Aplicación del cuestionario multidimensional del impacto de la evaluación de riesgo de cáncer (MICRA), en una muestra española

It is studied the psychosocial impact of Counselling Genetic Oncology (CGO) on the participants who have received the genetic test results. A sample of 59 participants that had undertaken genetic testing and received results was assessed by The Multidimensional Impact of Cancer Risk Assessment (MICRA) Questionnaire.It was studied possible differences in psychosocial impact according to: result type of, previous oncologist diagnosis, time passed from result communication and type of hereditarysyndrome. The outcomes showed that GCO does notproduce negative psychosocial impact. There were not differences by previous diagnosis,time communication and type of hereditary syndrome on MICRA. It is necessary more research for Spanish MICRA adaptation with the purpose to dispose of a specific instrument effective for psyhosocial impact study of genetic testing

Cirugía profiláctica como medida preventiva del cáncer de mama y ovario hereditario

Prophylactic surgery has become a very useful prevention tool for women at high risk of breast and ovarian cancer. Both prophylactic mastectomy and oophorectomy are considered as aggressive methods and women who are considering this procedure must have a very difficult decision making process to decide which preventive measures they choose. Both surgeries have demonstrated their efficacy to reduce cancer risk, but not to eliminate risk completely. This procedures may produce a negative impact on this women who undergone it, so it is necessary to assess every women who is considering this option and the psychological impact that it may produce.In this paper we try to review the state of art about psychological impact of prophylactic mastectomy and oophorectomy, and the most important issues that must be considered by women that are thinking about this surgery. Issues like efficacy, quality of life, satisfaction with the procedure and most important negative surgery effects are included in this paper.La cirugía profiláctica se ha convertido en una herramienta de prevención que se utiliza cada vez con más frecuencia en mujeres de alto riesgo de padecer cáncer de mama y ovario hereditario. Tanto la mastectomía como la ooforectomía profilácticas son medidas de prevención muy agresivas, que en muchos casos van a requerir para las mujeres a las que se les ofrece un difícil proceso de toma de decisión acerca de las medidas a llevar a cabo. Ambos tipos de cirugía han demostrado su eficacia como medidas de reducción de riesgo de cán¬cer, si bien no eliminan totalmente el riesgo de enfermedad. Sin embargo, estos procedimientos pueden provocar un impacto negativo en las mujeres que los llevan a cabo, lo que pone de manifiesto la necesidad de valorar detenidamente la realización de cirugías, así como el impacto psicológico que puede tener sobre cada mujer. En el presente artículo se pretende hacer una revisión que permita conocer el estado actual acerca del impacto psicológico de la mastectomía y la ooforectomía, así como de los aspectos más importantes que han de te¬nerse en cuenta a la hora de llevarlos a cabo. Aspectos como la eficacia del procedimiento, la calidad de vida, la satisfacción con la ciru¬gía y los aspectos negativos más importantes derivados de este procedimiento se comentan a continuación

Psychological impact and intervention needs in genetic counseling for women with hereditary breast cancer risk

Se exponen los aspectos psicológicos del Consejo Genético Oncológico en cáncer de mama (CGO). El CGO tiene como beneficio principal para los participantes obtener certidumbre, ser capaces de estimar el riesgo de desarrollar cáncer hereditario, adoptar medidas preventivas, y ayudar a los otros familiares. El CGO mejora la percepción de riesgo en los participantes, pero en muchos de ellos persisten errores debidos a fallos en la comprensión de la información y sesgos cognitivos o emocionales. La información en CGO debe partir de que las estimaciones de riesgo son herramientas para tomar decisiones que afectan a la salud y no una mera predicción de enfermedad. Es preferible informar del riesgo en términos de probabilidades absolutas, y evitar términos de riesgo relativo. Los valores de los participantes y las consecuencias para su bienestar a largo plazo deben ser incorporados al proceso de toma de decisiones. Los participantes deben valorar sus decisiones en términos de las ventajas que pueda suponer y no como correcto/incorrecto. La participación en CGO no tiene consecuencias adversas para la salud mental de la mayoría de los participantes. La comunicación abierta entre los miembros de la familia es un importante determinante de la adaptación al proceso. La intervención psicológica es necesaria en los siguientes casos: a) los participantes que tienen problemas de comunicación familiar; b) el ser el primer probando; c) los participantes que muestran un alto nivel de estrés previo al consejo genético, ansiedad, pe simismo, o pérdida de autoestima; d) antecedentes psicopatológicos familiares; e) los participantes que han tenido experiencia negativas de cáncer en la familia durante la adolescencia (11-20 años); f) la muerte reciente por cáncer de un familiar y el duelo; g) diagnóstico reciente de cáncer o recurrencia; f) el consultante declina continuar el CGO; g). Los portadores que no esperan serlo: h) los que consideran realizar cirugía profiláctica.The psychological aspects of genetic counseling for breast cancer are reviewed. The principal profits for the genetic counseling participants are: to obtain certainty, be capable of estimating the risk of developing hereditary cancer, to take preventive measures, and to help their relatives. Genetic risk counselling has been shown to improve significantly the accuracy of risk perception, but a significant proportion of women continue to hold misperceptions, which is caused by problems to understand the information and cognitive or emotional biases. The estimations of risk should be a mean to assist in health decision-making and not a mere predictor of cancer. It is preferable to provide the estimations about cancer risk in absolute probabilities, and to avoid terms of relative risk. The values of the participants and the consequences for his well-being in the long term must be incorporated to the process of decision-making. The participants must view their decisions in terms of the advantages/disadvantages and not as correct/wrong. The participation in CGO does not have negative consequences in mental health for the most people. The open communication among relatives is an important determinant of the adjustment to the process. The psychological intervention is necessary for the following conditions: a) the participants who have problems of familiar communication; b) those who are tested first; c) high levels of distress, anxiety, pessimism, or low self-esteem prior to testing; d) having lost a relative to hereditary cancer during the adolescence (11-20 years); e) the recent death of a relative from cancer and grief; f) recent diagnosis of cancer or recurrence; g) the participants who decline genetic testing; h) carriers who do not expect to be carriers; i) those who consider to undergoing prophylactic surgery

Iron Uptake Analysis in a Set of Clinical Isolates of Pseudomonas putida

Pseudomonas putida strains are frequent inhabitants of soil and aquatic niches and they are occasionally isolated from hospital environments. As the available iron sources in human tissues, edaphic, and aquatic niches are different, we have analyzed iron-uptake related genes in different P. putida strains that were isolated from all these environments. We found that these isolates can be grouped into different clades according to the genetics of siderophore biosynthesis and recycling. The pyoverdine locus of the six P. putida clinical isolates that have so far been completely sequenced, are not closely related; three strains (P. putida HB13667, HB3267, and NBRC14164T) are grouped in Clade I and the other three in Clade II, suggesting possible different origins and evolution. In one clinical strain, P. putida HB4184, the production of siderophores is induced under high osmolarity conditions. The pyoverdine locus in this strain is closely related to that of strain P. putida HB001 which was isolated from sandy shore soil of the Yellow Sea in Korean marine sand, suggesting their possible origin, and evolution. The acquisition of two unique TonB-dependent transporters for xenosiderophore acquisition, similar to those existing in the opportunistic pathogen P. aeruginosa PAO, is an interesting adaptation trait of the clinical strain P. putida H8234 that may confer adaptive advantages under low iron availability conditions.Work in our laboratories was supported by ERANET Pathogenomics program through the ADHERS project (Ref: BIO2008-04419-E) and Fondos FEDER from the European Union through project BIO2010-17227 of the Spanish Ministry of Economy and Competitivity. The work in Abengoa Research was funded by H2020 grant Empowerputida number 65703.Peer reviewedPeer Reviewe

Editorial

Sin resume

Descompresión transpedicular en las fracturas vertebrales por estallido

Se presentan 15 casos de fracturas vertebrales por estallido, a nivel toracolumbar y lumbar, tratadas mediante descompresión transpedicular y estabilización mediante instrumentación CD. Con un periodo mínimo de 1 año de seguimiento, se analiza la calidad de la descompresión del canal desde el punto de vista neurológico y la evolución de la reducción obtenida. Trece pacientes presentaban afectación neurológica incompleta, valorada según la escala de Frankel modificada por Bradford. Los casos se distribuyeron de la siguiente forma: T8 (1) T12 (1), L1 (5), L2 (3), L3 (2), L4 (1) y L5 (2). La ocupación del canal, la reducción obtenida y su evolución se han evaluado mediante TAC pre y postoperatoria, tomando como referencia el nivel superior sano. Se valoran también los parámetros radiográficos: índice sagital pre y postoperatorio, porcentaje de altura perdido del soma y la reconstrucción conseguida. Salvo en 1 caso, todos los pacientes mejoraron al menos 1 grado en la escala de Frankel modificada. La ocupación media preoperatoria del canal fue de 56% (25-95%). La ocupación postoperatoria media fue del 2 2% (0-70). La evolución al año mostró pérdidas mínimas en dos casos, con una media del 24% de ocupación final. La vía traspedicular ofrece unos resultados efectivos desde el punto de vista neurológico. Permite reducir el muro posterior sin pérdida de masa ósea para la fusión, y realizar una buena reconstrucción del cuerpo vertebral. La instrumentación CD proporciona estabilidad a esta técnica con pérdidas mínimas de la reducción obtenida, tanto del muro posterior como del índice sagital.We present 15 cases of thoracolumbar and lumbar burst fractures treated by decompression and stabilization with CD instrumentation. With a minimum of 1 year follow-up, the quality and the efficacy of the spinal canal decompression and the loss of reduction were evaluated. Thirteen patients presented incomplete neurological damage according to Frankel's score (modified by Bradford). The cases were distributed as follows: T8 (1), T12 (1), L1(5), L2 (3), L3 (2), L4 (1) and L5 (2). The canal occupation and the reduction obtained were assessed pre- and postoperative by CT scan. The healthy level above the fracture was used as reference. The saggital index (pre- and postop) and the height of the vertebral body were also evaluated by radiography. Except in one case, all the patients improved at least 1 grade (modified Frankel scale). The mean canal occupation was 56% (25-95%). The mean postoperative occupation was 22% (range 0-70); After 1 year follow up, these way minimum loss, (in 2 cases) with a mean 24% of final occupation. Transpedicular approach provides an efficient decompression from the neurological point of view, allowing reduction of the posterior wall without loss of the posterolateral structures for the fusion, as well as a sufficient reconstruction of the vertebral body. CD instrumentation permits enought stability with this technique, showing minimum loss of the reduction in the posterior wall and in the saggital index

Tratamiento quirúrgico de las fracturas vertebrales mediante instrumentación segmentaria Cotrel-Dubousset

Los autores presentan su experiencia personal en el tratamiento quirúrgico de las fracturas vertebrales torácicas y lumbares. Han sido incluidos en el estudio 27 pacientes operados entre 1988 y 1991, todos ellos estabilizados mediante la instrumentación Cotrel Dubousset. Excepto tres pacientes, todos fueron intervenidos por vía posterior. Se realiza un estudio de los resultados obtenidos desde el punto de vista radiológico (índice sagital, porcentaje de ocupación de canal), funcional y neurológico. La fractura estallido fue la más frecuente (52% de los casos). En 17 pacientes (63%) se objetivó lesión neurológica, 3 de los cuales (11%) mostraban paraplejia completa, no obteniendo mejoría tras la intervención. Todos los restantes mejoraron al menos un grado en la escala de Frankel modificada. No se registró pseudoartrosis. El índice sagital no mostró pérdidas superiores a 7o . La pérdida de altura del cuerpo vertebral fue inferior al 10%. La corrección del muro posterior no presentó pérdidas durante el seguimiento. Se concluye, que mediante las instrumentaciones segmentarias por vía posterior se puede obtener en la mayoría de las ocasiones una estabilidad mecánica y neurológica suficiente de la columna vertebral, incluyendo un número mínimo de niveles sanos, aunque precisando de ortesis durante el postoperatorio.The authors showed their experience on the surgical management of thoracic and lumbar fractures. A total of 27 patients surgically treated from 1988 to 1991 by posterior approach have been included in the study. Cotrel-Dubousset instrumentation was used in all cases. Except for three patients, all were operated on by posterior approach. In the burst fractures, decompression and reduction of the posterior wall was performed by transpedicular approach. The results obtained from the radiological (sagittal index, canal occupation) as well as functional and neurological point of view were reviewed. Burst fracture was the must frequent type (52% of cases). Seventeen patients (63%) showed neurological damage, 3 of them with (11%) had paraplegia and did not show any recovery after surgery. Those with incomplete neurological lesion improved at least one or two degrees on the Frankel's score. Neither pseudoarthrosis; nor loss of more than 7 degrees in the sagittal index were observed. The percentage of height loss of vertebral body was always less than 10%. When the sagittal index augmented, it was related with a collapse of discal space. Posterior wall alignement did not suffer loss of correction during follow-up. The CD segmentary instrumentation seems to be an efficient system for stabilization of vertebral fractures. CD shows a wide versatility adapting to different topographic lesions and saving healty levels. However, CD is less efficient with flexion stress and therefore patients require postoperative bracing in lordosis

Psychometric properties of the Valuing Questionnaire in a Spaniard sample and factorial equivalence with a Colombian sample

Background. The Valuing Questionnaire (VQ) is considered as one of the most psychometrically robust instruments to measure valued living according to the acceptance and commitment therapy model. It consists of 10 items that are responded to on a 7-point Likert-type scale and has two factors: Progression and Obstruction. The Spanish version of theVQshowed good psychometric properties in Colombian samples. However, there is no evidence of the psychometric properties of the VQ in Spaniard samples. This study aims to analyze the validity of the VQ in a large Spaniard sample and analyze the measurement invariance with a similar Colombian sample. Method. The VQ was administered to a Spaniard sample of 846 adult participants from general online population. Cronbach's alpha and McDonald's omega were computed to analyze the internal consistency of the VQ. The fit of the VQ's two-factor model was tested through a confirmatory factor analysis with a robust maximum likelihood (MLR) estimation method. Afterward, we analyzed the measurement invariance across countries and gender. Convergent construct validity was analyzed with a package of questionnaires that evaluated experiential avoidance (Acceptance and Action Questionnaire-II, AAQ-II), emotional symptoms (Depression Anxiety and Stress Scale-21, DASS-21), life satisfaction (Satisfaction with Life Scale, SWLS), and cognitive fusion (Cognitive Fusion Questionnaire, CFQ). Results. The internal consistency across samples was adequate (alphas and omegas were .85 for VQ-Progress and .84 for VQ-Obstruction). The two-factor model obtained a good fit to the data (RMSEA D 0.073, 90% CI [0.063, 0.083], CFI D 0.98, NNFI D 0.97, and SRMR D 0.053). The VQ showed strict invariance across countries and gender and showed theoretically coherent correlations with emotional symptoms, life satisfaction, experiential avoidance, and cognitive fusion. In conclusion, the Spanish version of the VQ demonstrated good psychometric properties in a large Spaniard sample

Ultra Wide-Band Localization and SLAM: A Comparative Study for Mobile Robot Navigation

In this work, a comparative study between an Ultra Wide-Band (UWB) localization system and a Simultaneous Localization and Mapping (SLAM) algorithm is presented. Due to its high bandwidth and short pulses length, UWB potentially allows great accuracy in range measurements based on Time of Arrival (TOA) estimation. SLAM algorithms recursively estimates the map of an environment and the pose (position and orientation) of a mobile robot within that environment. The comparative study presented here involves the performance analysis of implementing in parallel an UWB localization based system and a SLAM algorithm on a mobile robot navigating within an environment. Real time results as well as error analysis are also shown in this work