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espanolLa pandemia por COVID 19 ha generado una serie de consecuencias psicologicas a toda la poblacion, incrementado la presencia de psicopatologia y afectando a la calidad del sueno. El objetivo del presente estudio ha sido analizar las consecuencias psicologicas de la COVID 19 entre dos tipos de muestras: muestra clinica y muestra no clinica, en diferentes anos (2019 antes de la pandemia y 2020 despues de la pandemia). Para ello se ha evaluado un total de 69 adultos que acuden en busca de ayuda psicologica, siendo el 39,1% muestra no clinica. Las variables evaluadas fueron: psicopatologia a traves del SCL-90, calidad del sueno y la satisfaccion con la vida. Los resultados indicaron que existe un aumento de hostilidad en la muestra no clinica entre los anos 2019 y 2020. Que en ambas muestras se observo una reduccion de la calidad del sueno antes y durante la pandemia. Por ultimo, se encontro que la muestra no clinica obtuvo puntuaciones mayores en satisfaccion vital y calidad de sueno. En conclusion, resulta relevante detectar senales de riesgo porque la COVID 19 ha impactado psicologicamente en toda la poblacion, de esta manera se podra prevenir el desarrollo de futuros problemas psicologicos. EnglishThe COVID 19 pandemic has generated a series of psychological consequences to the whole population, increasing the presence of psychopathology and affecting sleep quality. The aim of the present study was to analyze the psychological consequences of COVID 19 between two types of samples: clinical sample and non-clinical sample, in different years (2019 before the pandemic and 2020 after the pandemic). For this purpose, a total of 69 adults seeking psychological help were assessed 39.1% being non-clinical sample. The variables assessed were psychopathology through the SCL-90, sleep quality and life satisfaction. The results indicated that there is an increase in hostility in the non-clinical sample between 2019 and 2020. That a reduction in sleep quality was observed in both samples before and during the pandemic. Finally, it was found that the non-clinical sample obtained higher scores in life satisfaction and sleep quality. In conclusion, it is relevant to detect signs of risk because COVID 19 has had a psychological impact on the entire population, thus preventing the development of future psychological problems.

Colorectal cancer (CRC) is the third most common cancer and the second cause of cancer death worldwide. Several factors have been postulated to be involved in CRC pathophysiology, including heritable and environmental factors, which are the latest to be closely associated with nutritional habits, physical activity, obesity, and the gut microbiota. The latter may also play a key role in CRC prognosis and derived complications in patients undergoing surgery. This is a single-center, open, controlled, randomized clinical trial, in patients with scheduled surgical intervention for CRC. The primary objective is to assess whether a pre-surgical nutritional intervention, based on a high-fiber diet rich in polyunsaturated fatty acids (PUFAs), can reduce disturbances of the gut microbiota composition and, consequently, the rate of post-surgical complications in patients with CRC. Patients will be randomized in a 1:1 ratio after receiving a diagnosis of CRC. In the control arm, patients will receive standard nutritional recommendations, while patients in the intervention arm will be advised to follow a high-fiber diet rich in PUFAs before surgery. Participants will be followed up for one year to evaluate the overall rate of postsurgical complications, recurrences of CRC, response to adjuvant therapy, and overall/disease-free survival.

Small-bowel involvement in patients with ovarian cancer has been strongly correlated with the possibility of cytoreduction and thus with survival. The main objective of this study was to evaluate the prognostic significance of small-bowel involvement in patients undergoing optimal-complete interval cytoreductive surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC).We included a series of patients diagnosed with stage IIIC-IVA (pleural effusion) high-grade serous epithelial ovarian cancer and in whom CRS + HIPEC was indicated after neoadjuvant systemic chemotherapy (NACT). The study period extended from January 2008 to January 2020, with a minimum follow-up of 12 months from the inclusion of the last patient. A multivariate analysis using Cox regression allowed us to identify the variables that were independently related to disease-free survival.A total of 144 patients were selected, 13 (9%) of whom were excluded from the analysis, because their disease was considered unresectable. The study included a series of 131 patients with a median age of 62 years (34-79 years) and a median Peritoneal Cancer Index (PCI) calculated during surgery of 9 (1-35). The median PCI of bowel areas 9-12 (SB-PCI) was 3 (1-10). Performance of a CC-1 cytoreduction (HR: 1.93, 95% CI: 1.02-3.64, p = 0.042) and SB-PCI greater than 3 (HR: 2.25, 95%CI: 1.13-4.48, p = 0.21) were independent factors associated with shorter disease-free survival.Small-bowel involvement, even in patients with a macroscopically complete resection, showed a correlation with worse prognostic outcomes and could be considered as a variable in the postoperative management of these patients.

Gastric cancer (GC) with peritoneal carcinomatosis (PC) is traditionally considered a terminal stage of the disease. The use of a multimodal treatment, including cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), can benefit these patients. Our goal was to evaluate the morbidity and survival outcomes of these patients. This is a retrospective, multicenter study from a prospective national database of patients diagnosed with PC secondary to GC treated with CRS and HIPEC from June 2006 to October 2017. Eighty-eight patients from seven specialized Spanish institutions were treated with CRS and HIPEC, with median age of 53 years; 51% were women. Median Peritoneal Cancer Index (PCI) was 6, and complete cytoreduction was achieved in 80 patients (90.9%). HIPEC was administered in 85 cases with 4 different regimens (Cisplatin + Doxorubicin, Mitomycin-C + Cisplatin, Mitomycin-C and Oxaliplatin). Twenty-seven cases (31%) had severe morbidity (grade III–IV) and 3 patients died in the postoperative period (3.4%). Median follow-up was 32 months. Median overall survival (OS) was 21.2 months, with 1-year OS of 79.9% and 3-year OS of 30.9%. Median disease-free survival (DFS) was 11.6 months, with 1-year DFS of 46.1% and 3-year DFS of 21.7%. After multivariate analysis, the extent of peritoneal disease (PCI ≥ 7) was identified as the only independent factor that influenced OS (hazard ratio [HR] 2.37, 95% confidence interval [CI] 1.26–4.46, p = 0.007). The multimodal treatment, including CRS and HIPEC, for GC with PC can improve the survival results in selected patients (PCI

Colorectal cancer (CRC) is the third most frequent malignancy and the second cause of cancer death worldwide. Several factors have been postulated to be involved in CRC pathophysiology, including physical inactivity, unhealthy dietary habits, obesity, and the gut microbiota. Emerging data suggest that the microbiome may play a key role in CRC prognosis and derived complications in patients undergoing colorectal surgery. On the other hand, dietary intervention has been demonstrated to be able to induce significant changes in the gut microbiota and related metabolites in different conditions; therefore, the manipulation of gut microbiota through dietary intervention may constitute a useful approach to improve perioperative dysbiosis and post-surgical outcomes in patients with CRC. In this article, we review the role of the gut microbiota in CRC surgery complications and the potential therapeutic modulation of gut microbiome through nutritional intervention in patients with CRC undergoing surgery.

Resumen La necesidad de cooperacion sanitaria en paises de bajo desarrollo es conocida y se implementa dia a dia. Sin embargo, la asistencia sanitaria quirurgica en estos paises, en el siglo XXI, es mas discutida, y se encuentra por debajo de niveles deseables y con soluciones mas complejas. Por otra parte, el numero de cirujanos que buscan implicarse aumenta progresivamente. Se analizan las causas que originan estos bajos niveles de asistencia, como la falta de personal cualificado, fuga de profesionales, coste de la asistencia o la falta de cuantificacion de las necesidades. Las oportunidades de mejora, como el hermanamiento institucional, las misiones quirurgicas de corta duracion o la realizacion de acciones dirigidas a la educacion, evaluacion, evidencia y formacion son algunas de las posibilidades propuestas.

The need for healthcare cooperation in low- and middle-income countries is known and is implemented day by day. However, the surgical sanitary assistance in these countries in the 21st century is very controversial, as it is still below desirable levels and entails complex solutions. On the other hand, the number of surgeons seeking to get involved is increasing progressively. We analyze the causes of the low levels of medical assistance, such as the lack of qualified personnel, the brain drain of surgeons, healthcare costs or the lack of quantified needs. Opportunities for improvement, such as institutional twinning, short-term surgical missions or activities aimed at education, evaluation, evidence and training, are some of the possibilities proposed.

Resumen Introduccion La cirugia citorreductora seguida de quimioterapia intraperitoneal hipertermica (HIPEC) se asocia frecuentemente a alteraciones de la hemostasia y a elevados requerimientos transfusionales perioperatorios. El proposito de este estudio fue analizar los trastornos hemostaticos asociados a cada una de las fases de este procedimiento terapeutico mediante tromboelastometria rotacional (ROTEM), niveles de fibrinogeno y recuento plaquetario, asi como su posible relacion con las necesidades transfusionales. Metodos Se efectuo un estudio prospectivo longitudinal. Se registraron niveles de hemoglobina, recuento plaquetario, niveles de fibrinogeno y parametros tromboelastometricos: tiempo de coagulacion (CT), tiempo de formacion del coagulo (CFT), firmeza maxima del coagulo (MCF), y angulo α (EXTEM, INTEM, FIBTEM). Las mencionadas determinaciones se realizaron: antes del inicio de la cirugia; al finalizar la cirugia citorreductora y al concluir la HIPEC. Se utilizaron los test estadisticos apropiados. Los valores de p Resultados Se incluyo en el estudio a 41 mujeres con una mediana de edad de 54 anos (rango: 34-76). Tras la cirugia citorreductora se observo una caida de la tasa de hemoglobina desde 11,4 ± 1,5 a 10,6 ± 1,6 g/dl; un descenso del fibrinogeno serico desde 269 ± 69 hasta 230 ± 48 mg/dl (p Conclusiones Las alteraciones hemostaticas observadas aparecen tras la cirugia citorreductora, probablemente a consecuencia de la hemorragia quirurgica. Se requieren mas estudios para confirmar una correlacion entre las necesidades transfusionales y las pruebas de coagulacion postoperatorias.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) is frequently associated with coagulation impairment and perioperative blood transfusion. Our aim was to investigate the impact of each procedure step on hemostasis, as measured by rotational thromboelastometry™ (ROTEM), fibrinogen level and platelet count as a primary outcome, along with its relationship with transfusion needs.A prospective longitudinal study was performed. Hemoglobin level, fibrinogen level, platelet count and ROTEM parameters: clotting time (CT), clot formation time (CFT), maximum clot firmness (MCF), α-angle (EXTEM, INTEM, FIBTEM) were measured before the procedure, at the end of cytoreductive surgery and after HIPEC. Appropriate statistical tests were used for comparison. A P.05 was considered as significant.Forty-one women, with median age 54 (range 34-76) were recruited. Cytoreductive surgery was followed by a reduction of hemoglobin level from 11,4±1,5g/dl to 10,6±1,6g/dl, a reduction of serum fibrinogen level from 269±69mg/dl to 230±48mg/dl (P.01) and MCF decline from 20±10 to 16±8mm (P.01), in the FIBTEM test. HIPEC was followed by no hemostatic impairment. The number of packed red blood cells administered during patients stay kept a mild significant relationship with both fibrinogen level (ρ = -0.5, P=.002), and MCF EXTEM values (ρ= -0.43, P=0.006), recorded after HIPEC.The mild observed hemostatic impairment appeared after cytoreductive surgery instead of HIPEC, involving surgical hemorrhage as the most likely responsible factor. Further studies are required to confirm a correlation between transfusion needs and postoperative hemostatic tests.

espanolEn este estudio se pone a prueba la viabilidad de la Terapia Cognitiva basada en la Consciencia Plena para mejorar la calidad de vida y el bienestar de los pacientes de cancer. La muestra esta constituida por siete pacientes de cancer de mama de la Comunidad Valenciana de edades comprendidas entre los 40 y 68 anos. Las pacientes fueron evaluadas psicologicamente antes de participar en un taller en el que se ofrecieron 8 sesiones de Mindfulness siguiendo el protocolo propuesto por Segal et al. (2002).Una vez finalizado el taller, las pacientes fueron evaluadas de nuevo y se contrastaron los cambios acaecidos tras la participacion del programa. Los resultados muestran efectos directos en la disminucion de la depresion, el aumento de la atencion y de la conciencia. catalaEn aquest estudi es posa a prova la viabilitat de la Terapia Cognitiva basada en la Consciencia Plena per millorar la qualitat de vida i el benestar dels pacients de cancer. La mostra esta constituida per set pacients de cancer de mama de la Comunitat Valenciana d’edats compreses entre els 40 i 68 anys. Les pacients van ser avaluades psicologicament abans de participar en un taller en el qual es van oferir 8 sessions de Mindfulness seguint el protocol proposat per Segal et al. (2002).Una vegada finalitzat el taller, les pacients van ser avaluades de nou i es van contrastar els canvis esdevinguts despres de la participacio del programa. Els resultats mostren efectes directes en la disminucio de la depressio, l’augment de l’atencio i de la consciencia. EnglishThis study tests the reliability of Cognitive Therapy based on Mindfulness to improve the quality of life and well-being of cancer patients. Seven breast cancer patients of Valencia aged between 40 and 68 years were recruited. They were psychologically evaluated before participating in a workshop. 8 sessions of Mindfulness following the protocol proposed by Segal et al. (2002) were offered in the workshop. At the end, patients were reassessed. Changes occurred after program participation were contrasted. Results show a direct effect of the workshop on depression reduction, attention increasing and awareness improvement.

Hepatoid carcinoma of the ovary (HCO) was first reported in 1987 in 5 cases of malignant ovarian tumors which were similar to hepatocarcinoma in the histological analysis. We report the first case in the literature of a patient diagnosed with HCO treated using HIPEC after extensive cytoreductive surgery, and we discuss the value of this therapeutical option in patients with HCO.

The present study evaluated the effects of heme oxygenase-1 (HO-1) induction on the changes in renal outer medullary nitric oxide (NO) and peroxynitrite levels during 45-min renal ischemia and 30-min reperfusion in anesthetized rats. Glomerular filtration rate (GFR), outer medullary blood flow (OMBF), HO and nitric oxide synthase (NOS) isoform expression, and renal low-molecular-weight thiols (–SH) were also determined. During ischemia significant increases in NO levels and peroxynitrite signal were observed (from 832.1 ± 129.3 to 2,928.6 ± 502.0 nM and from 3.8 ± 0.7 to 9.0 ± 1.6 nA before and during ischemia, respectively) that dropped to preischemic levels during reperfusion. OMBF and –SH significantly decreased after 30 min of reperfusion. Twenty-four hours later, an acute renal failure was observed (GFR 923.0 ± 66.0 and 253.6 ± 55.3 μl·min−1·g kidney wt−1 in sham-operated and ischemic kidneys, respectively; P < 0.05). The induction of HO-1 (CoCl2 60 mg/kg sc, 24 h before ischemia) decreased basal NO concentration (99.7 ± 41.0 nM), although endothelial and neuronal NOS expression were slightly increased. CoCl2 administration also blunted the ischemic increase in NO and peroxynitrite (maximum values of 1,315.6 ± 445.6 nM and 6.3 ± 0.5 nA, respectively; P < 0.05), preserving postischemic OMBF and GFR (686.4 ± 45.2 μl·min−1·g kidney wt−1). These beneficial effects of CoCl2 on ischemic acute renal failure seem to be due to HO-1 induction, because they were abolished by stannous mesoporphyrin, a HO inhibitor. In conclusion, HO-1 induction has a protective effect on ischemic renal failure that seems to be partially mediated by decreasing the excessive production of NO with the subsequent reduction in peroxynitrite formation observed during ischemia.