Ausencia de toracotomía mediante la sutura manual intratorácica y la extracción transabdominal de la pieza quirúrgica durante la esofagectomía robótica de Ivor Lewis / Absence of thoracotomy by intrathoracic manual suture and transabdominal removal of surgical specimen during Ivor Lewis robotic esophagectomy

En el tratamiento quirúrgico del cáncer de esófago, la cirugía robótica permite realizar una anastomosis manual intratorácica de manera más sencilla, rápida y cómoda para el cirujano que la cirugía abierta y la cirugía mínimamente invasiva tradicional. Con ello evitamos el uso de instrumentos de autosutura, algunos de los cuales precisan una pequeña toracotomía para su introducción. No obstante, la extracción de la pieza exige la práctica de esa toracotomía, de tamaño variable, y que puede asociar dolor torácico intenso. Describimos una sencilla modificación técnica del Ivor Lewis robótico clásico que permite la extracción de la pieza quirúrgica por una mínima incisión abdominal, evitando la necesidad de fracturar costillas de forma controlada, así como las posibles secuelas de practicar una incisión en la pared torácica.(AU)

In the surgical treatment of esophageal cancer, robotic surgery allows performing an intrathoracic hand-sewn anastomosis in a simpler, faster and more comfortable way for the surgeon than open surgery and traditional minimally invasive surgery. With this, we avoid the use of self-suture instruments, some of which require a small thoracotomy for their introduction. However, the retrieval of the specimen requires the practice of this thoracotomy, of variable size, that can be associated with intense chest pain. We describe a technical modification of the classic robotic Ivor Lewis that allows removal of the surgical piece through a minimal abdominal incision, thus avoiding controlled rib fracture, as well as the possible sequelae of making an incision in the chest wall.(AU)

Absence of thoracotomy by intrathoracic manual suture and transabdominal removal of surgical specimen during Ivor Lewis robotic esophagectomy.

In the surgical treatment of esophageal cancer, robotic surgery allows performing an intrathoracic handsewn anastomosis in a simpler, faster and more comfortable way for the surgeon than open surgery and traditional minimally invasive surgery. With this, we avoid the use of self-suture instruments, some of which require a small thoracotomy for their introduction. However, the retrieval of the specimen requires the practice of this thoracotomy, of variable size, that can be associated with intense chest pain. We describe a technical modification of the classic robotic Ivor Lewis that allows removal of the surgical piece through a minimal abdominal incision, thus avoiding controlled rib fracture, as well as the possible sequelae of making an incision in the chest wall.

Monitoring modifiable injury risk factors over an in-season mesocycle in semi-professional female field hockey players.

OBJECTIVE: This study aimed to determine changes of modifiable injury risk factors and fatigue parameters during a mesocycle (4 months of the competitive season) in semi-professional female field hockey players (Spanish 2nd Division). METHODS: Fourteen female field hockey players (age: 22.6 ± 4.9 years) participated in the study over 4 months of the competitive season (September-December 2019). The players were tested each month for their: maximal isometric knee flexion, hip adduction, and abduction muscle strength; passive straight leg raise and ankle dorsiflexion range of motion (ROM); countermovement jump height; and perceptual fatigue (through a perceived well-being questionnaire). RESULTS: Statistical differences were reported in isometric knee flexion torque in the dominant and non-dominant limb (p = < 0.001, ηp2 = 0.629,0.786 respectively), non-dominant isometric hip abductors torque (p = 0.016, ηp2 = 0.266) and isometric hip adductors torque in dominant and non-dominant limbs (p = < 0.001, ηp2 = 0.441-546). Also, significant differences were reported in the straight leg raise test (p = < 0.001, ηp2 = 0-523, 0.556) and ankle dorsiflexion (p = 0.001, ηp2 = 0.376, 0.377) for the dominant and non-dominant limb respectively. Finally, the jump height measured showed significant differences (p = <.001, ηp2 = 0.490), while no differences were reported in perceived well-being parameters (p = 0.089-0.459). CONCLUSION: Increments in isometric muscle strength and fluctuations in ROM values and vertical jumping capacity are reported over an in-season mesocycle (i.e., 4 months of the competitive season). This information can be used to target recovery strategies to make them more efficient.

Training in ambulatory surgery. A pending subject in our country.

The implementation and generalized use of Ambulatory Surgery worldwide is currently a clear reality. Its progressive growth is expected in the short term, but this globalization can also negatively affect the education and training of future doctors, as well as those who are being trained now, if it is not standardized and regulated, since a significant part of the management of the most common pathology that could be performed in Ambulatory Surgery is completed outside the training circuits of hospitals where resident doctors are trained.

Distance Education for children with a disability and/or from vulnerable families.

Different reasons may hinder the right to education of children with a disability and/or from vulnerable families; for example, living in rural areas where they do not have access to public transport, restriction of opportunities to access schools, precarious economic situations, lack of minimum services that meet the needs of hygiene and personal care, among other reasons. This has made it necessary to implement changes in traditional education systems. For this reason, the objective of this study is to build a theoretical base that facilitates the understanding of the requirements of these children in terms of distance education. To do this, the authors interviewed primary education teachers who work with children with a disability and/or from vulnerable families. A qualitative research methodology was used with the focus group as a technique for collecting information. Ten primary school teachers participated in an interview made up of a set of open-ended questions that facilitated their narratives regarding education strategies used for students with a disability and/or those living in vulnerable families, which were later grouped into categories. As a result of this research, the following strategies used by the participating teachers were collected: recreating the feeling of the physical classroom in the virtual classroom, fostering friendship and companionship among students, designing engagement strategies, and considering the socio-cultural variables that influence learning. The teachers assured that distance education is a perfectly viable alternative for children with a disability and/or from vulnerable families.

Consensus of the ambulatory surgery commite section of the Spanish Association of Surgeons on the role of ambulatory surgery in the SARS-CoV-2 pandemic.

The current situation of the SARS-CoV-2 pandemic has paralyzed non-urgent and/or oncological surgery in many hospitals in our country with what it means for the health of citizens who are awaiting a surgical procedure. Outpatient Surgery can afford more than 85% of the surgical procedures that are performed in a surgical department and is presented as a feasible and safe alternative at the present time since it does not require admission and decreases clearly the risk of infection. In addition, it is the tool that should be generalized to solve the accumulation of patients on the waiting list that the pandemic is generating, so it seems appropriate that the Ambulatory Surgery section of the Spanish Association of Surgeons present a series of recommendations for the implementation of outpatient surgery in these exceptional circumstances that we have to live.

Esophageal stricture as an initial manifestation of Crohn's disease.

Crohn's disease located in the esophagus is rare, being exceptional as the initial manifestation of the disease. Erosive ulcerative esophagitis, stricture and fistula are forms of presentation, as in other esophageal pathologies, so the differential diagnosis is broad. The histologic features of esophageal Crohn's disease can be nonspecific and increase the diagnostic challenge. Esophageal Crohn's disease should be included in the differential diagnosis of esophageal strictures and may require esophagectomy if medical-endoscopic treatment is not effective.

Consenso de la sección de cirugía mayor ambulatoria de la Asociación Española de Cirujanos sobre el papel de la cirugía mayor ambulatoria en la pandemia SARS-CoV-2 / Consensus of the ambulatory surgery commite section of the Spanish Association of Surgeons on the role of ambulatory surgery in the SARS-CoV-2 pandemic

La situación actual de la pandemia por SARS-CoV-2 tiene paralizada la cirugía no urgente y/u oncológica en muchos hospitales de nuestro país con lo que esto conlleva para la salud de los ciudadanos que están pendientes de una intervención quirúrgica. La cirugía mayor ambulatoria puede abarcar en su cartera de servicios más del 85% de los procedimientos quirúrgicos que se realizan en un servicio de cirugía y se presenta como una alternativa factible y segura en el momento actual ya que no requiere camas de ingreso y disminuye claramente el riesgo de infección. Además, es la herramienta que debería generalizarse para solucionar la acumulación de pacientes en lista de espera que la pandemia está generando, por lo que parece oportuno que desde la sección de Cirugía Mayor Ambulatoria de la Asociación Española de Cirujanos se presente una serie de recomendaciones para la implementación de la misma en estas circunstancias excepcionales que nos toca vivir.(AU)

The current situation of the SARS-CoV-2 pandemic has paralyzed non-urgent and/or oncological surgery in many hospitals in our country with what it means for the health of citizens who are awaiting a surgical procedure. Outpatient Surgery can afford more than 85% of the surgical procedures that are performed in a surgical department and is presented as a feasible and safe alternative at the present time since it does not require admission and decreases clearly the risk of infection. In addition, it is the tool that should be generalized to solve the accumulation of patients on the waiting list that the pandemic is generating, so it seems appropriate that the Ambulatory Surgery section of the Spanish Association of Surgeons present a series of recommendations for the implementation of outpatient surgery in these exceptional circumstances that we have to live.(AU)

[Consensus of the ambulatory surgery commite section of the Spanish Association of Surgeons on the role of ambulatory surgery in the SARS-CoV-2 pandemic]. / Consenso de la sección de cirugía mayor ambulatoria de la Asociación Española de Cirujanos sobre el papel de la cirugía mayor ambulatoria en la pandemia SARS-CoV-2.

The current situation of the SARS-CoV-2 pandemic has paralyzed non-urgent and/or oncological surgery in many hospitals in our country with what it means for the health of citizens who are awaiting a surgical procedure. Outpatient Surgery can afford more than 85% of the surgical procedures that are performed in a surgical department and is presented as a feasible and safe alternative at the present time since it does not require admission and decreases clearly the risk of infection. In addition, it is the tool that should be generalized to solve the accumulation of patients on the waiting list that the pandemic is generating, so it seems appropriate that the Ambulatory Surgery section of the Spanish Association of Surgeons present a series of recommendations for the implementation of outpatient surgery in these exceptional circumstances that we have to live.

Influence of Football Match-Play on Isometric Knee Flexion Strength and Passive Hip Flexion Range of Motion in Football Referees and Assistant Referees.

The aim of this study was to examine the acute effect of officiating a football (soccer) match on isometric knee flexion strength and passive hip flexion range-of-motion (ROM) in referees and assistant football referees. Twelve referees (25.3 ± 3.3 years) and twenty-three assistant referees (25.1 ± 4.8 years) underwent measurements on isometric knee flexion strength and passive hip flexion ROM before and after officiating an official football match. Referees' and assistant referees' running patterns were monitored during the match using GPS technology. In comparison to pre-match values, referees reduced their isometric knee flexion strength (-12.36%, p = 0.046, Effect size [ES] = -0.36) in the non-dominant limb, while no significant differences were reported in the dominant limb (-0.75%, p = 0.833, ES = -0.02). No effect of the match was found in hip flexion ROM values in dominant (-4.78%, p = 0.102, ES = -0.15) and non-dominant limb (5.54%, p = 0.544, ES = 0.19). In assistant referees, the pre-to-post-match changes in isometric knee flexion strength (dominant limb -3.10%, p = 0.323, ES = -0.13; non-dominant limb -2.18%, p = 0.980, ES= 0.00) and hip flexion ROM (dominant limb 1.90% p = -0.816, ES = 0.13; non-dominant limb 3.22% p = 0.051, ES = 0.23) did not reach statistical significance. Officiating a match provoked a reduction in isometric knee flexion strength in the non-dominant limb of football referees, while no differences were reported in assistant referees.

[Influence of the lockdown due to COVID-19 on weight-loss results during the first year after sleeve gastrectomy]. / Influencia del confinamiento por COVID-19 en los resultados ponderales durante el primer año tras la gastrectomía vertical.

INTRODUCTION: COVID-19 pandemic has lead to lockdown of population in many countries. In Spain, the state of alarm was established from March 15 to June 20, 2020. Usually this fact decreased people's mobility and physical activity, in addition to producing or exacerbating psychological disorders. Our aim was to determine the influence that this condition had over the short-term ponderal results of patients undergoing laparoscopic vertical gastrectomy from May 2019 to May 2020. METHODS: Case-control study for comparing the percentage of excess weight lost (%EWL) and the percentage of total weight lost (%TWL) of patients that underwent a VG during the last year, so they were affected by lockdown in April and part of March 2020 (group 1), to the %EWL and %TWL of a control group (group 2), obtained from our previous series. RESULTS: The mean %EWL in group 1 is 47,37 ± 18,59 and in group 2 is 51,13 ± 17,59, being p = 0,438. Meanwhile, the mean %TWL in group 1 is 21,14 ± 8,17 and in group 2 is 24,67 ± 8,01, with p = 0,115. CONCLUSIONS: Population lockdown by COVID-19 did not get worse short-term results of vertical gastrectomy. More studies with a larger number of patients are necessary to draw firm conclusions.

Impact of the Vaginal and Endometrial Microbiome Pattern on Assisted Reproduction Outcomes.

Uterine microbiota may be involved in reproductive health and disease. This study aims to describe and compare the vaginal and endometrial microbiome patterns between women who became pregnant and women who did not after in vitro fertilization. We also compared the vaginal and endometrial microbiome patterns between women with and without a history of repeated implantation failures (RIF). This pilot prospective cohort study included 48 women presenting to the fertility clinic for IVF from May 2017 to May 2019. Women who achieved clinical pregnancy presented a greater relative abundance of Lactobacillus spp. in their vaginal samples than those who did not (97.69% versus 94.63%; p = 0.027. The alpha and beta diversity of vaginal and endometrial samples were not statistically different between pregnant and non-pregnant women. The Faith alpha diversity index in vaginal samples was lower in women with RIF than those without RIF (p = 0.027). The alpha diversity of the endometrial microbiome was significantly higher in women without RIF (p = 0.021). There were no significant differences in the vaginal and endometrial microbiomes between pregnant and non-pregnant women. The relative abundance of the genera in women with RIF was different from those without RIF. Statistically significant differences in the endometrial microbiome were found between women with and without RIF.

Influencia del confinamiento por COVID-19 en los resultados ponderales durante el primer año tras la gastrectomía vertical / Influence of the lockdown due to COVID-19 on weight-loss results during the first year after sleeve gastrectomy

Introducción: La pandemia por COVID-19ha obligado al confinamiento de la población en muchos países. En España, el estado de alarma se estableció desde el 15 de marzo al 20 de junio del 2020. Este hecho, por lo general, disminuyó la movilidad y la actividad física de las personas, además de producir o exacerbar alteraciones psicológicas. Nuestro objetivo es analizar la influencia que esta situación ha ejercido sobre los resultados ponderales a corto plazo de los pacientes tratados mediante una gastrectomía vertical laparoscópica entre mayo del 2019 y mayo del 2020. Métodos: Estudio de casos y controles donde se compararon el porcentaje de exceso de peso perdido (%EWL) y el porcentaje de peso total perdido (%TWL) de los pacientes intervenidos en el último año y a los que ha afectado el confinamiento durante el mes de abril y parte de marzo del 2020 (grupo 1; n=20), con el de un grupo control (grupo 2; n=40) de nuestra casuística previa. Resultados: El %EWL medio en el grupo 1 es de 47,37±18,59 y en el grupo 2 es de 51,13±17,59, siendo la p=0,438. Por su parte, el %TWL medio en el grupo 1 es de 21,14±8,17 mientras que en el grupo 2 es de 24,67±8,01, resultando la p=0,115. Conclusiones: El confinamiento de la población por COVID-19 no empeoró los resultados ponderales a corto plazo de la gastrectomía vertical. Son necesarios más estudios con un mayor número de pacientes para obtener conclusiones más sólidas. (AU)

Introduction: COVID-19 pandemic has lead to lockdown of population in many countries. In Spain, the state of alarm was established from March 15 to June 20, 2020. Usually this fact decreased people's mobility and physical activity, in addition to producing or exacerbating psychological disorders. Our aim was to determine the influence that this condition had over the short-term ponderal results of patients undergoing laparoscopic vertical gastrectomy from May 2019 to May 2020. Methods: Case-control study for comparing the percentage of excess weight lost (%EWL) and the percentage of total weight lost (%TWL) of patients that underwent a VG during the last year, so they were affected by lockdown in April and part of March 2020 (group 1), to the %EWL and %TWL of a control group (group 2), obtained from our previous series. Results: The mean %EWL in group 1 is 47,37±18,59 and in group 2 is 51,13±17,59, being p=0,438. Meanwhile, the mean %TWL in group 1 is 21,14±8,17 and in group 2 is 24,67±8,01, with p=0,115. Conclusions: Population lockdown by COVID-19 did not get worse short-term results of vertical gastrectomy. More studies with a larger number of patients are necessary to draw firm conclusions. (AU)

Endurance running prevents the age-related decline of calcaneal bone stiffness.

This investigation presents a comparison of calcaneus bone stiffness of endurance runners of different ages and age-matched controls. We found that there was an age-associated decline in calcaneus bone stiffness in the control group while endurance runners prevented this decline, with a higher effect as the participants increased their age. PURPOSE: Previous investigations have found that endurance runners have higher bone mineral density and other bone quality variables in mechanically loaded bones. However, it is unknown if endurance running might counteract the decline in bone stiffness that occurs with age. The purpose of this study was to compare calcaneus bone stiffness of endurance runners of different ages to age-matched controls. METHODS: In a descriptive cross-sectional study, 182 endurance-trained male runners and 116 healthy untrained male controls underwent an ultrasonographic assessment of the calcaneus bone in the right and left heels. Calcaneal bone stiffness was calculated from assessments of the broadband ultrasound attenuation and the speed of sound. RESULTS: The line of best fit for the association between age and calcaneus stiffness was different between marathoners and controls (Z = - 2.1, P = 0.02). A two-way ANCOVA (condition × age) with body mass, and body mass index as covariates, revealed that there were main effects of condition (F = 26.8, P < 0.01) and age (F = 4.2, P < 0.01) for calcaneus stiffness, with a significant interaction between these two factors (F = 2.8, P = 0.03). The post hoc analysis revealed that calcaneus stiffness was significantly higher in marathoners of 40-44 years (121.5 ± 18.2 vs 101.1 ± 21.3 arbitrary units [A.U.], P = 0.01), 45-49 years (121.5 ± 19.7 vs 104.3 ± 13.4 A.U., P = 0.04), and > 50 years (111.2 ± 17.9 vs 92.4 ± 16.0 A.U., P < 0.01) than their untrained counterparts of the same age with no statistically significant differences in the remaining age groups. CONCLUSION: Endurance runners of > 40 years had higher values of calcaneus stiffness than controls, providing evidence to support the potential effect of endurance running to reduce the age-related decline on calcaneus bone stiffness.

Influence of the lockdown due to COVID-19 on weight-loss results during the first year after sleeve gastrectomy.

INTRODUCTION: COVID-19 pandemic has lead to lockdown of population in many countries. In Spain, the state of alarm was established from March 15 to June 20, 2020. Usually this fact decreased people's mobility and physical activity, in addition to producing or exacerbating psychological disorders. Our aim was to determine the influence that this condition had over the short-term ponderal results of patients undergoing laparoscopic vertical gastrectomy from May 2019 to May 2020. METHODS: Case-control study for comparing the percentage of excess weight lost (%EWL) and the percentage of total weight lost (%TWL) of patients that underwent a VG during the last year, so they were affected by lockdown in April and part of March 2020 (group 1), to the %EWL and %TWL of a control group (group 2), obtained from our previous series. RESULTS: The mean %EWL in group 1 is 47.37±18.59 and in group 2 is 51.13±17.59, being P=.438. Meanwhile, the mean %TWL in group 1 is 21.14±8.17 and in group 2 is 24.67±8.01, with P=.115. CONCLUSIONS: Population lockdown by COVID-19 did not get worse short-term results of vertical gastrectomy. More studies with a larger number of patients are necessary to draw firm conclusions.