Results of a Novel Long-Term Method for Laparoscopic Skills Online Training.

Introduction: Ensuring patient safety in minimally invasive surgery (MIS) within the field of pediatric surgery requires systematic and extensive practice. Many groups have proposed mastery learning programs encompassing a range of training methods. However, short courses often have a narrow focus on specific objectives, limiting opportunities for sustained training. Our aim was to analyze our results with an online long-term competency-based and supervised training. Methods: This is a retrospective cohort study with prospective data collection of scores and performance of trainees during online courses from October 2020 to April 2023. Results: All participants (n = 76) were able to set up their personal training gym and complete the intensive stage of the course. The total score evolved from 2.60 ± 0.56 at the first meeting to 3.67 ± 0.61 at the fourth meeting, exhibiting a significant difference (P < .013). A considerable drop out was observed in the follow-up stage, with only 53.8% of the participants completing the course. When compared with the first meeting, they also showed a significant improvement with a mean general score of 3.85 ± 0.25 (P < .013) Conclusion: We have presented a novel online training program, based on continuous training that demonstrated that the unlimited access to a personal training gym allows surgeons to improve and maintain MIS skills.

Visual analytics identifies key miRNAs for differentiating peripancreatic paraganglioma and pancreatic neuroendocrine tumors.

Introduction: Paragangliomas (PGL), a type of neuroendocrine tumor, pose a significant diagnostic challenge due to their potential for unpredictable locations and asymptomatic presentation. Misdiagnosis of peripancreatic PGLs, particularly as pancreatic neuroendocrine tumors (PANNETs), is a pressing issue as it can negatively impact both pre- and post-treatment decision-making. The aim of our study was to identify microRNA markers for the reliable differential diagnosis of peripancreatic PGLs and PANNETs, addressing a crucial unmet need in the field and advancing the standard of care for these patients. Methods: Morphing projections tool was used to analyze miRNA data from PGL and PANNET tumors present in the TCGA database. The findings were validated using two additional databases: GSE29742 and GSE73367. Results: Our research uncovered substantial differences in the miRNA expression profiles of PGL and PANNET, leading to the identification of 6 key miRNAs (miR-10b-3p, miR-10b-5p, and the miRNA families miR-200c/141 and miR-194/192) that can effectively differentiate between the two types of tumors. Discussion: These miRNA levels hold potential as biomarkers for improved diagnosis, offering a solution to the diagnostic challenge posed by these tumors and potentially improving the standard of care for patients.

Experiences of insecurity among non-standard workers across different welfare states: A qualitative cross-country study.

In recent decades, economic crises and political reforms focused on employment flexibilization have increased the use of non-standard employment (NSE). National political and economic contexts determine how employers interact with labour and how the state interacts with labour markets and manages social welfare policies. These factors influence the prevalence of NSE and the level of employment insecurity it creates, but the extent to which a country's policy context mitigates the health influences of NSE is unclear. This study describes how workers experience insecurities created by NSE, and how this influences their health and well-being, in countries with different welfare states: Belgium, Canada, Chile, Spain, Sweden, and the United States. Interviews with 250 workers in NSE were analysed using a multiple-case study approach. Workers in all countries experienced multiple insecurities (e.g., income and employment insecurity) and relational tension with employers/clients, with negative health and well-being influences, in ways that were shaped by social inequalities (e.g., related to family support or immigration status). Welfare state differences were reflected in the level of workers' exclusion from social protections, the time scale of their insecurity (threatening daily survival or longer-term life planning), and their ability to derive a sense of control from NSE. Workers in Belgium, Sweden, and Spain, countries with more generous welfare states, navigated these insecurities with greater success and with less influence on health and well-being. Findings contribute to our understanding of the health and well-being influences of NSE across different welfare regimes and suggest the need in all six countries for stronger state responses to NSE. Increased investment in universal and more equal rights and benefits in NSE could reduce the widening gap between standard and NSE.

Exploratory Analysis of the Gene Expression Matrix Based on Dual Conditional Dimensionality Reduction.

One of the major goals in gene expression data analysis is to explore and discover groups of genes and groups of biological conditions with meaningful relationships. While this problem can be addressed by algorithms, their results require an analysis within context, since they may be affected by many side processes -such as tissue differentiation- that could hinder the target goal. Visual analytics-based methods for exploratory analysis of the gene expression matrix (GEM) are essential in biomedical research since they allow us to frame the analysis within the user's knowledge domain. In this paper, we present a visual analytics approach to discover relevant connections between genes and samples based on linking a reordered GEM heatmap and dual 2D projections of its rows and columns, which can be recomputed conditioned by subsets of genes and/or samples selected by the user during the analysis. We demonstrate the capability of our approach to discover relevant knowledge in three case studies involving two cancer types plus normal tissue from the TCGA database.

Differential HIF2α Protein Expression in Human Carotid Body and Adrenal Medulla under Physiologic and Tumorigenic Conditions.

Hypoxia-inducible factors (HIF) 2α and 1α are the major oxygen-sensing molecules in eukaryotic cells. HIF2α has been pathogenically linked to paraganglioma and pheochromocytoma (PPGL) arising in sympathetic paraganglia or the adrenal medulla (AM), respectively. However, its involvement in the pathogenesis of paraganglioma arising in the carotid body (CB) or other parasympathetic ganglia in the head and neck (HNPGL) remains to be defined. Here, we retrospectively analyzed HIF2α by immunohistochemistry in 62 PPGL/HNPGL and human CB and AM, and comprehensively evaluated the HIF-related transcriptome of 202 published PPGL/HNPGL. We report that HIF2α is barely detected in the AM, but accumulates at high levels in PPGL, mostly (but not exclusively) in those with loss-of-function mutations in VHL and genes encoding components of the succinate dehydrogenase (SDH) complex. This is associated with upregulation of EPAS1 and the HIF2α-regulated genes COX4I2 and ADORA2A. In contrast, HIF2α and HIF2α-regulated genes are highly expressed in CB and HNPGL, irrespective of VHL and SDH dysfunctions. We also found that HIF2α and HIF1α protein expressions are not correlated in PPGL nor HNPGL. In addition, HIF1α-target genes are almost exclusively overexpressed in VHL-mutated HNPGL/PPGL. Collectively, the data suggest that involvement of HIF2α in the physiology and tumor pathology of human paraganglia is organ-of-origin-dependent and HIF1α-independent.

Non-Standard Employment and Unemployment during the COVID-19 Crisis: Economic and Health Findings from a Six-Country Survey Study.

The COVID-19 crisis is a global event that has created and amplified social inequalities, including an already existing and steadily increasing problem of employment and income insecurity and erosion of workplace rights, affecting workers globally. The aim of this exploratory study was to review employment-related determinants of health and health protection during the pandemic, or more specifically, to examine several links between non-standard employment, unemployment, economic, health, and safety outcomes during the COVID-19 pandemic in Sweden, Belgium, Spain, Canada, the United States, and Chile, based on an online survey conducted from November 2020 to June 2021. The study focused on both non-standard workers and unemployed workers and examined worker outcomes in the context of current type and duration of employment arrangements, as well as employment transitions triggered by the COVID-19 crisis. The results suggest that COVID-19-related changes in non-standard worker employment arrangements, or unemployment, are related to changes in work hours, income, and benefits, as well as the self-reported prevalence of suffering from severe to extreme anxiety or depression. The results also suggest a link between worker type, duration of employment arrangements, or unemployment, and the ability to cover regular expenses during the pandemic. Additionally, the findings indicate that the type and duration of employment arrangements are related to the provision of personal protective equipment or other COVID-19 protection measures. This study provides additional evidence that workers in non-standard employment and the unemployed have experienced numerous and complex adverse effects of the pandemic and require additional protection through tailored pandemic responses and recovery strategies.

Gender Differences in Dual Diagnoses Associated with Cannabis Use: A Review.

Gender differences in psychiatric disorders and drug use are well known. Cannabis is the most widely used illegal drug among young people. In recent years, its use has been related to the development of psychiatric pathologies; however, few studies have incorporated the gender perspective as of yet. The present work analyses the literature to determine the existence of gender differences in the development of psychotic, depressive and anxious symptoms associated with cannabis use. First, we describe cannabis misuse and its consequences, paying special attention to adolescent subjects. Second, the main gender differences in psychiatric disorders, such as psychosis, depression, anxiety and cannabis use disorders, are enumerated. Subsequently, we discuss the studies that have evaluated gender differences in the association between cannabis use and the appearance of psychotic, depressive and anxious symptoms; moreover, we consider the possible explanations for the identified gender differences. In conclusion, the studies referred to in this review reveal the existence of gender differences in psychiatric symptoms associated with cannabis use, although the direction of such differences is not always clear. Future research is necessary to discern the causal relationship between cannabis use and the development of psychiatric symptoms, as well as the gender differences found.

Costocondritis y espondilitis diferidas por Candida en paciente post-COVID tratado previamente con corticoides, antibióticos y tocilizumab / Delayed Candida costochondritis and spondylitis in a post-COVID patient previously treated with corticosteroids, antibiotics, and tocilizumab

No disponible

Morphing projections: a new visual technique for fast and interactive large-scale analysis of biomedical datasets.

MOTIVATION: Biomedical research entails analyzing high dimensional records of biomedical features with hundreds or thousands of samples each. This often involves using also complementary clinical metadata, as well as a broad user domain knowledge. Common data analytics software makes use of machine learning algorithms or data visualization tools. However, they are frequently one-way analyses, providing little room for the user to reconfigure the steps in light of the observed results. In other cases, reconfigurations involve large latencies, requiring a retraining of algorithms or a large pipeline of actions. The complex and multiway nature of the problem, nonetheless, suggests that user interaction feedback is a key element to boost the cognitive process of analysis, and must be both broad and fluid. RESULTS: In this article, we present a technique for biomedical data analytics, based on blending meaningful views in an efficient manner, allowing to provide a natural smooth way to transition among different but complementary representations of data and knowledge. Our hypothesis is that the confluence of diverse complementary information from different domains on a highly interactive interface allows the user to discover relevant relationships or generate new hypotheses to be investigated by other means. We illustrate the potential of this approach with three case studies involving gene expression data and clinical metadata, as representative examples of high dimensional, multidomain, biomedical data. AVAILABILITY AND IMPLEMENTATION: Code and demo app to reproduce the results available at https://gitlab.com/idiazblanco/morphing-projections-demo-and-dataset-preparation. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

Leucoencefalopatía multifocal progresiva en el curso de terapia combinada con bendamustina y rituximab / Progressive multifocal leukoencephalopathy in the course of combined therapy with bendamustine and rituximab

No disponible

Experimental and Numerical Study of the Thermo-Viscoplastic Behavior of NICRO 12.1 for Perforation Tests.

Dynamic impact tests using thin metal plates for ballistic characterization have received significant attention in recent years. The Johnson-Cook (J-C) model is extensively used in numerical modeling of impact and penetration in metals. The AISI (American Iron and Steel Institute) 301 steel family presents good impact behavior, excellent formability, and high corrosion resistance. Thus, NICRO (Nickel and Hard Chrome Plated Steel) 12.1 (part of the AISI 301 steel family) was chosen in this work, although parameters of the J-C model or impact results were not found in the literature. In this work, NICRO 12.1 steel plates, were characterized in ballistics with an initial impact velocity up to 200 m/s and three shape nose projectiles. The Johnson-Cook parameters for the NICRO 12.1 steel were calculated for a large range of temperatures and strain rates. Impact tests were carried out using three projectiles: conical, hemispherical, and blunt. The ballistic curves, failure mode, and maximum deformation obtained with each projectile, experimentally and numerically, were compared, and a good correlation was obtained.

Circulating miR-320a as a Predictive Biomarker for Left Ventricular Remodelling in STEMI Patients Undergoing Primary Percutaneous Coronary Intervention.

Restoration of epicardial coronary blood flow, achieved by early reperfusion with primary percutaneous coronary intervention (PPCI), is the guideline recommended to treat patients with ST-segment-elevation myocardial infarction (STEMI). However, despite successful blood restoration, increasing numbers of patients develop left ventricular adverse remodelling (LVAR) and heart failure. Therefore, reliable prognostic biomarkers for LVAR in STEMI are urgently needed. Our aim was to investigate the role of circulating microRNAs (miRNAs) and their association with LVAR in STEMI patients following the PPCI procedure. We analysed the expression of circulating miRNAs in blood samples of 56 patients collected at admission and after revascularization (at 3, 6, 12 and 24 h). The associations between miRNAs and left ventricular end diastolic volumes at 6 months were estimated to detect LVAR. miRNAs were also analysed in samples isolated from peripheral blood mononuclear cells (PBMCs) and human myocardium of failing hearts. Kinetic analysis of miRNAs showed a fast time-dependent increase in miR-133a, miR-133b, miR-193b, miR-499, and miR-320a in STEMI patients compared to controls. Moreover, the expression of miR-29a, miR-29b, miR-324, miR-208, miR-423, miR-522, and miR-545 was differentially expressed even before PPCI in STEMI. Furthermore, the increase in circulating miR-320a and the decrease in its expression in PBMCs were significantly associated with LVAR and correlated with the expression of miR-320a in human failing myocardium from ischaemic origin. In conclusion, we determined the time course expression of new circulating miRNAs in patients with STEMI treated with PPCI and we showed that miR-320a was positively associated with LVAR.

DCNN for condition monitoring and fault detection in rotating machines and its contribution to the understanding of machine nature.

Rotating machines are critical equipment in many processes, and failures in their operation can have serious implications. Consequently, fault detection in rotating machines has been widely investigated. Conventional detection systems include two blocks: feature extraction and classification. These systems are based on manually engineered features (ball pass frequencies, RMS value, kurtosis, crest factor, etc.) and therefore require a high level of human expertise (it is a human who designs and selects the most appropriate set of features to perform the classification). Instead, we propose a system for condition monitoring and fault detection in rotating machines based on a 1-D deep convolutional neural network (1D DCNN), which merges the tasks of feature extraction and classification into a single learning body. The proposed system has been designed for use on a rotating machine with seven possible operating states and it proves to be able to determine the operating condition of the machine almost as accurately as conventional feature-engineered classifiers, but without the need for prior knowledge of the machine. The proposed system has also reported good classification on a bearing fault dataset from another machine, thus demonstrating its capability to monitor the condition of different machines. Finally, the analysis of the features learned by the deep model has revealed valuable and previously unknown machine information, such as the rotational speed of the machine or the number of balls in the bearings. In this way, our results illustrate not only the good performance of CNNs, but also their versatility and the valuable information they could provide about the monitored machine.

[Alport syndrome. Report of two cases]. / Repercusiones oculares del Síndrome de Alport: A propósito de dos casos.

Alport syndrome is an inherited progressive form of glomerular disease that is often associated with sensorineural hearing loss and ocular abnormalities. We report two men with Alport syndrome. Both had chronic kidney disease and consulted for long-term loss of visual acuity. One had auditory abnormalities. On the ophthalmological examination, both had anterior lenticonus and one had dot or fleck retinopathy. Those findings are described in up to 50% and 70% of men with X-linked Alport syndrome, respectively. Both patients had a family history of Alport syndrome or suggestive signs and symptoms.