Perceived changes in psychological and physical symptoms after hospital clown performances in a cancer setting.

Background: The therapeutic role of humor and hospital clowns has become a focus of interest in recent decades. Most of the research in the area has focused on children; here, we explore the influence of clown performances on adult cancer patients, their companions, and health-care staff.Methods: Ninety-nine cancer patients and 113 companions were assessed pre- and post-interventions performed by professional clowns; 31 health professionals were asked about the possible influence of the presence of clowns in hospital on their work.Results: Patients felt that clowning performances helped to reduce their level of psychological symptoms, but not their physical symptoms. Companions reported improvements in all the psychological symptoms explored. Health professionals reported that the presence of clowns in the workplace improved their well-being.Conclusions: Clowning performances helped to improve psychological functioning in all the populations studied, especially in companions. Adult hospitals should consider promoting clowning interventions to improve general well-being.

Developing a consensus definition of psychosocial complexity in cancer patients using Delphi methods.

OBJECTIVE: Cancer is one of the biggest health challenges of our times, affecting all the personal areas of a patient. The interrelationships between these areas and the need for multidisciplinary care require the assessment of psychosocial complexity in cancer patients. The main aim of this study was to reach a consensus on the general definition of psychosocial complexity in cancer and its main elements according to the experts in the field. METHOD: A Delphi study was performed, which first involved a comprehensive review of the literature to create a questionnaire that was validated by two expert panels. The first panel consisted of intra-institutional experts, while the second included extra-institutional experts in the field. The study included three more rounds: (1) validation of the questionnaire by the internal panel, (2) discussion of the results and resolving discrepancies, and (3) validation of the questionnaire by the external panel. RESULTS: After the four-round Delphi process, we obtained a consensus definition of psychosocial complexity in cancer patients, as well as of its main factors: medical-physical, social-family, psychological, and spiritual. A 21-indicators list and its 8-indicators brief version were also proposed as indicators of psychosocial complexity. SIGNIFICANCE OF RESULTS: We present a definition of psychosocial complexity in cancer patients that has been agreed by experts, also establishing its four factors: medical-physical, social-family, psychological, and spiritual. This has led to the development of a list of indicators (and its brief version) that, after a validation process, could help health professionals to identify patients with high psychosocial complexity to provide them an optimal care.

The Standardization of Outpatient Procedure (STOP) Narcotics after anorectal surgery: a prospective non-inferiority study to reduce opioid use.

BACKGROUND: Prescription of opioid medication after ambulatory anorectal surgery may be excessive and lead to opioid misuse. The purpose of this study was to evaluate the efficacy of a multi-modality opioid-sparing approach to control postoperative pain and reduce opioid prescriptions after outpatient anorectal surgery. METHODS: A prospective non-inferiority pre- and post-intervention study was completed at three academic hospitals. Patients included were 18-75 years of age who had outpatient anorectal surgeries. The Standardization of Outpatient Procedure (STOP) Narcotics intervention was implemented, which is a multi-pronged analgesia bundle integrating patient education, health care provider education, and intra-/postoperative analgesia focused on multi-modal pain control strategies and opioid-reduced prescriptions. The primary outcome was patient-reported average pain in the first 7 postoperative days. Secondary outcomes included patient-reported quality of pain management, medication utilization, prescription refills and medication disposal. RESULTS: Ninety-three patients had outpatient anorectal surgery (42 pre-intervention and 51 post-intervention). No difference was seen in average postoperative pain in the pre- vs. post-intervention groups (2.8 vs. 2.6 on an 11-point scale, p = 0.33) or patient-reported quality of pain control (good/very good in 57% vs. 63%, p = 0.58). The median oral morphine equivalents (OME) prescribed was significantly less [112.5 (IQR 50-150) pre-intervention vs. 50 (IQR 50-50) post-intervention, p < 0.001]. In the post-intervention group, only 45% of patients filled their opioid prescription and median opioid use was 12.5 OME (2.5 pills). CONCLUSIONS: While pain control after anorectal surgery must consider the individual patient's needs, a standardized pain care bundle significantly decreased opioid prescribing without an increase in patient-reported postoperative pain.

Prevalence of active infection by herpes simplex virus type 2 in patients with high-risk human papillomavirus infection: A cross-sectional study.

The aim is to determine the prevalence of active infection by herpes simplex virus type 2 (HSV-2) among Mexican women with high-risk human papillomavirus (HR-HPV) cervical infection, recruited from public gynecology and colposcopy services. In a cross-sectional study, HSV-2 antibodies, HSV-2 DNA, and HR-HPV DNA were quantified. Significant differences in HSV-2 seroprevalence and HSV-2 active infection rates were found between negative and positive HR-HPV cases. HSV-2 seroprevalence was 28.15% and 16.1% (P = .0001), while HSV-2 active infection rates were 6.83% and 0.62% (P = .001) for positive and negative HR-HPV groups, respectively. The risk of HSV-2 seropositivity was 1.7 times greater for HR-HPV-positive cases (P = .02). Similarly, HR-HPV-positive cases were nine times more likely to have an HSV-2 active infection than HR-HPV-negative cases (P = .03). High HSV-2/h-HPV coinfection rates were observed among women recruited from public gynecology and colposcopy services. The main factors related to an HSV-2 active infection are a history of risky sexual behavior and HR-HPV infection. The prevalence of HSV-2 active infection among positive HR-HPV subjects indicate that these infections constitute an important group of STIs in Mexico.

Molecular mechanisms of cell death induced in glioblastoma by experimental and antineoplastic drugs: New and old drugs induce apoptosis in glioblastoma.

Glioblastoma multiforme (GBM) is one of the most aggressive astrocytic tumors; it is resistant to most chemotherapeutic agents currently available and is associated with a poor patient survival. Thus, the development of new anticancer compounds is urgently required. Herein, we studied the molecular mechanisms of cell death induced by the experimental drugs resveratrol and MG132 or the antineoplastic drugs cisplatin and etoposide on a human GBM cell line (D54) and on primary cultured mouse astrocytes (PCMAs). Caspases, Bcl-2, inhibitors of apoptosis proteins (IAP) family members, and p53 were identified as potential molecular targets for these drugs. All drugs had a cytotoxic effect on D54 cells and PCMAs, with a similar inhibitory concentration (IC50) after 24 h. However, MG132 and cisplatin were more effective to induce apoptosis and autophagy than resveratrol and etoposide. Cell death by apoptosis involved the activation of caspases-3/7, -8, and -9, increased lysosomal permeability, LC3 lipidation, poly-(ADP-ribose) polymerase (PARP)-1 fragmentation, and a differential expression of genes related with apoptosis and autophagy like Mcl-1, Survivin, Noxa, LC3, and Beclin. In addition, apoptosis activation was partially dependent on p53 activation. Since experimental and antineoplastic drugs yielded similar results, further work is required to justify their use in clinical protocols.

The role of posttraumatic stress and posttraumatic growth on online information use in breast cancer survivors.

OBJECTIVE: Changes perceived as both positive (eg, posttraumatic growth [PTG]) and negative (eg, posttraumatic stress symptoms [PTSS]) have been associated with intensive Internet use among breast cancer survivors. In this multicenter study, we analyzed the role of PTG and PTSS on the amount of time spent looking for online cancer information, its content, and its psychological impact. METHODS: Posttraumatic stress symptoms and PTG were assessed in 182 breast cancer survivors by using the Post-traumatic Stress Disorder Checklist and Post-traumatic Growth Inventory questionnaires. Subjects also completed a questionnaire about their behavior when looking for online illness-related information (ie, time spent, type of contents, and psychological impact). RESULTS: Posttraumatic stress symptoms positively correlated with the amount of time spent looking for cancer-related information, including both medical and psychosocial content. By contrast, PTG showed no relationships with the amount of time, but with a predominant search for cancer-related psychosocial information. The psychological impact of online information was associated with participants' levels of PTG and/or PTSS. Whereas PTG was related to a decrease of women's hope, PTSS was linked to the perception of being less conscious or inadequately informed about the illness, thereby increasing feelings of distress. CONCLUSIONS: Posttraumatic stress symptoms and PTG show relationships with the amount of time spent online, the type of information accessed online, and the psychological impact of Internet use. Health professionals should prescribe online information according to the psychological response to cancer. There is a need for professional-led online resources to provide patients with timely information as well as support sites to facilitate psychological adjustment.

Evaluación de la portación de cándida spp en pinzas ortodóncicas post utilización / Evaluation of candida spp carriage on orthodontic pliers, after using them

Objetivo: evaluar el nivel de contaminación por Candida spp, post uso del instrumental de ortodoncia que se utiliza intrabucalmente en pacientesColombianos y Argentinos. Materiales y métodos: Se incluyeron pacientesentre 16 y 65 años, de ambos sexos, con armado de brackets superior e inferior. Criterios de Exclusión: pacientes con brackets de autoligado, con enfermedades autoinmunes, con enfermedades sistémicas con manifestaciones en el periodonto, pacientes fumadores, menores de 16 años y con armado de brackets en un solo maxilar. Se analizaron los alicates de corte distal Hu Friedy luego de ser utilizados para seccionar el arco por distal del último tubo presente enboca. Se estudiaron 80 pacientes agrupados en: Grupo A 40 pacientesColombianos, Grupo B 40 pacientes argentinos. Se realizó una primer tomaintrabucal con un hisopo estéril y se llevó a un tubo con medio de Stuart. Se cortaron las 4 secciones distales de los arcos en boca tardando al menos 1 minuto. Con un segundo hisopo estéril se frota toda la superficie del alicate post uso y se llevaron a otro tubo. Se sembraron en Chromagar Candida y se realizaron pruebas microbiológicas convencionales. Resultados: Las pinzas estériles aparecen contaminadas post corte distal delos alambres en el 95% de los casos en ambos países. Hubo diferencia entrelos pacientes colombianos y los argentinos respecto a las especies, ya que enlos primeros la especie con mayor prevalencia fue Candida tropicalis tanto en lapinza como en la cavidad bucal, mientras que en los argentinos fue Candidaalbicans. Conclusión: las pinzas de ortodoncias se contaminan con Candidaspp post utilización en boca y son un fómite a partir del cual puede generarsediseminación sistémica así como infección cruzada.

Hydroxyapatite, polycaprolactone and alendronate composites for bone regeneration in rabbits' olecranon: histological features / Compósitos de hidroxiapatita, policaprolactona e alendronato na regeneração óssea em olécrano de coelhos: características histológicas

O presente trabalho teve como objetivo avaliar a biocompatibilidade e a osseointegração de compósitos de hidroxiapatita (HA), policaprolactona (PCL) e alendronato (ALN) em defeitos ósseos produzidos no olécrano de coelhos. Trinta e seis coelhos foram distribuídos em quatro grupos, recebendo como tratamento: (1) compósito de HA (49,5%), PCL (49,5%) e ALN (1%); (2) HA (50%) e PCL (50%); (3) PCL (100%); e (4) solução salina 0,9%. As amostras para análise histológica foram coletadas de três animais de cada grupo aos oito, 45 e 90 dias de pós-operatório. No oitavo dia, as bordas do defeito ainda eram identificáveis em todos os grupos. Tecido ósseo novo era formado em contato com o biomaterial apenas nas formulações que incluíam HA. Essas características continuaram evidentes nos outros momentos analisados, embora o defeito estivesse preenchido pelo tecido regenerado. A presença dos biomateriais foi verificada nos três momentos em todos os grupos. Não houve evidências de reação indesejável ao biomaterial. As análises histológicas e histomorfométricas mostraram que os biomateriais são biocompatíveis e aqueles contendo a hidroxiapatita favoreceram a formação óssea no início do processo de regeneração, embora o alendronato não tenha apresentado qualquer efeito.

Hydroxyapatite, polycaprolactone and alendronate composites for bone regeneration in rabbits' olecranon: histological features / Compósitos de hidroxiapatita, policaprolactona e alendronato na regeneração óssea em olécrano de coelhos: características histológicas

O presente trabalho teve como objetivo avaliar a biocompatibilidade e a osseointegração de compósitos de hidroxiapatita (HA), policaprolactona (PCL) e alendronato (ALN) em defeitos ósseos produzidos no olécrano de coelhos. Trinta e seis coelhos foram distribuídos em quatro grupos, recebendo como tratamento: (1) compósito de HA (49,5%), PCL (49,5%) e ALN (1%); (2) HA (50%) e PCL (50%); (3) PCL (100%); e (4) solução salina 0,9%. As amostras para análise histológica foram coletadas de três animais de cada grupo aos oito, 45 e 90 dias de pós-operatório. No oitavo dia, as bordas do defeito ainda eram identificáveis em todos os grupos. Tecido ósseo novo era formado em contato com o biomaterial apenas nas formulações que incluíam HA. Essas características continuaram evidentes nos outros momentos analisados, embora o defeito estivesse preenchido pelo tecido regenerado. A presença dos biomateriais foi verificada nos três momentos em todos os grupos. Não houve evidências de reação indesejável ao biomaterial. As análises histológicas e histomorfométricas mostraram que os biomateriais são biocompatíveis e aqueles contendo a hidroxiapatita favoreceram a formação óssea no início do processo de regeneração, embora o alendronato não tenha apresentado qualquer efeito.(AU)

EUS-guided single-incision needle-knife biopsy: description and results of a new method for tissue sampling of subepithelial GI tumors (with video).

BACKGROUND: The diagnostic efficacy of current tissue sampling techniques for upper GI subepithelial tumors (SETs) appears to be limited. Better tissue acquisition techniques are needed to improve the diagnostic yield in this setting. OBJECTIVE: Our purpose was to determine the safety and diagnostic yield of EUS-guided needle-knife incision and forceps biopsy (SINK biopsy) of upper GI SETs. DESIGN: Retrospective database review. SETTING: Academic tertiary-care referral center. PATIENTS: This study involved 14 consecutive patients referred for EUS evaluation of upper GI SETs with previous unsuccessful attempts at tissue diagnosis by conventional forceps biopsy. INTERVENTION: EUS-guided needle-knife incision and forceps biopsy. MAIN OUTCOME MEASUREMENTS: The safety and diagnostic yield of this method, compared with EUS-guided fine-needle aspiration (EUS-FNA), when possible. RESULTS: SINK biopsy provided tissue samples that were sufficient for definite histologic diagnosis in 13 of 14 cases (diagnostic yield 92.8%). There were 8 gastric GI stromal tumors. In 7 of 8, the size of SINK specimens allowed immunohistochemical analysis, and the evaluation of malignant potential was carried out by means of mitotic index determination in 5 cases (71.42%). SINK biopsies determined the pathological diagnosis of all (4 of 4) nonmesenchymal lesions. Eight patients underwent both EUS-FNA and SINK, with final histologic diagnosis determined in 6 of 8 cases (75%) by SINK versus 1 of 8 cases (12.5%) by EUS-FNA (Fisher exact test, P = .023). There were no procedure-related complications. LIMITATIONS: A single-center, retrospective analysis with small sample size. CONCLUSION: SINK biopsy appears to be an easy, safe, and effective technique for determining the definitive pathological diagnosis, evaluation of the malignant potential, and planning management of SETs. It could be a reliable alternative to conventional FNA, providing larger samples that improve the histologic yield.

Modulation of murine blastocyst hatching in vitro by glutamine and tryptophan

Enrichment of culture media with amino acids improves embryo development. However, little is known about the specific action of each amino acid during embryogenesis. The present study was undertaken to examine the effect of L-glutamine (Gln) and tryptophan (Trp) on mouse embryo hatching, expansion and viability in vitro. Blastocysts were collected from 6- to 8-week-old female BALB/c mice (N = 30) and cultured in M2 medium containing either 0.125, 0.25 or 0.5 mM Trp, 1 mM Gln, or M2 alone. Gln significantly increased (100 percent; P < 0.05) blastocyst hatching at 24 h compared to M2 alone or Trp; moreover, Trp inhibited blastocyst hatching when compared to M2 alone (P < 0.05) at 72 h. In contrast, the percentage of embryos reaching the state of expanded blastocyst at 48 h was significantly higher in medium with 1 mM Gln (66.6 percent; P < 0.05) or with 0.125 mM Trp (61.1 percent; P < 0.05). Unexpectedly, Trp increased the percentage of degenerated blastocysts after 48 h (67.7 percent; P < 0.05), while Gln preserved blastocyst viability. These results suggest that Gln may enhance blastocyst hatching, expansion and viability in vitro.

Cultivos de célllas de nervio ciático y de ganglio de la raíz dorsal de ratón adulto / Cell Cultures of the Sciatic Nerve and Dorsal Root Ganglia from Adult Mouse

Las células de Schwann (CS) son la glía de sistema nervio periférico. El diseño de prótesis nerviosas se ha centrado en la producción de CS autólogas cultivadas a partir de nervios ciáticos (NC) y de ganglios de la raíz dorsal (GRD). Muy poca literatura reporta cultivo de células perineurales (CP) y fibroblastos endoneurales (FE), y no son consideradas como elementos a incluir en una prótesis. En este trabajo, se describe la importancia de la microdisección del nervio ciático y de los GRD para obtener cultivos de CS, FE y CP con 98%±2 de purificación. Las CS crecen sobre diferentes soportes, con y sin mitógenos. Se obtuvo un porcentaje de CS elevado cuando se elimina el epineuro y perineuro de los NC 90%±3 y la cápsula de los GRD 94%±3 antes de la disociación enzimática, comparado a 70%±4,2 sin microdisección u 80%±3,5 sin epineuro. Los FE se adhieren preferencialmente en las primeras 24 h y 20% de suero favorece su crecimiento. En el primer sub-cultivo, son 99% CS o FE, siendo confluentes a los 6 y 8 días respectivamente. Las CP o de la cápsula de GRD no se disocian y no crecen en sub-cultivos, únicamente crecen a partir de explantes de perineuro; no forman monocapa sino una "lámina" de múltiples capas celulares. En conclusión, la microdisección del GRD y del NC y su disociación son indispensables para obtener en pocos días CS, FE y CP de animales adultos en cultivos altamente purificados.

The Schwann cells (SC) are glial of system peripheral nerve. The nervous prostheses are related to the production of autologous SC obtained from the peripheral nervous and from the dorsal root ganglia (DRG). There is a small amount of literature that reports perineural cells (PC) and endoneural fibroblast (EF) cultures as elements to take account of prostheses. In this work, the micro dissection importance is described in the sciatic nerve (SN) and in the DRG to achieve SC, EF and PC culture with a purity of 98%. The SC grows up on different supports with and without mitogens. An elevated percentage of SC was obtained when the epineurium and the perineurium were removed in the SN (90%±3) and in the GRD (94%±3) before the enzymatic dissociation compared to seventy percentage when the micro dissection was omitted or eighty percentage without the epineurium micro dissection. The EF was adhered in the first twenty four hours and the twenty percentage of serum improved their growth. In the first passage, there is 99 percentage SC or EF, and they get the confluence in the six and eight day, respectively. The PC or the cells of the DRG don´t have neither a good dissociation, nor a growth in subcultures, they only grow from the perineurium explants that forms a lamina of several cellular layers more than a monolayer. In conclusion, the DRG and SN micro dissection and dissociated are indispensable to acquire in few days SC, EF and PC cultures with a high purity from adult animals.

Effects of human versus mouse leukemia inhibitory factor on the in vitro development of bovine embryos.

Leukemia inhibitory factor (LIF) is a cytokine that shows conflicting effects on in vitro produced (IVP) bovine embryos. Bovine LIF (bLIF) has been cloned and used in culture, but there is no commercially available bLIF. Thus, researchers use human LIF (hLIF) to supplement the culture medium for bovine embryos because of its greater sequence homology compared to murine LIF (mLIF). We compared the effects of mLIF and hLIF on the development of bovine embryos in culture with the effects described for bLIF. Oocytes were matured and fertilized in vitro and cultured in modified synthetic oviduct fluid with BSA. On Day 6 post-insemination, morulae were cultured for 48h in the presence of: (1) mLIF, 100ngml(-1); (2) hLIF, 100ngml(-1); or (3) no LIF. Reduced blastocyst rates were observed on Day 8 for hLIF at the middle and expanded stages, while mLIF had no effect. In contrast, Day 8 blastocysts showed decreased cell counts both in terms of inner cell mass (ICM) and ICM/total cell proportions in the presence of mLIF, while hLIF had no effect. No changes were seen in trophectoderm (TE) and total cell counts. The increased hatching rates and TE cell counts previously described for bLIF, together with the disparate effects exhibited by hLIF and mLIF during blastocyst formation indicate these compounds are inappropriate to replace bLIF. We recommend that heterospecific LIF should not be used to supplement the culture medium for bovine embryo or embryonic stem cells.

[Usefulness of magnetic resonance angiography in surgery of ruptured intracranial aneurysms]. / Utilidad de la angiografía por resonancia magnética en la cirugía de aneurismas intracraneales rotos.

INTRODUCTION: Cerebral angiography (CA) is considered as the gold standard in diagnosis of intracranial aneurysms; nevertheless, the magnetic resonance angiography (MR-angiography) is wide spread used in detection of unruptured aneurysm. For this reason, several authors had proposed that MR-angiography could replace CA in the diagnosis of ruptured aneurysms. AIMS: To asses the efficacy of MR-angiography in diagnosis of ruptured intracranial aneurysms, and in addition to determine the safeness of its surgical management with MR-angiography alone. PATIENTS AND METHODS: We studied prospectively 52 patients with subarachnoid haemorrhage admitted at Teodoro Maldonado Carbo and Alcívar Guayaquil hospitals of Guayaquil, Ecuador, in a 5 years period. We compared the results of MR-angiography with CA and surgical findings in the diagnosis and categorization of intracranial aneurysms. RESULTS: We made diagnosis of 100% of 54 aneurysms with MR-angiography, while 98% with CA. The surgical findings were similar to the characteristics showed by MR-angiography. CONCLUSIONS: MR-angiography is an excellent no invasive method in the diagnosis of ruptured intracranial aneurysms, and could replace CA in selected cases.

Tumor filodes benigno de la mama: a propósito de un caso / Filodes benign tumor of the breast: a purpose of a case

El tumor filodes es una patología poco frecuente. Aunque por lo general es benigno histológicamente, puede presentar un comportamiento maligno con alta tasa de mortalidad. Muy similar al fibroadenoma, crece sustancialmente más rápido y puede alcanzar dimensiones de hasta 20 centimetros. Se presenta el caso de una paciente femenina de 44 años quien 1 año antes se le diagnóstico un tumor filodes de mama derecha de poco diámetro que progreso hasta alcanzar aproximadamente los 20 cms de diámetro acompaño de infección de piel y partes blandas. Al mejorar condiciones se resolvió con una mastectomía total y permanece asintomática al presente. Considerando la poca incidencia y la alta tasa de confusión con fibroadenomas se reviso la literatura que avalara las técnicas diagnósticas terapéuticas empleadas actualmente en el manejo de estos pacientes.

Uso de antibióticos en pacientes sometidos a apendidectomía: Hospital Patrocinio Peñuela Ruíz: enero de 2001 diciembre de 2004 / Use of antibiotics in patients undergoing appendicectomy: Hospital Patrocinio Peñuela Ruíz: january 2001-december 2004

Los antibióticos (ATB) previenen las complicaciones infecciosas post-apendicectomías. Se realizo un estudio descriptivo, retrospectivo de 220 casos de apendicectomías en el Hospital "Dr. Patrocinio Peñuela Ruíz" desde enero 2001 a diciembre 2004, cuyo objetivo fue determinar el tipo de ATB momento de colocación, duración y coincidencia preoperatoria (ATB-pre) y postoperatoria (ATB-post). El ATB-pre fue administrado un 62,73 por ciento; 2 horas antes de cirugía 48,92 por ciento. El 99,55 por ciento recibió ATB-post durante 3,31 días en promedio. La cefazolina fue el ATB-pre (34,78 por ciento) y ATB-post (16,82 por ciento) mas frecuente. En el 36,96 por ciento coincidieron ATB-pre y ATB-post, el 34,05 por ciento aumento y un 28,26 por ciento cambio totalmente el ATB-post.