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1.
Zhonghua Wei Chang Wai Ke Za Zhi ; 24(4): 319-326, 2021 Apr 25.
Artículo en Chino | MEDLINE | ID: mdl-33878821

RESUMEN

Objective: To understand the current status of diagnosis and treatment regarding the protection of defecation function in Chinese surgeons performing sphincter-preserving resections (SPR) for rectal cancer in order to discover the problems existing in the function protection during SPR and provide support and reference for the standardized clinical management of rectal cancer. Methods: A cross-sectional survey was performed. Colorectal surgeons who obtained the medical qualifications and volunteered to participate in this study were included, and respondents with incomplete information were excluded. From October 18 to 22, 2020, randomized sampling was conducted among Chinese colorectal surgeons from Chinese Association of Colorectal Surgeons, Chinese Colorectal Cancer Committee, Chinese Sexology Association Anal functional Surgery Committee and National Health Commission Capacity Building and Continuing Education Committee. The questionnaire included basic information of the respondents, assessment of defecation function before SPR, intraoperative details, postoperative follow-up, evaluation and intervention of patients with low anterior resection syndrome (LARS). Observation indicator: results of the questionnaire survey. Result: A total of 231 questionnaires were collected, and 230 were effective, with an effective rate of 99.6%. Among these participants, 217 (94.3%) were males; 107 (46.5%) had medical doctor degrees; 129 (56.1%) were national commission members in colorectal surgery; 137 (59.6%) performed more than 50 SPR operations per year; 211 (91.7%) assessed defection function by auxiliary examinations before SPR. Rigid sigmoidoscopy (n=116, 55.0%) and anorectal manometer (n=81, 38.4%) were the most commonly used method. Among the 230 respondents, 64.8% (n=149) of surgeons used 2D laparoscopy for SPR surgery most commonly, and 51.3% (n=118) of surgeons performed direct colorectal anastomosis for reconstruction, and 98.3% (n=226) used staplers during anastomosis. All the surgeons indicated that they would follow up patients after SPR, and outpatient clinic was the most common method (84.4%, 184/230). When LARS occurred, 50.0% (115/230) of surgeons chose defecation function scale and 78.7% (181/230) actively provided guidance and intervention for patients. Conclusions: Chinese colorectal surgeons still have shortcomings in the protection of defecation function during SPR for rectal cancer. They do not make enough preoperative functional evaluation and postoperative functional recovery estimate for patients. The knowledge and use of defecation function scales and interventions on LARS are expected to be standardized.


Asunto(s)
Neoplasias del Recto , Cirujanos , Canal Anal/cirugía , China , Estudios Transversales , Defecación , Humanos , Masculino , Complicaciones Posoperatorias/prevención & control , Neoplasias del Recto/cirugía , Encuestas y Cuestionarios , Síndrome
2.
Stomatologiia (Mosk) ; 100(2): 55-59, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33874662

RESUMEN

The aim of the clinical study was to improve prevention of postoperative sialocele and fistulas of parotid glands. MATERIALS AND METHODS: The study included 100 patients with tumors of parotid glands treated by superficial parotidecthomy. Fifty patients received incobotulinum toxin A preoperatively, while control group consisted of 50 patients without preoperative injections. RESULTS: Salivary fistulas formed in 17% of cases in control group. Discharging of saliva through the postoperative wound for 6 days after surgical treatment were noticed in the control group in 30% of cases. There were no complications such as forming of salivary fistula and sialocele and no saliva flow from the postoperative wound on the 4th day after surgical treatment in the main group. Conclusion. The use of botulinum toxin type A proved an efficient and effective way for prevention of postoperative salivary fistulas and sialocele.


Asunto(s)
Toxinas Botulínicas Tipo A , Fístula , Enfermedades de las Parótidas , Fístula/prevención & control , Humanos , Glándula Parótida/cirugía , Complicaciones Posoperatorias/prevención & control , Fístula de las Glándulas Salivales/etiología , Fístula de las Glándulas Salivales/prevención & control
3.
Kyobu Geka ; 74(4): 281-290, 2021 Apr.
Artículo en Japonés | MEDLINE | ID: mdl-33831888

RESUMEN

The technologies of endovascular treatment for aortic pathologies have progressed rapidly, and endovascular treatment for thoracic pathologies has gained widespread acceptance, and there has been a significant increase in the number of thoracic pathologies treated by thoracic endovascular aortic repair (TEVAR) over the last decade. The initial results of TEVAR such as operative mortality and morbidities have been good and acceptable. Therefore, indication of TEVAR has expanded along with the improvement of techniques and devices. However, as its mid-term and long-term results became available, complications including stroke, endoleaks and consequent aneurysm rupture have become apparent. Open repair is still the important treatment option because its results are acceptable and durable. This article provides an treatment strategy of aortic arch aneurysms to minimize the complications.


Asunto(s)
Aneurisma de la Aorta Torácica , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Aneurisma de la Aorta Torácica/cirugía , Prótesis Vascular , Humanos , Complicaciones Posoperatorias/prevención & control , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento
4.
Artículo en Ruso | MEDLINE | ID: mdl-33899454

RESUMEN

Bronchopulmonary complications are one of the leading causes of morbidity after cardiac surgery; they lengthen a patient's hospital stay and increase the cost of treatment. The most common postoperative bronchopulmonary complications include pneumonia, atelectasis, respiratory failure, pneumothorax, and bronchospasm. These complications are the consequences of anesthesia and surgical trauma aggravated by the presence of risk factors in the patient in the preoperative period such as any chronic disease involving the lungs, smoking history, persistent cough and / or wheezing, chest and spinal deformities, obesity, senior age. In addition, the presence of chronic heart failure, diabetes mellitus, and chronic kidney disease also increase the risk of developing bronchopulmonary complications. In the prevention and treatment of bronchopulmonary complications the clinical effectiveness of rehabilitation programs after coronary artery bypass grafting is undeniable. The effectiveness of the programs has been proven on the basis of both domestic and foreign long-term in-practice and scientific research. However, despite the significant advances in cardiac rehabilitation there are a number of unresolved issues. Is it possible in a short period of time of the first stationary rehabilitation stage to form the patient's skill to perform breathing exercises and, accordingly, to obtain the maximum effect in the prevention of bronchopulmonary complications? What factors can affect the speed of motor skill formation in the patient's mastering of breathing exercises? What should be the frequency of procedures per day and the number of exercises when a physical therapy instructor works with a patient to increase the effectiveness of the prevention of bronchopulmonary complications in the postoperative period? What category of patients is strictly required for the pre-rehabilitation stage? How should the pre-rehabilitation stage be organized and how long should it take? All these questions require the work-out and implementation of scientifically grounded individual rehabilitation programs with a step-by-step algorithm for managing the patient by a rehabilitation multi-team from the first hours after surgery with the mandatory inclusion of pre-rehabilitation and taking into account the social, anamnestic, clinical and psychological characteristics of the patient.


Asunto(s)
Rehabilitación Cardiaca , Procedimientos Quirúrgicos Cardíacos , Atelectasia Pulmonar , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Puente de Arteria Coronaria , Terapia por Ejercicio , Humanos , Complicaciones Posoperatorias/prevención & control
5.
Medicine (Baltimore) ; 100(14): e21323, 2021 Apr 09.
Artículo en Inglés | MEDLINE | ID: mdl-33832057

RESUMEN

ABSTRACT: Parathyroid protection during thyroid lobectomy was not illustrated previously. Aim of this study was to find out the influence of parathyroid glands in situ preservation and autotransplantation on postoperative parathyroid function in thyroid lobectomy.Consecutive patients who underwent primary thyroid lobectomy with unilateral central neck dissection for papillary thyroid carcinoma in our center were included retrospectively. Postoperative hypoparathyroidism was defined as low parathyroid hormone (PTH) levels (<1.6 pmol/L) and keeping over 6 months was defined as permanent. Patients were divided into 3 groups: all identified parathyroid glands preserved in situ (preservation group); at least one parathyroid gland autotransplanted without accidental resection (autotransplantation group); at least one parathyroid gland accidental resected (resection group).A total of 425 patients were included. No permanent hypoparathyroidism was reported, and the rates of transient hypoparathyroidism were similar among all groups. Significantly lower serum PTH levels were found in autotransplantation group versus preservation group at postoperative 1-day (3.77 ±â€Š1.61 vs 4.72 ±â€Š2.31, P < .001). Transient hypoparathyroidism was significantly associated with reduced intraoperative carbon nanoparticles utilization (57.1% vs 77.4%, P = .039).Thyroid lobectomy was a safe surgical method for parathyroid protection no matter the practice to ipsilateral parathyroid glands. However, preservation of all parathyroid glands was still recommended considering relatively stable PTH levels.


Asunto(s)
Glándulas Paratiroides/lesiones , Cáncer Papilar Tiroideo/cirugía , Neoplasias de la Tiroides/cirugía , Tiroidectomía/métodos , Adulto , Bases de Datos Factuales , Femenino , Humanos , Hipoparatiroidismo/prevención & control , Masculino , Persona de Mediana Edad , Órganos en Riesgo/lesiones , Complicaciones Posoperatorias/prevención & control , Estudios Retrospectivos , Tiroidectomía/efectos adversos
6.
Anticancer Res ; 41(4): 1895-1901, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33813394

RESUMEN

BACKGROUND/AIM: We created a novel, preoperative wellness program (WP) that promotes recovery. This study assessed its impact on patient outcomes after pancreatectomy. PATIENTS AND METHODS: Pancreatoduodenectomies (PD) and distal pancreatectomies (DP) performed from 2015 to 2018 were reviewed using our institutional NSQIP database. Patients in the WP had their medical conditions optimized and were provided with the following: chlorhexidine, topical mupirocin, incentive spirometer, and immune-nutrition supplements. RESULTS: Out of a total of 669 pancreatectomy patients (411 PD, 258 DP), 308 were enrolled in the WP (188 PD, 120 DP). In the PD subgroup, on multivariable analysis (MVA), the WP patients had shorter lengths of hospital stay (LOS) (12 vs. 10 days, p<0.001). On MVA, WP patients had less post-op transfusion (20 vs. 10%, p=0.027). For the combined groups on MVA, LOS continued to be significant (OR=0.89, 95%CI=0.82-0.97, p<0.007). CONCLUSION: A preoperative patient centered WP may reduce the length of stay.


Asunto(s)
Promoción de la Salud , Tiempo de Internación , Pancreatectomía , Pancreaticoduodenectomía , Atención Dirigida al Paciente , Cuidados Preoperatorios , Anciano , Bases de Datos Factuales , Femenino , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Pancreatectomía/efectos adversos , Pancreaticoduodenectomía/efectos adversos , Alta del Paciente , Complicaciones Posoperatorias/prevención & control , Evaluación de Programas y Proyectos de Salud , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento
7.
Medicine (Baltimore) ; 100(15): e25484, 2021 Apr 16.
Artículo en Inglés | MEDLINE | ID: mdl-33847656

RESUMEN

BACKGROUND: Percutaneous coronary intervention (PCI) has become one of the effective methods for the treatment of coronary heart disease (CHD). However, it is easy to have in-stent restenosis (ISR), even cardiovascular events after PCI, which affects the therapeutic effects. The incidence of ISR in diabetes mellitus (DM) patients increased by 2 to 4 times. Early identification of the risk factors of ISR in DM patients after PCI may help clinical staff to prevent and intervene as soon as possible, so it is very important to improve the clinical outcomes of DM patients. Although scholars at home and abroad have studied and summarized the risk factors of ISR in DM patients after PCI, the conclusions are different. Therefore, in this study, meta-analysis was used to summarize the risk factors of ISR in DM patients after PCI, and to explore the characteristics of high-risk groups of ISR, thus providing reference for early identification and prevention of ISR. METHODS: We will search related literature from PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang Database. Eligible studies will be screened based on inclusion criteria. Meanwhile, data extraction, risk of bias assessment, publication bias assessment, subgroup analysis, and quality assessment will be performed. Review Manager Version 5.3 software will be applied for data analysis. Each process is independently conducted by 2 researchers. If there is any objection, it will be submitted to a third researcher for resolution. RESULTS: We will disseminate the findings of this systematic review and meta-analysis via publications in peer-reviewed journals. CONCLUSIONS: The results of this analysis can be used to generate a risk prediction model and provide an intervention strategy for the occurrence of ISR in DM patients after PCI. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/WC87Y.


Asunto(s)
Enfermedad Coronaria/cirugía , Reestenosis Coronaria/prevención & control , Cardiomiopatías Diabéticas/cirugía , Intervención Coronaria Percutánea/efectos adversos , Complicaciones Posoperatorias/prevención & control , Stents/efectos adversos , Adulto , Enfermedad Coronaria/fisiopatología , Reestenosis Coronaria/etiología , Diabetes Mellitus , Cardiomiopatías Diabéticas/fisiopatología , Femenino , Humanos , Incidencia , Masculino , Metaanálisis como Asunto , Estudios Observacionales como Asunto , Complicaciones Posoperatorias/etiología , Proyectos de Investigación , Medición de Riesgo , Factores de Riesgo , Revisiones Sistemáticas como Asunto
8.
Vasc Health Risk Manag ; 17: 135-143, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33854322

RESUMEN

Purpose: To determine the incidence and risk factor of postoperative venous thromboembolism (VTE) in Thai populations and to evaluate morbidity, mortality, bleeding complications and the benefit of thromboprophylaxis in real-world practice. Patients and Methods: We performed a retrospective, single-center, cohort study of patients from all age groups who underwent elective open or laparoscopic major abdomino-pelvic surgery between January 2008 and December 2018 at Chulabhorn Hospital, Bangkok, Thailand. We collected general medical information and specific data based on items from the Caprini risk scoring system. Results: A total of 2462 major abdomino-pelvic surgeries were included. The study population consisted of 742 males (30.1%) and 1720 females (69.9%) aged 54.59 ± 13.27 years. The incidence of VTE in Thai patients that underwent major abdominal surgery was 0.48%. The most frequent influencing factor for VTE was a history of pulmonary embolism, which increased the risk of VTE 98.28-fold, whereas a history of deep vein thrombosis increased the risk of VTE by 12.34-fold. Other factors influencing VTE development were obesity, anticoagulant use, postoperative chemotherapy, preoperative chemotherapy, endometrium cancer, tumor-node-metastasis (TNM) stage 4 and American College of Chest Physicians (ACCP) class 4. Protective factors included no history of VTE, laparoscopic surgery, TNM stage 0 and benign disease and BMI<30. VTE significantly increased mortality whereas following ACCP guideline reduced mortality. Conclusion: Post-operative VTE incidence in Thai patients undergoing major abdomino-pelvic surgery was lower compared with Western patients. Factors influencing for VTE were history of VTE, anticoagulant use, postoperative chemotherapy, preoperative chemotherapy, endometrium cancer, TNM stage 4 and ACCP class 4. Following ACCP guideline reduced the incidence of mortality.


Asunto(s)
Abdomen/cirugía , Pelvis/cirugía , Complicaciones Posoperatorias/epidemiología , Tromboembolia/epidemiología , Adulto , Anciano , Anticoagulantes/uso terapéutico , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/prevención & control , Factores Protectores , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Centros de Atención Terciaria , Tailandia/epidemiología , Tromboembolia/diagnóstico , Tromboembolia/mortalidad , Tromboembolia/prevención & control , Adulto Joven
9.
Curr Opin Anaesthesiol ; 34(3): 373-380, 2021 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-33852505

RESUMEN

PURPOSE OF REVIEW: As the surgical population ages, preoperative diagnosis and optimization of frailty becomes increasingly important. Various concepts are used to define frailty, and several tools have been validated for use in the perioperative period. This article reviews current conceptual frameworks of frailty, references current literature and provides a practical approach to the preoperative frailty assessment with a focus on potential interventions. RECENT FINDINGS: A multipronged approach toward preoperative optimization should be used in patients with frailty syndrome. Oral protein supplementation and immunonutrition therapy can reduce complications in patients with malnutrition. Initiating a preoperative physical exercise regimen may mitigate frailty. Nonpharmacologic interventions to reduce preoperative anxiety and improve mood are effective, low-cost adjuncts associated with improvement in postoperative outcomes. Engaging in shared decision making is a critical component of the preoperative evaluation of frail patients. SUMMARY: Emerging evidence suggests that frailty may be mitigated with patient-specific, multidimensional preoperative interventions, thus potentially improving postoperative outcomes in this vulnerable patient population.


Asunto(s)
Fragilidad , Anciano , Anciano Frágil , Fragilidad/complicaciones , Fragilidad/diagnóstico , Evaluación Geriátrica , Humanos , Periodo Perioperatorio , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Cuidados Preoperatorios , Medición de Riesgo
10.
Medicine (Baltimore) ; 100(16): e25598, 2021 Apr 23.
Artículo en Inglés | MEDLINE | ID: mdl-33879722

RESUMEN

BACKGROUND: Acute pancreatitis is the most common complication of Endoscopic Retrograde Cholangiopancreatography (ERCP). There was no conclusion on the prevention of Post-ERCP Pancreatitis (PEP) by Lactated Ringer Solution. AIM: The purpose of this meta analyses is to determine whether aggressive hydration with Lactated Ringer Solution reduced the incidence of PEP. METHODS: We retrieved randomized clinical trials comparing the preventive effects of aggressive hydration with Lactated Ringer Solution and standard hydration on PEP from PubMed, the Cochrane Library, Embase, the Web of Science, Clinical Trial.gov, Scopus database, CNKI, CQVIP and WanFang Data. Primary outcome was incidence of PEP. Secondary outcomes included incidence of hyperamylasemia, abdominal pain and adverse events. RESULTS: Ten randomized controlled trials with 2200 patients were included in this meta-analysis. Meta-analysis showed that compared with standard hydration, aggressive hydration reduced the incidence of PEP (odds ratio [OR], 0.40; 95% confidence intervals [CI], 0.26-0.63; P < .0001). Compared with standard hydration, aggressive hydration also reduced the incidence of hyperamylasemia after ERCP (OR, 0.48; 95% CI, 0.38-0.60; P < .0001). There was significant difference between aggressive hydration and standard hydration in the incidence of abdominal pain (OR, 0.29; 95% CI, 0.11-0.73; P = .008). There was no difference in adverse events between aggressive hydration and standard hydration (OR, 0.93; 95% CI, 0.21-4.13; P = .93). Sensitivity analyses showed that neither alternative effect measures nor statistical models regarding heterogeneity affected the conclusions of this meta-analysis. CONCLUSION: Aggressive hydration with Lactated Ringer Solution during perioperative period of ERCP can prevent PEP.


Asunto(s)
Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Fluidoterapia/métodos , Pancreatitis/prevención & control , Complicaciones Posoperatorias/prevención & control , Lactato de Ringer/administración & dosificación , Dolor Abdominal/epidemiología , Dolor Abdominal/etiología , Dolor Abdominal/prevención & control , Adulto , Anciano , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Pancreatitis/epidemiología , Pancreatitis/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento
11.
Acta Chir Orthop Traumatol Cech ; 88(1): 13-17, 2021.
Artículo en Checo | MEDLINE | ID: mdl-33764862

RESUMEN

PURPOSE OF THE STUDY Heterotopic ossification is a frequent and a well-known complication after elective primary total hip arthroplasty. Prophylaxis is crucial since once the ossification is mature, the only treatment option is its surgical removal during revision hip surgery. There are pre-, peri- and postoperative prophylactic modalities. Ranking among the perioperative possibilities is the application of tranexamic acid in blood control management. The aim of our study is to prove the positive side effect of tranexamic acid application on reducing the heterotopic ossification ratio. MATERIAL AND METHODS A cohort of 401 total hip replacements was assessed retrospectively in the period from 2012 to 2016. Particular degrees were stratified based on the Brooker classification, sex, laterality and type of implant fixation. The average follow-up period is 6.10 years (range 40 m to 113 m). The hips treated in 2012 are taken as reference and the hips treated in 2016 are exposed to tranexamic acid protocol. Other secondary prophylactic modalities (pharmacological prophylaxis or radiotherapy), tertiary modalities (revision surgery) and trauma patients were excluded from the study. The acquired data were then statistically assessed. RESULTS Tranexamic acid protocol significantly reduces the incidence of heterotopic ossification after elective primary total hip replacement. In our cohort of 401 hips, the overall incidence of HO is 40.6%. The difference between the control group - 49.7% and the exposed group - 30.2% is statistically significant. More importantly, the clinically relevant types (III and IV) were also significantly reduced (12.7% vs. 4.2%). Other associated parameters such as uncemented implant, female sex and right-sided surgery further reduced the incidence of ossifications. DISCUSSION Identification of the risk patient, risk factors and subsequent care to maintain the range of motion, analgesia or potential removal of ossifications remain to be the priority in managing heterotopic ossifications after THA. Preoperative options to reduce the incidence of this complication are limited. Moreover, both the pharmacological prophylaxis and radiotherapy are associated with major complications and strict patient compliance is fundamental. Inclusion of simple tranexamic acid protocol in surgery management significantly reduces the risk of heterotopic ossification. CONCLUSIONS Development and maturation of heterotopic ossification is still intensively explored, but the main biochemical pathways are still unclear. Therefore, there is no causal treatment option nowadays. Individualisation of prophylactic treatment modalities leads to reduction in ossification development. It has been proven that one of these effective modalities is the tranexamic acid application before and after the procedure. This reduction is statistically significant and clinically relevant. Key words: tranexamic acid, total hip replacement, heterotopic ossification, prophylaxis, fixation type.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Osificación Heterotópica , Ácido Tranexámico , Artroplastia de Reemplazo de Cadera/efectos adversos , Femenino , Humanos , Incidencia , Osificación Heterotópica/epidemiología , Osificación Heterotópica/etiología , Osificación Heterotópica/prevención & control , Complicaciones Posoperatorias/prevención & control , Estudios Retrospectivos , Ácido Tranexámico/uso terapéutico
12.
Medicine (Baltimore) ; 100(12): e25151, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761684

RESUMEN

ABSTRACT: In 2014, the American College of Cardiology/American Heart Association (ACC/AHA) released guidelines for ordering pre-operative echocardiograms in patients undergoing non-cardiac surgery. The purpose of this study is to determine if pre-operative echocardiograms ordered prior to fragility hip fracture repair are ordered according to these guidelines, change anesthetic management or affect patient outcomes. In addition, we attempted to evaluate the efficacy of the ACC/AHA guidelines.We conducted a 4-year retrospective chart review of acute fragility hip fractures at a single institution. Charts were reviewed to determine which patients met criteria for a pre-operative echocardiogram. Within this group we then compared patients who received a pre-operative echocardiogram to those who did not. Comparisons were made with regard to time to surgery, changes from standard anesthetic management, major adverse cardiac events, length of hospital stay, and 1-year mortality. We also examined which patients received postoperative echocardiograms and the incidence of adverse cardiac events in this group.Of 402 patients, 87 (22%) had ACC/AHA indications for pre-operative echocardiogram, and 42 (48%) of them received one. The indication to order a pre-operative echocardiogram in stable heart failure or valve disease patients if their last echo was greater than 1 year was only followed 23% of the time. In the pre-operative echocardiogram group, anesthetic management was adjusted more frequently (P = .025), and average time to surgery was greater (P < .001). The incidence of a major adverse cardiac event was 10% in the ACC/AHA echocardiogram indicated group and 3% in the non-indicated echocardiogram group. An equal number of echocardiograms were completed postoperatively as were completed under ACC/AHA pre-operative guidelines. Sixty-seven percent of the postoperative echocardiograms did not have ACC/AHA pre-operative indications.Our data demonstrates that pre-operative echocardiograms for "stable heart failure and valvular disease with greater than 1 year from last echocardiogram" is infrequently performed without significant adverse cardiac outcomes. Pre-operative echocardiography was associated with more anesthetic adjustments and longer time to surgery. Postoperative echocardiograms were done for cardiopulmonary complications. Studies need to examine and refine clinical parameters that would improve the selection of patients who would benefit from pre-operative echocardiograms.


Asunto(s)
Ecocardiografía/normas , Cardiopatías/prevención & control , Fracturas de Cadera/diagnóstico por imagen , Fracturas Osteoporóticas/diagnóstico por imagen , Complicaciones Posoperatorias/prevención & control , Cuidados Preoperatorios/normas , Anciano de 80 o más Años , Femenino , Fijación de Fractura/efectos adversos , Fijación de Fractura/normas , Adhesión a Directriz/estadística & datos numéricos , Cardiopatías/epidemiología , Cardiopatías/etiología , Fracturas de Cadera/cirugía , Humanos , Incidencia , Masculino , Fracturas Osteoporóticas/cirugía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Medición de Riesgo
13.
BMC Surg ; 21(1): 155, 2021 Mar 21.
Artículo en Inglés | MEDLINE | ID: mdl-33745452

RESUMEN

INTRODUCTION: Disturbance in the lymphatic drainage during D2 dissection is associated with significant morbidity. We aimed to assess the effect of fibrin glue on the reduction of postoperative lymphatic leakage. METHODS: Prospective double-blinded randomized clinical trial with forty patients in each study arm was conducted. All patients diagnosed, staged, and became a candidate for D2 dissection based on NCCN 2019 guideline for gastric cancer. The intervention group received 1 cc of IFABOND® applied to the surgical bed. RESULTS: The difference between study groups regarding age, gender, tumor stage was insignificant. (All p-values > 0.05). The median daily drainage volume was 120 ml with the first and the third interquartile being 75 and 210 ml, respectively for the intervention group. The control group had median, the first, and the third interquartile of 350, 290, and 420 ml. The difference between daily drainage volumes was statistically significant (p-value < 0.001). The length of hospital stay was significantly different between the two groups. Notably, the intervention group was discharged sooner (median of 7 Vs 9 days, p-value: 0.001). CONCLUSION: This study showed the possible role of fibrin glue in reducing postoperative lymphatic leakage after gastrectomy and D2 dissection. Registration trial number: IRCT20200710048071N1, 2020.08.16.


Asunto(s)
Adhesivo de Tejido de Fibrina/uso terapéutico , Gastrectomía/efectos adversos , Escisión del Ganglio Linfático/efectos adversos , Escisión del Ganglio Linfático/métodos , Complicaciones Posoperatorias/prevención & control , Neoplasias Gástricas/cirugía , Anciano , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento
14.
Cochrane Database Syst Rev ; 3: CD008726, 2021 03 04.
Artículo en Inglés | MEDLINE | ID: mdl-33661539

RESUMEN

BACKGROUND: Caesarean section increases the risk of postpartum infection for women and prophylactic antibiotics have been shown to reduce the incidence; however, there are adverse effects. It is important to identify the most effective class of antibiotics to use and those with the least adverse effects.  OBJECTIVES: To determine, from the best available evidence, the balance of benefits and harms between different classes of antibiotic given prophylactically to women undergoing caesarean section, considering their effectiveness in reducing infectious complications for women and adverse effects on both mother and infant. SEARCH METHODS: For this 2020 update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (2 December 2019), and reference lists of retrieved studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing different classes of prophylactic antibiotics given to women undergoing caesarean section.  RCTs published in abstract form were also included. We excluded trials that compared drugs with placebo or drugs within a specific class; these are assessed in other Cochrane Reviews. We excluded quasi-RCTs and cross-over trials. Cluster-RCTs were eligible for inclusion but none were identified. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We included 39 studies, with 33 providing data (8073 women). Thirty-two studies (7690 women) contributing data administered antibiotics systemically, while one study (383 women) used lavage and was analysed separately. We identified three main comparisons that addressed clinically important questions on antibiotics at caesarean section (all systemic administration), but we only found studies for one comparison, 'antistaphylococcal cephalosporins (1st and 2nd generation) versus broad spectrum penicillins plus betalactamase inhibitors'.   We found no studies for the following comparisons: 'antistaphylococcal cephalosporins (1st and 2nd generation) versus lincosamides' and 'antistaphylococcal cephalosporins (1st and 2nd generation) versus lincosamides plus aminoglycosides'. Twenty-seven studies (22 provided data) included comparisons of cephalosporins (only) versus penicillins (only). However for this update, we only pooled data relating to different sub-classes of penicillins and cephalosporins where they are known to have similar spectra of action against agents likely to cause infection at caesarean section. Eight trials, providing data on 1540 women, reported on our main comparison, 'antistaphylococcal cephalosporins (1st and 2nd generation) versus broad spectrum penicillins plus betalactamase inhibitors'. We found data on four other comparisons of cephalosporins (only) versus penicillins (only) using systemic administration: antistaphylococcal cephalosporins (1st and 2nd generation) versus non-antistaphylococcal penicillins (natural and broad spectrum) (9 studies, 3093 women); minimally antistaphylococcal cephalosporins (3rd generation) versus non-antistaphylococcal penicillins (natural and broad spectrum) (4 studies, 854 women); minimally antistaphylococcal cephalosporins (3rd generation) versus broad spectrum penicillins plus betalactamase inhibitors (2 studies, 865 women); and minimally antistaphylococcal cephalosporins (3rd generation) versus broad spectrum and antistaphylococcal penicillins (1 study, 200 women). For other comparisons of different classes of antibiotics, only a small number of trials provided data for each comparison, and in all but one case data were not pooled. For all comparisons, there was a lack of good quality data and important outcomes often included few women. Three of the studies that contributed data were undertaken with drug company funding, one was funded by the hospital, and for all other studies the funding source was not reported. Most of the studies were at unclear risk of selection bias, reporting bias and other biases, partly due to the inclusion of many older trials where trial reports did not provide sufficient methodological information. We undertook GRADE assessment on the only main comparison reported by the included studies, antistaphylococcal cephalosporins (1st and 2nd generation) versus broad spectrum penicillins plus betalactamase inhibitors, and the certainty ranged from low to very low, mostly due to concerns about risk of bias, wide confidence intervals (CI), and few events. In terms of the primary outcomes for our main comparison of 'antistaphylococcal cephalosporins (1st and 2nd generation) versus broad spectrum penicillins plus betalactamase inhibitors': only one small study reported sepsis, and there were too few events to identify clear differences between the drugs (risk ratio (RR) 2.37, 95% CI 0.10 to 56.41, 1 study, 75 women, very low-certainty evidence). There may be little or no difference between these antibiotics in preventing endometritis (RR 1.10; 95% CI 0.76 to 1.60, 7 studies, 1161 women; low-certainty evidence). None of the included studies reported on infant sepsis or infant oral thrush. For our secondary outcomes, we found there may be little or no difference between interventions for maternal fever (RR 1.07, 95% CI 0.65 to 1.75, 3 studies, 678 women; low-certainty evidence). We are uncertain of the effects on maternal: wound infection (RR 0.78, 95% CI 0.32 to 1.90, 4 studies, 543 women), urinary tract infection (average RR 0.64, 95% CI 0.11 to 3.73, 4 studies, 496 women), composite adverse effects (RR 0.96, 95% CI 0.09 to 10.50, 2 studies, 468 women), and skin rash (RR 1.08, 95% CI 0.28 to 4.1, 3 studies, 591 women) (all very low certainty evidence). Although maternal allergic reactions were reported by two studies, there were no events. There were no infant outcomes reported in the included studies. For the other comparisons, the results for most outcomes had wide CIs, few studies and few women included. None of the included trials reported on longer-term maternal outcomes, or on any infant outcomes. AUTHORS' CONCLUSIONS: Based on the best currently available evidence, 'antistaphylococcal cephalosporins' and 'broad spectrum penicillins plus betalactamase inhibitors' may have similar efficacy at caesarean section when considering immediate postoperative infection, although we did not have clear evidence for several important outcomes. Most trials administered antibiotics at or after cord clamping, or post-operatively, so results may have limited applicability to current practice which generally favours administration prior to skin incision. We have no data on any infant outcomes, nor on late infections (up to 30 days) in the mother; these are important gaps in the evidence that warrant further research. Antimicrobial resistance is very important but more appropriately investigated by other trial designs.


Asunto(s)
Antibacterianos/uso terapéutico , Infecciones Bacterianas/prevención & control , Cefalosporinas/uso terapéutico , Cesárea/efectos adversos , Penicilinas/uso terapéutico , Complicaciones Posoperatorias/prevención & control , Antibacterianos/efectos adversos , Antibacterianos/clasificación , Profilaxis Antibiótica/métodos , Cefalosporinas/efectos adversos , Femenino , Humanos , Recién Nacido , Penicilinas/efectos adversos , Embarazo , Infección Puerperal/prevención & control , Ensayos Clínicos Controlados Aleatorios como Asunto , Inhibidores de beta-Lactamasas/uso terapéutico
15.
Cochrane Database Syst Rev ; 3: CD011557, 2021 03 15.
Artículo en Inglés | MEDLINE | ID: mdl-33720396

RESUMEN

BACKGROUND: Graft thrombosis is a well-recognised complication of solid organ transplantation and is one of the leading causes of graft failure. Currently there are no standardised protocols for thromboprophylaxis. Many transplant units use unfractionated heparin (UFH) and fractionated heparins (low molecular weight heparin; LMWH) as prophylaxis for thrombosis. Antiplatelet agents such as aspirin are routinely used as prophylaxis of other thrombotic conditions and may have a role in preventing graft thrombosis. However, any pharmacological thromboprophylaxis comes with the theoretical risk of increasing the risk of major blood loss following transplant. This review looks at benefits and harms of thromboprophylaxis in patients undergoing solid organ transplantation. OBJECTIVES: To assess the benefits and harms of instituting thromboprophylaxis to patients undergoing solid organ transplantation. SEARCH METHODS: We searched the Cochrane Kidney and Transplant Register of Studies up to 10 November 2020 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA: We included all randomised controlled trials (RCTs) and quasi-RCTs designed to examine interventions to prevent thrombosis in solid organ transplant recipients. All donor types were included (donor after circulatory (DCD) and brainstem death (DBD) and live transplantation). There was no upper age limit for recipients in our search. DATA COLLECTION AND ANALYSIS: The results of the literature search were screened and data collected by two independent authors. Dichotomous outcome results were expressed as risk ratio (RR) with 95% confidence intervals (CI). Random effects models were used for data analysis. Risk of bias was independently assessed by two authors using the risk of bias assessment tool. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS: We identified nine studies (712 participants). Seven studies (544 participants) included kidney transplant recipients, and studies included liver transplant recipients. We did not identify any study enrolling heart, lung, pancreas, bowel, or any other solid organ transplant recipient. Selection bias was high or unclear in eight of the nine studies; five studies were at high risk of bias for performance and/or detection bias; while attrition and reporting biases were in general low or unclear. Three studies (180 participants) primarily investigated heparinisation in kidney transplantation. Only two studies reported on graft vessel thrombosis in kidney transplantation (144 participants). These small studies were at high risk of bias in several domains and reported only two graft thromboses between them; it therefore remains unclear whether heparin decreases the risk of early graft thrombosis or non-graft thrombosis (very low certainty). UFH may make little or no difference versus placebo to the rate of major bleeding events in kidney transplantation (3 studies, 155 participants: RR 2.92, 95% CI 0.89 to 9.56; I² = 0%; low certainty evidence). Sensitivity analysis using a fixed-effect model suggested that UFH may increase the risk of haemorrhagic events compared to placebo (RR 3.33, 95% CI 1.04 to 10.67, P = 0.04). Compared to control, any heparin (including LMWH) may make little or no difference to the number of major bleeding events (3 studies, 180 participants: RR 2.70, 95% CI 0.89 to 8.19; I² = 0%; low certainty evidence) and had an unclear effect on risk of readmission to intensive care (3 studies, 180 participants: RR 0.68, 95% CI 0.12 to 3.90, I² = 45%; very low certainty evidence). The effect of heparin on our other outcomes (including death, patient and graft survival, transfusion requirements) remains unclear (very low certainty evidence). Three studies (144 participants) investigated antiplatelet interventions in kidney transplantation: aspirin versus dipyridamole (1), and Lipo-PGE1 plus low-dose heparin to "control" in patients who had a diagnosis of acute rejection (2). None of these reported on early graft thromboses. The effect of aspirin, dipyridamole and Lipo PGE1 plus low-dose heparin on any outcomes is unclear (very low certainty evidence). Two studies (168 participants) assessed interventions in liver transplants. One compared warfarin versus aspirin in patients with pre-existing portal vein thrombosis and the other investigated plasmapheresis plus anticoagulation. Both studies were abstract-only publications, had high risk of bias in several domains, and no outcomes could be meta-analysed. Overall, the effect of any of these interventions on any of our outcomes remains unclear with no evidence to guide anti-thrombotic therapy in standard liver transplant recipients (very low certainty evidence). AUTHORS' CONCLUSIONS: Overall, there is a paucity of research in the field of graft thrombosis prevention. Due to a lack of high quality evidence, it remains unclear whether any therapy is able to reduce the rate of early graft thrombosis in any type of solid organ transplant. UFH may increase the risk of major bleeding in kidney transplant recipients, however this is based on low certainty evidence. There is no evidence from RCTs to guide anti-thrombotic strategies in liver, heart, lung, or other solid organ transplants. Further studies are required in comparing anticoagulants, antiplatelets to placebo in solid organ transplantation. These should focus on outcomes such as early graft thrombosis, major haemorrhagic complications, return to theatre, and patient/graft survival.


Asunto(s)
Trasplante de Riñón/efectos adversos , Trasplante de Hígado/efectos adversos , Complicaciones Posoperatorias/prevención & control , Trombosis/prevención & control , Receptores de Trasplantes , Anticoagulantes/efectos adversos , Anticoagulantes/uso terapéutico , Aspirina/uso terapéutico , Sesgo , Dipiridamol/uso terapéutico , Hemorragia/inducido químicamente , Heparina/efectos adversos , Heparina/uso terapéutico , Heparina de Bajo-Peso-Molecular/efectos adversos , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Trasplante de Riñón/estadística & datos numéricos , Trasplante de Hígado/estadística & datos numéricos , Placebos/uso terapéutico , Inhibidores de Agregación Plaquetaria/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Warfarina/uso terapéutico
16.
Ann R Coll Surg Engl ; 103(4): 255-262, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33682461

RESUMEN

INTRODUCTION: Laparoscopic adhesiolysis is increasingly being used to treat adhesional small bowel obstruction (ASBO) as it has been associated with reduced postoperative length of stay (LOS) and faster recovery. However, concerns regarding limited working space, iatrogenic bowel injury and failure to relieve the obstruction have limited its uptake. This study reports our centre's experience of adopting laparoscopy as the standard operative approach. METHODS: A single-centre prospective cohort study was performed incorporating local data from the National Emergency Laparotomy Audit Database; January 2015 to December 2019. All patients undergoing surgery for ASBO were included. Patient demographic, operative and inhospital outcomes data were compared between different surgical approaches. Linear regression analysis was performed for LOS. RESULTS: A total of 299 cases were identified. Overall, 76.3% of cases were started laparoscopically and 52.2% were completed successfully. Patients treated laparoscopically had lower Portsmouth - Physiological and Operative Severity Score for the enuMeration of Mortality and morbidity (P-POSSUM) predicted mortality (median 2.1 (interquartile range (IQR) 1.3-5.0) vs 5.7 (IQR 2.0-12.4), p=<0.001) and shorter postoperative LOS compared with open (median 4.2 days (IQR 2.5-8.2) vs 11.3 days (IQR 7.3-16.6), p=0.000). Inhospital mortality was lower in the laparoscopic group (2 vs 7 deaths, p=<0.001). In regression analysis, laparoscopic surgery was found to have the strongest association with postoperative LOS (ß -8.51 (-13.87 to -3.16) p=0.002) compared with open surgery. CONCLUSIONS: Laparoscopy is a safe and feasible approach for adhesiolysis in the majority of patients with ASBO. It is associated with reduced LOS with no impact on complications or mortality.


Asunto(s)
Obstrucción Intestinal/cirugía , Intestino Delgado/cirugía , Laparoscopía , Adherencias Tisulares/cirugía , Anciano , Anciano de 80 o más Años , Bases de Datos Factuales , Urgencias Médicas , Femenino , Mortalidad Hospitalaria , Humanos , Obstrucción Intestinal/etiología , Tiempo de Internación/estadística & datos numéricos , Modelos Lineales , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Análisis Multivariante , Tempo Operativo , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Estudios Prospectivos , Adherencias Tisulares/complicaciones , Resultado del Tratamiento
17.
Rev Med Liege ; 76(3): 179-185, 2021 Mar.
Artículo en Francés | MEDLINE | ID: mdl-33682387

RESUMEN

Anesthesia remains a high-risk specialty, even though the discipline has evolved considerably over the last few decades. Independently of postoperative complications, some risks are inherent to the perioperative period itself. In this narrative review of the literature, we describe these risks and the predictive scores, allowing an assessment of these complications. All these scores are designed to detect high-risk patients and to promote personalized medicine and individualized anesthesia. They also increase the objectivity of the preoperative assessment. Finally, using these scores, the practitioner can more accurately respond to the patient who presents anxiety regarding the perioperative period.


Asunto(s)
Anestesia , Anestésicos , Humanos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/prevención & control , Medición de Riesgo
18.
Artículo en Alemán | MEDLINE | ID: mdl-33725737

RESUMEN

With patient safety being anesthesiologists' top priority, the focus of preoperative assessment must be to reduce perioperative morbidity and mortality of each patient entrusted to us. Perioperative risk is multifactorial and depends on the extent of surgery and the preoperative condition of the patient.The three main causes of unexpected perioperative death are cardiac arrest, hypoxemia and acute bleeding. Therefore, cardiac and pulmonary risk assessment should cover pre-existing conditions, patient's functional capacity and risk factors associated with the surgical procedure. Specific assessment tools have been developed, are easily accessible and have proven effective in every day clinical practice. Regarding the risk of bleeding, taking a detailed patients' history (including medication) seems to be more suitable to detect mild bleeding disorders than laboratory screening.Functional capacity, defined as the patient's ability to cope with everyday life, gains importance in preoperative risk assessment, as do further factors like deficiencies in nutrition, anaemia, physical capacity, the metabolic status or frailty in the elderly. Prehabilitation strategies reduce perioperative mortality and morbidity by improving functional capacity. These include preoperative nutrition supplementation, physical exercise, correction of iron deficiency and optimized treatment of hyperglycemia.A combination of thorough risk stratification and prehabilitation strategies can improve preoperative conditions and reduce complications in the postoperative period.


Asunto(s)
Anestesiología , Fragilidad , Paro Cardíaco , Anciano , Humanos , Complicaciones Posoperatorias/prevención & control , Cuidados Preoperatorios , Medición de Riesgo , Factores de Riesgo
19.
Artículo en Alemán | MEDLINE | ID: mdl-33725739

RESUMEN

The early postoperative period is of increasing importance in modern operative medicine with a continuously increasing surgical spectrum and patients with increasingly complex comorbidities. Even with optimal preoperative evaluation and intraoperative care, postoperative complications are not uncommon. The fastest possible diagnosis, including possible differential diagnoses and any combined disorders, is essential in order to initiate the indicated therapeutic measures. The spatial correlate of the postoperative phase is the post-anaesthesia care unit (PACU). The qualification of the medical staff and spatial structure must meet the recommended minimum and must be in line with the existing operational structures. Good interdisciplinary and interprofessional communication reduces the loss of information and a good error reporting culture helps to reduce critical incidents.


Asunto(s)
Quirófanos , Cuidados Preoperatorios , Hospitales , Humanos , Complicaciones Posoperatorias/prevención & control
20.
Medicine (Baltimore) ; 100(11): e24752, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33725941

RESUMEN

BACKGROUND: Knee Osteoarthritis (KOA) is a degenerative osteoarthrosis with knee joint pain as the main symptom. In recent years, arthroscopic removal of loose body and repair of meniscus have become common methods for the treatment of KOA. However, postoperative pain, swelling and limited joint movement affect the functional recovery of knee joint and the effect of surgical treatment. Early postoperative control of pain and swelling is of great significance to improve the curative effect of arthroscopic debridement and promote the recovery of knee joint function. In recent years, many clinical studies have reported that the nursing method of fumigation and washing with Chinese medicine after arthroscopic debridement of KOA can relieve pain, promote the recovery of joint function and improve the clinical curative effect, but there is a lack of evidence-based medicine. The purpose of this study is to evaluate the efficacy and safety of fumigation and washing with traditional Chinese medicine after KOA arthroscopy. METHODS: Computer retrieval English database (PubMed, Embase, Web of Science, the Cochrane Library) and Chinese database (China National Knowledge Infrastructure, Wanfang, VIP Database for Chinese Technical Periodicals, China Biology Medicine disc), moreover manual retrieval academic, Google and baidu from building to since December 2020, traditional Chinese medicine fumigation applied to KOA arthroscopy postoperative nursing of randomized controlled clinical research, by two researchers independently evaluated the quality of the included study and extracted the data. Meta-analysis of the included literatures was performed using RevMan5.3 software. RESULTS: The main observation index of this study was the effective rate, and the secondary indexes included Visual Analogue Scale Score, the Western Ontario and McMaster university orthopedic index, Lysholms score and adverse reactions, so as to evaluate the efficacy and safety of traditional Chinese medicine fumigation nursing after KOA arthroscopy. CONCLUSION: This study will provide reliable evidence for the clinical application of Fumigation and washing nursing of traditional Chinese medicine after KOA arthroscopy. ETHICS AND DISSEMINATION: Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval will not be required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/THZP4.


Asunto(s)
Medicamentos Herbarios Chinos/uso terapéutico , Fumigación/métodos , Medicina China Tradicional/métodos , Osteoartritis de la Rodilla/rehabilitación , Cuidados Posoperatorios/enfermería , Artroscopía/métodos , Artroscopía/rehabilitación , Desbridamiento/métodos , Desbridamiento/rehabilitación , Humanos , Metaanálisis como Asunto , Osteoartritis de la Rodilla/cirugía , Complicaciones Posoperatorias/prevención & control , Ensayos Clínicos Controlados Aleatorios como Asunto , Proyectos de Investigación , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento
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