Repeat cytoreduction with Hyperthermic Intraperitoneal chemotherapy in patients with peritoneal disease: A 5-year retrospective analysis.

BACKGROUND: Cytoreductive surgery with Hyperthermic Intraperitoneal Chemotherapy (CR-HIPEC) is a locorregional surgical therapy applied in patients with peritoneal-only metastatic disease of primary abdominal malignancies. Integrated in a multimodal treatment, CR-HIPEC is associated with increased overall survival. In cases of peritoneal-site only relapse, it may be carried out more than once. METHODS: Patients who received a CR-HIPEC between January 2016 and December 2020 at Instituto Português de Oncologia do Porto, Portugal were included in a unicentric, retrospective, observational study. Short- and long-term outcomes after surgery were analyzed. RESULTS: In this period, 259 CR-HIPEC were performed on 248 patients. Of these, 31 were CR-HIPEC repeats, with 6 being the third HIPEC in the same patient. Of the 31 cases, 15 (48.4 %) had an appendicular origin. Mean PCI in re-HIPEC group was 10.6 (SD ± 7.1). No significant differences in baseline characteristics between the first and re-HIPEC groups were found, except for mean PCI, higher in the 1st HIPEC group (p = 0.047). In re-HIPEC group, major complications rate (CT-CAE 3-4) was 12.9 % (n = 4), without postoperative mortality. The 1st and re-HIPEC group had similar morbidity rates and hospitalization time. With a median follow-up time of 44 months, relapse rate after repeat CR-HIPEC was 45.2 % (n = 14), with a mean overall survival (OS) of 68.7 months and 5-year OS of 78 %. CONCLUSIONS: Repeat CR-HIPEC is a safe approach with an acceptable complication rate for its complexity, associated with a survival benefit in selected patients. It should be presented as a valid therapeutic option in recurrent peritoneal disease.

Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy: Analysis of Perioperative Risk Factors and Impact on Outcome.

Background Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) is an effective treatment option for appropriately selected patients with peritoneal carcinomatosis. Our aim was to analyze a multidisciplinary approach and to study the perioperative risk factors associated with morbidity and mortality. Methods We reviewed all patients who underwent CRS + HIPEC from January 2019 till December 2020 at our oncologic center. Patient demographics, risk scores, intraoperative variables, postoperative care, analgesia protocol, and adverse events (AE) within 30 days after treatment were collected and statistically analyzed. Results Of the 98 patients evaluated preoperatively by a multidisciplinary team, 39 patients required active optimization. The median age was 61 years, and 67 were women. Most tumors were appendiceal in origin. The median peritoneal cancer index (PCI) score was 12, and the median operative time length (OTL) was 400 minutes. Body mass index, Physiological and Operative Severity Score for the enUmeration of morbidity, PCI score, crystalloid volume, cell concentrates, and OTL were associated with postoperative intensive care unit admission (p <0.05). Epidural analgesia was given to 74 patients. AEs occurred in 39 patients, and 25 of the AEs were classified as mild or moderate. The intraoperative variables associated with development of AEs were anesthesia technique, estimated blood loss, crystalloid volume, cell concentrates, OTL, and analgesia protocol (p <0.05). On multivariate analysis, crystalloid volume >6 L, intravenous sufentanil analgesic protocol, and OTL were associated with 67%, 38%, and 15% increased risk of AE, respectively. Conclusion Our study highlighted the importance of a perioperative protocol with a standardized multidisciplinary approach in order to decrease the incidence of postoperative AE.

Parametric fMRI of paced motor responses uncovers novel whole-brain imaging biomarkers in spinocerebellar ataxia type 3.

Machado-Joseph Disease, inherited type 3 spinocerebellar ataxia (SCA3), is the most common form worldwide. Neuroimaging and neuropathology have consistently demonstrated cerebellar alterations. Here we aimed to discover whole-brain functional biomarkers, based on parametric performance-level-dependent signals. We assessed 13 patients with early SCA3 and 14 healthy participants. We used a combined parametric behavioral/functional neuroimaging design to investigate disease fingerprints, as a function of performance levels, coupled with structural MRI and voxel-based morphometry. Functional magnetic resonance imaging (fMRI) was designed to parametrically analyze behavior and neural responses to audio-paced bilateral thumb movements at temporal frequencies of 1, 3, and 5 Hz. Our performance-level-based design probing neuronal correlates of motor coordination enabled the discovery that neural activation and behavior show critical loss of parametric modulation specifically in SCA3, associated with frequency-dependent cortico/subcortical activation/deactivation patterns. Cerebellar/cortical rate-dependent dissociation patterns could clearly differentiate between groups irrespective of grey matter loss. Our findings suggest functional reorganization of the motor network and indicate a possible role of fMRI as a tool to monitor disease progression in SCA3. Accordingly, fMRI patterns proved to be potential biomarkers in early SCA3, as tested by receiver operating characteristic analysis of both behavior and neural activation at different frequencies. Discrimination analysis based on BOLD signal in response to the applied parametric finger-tapping task significantly often reached >80% sensitivity and specificity in single regions-of-interest.Functional fingerprints based on cerebellar and cortical BOLD performance dependent signal modulation can thus be combined as diagnostic and/or therapeutic targets in hereditary ataxia. Hum Brain Mapp 37:3656-3668, 2016. © 2016 Wiley Periodicals, Inc.

Carotid endarterectomy: review of 10 years of practice of general and locoregional anesthesia in a tertiary care hospital in Portugal / Endarterectomia carotídea: revisão de 10 anos de prática de anestesia geral e locorregional num hospital terciário em Portugal / Endarterectomía carotídea: revisión de 10 años de práctica de la anestesia general y locorregional en un hospital terciario en Portugal

Retrospective and prospective randomized studies have compared general and locoregional anesthesia for carotid endarterectomy, but without definitive results.

Estudos retrospectivos e prospectivos randomizados têm comparado a anestesia locorregional e geral para endarterectomia carotídea, mas sem resultados definitivos.

Estudios retrospectivos y prospectivos aleatorizados han comparado la anestesia locorregional y la general para la endarterectomía carotídea pero sin resultados definitivos.

Carotid endarterectomy: review of 10 years of practice of general and locoregional anesthesia in a tertiary care hospital in Portugal.

BACKGROUND: Retrospective and prospective randomized studies have compared general and locoregional anesthesia for carotid endarterectomy, but without definitive results. OBJECTIVES: Evaluate the incidence of complications (medical, surgical, neurological, and hospital mortality) in a tertiary center in Portugal and review the literature. METHODS: Retrospective analysis of patients undergoing endarterectomy between 2000 and 2011, using a software for hospital consultation. RESULTS: A total of 750 patients were identified, and locoregional anesthesia had to be converted to general anesthesia in 13 patients. Thus, a total of 737 patients were included in this analysis: 74% underwent locoregional anesthesia and 26% underwent general anesthesia. There was no statistically significant difference between the two groups regarding per operative variables. The use of shunt was more common in patients undergoing general anesthesia, a statistically significant difference. The difference between groups of strokes and mortality was not statistically significant. The average length of stay was shorter in patients undergoing locoregional anesthesia with a statistically significant difference. CONCLUSIONS: We found that our data are overlaid with the literature data. After reviewing the literature, we found that the number of studies comparing locoregional and general anesthesia and its impact on delirium, cognitive impairment, and decreased quality of life after surgery is still very small and can provide important data to compare the two techniques. Thus, some questions remain open, which indicates the need for randomized studies with larger number of patients and in new centers.

[Carotid endarterectomy: review of 10 years of practice of general and locoregional anesthesia in a tertiary care hospital in Portugal]. / Endarterectomia carotídea: revisão de 10 anos de prática de anestesia geral e locorregional num hospital terciário em Portugal.

BACKGROUND: Retrospective and prospective randomized studies have compared general and locoregional anesthesia for carotid endarterectomy, but without definitive results. OBJECTIVES: Evaluate the incidence of complications (medical, surgical, neurological, and hospital mortality) in a tertiary center in Portugal and review the literature. METHODS: Retrospective analysis of patients undergoing endarterectomy between 2000 and 2011, using a software for hospital consultation. RESULTS: A total of 750 patients were identified, and locoregional anesthesia had to be converted to general anesthesia in 13 patients. Thus, a total of 737 patients were included in this analysis: 74% underwent locoregianal anesthesia and 26% underwent general anesthesia. There was no statistically significant difference between the two groups regarding perioperative variables. The use of shunt was more common in patients undergoing general anesthesia, a statistically significant difference. The difference between groups of strokes and mortality was not statistically significant. The average length of stay was shorter in patients undergoing locoregional anesthesia with a statistically significant difference. CONCLUSIONS: We found that our data are overlaid with the literature data. After reviewing the literature, we found that the number of studies comparing locoregional and general anesthesia and its impact on delirium, cognitive impairment, and decreased quality of life after surgery is still very small and can provide important data to compare the two techniques. Thus, some questions remain open, which indicates the need for randomized studies with larger number of patients and in new centers.

Clima social na família e estilos de pensar e criar / Social climate in the family and styles of thinking and creating

A família constitui o núcleo dos laços ativos, na medida em que nela se criam as condições propícias ao desenvolvimento do indivíduo. Na sociedade atual, marcada pela emergência de novos modelos de família, de educação e de trabalho, o potencial cognitivo-criativo do sujeito tem-se afirmado como um fator diferenciador, nas diversas áreas de intervenção. Nesse contexto de emergência de novos paradigmas, esta investigação coloca a seguinte questão: a família contribui significativamente para o desenvolvimento das capacidades cognitivo-criativas? A título de hipótese, esta investigação assume que, se a família contribui para o desenvolvimento daquelas capacidades, então existe uma correlação significativa entre o clima familiar e os estilos de pensar e criar. O presente estudo, constituído por uma amostra de 312 estudantes portugueses do Ensino Superior da Licenciatura de Psicologia, teve como objeto de análise o clima social da família, a partir da Social Climate Scales Family - R Form. Simultaneamente, através da Escala de Estilos de Pensar e Criar de Wechsler, analisou-se o Estilo predominante de pensar e criar e, posteriormente, procedeu-se à verificação da existência de correlações significativas entre os dois constructos. Os resultados demonstraram correlações positivas entre o clima familiar e o estilo de pensar e criar.

The family constitutes the core of active bonds, as the conditions favoring the individual's development are created within it. In contemporary society marked by the emergence of new family, educational and work models, the cognitive-creative potential of the invididual has been affirmed as a differentiating factor in the diverse aeas of intervention. In this context of the emergence of new paradigms, this investigation asks the followng question: does the family contribute significantly to the development of cognitive-creative abilities? As its hypothesis this research assumes that if the family contributes to the development of these abilities, then there would be a significant correlation between the family climate and the styles of thinking and creating. The aim of this study, composed of a sample of 312 Portuguese students of the Graduate Courses of the Degree in Psychology, was to evaluate the family social environment by means of the Social Climate Scales of the Family - R Form. Simultaneously, using the Wechsler Styles of Thinking and Creating Scale, the predominant thinking and creative style was analyzed. After this the presence of significant correlations between the two constructs was verified. The resulted demonstrated positive correlations between social family climate and the styles of thinking and creating.

Clima social na família e estilos de pensar e criar / Social climate in the family and styles of thinking and creating

A família constitui o núcleo dos laços ativos, na medida em que nela se criam as condições propícias ao desenvolvimento do indivíduo. Na sociedade atual, marcada pela emergência de novos modelos de família, de educação e de trabalho, o potencial cognitivo-criativo do sujeito tem-se afirmado como um fator diferenciador, nas diversas áreas de intervenção. Nesse contexto de emergência de novos paradigmas, esta investigação coloca a seguinte questão: a família contribui significativamente para o desenvolvimento das capacidades cognitivo-criativas? A título de hipótese, esta investigação assume que, se a família contribui para o desenvolvimento daquelas capacidades, então existe uma correlação significativa entre o clima familiar e os estilos de pensar e criar. O presente estudo, constituído por uma amostra de 312 estudantes portugueses do Ensino Superior da Licenciatura de Psicologia, teve como objeto de análise o clima social da família, a partir da Social Climate Scales Family - R Form. Simultaneamente, através da Escala de Estilos de Pensar e Criar de Wechsler, analisou-se o Estilo predominante de pensar e criar e, posteriormente, procedeu-se à verificação da existência de correlações significativas entre os dois constructos. Os resultados demonstraram correlações positivas entre o clima familiar e o estilo de pensar e criar.(AU)

The family constitutes the core of active bonds, as the conditions favoring the individual's development are created within it. In contemporary society marked by the emergence of new family, educational and work models, the cognitive-creative potential of the invididual has been affirmed as a differentiating factor in the diverse aeas of intervention. In this context of the emergence of new paradigms, this investigation asks the followng question: does the family contribute significantly to the development of cognitive-creative abilities? As its hypothesis this research assumes that if the family contributes to the development of these abilities, then there would be a significant correlation between the family climate and the styles of thinking and creating. The aim of this study, composed of a sample of 312 Portuguese students of the Graduate Courses of the Degree in Psychology, was to evaluate the family social environment by means of the Social Climate Scales of the Family - R Form. Simultaneously, using the Wechsler Styles of Thinking and Creating Scale, the predominant thinking and creative style was analyzed. After this the presence of significant correlations between the two constructs was verified. The resulted demonstrated positive correlations between social family climate and the styles of thinking and creating.(AU)