Prevalence of autonomic dysreflexia during spinal cord stimulation after spinal cord injury.

Over the past decade, clinical trials have shown that spinal cord stimulation can restore motor functions that were thought to be permanently impaired in persons with spinal cord injury. However, the off-target effects of delivering electrical impulses to intertwined spinal networks remain largely unknown. This generates safety concerns for this otherwise fast-progressing technology. Herein, we present the prevalence of autonomic dysreflexia (AD) that occurred during implanted spinal cord stimulation testing for motor activation of the lower extremities. Eleven participants with spinal cord injury underwent implantation of temporary percutaneous epidural and dorsal root ganglia stimulation leads. Participants completed two days of parameter testing at baseline, then six days of motor rehabilitation sessions, and two days of parameter testing at end of study. The goal of parameter testing was to determine electrode configuration(s), pulse amplitudes, and frequencies that activated lumbosacral spinal sensorimotor networks that generate lower extremity functions. During all parameter testing sessions, continuous blood pressure and heart rate monitoring recordings were collected. Evidence of autonomic dysreflexia was found in 22% of all parameter tests with participants at rest. Most of these episodes (97%) were asymptomatic. These episodes occurred more frequently when using epidural stimulation, at or near amplitudes that elicited whole leg muscle activation and using a wide-field electrode configuration. Although monitoring occurred during passive testing, motor rehabilitation sessions use stimulation for longer periods, at higher frequencies and amplitudes. These sessions may carry additional risks of autonomic dysreflexia. Investigation of these concerns should continue as spinal cord stimulation progresses toward clinical translation.NEW & NOTEWORTHY Spinal cord stimulation for motor recovery after spinal cord injury is a popular research intervention, though off-target effects are a concern. Using continual blood pressure and heart rate recordings during passive spinal cord stimulation parameter testing, we identified frequent episodes of autonomic dysreflexia that were rarely associated with symptoms. This presents a previously unrecognized risk of spinal cord stimulation and appropriate vigilance in targeted monitoring is urged to maintain participant safety.

The effect of pre-partum shearing of Corriedale ewes on placental and lamb development and neonatal behaviour.

AIMS: To evaluate the effects of early and late pre-partum shearing of Corriedale ewes carrying single fetuses on placental and lamb development and neonatal lamb behaviour. METHODS: At 70 days of gestation, 37 multiparous Corriedale ewes with known gestation dates were randomly allocated into three groups: S70 (n = 12) and S110 (n = 12), shorn at Day 70 and 110 of gestation, and US (n = 13), that were not shorn pre-partum. Gestation length, lambing duration, placental expulsion time, placental weight, number and weight of cotyledons, and placental efficiency (lamb weight/placental weight) were determined. At birth, body temperature, weight, morphometric measurements, ponderal index (lamb weight/lamb crown-rump length) and behaviour were recorded, with weight remeasured 72 hours later. Four male lambs per group were slaughtered immediately after parturition, and organ weight and perirenal brown fat weight and energy content recorded. RESULTS: Pre-partum shearing, regardless of timing, increased total dried placental weight per ewe. Pre-partum shearing at Day 70 of gestation increased the number and mean weight of the > 2 to ≤ 3-cm cotyledons, while pre-partum shearing at Day 110 of gestation increased only the weight of these cotyledons. At birth and at 72 hours, lambs from ewes shorn either at 70 days of gestation (birth: 5.5 (95% CI = 4.6-6.4) kg, p = 0.001; 72 hours: 6.4 (95% CI = 6.1-6.8) kg, p = 0.002) or at 110 days of gestation (birth: 5.4 (95% CI = 4.4-6.4) kg, p = 0.001; 72 hours: 6.5 (95% CI = 5.9-7.1) kg, p = 0.001) were heavier than lambs from unshorn ewes (birth: 4.0 (95% CI = 3.3-4.8) kg; 72 hours: 4.8 (95% CI = 3.5-6.1) kg). Lambs born to S70 and S110 ewes suckled sooner (31.5 (95% CI = 14.5-48.5) minutes, p = 0.001; and 39.3 (95% CI = 23.7-55.0) minutes, p = 0.001 respectively), than lambs born to the US group (70.3 (95% CI = 38.6-102.1) minutes). There was no evidence for an effect of pre-partum shearing on gestation length, parturition length, time of placental expulsion, placental efficiency, weight and energy of perirenal brown fat, and lamb temperature at birth. CONCLUSIONS AND CLINICAL RELEVANCE: Shearing ewes pre-partum may lead to placental changes affecting lamb development and behaviour and associated with higher survival. The findings suggest pre-partum shearing may improve lamb survival, farm profitability and sustainability.

WITHDRAWN: Malformación venosa verrugosa y sobrecrecimiento: a propósito de 2 casos.

The Publisher regrets that this article is an accidental duplication of an article that has already been published, https://doi.org/10.36959/472/363. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.

The Lifebox Surgical Headlight Project: engineering, testing, and field assessment in a resource-constrained setting.

BACKGROUND: Poor surgical lighting represents a major patient safety issue in low-income countries. This study evaluated device performance and undertook field assessment of high-quality headlights in Ethiopia to identify critical attributes that might improve safety and encourage local use. METHODS: Following an open call for submissions (December 2018 to January 2019), medical and technical (non-medical) headlights were identified for controlled specification testing on 14 prespecified parameters related to light quality/intensity, mounting and battery performance, including standardized illuminance measurements over time. The five highest-performing devices (differential illumination, colour rendering, spot size, mounting and battery duration) were distributed to eight Ethiopian surgeons working in resource-constrained facilities. Surgeons evaluated the devices in operating rooms, and in a comparative session rated each headlight in terms of performance and willingness to purchase. RESULTS: Of 25 submissions, eight headlights (6 surgical and 2 technical) met the criteria for full specification testing. Scores ranged from 8 to 12 (of 14), with differential performance in lighting, mounting and battery domains. Only two headlights met the illuminance parameters of more than 35 000 lux during initial testing, and no headlight satisfied all minimum specifications. Of the five headlights evaluated in Ethiopia, daily operation logbooks noted variability in surgeons' opinions of lighting quality (6-92 per cent) and spot size (0-92 per cent). Qualitative interviews also yielded important feedback, including preference for easy transport. Surgeons sought high quality with price sensitivity (using out-of-pocket funds) and identified the least expensive but high-functioning device as their first choice. CONCLUSION: No device satisfied all the predetermined specifications, and large price discrepancies were critical factors leading surgeons' choices. The favoured device is undergoing modification by the manufacturer based on design feedback so an affordable, high-quality surgical headlight crafted specifically for the needs of resource-constrained settings can be used to improve surgical safety.

ANTECEDENTES: Una iluminación quirúrgica deficiente conlleva importantes problemas de seguridad para los pacientes en países de bajos ingresos. En Etiopía, se evaluó el rendimiento y la capacidad de iluminar el campo quirúrgico de varias lámparas de alta calidad para identificar aspectos esenciales que podrían mejorar la seguridad y fomentar su uso local. MÉTODOS: Tras una convocatoria abierta (diciembre de 2018-enero de 2019), se identificaron lamparás médicas y técnicas (no médicas) para realizar un análisis de 14 variables previamente definidas en relación con la calidad/intensidad de la luz, montaje y rendimiento de la batería, además de mediciones estandarizadas de iluminancia a largo plazo. Los cinco dispositivos de mayor rendimiento (iluminación diferencial, reproducción del color, tamaño del foco, montaje y duración de la batería) se distribuyeron entre 8 cirujanos etíopes que trabajaban en instalaciones con recursos limitados. Los cirujanos evaluaron los dispositivos en quirófano y en sesiones comparativas calificaron el rendimiento de cada lámpara y la disposición para su compra. RESULTADOS: De las 25 propuestas presentadas, 8 lámparas (6 quirúrgicas y 2 técnicas) cumplieron los criterios para realizar las pruebas de especificación completas. Las puntuaciones oscilaron entre 8 y 12 (de un total de 14), con diferencias en los ámbitos de iluminación, montaje y batería. Solo 2 lámparas proporcionaron > 35000 lux de iluminancia durante la prueba inicial, y ninguna lámpara cumplió con todas las especificaciones mínimas. De las cinco lámparas evaluadas en Etiopía, hubo una gran variabilidad en las opiniones de los cirujanos anotadas en los registros realizados, tanto sobre la calidad de la iluminación (21-92%), como del tamaño del foco (0-92%). En las entrevistas cualitativas surgieron comentarios importantes como la preferencia por un transporte fácil. Los cirujanos buscaban la mejor calidad al precio más razonable (dado que se utilizaban fondos propios para su adquisición) e identificaron el dispositivo menos costoso pero con alto funcionamiento como primera opción. CONCLUSIÓN: El hecho de que ningún dispositivo satisfizo todas las especificaciones predeterminadas y la gran variabilidad de precios fueron los aspectos esenciales que determinaron la elección de los cirujanos. El dispositivo mejor valorado está siendo modificado por el fabricante en función de los comentarios de diseño, para lograr una lámpara quirúrgica asequible y de alta calidad diseñada específicamente para satisfacer las necesidades de entornos con recursos limitados en la mejora la seguridad quirúrgica.

Prevalence and pattern of cardiovascular magnetic resonance late gadolinium enhancement in highly trained endurance athletes.

BACKGROUND: Intensive endurance exercise may induce a broad spectrum of right ventricular (RV) adaptation/remodelling patterns. Late gadolinium enhancement (LGE) has also been described in cardiovascular magnetic resonance (CMR) of some endurance athletes and its clinical meaning remains controversial. Our aim was to characterize the features of contrast CMR and the observed patterns of the LGE distribution in a cohort of highly trained endurance athletes. METHODS: Ninety-three highly trained endurance athletes (> 12 h training/week at least during the last 5 years; 36 ± 6 years old; 53% male) and 72 age and gender-matched controls underwent a resting contrast CMR. In a subgroup of 28 athletes, T1 mapping was also performed. RESULTS: High endurance training load was associated with larger bi-ventricular and bi-atrial sizes and a slight reduction of biventricular ejection fraction, as compared to controls in both genders (p < 0.05). Focal LGE was significantly more prevalent in athletes than in healthy subjects (37.6% vs 2.8%; p < 0.001), with a typical pattern in the RV insertion points. In T1 mapping, those athletes who had focal LGE had higher extracellular volume (ECV) at the remote myocardium than those without (27 ± 2.2% vs 25.2 ± 2.1%; p < 0.05). CONCLUSIONS: Highly trained endurance athletes showed a ten-fold increase in the prevalence of focal LGE as compared to control subjects, always confined to the hinge points. Additionally, those athletes with focal LGE demonstrated globally higher myocardial ECV values. This matrix remodelling and potential presence of myocardial fibrosis may be another feature of the athlete's heart, of which the clinical and prognostic significance remains to be determined.

Chemoprophylaxis and vaccination in preventing subsequent cases of meningococcal disease in household contacts of a case of meningococcal disease: a systematic review.

Household contacts of an index case of invasive meningococcal disease (IMD) are at increased risk of acquiring disease. In revising WHO guidance on IMD in sub-Saharan Africa, a systematic review was undertaken to assess the effect of chemoprophylaxis and of vaccination in preventing subsequent cases of IMD in household contacts following an index case. A literature search for systematic reviews identified a single suitable review on chemoprophylaxis in 2004 (three studies meta-analysed). A search for primary research papers published since 2004 on chemoprophylaxis and without a date limit on vaccination was therefore undertaken. There were 2381 studies identified of which two additional studies met the inclusion criteria. The summary risk ratio for chemoprophylaxis vs. no chemoprophylaxis (four studies) in the 30-day period after a case was 0·16 [95% confidence interval (CI) 0·04-0·64, P = 0·008]; the number needed to treat to prevent one subsequent case was 200 (95% CI 111-1000). A single quasi-randomized trial assessed the role of vaccination. The risk ratio for vaccination vs. no vaccination at 30 days was 0·11 (95% CI 0·01-2·07, P = 0·14). The results support the use of chemoprophylaxis to prevent subsequent cases of IMD in household contacts of a case. Conclusions about the use of vaccination could not be drawn.

Functional outcomes and participants' perspectives during short-term application of spinal stimulation in individuals with spinal cord injury.

OBJECTIVE: The primary objective of this study was to quantify changes in performance of task-specific motor activities over 12 motor rehabilitation sessions with lumbosacral spinal cord stimulation (SCS) via either transcutaneous stimulation or epidural stimulation. Both stimulation modalities have been used in recent years to restore functions lost to spinal cord injury (SCI). Secondary outcomes examine participants' perspectives captured via the User Experience Questionnaire (UEQ) upon study completion to further understand their perception of SCS. METHODS: Six individuals with SCI completed 12 sessions with one modality of SCS during supine and/or side-lying, seated forward reaching, and standing activities. Changes in volitional lower extremity movement, the number of points of contact needed at hips and/or knees to facilitate standing, and changes in seated forward reaching distance were used to quantify performance. The UEQ was administered to gauge participants' perspectives following use of SCS to enable functions impaired due to SCI. RESULTS: For all participants, performance of motor activities improved with SCS compared to without stimulation. Responses for the UEQ showed an overall positive perception of trialing SCS with rehabilitation to enhance motor functions impaired by SCI. CONCLUSIONS: Regardless of injury severity, location of injury, time since SCI, or SCS modality, all participants experienced gains in motor function in the presence of SCS combined with a condensed rehabilitation program. However, no evidence of sustained motor functions was found in the absence of SCS. UEQ results highlight the positive perception of SCS with rehabilitation as well as the importance of consulting persons with lived experience of SCS during clinical trial design and protocol development.Trial registration: ClinicalTrials.gov identifier: NCT05095454.

Design and manufacture of a reinforced fuselage structure through automatic laying-up and in-situ consolidation with co-consolidation of skin and stringers using thermoplastic composite materials.

Thermoplastic composites can be used to construct safer and more efficient aircraft fuselage structures. They provide significant weight reduction compared to conventional metallic materials, reducing the fuel consumption of the aircraft and increasing its performance and profitability. In this study, we designed and manufactured a level 2* flat fuselage specimen. The specimen comprises 2 Ω-shaped stringers and one Z-shaped frame that were manufactured using a carbon fibre-reinforced thermoplastic material. The skin was laminated on top of the stiffeners and co-consolidated to them, eliminating the need for rivets or adhesives. The manufacturing processes of the stiffeners (press-forming) and skin (in-situ consolidation) are described herein. The quality of the manufactured specimens was evaluated through non-destructive and physical-chemical testing. The test results will serve as a reference for designing and manufacturing a level 3* curved fuselage in a future study. *Level 2: "Element tests according to the Building Block approach (MIL-HDBK-17, 2002) [18]"; Level 3: "Detail tests according to the Building Block approach (MIL-HDBK-17, 2002) [18]".

Sequential teratoma in pediatric patients: causation or coincidence? / Teratoma de aparición secuencial en edad pediátrica: ¿casualidad o causalidad?

We describe the unusual case of a female patient with a history of two mature teratomas non-correlated in terms of location and occurrence. A 12-year-old girl presented at our consultation as a result of a growing tumor in the hypogastric region, with no further clinical signs. She had undergone surgery neonatally due to a mature cystic sacrococcygeal teratoma, which was fully removed. No clinical sequelae were noted and no additional treatment was required over a 10-year follow-up. Radiological examination showed a large 20 × 12 × 18 cm cystic mass extending from the pelvic region to the lower hemiabdomen, associated with two similar small formations adjacent to the right ovary. Tumor markers were negative, and a laparoscopic right salpingoophorectomy was carried out, with an excellent postoperative progression. Pathological examination revealed it was, again, a mature cystic teratoma. The genetic study ruled out causation in this respect.

Describimos el inusual caso de una paciente con antecedente de dos teratomas maduros no relacionados en cuanto a su localización y debut. Una niña de 12 años consultó por la aparición de una tumoración en la región hipogástrica de crecimiento progresivo sin otra clínica asociada. Había sido intervenida por un teratoma quístico maduro sacrococcígeo en el periodo neonatal con su extirpación completa y, ausencia secuelas clínicas y tratamiento adicional durante diez años de seguimiento posterior. Los exámenes radiológicos mostraron una gran masa quística de 20 × 12 × 18 cm que se extendía entre la región pélvica y el hemiabdomen inferior, acompañada por otras dos pequeñas formaciones similares adyacentes al ovario derecho. Los marcadores tumorales resultaron negativos y se llevó a cabo una salpingooforectomía derecha laparoscópica con una excelente evolución postoperatoria. El examen histopatológico, de nuevo, informó la lesión como teratoma quístico maduro. El estudio genético descartó una posible causalidad en este ámbito.

Towards a standardized initial training program in experimental microsurgery for pediatric surgeons. / Hacia un programa inicial de formación estandarizadoen microcirugía experimental para cirujanos pediátricos.

OBJECTIVE: To describe a basic training program in microsurgery and to analyze the learning curve through the process, including improvement in operating times and functional outcome. MATERIALS AND METHODS: Our learning program included basic, transitional, and experimental models. The experimental model included tail vein cannulation, intestinal resection and anastomosis, dissection, division and anastomosis of the cava and aorta. Wistar rats (66.7% male; 406.9 ± 38.9 grams) were used. The program adhered to the 3R principle and obtained animal welfare committee approval. RESULTS: Mean tail vein cannulation time was 2.4 ± 1.2 minutes. Mean intestinal resection and jejunocolic anastomosis time was 14.8 ± 2.7 minutes and 10.4 ± 3 minutes, respectively. All anastomoses were functionally valid. Mean vessel dissection time was 22.9 ± 7.7 minutes, aortic artery anastomosis was 17.2 ± 7.1 minutes, and vena cava anastomosis was 25.9 ± 7.3 minutes. 66.7% of vena cava anastomoses were functionally valid vs. 88.9% for the aorta. The time required for all procedures decreased after the third attempt, except for vena cava anastomoses, which remained similar in all 9 procedures. CONCLUSIONS: Our model demonstrated that the procedures were suitable for trainer progression in terms of surgical time and functional outcome. Microsurgical training would benefit from standardized programs to optimize results.

OBJETIVO: Describimos un programa de formación básica en microcirugía y analizamos la curva de aprendizaje a través del proceso, incluyendo la mejora en los tiempos operatorios y en el resultado funcional del procedimiento. MATERIAL Y METODOS: Nuestro programa de aprendizaje incluye modelos básicos, de transición y experimentales. Dentro del modelo experimental se incluyeron: canulación de la vena de la cola, resección y anastomosis intestinal, disección, sección y anastomosis de la cava y la aorta. Se emplearon ratas Wistar (66,7% machos; 406,9 ± 38,9 gramos), el programa se adhirió al principio de las 3R y obtuvo la aprobación del comité de bienestar animal. RESULTADOS: El tiempo medio de canulación de la vena de la cola fue de 2.4 ± 1,2 minutos. El tiempo medio de resección intestinal y anastomosis yeyunocólica de 14.8 ± 2,7 minutos y 10.4 ± 3 minutos, respectivamente. Todas las anastomosis fueron funcionalmente válidas. El tiempo medio de la disección de vasos fue de 22,9 ± 7,7 minutos, la anastomosis de la arteria aorta de 17,2 ± 7,1 minutos, mientras que la anastomosis de la vena cava fue de 25,9 ± 7,3 minutos. El 66,7% de las anastomosis de la vena cava fueron funcionalmente válidas en comparación con el 88,9% de la aorta. El tiempo requerido para todos los procedimientos disminuyó después del tercer intento, excepto para las anastomosis de vena cava, que se mantuvo similar en los 9 procedimientos. CONCLUSIONES: Nuestro modelo demostró que los procedimientos eran adecuados para la progresión del entrenador en términos de tiempo quirúrgico y resultado funcional. La formación microquirúrgica se beneficiaría de programas estandarizados para optimizar los resultados.

Diffuse hepatocutaneous hemangiomatosis: an unusual presentation. / Hemangiomatosis hepatocutánea difusa: presentación inusual.

INTRODUCTION: Infantile hemangiomas with multi-organ involvement are rare, and presentation in the form of uncontrollable bleeding is exceptional. CLINICAL CASE: 4-day-old newborn with multiple hepatocutaneous hemangiomas and a purplish vascular lesion in the third finger of the right hand. In the third week of life, the lesion became ulcerated and caused uncontrollable bleeding. Therefore, urgent amputation was required, with a histopathological result of GLUT-1 positive infantile hemangioma, and an architecture compatible with arteriovenous malformation in the deep portion. Imaging tests revealed it was a high-flow lesion. Genetic tests (MAP2KI, RASA 1, EPHB4, GNAQ, and GNA 11) were negative. Patient progression was good, with hepatocutaneous lesions receding and eventually disappearing. DISCUSSION: No explanation has been given yet as to why the same vascular lesion may behave differently in different patients. New mutations may be accountable for this.

INTRODUCCION: Los hemangiomas infantiles con afectación multivisceral son escasos y su presentación en forma de hemorragia incontrolable es excepcional. CASO CLINICO: Recién nacido de 4 días de vida que presentaba múltiples hemangiomas hepatocutáneos y una lesión vascular púrpura-violácea, que abarcaba el tercer dedo de la mano derecha. En la tercera semana de vida, la lesión presentó ulceración y un sangrado incoercible requiriendo amputación urgente, con un resultado histopatológico de hemangioma infantil GLUT-1 positivo, con arquitectura compatible con malformación arteriovenosa en la parte profunda. Las pruebas de imagen mostraron que se trataba de una lesión de alto flujo. La genética (MAP2KI, RASA 1, EPHB4, GNAQ y GNA 11) fue negativa. La evolución del paciente fue buena, con la involución de las lesiones hepatocutáneas hasta su desaparición. COMENTARIOS: La divergencia en el comportamiento de las mismas lesiones vasculares en diferentes pacientes aún no ha encontrado explicación. Es posible que nuevas mutaciones puedan darnos una respuesta.

Native valve infective endocarditis due to ampicillin-resistant Escherichia coli in the postoperative period of a right radical nephrectomy due to xanthogranulomatous pyelonephritis. / Endocarditis infecciosa sobre válvula nativa por Escherichia coli resistente a ampicilina en el postoperatorio de una nefrectomía radical derecha por pielonefritis xantogranulomatosa.

Infective endocarditis (IE) due to Escherichia coli is a rare disease, although increasingly frequent. Persistent fever in septic patients despite adequate treatment raises the need to consider IE as a differential diagnosis. We present the case of a 36-year-old male patient who underwent a radical right nephrectomy as a result of diagnosis of xanthogranulomatous pyelonephritis, presenting in the postoperative period a state of septic shock with persistent fever of 41°C. Given the finding of a new-onset murmur, he was diagnosed with a mitroaortic IE by means of a transesophageal echocardiogram (TEE), having to undergo cardiac surgery for valve replacement. After multiple postoperative complications, he is successfully discharged.

Ischemic-hemorrhagic stroke in patients with Covid-19. / Afectación cerebrovascular isquémico-hemorrágica en pacientes con covid-19.

Coronavirus associated severe acute respiratory syndrome (SARS-CoV-2) causes a worldwide syndrome called Covid-19 that has caused 5,940,441 infections and 362,813 deaths until May 2020. In moderate and severe stages of the infection a generalized swelling, cytokine storm and an increment of the heart damage biomarkers occur. In addition, a relation between Covid-19 and neurological symptoms have been suggested. The results of autopsies suggest thrombotic microangiopathy in multiple organs. We present 2 cases of patients infected with severe Covid-19 that were hospitalized in the Reanimation Unit that presented cerebrovascular symptoms and died afterwards. A high dose prophylaxis with antithrombotic medication is recommended in patients affected by moderate to severe Covid-19.

Influence of the coronavirus 2 (SARS-Cov-2) pandemic on acute appendicitis.

INTRODUCTION: Acute appendicitis (AA) is the most common abdominal surgical emergency. No specific studies have been found that evaluate the impact of the coronavirus 2 (SARS-Cov-2) pandemic on AA and its surgical management. An analysis was made on the influence of this new pathology on the clinical course of AA. MATERIAL AND METHODS: Retrospective observational study was conducted on patients operated on for AA from January to April 2020. They were classified according to the time of the appendectomy, before the declaration of the state of alarm (Pre-COVID-19), and after its declaration (Post-COVID-19) in Spain, one the most affected countries in the world. An evaluation was made of demographic variables, duration of symptoms, type of appendicitis, surgical time, hospital stay, and postoperative complications. RESULTS: The study included 66 patients (41 Pre-COVID-19; 25 Post-COVID-19) with mean age of 10.7 ±â€¯3 and 9.3 ±â€¯3.1; P = .073, respectively. Fever was found in a higher number of post-COVID-19 patients (52 vs 19.5%; P = .013), as well as a higher CRP (72.7 ±â€¯96.2 vs 31.3 ±â€¯36.2 mg/dL; P = .042). This group presented with a higher proportion of complicated appendicitis when compared to Pre-COVID-19 (32 vs 7.3%; P = .015). The mean hospital stay was longer in the Post-COVID-19 group (5.6 ±â€¯5.9 vs 3.2 ±â€¯4.3 days; P = .041). No differences were found in the time of onset of symptoms or surgical time. CONCLUSIONS: The SARS-Cov-2 pandemic influenced the time of diagnosis of appendicitis, as well as its course, and mean hospital stay. Peritonitis was more frequently seen. As a result of the significant circumstances, delaying diagnosis and treatment of AA during SARS-Cov-2 pandemic, inappropriate management of this common surgical disorder has been noticed.

INTRODUCCIÓN: La apendicitis aguda (AA) es la urgencia quirúrgica abdominal más frecuente. No encontramos estudios específicos que evalúen el impacto de la pandemia causada por el coronavirus 2 (SARS-Cov-2) sobre la AA y su tratamiento quirúrgico. Analizamos la influencia de esta nueva patología sobre la AA. MATERIAL Y MÉTODOS: Estudio observacional retrospectivo en pacientes intervenidos por AA desde enero hasta abril de 2020. Fueron clasificados según el momento de la apendicectomía, antes de la declaración del estado de alarma (Pre-COVID19) y después de la declaración del estado de alarma (Post-COVID19) en España. Se evaluaron variables demográficas, duración de la sintomatología, tipo de apendicitis, tiempo quirúrgico, estancia hospitalaria y complicaciones postoperatorias. RESULTADOS: Se incluyeron 66 pacientes (41 Pre-COVID19; 25 Post-COVID19 con edad media de 10.7 ±â€¯3 y 9.3 ±â€¯3.1; P = .073; respectivamente). La fiebre se encontró en un mayor número de pacientes post-COVID19 (52 vs 19.5%; P = .013), así como una PCR más elevada (72.7 ±â€¯96.2 vs 31.3 ±â€¯36.2 mg/dl; P = .042). Este grupo presentó una mayor proporción de apendicitis complicada al compararle con el Pre-COVID19 (32 vs 7.3%; P = .015). La estancia media hospitalaria fue mayor en el grupo Post-COVID19 (5.6 ±â€¯5.9 vs 3.3 ±â€¯4.3 días; P = .041). No se encontraron diferencias en el tiempo de evolución de los síntomas ni en el tiempo quirúrgico. CONCLUSIONES: La pandemia por SARS-Cov-2 influye en el momento de diagnóstico de la apendicitis, así como en su grado de evolución y estancia hospitalaria. La peritonitis fue lo más frecuentemente observado. Una sospecha y orientación clínica más temprana, es necesaria para evitar un manejo inadecuado de este trastorno quirúrgico común.

Does time to antibiotic initiation and surgery have an impact on acute appendicitis results? / ¿Influye el tiempo hasta el inicio de la antibioterapia y la intervención en los resultados de la apendicitis aguda?

OBJECTIVE: Time to treatment initiation is a key element to be considered in infectious pathologies such as acute appendicitis (AA). There are few articles in the literature analyzing the relationship between early pre-surgical antibiotic treatment initiation and complication occurrence in AA. Our objective is to analyze such influence and the effects of late treatment initiation. MATERIALS AND METHODS: A retrospective, observational study was carried out in children undergoing surgery for AA between 2017 and 2018. Demographic variables, time to antibiotic treatment initiation, time to surgery, and postoperative complications were analyzed. RESULTS: 592 patients with a median 12-month follow-up were included in the study. Antibiotic treatment initiation in the first 8 hours following diagnosis prevents complications [OR 0.24 (95% CI: 0.07-0.80)] and dramatically reduces the occurrence of intra-abdominal abscess from 25.0% to 5.5% (p=0.03). Antibiotic treatment initiation in the first 4 hours following diagnosis significantly reduced wound infection rate in non-overweight patients [2.9% vs. 13.6%; OR 0.19 (95% CI: 0.045-0.793); p=0.042]. Surgery within the first 24 hours following diagnosis reduced the proportion of advanced AA (gangrenous appendicitis and peritonitis) from 100% to 38.6% (p=0.023). CONCLUSIONS: Antibiotic treatment initiation in the first 4 hours following AA prevented the occurrence of post-surgical complications, especially in non-overweight patients. An adequate clinical approach and an early assessment by the pediatric surgeon are key to reduce the morbidity associated with AA.

OBJETIVO: El tiempo hasta el inicio del tratamiento es un elemento fundamental a considerar en patologías infecciosas como la apendicitis aguda (AA). Existen escasos artículos en la literatura que analicen la relación entre el inicio precoz de la antibioterapia prequirúrgica y el desarrollo de complicaciones en la AA. Nuestro objetivo es analizar dicha influencia y el efecto de su retraso. MATERIAL Y METODOS: Se realizó un estudio observacional retrospectivo en niños intervenidos de AA entre 2017-2018. Se analizaron variables demográficas, tiempo transcurrido hasta el inicio de la antibioterapia, tiempo hasta la cirugía y complicaciones postoperatorias. RESULTADOS: Se incluyeron 592 pacientes con mediana de seguimiento de 12 meses. El inicio de la antibioterapia en las primeras 8 horas tras el diagnóstico previene la aparición de complicaciones [OR 0,24 (IC95% 0,07-0,80)], disminuyendo significativamente el porcentaje de aparición de abscesos intraabdominales del 25,0 al 5,5% (p= 0,03). El inicio de la antibioterapia en las primeras 4 horas tras el diagnóstico disminuyó significativamente la tasa de infección de herida en pacientes sin sobrepeso [2,9 vs. 13,6%; OR 0,19 (IC95% 0,045-0,793); p= 0,042]. La intervención quirúrgica en las primeras 24 horas tras el diagnóstico disminuyó la proporción de AA evolucionada (gangrenada y peritonitis) del 100 al 38,6% (p= 0,023). CONCLUSIONES: El inicio de la antibioterapia en las primeras 4 horas tras el diagnóstico de AA previno el desarrollo de complicaciones postquirúrgicas, sobre todo en pacientes sin sobrepeso. Una orientación clínica adecuada y valoración precoz por el cirujano pediátrico son un elemento clave para disminuir la morbilidad asociada a la AA.

An optimized, clinically relevant mouse model of cisplatin-induced ototoxicity.

Cisplatin-induced ototoxicity results in significant, permanent hearing loss in pediatric and adult cancer survivors. Elucidating the mechanisms underlying cisplatin-induced hearing loss as well as the development of therapies to reduce and/or reverse cisplatin ototoxicity have been impeded by suboptimal animal models. Clinically, cisplatin is most commonly administered in multi-dose, multi-cycle protocols. However, many animal studies are conducted using single injections of high-dose cisplatin, which is not reflective of clinical cisplatin administration protocols. Significant limitations of both high-dose, single-injection protocols and previous multi-dose protocols in rodent models include high mortality rates and relatively small changes in hearing sensitivity. These limitations restrict assessment of both long-term changes in hearing sensitivity and effects of potential protective therapies. Here, we present a detailed method for an optimized mouse model of cisplatin ototoxicity that utilizes a multi-cycle administration protocol that better approximates the type and degree of hearing loss observed clinically. This protocol results in significant hearing loss with very low mortality. This mouse model of cisplatin ototoxicity provides a platform for examining mechanisms of cisplatin-induced hearing loss as well as developing therapies to protect the hearing of cancer patients receiving cisplatin therapy.

Patient Attitudes to Medical Photography: Study of a Spanish Population at the Pius Hospital de Valls in Tarragona, Spain. / Actitudes de pacientes hacia la fotografía médica. Estudio en población española: Pius Hospital de Valls (Tarragona, España).

INTRODUCTION: Medical photography is a noninvasive technique used for diagnostic, monitoring, and educational purposes. It is important to understand the patient's attitude to all or part of their body being photographed. The objective of this study was to analyze the attitudes of patients towards medical photography at a district hospital in Tarragona, Spain. METHODOLOGY: This exploratory study used a questionnaire to evaluate attitudes to medical photography among outpatients at Pius Hospital de Valls. The questionnaire explored the patients' beliefs about the usefulness of medical photography, the circumstances in which they would agree to be photographed and by whom, as well as their prior experience of medical photography. They were also asked whether they would authorize the use of photography and, if not, to explain their motives. RESULTS: The questionnaire was completed by 134 patients. The results showed that patients had a clearly positive attitude to being photographed for medical purposes (94.8%), treatment follow-up (88.1%), and consultation of their case with other physicians (86.6%). Acceptance was 88.8% if the lesion was malignant and 85.1% if it was extensive. For facial lesions, only 78.4% were willing to be photographed and in the case of genitals the percentage fell to 70.2%. Most patients (95.5%) would agree to being photographed by their doctor. The rate of acceptance was 66.4% in the case of a nurse, 64.9% for another doctor, and 21.6% for a professional photographer. CONCLUSIONS: Our study revealed that patients have a positive attitude to being photographed for medical purposes, particularly when they have a malignant lesion, when the photograph is taken by their specialist, and when they cannot be identified.

Unilateral diaphragmatic paralysis after laparoscopic cholecystectomy. / Parálisis diafragmática unilateral tras colecistectomía laparoscópica.

Laparoscopic cholecystectomy is currently the gold standard treatment for acute biliary tract pathology. Despite its many advantages compared to open surgery, it is not without complications. We present the case of an 82-year-old man who, after a diagnosis of gangrenous cholecystitis, underwent urgent laparoscopic cholecystectomy. During the first 24hours after the surgery, he had an episode of acute respiratory failure, for which he was admitted to the critical care unit. Studies performed later showed paralysis of the right diaphragm that was probably related to the surgery.

Teratoma de aparición secuencial en edad pediátrica: ¿casualidad o causalidad? / Sequential teratoma in pediatric patients: causation or coincidence?

Describimos el inusual caso de una paciente con antecedente de dos teratomas maduros no relacionados en cuanto a su localización y debut. Una niña de 12 años consultó por la aparición de una tumoración en la regió n hipogástrica de crecimiento progresivo sin otra clínica asociada. Había sido intervenida por un teratoma quístico maduro sacrococcígeo en el periodo neonatal con su extirpació n completa y, ausencia secuelas clínicas y tratamiento adicional durante diez años de seguimiento posterior. Los exámenes radioló gicos mostraron una gran masa quística de 20 × 12 × 18 cm que se extendía entre la región pélvica y el hemiabdomen inferior, acompañada por otras dos pequeñas formaciones similares adyacentes al ovario derecho. Los marcadores tumorales resultaron negativos y se llevó a cabo una salpingooforectomía derecha laparoscópica con una excelente evolución postoperatoria. El examen histopatológico, de nuevo, informó la lesión como teratoma quístico maduro. El estudio genético descartó una posible causalidad en este ámbito.(AU)

We describe the unusual case of a female patient with a history of two mature teratomas non-correlated in terms of location and occurrence. A 12-year-old girl presented at our consultation as a result of a growing tumor in the hypogastric region, with no further clinical signs. She had undergone surgery neonatally due to a mature cystic sacrococcygeal teratoma, which was fully removed. No clinical sequelae were noted and no additional treatment was required over a 10-year follow-up. Radiological examination showed a large 20 × 12 × 18 cm cystic mass extending from the pelvic region to the lower hemiabdomen, associated with two similar small formations adjacent to the right ovary. Tumor markers were negative, and a laparoscopic right salpingoophorectomy was carried out, with an excellent postoperative progression. Pathological examination revealed it was, again, a mature cystic teratoma. The genetic study ruled out causation in this respect.(AU)

Hacia un programa inicial de formación estandarizado en microcirugía experimental para cirujanos pediátricos / Towards a standardized initial training program in experimental microsurgery for pediatric surgeons

Objetivo: Describimos un programa de formación básica en microcirugía y analizamos la curva de aprendizaje a través del proceso,incluyendo la mejora en los tiempos operatorios y en el resultado funcional del procedimiento. Material y métodos: Nuestro programa de aprendizaje incluyemodelos básicos, de transición y experimentales. Dentro del modeloexperimental se incluyeron: canulación de la vena de la cola, reseccióny anastomosis intestinal, disección, sección y anastomosis de la cava y laaorta. Se emplearon ratas Wistar (66,7% machos; 406,9 ± 38,9 gramos),el programa se adhirió al principio de las 3R y obtuvo la aprobación delcomité de bienestar animal. Resultados: l tiempo medio de canulación de la vena de la cola fuede 2.4 ± 1,2 minutos. El tiempo medio de resección intestinal y anastomosis yeyunocólica de 14.8 ± 2,7 minutos y 10.4 ± 3 minutos, respectivamente. Todas las anastomosis fueron funcionalmente válidas. El tiempomedio de la disección de vasos fue de 22,9 ± 7,7 minutos, la anastomosisde la arteria aorta de 17,2 ± 7,1 minutos, mientras que la anastomosisde la vena cava fue de 25,9 ± 7,3 minutos. El 66,7% de las anastomosisde la vena cava fueron funcionalmente válidas en comparación con el88,9% de la aorta. El tiempo requerido para todos los procedimientosdisminuyó después del tercer intento, excepto para las anastomosis devena cava, que se mantuvo similar en los 9 procedimientos. Conclusiones: Nuestro modelo demostró que los procedimientoseran adecuados para la progresión del entrenador en términos de tiempo quirúrgico y resultado funcional. La formación microquirúrgica sebeneficiaría de programas estandarizados para optimizar los resultados.(AU)

Objective: To describe a basic training program in microsurgery andto analyze the learning curve through the process, including improve-ment in operating times and functional outcome. Materials and methods: Our learning program included basic,transitional, and experimental models. The experimental model includedtail vein cannulation, intestinal resection and anastomosis, dissection,division and anastomosis of the cava and aorta. Wistar rats (66.7% male;406.9 ± 38.9 grams) were used. The program adhered to the 3R principleand obtained animal welfare committee approval. Results: Mean tail vein cannulation time was 2.4 ± 1.2 minutes.Mean intestinal resection and jejunocolic anastomosis time was14.8 ± 2.7 minutes and 10.4 ± 3 minutes, respectively. All anastomoseswere functionally valid. Mean vessel dissection time was 22.9 ± 7.7minutes, aortic artery anastomosis was 17.2 ± 7.1 minutes, and vena cavaanastomosis was 25.9 ± 7.3 minutes. 66.7% of vena cava anastomoseswere functionally valid vs. 88.9% for the aorta. The time required forall procedures decreased after the third attempt, except for vena cavaanastomoses, which remained similar in all 9 procedures. Conclusions: Our model demonstrated that the procedures weresuitable for trainer progression in terms of surgical time and functionaloutcome. Microsurgical training would benefit from standardized pro-grams to optimize results.(AU)