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Introduction and objectives: Asthma is the most prevalent chronic disease in childhood. However, the latest data on its prevalence in Spain are from Phase III of the International Study of Asthma and Allergies in Childhood (ISAAC), 2004. The objective of our study was to assess the prevalence of asthma symptoms, severity and diagnosis in the paediatric population aged between 13 and 14 years in the province of Salamanca. Material and methods: Cross-sectional multicentre study carried out in 2017–2018 in 13- and 14-year-old school children in the province of Salamanca as a centre participating in of the Global Asthma Network(GAN) Phase I. The standardised validated written questionnaire and that directed by a video was administered; it was self-completed by the pupils. Results: A total of 3485 questionnaires were completed, and the pupils’ participation rate was 95.01%. Among the total, 25.7% indicated having had wheeze ever (20.7% in the video questionnaire); 14.7% indicated having had wheeze in the past 12 months (11.3% in the video questionnaire). The prevalence of current wheeze that limited speech was 3.9% (7.5% in the video questionnaire) and the current prevalence of severe wheeze was 6.5%. Regarding asthma diagnosis, 19.7% of the sample answered that they had had asthma ever, whilst 14.0% referred to having physician-diagnosed asthma. The agreement between the written questionnaire and that directed by video was acceptable for the questions of wheeze ever (Cohen Kappa index [k] = 0.53) and current wheeze (k = 0.42). Conclusions: The prevalence of current asthma (wheeze in the past 12 months) in the population aged 13 and 14 years in the province of Salamanca is higher compared with that presented in 2004 in Spain, but similar to that described at the world level (low-moderate level), according to the ISAAC Phase III studies.

Acute confusional syndrome (ACS) is a geriatric syndrome that manifests itself with changes in cognition, attention, underactive or hyperactive motor response, and fluctuation in the level of consciousness after trauma, hospitalisation or surgery. The objective is to know the risk factors and prevention of acute confusional syndrome in the elderly with hip fractures (HF) .Prospective observational cohort study. The inclusion criteria was to be age ≥ 65 and HF operated under selective spinal anesthetic (bupivacaine ≤ 7 mg + fentanyl 10-15 .mu.g) without benzodiazepine, ketamine or propofol. The potential risk factors of ACS were recorded: demographic variables, fracture type, Charlson index, ASA risk, performance of a peripheral nerve block (PNB), and scale scores: Barthel, Fried, Pfeifer, RCMS, MNA and VAS. ACS was diagnosed by the CAM questionnaire. The risk factors were estimated by binary logistic regression.Of the 133 patients included, 60 (45.11%) developed preoperative ACS, and 25 developed (18.8%) postoperative ACS. Having identified cognitive impairment with ≥ 3 points on the RCMS (OR 11.04 [ 95% ic: 1.3 - 89.1], p0.001) or Pfeiffer (OR 6.94 [95% ic: 1.07 - 44.69], p0.0 41) was a risk factor of ACS. Among patients with cognitive impairment or dementia, the increase of surgical delay (OR 1.95 [ 95% CI: 1.2 -2.91], p0.001) was associated with the increased likelihood of presenting perioperative ACS, while performing a perioperative PNB decreased the likelihood of presenting perioperative ACS (without PNB: 43.8%, with PNB: 4.7%, OR 0.3 [0.2 to 0.43], p0.001).Identifying patients with HF and cognitive impairment using RCMS or the Pfeiffer test and performing HF surgery within 36 h administering perioperative PNB could reduce the incidence of ACS.

A 15-year-old adolescent girl diagnosed of interaortocaval paraganglioma with a positive 123I-MIGB SPECT/CT and 1 unsuccessful prior surgery was operated on with the assistance of a handheld gamma camera. Once the lesion was located and removed, 2 images were taken, one of the surgical field (without 123I-MIGB uptake) and another of the tumor ex vivo (with high 123I-MIGB uptake), confirming that the lesion had been satisfactorily excised. This case highlights the use of a portable gamma camera as a useful tool to locate this rare tumor, with a SPECT/CT positive for 123I-MIGB and a difficult anatomical location suspected.

Resumen Introduccion La cirugia bariatrica es uno de los procedimientos quirurgicos mas realizados en Espana, sin embargo actualmente es la cirugia con mayor demora en la lista de espera quirurgica (LEQ). Para disminuir la LEQ se pone en marcha un programa especial de autoconcertacion, y se quiere valorar su utilidad, estudiando las repercusiones clinicas y economicas en una unidad de alto volumen de cirugia bariatrica. Metodos Se realizo un estudio prospectivo de 3 meses comparando evolucion, resultados y consumo de recursos perioperatorios de 45 pacientes operados de cirugia bariatrica, divididos en 2 grupos, pacientes operados en quirofano de forma estandar y pacientes operados en programacion especial. Se tuvieron en cuenta factores epidemiologicos, asistenciales y economicos. Resultados Se operaron 2 grupos homogeneos de pacientes, reduciendo con exito la LEQ. La morbilidad fue similar en ambos grupos y el coste medio de las cirugias realizadas fue de 5.331,4 euros, 5372,5 ± 798,1 euros para el grupo estandar y 5.290,3 ± 685,1 euros para el grupo de programacion especial, sin diferencias significativas. Conclusiones En centros hospitalarios donde se realiza alto volumen de cirugia bariatrica es factible incorporar programas especiales quirurgicos que permiten la reduccion en la demora de las listas de espera quirurgica, manteniendo los criterios de calidad y sin suponer un mayor gasto al sistema sanitario.

Graphical abstract, Resumen Introducción La cirugía bariátrica es uno de los procedimientos quirúrgicos más realizados en España, sin embargo actualmente es la cirugía con mayor demora en la lista de espera quirúrgica (LEQ). Para disminuir la LEQ se pone en marcha un programa especial de autoconcertación, y se quiere valorar su utilidad, estudiando las repercusiones clínicas y económicas en una unidad de alto volumen de cirugía bariátrica. Métodos Se realizó un estudio prospectivo de 3 meses comparando evolución, resultados y consumo de recursos perioperatorios de 45 pacientes operados de cirugía bariátrica, divididos en 2 grupos, pacientes operados en quirófano de forma estándar y pacientes operados en programación especial. Se tuvieron en cuenta factores epidemiológicos, asistenciales y económicos. Resultados Se operaron 2 grupos homogéneos de pacientes, reduciendo con éxito la LEQ. La morbilidad fue similar en ambos grupos y el coste medio de las cirugías realizadas fue de 5.331,4 euros, 5372,5 ± 798,1 euros para el grupo estándar y 5.290,3 ± 685,1 euros para el grupo de programación especial, sin diferencias significativas. Conclusiones En centros hospitalarios donde se realiza alto volumen de cirugía bariátrica es factible incorporar programas especiales quirúrgicos que permiten la reducción en la demora de las listas de espera quirúrgica, manteniendo los criterios de calidad y sin suponer un mayor gasto al sistema sanitario.

espanolLa anemia es una condicion prevalente en pacientes con cancer y puede conducir a una disminucion de la capacidad funcional y de la calidad de vida en ellos. Las transfusiones de sangre siguen siendo eficaces cuando es necesario un aumento inmediato de los niveles de hemoglobina. Los agentes estimulantes de la eritropoyesis (AEE) elevan la hemoglobina y reducen los requerimientos de transfusion. Si los AEE se utilizan adecuadamente son agentes utiles y bien tolerados para el tratamiento de la anemia en pacientes que reciben radioterapia y/o quimioterapia. Sin embargo, los estudios han mostrado un mayor riesgo de eventos tromboembolicos, un tiempo mas corto para la progresion del cancer y un posible aumento del riesgo de mortalidad asociado al uso de los AEE, por lo que en los pacientes oncologicos que reciben tratamiento con intencion curativa debe evitarse su utilizacion. En el ambito paliativo, los AEE deben recetarse con precaucion y segun las directrices actuales. EnglishAnemia is a prevalent condition in cancer patients and can lead to a decrease in their functional capacity and quality of life. Blood transfusions continue to be effective when an immediate increase in hemoglobin levels is necessary. Erythropoiesis-stimulating agents (ESA) elevate hemoglobin and reduce transfusion requirements. If ESAs are used appropriately, they are useful, well-tolerated agents for the treatment of anemia in patients receiving radiotherapy and/or chemotherapy treatment. However, studies have shown a greater risk of thromboembolic events, a shorter cancer progression time, and a possible increase in mortality risk associated with ESA use. Therefore, oncological patients who receive curative care must avoid their use. In the scope of palliative care, ESAs must be prescribed with precaution and according to current guidelines.

espanolEl cancer de vejiga es la novena neoplasia mas frecuente en el mundo y la mas frecuente del tracto urinario. El factor de riesgo mas importante es el tabaquismo, ademas de la exposicion ambiental a carcinogenos. El sintoma habitual es la hematuria. El carcinoma de vejiga no musculoinvasivo incluye a los estadios pTa y pT1, aunque representan 2 entidades con curso clinico diferente; su tratamiento es la reseccion transuretral (RTU) de vejiga y, dependiendo de la estratificacion del riesgo, tambien la instilacion intravesical adyuvante de quimioterapia o inmunoterapia. El carcinoma de vejiga musculoinvasivo no metastasico se trata mediante la cistectomia radical y la administracion de quimioterapia perioperatoria basada en cisplatino. En casos seleccionados, existe como alternativa un tratamiento multimodal de preservacion vesical. En la enfermedad metastasica, el tratamiento se basa en la quimioterapia basada en cisplatino, en la inmunoterapia y en otros nuevos agentes inhibidores de tirosinquinasa (TKI) y anticuerpos conjugados. EnglishBladder cancer is the ninth most frequent neoplasm in the world and the most frequent urinary tract cancer. The most important risk factor is tobacco use in addition to environmental exposure to carcinogens. The most habitual symptom is hematuria. Nonmuscle-invasive bladder cancer includes stages pTa and pT1, although they are two entities with different clinical courses. Their treatment involves transurethral resection (TUR) of the bladder and, depending on the risk stratification, adjuvant intravesical instillation of chemotherapy or immunotherapy as well. Nonmetastatic muscle-invasive bladder cancer is treated with a radical cystectomy and administration of perioperative cisplatin-based chemotherapy. In select cases, multimodal treatment for bladder preservation is an alternative. In metastatic disease, treatment is based on cisplatin-based chemotherapy, immunotherapy, and other new tyrosine kinase inhibitor (TKI) agents and conjugated antibodies.

espanolEl cancer de prostata es el primer cancer en numero de casos en varones y el segundo mas mortal. La edad supone el principal factor de riesgo para su desarrollo, siendo al diagnostico en torno a 66 anos. El pronostico del cancer de prostata depende del estadio en el momento del diagnostico, presentando enfermedad localizada hasta en un 80% de los casos. Sin embargo, hasta un 20%-30% de los pacientes presentaran una recidiva de la enfermedad. Los factores determinantes para la estadificacion y la estratificacion del riesgo son la extension de la enfermedad, la gradacion de Gleason y los niveles de PSA. Los tumores confinados a la glandula se tratan con tecnicas radicales, tanto quirurgicas como radioterapicas, y requieren un abordaje multidisciplinar. El tratamiento en estadios avanzados se basa en la castracion androgenica acompanada de inhibidores de la senalizacion del receptor androgenico como abiraterona y enzalutamida, del uso de quimioterapia basada en docetaxel y cabazitaxel y del empleo de radium-223. EnglishProstate cancer is the leading malignancy in men and the second most deadly. Age is the main risk factor for the development of the disease, with an average age at diagnosis of 66 years and an increase in incidence from the age of 55. The prognosis of prostate cancer depends on the stage at diagnosis, with localised disease occurring in up to 80% of cases. However, up to 20%-30% of patients will have recurrent disease. The determining factors for staging and risk stratification in prostate cancer are the extent of disease, Gleason grade and PSA levels. PSA level is also the main screening tool. Tumours confined to the prostate gland are usually treated by radical surgical and radiotherapy-based techniques, always requiring a multidisciplinary approach. Treatment in advanced stages is based in androgen deprivation therapies with androgen-receptor signalling inhibitors abiraterone and enzalutamide, as well as treatment with docetaxel, cabazitaxel and radium-223.

espanolEl dolor se define como una experiencia sensorial y emocional desagradable. La percepcion del dolor es muy variable, pero se estima que hasta el 80% de los pacientes con cancer avanzado van a presentar dolor. Al menos un 30% de estos pacientes no tienen el dolor controlado, por lo que resulta imprescindible aprender a manejarlo. Las causas del dolor oncologico son diversas, siendo el dolor asociado a la enfermedad oncologica de base el mas frecuente. En el paciente oncologico podemos encontrar cuatro tipos distintos de dolor y es importante saber identificarlos para un correcto abordaje terapeutico. La escalera analgesica de la OMS fue disenada como un esquema de tratamiento progresivo del dolor y es nuestra base terapeutica. Aunque los opioides son los agentes mas utilizados, es habitual que se combinen con otros farmacos de la escalera, siendo necesario, en ocasiones, realizar una rotacion de opioides por falta de una actividad analgesica adecuada. EnglishPain is defined as an unpleasant sensory and emotional experience. Perception of pain varies widely, but it is estimated that 80% of patients with advanced cancer will present with pain. At least 30% of these patients have uncontrolled pain. Therefore, it is essential to learn to manage it. The causes of cancer pain are varied; pain associated with the underlying oncological disease is the most frequent. Among cancer patients, there are four different types of pain. It is important to know how to identify them for a proper therapeutic approach. The WHO pain scale was designed as a progressive treatment schedule for pain and is the foundation for our therapy. Although opioids are the most used agents, it is common to combine them with other drugs on the analgesic ladder. On occasion, it is necessary to rotate opioids due to lack of appropriate analgesic activity.

Resumen El hueso es la localizacion mas frecuente de metastasis de los tumores solidos que se desarrollan en un 65%-75% de los pacientes con cancer avanzado. Suponen una de las principales amenazas potenciales del paciente por la comorbilidad y el deterioro en la calidad de vida que producen. Los eventos oseos relacionados con el cancer (skeletal related events —SRE—) son complicaciones derivadas de esta afectacion osea y son las fracturas patologicas, la necesidad de cirugia o radioterapia y la compresion medular. Estas lesiones pueden tener caracter osteoblastico u osteolitico y su diagnostico ha de estar basado tanto en la sospecha clinica como en las pruebas de imagen como la gammagrafia osea, la tomografia por emision de positrones combinada con tomografia computarizada o la resonancia magnetica. El tratamiento de las metastasis oseas debe ser multidisciplinar, tanto sistemico con bifosfonatos o denosumab, como local con radioterapia o cirugia, sin olvidar la importancia de un adecuado tratamiento de la enfermedad tumoral subyacente y del posible dolor asociado.

Although a reliable procedure in morbid obesity treatment, bariatric surgery may be associated with serious complications such as leakage or bleeding. We aimed to analyze the preoperative factors involved in patients with early postoperative hemorrhage after any type of bariatric surgery who required conservative treatment or reoperation for this complication. Retrospective case-controlled study (1:3) of 2 patient cohorts (postoperative bleeding/controls) matched by type of surgical intervention. Hypertension (Odds Ratio 5.029; 95% Confidence Interval 1.78–14.13) and history of antiplatelet medication (OR 13.263; 95% CI 1.39–125.9) were independent risk factors in the bivariate analyses, confirmed in the logistic regression model on multivariate analysis. With no between-group differences in Body Mass Index (BMI) and type 2 Diabetes (T2D), early hemorrhagic complications were found to be more frequent in patients with hypertension or antiplatelet drug treatment.

Several studies have shown an association between psychosocial variables and functional capacity in chronic pain processes such as osteoarthritis. The aim of this study was to test a structural equations model that shows the predictive weight of certain variables such as catastrophizing, self-efficacy and kinesiophobia on functional pain and WOMAC subscales scores of pain and physical function of older patients diagnosed with hip and knee osteoarthritis. We also assessed the specific weight of age in terms of the factors. The study was conducted on a sample of 170 patients (142 women and 28 men mean age, 74.44 years range, 50-96 years). The main variables evaluated were WOMAC subscales scores of pain and physical function, self-efficacy, catastrophizing and kinesiophobia. To assess these variables, we used the Spanish validated version of the Western Ontario and McMaster Universities questionnaire, the Chronic Pain Self-Efficacy Scale, the Pain Catastrophizing Scale and the Tampa Scale for Kinesiophobia, respectively. We tested a structural equations model (IBM SPSS Amos version 22). The results showed the predominant predictive weight (both direct and indirect) of catastrophizing while simultaneously ruling out the relevance of age as a predictor of WOMAC subscales scores of pain and physical function. This study provides data of interest on the explanatory mechanisms that underlie the direct and inverse relationships between the studied psychological variables.

Introduction : Studying the historical design system of the pioneer concrete shells helps to reveal a relevant part of the History of Construction, which is also fundamental in acquiring the knowledge necessary to conserve and restore this iconic heritage. Cantilevered shells, like large domes, have been the most difficult to design and dimension when computers did not yet exist. Methods: The research included two phases: firstly, the selection and analysis of some of the most relevant pioneer cantilevered shells, and secondly, the comparative analysis of their design systems. Result and discussion: The analysis pointed out that the pioneer master engineers used different design systems. Pier Luigi Nervi and Eduardo Torroja mainly used scale model tests to check the structural behavior of their new continuous structural forms, Ildefonso Sanchez del Rio always used ribbed shells and chose geometric forms that were easy to calculate manually, and Felix Candela used real size models for the tests. The result reveals the different paths that they used to design and build their relevant legacies, which nowadays belong to the international heritage of Modernist Architecture.

After Roux-en-Y gastric bypass (RYGB), up to 30% failures in weight loss have been reported. Among multiple solutions available, we report our experience with shortening of the common channel (SCC) by performing a limb distalization of the alimentary or the biliopancreatic limb. University Hospital. We reviewed data from 23 patients that underwent limb distalization between 2001 and 2019 due to inadequate weight loss after an initial RYGB in our center. All patients who failed to achieve an excess weight loss reduction of > 50% or maintained a body mass index (BMI) above 35 kg/m2 were included. Multiple variables were analyzed during the follow-up at five time points: initial, after RYGB, before SCC, after SCC, and current. The mean BMI prior to the RYGB was 51.8 kg/m2, after RYGB was 37.6 kg/m2, before SCC was 43.6 kg/m2, after SCC was 36.1 kg/m2, and the final BMI was 36.3 kg/m2. No morbidity was seen after SCC. Long-term associated nutritional deficiencies were only identified in 3 patients which had iron deficiency and 1 patient with vitamin D deficiency. Patients with associated comorbidities significantly improved or were withdrawn from medications after the RYGB, with minor variations after SCC. Limb distalization with SCC is a safe and effective technique for patients who failed to achieve an adequate weight loss after RYGB. There is a slight increase in excess of weight loss after the SCC compared with RYGB. In addition, no further weight regain was documented.

Background: The management of Breakthrough cancer Pain (BTcP) remains unsatisfactory. Although many barriers to BTcP management have been identified, oncologists have not been able to overcome them. The aim of this study is to identify the barriers preventing proper BTcP management that Spanish medical oncologists have found, and to reach a consensus in order to draft the appropriate recommendations to overcome them. Methods: This study is based on two surveys conducted by oncologists. The first survey was designed to reach a consensus on the main barriers (related to patients, physicians and healthcare organizations) that stand in the way of BTcP control. The second survey (a Delphi questionnaire) was based on the barriers evaluated in the first survey, including recommendations assessed using the two-round Delphi methodology.

Introduction There is scarce real-world experience regarding direct oral anticoagulants (DOACs) perioperative management. No study before has linked bridging therapy or DOAC-free time (pre-plus postoperative time without DOAC) with outcome. The aim of this study was to investigate real-world management and outcomes. Methods RA-ACOD is a prospective, observational, multicenter registry of adult patients on DOAC treatment requiring surgery. Primary outcomes were thrombotic and hemorrhagic complications. Follow-up was immediate postoperative (24–48 hours) and 30 days. Statistics were performed using a univariate and multivariate analysis. Data are presented as odds ratios (ORs [95% confidence interval]). Results From 26 Spanish hospitals, 901 patients were analyzed (53.5% major surgeries): 322 on apixaban, 304 on rivaroxaban, 267 on dabigatran, 8 on edoxaban. Fourteen (1.6%) patients suffered a thrombotic event, related to preoperative DOAC withdrawal (OR: 1.57 [1.03–2.4]) and DOAC-free time longer than 6 days (OR: 5.42 [1.18–26]). Minor bleeding events were described in 76 (8.4%) patients, with higher incidence for dabigatran (12.7%) versus other DOACs (6.6%). Major bleeding events occurred in 17 (1.9%) patients. Bridging therapy was used in 315 (35%) patients. It was associated with minor (OR: 2.57 [1.3–5.07]) and major (OR: 4.2 [1.4–12.3]) bleeding events, without decreasing thrombotic events. Conclusion This study offers real-world data on perioperative DOAC management and outcomes in a large prospective sample size to date with a high percentage of major surgery. Short-term preprocedural DOAC interruption depending on the drug, hemorrhagic risk, and renal function, without bridging therapy and a reduced DOAC-free time, seems the safest practice.

Resumen Introduccion El objetivo de este trabajo es analizar la evolucion ponderal de las principales tecnicas quirurgicas bariatricas (bypass gastroyeyunal en Y de Roux [BPGY] y gastrectomia vertical [GV]) realizadas en un conjunto representativo de centros nacionales espanoles, con el fin de confeccionar unos graficos de percentiles del porcentaje de perdida total de peso perdido durante los 3 primeros anos despues de la cirugia. Metodos Se realiza un estudio de cohortes longitudinal retrospectivo a partir de los datos aportados por 9 centros hospitalarios espanoles. Se han analizado los datos ponderales tanto en porcentaje de perdida total de peso perdido como en porcentaje de exceso de peso perdido correspondientes al BPGY (n = 1.887) y a la GV (n = 1.210). Resultados El BPGY sigue siendo la tecnica mas frecuentemente realizada en nuestra muestra nacional. En ambas tecnicas quirurgicas, la perdida de peso maxima se produce a los 18 meses de la cirugia. Ambas tecnicas siguen la misma evolucion ponderal, aunque los valores del porcentaje de perdida total de peso perdido sean inferiores en el caso de la GV a los 36 meses (29,3 ± 10 vs. 33,6 ± 10). La edad y el genero son determinantes en los resultados ponderales (mejores en paciente mas jovenes para ambas tecnicas y mejores en mujeres para el BPGY). Conclusiones Los graficos de percentiles del porcentaje de peso total perdido despues de la cirugia bariatrica representan una herramienta muy util y un avance importante en la calidad asistencial para el seguimiento ponderal del paciente.

Introduction The aim of this work is to analyze the weight evolution of the main bariatric surgical techniques (Roux-en-Y gastric Bypass-RYGB and Sleeve Gastrectomy-SG) performed in a representative sample of Spanish centers, in order to make a percentiles charts of the percentage of total weight loss during the first 3 years after surgery. Methods A retrospective longitudinal cohort study was conducted based on the data provided by 9 Spanish hospitals. Weight data were analyzed both in %TWL (total weight loss) and %EWL (excess weight lost) corresponding to the RYGB (n = 1887) and SG (n = 1210). Results BPGY remains the most frequently performed technique in our national sample. In both surgical techniques, maximum weight loss occurs 18 months after surgery. Both techniques follow the same weight evolution, although the %TWL values are lower in the case of the SG at 36 months (% TWL RYGB = 33.6 ± 10 vs %TWL GV = 29.3 ± 10). Age and gender are decisive in the weight results (better in younger patients for both techniques and better in women for BPGY) Conclusions Percentile charts of % TWL after bariatric surgery represent a very useful tool and an important advance in the quality of patient management.

[Background] The evidence-based medicine (EBM) paradigm requires the development of health care professionals’ skills in the efficient search of evidence in the literature, and in the application of formal rules to evaluate this evidence. Incorporating this methodology into the decision-making routine of clinical practice will improve the patients’ health care, increase patient safety, and optimize resources use., [Objective] The aim of this study is to develop and evaluate a new tool (KNOWBED system) as a clinical decision support system to support scientific knowledge, enabling health care professionals to quickly carry out decision-making processes based on EBM during their routine clinical practice., [Methods] Two components integrate the KNOWBED system: a web-based knowledge station and a mobile app. A use case (bronchiolitis pathology) was selected to validate the KNOWBED system in the context of the Paediatrics Unit of the Virgen Macarena University Hospital (Seville, Spain). The validation was covered in a 3-month pilot using 2 indicators: usability and efficacy., [Results] The KNOWBED system has been designed, developed, and validated to support clinical decision making in mobility based on standards that have been incorporated into the routine clinical practice of health care professionals. Using this tool, health care professionals can consult existing scientific knowledge at the bedside, and access recommendations of clinical protocols established based on EBM. During the pilot project, 15 health care professionals participated and accessed the system for a total of 59 times., [Conclusions] The KNOWBED system is a useful and innovative tool for health care professionals. The usability surveys filled in by the system users highlight that it is easy to access the knowledge base. This paper also sets out some improvements to be made in the future., This project has received funding from the Andalusian Ministry of Health from Spain (reference PIN-0213-2016), and FEDER funds.

Resumen Objetivos Valorar la eficacia de la cirugia de conversion en una unidad de cirugia bariatrica con 25 anos de experiencia. Metodo Estudio observacional retrospectivo de pacientes con obesidad tipo II o superior reintervenidos mediante cirugia de conversion por reganancia de peso, indice de masa corporal (IMC) residual > 35 kg/m2 o perdida Resultados Se incluyeron un total de 112 pacientes con una media de edad de 40,2 anos intervenidos inicialmente mediante gastroplastia vertical anillada (GVA) (32,1%), banda gastrica ajustable (BGA) (23,2%), bypass gastrico en Y de Roux (BGYR) (21,4%) y gastrectomia vertical (GV) (23,2%). Las tecnicas de conversion, realizadas tras una mediana de 70 meses, incluyeron: BGYR (58,9%), GV (1,8%), bypass gastrico de una anastomosis (BAGUA) (11,6%), acortamiento de asa comun (AAC) (24,1%) y derivacion bilio-pancreatica (DBP) (3,6%). Hubo una reduccion del peso inicial de 144,2 ± 30,3 a 101,5 ± 21,8 kg tras la cirugia-1 y de 115,6 ± 24,0 a 91,5 ± 19,0 kg tras la cirugia-2. El peso en la actualidad es de 94,7 ± 16,4 kg tras una mediana de seguimiento de 27,5 meses. Un grado de reduccion similar ocurrio con el IMC. La mejoria de las comorbilidades se produjo sobre todo tras la primera intervencion. Conclusiones La cirugia de conversion provoca una reduccion de peso que no supera a la perdida alcanzada tras la primera cirugia, pero a diferencia de esta, logra estabilizar el peso a lo largo del tiempo. La tasa de morbilidad perioperatoria es aceptable y justificaria su aplicacion, a pesar de que el impacto en las comorbilidades sea limitado.

Yes

Background ECCO essential requirements for quality cancer care (ERQCC) are checklists and explanations of organisation and actions that are necessary to give high-quality care to patients who have a specific type of cancer. They are written by European experts representing all disciplines involved in cancer care. ERQCC papers give oncology teams, patients, policymakers and managers an overview of the elements needed in any healthcare system to provide high quality of care throughout the patient journey. References are made to clinical guidelines and other resources where appropriate, and the focus is on care in Europe. Oesophageal and gastric: essential requirements for quality care • Oesophageal and gastric (OG) cancers are a challenging tumour group with a poor prognosis and wide variation in outcomes among European countries. Increasing numbers of older people are contracting the diseases, and treatments and care pathways are becoming more complex in both curative and palliative settings. • High-quality care can only be a carried out in specialised OG cancer units or centres which have both a core multidisciplinary team and an extended team of allied professionals, and which are subject to quality and audit procedures. Such units or centres are far from universal in all European countries. • It is essential that, to meet European aspirations for comprehensive cancer control, healthcare organisations implement the essential requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship. Conclusion Taken together, the information presented in this paper provides a comprehensive description of the essential requirements for establishing a high-quality OG cancer service. The ERQCC expert group is aware that it is not possible to propose a ‘one size fits all’ system for all countries, but urges that access to multidisciplinary units or centres must be guaranteed for all those with OG cancer.

AimTo assess the predictive and prognostic aim of interim and end-treatment 18F-fluorocholine PET/CT (FCH-PET/CT) and 99mTc-methilen diphosphonate bone scintigraphy (BS) in patients with castration-resistant prostate cancer and bone metastases (CRPC-BM) treated with Radium 223 dichloride (223Ra). Methods: Prospective and multicentre ChoPET-Rad study including 82 patients with CRPC-BM. Baseline, after 3 (interim) and 6 doses (end-treatment) BS and FCH PET/CT were performed in patients who meet the study criteria. Clinical variables, imaging and clinical progression were obtained and their association with progression free survival (PFS), and overall survival (OS) was studied. Agreement between BS and FCH PET/CT response was assessed using Kappa (K) analysis.Results:Median of PFS and OS was 3 and 16 months, respectively. Agreement between interim BS and FCH PET/CT was weak (K: 0.28; p=0.004). No agreement was observed between end-treatment diagnostic studiesInterim and end-treatment FCH PET/CT were related to PFS (p=0.011 and pConclusions: Interim and end-treatment FCH PET/CT were good predictors of biochemical progression in patients treated with 223Ra. Therapeutic failure and progression in interim BS or FCH PET/CT were adverse factors for OS.

Hip fractures are an important socio-economic problem in western countries. Over the past 60 years orthogeriatric care has improved the management of older patients admitted to hospital after suffering hip fractures. Quality of care in orthogeriatric co-management units has increased, reducing adverse events during acute admission, length of stay, both in-hospital and mid-term mortality, as well as healthcare and social costs. Nevertheless, a large number of areas of controversy regarding the clinical management of older adults admitted due to hip fracture remain to be clarified. This narrative review, centered in the last 5 years, combined the search terms “hip fracture”, “geriatric assessment”, “second hip fracture”, “surgery”, “perioperative management” and “orthogeriatric care”, in order to summarise the state of the art of some questions such as the optimum analgesic protocol, the best approach for treating anemia, the surgical options recommendable for each type of fracture and the efficiency of orthogeriatric co-management and functional recovery.

Hip fractures are an important socio-economic problem in western countries. Over the past 60 years orthogeriatric care has improved the management of older patients admitted to hospital after suffering hip fractures. Orthogeriatric co-management units have increased quality of care, reducing adverse events during acute admission, length of stay, both in-hospital and mid-term mortality, as well as healthcare and social costs. Nevertheless, a large number of areas of controversy regarding the clinical management of older adults admitted due to hip fracture remain to be clarified. This narrative review, centered in the last 5 years, combined the search terms “hip fracture”, “geriatric assessment”, “second hip fracture”, “surgery”, “perioperative management” and “orthogeriatric care”, in order to summarise the state of the art of some questions such as the optimum analgesic protocol, the best approach for treating anemia, the surgical options recommendable for each type of fracture and the efficiency of orthogeriatric co-management and functional recovery.

In the last two years the number and volume of Special Purpose Acquisition Companies (SPACs) have reached an unprecedented high: 70% of total number of US IPOs were SPACs IPOs in 2021 -mid June- raising over $142 billion from investors (72,34% of total volume of US IPOs). This recent SPAC “hype” demands a closer academic research of the SPAC’s stocks performance, as we do in this study. Specifically, this is the first study analyzing SPACs short-term stock performance for SPACs gone public after 2010 (when their structure fundamentally changed) around two important events in their life using the cumulative abnormal returns (CARs) methodology: 1) the announcement of the agreement with the target firm and 2) the completion of the reversed merger; as well as identifying and proposing a taxonomy of 4 types of SPACs, according to 3 main factors for success. The sample consists of US-listed SPACs from 2016-2021. Once we have applied our taxonomy, we do the same analysis of the short-term stock performance for both events for the different clusters which gives us more insight into which SPACs are more heavily affected by the different events. Our contribution is threefold: First, this paper contributes to the SPAC-IPO research, expanding the investigation period to 2021. Second, we propose a taxonomy of the SPACs clustering them into four groups based on three specific characteristics: the number of days it takes the SPAC to announce the merger, the volatility of the price since the SPAC’s initial listing price until the reverse merger is completed (pump and dump effect) and the difference between today’s price and the listing price. Thirdly, an event study for both key events show us that the first event (target announcement) has a positive effect, mainly driven by the group A cluster (The Good). For the second event (completion of merger) there is a negative effect, mostly driven by the type C cluster (The Ugly).

Background: Non-metastatic Castration Resistant Prostate Cancer (nmCRPC) is a heterogenous disease state in which the epidemiology is not completely known. Development of more sensitive modalities for detection of metastasis as well as the emerging data on new generation Androgen Receptor (AR) pathway inhibitors, has changed the paradigm in the management of such patients. Methods: This is a clinical descriptive review. Using the key words “Non-metastatic castration resistant prostate cancer” and “Androgen receptor targeted agents” in PubMed database, we reviewed and summarized the current literature about the definition, diagnosis and treatment of nmCRPC. We highlight the results of recent Phase III trials that showed significant impact on the outcomes of treatment of nmCRPC. Primary outcome was Metastasis-free Survival (MFS) and secondary outcomes included were Overall Survival (OS) among others as well as rates of Adverse Events (AEs). Development and Discussion: The SPARTAN trial showed a median MFS for patients treated with apalutamide plus Androgen Deprivation Therapy (ADT) of 40.5 months compared to 16.2 months for patients who received ADT plus placebo [hazard ratio (HR) 0.30; 95% confidence interval (CI) 0.24-0.36; p < 0.0001). Apalutamide also showed a statistically significant benefit in OS compared to placebo, with a median of 73.9 versus 59.9 months [HR: 0.78 (95% CI: 0.64-0.96), p: 0.016]. In the PROSPER trial, the median MFS for the enzalutamide group was 36.6 months compared to 14.7 months for the placebo group [HR: 0.29 (95% CI: 0.24-0.35), p < 0.0001]. OS was significantly higher in the enzalutamide group (67 versus 56.3 months in the placebo group), reaching the statiscal significance [HR: 0.73 (95% CI: 0.61-0.89), p: 0.001]. The ARAMIS trial showed a median MFS for patients treated with darolutamide plus ADT of 40.4 months compared to 18 months for the placebo group [HR: 0.41; (95% CI: 0.34-0.5); p

Introduction: Introduction: after laparoscopic Roux-en-Y gastric bypass (LRYGBP) many patients complain of epigastric pain or food intolerance, leading to the performance of upper gastrointestinal (UGI) endoscopy. Objective: this study aims to assess which symptomatology as reported by LRYGBP patients during follow-up suggested correlation with pathological findings of endoscopy, and which factors might play a role, taking the timing of symptom presentation into account. Materials and methods: a retrospective cohort study was performed identifying LRYGBP patients presenting with food intolerance and/or epigastric pain who had undergone endoscopy. Primary outcomes were endoscopy findings, their association with patient characteristics, and timing of symptom presentation. Results: of the 514 patients complaining of epigastric pain and/or food intolerance, 81 (15.6 %) underwent endoscopy. A gastrojejunostomy complication was found in 58 % of cases. All patients who complained about food intolerance and epigastric pain presented pathological findings. The only preoperative factor associated with a gastrojejunostomy complication was being a smoker (p = 0.021). Time between surgery and endoscopy was also a predictive factor for endoscopic pathological findings (p = 0.007); in cases of epigastric pain, symptom onset during the first year (median: 10 months) was related to increased risk of gastrojejunal complications (p < 0.05). Conclusions: endoscopies performed within one year of surgery were significantly more likely to reveal pathological findings than endoscopies performed after the first postoperative year, especially in patients experiencing epigastric pain. Introduccion: Introduccion: tras un baipas gastrico laparoscopico en Y de Roux muchos pacientes refieren dolor epigastrico o intolerancia alimenticia, lo que motiva la realizacion de una endoscopia digestiva alta. Objetivos: el objetivo de este estudio es intentar establecer una relacion entre la sintomatologia referida por los pacientes sometidos a baipas gastrico con los hallazgos endoscopicos patologicos y conocer que factores pueden estar implicados, considerando el momento de presentacion. Material y metodos: estudio retrospectivo de cohortes, identificando a los pacientes sometidos a baipas gastrico laparoscopico que presentan dolor epigastrico o intolerancia alimenticia durante el seguimiento y a los que se realizo una endoscopia digestiva alta. El objetivo primario es relacionar los hallazgos endoscopicos con la sintomatologia y el momento de aparicion. Resultados: de los 514 pacientes que presentaban dolor epigastrico o intolerancia alimenticia, 81 (15,6 %) fueron sometidos a endoscopia digestiva alta. En un 58 % de los casos se encontraron complicaciones relacionadas con la gastroyeyunostomia. En todos los pacientes que presentaban simultaneamente dolor e intolerancia aparecieron hallazgos endoscopicos patologicos. El unico factor preoperatorio relacionado con las complicaciones fue el habito tabaquico (p = 0,021). El tiempo entre la cirugia y la realizacion de la endoscopia tambien fue un factor significativamente relacionado con los hallazgos endoscopicos (p = 0,007). En los casos de dolor epigastrico durante el primer ano (media: 10 meses) existia un incremento del riesgo de aparicion de complicaciones de la gastroyeyunostomia (p < 0,05). Conclusiones: las endoscopias realizadas durante el primer ano postoperatorio tenian mas probabilidades de presentar hallazgos patologicos, sobre todo en los pacientes afectos de dolor epigastrico.

To evaluate the impact of the hormonal treatment sequencing including abiraterone acetate plus prednisone (AAP) and enzalutamide (ENZ) in mCRPC, and determine which sequence provides more benefits for patients.Studies published in English between 1 January 2013 and 30 September 2017 were identified in PubMed and EMBASE electronic databases. Studies assessing the efficacy of treatment sequences, based on AAP and ENZ, in mCRPC patients, were eligible for analysis.Seventeen studies met the inclusion criteria. Two assessed both treatment sequences AAP → ENZ and ENZ → AAP; it was found that sequence of AAP → ENZ showed a statistically significantly longer PSA-PFS than the observed in ENZ → AAP (pooled HR: 0,54; 95% CI; 0,36-0,82; p 0,05). The nine studies analysing Doc → AAP → ENZ sequence, revealed favourable results in terms of PFS. The 5 studies which analysed AAP → ENZ sequence, show a decrease in PSA levels ≥ 50% in 11-41% of patients treated with enzalutamide after previous treatment with AAP. In the two studies that analysed the Doc → ENZ → AAP sequence, PSA response rates were much lower than those reported with Doc → AAP → ENZ, with decreases in PSA ≥ 30 of 3-18% and PSA ≥ 50 of 8-11%.Significant clinical efficacy of AAP administered as the first-line treatment in mCRPC patients followed by enzalutamide, delaying disease progression, compared with the ENZ → AAP sequence. However, more studies and randomized trials are needed, to validate the best treatment sequencing.

The addition of CDK4 and 6 inhibitors (abemaciclib, palbociclib or ribociclib) to endocrine therapy, as first-line treatment or following progression after initial endocrine therapy, significantly increased progression-free survival, objective response rates and in some trials overall survival, compared with endocrine therapy alone in HR+ and HER2- breast metastatic breast cancer. These CDK4 and 6 inhibitors are now approved in this context and have become a new standard of care. A hypothesis-generating exploratory analysis suggested that the addition of abemaciclib to endocrine therapy showed the largest effects in subgroups of women with indicators of poor prognosis, although these data require confirmation. This review provides updated clinical trial data for all three drugs in metastatic breast cancer, focusing on abemaciclib, the most recently approved agent.

The trial was financed by Ministerio de Sanidad y Consumo Español through their call for independent clinical research, Orden Ministerial SAS/2377, 2010 (EC10-115, EC10-116, EC10-117, EC10-119, EC10-122); CAIBER—Spanish Clinical Research Network, Instituto de Salud Carlos III (ISCIII) (CAI08/010044); and Gerencia Asistencial de Atención Primaria de Madrid. This study is also supported by the Spanish Clinical Research Network (SCReN), funded by ISCIII-Subdirección General de Evaluación y Fomento de la Investigación, project number PT13/0002/0007, within the National Research Program I+D+I 2013-2016 and co-funded with European Union ERDF funds (European Regional Development Fund). This project received a grant for the translation and publication of this article from the Foundation for Biomedical Research and Innovation in Primary Care (FIIBAP) Call 2017 for grants to promote research programs. Objectives To compare the effectiveness of oral versus intramuscular (IM) vitamin B12 (VB12) in patients aged ≥65 years with VB12 deficiency. Design Pragmatic, randomised, non-inferiority, multicentre trial in 22 primary healthcare centres in Madrid (Spain). Participants 283 patients ≥65 years with VB12 deficiency were randomly assigned to oral (n=140) or IM (n=143) treatment arm. Interventions The IM arm received 1 mg VB12 on alternate days in weeks 1–2, 1 mg/week in weeks 3–8 and 1 mg/month in weeks 9–52. The oral arm received 1 mg/day in weeks 1–8 and 1 mg/week in weeks 9–52. Main outcomes Serum VB12 concentration normalisation (≥211 pg/mL) at 8, 26 and 52 weeks. Non-inferiority would be declared if the difference between arms is 10% or less. Secondary outcomes included symptoms, adverse events, adherence to treatment, quality of life, patient preferences and satisfaction. Results The follow-up period (52 weeks) was completed by 229 patients (80.9%). At week 8, the percentage of patients in each arm who achieved normal B12 levels was well above 90%; the differences in this percentage between the oral and IM arm were −0.7% (133 out of 135 vs 129 out of 130; 95% CI: −3.2 to 1.8; p>0.999) by per-protocol (PPT) analysis and 4.8% (133 out of 140 vs 129 out of 143; 95% CI: −1.3 to 10.9; p=0.124) by intention-to-treat (ITT) analysis. At week 52, the percentage of patients who achieved normal B12 levels was 73.6% in the oral arm and 80.4% in the IM arm; these differences were −6.3% (103 out of 112 vs 115 out of 117; 95% CI: −11.9 to −0.1; p=0.025) and −6.8% (103 out of 140 vs 115 out of 143; 95% CI: −16.6 to 2.9; p=0.171), respectively. Factors affecting the success rate at week 52 were age, OR=0.95 (95% CI: 0.91 to 0.99) and having reached VB12 levels ≥281 pg/mL at week 8, OR=8.1 (95% CI: 2.4 to 27.3). Under a Bayesian framework, non-inferiority probabilities (Δ>−10%) at week 52 were 0.036 (PPT) and 0.060 (ITT). Quality of life and adverse effects were comparable across groups. 83.4% of patients preferred the oral route. Conclusions Oral administration was no less effective than IM administration at 8 weeks. Although differences were found between administration routes at week 52, the probability that the differences were below the non-inferiority threshold was very low. Publisher PDF

Introduction: Revisional surgery must be considered when insufficient weight loss is attained or weight is subsequently regained. This study aimed to investigate the value of Roux-en-Y gastric bypass (RYGB) as a revisional procedure after restrictive surgery. Materials and Methods: An observational, retrospective study including patients initially operated on for morbid obesity with restrictive techniques (vertical-banded gastroplasty [VBG], adjustable gastric band [AGB], and sleeve gastrectomy) and reoperated with RYGB in our centre between December 1994 and January 2019. Demographic and anthropometric data, associated comorbidities (diabetes mellitus type II, arterial hypertension, dyslipidaemia, and chronic obstructive pulmonary disease) and surgery-related data (approach, complications, and hospital stay) were evaluated at 5 different time points: initial (prior to first intervention), after the first surgical intervention, before the second intervention (gastric bypass), after the gastric bypass, and at present. Results: A total of 63 patients were included. VBG was the most frequent initial procedure (n = 33). The mean age was 39 ± 9.52 years, and the average initial weight was 143.53 ± 28.6 kg. Weight loss was achieved in all groups, with a median excess weight loss of 58% after the first surgery and 40.3% after gastric bypass. In terms of weight loss, the best results after the second surgery were obtained when the first surgery was AGB, with statistically significant differences. Conclusions: RYGB is effective as a conversion procedure after a previous restrictive surgery, obtaining a significant reduction in weight and BMI. It has an acceptable morbidity rate and is more effective after an AGB.

The management of genitourinary cancer, including bladder, prostate, renal and testicular cancer, has evolved dramatically in recent years due to a better understanding of tumour genetic mutations, alterations in molecular pathways, and to the development of new kinds of drugs such as targeted therapies and immunotherapies. In the field of immunotherapy, new drugs focused on stimulating, enhancing and modulating the immune system to detect and destroy cancer, have been recently discovered. Research in oncology moves quickly and new data of great relevance for clinical practice are communicated every year. For this reason, a group of experts, focused exclusively on the treatment of genitourinary tumours and who get together every year in the BestGU conference to assess the latest progress in this field have summarized the most important advances in a single review, along with a critical assessment of whether these results should alter daily clinical practice.

[Importance] The Enhanced Recovery After Surgery (ERAS) care protocol has been shown to improve outcomes compared with traditional care in certain types of surgery., [Objective] To assess the association of use of the ERAS protocols with complications in patients undergoing elective total hip arthroplasty (THA) and total knee arthroplasty (TKA)., [Design, Setting, and Participants] This multicenter, prospective cohort study included patients recruited from 131 centers in Spain from October 22 through December 22, 2018. All consecutive adults scheduled for elective THA or TKA were eligible for inclusion. Patients were stratified between those treated in a self-designated ERAS center (ERAS group) and those treated in a non-ERAS center (non-ERAS group). Data were analyzed from June 15 through September 15, 2019., [Exposures] Total hip or knee arthroplasty and perioperative management. Sixteen individual ERAS items were assessed in all included patients, whether they were treated at a center that was part of an established ERAS protocol or not., [Main Outcomes and Measures] The primary outcome was postoperative complications within 30 days after surgery. Secondary outcomes included length of stay and mortality., [Results] During the 2-month recruitment period, 6146 patients were included (3580 women [58.2%]; median age, 71 [interquartile range (IQR), 63-76] years). Of these, 680 patients (11.1%) presented with postoperative complications. No differences were found in the number of patients with overall postoperative complications between ERAS and non-ERAS groups (163 [10.2%] vs 517 [11.4%]; odds ratio [OR], 0.89; 95% CI, 0.74-1.07; P = .22). Fewer patients in the ERAS group had moderate to severe complications (73 [4.6%] vs 279 [6.1%]; OR, 0.74; 95% CI, 0.56-0.96; P = .02). The median overall adherence rate with the ERAS protocol was 50.0% (IQR, 43.8%-62.5%), with the rate for ERAS facilities being 68.8% (IQR, 56.2%-81.2%) vs 50.0% (IQR, 37.5%-56.2%) at non-ERAS centers (P, [Conclusions and Relevance] An increase in adherence to the ERAS program was associated with a decrease in postoperative complications, although only a few ERAS items were individually associated with improved outcomes., This study was supported by institutional and/or departmental sources. The Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol in Elective Total Hip and Knee Arthroplasty (POWER2) study was supported by the Spanish Perioperative Audit and Research Network (REDGERM)

The infection by the coronavirus SARS-CoV-2, which causes the disease called COVID19, mainly causes alterations in the respiratory system. In severely ill patients, the disease oftenevolves into an acute respiratory distress syndrome that can predispose patients to a state ofhypercoagulability, with thrombosis at both venous and arterial levels. This predisposition presents a multifactorial physiopathology, related to hypoxia as well as to the severe inflammatoryprocess linked to this pathology, including the additional thrombotic factors present in many ofthe patients. In view of the need to optimise the management of hypercoagulability, the working groupsof the Scientific Societies of Anaesthesiology-Resuscitation and Pain Therapy (SEDAR) and ofIntensive, Critical Care Medicine and Coronary Units (SEMICYUC) have developed a consensus to establish guidelines for actions to be taken against alterations in haemostasis observedin severely ill patients with COVID-19. These recommendations include prophylaxis of venousthromboembolic disease in these patients, and in the peripartum, management of patients onlongterm antiplatelet or anticoagulant treatment, bleeding complications in the course of thedisease, and the interpretation of general alterations in haemostasis. (c) 2020 Published by Elsevier Espana, S.L.U. on behalf of Sociedad Espanola de Anestesiologia, Reanimacion y Terap ' eutica del Dolor.

To establish the utility of baseline 18F-Fluorocholine (FCH) PET/CT and bone scintigraphy (BS) in the outcome prediction of patients with castration-resistant prostate cancer and bone metastases (CRPC-BM) treated with 223Ra. Prospective, multicenter and non-randomized study (ChoPET-Rad study). FCH PET/CT and BS were performed before the initiation of 223Ra (basal FCH PET/CT and BS). Bone disease was classified attending the number of lesions in baseline BS and PET/CT. FCH PET/CT was semiquantitatively evaluated. Gleason score, baseline levels of prostate-specific antigen (PSA), alkaline phosphatase and lactate dehydrogenase were determined. Progression-free survival (PFS) and overall survival (OS) since the onset of 223Ra treatment was calculated. PFS was defined by PSA rising. Relations between clinical and imaging variables with PFS and OS were evaluated by Pearson, Mann–Whitney tests and Kapplan–Meier analysis. Univariate and multivariate Cox regression analysis was performed. Forty patients were evaluated. The median PFS and OS were of 3.0 ± 2.3 and 23.0 ± 4.2 months, respectively. 33 patients progressed and 13 died during the follow-up. The extension of the bone disease by FCH PET/CT (p = 0.011, χ2 = 10.63), BS (p = 0.044, χ2 = 8.04), SUVmax (p = 0.012) and average SUVmax (p = 0.014) were related to OS. No significant association was found for the PFS. ROC analysis revealed significant association of SUVmax, average SUVmax and basal PSA with OS. Only therapeutic failure was associated with OS in the multivariate analysis (HR = 3.6, p = 0.04). FCH PET/CT and BS had prognostic aim in the prediction of OS. None clinical or imaging variable was able to predict the PFS, probably due to the high rate of progressive disease.

During the last few years, the number of patients receiving anticoagulant and antiplatelet therapy has increased worldwide. Since this is a chronic treatment, patients receiving it can be expected to need some kind of surgery or intervention during their lifetime that may require treatment discontinuation. The decision to withdraw antithrombotic therapy depends on the patient's thrombotic risk versus hemorrhagic risk. Assessment of both factors will show the precise management of anticoagulant and antiplatelet therapy in these scenarios. The aim of this consensus document, coordinated by the Cardiovascular Thrombosis Working Group of the Spanish Society of Cardiology, and endorsed by most of the Spanish scientific societies of clinical specialities that may play a role in the patient-health care process during the perioperative or periprocedural period, is to recommend some simple and practical guidelines with a view to homogenizing daily clinical practice.

Resumen En los ultimos anos, el numero de pacientes anticoagulados y antiagregados esta aumentando significativamente. Al ser un tratamiento cronico, es de esperar que a lo largo de su vida necesiten un procedimiento quirurgico o intervencionista que pueda requerir la interrupcion del farmaco antitrombotico. La decision de retirar o mantener dicho tratamiento estara determinada, por un lado, por el riesgo trombotico y, por otro, por el hemorragico. De la interaccion entre estos 2 factores dependera la actitud ante la anticoagulacion y la antiagregacion. El objetivo de este documento de consenso, coordinado desde el Grupo de Trabajo de Trombosis Cardiovascular de la Sociedad Espanola de Cardiologia y certificado por un amplio numero de sociedades cientificas que participan en el proceso asistencial del paciente durante el periodo perioperatorio o periprocedimiento, consiste en proponer una serie de recomendaciones practicas y sencillas con el fin de homogeneizar la practica clinica diaria.

Introduction: In 85% of patients, the cause of Primary Hyperparathyroidism (PHPT) is an adenoma. Parathyroid adenoma localization is usually simple. 96% of localizations prior to surgery are achieved with ultrasound and scintigraphy combination. Difficulties can appear. If the gland is not located in a cervical position and has no uptake in scintigraphy but there is high suspition of an adenoma causing the PHPT, some extra tests should be considered. Case Report: We present a case of giant cystic mediastinal adenoma, a quite rare condition, which was diagnosed as a thyroid colloid cyst by ultrasound, and was not localized by scintigraphy. We report the CT scan and the magnetic resonance imaging (MRI) images that show the tumour. It was surgically resected by a cervical approach. After the excision, the patient recovered normal levels of Calcium and Parathormone (PTH). Conclusion: We review literature about cystic and mediastinal adenomas and diagnostic methods when the standard ones do not give an accurate localization diagnosis.

Bone metastases are common in many advanced solid tumours, being breast, prostate, thyroid, lung, and renal cancer the most prevalent. Bone metastases can produce skeletal-related events (SREs), defined as pathological fracture, spinal cord compression, need of bone irradiation or need of bone surgery, and hypercalcaemia. Patients with bone metastases experience pain, functional impairment and have a negative impact on their quality of life. Several imaging techniques are available for diagnosis of this disease. Bone-targeted therapies include zoledronic acid, a potent biphosfonate, and denosumab, an anti-RANKL monoclonal antibody. Both reduce the risk and/or delay the development of SREs in several types of tumours. Radium 233, an alpha-particle emitter, increases overall survival in patients with bone metastases from resistant castration prostate cancer. Multidisciplinary approach is essential and bone surgery and radiotherapy should be integrated in the treatment of bone metastases when necessary. This SEOM Guideline reviews bone metastases pathogenesis, clinical presentations, lab tests, imaging techniques for diagnosis and response assessment, bone-targeted agents, and local therapies, as radiation and surgery, and establishes recommendations for the management of patients with metastases to bone.

Review article [Abstract] The immune system regulates angiogenesis in cancer by way of both pro- and antiangiogenic activities. A bidirectional link between angiogenesis and the immune system has been clearly demonstrated. Most antiangiogenic molecules do not inhibit only VEGF signaling pathways but also other pathways which may affect immune system. Understanding of the role of these pathways in the regulation of immunosuppressive mechanisms by way of specific inhibitors is growing. Renal cell carcinoma (RCC) is an immunogenic tumor in which angiogenesis and immunosuppression work hand in hand, and its growth is associated with impaired antitumor immunity. Given the antitumor activity of selected TKIs in metastatic RCC (mRCC), it seems relevant to assess their effect on the immune system. The confirmation that TKIs improve cell cytokine response in mRCC provides a basis for the rational combination and sequential treatment of TKIs and immunotherapy.

Resumen Introduccion La gastrectomia vertical (GV) se ha convertido en una tecnica con entidad propia cuya indicacion selectiva o global sigue siendo objeto de controversia. Los resultados ponderales a 5 anos son heterogeneos. El objetivo del estudio es identificar posibles factores pronosticos de perdida de peso insuficiente tras GV. Metodos Estudio multicentrico retrospectivo de GV con seguimiento mayor de un ano. Se considera fracaso si el PSP Resultados Se incluye a 1.565 pacientes intervenidos en 29 hospitales. PSP al ano: 70,58 ± 24,8; a los 3 anos 69,39 ± 29,2; a los 5 anos 68,46 ± 23,1. Pacientes con PSP 50 kg/m2, edad > 50 anos, DM2, HTA, SAOS, cardiopatia, varias comorbilidades asociadas, distancia a piloro > 5 cm, bujia > 40 F, tratamiento con antiagregantes. La sobresutura mejora los resultados. Las variables que mostraron ser factores predictivos de fracaso en el seguimiento fueron la DM2 y el IMC. Conclusion La GV asocia una perdida de peso satisfactoria en el 79% de los pacientes en los primeros 5 anos; sin embargo, algunas variables como el IMC > 50, la DM2, la edad > 50, la presencia de varias comorbilidades, la seccion a mas de 4 cm del piloro o la bujia > 40 F pueden aumentar el riesgo de fracaso ponderal.