Robotic-assisted right colectomy versus laparoscopic approach: case-matched study and cost-effectiveness analysis.

AIM: The aim of this study is to compare clinical and oncological outcomes of robot-assisted right colectomy with those of conventional laparoscopy-assisted right colectomy, reporting for the first time in literature, a cost-effectiveness analysis. METHODS: This is a case-matched prospective non-randomized study conducted from October 2013 to October 2017 at Sanchinarro University Hospital, Madrid. Patients with right-sided colonic adenocarcinoma or adenoma, not suitable endoscopic resection were treated with robot-assisted right colectomy and a propensity score-matched (1:1) was used to balance preoperative characteristics of a laparoscopic control group. Perioperative, postoperative, long-term oncological results and costs were analysed, and quality-adjusted life years (QALY), and the cost-effectiveness ratio (ICER) were calculated. The primary end point was to compare the cost-effectiveness differences between both groups. A willingness-to-pay of 20,000 and 30,000 per QALY was used as a threshold to recognize which treatment was most cost effective. RESULTS: Thirty-five robot-assisted right colectomies were included and a group of 35 laparoscopy-assisted right colectomy was selected. Compared with the laparoscopic group, the robotic group was associated with longer operation times (243 min vs. 179 min, p < 0.001). No significant difference was observed in terms of total costs between the robotic and laparoscopic groups (9455.14 vs 8227.50 respectively, p = 0.21). At a willingness-to-pay threshold of 20,000 and 30,000, there was a 78.78-95.04% probability that the robotic group was cost effective relative to laparoscopic group. CONCLUSION: Robot-assisted right colectomy is a safe and feasible technique and is a cost-effective procedure.

Feedback-guided exercises performed on a tablet touchscreen improve return to work, function, strength and healthcare usage more than an exercise program prescribed on paper for people with wrist, hand or finger injuries: a randomised trial.

QUESTION: In people with bone and soft tissue injuries of the wrist, hand and/or fingers, do feedback-guided exercises performed on a tablet touchscreen hasten return to work, reduce healthcare usage and improve clinical recovery more than a home exercise program prescribed on paper? DESIGN: Randomised, parallel-group trial with concealed allocation, assessor blinding and intention-to-treat analysis. PARTICIPANTS: Seventy-four workers with limited functional ability due to bone and soft tissue injuries of the wrist, hand and/or fingers. INTERVENTION: Participants in the experimental and control groups received the same in-patient physiotherapy and occupational therapy. Participants in the experimental group received a home exercise program using the ReHand tablet application, which guides exercises performed on a tablet touchscreen with feedback, monitoring and progression. Participants in the control group were prescribed an evidence-based home exercise program on paper. OUTCOME MEASURES: The primary outcome was the time taken to return to work. Secondary outcomes included: healthcare usage (number of clinical appointments); and functional ability, pain intensity, and grip and pinch strength 2 and 4 weeks after randomisation. RESULTS: Compared with the control group, the experimental group: returned to work sooner (MD -18 days, 95% CI -33 to -3); required fewer physiotherapy sessions (MD -7.4, 95% CI -13.1 to -1.6), rehabilitation consultations (MD -1.9, 95% CI -3.6 to 0.3) and plastic surgery consultations (MD -3.6, 95% CI -6.3 to -0.9); and had better short-term recovery of functional ability and pinch strength. CONCLUSION: In people with bone and soft-tissue injuries of the wrist, hand and/or fingers, prescribing a feedback-guided home exercise program using a tablet-based application instead of a conventional program on paper hastened return to work and improved the short-term recovery of functional ability and pinch strength, while reducing the number of required healthcare appointments. TRIAL REGISTRATION: ACTRN12619000344190.

Leucemia mieloide aguda en adulto mayor comórbido. A propósito de un caso / Acute myeloid leukemia in a comorbid adult. About a case

Caso clínico: paciente masculino de 81 años de edad, con cuadro de 24 horas de evolución secundario a caída, caracterizado por somnolencia, desorientación en persona, tiempo y espacio, incontinencia urinaria y dificultad para la deambulación, motivo por el cual se le efectúa una tomografía simple de cráneo encontrándose hematomas subdurales bilaterales, presenta episodios de sangrado recurrente y leucocitosis sostenida , en frotis de sangre periférica se observó 28% de blastos por lo que se realiza una biopsia de medula ósea descubriéndose un cariotipo medular compatible con leucemia mieloide aguda, debido a sus características clínicas y a su mala evolución fue catalogado como paciente paliativo. Conclusiones: la leucemia mieloide aguda es una patología hematológica cuya evolución al no ser detectada genera un alto grado de mortalidad, sobre todo en el adulto mayor comórbido.

It was presented a clinical case of a male patient of 81 years of age, with a 24-hour of secondary evolution to a fall. It was characterized by drowsiness, disorientation in person, time and space, urinary incontinence and difficulty in walking, that was why a simple skull tomography was performed, in which bilateral subdural hematomas were found. The patient presented episodes of recurrent bleeding and sustained leukocytosis. Peripheral blood smear showed 28% of blasts, so a bone marrow biopsy was performed, revealing a medullary karyotype compatible with acute myeloid leukemia. The patient was classified as palliative due to its clinical characteristics and evolution. The hematological pathology above was potentially fatal. If this one was not detected early, it would generate an accelerated unfavorable evolution, especially in the elderly comorbid, as occurred in the case presented.

Pendimethalin and oxyfluorfen degradation under two irrigation conditions over four years application.

A four-year field study was conducted to determine the effect of pluviometric conditions on pendimethalin and oxyfluorfen soil dynamics. Adsorption, dissipation and soil movement were studied in a sandy loam soil from 2003 to 2007. Pendimethalin and oxyfluorfen were applied every year on August at 1.33 and 0.75 kg ha(-1), respectively. Herbicide soil concentrations were determined at 0, 10, 20, 40, 90 and 340 days after application (DAA), under two pluviometric regimens, natural rainfall and irrigated (30 mm every 15 days during the first 90 DAA). More than 74% of the herbicide applied was detected at the top 2.5 cm layer for both herbicides, and none was detected at 10 cm or deeper. Pendimethalin soil half-life ranged from 10.5 to 31.5 days, and was affected mainly by the time interval between application and the first rain event. Pendimethalin soil residues at 90 DAA fluctuated from 2.5 to 13.8% of the initial amount applied, and it decreased to 2.4 and 8.6% at 340 DAA. Oxyfluorfen was more persistent than pendimethalin as indicated by its soil half-life which ranged from 34.3 to 52.3 days, affected primarily by the rain amount at the first rainfall after application. Oxyfluorfen soil residues at 90 DAA ranged from 16.7 to 34.8% and it decreased to 3.3 and 17.9% at 340 DAA. Based on half-life values, herbicide soil residues after one year, and soil depth reached by the herbicides, we conclude that both herbicides should be considered as low risk to contaminate groundwater. However, herbicide concentration at the top 2.5 cm layer should be considered in cases where runoff or soil erosion could occur, because of the potential for surface water contamination.

Dissipation and movement of flumioxazin in soil at four field sites in Chile.

BACKGROUND: Flumioxazin is a soil-applied herbicide recommended for broadleaf weed control in soybeans and peanuts, and was recently introduced for vineyard weed management. Considering the limited information available in relation to flumioxazin field soil behaviour, the main objectives of this study were to determine the persistence, adsorption and movement of flumioxazin in soil in four Chilean vineyard production areas. RESULTS: DT(50) values ranged from 10.6 +/- 1.0 to 32.1 +/- 3.1 days between localities, being correlated with rain events, time between herbicide application and first heavy rain event, and soil pH. Flumioxazin soil residue found at 90 days after application (DAA) varied from 9.6 to 24.9% of the initial amount applied, and depended on the total rainfall amount that occurred during the first 90 DAA. Herbicide leaching below 15 cm was approximately 45% of the flumioxazin detected at 90 DAA in the whole soil profile. Flumioxazin maximum leaching soil depth was 45 cm at all locations. K(d) values varied from 2.54 to 6.51 mg L(-1), depending on localities and soil profile depth, and correlated positively with organic carbon and clay content. CONCLUSIONS: These results indicate that flumioxazin is a herbicide with low environmental risk owing to its short DT(50), reduced soil residues 3 months after application and low effective dose.

Highly convergent three component benzyne coupling: the total synthesis of ent-clavilactone B.

The first total synthesis of (+)-clavilactone B, a potent antifungal agent and novel tyrosine kinase inhibitor, is described. The absolute configuration of clavilactones has been unambiguously established by using Sharpless asymmetric epoxidation to generate the enantiomerically pure substrate. The strategy highlights the use of a powerful and convergent three-component benzyne coupling with a methylallyl Grignard and a chiral epoxy-aldehyde to generate two C-C bonds and install the carbon skeleton of clavilactone. Oxidative lactonization, ten-membered ring construction by ring closing metathesis, and oxidation gave clavilactone B.

La momia del cerro El Plomo y los santuarios de altura del Tawantinsuyu / The mummies of the El Plomo hill and the height sanctuaries of Twantinsuyu

Una de las expresiones culturales más importantes del Area Andina es el reino de Tawantinsuyu. Entre otras metodologías podemos conocerlo a través de: la tradición oral, los cronistas, la historia y la arqueología. En el plano de las creencias y ofrendas de los santuarios de alturas son un registro arqueológico de gran importancia. En el año 1954, se encontró la momia de un niño de ocho años que había sido liofilizado (freeze-dried) por las especiales características de su tumba en el cerro El Plomo (5420 mts.). Tanto el ajuar que lo acompañaba, como las características de la momia misma, han sido motivo de estudio multidisciplinarios, los cuales han enriquecido el conocimiento del Area Andina

Alteraciones electrocardiográficas y de laboratorio en el latrodectismo / Electrocardiographic and laboratory alterations in the latrodectism

En 71 pacientes hospitalizados por Latrodectismo en el Hospital San José, de Victoria, IX Región, y que fueron tratados con dipirona 1 gr y diazepam 1 mg, intramuscular y cada 8 horas, se analizan los resultados de los exámenes de laboratorio habituales (sedimento urinario, uremia, glicemia, hemograma) y del electrocardiograma (en 52 casos), obtenidos al ingreso y en un controlambulatorio a los 10 días de la mordedura. Entre las alteraciones del sedimento urinario no atribuibles a otras patologías, se encontró 8 casos con proteinuria (0,20-0,40 gramos por litro) y 4 con hematuria (4-12 eritrocitos por campo). La uremia se elevó discretamente en 10 pacientes, 6 de los cuales presentaron hemoconcentración. La glicemia se mantuvo entre rangos normales. Los trastornos del ECG, descartando otra patología subyacente, fueron en su mayoría similares a los provocados por intensa estimulación del Sistema Nervioso Simpático sobre el músculo cardíaco. Los exámenes de control a los 10 días de todos estos pacientes fueron normales. Sobre la base de alteraciones observadas en veneno de Latrodectus sp tendría alguna acción tóxica sobre el endotelio capilar, lo cual explicaría los signos de inflación glomerular leve. La pequeña alza de la uremia está tal vez relacionada con los trastornos electrolíticos originados por la abundante diaforesis: en 6 pacientes, por la hemoconcentración, fue necesario aplicar suero y electrolitos. Las alteraciones del ECG podrían confundirse con una crisis isquémica si no se tienen en cuenta los antecedentes de mordedura por Latrodectus sp., más aún si hay síntomas como angustia, excitación psicomotora, dolor precordial y diaforesis

Evaluación de un nuevo tratamiento farmacológico para el latrodectismo / Evaluation of a new pharmacological treatment for lactrodietism

Un nuevo enfoque farmacológico para el tratamiento inicial de Latrodectismo es evaluado en 100 pacientes ingresados al Hospital San José, de Victoria, en los períodos estivales entre 1983 y 1985. Consiste en la administración intramuscular de diazepam (l0 mg) y dipirona (l g), tan pronto es hecho el diagnóstico. Con este esquema, l hora después, el 48% de los pacientes estaba ya recuperado, de los cuales 81,5% correspondió a los tratados de 3 a 24 horas después del mismo. Los 52 pacientes que no obtuvieron mejoría a la hora de iniciada la terapia continuaron con igual tratamiento cada 8 horas, agregándose en algunos petidina y suero glucosalino, hasta lograr su recuperación total en el lapso de 2,6 días en 49 y de 6 días en 3. Sobre la base de estos resultados, este esquema es recomendado para usar en Postas Rurales y Puestos de Socorro