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PURPOSE: The objective of this study was to determine the association between the presence of a microorganism resistant to the antibiotic used in empirical therapy and the development of intra-abdominal abscesses in children with perforated appendicitis. METHODS: A prospective cohort study was conducted in patients under 18 years of age who underwent laparoscopic appendectomy between November 1, 2019, and September 30, 2020, in whom perforated appendicitis was documented intraoperatively. Peritoneal fluid samples were taken for bacteria culture purposes, and clinical and microbiological data were collected from all patients. RESULTS: A total of 232 patients were included in the study. The most isolated microorganisms were Escherichia coli (80.14%) and Pseudomonas aeruginosa (7.45%). In addition, 5.31% of E. coli isolates were classified as ESBL-producing organisms. No association was found between a germ resistant to empiric antimicrobial therapy and the development of a postoperative intra-abdominal abscess. Multivariate analysis showed that being a high-risk patient on admission (OR 2.89 (p = 0.01)) was associated with the development of intra-abdominal abscesses postoperatively. CONCLUSION: E. coli was the most commonly isolated microorganism, with a low rate of ESBL-producing isolates. No association between resistance and risk of postoperative intra-abdominal abscess was found. However, it was identified that being a high-risk patient on admission was associated with this complication. TYPE OF STUDY: Prognosis study. LEVEL OF EVIDENCE: Level I.

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Proper modeling of flow or viscosity curves as a function of shear rate is a useful tool in any engineering activity. The rheology of foods depends on the composition, processing to which they have been subjected and the state of dispersion in which they are found. Liquid foods are complex biosystems, that show non-Newtonian behavior under flow conditions. This review presents models used in recent decades to describe the experimental rheological behavior of various liquid foods, ranging from Newtonian fluids to the most complex. Some non-Newtonian parameters such as those of the Ostwald-de Waele, Bingham, Herschel-Bulkley, Casson, Cross, and Carreau models are summarized. Examples of thixotropic behavior described by the Weltman and Abu-Jdayil models are also presented. In each model, explanations based on the composition and dispersion state of the food are made. This is useful in innovative processing technologies and for scientists new to the field of food rheology. An attempt is made to exemplify and group the expected behavior for most fluid foods, including some for a dysphagia diet, depending on their composition or the dispersed system formed, which will be useful for professionals who wish to compare reported rheological parameters with those obtained experimentally.

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Background: The single-port (SPL) and multi-port (MPL) laparoscopic approach are the gold standard of management of acute appendicitis, due to its multiple advantages over open surgery, mainly because of its direct effects on recovery, esthetics and costs of the procedure. However, in third-world countries, the laparoscopic approach is not yet fully reproducible due to the costs of the technique. The surgical-glove port single incision laparoscopic appendectomy (SGP-SILA) has been proposed as a viable option. However, it has never been studied in Colombia. Objective: To evaluate the cost-effectiveness and reliability of SGP-SILA in the management of complicated acute appendicitis, compared to traditional MPL approach. Materials and methods: A retrospective case control study was carried out comparing patients undergoing laparoscopic appendectomy by SGP-SILA vs. MPL, evaluating operating costs associated with intraoperative and postoperative variables in two tertiary centers in Bogota, Colombia. The data were analyzed and expressed according to their nature and distribution. Results: 116 patients were included (SGP-SILA: 62 and MPL: 54). The median surgical time for SGP-SILA was 60 min vs. 39 min for MPL. SGP-SILA was shown to cause lower frequency of surgical site infection (4 vs. 8 patients; p = 0.047). It was found a significant correlation between Grade III surgical site infection and surgery time (p = 0.047) in the MPL group; also, with hospital stay (p < 0.001). Also, a lower risk of surgical site infection was found with the SGP-SILA technique (22% vs. 31%). SGP-SILA generated a reduction in both direct and indirect operating costs of approximately 10% (616 USD vs. 683 USD). Conclusion: SGP-SILA and MPL are feasible and comparable procedures in the resolution of complicated acute appendicitis. SGP-SILA turns out to be more cost-effective compared to MPL, due to the use of more easily accessible instruments. This may be a reproducible technique in low- and middle-income countries.

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INTRODUCTION: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. The standard management for localized GIST is the complete surgical resection. For this procedure, laparoendoscopic cooperative surgery (LECS) has been proposed as a safe and effective alternative. We want to show our experience with LECS technique for the management of GIST and a literature review. MATERIALS AND METHODS: A retrospective, cross-sectional study was carried out, which included patients with a diagnosis of localized GIST treated with LECS technique between January 2011 and December 2018. RESULTS: During the period of the study, 21 patients were managed by LECS technique, with a male-female rate 3:1. Average surgical time was 98.5 min, 100% negative borders in all patients. Intraoperative bleeding was 30.7 cc and all patients had orally tolerance in the first 24 h. None of them required ICU management, no mortality was reported. CONCLUSIONS: The LECS technique has demonstrated to be a viable, safe, and effective technique for the management of gastric GIST's, showing superiority in organ function preservation and in the range of oncological margins. Prospective studies are necessary to obtain knowledge about the outcome of patients managed through LECS technique.

INTRODUCCIÓN: Los tumores del estroma gastrointestinal (GIST) son las neoplasias mesenquimales más comunes del tracto gastrointestinal. El tratamiento estándar para los GIST localizados es la resección quirúrgica completa. Para este procedimiento, el abordaje cooperativo laparo-endocopico (ACLE) se ha propuesto como una alternativa segura y eficaz. Queremos mostrar nuestra experiencia con la técnica ACLE para el manejo de GIST y unzaa revisión de la literatura. MATERIAL Y MÉTODOS: Se realizó un estudio retrospectivo, transversal, que incluyó pacientes con diagnóstico de GIST localizado tratados con la técnica ACLE entre enero de 2011 y diciembre de 2018. RESULTADOS: Durante el periodo de estudio se manejaron 21 pacientes con técnica de ACLE, con una tasa hombre-mujer de 3:1. El tiempo quirúrgico promedio fue de 98.5 min, con 100% de bordes negativos en todos los pacientes. El sangrado intraoperatorio fue de 30.7 cc y todos los pacientes tuvieron tolerancia oral en las primeras 24H. Ninguno de ellos requirió manejo en UCI, no se reportó mortalidad. CONCLUSIONES: La técnica ACLE ha demostrado ser una técnica viable, segura y eficaz para el manejo de los GIST gástricos. Mostrando superioridad en la preservación de la función orgánica y en los magines oncológicos. Son necesarios estudios prospectivos para conocer el resultado de los pacientes manejados mediante la técnica ACLE.

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The incidence of human cervix adenocarcinoma (CC) caused by papillomavirus genome integration into the host chromosome is the third most common cancer among women. Bacterial cyclodipeptides (CDPs) exert cytotoxic effects in human cervical cancer HeLa cells, primarily by blocking the PI3K/Akt/mTOR pathway, but downstream responses comprising gene expression remain unstudied. Seeking to understand the cytotoxic and anti-proliferative effects of CDPs in HeLa cells, a global RNA-Seq analysis was performed. This strategy permitted the identification of 151 differentially expressed genes (DEGs), which were either up- or down-regulated in response to CDPs exposure. Database analysis, including Gene Ontology (COG), and the Kyoto Encyclopedia of Genes and Genomes (KEGG), revealed differential gene expression on cancer transduction signals, and metabolic pathways, for which, expression profiles were modified by the CDPs exposure. Bioinformatics confirmed the impact of CDPs in the differential expression of genes from signal transduction pathways such as PI3K-Akt, mTOR, FoxO, Wnt, MAPK, P53, TGF-ß, Notch, apoptosis, EMT, and CSC. Additionally, the CDPs exposure modified the expression of cancer-related transcription factors involved in the regulation of processes such as epigenetics, DNA splicing, and damage response. Interestingly, transcriptomic analysis revealed the participation of genes of the mevalonate and cholesterol biosynthesis pathways; in agreement with this observation, total cholesterol diminished, confirming the blockage of the cholesterol synthesis by the exposure of HeLa cells to CDPs. Interestingly, the expression of some genes of the mevalonate and cholesterol synthesis such as HMGS1, HMGCR, IDI1, SQLE, MSMO1, SREBF1, and SOAT1 was up-regulated by CDPs exposure. Accordingly, metabolites of the mevalonate pathway were accumulated in cultures treated with CDPs. This finding further suggests that the metabolism of cholesterol is crucial for the occurrence of CC, and the blockade of the sterol synthesis as an anti-proliferative mechanism of the bacterial CDPs, represents a reasonable chemotherapeutic drug target to explore. Our transcriptomic study supports the anti-neoplastic effects of bacterial CDPs in HeLa cells shown previously, providing new insights into the transduction signals, transcription factors and metabolic pathways, such as mevalonate and cholesterol that are impacted by the CDPs and highlights its potential as anti-neoplastic drugs.

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Introducción. El aneurisma aórtico abdominal roto, tiene una mortalidad del 80 % al 90 %. Para su reparación existe una técnica abierta y otra endovascular, las cuales tienen diferencias entre sus beneficios y complicaciones. El método de elección en la actualidad para la corrección de esta alteración anatómica es endovascular, sin embargo, no es el más usado, porque no se cuenta todo el tiempo con el equipo humano de cirugía vascular para su realización. Caso clínico. Ingresa a urgencias un paciente en estado de shock de origen desconocido, con dolor abdominal de 24 horas de evolución. Se realiza una tomografía con contraste que demuestra un aneurisma aórtico abdominal infrarrenal roto. Debido a que no se contaba con el equipo de cirugía vascular, es llevado de urgencia a una corrección abierta que duró 153 minutos, con un sangrado intraoperatorio de 1754 cc. Fue dado de alta a los 12 días postoperatorios sin ninguna complicación. Discusión. La reparación endovascular del aneurisma aórtico abdominal roto es la mejor elección, ya que muestra mayores beneficios en comparación con la reparación abierta, sin embargo, no es el más utilizado, porque se necesita de un personal bien entrenado en cirugía endovascular, por lo que, dentro de la formación de los cirujanos generales, se tiene que incluir el aprendizaje de las técnicas abiertas

Introduction. The ruptured abdominal aortic aneurysm has a mortality of 80% to 90%. There is an open and an endovascular techniques for its repair, which have differences between their benefits and complications. The method of choice for the correction of this anatomical alteration is endovascular; however, it is not the most frequently used, mainly because the vascular surgical team is not available all the time to perform it.Clinical case. A patient in a state of shock of unknown origin was admitted to the emergency room, with abdominal pain of 24 hours of evolution. A contrast-enhanced CT scan demonstrated a ruptured infrarenal abdominal aortic aneurysm. Due to the lack of a vascular surgery team, the patient was rushed for an open surgery that lasted 153 minutes, with an intraoperative bleeding of 1754 cc. He was discharged 12 days after surgery without any complications.Discussion. Endovascular repair of ruptured abdominal aortic aneurysm is the best choice, since it shows greater benefits compared to open repair. However, it is not the most widely used because it requires well-trained personnel in endovascular surgery. Therefore, learning of open techniques must be included in the training of general surgeons

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BACKGROUND: Giant paraesophageal hernias have a surgical indication in case of symptoms. Since twenty years ago robot-assisted repair was incorporated to overcome the limitations of the laparoscopic surgery, and to offer new advantages. OBJECTIVE: To report the experience on repairing giant paraesophageal hernias assisted by robot in a fourth level hospital in Bogotá, Colombia, Shaio Clinic. METHOD: Retrospective and descriptive study of five cases of giant paraesophageal hernia type III or IV, taken to robotic correction during August 2016 to June 2018. Evaluation of post-surgery outcomes. RESULTS: Five paraesophageal robot-assisted repair were performed. Mean surgical time was 146 minutes, one conversion to open surgery, the average intraoperative bleeding was 100 mL, hospital stay time of 2.2 days. Morbidity, mortality and recurrence percentages in the short time were equal to 0%. CONCLUSIONS: Robot-assisted repair of giant paraesophageal hernias, has shown advantages that overcome the limitations of the laparoscopic approach such as dissections in difficult-to-reach angles, increased accuracy, ergonomics, three-dimensional, and closer view of the workspace. In addition, robot-assisted repair promotes better surgical and postoperative outcomes; these advantages have been demonstrated mainly in the repair of giant paraesophageal hernias.

ANTECEDENTES: Las hernias paraesofágicas gigantes tienen indicación quirúrgica en caso de ser sintomáticas. Hace 20 años se incorporó la reparación asistida por robot debido a las ventajas que ofrece sobre las limitantes de la laparoscopia. OBJETIVO: Reportar la experiencia en reparación de hernias paraesofágicas gigantes asistida por robot en un hospital de cuarto nivel en Bogotá, Colombia, Fundación Clínica Shaio. MÉTODO: Estudio retrospectivo, descriptivo, de cinco casos de hernia paraesofágica gigante tipo III o IV, llevados a corrección robótica, de agosto de 2016 a junio de 2018, con evaluación de los desenlaces posoperatorios. RESULTADOS: Cinco pacientes fueron sometidos a reparación asistida por robot, el tiempo quirúrgico fue de 146 minutos, se realizó una sola conversión a cirugía abierta, la media de sangrado fue de 100 ml, el tiempo de estancia hospitalaria de 2.2 días, y los porcentajes de morbilidad, mortalidad y recurrencia a 1 año fueron del 0%. CONCLUSIÓN: La reparación de este tipo de hernias asistida por robot ha mostrado ventajas sobre el abordaje laparoscópico, como realizar disecciones en ángulos de difícil acceso, precisión aumentada, ergonomía y vista tridimensional y más cercana del espacio de trabajo. Además, promueve mejores desenlaces quirúrgicos y posoperatorios, ventajas evidenciadas principalmente en la reparación de hernias paraesofágicas gigantes.

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Melanoma is an aggressive cancer that utilizes multiple signaling pathways, including those that involve oncogenes, proto-oncogenes, and tumor suppressors. It has been suggested that melanoma formation requires cross-talk of the PI3K/Akt/mTOR and Ras-ERK pathways. This pathway cross-talk has been associated with aggressiveness, drug resistance, and metastasis; thus, simultaneous targeting of components of the different pathways involved in melanoma may aid in therapy. We have previously reported that bacterial cyclodipeptides (CDPs) are cytotoxic to HeLa cells and inhibit Akt phosphorylation. Here, we show that CDPs decreased melanoma size and tumor formation in a subcutaneous xenografted mouse melanoma model. In fact, CDPs accelerated death of B16-F0 murine melanoma cells. In mice, antitumor effect was improved by treatment with CDPs using cyclodextrins as drug vehicle. In tumors, CDPs caused nuclear fragmentation and changed the expression of the Bcl-2 and Ki67 apoptotic markers and promoted restoration of hyperactivation of the PI3K/Akt/mTOR pathway. Additionally, elements of several signaling pathways such as the Ras-ERK, PI3K/JNK/PKA, p27Kip1/CDK1/survivin, MAPK, HIF-1, epithelial-mesenchymal transition, and cancer stem cell pathways were also modified by treatment of xenografted melanoma mice with CDPs. The findings indicate that the multiple signaling pathways implicated in aggressiveness of the murine B16-F0 melanoma line are targeted by the bacterial CDPs. Molecular modeling of CDPs with protein kinases involved in neoplastic processes suggested that these compounds could indeed interact with the active site of the enzymes. The results suggest that CDPs may be considered as potential antineoplastic drugs, interfering with multiple pathways involved in tumor formation and progression.

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Ultrasound treatment is known to increase the oil extractability in olive and palm oil processes. This work examined the effect of ultrasound conditioning of avocado puree on oil extractability and quality, at low (18+40kHz) and high (2MHz) frequencies, at litre-scale. Other ultrasound parameters evaluated included high frequency effect (0.4, 0.6, and 2MHz; 5min; 90kJ/kg) and sonication time (2.5-10min at 2MHz), without malaxation. Finally, a megasonic post-malaxation intervention was assessed at selected malaxation times (15, 30, and 60min). Both low and high frequency ultrasound treatments of the non-malaxed avocado puree improved extractability by 15-24% additional oil recovery, with the highest extractability achieved after 2MHz treatments, depending on the fruit maturity and oil content. There was no preferential improvement on oil extractability observed across high frequencies, even though extractability increased with sonication time. Ultrasound treatment also showed a positive effect after puree malaxation. Oils obtained from sonicated purees showed peroxide and free fatty acid values below the industrial specification levels and an increase in total phenolic compounds after 2MHz treatment. High frequency ultrasound conditioning of avocado puree can enhance oil separation and potentially decrease the malaxation time in industrial processes without impacting on oil quality.

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Pseudomonas aeruginosa PAO1, a potential pathogen of plants and animals, produces the cyclodipeptides cyclo(l-Pro-l-Tyr), cyclo(l-Pro-l-Phe), and cyclo(l-Pro-l-Val) (PAO1-CDPs), whose effects have been implicated in inhibition of human tumor cell line proliferation. Our purpose was to investigate in depth in the mechanisms of HeLa cell proliferation inhibition by the PAO1-CDPs. The results indicate that PAO1-CDPs, both purified individually and in mixtures, inhibited HeLa cell proliferation by arresting the cell cycle at the G0-G1 transition. The crude PAO1-CDPs mixture promoted cell death in HeLa cells in a dose-dependent manner, showing efficacy similar to that of isolated PAO1-CDPs (LD50 of 60-250 µM) and inducing apoptosis with EC50 between 0.6 and 3.0 µM. Moreover, PAO1-CDPs showed a higher proapoptotic activity (~10³-105 fold) than their synthetic analogs did. Subsequently, the PAO1-CDPs affected mitochondrial membrane potential and induced apoptosis by caspase-9-dependent pathway. The mechanism of inhibition of cells proliferation in HeLa cells involves inhibition of phosphorylation of both Akt-S473 and S6k-T389 protein kinases, showing a cyclic behavior of their expression and phosphorylation in a time and concentration-dependent fashion. Taken together our findings indicate that PI3K-Akt-mTOR-S6k signaling pathway blockage is involved in the antiproliferative effect of the PAO1-CDPs.

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