Surgical treatment for recurrent cholangiocarcinoma: a single-center series

Purpose: The present study aims to assess the results obtained after surgical treatment of cholangiocarcinoma (CC) recurrences. Methods: We carried out a single-center retrospective study, including all patients with recurrence of CC. The primary outcome was patient survival after surgical treatment compared with chemotherapy or best supportive care. A multivariate analysis of variables affecting mortality after CC recurrence was performed. Results: Eighteen patients were indicated surgery to treat CC recurrence. Severe postoperative complication rate was 27.8% with a 30-day mortality rate of 16.7%. Median survival after surgery was 15 months (range 0-50) with 1- and 3-year patient survival rates of 55.6% and 16.6%, respectively. Patient survival after surgery or CHT alone, was significantly better than receiving supportive care (p< 0.001). We found no significant difference in survival when comparing CHT alone and surgical treatment (p=0.113). Time to recurrence of <1 year, adjuvant CHT after resection of the primary tumor and undergoing surgery or CHT alone versus best supportive care were independent factors affecting mortality after CC recurrence in the multivariate analysis. Conclusion: Surgery or CHT alone improved patient survival after CC recurrence compared to best supportive care. Surgical treatment did not improve patient survival compared to CHT alone

A case of COVID-19 immediately after liver transplantation: Not only bad news

COVID-19, the illness caused by the SARS-CoV-2 virus originated in December 2019 in Wuhan, China and has caused more 3,3 million cases and more than 230,000 deaths throughout the world, with 25,000 of them only in Spain, where the first case was diagnosed on January 31st, 2020. As COVID-19 is a "new" disease, we still do not have data on prognosis or treatment in transplant patients or on how to manage immunosuppression in this complex scenario. We present a case of COVID-19 diagnosed during the early postoperative period in a recipient whose liver transplantation was performed on late March during the lockdown in Spain, with donor and recipient previously negative rRT-PCR to SARS-CoV-2. In the first post-operative week the patient suffered COVID-19 pneumonia that was treated with immunosuppression minimization, oral Hydroxycloroquine and Azithromycin with favorable outcome. The patient was discharged on POD 21 without complications. To date, few early post-liver transplantation SARS-CoV-2 infected recipients have been published, but only one was an early postoperative infection. In our case the outcome was favorable, even though it was an early post -liver transplantation COVID-19 in a frail patient

Preterm delivery and immigration

Prematurity is the main cause of perinatal morbidity and mortality. There are many and varied risk factors described: some related to the mother, such as age, parity, socioeconomic situation, lifestyles or obstetric history; others related to pregnancy, such as prenatal care received or gestational complications. Many of them can be found among immigrant women residing in Spain, but the literature is limited. A cross-sectional study is proposed with the objective of identifying the prematurity rate and related factors in a population of immigrant and native women. To do this, the records of 1,874 immigrant women who gave birth at the Hospital of El Ejido (Almería) between January 1997 and June 2003 are exploited, and compared with an equal group of native women, whose birth was immediately afterwards. It was observed that, although the percentage of premature newborns in immigrant women was somewhat higher than in Spanish women (7.31% vs. 6.72%), this difference was not significant. On the other hand, among immigrant women with premature children, a greater history of sexually transmitted infections, hypertensive disease, and inadequate prenatal care was observed (p<0.05).La prematuridad es la principal causa de morbimortalidad perinatal. Son muchos y variados los factores de riesgo descritos: unos relacionados con la madre, como la edad, paridad, situación socioeconómica, estilos de vida o antecedentes obstétricos; otros relacionados con el embarazo, como la atención prenatal recibida o las complicaciones gestacionales. Muchos de ellos pueden encontrarse entre las mujeres inmigrantes que residen en España, pero la literatura es limitada. Se plantea un estudio transversal con el objetivo de identificar la tasa de prematuridad y los factores relacionados en una población de mujeres inmigrantes y autóctonas. Para ello, se explotan los registros de 1.874 mujeres inmigrantes que dieron a luz en el Hospital de El Ejido (Almería) entre Enero de 1997 a Junio de 2003, y se compara con un grupo igual de mujeres autóctonas, cuyo parto fue inmediatamente posterior. Se observó que, aunque el porcentaje de recién nacidos prematuros en mujeres inmigrantes fue algo superior a las españolas (7,31% vs. 6,72%), esta diferencia no fue significativa. Por otro lado, entre las mujeres inmigrantes con hijos prematuros, se observó más antecedentes de infecciones de transmisión sexual, enfermedad hipertensiva, y control prenatal inadecuado (p<0,05)

The effect of a community-based group intervention on chronic disease self-management in a vulnerable population

Introduction:Chronic non-communicable diseases (NCDs) are predominantly related to modifiable health behaviors and account for 74% of global deaths at present. Behavior modification through self-management is a strategy to prevent NCDs. Chronic Disease Self-Management Programs (CDSMPs) have demonstrated improvements in health behaviors, health status, and use of healthcare. Objective:We evaluated the effects of a 6-week CDSMP on self-efficacy, health behaviors, mental health, health-related quality of life (HR-QoL), and health responsibilities among vulnerable populations with chronic disease in Europe. Methods: A prospective cohort study with a 6-month pre-post single-group design was conducted in five European countries. The intervention targeted adults with chronic conditions and low socioeconomic status, as well as their caregivers. The intervention was a 6-week community-based CDSMP in a group setting. Outcomes were measured per self-report questionnaire at baseline and 6-month follow-up: self-efficacy, health behaviors, mental health, HR-QoL, and health responsibilities. Results: Of 1,844 participants, 1,248 (67.7%) completed follow-up and attended ≥4 sessions. For the chronic condition group, the following outcome measures at follow-up significantly improved compared with baseline (all P &lt; 0.002): self-efficacy (SEMCD-6 6.7 vs. 6.4), mental health (PHQ-8 6.3 vs. 7.0), HR-QoL (SF-12 PCS 42.3 vs. 40.2, SF-12 MCS 42.8 vs. 41.4), health utility (EQ-5D-5L 0.88 vs. 0.86), self-rated health (EQ-5D-5L 67.2 vs. 63.9), communication with healthcare providers (2.28 vs. 2.11), understanding information (3.10 vs. 3.02), number of doctor visits (3.61 vs. 4.97), accident and emergency department visits (0.25 vs. 0.48), total nights in a hospital (0.65 vs. 1.13), and perceived medical errors (19.6 vs. 28.7%). No significant changes were detected in dietary habits, physical activity, substance use, and sleep and fatigue. For caregivers without a chronic condition, only doctor visits significantly decreased (1.54 vs. 2.25, P &lt; 0.001). Discussion: This CDSMP was associated with improvement in self-efficacy, depression, HR-QoL, and health responsibilities over 6 months in a diverse European population with a chronic condition. However, additional interventions targeting lifestyle risk factors are needed to improve health outcomes.</p

Surgical treatment for recurrent cholangiocarcinoma: a single-center series

PurposeThe present study aims to assess the results obtained after surgical treatment of cholangiocarcinoma (CC) recurrences.MethodsWe carried out a single-center retrospective study, including all patients with recurrence of CC. The primary outcome was patient survival after surgical treatment compared with chemotherapy or best supportive care. A multivariate analysis of variables affecting mortality after CC recurrence was performed.ResultsEighteen patients were indicated surgery to treat CC recurrence. Severe postoperative complication rate was 27.8% with a 30-day mortality rate of 16.7%. Median survival after surgery was 15 months (range 0-50) with 1- and 3-year patient survival rates of 55.6% and 16.6%, respectively. Patient survival after surgery or CHT alone, was significantly better than receiving supportive care (p&lt; 0.001). We found no significant difference in survival when comparing CHT alone and surgical treatment (p=0.113). Time to recurrence of &lt;1 year, adjuvant CHT after resection of the primary tumor and undergoing surgery or CHT alone versus best supportive care were independent factors affecting mortality after CC recurrence in the multivariate analysis.ConclusionSurgery or CHT alone improved patient survival after CC recurrence compared to best supportive care. Surgical treatment did not improve patient survival compared to CHT alone

Understanding COVID: Collaborative Government Campaign for Citizen Digital Health Literacy in the COVID-19 Pandemic

The strategy “Understanding COVID” was a Public Health campaign designed in 2020 and launched in 2021 in Asturias-Spain to provide reliable and comprehensive information oriented to vulnerable populations. The campaign involved groups considered socially vulnerable and/or highly exposed to COVID-19 infection: shopkeepers and hoteliers, worship and religious event participants, school children and their families, and scattered rural populations exposed to the digital divide. The purpose of this article was to describe the design of the “Understanding COVID” strategy and the evaluation of the implementation process. The strategy included the design and use of several educational resources and communication strategies, including some hundred online training sessions based on the published studies and adapted to the language and dissemination approaches, that reached 1056 people of different ages and target groups, an accessible website, an informative video channel, posters and other pedagogical actions in education centers. It required a great coordination effort involving different public and third-sector entities to provide the intended pandemic protection and prevention information at that difficult time. A communication strategy was implemented to achieve different goals: reaching a diverse population and adapting the published studies to different ages and groups, focusing on making it comprehensible and accessible for them. In conclusion, given there is a common and sufficiently important goal, it is possible to achieve effective collaboration between different governmental bodies to develop a coordinated strategy to reach the most vulnerable populations while taking into consideration their different interests and needs

The effect of a community-based group intervention on chronic disease self-management in a vulnerable population

IntroductionChronic non-communicable diseases (NCDs) are predominantly related to modifiable health behaviors and account for 74% of global deaths at present. Behavior modification through self-management is a strategy to prevent NCDs. Chronic Disease Self-Management Programs (CDSMPs) have demonstrated improvements in health behaviors, health status, and use of healthcare.ObjectiveWe evaluated the effects of a 6-week CDSMP on self-efficacy, health behaviors, mental health, health-related quality of life (HR-QoL), and health responsibilities among vulnerable populations with chronic disease in Europe.MethodsA prospective cohort study with a 6-month pre-post single-group design was conducted in five European countries. The intervention targeted adults with chronic conditions and low socioeconomic status, as well as their caregivers. The intervention was a 6-week community-based CDSMP in a group setting. Outcomes were measured per self-report questionnaire at baseline and 6-month follow-up: self-efficacy, health behaviors, mental health, HR-QoL, and health responsibilities.ResultsOf 1,844 participants, 1,248 (67.7%) completed follow-up and attended ≥4 sessions. For the chronic condition group, the following outcome measures at follow-up significantly improved compared with baseline (all P &lt; 0.002): self-efficacy (SEMCD-6 6.7 vs. 6.4), mental health (PHQ-8 6.3 vs. 7.0), HR-QoL (SF-12 PCS 42.3 vs. 40.2, SF-12 MCS 42.8 vs. 41.4), health utility (EQ-5D-5L 0.88 vs. 0.86), self-rated health (EQ-5D-5L 67.2 vs. 63.9), communication with healthcare providers (2.28 vs. 2.11), understanding information (3.10 vs. 3.02), number of doctor visits (3.61 vs. 4.97), accident and emergency department visits (0.25 vs. 0.48), total nights in a hospital (0.65 vs. 1.13), and perceived medical errors (19.6 vs. 28.7%). No significant changes were detected in dietary habits, physical activity, substance use, and sleep and fatigue. For caregivers without a chronic condition, only doctor visits significantly decreased (1.54 vs. 2.25, P &lt; 0.001).DiscussionThis CDSMP was associated with improvement in self-efficacy, depression, HR-QoL, and health responsibilities over 6 months in a diverse European population with a chronic condition. However, additional interventions targeting lifestyle risk factors are needed to improve health outcomes

Binding of CAP70 to Inducible Nitric Oxide Synthase and Implications for the Vectorial Release of Nitric Oxide in Polarized Cells

In this article we analyze the mechanisms by which the C-terminal four amino acids of inducible nitric oxide synthase (NOS2) interact with proteins that contain PDZ (PSD-95/DLG/ZO-1) domains resulting in the translocation of NOS2 to the cellular apical domain. It has been reported that human hepatic NOS2 associates to EBP50, a protein with two PDZ domains present in epithelial cells. We describe herein that NOS2 binds through its four carboxy-terminal residues to CAP70, a protein that contains four PDZ modules that is targeted to apical membranes. Interestingly, this interaction augments both the cytochrome c reductase and ·NO-synthase activities of NOS2. Binding of CAP70 to NOS2 also results in an increase in the population of active NOS2 dimers. In addition, CAP70 participates in the correct subcellular targeting of NOS2 in a process that is also dependent on the acylation state of the N-terminal end of NOS2. Hence, nonpalmitoylated NOS2 is unable to progress toward the apical side of the cell despite its interaction with either EBP50 or CAP70. Likewise, if we abrogate the interaction of NOS2 with either EBP50 or CAP70 by fusing the GFP reporter to the carboxy-terminal end of NOS2 palmitoylation is not sufficient to confer an apical targeting