[Self-sense and experiences of physical activity in breast cancer survivors: Qualitative evidence synthesis]. / Significados y experiencias de actividad física en mujeres sobrevivientes de cáncer de mama: síntesis cualitativa.

Breast cancer has a high incidence rate and a negative impact on women's lives. The practice of physical activity (PA) has shown strong evidence in controlling the side effects associated with the disease and its treatment. However, having an active lifestyle is influenced by socio-health inequities. The objective was to analyze the categories related to the meanings and perceived experiences with PA in breast cancer survivors (BCS). Protocol https://osf.io/7fwbs/. Articles describing the meanings of PA in BCS published after 2010 were included. Fourteen articles were analyzed using line-by-line coding. The emerging categories were: 1)PA as a strategy to re-signify and empower the body. 2)Cancer means a change in PA trajectories. 3)PA is a tool for a healthy and functional body in everyday life.

Prediction model for lower limb amputation in hospitalized diabetic foot patients using classification and regression trees.

BACKGROUND: The decision to perform amputation of a limb in a patient with diabetic foot ulcer (DFU) is not an easy task. Prediction models aim to help the surgeon in decision making scenarios. Currently there are no prediction model to determine lower limb amputation during the first 30 days of hospitalization for patients with DFU. METHODS: Classification And Regression Tree analysis was applied on data from a retrospective cohort of patients hospitalized for the management of diabetic foot ulcer, using an existing database from two Orthopaedics and Traumatology departments. The secondary analysis identified independent variables that can predict lower limb amputation (mayor or minor) during the first 30 days of hospitalization. RESULTS: Of the 573 patients in the database, 290 feet underwent a lower limb amputation during the first 30 days of hospitalization. Six different models were developed using a loss matrix to evaluate the error of not detecting false negatives. The selected tree produced 13 terminal nodes and after the pruning process, only one division remained in the optimal tree (Sensitivity: 69%, Specificity: 75%, Area Under the Curve: 0.76, Complexity Parameter: 0.01, Error: 0.85). Among the studied variables, the Wagner classification with a cut-off grade of 3 exceeded others in its predicting capacity. CONCLUSIONS: Wagner classification was the variable with the best capacity for predicting amputation within 30 days. Infectious state and vascular occlusion described indirectly by this classification reflects the importance of taking quick decisions in those patients with a higher compromise of these two conditions. Finally, an external validation of the model is still required. LEVEL OF EVIDENCE: III.

Measurement of event-related potentials from electroencephalography to evaluate emotional processing in Fibromyalgia Syndrome: A systematic review and meta-analysis.

OBJECTIVE: The present systematic review and meta-analysis intended to: 1) determine the extent of abnormalities in emotional processing linked to emotional event-related potentials (ERPs) in Fibromyalgia Syndrome (FMS) and 2) integrate data from similar emotional tasks into a meta-analysis to clearly demonstrate the scientific and clinical value of measuring emotional ERPs by electroencephalography (EEG) in FMS. METHODS: A systematic review and meta-analysis of studies comparing emotional processing indicated by ERPs in FMS patients and healthy controls was conducted. Fifteen articles were included in the systematic review after applying the eligibility criteria. RESULTS: Nine articles demonstrated disturbances in emotional processing in FMS. These emotional disturbances were distributed over the whole range of ERP latencies, mainly over central, parietal, temporal and occipital areas. Despite of this, quantitative analysis revealed only significant differences in N250 and LPP/LPC between FMS patients and healthy controls, with smaller LPP/LPC and greater N250 seen in FMS. DISCUSSION: N250 and LPP/LPC seem to be the ERPs with the greatest potential to determine emotional alterations in FMS. These ERPs are related to complex cognitive processes such as decoding features relevant to affect recognition (N250) as well differentiation between emotions, persistent engagement, conflict resolution or evaluation of emotional intensity (LPC/LPP). However, differences in task setup had an important impact on the variation of ERP outcomes. Systematization of protocols and tasks is indispensable for future studies.

Estimating tongue deformation during laryngoscopy using a hybrid FEM-multibody model and intraoperative tracking - a cadaver study.

Throat tumour margin control remains difficult due to the tight, enclosed space of the oral and throat regions and the tissue deformation resulting from placement of retractors and scopes during surgery. Intraoperative imaging can help with better localization but is hindered by non-image-compatible surgical instruments, cost, and unavailability. We propose a novel method of using instrument tracking and FEM-multibody modelling to simulate soft tissue deformation in the intraoperative setting, without requiring intraoperative imaging, to improve surgical guidance accuracy. We report our first empirical study, based on four trials of a cadaveric head specimen with full neck anatomy, yields a mean TLE of 10.8 ± 5.5 mm, demonstrating methodological feasibility.

Can We Do Anything Else before Removing a Button Battery from the Esophagus?-Hyaluronic Acid.

OBJECTIVE: This article tests the protective effect of a commercially available mixture of hyaluronic acid, chondroitin sulfate, and poloxamer 407 on the damage caused by the exposure of esophageal mucosa to button batteries in an animal model. METHODS: Experimental study. Sixty porcine esophageal samples were distributed in three groups: control (CG), exposure (EG), and exposure-protection (EPG). In EG and EPG, one CR2032 button battery per sample was inserted, both were subdivided into 2-, 4-, 6-, and 24-hour exposure subgroups, with subsequent battery removal. EPG samples were irrigated with the solution 1 hour after battery exposure. Esophageal pH and final voltage of the battery were measured. RESULTS: pH in CG remained stable. No significant differences in pH at 1 hour were found between EG and EPG. In EPG, the pH of the mucosa exposed to the anode was lower than in GE at 2 hours (12.44 vs. 11.89, p = 0.203) and 4 hours (13.78 vs. 11.77, p < 0.0001). In the cathode pH was significantly higher in EG at 2 hours (2.5 vs. 4.11, p < 0.0001), 4 hours (2.33 vs. 4.78, p < 0.0001), and 6 hours (2.17 vs. 2.91, p < 0.0001). Significant voltage reduction at 1 hour was found in EG compared to EPG (0.48 vs. 1.08 V, p = 0.004). CONCLUSION: Exposure to hyaluronic acid solution buffers the acidification on the side exposed to the cathode and basification on the anode. This effect can be maintained up to 3 to 5 hours, even after stopping its application. Our results suggest that a solution containing hyaluronic acid could be used as an esophageal protector after accidental ingestion of button batteries.

Return to full duty after anterior cruciate ligament reconstruction surgery in military personnel: A meta-analysis. / Retorno a la actividad completa tras cirugía de reconstrucción de ligamento cruzado anterior en personal militar: metaanálisis.

OBJECTIVE: A meta-analysis was carried out to evaluate the clinical-functional results of anterior cruciate ligament surgery in military population, as well as the complications associated with it. MATERIAL AND METHOD: Three major database sources up to December 2022 (PubMed, Google Scholar, and ScienceDirect) were searched for outcomes after anterior cruciate ligament surgery in military personnel. The systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses -PRISMA- standards, and the inclusion criteria following the PICO strategy. Data from included studies were analyzed using Review Manager 5.4 software. RESULTS: A total of 7 retrospective studies were selected. The general rate of return to full duty in military personnel was 62.3% (61.5% for the non-officer group vs. 68.3% for the officer group) without this difference being significant (p=0.92). The general rate of meniscal injury in the military was 58.8%, without this difference being significant (p=0.88). The homogeneity in both cases was good (I2=0%, p=0.99). CONCLUSION: Return to full military duty can be used in the military population as a marker of success after anterior cruciate ligament reconstruction. It should be noted that a large number of military personnel experience permanent activity limitations that prevent full return to service.

[Translated article] Return to full duty after anterior cruciate ligament reconstruction surgery in military personnel: A meta-analysis.

OBJECTIVE: A meta-analysis was carried out to evaluate the clinical-functional results of anterior cruciate ligament surgery in military population, as well as the complications associated with it. MATERIAL AND METHOD: Three major database sources up to December 2022 (PubMed, Google Scholar, and ScienceDirect) were searched for outcomes after anterior cruciate ligament surgery in military personnel. The systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses -PRISMA- standards, and the inclusion criteria following the PICO strategy. Data from included studies were analysed using Review Manager 5.4 software. RESULTS: A total of seven retrospective studies were selected. The general rate of return to full duty in military personnel was 62.3% (61.5% for the non-officer group versus 68.3% for the officer group) without this difference being significant (p=0.92). The general rate of meniscal injury in the military was 58.8%, without this difference being significant (p=0.88). The homogeneity in both cases was good (I2=0%, p=0.99). CONCLUSION: Return to full military duty can be used in the military population as a marker of success after anterior cruciate ligament reconstruction. It should be noted that a large number of military personnel experience permanent activity limitations that prevent full return to service.

A two-component model of hair cortisol concentration in fibromyalgia: Independent effects of pain chronicity and severity.

BACKGROUND: Fibromyalgia (FM) is a chronic pain disorder of unknown aetiopathogenesis, in which the role of activity of the hypothalamic-pituitary-adrenal (HPA) axis is not clearly established. METHODS: This study analysed the modulatory effects of disease chronicity and severity on cortisol levels. Hair cortisol concentrations (HCC) and clinical evaluation data (pain severity, impact of FM on daily activities, depression, anxiety, fatigue and insomnia) were collected from 47 female patients with FM and 36 healthy women (HW). RESULTS: The results showed that disease chronicity, with a negative effect, and symptom severity, with a positive effect, were independent predictors of HCC. Patients with a shorter disease duration had higher HCC than patients with a longer disease duration and healthy participants. Furthermore, patients with greater symptom severity had higher HCC than those patients with lower clinical severity and healthy participants. While disease chronicity in FM was associated with a decrease in HCC, clinical severity increased HCC. CONCLUSIONS: These results support the existence of a dysfunction in the regulation of the HPA axis in FM and its possible contribution to chronic pain development. SIGNIFICANCE: This is the first study to assess hair cortisol concentrations in a specific sample of patients with fibromyalgia (FM). This method is especially useful for the assessment of long-term regular cortisol excretion. Results showed a two-component model for explaining cortisol levels: disease chronicity, with a negative effect, and symptom severity, with a positive effect. This suggests that severe pain/stress evokes higher cortisol levels at earlier stages of FM, while in the longer term a decrease in cortisol levels was observed.

Decoding clinical and molecular pathways of liver dysfunction in Psoriatic Arthritis: Impact of cumulative methotrexate doses.

BACKGROUND: The occurrence of liver abnormalities in Psoriatic Arthritis (PsA) has gained significant recognition. Identifying key factors at the clinical and molecular level can help to detect high-risk patients for non-alcoholic fatty liver disease in PsA. OBJECTIVES: to investigate the influence of PsA and cumulative doses of methotrexate on liver function through comprehensive in vivo and in vitro investigations. METHODS: A cross-sectional study involving 387 subjects was conducted, 200 patients with PsA, 87 NAFLD-non-PsA patients, and 100 healthy donors (HDs), age and sex-matched. Additionally, a retrospective longitudinal study was carried out, including 83 PsA patients since initiation with methotrexate. Detailed clinical, and laboratory parameters along with liver disease risk were analyzed. In vitro, experiments with hepatocyte cell line (HEPG2) were conducted. RESULTS: PsA patients present increased liver disease risk associated with the presence of cardiometabolic comorbidities, inflammatory markers, onychopathy, and psoriasis. The treatment with PsA serum on hepatocytes encompassed inflammatory, fibrotic, cell stress, and apoptotic processes. At the molecular level, methotrexate impacts liver biology, although the cumulative doses did not affect those alterations, causing any potential damage to liver function at the clinical level. Finally, anti-PDE-4 or anti-JAK decreased the inflammatory profile induced by PsA serum on hepatocytes. CONCLUSION: 1)This study identifies the complex link between liver disease risk, comorbidities, and disease-specific features in PsA patients. 2)Methotrexate dose in PsA patients had no significant effect on liver parameters, confirmed by hepatocyte in vitro studies. 3)Anti-PDE-4 and anti-JAK therapies show promise in reducing PsA serum-induced hepatocyte activation, potentially aiding liver complication management.

Biofortification of Broccoli Microgreens (Brassica oleracea var. italica) with Glucosinolates, Zinc, and Iron through the Combined Application of Bio- and Nanofertilizers.

There is a severe need to develop a sustainable, affordable, and nutritious food supply system. Broccoli microgreens have attracted attention due to their rich nutritional content and abundant bioactive compounds, constituting an important opportunity to feed the ever-increasing population and fight global health problems. This study aimed to measure the impact of the combined application of biofertilizers and zinc and iron nanofertilizers on plant growth and the biofortification of glucosinolates (GLSs) and micronutrients in broccoli microgreens. Biofertilizers were based on plant growth-promoting (PGP) bacterial consortia previously isolated and characterized for multiple PGP traits. Nanofertilizers consisted of ZnO (77 nm) and γ-Fe2O3 (68 nm) nanoparticles synthesized with the coprecipitation method and functionalized with a Pseudomonas species preparation. Treatments were evaluated under seedbed conditions. Plant growth parameters of plant height (37.0-59.8%), leaf diameter (57.6-81.1%) and fresh weight (112.1-178.0%), as well as zinc (122.19-363.41%) and iron contents (55.19-161.57%), were mainly increased by nanoparticles subjected to the functionalization process with Pseudomonas species and uncapped NPs applied together with the biofertilizer treatment. Regarding GLSs, eight compounds were detected as being most positively influenced by these treatments. This work demonstrated the synergistic interactions of applying ZnO and γ-Fe2O3 nanofertilizers combined with biofertilizers to enhance plant growth and biofortify micronutrients and glucosinolates in broccoli microgreens.

Impact of digestive-surgical cross-disciplinary management in patients with esophageal atresia. / Impacto del manejo multidisciplinar digestivo-quirúrgico en los pacientes con atresia de esófago.

OBJECTIVE: The objective of this study was to analyze whether patients undergoing esophageal atresia (EA) surgery benefit from a cross-disciplinary follow-up program, based on current clinical guidelines, implemented in our institution. MATERIALS AND METHODS: An observational, analytical, retrospective study of patients undergoing EA surgery from 2012 to 2022 was carried out. The results of a joint pediatric surgery and gastroenterology consultation program -which was implemented in 2018 and applies a protocol based on the new ESPGHAN-NASPGHAN guidelines- were analyzed. Patients were divided according to whether they had been treated before or after 2018. Quantitative variables -follow-up losses, anti-reflux treatment initiation and duration, and enteral nutrition initiation- and qualitative variables -prevalence of gastroesophageal reflux, anti-reflux surgery, respiratory infections, anastomotic stenosis, re-fistulizations, dysphagia, impaction episodes, need for gastrostomy, and endoscopic results- were compared. RESULTS: 38 patients were included. 63.2% had gastroesophageal reflux. 97.4% received anti-reflux treatment in the first year of life, with treatment being subsequently discontinued in 47.4%. Discontinuation time decreased by a mean of 24 months following program implementation (p< 0.05). A 4.6-fold increase in the frequency of pH-metries was noted following program implementation. The protocol standardized endoscopies in asymptomatic patients when they turn 5 and 10 years old. 25 endoscopies with biopsy were carried out after 2018, with histological disorders being detected in 28% of them. The number of follow-up losses significantly decreased following protocol implementation (p< 0.05). CONCLUSIONS: Digestive-surgical cross-disciplinary follow-up of EA patients has a positive impact on patient progression. Applying the guidelines helps optimize treatment and early diagnosis of complications.

OBJETIVOS: El objetivo de este estudio es analizar si los pacientes intervenidos de atresia de esófago (AE) se benefician de un programa de seguimiento multidisciplinar, basado en las guías clínicas actuales, implantado en nuestro centro. MATERIAL Y METODOS: Estudio retrospectivo, observacional y analítico incluyendo los pacientes intervenidos de AE entre 2012 y 2022. Se analizaron los resultados de la implantación en 2018 de un programa de consultas conjuntas de gastroenterología y cirugía pediátrica aplicando un protocolo basado en las nuevas guías ESPGHAN-NASPGHAN. Se dividieron a los pacientes tratados antes y después de 2018 y se compararon las variables cuantitativas: pérdidas de seguimiento, inicio y duración del tratamiento antirreflujo e inicio de nutrición enteral, y cualitativas: prevalencia de reflujo gastroesfoágico, realización de cirugía antirreflujo, infecciones respiratorias, estenosis de la anastomosis, refistulizaciones, disfagia, episodios de impactación, necesidad de gastrostomía y resultados de las endoscopias. RESULTADOS: Se incluyeron 38 pacientes. Un 63,2% presentaron reflujo gastroesofágico. El 97,4% tomaron tratamiento antirreflujo el primer año de vida que posteriormente se retiró en el 47,4%. El tiempo de retirada se redujo una media de 24 meses tras la aplicación del programa (p< 0,05). Se realizaron 4,6 veces más pHmetrías tras la implantación del programa. El protocolo estandarizó la realización de endoscopias en pacientes asintomáticos al cumplir 5 y 10 años. Se realizaron 25 endoscopias con tomas de biopsia después de 2018, detectando alteraciones histológicas en un 28%. El número de pérdidas de seguimiento se redujo de forma significativa tras la implantación del protocolo (p< 0,05). CONCLUSIONES: El seguimiento multidisciplinar digestivo-quirúrgico de los pacientes con AE genera un impacto positivo en su evolución. La aplicación de las guías facilita la optimización del tratamiento y el diagnóstico precoz de las complicaciones.

Development and validation of a clinical score for early diagnosis of constipation in critically ill children.

Constipation affects almost 50% of critically ill pediatric patients and is related to their morbidity and mortality. However, little attention is paid to it and it is diagnosed late and when there are already complications. The objective of this study is to develop and validate a score to identify critically ill children with high risk of constipation 48 h after admission. A single center two phase-study was carried out; the first one (retrospective observational study) to develop the score and the second one to validate it in another prospective observational study. Children between 15 days of life and 18 years old admitted to the PICU for more than 3 days were included. Demographic and clinical data during the first 48 h after PICU admission were collected. Univariate and multivariate analysis and ROC curves were used to develop and validate the score. Data from 145 patients (62.8% boys) with a mean age of 34.9 ± 7.3 months were used to develop the score. Independent factors identified to develop the score were: weight > 7 kg, admission to PICU after surgery, need of vasoconstrictors, doses of fentanyl ≥ 2 mcg/kg/h, and initiation of enteral nutrition later than 48 h after admission. Two cut-off values were identified to set low constipation risk (< 5.7 points) and high constipation risk (> 6.2 points). This score was validated in 124 patients showing a sensibility of 63.2%, specificity of 95.5% and a positive/negative predictive values (P/NPV) of 100% and 82.1% respectively to identify constipated patients. This is the first score to identify high constipation risk in critically ill children. This score is easy to apply, and internal validation has shown a PPV of 100%.

Diagnosis and treatment of primary thyroid lymphoma from a surgical perspective: a multi-institutional study.

PURPOSE: Surgery of primary thyroid lymphoma (PTL) has been mostly limited to diagnostic work-up. This study aimed to further study its potential role. METHODS: This was a retrospective study from a multi-institutional registry of PTL patients. Clinical, diagnostic work-up (fine needle aspiration, FNA; core needle biopsy, CoreNB), contribution of surgery (open surgical biopsy, OpenSB; thyroidectomy), histology subtype, and outcome data were evaluated. RESULTS: Some 54 patients were studied. Diagnostic work-up included FNA in 47 patients, CoreNB in 11, and OpenSB in 21. CoreNB yielded the best sensitivity (90.9%). Thyroidectomy was performed in 14 patients with other diagnosis (incidental PTL), in 4 for diagnosis and in 4 for elective treatment of PTL. Incidental PTL was associated with not performed FNA nor CoreNB (OR 52.5; P = 0.008), mucosa-associated lymphoid tissue (MALT) subtype (OR 24.3; P = 0.012), and Hashimoto's thyroiditis (OR 11.1; P = 0.032). Lymphoma-related death (10 cases) mostly occurred within the first year after diagnosis and was associated with diffuse large B-cell (DLBC) subtype (OR 10.3; P = 0.018) and older patients (OR 1.08 for every 1-year increase; P = 0.010). There was a trend towards lower mortality rate in patients receiving thyroidectomy (2/22 versus 8/32, P = 0.172). CONCLUSION: Incidental PTL accounts for most of thyroid surgery cases and are associated with incomplete diagnostic work-up, Hashimoto's thyroiditis and MALT subtype. CoreNB appears to be the best tool for diagnosis. Most of PTL deaths occurred during the first year after diagnosis and mostly related to systemic treatment. Age and DLBC subtype are poor prognostic factors.

Predictive factors of destination at discharge after spinal cord injury.

INTRODUCTION: One of the main goals of the rehabilitation of patients with spinal cord injury (SCI) is the reintegration of the individual to their family, social, and work setting. The objective of this study was to identify the factors that determine the discharge destination after a traumatic spinal cord injury. MATERIAL AND METHODS: We conducted a retrospective descriptive study of 305 patients with SCI who completed the rehabilitation treatment at the spinal injury unit of Hospital Insular de Gran Canaria between 2001 and 2018. RESULTS: During the study period, we observed an increase in the number of patients referred to long-term care centres, from 9.14% between 2001 and 2010 to 18.4% between 2011 and 2018 (P < .01). Of 20 variables that presented a significant association with destination at discharge in the univariate study, 7 presented a significant association in the multivariate study: age (OR: 1.05; 95% CI, 1.02-1.08), living with a partner (OR: 0.26; 95% CI, 0.09-0.76), residing on another island (OR: 3.57; 95% CI, 1.32-9.63), smoking (OR: 3.44; 95% CI, 1.26-9.44), diabetes (OR: 6.51; 95% CI, 1.46-29.02), history of psychiatric disorders (OR: 3.79; 95% CI, 1.31-10.93), and scores on the Spinal Cord Independence Measure-III (SCIM-III) (OR: 0.48; 95% CI, 0.33-0.69). CONCLUSIONS: Our findings identified advanced age, living on the island of Tenerife, not being married, smoking, type 2 diabetes mellitus, history of psychiatric disorders, and low SCIM-III scores as predictive factors of referral to a long-term care centre in patients with traumatic SCI in the Canary Islands.

An optimized MNK1b aptamer, apMNKQ2, and its potential use as a therapeutic agent in breast cancer.

Breast cancer is the most commonly diagnosed and leading cause of cancer death among women worldwide. Mitogen-activated protein kinase-interacting kinases (MNKs) promote the expression of several oncogenic proteins and are overexpressed in several types of cancer. In human cells, there are four isoforms of MNKs. The truncated isoform MNK1b, first described in our laboratory, has a higher basal activity and is constitutively active. Aptamers are emerging in recent years as potential therapeutic agents that show significant advantages over drugs of other nature. We have previously obtained and characterized a highly specific aptamer against MNK1b, named apMNK2F, with a dissociation constant in the nanomolar range, which produces significant inhibition of proliferation, migration, and colony formation in breast cancer cells. Furthermore, its sequence analysis predicted two G-quadruplex structures. In this work, we show the optimization process of the aptamer to reduce its size, improving its stability. The obtained aptamer, named apMNKQ2, is able to inhibit proliferation, colony formation, migration, and invasion in breast cancer cells. In murine models of breast cancer, apMNKQ2 has demonstrated its efficacy in reducing tumor volume and the number of metastases. In conclusion, apMNKQ2 could be used as an anti-tumor drug in the future.

Histomorphological evaluation, cell proliferation and endothelial immunostaining in oral and maxillofacial myofibroblastic lesions.

BACKGROUND: Myofibroblasts (MF) are mesenchymal cells with features of both fibroblasts and smooth muscle cells. Although these are usually reactive cells, they can lead to myofibroblastic tumors that may share clinical and histomorphological characteristics but with different prognosis. The aim of this study is to perform a histomorphological evaluation as well as to compare and evaluate two different cell proliferation immunomarkers and two endothelial markers in a group of oral and maxillofacial myofibroblastic lesions (MFL). MATERIAL AND METHODS: Cross-sectional and retrospective study. Demographic, clinical, histomorphological and immunohistochemical characteristics of 39 cases of MFL were analyzed. Immunohistochemical reactions were performed with the Ki67, MCM2, CD34 and CD105 antibodies. Kruskal-Wallis test and Spearman correlation analysis were used. RESULTS: Four cases of nodular fasciitis (NF), 18 myofibromas (My), 6 desmoplastic fibromas (DF), 7 inflammatory myofibroblastic tumors (IMT) and 4 myofibroblastic sarcomas (MFS) were studied. There were twenty women (51.2%); the median age was 13 [Q1-Q3: 8-24] years and most cases occurred in the mandible (48.7%). A statistically significant difference with MCM2 immunostaining (p=0.0221) was observed between the MFL; furthermore, a correlation between CD34 and CD105 immunostaining in NF (p <0.0001) and IMT (p=0.0408), between MCM2 and CD34 in IMT (p=0.0362) and between MCM2 and CD105 in MFS (p <0001) were found. CONCLUSIONS: MCM2 immunostaining could assess more clearly the cell growth fraction in MFL. The correlation between MCM2 and CD34 in IMT and between MCM2 and CD105 in MFS are indicative of the high activity of these lesions. These results emphasize the importance of the studied immunohistochemistry markers as possible tools for a better characterization of some of the MFL.

Extended totally extraperitoneal (eTEP) treatment for lateral primary and incisional hernias. New approach to old problems.

PURPOSE: To describe the eTEP approach for treating lateral primary and incisional hernia and show its results in a prospective series of cases. METHODS: A descriptive prospective study with patients treated surgically for lateral hernias using eTEP approach. Every patient was operated by the same surgeon from November 2018 to December 2021. Inclusion criteria were primary and incisional hernia, lateral and W1 and W2 sized using the EHS classification. Exclusion criteria were W3 hernia, loss of domain, need to remove previous mesh, dystrophic or ulcerative skin, history of previous complex surgery. Details of the surgical technique are described. RESULTS: 34 patients were operated. Median age was 65 years old and BMI, 29.9 (22.1-47.1). There were several locations being the most frequent L3 in 18 patients. The median length was 41 mm (10-129) and width, 44 mm (10-97). The median of defect-mesh ratio was 5.05 (0.9-447.64). TAR was practised in 21 patients (61.8%). Only one patient suffered a clinically relevant complication, being a hematoma (Dindo-Clavien II). 50% of patients were operated in ambulatory surgery. After a median follow-up of 13.5 months, only one recurrence has been reported (2.9%). CONCLUSION: eTEP to treat lateral hernias is feasible and reproducible showing good results in terms of hernia recurrence and complications. A further prospective randomized clinical trial is needed to support these results.