Consistency between POLARS and LARS scores regarding the incidence of low anterior resection syndrome in a Chilean population undergoing rectal surgery secondary to cancer in a high-volume hospital.

AIM: The aim of this work was to evaluate the concordance between the low anterior resection syndrome (LARS) and preoperative LARS (POLARS) scores regarding the incidence of LARS in a Chilean population undergoing rectal surgery for cancer in a high-volume hospital. METHOD: The LARS score questionnaire, following telephone requests, was used to determine the presence and severity of LARS. The POLARS score was calculated based on variables described previously. Correlations and qualitative and quantitative concordance were evaluated using Spearman's correlation coefficient, the kappa coefficient and the Bland-Altman plot with Lin's concordance correlation coefficient. RESULTS: A total of 120 patients met the inclusion criteria: 37.5% underwent neoadjuvant radiotherapy, 61% underwent total mesorectal excision (TME) and 51.6% underwent ostomy. A total of 49% of patients did not present with LARS, whereas 28% had major LARS. The correlation between scales was poor, with a fair qualitative concordance to determine the presence/absence of LARS and a slight qualitative concordance to determine the degree of the intensity. The quantitative concordance was poor. CONCLUSION: In the Chilean population, concordance between the LARS and POLARS scores was qualitatively fair to determine the presence/absence of the disease and qualitatively slight to determine the degree of intensity. We do not suggest using the POLARS score in the perioperative period in the Chilean population deliberately, as the score may help to determine the presence/absence of LARS but cannot determine its degree of intensity. Additional evaluations are required to determine the factors contributing to the degree of agreement between the scales.

Estrategias orientadas a mejorar la adherencia a la rehabilitación y la actividad física tras cirugía de artroplastia total de rodilla: revisión sistemática con metaanálisis / Strategies aimed at improving adherence to rehabilitation and physical activity after total knee arthroplasty surgery: Systematic review with meta-analysis

Introducción y objetivo Los sujetos intervenidos por artroplastia total de rodilla (ATR) muestran bajos niveles de adherencia a la rehabilitación y al ejercicio físico. El objetivo de este estudio es recopilar y revisar los efectos de las estrategias orientadas a mejorar la adherencia al ejercicio físico en la rehabilitación tras ATR. Métodos Se llevó a cabo una revisión sistemática de la literatura (Cochrane, PEDro, MedLine), incluyendo aquellos estudios que emplearan estrategias encaminadas a mejorar la adherencia a la rehabilitación tras ATR. Se analizaron los efectos de las intervenciones en términos de dolor y funcionalidad (variables primarias), así como en las variables relacionadas con la adherencia, realizando un metaanálisis a partir de las diferencias de medias estandarizadas (DME; IC95%) entre las puntuaciones de la intervención experimental y control. Resultados Se recogieron nueve estudios que incluían estrategias encaminadas a mejorar la adherencia a la rehabilitación tras ATR. El metaanálisis reveló un ligero efecto a favor del grupo experimental en términos de dolor (DME; IC95%: 0,31 [0,09-0,54], p<0,01), pero no en cuanto a la funcionalidad. Cualitativamente, los resultados relacionados con la adherencia fueron heterogéneos o inconsistentes. Conclusiones Los efectos de las estrategias empleadas para mejorar la adherencia al ejercicio físico en la rehabilitación tras ATR son heterogéneos e inconcluyentes, aunque se sugieren ligeros efectos positivos en cuanto al dolor. La diversidad de resultados en los estudios individuales y la heterogeneidad en el diseño de las intervenciones implican la necesidad de futuras investigaciones (AU)

Introduction and objectives Subjects undergoing by total knee arthroplasty (TKA) show low levels of adherence to rehabilitation and physical exercise. The aim of this study is to collect and review the effects of strategies aimed at improving adherence to physical exercise in rehabilitation after TKA. Methods A systematic review of the literature (Cochrane, PEDro, and MedLine) was carried out, including those studies that employed strategies aimed at improving adherence to rehabilitation after TKA. We analyzed the effects of the interventions in terms of pain and functionality (primary variables), as well as adherence-related variables, performing a meta-analysis based on the standardized mean differences (SMD; 95%CI) between experimental and control intervention scores. Results Nine studies were collected that included strategies aimed at improving adherence to rehabilitation after TKA. Meta-analysis revealed a slight effect in favor of the experimental group in terms of pain (SMD; 95%CI: 0.31 [0.09-0.54], P<.01]), but not in terms of functionality. Qualitatively, results related to adherence were heterogeneous or inconsistent. Conclusion The effects of strategies employed to improve adherence to physical exercise in rehabilitation after TKA are heterogeneous and inconclusive, although slight positive effects on pain are suggested. The diversity of results in the individual studies and the heterogeneity in the design of the interventions imply the need for future research (AU)

Accumulation, distribution pattern and potential contamination of sulphur in vineyard soils of the Valdepeñas protected denomination origin.

Soil is the basis for almost all global agriculture and the medium in which most terrestrial biological activity occurs. Viticulture represents an important agricultural practice in the Castilla-La Mancha (CLM) community. In this region, there are several protected denominations of origin (PDO), the largest being Valdepeñas. This paper describes the accumulation pattern of sulphur (S) in the vineyard soils of this PDO. Samples were collected from 90 vineyard soil profiles. Sulphur content was determined using an X-ray Fluorescence spectrometer in the solid mode on a powdered aliquot of each sample. The results indicated that the total S in soils varied from 0.54 to 6.90 (g·kg-1) in surface soil (0-30 cm) and from 0.39 to 2.80 (g·kg-1) on the subsurface layer (30-80 cm). When comparing the mean values of surface horizons to the subsurface horizons, S content lowered as soil depth increased. Kurtosis exceeded 45 % in all cases, which indicates a wide variability of concentrations. These findings can be explained by the continuous fertiliser and fungicide applications (and therefore S) in these production systems. Using the geoaccumulation index (Igeo), most soils were included in Class 0 (Igeo <0) and were, thus, S uncontaminated; only a few points can be considered pollutants. The obtained results should contribute to extend the scarce existing database on S in Mediterranean regions like that herein studied.

Obscure digestive bleeding.

A 50-year-old woman presented to the emergency department with several episodes of melena in the last week. The patient was not hemodynamically compromised and was conservatively managed. Urgent upper gastrointestinal endoscopy and colonoscopy showed no source of bleeding. Abdominal CT demonstrated three mural nodular lesions up to 2cm in the mid jejunum with hypervascular characteristics in arterial phase without active bleeding in venous phase. Angiography (Figure 1A) revealed three tumours with neo-angiogenesis and no active bleeding. Each lesion was stained with methylene blue and followed by embolization with coils. Exploratory laparotomy (Figure 1B) showed the three nodules marked by angiography. Intestinal resection of the affected segment was performed. Histopathological study proved the diagnosis of suspicion (Figure 2).

Deep learning-assisted radiomics facilitates multimodal prognostication for personalized treatment strategies in low-grade glioma.

Determining the optimal course of treatment for low grade glioma (LGG) patients is challenging and frequently reliant on subjective judgment and limited scientific evidence. Our objective was to develop a comprehensive deep learning assisted radiomics model for assessing not only overall survival in LGG, but also the likelihood of future malignancy and glioma growth velocity. Thus, we retrospectively included 349 LGG patients to develop a prediction model using clinical, anatomical, and preoperative MRI data. Before performing radiomics analysis, a U2-model for glioma segmentation was utilized to prevent bias, yielding a mean whole tumor Dice score of 0.837. Overall survival and time to malignancy were estimated using Cox proportional hazard models. In a postoperative model, we derived a C-index of 0.82 (CI 0.79-0.86) for the training cohort over 10 years and 0.74 (Cl 0.64-0.84) for the test cohort. Preoperative models showed a C-index of 0.77 (Cl 0.73-0.82) for training and 0.67 (Cl 0.57-0.80) test sets. Our findings suggest that we can reliably predict the survival of a heterogeneous population of glioma patients in both preoperative and postoperative scenarios. Further, we demonstrate the utility of radiomics in predicting biological tumor activity, such as the time to malignancy and the LGG growth rate.

Detection of cytomegalovirus in bronchoalveolar lavage fluid from immunocompromised patients with pneumonitis by viral culture and DNA quantification.

PURPOSE: To compare the detection of human cytomegalovirus (HCMV) in bronchoalveolar lavage (BAL) fluid by viral culture and quantitative polymerase chain reaction (qPCR), and to establish a viral load threshold that can identify cases of HCMV replication indicative of pneumonitis. There is currently no universal viral load cut-off to differentiate between patients with and without pneumonitis, and the interpretation of qPCR results is challenging. METHODS: 176 consecutive BAL samples from immunosuppressed hosts with signs and/or symptoms of respiratory infection were prospectively studied by viral culture and qPCR. RESULTS: Concordant results were obtained in 81.25% of the BAL samples. The rest were discordant, as only 34% of the qPCR-positive BAL samples were positive by culture. The median HCMV load was significantly higher in culture-positive than in culture-negative BAL samples (5038 vs 178 IU/mL). Using a cut-off value of 1258 IU/mL of HCMV in BAL, pneumonia was diagnosed with a sensitivity of 76%, a specificity of 100%, a VPP of 100% and VPN of 98%, and HCMV was isolated in 100% of the BAL cultures. CONCLUSION: We found that a qPCR-negative was a quick and reliable way of ruling out HCMV pneumonitis, but a positive result did not always indicate clinically significant replication in the lung. However, an HCMV load in BAL fluid of ≥ 1258 IU/mL was always associated with disease, whereas < 200 IU/mL rarely so.

Hallazgo renal infrecuente en una paciente con anemia y pérdida de peso / Unexpected kidney finding in a patient with anemia and weight loss

Mujer de 57 años con trastorno del espectro autista y crisis epilépticas secundarias que consulta por clínica debida a anemia y pérdida de peso. Como antecedentes más relevantes destaca un ingreso hospitalario por sepsis urinaria, donde se evidenció Morganella morganii y una bacteriemia con aislamiento de Staphylococcus epidermidis. La paciente no refería en el momento de la consulta clínica urinaria.Se realizó un TC de abdomen donde se observa un aumento de tamaño del riñón derecho, con pérdida de la diferenciación córtico-medular y sustitución del parénquima renal normal por masas de baja atenuación en el espesor de un parénquima renal destruido que se corresponden con los cálices dilatados. Todo ello asociado a un cálculo coraliforme con afectación de la grasa peripélvica.(AU)

57-year-old woman with autism spectrum disorder and secondary epileptic seizures. A CT of abdomen is requested due to anemia and weight loss. The patient did not refer urinary symptoms. She was admitted four months to Internal Medicine Service, due to urinary sepsis, where Morganela morgani was isolated, and bacteremia, with Staphylococcus epidermidis isolation.In the CT performed, we found an increase in the size of the right kidney, with loss of corticomedullary differentiation and replacement of a destroyed renal parenchyma by low-attenuation masses that corresponds to the dilated calyces. A staghorn stone with involvement of the peripelvic fat was also described.(AU)

Efectos de las medidas de restricción sobre la actividad física y conducta sedentaria de niños, niñas y adolescentes durante la pandemia por COVID-19: revisión sistemática / Effects of restriction measures on physical activity and sedentary behavior of children and adolescents during COVID-19 pandemic: a systematic review

Introducción: La pandemia por COVID-19 obligó a los gobiernos a implementar medidas de restricción social para proteger la salud de la población, afectando la calidad de vida de las personas, especialmente en grupos vulnerables como los niños, niñas y adolescentes (NNA). El objetivo de esta revisión sistemática (RS) fue evaluar el efecto de las medidas de restricción sobre la actividad física (AF) y conducta sedentaria (CS) de los NNA. Adicionalmente, se exploraron posibles factores determinantes de estos cambios. Métodos: Se realizó una RS, utilizando tres bases de datos. Se incluyeron estudios observacionales en donde se hubiera analizado la AF y CS de los participantes, utilizando cualquier método de evaluación. Dos investigadores analizaron los estudios, extrajeron los datos y evaluaron la calidad metodológica de los artículos primarios. El metaanálisis se realizó utilizando el modelo de efectos aleatorios, considerando un valor p < 0,05 como estadísticamente significativo. Resultados: Se incluyeron 19 artículos, con una muestra total de 15.095 NNA. La mayoría de los estudios reveló una reducción de la AF y un incremento de la CS en los sujetos, durante los confinamientos por COVID-19. El metaanálisis mostró una caída en la AF total, la AF moderada a vigorosa y un incremento del tiempo de sedentarismo. Diversos factores biodemográficos, familiares y ambientales exacerbaron las variaciones en la AF y la CS de los NNA. Conclusión: Las medidas de restricción aplicadas durante pandemia por COVID-19 redujo la AF e incrementó la CS de los NNA. Factores biodemográficos, familiares y ambientales determinaron estas variaciones.

Introduction: The COVID-19 pandemic forced governments to implement social restriction measures to protect the health of the population, affecting the quality of life of people, especially in vulnerable groups, such as children and adolescents (CA). The objective of this systematic review (SR) was to evaluate the effect of restriction measures on physical activity (PA) and sedentary behavior (SB) of CA. Additionally, possible determining factors of these changes were explored. Methods: An SR was carried out, using three databases. Observational studies were included in which the PA and SB of the participants were analyzed, using any evaluation method. Two investigators analyzed the studies, extracted data, and assessed the methodological quality of the primary articles. The meta-analysis was performed using the random effects model, considering a value of p < 0.05 as statistically significant. Results: 19 articles were included, with a total sample of 15,095 subjects. Most studies revealed a reduction in PA and an increase in SB in subjects during COVID-19 lockdowns. The meta-analysis showed a drop in total PA, moderate to vigorous PA, and an increase in sedentary time. Various biodemographic, family and environmental factors exacerbated the variations in the PA and SB of the CA. Conclusion: The restriction measures applied during the COVID-19 pandemic reduced the PA and increased the SB of the CA. Biodemographic, family and environmental factors determined these variations.

Un hallazgo inesperado en hipocondrio derecho / An unexcepted finding in the right hypocondrium

A 90-years-old man comes to the emergency department with diffuse abdominal pain and fever three days. On physical examination, the abdomen is soft and depressible with air-fluid sound present and bilateral reductible inguinal hernias. A mass is palpated at the level of the roght hypochondrium with a positive Murphy´s sign whitout signs of peritoneal irritation. An abdominal CT with intravenous contrast is requested due to the suspicion of acute abdominal pathology, observing cholelithiasis and a markedly distended gallbladder with torsion. (AU)

Using Machine Learning for Predicting the Effect of Mutations in the Initiation Codon.

The effect of mutations has been traditionally predicted by studying what may happen due to the substitution of one amino acid for another one. This approach may be effective for mutations with impact in the function of the protein, but ineffective for mutations in the translation initiation codon. Such mutation might avoid the generation of the protein. Consequently, specific methods for predicting the effect of mutations in the translation initiation codon are needed. We propose a method for predicting the effect of mutations in the canonical translation initiation codon based on a biological model that considers specific features of such mutations, like the distance to a potential alternative initiation codon. Our predictor has been developed using tree-based machine learning algorithms and data extracted from Ensembl. Our final model is able to detect whether a mutation in the canonical initiation codon is deleterious or benign with a precision of 44.28% and an accuracy of 98.32%, which improves the results of state of the art tools such as PolyPhen, SIFT, or CADD for this type of mutation.

Antagonistic Interaction of Selenium and Cadmium in Human Hepatic Cells Through Selenoproteins.

Cadmium (Cd) is a highly toxic heavy metal for humans and animals, which is associated with acute hepatotoxicity. Selenium (Se) confers protection against Cd-induced toxicity in cells, diminishing the levels of ROS and increasing the activity of antioxidant selenoproteins such as glutathione peroxidase (GPx). The aim of this study was to evaluate the antagonistic effect of selenomethionine (SeMet) against Cd toxicity in HepG2 cells, through the modulation of selenoproteins. To this end, the cells were cultured in the presence of 100 µM SeMet and 5 µM, 15 µM, and 25 µM CdCl2 and a combination of both species for 24 h. At the end of the experiment, cell viability was determined by MTT assay. The total metal content of Cd and Se was analyzed by triple-quadrupole inductively coupled plasma-mass spectrometry (ICP-QqQ-MS). To quantify the concentration of three selenoproteins [GPx, selenoprotein P (SELENOP), and selenoalbumin (SeAlb)] and selenometabolites, an analytical methodology based on column switching and a species-unspecific isotopic dilution approach using two-dimensional size exclusion and affinity chromatography coupled to ICP-QqQ-MS was applied. The co-exposure of SeMet and Cd in HepG2 cells enhanced the cell viability and diminished the Cd accumulation in cells. Se supplementation increased the levels of selenometabolites, GPx, SELENOP, and SeAlb; however, the presence of Cd resulted in a significant diminution of selenometabolites and SELENOP. These results suggested that SeMet may affect the accumulation of Cd in cells, as well as the suppression of selenoprotein synthesis induced by Cd.

Comparative study of biological versus synthetic prostheses in the treatment of ventral hernias classified as grade II/III by the Ventral Hernia Working Group.

AIM OF THE STUDY: The implantation of biological prostheses in an at-risk environment has seen increasing use. Their markedly higher cost compared to synthetic prostheses makes it important to analyse their usefulness in terms of actual benefit and cost-effectiveness. This study aims to examine the relevance of bioprostheses during surgical repair of Grade II/III ventral hernias as classified by the Ventral hernia working group (VHWG). MATERIALS AND METHODS: This study analysed the data of 119 patients requiring non-emergency repair of VHWG II/III grade hernias between 2010 and 2017. The results of patients who were treated with a bioprosthesis (n=59) were compared to those receiving a synthetic prosthesis (n=60). The primary outcome was surgical site infection (SSI) at 90 days. The secondary endpoints were hernia recurrence rate, cost of the prosthesis, duration of hospital stay and re-hospitalisation rate. RESULTS: The two groups were shown to be comparable by analysis of demographic, pre- and intraoperative data. The SSI rate was significantly higher in the bioprosthesis group (20% vs. 7%; P=0.010), as was the recurrence rate (56% vs. 28%; P=0.003) with a median follow-up of 40 months. The cost of the bioprosthesis was significantly higher than that of the synthetic prosthesis (€3363 vs. €249; P<0.010). CONCLUSION: In this retrospective study, the use of a bioprosthesis for repair of VHWG II/III ventral hernias was associated with a higher rate of both SSI and hernia recurrence at a cost 13 times greater than the use of a synthetic prosthesis.

Combined pancreatojejunal and hepatojejunal anastomotic stent placement in total laparoscopic pancreaticoduodenectomy.

INTRODUCTION: Laparoscopic pancreaticoduodenectomy (LPD) is a technically demanding procedure that is considered safe and feasible if performed in a high-volume institution, where surgeons and medical staff is appropriately trained. For this advanced abdominal procedure only few studies described a reproducible stepwise technique and a standard approach is still lacking. METHODS: The attached video reports all steps of our standardized LPD with pancreatojejunal and hepatojejunal anastomotic stent placement performed with a double approach. The laparoscopic demolitive phase, exactly as the laparotomic one, begins with the surgeon placed on the patient's right side, while for the reconstructive one he moves between the patient's legs. The main characteristic of this technique is an easy realization of the end-to-side biliary anastomosis with a Kehr's "T" tube segment placement as internal biliary stent. This easy technical tip can facilitate the anastomosis realization that remains the most challenging step of this laparoscopic technique, especially in case of small common bile duct. RESULTS: We consider that our standardized technique can be safely performed and it can facilitate the anastomosis execution, especially the hepatic-jejunal. DISCUSSION: Despite our reproducible stepwise technique could help to minimize the learning curve for LPD, further randomized controlled trials are needed to validate the superiority of minimally invasive approach.