Study surgical treatment of early closing of ileostomy in rectal cancer: impact on the quality of life, morbidity and mortality and health spending

Introducción: Los pacientes sometidos a cirugía de recto con anastomosis bajas y que portan ileostomías de protección, ven prolongado el intervalo entre la realización del estoma y la cirugía de reconstrucción a veces durante meses, mientras dure el tratamiento adyuvante. El objetivo de este estudio es valorar el impacto de la calidad de vida, modificaciones en la morbimortalidad y el gasto sanitario ante el cierre de la ileostomía previo al tratamiento adyuvante. Material y métodos: Revisión retrospectiva. Se analizaron los pacientes sometidos a cierre de ileostomía entre enero 2012 y diciembre de 2013. El número de pacientes estudiado ha sido de 55: 41 varones (74,54%) y 14 mujeres (25,45%). En 27 pacientes se realizó cierre de ileostomía al año de su creación y en 28 al mes. En ambos grupos se analizó la morbimortalidad, coste sanitario y calidad de vida, este último parámetro mediante la aplicación del cuestionario GIQLI de calidad de vida. Resultados: El número de pacientes estudiado es 55. La edad media 63,83 años. Los pacientes con cierre precoz de ileostomía presentaron una estancia media hospitalaria menor, 11,87 días respecto a los pacientes con cierre anual, 14,96 días, descendiendo así el coste sanitario. El 18,33 % de los pacientes con cierre precoz de ileostomía presentó íleo postoperatorio frente a un 65,3% del cierre tardío. La calidad de vida (bienestar total) valorada en pacientes con cierre precoz ha sido de un 61, 2% frente a un 33,44 % en pacientes con cierre tardío. Conclusiones: La realización de ileostomías de protección en las anastomosis rectales bajas ha demostrado ser una medida preventiva eficaz para disminuir la morbimortalidad de las dehiscencias de las mismas. El cierre precoz de la ileostomía reduce el íleo postoperatorio, la estancia media hospitalaria, mejora la calidad de vida y el coste sanitario.Introduction: Patients undergoing rectal surgery with low anastomosis and carrying ileostomy protection, can see extended the interval between placing the stoma and the reconstructive surgery, sometimes during months, while the adjuvant treatment is being developed. The aim of this study was to assess the impact on the Quality of Life, changes in morbidity and mortality and health costs before the closure of the ileostomy prior to the adjuvant treatment. Material and methods: Retrospective study. 55 patients underwent closure of the ileostomy between January 2012 and December 2013 were studied. The sample consisted on 41 (74.54%) men and 14 (25.45%) women. In 27 Patients the closure of the ileostomy was performed in 1 year from its creation and in 28 patients was closed in one month. Morbidity and mortality, medical cost and Quality of Life were analyzed. Results: The average age was 63.83 years. Patients with early closure of ileostomy had a mean hospital stay lower, 11.87 days compared to patients with annual closure, 14.96 days, and so descending health costs. 18, 33% of patients with early closure of ileostomy presented postoperative ileus against the 65.3% of late closure. Quality of Life in Patients with early closure has been assessed 61, 2% compared to 33.44% in patients with late closure. Conclusions: Performing protection ileostomy in low rectal anastomosis has proven to be a preventive effective measure in reducing morbidity and mortality dehiscence. Early closure of the ileostomy reduces postoperative ileus, the average of hospital stay, and improves quality of life and health costs

Applications of Tissue Engineering in reparation of abdominal wall defects

En este trabajo se ha realizado una revisión bibliográfica de más de treinta artículos relevantes que han sido publicados en revistas científicas de impacto durante los últimos años con el objetivo de conocer la efectividad de las nuevas opciones terapéuticas en la reparación de defectos de la pared abdominal. La Ingeniería Tisular permite el desarrollo de nuevos sustitutos biológicos consistentes en matrices dérmicas acelulares sobre las que se cultivan células de diverso origen. Estas nuevas mallas biológicas no presentan las complicaciones habituales de las mallas artificiales que a día de hoy se utilizan en la clínica quirúrgica de forma rutinaria. Además de reducir la incidencia de complicaciones como son la infección con necesidad de retirada de la misma, falta de estímulo de la cicatrización o formación de seromas, estas nuevas opciones terapéuticas aportan beneficios adicionales como favorecer la angiogénesis, biocompatibilidad, y por tanto disminución del riesgo de infección. Existen varios tipos de matrices acelulares (humana, porcina, bovina,…) sin evidenciarse diferencias significativas entre ellas, siendo la más utilizada la humana. El cultivo de células sobre estas matrices ha demostrado mejores resultados que cuando se utiliza una matriz acelular. La colocación quirúrgica de la malla parece influir en el porcentaje de recidivas, habiéndose mostrado la colocación pre-peritoneal y la técnica de separación anatómica por componentes como las mejores. El principal problema que existe es que los estudios tienen un período de seguimiento corto, por lo que aún no se conocen los resultados a largo plazo de las mismas. A esto se añade el elevado coste de los biomateriales empleados, aún inviable en la práctica quirúrgica diaria. Por todo ello es fundamental una mayor investigación de los nuevos biomateriales para poder trasladar este tipo de opciones terapéuticas a la clínica, así como una adecuada selección del caso y el paciente cuando se decida utilizarlas.In this work we have reviewed more than thirty relevant issues recently published in scientific journal with impact factor in order to estimate the effectiveness of new therapeutic approaches in reparation of abdominal wall defects. Tissue Engineering can be used for the development of new biological substitutes consisting on acellular dermal matrix seeded with different types of cells. These new biological meshes do not present some complications that are relatively common when artificial polymeric meshes are used in actual surgical practice. Besides the decrease of incidences such as infection and need to removal, lack of healing signals, or seromas, these new therapeutic approaches lead to some additional benefits such as to induce angiogenesis, biocompatibility and, thus, decrease of infection risk. There are several types of acellular dermal matrix (human, porcine, bovine …) with no significant evidence among them, although the most used is humanderived matrix. Cell culture over these biomaterials has reported better results than using acellular matrix. Matrix localization can also modify the relapse rate. In this sense, pre-peritoneal localization and anatomical separation of components technique have been reported as the best techniques. The main concern about the included studies is a short-term following period after treatment, and thus, scarce data about long-term effectiveness of these therapeutic approaches. Furthermore, due to the high price of the used biomaterials, these therapies are unfeasible nowadays in daily surgical practice. In summary, it is necessary advanced research about these new biomaterials in order to translate them to daily practice, as well as an adequate diagnosis and selection of the patient to be treated

A Telehealth-Based Cognitive-Adaptive Training (e-OTCAT) to Prevent Cancer and Chemotherapy-Related Cognitive Impairment in Women with Breast Cancer: Protocol for a Randomized Controlled Trial

Background: Many women with breast cancer experience a great number of side effects, such as cognitive impairment, during and after chemotherapy that reduces their quality of life. Currently, research focusing on the use of non-pharmacological, and specifically telehealth interventions to prevent or mitigate them has been insufficient. Methods: This protocol describes a randomized controlled trial aimed at studying the preventive effects of a videoconferenced cognitive-adaptive training (e-OTCAT) program (ClinicalTrials.gov NCT04783402). A number of 98 eligible participants will be randomized to one of the following groups: (a) the experimental group receiving the e-OTCAT program during 12 consecutive weeks since the beginning of chemotherapy; and (b) the control group receiving and educational handbook and usual care. The primary outcome will be the cognitive function. Secondary measures will be psychological distress, fatigue, sleep disturbance, quality of life and occupational performance. The time-points for these measures will be placed at baseline, after 12 weeks and six months of post-randomization. Conclusion: This trial may support the inclusion of multidimensional interventions through a telehealth approach in a worldwide growing population suffering from breast cancer, emphasizing the prevention of cognitive impairment as one of the side effects of cancer and its treatments.Spanish Government FPU17/00939 FPU18/03575Instituto de Salud Carlos III FI19/0023

Neurotoxicity prevention with a multimodal program (ATENTO) prior to cancer treatment versus throughout cancer treatment in women newly diagnosed for breast cancer: Protocol for a randomized clinical trial

The authors thank the Asociación Española Contra el Cáncer (IDEAS19055CANT), the Spanish Ministry of Education Culture and Sport (MECD) (FPU17/00939, FPU18/03575), the Carlos III Health Institute (FI19/00230), and Carlos III Health Insitute and the European Regional Development Fund (FEDER) (PI18/01840), for funding this study and all participants of the study. IEC is supported by the Spanish Ministry of Economy and Competitiveness. This study was part of a Ph.D thesis conducted in the Clinical Medicine and Public Health Doctoral Studies of the University of Granada, Spain. Trial registration: ClinicalTrials. Gov identifier: NCT04583124.A current challenge in breast cancer (BC) patients is how to reduce the side effects of cancer and cancer treatments and prevent a decrease in quality of life (QoL). Neurotoxic side effects, especially from chemotherapy, are present in up to 75% of women with BC, which implies a large impact on QoL. There is a special interest in the preventive possibilities of therapeutic exercise (TE) for these neurological sequelae, and the benefits of TE could be improved when it is combined with vagal activation techniques (VATs). This superiority randomized controlled trial aims to examine the feasibility and efficacy of an 8-week multimodal intervention (ATENTO) based on moderate-vigorous intensity and individualized TE (aerobic and strength exercises) and VAT (myofascial and breathing exercises), on neurotoxicity prevention in women with BC before starting adjuvant chemotherapy (ATENTO-B) versus throughout adjuvant chemotherapy (ATENTO-T). A sample of 56 women newly diagnosed with BC, as calculated with a power of 85%, will be randomly allocated into these two groups. This study could provide an impetus for the introduction of early multimodal intervention methods to prevent neurotoxicity and consequently avoid the QoL deterioration that BC patients presently suffer throughout their treatments.Fundacion Cientifica Asociacion Espanola Contra el Cancer IDEAS19055CANTSpanish Ministry of Education Culture and Sport FPU17/00939 FPU18/03575Instituto de Salud Carlos III FI19/00230 PI18/01840Fondos Estructurales de la Union Europea (FEDER) PI18/01840Spanish Ministry of Economy and Competitivenes

Association of breast and gut microbiota dysbiosis and the risk of breast cancer: a case-control clinical study

We would like to thank M Luisa Puertas-Martin and Isabel Manzano-Jimenez, nurses at the Unit of Mammary Pathology, General Surgery Service, San Cecilio University Hospital (Granada), without whose enthusiasm the enrolment of participants in Granada would still be stalled. We are indebted to all the women taking part in the study.The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Trial registration ClinicalTrials.gov NCT03885648, 03/25/2019. Retrospectively registered.Background Breast cancer ranks first in women, and is the second cause of death in this gender. In addition to genetics, the environment contributes to the development of the disease, although the factors involved are not well known. Among the latter is the influence of microorganisms and, therefore, attention is recently being paid to the mammary microbiota. We hypothesize that the risk of breast cancer could be associated with the composition and functionality of the mammary/gut microbiota, and that exposure to environmental contaminants (endocrine disruptors, EDCs) might contribute to alter these microbiota. Methods We describe a case-control clinical study that will be performed in women between 25 and 70 years of age. Cases will be women diagnosed and surgically intervened of breast cancer (stages I and II). Women with antecedents of cancer or advanced tumor stage (metastasis), or who have received antibiotic treatment within a period of 3 months prior to recruitment, or any neoadjuvant therapy, will be excluded. Controls will be women surgically intervened of breast augmentation or reduction. Women with oncological, gynecological or endocrine history, and those who have received antibiotic treatment within a period of 3 months prior to recruitment will also be excluded. Blood, urine, breast tissue and stool samples will be collected. Data regarding anthropometric, sociodemographic, reproductive history, tumor features and dietary habits will be gathered. Metabolomic studies will be carried out in stool and breast tissue samples. Metagenomic studies will also be performed in stool and breast tissue samples to ascertain the viral, fungal, bacterial and archaea populations of the microbiota. Quantitation of estrogens, estrogen metabolites and EDCs in samples of serum, urine and breast tissue will also be performed. Discussion: This is the first time that the contribution of bacteria, archaea, viruses and fungi together with their alteration by environmental contaminants to the risk of breast cancer will be evaluated in the same study. Results obtained could contribute to elucidate risk factors, improve the prognosis, as well as to propose novel intervention studies in this disease.This work is funded by grants PI-0538-2017 (Junta de Andalucía, Spain, to LF) and Biomedical Research Networking Center-CIBER de Epidemiología y Salud Pública (CIBERESP) of the Institute of Health Carlos III -supported by European Regional Development Fund/FEDER (FIS-PI16/01812) (to MFF)

Estudio de calidad de vida en pacientes con obesidad mórbida tras gastrectomía tubular laparoscópica

La obesidad mórbida es una enfermedad crónica y multifactorial caracterizada por un exceso de grasa corporal que ocasiona un aumento de peso patológico IMC >40 kg/m2 aunque también puede ser definida como aquella que sufren los pacientes cuyo peso supera los 75 kilogramos sobre el peso ideal. La cirugía bariátrica ofrece un tratamiento eficaz a largo plazo para el control de las comorbilidades del obeso mórbido. Uno de los procedimientos quirúrgicos de elección es la Gastrectomía Tubular Laparoscópica (GTL), esta técnica restrictiva se considera segura, eficaz y reproductible para el tratamiento de la obesidad mórbida, permitiendo una reducción del peso corporal en el primer año postquirúrgico que oscila entre un 33- 85 %. El objetivo de esta tesis doctoral fue analizar los cambios en la calidad de vida, mediante la valoración de la condición física, y la percepción del dolor, y evaluar los cambios en el perfil glucémico y lipídico y su relación con las características antropométricas de personas con obesidad mórbida intervenidas mediante GTL. Se evaluó un total de 72 pacientes que cumplieron los criterios de inclusión para ser intervenidos mediante GTL en el servicio de Cirugía General y del aparato digestivo del Hospital Universitario San Cecilio de Granada entre los años 2013-2015. Los resultados de este trabajo muestran que los pacientes obesos mórbidos intervenidos mediante la citada técnica quirúrgica presentan, a los 6 meses de la cirugía una mejora en la condición física general, la calidad de vida percibida, el dolor musculoesquelético y el perfil cardiometabólico.Tesis Univ. Granada.Programa Oficial de Doctorado en Medicina Clínica y Salud Públic