An Easy Learning Approach to a Complex Surgical Technique: A Step-by-Step Site-Relapse Lateral Extended Endopelvic Resection (LEER).

Lateral pelvic sidewall involvement by gynecological tumors has been considered traditionally an absolute contraindication to curative resection.1 Moreover, the involvement of the pelvic sidewall at the time of relapse in cervical cancer after primary or adjuvant pelvic radiation occurs in 8.3% of patients.2,3 Laterally extended endopelvic resection (LEER), based on the ontogenetic compartment theory, provides a potential surgical option for patients for whom palliative therapy is the only alternative.4 This complex and ultraradical, surgical technique allows a high rate of complete resection in more than 70% of patients with gynecological cancers and lateral pelvic sidewall involvement. An adequate selection of patients and a deep knowledge of pelvic anatomy are crucial to obtain acceptable morbimortality rates and improved overall survival in this population.5 To deconstruct this complex procedure, we show a detailed step-by-step technique to facilitate the easy learning curve of this surgical technique. We review the Höckel original technique with different site-relapse adapted steps. We provide a pedagogical high-quality video (Video 1) and anatomical outline drawings (Fig. 1) to understand lateral pelvic wall anatomy and standardize this surgical technique. Our purpose is to bring this knowledge to gynecologists and pelvic surgeons in which pelvic lateral approach may be useful beyond gynecological oncologic surgery (Table 1).

Efficacy of Adjuvant Tamsulosin for Improving the Stone-Free Rate after Extracorporeal Shock Wave Lithotripsy in Renal Stones: A Randomized Controlled Trial.

Introduction: Extracorporeal shock wave lithotripsy (ESWL) is an effective treatment for urolithiasis. Tamsulosin is capable of causing dilation and facilitating the migration of stones. The aim of this study is to evaluate the efficacy of adjuvant treatment with tamsulosin for improving the stone-free rate after a single session of ESWL in the treatment of kidney stones. Methods: This is a randomized, nonplacebo-controlled study with a sample of 60 adults with a single radiopaque kidney stone of 5-20 mm in diameter. After the ESWL session, the patients were divided into two groups. The control group received standard treatment for analgesia consisting of oral diclofenac (75 mg/12 h) as needed. The tamsulosin group received standard treatment for analgesia plus oral tamsulosin (0.4 mg/day) for eight weeks. In both groups, stone-free status was determined using a CT scan eight weeks after ESWL. The protocol of this study was registered with ClinicalTrials.gov, identifier: NCT04819828. Results: Only 57 patients completed the study (28 tamsulosin and 29 control). Overall, the average stone diameter was 11.42 ± 4.52 mm. The stone-free rate was 50.88% (29 of 57) overall, 53.57% (15 of 28) for the tamsulosin group, and 48.27% (14 of 29) for the control group (p = 0.680). The estimated relative risk in favor of the tamsulosin group to achieve a stone-free status was 1.11 (95% CI 0.67-1.9). The estimated number needed to treat to achieve a single patient with renal stone-free status after eight weeks of ESWL adjuvant treatment with tamsulosin was 19. Conclusion: Our findings suggest that tamsulosin as adjuvant treatment after a single ESWL session is well tolerated and safe, but it does not increase the stone-free rate in patients with a single radiopaque renal stone of 5-20 mm in diameter. Our results may support the use of tamsulosin with ESWL in the case of patients with a single radiopaque renal stone of 11-20 mm in diameter based on an apparent higher stone-free rate and a low rate of complications.

Heart Failure With Reduced Ejection Fraction in a Patient With Erdheim-Chester Disease on Dabrafenib.

A 54-year-old woman with a diagnosis of Erdheim-Chester disease under therapy with dabrafenib presents with clinical signs of heart failure. After discontinuing the offending medication and initiating guideline-directed medical therapy for heart failure with reduced ejection fraction, the clinical picture improved.

How Does Time Affect the Antimicrobial Activity of Super-Oxidized Commercial Antiseptic Solutions? An In Vitro Test.

This study aimed to identify variation in the minimum biocidal concentration (MBC) over time, comparing three commercial super-oxidized solutions with different chemical compositions. In the bactericidal assay, the following bacteria were tested: Escherichia coli (ATCC 25922), Pseudomonas aeruginosa (ATCC 27853), Staphylococcus aureus (ATCC 25923), and for each ATCC, one wild-type strain was used. In vitro experiments were performed in triplicate at 0, 60, and 120 days of follow up. A commercial formulation based on sodium and chloride ions (SCSS) was tested using a standard accelerated aging protocol. Data were analyzed with the Friedman and Wilcoxon signed-rank tests. The results showed that super-oxidized solution bases of 20 ppm of sodium (SSS) had a significant change in MBC at 120 days (p < 0.001), whereas SCSS remained stable during the same period (p = 0.18). However, after accelerated aging treatment, the MBC of SCSS increased (p < 0.001). With our proposed approach, the two SSS showed MBC variation at 120 days, whereas SCSS showed stability over time, similar to chlorhexidine, but lost its bactericidal properties after accelerated aging treatment.

Social networks and aggressive attitudes: who is who. Scoping review of the scientific production on their relationships.

Introduction: In the current world, an increasing number of people use social networks as a scenario for socialization, which have come to stay as a part of human development. During this socialization process, violent situations occur all too often, despite their virtuality, and seriously compromises the emotional well-being of the other participants. Based on the work conducted on this subject, the following systematic review aims to establish the state of the art regarding the relationship between moral disengagement, disruptive behavior and emotional intelligence of social network users. Method: A scoping review is carried out, according to the PRISMA-ScR criteria, consulting the WoS, Scopus, Education database, PsycINFO, PsycARTICLES, PLOS one and ScienceDirect databases, from 2021 up to the present day. Results: A total of 999 articles related to the research topic were collected, although the result of research responding to the specific search criteria was reduced to 10. Discussion: The research identified shows that there is a relationship between the level of moral development of social network users and their participation in aggressive online behavior. However, more research is needed, as it has not been demonstrated whether it is the networks that develop or favor the emergence of these attitudes, or simply act as facilitators for their amplified expression.

[Saline solution as culture media from a viewpoint of nosocomial bacteremia]. / Solución salina como medio de cultivo desde el punto de vista de las bacteriemias nosocomiales.

INTRODUCTION: Nutrient-containing aqueous solutions for parenteral use are susceptible of microbial contamination, beeing an important cause of serious infectious complications. Objective. To determine the capacity of organisms for growing in saline as compared with dextrose solution and tri-destilled sterile water. MATERIAL AND METHODS: Experimental controlled study. Different microbial strains were innoculated in aqueous solutions (5% dextrose and 0.9% saline) as well as tri-destilled sterile water. Results were analized using the ANOVA test for repeated measurements. RESULTS: In 0.9% saline solution, all the Enterobacteriaceae strains tested had a significant increase in their bacterial quantification in the analized time period (F = 8.35, p = 0.0145). For most organisms, the growth was even better than the one observed in nutrient-containing solution. CONCLUSIONS: The 0.9% saline solution can support significative growing of potentially pathogenic bacteria. We recommend a strict compliance to the good nursing standards when handling this kind of solutions.

[Microbiology of the diabetic foot: is the swab culture useful?]. / Microbiología del pie diabético: ¿es útil el cultivo tomado con hisopo?

BACKGROUND: The microbiology of the diabetic foot is complex, making swab culture controversial; biopsy culture is the gold standard. OBJECTIVE: To determine the diagnostic utility of swab culture in diabetic foot ulcers. METHODS: Comparative study of diagnostic utility. Diabetic foot ulcers were classified according to the University of Texas scale. Cultures by biopsy and swabbing were performed. Bacterial identification was performed by standard biochemical methods. Antimicrobial susceptibility was determined by the plate diffusion method. An analysis of the diagnostic test was made, reporting descriptive measures of frequencies. RESULTS: We obtained specimens for culture from 118 patients. Grade II and III lesions were the most frequently occurring (80%). Overall, 132 organisms were isolated from biopsies and 118 from swabs, with those of the Enterobacteriaceae family being the most frequent (56% from biopsies and 60% from swabs). Swab culture had a calculated sensitivity of 0.85, specificity of 0.86, positive predictive value of 0.98, negative predictive value of 0.43, positive likelihood ratio of 5.9, and negative likelihood ratio of 0.2. CONCLUSION: Swab culture is a reasonable option to determine the diabetic foot microbiology.

Inflammation in the intervertebral disc herniation. / Inflamación en la hernia del disco intervertebral.

Up until fairly recently, it was thought that sciatic pain in the lumbar herniated disc was caused by compression on the nerve root. However, the lumbar herniated disc shows mixed pictures which are difficult to explain by simple mechanical compromise. In recent years various immunology, immunohistochemistry and molecular biology studies have shown that the herniated tissue is not an inert material, but rather it Is biologically very active with the capability of expressing a series of inflammatory mediators: cytokines such as interleukin-1, interleukin-6, interleuquin-8 and tumor necrosis factor being the ones which stand out. The inflammation is not only induced by the chemical irritation of the bioactive substances released by the nucleus pulposus but also by an autoimmune response against itself. Thus, in addition to the mechanical factor, the biomechanical mediation plays an important role in the pathophysiology of sciatic pain and of radiculopathy. Through a review of a wide range of literature, we researched the cellular molecular mediators involved in this inflammatory process around the lumbar herniated disc and its involvement in sciatic pain.

Comparison of Emotional Behaviour of Spanish, Chilean and England Adolescents, and Their Relationship with Effective Personality.

Analysing the emotional behaviour of adolescents is fundamental because of its relationship with maladaptive behaviour and even possible psychological maladjustments. For this reason, this study had two objectives: to analyse the existence of significant differences in socio-emotional behaviour in English, Spanish, and Chilean adolescents, taking gender into account, and to analyse the relationship between emotional behaviour and the effective personality model in the Spanish and Chilean samples. A total of 2534 adolescents participated (609 English, 1677 Spanish, and 248 Chilean). The Abbreviated Scale of Emotional Behaviour (ECEA_R: aggressive tendency, social reactivity, and social support) and the Effective Personality Questionnaire-Adolescents (CPE-A: academic self-realisation, socio-affective self-realisation, and resolute efficacy) were applied. A MANOVA was carried out to study the differences in adolescents' socio-emotional behaviour, taking gender and nationality into account, and a correlational analysis was undertaken to explore the relationship between the variables of emotional behaviour (aggressive tendency, social reactivity, and social support) and effective personality (academic self-realisation, socio-affective self-realisation, and resolute efficacy). Regarding the first objective, for aggressive tendency, English male adolescents stood out, followed by Spanish and Chilean male adolescents and females of all nationalities. In terms of social reactivity, female adolescents stood out over male adolescents and, with regard to social support, Spanish adolescents (male and female) stood out over other nationalities, followed by Chilean and English adolescents (males and females). The results of the second objective indicated a negative relationship between aggressive tendency and academic self-realisation, but a positive relationship for social reactivity and social support (only in the Spanish sample) with most of the effective personality factors. The results are relevant for the application of prevention and intervention programs that improve or implement social and affective competencies in adolescents who develop the effective personality construct.

[Diabetic foot microbiology through biopsy cultures]. / Microbiología del pie diabético determinada por estudio de biopsia.

OBJECTIVE: To determine the microbiology of diabetic foot wounds, through biopsy cultures. MATERIALS AND METHODS: Patients with diabetic foot and clinical data of infection were recruited consecutively. Cultures were processed for aerobic organisms after mortar homogenization. For cases with multiple isolates, only the two predominant organisms were identified. The bacterial identification was carried out by biochemical procedures. The sensitivity to antibiotics was made by the disk diffusion method. RESULTS: A total of 91 biopsies were studied, 47 from men (52%). There were 102 isolates, 68 being Gram-negative bacilli (67%), with predominance of Escherichia coli (21%). A total of 28 Gram-positive cocci were isolated (28%) and 6 yeasts (6%). Of the 68 Gram-negative bacilli, 24 were resistant to ciprofloxacin (35%). A total of 55 Enterobacteriaceae were isolated, of which 4 (7%) produced extended-spectrum beta-lactamases. There were 8 Staphylococcus aureus isolates, 3 of which (38%) were resistant to methicillin. CONCLUSIONS: In comparison with reports from industrialized countries, we found a higher proportion of Gram-negative and resistant organisms.

[Endemic intravenous fluid contamination in pediatric wards]. / Contaminación endémica de soluciones parenterales en servicios pediátricos.

OBJECTIVE: To determine the rate of contamination of intravenous solutions and injection ports in pediatric patients. MATERIAL AND METHODS: During non-epidemic periods, eight pediatric wards in Mexican hospitals were studied. Qualitative cultures were performed from the surface of injection ports and from intravenous solutions in use in pediatric patients younger than 2 years, culturing 750 infusion systems from 728 patients. RESULTS: The rate of contamination of intravenous solutions was 2.4% (18/750; CI 95%: 1.3% to 3.5%) and for injection ports it was 3.2% (24/750; CI 95%: 2.1% to 4.3%). Enterobacteriaceae predominated; in four cases the organisms isolated from the port and from the solutions were coincident (Klebsiella spp. and Enterobacter sp.). The rate of contamination for solutions mixed in the wards was 5.1%, against 1.3% of those not mixed (chi2 = 9.19, p < 0.01). DISCUSSION: Contamination of parenteral solutions is not a rare phenomenon and it could be related to inappropriate practices in the preparation of intravenous solutions and medications as well as the contamination of injection ports. In hospitals working with standards similar to those reported here, the monitoring of sterility of intravenous solutions could contribute to reduce the rate of nosocomial bacteremia.

[Methicillin-resistant Staphylococcus aureus at a general hospital: epidemiological overview between 2000-2007]. / Staphylococcus aureus resistente a meticilina en un hospital general: panorama epidemiológico del 2000 al 2007.

INTRODUCTION: The high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in hospitalized patients is a significant problem due to its associated morbidity and mortality. It is important to know the recent MRSA epidemiology at a General Hospital. OBJECTIVES: To determine the MRSA epidemiology at a Mexican general hospital from 2000 to 2007, in order to know if there is a significant trend in its proportion. MATERIAL AND METHODS: Prevalence survey. The resistance to oxacillin was identified by the Kirby-Bauer's method. The specimens were classified by type and year of isolation. Trend statistics were used for analysis. RESULTS: S. aureus was identified in 1,008 samples, being 301 resistant to oxacillin (30%, 95% Confidence Interval [CI], 25 to 35%). The proportion of MRSA went from 37% (95% CI, 29 to 44%) to 49% (95% CI, 40 to 58%) in the period of study (chi2 for trends = 6.676, p < 0.01). Specimens with the highest proportion of MRSA were blood and sterile liquids with 32% (95% CI, 26 to 39%), secretions with 29% (95% CI, 24 to 33%), and catheters with 21% (95% CI, 16 to 26%). CONCLUSIONS: The proportion of MRSA has increased significantly. This leads to higher costs and morbi-mortality for the hospitalized patients. We require stricter policies to prevent transmission and to control the use of antibiotics.

BRAF mutation associated with other genetic events identifies a subset of aggressive papillary thyroid carcinoma.

PURPOSE: BRAF(V600E) mutation represents the most common oncogenic event in sporadic papillary thyroid cancer (PTC). There are, however, significant discrepancies regarding the overall frequency, its prevalence in PTC-variants, and its relationship with clinico-pathological parameters of poor outcome. Moreover, the impact of BRAF(V600E) mutants on tumour-related patient's death has not been evaluated. DESIGN: We analysed, by PCR-SSCP and/or PCR-direct sequencing, exons 8, 10, 11 and 15 of BRAF in 113 tumour samples from 49 PTC-patients. Matched lymph node metastases and/or distant metastases (DMs) were screened in 35 patients. Focal changes in the growth pattern or microscopic grade within the primary tumour (Pt) or the metastases were separately genotyped. Mutations at H-, K-, N-ras and PIK3CA exons 9 and 20 were also investigated. For comparison with PTC cases, the BRAF and Ras mutational status was evaluated in 89 specimens obtained from 24 poorly differentiated thyroid carcinomas (PDCs) and 36 anaplastic thyroid carcinomas (ATCs). RESULTS: BRAF(V600E) was found in 13/16 classical PTCs (CL-PTCs), 6/17 follicular variant PTCs (FV-PTCs) and 8/16 mixed (papillary/follicular) PTCs (Mx-PTCs), being significantly associated with CL-PTCs (P = 0.015). BRAF(V600E) segregated with metastatic PTC-cells in 43% of the patients, but only one DM disclosed the mutation. PTC-tumours featuring concurrent less-differentiated foci were BRAF wild-type in both components. Noteworthy, the frequency of BRAF mutations among PDCs and ATCs resulted considerably lower (16.6% and 25%, respectively) than in PTCs (55%). The prevalence of Ras mutations among PDCs and ATCs (46% and 36%, respectively) was, however, much higher than in PTCs (14%). Five (71%) of the patients who died of PTC displayed somatic mutations. Four of them had other gene alteration associated with BRAF(V600E) and the only one that did not, BRAF(V600E) was restricted to the Pt. The occurrence of BRAF(V600E) associated with other genetic events was an independent predictor of DMs during follow-up, recurrence and tumour-related death. Remarkably, two PDCs (8.3%) and five ATCs (14%) revealed concurrent BRAF and Ras mutations. CONCLUSION: BRAF(V600E)'alone' does not represent a marker for poor outcome, however, when associated with alterations in other genes identifies a subset of PTCs with increased risk of recurrence and decreased survival.

Evidencias de validez de la Escala de Sentimiento de Autoeficacia Docente en una muestra española / Evidence for the validity of the Teachers’ Sense of Self-Efficacy Scale in a Spanish sample

El sentimiento de autoeficacia docente (SAD) es un constructo de compleja medida pero relevante por su relación con la calidad de la educación. Con este trabajo se pretende acumular evidencias de consistencia y validez para su uso en España de una versión del Teachers’ Sense of Efficacy Scale (TSES). Los datos proceden de un colectivo español de futuros profesores de infantil, primaria y secundaria (N = 744) y se analizan desde un enfoque multivariado adecuado para escala ordinal, mediante análisis factorial confirmatorio (ULSMV) y árboles de decisión (CHAID y CART). Tras evaluar tres modelos de medida, se aportan evidencias de validez de una estructura del constructo en tres factores y 17 ítems, con índices de ajuste aceptables. Además, se avala tanto la convergencia y consistencia del constructo, como la utilidad de los ítems para la predicción de la autoeficacia docente global en los colectivos de estudiantes de grado y de máster que componen la muestra estudiada.(AU)

Teachers’ sense of self-efficacy is a hard construct to measure but is important in view of to its relationship with the quality of education. This work aims to gather evidence regarding the consistency and validity of a version ofthe Teachers’ Sense of Efficacy Scale (TSES) for use in Spain. The data come from a Spanish group of future early-years, primary and high school teachers (N= 744), and they are analysed using a multivariate approach suitable for ordinal scales, with confirmatory factor analysis (ULSMV) and decision trees (CHAID and CART). After evaluating three measurement models, evidence for the validity of a construct structure with three factors and 17 items with acceptable fit indices is provided. In addition, the convergence and consistency of the construct are both en-dorsed, as is the usefulness of the items for predicting overall teacher self-efficacy in the groups ofundergraduate and master’s students in the sam-ple studied.(AU)

Inflamación en la hernia del disco intervertebral / Inflammation in the intervertebral disc herniation

Hasta no hace muchos años, se consideró que el dolor ciático, en la hernia del disco intervertebral lumbar, estaba originado por la compresión sobre la raíz nerviosa. Sin embargo, la hernia del disco intervertebral lumbar presenta cuadros muy heterogéneos inexplicables con el simple compromiso mecánico. En los últimos años, numerosos estudios de inmuhistoquímica y de biología molecular han demostrado que el tejido herniado no es un material inerte sino, por el contrario, biológicamente muy activo con capacidad de expresar una serie de mediadores de inflamación entre los que destacan citoquinas proinflamatorias como la interleuquina1, interleuquina 6, interleuquina 8 y el factor de necrosis tumoral. La inflamación parece estar no solo inducida por la irritación química de las sustancias bioactivas liberadas por el núcleo pulposo, sino también mediante una respuesta autoinmune contra el mismo. Por tanto, además del factor mecánico, la mediación bioquímica tiene un papel importante en la fisiopatología del dolor ciático y de la radiculopatía. A través de una extensa revisión sistemática de la literatura se han investigado los mediadores celulares y moleculares que intervienen en dicho proceso inflamatorio alrededor de la hernia del disco intervertebral lumbar y su implicación en el dolor ciático (AU)

Up until fairly recently, it was thought that sciatic pain in the lumbar herniated disc was caused by compression on the nerve root. However, the lumbar herniated disc shows mixed pictures which are difficult to explain by simple mechanical compromise. In recent years various immunology, immunohistochemistry and molecular biology studies have shown that the herniated tissue is not an inert material, but rather it Is biologically very active with the capability of expressing a series of inflammatory mediators: cytokines such as interleukin-1, interleukin-6, interleuquin-8 and tumor necrosis factor being the ones which stand out. The inflammation is not only induced by the chemical irritation of the bioactive substances released by the nucleus pulposus but also by an autoimmune response against itself. Thus, in addition to the mechanical factor, the biomechanical mediation plays an important role in the pathophysiology of sciatic pain and of radiculopathy. Through a review of a wide range of literature, we researched the cellular molecular mediators involved in this inflammatory process around the lumbar herniated disc and its involvement in sciatic pain (AU)

Presentation, treatment, and multivariate analysis of risk factors for obstructive and perforative colorectal carcinoma.

BACKGROUND: It is known that emergency surgery for colorectal cancer is associated with high morbidity and mortality. The aim of this study was to assess the presentation, treatment, and outcome of patients with complicated colorectal cancer. Risk factors for morbidity and mortality were also evaluated. METHODS: From 1991 to 2002, the medical records of 107 consecutive patients undergoing emergency surgery for obstructing or perforating colorectal carcinoma were retrospectively reviewed. Information regarding patient and tumor characteristics, treatment, and outcome was recorded. Risk factors were assessed by multivariate analysis. RESULTS: Eighty-three patients (78%) had complete obstruction and 24 (22%) had perforation. Overall and major complications occurred in 70% and 34%, respectively. The mortality rate was 15%. Independent risk factors for major morbidity were perioperative blood transfusion and high American Society of Anesthesiologists (ASA) class, whereas those for mortality were older age and high Acute Physiology and Chronic Health Evaluation II (APACHE II) score. CONCLUSIONS: Emergency surgery for complicated colorectal carcinoma carries high rates of morbidity and mortality. To achieve improvements in outcome, intensive treatment after surgery in patients with risk factors is recommended.

Evaluación de la percepción de autoeficacia en pacientes de oncología infantil / Evaluation of perception of self-efficacy in pediatric oncology patients

Objetivo: Estudios realizados con pacientes adultos oncológicos revelan el efecto protector y terapéutico que la autoeficacia tiene en el afrontamiento de dicha enfermedad. No habiéndose estudiado la influencia de dicha variable en el cáncer infantil, se plantea este estudio con el objeto de evaluar la percepción de autoeficacia en estos pacientes. Método: Para ello se ha creado la Escala de Autoeficacia en Pacientes de Oncología Infantil (EAPOI) que arroja un índice de consistencia interna alfa de Cronbach de 0,889. Resultados: Los resultados evidencian que la población objeto de estudio manifiesta una adecuada percepción de autoeficacia al situarse el 85% entre los niveles medio y muy alto; tan solo un 15% se sitúa en el nivel bajo. Conclusión: Estos resultados confirman la tendencia observada en los estudios de los últimos años que muestran una adecuada adaptación psicosocial del niño oncológico ante la enfermedad y sus tratamientos

Objective: Studies with adult oncology patients reveal the protective and therapeutic effect that self-efficacy has on facing the disease. The influence of this variable has not been studied in childhood cancer cases, thus this study is proposed in order to evaluate the perception of self-efficacy in these patients. Method: In doing so, Self-Efficacy Scale in Pediatric Oncology Patients has been created, providing an internal consistency index of Cronbach of .889. Results: The results of our investigation show that subjects believe themselves properly self-efficient to cope with their disease: 85% of them have medium-high level, and just 15% of them have low level. Conclusion: These results confirm the observed trend in recent studies that show an appropriate psychosocial adaptation of oncological children in the presence of the disease and its treatments