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Quality-adjusted life years and surgical waiting list:Systematic review of the literature

World Journal of Gastrointestinal Surgery 2024年第4期16卷 1155-1164页

作者： roberto de la plaza llamas Lorena Ortega Azor Marina Hernández Yuste Ludovica Gorini Raquel Aránzazu latorre-Fragua Daniel Alejandro Díaz Candelas Farah Al Shwely Abduljabar Ignacio Antonio Gemio del Rey department of General and Digestive Surgery Hospital Universitario de GuadalajaraGuadalajara 19002Spain department of Surgery Medical and Social SciencesFaculty of Medicine and Health SciencesUniversity of AlcaláAlcaláde Henares 28871MadridSpain

BACKGROUND The quality-adjusted life year(QALY)is a metric that is increasingly used today in the field of health economics to evaluate the value of different medical treatments and *** waiting lists(SWLs)represent a pressing problem in public *** QALY measure has rarely been used in the context of *** would be interesting to know how many QALYs are lost by patients on *** To investigate the relationship between QALYs and SWLs in a systematic review of the scientific *** The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses *** unlimited search was carried out in PubMed,updated on January 19,*** on the following variables were investigated and analyzed:Specialty,country of study,procedure under study,scale used to measure QALYs,the use of a theoretical or real-life model,objectives of the study and items measured,the economic value assigned to the QALY in the country in question,and the results and conclusions *** Forty-eight articles were selected for the *** data were found regarding QALYs lost on *** specialties in which QALYs were studied the most in relation to the waiting list were urology and general surgery,with 15 articles *** country in which the most studies of QALYs were carried out was the United States(n=21),followed by the United Kingdom(n=9)and Canada(n=7).The most studied procedure was organ transplantation(n=39),including 15 kidney,14 liver,5 heart,4 lung,and 1 ***(n=4),cataract surgery(n=2),bariatric surgery(n=1),mosaicplasty(n=1),and septoplasty(n=1)completed the surgical interventions ***-nine of the models used were theoretical(the most frequently applied being the Markov model,n=34),and nine were *** survey used to measure quality of life in 11 articles was the European Quality of Life-5 dimensions,but in 32 articles the survey was not specified.T

关键词： Quality-adjusted life year Waitlist Quality of life Surgery Systematic review

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Cost of postoperative complications:How to avoid calculation errors

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World Journal of Gastroenterology 2020年第21期26卷 2682-2690页

作者： roberto de la plaza llamas JoséM Ramia department of General and Digestive Surgery Hospital Universitario de GuadalajaraGuadalajara 19002Spain

Postoperative complications(PC)are a basic health outcome,but no surgery service in the world records and/or audits the PC associated with all the surgical procedures it *** studies that have assessed the cost of PC suffer from poor quality and a lack of transparency and *** payment system in place often rewards the volume of services provided rather than the quality of patients’clinical *** a thorough registration of PC,the economic costs involved cannot be *** accurate,reliable appraisal would help identify areas for investment in order to reduce the incidence of PC,improve surgical results,and bring down the economic *** article describes how to quantify and classify PC using the Clavien-Dindo classification and the comprehensive complication index,discusses the perspectives from which economic evaluations are performed and the minimum postoperative follow-up established,and makes various *** availability of accurate and impartially audited data on PC will help reduce their incidence and bring down ***,the health authorities,and society as a whole are sure to benefit.

关键词： Morbidity Postoperative complications Costs and cost analysis Economic evaluation Healthcare costs Opportunity cost Clavien-Dindo classification Comprehensive complication index

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Postoperative complications in gastrointestinal surgery: A “hidden” basic quality indicator

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World Journal of Gastroenterology 2019年第23期25卷 2833-2838页

作者： roberto de la plaza llamas JoséM Ramia department of General and Digestive Surgery Hospital Universitario de GuadalajaraGuadalajara 19002Spain

Postoperative complications represent a basic quality indicator for measuring outcomes at surgical units. At present, however, they are not systematically measured in all surgical procedures. A more accurate assessment of their impact could help to evaluate the real morbidity associated with different surgical interventions, establish measures for improvement, increase efficiency and identify benchmarking services. The Clavien-Dindo Classification is the most widely used system worldwide for assessing postoperative ***, the postoperative period is summarized by the most serious complication without taking into account others of lesser magnitude. Recently,two new scoring systems have emerged, the Comprehensive Complication Index and the Complication Severity Score, which include all postoperative complications and quantify them from 0(no complications) to 100(patient’s death), These allow the comparison of results. It is important to train surgical staff to report and classify complications and to record 90-d morbidity rates in all patients. Comparisons with other services must take into account patient comorbidities and the complexity of the particular surgical procedure. To avoid subjectivity and bias, external audits are necessary. In addition, ensuring transparency in the reporting of the results is an urgent obligation.

关键词： Morbidity Postoperative complications Health policy Comprehensive Complication Index Clavien-Dindo Classification Complication Severity Score

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laparoscopic gastrojejunostomy for gastric outlet obstruction in patients with unresectable hepatopancreatobiliary cancers: A personal series and systematic review of the literature

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World Journal of Gastroenterology 2018年第18期24卷 1978-1988页

作者： Alba Manuel-Vázquez Raquel latorre-Fragua Carmen Ramiro-Pérez Aylhin López-Marcano roberto de la plaza-llamas José Manuel Ramia department of General and Digestive Surgery University Hospital of Guadalajara

The major symptoms of advanced hepatopancreaticbiliary cancer are biliary obstruction, pain and gastric outlet obstruction(GOO). For obstructive jaundice, surgical treatment should de consider in recurrent stent complications. The role of surgery for pain relief is marginal nowadays. On the last, there is no consensus for treatment of malignant GOO. Endoscopic duodenal stents are associated with shorter length of stay and faster relief to oral intake with more recurrent symptoms. Surgical gastrojejunostomy shows better long-term results and lower re-intervention rates, but there are limited data about laparoscopic approach. We performed a systematic review of the literature, according PRISMA guidelines, to search for articles on laparoscopic gastrojejunostomy for malignant GOO treatment. We also report our personal series, from 2009 to 2017. A review of the literature suggests that there is no standardized surgical technique either standardized outcomes to report. Most of the studies are case series, so level of evidence is low. decisionmaking must consider medical condition, nutritional status, quality of life and life expectancy. Evaluation ofthe patient and multidisciplinary expertise are required to select appropriate approach. Given the limited studies and the difficulty to perform prospective controlled trials, no study can answer all the complexities of malignant GOO and more outcome data is needed.

关键词： Duodenal obstruction Gastrojejunostomy Gastroenterosmy Gastric outlet obstruction Gastric bypass laparoscopy laparoscopic surgery Sytematic review

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Ninety-day readmissions after inpatient cholecystectomy: A 5-year analysis

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World Journal of Gastroenterology 2017年第16期23卷 2972-2977页

作者： Alba Manuel-Vázquez Raquel latorre-Fragua Carmen Ramiro-Pérez Aylhin López-Marcano Farah Al-Shwely roberto de la plaza-llamas JoséManuel Ramia department of General and Digestive Surgery University Hospital of Guadalajara19002 GuadalajaraSpain

AIM To determine the incidence of readmission after cholecystectomy using 90 d as a time limit. METHODS We retrospectively reviewed all patients undergoing cholecystectomy at the General Surgery and Digestive System Service of the University Hospital of Guadalajara, Spain. We included all patients undergoing cholecystectomy for biliary pathology who were readmitted to hospital within 90 d. We considered readmission to any hospital service as cholecystectomyrelated complications. We excluded ambulatory cholecystectomy, cholecystectomy combined with other procedures, oncologic disease active at the time of cholecystectomy, finding of malignancy in the resection specimen, and scheduled re-admissions for other unrelated pathologies. RESULTS We analyzed 1423 patients. There were 71 readmissions in the 90 d after discharge, with a readmission rate of4.99%. Sixty-four point seven nine percent occurred after elective surgery(cholelithiasis or vesicular polyps) and 35.21% after emergency surgery(acute cholecystitis or acute pancreatitis). Surgical non-biliary causes were the most frequent reasons for readmission, representing 46.48%; among them, intra-abdominal abscesses were the most common. In second place were non-surgical reasons, at 29.58%, and finally, surgical biliary reasons, at 23.94%. Regarding time for readmission, almost 50% of patients were readmitted in the first week and most second readmissions occurred during the second month. Redefining the readmissions rate to 90 d resulted in an increase in re-hospitalization, from 3.51% at 30 d to 4.99% at 90 d. CONCLUSION The use of 30-d cutoff point may underestimate the incidence of complications. The current tendency is to use 90 d as a limit to measure complications associated with any surgical procedure.

关键词： Cholecystectomy 90-d Hospital readmission Readmission rate Cholelithiasis

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Hepatic gastrointestinal stromal tumor: Systematic review of an exceptional location

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World Journal of Meta-Analysis 2019年第5期7卷 224-233页

作者： Alba Manuel-Vázquez Raquel latorre-Fragua roberto de la plaza-llamas José Manuel Ramia General and Digestive Surgery University Hospital of Guadalajara

BACKGROUND A minor subset of primary gastrointestinal stromal tumors(GIST)can also arise outside the gastrointestinal tract,which is known as an extra-GIST(E-GIST).Primary GIST of the liver is an exceptional *** To characterize epidemiological,clinical and pathological features and options of *** We performed a systematic review to search for articles on primary hepatic *** This review shows that right hepatic lobe was the most frequent *** pathological and immunohistochemical features,mitotic count was≥5/50 High Power Fields in more than 50%;and CD117 was negative in only 1 *** than 70%of patients had a lesion with high risk of *** The diagnosis of E-GIST must be considered in a liver *** an accurate diagnosis is a challenge,as well as the confirmation of their primary or metastatic nature.

关键词： Gastrointestinal stromal tumors Extra-gastrointestinal stromal tumor Primary hepatic tumor CD117 Primary hepatic gastrointestinal stromal tumor Primary gastrointestinal stromal tumor of the liver

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Woody plant taxonomic,functional,and phylogenetic diversity decrease along elevational gradients in Andean tropical montane forests:Environmental filtering and arrival of temperate taxa

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Plant Diversity 2024年第4期46卷 491-501页

作者： Guillermo Bañares-de-Dios Manuel J.Macía Gabriel Arellano Íñigo Granzow-de la Cerda Julia Vega-álvarez Itziar Arnelas Carlos I.Espinosa Norma Salinas Luis Cayuela departamento de Biología y Geología Física y Química InorgánicaUniversidad Rey Juan CarlosCalle Tulipán s/nMóstolesMadridES-28933Spain departamento de Biología Área de BotánicaUniversidad Autónoma de MadridCalle Darwin 2MadridES-28049Spain Centro de Investigación en Biodiversidad y Cambio Global(CIBC-UAM) Universidad Autónoma de MadridCalle Darwin 2MadridES-28049Spain Ecology and Evolutionary Biology University of MichiganAnn ArborMI 48109USA Oikobit LLC ***AlbuquerqueNM87120USA Real Jardín Botánico–CSIC Plaza Murillo 2MadridES-28014Spain departamento de Biología Animal EcologíaParasitologíaEdafología y Química AgrícolaUniversidad de SalamancaCalle Donantes de Sangre s/nSalamancaES-37007Spain departamento de Biodiversidad Ecología y EvoluciónUniversidad Complutense de MadridCalle JoséAntonio Nováis 12Ciudad UniversitariaES-28040Spain departamento de Ciencias Biológicas y Agropecuarias Universidad Técnica Particular de LojaA.P.11-01-608 LojaEcuador Sección Química Pontificia Universidad Católica del PerúA.P.Lima 32LimaPeru ECI School of Geography and EnvironmentUniversity of OxfordOX13QYOxfordshireUnited Kingdom Instituto de Investigación en Cambio Global(IICG-URJC) Universidad Rey Juan CarlosCalle Tulipán s/nMóstolesMadridES-28933Spain

Mountains are paramount for exploring biodiversity patterns due to the mosaic of topographies and climates encompassed over short *** research has traditionally focused on taxonomic diversity when investigating changes along elevational gradients,but other facets should be *** first time,we simultaneously assessed elevational trends in taxonomic,functional,and phylogenetic diversity of woody plants in Andean tropical montane forests and explored their underlying ecological and evolutionary *** investigation covered four transects(traversing ca.2200 m a.s.l.) encompassing 114 plots of 0.1 ha across a broad latitudinal range(ca.10°).Using Hill numbers to quantify abundance-based diversity among 37,869 individuals we observed a consistent decrease in taxonomic,functional,and phylogenetic diversity as elevation increased,although the decrease was less pronounced for higher Hill *** exception was a slight increase in phylogenetic diversity when dominant species were *** decrease in taxonomic and functional diversity might be attributed to an environmental filtering process towards highlands,where the increasingly harsher conditions exclude species and functional ***,the differences in steepness decrease between Hill orders suggest that rare species disproportionately contribute to functional *** phylogenetic diversity the shifting elevational trend between Hill orders indicates a greater than previously considered influence in central Andean highlands of tropical lowlands originated species with strong niche conservatism relative to distantly related temperate *** could be explained by a decreasing presence and abundance of temperate,extratropical taxa towards the central Andes relative to northern or southern Andes,where they are more prevalent.

关键词： Altitudinal gradients Andes Environmentalﬁltering Out of the Tropical Lowlands Functional rarity Tropical Niche Conservatism

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Association between lifestyle factors and thyroid function in young euthyroid adults

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Food Science and Human Wellness 2024年第1期13卷 265-275页

作者： Elisa Merchan-Ramirez Guillermo Sanchez-delgado Lucas Jurado-Fasoli Francisco M Acosta Manuel Munoz-Torres Jose M.llamas-Elvira Jonatan R Ruiz Sport and Health University Research Institute(iMUDS) Faculty of Sports ScienceUniversity of GranadaGranada 18016Spain Pennington Biomedical Research Center Baton Rouge 70808USA Faculty of Medicine University of GranadaGranada 18071Spain Turku PET Centre University of TurkuTurku 20500Finland Turku PET Centre Turku University HospitalTurku 20520Finland Biosanitary Research Institute of Granada(Ibs.Granada) Granada 18012Spain CIBERFES Instituto de Salud CarlosⅢMadrid 28029Spain Endocrinology and Nutrition Service University Hospital San CecilioGranada 18016Spain Nuclear Medicine Service "Virgen de las Nieves"University HospitalGranada 18014Spain

Purpose:The present work examines the associations of dietary habits,sedentarism,physical activity(PA)levels and sleep habits,with thyroid function in young euthyroid ***:A total of 105 young euthyroid adults participated in this cross-sectional *** function was determined in fasting conditions(>6 h).Dietary habits were measured by a food frequency questionnaire and three non-consecutive 24 h recalls,and different dietary intake and patterns were then *** time spent in sedentary,PA levels and sleep habits were objectively measured using a wrist-worn ***:Energy and carbohydrate intake were positively associated with thyroid stimulating hormone(TSH)(β=0.222;R^(2)=0.102;P=0.022 andβ=0.425;R^(2)=0.129;P=0.007,respectively)whereas fat intake was negatively associated with TSH(β=-0.428;R^(2)=0.137;P=0.004).Energy intake was also positively associated with free triiodothyronine(β=0.277;R^(2)=0.137;P=0.004).Further,adherence to the Mediterranean diet was negatively related to TSH and free thyroxine(FT4)(β=-0.221;R^(2)=0.113;P=0.020 andβ=-0.268;R^(2)=0.071;P=0.007,respectively).Vigorous-intensity and overall PA were negatively associated with FT4(β=-0.227;R^(2)=0.052;P=0.022 andβ=-0.204;R^(2)=0.042;P=0.041,respectively).In contrast,no associations were found between sleep parameters and thyroid ***:Lifestyle factors such as dietary intake and PA levels seems to be related to thyroid function even in young euthyroid adults.

关键词： Thyroid hormones Dietary intake Sleep Physical activity Euthyroid

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Liver metastasis of endometrial stromal sarcoma

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World Journal of Hepatology 2012年第12期4卷 415-418页

作者： Jose M Ramia roberto de la plaza Ines Garcia Cristian Perna Pilar Veguillas Jorge García-Parreo department of Surgery Hepatopancreatobiliary Surgical UnitHospital Universitario de GuadalajaraGuadalajara28020 MadridSpain department of Oncology Hospital Universitario de GuadalajaraGuadalajara28020 MadridSpain department of Pathology Hospital Universitario de GuadalajaraGuadalajara28020 MadridSpain

Resection of liver metastases from gynaecological tumours is *** stromal sarcomas(ESS) are low incidence gynecological tumours which can originate in previous sites of endometriosis or following metaplasia of the pelvic peritoneal wall,and which are exceptionally associated with liver *** present a 68-year-old woman with a ESS and metachronic liver metastasis treated by liver *** is very little literature on clinical management about liver metastasis from ESS,but extrapolating the data obtained with liver metastasis from sarcomas and uterine tumours,we should recommend resection as this is considered a resectable extrauterine *** cases with more sites of extrauterine disease,liver resection should also be performed if the other sites are resectable.

关键词： Sarcoma Stromal Endometrial Liver Metastasis Review

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Percutaneous drainage as a first therapeutic step prior to surgery in liver hydatid cyst abscess:Is it worth it?

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World Journal of Hepatology 2017年第2期9卷 114-118页

作者： Aylhin J Lopez-Marcano Jose M Ramia Vladimir Arteaga roberto de la plaza Jhonny D Gonzales Anibal Medina Hepato-Pancreato-Biliary Surgical Unit Department of SurgeryHospital Universitario de Guadalajara19002 GuadalajaraSpain

AIMTo delay surgery until the patient is in a better condition, and thus to decrease postoperative morbidity. METHODSUsing this algorithm we treated three patients aged 55, 75 and 80 years. In all three patients the clinical presentation was fever without a clear source of infection; all had nonspecific symptoms such as general malaise, dyspnea, and abdominal discomfort in the previous 15 d. They came to the emergency room at our hospital due to deterioration of their general condition. Analytical tests showed leukocytosis, neutrophilia and increased polymerase chain reaction. In all cases an abdominal computed tomography (CT) was performed and liver hydatid abscess (LHA) was detected. The mean size of the LHA was 12 cm. RESULTSAll patients underwent CT-guided percutaneous drainage. The purulent material obtained was cultured, and Klebsiella pneumoniae, Streptococcus viridans and Streptococcus salivarius were identified. Antibiotic treatment was given adapted to antibiotic sensitivity testing. Surgery was performed two weeks after admission, once the patient’s condition had improved. All three patients underwent an almost total cystectomy, cholecystectomy and omentoplasty in the residual cavity. Complications were: Clavien I (atelectasis and pleural effusion) and Clavien II (transfusion). The average length of stay (pre and postoperative) was 23 d. At the follow-up, no relapses were recorded. CONCLUSIONLHA management is not standardized. Emergency surgery offers suboptimal results. Percutaneous drainage plus antibiotics allows improving patient’s general condition. This enables treating patients in greater safety and also reduces complications.

关键词： Hydatidosis Review Surgery Abscess Liver

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