[Autologous blood pleurodesis for treatment of spontaneous pneumothorax and persistent air leak in pediatric patients]. / Pleurodesis con sangre autóloga en el tratamiento del neumotórax en pacientes pediátricos.

AIM OF THE STUDY: Recurrent spontaneous pneumothorax (SP) and persistent air leak (PAL) are a therapeutic challenge in some patients. Autologous blood pleurodesis (ABP) is an alternative treatment, but its usefulness in pediatric patients has not been determined yet. MATERIAL AND METHODS: Retrospective study of pediatric patients treated with ABP at our institution between 2010 and 2014, with special assessment of its indications, description of the technique, volume of blood used, complications and outcomes. RESULTS: During this period, 29 patients were treated for SP. 5 of them (17.2%) received ABP. Indications were: 2 patients with recurrent SP after thoracoscopic bullae resection and pleurodesis and 3 patients with PAL (1 after thoracoscopic bullae resection and 2 in lung transplantation candidates who were not suitable for surgery). Median age was 14.3 years (11.9-16.6) and volume of blood used was 50 ml (26-60). The air leak stopped in a median of 2.6 days (1-7). One patient needed a second ABP for PAL and another one presented an ipsilateral recurrence of SP after ABP. Follow up time was 2.21 years (0.49-3.42). No complications were observed. CONCLUSIONS: ABP is a cheap, safe and easy to perform procedure and may be considered as a therapeutic option in some pediatric patients with SP or PAL.

OBJETTIVOS: Los neumotórax recurrentes y la fuga aérea persistente (FAP) plantean dificultades terapéuticas en determinados pacientes. La pleurodesis con sangre autóloga (PSA) constituye una alternativa en su tratamiento, aunque su utilidad en pacientes pediátricos no ha sido determinada. MATERIAL Y METODOS: Estudio retrospectivo de los pacientes pediátricos tratados con PSA en nuestro centro entre los años 2010 y 2014, centrado en las indicaciones, descripción de la técnica de administración, cantidad de sangre empleada, complicaciones y resultados. RESULTADOS: Durante este periodo, 29 pacientes presentaron neumotórax espontáneos. En 5 de ellos (17,2%) se realizó PSA como método de rescate. Las indicaciones fueron: 2 recidivas de neumotórax tras resección de bullas y pleurodesis y 3 casos de fuga aérea persistente (1 tras resección toracoscópica de bullas subpleurales y en 2 candidatos a trasplante pulmonar con bullas en los que se descartó la cirugía). La mediana de edad fue de 14,3 años (11,9-16,6) y la cantidad de sangre empleada 50 ml (26-60). La fuga aérea se resolvió en una media de 2,6 días (1-7). Un paciente requirió una nueva PSA por persistencia de fuga aérea tras la primera administración y otro presentó una recurrencia posterior del neumotórax. El tiempo de seguimiento fue de 2.21 años (0,49-3,42). No se describieron otras complicaciones. CONCLUSIONES: La PSA es un método de fácil aplicación, seguro y económico que puede ser considerado como opción terapéutica de rescate en determinados pacientes pediátricos con neumotórax o fuga aérea persistente.

Yellow and orange in cutaneous lesions: clinical and dermoscopic data.

Colour of the lesions is clue for the clinical and dermoscopic diagnosis. Nevertheless, we have detected in the literature an uneven relevance of the colours as a diagnostic criterion. Thus, while red, brown and blue have taken important role in dermoscopic descriptions, other like yellow and orange have been given much less importance. This article reviews those lesions in which the yellow and orange colours have been considered constitutive or essential for diagnosis, and on the other hand it emphasizes the entities in which may appear these colours and are not well reflected in the literature. We believe that organize all this information will help us in a better understanding of these pathologies.

[Spontaneous pneumothorax in children: factors associated with their recurrence]. / Neumotórax espontáneo en la edad pediátrica: factores asociados a su recidiva.

INTRODUCTION: Recurrence of spontaneous pneumothorax (SP) is more frequent in pediatric patients. The purpose of our study was to identify factors associated with this recurrence. MATERIAL AND METHODS: Retrospective review of the chart of patients with SP treated at our institution between 2004 and 2014. Statistic methods (χ2 and logistic regression) were used analyzing age, gender, side and size of pneumothorax and therapeutic approach as possible predictive factors of SP recurrence. RESULTS: A total of 81 SP cases in 43 patients (29 men, 14 women) were reviewed: 50 primary (PSP) and 31 secondary (SSP). Median age at presentation was 15,1 years (0.5-18.59). Follow up was 3.52 years (0.21-18.59). Twenty-three cases (28.4%) underwent surgery (22 thoracoscopies, 1 thoracotomy), consisting of bleb resection with abrasive and chemical pleurodesis. Ipsilateral recurrence after surgery was 21.7% (22.2% in PSP, 20% in SSP, p = 0.096) and 41.4% after non-surgical treatment. Age was a risk factor for recurrence (p= 0.049; OR = 1.16), especially between 10 and 15 years (44.6% in front of 19%, p = 0.013). Male gender and size >20% were associated with higher recurrence risk in SSP that received non-surgical treatment (p<0.05). CONCLUSIONS: Recurrences of SP in children are frequent even after surgical treatment. Age (preadolescence and early adolescence), male gender and initial size of pneumothorax may be factors associated with higher recurrence risk.

INTRODUCCION: Las recurrencias de los neumotórax espontáneos (NE) son más frecuentes en niños que en adultos. Nuestro objetivo es analizar qué factores pueden estar asociados a su recidiva. MATERIAL Y METODOS: Análisis retrospectivo de los casos de NE tratados en nuestro centro entre 2004 y 2014. Se utilizaron métodos estadísticos (χ2 y regresión logística) para identificar factores asociados a su recurrencia analizando edad, sexo, lateralidad, tamaño del neumotórax y tratamiento recibido. RESULTADOS: Se recogieron 81 episodios en 43 pacientes (29 hombres, 14 mujeres): 50 primarios y 31 secundarios (14 pacientes: 10 procesos bronquíticos, 1 displasia broncopulmonar, 1 fibrosis quística y 2 fibrosis pulmonares) con una mediana de edad de 15,1 años (0,5-18,59). El seguimiento fue de 3,52 años (0,21-9,93). Veintitrés casos (28,4%) fueron intervenidos (22 toracoscopias, 1 toracotomía), realizándose resección de bullas asociada a pleurodesis abrasiva. La tasa de recidiva ipsilateral tras la cirugía fue del 21,7% (22,2% en los primarios y 20% en los secundarios, p = 0,92) y del 41,4% en pacientes no intervenidos (p = 0,096). La edad se comportó como factor de riesgo para la recidiva (p = 0,049; OR = 1,16), principalmente entre los 10 y los 15 años (44,6% frente al 19%, p = 0,013). El sexo masculino y el tamaño >20% se asociaron a la recidiva de los NE secundarios no intervenidos (p<0,05). CONCLUSIONES: Las recurrencias de los NE en niños son frecuentes incluso tras la cirugía. La preadolescencia y el inicio de la adolescencia, el sexo masculino y el tamaño inicial del neumotórax pueden ser factores asociados a un mayor índice de recidiva.

Integration of conflict into integrative taxonomy: fitting hybridization in species delimitation of Mesocarabus (Coleoptera: Carabidae).

In species differentiation, characters may not diverge synchronously, and there are also processes that shuffle character states in lineages descendant from a common ancestor. Species are thus expected to show some degree of incongruence among characters; therefore, taxonomic delimitation can benefit from integrative approaches and objective strategies that account for character conflict. We illustrate the potential of exploiting conflict for species delimitation in a study case of ground beetles of the subgenus Carabus (Mesocarabus), where traditional taxonomy does not accurately delimit species. The molecular phylogenies of four mitochondrial and three nuclear genes, cladistic analysis of the aedeagus, ecological niche divergence and morphometry of pronotal shape in more than 500 specimens of Mesocarabus show that these characters are not fully congruent. For these data, a three-step operational strategy is proposed for species delimitation by (i) delineating candidate species based on the integration of incongruence among conclusive lines of evidence, (ii) corroborating candidate species with inconclusive lines of evidence and (iii) refining a final species proposal based on an integrated characterization of candidate species based on the evolutionary analysis of incongruence. This procedure provided a general understanding of the reticulate process of hybridization and introgression acting on Mesocarabus and generated the hypothesis of seven Mesocarabus species, including two putative hybrid lineages. Our work emphasizes the importance of incorporating critical analyses of character and phylogenetic conflict to infer both the evolutionary history and species boundaries through an integrative taxonomic approach.

Treatment of thyroglossal cyst using Koempel's technique: initial experience. / Tratamiento del quiste tirogloso mediante técnica de Koempel. Experiencia inicial.

INTRODUCTION: In spite of being inaccurate in terms of suprahyoid dissection, Sistrunk's procedure is the gold-standard technique in the treatment of thyroglossal cyst. Since it was first described in 2014, the modifications introduced by Koempel have allowed for a more reproducible suprahyoid approach. We present our initial experience with this technique. METHODS: A retrospective study of patients with thyroglossal cyst undergoing Koempel's technique in our institution from 2021 to 2022 was carried out. Demographic, clinical, and histological data was collected. RESULTS: In the study period, 5 patients -3 girls and 2 boys- underwent surgery. Median age and weight were 5 years (2-6) and 16 kg (14-25), respectively. All patients had suffered from previous infections, with 60% having cutaneous fistulization. In 2 patients, surgery was indicated following Sistrunk's procedure as a result of recurrence. Median operating time was 77 minutes (57-110), with the genioglossal muscle plane being identified in the 5 patients. No immediate complications were recorded, and diagnosis of thyroglossal cyst was histologically confirmed in all cases. One of the formerly recurrent patients had recurrence following surgery, but it was subclinical and incidentally diagnosed at control ultrasonography. The remaining patients had no recurrences after a median 8-month (1-12) follow-up period. CONCLUSIONS: Koempel's technique allows for a safe and reproducible approach of the suprahyoid segment. It is an attractive option in complicated cases as a result of previous infection or recurrence.

INTRODUCCION: La intervención de Sistrunk es el gold-standard en el tratamiento del quiste tirogloso pese a su imprecisión en cuanto a la disección suprahioidea. Tras su descripción en 2014, las modificaciones introducidas por Koempel, han permitido un abordaje suprahioideo más reproducible. Presentamos nuestra experiencia inicial con esta técnica. METODOS: Estudio retrospectivo de los pacientes con quiste tirogloso intervenidos mediante técnica de Koempel en nuestro centro en el periodo 2021-2022, recogiéndose datos demográficos, clínicos e histológicos. RESULTADOS: Durante el periodo de estudio se intervinieron 5 pacientes (3 mujeres/2 varones), con una mediana de edad y peso de 5 años (2-6) y 16 kg (14-25) respectivamente. Todos los casos habían sufrido infecciones previas presentando fistulización cutánea el 60%. En 2 de los pacientes se indicó la cirugía por recidiva tras intervención de Sistrunk. La mediana del tiempo quirúrgico fue de 77minutos (57-110) identificándose el plano del músculo geniogloso en los 5 pacientes. No hubo complicaciones inmediatas y el diagnóstico de quiste tirogloso se confirmó histológicamente en todos los casos. Uno de los pacientes del grupo con recidiva previa, presentó recidiva tras la intervención, siendo esta subclínica y diagnosticada incidentalmente tras ecografía de control. El resto de los pacientes no presentó ninguna recurrencia tras un seguimiento mediana de 8 meses (1-12). CONCLUSIONES: La técnica de Koempel permite un abordaje seguro y reproducible del segmento suprahioideo siendo una opción atractiva en casos complicados por infección o recidiva previa.

Urgent laparoscopic cholecystectomy as a result of acute calculous cholecystitis in Pediatrics. / Colecistectomía laparoscópica urgente por colecistitis aguda litiásica en Pediatría.

INTRODUCTION: In spite of the increase in the prevalence of cholelithiasis in the last decades, no recommendations regarding the best treatment of acute calculous cholecystitis (AC) in Pediatrics have been developed. CLINICAL CASE: 4-year-old, 20kg male patient with no significant history referred to our institution as a result of abdominal sepsis. The blood count showed leukocytosis, with normal hemoglobin and bilirubin levels, and a normal liver function. The abdominal ultrasonography revealed cholelithiasis, gallbladder hydrops, and an inflammatory process compatible with appendicular plastron. In the diagnostic laparoscopy, the appendix was macroscopically normal, and acute cholecystitis was observed. Given the patient's situation, and in cooperation with the General Surgery Department, laparoscopic cholecystectomy was carried out. The patient recovered uneventfully on hospitalization day 5 under piperacillin-tazobactam treatment. DISCUSSION: There are no recommendations regarding AC treatment in children. In septic patients, cooperation between general and pediatric surgeons allows urgent cholecystectomy to be considered as a safe option.

INTRODUCCION: Pese al aumento en la prevalencia de colelitiasis durante las últimas décadas, no se han desarrollado recomendaciones sobre el mejor tratamiento de la colecistitis aguda litiásica (CA) en Pediatría. CASO CLINICO: Paciente varón de 4 años y 20 kg de peso sin antecedentes de interés, que acude derivado por sepsis de origen abdominal. Analíticamente destaca leucocitosis con hemoglobina, función hepática y bilirrubina normales. La ecografía abdominal muestra colelitiasis, hidrops vesicular y proceso inflamatorio compatible con plastrón apendicular. En laparoscopia diagnóstica se observa apéndice macroscópicamente normal y colecistitis aguda. Ante la situación del paciente se realiza, conjuntamente con Cirugía General, colecistectomía laparoscópica. El paciente se recupera sin incidencias tras 5 días de ingreso bajo cobertura con piperacilina-tazobactam. COMENTARIOS: No existen recomendaciones sobre el tratamiento de la CA en niños. En los pacientes sépticos, la colaboración entre cirujanos pediátricos y cirujanos generales permite contemplar la colecistectomía urgente como una opción segura.

Management of splenic and/or hepatic pseudoaneurysm following abdominal trauma in pediatric patients. / Manejo del pseudoaneurisma esplénico y/o hepático después de un traumatismo abdominal en pediatría.

INTRODUCTION: Splenic and hepatic pseudoaneurysm (PA) is a rare arteriovenous injury that may occur following abdominal trauma. The most frequent complication of PA is late rupture, which can lead to hemodynamic instability. The objective of this study was to describe our experience in the management of visceral PA. MATERIAL AND METHODS: A retrospective study of patients under 15 years of age with blunt abdominal trauma associated with splenic and/or hepatic injury treated from 2012 to 2020 was carried out. PA formation and management were analyzed. All patients underwent CT-scan, which allowed trauma grade to be established, and also control contrast-enhanced ultrasonography (CEUS) in the first week following trauma. If PA was confirmed, angiography ± percutaneous embolization were performed. RESULTS: A total of 32 patients with blunt trauma were included. Mean age was 8.7 ± 3.2 years (2-15 years). 68.7% (n = 22) of patients were male. Median trauma grade was grade III (grades II-IV). 33.3% (n = 5/15) of patients developed splenic PA, and 5.8% (n = 1/17) of patients developed hepatic PA, with mean diagnostic time being 3.7 ± 3 (3-8) days. PA formation was associated with higher severity scores, with a mean difference of 15.6 ± 5.3 (95% CI: 4.37:26.14 p < 0.008). All PA cases - except for one, which required urgent splenectomy - were treated with embolization (85.7%) (n = 5/6). CONCLUSION: Visceral PA is underdiagnosed, with an incidence higher than reported. Imaging studies (CEUS) are required prior to discharge in the presence of severe trauma. Treatment remains controversial, but we recommend percutaneous embolization, with splenectomy being reserved for unstable patients.

INTRODUCCION: Los pseudoaneurismas (PA) esplénicos y hepáticos son lesiones arteriovenosas raras que se pueden desarrollar tras un traumatismo abdominal. La rotura tardía es su complicación más frecuente que puede conducir a inestabilidad hemodinámica. El objetivo del presente es presentar nuestra experiencia en el manejo de los PA viscerales. METODOLOGIA: Estudio retrospectivo en pacientes menores de 15 años con traumatismo abdominal cerrado con lesión esplénica y/o hepática, entre 2012-2020. Se analizó el desarrollo de PA y el manejo realizado. En todos los pacientes se realizó tomografía computarizada estableciendo el grado del traumatismo, y estudio control en la primera semana postratumatismo mediante ecografía con contraste (CEUS). Si se confirmaba un PA se procedió a angiograma ± embolización percutánea. RESULTADOS: Un total de 32 pacientes con traumatismo cerrado, edad media 8,7 ± 3,2 años (2-15 años), 68,7% (n = 22) hombres y mediana de grado de traumatismo grado III (grado II-IV), 33,3% (n = 5/15) desarrollaron un PA esplénico y 5,8% (n = 1/17) desarrollaron un PA hepático con tiempo diagnóstico medio de 3,7 ± 3 (3-8) días. El desarrollo de PA se asoció a mayor puntuación en el índice de severidad con una diferencia de medias de 15,6 ± 5,3 (CI 95% 4,37:26,14 p < 0,008). Todos los PA se trataron mediante embolización un 85,7% (n = 5/6) excepto una esplenectomía urgente. CONCLUSION: Los PA viscerales están infradiagnosticados, con una incidencia mayor a la reportada. Consideramos que un estudio de imagen (CEUS) debe ser realizado previo al alta en los traumatismos severos. El tratamiento sigue siendo controversial: sin embargo, recomendamos la embolización percutánea reservando la esplenectomía para paciente inestables.

Immediate impact of the COVID-19 pandemic on pediatric surgery: analysis of a tertiary healthcare facility. / Impacto inmediato de la pandemia por COVID-19 en cirugía pediátrica: análisis de un centro terciario.

INTRODUCTION: The pandemic caused by the SARS-CoV-2 virus has led to an unprecedented situation, with population lockdowns, congestion of healthcare resources, cancellation of scheduled surgical activity, fear of contagion, and delays in patient care. The objective of this study was to analyze its impact on pediatric surgical activity at a reference healthcare facility. MATERIAL AND METHODS: A comparative study of activity in the pediatric surgery environment at a Spanish reference healthcare facility was carried out. It included outpatient consultations, scheduled surgeries, and activity at the emergency department during the lockdown period in Spain (March-May 2020) vs. the same 2019 period. Number of consultations and surgeries, type of surgery performed and/or cancelled, and stage of the pathologies treated were collected. RESULTS: A 98% decrease in scheduled surgeries, an 84% decrease in healthcare burden from the pediatric emergency department, a 55.24% decrease in urgent surgeries, an 82% decrease in outpatient activity at external consultations, and a 94% decrease in inter-hospital referrals, along with a 66% increase in urgent pathology severity, were found. CONCLUSIONS: The COVID-19 pandemic cancelled virtually all pediatric surgery activity, which caused treatment delays in severe pathologies and increased morbidity in regular urgent procedures.

INTRODUCCION: La pandemia surgida como consecuencia del virus SARS-CoV-2 ha provocado una situación inaudita, el confinamiento de la población, el colapso de los recursos sanitarios, la suspensión de la actividad programada en los servicios quirúrgicos, el miedo al contagio y la demora en la atención de pacientes. El objetivo es analizar el impacto de esta situación en la actividad del Servicio de Cirugía Pediátrica de un centro de referencia. MATERIAL Y METODOS: Se ha realizado un estudio comparativo de la actividad realizada en el ámbito de Cirugía Pediátrica de un centro de referencia español, incluyendo consultas ambulatorias, cirugía programada y actividad en urgencias durante el periodo de confinamiento (marzo-mayo 2020) frente al mismo periodo de tiempo en 2019. Se recogen el número de consultas e intervenciones, el tipo de cirugía practicada y/o anulada y el grado de evolución de las patologías atendidas. RESULTADOS: Se ha registrado un descenso del 98% de las cirugías programadas, del 84% de la presión asistencial desde urgencias pediátricas, un 55,24% menos de cirugías urgentes y un 82% la actividad ambulatoria en Consultas Externas. Se ha registrado un descenso en los traslados interhospitalarios del 94% y un incremento del 66% de la gravedad de la patología urgente. CONCLUSIONES: La pandemia por COVID-19 ha supuesto la anulación de la práctica totalidad de la actividad del Servicio de Cirugía Pediátrica, con la consiguiente demora en el tratamiento de patologías graves y un aumento en la morbilidad de procesos urgentes habituales.

Polyorchidism in pediatric patients: a case report and a literature review. / Poliorquidismo en la edad pediátrica: a propósito de un caso y revisión de la literatura.

Polyorchidism or testicular duplication is defined as the histologically confirmed presence of more than two testes. This is the case of a full left testicular duplication in an 11-year-old patient presenting with occasional pain in the left hemiscrotum. At physical exploration, a palpable scrotal mass was detected. An ultrasonography was performed, which revealed the presence of testicular duplicity. Diagnostic suspicion was confirmed by means of a nuclear MRI and a histopathological study following excision. Polyorchidism is a rare abnormality requiring a high degree of suspicion in the presence of an extratesticular mass. Most authors advocate conservative treatment and follow-up in the absence of pain, cryptorchidism, tumors, and unclear diagnosis.

El poliorquidismo o duplicación testicular se define como la presencia de más de dos testículos confirmados mediante histología. Se presenta un caso de duplicación testicular izquierda completa en un niño de 11 años de edad que consultó por dolor ocasional en el hemiescroto izquierdo. En su exploración física destacaba una masa escrotal palpable. Se practicó ecografía que reveló la presencia de una duplicidad testicular. La sospecha diagnóstica fue corroborada mediante resonancia magnética nuclear y el estudio histopatológico tras la exéresis, confirmó el diagnóstico. El poliorquidismo es una anomalía excepcional que require un alto índice de sospecha ante la presencia de una masa extratesticular. La mayoría de autores abogan por un tratamiento conservador y seguimiento si no causa dolor o si no existen dudas diagnósticas, criptorquidia o excepcionalmente, tumores.

Arterial tortuosity syndrome: relevance in pediatric surgery. A case report. / El síndrome de tortuosidad arterial y su relevancia en cirugía pediátrica. A propósito de un caso.

INTRODUCTION: Arterial tortuosity syndrome (ATS) is an extremely rare autosomal recessive disorder of the connective tissue. It is characterized by tortuosity and elongation of medium and large arteries, with multiple disorders associated with the widespread involvement of the connective tissue. CASE REPORT: Newborn diagnosed with ATS, with multiple vascular malformations, hiatal hernia, and bilateral inguinal hernia. He underwent surgery at three months of age. The hiatal hernia was closed, and bilateral inguinal hernia repair was performed. The inguinal hernias required up to 4 surgeries as a result of recurrences.During follow-up, the patient had retrocardiac diaphragmatic hernia. It was operated on, with subsequent incisional hernia. 8 years later, he was admitted as a result of septic shock secondary to intestinal occlusion. Emergency surgery was scheduled, demonstrating gastric herniation in the right pleural cavity, with perforation of the fundus. The patient died at the ICU 24 hours later. DISCUSSION: The pediatric surgeon should be familiar with ATS, since it may cause multiple surgical pathologies, it is difficult to manage, and it is associated with a high risk of recurrence and complications.

INTRODUCCION: El síndrome de tortuosidad arterial (STA) es un trastorno autosómico recesivo del tejido conectivo muy infrecuente, caracterizado por tortuosidad y elongación de arterias de medio y gran calibre y múltiples trastornos derivados de la afectación generalizada del tejido conectivo. CASO CLINICO: Neonato diagnosticado de STA, con múltiples malformaciones vasculares, hernia de hiato y hernia inguinal bilateral. Intervenido a los tres meses, practicándose cierre de hernia de hiato y herniorrafia inguinal bilateral. Estas últimas requirieron hasta cuatro intervenciones por recidiva. Durante el seguimiento presentó hernia diafragmática retrocardiaca, siendo intervenida, con posterior eventración. A los ocho años ingresó por shock séptico secundario a oclusión intestinal. Se intervino urgente objetivando herniación gástrica en cavidad pleural derecha con perforación en fundus. El paciente falleció en la UCI tras 24 horas. COMENTARIOS: El cirujano pediátrico debe conocer el STA debido a la múltiple patología quirúrgica que puede presentar, difícil manejo, riesgo de recidiva y complicaciones.

Response of RAW 264.7 and J774A.1 macrophages to particles and nanoparticles of a mesoporous bioactive glass: A comparative study.

Mesoporous bioactive glasses (MBGs) are bioceramics designed to induce bone tissue regeneration and very useful materials with the ability to act as drug delivery systems. MBGs can be implanted in contact with bone tissue in different ways, as particulate material, in 3D scaffolds or as nanospheres. In this work, we assessed the effects of particles of mesoporous bioactive glass MBG-75S and mesoporous nanospheres NanoMBG-75S on RAW 264.7 and J774A.1 macrophages, which present different sensitivity and are considered as ideal models for the study of innate immune response. After evaluating several cellular parameters (morphology, size, complexity, proliferation, cell cycle and intracellular content of reactive oxygen species), the action of MBG-75S particles and NanoMBG-75S on the polarization of these macrophages towards the pro-inflammatory (M1) or reparative (M2) phenotype was determined by the expression of specific M1 (CD80) and M2 (CD206, CD163) markers. We previously measured the adsorption of albumin and fibrinogen on MBG-75S particles and the production of pro-inflammatory cytokines as TNF-α and IL-6 by macrophages in response to these particles. This comparative study demonstrates that particles of mesoporous bioactive glass MBG-75S and mesoporous nanospheres NanoMBG-75S allow the appropriated development and function of RAW 264.7 and J774A.1 macrophages and do not induce polarization towards the M1 pro-inflammatory phenotype. Therefore, considering that these mesoporous biomaterials offer the possibility of loading drugs into their pores, the results obtained indicate their high potential for use as drug-delivery systems in bone repair and osteoporosis treatments without triggering an adverse inflammatory response.

Initial experience with 3D printing in the use of customized Nuss bars in pectus excavatum surgery. / Experiencia inicial en la impresión 3D para el uso de barras de Nuss personalizadas en la cirugía del pectus excavatum.

INTRODUCTION: Pectus excavatum (PE) surgical repair according to Nuss procedure is based on the intrathoracic insertion of one (or more) metallic bars for anatomical defect repair. Number of bars, bar length, bar shape, and thoracic insertion site are established during surgery, according to patient morphology, CT-scan, and especially the surgeon's experience. OBJECTIVE: To assess the usefulness of the design, simulation, and 3D printing of customized Nuss bars for each patient. MATERIAL AND METHODS: A prospective descriptive study of all patients undergoing PE surgery under 3D printing from June to December 2019 was carried out. Curvature, bar length, and optimal intercostal space were designed based on diagnostic CT-scan, and they were 3D printed full size. The resulting model was reproduced preoperatively on the usual prosthetic material, sterilized, and kept until surgery. RESULTS: The study cohort consisted of 6 patients. Median age was 15 years old (interquartile range: 14.25-15.25), median Haller index was 4.05 (interquartile range: 3.5-4.49), and repair index was 36.98% (interquartile range: 33.86-38.48%). A Nuss bar was introduced in all cases, without requiring removal or re-insertion. Median operating time was 79.5 minutes (interquartile range: 72.5-103). No postoperative complications were noted during follow-up (12 months). CONCLUSIONS: The preoperative design of Nuss bars with customized shape and size facilitates surgical planning. It also allows for the most optimal and accurate morphological repair possible, according to patient anatomy, thus reducing the risk of requiring removal and/or re-insertion, and therefore, of surgical complications.

INTRODUCCION: La corrección quirúrgica del pectus excavatum (PE) con técnica de Nuss, se basa en la inserción intratorácica de una (o más) barras metálicas para la corrección del defecto anatómico. El número de barras, su longitud, forma y punto de inserción torácico, se deciden durante la cirugía, según la morfología del paciente, el TC y, fundamentalmente, la experiencia del cirujano. OBJETIVO: Evaluar la utilidad del diseño, simulación e impresión 3D de barras de Nuss personalizadas para cada paciente. MATERIAL Y METODOS: Estudio descriptivo prospectivo, incluyendo a todos los pacientes intervenidos de PE bajo impresión 3D entre junio-diciembre 2019. Se diseñó la curvatura, longitud de la barra y espacio intercostal óptimo, en base al TC diagnóstico, y se imprimió en 3D en tamaño real. El modelo resultante se reprodujo prequirúrgicamente sobre material protésico habitual, se esterilizó y se reservó hasta la cirugía. RESULTADOS: Se recogieron 6 pacientes, mediana de edad 15 años (rango intercuartil 14,25-15,25 años). Mediana del Índice de Haller 4,05 (rango intercuartil 3,5-4,49) e índice de corrección 36,98% (rango intercuartil 33,86-38,48%). Se introdujo una barra de Nuss en todos los casos, sin precisar retirada ni reinserción. Mediana del tiempo quirúrgico 79,5 minutos (rango intercuartil 72,5-103 min). Ninguna complicación postquirúrgica durante el seguimiento (12 meses). CONCLUSIONES: El diseño prequirúrgico de la barra de Nuss, mediante forma y tamaño personalizados, facilita la planificación del procedimiento. A su vez, permite conseguir la corrección morfológica más óptima y precisa posible, según la anatomía del paciente, disminuyendo el riesgo de precisar retirada y/o reinserción de la barra, y por ende de complicaciones quirúrgicas.

Dispersal Reduction: Causes, Genomic Mechanisms, and Evolutionary Consequences.

Recent biological analyses suggest that reductions in dispersal ability have been key drivers of diversification across numerous lineages. We synthesise emerging data to highlight similarities regarding the causes and consequences of dispersal reduction across taxa and ecosystems, as well as the diverse genomic mechanisms underpinning these shifts. Natural selection has acted on standing genetic variation within taxa to drive often rapid - and in some cases parallel - losses of dispersal, and ultimately speciation. Such shifts can thus represent an important nexus between adaptive and neutral diversification processes, with substantial evolutionary consequences. Recognition of the links between these concepts that are emerging from different fields, taxa and ecosystems is transforming our understanding of the fascinating role of dispersal reduction in the formation of biodiversity.

Applicability of Clavien-Dindo classification in Nuss procedure surgical complications. / Aplicabilidad de la clasificación Clavien-Dindo en las complicaciones quirúrgicas del procedimiento de Nuss.

OBJECTIVES: Nuss procedure is a safe surgery but not exempt from complications. Clavien-Dindo classification (1992) allows complications of any surgery to be recorded. Our objective was to prove its applicability in the study of Nuss procedure complications. MATERIAL AND METHODS: We present a retrospective series of PE patients undergoing surgery from January 2010 to January 2018. Nuss procedure associated morbidity prior to bar removal was studied. Complications were stratified according to Clavien-Dindo classification. RESULTS: A total of 31 patients were included. Mean age was 14.67 years (4-27 years), with a mean Haller index of 6.06 (3.35-14.14) and a mean correction index of 41.2% (16-87%). Clavien-Dindo classification I-IIIb mild complications were recorded in 35.48% of patients. Seroma was found in 4 patients (12%), of whom 1 had superinfection and 1 had wound dehiscence. In 6 patients, bar and/or stabilizer mobilization was noted, and in 1 patient, postoperative acute pulmonary edema (3%) was observed. Of the 11 patients with complications, only 6 required re-intervention -5 as a result of prosthesis mobilization, and 1 as a result of infection not resolved with intravenous antibiotic therapy. CONCLUSIONS: Clavien-Dindo classification is being increasingly used as a way of unifying surgical complication criteria by comparing results. Our study demonstrated that such classification is a feasible and reproducible method when it comes to reflecting Nuss procedure morbidity and comparing it with other groups.

OBJETIVOS: La intervención de Nuss es una cirugía segura pero no está exenta de complicaciones. La clasificación de Clavien-Dindo (1992) permite registrar complicaciones de cualquier operación. Nuestro objetivo es demostrar la aplicabilidad de dicha clasificación para el estudio de las complicaciones de la cirugía de Nuss. MATERIAL Y METODOS: Presentamos una serie retrospectiva de pacientes afectos de PE intervenidos entre enero 2010 y enero 2018 y su morbilidad asociada a la cirugía de Nuss hasta la retirada de la barra. Dichas complicaciones se agruparán mediante la clasificación de Clavien-Dindo. RESULTADOS: Se recogen un total de 31 pacientes. La media de edad fue 14,67 años (4-27 años), con una media de índices de Haller de 6,06 (3,35-14,14) y una media de índices de corrección de 41,2% (16-87%). Se observaron complicaciones leves I-IIIb de la clasificación de Clavien-Dindo en el 35,48% de los pacientes. Se constató seroma en 4 pacientes (12%), de los cuales 1 presentó sobreinfección y otro, dehiscencia de herida. En 6 pacientes se observó movilización de la barra y/o estabilizador y en 1 paciente, edema agudo de pulmón postoperatorio (3%). De los 11 pacientes que presentaron complicaciones, solo 6 requirieron reintervención: 5 de ellos por movilización de la prótesis y uno por infección no resuelta con antibioterapia endovenosa. CONCLUSIONES: La clasificación de Clavien-Dindo se emplea cada vez más como una forma de unificar los criterios de las complicaciones quirúrgicas permitiendo comparar los resultados obtenidos. Comprobamos que es perfectamente factible y reproducible para reflejar la morbilidad del procedimiento quirúrgico de Nuss y poder compararla con otros grupos.

Genotypic and technological characterization of Lactococcus lactis isolates involved in processing of artisanal Manchego cheese.

AIMS: Genotypic and technological characterization of wild lactococci isolated from artisanal Manchego cheese during the ripening process for selection of suitable starter cultures. METHODS AND RESULTS: A total of 114 isolates of lactococci were typed using randomly amplified polymorphic DNA-polymerase chain reaction (RAPD-PCR). Sixteen distinct RAPD-PCR patterns, at a similarity level of 73%, were obtained. On the basis of species-specific PCR reaction, the isolates were assigned to the species Lactococcus lactis subsp. lactis and Lactococcus lactis subsp. cremoris with L. lactis subsp. lactis being predominant at both dairies. Twenty-six isolates were technologically characterized to select those with the best properties. Most of them showed good technological properties although some could produce tyramine. CONCLUSIONS: The presence of coincident genotypes at both dairies has been demonstrated, which would suggest that they are well adapted to the Manchego cheese environment. Interesting differences were found in the technological characterization and the potential role of autochthonous lactococci strains as starter culture has been displayed. SIGNIFICANCE AND IMPACT OF THE STUDY: The great economic importance of Manchego cheese encouraged a deeper knowledge of its microbiota, to select strains with the best properties to use as starter cultures in industrial Manchego cheeses, preserving the autochthonous characteristics.

Tratamiento del quiste tirogloso mediante técnica de Koempel. Experiencia inicial / Treatment of thyroglossal cyst using Koempel’s technique: initial experience

Introducción: La intervención de Sistrunk es el gold-standard en el tratamiento del quiste tirogloso pese a su imprecisión en cuanto a la disección suprahioidea. Tras su descripción en 2014, las modificaciones introducidas por Koempel, han permitido un abordaje suprahioideo más reproducible. Presentamos nuestra experiencia inicial con esta técnica. Métodos: Estudio retrospectivo de los pacientes con quiste tirogloso intervenidos mediante técnica de Koempel en nuestro centro en el periodo 2021-2022, recogiéndose datos demográficos, clínicos e histológicos. Resultados. Durante el periodo de estudio se intervinieron 5 pacientes (3 mujeres/2 varones), con una mediana de edad y peso de 5 años (2-6) y 16 kg (14-25) respectivamente. Todos los casos habían sufrido infecciones previas presentando fistulización cutánea el 60%. En 2 de los pacientes se indicó la cirugía por recidiva tras intervención de Sistrunk. La mediana del tiempo quirúrgico fue de 77minutos (57-110) identificándose el plano del músculo geniogloso en los 5 pacientes. No hubo complicaciones inmediatas y el diagnóstico de quiste tirogloso se confirmó histológicamente en todos los casos. Uno de los pacientes del grupo con recidiva previa, presentó recidiva tras la intervención, siendo esta subclínica y diagnosticada incidentalmente tras ecografía de control. El resto de los pacientes no presentó ninguna recurrencia tras un seguimiento mediana de 8 meses (1-12). Conclusiones: La técnica de Koempel permite un abordaje seguro y reproducible del segmento suprahioideo siendo una opción atractiva en casos complicados por infección o recidiva previa.(AU)

Introduction: In spite of being inaccurate in terms of suprahyoid dissection, Sistrunk’s procedure is the gold-standard technique in the treatment of thyroglossal cyst. Since it was first described in 2014, the modifications introduced by Koempel have allowed for a more reproducible suprahyoid approach. We present our initial experience with this technique.Methods: A retrospective study of patients with thyroglossal cyst undergoing Koempel’s technique in our institution from 2021 to 2022 was carried out. Demographic, clinical, and histological data was collected. Results. In the study period, 5 patients –3 girls and 2 boys– underwent surgery. Median age and weight were 5 years (2-6) and 16 kg (14-25), respectively. All patients had suffered from previous infections, with 60% having cutaneous fistulization. In 2 patients, surgery was indicated following Sistrunk’s procedure as a result of recurrence. Median operating time was 77 minutes (57-110), with the genioglossal muscle plane being identified in the 5 patients. No immediate complications were recorded, and diagnosis of thyroglossal cyst was histologically confirmed in all cases. One of the formerly recurrent patients had recurrence following surgery, but it was subclinical and incidentally diagnosed at control ultrasonography. The remaining patients had no recurrences after a median 8-month (1-12) follow-up period. Conclusions: Koempel’s technique allows for a safe and reproducible approach of the suprahyoid segment. It is an attractive option in complicated cases as a result of previous infection or recurrence.(AU)

Colecistectomía laparoscópica urgente por colecistitis aguda litiásica en Pediatría / Urgent laparoscopic cholecystectomy as a result of acute calculous cholecystitis in pediatrics

Introducción: Pese al aumento en la prevalencia de colelitiasisdurante las últimas décadas, no se han desarrollado recomendacionessobre el mejor tratamiento de la colecistitis aguda litiásica (CA) enPediatría. Caso clínico: Paciente varón de 4 años y 20 kg de peso sin antecedentes de interés, que acude derivado por sepsis de origen abdominal. Analíticamente destaca leucocitosis con hemoglobina, función hepáticay bilirrubina normales. La ecografía abdominal muestra colelitiasis, hidrops vesicular y proceso inflamatorio compatible con plastrón apendicular. En laparoscopia diagnóstica se observa apéndice macroscópicamentenormal y colecistitis aguda. Ante la situación del paciente se realiza,conjuntamente con Cirugía General, colecistectomía laparoscópica. Elpaciente se recupera sin incidencias tras 5 días de ingreso bajo coberturacon piperacilina-tazobactam. Comentarios: No existen recomendaciones sobre el tratamiento dela CA en niños. En los pacientes sépticos, la colaboración entre cirujanospediátricos y cirujanos generales permite contemplar la colecistectomíaurgente como una opción segura.(AU)

Introduction: In spite of the increase in the prevalence of cholelithiasis in the last decades, no recommendations regarding the best treatmentof acute calculous cholecystitis (AC) in pediatrics have been developed. Clinical case: 4-year-old, 20kg male patient with no significanthistory referred to our institution as a result of abdominal sepsis. Theblood count showed leukocytosis, with normal hemoglobin and bilirubinlevels, and a normal liver function. The abdominal ultrasonography revealed cholelithiasis, gallbladder hydrops, and an inflammatory processcompatible with appendicular plastron. In the diagnostic laparoscopy,the appendix was macroscopically normal, and acute cholecystitis wasobserved. Given the patient’s situation, and in cooperation with theGeneral Surgery Department, laparoscopic cholecystectomy was carriedout. The patient recovered uneventfully on hospitalization day 5 underpiperacillin-tazobactam treatment. Discussion: There are no recommendations regarding AC treatmentin children. In septic patients, cooperation between general and pediatricsurgeons allows urgent cholecystectomy to be considered as a safe option.(AU)

Positioning document on incorporating point-of-care ultrasound in Internal Medicine departments. / Documento de posicionamiento sobre la incorporación de la ecografía clínica en los servicios de Medicina Interna.

This positioning document describes the most important aspects of clinical ultrasonography in the internal medicine setting, from its fundamental indications to the recommended training period. There is no question as to the considerable usefulness of this tool in the standard clinical practice of internists in numerous clinical scenarios and settings (emergencies, hospital ward, general and specific consultations and home care). Ultrasonography has a relevant impact on the practitioner's ability to resolve issues, increasing diagnostic reliability and safety and providing important information on the prognosis and progression. In recent years, ultrasonography has been incorporated as a tool in undergraduate teaching, with excellent results. The use of ultrasonography needs to be widespread. To accomplish this, we must encourage structured training and the acquisition of equipment. This document was developed by the Clinical Ultrasonography Workgroup and endorsed by the Spanish Society of Internal Medicine.

The mitogenome of Hydropsyche pellucidula (Hydropsychidae): first gene arrangement in the insect order Trichoptera.

We describe the mitochondrial genome of Hydropsyche pellucidula Curtis 1834, which is first described for the suborder Annulipalpia and the first in the order Trichoptera to show a non-canonical gene order. The mitogenome was obtained by de novo assembly of shotgun sequenced total genomic DNA using Illumina Miseq technology, which produced an average coverage of 115× and a minimum coverage of 48×. The mitochondrial genome includes 13 protein-coding genes, 2 rRNAs and 22 tRNAs. The genome is characterized by a rearrangement in the relative position of protein-coding and ribosomal genes. This mitogenome sequence will be useful for studying the family Hydropsychidae, which is commonly used for freshwater pollution biomonitoring.

Manejo del pseudoaneurisma esplénico y/o hepáticodespués de un traumatismo abdominal en pediatría / Management of splenic and/or hepatic pseudoaneurysm following abdominal trauma in pediatric patients

Introducción: Los pseudoaneurismas (PA) esplénicos y hepáticos son lesiones arteriovenosas raras que se pueden desarrollar tras un tramatismo abdominal. La rotura tardía es su complicación más frecuente que puede conducir a inestabilidad hemodinámica. El objetivo del presente es presentar nuestra experiencia en el manejo de los PA viscerales.Metodología: Estudio retrospectivo en pacientes < 15 años con traumatismo abdominal cerrado con lesión esplénica y/o hepática, entre 2012-2020. Se analizó el desarrollo de PA y el manejo realizado. En todos los pacientes se realizó tomografía computarizada estableciendo el grado del traumatismo, y estudio control en la primera semana postratumatismo mediante ecografía con contraste (CEUS). Si se confirmabaun PA se procedió a angiograma ± embolización percutánea.Resultados: Un total de 32 pacientes con traumatismo cerrado, edad media 8,7 ± 3,2 años (2-15 años), 68,7% (n = 22) hombres y mediana de grado de traumatismo grado III (grado II-IV), 33,3% (n =5/15) desarrollaron un PA esplénico y 5,8% (n = 1/17) desarrollaron un PA hepático con tiempo diagnóstico medio de 3,7 ± 3 (3-8) días. El desarrollo de PA se asoció a mayor puntuación en el índice de severidad con una diferencia de medias de 15,6 ± 5,3 (CI 95% 4,37:26,14 p < 0,008). Todos los PA se trataron mediante embolización un 85,7% (n = 5/6) excepto una esplenectomía urgente.Conclusiones: Los PA viscerales están infradiagnosticados, con una incidencia mayor a la reportada. Consideramos que un estudio de imagen (CEUS) debe ser realizado previo al alta en los traumatismos severos. El tratamiento sigue siendo controversial: sin embargo, recomendamos la embolización percutánea reservando la esplenectomíapara paciente inestables.

Introduction: Splenic and hepatic seudoaneurysm (PA) is a rare arteriovenous injury that may occur following abdominal trauma. The most frequent complication of PA is late rupture, which can lead to hemodynamic instability. The objective of this study was to describe our experience in the management of visceral PA.Materials and methods: A retrospective study of patients under15 years of age with blunt abdominal trauma associated with splenicand/or hepatic injury treated from 2012 to 2020 was carried out. PAformation and management were analyzed. All patients underwent CT-scan, which allowed trauma grade to be established, and also controlcontrast-enhanced ultrasonography (CEUS) in the first week followingtrauma. If PA was confirmed, angiography ± percutaneous embolizationwere performed.Results: A total of 32 patients with blunt trauma were included.Mean age was 8.7 ± 3.2 years (2-15 years). 68.7% (n = 22) of patientswere male. Median trauma grade was grade III (grades II-IV). 33.3%(n = 5/15) of patients developed splenic PA, and 5.8% (n = 1/17) ofpatients developed hepatic PA, with mean diagnostic time being 3.7 ± 3(3-8) days. PA formation was associated with higher severity scores,with a mean difference of 15.6 ± 5.3 (95% CI: 4.37:26.14 p < 0.008). AllPA cases – except for one, which required urgent splenectomy – weretreated with embolization (85.7%) (n = 5/6).Conclusions: Visceral PA is underdiagnosed, with an incidencehigher than reported. Imaging studies (CEUS) are required prior todischarge in the presence of severe trauma. Treatment remains contro-versial, but we recommend percutaneous embolization, with splenectomybeing reserved for unstable patients.