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Colorectal cancer is the third most common cancer worldwide both in men and women. Around one-third of patients with cancer will suffer from anxiety or depression symptoms. The aim of this study was to evaluate the effectiveness of a Mindfulness-based stress reduction intervention through a mobile application ("En Calma en el Quirófano").This study is a multicenter, single-blind (evaluator), controlled, randomised trial that compares the effectiveness of a mindfulness training through a mobile application (intervention group) and treatment as usual (control group) in three different moments (T0 or baseline, T1 or hospital discharge and T2 or one month after surgery). Anxiety and depression symptoms (HADS), quality of life (WHOQOL), pain, (VAS) and satisfaction (CSQ) were assessed.In all, there were 270 referred patients. Among them, 39 and 43 were assigned to the intervention and control groups respectively. 82 patients were analyzed: 39 patients used the app, and 43 patients continued with the treatment as usual. There were no significant changes between groups and time. We observed a slight trend in which intervention group had less depression and anxiety symptoms since T0 and T2 (B = -0.2; 95% CI between 8.8 and 9.2).The sample of this study had a high mean age (65 years old), and low levels of anxiety and depression and medium levels of pre-surgery quality of life in baseline. These factors could have influenced limiting the effectiveness of the app. Prospective research lines should focus on evaluating the effectiveness of mobile applications for younger patients with surgical pathologies.

COVID-19; Immunosuppression; Inflammatory bowel disease COVID-19; Immunosupressió; Malaltia inflamatòria intestinal COVID-19; Inmunosupresión; Enfermedad inflamatoria intestinal (1) Scant information is available concerning the characteristics that may favour the acquisition of COVID-19 in patients with inflammatory bowel disease (IBD). Therefore, the aim of this study was to assess these differences between infected and noninfected patients with IBD. (2) This nationwide case−control study evaluated patients with inflammatory bowel disease with COVID-19 (cases) and without COVID-19 (controls) during the period March−July 2020 included in the ENEIDA of GETECCU. (3) A total of 496 cases and 964 controls from 73 Spanish centres were included. No differences were found in the basal characteristics between cases and controls. Cases had higher comorbidity Charlson scores (24% vs. 19%; p = 0.02) and occupational risk (28% vs. 10.5%; p < 0.0001) more frequently than did controls. Lockdown was the only protective measure against COVID-19 (50% vs. 70%; p < 0.0001). No differences were found in the use of systemic steroids, immunosuppressants or biologics between cases and controls. Cases were more often treated with 5-aminosalicylates (42% vs. 34%; p = 0.003). Having a moderate Charlson score (OR: 2.7; 95%CI: 1.3−5.9), occupational risk (OR: 2.9; 95%CI: 1.8−4.4) and the use of 5-aminosalicylates (OR: 1.7; 95%CI: 1.2−2.5) were factors for COVID-19. The strict lockdown was the only protective factor (OR: 0.1; 95%CI: 0.09−0.2). (4) Comorbidities and occupational exposure are the most relevant factors for COVID-19 in patients with IBD. The risk of COVID-19 seems not to be increased by immunosuppressants or biologics, with a potential effect of 5-aminosalicylates, which should be investigated further and interpreted with caution.

Background The exploration of clinically relevant information in the free text of electronic health records (EHRs) holds the potential to positively impact clinical practice as well as knowledge regarding Crohn disease (CD), an inflammatory bowel disease that may affect any segment of the gastrointestinal tract. The EHRead technology, a clinical natural language processing (cNLP) system, was designed to detect and extract clinical information from narratives in the clinical notes contained in EHRs. Objective The aim of this study is to validate the performance of the EHRead technology in identifying information of patients with CD. Methods We used the EHRead technology to explore and extract CD-related clinical information from EHRs. To validate this tool, we compared the output of the EHRead technology with a manually curated gold standard to assess the quality of our cNLP system in detecting records containing any reference to CD and its related variables. Results The validation metrics for the main variable (CD) were a precision of 0.88, a recall of 0.98, and an F1 score of 0.93. Regarding the secondary variables, we obtained a precision of 0.91, a recall of 0.71, and an F1 score of 0.80 for CD flare, while for the variable vedolizumab (treatment), a precision, recall, and F1 score of 0.86, 0.94, and 0.90 were obtained, respectively. Conclusions This evaluation demonstrates the ability of the EHRead technology to identify patients with CD and their related variables from the free text of EHRs. To the best of our knowledge, this study is the first to use a cNLP system for the identification of CD in EHRs written in Spanish.

En este artículo analizamos la evolución de tres rasgos escénicos de la ópera Carmen de Bizet: el orientalismo, los gitanos y el baile español. Las acotaciones del libreto y la escenografía de sus primeras representaciones son el resultado de la evolución de aspectos que comenzaron a desarrollarse en las principales escenas parisinas a partir de 1820. Los decorados y la indumentaria se convirtieron en los recursos plásticos que crearon el color local español en la escena parisina. Unos elementos escénicos que se pusieron al servicio del ballet a principios del siglo xix y que tendrían su difusión en la literatura de viajes a partir de 1840. In this article we analyze the evolution of three scenic features of the opera Carmen de Bizet: Orientalism, Gypsies and Spanish dance. The libretto and the scenography of its first performances are the result of the evolution of aspects that began to develop in the main Parisian scenes from 1820. Scenic design and costume became the plastic resource that created the local Spanish color in the Parisian scene. Some scenic elements appeared at the service of ballet in the early nineteenth century. These elements will be disseminated from 1840.

The impact of relapses on disease burden in Crohn's disease (CD) warrants searching for predictive factors to anticipate relapses. This requires analysis of large datasets, including elusive free-text annotations from electronic health records. This study aims to describe clinical characteristics and treatment with biologics of CD patients and generate a data-driven predictive model for relapse using natural language processing (NLP) and machine learning (ML).We performed a multicenter, retrospective study using a previously validated corpus of CD patient data from eight hospitals of the Spanish National Healthcare Network from 1 January 2014 to 31 December 2018 using NLP. Predictive models were created with ML algorithms, namely, logistic regression, decision trees, and random forests.CD phenotype, analyzed in 5938 CD patients, was predominantly inflammatory, and tobacco smoking appeared as a risk factor, confirming previous clinical studies. We also documented treatments, treatment switches, and time to discontinuation in biologics-treated CD patients. We found correlations between CD and patient family history of gastrointestinal neoplasms. Our predictive model ranked 25 000 variables for their potential as risk factors for CD relapse. Of highest relative importance were past relapses and patients' age, as well as leukocyte, hemoglobin, and fibrinogen levels.Through NLP, we identified variables such as smoking as a risk factor and described treatment patterns with biologics in CD patients. CD relapse prediction highlighted the importance of patients' age and some biochemistry values, though it proved highly challenging and merits the assessment of risk factors for relapse in a clinical setting.

Successive to the Millennium Development Goals initiated in 2000, the 2030 Agenda for Sustainable Development approved in 2015 by the United Nations affects many of the political decisions currently being made. Through this Agenda, countries commit to taking actions aimed at 17 goals, 169 targets and 232 indicators created by the UN to measure them in terms of performance. Parallel to the creation of global objectives by the UN, Eurostat established 100 indicators (many equal or similar to those of the UN) focused on the countries of the European Union to monitor their development with respect to the 2030 Agenda. This work proposes to undertake an exhaustive analysis of the strengths and weaknesses of the European Union countries with respect to these set objectives, also analyzing the convergence or divergence among EU member states. To this end, we build partial synthetic indices for each goal, taking existing information on the indicators collected by Eurostat in order to combine these into a composite index that provides a global vision of the (relative) situation of each country in the EU region.

Background: Onset during old age has been reported in upto 10% of total cases of inflammatory bowel disease (IBD). Aim: To evaluate phenotypic characteristics and the use of therapeutic resources in patients with elderly onset IBD. Methods: Case-control study including all those patients diagnosed with IBD over the age of 60 years since 2000 who were followed-up for >12 months, identified from the IBD databases. Elderly onset cases were compared with IBD patients aged 18 to 40 years at diagnosis, matched by year of diagnosis, gender and type of IBD (adult-onset). Results: One thousand three hundred and seventy-four elderly onset and 1374 adult-onset cases were included (62% ulcerative colitis (UC), 38% Crohn's disease (CD)). Among UC patients, elderly onset cases had a lower proportion of extensive disease (33% vs 39%; P < 0.0001). In CD, elderly onset cases showed an increased rate of stenosing pattern (24% vs 13%; P < 0.0001) and exclusive colonic location (28% vs 16%; P < 0.0001), whereas penetrating pattern (12% vs 19%; P < 0.0001) was significantly less frequent. Regarding the use of therapeutic resources, there was a significantly lower use of corticosteroids (P < 0.0001), immunosuppressants (P < 0.0001) and anti-TNFs agents (P < 0.0001) in elderly onset cases. Regarding surgery, we found a significantly higher surgery rate among elderly onset UC cases (8.3% vs 5.1%; P < 0.009). Finally, elderly onset cases were characterised by a higher rate of hospitalisations (66% vs 49%; P < 0.0001) and neoplasms (14% vs 0.5%; P < 0.0001). Conclusions: Elderly onset IBD shows specific characteristics and they are managed differently, with a lower use of immunosuppressants and a higher rate of surgery in UC.

Background and aims: The aims of this study were to evaluate the frequency of entero-urinary fistulas in a cohort of Crohn’s disease (CD) patients and to analyse the outcomes of medical and surgical therapy. Methods: This multicentre retrospective study included all CD patients with entero-urinary fistulas diagnosed by the presence of clinical symptoms and confirmed at surgery or by radiological or endoscopic techniques. We evaluated outcomes of medical and surgical therapy. We defined remission as absence of clinical symptoms with a radiological confirmation of fistula closure. Cox regression analysis was performed to evaluate factors predictive of achieving remission without need for surgery. Results: Of 6081 CD patients screened, 97 had entero-urinary fistulas (frequency 1.6%). Seventy-five percent of fistulas occurred in men. After a median follow-up of 91 months, 96% of patients were in sustained remission. Thirty-three patients (35%) received anti-tumour necrosis factor (TNF) therapy. Of these, 45% achieved sustained remission (median follow-up 35 months) without needing surgery. More than 80% of patients required surgery, which induced remission (median follow-up 101 months) in 99% of them. Only the use of anti-TNF agents was associated with an increased rate of remission without need for surgery (hazard ratio 0.23, 95% confidence interval 0.12–0.44; p < 0.001). Conclusion: In this large cohort of CD patients, the frequency of entero-urinary fistulas was lower than previously described. More than 80% of patients required surgery, and in all but one of them surgery induced sustained remission. In a selected subgroup of patients, anti-TNF may induce long-term fistula remission and radiographic closure, making it possible to avoid surgery.

[EN] This work analyzes the teaching of photography in art history studies, starting from the origin of this subject in undergraduate programs, and making a balance on the process of adaptation to the new degrees and masters that have been developed with the reform of the university education of the last years, analyzing its transformation and / or disappearance. A reflection is also considered on how this teaching has been changing epistemologically, taking a tour of the evolution of this subject in university studies, paying special attention to the traditional use of this discipline and to the similarities and differences that have been generated in the context of the European studies of History of Art, drawing a correlation and analysis compared with other countries. Likewise, based on our experience as professors and researchers in subjects of photography and contemporary art in the degrees of Art History and Fine Arts, the main problems derived from the traditional teaching model and from the new needs that Bologna needs are pointed out. In this sense, a fieldwork is developed, both to analyze its protagonism or in its absence its lack in artistic studies, as well as the teaching innovations that have been developed in these subjects. Finally, we reflect on the use of photography as a source for the History of Art, the teaching methodologies for its teaching and the challenges imposed by the digital culture in which its research, teaching, conservation and management are carried out., [ES] Este trabajo analiza la enseñanza de la fotografía en los estudios de Historia del Arte, partiendo del origen de esta asignatura en los programas de licenciatura, y haciendo un balance sobre el proceso de adaptación a los nuevos grados y másteres que se han desarrollado con la reforma de la enseñanza universitaria de los últimos años, analizando su transformación y/o desaparición. Se plantea asimismo una reflexión sobre cómo ha ido cambiando epistemológicamente esta enseñanza, realizando un recorrido por la evolución de esta materia en los estudios universitarios, prestando especial atención al uso tradicional de esta disciplina y a las semejanzas y diferencias que se han generado en el contexto de los estudios europeos de Historia del Arte, trazando una correlación y análisis comparado con otros países. Asimismo, partiendo de nuestra experiencia como profesores e investigadores en asignaturas de fotografía y arte contemporáneo de los grados de Historia del Arte y de Bellas Artes, se señalan los principales problemas derivados del modelo de enseñanza tradicional y de las nuevas necesidades que Bolonia precisa. En este sentido, se desarrolla un trabajo de campo, tanto para analizar su protagonismo o en su defecto su carencia en los estudios artísticos, así como de las innovaciones docentes que se han desarrollado en estas materias. Por último, se reflexiona sobre el uso de la fotografía como fuente para la Historia del Arte, las metodologías docentes para su enseñanza y los retos que impone la cultura digital en la que se desarrolla su investigación, docencia, conservación y gestión., Este trabajo se inscribe en el marco del Proyecto de Investigación " Identidad y Construcción Cultural de Andalucía: Arte y Turismo (1839-1939) ((HAR2016-79758-P), financiado por el Ministerio de Economía, Industria y Competitividad.

Resumen Objetivos Analizar las caracteristicas al ingreso, el curso evolutivo y el pronostico de la hemorragia digestiva alta (HDA) en el paciente anciano. Material y metodos Estudio prospectivo en el que se incluyeron 103 pacientes con edad igual o superior a 80 anos, que ingresaron en una Unidad de Sangrantes por un episodio de HDA en un ano. Analizamos los antecedentes personales, caracteristicas de la hemorragia, realizacion de la endoscopia urgente diagnostica y terapeutica y factores pronosticos asociados. Resultados La etiologia mas frecuente de la HDA fue el sangrado por ulcera gastroduodenal en el 65,1%, siendo el 60,2% consumidores cronicos de antiinflamatorios no esteroideos. Se realizo endoscopia diagnostica urgente en todos ellos, con una eficacia del 94,2% y terapeutica en el 28,2%. La tasa de resangrado fue del 8%, requiriendo cirugia urgente el 4,9%, con una mortalidad global del 5,8%. Conclusiones La realizacion de endoscopia urgente y la aplicacion de terapeutica endoscopica es un metodo seguro y eficaz para detener el sangrado por HDA en el anciano, lo cual ha reducido la necesidad de cirugia urgente, mejorando la supervivencia del enfermo anciano sangrante.

Plasmablastic lymphoma is a very rare and recently-described subtype of diffuse large B-cell lymphoma. It has a poor prognosis despite intensive chemotherapy treatment. A 57-year old woman with perianal Crohn's disease receiving azathioprine and infliximab developed this type of lymphoma after a short period of time on the treatment. She also had a hepatitis C virus chronic infection which had not been diagnosed or treated before. There is no solid scientific evidence that either immunomodulators or anti-TNF drugs have a definitive role in the appearance of malignancies, and therefore there are no clear recommendations to limit their use. In these patients, there are some other factors we have to take into account, like the inflammatory bowel disease in itself and its behaviour over time, or the comorbidities of the patient, with special attention to virus infections. In this case report, we will analyse the role of these factors in the development of lymphoproliferative disorders and the recommendations given by experts to avoid their appearance.

In the course of inflammatory bowel disease (IBD) a number of extraintestinal manifestations are known to occur, being the dermatological ones often associated to both ulcerative colitis and Crohn's disease. Pyoderma gangrenosum and erythema nodosum are the most frequent, but there are other skin manifestations less frequently reported such as leukocytoclastic vasculitis. We present a case, in which Crohn's disease and leukocytoclastic vasculitis were simultaneously diagnosed, and corticoids treatment achieved complete remission of the both cutaneous and gastrointestinal manifestations.

To evaluate the patient characteristics, outcome, and prognosis of upper gastrointestinal haemorrhage in the elderly.A prospective study was conducted on 103 patients aged 80 years and over, admitted to a Gastrointestinal Bleeding Unit after an episode of upper gastrointestinal bleeding. We analysed the personal history, the characteristics of the bleeding event, and whether an urgent diagnostic or therapeutic endoscopy was performed, in order to identify clinical data and endoscopic findings that may have an influence on the outcome of the haemorrhage.The major cause of the haemorrhage was peptic ulcer in 65.1%, and 60.2% of patients were on chronic treatment with non-steroidal anti-inflammatory drugs. An urgent diagnostic endoscopy was performed in all of them, identifying the source of bleeding in 94.2%, and treatment was carried out on 28.2%. The likelihood of rebleeding was 8%, and 4.9% of patients underwent emergency surgery, with an overall mortality rate of 5.8%.The performance of urgent endoscopy and the application of endoscopic haemostasis are safe and effective in stopping upper gastrointestinal bleeding in the elderly. This has significantly reduced the need for emergency surgery, improving the survival of the bleeding elderly patient and preventing recurrent bleeding.

In the course of inflammatory bowel disease (IBD) a number of extraintestinal manifestations are known to occur, being the dermatological ones often associated to both ulcerative colitis and Crohn's disease. Pyoderma gangrenosum and erythema nodosum are the most frequent, but there are other skin manifestations less frequently reported such as leukocytoclastic vasculitis. We present a case, in which Crohn's disease and leukocytoclastic vasculitis were simultaneously diagnosed, and corticoids treatment achieved complete remission of the both cutaneous and gastrointestinal manifestations.

Sr. Director: Amiloidosis es el termino generico utilizado para referirse al deposito extracelular anormal de proteinas fibrilares insolubles en varios organos. Se identifican en las biopsias por su apariencia en microscopia electronica y su capacidad para unirse a la tincion rojo Congo provocando birrefringencia verde bajo luz polarizada. La amiloidosis sistemica se asocia con afectacion gastrointestinal en un 50-70% de los casos, siendo infrecuente el deposito local confinado a un organo como pueda ser el estomago (< 1%)1. Presentamos el caso de un varon de 87 anos que acude a urgencias por un cuadro de hematemesis con inestabilidad hemodinamica sin ingesta previa de gastroerosivos y en el contexto de una sobredosificacion de acenocumarol que tomaba por una fibrilacion auricular. Se realizo una gastroscopia urgente observandose una cavidad gastrica poco distensible con una mucosa de aspecto atrofico encontrandose en cara posterior de la union de cuerpo y antro una sobreelevacion de la mucosa de gran tamano, con ulceracion profunda en su centro con fondo sanioso muy indicativa de ulcera gastrica maligna, realizandose esclerosis con 4 cc de etanolamina al 5% y tomandose biopsias (Figura 1). El resto de la mucosa antral presentaba numerosas lesiones nodulares, algunas de gran tamano, erosionadas, que parecian senalar en conjunto una infiltracion gastrica. La histologia fue informada como una mucosa con cambios hiperplasicos glandulares, metaplasia intestinal y escara necrotica y fibrino-leucocitaria correspondiente con el fondo y los bordes de una lesion ulcerada. En la porcion profunda de la mucosa y entremezcladas con la escara se observaban acumulaciones de...

Phenotypic Characteristics and Use of Therapeutic Resources in Elderly-Onset Inflammatory Bowel Disease: A Multicentre, Case-Control Study Miriam Manosa, Margalida Calafat, Ruth de Francisco, Carmen Garcia Caparros, Maria Jose Casanova, Patricia Huelin, Marta Calvo, Luis Fernandez Salazar, Miguel Minguez, Alexandra Ruiz-Cerulla, Yamile Zabana, Guillermo Bastida, Joaquin Hinojosa, Lucia Marquez, Manuel Barreiro-de Acosta, Xavier Calvet, David Monfort, Rosario Gomez, Esther Rodriguez, Jose Maria Huguet, Maria Rojas-Feria, Daniel Hervias, Ramon Atienza, David Busquets, Eva Zapata, Carmen Duenas-Sadornil, Mara Charro, Francesc J. Martinez-Cerezo, Rocio Plaza, Juan Maria Vazquez Moron, Javier P. Gisbert, Eduard Cabre, Eugeni Domenech

One UC patient (9.1%) had synchronous adenocarcinomas at rectum and descending colon. The histologies of CRCs were as follows; moderately differentiated adenocarcinoma in seven (36.8%), mucinous adenocarcinoma in five (26.3%), poorly differentiated adenocarcinoma in three (15.8%), well differentiated adenocarcinoma in three (15.8%), and signet ring cell carcinoma in one (5.3%). The stage distribution of cancer was as follows; I in one (5.3%), II in seven (36.8%), III in three (15.8%) and IV in eight (42.1%). The cumulative risks of CRC at 10 years after UC, CD, and IBD diagnosis were 0.4%, 0.4%, and 0.4%, respectively. They were 4.9%, 6.6% and 5.5%, respectively after 20 years (Figure 1).

Background and Aims The aims of this study were to determine the prevalence of fatigue in patients with inflammatory bowel disease [IBD], to identify the factors associated with fatigue and its severity, to assess the impact of fatigue on quality of life [QoL], and to evaluate the relationship between fatigue and sleep disorders. Methods This was a prospective multicentre study conducted at 22 Spanish centres. Consecutive patients followed at IBD Units were included. Fatigue was evaluated with the Fatigue Severity Scale [FSS] and the Fatigue Impact Scale [FIS]. Quality of life and sleep quality were assessed using the IBD Questionnaire-Short Form [IBDQ-9] and the Pittsburgh Sleep Quality Index [PSQI], respectively. Results A total of 544 consecutive adult IBD patients were included [50% women, mean age 44 years, 61% Crohn’s disease]. The prevalence of fatigue was 41% (95% confidence interval [CI] = 37–45%). The variables associated with an increased risk of fatigue were: anxiety [OR = 2.5, 95% CI = 1.6–3.7], depression [OR = 2.4, 95% CI = 1.4–3.8], presence of extraintestinal manifestations [EIMs] [OR = 1.7, 95% CI = 1.1–2.6], and treatment with systemic steroids [OR = 2.8, 95% CI = 1.4–5.7]. The presence of EIMs [regression coefficient, RC = 8.2, 95% CI = 2.3–14.2], anxiety [RC = 25.8, 95% CI = 20.0–31.5], depression [RC = 30.6, 95% CI = 24.3–37.0], and sleep disturbances [RC = 15.0, 95% CI = 9.3–20.8] were associated with severity of fatigue. Patients with fatigue had a significantly decreased IBDQ-9 score [p < 0.001]. Conclusions The prevalence of fatigue in IBD patients is remarkably high and has a negative impact on QoL. Therapy with systemic steroids is associated with an increased risk of fatigue. The severity of fatigue is associated with anxiety, depression, sleep disorders, and the presence of EIMs. Fatigue was not associated with anaemia, disease activity or anti-TNF therapy.