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.

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.

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.

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.

What do beta-lactams add to vancomycin or daptomycin in the treatment of patients with methicillin-resistant Staphylococcus aureus bacteraemia? A review.

Several studies have documented the synergy between vancomycin/daptomycin and various beta-lactams, and clinical studies have studied this combination therapy in humans. We review the published literature on this topic to know the utility of the combined treatment with beta-lactams in treating bacteraemia methicillin-resistant Staphylococcus aureus (MRSA) infections. Fifteen observational studies, three randomised clinical trials and three systematics reviews are analysed in this article. Observational studies used ceftaroline, cefazolin, piperacillin/tazobactam or cefepime among the beta-lactams. Clinical trials used cloxacillin or flucloxacillin as the most used beta-lactam in two trials and ceftaroline in one. Three systematic reviews are published. One of them only includes studies with vancomycin and included six studies. The other two systematic reviews include patients with daptomycin or vancomycin and included 15 and 9 studies, respectively. Adding a beta-lactam to vancomycin or daptomycin may help shorten bacteraemia and avoid recurrences in patients with MRSA bacteraemia. There is no evidence that combined therapy improves mortality. Nephrotoxicity in clinical trials precludes the use of combination therapy mainly with cloxacillin or flucloxacillin, but systematic reviews have not found a significant difference in this point in observational studies with other beta-lactams. The role of other beta-lactams such as ceftaroline should be thoroughly studied in these patients.

Parental experiences of homeschooling during the COVID-19 pandemic: differences between seven European countries and between children with and without mental health conditions.

The aim of the present study was to examine parental experiences of homeschooling during the COVID-19 pandemic in families with or without a child with a mental health condition across Europe. The study included 6720 parents recruited through schools, patient organizations and social media platforms (2002 parents with a child with a mental health condition and 4718 without) from seven European countries: the UK (n = 508), Sweden (n = 1436), Spain (n = 1491), Belgium (n = 508), the Netherlands (n = 324), Germany (n = 1662) and Italy (n = 794). Many parents reported negative effects of homeschooling for themselves and their child, and many found homeschooling to be of poor quality, with insufficient support from schools. In most countries, contact with teachers was limited, leaving parents with primary responsibility for managing homeschooling. Parents also reported increased levels of stress, worry, social isolation, and domestic conflict. A small number of parents reported increased parental alcohol/drug use. Some differences were found between countries and some negative experiences were more common in families with a child with a mental health condition. However, differences between countries and between families with and without a mental health condition were generally small, indicating that many parents across countries reported negative experiences. Some parents also reported positive experiences of homeschooling. The adverse effects of homeschooling will likely have a long-term impact and contribute to increased inequalities. Given that school closures may be less effective than other interventions, policymakers need to carefully consider the negative consequences of homeschooling during additional waves of the COVID-19 pandemic and future pandemics.

Three years prospective clinical and radiologic follow-up of laparoscopic sacrocolpoperineopexy.

BACKGROUND: When Rectocele is part of a complex pelvic organ prolapse, a full repair is recommended. The aim of this study was to evaluate the clinical and radiological results after laparoscopic surgery in patients with symptomatic rectocele and III/IV stage vaginal vault prolapse METHODS: This is a prospective cohort study of women with symptomatic rectoceles and middle compartment prolapse operated on between 2013 and 2015, who underwent a laparoscopic sacrocolpoperineopexy with synthetic Y mesh attached to puborectalis muscles, the anterior and posterior vagina wall and the sacrum. The clinical outcomes measured were symptoms of prolapse, obstructive defecation syndrome and quality of life. Radiological outcomes were distance of the vaginal vault below pubococcigeal line and depth of rectovaginal wall protrusion in dynamic pelvic resonance. RESULTS: 33 patients were included. 32 of them remained asymptomatic after a three years follow-up. Significant differences were shown in the obstructed defecation score and quality of life after 6, 12 and 36 months compared to preoperatively. No differences were identified when the postoperative results were compared. Significant differences were shown in preoperative vaginal vault prolapse (3.2 cms ± 0.8 SD below the pubococcigeal Line) and rectocele size, compared with 1 and 3 years after surgery. There were no significant differences in vaginal vault prolapse when compared after 1 and 3 years. When rectocele size after 1 and 3 years was compared, significant differences were shown, but only one clinical recurrence (3%) was identified after a mean follow-up of 47 months. CONCLUSIONS: Laparoscopic sacrocolpoperineopexy in patients with symptomatic rectocele and III/IV vaginal vault prolapse solves the constipation and obstructed defecation with an excellent quality of life and low clinical recurrences. Radiological deterioration, especially in rectocele size, was identified in the mid-term follow-up without clinical significance.

Species diversification in the lowlands of mid-latitude South America: Turnera sidoides subsp. carnea as a case study.

The lowlands of mid-latitude South America comprise complex temperate ecoregions characterized by a unique biodiversity. However, the processes responsible for shaping its species diversity are still largely unknown. Turnera sidoides subsp. carnea is a variable subspecies occurring in the lowlands of northeastern Argentina and Uruguay, extending to southern Paraguay and Brazil. It constitutes a good model to perform evolutionary studies. Here we used an integrative approach to understand the process of diversification within this subspecies and to increase the knowledge concerning patterns and processes responsible for shaping the species diversity in the temperate lowlands of South America. The results provided strong evidences that this subspecies is an autopolyploid complex per se, being in an active process of intrasubspecific diversification. Morphological and genetic data show that the diversity of T. sidoides subsp. carnea is in congruence with the great past and present abiotic and biotic variability of the mid-latitude South American lowlands. The evolutionary history of this subspecies is consistent with past fragmentation and allopatric differentiation at diploid level. Geographic isolation and local adaptation would have promoted strong morphological, ecological, and genetic differentiation, resulting in two morphotypes and different genetic groups indicative of incipient speciation.

Detecting Phase-Synchrony Connectivity Anomalies in EEG Signals. Application to Dyslexia Diagnosis.

Objective Dyslexia diagnosis is a challenging task, since traditional diagnosis methods are not based on biological markers but on behavioural tests. Although dyslexia diagnosis has been addressed by these tests in clinical practice, it is difficult to extract information about the brain processes involved in the different tasks and, then, to go deeper into its biological basis. Thus, the use of biomarkers can contribute not only to the diagnosis but also to a better understanding of specific learning disorders such as dyslexia. In this work, we use Electroencephalography (EEG) signals to discover differences among controls and dyslexic subjects using signal processing and artificial intelligence techniques. Specifically, we measure phase synchronization among channels, to reveal the functional brain network activated during auditory processing. On the other hand, to explore synchronicity patterns risen by low-level auditory processing, we used specific stimuli consisting in band-limited white noise, modulated in amplitude at different frequencies. The differential information contained in the functional (i.e., synchronization) network has been processed by an anomaly detection system that addresses the problem of subjects variability by an outlier-detection method based on vector quantization. The results, obtained for 7 years-old children, show that the proposed method constitutes an useful tool for clinical use, with the area under ROC curve (AUC) values up to 0.95 in differential diagnosis tasks.

Giant pancreatic cystic lymphangioma.

A giant cystic lymphangioma in the pancreatic body-tail was diagnosed as an incidental ultrasound mass in a 41-year-old patient, with a progressive size that had increased in the last year by about 20 cm size. An ultrasound guided fine needle puncture was performed and the result was a benign cystic lesion. Given the increase in size, a surgical intervention was decided. A retroperitoneal cystic tumor dependent on the posterior pancreatic wall was identified and a full laparoscopic resection with pancreas and spleen preservation was performed. The pathological report confirmed the diagnosis of benign cystic lymphangioma. The patient was discharged on the fifth postoperative day without any remarkable complications. After one year of follow-up, the patient remains asymptomatic.

Clip migration after cholecystectomy.

We present the case of a 43-year-old female who underwent cholecystectomy with choledochotomy and laparoscopic lithoextraction for choledocholithiasis, who came to the emergency room due to abdominal pain of 3 days' evolution. An abdominal CT scan showed a possible cholangitis with a liver abscess at the level of segment VI, with metal density material near to the lesion. The inflammatory process extended to the right iliac psoas.

Hospitalization burden and comorbidities of patients with rheumatoid arthritis in Spain during the period 2002-2017.

BACKGROUND: Rheumatoid arthritis (RA) is a chronic autoimmune rheumatic disease that is associated with multiple comorbidities and has a significant economic impact on the Spanish health system. The objective of this study was to estimate the rates of hospitalization of rheumatoid arthritis in Spain, and describing hospitalization rates and their changing by age, region, RA variant, and when RA as a main cause of hospitalization or a comorbidity. METHODS: Observational descriptive study that reviewed hospital records from the CMBD. We included all hospitalizations of patients in Spain whose main diagnosis or comorbidity in the ICD-9-CM was rheumatoid arthritis during the period of 2002-2017. RESULTS: A total of 315,190 hospitalizations with the RA code were recorded; 67.3% were in women. The mean age of the patients was 68.5 ± 13.9 years. The median length of hospital stay was 7 days (IQR 3-11 days). In 29,809 of the admissions, RA was coded as the main diagnosis (9.4%). When RA was not coded as the main diagnosis, the most frequent main diagnoses were diseases of the circulatory system (18.9%) and diseases of the respiratory system (17.4%). The hospitalization rate during the period of 2002-2017 was 43.8 (95% CI: 43.7-44.0) per 100,000 inhabitants and constantly increased during the period. The total cost for the healthcare system was 1.476 million euros, with a median of 3542 euros per hospitalization (IQR 2646-5222 euros). CONCLUSIONS: In Spain, the hospitalization rate of patients with RA increased during the study period, despite the decrease in the hospitalization rate when RA was the main diagnosis.

Intellectual disability due to monoallelic variant in GATAD2B and mosaicism in unaffected parent.

The GATA zing finger domain-containing protein 2B (GATAD2B) gene encodes the p66beta protein, a subunit of the MeCP1-Mi2/ nucleosome remodeling and deacetylase complex, which is involved in transcription regulation and chromatin remodeling. Pathogenic variants in the GATAD2B gene have recently been associated with a recognizable neurodevelopmental syndrome, characterized by intellectual disability, limited speech, childhood hypotonia, and dysmorphic features. The majority of reported patients resulted from de novo loss of function (LOF) variants. We report a patient identified through whole exome sequencing analysis where a healthy mother was found to be low level mosaic for the pathogenic LOF variant found in her child, who is affected with GATAD2B-associated neurodevelopmental disorder (GAND). This variant was only found with the use of next generation sequencing technology in the mother and confirmed by digital droplet PCR. We summarize additional patients with GATAD2B LOF variants from a literature review and with our patient we contribute to delineate the phenotypic spectrum of GAND. We highlight the importance of detailed genetic testing, testing method, and counseling for cases of somatic mosaicism in an unaffected parent of children with GAND. This inheritance may be underreported and has a direct impact on reproductive planning and prenatal diagnosis.

Laparoscopic intracorporeal rectus aponeuroplasty (LIRA technique): a step forward in minimally invasive abdominal wall reconstruction for ventral hernia repair (LVHR).

BACKGROUND: Closing the defect (CD) during laparoscopic ventral hernia repair began to be performed in order to decrease seroma, to improve the functionality of the abdominal wall, and to decrease the bulging effect. However, tension at the incision after CD in large defects is related to an increased rate of pain and recurrence. We present the preliminary results of a new technique for medium midline hernias as an alternative to conventional CD. METHODS: A prospective controlled study was conducted from January 2015 to January 2017 to evaluate an elective new procedure (LIRA) performed on patients with midline ventral hernias (4-10 cm width). The posterior rectus aponeurosis was opened lengthwise around the hernia defect using a laparoscopic approach to create two flaps and was then sutured. The size of the flaps was estimated using a mathematical formula. An on-lay mesh was placed intraperitoneal overlapping the fascia defect. The data analyzed included patient demographics, operative parameters, and complications. A computerized tomography was performed preoperatively and postoperatively (1 month and 1 year) to evaluate recurrence, distance between rectus and seroma. RESULTS: Twelve patients were included. Mean width of the defect was 5.5 cm. Average VAS (24 h) was 3.9, 1.1 (1 month), and 0 (1 year). Mean preoperative distance between rectus was 5.5 cm; postoperative was 2.2 cm (1 year). Radiological seroma at first month was detected in 50%. Mean follow-up was 15 months. CONCLUSION: The LIRA technique could be considered as an alternative to conventional CD or endoscopic component separation for medium defects under 10 cm in width. This technique obtained a "no tension" effect that could be related to a lower rate of postoperative pain with no recurrence or bulging, being a safe, feasible, and reproducible technique.

The role of triploids in the origin and evolution of polyploids of Turnera sidoides complex (Passifloraceae, Turneroideae).

Triploids can play an important role in polyploid evolution. However, their frequent sterility is an obstacle for the origin and establishment of neotetraploids. Here we analyzed the microsporogenesis of triploids (x = 7) and the crossability among cytotypes of Turnera sidoides, aiming to test the impact of triploids on the origin and demographic establishment of tetraploids in natural populations. Triploids of T. sidoides exhibit irregular meiotic behavior. The high frequency of monovalents and of trivalents with non-convergent orientations results in unbalanced and/or non-viable male gametes. In spite of abnormalities in chromosome pairing and unbalanced chromosome segregation, triploids are not completely sterile and yielded up to 67% of viable pollen. Triploids that originated by the fusion of 2n × n gametes of the same taxon showed more regular meiotic behavior and higher fertility than triploids from the contact zone of diploids and tetraploids or triploids of hybrid origin. The reproductive isolation of T. sidoides cytotypes of different ploidy level is not strict and the 'triploid block' may be overcome occasionally. Triploids of T. sidoides produce diploid and triploid progeny suggesting that new generations of polyploids could originate from crosses between triploids or from backcrosses with diploids. The capability of T. sidoides to multiply asexually by rhizomes, would enhance the likelihood that a low frequency of neopolyploids can be originated and maintained in natural populations of T. sidoides.

Correction to: Safety and effectiveness of self-adhesive mesh in laparoscopic ventral hernia repair using transabdominal preperitoneal route.

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Safety and effectiveness of self-adhesive mesh in laparoscopic ventral hernia repair using transabdominal preperitoneal route.

BACKGROUND: Laparoscopic ventral or incisional hernia repair requires intraperitoneal mesh placement. This is associated with an increase in adhesions, bowel obstruction and enterocutaneous fistula. Intraabdominal meshes are laparoscopically fixed using traumatic fixation methods that increase acute, chronic pain and adhesions to bowel loops. The aim was to check the safety and effectiveness of the laparoscopic approach in ventral or incisional hernia, using a self-adhesive mesh in the preperitoneal space without tacks or transfascial sutures, and to objectively assess its benefits and complications. METHODS: Patients aged between 18 and 67 years old with medial, lateral ventral and incisional hernias between 3 and 8 cm in size were included in this study. Fifty patients were included in the study, which was conducted between January 2013 and March 2015. RESULTS: The average length of surgery was 57.3 ± 18 min. The average hospital stay was 1.1 ± 0.3 days. The average time taken to return to work was 9.2 ± 2.4 days. The most common post-operative complication was seroma, which was observed in 13 patients (26 %). The average follow-up was 15.4 ± 5.5 months. Three patients were lost to follow-up during this period. There was no hernia recurrence during examination nor on CT scan during the follow-up period. The average score on the visual analogue scale before surgery was 4 ± 1. After surgery, the score was as follows: 3 ± 0.8 on the first day after surgery, 0.9 ± 0.5 after the first week, 0.4 ± 0.4 after the first month and 0 after 90 days. No patient showed chronic pain. Overall satisfaction (VAS for surgery) was 8.3 ± 0.6. CONCLUSIONS: The use of self-adhesive meshes during the laparoscopic transabdominal preperitoneal approach in small- and medium-sized ventral or incisional hernias is safe and effective, with low post-operative pain, quick functional recovery and high overall satisfaction after surgery with no increase in recurrence in the short term.

Syllabic parsing in children: a developmental study using visual word-spotting in Spanish.

Some inconsistency is observed in the results from studies of reading development regarding the role of the syllable in visual word recognition, perhaps due to a disparity between the tasks used. We adopted a word-spotting paradigm, with Spanish children of second grade (mean age: 7 years) and sixth grade (mean age: 11 years). The children were asked to detect one-syllable words that could be found at the beginning of pseudo-words, with the boundary between the word and the remaining letters being manipulated. The end of the embedded word could either match the syllabic boundary (e.g. the word FIN in the pseudo-word FINLO, where the syllable boundary is between N and L) or not (e.g. FINUS, where the syllable boundary is located between I and N). The results showed that children of both grades were faster in the syllabic than the non-syllabic condition, and that the magnitude of this effect was the same regardless of reading ability. The results suggest an early universality in the use of syllables in Spanish, regardless of reading level.

Rates of Surgical Site Infection in Cholecystectomy: Comparison between a University Teaching Hospital, Madrid Region, Spain, and USA Rates.

BACKGROUND: There are many factors that can influence surgical site infections (SSI) in cholecystectomies. Incidence of cholecystectomy SSI was studied and compared with the incidence in Madrid Region, Spain, and the United States. METHODS: A prospective cohort study was conducted which included all patients who underwent gallbladder surgery for 5 consecutive years, at the Alcorcón Foundation University Teaching Hospital. SSI incidence rate was calculated. An association between risk factors and SSI incidence was assessed with the relative risk (RR). Infection rates were compared to those in the Madrid Region and to the overall Spanish and United States rates using the standardized infection ratio (SIR). RESULTS: The study included 1532 patients. Cumulative overall SSI was 1.96% (95% confidence interval [CI]: 1.3-2.7). The SIR was 0.89 with respect to the Madrid Region, 0.77 with respect to Spain's rate, and 1.77 with respect to the United States' rate. A laparoscopic route protected against infection (RR = 0.43; 95% CI: 0.2-0.9). Razor shaving in surgical preparation, duration of surgery, and neoplasm increased SSI incidence. CONCLUSIONS: SSI incidence rates among cholecystectomized patients at our hospital are higher than rates in the United States. A laparoscopic route protected against SSI.