortality decreased non-significantly to 4.7% and anastomotic leaks from 24% to 9.5% with a reduction in postoperative stay from 15 to 11 days during the period analysed (P=0.029).Conclusions Several indicators have significantly improved in a relatively short period of time due to self-evaluations of the process (AU)

[Self-evaluation of a clinical pathway to improve the results of rectal cancer]. / Autoevaluación de una vía clínica para mejora del proceso quirúrgico carcinoma de recto.

OBJECTIVES: To analyse whether the self-evaluation of a clinical pathway improves the results of rectal cancer (RC) treatment. PATIENTS AND METHOD: Patients operated on for RC were divided into 3 groups according to biannual modifications of a clinical pathway analysing several indicators. RESULTS: 166 patients: Group A: 2002-3 n=50, B: 2004-5 n=53 and C: 2006-7 n=63, without any differences in age, gender or comorbidity. Preoperative study improved with the introduction of CT scan: 76% in Group C vs. 6% in Group A (P<0.001). All Group C tumours were staged using MR, rectal ultrasound or both, compared to 84% in Group A (P<0.001). The rate of abdominal-perineal resections was reduced from 42% (Group A) to 17% (Group C); (P=0.007) and about 48% of surgeons in Group A vs. 94% in the C had a specific activity in coloproctology (P<0.001). The average lymph node count was: Group A=6.2+/-4.5 vs. 13+/-6.5 in the C and circumferential margin analysis was reported in 24% of Group A vs. 76% in Group C (P<0.001). Parameters such as perioperative blood transfusion, ICU admission, use of nasogastric tube, early feeding or epidural analgesia also improved progressively. Operative mortality decreased non-significantly to 4.7% and anastomotic leaks from 24% to 9.5% with a reduction in postoperative stay from 15 to 11 days during the period analysed (P=0.029). CONCLUSIONS: Several indicators have significantly improved in a relatively short period of time due to self-evaluations of the process.

[Use of nasogastric tubes and drains after colorectal surgery. Have attitudes changed in the last 10 years?]. / Utilización de sonda nasogástrica y drenajes tras cirugía colorrectal. Se ha modificado la actitud en los últimos 10 años?

OBJECTIVE: To evaluate attitudes and opinions of Spanish surgeons on the use of nasogastric tubes (NGT) and drainages after colorectal surgery. MATERIAL AND METHOD: E-mail survey to the members of the Spanish Association of Coloproctology, and Coloproctology Division of the Spanish Surgical Association comparing the results with a previous survey from 1996. RESULTS: Of the 413 surveys sent out, 131 (31.7%) were returned, this compared with 190 from 1996. NGT is routinely used by 22%, selectively by 35% and never by 43%, vs 62%, 31% and 7% in 1996 (p < 0.001). Experience and accreditation in colorectal surgery was associated with its lower use. NGT is removed by 16% 24 hours after surgery, 9% later and 51% when peristalsis begins vs. 6%, 21% and 66% in 1996 (p < 0.001). Of the total, 76% believe that the ileus is not reduced by NGT and 89% that it does not increase comfort vs 27% and 48% (p < 0.001). Drainages are routinely used by 38.5% and selectively by a 57.7%, more than in 1996 (25% and 63%) (p < 0.05). Board-Certification in colorectal surgery was associated with a lower use of drains (p < 0.0001). Drains are not used by 46% in right colon surgery; 22% in left colon and 3.1% in rectal surgery. A total of 66% believe that its used reduce fluid collections and 43% that they drain anastomosis leaks without any differences from previous survey. Drains are considered very useful by 16% in colon surgery and by 52% in rectal surgery. CONCLUSIONS: There is a tendency to decrease the use of NGT. However, drainages continue to be widely employed.

Utilización de sonda nasogástrica y drenajes tras cirugía colorrectal. ¿Se ha modificado la actitud en los últimos 10 años? / Use of nasogastric tubes and drains after colorectal surgery. Have attitudes changed in the last 10 years?

Objetivo. Valorar actitudes y opiniones de los cirujanos españoles respecto del uso de sonda nasogástrica (SNG) y drenajes tras cirugía colorrectal. Material y método. Encuesta efectuada a los miembros de la Asociación Española de Coloproctología y de la Sección de Coloproctología de la Asociación Española de Cirujanos, y se comparan los resultados con los de otra realizada a cirujanos españoles en 1996. Resultados. Se recibieron 131 (31,7%) de las encuestas remitidas, y se las comparó con 190 de 1996. La SNG la usa de forma sistemática el 22%; selectivamente, el 35%, y nunca, el 43%, frente al 62, el 31 y el 7% en 1996 (p < 0,001). La experiencia y acreditación en cirugía colorrectal se asoció a menor empleo. Un 16% la retira a las 24 horas de la cirugía; el 9%, más tarde, y el 51%, al inicio del peristaltismo, frente al 6, el 21 y el 66% en 1996 (p < 0,001). El 76% considera que no reduce el íleo y el 89%, que no ofrece confort, frente al 27 y el 48% (p < 0,001). Los drenajes se usan de forma sistemática por el 38,5% y selectivamente por el 57,7%, más que en 1996 (el 25 y el 63%) (p < 0,05). La certificación en cirugía colorrectal se asoció a menor empleo de drenajes (p < 0,0001). En colon derecho no los emplea el 46%; en izquierdo, el 22%, y en recto, el 3,1%, y un 66% piensa que reducen colecciones líquidas, y el 43%, que canalizan dehiscencias, sin diferencias con la encuesta previa. Los considera muy útiles en cirugía cólica el 18%, y en la rectal, el 52%. Conclusiones. Hay tendencia a reducir el empleo de SNG, aunque los drenajes se sigue usándolos ampliamente (AU)

Objective. To evaluate attitudes and opinions of Spanish surgeons on the use of nasogastric tubes (NGT) and drainages after colorectal surgery. Material and method. E-mail survey to the members of the Spanish Association of Coloproctology, and Coloproctology Division of the Spanish Surgical Association comparing the results with a previous survey from 1996. Results. Of the 413 surveys sent out, 131 (31.7%) were returned, this compared with 190 from 1996. NGT is routinely used by 22%, selectively by 35% and never by 43%, vs 62%, 31% and 7% in 1996 (p < 0.001). Experience and accreditation in colorectal surgery was associated with its lower use. NGT is removed by 16% 24 hours after surgery, 9% later and 51% when peristalsis begins vs. 6%, 21% and 66% in 1996 (p < 0.001). Of the total, 76% believe that the ileus is not reduced by NGT and 89% that it does not increase comfort vs 27% and 48% (p < 0.001). Drainages are routinely used by 38.5% and selectively by a 57.7%, more than in 1996 (25% and 63%) (p < 0.05). Board-Certification in colorectal surgery was associated with a lower use of drains (p < 0.0001). Drains are not used by 46% in right colon surgery; 22% in left colon and 3.1% in rectal surgery. A total of 66% believe that its used reduce fluid collections and 43% that they drain anastomosis leaks without any differences from previous survey. Drains are considered very useful by 16% in colon surgery and by 52% in rectal surgery. Conclusions. There is a tendency to decrease the use of NGT. However, drainages continue to be widely employed (AU)