Efectos de la intervención nutricional en los programas fast-track en cirugía de cáncer colorrectal: revisión sistemática

Background and aim: Preoperative nutritional status (NS) has consequences on postoperative (POSTOP) recovery. Our aim was to systematically review the nutritional interventions (NI) in Fast-Track protocols for colorectal cancer surgery and assess morbidity-mortality and patient´s recovery. Method: Systematic review of scientific literature after consulting bibliographic databases: Medline, The Cochrane Library, Scopus, Embase, Web of Science, Institute for Scientific Information, Latin American and Caribbean Health Sciences Literature, The Cumulative Index to Nursing and Allied Health Literature. MeSH Descriptors: “Colorectal Surgery”, “Fast-Track”, “Perioperative Care”, “Nutrition Therapy” and “Enhanced recovery programme”. Filters: “Humans”, Adult (19+ years) and “Clinical Trial”. Variables POSTOP outcomes: bowel recovery (BR), hospital stay (HS), complications and death. Results: Selected studies, 27, had good or excellent methodological quality. From 25 to 597 patients were included. Aged between 16-94 years, men were predominant in 66.6%. NS was evaluated in 13 studies; 7 by Body Mass Index while one by Subjective Global Assessment. One presented POSTOP data. Fast-Track groups had solids, liquids or supplements (SS) in prior 2-8 hours. SS were high in carbohydrates, immune-nutrients and non-residue. Free liquids, solids and SS intake was allowed in POSTOP. Half traditional groups fasted between 3-12 hours and resumed POSTOP food intake progressively. Conclusions: Fast-Track groups had early BR (p < 0.01). Traditional groups had more infections episodes, deaths and a longer HS. Great variability between NI but had a common item; early intake. Although was seen patient’s recovery. Future studies with detailed NI characteristics are need. Nutritional status must be assessed for a higher acknowledgement of NI impact.Introducción y objetivo: el estado nutricional (NS) preoperatorio tiene consecuencias sobre la recuperación postoperatoria (POSTOP). El objetivo fue revisar sistemáticamente las intervenciones nutricionales (NI) en los protocolos de fast-track en la cirugía de cáncer colorrectal y evaluar la morbilidad-mortalidad y la recuperación del paciente. Método: revisión sistemática de la literatura científica previa consulta a las bases de datos bibliográficas: Medline, Cochrane Library, Scopus, Embase, Web of Science, Latin American and Caribbean Health Sciences Literature (LILACS), The Cumulative Index to Nursing and Allied Health Literature (CINAHL). Descriptores MeSH: “colorectal surgery”, “fast-track”, “perioperative care”, “nutrition therapy” and “enhanced recovery programme”. Filtros: “humans”, “adult (19+ years)” and “clinical trial”. Variables resultados después de la operación: recuperación del intestino (BR), estancia hospitalaria (HS), complicaciones y la muerte. Resultados: los 27 estudios seleccionados tenían buena o excelente calidad metodológica. Incluían desde 25 a 597 pacientes, con edades comprendidas entre 16-94 años; los hombres fueron predominantes en el 66,6%. El estado nutricional se evaluó en 13 estudios; 7 por el índice de masa corporal, mientras que uno lo fue por la evaluación subjetiva general. Uno de ellos presentó datos después de la operación. Los grupos fast-track ingirieron, líquidos o suplementos (SS) en 2-8 horas antes. SS contenían altas cantidades de hidratos de carbono, inmunonutrientes y sin-residuos. En POSTOP se administraron líquidos, sólidos y SS. Los grupos tradicionales estuvieron en ayunas entre 3-12 horas y se reanudó la ingesta de alimentos progresivamente. Conclusiones: los grupos fast-track presentaron BR temprana (p < 0,01), los tradicionales tuvieron más infecciones, muertes y un HS más larga. Se observó gran variabilidad en las NI, pero había un punto común: ingesta temprana. A pesar de que se observó una recuperación del paciente, se necesitan futuros estudios con características de la NI más detalladas. Se debe evaluar el NS para poder reconocer el estado nutricional para un mayor reconocimiento del impacto NI

Nonlinearity-induced synchronization enhancement in micromechanical oscillators

An autonomous oscillator synchronizes to an external harmonic force only when the forcing frequency lies within a certain interval - known as the synchronization range - around the oscillator's natural frequency. Under ordinary conditions, the width of the synchronization range decreases when the oscillation amplitude grows, which constrains synchronized motion of micro- and nanomechanical resonators to narrow frequency and amplitude bounds. Here, we show that nonlinearity in the oscillator can be exploited to manifest a regime where the synchronization range increases with increasing oscillation amplitude. Experimental data are provided for self-sustained micromechanical oscillators operating in this regime, and analytical results show that nonlinearities are the key determinants of this effect. Our results provide a new strategy to enhance the synchronization of micromechanical oscillators by capitalizing on their intrinsic nonlinear dynamics.Fil: Antonio, Dario. Argonne National Laboratory; Estados UnidosFil: Czaplewski, David A.. Argonne National Laboratory; Estados UnidosFil: Guest, Jeffrey R.. Argonne National Laboratory; Estados UnidosFil: López, Daniel. Argonne National Laboratory; Estados UnidosFil: Arroyo, Sebastián Ismael. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte; Argentina. Comisión Nacional de Energía Atómica. Centro Atómico Bariloche; Argentina. Comisión Nacional de Energía Atómica. Gerencia del Área de Energía Nuclear. Instituto Balseiro; ArgentinaFil: Zanette, Damian Horacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte; Argentina. Comisión Nacional de Energía Atómica. Centro Atómico Bariloche; Argentina. Comisión Nacional de Energía Atómica. Gerencia del Área de Energía Nuclear. Instituto Balseiro; Argentin

Assessment of Body Composition as an Indicator of Early Peripheral Parenteral Nutrition Therapy in Patients Undergoing Colorectal Cancer Surgery in an Enhanced Recovery Program

Background: A poor body composition (BC) has been identified as a risk factor for patients with colorectal cancer (CRC). This study was performed to assess the effect of early peripheral parenteral nutrition (PPN) on BC in patients undergoing CCR surgery within an enhanced recovery program. Methods: Patients with normal nutritional status were prospectively included between October 2016 and September 2019, randomized into two groups (PPN with periOlimel N4-E versus conventional fluid therapy) and subsequently classified according to their preoperative CT scan into high- or low-risk BC groups. Postoperative complications and length of hospital stay (LOS) were assessed. Results: Of the 156 patients analyzed, 88 patients (56.4%) were classified as having high-risk BC according to CT measurements. PPN led to a 15.4% reduction in postoperative complications in high-risk vs. 1.7% in low-risk BC patients. In the multivariate analysis, high-risk BC was related to an OR (95% CI) of 2 (p = 0.044) of presenting complications and of 1.9 (p = 0.066) for major complications, and was associated with an increase in LOS of 3.6 days (p = 0.039). Conclusions: The measurement of patients’ BC can allow for the identification of target patients where PPN has been proven to be an effective tool to improve postoperative outcomes

Science Mapping: A Bibliometric Analysis on Cyberbullying and the Psychological Dimensions of the Self

Cyberbullying prevalence is increasing in the world, being a form of abuse that follows victims into their most intimate settings. Cyberbullying affects victims’ mental health, self-esteem, emotions, and academic performance. Cyberbullies present low levels of self-control and empathy. This research aimed to map scientific research on Cyberbullying and the Psychological Dimensions of the Self. A bibliometric analysis of scientific documents published in journals indexed in the Web of Science (WoS) was performed. Traditional bibliometric laws were applied and VOSviewer was used to generate visualizations. The annual publications followed exponential growth. Computers in Human Behaviour was the journal with the most publications. Researchers from the USA and Spain were the most prolific. Sameer Hinduja and Justin Patchin were the most cited authors. Hence, there is a growing interest among researchers in Cyberbullying and the emotional aspects of children and adolescents. The USA and Spain were the leading countries in research on this subject. Rosario Ortega-Ruiz, Sameer Hinduja and Justin Patchin were the most prolific and influential authors.The APC was funded by the Open Access Program of Universidad de Las Américas. Funding was provided by Internal Research Project Nº812022 of Universidad de Las Americas. The author Á.D.-Z. (FPU20/04201) was supported by a grant from the Spanish Ministry of Education, Culture, and Sport. Grants FPU20/04201 funded by MCIN/AEI/10.13039/501100011033 and, as appropriate, by “European Social Fund Investing in your future” or by “European Union NextGenerationEU/PRTR”. We also thank the Universidad de Las Américas for their support of the Open Access initiative

Fear of becoming pregnant among female healthcare students in Spain

The inconsistent use of hormonal contraceptive methods can result, during the first year of use, in one in twelve women still having an undesired pregnancy. This may lead to women experiencing fear of becoming pregnant (FBP). We have only found one study examining the proportion of FBP among women who used hormonal contraceptives. To gather further scientific evidence we undertook an observational, cross-sectional study involving 472 women at a Spanish university in 2005–2009. The inclusion criteria were having had vaginal intercourse with a man in the previous three months and usual use for contraception of a male condom or hormonal contraceptives, or no method of contraception. The outcome was FBP. The secondary variables were contraceptive method used (oral contraceptives; condom; none), desire to increase the frequency of sexual relations, frequency of sexual intercourse with the partner, the sexual partner not always able to ejaculate, desire to increase the partner’s time before orgasm, age and being in a stable relationship. A multivariate logistic regression model was used to determine the associated factors. Of the 472 women, 171 experienced FBP (36.2%). Factors significantly associated (p < 0.05) with this FBP were method of contraception (condom and none), desire to increase the partner’s ability to delay orgasm and higher frequency of sexual intercourse with the partner. There was a high proportion of FBP, depending on the use of efficient contraceptive methods. A possible solution to this problem may reside in educational programmes. Qualitative studies would be useful to design these programmes

The research about the El Pirulejo: an interdisciplinary approach

El estudio interdisciplinar que constituye esta obra pone de manifiesto que El Pirulejo es el mejor yacimiento conocido para el conocimiento del Tardiglaciar en las comarcas interiores del sur de la Península Ibérica. El enclave conserva una secuencia muy rica en cantidad, calidad y diversidad de materiales arqueológicos que han permitido un análisis desde múltiples ópticas (cultura material, manifestaciones simbólicas, paleoeconomía, secuencia paleoambiental, etc.).This work is an interdisciplinary study about El Pirulejo, one of the most important site by the knowledge of the Lateglacial in the south of the Iberian peninsula. The archaoelogical site conservated a very richness sequence with a lot and variability archaeological rests that we permit a multiphocal analysis (material culture, simbolic evidences, palaeoeconomy, paleoenvironmental sequence, etc.)

With flowers to La Atkins

Photobook, Flowers, Gardens, Vegetables, Plants, World Photobook Day, International Photobook Day, 2021Anna Atkins nos regaló un fotolibro de algas, maravillosamente azules, que son como flores del mundo subacuático. Este año, para celebrar el Día Internacional del Fotolibro 2021, os proponemos hacer un fotolibro colectivo que será como un ramo de flores para Anna. Se trata de hacer fotos a flores, hierbas, plantas, hierbajos, suculentas, cactus... Las fotos nos van a permitir poner en el ramo lo que más nos guste sin preocuparnos de los problemas que nos daría una pieza floral fresca. Podéis sacar la foto a una flor o planta viva, vuestra o de un jardín público o del campo Podéis fotografiar algo de un herbario o una flor prensada que guardabais dentro de un libro Podéis fotografiar una foto de una flor Podéis sacarle una foto a una flor de plástico Podéis fotografiar un dibujo o una pintura (con motivos florales o vegetales, claro) Podéis fotografiar una planta carnívora (en ayunas o haciendo la digestión) Podéis fotografiar flores del mal o del "buenri" Siempre que sea vegetal y/o floral entrará en este libro ramo para Anna. ¡Queremos tanto a Anna! Vamos a mandarle flores como para una boda, como para un fiestón, como para una diva de la ópera que no conoce las alergias y le cabe de todo en el camerino, como para la primavera que está comenzando en el Cono Sur. Organizan: Biblioteca de la Facultad de Bellas Artes de la UCM Photobook Club MadridFac. de Bellas Artesunpu

Identification of genetic variants associated with Huntington's disease progression: a genome-wide association study

Background Huntington's disease is caused by a CAG repeat expansion in the huntingtin gene, HTT. Age at onset has been used as a quantitative phenotype in genetic analysis looking for Huntington's disease modifiers, but is hard to define and not always available. Therefore, we aimed to generate a novel measure of disease progression and to identify genetic markers associated with this progression measure. Methods We generated a progression score on the basis of principal component analysis of prospectively acquired longitudinal changes in motor, cognitive, and imaging measures in the 218 indivduals in the TRACK-HD cohort of Huntington's disease gene mutation carriers (data collected 2008–11). We generated a parallel progression score using data from 1773 previously genotyped participants from the European Huntington's Disease Network REGISTRY study of Huntington's disease mutation carriers (data collected 2003–13). We did a genome-wide association analyses in terms of progression for 216 TRACK-HD participants and 1773 REGISTRY participants, then a meta-analysis of these results was undertaken. Findings Longitudinal motor, cognitive, and imaging scores were correlated with each other in TRACK-HD participants, justifying use of a single, cross-domain measure of disease progression in both studies. The TRACK-HD and REGISTRY progression measures were correlated with each other (r=0·674), and with age at onset (TRACK-HD, r=0·315; REGISTRY, r=0·234). The meta-analysis of progression in TRACK-HD and REGISTRY gave a genome-wide significant signal (p=1·12 × 10−10) on chromosome 5 spanning three genes: MSH3, DHFR, and MTRNR2L2. The genes in this locus were associated with progression in TRACK-HD (MSH3 p=2·94 × 10−8 DHFR p=8·37 × 10−7 MTRNR2L2 p=2·15 × 10−9) and to a lesser extent in REGISTRY (MSH3 p=9·36 × 10−4 DHFR p=8·45 × 10−4 MTRNR2L2 p=1·20 × 10−3). The lead single nucleotide polymorphism (SNP) in TRACK-HD (rs557874766) was genome-wide significant in the meta-analysis (p=1·58 × 10−8), and encodes an aminoacid change (Pro67Ala) in MSH3. In TRACK-HD, each copy of the minor allele at this SNP was associated with a 0·4 units per year (95% CI 0·16–0·66) reduction in the rate of change of the Unified Huntington's Disease Rating Scale (UHDRS) Total Motor Score, and a reduction of 0·12 units per year (95% CI 0·06–0·18) in the rate of change of UHDRS Total Functional Capacity score. These associations remained significant after adjusting for age of onset. Interpretation The multidomain progression measure in TRACK-HD was associated with a functional variant that was genome-wide significant in our meta-analysis. The association in only 216 participants implies that the progression measure is a sensitive reflection of disease burden, that the effect size at this locus is large, or both. Knockout of Msh3 reduces somatic expansion in Huntington's disease mouse models, suggesting this mechanism as an area for future therapeutic investigation

La presbifonía como causa de insuficiencia glótica

Introduction and objective: The aging of the voice has become a frequent cause of consultation in the otolaryngologist's daily practice, due to the progressive aging of the population and societies of industrialized countries. With this review, we intend to update the clinical and pathological changes of the larynx that lead to presbyphonia, addressing the most relevant aspects about its causes, clinical manifestations and therapeutic measures. Materials and methods: descriptive and narrative literature review, result of the bibliographic search in the database PubMed with the descriptors strategies [(presbyphonia OR aging voice disorders) AND vocal atrophy]. Revisions, clinical trials and general articles in both english and spanish were selected for the past 10 years. Clinical cases, articles of glottic insufficiency or dysphonia due to other causes were excluded. Results: The systematic review offered 34 articles, of which, 17 met the inclusion criteria. The results should be interpreted with optimism, despite its variability; the presbyphonia is a growing diagnosis, with a greater rise among otorhinolaryngologists dedicated to laryngology. Conclusions: We perform a review on the most relevant aspects regarding the clinical, endoscopic and anatomical findings that occur in presbyphonia. We present the different forms of treatment proposed so far to minimize glottic insufficiency and improve vocal competence in aged peopleIntroducción y objetivo: El envejecimiento de la voz se ha convertido en una causa frecuente de consulta en la práctica diaria del otorrinolaringólogo, debido entre otras causas al envejecimiento progresivo de la población y sociedades de los países industrializados. Con este trabajo de revisión pretendemos una puesta al día en relación a los cambios clínicos y patológicos de la laringe que conllevan a la presbifonía, abordando los aspectos más relevantes sobre sus causas, manifestaciones clínicas y medidas terapéuticas. Materiales y métodos: trabajo descriptivo, resultado de la búsqueda bibliográfica en la base de datos PubMed con las estrategias de búsqueda [(presbyphonia OR aging voice disorders) AND vocal atrophy]. Se seleccionaron revisiones, ensayos clínicos y artículos en inglés y español de los últimos 10 años. Se excluyeron casos clínicos, artículos de insuficiencia glótica o disfonía por otras causas. Resultados: La revisión sistemática ofreció 34 artículos, de los cuales, 17 cumplieron los criterios de inclusión. Los resultados deben interpretarse con optimismo, a pesar de su variabilidad la presbifonía es un diagnóstico en crecimiento, con mayor auge entre otorrinolaringólogos dedicados a laringología. Conclusiones: Realizamos una revisión sobre los aspectos más relevantes en relación a los hallazgos clínicos, endoscópicos y anatómicos que ocurren en la presbifonía. Presentamos las diferentes formas de tratamiento propuestas hasta ahora para minimizar la insuficiencia glótica y mejorar la competencia vocal en personas envejecidas

Programa de implantación y desarrollo de la cirugía menor ambulatoria en atención primaria

Introducción. A pesar de su priorización, la realización de la cirugía menor (CM) en atención primaria (AP) es deficitaria. Objetivo. Creación y evaluación de un programa de implantación y desarrollo de CM en AP adecuado a los problemas de nuestra área sanitaria. Diseño. Prospectivo, longitudinal y descriptivo. Emplazamiento. Área Sanitaria 19 (Servicio Valenciano de Salud): Servicio de Cirugía del Hospital de Elche y tres centros de Salud (CS) (Altabix, Crevillente y Santa Pola). Participantes. Médicos de AP y médicos especialistas en cirugía. Fases. Se establecieron las siguientes fases: a) selección de CS. Protocolización del tipo de paciente, patología, documentación y establecimiento de circuitos de trabajo; b) realización de sesiones quirúrgicas en los CS a cargo de dos cirujanos ayudados por médicos de AP («líderes quirúrgicos»), con instrumental quirúrgico de hospital, y c) realización de la cirugía por médicos de AP supervisados por un cirujano, con instrumental y circuito de esterilización en los CS. El programa finaliza con la autonomía quirúrgica del médico de AP y de los medios del CS. Resultados. Se han realizado 41 sesiones quirúrgicas (14 en Altabix, 14 en Crevillente y 13 en Santa Pola). Se intervino a 335 pacientes, practicándose 398 procedimientos quirúrgicos (un 55,5% escisiones, un 34,9% electrocoagulación y un 9,6%, otras). No se presentó ninguna complicación inmediata. La evolución mensual del número de pacientes fue constante, con una media de 10,22 programaciones/sesión. Remitieron pacientes 36 médicos y de ellos 24 realizaron actividad quirúrgica. Conclusiones. Se consiguió un programa práctico y seguro de implantación y desarrollo de la CM en AP, con satisfacción tanto del médico como del paciente