Influence of apical enlargement on the repair of apical periodontitis in rats.

AIM: To evaluate the influence of different apical enlargement protocols on the radiographic and histological healing of apical periodontitis in rats. METHODOLOGY: Apical periodontitis was induced bilaterally in the mandibular right and left first molars of 24 Wistar rats by pulp exposure to the oral cavity for 3 weeks. A standard serial root canal preparation technique was performed in the molar of one side, whilst the opposite side was the control group. Rats were randomly divided into three experimental groups (n = 8), according to the diameter of apical enlargement during root canal preparation: K-files size 20 (EG1), size 25 (EG2) and size 30 (EG3). Each animal was its own positive control, because the opposite arch remained untreated. Root canals were filled with a standard technique. After 3 weeks, the animals were euthanized. The main outcome of apical periodontitis healing was evaluated radiographically (mm2 ) and histologically (ordinal scores of inflammation) using a HE staining technique. The measurement of effect was obtained between the three experimental groups by carrying out generalized estimating equations, with Poisson regression with robust variance, pairing each experimental group with its respective control group within animals, adjusted for the mean within animal differences, with α = 5%. RESULTS: The mean and standard deviations of radiographic apical periodontitis size (mm2 ) and intensity of histological inflammatory scores were, respectively: EG1 (0.44 ± 0.27; 2.25 ± 0.46), EG2 (0.33 ± 0.10; 2.50 ± 0.53) and EG3 (0.22 ± 0.08; 2.63 ± 0.74). After 3 weeks, a significantly more favourable radiographic repair was observed when larger apical enlargement was performed (EG3), compared to EG1 and EG2 (P = 0.001). All experimental groups were associated with a significant difference on the radiographic and histological healing of apical periodontitis compared with its respective control group. CONCLUSION: Under the experimental conditions of this study, a larger apical enlargement protocol favoured a more rapid radiographic repair of apical periodontitis in rats after a 3-week follow-up.

Blood volumes in cardiac surgery with cardiopulmonary bypass.

PURPOSE: Total blood volume (TBV) estimation potentially impacts various aspects of cardiac surgical care, including pharmacological and transfusion interventions, hemodynamic and volume management and perfusion equipment selection. TBV is commonly computed during cardiopulmonary bypass (CPB), using standardized formulae. We hypothesized that these equations fail to accurately predict individual blood volume variability. The aim of this study was to determine TBV with a dilution technique and compare the results to commonly utilized TBV calculations. METHODS: After institutional review board approval, data was prospectively collected and analyzed for 101 patients undergoing open-heart surgery. Hematocrits (Hct) just prior to and immediately after the initiation of CPB were used to calculate the TBV. Results were compared to (1) the Allen formula and (2) weight-based standards (70 ml/kg for males (SM); 65 ml/kg for females (SF)). RESULTS: The average dilution TBV (male: 4684 ± 1641 ml; female: 3027 ± 1067 ml; total: 4175 ± 1617 ml) was significantly smaller (p<0.05) than TBV estimated by Allen's formula (male: 6328 ± 973 ml; female: 4167 ± 643 ml; total: 5665 ± 1134 ml) and weight-based standards (male: 6278 ± 1256 ml; female: 4924 ± 1064 ml; total: 5862 ± 1350 ml). Allen's formula and the weight-based standards correlated strongly (R(2) = 0.821, p<0.001), suggesting similar estimates of TBV when using these methods. In contrast, hemodilution correlated poorly with the estimates by Allen (R(2) = 0.221, p<0.001) and weight-based formulae (R(2) = 0.122, p<0.001), suggesting different TBV computation. CONCLUSIONS: The dilution method during CPB for TBV estimation is applicable and reproducible in the cardiac surgical arena and can be utilized to calculate TBV. Our results suggest that traditional TBV assessment in cardiac surgical patients by Allen's and weight-based formulae lacks the desired accuracy in estimating true TBV.

Blood volume measurement by hemodilution: association with valve disease and re-evaluation of the Allen Formula.

BACKGROUND: Total blood volume (TBV) assessment is central to the management of cardiac surgical patients with cardiopulmonary bypass (CPB). The widely accepted Allen Formula lacks accuracy in estimating TBV in these patients. Moreover, the impact of commonly encountered cardiac disease states on TBV has not been systematically investigated. The aim of this study was to determine TBV by hemodilution (TBVHD) for patients with valve disease, compare TBVHD to algorithms frequently used during cardiac surgery and to modify the Allen Formula to better fit today's patient population. METHODS: TBVHD was prospectively measured upon initiation of CPB. Ninety-six patients were grouped into 4 cohorts by preoperative diagnosis and compared to Allen and weight-based formulae in a univariate analysis: mitral regurgitation (MR), coronary artery disease requiring bypass surgery (CABG) and aortic stenosis (AS) ± CABG. The independent effects of height and weight on TBV were correlated to the original Allen Formula by multiple linear regression. RESULTS: Patients with MR had significantly larger TBVHD compared to patients with AS, CABG or both. The smallest TBVHD was found in the patients with AS and CABG. The modified Allen Formula had an excellent model fit (R(2) = 0.88 and R(2) = 0.95 for males and females, respectively; p<0.001) while the classic formula overestimated TBV by 30% in males and females. For males, height impacted TBV calculations the most whereas weight was the predominant determinant in females. CONCLUSION: Blood volume assessment via the Allen Formula or bodyweight overestimated TBV in cardiac surgical patients, with potential implications on their management. The assumption that MR frequently presents with increased intravascular volume was confirmed whereas AS patients with coronary disease had a relatively smaller TBV. Lastly, a modified Allen Formula to better reflect today's patient population was derived to reproducibly improve accuracy in mathematical estimates of TBV.

[Surgical treatment of renal hyperparathyroidism. Experience in 71 patients]. / Tratamiento quirúrgico del hiperparatiroidismo asociado a insuficiencia renal crónica.

BACKGROUND: Surgery is an effective method for the management of renal hyperparathyroidism. AIM: To report the clinical presentation and results of surgical treatment of renal hyperparathyroidism. MATERIAL AND METHODS: Retrospective analysis of 58 patients aged 46 ± 11 years with secondary hyperparathyroidism (HPT2) and 13 patients aged 53 ± 11 years with tertiary hyperparathyroidism (HPT3), operated at a clinical hospital. RESULTS: In 55 cases (77.4%) the indications for surgery were complications of excess parathyroid hormone (PTH) and in 16 patients (22.6%) a failure of medical treatment. Total parathyroidectomy with intraoperative measurement of PTH (PTHop) plus a forearm parathyroid autograft was performed in 54 (93.1%) patients with HPT2 and in all patients with HPT3. PTHop decreased ≥ 75% in 51 patients (88%) with HPT2 and in 9 patients (69.2%) with HPT3, respectively. Cure of the disease was achieved in 52 (89.7%) and 11 (84.6%) patients with HPT2 and 3, respectively. Median follow-up was 41 months. Five (9.6%) patients with HPT2 and two patients (18.2%) with HPT3 had a recurrence of the disease. CONCLUSIONS: In patients with renal hyperparathyroidism, the primary indication for surgery was the presence of complications of PTH excess. A drop in PTHop ≥ 75% from baseline predicts healing in 98% and 100% of cases with secondary or tertiary HPT respectively. Surgery was a safe and effective treatment in both groups.

Spanish Mediterranean diet and other dietary patterns and breast cancer risk: case-control EpiGEICAM study.

BACKGROUND: Although there are solid findings regarding the detrimental effect of alcohol consumption, the existing evidence on the effect of other dietary factors on breast cancer (BC) risk is inconclusive. This study aimed to evaluate the association between dietary patterns and risk of BC in Spanish women, stratifying by menopausal status and tumour subtype, and to compare the results with those of Alternate Healthy Index (AHEI) and Alternate Mediterranean Diet Score (aMED). METHODS: We recruited 1017 incident BC cases and 1017 matched healthy controls of similar age (±5 years) without a history of BC. The association between 'a priori' and 'a posteriori' developed dietary patterns and BC in general and according to menopausal status and intrinsic tumour subtypes (ER+/PR+ and HER2-; HER2+; and ER-/PR- and HER2-) was evaluated using logistic and multinomial regression models. RESULTS: Adherence to the Western dietary pattern was related to higher risk of BC (OR for the top vs the bottom quartile 1.46 (95% CI 1.06-2.01)), especially in premenopausal women (OR=1.75; 95% CI 1.14-2.67). In contrast, the Mediterranean pattern was related to a lower risk (OR for the top quartile vs the bottom quartile 0.56 (95% CI 0.40-0.79)). Although the deleterious effect of the Western pattern was similarly observed in all tumour subtypes, the protective effect of our Mediterranean pattern was stronger for triple-negative tumours (OR=0.32; 95% CI 0.15-0.66 and Pheterogeneity=0.04). No association was found between adherence to the Prudent pattern and BC risk. The associations between 'a priori' indices and BC risk were less marked (OR for the top vs the bottom quartile of AHEI=0.69; 95% CI 0.51-0.94 and aMED=0.74; 95% CI 0.46-1.18)). CONCLUSIONS: Our results confirm the harmful effect of a Western diet on BC risk, and add new evidence on the benefits of a diet rich in fruits, vegetables, legumes, oily fish and vegetable oils for preventing all BC subtypes, and particularly triple-negative tumours.

Oxidative stress in the mollusk Echinolittorina peruviana (Gasteropoda: Littorinidae, Lamarck, 1822) and trace metals in coastal sectors with mining activity.

The aim of the study was to evaluate the effect of coastal waters of sites with mining activity in Echinolittorina peruviana, through oxidative stress biomarkers and heavy metals determination both in water and in tissue. Organisms were collected in the intertidal zone in areas with and without mining activity. Metal concentrations in the water and tissues, and also, the following biomarkers of oxidative stress: antioxidant enzyme activity, superoxide dismutase and catalase, non-enzymatic oxidative capacity (TRAP), oxidative damage to proteins (carbonyls) and TBARS, were measured The concentrations of accumulated metals had the following order Fe > Cu > Cd > Zn > Cr > Mo > As; the highest concentrations of metals in water and tissues were found in Caleta Palito and Chañaral. Results suggest that the coastal waters with mining activity and greatest concentrations of copper and iron induced the greater antioxidant response and oxidative damage to lipids in E. peruviana.

Accumulation and distribution of perchlorate in spinach and chard growing under greenhouse: Implications for food safety in baby foods commodities.

Very little information is available with regards to the bioavailability of perchlorate in spinach or chard used in the production of baby foods commodities. In the present study, the uptake and accumulation of perchlorate were compared under two different treatments (T1: 1 and T2: 10 mg L-1 ClO4-). Our results indicate that spinach has a higher capacity to accumulate perchlorate than chard (p < 0.0185). Concentrations of perchlorate in leaves, stems and roots (leaves > stem > roots) all gradually increased (p < 0.0001) as vegetable growing and treatment (T2 > T1). No significant differences were found between the control and T1. The daily intake for perchlorate (control) is below the proposed international standard, however, it was exceeded in T1 and T2. The results suggested that perchlorate is actively accumulate in high concentrations in vegetables used in the production of baby food commodities and the exposure of perchlorate via the food consumption (baby foods) was evaluated as not safe.

Exploring the destiny and distribution of thiocyanate in the water-soil-plant system and the potential impacts on human health.

Endocrine disruptors like thiocyanate are some of the principal causes of chronic disorders worldwide. Prenatal and postnatal exposure to thiocyanate can interfere with normal neurological development in both fetuses and newborns. Currently, little information regarding thiocyanate levels and potential sources of exposure is available. In this study, we evaluated thiocyanate uptake and accumulation in chard and spinach grown under greenhouse conditions. Both chard and spinach are commonly used to produce baby foods. Three thiocyanate concentrations were compared: Control, T1 (30 ng mL-1), and T2 (70 ng mL-1). Thiocyanate accumulation depended on the concentration and exposure time. Chard was found to accumulate more thiocyanate than spinach, with leaf accumulation > stem accumulation (p < 0.0194) and maximum concentrations of 76 ng g-1 (control), 112 ng g-1, (T1), and 134 ng g-1 (T2). The estimated daily intake (EDI) of thiocyanate for chard and spinach (fresh) exceeded the subchronic reference dose of 200 ng-1 kg-1 day-1 and the chronic reference dose of 600 ng-1 kg-1 day-1. In addition, the EDI of thiocyanate for spinach in baby food exceeded twice the chronic reference dose in the vulnerable newborn-1 year age group. However, all EDIs were lower than the lowest observed adverse effect level (LOAEL) of 1.9 × 105 ng kg-1 day-1. Further studies are needed that increase our knowledge of thiocyanate levels and potential environmental sources to reduce opportunities for exposure, especially in vulnerable groups.

Polymorphisms in cytochromes P450 2C8 and 3A5 are associated with paclitaxel neurotoxicity.

Neurotoxicity is one of the most relevant dose-limiting toxicities of the anticancer drug paclitaxel. It exhibits substantial interindividual variability of unknown molecular basis, and represents one of the major challenges for the improvement of paclitaxel therapy. The extensive variability in paclitaxel clearance and metabolism lead us to investigate the association between polymorphisms in paclitaxel elimination pathway and neurotoxicity. We selected 13 relevant polymorphisms in genes encoding paclitaxel metabolizing enzymes (CYP2C8, CYP3A4 and CYP3A5) and transporters (organic anion transporting polypeptide (OATP) 1B1, OATP1B3 and P-glycoprotein) and genotyped them in 118 Spanish cancer patients treated with paclitaxel. After adjusting for age and treatment schedule, CYP2C8 Haplotype C and CYP3A5*3 were associated with protection (hazard ratio (HR) (per allele)=0.55; 95% confidence interval (CI)=0.34-0.89; P=0.014 and HR (per allele)=0.51; 95%CI=0.30-0.86; and P=0.012, respectively) and CYP2C8*3 with increased risk (HR (per allele)=1.72; 95%CI=1.05-2.82; and P=0.032). In each case, the allele causing increased paclitaxel metabolism was associated with increased neurotoxicity, suggesting an important role for metabolism and hydroxylated paclitaxel metabolites. We estimated the HR per paclitaxel-metabolism increasing allele carried across the three polymorphisms to be HR=1.64 (95% CI=1.26-2.14; P=0.0003). The results for P-glycoprotein were inconclusive, and no associations were observed for the other genes studied. The incorporation of this genetic data in treatment selection could help to reduce neurotoxicity events, thereby individualizing paclitaxel pharmacotherapy. These results warrant validation in independent series.

Electronic health records and patient registries in medical oncology departments in Spain.

PURPOSE: We aimed to evaluate the current situation of electronic health records (EHRs) and patient registries in the oncology departments of hospitals in Spain. METHODS: This was a cross-sectional study conducted from December 2018 to September 2019. The survey was designed ad hoc by the Outcomes Evaluation and Clinical Practice Section of the Spanish Society of Medical Oncology (SEOM) and was distributed to all head of medical oncology department members of SEOM. RESULTS: We invited 148 heads of oncology departments, and 81 (54.7%) questionnaires were completed, with representation from all 17 Spanish autonomous communities. Seventy-seven (95%) of the respondents had EHRs implemented at their hospitals; of them, over 80% considered EHRs to have a positive impact on work organization and clinical practice, and 73% considered that EHRs improve the quality of patient care. In contrast, 27 (35.1%) of these respondents felt that EHRs worsened the physician-patient relationship and conveyed an additional workload (n = 29; 37.6%). Several drawbacks in the implementation of EHRs were identified, including the limited inclusion of information on both outpatients and inpatients, information recorded in free text data fields, and the availability of specific informed consent. Forty-six (56.7%) respondents had patient registries where they recorded information from all patients seen in the department. CONCLUSION: Our study indicates that EHRs are almost universally implemented in the hospitals surveyed and are considered to have a positive impact on work organization and clinical practice. However, EHRs currently have several drawbacks that limit their use for investigational purposes. CLINICAL TRIAL REGISTRATION: Not applicable.

Situation, challenges, and SEOM recommendations for the future of undergraduate education in Oncology in Spain.

PURPOSE: The Spanish Society of Medical Oncology (SEOM, for its Spanish acronym) would like to attest to the relevance of training in Oncology as part of the undergraduate education in Medicine program and issue recommendations to improve said training, with the aim of responding better to the challenges that cancer poses to our society. MATERIALS AND METHODS: The curricula of 42 schools of medicine were reviewed with interviews with at least one teaching medical oncologist from each faculty. The qualitative and opinion analysis was completed by means of an online questionnaire targeting lecturers, resident tutors, and residents in Medical Oncology (MO), enabling the detection of needs and areas for improvement at an organizational level and in terms of skill acquisition. RESULTS: While the number of medical schools with a specific, mandatory program in MO has grown by up to 90%, it has not been accompanied by an increase in independent programs. Instead, they largely consist of programs shared with other specialties (61% of the medical faculties). In most of the undergraduate education programs, Oncology contents are fragmented and approached from the perspective of each organ system. CONCLUSIONS: Despite the positive evolution in recent years, the heterogeneity in Oncology contents during undergraduate education training continues to be remarkable. Cross-sectional programs with an integral vision, taught in the final years of undergraduate medical education would be desirable. Among the recommendations for improvement of training in Medical Oncology, the SEOM proposes that updated, theoretical content be incorporated and clinical practice in Medical Oncology departments be promoted.

Conservation assessment of southern South American freshwater ecoregions on the basis of the distribution and genetic diversity of crabs from the genus Aegla.

We assessed the conservation priority of 18 freshwater ecoregions in southern South America on the basis of Aegla (genus of freshwater crabs) genetic diversity and distribution. Geographical distributions for 66 Aegla species were taken from the literature and plotted against ecoregions and main river basins of southern South America. Species richness and number of threatened and endemic species were calculated for each area. To assess taxonomic and phylogenetic diversity, we generated a molecular phylogeny based on DNA sequences for one nuclear (28S) and 4 mitochondrial (12S, 16S, COI, and COII) genes. All species richness and phylogenetic methods agreed, to a large extent, in their rankings of the importance of conservation areas, as indicated by the Spearman's rank correlation coefficient (p < 0.01); nonetheless, some of the lowest correlations were observed between taxonomic and phylogenetic diversity indices. The 5 ecoregions of the Laguna dos Patos Basin (Eastern Brazil), Central Chile, South Brazilian Coast, Chilean Lakes, and Subtropical Potamic Axis (northern Argentina and southern Uruguay and Paraguay) had the highest biodiversity scores. Conservation of these regions will preserve the largest number of species and the greatest amount of genetic diversity within the South American freshwater Aegla fauna. Biodiversity across rivers and within areas was heterogeneously distributed in the ecoregions of Upper Paraná, Ribeira do Iguape, Upper Uruguay, and South Brazilian Coast (i.e., one river showed significantly more biodiversity than any other river from the same ecoregion), but homogeneously distributed in the other ecoregions. Hence, conservation plans in the former regions will potentially require less effort than plans in the latter regions.

Pretreatment neutrophil/lymphocyte, platelet/lymphocyte, lymphocyte/monocyte, and neutrophil/monocyte ratios and outcome in elderly breast cancer patients.

PURPOSE: Several studies have found an association between peripheral inflammatory cells and outcome. However, no study has explored their impact specifically in elderly patients. We have retrospectively examined pretreatment peripheral neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), and neutrophil/monocyte ratio (NMR) in 113 elderly breast cancer patients and correlated our findings with disease-free survival (DFS) and overall survival (OS). METHODS: All patients ≥ 65 years diagnosed from 2004 to 2018 with locally advanced breast cancer were included and classified as high vs low NLR, PLR, LMR, and NMR based on previously identified cutoffs. Estimated 1-, 3-, and 5-year DFS and OS were compared by Chi square analysis. RESULTS: Among 104 evaluable patients, only PLR was significantly associated with estimated 3-year DFS (85.1% vs 63.6%; P = 0.04) and OS (89.3% vs 68.1%; P = 0.03). Among 69 patients with three or more years of follow-up, PLR (P = 0.05), absolute lymphocyte count (ALC) (P = 0.01), polychemotherapy (P = 0.04), number of comorbidities (P = 0.02), polypharmacy (P = 0.005), and clinical stage (P = 0.03) were associated with 3-year DFS. Polypharmacy (OR 4.9; P = 0.02) and ALC (OR 4.6; P = 0.04) retained their significance in the multivariate analysis. CONCLUSIONS: We have found an association between low PLR and longer DFS in elderly breast cancer patients that is in line with findings in patients with a wider range of ages. Our findings on NLR contrast with those of other studies, indicating a potential differential effect in elderly patients. In addition, the effect of polypharmacy on outcome in elderly patients warrants further investigation.

Motility and recovery of alpaca (Vicugna pacos) spermatozoa after centrifugation in a density gradient solution.

BACKGROUND: One of the factors limiting successful processing of alpaca (Vicugna pacos) semen is the viscosity of seminal plasma. The viscous nature of the collected ejaculate has hindered sperm cryopreservation as well as artificial insemination (AI) under field conditions. AIMS: The objective of this investigation was to evaluate recovery, motility, and plasma membrane integrity of alpaca spermatozoa after centrifugation in one of two different solutions at one of three different combinations of speed and time. METHODS: A total of 24 ejaculates was recovered from seven reproductively sound Huacaya males using a modified artificial vagina (AV) after training the animals for semen collection. A 2 × 3 factorial treatment arrangement was utilized for this study. Ejaculates were divided into fractions for centrifugation in one of two solutions (Tris extender or PureSperm®80 density gradient solution) at one of three combinations of speed and time (492 × g for 15 min, 1968 × g for 10 min, or 4448 × g for 7 min). The experiment was replicated eight times. RESULTS: Analysis revealed that centrifugation at 4448 × g for 7 min in PureSperm®80 provided a high recovery rate of spermatozoa with the highest sperm motility and functional integrity of plasma membrane post-centrifugation. Conclusion: Results suggest that adoption of this procedure (centrifugation at 4448 × g for 7 min in PureSperm®80) in the initial processing of alpaca ejaculates may enhance subsequent ability to use semen for AI and other assisted reproductive biotechnologies in this species.

Analysis of several methods for the extraction of high quality DNA from acetic acid bacteria in wine and vinegar for characterization by PCR-based methods.

Acetic acid bacteria (AAB) are fastidious microorganisms with poor recovery in culture. Culture-independent methods are currently under examination. Good DNA extraction is a strict requirement of these methods. We compared five methods for extracting the DNA of AAB directly from wine and vinegar samples. Four matrices (white wine, red wine, superficial vinegar and submerged vinegar) contaminated with two AAB strains belonging to Acetobacter pasteurianus and Gluconacetobacter hansenii were assayed. To improve the yield and quality of the extracted DNA, a sample treatment (washing with polyvinyl pyrrolidone or NaCl) was also tested. DNA quality was measured by amplification of the 16S rRNA gene with conventional PCR. DNA recovery rate was assessed by real-time PCR. DNA amplification was always successful with the Wizard method though DNA recovery was poor. A CTAB-based method and NucleoSpin protocol extracted the highest DNA recoveries from wine and vinegar samples. Both of these methods require treatment to recover suitable DNA for amplification with maximum recovery. Both may therefore be good solutions for DNA extraction in wine and vinegar samples. DNA extraction of Ga hansenii was more effective than that of A. pasteurianus. The fastest and cheapest method we evaluated (the Thermal shock protocol) produced the worst results both for DNA amplification and DNA recovery.

SEOM clinical guideline for treatment of cancer pain (2017).

Pain is a highly prevalent symptom in patients with cancer. Despite therapeutic advances and well-accepted treatment guidelines, a percentage of patients with pain are under-treated. Currently, it has been recognized that several barriers in pain management still exist and, in addition, there are new challenges surrounding complex subtypes of pain, such as breakthrough and neuropathic pain, requiring further reviews and recommendations. This is an update of the guide our society previously published and represents the continued commitment of SEOM to move forward and improve supportive care of cancer patients.

The relationship between physician and cancer patient when initiating adjuvant treatment and its association with sociodemographic and clinical variables.

PURPOSE: The aim of this study was to analyze differences in physician and patient satisfaction in shared decision-making (SDM); patients' emotional distress, and coping in subjects with resected, non-metastatic cancer. METHODS: 602 patients from 14 hospitals in Spain were surveyed. Information was collected regarding physician and patient satisfaction with SDM, participants' emotional distress and coping, as well as patient sociodemographic and clinical characteristics by means of specific, validated questionnaires. RESULTS: Overall, 11% of physicians and 19% of patients were dissatisfied with SDM; 22% of patients presented hopelessness or anxious preoccupation as coping strategies, and 56% presented emotional distress. By gender, female patients showed a higher prevalence of dissatisfaction with SDM (23 vs 14%), anxious preoccupation (26 vs 17%), and emotional distress (63 vs 44%) than males. Hopelessness was more prevalent in individuals with stage III disease than those with stages I-II (28 vs 18%). CONCLUSION: Physicians must be mindful of the importance of emotional support and individual characteristics when communicating treatment options, benefits, and adverse effects of each alternative to oncological patients.

Programa de entrenamiento de parotidectomía en modelo cadavérico perfundido

Introducción: La parotidectomía es una cirugía infrecuente y técnicamente compleja determinada por la dificultad de disección del nervio facial, cuya lesión produce alto grado de morbilidad en los pacientes. Los modelos de simulación animales no logran reproducir las características de la anatomía regional, por lo que se hace necesario explorar otras alternativas para el entrenamiento de estas habilidades. Nuestro objetivo es evaluar un programa de entrenamiento de técnicas de parotidectomía en un modelo cadavé-rico perfundido. Métodos: Se diseñó un programa educacional de Kern de entrenamiento de residentes de Cirugía de Cabeza y Cuello para la realización de parotidectomía total en un modelo cadavérico perfundido. La evaluación se realizó mediante el modelo de Kirkpatrick, en los niveles 1 (reacción), 2A (cambio de actitudes) y 2B (adquisición de conocimientos y habilidades). Resultados: Se elaboró un programa teórico-práctico basado en cátedras y simulación de alta fidelidad. En su mayoría los participantes: recomendarían el curso (Nivel 1); tuvieron mayor motivación para el aprendizaje (Nivel 2) y presentaron mejores indicadores sobre conocimientos, habilidades y percepción de mejoría de sus competencias (Nivel 2B). Conclusión: La utilización de un programa de parotidectomía simulado en un modelo de alta fidelidad basado en modelos cadavéricos humanos perfundidos es una alternativa que mejora la calidad de entrenamiento y es útil y factible para el aprendizaje de técnicas de parotidectomía en residentes de Cirugía de Cabeza y Cuello.

Introduction: The parotidectomy is an infrequent and technically complex surgery due to a difficult dissection that may affect the facial nerve, generating high degree of morbidity in patients. Animal simulation models may not reproduce the human characteristics of cervical anatomy. Therefore, it is necessary to explore other alternatives for training dissection skills. Our objective is to evaluate a parotidectomy's techniques training program in a perfused cadaveric model. Methods: A Kern educational program was designed to train Head and Neck Surgery residents to perform total parotidectomy in a perfused cadaveric model. The evaluation was performed using Kirkpatrick model, at levels 1 (reaction), 2A (change of attitudes) and 2B (acquisition of knowledge and skills). Results: A theoretical-practical program based on lectures and high-fidelity simulation was developed. Most of the participants would recommend the course (Level 1); had greater motivation for learning (Level 2) and showed better indicators of knowledge, skills and perception of improvement in their competencies (Level 2B). Conclusion: The use of a simulated parotidectomy program in a high-fidelity model based on perfused human cadaveric models is an alternative that improves the quality of training and is useful and feasible for learning parotidectomy techniques in residents of Head and Head Surgery.

Prospective analysis of psychological differences between adult and elderly cancer patients during postoperative adjuvant chemotherapy.

PURPOSE: Despite the burgeoning geriatric population with cancer and the importance of understanding how age may be related to mental adjustment and quality of life so far, differences in coping strategies and psychological harm between the elderly and adults are hardly being taken into account to modify the approach to this population. The aim of this prospective study is to describe the differences in psychological characteristics between older and adult cancer patients and examine dissimilarities in their psychological evolution during adjuvant chemotherapy. METHODS: Adults (18-69 years old) and older patients (≥ 70) with newly diagnosed non-metastatic resected cancer admitted to receive adjuvant chemotherapy were recruited. Patients completed the following questionnaires: mini-mental adjustment to cancer, brief symptom inventory, shared decision-making questionnaire-patient's version, multidimensional scale of perceived social support, EORTC quality-of-life instrument, life orientation test-revised, and satisfaction with life scale. RESULTS: 500 cancer patients (394 adults and 106 older) were evaluated. The impact of the diagnosis was less negative among older patients, with no differences in coping strategies, quality of life, or search for support. Regarding psychological changes from the beginning to the end of the adjuvant treatment, both age groups reported more somatic symptoms, increased psychological difficulty, reduced coping strategies, and a significant decrease in quality of life at the end of postoperative chemotherapy. CONCLUSION: Although there were clear psychological differences between adults and senior cancer patients, their evolution during adjuvant chemotherapy was similar, with deterioration in quality of life and coping. This negative psychological impact of adjuvant chemotherapy should be taken into account when considering interventions.

Resultado de los primeros 2 años de implementación de un protocolo ERAS o STAR (eSTrategias para Adelantar la Recuperación) en un hospital público de Chile

Introducción: Las herramientas que han demostrado ser más eficaces en el manejo perioperatorio, corresponden a los protocolos ERAS o STAR (eSTrategias para Adelantar la Recuperación) como nombre local. Objetivo: Describir los resultados obtenidos luego de 2 años de implementación del protocolo STAR en estadía hospitalaria, complicaciones y reingresos. Objetivo secundario describir adherencia al protocolo. Material y Método: Estudio de cohorte retrospectivo no concurrente, en cirugía colorrectal electiva. Enero-diciembre 2016 manejo no protocolizado (grupo no-STAR), agosto 2018 a julio 2020 manejo protocolo STAR (grupo STAR). Registro de variables demográficas, adherencias, complicaciones y reingreso. Se utilizaron variables continuas (cuartiles, promedio y DE), test t-Student, test de Wilcoxon, variables categóricas (frecuencias y porcentajes), test de Fisher y Propensisty Score (PS). Resultados: 239 pacientes; grupo no-STAR 85 pacientes (35,5%), grupo STAR 154 (64,5%), sexo masculino 111 pacientes (43 no-STAR p = 0,347). Promedio edad no-STAR 64,2 (SD 14,7) vs. STAR 66,3 (SD 14,39) (p = 0,3147). Mediana de estadía no-STAR 5 días (promedio 6,9, SD 6,2) y STAR 3 días (promedio 4,8 días, SD 4,4). No-STAR tuvo 22 complicaciones (25,9%) vs 28 STAR (18,2%) p = 0,185. No-STAR 7 reingresos vs 17 STAR (p = 0,654). Análisis de covarianza días de hospitalización ajustado por sexo, edad y cirugía laparoscópica, grupo STAR produce 1,93 días menos de hospitalización (p = 0,005) y PS disminuye en 1,92 días la estadía hospitalaria (p-value = 0,007). Discusión y Conclusión: La implementación de un protocolo de recuperación avanzada logra la reducción de 2 días en la estadía hospitalaria de los pacientes sometidos a una cirugía colorrectal, sin aumentar complicaciones, mortalidad ni reingresos.

Introduction: >Enhanced recovery after Surgery (ERAS) or STAR are the tools that have proven to be more effective in perioperative management. Objective: Primary objective is to describe the results obtained regarding complications, hospital stay and readmissions after 2 years of implementation of the STAR. Secondary objective is to describe protocol adherence. Materials and Method: Non-concurrent retrospective cohort study, in patients with elective colorectal surgery. From January to December 2016 non-protocolized management (non-STAR group), August 2018 to July 2020 STAR protocol management (STAR group). Registration of data like the demographic variables, adherence to protocol, complications and readmissions. Continuous variables (quartiles, mean and SD), t-Student test, Wilcoxon test, categorical variables (frequencies and percentages), Fisher test and propensity score (PS) were used. Results: 239 patients; non-STAR group 85 patients (35.5%), STAR group 154 (64.5%), male 111 patients (43 non-STAR p = 0.347). Average age non-STAR 64.2 (SD 14.7) vs STAR 66.3 (SD 14.39) (p = 0.3147). Median non-STAR stays 5 days (average 6.9, SD 6.2) and for STAR 3 days (average 4.8 days, SD 4.4). Non-STAR had 22 complications (25.9%) vs 28 STAR (18.2%) p = 0.185. No-STAR 7 hospital readmissions vs 17 STAR (p = 0.654). Analysis of covariance (ANCOVA) for hospitalization days adjusted by gender, age and laparoscopic surgery shows 1.93 less hospitalization days (p = 0.005); Propensity Score (PS) shows reduced hospital stay in 1.92 days (p-value = 0.007). Discussion and Conclusión: The implementation of an advanced recovery protocol achieves a reduction of 2 days in the hospital stay of patients undergoing colorectal surgery, without increasing complications, mortality or readmissions.