Use of Polar Heliostats to Improve Levels of Natural Lighting inside Buildings with Little Access to Sunlight.

The growing need to increase environmental and energy sustainability in buildings (housing, offices, warehouses, etc.) requires the use of solar radiation as a renewable source of energy that can help to lower carbon footprint, making buildings more efficient and thereby contributing to a more sustainable planet, while enhancing the health and wellbeing of its occupants. One of the technologies deployed in the use of solar energy in buildings is heliostats. In this context, this paper presents an analysis of the performance of a heliostat illuminator to improve illumination in a classroom at the Campus of Rabanales of the University of Cordoba (Spain). A design of a system in charge of monitoring and measuring daylighting variables using Arduino hardware technology and free software is shown. This equipment develops the communications, programming and collection of lighting data. In parallel, installation of an artificial lighting system complementary to the natural lighting system is implemented. Finally, an analysis of the impact of the proposed solution on the improvement of energy efficiency is presented. Specifically, it is estimated that up to 64% of savings in artificial lighting can be achieved in spaces with heliostatic illuminators compared to those without them.

Duodenal schwannoma, an infrequent entity.

Schwannomas are benign tumors derived from the Schwann cells of the neural sheath. Their incidence in the digestive tract is very low and generally occurs in the stomach, colon and rectum. Duodenal schwannoma is even rarer.

Tendencias divergentes en la mortalidad por suicidio según comunidad autónoma y sexo (1980-2016) / Divergent trends in suicide mortality by Autonomous Community and sex (1980-2016)

OBJETIVOS: Analizar los cambios en las tendencias de la mortalidad por suicidio según comunidad autónoma y sexo en España durante el período 1980-2016 utilizando modelos de regresión joinpoint. MÉTODOS: Los datos de mortalidad se obtuvieron del Instituto Nacional de Estadística. Para cada comunidad autónoma y sexo, se calcularon las tasas brutas y estandarizadas. El análisis de regresión joinpoint se utilizó para identificar los puntos más adecuados en los que se produjo un cambio estadísticamente significativo en la tendencia. RESULTADOS: El análisis joinpoint permite diferenciar comunidades en las que las tasas permanecen a lo largo de todo el periodo de estudio estables tanto en hombres (Cantabria, Castilla-La Mancha) como en mujeres (Canarias y Cantabria) y otras con un descenso continuado (Extremadura en hombres y mujeres y Castilla-La Mancha en mujeres). En aquellas comunidades en las que se observan cambios en la tendencia se aprecia, en casi todas ellas, un primer periodo de incremento en las tasas tanto en hombres como en mujeres. Las tendencias más recientes muestran divergencias entre las diferentes comunidades autónomas así, en los hombres, Andalucía, Canarias, Castilla-León, Comunidad Valenciana, Galicia, Murcia, País Vasco y La Rioja muestran tendencias descendentes significativas mientras que Cataluña y Madrid muestran incrementos significativos (2007-2016: 2,4% y 2010-2016: 18,7%, respectivamente). Algo similar se observa en las mujeres, para las que Andalucía, Castilla y León, Comunidad Valenciana, Galicia, Murcia, País Vasco y La Rioja muestran tendencias descendentes mientras que en Baleares, Cataluña y Madrid la tendencia es ascendente (2001-2016: 5,0%; 2006-2016: 4,2% y 2010-2016: 18,7% respectivamente). CONCLUSIONES: La mortalidad por suicidio varía ampliamente a nivel de comunidad autónoma, tanto en términos de nivel de mortalidad como de tendencias. Poco se sabe sobre los determinantes de las tendencias observadas y, por lo tanto, se necesitan más estudios

OBJECTIVES: To analyse the changes in mortality trends by suicide according to Autonomous Community and sex in Spain during the period 1980-2016 using joinpoint regression models. METHODS: Mortality data were obtained from the Instituo Nacional de Estadística. For each Spanish autonomous community and sex, crude and standardised rates were calculated. The joinpoint analysis was used to identify the best-fitting points where a statistically significant change in the trend occurred. RESULTS: The joinpoint analysis allows to differentiate areas in which the rates remain stable in men (Cantabria, Castilla-La Mancha) and women (Canary and Cantabria) throughout the study period and others with a continued decline (Extremadura in both men and women and Castilla-La Mancha in women). In those communities where changes in the trend are observed, in almost all of them, there is a first period of increase in rates in both men and women. The most recent trends show divergences between the different autonomous communities and, in men, Andalusia, the Canary Islands, Castilla-León, the Valencian Community, Galicia, Murcia, the Basque Country and La Rioja show significant downward trends, while Catalonia and Madrid show significant increases (2007-2016: 2.4% and 2010-2016: 18.7% respectively). Something similar is observed in women where Andalusia, Castilla y León, Valencian Community, Galicia, Murcia, País Vasco and La Rioja show downward trends while in the Balearic Islands, Catalonia and Madrid the trend is upward (2001-2016: 5.0%; 2006-2016: 4.2% and 2010-2016: 18.7% respectively). CONCLUSIONS: Suicide mortality varies widely among the Spanish autonomous communities, both in terms of mortality level and trends. Little is known about the determinants of observed trends and, therefore, more studies are needed

Tendencias de la mortalidad por suicidio en España, 1980-2016 / Suicide mortality trends in Spain, 1980-2016

OBJETIVOS: Analizar los cambios en las tendencias de la mortalidad por suicidio en España durante el periodo 1980-2016 utilizando modelos de regresión joinpoint. MÉTODOS: Los datos de mortalidad se obtuvieron del INE. Para cada sexo, las tasas específicas por grupo de edad y estandarizadas (general y truncada) (ASR) se calcularon por el método directo (utilizando la población estándar europea). El análisis joinpoint se utilizó para identificar los puntos más adecuados donde se produjo un cambio estadísticamente significativo en la tendencia. RESULTADOS: La tasa de mortalidad por suicidio ajustada por edad en hombres pasó en el periodo de estudio de 9,8/100.000 varones en 1980 a 11,8 en el año 2016, con un incremento anual medio del 0,8%. En las mujeres, las tasas se incrementaron un 1,0% anual pasando de 2,7/100.000 mujeres en 1980 a 3,7 en 2016. El análisis joinpoint identificó 3 puntos de inflexión en las tasas, tanto en hombres (1986, 2000 y 2010) como en mujeres (1986, 2004 y 2010), que identifican cambios en la tendencia. En el periodo 2010-2016 las tasas se incrementan en las mujeres, mientras que en los hombres las tasas permanecen estables. CONCLUSIONES: Nuestro trabajo muestra un marcado aumento en la mortalidad por suicidio en las mujeres españolas (2010-2016), mientras que en los hombres las tasas permanecen estables. Poco sabemos sobre los determinantes del aumento y, por ello, son necesarios más estudios

OBJECTIVES: To analyse changes in suicide mortality trends in Spain between 1980-2016 using joinpoint regression models. METHODS: Mortality data were obtained from the INE. For each gender, age-group-specific and standardised (overall and truncated) rates (ASR) were calculated by the direct method (using the European standard population). The joinpoint analysis was used to identify the best-fitting points where a statistically significant change in the trend occurred. RESULTS: Age adjusted mortality rates due to suicide in men was 9.8/100,000 males in 1980 and 11.8 in 2016, with an average annual increase of .8%. In women, the rates increased by 1.0% per year from 2.7 women per 100,000 in 1980 to 3.7 in 2016. The joinpoint analysis identified three turning points in the rates for both men (1986, 2000 and 2010) and women (1986, 2004 and 2010), which identify changes in the trend. In the period 2010-2016 the rates increase in women while in men the rates remain stable. CONCLUSIONS: Our work shows a marked increase in mortality by suicide in Spanish women (2010-2016) while in men the rates remain stable. Little is known about the determinants of the increase and, therefore, more studies are needed

Suicide mortality trends in Spain, 1980-2016. / Tendencias de la mortalidad por suicidio en España, 1980-2016.

OBJECTIVES: To analyse changes in suicide mortality trends in Spain between 1980-2016 using joinpoint regression models. METHODS: Mortality data were obtained from the INE. For each gender, age-group-specific and standardised (overall and truncated) rates (ASR) were calculated by the direct method (using the European standard population). The joinpoint analysis was used to identify the best-fitting points where a statistically significant change in the trend occurred. RESULTS: Age adjusted mortality rates due to suicide in men was 9.8/100,000 males in 1980 and 11.8 in 2016, with an average annual increase of .8%. In women, the rates increased by 1.0% per year from 2.7 women per 100,000 in 1980 to 3.7 in 2016. The joinpoint analysis identified three turning points in the rates for both men (1986, 2000 and 2010) and women (1986, 2004 and 2010), which identify changes in the trend. In the period 2010-2016 the rates increase in women while in men the rates remain stable. CONCLUSIONS: Our work shows a marked increase in mortality by suicide in Spanish women (2010-2016) while in men the rates remain stable. Little is known about the determinants of the increase and, therefore, more studies are needed.

Divergent trends in suicide mortality by Autonomous Community and sex (1980-2016). / Tendencias divergentes en la mortalidad por suicidio según comunidad autónoma y sexo (1980-2016).

OBJECTIVES: To analyse the changes in mortality trends by suicide according to Autonomous Community and sex in Spain during the period 1980-2016 using joinpoint regression models. METHODS: Mortality data were obtained from the Instituo Nacional de Estadística. For each Spanish autonomous community and sex, crude and standardised rates were calculated. The joinpoint analysis was used to identify the best-fitting points where a statistically significant change in the trend occurred. RESULTS: The joinpoint analysis allows to differentiate areas in which the rates remain stable in men (Cantabria, Castilla-La Mancha) and women (Canary and Cantabria) throughout the study period and others with a continued decline (Extremadura in both men and women and Castilla-La Mancha in women). In those communities where changes in the trend are observed, in almost all of them, there is a first period of increase in rates in both men and women. The most recent trends show divergences between the different autonomous communities and, in men, Andalusia, the Canary Islands, Castilla-León, the Valencian Community, Galicia, Murcia, the Basque Country and La Rioja show significant downward trends, while Catalonia and Madrid show significant increases (2007-2016: 2.4% and 2010-2016: 18.7% respectively). Something similar is observed in women where Andalusia, Castilla y León, Valencian Community, Galicia, Murcia, País Vasco and La Rioja show downward trends while in the Balearic Islands, Catalonia and Madrid the trend is upward (2001-2016: 5.0%; 2006-2016: 4.2% and 2010-2016: 18.7% respectively). CONCLUSIONS: Suicide mortality varies widely among the Spanish autonomous communities, both in terms of mortality level and trends. Little is known about the determinants of observed trends and, therefore, more studies are needed.

Cuff-assisted versus cap-assisted colonoscopy for adenoma detection: results of a randomized study.

BACKGROUND: The adenoma detection rate (ADR) is the most important marker of colonoscopy quality. Devices to improve adenoma detection have been developed, such as the Endocuff and transparent cap. The aim of the current study was to examine whether there was a difference in ADR between Endocuff-assisted (EAC) and cap-assisted colonoscopy (CAC). METHODS: A randomized prospective trial was conducted. Eligible patients included adults ≥ 18 years referred because of symptoms, surveillance, or colonoscopies as part of the Bowel Cancer Screening Programme (BCSP). The primary outcome measure was ADR. Secondary outcomes included mean number of adenomas, mean number of polyps, polyp detection rate, cecal intubation rate, and time to cecal intubation. Procedural measures, device removal rate, and adverse events were also recorded. RESULTS: A total of 711 patients (51.1 % men; median age 63 years) were included, of whom 357 patients were randomized to EAC and 354 patients to CAC. In the intention-to-treat analysis, the ADR was similar in both groups: EAC 50.4 % (95 % confidence interval [CI] 45.1 - 55.7) vs. CAC 50.6 % (95 %CI 45.2 - 55.9). Similar results were obtained in the per-protocol analysis: EAC 51.6 % (95 %CI 46.2 - 57) vs. CAC 51.4 % (95 %CI 46 - 56.8). There were no differences between the two devices in ADR according to the mean number of adenomas and polyps per procedure, polyp detection rate, cecal intubation rate, and time to cecal intubation. Device removal rate and adverse events were also similar. CONCLUSION: In this randomized study, no differences in ADR were found between Endocuff- and cap-assisted colonoscopy.

Accuracy for optical diagnosis of colorectal polyps in clinical practice.

BACKGROUND: Optical diagnostic involves predicting polyp histopathology from its endoscopic characteristics. It is only recommended for diminutive polyps ( < or = 5 mm) and for predictions made with high confidence. OBJECTIVES: To evaluate the accuracy of optical imaging in clinical practice and to assess if optical diagnosis is useful for predicting future colonoscopy surveillance intervals without waiting for histopathological analysis. METHODS: consecutive > 18 years patients were enrolled in this prospective study. Colonoscopies were performed by five expert endoscopists who previously participated in an ex-vivo training. Colonoscopes CF-H180AL and CF-Q180AL were used together with Exera II (Olympus Medical System, Tokyo, Japan) processors. Each polyp was characterized in real time using white light and Narrow Band Imaging. Accuracy of optical diagnosis (S, E, NPV, PPV) and correlation between surveillance interval based on optical diagnosis and histopathological analysis were calculated. RESULTS: 311 colon polyps < 10 mm (216 diminutive) in 195 patients were analyzed. Accuracy of optical diagnostics for predictions made with high confidence: Diminutive polyps(sensitivity 0.59, specificity 0.92, NPV 0.48); polyps < 10 mm (sensitivity 0.73, specificity 0.88, NPV 0.50). An optical diagnosis based surveillance recommendation was given to 90 patients. Concordance with histopathology based recommendation was 92.2% according to the European guideline and 93.3% according to the ESGE guideline. CONCLUSIONS: Optical diagnostics can be used to predict future surveillance intervals immediately after colonoscopy. However, in this study, based on clinical practice, the accuracy of optical imaging is below the recommended standards.

Precisión del diagnóstico óptico de pólipos de colon en la práctica clínica / Accuracy for optical diagnosis of colorectal polyps in clinical practice

Antecedentes: el diagnostico óptico consiste en predecir la histopatología de un pólipo a partir de sus características endoscópicas. Sólo es recomendable para pólipos diminutos (≤5 mm) y para predicciones realizadas con alta confianza. Objetivos: evaluar la precisión del diagnóstico óptico en la práctica clínica habitual y valorar si es posible recomendar un intervalo de seguimiento basado en diagnóstico óptico sin esperar el análisis histopatológico. Métodos: estudio prospectivo con pacientes consecutivos > 18 años. Las colonoscopias fueron realizadas por 5 endoscopistas expertos que realizaron previamente un entrenamiento ex-vivo. Se emplearon colonoscopios CF-H180AL y CF-Q180AL y procesadores Exera II (Olympus Medical System, Tokyo, Japan). Se evaluó cada pólipo en tiempo real con luz blanca y narrow band imaging. Se calculó la precisión del diagnóstico óptico (sensibilidad, especificidad, VPN, VPP), así como la concordancia entre la recomendación de seguimiento basada en diagnóstico óptico y en diagnóstico histopatológico. Resultados: se analizaron 311 pólipos de colon < 10 mm (216 diminutos) en 195 pacientes. Precisión del diagnóstico óptico para las predicciones realizadas con alta confianza: pólipos diminutos (sensibilidad 0,59, especificidad 0,92, VPN 0,48); pólipos < 10 mm (sensibilidad 0,73, especificidad 0,88, VPN 0,50). Pudo darse una recomendación de seguimiento basada en diagnóstico óptico a 90 pacientes, coincidiendo con la recomendación tras histopatología según la guía europea en 92,2% y según la guía ESGE en 93,3%. Conclusiones: el diagnóstico óptico permite dar una recomendación de seguimiento tras la colonoscopia. Sin embargo, en este estudio basado en práctica clínica, la precisión del diagnóstico óptico está por debajo de los estándares recomendados (AU)

BACKGROUND: Optical diagnostic involves predicting polyp histopathology from its endoscopic characteristics. It is only recommended for diminutive polyps (≤ 5 mm) and for predictions made with high confidence. OBJECTIVES: To evaluate the accuracy of optical imaging in clinical practice and to assess if optical diagnosis is useful for predicting future colonoscopy surveillance intervals without waiting for histopathological analysis. METHODS: consecutive > 18 years patients were enrolled in this prospective study. Colonoscopies were performed by five expert endoscopists who previously participated in an ex-vivo training. Colonoscopes CF-H180AL and CF-Q180AL were used together with Exera II (Olympus Medical System, Tokyo, Japan) processors. Each polyp was characterized in real time using white light and Narrow Band Imaging. Accuracy of optical diagnosis (S, E, NPV, PPV) and correlation between surveillance interval based on optical diagnosis and histopathological analysis were calculated. RESULTS: 311 colon polyps < 10 mm (216 diminutive) in 195 patients were analyzed. Accuracy of optical diagnostics for predictions made with high confidence: Diminutive polyps (sensitivity 0.59, specificity 0.92, NPV 0.48); polyps < 10 mm (sensitivity 0.73, specificity 0.88, NPV 0.50). An optical diagnosis based surveillance recommendation was given to 90 patients. Concordance with histopathology based recommendation was 92.2% according to the European guideline and 93.3% according to the ESGE guideline. CONCLUSIONS: Optical diagnostics can be used to predict future surveillance intervals immediately after colonoscopy. However, in this study, based on clinical practice, the accuracy of optical imaging is below the recommended standards

Técnica de «stent in stent» en la hiperplasia benigna del esófago. Complicaciones y tratamiento del manejo de las fístulas tras gastrectomía vertical / “Stent in stent” technique for oesophageal benign hyperplasia. Complications and treatment of fistulas after sleeve gastrectomy

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Factors related to the effectiveness of variable stiffness colonoscope: results of a multivariate analysis.

BACKGROUND: Various studies and two meta-analysis have shown that a variable stiffness colonoscope improves cecal intubation rate. However, there are few studies on how this colonoscope should be used. OBJECTIVE: The aim of this study was to identify factors related to the advancement of the colonoscope when the variable stiffness function is activated. METHODS: Prospective study enrolling consecutive patients referred for colonoscopy. The variable stiffness colonoscope (Olympus CF-H180DI/L®) was used. We performed univariate and multivariate analyses of factors associated with the success of the variable stiffness function. RESULTS: After the data inclusion period, 260 patients were analyzed. The variable stiffness function was used most in the proximal colon segments (ascending and transverse colon 85%; descending/sigmoid colon 15.2%). The body mass index was lower in patients in whom the endoscope advanced after activating the variable stiffness than those in which it could not be advanced (25.9 + or - 4.8 vs. 28.3 + or - 5.4 kg/m2, p = 0.009). The endoscope advanced less frequently when the stiffness function was activated in the ascending colon versus activation in other segments of the colon (25% vs. 64.5% ascending colon vs. other segments; p < 0.05). In the multivariate analysis, only the colon segment in which the variable stiffness was activated was an independent predictor of advancement of the colonoscope. CONCLUSIONS: The variable stiffness function is effective, allowing the colonoscope advancement especially when applied in the transverse colon, descending colon and sigmoid. However, when used in the ascending colon it has a lower effectiveness.

Direct peroral cholangioscopy using an ultrathin endoscope: making technique easier.

BACKGROUND: Cholangioscopy is a useful tool for the study and treatment of biliary pathology. Ultrathin upper endoscopes allow direct peroral cholangioscopy (DPC) but have some drawbacks. OBJECTIVE: The aim of the study was to evaluate the success rate of DPC with an ultrathin endoscope using a balloon catheter to reach the biliary confluence. MATERIAL AND METHODS: Prospective observational study. An ultrathin endoscope (Olympus XP180N, outer diameter 5.5 mm, working channel 2 mm) was used. To access the biliary tree, free-hand technique was used. To reach the biliary confluence an intraductal balloon catheter (Olympus B5-2Q diameter 1.9 mm) and a 0.025 inch guide wire was used. In all cases sphincterotomy and/or sphincteroplasty was performed. The success rate was defined as the percentage of cases in which the biliary confluence could be reached with the ultrathin endoscope. RESULTS: Fifteen patients (8 men/7 women) were included. Mean age was 77.7 + or - 10.8 years (range 45-91). The indications for cholangioscopy were suspected bile duct stones (n = 9), electrohydraulic lithotripsy for the treatment of difficult choledocholithiasis (n = 5) and evaluation of biliary stricture (n = 1). Access to the bile duct was achieved in 14/15 cases (93.3%). Biliary confluence was reached in 13/15 cases (86.7%). One complication was observed in one patient (oxigen desaturation). CONCLUSIONS: DPC with an ultrathin endoscope can be done with the free-hand technique. Intraductal balloon-guided DPC allows full examination of the common bile duct in most cases.

Does "responsive insertion technology" improve practice of colonoscopy? Results of a randomized study.

OBJECTIVE. During colonoscopy, advancing the endoscope can sometimes be difficult due to the appearance of loops or bends in the insertion tube. Therefore, research continues toward improving colonoscope technology. The aim of this study is to compare the use of colonoscopes equipped with "responsive insertion technology" (RIT) versus regular non-RIT colonoscopes. MATERIALS AND METHODS. Prospective, comparative and randomized trials that included patients submitted to colonoscopy. In group I, RIT colonoscopes were used, while in group II, colonoscopies with variable stiffness but without the other components of the RIT technology were used. Demographic variables and variables related to colonoscopy, as well as the pain perceived by the patient and the difficulty in performing endoscopy were recorded. RESULTS. A total of 122 patients were included in group I and 120 patients in group II. The cecal intubation rate was similar in both groups. The use of the RIT colonoscopes was associated with a lower cecal intubation time (4.4 ± 2.0 vs. 5.4 ± 3.5, p = 0.005) and a lower difficulty in performing examinations for both the endoscopist (19.1 ± 20.0 vs. 27.7 ± 22.2, p = 0.002) and the nursing staff (20.8 ± 17.0 vs. 26.3 ± 19.6, p = 0.04). No significant differences were found between both groups in the need for ancillary maneuvers or in the pain perceived by the patient. CONCLUSIONS. RIT colonoscopes allow cecal intubation in a shorter time compared to variable stiffness colonoscopes, and are associated with a greater level of ease of the procedure.

Factores relacionados con la eficacia del colonoscopio de rigidez variable: resultados de un análisis multivariante / Factors related to the effectiveness of variable stiffness colonoscope: results of a multivariate analysis

Introducción: diversos estudios y dos metaanálisis han demostrado que los colonoscopios con rigidez variable mejoran el porcentaje de intubación cecal. Sin embargo, hay pocos estudios sobre la forma en que deben utilizarse estos colonoscopios. Objetivo: el objetivo del presente estudio fue identificar factores relacionados con el avance del colonoscopio cuando se activa la rigidez variable. Métodos: estudio prospectivo en el que se incluyeron pacientes consecutivos remitidos para colonoscopia. Se utilizó el colonoscopio con rigidez variable (Olympus CF-H180DI/L®). Se realizó análisis univariante y multivariante para identificar los factores relacionados con el avance del colonoscopio tras activar la rigidez variable. Resultados: se analizaron los datos de 260 pacientes. La rigidez variable se utilizó más en segmentos proximales del colon (84 % en colon ascendente y transverso vs. 15.2 % en colon descendente/sigmoide). El índice de masa corporal fue menor en los pacientes en los que el endoscopio avanzó tras activar la rigidez variable que en los que no avanzó (25,9 ± 4,8 vs. 28,3 ± 5,4 kg/m2; p = 0,009). El endoscopio avanzó en menos ocasiones cuando se activó la rigidez en colon ascendente frente a la activación en el resto de segmentos del colon (25 % colon ascendente vs. 64,5 % resto de segmentos; p < 0,05). En el análisis multivariado sólo el segmento del colon en el que se activó la rigidez fue un factor predictivo independiente del avance del endoscopio. Conclusiones: El empleo de la rigidez variable permite el avance del colonoscopio sobre todo cuando se activa en colon transverso, descendente y sigma. Cuando se activa en colon ascendente su eficacia es menor (AU)

Background: Various studies and two meta-analysis have shown that a variable stiffness colonoscope improves cecal intubation rate. However, there are few studies on how this colonoscope should be used. Objective: The aim of this study was to identify factors related to the advancement of the colonoscope when the variable stiffness function is activated. Methods: Prospective study enrolling consecutive patients referred for colonoscopy. The variable stiffness colonoscope (Olympus CF-H180DI/L®) was used. We performed univariate and multivariate analyses of factors associated with the success of the variable stiffness function. Results: After the data inclusion period, 260 patients were analyzed. The variable stiffness function was used most in the proximal colon segments (ascending and transverse colon 85 %; descending/sigmoid colon 15.2 %). The body mass index was lower in patients in whom the endoscope advanced after activating the variable stiffness than those in which it could not be advanced (25.9 ± 4.8 vs. 28.3 ± 5.4 kg/m2, p = 0.009). The endoscope advanced less frequently when the stiffness function was activated in the ascending colon versus activation in other segments of the colon (25 % vs. 64.5 % ascending colon vs. other segments; p < 0.05). In the multivariate analysis, only the colon segment in which the variable stiffness was activated was an independent predictor of advancement of the colonoscope. Conclusions: The variable stiffness function is effective, allowing the colonoscope advancement especially when applied in the transverse colon, descending colon and sigmoid. However, when used in the ascending colon it has a lower effectiveness (AU)

Colangioscopia peroral directa con endoscopios ultrafinos: haciendo más simple la técnica / Direct peroral cholangioscopy using an ultrathin endoscope: making technique easier

Introducción: la colangioscopia es una técnica muy útil para el estudio y tratamiento de la patología biliar. Los endoscopios ultrafinos permiten realizar la colangioscopia peroral directa (CPOD) pero presentan algunos inconvenientes. Objetivo: el objetivo del estudio fue evaluar la eficacia de la CPOD con endoscopio ultrafino, accediendo a la vía biliar con la técnica de manos libres y utilizando un balón intraductal para alcanzar la confluencia biliar. Material y métodos: estudio observacional prospectivo. Se utilizó un endoscopio ultrafino (Olympus XP180N, diámetro externo 5,5 mm, canal trabajo 2 mm). Para avanzar el endoscopio hasta la confluencia biliar se utilizó un balón intraductal (Olympus B5-2Q diámetro 1,9 mm), sobre guía de 0,025 pulgadas. Se realizó en todos los casos papilotomía y/o papiloplastia. La eficacia de la CPOD se valoró por el porcentaje de casos en que se alcanzó la confluencia biliar. Resultados: se incluyeron 15 pacientes (8 hombres / 7 mujeres). La edad media fue de 77,7 ± 10,8 años (rango 45-91). Las indicaciones para la colangioscopia fueron: sospecha de cálculos de vía biliar (n = 9), tratamiento de coledocolitiasis difíciles mediante litotricia electrohidráulica (n = 5) y evaluación estenosis biliar (n = 1). Se accedió a la vía biliar en 14/15 casos (93,3 %). Se alcanzó la confluencia biliar en 13/15 casos (86,7 %). Se observó una complicación en un paciente (desaturación). Conclusiones: la CPOD con endoscopio ultrafino puede realizarse con técnica de manos libres, consiguiendo, apoyada por el balón intraductal, la exploración completa de la vía biliar principal en la mayoría de los casos (AU)

Background: Cholangioscopy is a useful tool for the study and treatment of biliary pathology. Ultrathin upper endoscopes allow direct peroral cholangioscopy (DPC) but have some drawbacks. Objective: The aim of the study was to evaluate the success rate of DPC with an ultrathin endoscope using a balloon catheter to reach the biliary confluence. Material and methods: Prospective observational study. An ultrathin endoscope (Olympus XP180N, outer diameter 5.5 mm, working channel 2 mm) was used. To access the biliary tree, free-hand technique was used. To reach the biliary confluence an intraductal balloon catheter (Olympus B5-2Q diameter 1.9 mm) and a 0.025 inch guide wire was used. In all cases sphincterotomy and/ or sphincteroplasty was performed. The success rate was defined as the percentage of cases in which the biliary confluence could be reached with the ultrathin endoscope. Results: Fifteen patients (8 men/7 women) were included. Mean age was 77.7 ± 10.8 years (range 45-91). The indications for cholangioscopy were suspected bile duct stones (n = 9), electrohydraulic lithotripsy for the treatment of difficult choledocholithiasis (n = 5) and evaluation of biliary stricture (n = 1). Access to the bile duct was achieved in 14/15 cases (93.3 %). Biliary confluence was reached in 13/15 cases (86.7 %). One complication was observed in one patient (oxigen desaturation). Conclusions: DPC with an ultrathin endoscope can be done with the free-hand technique. Intraductal balloon-guided DPC allows full examination of the common bile duct in most cases (AU)

Does the use of a variable stiffness colonoscope offer advantages during colonoscopy under deep sedation? Results of a randomized trial.

INTRODUCTION: Variable stiffness colonoscope may be useful in performing colonoscopies in nonsedated patients or under endoscopist-controlled sedation. The objective of this study is to evaluate whether this instrument facilitates colonoscopy in patients under deep sedation monitored by an anaesthesiologist. METHODS: Prospective and randomized study enroling consecutive patients referred for colonoscopy under deep sedation monitored by an anaesthesiologist. In group I, a variable stiffness colonoscope was used, whereas in group II, a standard colonoscope was used. The main variable was the need to change the position of the patient during the endoscopy. RESULTS: Fifty-six patients were included in group I (variable stiffness colonoscope) and 54 in group II (standard colonoscope). The caecum was reached in 92.9% of patients in group I and in 90.7% of group II (P=0.7). The time required to reach the caecum was significantly less in group I (6.14±3.5 vs. 7.7±3.8; P=0.035). The variable stiffness colonoscope was effective in 66.7% of cases. Changing the position of the patient was necessary in 12.5% of cases in group I compared with 33.3% of cases in group II (P=0.01). CONCLUSION: The variable stiffness colonoscope avoids the need to change the patient's position and reduces caecal intubation time in patients undergoing colonoscopy under deep sedation controlled by an anaesthesiologist.

Cytokine genotypes in acute pancreatitis: association with etiology, severity, and cytokine levels in blood.

UNLABELLED: The circumstances that determine how acute pancreatitis (AP) becomes severe are unknown. Differences in cytokine genetic encoding may determine the severity or influence the etiology of AP. This article investigates the relationship between different polymorphisms of tumor necrosis factor alpha (TNF-alpha), interleukin 1 (IL-1), IL-1 receptor antagonist, IL-6, and IL-10 with the severity and etiology of AP and the serum levels of the cytokine encoded. METHODS: Patients with AP were included prospectively. Severity of the disease was determined according to Atlanta classification. Serum levels of these cytokines were determined within the first 72 hours after the onset of symptoms. The following polymorphisms were determined by polymerase chain reaction: IL-1a -889, IL-1b +3954, IL-1b -511, variable number tandem repeats, IL-6 -174, IL-6 -597, IL-10 -592, TNF-alpha 308, TNF-alpha 238, and TNF-B250. RESULTS: Eighty-four patients were included. The GA genotype of the TNF-alpha 238 polymorphism was associated with more frequent respiratory failure and shock than the GG genotype. Gallstone pancreatitis was associated with the CC genotype of the IL-6 -174 CC polymorphism. CONCLUSIONS: AG genotype of the TNF-alpha 238 polymorphism is associated with organic failure in patients with AP. The CC genotype of the IL-6 174 polymorphism is associated with biliary etiology of acute pancreatitis.

Factors associated with non-attendance at outpatient endoscopy.

OBJECTIVE: Non-attendance at endoscopy procedures leads to wasted resources and increased costs. The purpose of this study was to investigate the factors associated with non-attendance. MATERIAL AND METHODS: All patients who attended the outpatient clinic for gastroscopy or colonoscopy examinations were included in the study. Patients who missed their appointment were identified and their data were collected prospectively. Patients who kept their appointment in the same period of time served as controls. RESULTS: Between August 2002 and February 2003, 1051 gastroscopies and 756 colonoscopies were scheduled. A total of 265 patients (14.7%) missed their appointment. No significant differences were found between attendees and non-attendees for mean age, gender, type of examination and day of the week on which the examination was scheduled. The time on the waiting list was longer in patients who did not keep their appointment than in those who did. Fewer appointments were missed in patients with a preferent referral, and among patients referred by their general practitioner a higher percentage failed to keep their appointment compared with those referred by a specialist. In the multivariate analysis, length of time on the waiting list and the source of referral were the only two independent predictive factors for non-attendance. CONCLUSIONS: A longer time on the waiting list and referral by a general practitioner are factors associated with patients failing to keep their endoscopy appointment.

A sequential study of serum bacterial DNA in patients with advanced cirrhosis and ascites.

Bacterial translocation is currently considered the main pathogenic mechanism leading to spontaneous bacterial peritonitis in patients with advanced cirrhosis and ascites. However, to the authors' knowledge there is no information regarding the characteristics of this process in humans. The goals of the current study were to pursue partially identified bacterial DNA in blood (what the authors consider molecular evidence of bacterial translocation) through its relative quantification in a 72-hour study period by using real-time polymerase chain reaction (PCR). A consecutive series of 17 patients with advanced cirrhosis and culture-negative, nonneutrocytic ascites were studied. Therapeutic paracentesis was performed at the time of admission, and blood samples were obtained at baseline and every 8 hours in a 3-day period. Bacterial DNA was detected by a PCR-based method, relatively quantified by real-time PCR, and identified by automated nucleotide sequencing. Seven of 17 patients demonstrated the simultaneous presence of bacterial DNA in blood and ascitic fluid at the time of admission. After therapeutic paracentesis was performed, bacterial DNA persisted in the blood for a minimum of 24 hours, and was reported to last as long as 72 hours in some patients. In addition, different patterns of bacterial DNA appearance and clearance from the blood were identified. The nucleotide sequencing process demonstrated that bacteria detected in the first sample were identical to those noted in subsequent detections over time. In conclusion, bacterial translocation is a single-species, dynamic process that appears to develop in a subgroup of patients with advanced cirrhosis.