Association between Variables of Eating Habits and Gastric Trophic Changes in a Gastroenterology Institution in Medellín, Colombia

Aim: To establish the relationship between consuming foods considered risk factors for gastric cancer and trophic changes in gastric mucosa. Materials and methods: Cross-sectional study. We included patients older than 18 admitted for upper GI endoscopy with biopsies who adequately answered a survey of personal history and eating habits. Those with a history of gastric cancer or gastric surgical resection for any reason were excluded. The association between feeding variables and trophic changes in the gastric mucosa was estimated. Results: In a population of 1,096 patients, the average age was 51 years (standard deviation [SD]: 15.5), and 59% were women. Trophic changes in the gastric mucosa were identified in 173 patients (15.8%). No statistical association was found between the independent variables of eating habits, obesity, and positive Helicobacter pylori versus the variable "trophic changes," unlike the variable "family history of gastric cancer" (odds ratio [OR]: 1.49 95% confidence interval [CI]: 1.03-2.17, p = 0.036). One case of high-grade dysplasia was detected in the study population (0.91 cases in 1,000 patients). Conclusions: No association was established between eating habits and trophic changes in the gastric mucosa in the studied population. A family history of gastric cancer is a statistically significant risk factor for developing atrophy, metaplasia, or dysplasia changes.

Objetivo: establecer la relación entre el consumo de alimentos considerados como factores de riesgo para cáncer gástrico y la presencia de cambios tróficos de la mucosa gástrica. Materiales y métodos: estudio de corte transversal. Se incluyeron los pacientes mayores de 18 años admitidos para realización de endoscopia digestiva superior con toma de biopsias que respondieron adecuadamente una encuesta de antecedentes personales y hábitos de alimentación. Se excluyeron aquellos con antecedente de cáncer gástrico o resección quirúrgica gástrica por cualquier motivo. Se estimó la asociación entre las variables de alimentación y la presencia de cambios tróficos de la mucosa gástrica. Resultados: en una población de 1096 pacientes, el promedio de la edad fue 51 años (desviación estándar [DE]: 15,5), y correspondió en un 59% a mujeres. Se identificaron cambios tróficos de la mucosa gástrica en 173 pacientes (15,8%). No se obtuvo asociación estadística entre las variables independientes de hábitos de alimentación, obesidad y Helicobacter pylori positivo frente a la variable "cambios tróficos", a diferencia de la variable "antecedente familiar de cáncer gástrico" (odds ratio [OR]: 1,49; intervalo de confianza [IC] 95%: 1,03-2,17; p = 0,036). Se obtuvo 1 caso de displasia de alto grado en la población estudiada (0,91 casos en 1000 pacientes). Conclusiones: no se estableció una asociación entre los hábitos de alimentación y la presencia de cambios tróficos de la mucosa gástrica en la población estudiada. El antecedente familiar de cáncer gástrico se muestra como un factor de riesgo estadísticamente significativo para el desarrollo de cambios de atrofia, metaplasia o displasia.

[Post-COVID-19 severe cholangiopathy: report of 6 cases]. / Colangiopatía post-COVID-19 grave: reporte de 6 casos.

Coronavirus disease 2019 (COVID-19) is a predominantly respiratory tract infection with the capacity to affect other organs. Liver chemistry abnormalities are a frequent manifestation of COVID-19 but are usually transient. We describe the clinical course and most relevant findings of 6 patients who developed a cholangiopathy after severe COVID-19. The mean age of the patients, 4 men and 2 women, was 56 years and the mean time from COVID-19 diagnosis to diagnosis of cholangiopathy was 138 days. The features most important were the increase of alkaline phosphatase and destructuring and beading of the intrahepatic bile duct in magnetic resonance imaging. Cholangiopathy after severe COVID-19 constitutes a novel entity with unique features and potential for progressive biliary injury and secondary biliary cirrhosis. Further studies are required to understand this disease.

Colangiopatía post-COVID-19 grave: reporte de 6 casos / Post-COVID-19 severe cholangiopathy: report of 6 cases

RESUMEN La enfermedad por coronavirus de 2019 (COVID-19) es una infección predominantemente del tracto respiratorio con la capacidad de afectar otros órganos. Las alteraciones en las pruebas hepáticas son una manifestación frecuente de la COVID-19 pero suelen ser transitorias. Describimos el curso clínico y los hallazgos más relevantes de 6 pacientes que desarrollaron una colangiopatía tras una COVID-19 grave. La edad promedio de los pacientes, 4 hombres y dos mujeres, fue de 56 años y el tiempo promedio desde el diagnóstico de COVID-19 hasta el diagnóstico de la colangiopatía fue de 138 días. Las características más importantes fueron la elevación de la fosfatasa alcalina y la desestructuración y el arrosariamiento de la vía biliar intrahepática en las imágenes de resonancia magnética. La colangiopatía tras una COVID-19 grave constituye una nueva entidad con características únicas con el potencial para la lesión progresiva biliar y la cirrosis biliar secundaria. Se requieren más estudios para entender esta enfermedad.

ABSTRACT Coronavirus disease 2019 (COVID-19) is a predominantly respiratory tract infection with the capacity to affect other organs. Liver chemistry abnormalities are a frequent manifestation of COVID-19 but are usually transient. We describe the clinical course and most relevant findings of 6 patients who developed a cholangiopathy after severe COVID-19. The mean age of the patients, 4 men and 2 women, was 56 years and the mean time from COVID-19 diagnosis to diagnosis of cholangiopathy was 138 days. The features most important were the increase of alkaline phosphatase and destructuring and beading of the intrahepatic bile duct in magnetic resonance imaging. Cholangiopathy after severe COVID-19 constitutes a novel entity with unique features and potential for progressive biliary injury and secondary biliary cirrhosis. Further studies are required to understand this disease.

COVID-19 Serology in New York State Using a Multiplex Microsphere Immunoassay

The emergence of SARS-CoV-2, leading to COVID-19, necessitated the development of new molecular and serological tests. Here, we describe a multiplexed serological assay developed as the global pandemic moved into New York State in the spring of 2020. The original microsphere immunoassay used a target antigen from the SARS-CoV-1 virus responsible for the 2003 SARS outbreak, but evolved to incorporate multiple SARS-CoV-2 protein antigens (nucleocapsid, spike and spike domains, spike and nucleocapsid proteins from seasonal human coronaviruses). Besides being highly versatile due to multiplex capabilities, the assay was highly specific and sensitive and adaptable to measuring both total antibodies and antibody isotypes. While determining the assay performance characteristics, we were able to identify antibody production patterns (e.g., kinetics of isotypes, individual variations) for total antibodies and individual antibody classes. Overall, the results provide insights into the laboratory response to new serology needs, and how the evolution and fine-tuning of a serology assay helped contribute to a better understanding of the antibody response to SARS-CoV-2.

Desarrollo y validación de un modelo diagnóstico de resistencia antimicrobiana por beta-lactamasas de espectro extendido en infecciones urinarias adquiridas en la comunidad. ¿Cómo ajustar la predicción en prevalencias variables del desenlace? La utilidad de la contracción de predictores con regresión LASSO / Development and validation of a diagnostic model of antimicrobial resistance by extended-spectrum beta-lactamases in community-acquired urinary tract infections. How to adjust the prediction in variable outcome prevalences? The usefulness of contracting predictors with LASSO regression

INTRODUCCIÓN: Para el caso de infección urinaria adquirida en la comunidad la identificación de enterobacterias con beta-lactamasas de espectro extendido (BLEE) puede optimizar las estrategias de tratamiento, control y seguimiento; sin embargo, el efecto de prevalencias variables de este patrón de resistencia ha afectado la validez externa de este tipo de modelos. OBJETIVO: Desarrollar un modelo predictor diagnóstico que ajuste el error de predicción en prevalencias variables utilizando la regresión LASSO. MÉTODOS: Se diseñó un modelo predictor diagnóstico de infección urinaria adquirida en la comunidad por enterobacterias productoras de BLEE. Se empleó un estudio de corte transversal, tanto para la construcción como para la validación. Para evaluar el efecto de la prevalencia variable del desenlace, la validación se realizó con población en la que la proporción de aislados con este mecanismo de resistencia fue menor, los participantes fueron pacientes adultos que consultaron a servicios de urgencias de dos instituciones hospitalarias de mediano nivel de complejidad de la ciudad de Medellín. Para ajustar el efecto de un medio ambiente con menor proporción de resistencia antimicrobiana, utilizamos la contracción de predictores por regresión LASSO. RESULTADOS: Se incluyeron 303 pacientes para la construcción del modelo, se evaluaron seis predictores y la validación se realizó en 220 pacientes. CONCLUSIÓN: El modelo ajustado con regresión LASSO favoreció la validez externa del modelo en poblaciones con proporción de aislados productores de BLEE en urocultivo de pacientes ambulatorio entre 11 y 16%. Este estudio brinda criterios para un aislamiento temprano cuando los predictores están presentes en poblaciones con proporciones de resistencia en urocultivos ambulatorios cercanas a 15% y propone una metodología para ajuste de error en el diseño de modelos de predicción en resistencia antimicrobiana

BACKGROUND: In the case of community-acquired urinary tract infection, the identification of Enterobacteriaceae with extended spectrum beta-lactamases (ESBL) can optimize treatment, control and follow-up strategies, however the effect of variable prevalences of this resistance pattern has affected the external validity of this type of models. AIM: To develop a diagnostic predictive model that adjusts the prediction error in variable prevalences using the LASSO regression. METHODS: A diagnostic predictive model of community-acquired urinary tract infection by infection by ESBL producing Enterobacteriaceae was designed. A cross-sectional study was used for both construction and validation. To assess the effect of the variable prevalence of the outcome, the validation was performed with a population in which the proportion of isolates with this resistance mechanism was lower, the participants were adult patients who consulted the emergency services of two medium-level hospital institutions. complexity of the city of Medellin. To adjust for the effect of an environment with a lower proportion of antimicrobial resistance, we used the contraction of predictors by LASSO regression. RESULTS: 303 patients were included for the construction of the model, six predictors were evaluated and validation was carried out in 220 patients. CONCLUSION: The adjusted model with LASSO regression favored the external validity of the model in populations with a proportion of ESBL producing isolates in urine culture of outpatients between 11 and 16%. This study provides criteria for early isolation when predictors are present in populations with proportions of resistance in ambulatory urine cultures close to 15% and proposes a methodology for the adjustment of errors in the design of prediction models for antimicrobial resistance.

Sediment Transport Assessment for Rio Gualaxo Do Norte After the Fundão Dam Failure.

The debris flood created by the 5 November 2015 failure of the Fundão dam in Brazil injected a large amount of fine sediment in the Gualaxo do Norte River system. Although coarse and sand-sized sediment injections in rivers have been studied in relative detail, little is known about river response to overloading of mud-sized sediments (consisting of clay and silt). This paper presents an assessment of suspended sediment transport occurring in and along the Gualaxo do Norte River after the Fundão dam failure to contribute to the general understanding of how rivers recover following large inputs of mud-sized sediments (consisting of clay and silt). The average total sediment removal estimated based on the last 2 rainy periods is 54 466 tonnes, ranging from 37 385 to 71 546 tonnes according to the uncertainty analysis. The sediment transport analysis suggests that the Gualaxo do Norte River is returning to its pre-event morphological character in terms of sediment transport. However, the morphologic recovery of the system has been constrained in recent years by decreased stream power, the result of moderate wet seasons and limited large flood events. We anticipate that future larger flood events will transport most of the remaining available in-channel tailings, speeding up the physical morphologic recovery of the Gualaxo do Norte River, which is a key component of improving water quality and eventually the river ecology. Although the proposed approach for the sediment budget is simplified and has limitations and uncertainties, it provides a scientific basis to explain the natural fluvial processes that have been occurring in the river system. The approach used for the sediment budget presented in this paper could be applied to similar cases with limited data. Integr Environ Assess Manag 2020;16:572-582. © 2020 SETAC.

A passagem da onda de rejeitos criada pelo rompimento da barragem de Fundão, em 5 de novembro de 2015, despejou uma grande quantidade de sedimentos finos no rio Gualaxo do Norte. Embora a inserção de sedimentos grossos e do tamanho de areia em rios tenham sido estudada em maiores detalhes, pouco se sabe sobre a resposta de rios à uma sobrecarga de rejeitos do tipo lama (sedimentos do tamanho de argila-silte). Este artigo apresenta uma avaliação do transporte de sedimentos em suspensão que tem ocorrido no rio Gualaxo do Norte depois do rompimento da barragem de Fundão, com o objetivo de contribuir para o entendimento geral de como sistemas fluviais se recuperam após sobrecargas de sedimentos finos (argila-silte). A remoção média total de sedimentos estimada com base nos dois últimos períodos chuvosos é de 54.466 toneladas, variando de 37.385 a 71.546 toneladas de acordo com a análise de incerteza. A análise do transporte de sedimentos sugere que o rio Gualaxo do Norte está retornando a sua condição morfológica pré-evento em termos de transporte de sedimentos. No entanto, a recuperação física do sistema tem sido limitada pelo comportamento hidráulico do rio nos últimos anos, com estações de chuvosas moderadas e limitados eventos de cheia de grande magnitude. É muito provável que futuros eventos de cheia de grande magnitude irão transportar a maior parte dos rejeitos restantes disponíveis no canal, acelerando a recuperação morfológica física do rio Gualaxo do Norte. Esse processo é um componente essencial na recuperação da qualidade da água e da ecologia do rio. Embora a abordagem proposta para o balanço de massa de sedimentos seja simplificada e tenha limitações e incertezas, ela fornece uma base científica para explicar os processos fluviais naturais que vêm ocorrendo no sistema fluvial. A abordagem apresentada para o balanço de massa de sedimentos pode ser aplicada a casos semelhantes com dados limitados. Integr Environ Assess Manag 2020;16:572-582.

[Development and validation of a diagnostic model of antimicrobial resistance by extended-spectrum beta-lactamases in community-acquired urinary tract infections. How to adjust the prediction in variable outcome prevalences? The usefulness of contracting predictors with LASSO regression]. / Desarrollo y validación de un modelo diagnóstico de resistencia antimicrobiana por ß-lactamasas de espectro extendido en infecciones urinarias adquiridas en la comunidad. ¿Cómo ajustar la predicción en prevalencias variables del desenlace? La utilidad de la contracción de predictores con regresión LASSO.

BACKGROUND: In the case of community-acquired urinary tract infection, the identification of Enterobacteriaceae with extended spectrum beta-lactamases (ESBL) can optimize treatment, control and follow-up strategies, however the effect of variable prevalences of this resistance pattern has affected the external validity of this type of models. AIM: To develop a diagnostic predictive model that adjusts the prediction error in variable prevalences using the LASSO regression. METHODS: A diagnostic predictive model of community-acquired urinary tract infection by infection by ESBL producing Enterobacteriaceae was designed. A cross-sectional study was used for both construction and validation. To assess the effect of the variable prevalence of the outcome, the validation was performed with a population in which the proportion of isolates with this resistance mechanism was lower, the participants were adult patients who consulted the emergency services of two medium-level hospital institutions. complexity of the city of Medellin. To adjust for the effect of an environment with a lower proportion of antimicrobial resistance, we used the contraction of predictors by LASSO regression. RESULTS: 303 patients were included for the construction of the model, six predictors were evaluated and validation was carried out in 220 patients. CONCLUSION: The adjusted model with LASSO regression favored the external validity of the model in populations with a proportion of ESBL producing isolates in urine culture of outpatients between 11 and 16%. This study provides criteria for early isolation when predictors are present in populations with proportions of resistance in ambulatory urine cultures close to 15% and proposes a methodology for the adjustment of errors in the design of prediction models for antimicrobial resistance.

Purification and Biochemical and Kinetic Properties of an Endo-Polygalacturonase from the Industrial Fungus Aspergillus sojae.

An endo-polygalacturonase secreted by Aspergillus sojae was characterized after being purified to homogeneity from submerged cultures with orange peel as the sole carbon source by gel filtration and ion-exchange chromatographies. According to SDS-PAGE and analytical isoelectric focusing analyses, the enzyme presents a molecular weight of 47 kDa and pI value of 4.2. This enzyme exhibits considerable stability under highly acidic to neutral conditions (pH 1.5-6.5) and presents a half-life of 2 h at 50°C. Besides its activity towards pectin and polygalacturonic acid, the enzyme displays pectin-releasing activity, acting best in a pH range of 3.3-5.0. Thin-layer chromatographic analysis revealed that tri-galacturonate is the main enzymatic end product of polygalacturonic acid hydrolysis, indicating that it is an endo-polygalacturonase. The enzyme exhibits Michaelis-Menten kinetics, with KM and VMAX values of 0.134 mg/mL and 9.6 µmol/mg/min, respectively, and remained stable and active in the presence of SO2, ethanol, and various cations assayed except Hg2+.

Neoadjuvant Chemoradiotherapy Treatment for a Classic Biphasic Pulmonary Blastoma with High PD-L1 Expression.

Pulmonary blastomas are rare malignant tumors, comprising only 0.25-0.5% of all malignant lung neoplasms. The prognosis of pulmonary blastoma is very poor, with an overall five-year survival of 16%. No standard treatment has been defined for unresectable disease. We present the case of a 25-year-old woman with unresectable locally advanced classic biphasic pulmonary blastoma (CBPB) successfully treated with neodjuvant chemoradiotherapy based on two chemotherapy induction cycles of cisplatin plus etoposide, followed by concurrent weekly cisplatin to 50.4 Gy radiotherapy treatment. The patient had a significant reduction in tumor size, allowing for complete resection by pneumonectomy. Molecular study for epidermal growth factor receptor (EGFR) mutations, anaplastic lymphoma kinase (ALK), proto-oncogene receptor tyrosine kinase (ROS1) and rearranged during transfection (RET) rearrangements, and programmed death ligand 1 (PD-L1) expression was performed in the pre-treatment tumor sample. Our patient presented a high expression (>90% of tumor cells) of PD-L1. To our knowledge, this is the first report of PD-L1 expression in CBPB. This could lead to new treatment options based on new immunotherapy agents blocking the PD-1/PD-L1 pathway for this rare disease with poor prognosis.

Enzymatic hydrolysis of gelatin layers of X-Ray films and release of silver particles using keratinolytic serine proteases from Purpureocillium lilacinum LPS # 876.

Enzymatic decomposition of gelatin layers on used X-ray films and repeated utilization of the enzyme for potential application in silver recovery were investigated using keratinolytic serine proteases from Purpureocillium lilacinum LPS # 876. At pH 9.0, the enzymatic reaction was enhanced by the increase of enzyme concentration or by the increase of the temperature up to 60℃. Under the conditions of 6.9 U/ml, 60℃, and pH 9.0, hydrolysis of the gelatin layers and the resulting release of silver particles were achieved within 6 min. The protective effect of polyols against thermal denaturation was investigated. The presence of glycerol and propylene glycol increased enzyme stability. When the reusability of the enzyme for gelatin hydrolysis was tested, it could be seen that it could be effectively reused for more cycles when glycerol was added, compared with the enzyme without protective agents. The results of these repeated treatments suggested that a continuous process of recycling silver from used X-ray is feasible. Keeping in mind that recycling is (at the present time) needed and imperative, it can be remarked that, in this research, three wastes were successfully used: hair waste in order to produce serine proteases; glycerol in order to enhance enzyme thermal stability; and used Xray films in order to recover silver and PET films.

Aspergillus kawachii produces an inulinase in cultures with yacon (Smallanthus sonchifolius) as substrate

Background: Inulinases have been extracted and characterized from inulin-storing tissues; however, production of microbial inulinases have recently draw much attention as they offer several industrial advantages. Many microorganisms, including filamentous fungi, yeast and bacteria have been claimed as inulinase producers. These hydrolases are usually inducible and their exo-acting forms may hydrolyze fructose polymers (inulin) and oligosaccharides such as sucrose and raffinose. Fungal inulinase extracts are often produced as stable mixture of highly active fructanhydrolases. From a practical prospective, the best known inulinases to date are those produced by species of Penicillium, Aspergillus and Kluyveromyces. Results: The production of extracellular inulinase by A. kawachii in liquid cultures, using either inulin or yacon derived materials as CES as well as inulinase inducers, is reported. In addition, a partial characterization of the enzyme activity is included. Conclusions: Yacon derived products, particularly yacon juice, added to the culture medium proved to be a good CES for fungal growth as well as an inducer of enzyme synthesis. Partial characterization of the enzyme revealed that it is quite stable in a wide range of pH and temperature. In addition, characterization of the reaction products revealed that this enzyme corresponds to an exo-type. These facts are promising considering its potential application in inulin hydrolysis for the production of high fructose syrups.

Purification and characterization of a novel alkaline α-L-rhamnosidase produced by Acrostalagmus luteo albus.

Rhamnosidases are enzymes that catalyze the hydrolysis of terminal nonreducing L-rhamnose for the bioconversion of natural or synthetic rhamnosides. They are of great significance in the current biotechnological area, with applications in food and pharmaceutical industrial processes. In this study we isolated and characterized a novel alkaline rhamnosidase from Acrostalagmus luteo albus, an alkali-tolerant soil fungus from Argentina. We also present an efficient, simple, and inexpensive method for purifying the A. luteo albus rhamnosidase and describe the characteristics of the purified enzyme. In the presence of rhamnose as the sole carbon source, this fungus produces a rhamnosidase with a molecular weight of 109 kDa and a pI value of 4.6, as determined by SDS-PAGE and analytical isoelectric focusing, respectively. This enzyme was purified to homogeneity by chromatographic and electrophoretic techniques. Using p-nitrofenil-α-L-rhamnopiranoside as substrate, the enzyme activity showed pH and temperature optima of 8.0 and 55°C, respectively. The enzyme exhibited Michaelis-Menten kinetics, with K (M) and V (max) values of 3.38 mmol l(-1) and 68.5 mmol l(-1) min(-1), respectively. Neither divalent cations such as Ca(2+), Mg(2+), Mn(2+), and Co(2+) nor reducing agents such as ß-mercaptoethanol and dithiothreitol showed any effect on enzyme activity, whereas this activity was completely inhibited by Zn(2+) at a concentration of 0.2 mM. This enzyme showed the capacity to hydrolyze some natural rhamnoglucosides such as hesperidin, naringin and quercitrin under alkaline conditions. Based on these results, and mainly due to the high activity of the A. luteo albus rhamnosidase under alkaline conditions, this enzyme should be considered a potential new biocatalyst for industrial applications.

Hipoplasia pulmonar en el adulto / Pulmonary hypoplasia in the adult

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Role of PPase-SE in Geotrichum klebahnii, a yeast-like fungus able to solubilize pectin

Protopectinases (PPases) constitute a heterogeneous group of extracellular enzymes able to release soluble pectin from insoluble protopectin in plant tissues. Geotrichum klebahnii (ATCC 42397) produces PPase-SE with endopolygalacturonase activity. PPase-SE has been used for pectin extraction and maceration of plant tissues. Here, the capacity of G. klebahnii to use different pectins as carbon and energy sources (CES) was studied, in addition to PPase-SE capacity to release pectin from lemon peel. The strain was unable to use pectin from different origins as CES. When G. klebahnii was cultivated with mixtures of different amounts of glucose and citrus pectin as CES, the biomass obtained was proportional to the initial concentration of glucose, which was completely consumed. In addition, it produced PPase-SE in a glucose-containing medium. A culture was used for the extraction of pectin from lemon peels. Pectin was enzymatically extracted simultaneously with tissue maceration, yielding 3.7 g of (dry) pectin per 100 g of (wet) lemon peel. Extracted pectin was not metabolized by the strain. It was concluded that G. klebahnii uses PPase-SE to macerate, invade and colonize plant tissues, thus releasing soluble sugars to be used as CES without metabolizing solubilized pectin.

[Analysis of the results of a short-stay thoracic surgery program (2001-2005)]. / Análisis de los resultados del programa de corta estancia en cirugía torácica en el período 2001-2005.

INTRODUCTION: A short-stay thoracic surgery program was implemented and a prospective study was initiated to evaluate its results. OBJECTIVE: To analyze the results of the short-stay thoracic surgery program. PATIENTS AND METHOD: The results of 350 procedures (283 lobectomies and 67 pneumonectomies) performed between 2001 and 2005 were analyzed. The variables analyzed were: a) mean length of stay, b) mortality, c) complications, and d) readmission rate. RESULTS: The mean length of postoperative stay was 5.8 +/- 2.8 days for lobectomy and 5.36 +/- 1.8 days for pneumonectomy. Mortality was 3.5% in lobectomy and 3% in pneumonectomy. Complications occurred in 17.3% of lobectomies and 23.8% of pneumonectomies. The readmission rate was 7%. CONCLUSIONS: The results obtained show that, as expected, the short-stay thoracic surgery program reduces the mean length of hospital stay. Moreover, this program is safe, since mortality and morbidity were lower than or similar to the mean and the readmissions rate was similar to the national average. These results have encouraged us to continue the program started in 1998.

Análisis de los resultados del programa de corta estancia en cirugía torácica en el período 2001-2005 / Analysis of the results of a short-stay thoracic surgery program (2001-2005)

Introducción. Tras la puesta en marcha del programa de cirugía de corta estancia iniciamos un estudio prospectivo para evaluarlo. Objetivo. Analizar los resultados asitenciales del programa de cirugía de corta estancia. Pacientes y metodo. Se han analizado los resultados de los 350 procedimientos (283 lobectomías y 67 neumonectomías) realizados entre los años 2001 y 2005 en referencia a: a) estancia media; b) mortalidad; c) complicaciones, y d) tasa readmisiones. Resultados. La estancia media postoperatoria ha sido de 5,8 ± 2,8 días para las lobectomías y de 5,36 ± 1,8 días para las neumonectomías. La mortalidad ha sido del 3,5% en las lobectomías y del 3% en las neumonectomías. La morbilidad ha sido del 17,3% en las lobectomías y del 23,8% en las neumonectomías. El índice de readmisiones ha sido del 7%. Conclusiones. Los resultados asistenciales obtenidos muestran que el programa de cirugía torácica de corta estancia no sólo mejora la estancia media (que ya era esperado), sino que es seguro, ya que las tasas de mortalidad y de morbilidad son menores o similares a la media, con una tasa de readmisiones ajustada a la media nacional. Ello nos estimula a continuar con el programa iniciado en 1998 (AU)

Introduction. A short-stay thoracic surgery program was implemented and a prospective study was initiated to evaluate its results. Objective. To analyze the results of the short-stay thoracic surgery program. Patients and method. The results of 350 procedures (283 lobectomies and 67 pneumonectomies) performed between 2001 and 2005 were analyzed. The variables analyzed were: a) mean length of stay, b) mortality, c) complications, and d) readmission rate. Results. The mean length of postoperative stay was 5.8 ± 2.8 days for lobectomy and 5.36 ± 1.8 days for pneumonectomy. Mortality was 3.5% in lobectomy and 3% in pneumonectomy. Complications occurred in 17.3% of lobectomies and 23.8% of pneumonectomies. The readmission rate was 7%. Conclusions. The results obtained show that, as expected, the short-stay thoracic surgery program reduces the mean length of hospital stay. Moreover, this program is safe, since mortality and morbidity were lower than or similar to the mean and the readmissions rate was similar to the national average. These results have encouraged us to continue the program started in 1998 (AU)

Clinical value of p53, c-erbB-2, CEA and CA125 regarding relapse, metastasis and death in resectable non-small cell lung cancer.

The prognostic value of p53 and c-erbB-2 immunostaining and preoperative serum levels of CEA and CA125 was investigated in a prospective multicentric study including 465 consecutive non-small cell lung cancer (NSCLC) patients with resectable tumors. Four end-points were used: lung cancer death, first relapse (either locoregional or metastasis), loco-regional recurrence and metastasis development. Standard statistical survival methods (Kaplan-Meier and Cox regression) were used. The specificity of the prognostic effect across different types of tumors was also explored, as had been planned in advance. Our results showed, once again, that pathological T and N classifications continue to be the strongest predictors regarding either relapse or mortality. Three of the studied markers seemed to add further useful information, however, but in a more specific context. For example, increased CEA concentration defined a higher risk population among adenocarcinomas but not among people with squamous tumors; and p53 overexpression implied a worse prognosis mainly in patients with well differentiated tumors. The analysis of type of relapse proved to be very informative. Thus, CA125 level was associated with a worse prognosis mainly related with metastasis development. Another interesting result was the influence of smoking, which showed a clear dose-response relationship with the probability of metastasis. For future studies, we recommend the inclusion of different endpoints, namely considering the relationship of markers with the type of relapse involved in lung-cancer recurrence. They can add useful information regarding the complex nature of prognosis.