Predicting Adherence to Walking from Anxiety, Depression, Disease Impact, Catastrophizing, and Cognitive Fusion in Patients with Fibromyalgia: Does Pain Severity Matter?

AIM: This study analyzed whether the contribution of several factors associated with walking adherence in fibromyalgia (FM) patients varies across pain severity levels. METHODS: Participants were 228 women with FM (mean age 57 years; SD = 8.49). RESULTS: Bivariate analyses replicated the expected association between predictors (FM impact, anxiety, depression, catastrophizing, and cognitive fusion) and poorer adherence to walking. Multivariate analyses showed a negative contribution of FM impact, catastrophizing, and depression on walking adherence after controlling for pain levels (all p < 0.01). A moderation effect of pain severity in the relationship between predictors and adherence to walking was only found for cognitive fusion (B = -0.01, t = -2.02, p = 0.040). Specifically, cognitive fusion only contributed to poor walking adherence at moderate and severe pain levels, but not when pain was mild. The contribution of the remaining predictors was not moderated by pain levels, which means that they contributed to walking adherence irrespective of the pain severity of the patient. Pain severity did not contribute to walking adherence when controlling for the predictors. CONCLUSION: Clinical implications are discussed from the perspective of personalized interventions and preferable target interventions when attempting to increase adherence to walking in this population.

Do Cognitive Abilities Influence Physical and Mental Fatigue in Patients with Chronic Pain after Walking According to a Clinical Guideline for Physical Exercise?

The objective of this study is to explore the mediator role of cognitive fusion and chronic pain acceptance on the effects that the walking pattern, following an established clinical guideline for physical exercise, can have on fatigue (physical and mental) in patients with chronic pain. The sample consisted of a total of 231 women with fibromyalgia with a mean age of 56.91 years (Standard Deviation SD = 9.58 years, range 30-78 years). The results show a significant indirect effect of the walking pattern on both physical and mental fatigue through cognitive fusion and chronic pain acceptance. Specifically, walking predicted less cognitive fusion, which predicted greater chronic pain acceptance, which, in turn, predicted less mental and physical fatigue (Beta-B- = -0.04, Standard Error SE = 0.02, 95% Confidence Interval 95% CI = [-0.09, -0.02]; B = -0.09, SE = 0.05, 95% CI = [-0.22, -0,15], respectively). It can be concluded that the walking pattern is linked to both physical and mental fatigue through cognitive defusion and chronic pain acceptance. These cognitive abilities would allow fibromyalgia patients to perceive an improvement in both physical and mental fatigue by carrying out the walking pattern. Emphasizing the training of cognitive defusion and pain acceptance would improve the adherence of these patients to walking.

Results of systematic second-look surgery plus hipec in perforated or pt4 colon cancer. Case series.

BACKGROUND: Perforated or pT4 colonic tumors have a bad prognosis with a high rate of relapse, including peritoneal relapse (20-30%). Our aim is to analyze the effectiveness of Second Look surgery (SLS) + hyperthermic intraperitoneal chemotherapy (HIPEC) in these patients for early treatment of peritoneal relapse (PR) or for preventing it. PATIENTS AND METHODS: Patients previously operated for colon cancer, either pT4 or perforated (M0), with no evidence of disease at any level after adjuvant chemotherapy, who undergo systematic SLS + HIPEC (Oxaliplatin 30 min) one year after the initial surgery. RESULTS: Since February 2014 to July 2018, we performed SLS + HIPEC in 42 patients with M0, either pT4 (n = 33) or perforated (n = 9) colon cancer. Although during SLS there were suspicious lesions in 15 cases (37.5%), they were histologically confirmed in only 4 (9.5%). Histologically confirmed peritoneal relapse (PR) rate at SLS was 6% in pT4 (2/33) and 22.2% in perforated tumors (2/9). Prophylactic HIPEC was performed in all the cases. There was no postoperative mortality. Grade III-IV morbidity occurred in 19% (8/42). With a median follow-up of 33.8 months after primary tumor surgery, 6/42 patients (14.3%) presented peritoneal relapse (PR). 3-year peritoneal disease free survival was 86%, with 3-year disease free survival of 78.6% and 5-year overall survival (OS) of 97.4%. CONCLUSION: Peritoneal relapse and survival rates are remarkable in these groups of, a priori, very bad prognosis, which could suggest a beneficial effect of HIPEC.

Systematic Second-look Surgery Plus HIPEC in Patients Without Evidence of Recurrence, at High Risk of Carcinomatosis After Colorectal Cancer Resection. / Cirugía de second look más HIPEC en pacientes sin evidencia de recidiva con alto riesgo de desarrollar carcinomatosis tras resección de cáncer colorrectal.

INTRODUCTION: To analyze the impact of systematic second-look surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC) performed 1 year after resection of the primary tumor, in asymptomatic patients at high risk of developing peritoneal carcinomatosis (PC). METHODS: Between 2012-2016, 33 patients without any sign of peritoneal recurrence on imaging studies were prospectively included in the study and underwent second-look surgery aimed at treating limited PC earlier and were prospectively recorded. They were selected based on 5 primary tumor-associated criteria: resected minimal synchronous macroscopic PC (n = 10), synchronous ovarian metastases (n = 2), positive peritoneal cytology (n = 2), pT4 primary tumors (n = 15) and perforation (n = 4). RESULTS: PC was found and treated by cytoreduction plus HIPEC in 10 of the 33 (30.3%) patients, although it was detected in only 2/15 patients of the pT4 subgroup (13.3%). The patients without PC underwent complete abdominal exploration plus HIPEC. Median follow-up was 14.5 months. One patient died postoperatively at day 55. Severe morbidity rate (Clavien-Dindo III-V) was low (15.2%). The 3-year overall survival rate was 93% and the 3-year disease-free survival rate was 33%. Peritoneal recurrences occurred in 4 patients (12.1%), 2 of whom had macroscopic PC discovered at the second-look (20%), while the other 2 patients had no macroscopic PC (8.7%) (P = .04). CONCLUSIONS: The second look + HIPEC strategy in our series of patients at high risk of developing PC, allows its early detection and its treatment in 30.3% of cases, with a very low rate of peritoneal recurrence. It is important to continue evaluating the results to increase the accuracy of the inclusion criteria, especially the pT4 criterion that in this series has a low predictive power for the occurrence of PC.

Cirugía de second look más HIPEC en pacientes sin evidencia de recidiva con alto riesgo de desarrollar carcinomatosis tras resección de cáncer colorrectal / Systematic Second-look Surgery Plus HIPEC in Patients Without Evidence of Recurrence, at High Risk of Carcinomatosis After Colorectal Cancer Resection

Introducción: Analizar el impacto de la cirugía de second look (CSL) combinada con quimioterapia intraperitoneal hipertérmica (HIPEC) realizada un año después de la cirugía del tumor primario en pacientes asintomáticos con alto riesgo de desarrollar carcinomatosis peritoneal (CP) tras resección de cáncer colorrectal. Métodos: Entre febrero 2012 y febrero 2016, 33 pacientes con alto riesgo de recidiva peritoneal, sin signos de recurrencia en pruebas de imagen fueron prospectivamente incluidos en el estudio y sometidos a CSL con el objetivo de tratar posibles recidivas peritoneales precozmente. Los pacientes fueron seleccionados por 5 criterios: pT4 (n = 15), citología peritoneal positiva por cáncer (n = 2), tumor perforado (n = 4), enfermedad peritoneal sincrónica resecada (n = 10), metástasis ováricas sincrónicas resecadas (n = 2). Resultados: Se detectó carcinomatosis peritoneal (CP) en 10 de los 33 pacientes (30,3%) (CP+), en los cuales se realizó citorreducción completa más HIPEC. En el subgrupo de los pacientes pT4 (n = 15) se detectó CP solo en 2 casos (13,3%). El resto de los pacientes (CP-) fueron sometidos a HIPEC profiláctica. La mediana de seguimiento después de CSL ha sido de 14,5 meses. La tasa de morbilidad postoperatoria grave (Clavien-Dindo III-V) fue del 15,2% (5/33) y la mortalidad del 3,0% (1 paciente al 55.° día postoperatorio). La supervivencia global a 3 años fue del 93% y la supervivencia libre de enfermedad del 33%. Tras CSL + HIPEC, 4/33 pacientes (12,1%) recidivaron en el peritoneo, 2 CP + (20%) y 2 CP - (8,7%) (p = 0,04). Conclusiones: La realización de CSL + HIPEC en nuestra serie de pacientes con alto riesgo de desarrollar CP permite su detección temprana y su tratamiento en el 30,3% de los casos, con una tasa muy baja de recurrencia peritoneal posterior. Es importante continuar evaluando los resultados para aumentar la precisión de los criterios de inclusión, especialmente del criterio pT4, que en esta serie tiene un bajo poder predictivo para la aparición de CP (AU)

Introduction: To analyze the impact of systematic second-look surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC) performed 1 year after resection of the primary tumor, in asymptomatic patients at high risk of developing peritoneal carcinomatosis (PC). Methods: Between 2012-2016, 33 patients without any sign of peritoneal recurrence on imaging studies were prospectively included in the study and underwent second-look surgery aimed at treating limited PC earlier and were prospectively recorded. They were selected based on 5 primary tumor-associated criteria: resected minimal synchronous macroscopic PC (n = 10), synchronous ovarian metastases (n = 2), positive peritoneal cytology (n = 2), pT4 primary tumors (n = 15) and perforation (n = 4). Results: PC was found and treated by cytoreduction plus HIPEC in 10 of the 33 (30.3%) patients, although it was detected in only 2/15 patients of the pT4 subgroup (13.3%). The patients without PC underwent complete abdominal exploration plus HIPEC. Median follow-up was 14.5 months. One patient died postoperatively at day 55. Severe morbidity rate (Clavien-Dindo III-V) was low (15.2%). The 3-year overall survival rate was 93% and the 3-year disease-free survival rate was 33%. Peritoneal recurrences occurred in 4 patients (12.1%), 2 of whom had macroscopic PC discovered at the second-look (20%), while the other 2 patients had no macroscopic PC (8.7%) (P = .04). Conclusions: The second look + HIPEC strategy in our series of patients at high risk of developing PC, allows its early detection and its treatment in 30.3% of cases, with a very low rate of peritoneal recurrence. It is important to continue evaluating the results to increase the accuracy of the inclusion criteria, especially the pT4 criterion that in this series has a low predictive power for the occurrence of PC (AU)

Tick-host conflict: immunoglobulin E antibodies to tick proteins in patients with anaphylaxis to tick bite.

Tick-borne infectious diseases and allergies are a growing problem worldwide. Tick bite allergy has been associated with the direct effect of immunoglobulin E (IgE) response to tick salivary antigens, or secondary to the induction of allergy to red meat consumption through IgE antibodies against the carbohydrate α-Gal (Gal α 1-3Gal ß 1-(3)4GlcNAc-R). However, despite the growing burden of this pathology, the proteins associated with anaphylaxis to tick bite have not been characterized. To address this question, a comparative proteomics approach was used to characterize tick proteins producing an IgE antibody response in a healthy individual with record of tick bites, which had not resulted in any allergic reactions, and two patients with anaphylactic reactions to Rhipicephalus bursa or Hyalomma marginatum tick bites. Both patients and the healthy individual were red meat tolerant. The results supported a patient-specific IgE antibody response to tick species responsible for the anaphylaxis to tick bite. Both patients and the healthy individual serologically recognized tick proteins with and without α-Gal modifications, with proteins differentially recognized by patients but not control sera. These proteins could be used as potential antigens for diagnostics, treatment and prevention of tick bite-induced allergies.

Adverse reactions and tolerability of high-dose sublingual allergen immunotherapy.

BACKGROUND: Sublingual allergen immunotherapy is an effective treatment against allergic respiratory disease. Many studies have shown the safety of this type of therapy, although the factors that might affect the tolerability of high-dose sublingual immunotherapy have not been well established. The aim of this study was to determine the factors that affect the tolerability of sublingual allergen immunotherapy. PATIENTS AND METHODS: A total of 183 subjects aged ≥5 years, diagnosed with allergic rhinitis with/without mild to moderate asthma due to sensitization to grass, olive pollen, or mites, were included in this open, retrospective, multicentric, noninterventional study. Sublingual immunotherapy was administered for at least 3 months. RESULTS: The most frequent adverse reaction was oral pruritus (13.7% of the patients). Most of the reactions were local (84.7%) and immediate (93.5%) and occurred during the initiation phase (60.6%). All reactions were mild to moderate in severity. No serious adverse reactions were registered. When comparing factors with potential influence on the occurrence of adverse reactions, the results between the groups of subjects with and without adverse reactions showed no statistically significant differences in sex (P=0.6417), age (P=0.1801), years since the disease was first diagnosed (P=0.3800), treatment composition (P=0.6946), polysensitization (P=0.1730), or clinical diagnosis (P=0.3354). However, it was found that treatment duration had a statistically significant influence (3 months, >3 months: P=0.0442) and the presence of asthma was close to statistical significance (P=0.0847). CONCLUSION: In our study, treatment duration is significantly associated with the occurrence of adverse reactions after the administration of high doses of sublingual allergen immunotherapy.

Validation and psychometric properties of the Spanish version of the Quality of Life Scale (QOLS) in patients with fibromyalgia.

Fibromyalgia (FM) is a chronic disease associated with high disability levels, which in turn lead to low quality of life (QOL). The objectives of this study were to translate the Quality of Life Scale (QOLS) into Spanish and to assess its reliability and validity for its use in patients with FM. A total of 140 women are suffering from FM (52.87 ± 9.35 years old). All belonged to an association of FM patients (AFIXA, Jaén, Spain). The Spanish versions of the FM impact questionnaire (FIQ), the SF-36, and Beck's Depression Inventory were used to assess them. The construct's validity was checked by means of exploratory factorial analysis (varimax with Kaiser normalization). Test-retest reliability was assessed through intraclass correlation coefficient (ICC), and convergent validity through Spearman's correlation. Results show that Cronbach's alpha was 0.887, which revealed high internal consistency. The value of ICC for the QOLS total was 0.765 (95 % CI 0.649-0.843, p < 0.001). QOLS presented a significant Spearman's correlation (p < 0.01) with Beck's Inventory, with the physical and mental subtotals of SF-36 and with FIQ. The main component analysis and the varimax rotation revealed the convergence on three factors that account for 54.05 % of variance. Taking into account the severity of the disorder, significant differences (p < 0.05) appeared in QOLS, with moderately afflicted patients getting higher scores than the most severe cases. In conclusion, our study shows that the Spanish version of the QOLS is a reliable instrument, with a good convergent and discriminant construct validity, for measuring the QOL of Spanish FM patients.

Mecánica de la succión: comparación entrela lactancia artificial y la lactancia materna / Mechanics of sucking: comparison between bottle feeding and breastfeeding

Introducción: Hay poco conocimiento sobre la similitud de la mecánicaentre la lactancia materna y la artificial. Evaluamos la mecánica dela succión en neonatos con lactancia materna exclusiva, lactancia artificialexclusiva y lactancia mixta. Nuestra hipótesis fue que el patrón fisiológicode los movimientos de succión varía según el tipo de alimentación.Según esta hipótesis, los niños con lactancia materna exclusivarealizan unos movimientos al mamar distintos a los de la succión deuna tetina, realizados por niños con lactancia artificial. Los niños conlactancia mixta mezclan ambos tipos de movimientos de succión.Métodos: Estudio transversal de neonatos de 21-28 días de edad conlactancia materna o artificial exclusiva (124 parejas madre-hijo), y ensayode campo, abierto, cruzado y aleatorizado, realizado en neonatosde 21-28 días (110 parejas madre-hijo) y en lactantes de 3-5 meses deedad (125 parejas madre-hijo) con lactancia mixta. Las variables principalesfueron los movimientos de succión y las pausas.Resultados: Los neonatos de 21-28 días de edad alimentados conlactancia artificial exclusiva mostraron un menor número de movimientosde succión y el mismo número de pausas, pero de mayor duración,que los neonatos con lactancia materna exclusiva. Entre los niños querecibieron lactancia mixta, el número de movimientos de succión al recibiralimentación con biberón fue similar y las pausas menos numerosasy de menor duración respecto a lo observado al amamantar, tanto a (..) (AU)

Background: There is very little evidence of the similarity of the mechanicsof maternal and bottle feeding. We assessed the mechanics ofsucking in exclusive breastfeeding, exclusive bottle feeding, and mixedfeeding. The hypothesis established was that physiological pattern forsuckling movements differ depending on the type of feeding. Accordingto this hypothesis, babies with breastfeeding have suckling movementsat the breast that are different from the movements of suckling a teat ofbabies fed with bottle. Children with mixed feeding mix both types ofsuckling movements.Methods: Cross-sectional study of infants aged 21-28 days with onlymaternal feeding or bottle feeding (234 mother-infant pairs), and a randomizedopen cross-over field trial in newborns aged 21-28 days andbabies aged 3-5 months with mixed feeding (125 mother-infant pairs).Primary outcome measures were sucks and pauses.Results: Infants aged 21-28 days exclusively bottle-fed showed fewersucks and the same number of pauses but of longer duration comparedto breastfeeding. In mixed feeding, bottle feeding compared to breastfeedingshowed the same number of sucks but fewer and shorter pauses,both at 21-28 days and at 3-5 months. The mean number of breastfeedingsin a day (in the mixed feed group) was 5.83 ± 1.93 at 21-28 daysand 4.42 ± 1.67 at 3-5 months. In the equivalence analysis of the mixed (..) (AU)

Mechanics of sucking: comparison between bottle feeding and breastfeeding.

BACKGROUND: There is very little evidence of the similarity of the mechanics of maternal and bottle feeding. We assessed the mechanics of sucking in exclusive breastfeeding, exclusive bottle feeding, and mixed feeding. The hypothesis established was that physiological pattern for suckling movements differ depending on the type of feeding. According to this hypothesis, babies with breastfeeding have suckling movements at the breast that are different from the movements of suckling a teat of babies fed with bottle. Children with mixed feeding mix both types of suckling movements. METHODS: Cross-sectional study of infants aged 21-28 days with only maternal feeding or bottle feeding (234 mother-infant pairs), and a randomized open cross-over field trial in newborns aged 21-28 days and babies aged 3-5 months with mixed feeding (125 mother-infant pairs). Primary outcome measures were sucks and pauses. RESULTS: Infants aged 21-28 days exclusively bottle-fed showed fewer sucks and the same number of pauses but of longer duration compared to breastfeeding. In mixed feeding, bottle feeding compared to breastfeeding showed the same number of sucks but fewer and shorter pauses, both at 21-28 days and at 3-5 months. The mean number of breastfeedings in a day (in the mixed feed group) was 5.83 +/- 1.93 at 21-28 days and 4.42 +/- 1.67 at 3-5 months. In the equivalence analysis of the mixed feed group, the 95% confidence interval for bottle feeding/breastfeeding ratio laid outside the range of equivalence, indicating 5.9-8.7% fewer suction movements, and fewer pauses, and shorter duration of them in bottle feeding compared with breastfeeding. CONCLUSIONS: The mechanics of sucking in mixed feeding lay outside the range of equivalence comparing bottle feeding with breastfeeding, although differences were small. Children with mixed feeding would mix both types of sucking movements (breastfeeding and bottle feeding) during the learning stage and adopt their own pattern.

Effects of air pollution on cup a 3 allergen in Cupressus arizonica pollen grains.

BACKGROUND: Cupressaceae is a family of plants resistant to airborne contamination, and its pollen is the main cause of winter allergic respiratory diseases, especially in North America, Japan, and Mediterranean countries. Recently, a major allergen from Cupressus arizonica pollen grains, Cup a 3, was cloned and expressed. OBJECTIVE: To study the effects of air pollution on the expression of Cup a 3, a thaumatinlike protein, in C. arizonica pollen grains using a combination of transmission electron microscopy and immunocytochemical techniques. METHODS: Observations were made in mature and hydrated C. arizonica pollen grains from various regions in Spain with different degrees of air pollution. Specimens were fixed using freezing protocols, and ultrathin sections were incubated with anti-rCup a 3 rabbit polyclonal antibodies. RESULTS: Labeling of Cup a 3 was detected in mature and hydrated C. arizonica pollen grains. It was more intense in pollen from polluted air regions, and abundant gold particles were observed as they were released through the pollen grain walls. Furthermore, gold particles remained abundant in the pollen cytoplasm. The labeling was noticeably lower in pollen grains from unpolluted air regions. CONCLUSIONS: Cup a 3 is present in the cytoplasm and walls of cypress pollen grains during the air dispersion and hydration stages. The abundance of Cup a 3 in pollen grains under polluted air conditions indicates that these cypresses intensify their activity as a defense from environmental pollution, thus strengthening their allergenicity.

El parto prematuro: la emboscada en la preparación maternal / Premature labour: the ambush in maternal education

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Occupation and larynx and hypopharynx cancer: an international case-control study in France, Italy, Spain, and Switzerland.

OBJECTIVE: To estimate risks for laryngeal/hypopharyngeal cancer associated with occupational titles and industrial activities. METHODS: A multicentre population-based case-control study was conducted in the early 1980s in six southern European areas. Analyses included 1010 male cases and 2176 controls. Odds ratios (ORs) (adjusted for age, study area, tobacco consumption, and alcohol consumption) were estimated for 156 occupations and 70 industrial activities. RESULTS: An excess risk has been confirmed for categories of construction workers, potters (OR: 5.91, 95% confidence intervals 1.46-24.0), butchers (2.53, 1.22-5.22), barbers (2.33, 1.00-5.40), laborers not otherwise specified (1.52, 1.12-2.06), as well as for men who had been employed in railway transport (1.52, 0.97-2.39), shipbuilding (2.05, 0.89-4.94), and hotels (2.06, 0.89-4.75). An association was also found for shoe finishers (3.23, 0.75-13.9), loggers (2.07, 0.87-4.90), and some groups of metal workers. ORs for loggers, butchers, railway transport workers, laborers, and reinforced concreters increased with duration of employment. The suggestion of a risk for machine operators among woodworkers (3.10, 0.92-10.5) conflicts with previous findings. No significant excess of risk was found for categories previously reported to be associated with laryngeal and hypopharyngeal cancer, such as drivers, mechanics, welders, machinists, and painters. CONCLUSIONS: The present study provides additional evidence to the hypothesis of a risk of cancer of the larynx/ hypopharynx for workers engaged in jobs in the construction, metal, textile, ceramic, and food industries and in railway transport. Loggers were also found at risk; a previously unreported finding.