Intensive follow-up strategies improve outcomes in nonmetastatic colorectal cancer patients after curative surgery: a systematic review and meta-analysis.

BACKGROUND: A wide variety of follow-up strategies are used for patients with colorectal cancer (CRC) after curative surgery. The aim of this study is to review the evidence of the impact of different follow-up strategies in patients with nonmetastatic CRC after curative surgery, in relation to overall survival and other outcomes. PATIENTS AND METHODS: A systematic search of PubMed, EMBASE, SCOPUS and ISI Web of Knowledge up to June 2014 was carried out. Eligible studies were all randomized clinical trials comparing the effectiveness of different follow-up strategies after curative resection in nonmetastatic CRC. RESULTS: Eleven studies with n = 4055 participants were included in a meta-analysis. A significant improvement in overall survival was observed in patients with more intensive follow-up strategies [hazard ratio = 0.75; 95% confidence interval (CI) 0.66-0.86]. A higher probability of detection of asymptomatic recurrences [relative risk (RR) = 2.59; 95% CI 1.66-4.06], curative surgery attempted at recurrences (RR = 1.98; 95% CI 1.51-2.60), survival after recurrences (RR = 2.13; 95% CI 1.24-3.69), and a shorter time in detecting recurrences (mean difference = -5.23 months; 95% CI -9.58 to -0.88) was observed in the intervention group. There were no significant differences in the total tumor recurrences, nor in the mortality related to disease. CONCLUSION: Intensive follow-up strategies improve overall survival, increase the detection of asymptomatic recurrences and curative surgery attempted at recurrence, and are associated with a shorter time in detecting recurrences. This more intensive follow-up could not be associated with an improvement in cancer-specific survival nor with an increased detection of total tumor recurrences. Follow-up with serum carcinoembryonic antigen and colonoscopies are related to an increase in overall survival.

A randomized clinical trial to determine the effect of angiotensin inhibitors reduction on creatinine clearance and haemoglobin in heart failure patients with chronic kidney disease and anaemia.

BACKGROUND: Chronic kidney disease is a common comorbidity in elderly patients with heart failure. Evidence supports the use of angiotensin inhibitors for patients with heart failure. However, there is little evidence with which to assess the risk and benefits of this treatment in elderly patients with renal dysfunction. OBJECTIVE: To determine the efficacy and safety of angiotensin inhibitor reduction in patients with heart failure, chronic kidney disease and anaemia. STUDY DESIGN: Open randomized controlled clinical trial. SETTING: Complexo Hospitalario Universitario A Coruña (Spain). PATIENTS: Patients ≥ 50 years old, with heart failure, haemoglobin (Hb) < 12 mg/dl and creatinine clearance <60 ml/min/1.73 m(2) admitted to hospital, in treatment with angiotensin inhibitors. Informed consent and Ethical Review Board approval were obtained. INTERVENTION: A 50% reduction of angiotensin inhibitor dose of the basal treatment on admission (n = 30) in the intervention group. Control group (n = 16) with the standard basal dose. MAIN OUTCOME MEASURE: Primary outcome was difference in Hb (gr/dl), creatinine clearance (ml/min/1.73 m(2) ) and protein C (mg/dl) between admission and 1-3 months after discharge. Secondary outcome was survival at 6-12 months after discharge. RESULTS: Patients in the intervention group experienced an improvement in Hb (10.62-11.47 g/dl), creatinine clearance (32.5 ml/min/1.73 m(2) to 42.9 ml/min/1.73 m(2) ), and a decrease in creatinine levels (1.98-1.68 mg/dl) and protein C (3.23 mg/dl to 1.37 mg/dl). There were no significant differences in these variables in the control group. Survival at 6 and 12 months in the intervention and control group was 86.7% vs. 75% and 69.3% vs. 50%, respectively. CONCLUSION: The reduction of the dose of angiotensin inhibitors in the intervention group resulted in an improvement in anaemia and kidney function, decreased protein C and an increased survival rate. TRIAL REGISTRATION: EudraCT: 2008-008480-10.

[Efficacy of high-intensity exercise in people with chronic low back pain: A systematic review]. / Eficacia del ejercicio de alta intensidad en personas con dolor lumbar crónico: una revisión sistemática.

Chronic low back pain causes disability and socioeconomic impact. High-intensity exercise shows positive results in other diseases, but there is no evidence on this pathology. The aim is to determine its efficacy on health-related quality of life, disability, pain intensity and adherence to treatment in people with chronic low back pain. A literature review is conducted in Pubmed, PEDro and Scopus, including randomized clinical trials, clinical practice guidelines and systematic reviews in Spanish, English or Portuguese (2012-2022). In addition, a snowball search is performed. Eight randomized clinical trials (n=379) are incorporated. Different high-intensity exercise modalities are analyzed, which seem to improve health-related quality of life and reduce disability and pain intensity. These data should be taken with caution given the small number of studies and the risk of bias presented.

Sexual dimorphism on growth hormone secretion after oral glucose administration.

Sexual dimorphism of GH secretion is unclear in humans. There is evidence that oral glucose (OG) administration initially decreases and subsequently stimulates GH secretion. Our aim was to study fasting GH concentrations and their response to OG administration in obese and healthy women and men, in order to elucidate the mechanism of sexual dimorphism of GH secretion and the possible contribution of ghrelin. We selected 33 women and 11 men as obese and healthy subjects. After an overnight fast, 75 g of oral glucose were administered; glucose, insulin, ghrelin, and PYY1-36 were obtained at baseline and during 300 min. Fasting GH (µg/l) was higher in women than men; 1.3 ± 0.3 vs. 0.2 ± 0.1, p=0.009, for women and men, respectively. The area under the curve between 0 and 150 min (AUC) of GH (µg/l · min) was higher in women than men; 98.2 ± 25.9 vs. 41.5 ± 28.6, p=0.002, for women and men, respectively. The AUC of total ghrelin (pg/ml · min, mean ± SEM) between 0 and 150 min was borderline and significantly higher in women than men; 128 562.3 ± 8 335.9 vs. 98 839.1 ± 7 668.6, p=0.069, for women and men, respectively. Several initial time points were higher in women than men. Glucose, insulin, and PYY1-36 were similar in women and men after OG. There were significant correlations between indices of post-oral glucose GH and ghrelin secretion. Fasting and initial GH secretion is higher in women than men, in contrast to peak and late GH secretion, which is similar in both cases. Sexual dimorphism in the regulation of GH secretion probably involves ghrelin.

Growth hormone, ghrelin and peptide YY secretion after oral glucose administration in healthy and obese women.

The mechanism of the altered GH secretion in obesity is unclear. There is evidence that oral glucose (OG) administration initially decreases and subsequently stimulates GH secretion. Ghrelin is a peptide that displays strong growth hormone-releasing activity. Its physiological importance on GH regulation is unclear. Our aim was to study fasting GH concentrations and their response to OG administration in relation with ghrelin secretion in obese and healthy women, in order to elucidate the hypothetical participation of ghrelin on post-oral glucose GH secretion. 36 women were included in the study. After an overnight fast, 75 g of oral glucose was administered; glucose, insulin, ghrelin, and PYY (1-36) were obtained at baseline and during 300 min. The area under the curve between 0 and 300 min (AUC) of GH µ/l·min) was lower in obese patients than in controls; 262.5±57.5 vs. 534.9±95.6, p=0.01, for obese and controls respectively. GH peak (µg/l) was lower in obese patients than in controls; 3.7±0.7 vs. 7.1±1.0, p=0.012, for obese and controls, respectively. The AUC of total ghrelin (pg/ml·min) was lower in obese patients than in controls; 233,032±12,641 vs. 333,697±29,877, p=0.004, for the obese patients and controls respectively. PYY (1-36) was similar in obese and healthy women after OG. There were significant correlations between the different indices of post-oral glucose GH and ghrelin secretion. These data suggest that ghrelin is a physiological regulator of GH in the post-oral glucose state, and the decreased ghrelin secretion could be one of the mechanisms responsible for the altered GH secretion in obesity.

Continuous infusion of antibiotics using elastomeric pumps in the hospital at home setting.

OBJECTIVE: To describe the avoided costs and to analyze the effectiveness of intravenous antibiotic treatment in continuous perfusion in patients at Hospital at Home Units (HHU) administered using elastomeric infusion pumps (EIP) prepared in a Hospital Pharmacy Service (HPS). METHODS: Retrospective observational study of the number and type of EIP prepared in the HPS and of the treated patients. Study period: January 2017-December2018. Analyzed data: demographic data of patients, location of infection, responsible microorganism, medication and type of EIP, dose and duration of treatment and its effectiveness in terms of cure or non-cure or patient's death. Economic valuation considering: costs of EIP, nursing time needed for preparation and cost of HHU care. RESULTS: A total of 1,688 EIP to treat 102 patients resulted in 106 episodes of outpatient treatment of parenteral antibiotic therapy (OPAT) for 1,409 days, thereby avoiding 1,409 days of hospital admission. A total of 59.8% of the patients were men and the mean age was 70.5 ± 17 years. A 31.1% and 68.9% of the cases were empirical and pathogen-directed treatments, respectively. The most used antimicrobials were piperacillin/tazobactam (42.7%), ceftazidime (24.5%), meropenem (19.8%), ceftolozane/tazobactam (2.8%), and cloxacillin (1.9%). Mean duration of treatment was 13.29 ± 8.60 days. Location of infection: respiratory (42.5%), urinary (17.9%), skin and soft tissue (12.3%), bacteraemia (11.3%), osteomyelitis (7.5%), abdominal (3.8%) and 4.7% in other locations. The cure rate was 84%. Total avoided cost: 580,788.28€ in the 24 months studied. CONCLUSIONS: This program represents very important economic savings for the health system, and the effectiveness of the antibiotic treatment has not been compromised.

Epidemiology and outcome of HIV-infected patients admitted to the ICU in the current highly active antiretroviral therapy era.

PURPOSE: To describe the epidemiology of critical disease in HIV-infected patients during the current highly active antiretroviral therapy (HAART) era and to identify hospital mortality predictors. METHODS: A longitudinal, retrospective observational study was made of HIV-infected adults admitted to the ICU in two Spanish hospitals between 1 January 2000 and 31 December 2014. Demographic and HIV-related variables were analyzed, together with comorbidities, severity scores, reasons for admission and need for organ support. The chi-squared test was used to compare categorical variables, while continuous variables were contrasted with the Student's t-test, Mann-Whitney U-test or Kruskal-Wallis test, assuming an alpha level=0.05. Multivariate logistic regression analysis was used to calculate odds ratios for assessing correlations to mortality during hospital stay. Joinpoint regression analysis was used to study mortality trends over time. RESULTS: A total of 283 episodes were included for analyses. Hospital mortality was 32.9% (95%CI: 21.2-38.5). Only admission from a site other than the Emergency Care Department (OR 3.64, 95%CI: 1.30-10.20; p=0.01), moderate-severe liver disease (OR 5.65, 95%CI: 1.11-28.87; p=0.04) and the APACHE II score (OR 1.14, 95%CI: 1.04-1.26; p<0.01) and SOFA score at 72h (OR 1.19, 95%CI: 1.02-1.40; p=0.03) maintained a statistically significant relationship with hospital mortality. CONCLUSIONS: Delayed ICU admission, comorbidities and the severity of critical illness determine the prognosis of HIV-infected patients admitted to the ICU. Based on these data, HIV-infected patients should receive the same level of care as non-HIV-infected patients, regardless of their immunological or nutritional condition.

Predictor of enhanced mortality in patients with multimorbidity and atrial fibrillation in an acute hospital setting.

BACKGROUND: Patients with atrial fibrillation (AF) admitted to hospital commonly have comorbidities. Few studies have attempted to determine factors prognostic of mortality in hospitalized AF patients with multimorbidity. AIM: To identify factors associated with mortality in hospitalized AF patients. DESIGN: Retrospective cohort study. METHODS: Patients with multimorbidity (≥2 chronic diseases), with or without AF, discharged from Lugo hospital (Spain) between 1 January 2000 and 31 December 2015. Data were extracted from hospital medical records. RESULTS: Of 74 220 patients (170 978 hospitalizations), 52 939 had multimorbidity (14 181 had AF; 38 758 no AF) and were included in our study. Patients with AF were older (mean ± standard deviation 78.6 ± 10.0 vs. 71.9 ± 14.2 years) and had a higher mortality rate (27.1 vs. 20.5%) than those without AF. Gender (female), age, stroke and congestive heart failure (CHF), but not AF, were independently associated with mortality. AF significantly increased the mortality risk in women [relative risk (RR) 1.091; 95% confidence interval (CI) 1.021-1.165; P = 0.010] and in those aged >80 years (RR 1.153; 95% CI, 1.1-1.2; P < 0.001). CHF independently increased the risk of mortality across all age groups (RR 1.496; 95% CI 1.422-1.574; P < 0.001). CONCLUSIONS: Hospitalized patients with AF have a higher mortality rate than those without AF. The prognostic significance of AF changes with age and gender while CHF is associated with the greatest risk of death.

Effectiveness and safety of daclatasvir/sofosbuvir with or without ribavirin in genotype 3 hepatitis C virus infected patients. Results in real clinical practice.

OBJECTIVE: Direct-acting antivirals have shown high efficacy in all hepatitis C virus (HCV) genotypes, but genotype 3 (G3) treatments continue to be a challenge, mainly in cirrhotic patients. The aim of this study is to analyse effectiveness and safety of daclatasvir associated with sofosbuvir with or without ribavirin in G3-HCV infected patients in real clinical practice. METHODS: An observational, prospective, cohort study over 2.5 years, in G3-HCV infected adult patients, in all fibrosis stages including patients with decompensated cirrhosis. Treatment was a combination of sofosbuvir 400 mg/day + daclatasvir 60 mg/day, with or without a weight-adjusted dosing of ribavirin for 12 or 24 weeks. The primary efficacy endpoint was sustained virologic response rates 12 weeks after therapy (SVR12). The primary safety endpoint was treatment withdrawal rates secondary to severe adverse events. RESULTS: A total of 111 patients were enrolled, 32.4% cirrhotics and 29.9% treatment-experienced. The global SVR12 rate was 94.6%, while the SVR12 rate in F3-4 fibrosis stage patients was 90.8% versus 100% in patients with F0-2 fibrosis (p=0.03). In cirrhotic patients, SVR12 was 100% versus 40% depending on whether ribavirin was added or not to daclatasvir/sofosbuvir (p=0.001). No other patient or treatment basal variables influenced the treatment effectiveness. No patient treatment withdrawal secondary to severe adverse events was observed. CONCLUSIONS: Daclatasvir/sofosbuvir ± ribavirin is highly effective in G3-HCV infected patients. Advanced degrees of fibrosis significantly decrease the effectiveness of this treatment, which motivates the need for the addition of ribavirin in cirrhotic patients. The regimen was safe and well tolerated.

[Insignificant prostate cancer. Analysis our series]. / Cancer de próstata insignificante. Análisis de nuestra serie.

The objective of this study is to analyse the specimen of radical prostatectomy of patients who had, prior to the surgery insignificant prostate cancer biopsies. The end point is demonstrate the possibility of an active surveillance as a therapeutic option for prostate cancer in selected is the possibility of an active surveillance as therapeutic for the prostate cancer, in selected individuals if we are able to find diagnostic algorisms to predict the real insignificant tumours. The selected group of patients for the study has a PSA less or equal 10, one positive core of prostatic transrectal ultrasound biopsy with a Gleason score less than 7. This group of patients is considerate as having a potential insignificant tumour. We will consider prostatectomy's specimens and the Gleason sore is less than 7 and the tumoral volume is les or equal to 5%. Of 394 patients with prostate cancer and homogeneous criterias for our study, we have selected 53 patients according to the criteria of insignificant tumour in the biopsy. Our results showed that only 22 of 53 (41.5%) patients were identified as having an insignificant prostate cancer in the RP specimens. Moreover 92.2% of this tumours were organ-confined. In conclusion we are able to say that tumours of low-risk and low tumoral volume in the biopsy, do not correlate always to insignificant tumours in PR specimens, but we have observed that the majority are organ-confined tumours. Finally, the diagnostic's algorisms dies not to predict tumours that may safely treated with active monitoring.

Incidence of cardiovascular events in renal transplant recipients and clinical relevance of modifiable variables.

INTRODUCTION: The aims of this study were to quantify the incidence of cardiovascular events and identify the clinical relevance of modifiable variables. MATERIALS AND METHODS: The 1729 patients who underwent renal transplantation from 1981 to 2004 were evaluated in an observational, prospective follow-up study with no exclusions. A cardiovascular event was defined as the presence of ischemic cardiac disease (chest pain-myocardial infarction), cardiac insufficiency, arrhythmia (auricular fibrillation), peripheral vascular disease, or cerebrovascular accident. A survival analysis was performed using the Kaplan-Meier method. A Cox regression analysis was applied. Having identified the predictive variables of cardiovascular events, the population attributable fraction (PAF) and the etiological fraction (EF) were estimated. A risk score was calculated using Cox regression coefficients. RESULTS: The accumulated incidence of cardiovascular events was 22.2%, with an incidence rate of 468.6 x 10,000 follow-up years. From the Cox regression model, the variables with an independent effect close to statistical significance to predict cardiovascular events were as follows: recipient age (RR = 1.05), smoking at the time of the transplantation (RR = 2.1), left ventricle hypertrophy during follow-up (RR = 2.4), prior diabetes mellitus, and obesity (body mass index >or=30). At the time of transplantation, 41.7% were smokers. During follow-up, a clear difference was observed in the incidence rates of cardiovascular events between smokers and nonsmokers. Similar phenomena were observed for left ventricle hypertrophy and obesity. The resulting scores ranged between 0 and 5. The area under the ROC curve of the score for the prediction of cardiovascular events was 0.74. CONCLUSION: The incidence of cardiovascular events was consistent with the literature. A series of modifiable variables of major clinical relevance exist to decrease the frequency of cardiovascular events following renal transplantation.

[The utility of artificial neural networks in the prediction of prostate cancer on transrectal biopsy]. / Utilidad de las redes neuronales artificiales en la predicción de cáncer de próstata en la biopsia transrectal.

OBJECTIVE: To determine whether the development of an artificial neural network (ANN) made up of clinical variables allows for the prediction of prostate biopsy (PB) outcome. MATERIALS AND METHODS: Patients (n=953) underwent PB at the Arquitecto Marcide Hospital in Ferrol (Spain), between january 2000 and june 2005. The variables studied were age, PSA, digital rectal examination (DRE) and prostate volume, data for all of which were available in 843 cases. In order to determine factors related to prostate cancer (PC) diagnosis, a logistic regression analysis and a feed-forward neural network were developed, including three hidden layer nodes and an output node, representing the probability of PC. Both models were constructed from a random sample of n=643 patients (derivation set). The predictive capacity was assessed with the remaining 200 patients (validation set), by means of ROC curves and the area under the curve (AUC). RESULTS: PC was detected in 500 (59.3%) cases. Adjusting for age, PSA, digital rectal examination and prostate volume, in a multivariate logistic regression model it was observed that all the variables were independent predictors of PC. The AUC were 0.693 for PSA, 0.707 for prostate volume, 0.815 for logistic regression and 0.819 for ANN. The predictive capacity of the ANN was significantly higher than that of the PSA (p=0.002) and prostate volume (p<0,001) and similar to that of logistic regression (p=0.760). CONCLUSIONS: The ANN shows a PC prediction capacity that is significantly higher than unimodal diagnosis methods, and similar to that of logistic regression.

[Sedation and analgesia practices among Spanish neonatal intensive care units]. / Manejo de la sedación y la analgesia en unidades de cuidados intensivos neonatales españolas.

INTRODUCTION: Pain management and sedation is a priority in neonatal intensive care units. A study was designed with the aim of determining current clinical practice as regards sedation and analgesia in neonatal intensive care units in Spain, as well as to identify factors associated with the use of sedative and analgesic drugs. METHOD: A multicenter, observational, longitudinal and prospective study. RESULTS: Thirty neonatal units participated and included 468 neonates. Of these, 198 (42,3%) received sedatives or analgesics. A total of 19 different drugs were used during the study period, and the most used was fentanyl. Only fentanyl, midazolam, morphine and paracetamol were used in at least 20% of the neonates who received sedatives and/or analgesics. In infusions, 14 different drug prescriptions were used, with the most frequent being fentanyl and the combination of fentanyl and midazolam. The variables associated with receiving sedation and/or analgesia were, to have required invasive ventilation (P<.001; OR=23.79), a CRIB score >3 (P=.023; OR=2.26), the existence of pain evaluation guides in the unit (P<.001; OR=3.82), and a pain leader (P=.034; OR=2.35). CONCLUSIONS: Almost half of the neonates admitted to intensive care units receive sedatives or analgesics. There is significant variation between Spanish neonatal units as regards sedation and analgesia prescribing. Our results provide evidence on the "state of the art", and could serve as the basis of preparing clinical practice guidelines at a national level.

Influence of the management of asystolic donors on kidney transplantation outcome.

Two methods of donor management were analysed, namely, with and without in situ cooling perfusion of the kidney in an attempt to determine the optimal management and preservation methods for asystolic kidney donors. The group of recipients of in situ cooling perfusion kidneys showed more days of oliguria (P <.05), needed more dialysis sessions (P <.05), and showed no transplant function during the first week after surgery. This group also had a greater probability of acute rejection (P =.071) and a higher rate of nonfunctioning grafts (P =.09). We conclude that in situ cooling perfusion of asystolic kidney donors impairs graft function.

Autopsy-determined causes of death in solid organ transplant recipients.

The aim of this study was to review the main causes of death as determined by autopsy of deceased solid organ transplant recipients. We reviewed 156 autopsies including 76 heart, 32 liver, 29 kidney, and 19 lung transplant recipients. The mean survival period varied depending on the transplanted organ: namely heart, 497 days; liver, 189 days; kidney, 1124 days; and lung, 252 days. Infections were the most common cause of death in all groups, varying from 21% in heart to 63% in lung recipients. Acute rejection, chronic rejection, and malignancies only appeared as the cause of death in heart recipients (14.5%, 9.2%, and 4%, respectively). Primary graft failure was present in heart (15.7%), kidney (3.4%), and lung (5.3%) recipients. The highest rate of surgical complications as a cause of death was observed in heart transplant recipients. In all groups there was a significant percentage (about 30%) of other pathologies that were responsible for death, such as pulmonary embolism, central nervous system pathology, acute pancreatitis, digestive hemorrhage, and acute myocardial infarction. Our results emphasize that infections are the main cause of death within the first year posttransplant, independent of the organ transplanted.

[Survival and prognostic factors for gastric cancer. Analysis of 2,334 patients]. / Supervivencia en 2.334 pacientes con cáncer gástrico y factores que modifican el pronóstico.

BACKGROUND: The analysis of the survival of patients diagnosed with gastricadenocarcinoma and the factors which modify prognosis. PATIENTS AND METHOD: Retrospective cohort study of overall patients diagnosed with gastric adenocarcinoma treated in the Xeral-Calde and Juan Canelejo hospitals of Lugo and La Coruña (Spain) between 1975 and 1993. The following variables were studied: age, sex, the year of diagnosis, place of residence, delayed diagnosis, localisation of the primitive tumour, the TNM classification, the Laurén histological type and the type of surgical resection when conducted. The Kaplan-Meier statistical method was employed to determine the probability of survival. Cox regression was used to determine prognosis factors. RESULTS: The diagnosis was established on 2,334 patients: 63,2% were males;the average overall age was 66.5 (11,9 SD) years, the median delayed diagnostic was 3,19 months, the lower third was the most common localisation (46,3%), 30,2% of the cases were diagnosed in the IV stage, and curative surgery was conducted in 46,4% of the cases. The probability of survival for overall numbers was 26% and curative surgery, was conducted in 45% of cases. The most advanced states in the TNM classification and the absence of curative surgery were factors associated with the poorest prognosis. CONCLUSIONS: Survival after gastric cancer is low. Initial stage and radical surgical treatment are the main factors for prognosis.

[Advanced gastric cancer: characteristics at presentation and therapeutic possibilities].

OBJECTIVE: To analyse the presentation forms and prognosis of patients with advanced gastric cancer at the time of diagnosis. DESIGN: Retrospective cohort study. PATIENTS AND METHODS: We studied all patients with gastric cancer (n=2,334) and synchronic metastases diagnosed in Lugo and A Coruña hospitals between 1975 and 1993. We estimated survival probability using the Kaplan-Meier method, and prognostic factors with Cox's regression models. RESULTS: Metastases were detected at the time of diagnosis in 585 (25.1%) patients, with the liver (346; 14.8%) and peritoneum (61; 6.9%) being the most frequently involved sites. The liver was exclusively affected in 213 (9.1%) cases, the peritoneum in 70 (3.3%), and another intraabdominal site in 121 (5.2%). Patients with peritoneal metastases were older (p=0.05), more commonly had a diffuse type of cancer according to Lauren's tumor classification (p<0.001), and underwent surgery more frequently (p=0.01). Curative resection was possible for only 11 (5.2%), 7 (10%), and 25 (20.7%) patients with metastases in only the liver, peritoneum, or another site, respectively, but in all cases survival probability was significantly enhanced. No surgery (HR=2.92), and simultaneous involvement of the liver and peritoneum (HR=1.62) were factors associated with a higher mortality rate. CONCLUSIONS: Patients with gastric cancer and metastases in only one intraabdominal organ show characteristic forms of presentation. Furthermore, in all cases candidacy for surgery should be carefully evaluated, as prognosis may improve in selected patients.

[Impact of an asthma educational intervention programme on teachers]. / Impacto de una intervención educativa sobre asma en los profesores.

OBJECTIVE: Our objective was to measure the impact of an educational intervention program on teacher's knowledge about asthma and its management. MATERIAL AND METHOD: Before and after quasi-experimental study, with control group, of an educational intervention, which had as its aim to improve the teacher's knowledge of asthma and its management, was conducted in some schools of San Sebastian (Gipuzkoa), Spain. The Newcastle Asthma knowledge Questionnaire (NAKQ) was used as a measuring tool, and an adaptation of the asthma, sport and health program was used as an educational intervention. The Wilcoxon signed rank test was used to compare the total score of the questionnaire before and after the intervention, and the McNemar test was performed to compare the percentages of correct answers to each item. The Mann-Whitney U test was also performed to compare the baseline score and the score at three months between the intervention group and control group. The size of the effect and the standardised mean response were studied. RESULTS: A total of 138 teachers from 6 schools, which were chosen at random (study group), and 43 teachers in the control group participated in the study. In the study group, the mean score of the NAKQ before the educational intervention was 16.1±3.4 points, with a median of 16 (range 7 to 23). After the intervention the mean score increased to 22.3±4.1, with a median of 23 (range, 6 to 29). The mean difference in the overall score of the NAKQ was 7.0±4.2 points, with a median of 8 (range, -2 to17). Furthermore, the size of the effect was 2.0 (> 0.8) and the standardised mean response was 1.7. After 3 months of the intervention the mean score of the NAKQ was 21.4±3.0 points, with a median of 22 (range, 12 to 29) which was significantly higher than the score obtained before the intervention (P<.001) and slightly lower than the score obtained immediately after the intervention, assuming a size of the effect of 1.6 and a standardised mean response of 1.2. In the control group, the level of knowledge did not change modified and was lower than the level of the intervention group (P<.001). CONCLUSIONS: An educational intervention program conducted among teachers significantly increases their knowledge of asthma. Moreover, the increase reduces slightly but maintains its higher level for at least 3 months. In spite of the fact that some aspects of knowledge improved with the educational intervention, they were not optimal.

[Relationship of preoperative PSA velocity to histopathological findings in the surgical specimen and survival after radical prostatectomy]. / Relación de la velocidad preoperatoria de PSA con los hallazgos histopatológicos de la pieza quirúrgica y la supervivencia tras prostatectomía radical.

OBJECTIVE: To assess whether PSA velocity (PSV) is related to pathological findings in surgical specimen, biochemical recurrence-free survival (BRFS), cancer-related survival (CRS), and overall survival (OS). MATERIALS AND METHODS: A retrospective and prospective observational cohort study on 265 patients with prostate cancer (PCa) who underwent radical prostatectomy (RP) from 2000 to 2008. PSAV was calculated arithmetically and by linear regression analysis, using PSA values in the year prior to diagnosis. A multivariate logistic regression analysis was performed to detect variables associated to extracapsular disease (ECD). Variables related to BRFS, CRS, and OS were analyzed using Kaplan-Meier methodology (PSAV 3 ng/mL/year) and a multivariate Cox regression analysis. The ability of PSA velociy to predict BRFS, CRS, and OS was evaluated by c-index. RESULTS: Median follow-up was 56.16 months (9.14-106.75). Median PSAV was 0.65 and 0.63 ng/ml/year using the arithmetic and regression methods respectively. ECD was detected in 74 specimens (27.92%), and biochemical recurrence in 50 patients (18.87%). Cancer-related mortality was seen in 4 patients (1.52%) and overall mortality in 16 (6.08%). In the multivariate analysis, PSAV was not related to ECD. PSAV was an independent predictor for BRFS (RR: 1.06, 95% CI: 1.02-1.13, p=0.008), CRS (RR: 1.22, 95% CI: 1.00-1.50, p=0.048), and OS (RR: 1.35, 95% CI: 1.18-1.55, p<0.001) in the multivariate Cox regression analysis. CONCLUSIONS: PSAV is a preoperative parameter that predicts for BFRS, CRS, and OS in patients undergoing RP. No association was found between PSA velocity and presence of ECD.

Influence of early graft function after renal transplantation and its impact on long-term graft and patient survival.

OBJECTIVE: To determine whether early graft function after transplantation impacted graft and patient survivals. MATERIALS AND METHODS: Between 1981 and 2008, we performed 1308 renal transplantations. Poor early graft function was defined as a Cockroft-Gault glomerular filtration rate<60 mL/min or less at 1 and 3 months posttransplant. Patients who lost their kidney or died within the first 12 months after transplantation were excluded from the study. Multivariate statistical analysis used Cox proportional hazards models. RESULTS: Of the 1308 patients 994 (78.8%) displayed poor early graft function at 1 month after transplantation (glomerular filtration rate<60 mL/min), while 268 (21.2%) showed normal function (glomerular filtration rate≥60 mL/min). The 2- and 6-year graft survival rates among the poor early graft function group were 96.8% and 85.8%, respectively, while those among the control group were 97.0% and 88.3%, respectively. The 2- and 6-year patient survival rates in the poor early graft function were 98.5% and 89.8% versus 98.9% and 96.3% in the control group. Similar results were observed at 3 months posttransplant. Controlling for patient age, donor age, HLA-AB and -DR mismatches, cold ischemia time, acute rejection episodes, cyclosporine therapy, and waiting time for transplantation, we did not observe early graft function to be a risk factor for graft survival or patient survival. Glomerular filtration rate at 2, 5, and 6 years after kidney transplantation was significantly lower in the poor early graft function than in the control group. CONCLUSION: This study suggested that the quality of early graft function had no significant effect on graft and patient survival rate, but did have a significant influence on long-term renal function.