Life or limb: an international qualitative study on decision making in sarcoma surgery during the COVID-19 pandemic.

OBJECTIVES: The COVID-19 pandemic is unprecedented as a global crisis over the last century. How do specialist surgeons make decisions about patient care in these unprecedent times? DESIGN: Between April and May 2020, we conducted an international qualitative study. Sarcoma surgeons from diverse global settings participated in 60 min interviews exploring surgical decision making during COVID-19. Interview data were analysed using an inductive thematic analysis approach. SETTING: Participants represented public and private hospitals in 14 countries, in different phases of the first wave of the pandemic: Australia, Argentina, Canada, India, Italy, Japan, Nigeria, Singapore, Spain, South Africa, Switzerland, Turkey, UK and USA. PARTICIPANTS: From 22 invited sarcoma surgeons, 18 surgeons participated. Participants had an average of 19 years experience as a sarcoma surgeon. RESULTS: 17/18 participants described a decision they had made about patient care since the start of the pandemic that was unique to them, that is, without precedence. Common to 'unique' decisions about patient care was uncertainty about what was going on and what would happen in the future (theme 1: the context of uncertainty), the impact of the pandemic on resources or threat of the pandemic to overwhelm resources (theme 2: limited resources), perceived increased risk to self (theme 3: duty of care) and least-worst decision making, in which none of the options were perceived as ideal and participants settled on the least-worst option at that point in time (theme 4: least-worst decision making). CONCLUSIONS: In the context of rapidly changing standards of justice and beneficence in patient care, traditional decision-making frameworks may no longer apply. Based on the experiences of surgeons in this study, we describe a framework of least-worst decision making. This framework gives rise to actionable strategies that can support decision making in sarcoma and other specialised fields of surgery, both during the current crisis and beyond.

Nutrient content in wheat grain and straw using sludge and compost from a wastewater treatment plant as a fertiliser.

BACKGROUND: The present study aimed: (i) to evaluate the response of nutrient uptake after applying 15 ha-1 of sewage sludge, compost and a commercial fertiliser to soil in the grain and straw of winter wheat (Triticum turgidum L. cv. Vitron) and (ii) to investigate the composition of the same parameters in the original soil and compare them with soil after applying fertiliser treatments. A field-scale experiment established the agronomic performance of air-dried sewage sludge and composted sludge for winter wheat. RESULTS: Sewage sludge promoted a higher grain Zn content and yield than compost or the commercial fertiliser. N, P and Zn were higher after harvests in soils where sludge or compost was applied, showing significant differences compared to those with a commercial fertiliser. When sludge or compost was used as an organic amendment, no significant differences were observed in pH or electrical conductivity in soils, as well as nutrient absorption for crop. CONCLUSION: Because no nutritional imbalances were observed in either grain or straw of durum wheat (Triticum turgidum L. cv. Vitron), sewage sludge from the Alcázar de San Juan wastewater treatment plant has an aptitude for agricultural use and could be recommended as an alternative to the standard commercial fertilisation used in the study area. © 2018 Society of Chemical Industry.

Effects of wastewater irrigation on soil properties and turfgrass growth.

Reuse of treated wastewater for turf irrigation is often viewed as one way to maximize existing urban water resources. The aim of this study is to evaluate the applicability of treated wastewater for turfgrass and assess the effects of continuous use of treated water on the soil and crop. Two turfgrass plots irrigated with drinking water and treated wastewater were monitored over a two-year period. Physical and chemical parameters in the soil and foliar tissue were analyzed. Plants irrigated with treated wastewater had highest sodium content. There were no negative effects with respect to changes in soil pH but a significant increase in electrical conductivity and sodium content was observed in wastewater-irrigated soil. Treated wastewater could be used as a resource for agricultural irrigation since it contributes phosphorus and organic matter. However, it is necessary to consider that several crops could be negatively affected by wastewater irrigation because of the sodium content and this should be taken into account when water-sprinklers are in use, since this is the case in the present study. The benefits of irrigation with treated urban wastewater include contributing plant nutrients to turfgrass while conserving freshwater.

Irrigation with treated wastewater: effects on soil, lettuce (Lactuca sativa L.) crop and dynamics of microorganisms.

The aim of this study was to evaluate the applicability of treated wastewater for horticultural crops, assess the effects of continuous use of treated water on soil and crops, and analyse the physical, chemical and biological effects of irrigation with recycled water. Two lettuce plots watered with drinking water and treated wastewater were monitored over a three year period. Nutrients, heavy metal and the dynamics of pathogen and indicator microorganism content in soil and foliar tissues were analysed. Wastewater irrigation had a high influence on soil parameters: organic matter, N, P, Ca, Al, Fe, Pb and Zn. Indicator and pathogenic microorganisms were detected in soil and plants grown in the wastewater-irrigated plot, and persisted in the soil for 27 days during the study under humid conditions. N, P, Pb and Al content were significantly higher in plant tissues of wastewater-irrigated plots than in the control after 3 years of irrigation. Harvest was significantly higher in the wastewater-irrigated plot. Wastewater can be a resource for agricultural irrigation. In any case, the possible heavy metal accumulation in soils and presence of pathogenic organisms require careful management of this alternative resource: use of a drip irrigation system, previous wastewater disinfection and a limited irrigation period are recommended.

Long-term results of the Spanish Protocol SO-95 for the treatment of non-metastatic high-grade osteosarcoma of the extremities in children.

INTRODUCTION: The long-term results of the Spanish Study Protocol SEOP-SO-95 for treatment of localised osteosarcoma of the extremities in children were evaluated. PATIENTS AND METHODS: One hundred consecutive patients under 18 years of age from 22 institutions were enrolled from January 1995 to December 2000. Immunohistochemical expression of p53, HER/erbB-2 and P-glycoprotein were retrospectively studied in 27 patients. Treatment consisted of: preoperative chemotherapy with doxorubicin, cisplatin, high-dose methotrexate with leucovorin rescue and ifosfamide for 14 weeks; surgery of primary tumour in week 16; postoperative chemotherapy with the above-mentioned drugs for 25 weeks. RESULTS: With a median follow-up of 124 months (range 84-158 months), 69 patients (69%) were continuously event-free survivors; the 10-year probability of event-free survival (EFS) was 62%. Conservative surgery was performed in 85% of patients. Twenty-six patients had local recurrence or distant relapse. The median time to recurrence/ relapse was 27 months (range 17-93 months). The local recurrence rate was 7% (7 of the 100 patients); 4 had wide surgical margins, 2 marginal and 1 intralesional. Four patients died as a result of chemotherapy-related toxicity and 1 developed a second neoplasia (acute myeloid leukaemia). p53 expression and HER2/erbB-2 expression showed no effect on survival or EFS. CONCLUSIONS: This therapeutic protocol achieved good oncologic and orthopaedic results. We observed a significant treatment-related toxicity.

Equidad en educación superior: experiencia de un programa especial de ingreso a carreras de la salud / Equity in higher education: experience from special program for admission to health careers

Propósito: Describir los resultados de los primeros 5 años de un programa de ingreso diferenciado de estudiantes destacados de nivel socioeconómico bajo a carreras de la salud de la Facultad de Medicina de la Universidad de Chile. Material y Método: Se incorporaron anualmente 10 a 20 alumnos de tercero y cuarto Medio de escasos recursos por sus antecedentes académicos y psicosociales. Durante uno o dos años recibieron refuerzo en ramos científicos y habilidades para la vida, tutoría y orientación vocacional. Rindieron también la PAA/PSU. De los preseleccionados, se eligieron hasta 5 por año para ingresar a la Facultad de acuerdo a sus antecedentes académicos, vocacionales y condiciones psicosociales de adaptación. Cursaron las carreras con beca completa y otros apoyos económicos. A aquellos que no ingresaron se les facilitaron otras instancias de educación superior. Resultados: A la fecha, han participado 57 estudiantes, 43,9% mujeres y 56,1% hombres. Su promedio de notas de enseñanza media fue x igual 6,1. 43,5% no tenía expectativas previas de ingresar a la universidad. Durante el apoyo inicial 41,1% evidenció déficit de hábitos y técnicas de estudio, 67,3% desorientación vocacional, 33,3% psicopatología y 38,6% conductas de riesgo. 15,8% desertó y 17,5% fue excluido. La deserción se debió principalmente a problemas vocacionales y stress, y la exclusión a mal rendimiento y psicopatología. 47,4% de los que finalizaron la etapa previa fue seleccionado para cursar carreras en la Facultad. Sus puntajes ponderados estuvieron bajo los mínimos para el ingreso regular. Su desempeño posterior fue en general satisfactorio. Conclusiones: El programa generó oportunidades de acceso a la universidad fuera de las expectativas de este grupo de jóvenes. Su realidad psicosocial dificultó su desempeño. El apoyo en esta área es muy importante en este tipo de programas...

Purpose: To describe the results from the first 5 years of a differentiated admission program designed for outstanding students of low socioeconomic income admitted to health careers of the Faculty of Medicine, University of Chile. Materials and Methods: Annually, 10 to 20 low-income- students from 3rd and 4th years of secondary school entered the program in virtue of their academic and psychosocial background. For one or two years, they received extra support in scientific subjects and abilities for life, tutoring and vocational guidance. They also took the PAA/PUU (general post-secondary school test). Of the students who succeeded the pre-selection, up to 5 per year were chosen for admission to University according to their academic and vocational background and their psychosocial adaptation conditions. They studied their careers under full bursary coverage and other financial supports. Those who failed admission were helped to access other instances of higher education. Results: To date, 57 students have participated in the program. Of these, 43,9% are females and 56,1% are men. Their average secondary school grade was x = 6,1. In total, 43,5% had no prior expectations on being admitted to university. During the initial support delivery, 41,1% evidenced a lack of study habits and techniques, 33,3%showed a psychopathological condition and 38,6% evidenced risk behaviors. In 15,8% of the cases students dropped out and in 17,5% there was student exclusion. Drop out was due mainly to vocational problems and stress, and exclusion was due to low performance and psychopathological conditions. Of the students who completed the previous stage, 47,4% was selected to study careers at the Faculty. Their test scores were below the minimum for regular admission. In general, their subsequent performance was satisfactory. Conclusions: The program generated university access opportunities that...

Supracondylar fractures of the humerus in children.

Supracondylar fractures of the humerus need a precise treatment in order to obtain a satisfactory result because of the low bone remodeling associated with these injuries. It is important to use a systematic procedure for closed reduction and percutaneous fixation. A retrospective review of fractures treated using two K-wires from the lateral side was done in 77 patients with a mean age of 6.7 years (range, 1-13 years). Displacement of the fracture was classified as Gartland Type II in 39 patients (50.6%) and Gartland Type III in 38 patients (49.4%). The results according to Flynn criteria were excellent in 70 patients (90.9%), fair in three patients (3.9%) and poor in four patients (5.2%), with overall satisfactory results in 96.1% of the cases. In four patients there was secondary displacement of the fragments in internal rotation and three of these patients were operated on again, increasing fixation with a third K-wire either from the lateral or medial side. There were two nerve lesions (2.6%), and four patients (5.2%) had a pulseless pink hand that recovered when the fracture was reduced. In three patients (3.9%) infection developed. To obtain satisfactory results using this procedure, enough stability should be achieved, avoiding iatrogenic damage of the ulnar nerve.

Effects of several applications of digested sewage sludge on soil and plants.

Sewage sludge production has significantly increased during the last years in European Union (EU) countries, being primarily used for agricultural purposes. In this study, digested sewage sludge was applied to greenhouse soil over a three-year period (2001--2003), with three sludge treatments in the first two years (2, 4, and 6 kg m(-2)) and three more applications using a greater quantity in the last year (6, 8, and 10 kg m(-2)). The effects of sewage sludge application on soil and on a leafy crop (Lactuca sativa L.) were studied. Mineral elements, organic matter, pH, and heavy metals were measured in soil and plant tissues. Pathogen and indicator microorganism dynamics in soil were also determined after each sludge application. Results showed that sewage sludge applications increased organic matter, P, and N Ca content in soil. Furthermore, Zn, Pb, Ni, and Cu content increased in soils, primarily after high doses of sludge. The highest yield value was obtained in the second-year harvest, since the last sludge application did not increase yield. Fecal coliform numbers decreased significantly one month after sludge application. However, total coliforms, Clostridium sulphite-reducers and Salmonella, were present in soils three months after sludge application.

STR data for nine Y-chromosomal loci in Guinea Equatorial (central Africa).

Allele and haplotype frequencies for nine Y-specific STR loci (DYS19, DYS389-I, DYS389-II, DYS390, DYS391, DYS393, DYS434, DYS437, and DYS439) were obtained from a sample of 57 males from Guinea Equatorial.

Anomalías del cordón umbilical y su asociación con malformaciones fetales / Anomalies of the umbilical cord and its association with fetal malformations

Se presenta una evolución de 1.500 autopsias perinatales; y se relaciona los hallazgos de anomalías del cordón umbilical con malformaciones fetales mayores y menores. Se destacan la arteria umbilical única y las estenosis del cordón. Como las más frecuentes se señala la importancia de un examen acucioso del cordón umbilical y la placenta

Hemangioma de bazo en recién nacido: evolución postesplenectomía y autotrasplante de bazo / Splenic hemangioma in newborn

Se presenta un paciente en quien se detectó esplenomegalia voluminosa, trombocitopenia y anemia hemolítica microangiopática en el momento de nacer, que resultó ser un hemangioma de bazo. Se le realizó esplenectomía total y autotrasplante de una zona de tejido esplénico normal. Su evolución hasta los cuatro años de edad ha sido sin complicaciones infecciosas, con normalidad hematológica y evidencias de neoimplante de bazo funcionante. Esta experiencia apoya la utilidad del autotrasplante de bazo, cuando ello es posible, en los pacientes menores de 5 años qye deben someterse a esplenectomía

Tumor de Wilms: histopatología y pronóstico / Wilms' tumor: histopathology and prognosis

Se analizan 40 casos de tumor de Wilms con el objeto de establecer la relación existente entre los estadios clínicos, la histopatología del tumor y el pronóstico del mismo, así como la frecuencia de presentación de cada uno de los subtipos histológicos. El mayor porcentaje de nuestros casos correspondían al tipo histológico mixto, seguido de la variedad epitelial, blastematosa y estromatosa. El 77.5% de los casos correspondían a subtipos histológicos de "pronóstico favorable" y el 22% a subtipos histológicos de "pronóstico desfavorable" (con anaplasia o componentes sarcomatosos). Se observó una mortalidad menor en los estadios I y II de la clasificación del NWTS, los que a su vez muestran un mayor porcentaje de subtipos histológicos de pronóstico favorable. Se observó un peor pronóstico en los pacientes cuyos tumores correspondían a la variedad sarcomatosa o que presentaban anaplasia. En ellos la mortalidad fue de un 55.5% en contraposición con los otros subtipos, en los cuales esta fue de un 25.5%. Todos los casos con anaplasia correspondían al tipo mixto, sin que se observaran diferencias significativas en la mortalidad de este grupo entre los subtipos con o sin anaplasia. Los resultados de este estudio confirman la importancia de que la clasificación histológica del tumor de Wilms, en grupos de pronóstico favorable y desfavorable, sea parte integral del protocolo de tratamiento de los pacientes con este tumor

Linfagiectasia intestinal secundaria a pericarditis constrictiva / Intestinal lymphangiectasia secondary to constrictive pericarditis

Se presenta un enfermo con linfangiectasia intestinal secundaria a pericarditis constrictiva que consultó por retraso del peso, edema generalizado asimétrico, hipoproteinemia, linfopemia e hipogamaglobulinemia. El diagnóstico se confirmó por la presencia de linfáticos dilatados en las vellosidades intestinales en la biopsia de yeyuno y por el aumento de la excreción fecal de proteínas marcadas con Cr51. La existencia de injurgitación yugular discreta y reflujo hepato yugular positivo insinuaron el diagnóstico de pericarditis constrictiva. Este fue confirmado por la ecocardiografía modo M y bidimensional. Con el tratamiento quirúrgico se logró una rápida remisión clínica, de laboratorio y de la morfología de la mucosa yeyunal