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Backgrounds/Aims: Within two years of surgery, 70% of resected intrahepatic cholangiocarcinoma (iCCA) recur. Better biomarkers are needed to identify those at risk of "early recurrence" (ER). In this study, we defined ER and investigated whether preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic-inflammatory index were prognostic of both overall relapse and ER after curative hepatectomy for iCCA. Methods: A retrospective cohort of patients who underwent curative-intent hepatectomy for iCCA between 2005 and 2017 were created. The cut-off timepoint for the ER of iCCA was estimated using a piecewise linear regression model. Univariable analyses of recurrence were conducted for the overall, early, and late recurrence periods. For the early and late recurrence periods, multivariable Cox regression with time-varying regression coefficient analysis was used. Results: A total of 113 patients were included in this study. ER was defined as recurrence within 12 months of a curative resection. Among the included patients, 38.1% experienced ER. In the univariable model, a higher preoperative NLR (> 4.3) was significantly associated with an increased risk of recurrence overall and in the first 12 months after curative surgery. In the multivariable model, a higher NLR was associated with a higher recurrence rate overall and in the ER period (≤ 12 months), but not in the late recurrence period. Conclusions: Preoperative NLR was prognostic of both overall recurrence and ER after curative iCCA resection. NLR is easily obtained before and after surgery and should be integrated into ER prediction tools to guide preoperative treatments and intensify postoperative follow-up.

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Introducción: En el último año, el Perú experimentó un fenómeno climático denominado el Niño costero. Este generó lluvias, huaicos e inundaciones, afectando a miles de personas y ocasionando la declaración en emergencia sanitaria del país. A pesar de la ocurrencia de fenómenos similares en las zonas afectadas, estas suelen ser ocupadas como lugares de residencia. Objetivo: Identificar las características de la percepción de riesgo ante las inundaciones en personas que habitan en zonas vulnerables. Método: Investigación empírica cualitativa desarrollada en el año 2017. Se aplicó la técnica de la entrevista semiestructurada a nueve personas residentes en cuatro distritos de Lima (Perú) propensos a inundaciones. La información recolectada se analizó con el apoyo del software para el análisis cualitativo de datos Atlas.ti v.7.0, utilizando elementos de la Teoría Fundamentada para desarrollar los procesos de codificación y categorización. Resultados: Se encontró que los participantes no poseen percepción de riesgo ante la amenaza de las inundaciones. Conciben a las inundaciones como una amenaza cuando experimentan sus consecuencias. Conclusiones: Se requieren desarrollar investigaciones de carácter interdisciplinario que permitan generar evidencia para el desarrollo de intervenciones orientadas a la construcción de una percepción de riesgo coherente con las consecuencias e impacto de las inundaciones(AU)

Introduction: In the last year, Peru experienced a climatic phenomenon called Niño Costero. This generated rains, alluviums and floods affecting thousands of people and causing the declaration of health emergency in the country. In spite of the occurrence of similar phenomena in the affected areas, these are usually occupied as places to live. Objective: To identify the characteristics of risk's perception during floods in people who live in vulnerable zones. Method: A qualitative empirical research was developed in the year 2017. The semi-structured interview technique was conducted in nine people living in four districts of Lima (Peru) whom were susceptible to flooding. The information collected was analyzed with the support of Atlas.ti v. 7.0., software for the qualitative data analysis, using elements of the Grounded Theory to develop the coding and categorization processes. Results: It was found that the participants do not elaborate a perception of risk before the threat of floods. They envisage the floods as a threat when experience their consequences. Conclusions: It is necessary to implement interdisciplinary researches that allow to generate evidence for the development of interventions aimed to the creation of a risk's perception that will be coherent with the consequences and the impact of floods(AU)

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Publications of hypertension-related meta-analyses (MAs) have increased exponentially in the past 25 years and now average 8/month. Theoretically, this is facilitating evidence-based management of patients. However, some practitioners and authors of guidelines have questioned the quality of published MAs. By extending a prior review, we have assessed the quality of 212 hypertension-related meta-analyses over 5 years based on systematically searching three computerized libraries. Seventeen criteria grouped into four domains of quality yielded the following results: (1) Assessment of trial quality was accomplished in 89% of MAs, and 38% analyzed trials in subgroups of trial quality where appropriate. (2) All three measures of heterogeneity (I 2, tau, and P for heterogeneity) were reported in 36%, reflecting the failure to report tau, the standard deviation of the main effect. (3) Publication bias was assessed in 75%, and 43% of MAs used a statistical test for publication bias. (4) Regarding transparency, 9 to 31% of MAs reported problems in the previous three domains in the article's abstract. Journal impact factor reporting the MAs declined significantly over 5 years. The percent with criteria of quality in a MA was modestly correlated with journal impact factor (R 2 = 0.05, P = 0.001). False-positive results from inappropriate application of the DerSimonian-Laird model affected 25% of articles, which reported these false positives in the article's abstract in 72%. No more than 25% of MAs had 67% or more of the criteria of quality. In conclusion, skepticism of hypertension-related MAs is justified, but their quality can be readily corrected.

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