Robotic surgery as a driver of surgical digitalization.

Classical surgery, also called analog surgery, is transmitted to us by our mentors, whose knowledge has been delegated from generation to generation throughout the history of surgery. Its main limitations are limited surgical precision and dependence on the surgeon's skill to achieve surgical goals. So-called digital surgery incorporates the most advanced technology, with the aim of improving the results of all phases of the surgical process. Robotic platforms are currently considered to be one of the main drivers of the digital transformation of surgery. They bring considerable advances to the digitalization of surgery, including: higher quality visualization, more controlled and stable movements with elimination of tremor, minimized risk of errors, data integration throughout the patient's surgical process, use of various systems for better surgical planning, application of virtual and augmented reality, telementoring, and artificial intelligence.

Unusual presentation of biliopancreatic cancer as primary retroperitoneal tumor.

Primary retroperitoneal tumors are little-known neoplasias and consequently, difficult to diagnose. We report an extremely unusual case of a biliopancreatic adenocarcinoma with retroperitoneal localization simulating a primary retroperitoneal tumor. As far as we know, there are no similar cases published up to date.

Full endoscopic minimally invasive extraperitoneal modified Sugarbaker approach for para-colostomy hernia repair: Technical aspects and 2-year follow-up results of a prospective cohort.

AIM: This study aimed to assess technical aspects and clinical results of a new minimally invasive technique in parastomal hernia (PSH) repair, full endoscopic retromuscular access, after 2 years of follow-up. METHODS: Data from consecutive patients requiring minimally invasive ventral PSH repair were collected from 2019 to 2022. The inclusion criteria were patients aged between 18 and 80 years old with symptomatic PSH. Demographics and perioperative and postoperative data were collected. Postoperative pain and functional recovery were compared with preoperative data. RESULTS: Twelve patients with symptomatic PSH were included. The mean PSH defect area was 16.2 cm2 and the mean midline defect was 8.7 cm2 . No intra-operative complications or conversion to open surgery were detected. One patient (8%) required postoperative readmission due to partial bowel obstruction symptoms that required catheterization of the stoma. Pain significantly worsened after the first postoperative day compared to preoperative data but improved after the first postoperative month compared to the first postoperative week and after the 90th postoperative day compared to the first postoperative month, with significant differences. Significant restriction improvement was identified when 30 days after surgery data were compared to preoperative data and when the 180th postoperative day results were compared to 30 days after surgery. The average follow-up was 29 months. During the follow-up no clinical or radiological recurrence was observed. CONCLUSION: This paper shows low rate of intra- and postoperative complications with significant improvement in terms of pain activities restriction compared to preoperatory. After 29 months follow-up, no recurrence was identified, confirming that this approach offers good mid-term results.

Hybrid Genetic Algorithm for Clustering IC Topographies of EEGs.

Clustering of independent component (IC) topographies of Electroencephalograms (EEG) is an effective way to find brain-generated IC processes associated with a population of interest, particularly for those cases where event-related potential features are not available. This paper proposes a novel algorithm for the clustering of these IC topographies and compares its results with the most currently used clustering algorithms. In this study, 32-electrode EEG signals were recorded at a sampling rate of 500 Hz for 48 participants. EEG signals were pre-processed and IC topographies computed using the AMICA algorithm. The algorithm implements a hybrid approach where genetic algorithms are used to compute more accurate versions of the centroids and the final clusters after a pre-clustering phase based on spectral clustering. The algorithm automatically selects the optimum number of clusters by using a fitness function that involves local-density along with compactness and separation criteria. Specific internal validation metrics adapted to the use of the absolute correlation coefficient as the similarity measure are defined for the benchmarking process. Assessed results across different ICA decompositions and groups of subjects show that the proposed clustering algorithm significantly outperforms the (baseline) clustering algorithms provided by the software EEGLAB, including CORRMAP.

Assessing Functional Brain Network Dynamics in Dyslexia from fNIRS Data.

Developmental dyslexia is characterized by a deficit of phonological awareness whose origin is related to atypical neural processing of speech streams. This can lead to differences in the neural networks that encode audio information for dyslexics. In this work, we investigate whether such differences exist using functional near-infrared spectroscopy (fNIRS) and complex network analysis. We have explored functional brain networks derived from low-level auditory processing of nonspeech stimuli related to speech units such as stress, syllables or phonemes of skilled and dyslexic seven-year-old readers. A complex network analysis was performed to examine the properties of functional brain networks and their temporal evolution. We characterized aspects of brain connectivity such as functional segregation, functional integration or small-worldness. These properties are used as features to extract differential patterns in controls and dyslexic subjects. The results corroborate the presence of discrepancies in the topological organizations of functional brain networks and their dynamics that differentiate between control and dyslexic subjects, reaching an Area Under ROC Curve (AUC) up to 0.89 in classification experiments.

Radiofrequency-assisted transection of the pancreas versus stapler in distal pancreatectomy: study protocol for a multicentric randomised clinical trial (TRANSPAIRE).

INTRODUCTION: To date, no pancreatic stump closure technique has been shown to be superior to any other in distal pancreatectomy. Although several studies have shown a trend towards better results in transection using a radiofrequency device (radiofrequency-assisted transection (RFT)), no randomised trial for this purpose has been performed to date. Therefore, we designed a randomised clinical trial, with the hypothesis that this technique used in distal pancreatectomies is superior in reducing clinically relevant postoperative pancreatic fistula (CR-POPF) than mechanical closures. METHODS AND ANALYSIS: TRANSPAIRE is a multicentre randomised controlled trial conducted in seven Spanish pancreatic centres that includes 112 patients undergoing elective distal pancreatectomy for any indication who will be randomly assigned to RFT or classic stapler transections (control group) in a ratio of 1:1. The primary outcome is the CR-POPF percentage. Sample size is calculated with the following assumptions: 5% one-sided significance level (α), 80% power (1-ß), expected POPF in control group of 32%, expected POPF in RFT group of 10% and a clinically relevant difference of 22%. Secondary outcomes include postoperative results, complications, radiological evaluation of the pancreatic stump, metabolomic profile of postoperative peritoneal fluid, survival and quality of life. Follow-ups will be carried out in the external consultation at 1, 6 and 12 months postoperatively. ETHICS AND DISSEMINATION: TRANSPAIRE has been approved by the CEIM-PSMAR Ethics Committee. This project is being carried out in accordance with national and international guidelines, the basic principles of protection of human rights and dignity established in the Declaration of Helsinki (64th General Assembly, Fortaleza, Brazil, October 2013), and in accordance with regulations in studies with biological samples, Law 14/2007 on Biomedical Research will be followed. We have defined a dissemination strategy, whose main objective is the participation of stakeholders and the transfer of knowledge to support the exploitation of activities. REGISTRATION DETAILS: ClinicalTrials.gov Registry (NCT04402346).

[SARS-CoV-2 seroprevalence study in patients undergoing addiction treatment in Madrid.] / Estudio de sero-prevalencia al SARS-CoV-2 en pacientes en tratamiento por adicciones en Madrid.

OBJECTIVE: Patients with addiction are a vulnerable group in which there is little data on the infection and severity of COVID-19. The objective of this study was to analyze the seroprevalence against SARS-CoV-2 in users in treatment for addictions in Madrid and to describe the factors related to the infection in this group. METHODS: Cross-sectional descriptive study (June-October 2020), in a non-probabilistic sample of 473 patients with Substance Use Disorder, from the 8 Addiction Care Centers (CAD) of the Madrid City Council. Their demographic, habits and health characteristics, IgM and IgG for SARS-CoV-2, previous PCR, presence of symptoms, contact with COVID-19 cases were described, and multivariate analysis was performed using binary logistic regression. RESULTS: 5.1% of the users had positive serology for SARS-CoV-2 (5.8% in men and 2.7% in women). The patients with the highest percentage of seropositivity were between 50-59 years old (8.3%), being the most prevalent main substance consumed alcohol (7.4%). Having a previous positive CRP showed a significant odds ratio (OR) regarding being seropositive in the frequentist analysis. CONCLUSIONS: The highest seroprevalence rate occurred among men, epidemiologically known factors being the ones that showed the greatest strength of association. The CAD seropositive user profile was a man at the age of 50, an alcohol user and without comorbidities. No characteristic related to substance use was found to justify the difference in risk of infection with the general population.

OBJETIVO: Los pacientes con adicción son un colectivo vulnerable en el que apenas hay datos sobre la infección y gravedad de la COVID-19. El objetivo de este estudio fue analizar la seroprevalencia frente a SARS-CoV-2 en usuarios en tratamiento por adicciones en Madrid y describir los factores relacionados con la infección en este colectivo. METODOS: Estudio descriptivo transversal (junio-octubre 2020), en una muestra no probabilística de 473 pacientes con Trastorno por Uso de Sustancias, de los 8 Centros de Atención a las Adicciones (CAD) del Ayuntamiento de Madrid. Se describieron sus características demográficas, de hábitos y de salud, IgM e IgG para SARS-CoV-2, PCR previa, presencia de síntomas, contacto con casos de COVID-19 y se realizó análisis multivariante mediante regresión logística binaria. RESULTADOS: El 5,1% de los usuarios tuvo serología positiva para SARS-CoV-2 (5,8% en hombres y 2,7% en mujeres). Los pacientes con mayor porcentaje de seropositividad tenían entre 50-59 años (8,3%), siendo la sustancia principal consumida más prevalente el alcohol (7,4%). Tener PCR positiva previa mostró una odds ratio (OR) significativa respecto a ser seropositivo en el análisis frecuentista. CONCLUSIONES: La mayor tasa de seroprevalencia se dio entre los hombres, siendo los factores epidemiológicamente conocidos los que más fuerza de asociación mostraron. El perfil de usuario seropositivo de los CAD fue un hombre en la década de los 50, consumidor de alcohol y sin comorbilidades. No se encontró característica alguna relacionada con el consumo de sustancias que justificase la diferencia de riesgo de infección con la población general.

CIBERER: Spanish national network for research on rare diseases: A highly productive collaborative initiative.

CIBER (Center for Biomedical Network Research; Centro de Investigación Biomédica En Red) is a public national consortium created in 2006 under the umbrella of the Spanish National Institute of Health Carlos III (ISCIII). This innovative research structure comprises 11 different specific areas dedicated to the main public health priorities in the National Health System. CIBERER, the thematic area of CIBER focused on rare diseases (RDs) currently consists of 75 research groups belonging to universities, research centers, and hospitals of the entire country. CIBERER's mission is to be a center prioritizing and favoring collaboration and cooperation between biomedical and clinical research groups, with special emphasis on the aspects of genetic, molecular, biochemical, and cellular research of RDs. This research is the basis for providing new tools for the diagnosis and therapy of low-prevalence diseases, in line with the International Rare Diseases Research Consortium (IRDiRC) objectives, thus favoring translational research between the scientific environment of the laboratory and the clinical setting of health centers. In this article, we intend to review CIBERER's 15-year journey and summarize the main results obtained in terms of internationalization, scientific production, contributions toward the discovery of new therapies and novel genes associated to diseases, cooperation with patients' associations and many other topics related to RD research.