[Spinal cord stimulation in refractory complex regional pain syndrome. A prospective study]. / Estimulación medular en el síndrome de dolor regional complejo refractario. Un estudio prospectivo.

INTRODUCTION AND AIMS: The objective of treatment of complex regional pain syndrome is to relieve pain and restore function in the affected limb. The aim of this study is to evaluate spinal cord stimulation as a therapy for patients diagnosed with complex regional pain syndrome, for whom adequate pain control could not be achieved with other previous treatments. PATIENTS AND METHODS: A prospective study was conducted from 2018 to 2020. We included patients diagnosed with complex regional pain syndrome refractory to other treatments or techniques, classified by demographic data. Efficacy, functionality and opioid dependence in each patient were subsequently monitored for one year. RESULTS: Seven of the 13 patients (53.84%) included in the study achieved significant pain relief with spinal cord stimulation. Improvements in pain and functionality were obtained, and both were statistically significant (p < 0.001 and p = 0.003, respectively). Improvement in the Oswestry Disability Index/Neck Disability Index (ODI/NDI) was significantly associated with body mass index (BMI) (p = 0.011) and was lower as BMI increased. CONCLUSIONS: The results suggest that spinal cord stimulation is an effective therapeutic option for patients with CRPS refractory to other treatments. BMI and ODI/NDI also showed a significant correlation.

TITLE: Estimulación medular en el síndrome de dolor regional complejo refractario. Un estudio prospectivo.Introducción y objetivos. En el tratamiento del síndrome de dolor regional complejo se pretende aliviar el dolor y restaurar la función de la extremidad afectada. El objetivo de este estudio es evaluar la estimulación de la médula espinal como terapia para pacientes a quienes se les diagnosticó síndrome de dolor regional complejo, en los que no se ha podido conseguir un control adecuado del dolor con otros tratamientos previos. Pacientes y métodos. Se realizó un estudio prospectivo de 2018 a 2020. Se incluyó a pacientes diagnosticados de síndrome de dolor regional complejo refractario a otros tratamientos o técnicas, clasificados por datos demográficos. Posteriormente, se hizo seguimiento de la eficacia, la funcionalidad y la dependencia de opioides de cada paciente durante un año. Resultados. Siete de los 13 (53,84%) pacientes incluidos en el estudio consiguieron un alivio significativo de su dolor con la estimulación medular. Se obtuvo mejoría del dolor y de la funcionalidad, y ambas fueron estadísticamente significativas (p < 0,001 y p = 0,003, respectivamente). La mejoría en el Oswestry Disability Index/Neck Disability Index (ODI/NDI) se asoció significativamente con el índice de masa corporal (IMC) (p = 0,011) y fue menor cuanto mayor era el IMC. Conclusiones. Los resultados sugieren que la estimulación de la médula espinal es una opción terapéutica eficaz para pacientes con SDRC refractario a otros tratamientos. Además, el IMC y el ODI/NDI mostraron una correlación significativa.

Uso de toxina botulínica en el dolor tras amputación / Use of botulinum toxin for pain after amputation

Introducción: Una amputación es un suceso demoledor para todo paciente que lo sufre, puesto que presenta un cambio importante, interfiriendo en la esfera física, psíquica y social del individuo, requiriendo una adap­tación y reacondicionamiento progresivo. Uno de los puntos más importantes a controlar ante esta situación es el dolor del muñón, puesto que en muchas ocasiones será aquello que realmente determine la calidad de vida del paciente. En los últimos años, se ha estudiado la utilidad de la toxina botulínica para el tratamiento del dolor con resultados esperanzadores. Objetivo: Realizar una revisión sistemática de la litera­tura científica existente, sin restricción de año de publicación, sobre el empleo de la toxina botulínica en el dolor de los pacientes amputados, para agrupar los datos existentes. Métodos: La literatura se extrajo de PubMed, EMBASE, Cochrane, Clinical Key, Science Direct, Medes, Dialnet, Scielo y Google Schoolar. Se definió como único criterio de exclusión estudios realizados en no humanos. Se incluyeron todos los documentos relacionados con el objetivo de la búsqueda, independientemente de año, idioma, sexo, edad, tipo de amputación o toxina botulínica. De los 1795 estudios hallados tras la búsqueda inicial, se seleccionaron 19. Los niveles de evidencia corresponden a 2B, grado de recomendación B (2 estudios piloto, aleatorizados, doble ciego, con grupo control) y 4C (2 estudios observacionales longitudinales prospectivos, 15 casos clínicos). Resultados: Se estima una mejoría para el dolor resi­dual del muñón ± sensación del miembro fantasma del 80,43 % (74 pacientes) y un alivio del dolor del miembro fantasma ± dolor residual del 65,22 % (60). Se describe una ausencia de modificación del dolor del miembro fantasma para 32 pacientes (34,7 %) y ausencia de alivio del dolor residual en 18 pacientes (19,57 %). En ningún estudio se refleja un empeoramiento de la clínica...(AU)

Introduction: An amputation is a devastating event for all patients who suffer it. It introduces significant chan­ges in the patient's physical, psychic and social spheres. It requires progressive adaptation and reconditioning. Stump pain is one of the most important points in order to control this situation as, on many occasions, it will be what truly determines the patient's life quality. In the recent years, the usefulness of botulinum toxin was stu­died for pain treatment with encouraging results. Objetive: Provide a systematic review on existing scien­tific literature, with no restrictions on publication year, about the use of botulinum toxin for the pain of amputa­ted patients in order to compile the existing data. Methodology: Literature was retrieved from PubMed, EMBASE, Cochrane, Clinical Key, Science Direct, Medes, Dialnet, Scielo and Google Schoolar. The only exclusion criterium was studies carried out on non-human. All do­cuments related to the objective of this research were included independently of year, language, sex, age, type of amputation or botulinum toxin. From 1795 studies found after initial research, 19 studies were selected. The levels of evidence are pertained to 2b, degree of recommendation B (2 pilot studies, randomised, double-blind, with control group) and 4C (2 observational and longitudinal prospective studies, 15 clinical cases). Results: It is estimated that an 80.43 % (74 patients) improvement of stump residual pain and/or of the sensation on the phantom limb and a 65.22 % (60 patients) relief of the phantom limb pain and/or of the residual pain. An absence of change of the phantom limb pain was described by 32 patients (34.7 %) and an absence of relief of residual pain was reported on 18 patients (19.57 %). No studies reflect a deterioration of the disease...(AU)

Hábitos de prescripción para el abordaje del dolor neuropático en España: resultados de la encuesta del grupo de trabajo de dolor neuropático de la Sociedad Española del Dolor / Prescribing habits for neuropathic pain management in Spain: results of the survey of the neuropathic pain working group of the Spanish Pain Society

Objetivos: Hace más de diez años que salieron al mercado los últimos fármacos con indicación en las guías internacionales de dolor neuropático (DN). Estas recomiendan iniciar con monoterapia y sitúan el tratamiento combinado en el segundo escalón. Un considerable número de pacientes no alcanza un suficiente alivio del dolor o mejora de su calidad de vida con los fármacos disponibles. Bajo esta perspectiva, el Grupo de Trabajo (GT) de DN de la Sociedad Española del Dolor (SED) diseñó una encuesta para el abordaje del DN mediante fármacos, técnicas intervencionistas y tratamientos fuera de indicación en nuestro medio. En este artículo se analiza solo la parte de tratamientos farmacológicos. Material y métodos: Estudio descriptivo mediante un cuestionario autoadministrado difundido por correo electrónico a los socios de la SED en dos oleadas durante 2019. Al inicio del cuestionario se realizaba una pregunta de selección sobre si utilizaban o no tratamientos fuera de ficha técnica o fuera de indicación. Solo los que respondieron afirmativamente procedieron a todo el conjunto de preguntas. Este se dividió en los siguientes bloques: antiepilépticos, antidepresivos, antipsicóticos, anestésicos, anti-nmda, cannabinoides, naltrexona, tratamientos tópicos, toxina botulínica, polifarmacia y tratamientos fuera de ficha. Dentro de la sección de tratamientos tópicos se incluyó la toxina botulínica. Resultados: La tasa de respuesta fue del 13,82 %, siendo del 10,05 % una vez descartadas las no válidas. El 21 % comienzan el tratamiento del DN con polifarmacia y un 43 % lo hace cuando no responden a una primera línea. El 40 % de los encuestados opinan que no hay evidencia suficiente para el uso de polifarmacia. El 70 % de los participantes trataban hasta un 30 % de sus pacientes con DN con fármacos fuera de indicación. El 23,3 % utilizaban medicamentos fuera de ficha técnica entre el 40 % y el 60 % de los pacientes con DN y un 6,6 % lo hacía en un 70-90 %...(AU)

Objectives: Latest drugs with an indication for neuropathic pain (NP) in the international guidelines came onto the market more than ten years ago. They recommend starting with monotherapy and place the combined treatment in the second step. A considerable number of patients do not achieve sufficient pain relief or improvement in their quality of life with the available drugs. From this perspective, the NP Working Group (WG) of the Spanish Pain Society (SED) designed a survey to address how NP drugs, off-label treatments and interventional techniques are being used in our setting. In this article we will only discuss the pharmacological treatment options.Material and methods: Descriptive study using a self-administered questionnaire distributed by email to SED members in two waves during 2019. At the beginning of the questionnaire, a selection question was asked whether or not they used non-technical or off-label treatments. Only those who answered affirmatively proceeded to the entire set of questions. It was divided into the following blocks: antiepileptics, antidepressants, antipsychotics, anesthetics, anti-nmda, cannabinoids, naltrexone, topical treatments, botulinum toxin, polypharmacy and off-label treatments. Botulinum toxin was included in the topical treatments section. Results: The response rate was 13.82 %, being 10.05 % once the invalid ones had been ruled out. 21 % begin the treatment of NP directly on polypharmacy and 43 % do so when they do not respond to a first line. 40 % of those surveyed think that there is insufficient evidence for the use of polypharmacy. 70 % of the participants treated up to 30 % of their NP patients with off-label drugs. 23.3 % used off-label me­dications in between 40 % and 60 % of patients with NP and 6.6 % did so in 70-90 % of patients...(AU)

Bioconversion of polyphenols and organic acids by gut microbiota of predigested Hibiscus sabdariffa L. calyces and Agave (A. tequilana Weber) fructans assessed in a dynamic in vitro model (TIM-2) of the human colon.

The present work aimed at understanding gut microbiota bioconversion of phenolic compounds (PC) and organic acids in predigested Hibiscus sabdariffa (Hb) calyces and the mixture of Hb and Agave (Agave tequilana Weber) fructans (AF). With this purpose, dried Hb and Hb/AF were predigested with enzymatic treatment, and then fermented in a dynamic in vitro model of the human colon (TIM-2). After HPLC-ESI-QToF-MS analysis of samples taken at 0, 24, 48 and 72 h of fermentation, it was observed that hydroxycinnamic acids, flavanols, flavonols, and anthocyanins were mainly transformed into derivatives of hydroxyphenylpropionic, hydroxyphenylacetic and hydroxybenzoic acids. Moreover, organic acids, such as hydroxycitric and hibiscus acids, were formed along with unidentified lactones and reduced compounds. Interestingly, no differences were observed between microbial-derived metabolites formed after the fermentation of Hb and Hb/AF. In conclusion, colonic fermentation of polyphenol-rich Hb yields a wide range of microbial phenolic metabolites with potential effects on health.

Effect of perfluorohexane sulfonate on pig oocyte maturation, gap-junctional intercellular communication, mitochondrial membrane potential and DNA damage in cumulus cells in vitro.

Perfluorohexane sulfonate (PFHxS) is one of the most abundant perfluorinated compounds in the environment. Exposure to this compound has been correlated to a decrease in human fertility, although the molecular and cellular mechanisms underlying this correlation have not been described. The adverse reproductive effects of PFHxS could be based on alterations in oocyte maturation, the process rendering oocytes competent for fertilization. The aim of this study was to evaluate the effect of PFHxS on porcine oocyte viability and maturation in vitro, as well as on gap-junctional intercellular communication (GJIC) in cumulus-oocyte complexes (COCs), oocyte mitochondrial membrane potential (mΔΨ) and DNA damage in cumulus cells, as possible mechanisms of action. PFHxS caused cytotoxicity (medium lethal concentration, LC50 = 329.1 µM) and inhibition of oocyte maturation (medium inhibitory concentration, MIC50 = 91.68 µM). GJIC was not affected in exposed COCs. However, the mitochondrial membrane potential was significantly decreased in PFHxS-exposed oocytes at the germinal vesicle breakdown (GVBD) stage. In addition, exposure to PFHxS induced DNA damage in cumulus cells. Thus, inhibition of oocyte maturation by PFHxS could be attributed to a decreased oocyte mΔΨ at the GVBD and to DNA damage of the cumulus cells that support the oocyte.

Pre-surgical risk assessment in patients with cirrhosis.

Over the last decades, significant improvements in the clini- cal management of patients with cirrhosis have increased their life expectancy. Thus, indications for surgical procedures other than liver transplantation are becoming more frequent. However, patients with advanced liver disease are at high risk of perioperative morbidity and mortality. This is the consequence of multiple factors that include the presence of portal hypertension, alterations on hemostasis and coagulation, the immune dysfunction that entails an increased risk of infections, and the impaired synthesis of proteins that impacts on the nutritional status and the wound healing. Surgical outcomes are not only determined by the severity of the liver disease, but also by the type of surgery and the presence of other comorbidities. Different models to predict mortality have been proposed, including the MELD score, the Child-Pugh classification, the hepatic venous pressure gradient, and the Mayo postoperative mortality risk calculator, among others. Multidisciplinary committees including surgeons, anesthesiologists, hepatologists, critical care physicians and other specialties involved in each case, should assess individually the risk-benefit of the surgical procedure, also considering patient`s expectations and will.

Experimental confounding factors affecting stability, transport and metabolism of flavanols and hydroxycinnamic acids in Caco-2 cells.

Studying bioavailability of polyphenols is essential to understand the health effects of these compounds. Human epithelial cells are commonly used in intestinal absorption and transport experiments but the changes polyphenols undergo during incubation, due to their chemical instability under the cell culture conditions, are scarcely known and might lead to inaccurate conclusions. Based on abundance of flavanols and hydroxycinnamic acids in the diet, epicatechin, epicatechin-3-gallate and procyanidin B2 as flavanols along with 5-caffeoylquinic and 3,5-dicaffeoylquinic acids as hydroxycinnamic acids were selected to comparatively evaluate their absorption and metabolism using an in vitro Caco-2 cell model. Special emphasis was paid to the structure-stability relationship of these phenolic compounds in Dulbecco's Modified Eagle's Medium (DMEM) under the cell culture conditions. The tested compounds were scarcely absorbed and minimally metabolized by the intestinal epithelium cells. The cell transport study showed prevalent efflux for flavanols opposite to absorption for hydroxycinnamates. Intestinal metabolism revealed that hydroxycinnamates were preferentially hydrolyzed and subsequently methylated, whereas hydrolysis of flavanols could not be confirmed, being mostly conjugated to sulfate, methyl- and methyl-sulfate derivatives. It is noteworthy that methyl derivatives of procyanidin-B2 were detected inside Caco-2 cells, confirming its absorption. In addition, culture medium influenced phenol isomerization to a higher extent than cells. In conclusion, hydroxycinnamates were better absorbed than flavanols although their bioavailability was limited in this intestinal cell model.

Influence of Dietary Supplementation of Ensiled Devil Fish and Staphylococcus saprophyticus on Equine Fecal Greenhouse Gases Production.

The present context was designed to investigate the efficacy of devil fish (DF; Plecostomus sp.) silage and Staphylococcus saprophyticus on fermentation characteristics as well as greenhouse gases production mitigation attributes in horses. Four levels of ensiled DF at 0 (control DF0), 6 (DF6), 12 (DF12), and 18 (DF18) % were added into the diet. Moreover, three doses of S. saprophyticus (0, 1, and 3 mL/g dry matter [DM]) were used for in vitro fecal fermentation. The use of ensiled DF resulted in increased (P < .0001) pH during fermentation. The asymptotic gas production was the highest (P < .0001) in DF6, whereas other supplementation caused lower production than that of control. Lag time for the asymptotic gas production decreased (P < .05) with increasing dietary DF doses. Inclusion of S. saprophyticus resulted in the lowest (P < .05) gas production and mL/0.5 g DM incubated and thus, the reduced gas production up to 23.17% than that of control. The interaction of DF × S. saprophyticus showed the lowest gas production at DF18, whereas the highest production was estimated at DF6 without S. saprophyticus after 48 hours. The lowest emission of CO2 (P < .0001) was observed in DF18 inclusion, which was 15.25% lower than that of control at 48 hours of fermentation. In contrast, the lowest hydrogen (H2) production was estimated in DF0, whereas DF18 exhibited the highest. Inclusion of DF12 and DF18 reduced (P < .05) methane (CH4) emission by 58.24% and 59.33%, respectively. However, DF, S. saprophyticus, and DF × S. saprophyticus interaction had no significant effect (P > .05) on CH4 production. In conclusion, ensiled DF and S. saprophyticus could be supplemented in equine diet as promising alternatives to corn for mitigating the emission of greenhouse gases effectively.

Moderate consumption of a soluble green/roasted coffee rich in caffeoylquinic acids reduces cardiovascular risk markers: results from a randomized, cross-over, controlled trial in healthy and hypercholesterolemic subjects.

PURPOSE: Coffee is rich in bioactive compounds with health beneficial properties, with green coffee presenting higher phenol content than roasted. We evaluated the effects of regularly consuming realistic amounts of a green/roasted coffee blend on cardiovascular health-related biomarkers. METHODS: A randomized, cross-over, controlled study was carried out in 25 normocholesterolemic [total cholesterol (TC) < 200 mg/dL] and 27 hypercholesterolemic (TC 200-240 mg/dL) subjects. During 8 weeks, volunteers consumed 6 g/day of soluble green/roasted (35:65) coffee or a control beverage (water or an isotonic drink). Blood pressure, heart rate and body weight were monitored at the end of each intervention, and serum lipids [TC, HDL-C, LDL-C, VLDL-C, triglycerides and phospholipids], cytokines and chemokines (IL-1ß, IL-2, IL-4, IL-5, IL-6, IL-7, IL-10, IL-12, IL-13, IL-17, G-CSF, GM-CSF, MCP-1, MIP-1ß, TNF-α, INF-γ), adhesion molecules (ICAM-1, VCAM-1), and C-reactive protein were measured. Plasma antioxidant capacity (FRAP, ORAC and ABTS methods), and lipid (malondialdehyde, MDA) and protein (carbonyl groups, CG) oxidation were also determined. RESULTS: Attending to the general lineal model of variance for repeated measures, after the green/roasted coffee intervention significant reductions in TC, LDL-C, VLDL-C and triglycerides levels (p = 0.006, 0.001, 0.003 and 0.017, respectively), and a significant group effect were observed (0.001, < 0.001, 0.019 and 0.027, respectively). Only within the hypercholesterolemic group, attending to the Bonferroni test, the aforementioned lipid parameters were significantly lower after regular green/roasted coffee intake compared to baseline values. Moreover, after the coffee stage, plasma antioxidant capacity improved, according to the increase in ORAC and FRAP values (p < 0.001 and p < 0.001, respectively) and decrease of MDA (p = 0.015) and CG (p < 0.001) levels, without differences between groups. Systolic (p = 0.001) and diastolic (p < 0.001) blood pressure, heart rate (p = 0.035), and body weight (p = 0.017) were reduced in both normo- and hypercholesterolemic groups. CONCLUSION: Regular consumption of moderate amounts of a soluble green/roasted (35:65) coffee blend may contribute to improve cardiovascular health in moderately hypercholesterolemic people, as reducing serum lipids, blood pressure and body weight effects, as well as increasing plasma antioxidant capacity, have been observed. Moreover, positive influences on blood pressure, body weight, and plasma antioxidant capacity were obtained in the healthy group. Therefore, incorporation of green coffee beans into the coffee brew can be recommended as part of a dietary strategy to protect from cardiovascular disease.

Estudio CRONO: prevalencia del dolor irruptivo en pacientes con dolor crónico no oncológico en Andalucía, España / CRONO study: prevalence of breakthrough pain in patients with non-cancer chronic pain in Andalusia, Spain

Objetivo: El objetivo de este estudio es evaluar la prevalencia de dolor irruptivo (DI) en pacientes ambulatorios con dolor crónico de origen no oncológico y caracterizar la fisiopatología, localización, intensidad y frecuencia de los episodios de DI. Material y métodos: Estudio observacional, prospectivo y no intervencionista realizado en 16 unidades de dolor ambulatorias de hospitales de Andalucía y Ceuta. Se preguntó a los pacientes consecutivos elegibles si experimentan DI definido como "una exacerbación transitoria del dolor que ocurre espontáneamente, o en relación con un desencadenante predecible o impredecible específico, a pesar del dolor de base estable y controlado". En cada día de la encuesta, los dos primeros pacientes que confirmaron DI fueron preguntados sobre las características clínicas de su PTP (etiología, inicio, intensidad, frecuencia y tratamiento). Resultados: Se realizó un cribaje a un total de 3209 pacientes con dolor crónico no oncológico para identificar a 1118 pacientes con DI, lo que representó una prevalencia del 36 %. Se obtuvieron las características del DI de 350 pacientes: la intensidad media fue de 8,3 (± 1,4) en una Escala Analógica Visual (EVA), con una media de 2 episodios/24 horas (rango 1-5/24 h). El mecanismo del dolor fue mixto en 149 (42,6 %), neuropático en 91 (26 %) y nociceptivo en 72 (20,6 %) de los pacientes. Se encontró correlación positiva entre una mayor intensidad de DI con el nivel de dolor basal (r = 0,243, p < 0,001), y el número de crisis diarias de DI (r = 0,123, p = 0,003), ambas estadísticamente significativas. El 78 % de los pacientes estaba en tratamiento con opioides. Los más frecuentes fueron el citrato de fentanilo (52,6 %) y el tramadol (17,4 %). Conclusiones: La tasa de prevalencia del DI en pacientes con dolor crónico no oncológico es superior a un tercio de los pacientes atendidos en las unidades ambulatorias de dolor hospitalario en España. El DI provoca niveles reducidos de funcionalidad, trastornos psicológicos y un aumento del gasto asistencial. La clave del tratamiento es la individualización

Objective: The aim of this study was to evaluate the prevalence of breakthrough pain (BTP) in ambulatory patients with non-cancer chronic pain in Spain and to characterize physiopathology, location, intensity and frequency of BTP episodes. Methods: Prospective, non-interventional, observational study conducted in 16 pain units of hospitals of Andalusia and Ceuta. Eligible consecutive patients were are asked if they experience BTP defined as "a transient exacerbation of pain that occurs either spontaneously, or in relation to a specific predictable or unpredictable trigger, despite stable and controlled background pain". At each survey day, the first two patients reporting BTP were further interrogated on the clinical characteristics of their BTP (etiology, onset, intensity, frequency and treatment). Results: A total of 3,209 patients with non-cancer chronic pain were screened to identify 1,118 patients with BTP, which represented a prevalence of 36 %. BTP characteristics were retrieved from 350 patients: mean BTP intensity was 8.3 (± 1.4) on a Visual Analogue Scale (VAS), with a mean of 2 episodes/24 hour (range 1-5/24 h). Pain mechanism was mixed in 149 (42.6 %), neuropathic in 91 (26 %) and nociceptive in 72 in (20.6 %) of patients. Significant correlation was found between BTP intensity and both higher background pain (r = 0.243, p < 0.001), and daily BTP episodes frequency (r = 0.123, p = 0.003). 78 % of the patients were on opioid treatment. The most frequent were fentanyl citrate (52.6 %) and tramadol (17.4 %). Conclusions: The prevalence rate of BTP in patients with chronic non-oncologic pain is higher than one-third of the patients seen in outpatient hospital pain units in Spain. BTP causes reduced levels of functionality, psychological disorders, and an increase in health care expenditure. Individualization is the key to treatment

Antiproliferative and cytotoxic effects of green coffee and yerba mate extracts, their main hydroxycinnamic acids, methylxanthine and metabolites in different human cell lines.

This work aimed at studying the effects of green coffee bean (GCBE) and yerba mate (YME) extracts, their main phenolic components (5-caffeoylquinic acid, 5-CQA; 3,5-dicaffeoylquinic acid, 3,5-DCQA) and metabolites (ferulic acid, FA; caffeic acid, CA; dihydrocaffeic acid, DHCA; and dihydroferulic acid, DHFA) along with caffeine (CAF) on the viability and proliferation of different human cell lines. Extracts (10-1000 µg/mL) and standards (10-1000 µM) were assayed in colon (Caco-2), lung (A549), oesophageal (OE-33), urinary bladder (T24) human carcinoma cells, and a non-cancer cell line (CCD-18Co). YME significantly reduced viability of cancer cells at all assayed concentrations, the higher doses also reducing cell proliferation. GCBE effects on cell viability were more effective at 100 and 1000 µg/mL, showing modest effects on cell proliferation. The highest doses of 5-CQA and 3,5-DCQA reduced cell viability and proliferation in all cell lines, whereas FA, DHCA and DHFA had lower and variable effects. Caffeine had no effect. Dietary-attainable concentrations (0.1, 1 and 10 µg/mL) of YME were tested for cytotoxicity and reactive oxygen species generation, showing no cytotoxic effect. Low concentrations of all tested compounds were non-cytotoxic to CCD-18Co cells. CONCLUSION: YME and to a lower degree GCBE, their phenolic components and metabolites may decrease cancer cell viability and proliferation.

Evaluation of the efficacy of therapeutic endoscopy in gastrointestinal bleeding secondary to angiodysplasias. / Evaluación de la eficacia terapéutica endoscópica en hemorragia digestiva secundaria a angiodisplasias.

INTRODUCTION: Gastrointestinal angiodysplasias are defined as vascular dilations that communicate capillaries and veins in the walls of the digestive tract. The clinical presentation of these lesions varies from chronic occult bleeding to severe gastrointestinal hemorrhage. AIM: The primary aim of our study was to analyze lesion location, the efficacy of therapeutic endoscopy with argon plasma coagulation, and the factors associated with rebleeding in patients with gastrointestinal angiodysplasias. MATERIAL AND METHODS: A retrospective study of 32,042 endoscopies was carried out within the time frame of January 2012 and December 2013 at our hospital center. Gastrointestinal angiodysplasia was the diagnosis in 331 of the endoscopies. The procedures included upper gastrointestinal endoscopy, colonoscopy, sigmoidoscopy, and enteroscopy. RESULTS: The most frequent location of the angiodysplasias was the cecum (49%), followed by the ascending colon (17%) and the sigmoid colon (16%). They were most frequently found in the duodenum (60%) and gastric body (49%) at upper gastrointestinal endoscopy. Therapeutic endoscopy was performed in 163 cases (49.8%) and the most predominant methods were fulguration with argon (90%) and combination treatment (argon plasma coagulation and injection sclerotherapy) (6.7%). The macroscopic rebleeding rate after therapeutic endoscopy was 7.4%. Patients that had rebleeding presented with a lower hemoglobin concentration, higher mean age, and the presence of multiple angiodysplasias at endoscopy (P<.05). CONCLUSIONS: Therapeutic endoscopy was performed in 49.8% of the patients with angiodysplasias. The macroscopic rebleeding rate after treatment was 7.4%. There were statistically significant differences in the patients with rebleeding in relation to mean age, hemoglobin values, and the presence of multiple angiodysplasias.

A phenolic extract from grape by-products and its main hydroxybenzoic acids protect Caco-2 cells against pro-oxidant induced toxicity.

Grape/wine industry produces large amounts of by-products, however knowledge on their health-promoting qualities is limited. This study investigated the effects of a grape phenolic extract (GPE) and its phenolic compounds, gallic acid (GA) and syringic acid (SA) on human intestinal Caco-2 cells, directly or after cytotoxicity induced by tert-butylhydroperoxide (t-BOOH). Direct treatment with 0.1-10 µg/mL GPE, or 0.1-10 µM GA and SA produced no major cytotoxic effect, either changes in antioxidant defences (glutathione content, glutathione peroxidase and reductase activities) or protein damage (carbonyl groups). However, 10 µg/mL GPE, 1 and 10 µM GA and 10 µM SA decreased reactive oxygen species (ROS) production. Pre-treatment with GPE, SA and GA at the same concentrations for 20 h showed that 10 µg/mL GPE and 10 µM GA or SA significantly counteracted ROS increase induced by t-BOOH. 10 µg/mL GPE and 1-10 µM GA or 10 µM of SA significantly reduced pro-oxidant-induced cytotoxicity. 1-10 µg/mL GPE, 1-10 µM GA and 10 µM SA significantly recovered both depleted glutathione and enhanced glutathione reductase and peroxidase activities, and reduced protein oxidative damage. Therefore, treatment with realistic concentrations of GPE and its main hydroxybenzoic acids protected Caco-2 cells against induced oxidative stress.

Mind the model for end-stage liver disease: model for end-stage liver disease score as an indicator of hemoderivate transfusion and survival in liver transplantation.

The scarcity of liver donors has increased the necessity to closely select recipients to improve liver transplantation outcomes. If we were able to recognize those recipients with the best outcomes, then this could result in a better and more accurate selection of our donors. Hemoderivate transfusion is one of the main important factors to analyse. We reviewed the data of all of our liver transplant recipients from May 1998 to December 2013 and selected 888 patients with complete records. We divided these patients into 5 groups to get a better selection. We found differences between these groups with respect to the following: recipient age at the time of transplantation, percentage of patients with hepatocarcinoma, and those with hepatitis C virus (HCV)-related etiology. Also, intensive care unit (ICU) time and the need for retransplantation were distinctive factors with observable differences between our groups. With respect to model for end-stage liver disease (MELD) score, the groups were clearly defined by their mean MELD score, finding significant statistical differences between these groups with respect to this score. We also found a significant relationship between MELD scores and survival in the different groups. This is also the first review in which the MELD score and intraoperative transfusion requirements are well associated with patient and graft survival.

Slow femoral venous flow and venous thromboembolism following inguinal hernioplasty in patients without or with low molecular weight heparin prophylaxis.

BACKGROUND: Prosthetic material (mesh) is commonly used to repair inguinal hernias. Its implantation close to the common femoral vein (CFV) can induce slow flow and favor the appearance of venous thromboembolism (VTE) events. AIM: To investigate the speed of flow, diameter and area of the CFV after inguinal hernioplasty. METHODS: Two hundred and fifty patients receiving open hernioplasty with a non-resorbable mesh for the repair of a unilateral, primary, simple inguinal hernia were prospectively investigated. Patients were stratified, by consensus, into a low or a moderate risk of VTE group. The moderate-risk group (n = 163) received low molecular weight heparin. On day 10 post-operation a blinded Echo-Doppler was carried out, and repeated 7 days later in patients with a venous flow of <15 cm/s. The speed of flow (cm/s), diameter (cm), and area (cm(2)) of the ipsilateral and contralateral CFV of the groin operated upon were measured. RESULTS: No event symptomatic of VTE was documented. One case of asymptomatic deep vein thrombosis (1/163, 0.6%) was found in the moderate-risk group. In 29 patients (2 and 27 in the low- and moderate-risk groups, respectively; p < 0.001) a maximum blood flow velocity of <15 cm/s was found in the ipsilateral CFV; these flows were close to normal in the second measurement. Taking the entire sample into account, the maximum venous blood flow found in the ipsilateral CFV of the operated groin was less than that measured in the contralateral CFV (20.88 vs. 24.01 cm/s; p < 0.001); this difference was significant in both VTE risk groups. The diameter and area of the CFV were both greater in the ipsilateral than the contralateral CFV (p < 0.01); this finding proved to be significant only in hernias of the left groin (p < 0.001). CONCLUSIONS: In the immediate postoperative period, inguinal hernioplasty with mesh induces a temporarily slow venous flow in the ipsilateral CFV. However, this does not lead to an increase in the incidence of VTE.

Hepatocyte growth factor is elevated in amniotic fluid from obese women and regulates placental glucose and fatty acid metabolism.

INTRODUCTION: To evaluate the impact of the pro-inflammatory cytokine hepatocyte growth factor (HGF) on the regulation of glucose and lipid placental metabolism. METHODS: HGF levels were quantified in amniotic fluid and placenta from control and obese women. 2-deoxy-glucose (2-DOG) uptake, glycolysis, fatty acid oxidation (FAO), fatty acid esterification, de novo fatty acid synthesis, triglyceride levels and carnitine palmitoyltransferase activities (CPT) were measured in placental explants upon addition of pathophysiological HGF levels. RESULTS: In obese women, total- and -activated-HGF levels in amniotic fluid were elevated ∼24%, and placental HGF levels were ∼3-fold higher than in control women. At a similar dose to that present in amniotic fluid of obese women, HGF (30 ng/mL) increased Glut-1 levels and 2-DOG uptake by ∼25-30% in placental explants. HGF-mediated effect on 2-DOG uptake was dependent on the activation of phosphatidylinositol 3-kinase signaling pathway. In addition, HGF decreased ∼20% FAO, whereas esterification and de novo fatty acid synthesis increased ∼15% and ∼25% respectively, leading to 2-fold triglyceride accumulation in placental explants. In parallel, HGF reduced CPT-I activity ∼70%. DISCUSSION: HGF is a cytokine elevated in amniotic fluid and placental tissue of obese women, which through its ability to stimulate 2-DOG uptake and metabolism impairs FAO and enhances esterification and de novo fatty acid synthesis, leading to accumulation of placental triglycerides.

Scaling-up of membraneless microbial electrolysis cells (MECs) for domestic wastewater treatment: Bottlenecks and limitations.

Microbial electrolysis cells (MECs) have the potential to become a sustainable domestic wastewater (dWW) treatment system. However, new scale-up experiences are required to gain knowledge of critical issues in MEC designs. In this study we assess the ability of two twin membraneless MEC units (that are part of a modular pilot-scale MEC) to treat dWW. Batch tests yielded COD removal efficiencies as high as 92%, with most of the hydrogen (>80% of the total production) being produced during the first 48h. During the continuous tests, MECs performance deteriorated significantly (energy consumption was relatively high and COD removal efficiencies fell below 10% in many cases), which was attributed to an inadequate configuration of the anodic chamber, insufficient mixing inside this chamber, inefficient hydrogen management on the cathode side and finally to dWW in itself. Some alternatives to the current design are suggested.

Diagnóstico y tratamiento del dolor irruptivo oncológico: recomendaciones de consenso / Diagnosis and treatment of breakthrought pain: consensus document

Introducción y objetivos: el dolor irruptivo oncológico (DIO) es una exacerbación aguda del dolor que presenta diferentes criterios diagnósticos y de tratamiento por parte de los distintos especialistas implicados en su manejo. Para facilitar la toma de decisiones en la práctica clínica habitual, ocho especialistas de referencia de cuatro sociedades científicas implicadas en el manejo del paciente oncológico handiseñado este documento. Métodos: tras una búsqueda bibliográfica en las publicaciones más relevantes sobre DIO se establecieron las recomendaciones preliminares. El grupo de expertos realizó una reunión de trabajo siguiendo la metodología Metaplan® en la que se debatieron las recomendaciones que incorporar al documento. Cada una de las afirmaciones y recomendaciones fueron clasificadas según su grado de recomendación, atendiendo a las categorías del sistema SIGN (Scottish Intercollegiate Guidelines Network). Resultados: el manejo del DIO requiere una anamnesis completa tanto del DIO como del dolor basal y una exploración física del paciente asociada a pruebas complementarias cuando sean precisas. Los fármacos de elección para el tratamiento del DIO deben ser aquellos que muestren una analgesia potente, con rápido inicio, de efectos secundarios mínimos y de fácil administración. El fentanilo administrado por vía transmucosa es actualmente el principio activo más adecuado a las necesidades analgésicas del dolor irruptivo, con independencia del opioide mayor utilizado para el control del dolor basal. Conclusión: este consenso puede ser una herramienta útil para la mejora de la calidad de vida del paciente con cáncer, ya que permite un mejor diagnóstico y tratamiento del DIO (AU)

Introduction and objectives: Breakthrough cancer pain (BTcP) is an acute exacerbation of baseline pain. The clinicians involved in its management have different diagnostic and therapeutic criteria. In order to facilitate decision making in usual clinical practice, 8 reference experts from 4 scientific associations involved in the management of patients with cancer pain have developed this Consensus Document. Methods: After an initial search on the most relevant publicationsin BTcP literature, a set of preliminary recommendations were established. A working meeting was subsequently held with the experts, following the Metaplan® methodology -a structured brainstorming technique- that produced a first version of theConsensus Document which, after several review rounds, was validated by all the participants. Every statement and recommendation was sorted according to its degree of recommendation, following the categories in the SIGN (Scottish IntercollegiateGuidelines Network) system. Results: The management of BTcP requires a full anamnesis, both of BTcP itself and of baseline pain, a physical examination and the supplementary tests that are deemed necessary. The drugs of choice for the treatment of BTcP must be those with a potent and rapid analgesic effect a short duration, minimal side effects and easy administration. Transmucosal fentanyl is currently the active ingredient most fitting to the analgesic needs of BTcP, regardless of the major opioid used for control of the baseline pain. Conclusion: This Consensus can be a very useful tool to improve the quality of life in cancer patients, because it guidesthe clinician towards a better diagnose and treatment of BTcP (AU)

Prevención de eventos adversos para la seguridad del paciente en las unidades de tratamiento del dolor crónico / Prevention of adverse events for patient safety in chronic pain treatment units

Objetivos. Identificar acciones preventivas que minimicen el riesgo para la seguridad de los pacientes atendidos en las unidades de tratamiento del dolor, y agrupar en lotes las acciones preventivas que presenten características homogéneas. El trabajo es una parte de un proyecto de mejora de la seguridad de pacientes atendidos en dichas unidades, cuyo propósito global ha sido la identificación, priorización y prevención de riesgos. Material y métodos. Se seleccionó un grupo de expertos formado por profesionales con formación clínica específica y experiencia en programas y servicios de atención al dolor. Se les proporcionó formación en seguridad de pacientes e información sobre los eventos adversos identificados, los fallos y las causas asociados. Mediante la técnica de tormenta de ideas los participantes respondieron a la pregunta: ¿qué modificaciones o mejoras habría que hacer al proceso asistencial para evitar absolutamente la aparición de cada uno de los eventos adversos? Las propuestas generadas se consensuaron y agruparon en lotes en función de su homogeneidad. Resultados. Se identificaron 456 acciones preventivas. El apartado más numeroso fue el de las modificaciones en la organización del proceso asistencial, seguido de los de las mejoras en la práctica clínica, las actividades formativas, la protocolización y la comunicación con el paciente. Conclusiones. Según el consenso de los expertos, son los cambios organizativos y las mejoras en la práctica asistencial, las intervenciones que más podrían reducir el riesgo para los pacientes en las unidades de tratamiento del dolor(AU)

Objectives. To identify preventive actions that minimise risk of patients safety in pain treatment units, and to cluster preventive actions into homogeneous groups. The current study is part of a project intended to improve patient safety in pain treatment units, and is aimed at identifying, prioritising and preventing patient safety risk. Material and methods. A group of experts was selected from professionals with a specific clinical background and experience in pain treatment units. This group was provided with information on patient safety and on known adverse events, errors and related causes. Through a brainstorming method the participants were asked: What changes or improvements would need to be undertaken to absolutely prevent the occurrence of each adverse event? The participant's proposals were analysed and grouped according to their homogeneity. Results. A total of 456 preventive actions were identified. The group that received the highest number of suggestions was the one including changes in the management of healthcare processes, followed by the group that considered improvements in clinical practice, training activities, protocols and policies, and patient communication. Conclusions. According to the consensus of the experts, management of healthcare processes and improvements in health care practices are the 2 interventions that are most likely to reduce patient safety risk in pain treatment units(AU)

Diagnóstico y tratamiento del dolor irruptivo oncológico: recomendaciones de consenso / No disponible

Introducción y objetivos: El dolor irruptivo oncológico (DIO) es una exacerbación aguda del dolor que presenta diferentes criterios diagnósticos y de tratamiento por parte de los diferentes especialistas implicados en su manejo. Para facilitar la toma de decisiones en la práctica clínica habitual, ocho especialistas de referencia de 4 sociedades científicas implicadas en el manejo del paciente oncológico, han diseñado este documento de consenso. Métodos: Tras una búsqueda bibliográfica en las publicaciones más relevantes sobre DIO, se establecieron las recomendaciones preliminares. El grupo de expertos realizó una reunión de trabajo siguiendo la metodología Metaplan®, donde se debatieron las recomendaciones a incorporar al documento. Cada una de las afirmaciones y recomendaciones fueron clasificadas según su grado de recomendación, atendiendo a las categorías del sistema SIGN (Scottish Intercollegiate Guidelines Network). Resultados: El manejo del DIO requiere de una anamnesis completa, tanto del DIO como del dolor basal, y una exploración física del paciente asociada a pruebas complementarias cuando sean precisas. Los fármacos de elección para el tratamiento del DIO deben ser aquellos que muestren una analgesia potente, con rápido inicio de acción, efectos secundarios mínimos y de fácil administración. El fentanilo administrado por vía transmucosa es actualmente el principio activo más adecuado a las necesidades analgésicas del dolor irruptivo, con independencia del opioide mayor utilizado para el control del dolor basal. Conclusión: Este consenso puede ser una herramienta útil para la mejora de la calidad de vida del paciente con cáncer, ya que permite un mejor diagnóstico y tratamiento del DIO (AU)

Introduction objectives: Breakthrough cancer pain (BTcP) is an acute exacerbation of baseline pain. The clinicians involved n its management have different diagnostic and therapeutic criteria. In order to facilitate decision making in usual clinical practice, 8 reference experts from 4 scientific associations involved in the management of patients with cancer pain have developed this Consensus Document. Methods: After an initial search on the most relevant publications in BTcP literature, a set of preliminary recommendations were established. A working meeting was subsequently held with the experts, following the Metaplan® methodology –a structured brainstorming technique– that produced a first version of the Consensus Document which, after several review rounds, was validated by all the participants. Every statement and recommendation was sorted according to its degree of recommendation, following the categories in the SIGN (Scottish Intercollegiate Guidelines Network) system. Outcomes: The management of BTcP requires a full anamnesis, both of BTcP itself and of baseline pain, a physical examination and the supplementary tests that are deemed necessary. The drugs of choice for the treatment of BTcP must be those with a potent and rapid analgesic effect a short duration, minimal side effects and easy administration. Transmucosal fentanyl is currently the active ingredient most fitting to the analgesic needs of BTcP, regardless of the major opioid used for control of the baseline pain (AU)