Cannabis and anhedonia: A systematic review.

This paper employs a systematic review to examine the correlation between anhedonia and marijuana use, exploring whether individuals with anhedonia use marijuana as a coping mechanism or if marijuana use plays a role in the onset of anhedonia. The search utilised PubMed and Web of Science databases, following PRISMA guidelines for paper selection. A total of 21 papers were selected to address this inquiry, and assessments were carried out using the Risk of Bias in Non-randomized Studies of Exposures (ROBINS-E) tool. The results revealed that 17 studies exhibited moderate and low risk of bias. The evaluation encompassed a total of 12,427 participants, including both animals and humans. Experimental animal studies focused on exploring the association between cannabidiol (CBD) and anhedonia, while human studies primarily employed observational research, examining various forms of anhedonia in individuals with or without mental disorders such as depression or psychosis. These studies also delved into understanding the effects of anhedonia during adolescence and explored the causal relationship between these concepts. The findings indicate a reciprocal rather than unidirectional relationship, establishing that initial anhedonia predisposes individuals to cannabis use, and subsequent consumption significantly intensifies the anhedonia experienced. Particularly, the studies placed special emphasis on adolescents and individuals with mental disorders.

The loss of a child, bereavement and the search for meaning: A systematic review of the most recent parental interventions.

The loss of a child is considered one of the most tragic experiences that parents can go through. The present systematic review aims to compile the most recently published interventions in bereavement support for these parents, being particularly interested in those made from a meaning-centered approach. The search for the units of analysis was guided by the standards of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement and was entered in Web of Science, Scopus and EBSCO, obtaining a total of 485 papers of which 21 have been included in this article. The results found are heterogeneous in terms of the type of intervention used and results, but they all seem to have something in common: the lack of research and reliable interventions that exist for this population. With this systematic review we intend to achieve a better understanding of these parents' needs and to highlight the enormous work that still remains ahead in order to make their bereavement experience a little less devastating.

Laparoscopic versus open surgery for rectal cancer: results of a prospective multicentre analysis of 4,970 patients.

OBJECTIVE: To compare laparoscopic versus open surgery for rectal cancer and analyse the results of the multidisciplinary audited project on total mesorectal excision conducted in Spain. BACKGROUND: The safety and therapeutic efficiency of laparoscopic surgery for rectal cancer are controversial due to the technical difficulties it involves. A deviation from the oncological principles of mesorectal excision would mean a potential increase in local recurrence and shorter survival. METHODS: This prospective non-randomised multicentre study includes 4,970 patients with rectal cancer. The study compares perioperative, postoperative, anatomicopathological and survival variables. RESULTS: Five hundred and sixty five patients were excluded. Of the remaining 4,405, 3,018 (68.51%) had open surgery (OS) and 1,387 (31.49%) laparoscopic surgery (LS). The rate of anterior resections was higher in the LS group. The rate of intraoperative tumour perforation, number of red blood cell concentrates transfused and length of hospital stay were greater in the OS group, whereas surgical time was longer in the LS group. The incidence of complications was 45.6% in the OS group and 38.3% in the LS group. Involvement of the circumferential and distal margin, as well as unsatisfactory and partially satisfactory quality of the mesorectum, were greater in the OS group. There were no differences for local recurrence and survival rates. CONCLUSIONS: According to these results, laparoscopic surgery is the best option for the surgical treatment of rectal cancer, with similar rates of local recurrence and survival, although there are oncological indicators in this study to suggest that these results can be improved with laparoscopic surgery.

The value of 18F-FDG PET/CT for assessing the response to neoadjuvant therapy in locally advanced rectal cancer.

PURPOSE: Neoadjuvant radiochemotherapy (RCT) is an accepted treatment for locally advanced rectal cancer (LARC) that improves surgical outcomes. If a pathological complete response is achieved, conservative surgery can be considered. The objective of our study was to assess the reliability of (18)F-FDG PET/CT for evaluating the response to neoadjuvant RCT in LARC. METHODS: We prospectively studied 41 patients diagnosed with LARC and candidates for neoadjuvant RCT. PET/CT was performed before RCT and again 7 weeks later. A visual and semiquantitative analysis was carried out. The pathological response was classified according to the Mandard tumour regression grade (TRG). We analysed: (a) the relationship between TRG and the result of the posttreatment PET/CT scan, and (b) the correlation between the percentage of pathological response and the percentage decrease in SUVmax according to the response index (RI). RESULTS: The mean SUVmax of the rectal lesions at diagnosis was 13.6 and after RCT 3.96. The mean RI was 65.32 %. Sensitivity was 88.88 %, specificity 92.86 %, positive predictive value 96 %, negative predictive value 81 %. Of the 41 patients, 8 had TRG I (all negative PET/CT); 6 had TRG II (5 negative, 1 positive PET/CT); 16 had TRG III (13 positive, 3 negative PET/CT); 9 had TRG IV (all positive PET/CT); 2 had TRG V (all positive PET/CT). Of the 14 patients classified as responders (TRG I, II), 13 (92.86 %) had negative PET/CT. Of the 27 patients classified as nonresponders (TRG III-V), 24 (88.88 %) had positive PET/CT. Differences were statistically significant (p < 0.0001). The RI in responders was 79.9 % and in nonresponders was 60.3 %. Differences were statistically significant (p < 0.037). CONCLUSION: PET/CT is a reliable technique for assessing response to neoadjuvant RCT in LARC, with a view to considering more conservative surgical treatment. The combination of the visual and semiquantitative analysis increases the diagnostic validity of PET/CT.

Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer.

BACKGROUND: The laparoscopic treatment of rectal cancer is controversial. This study compared surgical outcomes after laparoscopic and open approaches for mid and low rectal cancers. METHODS: Some 204 patients with mid and low rectal adenocarcinomas were allocated randomly to open (103) or laparoscopic (101) surgery. The surgical team was the same for both procedures. Most patients had stage II or III disease, and received neoadjuvant therapy with oral capecitabine and 50-54 Gy external beam radiotherapy. RESULTS: Sphincter-preserving surgery was performed in 78.6 and 76.2 per cent of patients in the open and laparoscopic groups respectively. Blood loss was significantly greater for open surgery (P < 0.001) and operating time was significantly greater for laparoscopic surgery (P = 0.020), and return to diet and hospital stay were longer for open surgery. Complication rates, and involvement of circumferential and radial margins were similar for both procedures, but the number of isolated lymph nodes was greater in the laparoscopic group (mean 13.63 versus 11.57; P = 0.026). There were no differences in local recurrence, disease-free or overall survival. CONCLUSION: Laparoscopic surgery for rectal cancer has a similar complication rate to open surgery, with less blood loss, rapid intestinal recovery, shorter hospital stay, and no compromise of oncological outcomes.

[Biological evaluation of a protein mixture intended for enteral nutrition]. / Evaluación biológica de la calidad de una mezcla de proteínas para uso en nutrición enteral.

UNLABELLED: Enteral nutrition is the best way to feed or supplement the diet when gastrointestinal tract functions of patients are partially or totally preserved. Whenever total enteral nutrition is needed, it represents the only source of nutrients for patients. Thus, it is mandatory to ensure that high biological value proteins are included in enteral formulae. OBJECTIVE: To assess the biological quality of a protein blend constituted by 50% potassium caseinate, 25% whey protein and 25% pea protein intended to be used in enteral nutrition products. MATERIALS AND METHODS: Forty Wistar rats (20 male and 20 female), with initial body weight of 51 g, where divided into four groups and feed for 10 days with: casein (Control), experimental protein blend (Experimental), liophylized normo- and hyperproteic enteral nutrition formulae adapted to the animal nutritional requirements (Normoproteic and Hyperproteic). Protein efficiency ratio (PER), apparent digestibility coefficient (ADC), relationship between retained and absorbed nitrogen (R/A) and relationship between retained and consumed nitrogen (R/I) where calculated. RESULTS: Experimental and control groups had similar values for all analysed indices (PER, ADC, R/A and R/I). These indices where also similar between normo and hyperproteic groups, but lower than experimental and control groups, except in PER, where normoproteic group was either similar to control and hiperproteic group. CONCLUSION: The quality of the protein blend used in this study is high. It is a good protein source to be used in the development of new enteral nutritional products.

[Laparoscopic nephrectomies: initial experience of a community hospital]. / Nefrectomías laparoscópicas: experiencia inicial de un hospital comunitario.

We present our initial experience with 34 laparoscopic nephrectomies performed in a 29 months period of time. 32% of the patients with renal tumor (clinical stage T1-T2) and the others for benign pathology. Average surgical time was 131 minutes (70-210). Average bleeding was 330 ml (50-2500). Average time of hospitalization was 2,7 days (1-14). 62% of patients were discharged to home between the first and second day post surgery. One patient with tumor required conversion to open surgery for an hilium bleeding. There were 3 serious complications (9%), included one patient died by septic shock and one lesion of left colon that required segmental colectomy. The results of this initial serie are promissory and a special care should be taken in selection of patients to achieve good results with low surgical morbidity.

Motor threshold in transcranial magnetic stimulation: comparison of three estimation methods.

AIMS: Motor threshold (MT) is an important parameter for the practice of transcranial magnetic stimulation. Our goal was to compare three methods to estimate MT in a clinical setting. METHODS: Comparison of three MT estimation algorithms: 1) the Rossini-Rothwell method consists in lowering stimulus intensity until only five positive responses out of 10 trials are recorded, defining MT; 2) the Mills-Nithi method considers the MT as the mean of an upper threshold (10 positive out of 10 trials) and a lower threshold (0 out of 10 trials); 3) the supervised parametric method estimates the MT by fitting (mathematically and graphically) a sigmoid function on raw data obtained by stimulation at variable intensities. Six MT estimations (two per method) were recorded in a single session in 10 healthy subjects. RESULTS: The within-subject variation of MT (expressed as % of the mean MT+/-standard deviation) during a single session was of 8.5+/-7.2% for the Rossini-Rothwell method, 8.7+/-5.7% for the Mills-Nithi method and 9.5+/-4.0% for the supervised parametric method. No significant differences in variability of MT estimation were found between the methods, but the Rossini-Rothwell method was significantly shorter (half the number of stimuli compared to the two other methods). CONCLUSION: In our setting, Rossini-Rothwell method was superior to the two other methods. The variability of MT estimation measured in our study is important, yet acceptable for clinical applications. However, this variability can be a source of considerable errors in excitability studies and should be a focus of future research.

Morbilidad perioperatoria y resultados a mediano plazo de la malla de prolene suburetral según índice de masa corporal / Post-operatory morbility and sub-uretral prolene tape results in the medium term periods according to body mass

Este trabajo muestra los resultados de la malla suburetral sin tensión según el índice de masa corporal. Durante un período de 44 meses, 233 pacientes fueron operadas con una malla tipo TVT. Las pacientes fueron clasificadas según índice de masa corporal (IMC) como normales (IMC <25, n=37), sobrepeso (IMC 25-30, n=95), obesas (IMC 30-35, n=66) y obesas moderadas-severas (IMC >35, n=35). No hubo diferencias en cuanto a complicaciones (perforación, retención urinaria, infección). La tasa de continencia objetiva para los cuatro grupos (normales, sobrepeso, obesidad, obesidad moderada-severa) fue de: 92 por ciento, 89 por ciento, 90 por ciento y 88 por ciento, respectivamente (p=0,2). Los últimos dos grupos presentaron mayor incidencia de urgencia "de novo" (12 por ciento y 10 por ciento vs 3 por ciento y 4 por ciento). (p <0,05). La obesidad no sería un factor de riesgo para el éxito de la malla y al igual que otros estudios, coincidimos que es la técnica quirúrgica de elección en pacientes con obesidad moderada y severa.

¿Son los cánceres de próstata clínicamente T1c y Gleason menor o igual a 6 insignificantes?: características clínicas y patológicas de 127 piezas de prostatectomía radical / Are the clinically T1c and Gleason prostate cancers lower or equal to 6 insignificant?: clinical and pathological characteristics of 127 pieces of radical prostactectomy

Este trabajo muestra una revisión de 127 pacientes sometidos a prostatectomía radical con un Gleason en la punción menor o igual a 6, compromiso de un solo cilindro y clínicamente T1c. Los resultados de la anatomía patológica mostraron que un 30 por ciento de los pacientes tienen un Gleason mayor o igual a 7 y 21 por ciento tienen compromiso extraglandular (pT3). Los márgenes quirúrgicos fueron positivos en 13,3 por ciento de los casos. Estos pacientes portadores de un tumor "insignificante", están en riesgo de estar subgraduados y debieran ser manejados en forma agresiva mediante la cirugía radical.

Pielo/ureterolitectomía por retroperitoneoscopia: análisis de 10 casos / Pielo/ureterolithtomy through retroperitoneoscopy: analysis of 10 cases

Este trabajo muestra los resultados de la pielo/ureterolitectomía por retroperitoneoscopia. Esta técnica se desarrolló en 10 pacientes portadores de una litiasis piélica o ureteral mayor a 1 cm de diámetro. La cirugía fue exitosa en el 90 por ciento de los casos (9/10). El tiempo quirúrgico promedio fue de 110 minutos. Un paciente presentó filtración urinaria requiriendo de catéter ureteral. Esta cirugía es segura y efectiva y debiera realizarse cada vez que se requiere una cirugía abierta.

Neoadjuvant radiation and chemotherapy in rectal cancer does not increase postoperative complications.

BACKGROUND AND AIMS: Neoadjuvant radiation and chemotherapy in rectal cancer reduces local recurrences and increases the rate of conservative sphincter surgery. However, an increase in postoperative morbidity and mortality has also been observed. This study analyzed the operative difficulty and postoperative complications in patients with this treatment. PATIENTS AND METHODS: Retrospective review of 103 patients with rectal cancer, divided into two groups: group A, 53 patients undergoing preoperative radiotherapy with 45 Gy combined with chemotherapy, and group B, 50 patients with rectal cancer who received surgery after diagnosis. Both groups were homogeneous. The two groups were compared for both technical difficulty, using intraoperative data and rate of complications. RESULTS: There were no statistically significant differences between the two groups with regard to intraoperative or postoperative data. In group A there were 20 complications in 17 patients (32%) and in group B 22 complications in 19 patients (38%). The rates of perineal wound infection were similar. The percentage of anastomotic leaks was higher in group A. A greater number of anterior resections was performed in group A. CONCLUSION: Preoperative radiation and chemotherapy in rectal cancer does not increase postoperative complications and increases the rate of sphincter-preserving surgery.

Laparoscopic gastric bypass in the treatment of morbid obesity. Preliminary results of a new technique.

INTRODUCTION: Gastric bypass is one of the most commonly used surgical techniques for the management of morbid obesity. It is usually done as an open surgery procedure, and in recent years surgeons have begun to perform it via the laparoscopic approach. The aim of this paper is to describe our surgical technique for laparoscopic gastric bypass (LGBP) and present the short-term results. MATERIALS AND METHODS: Between January 2000 and January 2002 we operated on 50 patients with morbid obesity who met criteria for bariatric surgery. The patients had a mean age of 34 years and a body mass index (BMI) of 47. RESULTS: Conversion was necessary in 4 of the 50 patients (8%). Mean operating time was 181 min, with a difference of 60 min between the first 10 and last 10 cases. There was a 26% rate of complications, 14% of which were early (%<% 30 days) and 12% late (%>%30 days). Mean hospital stay was 4.5 days. CONCLUSION: LGBP is a technique with good short-term results as far as weight loss is concerned, although it has one of the most complex learning curves in laparoscopic surgery. Surgeons who regard gastric bypass as the technique of choice for the surgical management of morbid obesity should consider performing it via the laparoscopic approach.

[Primitive neuroectodermal tumor of the kidney. A case report]. / Tumor neuroectodérmico primitivo del riñón. Caso clínico.

A 27 years old female presented with diffuse abdominal pain, malaise, weight loss and a palpable mass in the left abdomen. Abdominal CAT scan showed a 18 cm heterogeneous tumoral mass that originated in the kidney. The patient was operated on and it was not possible to completely remove the mass. In the postoperative period the patient received chemotherapy with vincristine, cyclophosphamide and adryamicin but the disease progressed and the patient died 16 months later. The pathological study of the surgical specimen disclosed a tumor with monotonous proliferation of small round cells with a basophilic nucleus and scanty cytoplasm with PAS positive granules. Immunohistochemistry was positive for specific neuronal enolase and CD99. Involvement of the urinary system with primary neuroectodermal tumors is very infrequent.

Lesiones latrogénicas del ureter / Iatrogenic ureteral lesions

Este trabajo muestra las características clínicas y la experiencia en el diagnóstico y tratamiento de las lesiones iatrogénicas del uréter de nuestro Servicio. Se realiza un estudio retrospectivo de análisis de fichas clínicas de 11 pacientes con daño uretral en un período de ocho años. El promedio de edad fue de 43 años, con mayor frecuencia de sexo femenino (87, 5 porciento). La principal causa fue histerectomía abdominal y el sitio más afectado fue el uréter pelviano. El método diagnóstico más usado fue pielografía endovenosa en la mitad de los casos. No se registraron nefrectomías ni mortalidad. Actualmente todos los pacientes están con su unidad renal afectada funcionante.

Contenido bacteriano del tejido prostático obtenido mediante, resección transuretral / Bacterial content of the prostatic gland obtained by means of transurethral resection

Este trabajo muestra la colonización bacteriana del tejido de la glándula prostática en condiciones que asemejen a la normalidad.Realizamos un estudio prospectivo con 45 pacientes sometidos a resección transuretral. Se realizó cultivo corriente de tejido prostático, resultando positivo en 25 porciento de las muestras.Los gérmenes Gram (+) fueron lo más frecuentes.La presencia de inflamación prostática se asoció a presencia bacteriana en 22 porciento.Este hecho apoya la hipótesis de la etiología autoinmune de las prostatitis.