A multistate model and its standalone tool to predict hospital and ICU occupancy by patients with COVID-19.

Objective: This study aims to build a multistate model and describe a predictive tool for estimating the daily number of intensive care unit (ICU) and hospital beds occupied by patients with coronavirus 2019 disease (COVID-19). Material and methods: The estimation is based on the simulation of patient trajectories using a multistate model where the transition probabilities between states are estimated via competing risks and cure models. The input to the tool includes the dates of COVID-19 diagnosis, admission to hospital, admission to ICU, discharge from ICU and discharge from hospital or death of positive cases from a selected initial date to the current moment. Our tool is validated using 98,496 cases positive for severe acute respiratory coronavirus 2 extracted from the Aragón Healthcare Records Database from July 1, 2020 to February 28, 2021. Results: The tool demonstrates good performance for the 7- and 14-days forecasts using the actual positive cases, and shows good accuracy among three scenarios corresponding to different stages of the pandemic: 1) up-scenario, 2) peak-scenario and 3) down-scenario. Long term predictions (two months) also show good accuracy, while those using Holt-Winters positive case estimates revealed acceptable accuracy to day 14 onwards, with relative errors of 8.8%. Discussion: In the era of the COVID-19 pandemic, hospitals must evolve in a dynamic way. Our prediction tool is designed to predict hospital occupancy to improve healthcare resource management without information about clinical history of patients. Conclusions: Our easy-to-use and freely accessible tool (https://github.com/peterman65) shows good performance and accuracy for forecasting the daily number of hospital and ICU beds required for patients with COVID-19.

Cirugía oncoplástica y radioterapia intraoperatoria en el cáncer de mama / Oncoplastic surgery and intraoperative radiotherapy in breast cancer

Objetivo: Estudio prospectivo de pacientes con cáncer de mama precoz tratadas con cirugía conservadora oncoplástica y radioterapia intraoperatoria con intención de dosis única o monoterapia. Material y método: Veintitrés pacientes intervenidas entre junio de 2016 y agosto de 2018, que han cumplido criterios de administración de radioterapia intraoperatoria establecidos por nuestro comité multidisciplinar de tumores de mama (carcinoma ductal infiltrante<3cm, unifocal, con axila clínica y radiológicamente negativa, receptores hormonales positivos y HER2 negativo) y han sido candidatas a cirugía oncoplástica. Resultados: Tras el estudio anatomopatológico, todas las piezas de resección tenían márgenes libres y 16 pacientes seguían cumpliendo criterios de radioterapia intraoperatoria como monoterapia. En 7 pacientes se precisó administrar radioterapia glandular externa por no cumplir alguno de los criterios. Conclusiones: La cirugía oncoplástica asociada a radioterapia intraoperatoria es una evolución en el tratamiento del cáncer de mama precoz en un importante número de nuestras pacientes. Presenta un alto grado de satisfacción y una menor percepción de la enfermedad por parte de las pacientes

Objective: Prospective study of patients with early breast cancer treated with oncoplastic conservative surgery and intraoperative radiotherapy with single-dose intent or monotherapy. Material and method: We included 23 patients who underwent surgery between June 2016 and August 2018 and who met the criteria for administration of intraoperative radiotherapy established by our multidisciplinary committee of breast tumours (infiltrating ductal carcinoma<3cm, unifocal, with a clinically and radiologically negative axilla, hormone receptor-positive and HER2-negative) and who were candidates for oncoplastic surgery. Results: After pathological study, all the surgical specimens had free margins and 16 patients continued to meet the intraoperative radiotherapy criteria for monotherapy. In 7 patients who did not meet any of the criteria, external glandular radiotherapy was administered. Conclusions: Oncoplastic surgery associated with intraoperative radiotherapy is a development in the treatment of early breast cancer in a significant number of patients. It produces a high degree of satisfaction and a lower disease perception among patients

Major hepatectomies in liver cystic echinococcosis: A bi-centric experience. Retrospective cohort study.

Surgical treatment of liver cystic echinococcosis (LCE) could be conservative or radical. Radical surgery includes liver resection, but usually are minor hepatectomy in favourable segments. Experience in major hepatectomy (MH) for LCE is limited. METHODS: Retrospective study. PERIOD: January 2007-December 2014. INCLUSION CRITERIA: liver infestation with Echinococcus granulosus causing active or complicated cysts. Epidemiological, clinical, radiological and surgical data were studied. RESULTS: 145 patients underwent surgery for LCE. MH was performed in 49 patients (34%) with 81 cysts. 51% of patients were women. Mean age: 56 years. Sixteen patients (32.7%) had recurrent disease. The mean diameter cyst was 9.9 cm. The MH performed were right hepatectomy (n = 15), left hepatectomy (6) and others (n = 28). The reason for MH was occupation of the entire lobe (14), severe vascular or biliary involvement (17), or a combination of the two (18). Major morbidity (Clavien III-V) was 26%. Mortality was 2%. Mean hospital stay: 15.3 days. At follow-up (mean: 31 months) the rate of liver recurrence after MH was 0%. CONCLUSIONS: MH is feasible in LCE, with a major morbidity rate of (26%), and zero recurrence. Indications of MH are occupation of an entire lobe, extreme biliary or vascular involvement or recurrent cysts.

Contribution of Dry Needling to Individualized Physical Therapy Treatment of Shoulder Pain: A Randomized Clinical Trial.

Study Design Multicenter, parallel randomized clinical trial. Background Myofascial trigger points (MTrPs) are implicated in shoulder pain and functional limitations. An intervention intended to treat MTrPs is dry needling. Objectives To investigate the effectiveness of dry needling in addition to evidence-based personalized physical therapy treatment in the treatment of shoulder pain. Methods One hundred twenty patients with nonspecific shoulder pain were randomly allocated into 2 parallel groups: (1) personalized, evidencebased physical therapy treatment; and (2) trigger point dry needling in addition to personalized, evidence-based physical therapy treatment. Patients were assessed at baseline, posttreatment, and 3-month follow-up. The primary outcome measure was pain assessed by a visual analog scale at 3 months, and secondary variables were joint range-of-motion limitations, Constant-Murley score for pain and function, and number of active MTrPs. Clinical efficacy was assessed using intention-to-treat analysis. Results Of the 120 enrolled patients, 63 were randomly assigned to the control group and 57 to the intervention group. There were no significant differences in outcome between the 2 treatment groups. Both groups showed improvement over time. Conclusion Dry needling did not offer benefits in addition to personalized, evidencebased physical therapy treatment for patients with nonspecific shoulder pain. Level of Evidence Therapy, level 1b. Registered February 11, 2009 at www.isrctn.com (ISRCTN30907460). J Orthop Sports Phys Ther 2017;47(1):11-20. Epub 9 Dec 2016. doi:10.2519/jospt.2017.6698.

Reconstruction after pancreatoduodenectomy: Pancreatojejunostomy vs pancreatogastrostomy.

Pancreatic surgeons try to find the best technique for reconstruction after pancreatoduodenectomy (PD) in order to decrease postoperative complications, mainly pancreatic fistulas (PF). In this work, we compare the two most frequent techniques of reconstruction after PD, pancreatojejunostomy (PJ) and pancreatogastrostomy (PG), in order to determine which of the two is better. A systematic review of the literature was performed, including major meta-analysis articles, clinical randomized trials, systematic reviews, and retrospective studies. A total of 64 articles were finally included. PJ and PG are usually responsible for most of the postoperative morbidity, mainly due to the onset of PF, being considered a major trigger of life-threatening complications such as intra-abdominal abscess and hemorrhagia. The included systematic reviews reported a significant difference only in the incidence of intraabdominal collections favouring PG. PF, delayed gastric emptying and mortality were not different. Although there was heterogeneity between these studies, all were conducted in specialized centers by highly experienced surgeons, and the surgical care was likely to be similar for all the studies. The disadvantages of PG include an increased incidence of delayed gastric emptying and of main pancreatic duct obstruction due to overgrowth by the gastric mucosa. Exocrine function appears to be worse after PG than after PJ, resulting in severe atrophic changes in the remnant pancreas. Depending on the type of PJ or PG used, the PF rate and other complications can also be different. The best method to deal with the pancreatic stump after PD remains questionable. The choice of method of pancreatic anastomosis could be based on individual experience and on the surgeon's preference and adherence to basic principles such as good exposure and visualization. In conclusion, up to now none of the techniques can be considered superior or be recommended as standard for reconstruction after PD.

Miopericitoma con componente lipomatoso / Myopericytoma with a lipomatous component

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