[Recurring genital bleeding in an extreme premature infant]. / Sangrado genital recurrente en una lactante prematura extrema.

Mini-puberty refers to the transient activation of the hypothalamic-pituitary-gonadal axis during the first months of life. This activation in preterm infants could be more exaggerated and prolonged. Ob jective: To present a case of exaggerated mini-puberty in an extremely preterm infant, with recurrent genital bleeding. Clinical Case: A 25-week preterm newborn presented at 5 months old with breast buds, areolar pigmentation, and estrogenic effects on the vaginal mucosa, with recurrent genital blee ding in three consecutive months. Her laboratory evaluation showed elevated values of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estradiol (E2). An exaggerated mini-puber ty due to extreme prematurity was suspected, therefore a conservative approach was taken. During follow-up, the patient showed partial regression of breast buds and cessation of genital bleeding, and decreasing levels of gonadotropin and estradiol. Conclusion: Mini-puberty in preterm newborns can present exaggeratedly, simulating precocious puberty and even presenting, exceptionally, recurrent genital bleeding. Considering the increasing survival of extremely premature infants, it is important to know the spectrum of clinical and laboratory manifestations of this phenomenon, in order to carry out adequate management.

[Diagnosis of laryngopharyngeal Reflux by Impedance with esophageal pHmetry in children with chronic dysphonia]. / Diagnóstico de Reflujo faringolaríngeo mediante Impedanciometría con pHmetría esofágica en niños con disfonía crónica.

INTRODUCTION: Laryngopharyngeal Reflux (LPR) is the retrograde flow of gastric or duodenal contents into the pharynx and larynx, causing inflammation in the upper aerodigestive tract. Traditionally, a pH monitoring study with an acid reflux index was used. The use of multichannel intraluminal impedance testing with pH monitoring (MII-pH) confirms a causal relationship between suspicious symptoms and LPR. OBJECTIVES: To evaluate LPR diagnosed by MII-pH in the pediatric population consulting due to chronic dysphonia and laryngoscopic findings suggestive of LPR, in addition, to measure the concordance between MII-pH and traditional pH monitoring. PATIENTS AND METHOD: Descriptive, prospective study of patients consulting at the Gastroenterology or Otorhinolaryngology polyclinic due to chronic dysphonia, whose nasofibrolaryngoscopy (NFL) was suggestive of LPR. The patients were hospitalized for a 24-hour MII-pH. Patients with a congenital or acquired morbid history were excluded. Pathological LPR was considered if there were 3 or more acid reflux episodes at the pro ximal level in MII-pH. The frequency of traditional pH monitoring and altered MII-pH and the concordance between both methods were evaluated. RESULTS: 12 patients were recruited, 10 men, 6 to 15 years old. On 9/12, pathological LPR was confirmed by MII-pH, of which 2/9 had traditional pH measurements in normal ranges and 7/9 altered pH measurements. In 3 patients, LPR was ruled out by normal proximal MII-pH. The concordance between MII-pH and traditional pH monitoring was acceptable (kappa 0.4). CONCLUSIONS: 75% of the patients with dysphonia and suggestive NFL showed objective evidence of pathological LPR. Since only with the clinical evaluation, NFL and conventional pH monitoring it is not possible to diagnose LPR, we recommend perform MII-pH for greater diag nostic certainty, avoiding unnecessary treatment, and with unwanted effects in 25% of cases.

Introducción: Covid-19: Revisión de la evidencia / Introduction

No disponible

Posicionamiento y recomendaciones sobre cambio climático y salud respiratoria 2021 / Positioning and recommendations on climate change and respiratory health 2021

La Sociedad Madrileña de Neumología y Cirugía Torácica (Neumomadrid) está comprometida con la promoción de la salud respiratoria y con la prevención de las enfermedades que sean derivadas del cambio climático. Por ello elaboramos este documento para contribuir a concienciar a la sociedad general y al personal sanitario de la importancia de contribuir a luchar contra el cambio climático. Neumomadrid establece recomendaciones sobre un uso eficaz y sostenible de los inhaladores que permitan disminuir su huella de carbono, y sobre acciones que permitan a las sociedades científicas defender el medio ambiente. Finalmente, se recogen indicadores de medida que puedan servir para conocer el grado de compromiso con el cambio climático y llevar a cabo nuevas acciones de mejora

The Society of Pneumology and Thoracic Surgery of Madrid (Neumomadrid) is committed to promoting respiratory health and preventing diseases caused by climate change. For this reason we have prepared this document to help raise the public's awareness and healthcare personnel of the importance of contributing to the fight against climate change. Neumomadrid establishes recommendations on an efficient and sustainable use of inhalers, which allow to reduce their carbon footprint, and on activities for scientific societies to protect the environment. Finally, key performance indicators are collected to be used for determining the degree of climate change commitment and taking new actions to improve the situation

A nurse- and peer-led psycho-educational intervention to support women with gynaecological cancers receiving curative radiotherapy: The PeNTAGOn randomised controlled trial - ANZGOG 1102.

OBJECTIVE: Radiotherapy for gynaecological cancer is associated with multiple adverse effects. This randomised controlled trial evaluated the impact of a combined nurse- and peer-led psycho-educational intervention on psychological distress, preparation for treatment, quality of life, psychosexual function, unmet needs and vaginal stenosis. METHODS: Eligible women had a confirmed diagnosis of gynaecological cancer, scheduled to receive radiotherapy with curative intent, aged ≥18 years, and able to read and write English. Participants randomly assigned one-to-one to either four nurse-led consultations plus four peer-led telephone sessions, or to usual care. Participants completed study measures at baseline, immediately before first radiotherapy (FU1), and four weeks (FU2), three (FU3), six (FU4), and 12 months (FU5) post radiotherapy. The primary outcomes were psychological distress at FU1 and FU2 measured by the Hospital Anxiety and Depression Scale. RESULTS: Of 840 eligible participants, 625 were approached and 319 (51%) consented; 158 assigned to intervention, 160 to usual care with 1 withdrawing before randomisation. Between-groups differences for primary outcomes were trivial- and small-sized, (both p > 0.05). Notable effects on secondary outcomes favouring the intervention at FU2 included preparation for treatment (sensory/psychological concerns, d = 0.57; and procedural concerns, d = 0.52) and specific needs domains (sexuality needs, d = 0.38; and health system and information needs, d = 0.41). CONCLUSIONS: There was no evidence that a nurse- and peer-led intervention had a beneficial effect on psychological distress compared to usual care. However, improved treatment readiness and lower health system and sexuality needs indicate the intervention may have addressed outcomes known to be important to this population.

Actualización de las guías clínicas en la EPOC / Update of clinical guidelines in COPD

La enfermedad pulmonar obstructiva crónica (EPOC) ocupa la cuarta causa de muerte a nivel mundial. Es considerada una enfermedad infradiagnosticada con una alta morbimortalidad e importante carga económica y sociosanitaria. A medida que nuestra comprensión de la fisiopatología en la enfermedad evoluciona, se han desarrollado guías clínicas basadas en la evidencia que ayudan en el diagnóstico y manejo de la EPOC. En el año 2001 se publica la primera edición de las recomendaciones de la Global Initiative for Obstructive Lung Diseases (GOLD), siendo referencia a nivel mundial. Posteriormente en el año 2012, nace la primera versión de la Guía Española de la EPOC (GesEPOC). Ambas guías son actualizadas y revisadas periódicamente, representando un paso más hacia la atención personalizada del paciente con EPOC. El propósito del manuscrito es revisar los cambios de la guías más utilizadas en nuestro medio, en su última versión publicada

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death worldwide. Considered as underdiagnosed disease with a high morbidity and mortality, it represents an important socio-sanitary and economic burden. As our understanding of the pathophysiology of the disease evolves, evidence-based clinical guidelines have been developed to aid in the diagnosis and management of COPD. The first recommendations of the Global Initiative for Obstructive Lung Disease (GOLD) were published in 2001, the most it used worldwide. Later in 2012, the Spanish Guide to COPD (GesEPOC) was born. Both guides are updated and reviewed periodically and represent a step towards the personalized attention of the patient with COPD. The purpose of the manuscript is to review the changes of the most used guidelines in our medium, in its latest published versión

Estado de la ventilación mecánica en la Comunidad de Madrid / Home mechanical ventilation in Madrid area

Introducción. En la actualidad, la ventilación mecánica domiciliaria (VMD) se ha convertido en una terapia de uso habitual. La tasa de uso en España es desconocida, por lo que se ha realizado una encuesta en todos los hospitales de la Comunidad de Madrid (CAM) adscritos al Sistema Nacional de Salud para recoger los datos de los pacientes tratados con VMD en octubre y noviembre de 2018. Material y métodos. Se distribuyó una encuesta on-line entre todos los hospitales de la CAM de los grupos funcionales homogéneos (GFH) 1, 2 y 3 pertenecientes al Sistema Nacional de Salud. La encuesta constaba de 50 preguntas y se solicitó que se respondiera a las preguntas con datos reales, no estimados. Resultados. La encuesta la contestaron 18 hospitales, aunque todas las preguntas del cuestionario solo fueron contestadas por 10. La tasa de uso de VMD en la CAM fue de 74/100.000 habitantes. La edad media de los pacientes en VMD era de 69 años (63-76) y el 56% eran varones. La patología que más frecuentemente justificaba la VMD fue el síndrome de obesidad hipoventilación 41% (25-70). Se encontró mucha variabilidad intercentro tanto en la tasa de VMD como en la patología que justificaba la indicación. Todos los hospitales menos 2 disponían de consulta monográfica de VMD. La adaptación se realizaba fundamentalmente en hospitalización (33%) u hospital de día (33%). Se necesita más tiempo, más personal y mejores recursos técnicos para realizar una adecuada monitorización. La relación con las empresas suministradoras de terapias es buena

Introduction. Nowadays home mechanical ventilation (HMV) is a normal use in pneumology. Rate of use in Spain is unknown. We have developed a survey in all Public Madrid Area Hospitals to keep data about HMV patients between 2018 october and november. Methods. We sent an on-line survey to all Public Madrid Area Hospitals with 50 questions about HMV uses. We asked for real data answers, trying to not estimate answers. Results. The survey was answered by 18 hospitals, although all survey questions were answered by 10 hospitals. Rate of use of HMV in Madrid Area was 74/100.000. Mean age was 69 (63-76) years and 56% were males. The most frequent pathology that justified HMV was obesity hipoventilation syndrome 41% (25-70). We found a high variability interhospital in HMV rate and in the pathology that justified it. All the hospitals instead 2 of them had a monography HMV consult. HMV adaptation was done majority in hospitalization (33%) and in day hospital (33%). It is necessary more time, more people and better devices to achieve a proper monitoring. The relationship with the therapy providers is good

Recomendaciones dietéticas y suplementos nutricionales en la EPOC / Dietary recommendations and nutritional supplements in COPD

La evaluación y el tratamiento médico nutricional deben formar el manejo integral de los pacientes con EPOC. Con ello se pretende prevenir y tratar la desnutrición. La adaptación de la dieta oral a los requerimientos y las características clínicas de cada paciente representa la base del tratamiento nutricional. Cuando estas recomendaciones no resultan suficientes, los suplementos nutricionales orales pueden contribuir a que el paciente alcance sus requerimientos nutricionales. La nutrición parenteral se reserva para los casos en los que exista una contraindicación para la utilización de la vía digestiva (íleo, perforación o hemorragia digestiva)

The evaluation and nutritional medical treatment should form the integral management of patients with COPD. This is intended to prevent and treat malnutrition. The adaptation of the oral diet to the requirements and clinical characteristics of each patient represents the basis of nutritional treatment. When these recommendations are not enough, oral nutritional supplements can help the patient reach their nutritional requirements. Parenteral nutrition is reserved for cases in which there is a contraindication for the use of the digestive tract (ileus, perforation or gastrointestinal bleeding)

Epidural analgesia in laparoscopic radical prostatectomy / Analgesia epidural en la prostatectomía radical laparoscópica

Introduction: Epidural analgesia is an effective technique for postoperative pain relief. Our aim in this retrospective study was to assess the postoperative pain control and complications relating to epidural technique in laparoscopic radical prostatectomy (LRP). Material and methods: A retrospective analysis of 193 patients who underwent LRP, in which epidural analgesia was the postoperative pain approach, was performed. The procedure is generally performed under combined anesthesia. Data collected was postoperative pain data; appearance of neurological disorders (Bromage scale was used for motor weakness assessment); data related to the epidural technique and possible difficulties when performing it; data on epidural infusion; catheter-related complications; hospital stay, postoperative complications, and outcome. Results: Firstly, average VAS at rest was 1.2 ± 1.6; and upon movement, average VAS was 1.9 ± 1.8 during the hospital stay. Secondly, complications related to epidural technique appeared in 37 % of patients. There were 3 cases of hematic puncture; 3 accidental catheter disconnections; 1 dural puncture, and 1 subdural block. As for neurological secondary effects of local anesthetics in the epidural technique, 56 patients (30.1 %) presented with motor block of one or both lower extremities after surgery, and 5 (2.7 %) with paresthesia. Statistical analysis showed that motor weakness was not related to age, weight, type of local anesthetic used, infusion rate, level of epidural puncture nor length of catheter within the epidural space (p > 0.05). Conclusion: Postoperative epidural analgesia offers excellent analgesic quality but it can be associated with several complications secondary to the use of local anesthetics, which could disagree with the terms of Fast-track surgery. New techniques like the TAP block could offer the same analgesic quality, without the epidural's technique potential complications (AU)

Objetivos: La analgesia epidural es una técnica eficaz para el control del dolor postoperatorio. Nuestro objetivo en este estudio retrospectivo fue evaluar el control del dolor postoperatorio mediante la escala visual analógica del dolor (EVA) y las complicaciones relacionadas con la técnica epidural, en la prostatectomía radical laparoscópica (PRL). Material y métodos: Llevamos a cabo un análisis retrospectivo de 193 pacientes sometidos a PRL, en los que se realizó la técnica epidural analgésica para el control del dolor postoperatorio. El procedimiento se hizo bajo una anestesia combinada. Registramos los datos relacionados con el dolor postoperatorio; la aparición de sintomatología neurológica (la escala de Bromage se utilizó para evaluar la debilidad motora); datos relacionados con la técnica epidural y posibles dificultades al realizarla; datos sobre la infusión epidural, como tipo de anestésico local utilizado; complicaciones relacionadas con el catéter y complicaciones postoperatorias asociadas al mismo, estancia hospitalaria y resultado. Resultados: En primer lugar, durante la estancia hospitalaria de los pacientes, el EVA promedio en reposo fue 1,2 ± 1,6; y durante el movimiento, el EVA promedio fue de 1,9 ± 1,8. En segundo lugar, las complicaciones relacionadas con la técnica epidural aparecieron en el 37 % de los pacientes. Hubo 3 casos de punción hemática; 3 desconexiones accidentales del catéter, 1 punción dural y 1 bloqueo subdural. En cuanto a las complicaciones neurológicas debidas a los efectos secundarios de los anestésicos locales en la técnica epidural, 56 (30,1 %) pacientes presentaron bloqueo motor de una o ambas extremidades inferiores después de la cirugía y 5 (2,7 %) refirieron parestesias. No hubo ninguna complicación neurológica que persistiese tras el alta hospitalaria. El análisis estadístico mostró que la debilidad motora no estaba relacionada con la edad, el peso, el tipo de anestésico local utilizado, la velocidad de infusión, el nivel de punción epidural ni la longitud del catéter en el espacio epidural (p > 0,05). Conclusión: La analgesia epidural postoperatoria ofrece una excelente calidad analgésica, pero puede estar asociada a varias complicaciones secundarias al uso de anestésicos locales, lo que podría estar en contraposición con las tendencias actuales de cirugía fastrack. Las nuevas técnicas emergentes podrían ofrecer la misma calidad analgésica evitando las potenciales complicaciones de la técnica epidural (AU)

Perspectives of oncology nurses and oncologists regarding barriers to working with patients from a minority background: Systemic issues and working with interpreters.

This study aimed to ascertain the systemic barriers encountered by oncology health professionals (HPs) working with patients from ethnic minorities to guide the development of a communication skills training programme. Twelve medical and five radiation oncologists and 21 oncology nurses were invited to participate in this qualitative study. Participants were interviewed individually or in a focus group about their experiences working with people from minority backgrounds. All interviews were transcribed verbatim and analysed thematically. HPs encountered language and communication barriers in their interactions with patients and their families, which were perceived to impact negatively on the quality and amount of information and support provided. There was a shortage of, and poor processes for engaging, interpreters and some HPs were concerned about the accuracy of interpretation. HPs expressed a need for training in cultural awareness and communication skills with a preference for face-to-face delivery. A lack of funding, a culture of "learning on the job", and time constraints were systemic barriers to training. Oncologists and oncology nurses encounter complex challenges in clinical interactions with minority patients and their families, including difficulties working with interpreters. Formal training programmes targeted to the development of culturally competent communication skills are required.

Interventions to improve patient understanding of cancer clinical trial participation: a systematic review.

Patient misunderstanding of cancer clinical trial participation is identified as a critical issue and researchers have developed and tested a variety of interventions to improve patient understanding. This systematic review identified nine papers published between 2000 and 2013, to evaluate the effects of interventions to improve patient understanding of cancer clinical trial participation. Types of interventions included audio-visual information, revised written information and a communication training workshop. Interventions were conducted alone or in combination with other forms of information provision. The nine papers, all with methodological limitations, reported mixed effects on a small range of outcomes regarding improved patient understanding of cancer clinical trial participation. The methodological limitations included: (1) the intervention development process was poorly described; (2) only a small element of the communication process was addressed; (3) studies lacked evidence regarding what information is essential and critical to enable informed consent; (4) studies lacked reliable and valid outcome measures to show that patients are sufficiently informed to provide consent; and (5) the intervention development process lacked a theoretical framework. Future research needs to consider these factors when developing interventions to improve communication and patient understanding during the informed consent process.

Qué no hacer en la EPOC. Análisis metodológico / No disponible

Objetivo: Identificar en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) prácticas diagnósticas, terapéuticas y de autocuidado que resultan inadecuadas, de dudosa efectividad o que no son coste-efectivas, tanto en fase estable como durante una agudización. Material y método: El estudio se ha organizado en 3 fases y diseñado para identificar prácticas que no aportan valor o que deben desaconsejarse en el manejo de la EPOC estable y agudizada, y en los autocuidados llevados a cabo por estos pacientes. La primera fase se realizó mediante la técnica Metaplan en la que se puntuaron y seleccionaron las prácticas que con más frecuencia claramente debían desaconsejarse. La segunda fase se hizo a través de la web mediante una técnica de conferencia de consenso que permitió la valoración y la selección jerarquizada de las recomendaciones en función de la frecuencia en que ocurren y la intensidad en el que esa práctica resultaba inútil o perjudicial. En la tercera fase se elaboró una ficha descriptiva de cada una de las recomendaciones finales, que incluye la descripción de la práctica a erradicar, el nivel de evidencia y grado de recomendación y los indicadores de la medida en que se ha logrado un cambio en la práctica. Resultados: Los resultados se mostrarán en una tabla que recogerá las prácticas ‘no hacer’ en la EPOC, con la frecuencia con que se produce la práctica que se desaconseja y la intensidad con que la práctica resulta inadecuada, tanto en la EPOC estable como en la EPOC agudizada y en las prácticas realizadas por los pacientes. Además, se desarrollará en una ficha técnica para cada recomendación en el que se expondrá la denominación, la justificación y el nivel de evidencia de la recomendación. También se elaborarán indicadores que permitan evaluar los datos recogidos y que se haya logrado cambiar la práctica inadecuada, ineficaz o no coste-efectiva. Conclusiones: Las recomendaciones 'Qué no hacer en la EPOC' mejorarán el manejo de esta patología al reducir las prácticas diagnósticas, terapéuticas o de cuidados que sean inadecuadas o no coste-efectivas

Objective: To identify diagnostic, therapeutic and self-care practices in chronic obstructive pulmonary disease (COPD) patients which are inadequate, of dubious effectiveness or non cost-effective, both in stable phase and during an exacerbation. Material and Methods: The study was performed in 3 phases and designed to identify practices which do not add value or must be discouraged in the management of stable COPD and its exacerbations, and also in self-care carried out by the patients. The first phase was carried out by the Metaplan technique in which the most frequent practices which had to be clearly discouraged were rated and selected . The second phase was made through the web by a consensus conference technique that allowed to evaluate and select hierarchically recommendations based on the frequency of occurrence and intensity of the practices which were found useless or harmful. In the third phase a technical file on each of the final recommendations was created. It includes the description of the practices which must be eradicated, evidence levels and recommendation degrees, as well as indicators of the measure achieved thanks to the change in practice. Results: The results are shown in a table that summarizes ‘do not do’ practices in COPD, the frequency with which the practice is discouraged and the intensity with which the practice is inadequate, both in stable and exacerbated COPD and in practices carried out by patients. In addition, there will be a technical file developed for each recommendation with denomination, justification and evidence level of the recommendation. Indicators, permitting to evaluate collected data and the improvements reached by decreasing inadequate, ineffective or non cost-effective practices, will also be developed. Conclusions: 'Do not do' recommendations in COPD will improve the management of this patology by reducing inadequate or non cost-effective diagnostic, therapeutic or care practices

Clasificación de la EPOC: ¿qué guía seguir? / No disponible

No disponible

Synthesis and characterization of hybrid silica/PMMA nanoparticles and their use as filler in dental composites.

The effect of hybrid silica/poly(methylmethacrylate) (PMMA) nanoparticles on the properties of composites for dental restoration was evaluated. Hybrid nanoparticles with silica as core and PMMA as shell were obtained by a seeded emulsion polymerization process. Fourier transform infrared spectrum of the hybrid nanoparticles shows an intense peak at 1,730 cm(-1), corresponding to carbonyl groups (CO) of the ester. The thermal stability of the hybrid particles decreases with increasing amounts of PMMA and the residual mass at 700°C corresponds to the silica content in the hybrid particles. Composites were obtained by dispersing nanoparticles (silica or hybrid), as fillers, in a resin-bis glycidyl dimethacrylate (Bis-GMA)/triethylene glycol dimethacrylate (TEGDMA) (40%/60% (w/w)). The paste was then placed in a mold and polymerized under light irradiation. During the preparation of the composites, with the hybrid nanoparticles, the monomers swell the PMMA shell and after photo-curing, a semi-interpenetrating network (semi-IPN) is obtained around the silica core. The properties of the composites, obtained using the hybrid nanoparticles, depend on the filler content and the amount of PMMA in the semi-IPN matrix. For composites with similar inorganic filler contents, the composites with low amounts of PMMA shell had higher modulus than those in which silica was used as the filler.

Soil factors involved in the diversity and structure of soil bacterial communities in commercial organic olive orchards in Southern Spain.

Nowadays, there is a tendency in olive production systems to reduce tillage or keep a vegetative cover to reduce soil erosion and degradation. However, there is scarce information on the effects of different soil management systems (SMS) in soil bacterial community composition of olive groves. In this study, we have evaluated the effects of soil type and different SMS implemented to control weeds in the structure and diversity of bacterial communities of 58 soils in the two geographic areas that best represent the organic olive production systems in Spain. Bacterial community composition assessed by frequency and intensity of occurrence of terminal restriction profiles (TRFs) derived from terminal restriction fragment length polymorphism (T-RFLP) analysis of amplified 16S ribosomal deoxyribonucleic acid were strongly correlated with soil type/field site (Eutric/Calcaric) that differed mainly in soil particle size distribution and soil pH, followed by a strong effect of SMS, in that order. Canonical discriminant (CD) analysis of TRFs properly classified all of the olive orchard soils as belonging to their respective soil type or SMS. Furthermore, only a small set of TRFs were enough to clearly and significantly differentiate soil samples according to soil type or SMS. Those specific TRFs could be used as bioindicators to assess the effect of changes in SMS aimed to enhance soil quality in olive production systems.

Reduction of health risk factors through an adapted physical activity program in patients with breast cancer.

PURPOSE: After a breast cancer diagnosis, patients are at high risk of reducing their physical activity and gaining weight. Lack of physical activity and weight gain are known negative but modifiable prognostic factors. An observational study of a 3-month adapted physical activity (APA) program was performed to assess its effectiveness in improving physical activity level and reducing risk factors related to health during or after breast cancer treatments. METHOD: Height, weight, and waist circumference (WC) were measured at the beginning and end of the 26-session program. Body mass index (BMI) and WC to height ratio (WHtR) were calculated. Physical activity profile, aerobic capacity, and usual average daily energy expenditure were estimated. Median values were compared using nonparametric tests. RESULTS: Sixty-one (61) voluntary breast cancer patients attended 80% of the sessions. At baseline, median (minimum-maximum) BMI was 23.3 (16.1-36.8) kg.m(-2) and WC and WHtR showed metabolic risks. After 3 months, anthropometric data remained stable. Moderate physical activity significantly improved (+13 min/day) and sedentary tended to decrease (-18 min/day). CONCLUSION: A 3-month APA program allows patients to limit risk factors related to health such as physical inactivity and metabolic risks. This study reinforces the need to promote physical activity as early as possible in cancer patients' care.

Synthesis and characterization of core-shell nanoparticles and their influence on the mechanical behavior of acrylic bone cements.

Core-shell nanoparticles consisting of polybutyl acrylate (PBA) rubbery core and a polymethyl methacrylate (PMMA) shell, with different core-shell ratios, were synthesized in order to enhance the fracture toughness of the acrylic bone cements prepared with them. It was observed by TEM and SEM that the core-shell nanoparticles exhibited a spherical morphology with ca. 120 nm in diameter and that both modulus and tensile strength decreased by increasing the PBA content; the desired structuring pattern in the synthesized particles was confirmed by DMA. Also, experimental bone cements were prepared with variable amounts (0, 5, 10 and 20 wt.%) of nanoparticles with a core-shell ratio of 30/70 in order to study the influence of these nanostructured particles on the physicochemical, mechanical and fracture properties of bone cements. It was found that the addition of nanostructured particles to bone cements caused a significant reduction in the peak temperature and setting time while the glass transition temperature (Tg) of cements increased with increasing particles content. On the other hand, modulus and strength of bone cements decreased when particles were incorporated but fracture toughness was increased.