High prevalence of microplastics in the digestive tract of Scyliorhinus canicula (Linneaus, 1758) shows the species biomonitoring potential.

Plastic pollution is widespread in oceans and the ingestion of plastic by marine organisms is causing concern about potential adverse effects. The purpose of this study was to analyze the different types of plastics in the digestive tract of female small-spotted catshark (Scyliorhinus canicula). An alkaline digestion method using 10 % potassium hydroxide (KOH), was used. The samples were filtered and visually observed to classify the plastics according to size, shape, and color. Raman spectroscopy was further employed to identify the polymer types. The study found the presence of plastics in 89.5 % of the 200 females analyzed, including 10 polymers, with polystyrene (PS), polyamide-6 (PA6), polyvinyl chloride (PVC), and silicone rubber (SR) being the most common. The polymers identified largely reflect the results of similar studies in the marine environment and were similar to global polymer diversity of microplastics, which highlights the potential of S. canicula females for biomonitoring microplastic pollution.

Impact of overweight and obesity in postmenopausal women.

OBJECTIVE: This study aimed to investigate the association between overweight and obesity in postmenopausal women and different aspects related to health such as quality of life, physical activity, sleep quality and level of physical activity. METHODS: An observational cross-sectional study was carried out during 2021-2022 in Spain in postmenopausal women. Health-related quality of life was assessed using the 12-item short-form survey (SF-12). The Pittsburgh Sleep Quality Index (PSQI) was used to determine sleep quality, and the International Physical Activity Validated Questionnaire (IPAQ) was used for physical activity. A multivariate analysis was conducted using binary logistic regression to control the confounding bias. RESULTS: A total of 395 postmenopausal women participated: 64.6% (n = 255) were overweight or obese. Obesity was associated with higher odds of having a lower quality of life (adjusted odds ratio [aOR] = 2.88; 95% confidence interval [CI]: 1.51-5.49), including alterations in physical role and function, pain and vitality. Postmenopausal women with overweight/obesity had higher odds of cardiovascular problems (aOR = 2.09; 95% CI: 1.04-4.19/aOR = 4.44; 95% CI: 2.12-9.31), and women with obesity were more likely to develop endocrine problems (aOR = 2.29; 95% CI: 1.10-4.75). Finally, women with obesity had higher odds of suffering urinary incontinence (aOR = 2.10; 95% CI: 1.10-4.01) or fecal incontinence (aOR = 2.70; 95% CI: 1.35-5.39), and pelvic pain (aOR = 2.33; 95% CI: 1.18-4.59). CONCLUSIONS: Obesity in postmenopausal women negatively affects perceived quality of life, sleep quality, physical activity, the development of cardiovascular problems and pelvic floor-related problems.

Ha sido el 2020 un año perdido en la formación de cirugía ortopédica y traumatología? Percepción de los residentes / Has 2020 been a lost year in orthopedic surgery and trauma training? Residents’ perceptions

Objetivo: La pandemia de la COVID-19 ha afectado a la formación sanitaria especializada a todos los niveles. El aprendizaje en el ámbito quirúrgico se ha visto gravemente afectado y hasta ahora no se ha valorado el impacto en la formación de residentes de traumatología. Material y métodos: Se hizo llegar mediante enlace web y redes sociales una encuesta en línea de 17 preguntas a los residentes de cirugía ortopédica y traumatología de todo el territorio español entre el 10 de febrero y el 28 de febrero de 2021. Se analizaron los efectos de la pandemia de la COVID-19 en la actividad asistencial y formativa de los residentes. Resultados: Un total de 307 residentes de cirugía ortopédica y traumatología de toda España respondieron la encuesta. El 77,2% de los encuestados tuvo que suspender sus rotaciones. De estos, al 67,5% le gustaría retomar las rotaciones perdidas durante la pandemia. Un 69,7% de las cirugías programadas fueron suspendidas. La actividad quirúrgica estuvo completamente parada una media de 8 semanas. El 66,8% de los residentes considera que se ha visto afectada su formación quirúrgica y que esto repercutirá en su futuro laboral. El 49,5% considera insuficiente la oferta formativa en línea. Del total de encuestados, el 52,1% considera que el impacto de la situación de pandemia respecto a su situación formativa ha sido malo o muy malo. Conclusiones: La recogida de datos muestra un impacto negativo sobre la formación asistencial y teórica. Este estudio pone de manifiesto la necesidad de continuar ofreciendo una formación de calidad y maximizar las oportunidades de aprendizaje.(AU)

Objective: The COVID-19 pandemic has affected specialized healthcare training at all levels. Surgical learning has been severely affected, and the impact on orthopedic surgery residency training has so far not been assessed. Material and methods: An online survey of 17 questions was sent via web link to orthopedic surgery residents throughout Spain between February 10, 2021 and February 28, 2021. The effects of the COVID-19 pandemic on the care and training activities of residents were analyzed. Results: A total of 307 orthopedic surgery residents from all over Spain responded to the online survey. A total of 77.2% of the respondents had to suspend their rotations. Of these, 67.5% would like to resume the rotations they missed during the pandemic. A total of 69.7% of scheduled surgeries were suspended. Surgical activity was completely stopped for an average of 8 weeks. 66.8% of the residents consider that their surgical training has been affected and this will have repercussions on their future work. 49.5% considered the online training offered to be insufficient. Of the total number of respondents, 52.1% considered that the impact of the pandemic situation on their training situation was bad or very bad. Conclusions: The data collection shows a negative impact on both theoretical and clinical training. This study highlights the need to continue offering quality training by maximizing learning opportunities.(AU)

[Translated article] Has 2020 been a lost year in orthopaedic surgery and trauma training? Residents’ perceptions / Ha sido el 2020 un año perdido en la formación de cirugía ortopédica y traumatología? Percepción de los residentes

Objetivo: La pandemia de la COVID-19 ha afectado a la formación sanitaria especializada a todos los niveles. El aprendizaje en el ámbito quirúrgico se ha visto gravemente afectado y hasta ahora no se ha valorado el impacto en la formación de residentes de traumatología. Material y métodos: Se hizo llegar mediante enlace web y redes sociales una encuesta en línea de 17 preguntas a los residentes de cirugía ortopédica y traumatología de todo el territorio español entre el 10 de febrero y el 28 de febrero de 2021. Se analizaron los efectos de la pandemia de la COVID-19 en la actividad asistencial y formativa de los residentes. Resultados: Un total de 307 residentes de cirugía ortopédica y traumatología de toda España respondieron la encuesta. El 77,2% de los encuestados tuvo que suspender sus rotaciones. De estos, al 67,5% le gustaría retomar las rotaciones perdidas durante la pandemia. Un 69,7% de las cirugías programadas fueron suspendidas. La actividad quirúrgica estuvo completamente parada una media de 8 semanas. El 66,8% de los residentes considera que se ha visto afectada su formación quirúrgica y que esto repercutirá en su futuro laboral. El 49,5% considera insuficiente la oferta formativa en línea. Del total de encuestados, el 52,1% considera que el impacto de la situación de pandemia respecto a su situación formativa ha sido malo o muy malo. Conclusiones: La recogida de datos muestra un impacto negativo sobre la formación asistencial y teórica. Este estudio pone de manifiesto la necesidad de continuar ofreciendo una formación de calidad y maximizar las oportunidades de aprendizaje.(AU)

Objective: The COVID-19 pandemic has affected specialized healthcare training at all levels. Surgical learning has been severely affected, and the impact on orthopedic surgery residency training has so far not been assessed. Material and methods: An online survey of 17 questions was sent via web link to orthopedic surgery residents throughout Spain between February 10, 2021 and February 28, 2021. The effects of the COVID-19 pandemic on the care and training activities of residents were analyzed. Results: A total of 307 orthopedic surgery residents from all over Spain responded to the online survey. A total of 77.2% of the respondents had to suspend their rotations. Of these, 67.5% would like to resume the rotations they missed during the pandemic. A total of 69.7% of scheduled surgeries were suspended. Surgical activity was completely stopped for an average of 8 weeks. 66.8% of the residents consider that their surgical training has been affected and this will have repercussions on their future work. 49.5% considered the online training offered to be insufficient. Of the total number of respondents, 52.1% considered that the impact of the pandemic situation on their training situation was bad or very bad. Conclusions: The data collection shows a negative impact on both theoretical and clinical training. This study highlights the need to continue offering quality training by maximizing learning opportunities.(AU)

[Translated article] Has 2020 been a lost year in orthopaedic surgery and trauma training? Residents' perceptions.

OBJECTIVE: The COVID-19 pandemic has affected specialised healthcare training at all levels. Surgical learning has been severely affected, and the impact on orthopaedic surgery residency training has so far not been assessed. MATERIAL AND METHODS: An online survey of 17 questions was sent via web link to orthopaedic surgery residents throughout Spain between February 10, 2021 and February 28, 2021. The effects of the COVID-19 pandemic on the care and training activities of residents were analysed. RESULTS: A total of 307 orthopaedic surgery residents from all over Spain responded to the online survey. A total of 77.2% of the respondents had to suspend their rotations. Of these, 67.5% would like to resume the rotations they missed during the pandemic. A total of 69.7% of scheduled surgeries were suspended. Surgical activity was completely stopped for an average of 8 weeks. 66.8% of the residents consider that their surgical training has been affected and this will have repercussions on their future work. 49.5% considered the online training offered to be insufficient. Of the total number of respondents, 52.1% considered that the impact of the pandemic situation on their training situation was bad or very bad. CONCLUSIONS: The data collection shows a negative impact on both theoretical and clinical training. This study highlights the need to continue offering quality training by maximising learning opportunities.

Efecto de un programa de refuerzo motriz en alumnado con dificultades motrices y/o sociales / Efeito de um programa de reforço motor sobre os estudantes com dificuldades motoras e/ou sociais / Effect of a motor reinforcement programme in students with motor and/or social difficulties

El objetivo del presente estudio fue mejorar la competencia motriz y las relaciones sociales en alumnado con dificultades de coordinación y/o sociales a través de un programa integral de refuerzo motriz. Para ello, el estudio se dividió en cuatro fases. En la primera fase se seleccionaron, de entre los 60 niños participantes de tercer curso de Educación infantil, aquellos susceptibles de sufrir dificultades de movimiento y/o déficit en sus relaciones sociales, tras la aplicación de una serie de pruebas filtro. En la segunda y tercera fase se evaluó la competencia motriz, mediante la Batería de evaluación del movimiento para niños (MABC-2) y se implementó un programa de alfabetización física orientado al desarrollo de las habilidades motrices básicas para, finalmente, en la cuarta fase, comprobar si se había producido alguna mejora en la competencia motriz y en las relaciones sociales del alumnado participante. Tras la aplicación de la intervención se comprobaron mejoras significativas entre las medias pre y post en la dimensión equilibrio, puntería y atrape y puntuación global, además de una mejora significativa en amigo positivo. Estos resultados invitan a seguir trabajando en esta línea para favorecer un adecuado desarrollo de los alumnos de la etapa de infantil, tanto a nivel motriz como a nivel social. (AU)

The goal of this study was to improve motor competence and social relationships among students with coordination and / or social difficulties, through an integrative reinforcement program, from motor skills. For that purpose, the study was divided into four phases. In the first one, from among 60 children participating in the third year of Early Childhood Education, those who were susceptible to suffer difficulties with movement and / or deficits in their social relationships were selected, after having applied different filter tests. In the second and third phase, motor competence was evaluated through the Children's Movement Assessment Battery (MABC-2) and a physical literacy program was implemented aimed at the development of basic motor skills. Finally, in the fourth phase, it was checked whether there had been any improvement in the motor competence and social relations of the participating students. After intervention, significant improvements were found between the pre and post averages in the dimension balance, aim and catch and overall score, plus a significant improvement in positive friend. These results invite us to continue working to promote the adequate development among students in the infant stage, both at the motor and social levels. (AU)

Esta pesquisa tem como objetivo melhorar a competência motora e as relações sociais em estudantes com dificuldades de coordenação e/ou sociais, por meio de um programa abrangente de reforço das habilidades motoras. Para isso, o estudo está dividido em quatro fases. Na primeira, foram selecionados entre os 60 alunos participantes do terceiro curso de educação infantil, aqueles suscetíveis de apresentar dificuldades de movimento e/ou de relações sociais, após a aplicação de uma série de testes de filtragem. Na segunda e terceira fases, avaliou-se a competência motora por meio da Bateria de Avaliação de Movimentos para Crianças (Mabc-2) e se implementou um programa de alfabetização física orientada ao desenvolvimento das habilidades motoras básicas; para, finalmente, na quarta fase, comprovar se houve melhora na competência motora e nas relações sociais dos participantes. Após a aplicação da intervenção, melhorias significativas entre as médias pré e post na dimensão equilíbrio, pontaria e captura e pontuação global , bem como uma melhoria significativa em amigo positivo. O que nos sugere a continuar trabalhando nesta linha para promover o desenvolvimento adequado dos alunos na fase infantil, tanto no nível motor quanto no social. (AU)

[Has 2020 been a lost year in orthopedic surgery and trauma training? Residents' perceptions]. / ¿Ha sido el 2020 un año perdido en la formación de cirugía ortopédica y traumatología? Percepción de los residentes.

Objective: The COVID-19 pandemic has affected specialized healthcare training at all levels. Surgical learning has been severely affected, and the impact on orthopedic surgery residency training has so far not been assessed. Material and methods: An online survey of 17 questions was sent via web link to orthopedic surgery residents throughout Spain between February 10, 2021 and February 28, 2021. The effects of the COVID-19 pandemic on the care and training activities of residents were analyzed. Results: A total of 307 orthopedic surgery residents from all over Spain responded to the online survey. A total of 77.2% of the respondents had to suspend their rotations. Of these, 67.5% would like to resume the rotations they missed during the pandemic. A total of 69.7% of scheduled surgeries were suspended. Surgical activity was completely stopped for an average of 8 weeks. 66.8% of the residents consider that their surgical training has been affected and this will have repercussions on their future work. 49.5% considered the online training offered to be insufficient. Of the total number of respondents, 52.1% considered that the impact of the pandemic situation on their training situation was bad or very bad. Conclusions: The data collection shows a negative impact on both theoretical and clinical training. This study highlights the need to continue offering quality training by maximizing learning opportunities.

Risk of caesarean delivery in labour induction: a systematic review and external validation of predictive models.

BACKGROUND: Despite the existence of numerous published models predicting the risk of caesarean delivery in women undergoing induction of labour (IOL), validated models are scarce. OBJECTIVES: To systematically review and externally assess the predictive capacity of caesarean delivery risk models in women undergoing IOL. SEARCH STRATEGY: Studies published up to 15 January 2021 were identified through PubMed, CINAHL, Scopus and ClinicalTrials.gov, without temporal or language restrictions. SELECTION CRITERIA: Studies describing the derivation of new models for predicting the risk of caesarean delivery in labour induction. DATA COLLECTION AND ANALYSIS: Three authors independently screened the articles and assessed the risk of bias (ROB) according to the prediction model risk of bias assessment tool (PROBAST). External validation was performed in a prospective cohort of 468 pregnancies undergoing IOL from February 2019 to August 2020. The predictive capacity of the models was assessed by creating areas under the receiver operating characteristic curve (AUCs), calibration plots and decision curve analysis (DCA). MAIN RESULTS: Fifteen studies met the eligibility criteria; 12 predictive models were validated. The quality of most of the included studies was not adequate. The AUC of the models varied from 0.520 to 0.773. The three models with the best discriminative capacity were those of Levine et al. (AUC 0.773, 95% CI 0.720-0.827), Hernández et al. (AUC 0.762, 95% CI 0.715-0.809) and Rossi et al. (AUC 0.752, 95% CI 0.707-0.797). CONCLUSIONS: Predictive capacity and methodological quality were limited; therefore, we cannot currently recommend the use of any of the models for decision making in clinical practice. TWEETABLE ABSTRACT: Predictive models that predict the risk of cesarean section in labor inductions are currently not applicable.

Papillary thyroid microcarcinoma with minimal extrathyroidal extension. Is its course so indolent that it requires a less aggressive treatment?

BACKGROUND: Although the incidence of papillary thyroid microcarcinoma (PTMC) has increased in recent decades, the role played by minimal extrathyroidal extension (mETE) in the prognosis of PTMC is still unclear. The aim of this study is to analyze the factors associated with PTMC with mETE and its long-term prognosis. MATERIAL AND METHODS: We conducted a retrospective study on patients with a histological diagnosis of PTMC. We excluded patients who had previously undergone thyroid surgery, those who had other synchronous malignancies, those with an ectopic location of the PTMC, and those lost to follow-up within two years. We compared group 1 (PTMC without extrathyroidal extension) to group 2 (PTMC with mETE) and performed a multivariate analysis. RESULTS: We observed PTMC with mETE in 11.2% (n = 18) of patients. On the multivariate analysis, mETE was associated with an age ≥45 years (OR: 4.383; 95% CI: 1.051-18.283, p = .043), tumor size ≥8 mm (OR: 5.913; 95% CI: 1.795-19.481; p = .003), bilaterality (OR: 4.430; 95% CI: 1.294-15.173; p = .018) and metastatic lymph nodes (OR: 12.588; 95% CI: 2.919-54.280; p = .001). Over the mean follow-up period of 119.8 ±â€¯65 months, one case of recurrence was detected in group 2 (0% vs. 5.6%; p = .112). No patients died of the disease. Disease-free survival was lower in group 2 (124.9 ±â€¯5.6 vs. 97.4 ±â€¯10.3 months; p = .034). CONCLUSIONS: The mETE of PTMC is a factor of worse prognosis associated with the presence of metastatic lymph nodes and a lower rate of disease-free survival.

Microcarcinoma papilar de tiroides con extensión extratiroidea mínima. ¿Tiene un curso tan indolente para precisar un tratamiento menos intensivo? / Papillary thyroid microcarcinoma with minimal extrathyroidal extension. Is its course so indolent that it requires a less aggressive treatment?

Introducción Aunque el microcarcinoma papilar de tiroides (MCPT) ha sufrido un incremento en la incidencia en las últimas décadas, todavía no está claro qué papel desempeña la extensión extratiroidea mínima (EETm) en su pronóstico. El objetivo de este estudio es analizar los factores asociados al MCPT con EETm y su pronóstico a largo plazo. Material y métodos Estudio retrospectivo cuya población a estudio la constituyen los pacientes con diagnóstico histológico de MCPT. Se excluye a los pacientes con: cirugía tiroidea previa, otras enfermedades malignas sincrónicas, localización ectópica del MCPT o pérdida durante el seguimiento antes de los 2 años. Se comparan 2grupos: grupo 1 (MCPT sin extensión extratiroidea) y grupo 2 (MCPT con EETm). Se realiza un análisis multivariante. Resultados El 11,2% (n = 18) de los pacientes presentaron MCPT con EETm. En el análisis multivariante, la EETm se asoció con la edad ≥ 45 años (OR: 4,383; IC del 95%: 1,051-18,283; p = 0,043), el tamaño tumoral ≥ 8mm (OR: 5,913; IC del 95%; 1,795-19,481; p = 0,003), la bilateralidad (OR: 4,430, IC del 95%; 1,294-15,173; p = 0,018) y las adenopatías metastásicas (OR: 12,588; IC del 95%; 2,919-54,280; p = 0,001). Durante un seguimiento medio de 119,8 ± 65 meses, una recurrencia fue detectada en el grupo 2 (0% vs. 5,6%; p = 0,112). Ningún paciente falleció debido a la enfermedad. La supervivencia libre de enfermedad fue menor en el grupo 2 (124,9 ± 5,6 vs. 97,4 ± 10,3 meses; p = 0,034). Conclusión La EETm del MCPT es un factor de peor pronóstico, asociada a la presencia de adenopatías metastásicas y a una menor supervivencia libre de enfermedad (AU)

Background Although the incidence of papillary thyroid microcarcinoma (PTMC) has increased in recent decades, the role played by minimal extrathyroidal extension (mETE) in the prognosis of PTMC is still unclear. The aim of this study is to analyze the factors associated with PTMC with mETE and its long-term prognosis. Material and methods We conducted a retrospective study on patients with a histological diagnosis of PTMC. We excluded patients who had previously undergone thyroid surgery, those who had other synchronous malignancies, those with an ectopic location of the PTMC, and those lost to follow-up within 2years. We compared group 1 (PTMC without extrathyroidal extension) to group 2 (PTMC with mETE) and performed a multivariate analysis. Results We observed PTMC with mETE in 11.2% (n=18) of patients. On the multivariate analysis, mETE was associated with age ≥45 years (OR: 4.383; 95% CI: 1.051-18.283, p = .043), tumor size ≥8mm (OR: 5.913; 95% CL: 1.795-19.481; p = .003), bilaterality (OR: 4.430; 95% CI: 1.294-15.173; p = .018) and metastatic lymph nodes (OR: 12.588; 95% CI: 2.919-54.280; p = .001). During a mean follow-up of 119.8±65 months, one recurrence was detected in group 2 (0% vs. 5.6%; p = .112). No patients died of the disease. Disease-free survival was lower in group 2 (124.9±5.6 vs. 97.4±10.3 months; p = .034). Conclusions The mETE of PTMC is a factor of worse prognosis associated with the presence of metastatic lymph nodes and a lower rate of disease-free survival (AU)

Risk factors for methicillin-resistant Staphylococcus aureus and extended-spectrum ß-lactamase producing Enterobacterales in patients with diabetic foot infections requiring hospital admission.

OBJECTIVE: Methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum ß-lactamase-producing Enterobacterales (ESBL-E) may complicate the treatment of diabetic foot infections (DFIs). The aim of this study was to determine the risk factors for these pathogens in DFIs. METHODS: This was a prospective observational study of 167 consecutive adult patients with DFIs. The diagnosis and severity of DFIs were based on the Infectious Disease Society of America (IDSA) classification system. Multivariate analyses were performed in order to identify risk factors for MRSA and ESBL-E infections. RESULTS: S. aureus was the most isolated pathogen (n=82, 37.9 %) followed by Escherichia coli (n= 40, 18.5%). MRSA accounted for 57.3% of all S. aureus and 70% of Klebsiella pneumoniae and 25% of E. coli were ESBL producers, respectively. Deep ulcer [OR 8,563; 95% CI (1,068-4,727)], previous use of fluoroquinolones [OR 2,78; 95% CI (1,156-6,685)] and peripheral vasculopathy [OR 2,47; 95% CI (1.068-4.727)] were the independent predictors for MRSA infections; and osteomyelitis [OR 6,351; 95% CI (1,609-25,068)] and previous use of cephalosporins [OR 5,824; 95% CI (1,517-22,361)] for ESBL-E infections. CONCLUSIONS: MRSA and ESBL-E have adquired a great clinical relevance in DFIs. The availability of their risk factors is very convenient to choose the empirical treatment in severe forms.

Papillary thyroid microcarcinoma with minimal extrathyroidal extension. Has it so indolent course to require a less aggressive treatment? / Microcarcinoma papilar de tiroides con extensión extratiroidea mínima. ¿Tiene un curso tan indolente para precisar un tratamiento menos intensivo?

BACKGROUND: Although the incidence of papillary thyroid microcarcinoma (PTMC) has increased in recent decades, the role played by minimal extrathyroidal extension (mETE) in the prognosis of PTMC is still unclear. The aim of this study is to analyse the factors associated with PTMC and mETE and the long-term prognosis of PTMC. MATERIAL AND METHODS: We conducted a retrospective study with a population consisting of patients with a histological diagnosis of PTMC. We excluded patients who had previously undergone thyroid surgery, those who had other synchronous malignancies, those with an ectopic location of the PTMC and those lost to follow-up within 2years. We compared group 1 (PTMC without extrathyroidal extension) versus group 2 (PTMC with mETE) and performed a multivariate analysis. RESULTS: We observed PTMC with mETE in 11.2% (n=18) of the patients. In the multivariate analysis, mETE was associated with an age ≥45 years (OR, 4.383; 95% CI 1.051-18.283, p=.043), a tumour size ≥8mm (OR, 5.913; 95% CI 1.795-19.481; p=.003), bilaterality (OR, 4.430; 95% CI 1.294-15.173; p=.018) and metastatic lymph nodes (OR, 12.588; 95% CI 2.919-54.280; p=.001). During a mean follow-up of 119.8±65 months, one recurrence was detected in group 2 (0% vs. 5.6%; p=.112), but none of the patients died due to the disease. Disease-free survival was lower in group 2 (124.9±5.6 vs. 97.4±10.3 months; p=.034). CONCLUSIONS: The mETE of MCPT is a factor of worse prognosis, associated with the presence of metastatic lymph nodes and lower disease-free survival.

18F-FDG PET/CT in staging and delineation of radiotherapy volume for head and neck cancer. / 18F-FDG PET/TC para la estadificación y la delineación del volumen de radioterapia en el cáncer de cabeza y cuello.

PURPOSE: The aim is to investigate the use of 18F-FDG (fluorine-18 fluorodeoxyglucose) PET/CT in head and neck cancer (HNC) staging and its effect on the therapeutic strategy and radiotherapy (RT) planning. METHODS AND MATERIALS: One hundred patients with HNC were included. Primary tumor sites: 18% oral cavity, 20% oropharynx, 12% hypopharynx, 11% nasopharynx, 37% larynx, 2% paranasal sinuses. Patients were staged according to the American Joint Committee of Cancer 7th edition. Stage: 5% stage I, 7% stage II, 14% stage III, 61% stage IVA, 7% stage IVB and 6% stage IVC. A contrast-enhanced CT and a 18F-FDG PET/CT acquired under RT position were performed. Both exams were compared to analyze patients' staging reclassification. Changes in therapeutic strategy were analyzed. RESULTS: 18F-FDG PET/CT detected 6 distant metastases and treatment intention changed to palliative. Eight synchronous tumors were detected; one received palliative treatment. 18F-FDG PET/CT reclassified cTNM staging in 27patients. Tumor extension changed in 28 (14% up-staged; 14% down-staged), implying a change in GTV (Gross Tumor Volume) delineation. Nodal detection was reclassified in 47 patients: 8 patients down-staged (N2C to N2A/N2B/N1) and 2 were false positive. Nineteen patients were false negatives and 5 staged as N+(N1/N2A/N2B) turned out into N2C. These staging modifications imply adapting the nodal volume to be irradiated. CONCLUSIONS: 18F-FDG PET/CT reclassification was higher than 10% in almost all categories studied (cTNM, tumor extension and nodal disease) and detects more metastases and synchronous tumors than conventional studies, which has an impact on the therapeutic patient management and RT planning.

Validación de la capacidad predictiva de resultado de parto del índice de Bishop y Burnett modificado por paridad / Predictive validity of Bishop and Burnett Scores for vaginal deliverymodified by parity

Fundamento: Validar la capacidad predictiva del resultado de parto de los índices Bishop (BS) y Burnett (BRS) frente a versiones modificadas en las que se incorpora la paridad (BSM y BRSM). Método: Cohortes históricas sobre un total de 728 inducciones realizadas durante los años 2011-2013 en el Hospital «La Mancha-Centro» (HLMC) de Alcázar de San Juan. Se evaluaron las características predictivas (análisis de validez interna) mediante áreas bajo la curva (ABC) ROC de cada parámetro de los BS y BRS y de la paridad, así como de cada uno de los 4 índices. Resultados: La paridad y todos los parámetros del BS y BRS, a excepción de la estación fetal y la posición del cuello, se asociaron con el resultado de parto. Se definieron dos nuevas escalas modificadas a partir del BS y BRS, previa eliminación del parámetro de la estación fetal, por ser el que menor capacidad discriminativa mostraba: BSM y BRSM. Se asignó un valor de 0 en las nulíparas y, en el caso de las multíparas, 3 puntos a BSM y 2 a BRSM. Los índices modificados mostraron una capacidad predictiva (ABC) de parto vaginal superior a la de los índices originales, tanto para BS (0,70 vs. 0,62) como para BRS (0,69 vs. 0,62). Conclusión: Los índices modificados BSM y BRSM, donde se sustituye el parámetro altura de la presentación por la paridad, presentan mejor capacidad predictiva respecto de los índices originales BS y BRS para determinar el resultado de parto (AU)

Background: Validating the predictive capacity on the outcome of labour of the Bishop Score (BS) and the simplified Burnett Score (BRS) compared to their modified versions, in which parity is incorporated. Methods: Historical cohorts out of a total of 728 inductions during the years 2012-2013 in the «La Mancha-Centro» Hospital of Alcázar de San Juan. We evaluated the predictive characteristics by areas under the (AUC) ROC curve for each parameter of BS and BRS and for parity, as well as for each of the 4 indices. Results: Parity and all the parameters of BS and BRS, except for foetal station and cervical position, were associated with the outcome of labour. Two modified scales were defined on the basis of BS and BRS, following removal of the "foetal station" parameter due to its low discriminative capacity: BSM and BRSM. Nulliparity was given a value of 0 points, and multiparity a value of 3 points for BSM, and 2 for BRSM. Modified indices showed a higher predictive ability (AUC) for vaginal delivery than the original indices, for both BS (0.70 vs. 0.62) and for BRS (0.69 vs. 0.62). Conclusion: Replacing the «foetal station» parameter with parity in BS and BRS, improves predictive capacity with regard to the original indices in order to determine the outcome of labour (AU)

[Predictive validity of Bishop and Burnett Scores for vaginal delivery modified by parity]. / Validación de la capacidad predictiva de resultado de parto del índice de Bishop y Burnett modificado por paridad.

BACKGROUND: Validating the predictive capacity on the outcome of labour of the Bishop Score (BS) and the simplified Burnett Score (BRS) compared to their modified versions, in which parity is incorporated. METHODS: Historical cohorts out of a total of 728 inductions during the years 2012-2013 in the "La Mancha-Centro" Hospital of Alcázar de San Juan. We evaluated the predictive characteristics by areas under the (AUC) ROC curve for each parameter of BS and BRS and for parity, as well as for each of the 4 indices. RESULTS: Parity and all the parameters of BS and BRS, except for foetal station and cervical position, were associated with the outcome of labour. Two modified scales were defined on the basis of BS and BRS, following removal of the "foetal station" parameter due to its low discriminative capacity: BSM and BRSM. Nulliparity was given a value of 0 points, and multiparity a value of 3 points for BSM, and 2 for BRSM. Modified indices showed a higher predictive ability (AUC) for vaginal delivery than the original indices, for both BS (0.70 vs. 0.62) and for BRS (0.69 vs. 0.62). CONCLUSION: Replacing the "foetal station" parameter with parity in BS and BRS, improves predictive capacity with regard to the original indices in order to determine the outcome of labour. Key Words. Bishop Score. Induction of labour. Outcome of labour. Parity. Predictive model.

[Factors associated with blood loss during precipitate labor]. / Factores asociados a la pérdida sanguínea en partos precipitados.

BACKGROUND: Precipitate labour is related to the appearance of postpartum haemorrhage due to posterior uterine atony. However, preventive measures that may be effective in reducing blood loss in this type of delivery are still unknown. Therefore, the objective of this study was to determine the risk factors associated with blood loss produced in precipitate labour. METHODS: This was an observational, analytical retrospective cohort study based on a total sample of 742 women with vaginal delivery whose duration was less than 180 minutes, during the period 2010-2014. Dead foetus antepartum gestations, twin gestations and labour induction were excluded from the analysis. The main outcome variable was intrapartum blood loss. RESULTS: By making use of multivariate analysis, the risk factors independently associated with higher blood loss (g/dL) during precipitate labour were nulliparity (0.38; p<0.001), higher antepartum haemoglobin levels (0.23; p<0.001), higher gestational age (0.06; p<0.001), manual removal of the placenta (0.92; p=0.004) and the use of episiotomy (0.34; p<0.001). Performing active management emerges as a protective factor against increased blood loss (-0.23; p<0.001). The average loss of haemoglobin was 1.0 g/dL (standard deviation =0.92). CONCLUSION: The restriction in the practice of episiotomy and the use of active management can therefore be established as key measures that professionals can modify in order to reduce blood loss during precipitate labour and to improve these mothers' postpartum period. Key words. Haemoglobin. Precipitate labour.

Factores asociados a la pérdida sanguínea en partos precipitados / Factors associated with blood loss during precipitate labour

Fundamento: El parto precipitado se relaciona con la aparición de hemorragia postparto por atonía uterina posterior. Sin embargo, las medidas preventivas que pueden resultar efectivas para lograr reducir las pérdidas sanguíneas en este tipo de parto son aún desconocidas. Por ello, el objetivo de este estudio fue conocer los factores relacionados con la pérdida sanguínea en los partos precipitados. Material y método: Se realizó un estudio observacional y analítico de cohortes retrospectivo sobre una muestra total de 742 mujeres con parto vaginal cuya duración fue inferior a 180 minutos durante el periodo 2010-2014. Las gestaciones con feto muerto anteparto, gemelares e inducciones de parto fueron excluidos del análisis. La variable resultado principal fue la pérdida hemática intraparto. Resultados: Mediante el empleo de análisis multivariante, los factores de riesgo asociados de manera independiente a mayores pérdidas sanguíneas (g/dL) en partos precipitados fueron la nuliparidad (0,38; p<0,001), niveles de hemoglobina preparto elevados (0,23; p<0,001), mayor edad gestacional (0,06; p<0,001), realización de alumbramiento manual (0,92; p=0,004) y empleo de episiotomía (0,34; p<0,001). La realización de alumbramiento dirigido surge como factor protector frente a mayores pérdidas sanguíneas (-0,23; p<0,001). La pérdida de hemoglobina promedio se situó en un 1,0 g/dL (desviación típica =0,92). Conclusiones: La estricción de la práctica de la episotomía y el empleo del alumbramiento dirigido se establece como medidas clave modificables por los profesinales para reducir las pérdidas sanguíneas en partos precipitados y mejorar el estado materno postparto (AU)

Background: Precipitate labour is related to the appearance of postpartum haemorrhage due to posterior uterine atony. However, preventive measures that may be effective in reducing blood loss in this type of delivery are still unknown. Therefore, the objective of this study was to determine the risk factors associated with blood loss produced in precipitate labour. Methods: This was an observational, analytical retrospective cohort study based on a total sample of 742 women with vaginal delivery whose duration was less than 180 minutes, during the period 2010-2014. Dead foetus antepartum gestations, twin gestations and labour induction were excluded from the analysis. The main outcome variable was intrapartum blood loss. Results: By making use of multivariate analysis, the risk factors independently associated with higher blood loss (g/dL) during precipitate labour were nulliparity (0.38; p<0.001), higher antepartum haemoglobin levels (0.23; p<0.001), higher gestational age (0.06; p<0.001), manual removal of the placenta (0.92; p=0.004) and the use of episiotomy (0.34; p<0.001). Performing active management emerges as a protective factor against increased blood loss (-0.23; p<0.001). The average loss of haemoglobin was 1.0 g/dL (standard deviation =0.92). Conclusion: The restriction in the practice of episiotomy and the use of active management can therefore be established as key measures that professionals can modify in order to reduce blood loss during precipitate labour and to improve these mothers' postpartum period (AU)