Evaluación de la adquisición de habilidades quirúrgicas mediante el empleo de simuladores laparoscópicos

[Resumen] El desarrollo de la cirugía laparoscópica supuso un gran avance tecnológico. Dicha técnica presenta los beneficios de la cirugía mínimamente invasiva, menor riesgo de infección, menor dolor postoperatorio o recuperación más temprana entre otros, pero no se encuentra exenta de inconvenientes como son la pérdida de visión en 3D, el efecto fulcro o la pérdida de la sensación táctil, que supone que sea necesario la adquisición de nuevas habilidades por parte de los cirujanos. Hay muchos simuladores, pero a día de hoy aún existen dudas acerca de qué equipo es superior y más rentable para adquirir dichas habilidades. Además no existe un programa de entrenamiento estandarizado, y tampoco se conoce el impacto clínico que ocasiona dicho entrenamiento. Objetivos: Con este trabajo se pretende determinar qué equipo de simulación es mejor para la adquisición de habilidades y destrezas motoras básicas en residentes de cirugía noveles y comparar dos escalas de valoración. Metodología: Ensayo clínico aleatorizado de grupos paralelos y controlado con ciego simple. Se incluirán 32 aprendices quirúrgicos que hayan participado en menos de 10 cirugías como cirujano principal. Los participantes serán incluidos al grupo de entrenamiento con pelvitrainer o con simulador de realidad virtual LapMentorTM. A los participantes de ambos grupos se les realizarán una prueba pre y post-entrenamiento y se evaluarán sus habilidades en ambos casos con dos escalas de valoración deferentes[Abstract] The laparoscopc surgery development was a very important technology advance. This technique has the advantages of minimun invasive surgery, such as lower risk of infection, lower pain postsurgery and earlier recuperation, but it also has disadvantages like lose of 3D vision, fulcrum effect or lose of haptic sensation, which implies that surgeons acquire new skills. Nowadays there are many types of simulators, but there are still doubts about which equipment is higher and more profitable to acquire those abilities. Moreover, there is not a standaridized training program, and the clinical impact caused by this training is not known. Objectives: The aim of this work is to determine which laparoscopic simulator is better for the acquisition of basic motor and surgical skills in novice residents, and to compare two different rating scales. Metodology: It will be a randomized clinical trial, of parallel groups and controlled with single blind. 32 Surgical trainees who have participated in less than ten surgeries as a principal surgeon will be included. Participants will be included randomized into two grupos: the pelvitrainer training group or in the virtual reality simulator laparoscopic group with LapMentorTM. Every participants will be tested before and after training and their skills will be assessed with two different rating scales.[Resumo] O desenvolvemento da cirurxía laparoscópica foi un gran avance tecnolóxico. Esta técnica presenta os beneficios da cirurxía mínimamente invasiva, menor risco de infección, menor dor postoperatoria ou recuperación previa entre outros, pero non sen os seus inconvenientes como a perda de visión 3D, o efecto fulcro ou a perda de sensación táctil, que asume que é necesaria a adquisición de novas habilidades por parte dos cirurxiáns. Hai moitos simuladores, pero aínda hai dúbidas de que equipos son superiores e máis rendibles para adquirir estas habilidades. Ademais, non hai un programa de adestramento normalizado, nin o coñecemento do impacto clínico causado por esa formación. Obxectivos: Este traballo ten como obxectivo determinar que equipo de simulación é mellor para a adquisición de habilidades e destrezas motrices básicas en cirurxiáns noveles e comparar dúas escalas de avaliación. Metodoloxía: Ensaio clínico randomizado, de grupos paralelos e controlado con cego simple. Incluiranse 32 aprendices cirúrxicos que participaron en menos de dez ciruxías como cirurxián principal. Os participantes incluiranse no grupo de adestramento con pelvitrainer ou co simulador de realidade virtual LapMentorTM. Os participantes de ambos grupos realizarán un exame de pre- e post-adestramento e as súas habilidades serán avaliadas nos dous casos con dúas escalas de valoración diferentes.Traballo fin de mestrado (UDC.FCS). Asistencia e investigación sanitaria. Especialidade en investigación clínica. Curso 2018/2019

Evaluation of Glycerylphytate Crosslinked Semi- and Interpenetrated Polymer Membranes of Hyaluronic Acid and Chitosan for Tissue Engineering

In the present study, semi- and interpenetrated polymer network (IPN) systems based on hyaluronic acid (HA) and chitosan using ionic crosslinking of chitosan with a bioactive crosslinker, glycerylphytate (G1Phy), and UV irradiation of methacrylate were developed, characterized and evaluated as potential supports for tissue engineering. Semi- and IPN systems showed significant differences between them regarding composition, morphology, and mechanical properties after physicochemical characterization. Dual crosslinking process of IPN systems enhanced HA retention and mechanical properties, providing also flatter and denser surfaces in comparison to semi-IPN membranes. The biological performance was evaluated on primary human mesenchymal stem cells (hMSCs) and the systems revealed no cytotoxic effect. The excellent biocompatibility of the systems was demonstrated by large spreading areas of hMSCs on hydrogel membrane surfaces. Cell proliferation increased over time for all the systems, being significantly enhanced in the semi-IPN, which suggested that these polymeric membranes could be proposed as an effective promoter system of tissue repair. In this sense, the developed crosslinked biomimetic and biodegradable membranes can provide a stable and amenable environment for hMSCs support and growth with potential applications in the biomedical field.The authors thanks to “La Caixa” Foundation (ID 100010434), which supported Ana Mora-Boza (scholarship code LCF/BQ/ES16/11570018) and to the Spanish Ministry of Economy and Competitiveness for financial support (project RTC-2016-5451-1) and the Fundación Mutua Madrileña (project FMM-AP17196-2019). M. R. Aguilar and B. Vázquez-Lasa are members of the SusPlast platform (Interdisciplinary Platform for Sustainable Plastics towards a Circular Economy) from the Spanish National Research Council (CSIC)

The use of antidotes for calcium gluconate extravasation: an experimental study in mice

[Abstract] Background: Calcium gluconate extravasation is a process that can cause serious lesions, such as necrosis and calcification of the soft tissues. The aim of the present study was to analyze the beneficial effects of four possible local antidotes for calcium gluconate extravasation: hyaluronidase, sodium thiosulfate, triamcinolone acetonide, and physiologic saline solution. Methods: Seventy-four BALB/c mice were used in the study. The substances selected for use in this study were calcium gluconate (4.6 mEq/ml), hyaluronidase (1500 IU/ml), sodium thiosulfate (25%), triamcinolone acetonide (40 mg/ml 0.5 mg/kg), and saline solution 0.9%. Five minutes were allowed to lapse after the calcium gluconate infiltration, and then an antidote was infiltrated. After 3 weeks, a skin biopsy was performed and a radiographic and histologic study was carried out. Results: Only in the group infiltrated with sodium thiosulfate did all skin lesions disappear after the 3-week period after infiltration. In the radiographic study, calcium deposits larger than 0.5 mm were observed in 40 percent of cases without an antidote, in 33 percent with triamcinolone acetonide, in 13 percent with a saline solution, and in none with thiosulfate and hyaluronidase. In the histologic study, calcium deposits were found in 53 percent of cases without antidote, 100 percent of cases with triamcinolone acetonide, 33 percent of cases with saline solution, and 13 percent of cases with sodium thiosulfate or hyaluronidase. Conclusion: Sodium thiosulfate and hyaluronidase prevent the development of calcium deposits after calcium gluconate extravasation

Atlas QR de procedimientos básicos en clínica hospitalaria equina

Los códigos QR se utilizan actualmente como herramienta docente de gran utilidad ya que permiten al alumno emplear las nuevas tecnologías para el aprendizaje. Con este proyecto pretendemos acercar la actividad clínica equina al alumno de veterinaria

Tuberculosis prophylaxis with levofloxacin in liver transplant patients is associated with a high incidence of tenosynovitis: safety analysis of a multicenter randomized trial

This work was supported by the Ayudas para el fomento de la investigacion clinica independiente [EC 10-120] and Programa Intramural Consorcio de Apoyo a la Investigación Biomédica en Red 2010. Other funding sources: National R&D&I Plan 2008–2011 and the Instituto de Salud Carlos III (ISCIII), Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Economía y Competitividad, Spanish Network for Research in Infectious Diseases [RD06/0008, RD12/0015] - co-financed by European Development Regional Fund “A way to achieve Europe” ERDF. Consorcio de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas is financed by the ISCIII.Background: It is necessary to develop a safe alternative to isoniazid for tuberculosis prophylaxis in liver transplant recipients. This study was designed to investigate the efficacy and safety of levofloxacin. Methods: An open-label, prospective, multicenter, randomized study was conducted to compare the efficacy and safety of levofloxacin (500 mg q24h for 9 months) initiated in patients awaiting liver transplantation and isoniazid (300 mg q24h for 9 months) initiated post-transplant when liver function was stabilized. Efficacy was measured by tuberculosis incidence at 18 months after transplantation. All adverse events related to the medication were recorded. Results: CONSORT guidelines were followed in order to present the results. The safety committee suspended the study through a safety analysis when 64 patients had been included (31 in the isoniazid arm and 33 in the levofloxacin arm). The reason for suspension was an unexpected incidence of severe tenosynovitis in the levofloxacin arm (18.2%). Although the clinical course was favorable in all cases, tenosynovitis persisted for 7 weeks in some patients. No patients treated with isoniazid, developed tenosynovitis. Only 32.2% of patients randomized to isoniazid (10/31) and 54.5% of patients randomized to levofloxacin (18/33, P = .094) completed prophylaxis. No patient developed tuberculosis during the study follow-up (median 270 days). Conclusions: Levofloxacin prophylaxis of tuberculosis in liver transplant candidates is associated with a high incidence of tenosynovitis that limits its potential utility.Ayudas para el fomento de la investigación clínica independiente [EC 10-120]Programa Intramural Consorcio de Apoyo a la Investigación Biomédica en Red 2010National R&D&I Plan 2008–2011Instituto de Salud Carlos III (ISCIII)Ministerio de Economía y Competitividad RD06/0008, RD12/0015European Development Regional Fun

CAR density influences antitumoral efficacy of BCMA CAR T cells and correlates with clinical outcome

Identification of new markers associated with long-term efficacy in patients treated with CAR T cells is a current medical need, particularly in diseases such as multiple myeloma. In this study, we address the impact of CAR density on the functionality of BCMA CAR T cells. Functional and transcriptional studies demonstrate that CAR T cells with high expression of the CAR construct show an increased tonic signaling with up-regulation of exhaustion markers and increased in vitro cytotoxicity but a decrease in in vivo BM infiltration. Characterization of gene regulatory networks using scRNA-seq identified regulons associated to activation and exhaustion up-regulated in CARHigh T cells, providing mechanistic insights behind differential functionality of these cells. Last, we demonstrate that patients treated with CAR T cell products enriched in CARHigh T cells show a significantly worse clinical response in several hematological malignancies. In summary, our work demonstrates that CAR density plays an important role in CAR T activity with notable impact on clinical response

Integrative development of a short screening questionnaire of highly processed food consumption (sQ-HPF)

Background: Recent lifestyle changes include increased consumption of highly processed foods (HPF), which has been associated with an increased risk of non-communicable diseases (NCDs). However, nutritional information relies on the estimation of HPF consumption from food-frequency questionnaires (FFQ) that are not explicitly developed for this purpose. We aimed to develop a short screening questionnaire of HPF consumption (sQ-HPF) that integrates criteria from the existing food classification systems. Methods: Data from 4400 participants (48.1% female and 51.9% male, 64.9 +/- 4.9 years) of the Spanish PREDIMED-Plus (PREvention with MEDiterranean DIet) trial were used for this analysis. Items from the FFQ were classified according to four main food processing-based classification systems (NOVA, IARC, IFIC and UNC). Participants were classified into tertiles of HPF consumption according to each system. Using binomial logistic regression, food groups associated with agreement in the highest tertile for at least two classification systems were chosen as items for the questionnaire. ROC analysis was used to determine cut-off points for the frequency of consumption of each item, from which a score was calculated. Internal consistency of the questionnaire was assessed through exploratory factor analysis (EFA) and Cronbach's analysis, and agreement with the four classifications was assessed with weighted kappa coefficients. Results: Regression analysis identified 14 food groups (items) associated with high HPF consumption for at least two classification systems. EFA showed that items were representative contributors of a single underlying factor, the HPF dietary pattern (factor loadings around 0.2). We constructed a questionnaire asking about the frequency of consumption of those items. The threshold frequency of consumption was selected using ROC analysis. Comparison of the four classification systems and the sQ-HPF showed a fair to high agreement. Significant changes in lifestyle characteristics were detected across tertiles of the sQ-HPF score. Longitudinal changes in HPF consumption were also detected by the sQ-HPF, concordantly with existing classification systems. Conclusions: We developed a practical tool to measure HPF consumption, the sQ-HPF. This may be a valuable instrument to study its relationship with NCDs

Conviviendo en Positivo: Educación en salud, Atención Consciente, Compasión activa y Resiliencia

Proyecto de innovación docente enfocado en valores nucleares y convivencia en una sociedad serodiscordante, es continuidad del P89/2018, titulado “competencias intra e interpersonales, sexo consciente, fármacos y mindfulness”. Durante el primer semestre, desde el paradigma de aprendizaje cooperativo, basado en resolución de proyectos, se desarrolló la investigación documental, reflexión y debate sobre estos centros de interés: valores nucleares & VIH: abordaje de la seropositividad; adherencia terapéutica; estudio PARTNER indetectable es igual a intransmisible; profilaxis pre-exposición (PrEP); convivir en serodiscordancia; encuestas sobre estigmatización y discriminación social y sanitaria; riesgos globales de la discriminación terapéutica; relaciones interpersonales y emociones aflictivas; mindfulness y compasión basado en la evidencia; psicología positiva y resiliencia. En el segundo semestre, durante la fase cero del estado de alerta sanitaria, se desarrolló una intervención psicoeducativa, dirigida a facilitar estrategias que ayudasen a gestionar mejor el impacto emocional generado por la incertidumbre, la restricción de movilidad territorial, el confinamiento, y el miedo al contagio de la COVID-19. Perpetuar el estigma ante VIH, es una violación de los derechos humanos. Como antídoto a la indiferencia, se integró en nuestra intervención el fomento de la compasión activa, entendida como un sentido básico de cuidado, sensibilidad y apertura hacia el sufrimiento propio y de los demás, y la intención genuina de intentar aliviarlo y prevenirlo. La pandemia generada por el SARS-CoV-2 es una oportunidad para entender que ante este virus, aquí y ahora, la única opción es prevenirlo, detectarlo mediante pruebas y confinarlo, es decir no transmitirlo y no reinfectarse. Si de forma transversal somos capaces de interiorizarlo y normalizar la convivencia en serodiscordancia, si normalizamos las pruebas diagnósticas rutinarias, podremos entre todas y todos reducir hasta un 90% la transmisión activa otra pandemia de la que hoy no se habla, del VIH, de este modo conseguiríamos minimizar la aparición de nuevos casos, frenar su avance y vencer definitivamente al SIDA

Long-Term Real-World Effectiveness and Safety of Ustekinumab in Crohn’s Disease Patients: The SUSTAIN Study

Background Large real-world-evidence studies are required to confirm the durability of response, effectiveness, and safety of ustekinumab in Crohn’s disease (CD) patients in real-world clinical practice. Methods A retrospective, multicentre study was conducted in Spain in patients with active CD who had received ≥1 intravenous dose of ustekinumab for ≥6 months. Primary outcome was ustekinumab retention rate; secondary outcomes were to identify predictive factors for drug retention, short-term remission (week 16), loss of response and predictive factors for short-term efficacy and loss of response, and ustekinumab safety. Results A total of 463 patients were included. Mean baseline Harvey-Bradshaw Index was 8.4. A total of 447 (96.5%) patients had received prior biologic therapy, 141 (30.5%) of whom had received ≥3 agents. In addition, 35.2% received concomitant immunosuppressants, and 47.1% had ≥1 abdominal surgery. At week 16, 56% had remission, 70% had response, and 26.1% required dose escalation or intensification; of these, 24.8% did not subsequently reduce dose. After a median follow-up of 15 months, 356 (77%) patients continued treatment. The incidence rate of ustekinumab discontinuation was 18% per patient-year of follow-up. Previous intestinal surgery and concomitant steroid treatment were associated with higher risk of ustekinumab discontinuation, while a maintenance schedule every 12 weeks had a lower risk; neither concomitant immunosuppressants nor the number of previous biologics were associated with ustekinumab discontinuation risk. Fifty adverse events were reported in 39 (8.4%) patients; 4 of them were severe (2 infections, 1 malignancy, and 1 fever). Conclusions Ustekinumab is effective and safe as short- and long-term treatment in a refractory cohort of CD patients in real-world clinical practice

Effectiveness and Safety of the Sequential Use of a Second and Third Anti-TNF Agent in Patients With Inflammatory Bowel Disease: Results From the Eneida Registry

Background: The effectiveness of the switch to another anti-tumor necrosis factor (anti-TNF) agent is not known. The aim of this study was to analyze the effectiveness and safety of treatment with a second and third anti-TNF drug after intolerance to or failure of a previous anti-TNF agent in inflammatory bowel disease (IBD) patients. Methods: We included patients diagnosed with IBD from the ENEIDA registry who received another anti-TNF after intolerance to or failure of a prior anti-TNF agent. Results: A total of 1122 patients were included. In the short term, remission was achieved in 55% of the patients with the second anti-TNF. The incidence of loss of response was 19% per patient-year with the second anti-TNF. Combination therapy (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.8-3; P < 0.0001) and ulcerative colitis vs Crohn's disease (HR, 1.6; 95% CI, 1.1-2.1; P = 0.005) were associated with a higher probability of loss of response. Fifteen percent of the patients had adverse events, and 10% had to discontinue the second anti-TNF. Of the 71 patients who received a third anti-TNF, 55% achieved remission. The incidence of loss of response was 22% per patient-year with a third anti-TNF. Adverse events occurred in 7 patients (11%), but only 1 stopped the drug. Conclusions: Approximately half of the patients who received a second anti-TNF achieved remission; nevertheless, a significant proportion of them subsequently lost response. Combination therapy and type of IBD were associated with loss of response. Remission was achieved in almost 50% of patients who received a third anti-TNF; nevertheless, a significant proportion of them subsequently lost response