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Background The incidence of venous thromboembolism (VTE) in morbidly obese patients after obesity surgery is between .2% and 3.5%. Because there are a lack of prospective studies on the type of drug, the correct dosage, and the optimal duration, there are no specific recommendations found in the guidelines on thrombophylaxis. Objectives To compare the incidence of VTE and hemorrhagic events in bariatric surgical patients receiving bemiparin thromboprophylaxis who have prophylactic and nonprophylactic Anti-factor Xa (AFXa) levels. Setting University General Hospital of Ciudad Real, Spain, public practice. Methods A cohort study of 122 morbidly obese patients who underwent bariatric surgery. The thromboprophylactic regimen consisted of bemiparin 5000 IU/24 hr for 30 days. AFXa levels were measured on the second and third day postoperation (prophylactic range: .3–.5 IU/mL). Body mass index, co-morbidities, prothrombotic risk factors, and thrombotic and hemorrhagic events were noted. Results The mean body mass index was 48.4 kg/m 2 . In 50 samples, the level of AFXa was within the prophylactic range; in 71, they were in the subprophylactic range. No VTEs were observed. Major hemorrhagic events were observed in 2.4%. We did not find a significant association between AFXa and thromboembolic and hemorrhagic events. There is a significant negative correlation between the level of AFXa and body mass index. Conclusion A regimen of 5000 IU/24 hr of bemiparin for 30 days after obesity surgery appears to prevent VTE without increasing the risk of a major hemorrhage. The level of AFXa is not associated with postoperative thrombotic or hemorrhagic events occurring after bariatric surgery.

The origin of pancreatic cancer has been identified as a population of malignant pancreatic stem cells CD133+ CXCR4+ immunophenotype. These cells have high capacity for early locoregional invasion, being responsible for early recurrence and high mortality rates of pancreatic cancer. We propose a study for decreasing tumor progression of pancreatic cancer by reducing the volume and neoplastic subpopulation of pancreatic cancer stem cells CD133+ CXCR4+. Therefore, we develop a new therapeutic model, characterized by the application of HIPEC (Hyperthermic Intraperitoneal Chemotherapy) with gemcitabine.Pancreatic tumor cell line: human cell line BxPC-3. The animal model involved 18 immunosuppressed rats 5 weeks weighing 150-200 gr. The implantation of 13 × 10(6) cells/mL was performed with homogeneous distribution in the 13 abdominopelvic quadrants according to the peritoneal carcinomatosis index (PCI) and were randomized into three treatment groups. Group I (4 rats) received intravenous saline. Group II (6 rats) received intravenous gemcitabine. Group III (8 rats) received HIPEC at 41 °C for 30 min with gemcitabine + gemcitabine IV. A histological study confirmed pancreatic cancer and immunohistochemical quantification of pancreatic cancer stem cells CD133+ CXCR4+ tumor cells.There was a population decline of pancreatic cancer stem cells CD133+ CXCR4+ in the HIPEC group with respect to the other two groups (p 0.001). There was a decrease in PCI between treatment groups (p 0.05).The initial results are encouraging since there is a declining population of cancer stem cells CD133+ CXCR4+ in the HIPEC group and decreased tumor volume compared to the other two treatment groups. All the conclusions are only valid for BxPC3 cell line, and the effects HIPEC on Kras-driven pancreatic tumors remain to be determined.