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Ir(iii) complexes derived from 2-(tetrazole-5-yl)-1,10-phenanthroline (phenttz) were prepared. The complex [Ir(tpy)(phenttz)]2+ was embedded within silica nanoparticles and its emissive properties improved.

Introduction: The objective of this work was to analyse the postoperative clinical results of patients surgically treated for colorectal cancer in relation to the results of the preoperative comprehensive geriatric evaluation. Methods: Observational study in which postoperative morbidity and mortality at 30 and 90 days were analysed in a cohort of patients surgically treated for colorectal cancer according to age groups: group 1) between 75 and 79 years old; group 2) between 80 and 84 years old, and group 3) >= 85 years old. In addition to the anaesthetic risk assessment, patients were assessed with the Karnofsky, Barthel and Pfeiffer indexes. Mortality at 30 and 90 days after surgery was analysed in relation to the results of the comprehensive evaluation. Results: A total of 227 patients with colorectal cancer were included in the study period: 91 in group 1, 89 in group 2 and 47 in group 3. There were statistically significant differences in mortality at 30 days (p = 0,029) but not at 90 days after surgery, according to age groups. Mortality at 90 days was significantly higher in patients with worse scores on the Karnofsky andBarthel scales. Conclusions: Comprehensive geriatric assessment using different scales is a good tool to assess postoperative mortality in the mid-term postoperative period. (C) 2020 Elsevier Espana, S.L.U. All rights reserved.

Resumen Introduccion El objetivo de este trabajo fue analizar los resultados clinicos postoperatorios de los pacientes tratados quirurgicamente por cancer colorrectal en relacion con los resultados de la valoracion geriatrica integral preoperatoria. Metodos Estudio observacional en el que se analizo la morbimortalidad postoperatoria a los 30 y 90 dias en una cohorte de pacientes intervenidos por cancer colorrectal segun grupos de edad: grupo 1) edad entre 75 y 79 anos; grupo 2) entre los 80 y los 84 anos, y grupo 3) ≥ 85 anos. Ademas de la evaluacion del riesgo anestesico, se evaluo a los pacientes con los indices de Karnofsky, Barthel y Pfeiffer. Se analizo la mortalidad a los 30 y 90 dias de la cirugia en relacion con los resultados de la evaluacion integral. Resultados Se incluyeron 227 pacientes afectados de cancer colorrectal en el periodo de estudio: 91 del grupo 1, 89 del grupo 2 y 47 del grupo 3. Hubo diferencias estadisticamente significativas en la mortalidad a los 30 dias (p = 0,029), pero no a los 90 dias de la cirugia, segun los grupos de edad. La mortalidad a los 90 dias fue significativamente superior en los pacientes con peores puntuaciones en las escalas de Karnofsky y Barthel. Conclusiones La valoracion geriatrica integral mediante distintas escalas es una buena herramienta para evaluar la mortalidad postoperatoria en el postoperatorio a medio plazo.

The aim of this study was to review and to assess the quality of the scientific articles regarding early and late anastomotic leak (AL) after colorectal surgery and their risk factors. An electronic systematic search for articles on Colorectal Surgery, AL and its timing was undertaken using the MEDLINE database via PubMed, Cochrane and Embase. The selected articles were thoroughly reviewed and assessed for methodological quality using a validated methodology quality score (MINCIR score). This review was registered in the PROSPERO registry under ID: CRD42022303012. 9 articles were finally reviewed in relation to the topic of early and late anastomotic leak. There is a lack of consensus regarding the exact cut-off in time to define early and late anastomotic leak, but it is clear that they are two differentiated entities. The first, occurring in relation to technical factors; whereas the latter, is related to impaired healing.

Crohn's disease (CD) is a complex and multifactorial illness. There are still considerable gaps in our knowledge regarding its pathophysiology. A transcriptomic approach could shed some light on little-known biological alterations of the disease. We therefore aimed to explore the ileal transcriptome to gain knowledge about CD. We performed whole transcriptome gene expression analysis on ileocecal resections from CD patients and inflammatory bowel disease-free controls, as well as on a CD-independent cohort to replicate selected results. Normalized data were hierarchically clustered, and gene ontology and the molecular network were studied. Cell cultures and molecular methods were used for further evaluations. Genome-wide expression data analysis identified a robust transmembrane immunoglobulin domain-containing 1 (TMIGD1) gene underexpression in CD tissue, which was even more marked in inflamed ileum, and which was replicated in the validation cohort. Immunofluorescence showed TMIGD1 to be located in the apical microvilli of well-differentiated enterocytes but not in intestinal crypt. This apical TMIGD1 was lower in the noninflamed tissue and almost disappeared in the inflamed mucosa of surgical resections. In vitro studies showed hypoxic-dependent TMIGDI decreased its expression in enterocyte-like cells. The gene enrichment analysis linked TMIGD1 with cell recovery and tissue remodeling in CD settings. involving guanylate cyclase activities. Transcriptomics may be useful for finding new targets that facilitate studies of the CD pathology. This is how TMIGD1 was identified in CD patients, which was related to multiciliate ileal epithelial cell differentiation. NEW & NOTEWORTHY This is a single-center translational research study that aimed to look for key targets involved in Crohn's disease and define molecular pathways through different functional analysis strategies. With this approach, we have identified and described a novel target, the almost unknown TMIGD1 gene, which may be key in the recovery of injured mucosa involving intestinal epithelial cell differentiation.

BACKGROUND Hemorrhoidal disease in women during pregnancy is common in clinical practice. However, prospective data on its real prevalence and women's demographics are scarce. OBJECTIVE The aim of this study was to determine the prevalence of hemorrhoidal disease during pregnancy and to assess its impact on quality of life. In addition, this study aimed to identify the relationship between patients' characteristics, bowel habits, hormonal changes, and the presence of symptomatic hemorrhoids. DESIGN This is a prospective longitudinal cohort study. SETTING This study was conducted in the Obstetrics Department for pregnancy follow-up. PATIENTS The patients evaluated were a cohort of pregnant women. INTERVENTION The study was designed to follow a homogeneous cohort of women for 15 months. Visits took place in the first and third trimesters of pregnancy, and 3 and 6 months after delivery. Women's demographics (age, medical history, bowel habit, Bristol stool scale) and serum determination of pregnancy-related hormones (estrogen, progesterone, and relaxin) were determined. MAIN OUTCOME MEASURES The primary outcome was the development of hemorrhoidal disease. RESULTS Overall, 109 women (mean age, 31.2 ± 5.4 years) were included in the study. The prevalence of symptoms and physical findings of hemorrhoidal disease was present in 11% in the first trimester, 23% in the third trimester, 36.2% at 1 month after delivery, and 16.9% at 3 months after delivery. A medical history of hemorrhoidal disease was significantly associated with the diagnosis of hemorrhoids in the first trimester (p < 0.0001) and third trimester (p = 0.005). Symptoms of constipation were associated with this clinical disorder in the first trimester (p = 0.011) and the third trimester of pregnancy (p = 0.022). No association was found between hormonal changes and the development of hemorrhoidal disease. LIMITATIONS A larger sample would provide more information. CONCLUSIONS The prevalence of women with hemorrhoidal disease increases during pregnancy and after delivery. A history of hemorrhoidal disease and constipation is significantly associated with the diagnosis of symptomatic hemorrhoidal disease. See Video Abstract at http://links.lww.com/DCR/B504. INFLUENCIA DEL HBITO INTESTINAL Y LOS CAMBIOS HORMONALES EN EL DESARROLLO DE LA ENFERMEDAD HEMORROIDAL DURANTE EL EMBARAZO Y EL PERODO POSTERIOR AL PARTO UN ESTUDIO DE COHORTE PROSPECTIVO ANTECEDENTES:La enfermedad hemorroidal en mujeres durante el embarazo es comun en la practica clinica. Sin embargo, hay escasos datos prospectivos sobre su prevalencia real y la demografia de las mujeres.OBJETIVO:El objetivo fue determinar la prevalencia de enfermedad hemorroidal durante el embarazo y evaluar su impacto en la calidad de vida. Ademas, identificar la relacion entre las caracteristicas de los pacientes, los habitos intestinales, los cambios hormonales y la presencia de hemorroides sintomaticas.DISENO:Estudio prospectivo de cohorte longitudinal.AJUSTE:Este estudio se realizo en el Departamento de Obstetricia para el seguimiento del embarazo.PACIENTES:Una cohorte de mujeres embarazadas.INTERVENCION:El estudio se diseno para realizar un seguimiento de una cohorte homogenea de mujeres durante 15 meses. Las visitas se realizaron en el primer y tercer trimestre del embarazo, y a los 3 y 6 meses despues del parto. Se determinaron los datos demograficos de las mujeres (edad, antecedentes medicos, habito intestinal, escala de heces de Bristol) y la determinacion serica de hormonas relacionadas con el embarazo (estrogeno, progesterona y relaxina).PRINCIPALES MEDIDAS DE RESULTADO:El resultado principal fue el desarrollo de enfermedad hemorroidal.RESULTADOS:Se incluyo en el estudio a 109 mujeres (edad media, 31,2 ± 5,4 anos). La prevalencia de sintomas y hallazgos fisicos de enfermedad hemorroidal estuvo presente en 11% en el primer trimestre, 23% en el tercer trimestre, 36,2% 1 mes despues del parto y 16,9% 3 meses despues del parto. Un historial medico previo de enfermedad hemorroidal se asocio significativamente con el diagnostico de hemorroides en el primer trimestre (p

Background Higher life expectancy in the general population entails a growing interest in the surgical management of diseases affecting elderly patients. Preoperative assessment when planning surgery needs to carefully evaluate physical and functional status of the patient. This review aims to describe the most commonly used scales in the evaluation of elderly patients scheduled for surgery and provides a useful tool to decide the scales that would be better to assess these specific patients. Methods According to the PRISMA statement of publications published, we have carried out a systematic review focused on elderly patients who underwent surgical procedures in General and Surgery. Using Medline, Embase, and Cochrane library, a systematic search of the literature from 1992 to 2018 was performed. This enabled us to retrieve information from the selected articles on scales to evaluate medical fitness, functional status, or both, in the elderly or frail patients. Results We reviewed 102 articles and selected the most frequently used assessment scales or indexes. After this extensive analysis, we selected 4 functional scales (Katz Index, Barthel Scale, Karnofsky Performance Score, and Vulnerable Elders Survey), 4 clinical scales (American Society of Anaesthesiologists Index, Charlson Comorbidity Index, Pfeiffer Test, and Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity Scale) and finally, 2 mixed scales (American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator and Edmonton Frail Scale). Conclusions No consensus on the use of a unified assessment scale for elderly patients exists. However, with this review, we provide a brief guideline about the most useful and used scales to perform a comprehensive assessment of geriatric patients undergoing surgery.

Background: : Despite the efficacy of biological agents, surgery is still required for a large percentage of patients with inflammatory bowel disease (IBD). Aims: To assess the postoperative mortality rates and associated risk factors in IBD patients in a population-based setting in the era of biological agents. Methods: This is a population-based longitudinal study including all patients diagnosed with IBD in Catalonia who underwent intestinal resection or colectomy between 2007 and 2016, identified from the Catalan Health Surveillance System database. Logistic regression was used to calculate the adjusted odds ratio for postoperative in-hospital and 30-day mortality. Data for Crohn's disease (CD) and ulcerative colitis (UC) were analysed separately. Results: A total of 1,660 interventions for CD (69%) and 738 for UC (31%) were performed at 55 centres. In-hospital and 30-day postoperative mortality rates were 2.1% and 2.5% for CD, and 5.4% and 6.4% for UC, respectively. In the multivariate logistic regression analysis, comorbidity was associated with in-hospital and 30-day postoperative mortality in CD and UC, whereas age was only associated with mortality in CD and a non-laparoscopic surgical approach with UC. Conclusions: In the era of biologicals, the postoperative mortality rate for IBD depends mostly on comorbidities and age. (C) 2020 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Resumen Introduccion La tecnica de colgajo de avance endorrectal es una de las alternativas en el tratamiento de la fistula anal en pacientes con enfermedad de Crohn. Metodos Disenamos una revision sistematica de la literatura, seleccionando estudios que incluyeron a pacientes afectos de enfermedad de Crohn y fistula anal tratados mediante esta tecnica. De esos estudios solo se seleccionaron los pacientes seguidos durante al menos 6 meses. Resultados Se seleccionaron 11 estudios con un total de 135 pacientes. Los resultados, con seguimientos de 8,4 a 82 meses, indicaron una curacion del 66% y una tasa de recurrencia de alrededor del 30%. Sin embargo, se observo importante heterogeneidad en los resultados de las series revisadas. Conclusiones El colgajo de avance endorrectal es una alternativa adecuada en los pacientes con fistula anal y enfermedad de Crohn. Sin embargo, es necesario desarrollar nuevos estudios que aporten un mayor nivel de evidencia cientifica.

Background: the aim of this study was to analyze the clinical results of the multidisciplinary management of elderly patients with colorectal cancer in a single center and to describe postoperative quality of life. Methods: a comparative study was designed to compare the results and quality of life of patients treated in our center for colon cancer, aged from 80 to 84 years (study group) compared to a control group (aged form 75 to 79 years of age). Morbidity, mortality, oncological results and quality of life were analyzed. Results: eighty-seven patients aged between 80 and 84 years of age (study group) were compared to a control group, which was formed by 91 patients aged from 75 to 79 years of age. There were no significant differences in technique and morbidity. Survival at 30 days, 90 days and at the end of follow-up (median 48 months) were similar in both groups.There were no differences in quality of life except for one item with regard to physical function (p = 0.0138). Conclusion: similar clinical results and quality of life were achieved after treating elderly patients with colon cancer with a multidisciplinary management approach.

Introduction Treatment for anal fistulas in patients with Crohn's disease is still challenging, even for the expert surgeon. The advancement flap technique is characterized by the preservation of the anal sphincter complex. Methods A systematic review of the literature, selecting series of patients affected by Crohn's disease and anal fistulas and treated using advancement flap technique was performed. Patients followed during at least 6 months have been included. Results From 128 initial studies, 11 studies were selected, including overall 135 patients. Those studies show low-level evidence. Results in a series with follow-up from 8.4 to 82 months, stated a clinical success of 66% and recurrence rate around 30%. However there was an evident heterogeneity of results. Conclusion The review concludes that the advancement flap technique to treat anal fistulas in patients with Crohn's disease is an adequate alternative. New studies are necessary to provide higher-level evidence.

Because splenectomy has been linked to overwhelming infection years ago, management of splenic traumatisms has become progressively conservative. To assess the immunological function of the spleen in patients with splenic traumatism of different intensity, 43 patients with splenic injury (grades I through V) undergoing either nonoperative management, splenectomy, splenectomy with autotransplantation, or splenic embolization were analyzed for lymphocyte subpopulations and antibody responses to Streptococcus pneumoniae and Haemophilus influenzae vaccinations. Patients treated with splenectomy exhibited a significant decrease in CD4+ T lymphocytes and in Immunoglobulin (Ig) M high IgD low B cells (related to T-cell independent responses). Median fluorescence intensity of CD54+ in B cells also was reduced. The percent of IgM high IgD low B cells—a marker of marginal zone function—was inversely correlated with the number of pitted-red blood cells—a marker of red pulp function loss. IgM anti- S pneumoniae identified those patients with a defective rapid response to polysaccharide antigens. These results reinforce the importance of conservative options in the treatment of splenic traumatism for even a severely damaged organ. Despite the significant differences among the groups reported, it remains difficult to predict the IgM response to S pneumoniae vaccine of the individual patients. Better markers to assess splenic function and vaccination response after severe splenic traumatism—even in patients with nonoperative management—might improve risk assessment for overwhelming postsplenectomy infection.

Fundamento y objetivo Cuantificar la funcion esplenica de los pacientes controlados en el Servicio de Cirugia General y Digestiva del Hospital Universitari Germans Trias i Pujol (HUGTiP) desde 1985 hasta 2003 tras haber sufrido diferentes grados de lesion traumatica del bazo segun la clasificacion de la American Association for the Surgery of Trauma (AAST) del ano 1994 y relacionarla con el tratamiento recibido (no operatorio, esplenectomia total con o sin esplenosis y esplenectomia mas autotrasplante), con la finalidad de detectar disfunciones esplenicas que predispongan al desarrollo de la sepsis tras la esplenectomia. Pacientes y metodo Se ha realizado a 43 pacientes un estudio isotopico con gammagrafia esplenica «dinamica », estudio de «pits» de la membrana eritrocitaria (optica de Nomarsky) y de vacuolas submembranarias (microscopia electronica de transmision). Resultados El grupo de no operados presenta una funcion normal de fagocitosis y filtracion, con una mediana de velocidad de captacion esplenica de 3,46 Kcts/s2 (intervalo, 0,8-6,98). El porcentaje mediano de «pits» de membrana fue del 2% (intervalo, 0-8,8%); el numero de «pits» por hematies, de 0,03 (intervalo, 0-0,12), y el porcentaje de hematies con 1, 2, 3 y 4 «pits», del 1,6, el 0,4, el 0 y el 0%, respectivamente. El porcentaje mediano de hematies con vacuolas submembranarias fue el 2,55% (intervalo, 0-5,6%); el numero de vacuolas por hematie, de 0,03 (intervalo, 0-0,06), y el porcentaje de hematies con 1, 2, 3 y 4 vacuolas, del 2, el 0,2, el 0 y el 0%, respectivamente. En el grupo operado, la velocidad mediana de captacion esplenica fue de 0,08 Kcts/s2 (intervalo, 0-1,75; p Conclusiones La funcion esplenica de los pacientes con antecedentes de traumatismo esplenico tratados de forma conservadora es normal, independientemente del grado de la lesion. Ello refuerza la conveniencia de aplicar de entrada esta actitud a todos los protocolos para intentar evitar la sepsis tras la esplenectomia. En los casos tratados con esplenectomia, con o sin esplenosis, la funcion esplenica esta ausente o muy alterada, mientras que en los casos tratados con esplenectomia y autotrasplante esta parcialmente conservada.

The splenic function of patients followed by the Department of General and Digestive Surgery in the Hospital Universitari Germans Trias i Pujol (HUGTiP) from 1985 to 2003 for different degrees of splenic trauma according to the classification of the American Association for the Surgery of Trauma (AAST) 1994 was quantified and related to the treatment received (non surgical, total splenectomy with or without splenosis and splenectomy plus autotransplantation) to detect splenic dysfunction predisposing the development of postsplenectomy sepsis (PSS).43 patients underwent an isotopic study with dynamic splenic gammagraphy and pitted erythrocytes (Normarsky optics) and submembranous vacuoles (transmission electron microscopy) were evaluated.The non surgical group presented normal phagocytic and filtration function with the median speed of splenic enhancement being 3.46 Kcts/s2 (interval: 0.8-6.98). The percentage of pitted erythrocytes was 2% (0-8.8), the number of pits per erythrocyte was 0.03 (0-0.12) and the percentage of erythrocytes with 1, 2, 3 and 4 pits was 1.6%, 0.4%, 0% and 0%, respectively. The percentage of red cells with submembranous vacuoles was 2.55% (0-5.6), the number of vacuoles per red cell was 0.03 (0-0.06) and the percentage of red cells with 1, 2, 3 and 4 vacuoles was 2%, 0.2%, 0% and 0%, respectively. In the operated group, the splenic enhancement speed was 0.08 Kcts/s2 (0-1.75) (p0.0001). The percentage of pitted erythrocytes was 38% (0.2-64) (p0.0001), the number of pits per erythrocyte was 0.86 (0-1.8) (p0.0001) and the percentage of erythrocytes with 1,2,3 and 4 pits was 16.39%, 7.2%, 3.59% and 2.52%, respectively (p0.0001). The percentage of red cells with submembranous vacuoles was 11.2% (1.8-31.9) (p = 0.0006); the number of vacuoles per cell was 0.16 (p = 0.0022) and the percentage of red cells with 1, 2, 3 and 4 vacuoles was 6.51%, 1.73%, 0.4% and 0.2%, respectively (p = 0.0246, 0.0010,0.0001 and 0.0002, respectively).Splenic function of patients with a history of splenic trauma receiving conservative treatment is normal, independently of the degree of the lesion, thereby reinforcing the use of this therapeutic approach to avoid the development of postsplenectomy sepsis. In the patients treated with splenectomy, with or without splenosis, splenic function was absent or very altered being partially conserved in cases treated with splenectomy plus autotransplantation.