22 research outputs found
Step‐by‐step right colectomy and intracorporeal stapled side‐to‐side ileocolic anastomosis – a video vignette
No full textDepto. de CirugíaFac. de MedicinaTRUEpu
Absence of allelic imbalance involving EMSY, CAPNS, and PAK1 genes in papillary thyroid carcinoma
No full textPapillary thyroid cancer (PTC) accounts for 80% of all thyroid malignancies, and genetic alterations associated to its etiology remain largely unknown. Chromosomal band 11q13 seems to be one of the most frequently amplified regions in human cancer, providing several candidate genes that need detailed characterization. The aim of our study was to investigate the existence of allelic imbalance at EMSY, CAPN5, and PAK1, as candidate genes within 11q13.5-q14 region using a single nucleotide polymorphism-based analysis. We selected a panel of 9 polymorphisms that were analyzed in 41 thyroid carcinoma samples, their contralateral non-pathological tissue and 178 controls from the general population. We did not detect allelic imbalance at these loci in our series. However, we observed a difference in the EMSY-haplotype distribution among PTC patients when compared to controls (odds ratio=2.00; p=0.02). We conclude that 11q13.5-q14 is not imbalanced in PTC, but there is evidence suggesting that EMSY might be of relevance in PTC etiology.Fundación de Investigación Biomédica Mutua Madrileña AutomovilistaMinisterio de Ciencia y TecnologíaDepto. de CirugíaFac. de MedicinaTRUEpu
Sodium Metal Oxyhalides with High Ionic Conductivities
No full textHalide-based ionic conductors have attracted growing interest as solid electrolyte candidates because of their suggested electrochemical oxidation stability and deformability. However, most of the discovered sodium metal halides exhibit relatively low ionic conductivities. To address this, a new class of mechanochemically stabilized, low-crystalline sodium metal oxyhalides is developed. By using the combination of scanning electron microscopy–energy dispersive X-ray spectroscopy, X-ray diffraction, pair distribution function analysis, Raman spectroscopy, and nuclear magnetic resonance spectroscopy, we qualitatively explored the composition and local structure of these oxyhalides. Notably, and exhibit high ionic conductivities of 1.2 and 1.5 , respectively. Although the instability of against Na excludes their use as stand-alone separators in solid-state sodium metal batteries, the successful operation of a solid-state battery employing as a catholyte at room temperature demonstrates that is a promising catholyte material
Solid Ion Conductors under Pressure: In Situ Monitoring of the Tetragonal to Cubic Phase Transition of and
No full textThe solid electrolytes are promising candidates for sodium solid-state batteries due to their potential high ionic conductivities. Structural modifications of these materials can induce a tetragonal-to-cubic phase transition, either by increasing temperature or by aliovalent substitutions. In this study, we introduce pressure as an alternative approach to observe the tetragonal-to-cubic phase transition in these materials. In situ synchrotron high-pressure powder X-ray diffraction shows a tetragonal-to-cubic phase transition at pressures of 2.9 GPa for and 14.6 GPa for . Rietveld refinements and symmetry analysis provide insights into the displacive phase transition mechanism related to the motion of and the rotation of the tetrahedra. Density functional theory calculations confirm that the cubic phase becomes thermodynamically favorable under high pressure compared to the tetragonal phase. These findings highlight the importance of high-pressure considerations in tailoring the properties of ionic conductors, an area that remains underexplored
Intraperitoneal drain placement and outcomes after elective colorectal surgery: International matched, prospective, cohort study
No full textBackground: Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods: COMPASS (COMPlicAted intra-Abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results: Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P=0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P=0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P=0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P,0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P,0.001). Conclusion: Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk
Surgeons' practice and preferences for the anal fissure treatment: results from an international survey
No full textThe best nonoperative or operative anal fissure (AF) treatment is not yet established, and several options have been proposed. Aim is to report the surgeons' practice for the AF treatment. Thirty-four multiple-choice questions were developed. Seven questions were about to participants' demographics and, 27 questions about their clinical practice. Based on the specialty (general surgeon and colorectal surgeon), obtained data were divided and compared between two groups. Five-hundred surgeons were included (321 general and 179 colorectal surgeons). For both groups, duration of symptoms for at least 6 weeks is the most important factor for AF diagnosis (30.6%). Type of AF (acute vs chronic) is the most important factor which guide the therapeutic plan (44.4%). The first treatment of choice for acute AF is ointment application for both groups (59.6%). For the treatment of chronic AF, this data is confirmed by colorectal surgeons (57%), but not by the general surgeons who prefer the lateral internal sphincterotomy (LIS) (31.8%) (p = 0.0001). Botulin toxin injection is most performed by colorectal surgeons (58.7%) in comparison to general surgeons (20.9%) (p = 0.0001). Anal flap is mostly performed by colorectal surgeons (37.4%) in comparison to general surgeons (28.3%) (p = 0.0001). Fissurectomy alone is statistically significantly most performed by general surgeons in comparison to colorectal surgeons (57.9% and 43.6%, respectively) (p = 0.0020). This analysis provides useful information about the clinical practice for the management of a debated topic such as AF treatment. Shared guidelines and consensus especially focused on operative management are required to standardize the treatment and to improve postoperative results
Correction: Protective ileostomy creation after anterior resection of the rectum (PICARR): a decision-making exploring international survey
No full textProtective ileostomy creation after anterior resection of the rectum (PICARR): a decision-making exploring international survey.
No full textIn our previous survey of experts, surgeon's decision-making process (DMP) about protective ileostomy (PI) creation after anterior resection was investigated. Based on our previous data, a multiple choice questionnaire has been developed. The aim is to perform a quantitative analysis of the results obtained from an international survey and to describe the clinical practice worldwide. Ten questions were related to participants' demographics and, 20 questions (of which 17 Likert scale questions) investigated the DMP regarding PI creation. To evaluate the tendency of the answers in the Likert-type questions, the mean of the answers obtained was compared with the mean point of the Likert scale. The survey was completed by 1019 physicians. Neoadjuvant chemoradiotherapy and distance of the anastomosis from the anal verge ≤ 10 cm were each considered alone sufficient to justify creation of a PI, with statistically significant differences in comparison to the mean point of the scales in (p = < 0.0001 in both cases). Total Mesorectal Excision alone was not considered a factor sufficient to create a PI (p = 0.416). Most of the participants agree to define their approach to create a PI "tailored" to patients' risk factors (p = < 0.0001) and "influenced by my experience" in case of patients with low/moderate risk of anastomotic leakage (p = < 0.0001). This study provides useful insights on the worldwide clinical practice regarding creation of PI following anterior resection. Given the lack of standardization and evidence-based guidelines, this analysis may be helpful to assist surgeons' practice
Towards safer colorectal surgery worldwide: Outcomes and benchmarks from the ESCP CORREA 2022 audit
No full textIntroduction: Benchmarking colorectal surgery outcomes informs quality improvement. The ESCP CORREA 2022 snapshot audit aimed to assess contemporary colorectal resection practices and short-term outcomes across European countries and beyond. Methods: An international prospective multicentre audit was conducted in which adults undergoing elective or emergency colorectal resection during a 6-week period (January-April 2022) at participating hospitals were included. Data on patient demographics, indications, surgical approach (open, laparoscopic or robotic) and 30-day postoperative outcomes (complications, reoperation and mortality) were collected for analysis. The outcomes were analysed and compared with those of previous audits to identify trends in colorectal surgery. Results: The study enrolled 3521 patients (56.8% men) from 216 hospitals across 53 countries. In 72.2% of the cases, the indication for resection was malignancy, followed by diverticular disease in 9.0%, Crohn's disease in 3.7% and ulcerative colitis in 2.3% of the cases. Of the surgeries, 74.4% were elective. Minimally invasive surgery was performed in 55.2% of the cases (48.7% laparoscopic and 6.5% robotic). Primary anastomosis was performed in 90.3% of the patients. The 30-day anastomotic leak rate was 7.96%; in malignant and benign diseases, the leak rates were 7.3% and 10.2%, respectively. The leak rates for right, left, anterior rectal resection, pouch and subtotal colectomy were 6.9%, 7.7%, 9.7%, 16.0% and 11.8%, respectively. In the multivariable analysis, the risk factors for leakage included male sex (9.3% vs. 6.3%, OR = 0.69, 95% CI 0.51-0.95, p = 0.023) and emergency surgery (11.4% vs. 7.1%, OR = 1.58, 95% CI 1.10-2.27, p = 0.013). Thirty-day mortality was 2.38%. Conclusions: This large international audit provides the status of the management of colorectal surgery. This shows that minimally invasive techniques are widely adopted, and 30-day mortality is low; however, anastomotic leak rates remain persistently high. These findings highlight the ongoing need for targeted research and quality-improvement initiatives to reduce anastomotic failure and improve outcomes of colorectal surgery
Intraperitoneal drain placement and outcomes after elective colorectal surgery: International matched, prospective, cohort study
No full text
