The evolution of incisional hernia repair in Spain. A comparative analysis of results from the EVEREG registry.

BACKGROUND: The aim of this study was to assess the utility of the EVEREG registry in evaluating the evolution of surgical treatment for incisional hernia and its outcomes in Spain by comparing data from 2 study periods. METHODS: A retrospective comparative analysis of hernia surgeries performed between 2011 and 2015 (first period) and between 2017 and 2022 (second period) was conducted using data collected from the EVEREG registry. RESULTS: Statistically significant differences were observed in the second cohort, including: a decrease in minimally invasive procedures (11.7% vs 8.2%; P < .001), an increase in emergency surgeries for males (31.7% vs 41.2%; P = .017), an increase in trocar hernia repairs (16% vs 26.2%; P < .0001), a reduction in suture repairs (2.8% vs 1.5%; P < .0001), and an increase in retromuscular techniques (36.4% vs 52.4%; P < .001) in open surgery with mesh. In elective surgery, there was a decrease in the average length of stay (4.9 vs 3.8 days; P < .0001), the percentage of complications (27.9% vs 24.0%; P < .0001), reoperations (3.5% vs 1.4%; P < .0001), and mortality (0.6% vs 0.2%; P = .002). Long-term outcomes included a decrease in recurrences after 12 months (20.7% vs 14.5%; P < .0001) and in chronic pain (13.7% vs 2.5%; P < .0001) and chronic infections (9.1% vs 14.5%; P < .0001) after 6 months. CONCLUSION: In recent years, there has been a significant improvement in the outcomes of incisional hernia treatment. The registry serves as a fundamental tool for assessing the evolution of hernia treatment and enables the identification of key areas for improvement and the evaluation of treatment outcomes.

Data quality validation of the Spanish Incisional Hernia Surgery Registry (EVEREG): pilot study.

PURPOSE: The Spanish Incisional Hernia Surgery Registry (EVEREG) was promoted by the Abdominal Wall Section of the Spanish Association of Surgeons, starting data collection in July 2012 and currently has more than 14,000 cases. The objective of this study was to validate the data collected through a pilot audit process. METHODS: A sample of hospitals participating in the EVEREG registry since the beginning was selected. Patients registered in these centers in the 2012-2020 period were included. A stratified random sampling was carried out, with the inclusion of 10% of registered cases per center with a minimum of 20 cases per center. At each participating center, two researchers not belonging to the center undergoing the audit checked (on site or telematically) the concordance between the data in the registry and the data contained in the case history of each patient. RESULTS: 330 patients have been analyzed, out of a total of 2673 registered, in 9 participating centers. The average accuracy has been 95.7%. Incorrect data 1.5% and missing data 2.3% CONCLUSION: The group of pilot hospitals from this EVERG incisional hernia surgery registry shows a very high precision of 95.7%. The confirmation of these findings in all the centers participating in the registry will make it possible to guarantee the quality of the studies made and their comparability with other similar national registries. TRIAL REGISTRATION: nnTrial registration number: ClinicalTrials.gov ID:NCT03899012.

Open preperitoneal vs. open anterior repair for the treatment of emergency femoral hernia: a bicentric retrospective study.

PURPOSE: The aim of this study is to compare the postoperative results, in terms of complications and recurrence, between the anterior and open preperitoneal approaches in emergency femoral hernia. METHODS: This bi-centric retrospective cohort study included patients who underwent emergency femoral hernia repair between January 2010 and December 2018. Postoperative complications and recurrence were analyzed comparing anterior and open preperitoneal approaches. The predictors of complications, mortality and recurrence were investigated using multivariate logistic regression. RESULTS: A total of 204 patients met the inclusion criteria. Open anterior approach was performed in 128 (62.7%) patients and open preperitoneal was performed in 76 (37.3%). Open preperitoneal approach was associated with lower rates of recurrence (P = 0.033) and associated midline laparotomies (P = 0.006). Multivariable analysis identified patients with chronic nephropathy (OR, 3.801; 95%CI, 1.034-13.974; P = 0.044), preoperative bowel obstruction (OR, 2.376; 95%CI, 1.118-5.047; P = 0.024) and required midline laparotomy (OR, 12.467; 95%CI, 11.392-102.372; P = 0.030) as risk factors for complications and ASA ≥ III (OR, 7.820; 95%CI, 1.279-47.804; P = 0.026), COPD (OR, 5.064; 95%CI, 1.188-21.585; P = 0.028), necrotic contents (OR, 36.968; 95%CI, 4.640-294.543; P = 0.001), and required midline laparotomy (OR, 11.047; 95%CI, 1.943-62.809; P = 0.007). as risk factors for 90-day mortality. Male gender (OR, 4.718; 95%CI, 1.668-13.347; P = 0.003) and anterior approach (OR, 5.292; 95%CI, 1.114-25.149; P = 0.036) were risk factors for recurrence. CONCLUSION: Open preperitoneal approach may be superior to anterior approach in the emergency setting because it can avoid the morbidity of associated midline laparotomies, with a lower long-term recurrence rate.

The Debye length and anionic transport properties of composite membranes based on supported ionic liquid-like phases (SILLPS).

An analysis of the ionic transport properties of BMIM [NTf2] in supported ionic-liquid-like phase (SILLP)-based membranes has been carried out based on experimental impedance spectroscopy measurements. The direct current (dc)-conductivity was analyzed to determine the temperature and frequency dependence. The fit of the loss tangent curve data with the Cole-Cole approximation of the electrode polarization model provides the conductivity, diffusivity, and density of charge carriers. Among these quantities, a significant increase in conductivity is observed when an ionic liquid is added to the polymeric matrix containing imidazolium fragments. The use of a recent generalization of Eyring's absolute rate theory allowed the elucidation of how the local entropy restrictions, due to the porosity of the polymeric matrix, control the conductive process. The fit of the conductivity data as a function of temperature manifests the behavior of the excess entropy with respect to the temperature. The activation entropy and enthalpy were also determined. Our results correlate the Debye length (LD) with the experimental values of conductivity, electrode polarization relaxation time, and sample relaxation time involved. Our work provides novel insights into the description of ionic transport in membranes as the diffusivity, mobility, and free charge density depend on the LD. Moreover, we discuss the behavior of the polarization relaxation time, the sample relaxation time, and the static permittivity as a function of the temperature.

Computational modeling of the effect of five mutations on the structure of the ACE2 receptor and their correlation with infectivity and virulence of some emerged variants of SARS-CoV-2 suggests mechanisms of binding affinity dysregulation.

Interactions between the human angiotensin-converting enzyme 2 (ACE2) and the RBD region of the SARS-CoV-2 Spike protein are critical for virus entry into the host cell. The objective of this work was to identify some of the most relevant SARS-CoV-2 Spike variants that emerged during the pandemic and evaluate their binding affinity with human variants of ACE2 since some ACE2 variants can enhance or reduce the affinity of the interaction between the ACE2 and S proteins. However, no information has been sought to extrapolate to different variants of SARS-CoV-2. Therefore, to understand the impact on the affinity of the interaction between ACE2 protein variants and SARS-CoV-2 protein S variants, molecular docking was used in this study to predict the effects of five mutations of ACE2 when they interact with Alpha, Beta, Delta, Omicron variants and a hypothetical variant, which present mutations in the RBD region of the SARS-CoV-2 Spike protein. Our results suggest that these variants could alter the interaction of the Spike and the human ACE2 protein, losing or creating new inter-protein contacts, enhancing viral fitness by improving binding affinity, and leading to an increase in infectivity, virulence, and transmission. This investigation highlighted that the S19P mutation of ACE2 decreases the binding affinity between the ACE2 and Spike proteins in the presence of the Beta variant and the wild-type variant of SARS-CoV-2 isolated in Wuhan-2019. The R115Q mutation of ACE2 lowers the binding affinity of these two proteins in the presence of the Beta and Delta variants. Similarly, the K26R mutation lowers the affinity of the interaction between the ACE2 and Spike proteins in the presence of the Alpha variant. This decrease in binding affinity is probably due to the lack of interaction between some of the key residues of the interaction complex between the ACE2 protein and the RBD region of the SARS-CoV-2 Spike protein. Therefore, ACE2 mutations appear in the presence of these variants, they could suggest an intrinsic resistance to COVID-19 disease. On the other hand, our results suggested that the K26R, M332L, and K341R mutations of ACE2 expressively showed the affinity between the ACE2 and Spike proteins in the Alpha, Beta, and Delta variants. Consequently, these ACE2 mutations in the presence of the Alpha, Beta, and delta variants of SARS-CoV-2 could be more infectious and virulent in human cells compared to the SARS-CoV-2 isolated in Wuhan-2019 and it could have a negative prognosis of the disease. Finally, the Omicron variant in interaction with ACE2 WT, S19P, R115Q, M332L, and K341R mutations of ACE2 showed a significant decrease in binding affinity. This could be consistent that the Omicron variant causes less severe symptoms than previous variants. On the other hand, our results suggested Omicron in the complex with K26R, the binding affinity is increased between ACE2/RBD, which could indicate a negative prognosis of the disease in people with these allelic conditions.

Tendencia de la hospitalización por ictus isquémico en adultos jóvenes de la Región de Murcia durante el periodo 2006-2014 / Trends in hospitalisation for ischaemic stroke in young adults in the region of Murcia (Spain) between 2006 and 2014

Introducción: Estudios recientes en Europa y Estados Unidos muestran un posible aumento de la incidencia y la hospitalización por ictus isquémico en adultos jóvenes, sin embargo, en España la información disponible de la tendencia es escasa. Por ello planteamos analizar la tendencia de hospitalización por ictus isquémico en adultos menores de 50 años en la Región de Murcia entre 2006 y 2014. Método: Se realizó un estudio retrospectivo de las altas de hospitalización por enfermedad cerebrovascular (ECV) extraídas del Registro del conjunto mínimo de datos al alta hospitalaria. Se obtuvieron las tasas estandarizadas, desagregadas según edad y subtipo de ECV. La tendencia de los episodios fue analizada mediante regresión de joinpoint, obteniendo la tasa estandarizada anual calculada y el porcentaje de cambio anual (PCA). Resultados: Se identificaron un total de 27.064 altas por ECV en los 9 años del estudio. Los episodios generados por ictus isquémico fueron los más numerosos (61,0%), en pacientes entre 18 y 49 años; entre los años extremos, se registró un aumento del 26% de los episodios por ictus isquémico y del 29,2% de las tasas, mientras que en la regresión de joinpoint no se observó tendencia (PCA = 2,74%, p ≥ 0,05). Por el contrario, en mayores de 49 años esta tendencia fue descendente (PCA = –1,24%, p < 0,05). Conclusiones: No se ha identificado una tendencia en la hospitalización por ictus isquémico en adultos jóvenes a pesar del descenso en adultos de mayor edad. Sería importante identificar las causas de este comportamiento desigual para desarrollar medidas específicas dirigidas al grupo de menor edad. (AU)

Introduction: Recent studies conducted in Europe and the United States suggest upward trends in both incidence and hospitalisation rates for ischaemic stroke in young adults; however, data for Spain are scarce. This study analyses the trend in hospitalisation due to ischaemic stroke in adults aged under 50 years in the region of Murcia between 2006 and 2014. Method: We performed a retrospective study of patients discharged after hospitalisation due to cerebrovascular disease (CVD); data were obtained from the regional registry of the Minimum Basic Data Set. Standardised rates were calculated, disaggregated by age and CVD subtype. Time trends were analysed using joinpoint regression to obtain the annual calculated standardised rate and the annual percentage of change (APC). Results: A total of 27 064 patients with CVD were discharged during the 9-year study period. Ischaemic stroke was the most frequent subtype (61.0%). In patients aged 18 to 49 years, the annual number of admissions due to ischaemic stroke increased by 26%, and rates by 29.2%; however, the joinpoint regression analysis showed no significant changes in the trend (APC = 2.74%, P≥.05). By contrast, a downward trend was identified in individuals older than 49 (APC = –1.24%, P<.05). Conclusions: No significant changes were observed in the rate of hospitalisation due to ischaemic stroke among young adults, despite the decline observed in older adults. Identifying the causes of these disparate trends may be beneficial to the development of specific measures targeting younger adults. (AU)

Hernia incisional umbilical (M3). ¿Son diferentes las hernias de trócar? Análisis comparativo del registro EVEREG / Umbilical incisional hernias (M3): Are trocar-site hernias different? Comparative analysis of the EVEREG Registry

Introducción La hernia incisional (HI) es una complicación frecuente. El objetivo principal de este estudio es comparar características, complicaciones y recurrencias de las HI producidas por la colocación de un trócar laparoscópico umbilical (M3T) con las de misma localización tras cirugía abierta (M3O); y de forma secundaria, la identificación de factores de riesgo. Método Estudio observacional transversal analizando al registro EVEREG durante el periodo entre julio del 2012 y junio del 2018. Las variables principales fueron recurrencias y complicaciones postoperatorias. Se compararon ambos grupos (M3T y M3O). Se realizó regresión logística múltiple para identificar los factores de riesgo de la cohorte completa. Resultados Se incluyeron un total de 882 casos. El grupo M3O presentó un ASA superior, HI con criterios de mayor complejidad para la reparación, mayor número de recurrencias a los 12 y 24 meses (8,6 vs. 2,5%; p < 0,0001 y 9,3 vs. 2,9%; p < 0,0001, respectivamente) y complicaciones postoperatorias (21,9 vs. 14,6%; p = 0,02). Se identificaron como factores de riesgo para la aparición de complicaciones postoperatorias, la reparación previa, la duración de la intervención y el requerimiento de procedimientos asociados, y para las recidivas: la ausencia de especialista de pared abdominal, la reparación previa y la aparición de complicaciones. El análisis por puntuación de propensión no detectó diferencias significativas en complicaciones y recurrencias. Conclusiones Las HI M3 de trócar umbilical son menos complejas que las originadas por cirugía abierta. La complejidad no se relaciona con el origen de la hernia, sino con sus características y las del paciente (AU)

Introduction Incisional hernia (HI), in open and laparoscopic surgery, is a very frequent complication. HI located in the umbilical region are called M3. The main aim of this study is to compare HI produced by the placement of an umbilical laparoscopic trocar (M3T) with those located in M3 in open surgery (M3O) in terms of basal characteristics, complications and recurrences; and secondarily the identification of risk factors. Method Cross-sectional observational study based on the national prospective registry EVEREG during the period of July 2012 - June 2018. The main variables were recurrences and postoperative complications. Both groups (M3T and M3O) were compared. Multiple logistic regression was performed to identify the risk factors of the entire cohort. Results 882 had a follow-up time longer than 12 months. M3O group presented superior ASA-Class, more complex HI and previous repair. It also presented a higher recurrence rate at 12 and 24 months (8.6 vs. 2.5%; p < 0,0001 and 9.3 vs. 2.9%; p < 0.0001) and higher postoperative complications rate (21.9 vs. 14.6%; p = 0.02). Previous repair, intervention length and associated procedures requirement were identified as risk factors for postoperative complications. Absence of a specialist present during surgery, previous repair, and the absence of complications were identified as risk factors for recurrence. In the PSM analysis no differences were detected in of complications and recurrences. Conclusions HI M3O is more complex than M3T. The complexity is not related to the origin of the hernia but to its characteristics and those of the patient (AU)

Antithrombotic Treatment after Carotid Stenting in Patients with Concomitant Atrial Fibrillation.

BACKGROUND AND PURPOSE: Antithrombotic therapy following carotid artery stent placement with concomitant atrial fibrillation is not well-established. Our aim was to assess the safety and efficacy of the combination of direct oral anticoagulants and a P2Y12 inhibitor at 30 days after carotid artery stent placement in patients with atrial fibrillation. MATERIALS AND METHODS: We designed an observational single-center study including patients who underwent carotid artery stent placement with concomitant atrial fibrillation. We studied 3 groups according to antithrombotic therapy: 1) the direct oral anticoagulants plus clopidogrel (DC) group: receiving direct oral anticoagulants plus a P2Y12 inhibitor; 2) the triple therapy group: anticoagulation and dual antiplatelet therapy; and 3) the dual antiplatelet therapy group: following dual antiplatelet therapy alone. The safety outcome was a major or clinically relevant non-major bleeding event at the first month. The efficacy outcomes were the thromboembolic events (myocardial infarction, stroke, systemic embolism, or stent thrombosis). RESULTS: Of 959 patients with carotid artery stent placement, 91 met the inclusion criteria, including 24 patients in the DC group, 42 patients in the triple therapy group, and 25 in the dual antiplatelet therapy group. The mean age was 72.27 (SD, 8.1 ) years, with similar baseline characteristics. The median CHA2DS2-VASc score for each group was 6 (interquartile range = 5-6), 5 (interquartile range = 4-6), and 5 (interquartile range = 4-6), respectively. The median HAS-BLED score was 4 in the 3 groups (P = .17). The primary safety end point was 23.8% in the triple therapy group compared with 4% in the dual antiplatelet therapy group (P = .032), with no bleeding events in the DC group (P = .007). There was 1 stent thrombosis in DC group and a cardioembolic stroke in the dual antiplatelet therapy group (P = .41). CONCLUSIONS: Among patients with carotid artery stent placement with atrial fibrillation, triple therapy confers a high bleeding risk. A regimen of direct oral anticoagulants plus a P2Y12 inhibitor might confer a good safety profile with significantly lower rates of bleeding and optimal efficacy.

Modelo impreso en 3D para entrenamiento en ureteroscopia flexible, una opción de bajo coste para el entrenamiento quirúrgico / 3D printed model for flexible ureteroscopy training, a low-cost option for surgical training

Introducción La práctica en modelos experimentales es una opción válida que mejora los resultados y acorta las curvas de aprendizaje de las técnicas quirúrgicas.Nuestro objetivo fue desarrollar un modelo en plástico, impreso en 3D para la docencia, el entrenamiento y la formación en ureteroscopia flexible, analizando costes e idoneidad para la práctica de esta técnica quirúrgica.Métodos Se elaboró un modelo impreso en 3D a partir de una tomografía axial computarizada de una vía urinaria superior de un paciente real. La segmentación se llevó a cabo mediante el software HorosTM y la impresión mediante una impresora FDM-Ultimaker.Se numeró los cálices renales para ser identificados, como en el plan de formación de tratamiento endoscópico de litiasis, ejercicio 4, de la Asociación Europea de Urología.Se utilizaron: un ureteroscopio flexible desechable Innovex (Palex) y cestillas de nitinol (Coloplast).Resultados El tiempo de impresión fue de 19h, con un coste total de 8,77€.El modelo tridimensional permitió la introducción del ureteroscopio flexible y la exploración de los cálices renales por parte de urólogos tanto en formación como en ejercicio actual de la especialidad sin dificultad.El modelo también permitió la utilización de cestillas y la movilización y extracción de litiasis previamente colocadas.Conclusión Damos a conocer un modelo tridimensional válido para ejercicios de formación en ureteroscopia flexible con unos costes razonables, que permitirá adquirir la destreza y la confianza necesaria para iniciar el procedimiento en un escenario real (AU)

Introduction Training in experimental models is a valid option that improves the outcomes and shortens surgical learning curves.Our objective was to develop a 3D printed plastic model for teaching, training and education in flexible ureteroscopy, analyzing costs and suitability for the practice of this surgical technique.Methods A 3D printed model was developed based on a CT scan from a real-life patient's upper urinary tract. HorosTM software was used for segmentation and an FDM-Ultimaker for 3D printing.Renal calyces were numbered to be identified, as in the European Association of Urology Endoscopic Stone Treatment training curriculum, Task 4.The following were used: Innovex single-use flexible ureteroscope (Palex) and nitinol baskets (Coloplast).Results Printing time was 19hours, with a total cost of €8.77.The three-dimensional model allowed the insertion of the flexible ureteroscope and the exploration of the renal calyces by urologists in training as well as in current practice of the specialty without difficulty.The model also allowed the use of baskets and the mobilization and removal of previously placed stones.Conclusion We unveil a valid three-dimensional model for flexible ureteroscopy training exercises with reasonable costs, which will allow acquiring the necessary skills and confidence to initiate the procedure in a real-life scenario (AU)

Implementing a protocol to prevent incisional hernia in high-risk patients: a mesh is a powerful tool.

PURPOSE: The small bites (SB) technique for closure of elective midline laparotomies (EMLs) and a prophylactic mesh (PM) in high-risk patients are suggested by the guidelines to prevent incisional hernias (IHs) and fascial dehiscence (FD). Our aim was to implement a protocol combining both the techniques and to analyze its outcomes. METHODS: Prospective data of all EMLs were collected for 2 years. Results were analyzed at 1 month and during follow-up. The incidence of HI and FD was compared by groups (M = Mesh vs. S = suture) and by subgroups depending on using SB. RESULTS: A lower number of FD appeared in the M group (OR 0.0692; 95% CI 0.008-0.56; P = 0.01) in 197 operations. After a mean follow-up of 29.23 months (N = 163; min. 6 months), with a lower frequency of IH in M group (OR 0.769; 95% CI 0.65-0.91; P < 0.0001). (33) The observed differences persisted after a propensity matching score: FD (OR 0.355; 95% CI 0.255-0.494; P < 0.0001) and IH (OR 0.394; 95% CI 0.24-0.61; P < 0.0001). On comparing suturing techniques by subgroups, both mesh subgroups had better outcomes. PM was the main factor related to the reduction of IH (HR 11.794; 95% CI 4.29-32.39; P < 0.0001). CONCLUSION: Following the protocol using PM and SB showed a lower rate of FD and HI. A PM is safe and effective for the prevention of both HI and FD after MLE, regardless of the closure technique used.

Understanding patient-reported knowledge of hernia surgery: a quantitative study.

PURPOSE: The objective of this study was to gather information on patient-reported knowledge (PRK) in the field of hernia surgery. METHODS: A prospective quantitative study was designed to explore different aspects of PRK and opinions regarding hernia surgery. Patients referred for the first time to a surgical service with a presumed diagnosis of hernia and eventual hernia repair were eligible, and those who gave consent completed a simple self-assessment questionnaire before the clinical visit. RESULTS: The study population included 449 patients (72.8% men, mean age 61.5). Twenty (4.5%) patients did not have hernia on physical examination. The patient's perceived health status was "neither bad nor good" or "good" in 56.6% of cases. Also, more patients considered that hernia repair would be an easy procedure (35.1%) rather than a difficult one (9.8%). Although patients were referred by their family physicians, 32 (7.1%) answered negatively to the question of coming to the visit to assess the presence of a hernia. The most important reason of the medical visit was to receive medical advice (77.7%), to be operated on as soon as possible (40.1%) or to be included in the surgical waiting list (35.9%). Also, 46.1% of the patients considered that they should undergo a hernia repair and 56.8% that surgery will be a definitive solution. CONCLUSION: PRK of patients referred for the first time to an abdominal wall surgery unit with a presumed diagnosis of hernia was quite limited and there is still a long way towards improving knowledge of hernia surgery.

3D printed model for flexible ureteroscopy training, a low-cost option for surgical training.

INTRODUCTION: Training in experimental models is a valid option that improves the outcomes and shortens surgical learning curves. Our objective was to develop a 3D printed plastic model for teaching, training and education in flexible ureteroscopy, analyzing costs and suitability for the practice of this surgical technique. METHODS: A 3D printed model was developed based on a CT scan from a real-life patient's upper urinary tract. Horos™ software was used for segmentation and an FDM-Ultimaker for 3D printing. Renal calyces were numbered to be identified, as in the European Association of Urology Endoscopic Stone Treatment training curriculum, Task 4. The following were used: Innovex single-use flexible ureteroscope (Palex) and nitinol baskets (Coloplast). RESULTS: Printing time was 19 h, with a total cost of €8.77. The three-dimensional model allowed the insertion of the flexible ureteroscope and the exploration of the renal calyces by urologists in training as well as in current practice of the specialty without difficulty. The model also allowed the use of baskets and the mobilization and removal of previously placed stones. CONCLUSION: We unveil a valid three-dimensional model for flexible ureteroscopy training exercises with reasonable costs, which will allow acquiring the necessary skills and confidence to initiate the procedure in a real-life scenario.

Treatment for T1DM patients by a neuro-fuzzy inverse optimal controller including multi-step prediction.

Diabetes Mellitus is a serious metabolic condition for global health associations. Recently, the number of adults, adolescents and children who have developed Type 1 Diabetes Mellitus (T1DM) has increased as well as the mortality statistics related to this disease. For this reason, the scientific community has directed research in developing technologies to reduce T1DM complications. This contribution is related to a feedback control strategy for blood glucose management in population samples of ten virtual adult subjects, adolescents and children. This scheme focuses on the development of an inverse optimal control (IOC) proposal which is integrated by neural identification, a multi-step prediction (MSP) strategy, and Takagi-Sugeno (T-S) fuzzy inference to shape the convenient insulin infusion in the treatment of T1DM patients. The MSP makes it possible to estimate the glucose dynamics 15 min in advance; therefore, this estimation allows the Neuro-Fuzzy-IOC (NF-IOC) controller to react in advance to prevent hypoglycemic and hyperglycemic events. The T-S fuzzy membership functions are defined in such a way that the respective inferences change basal infusion rates for each patient's condition. The results achieved for scenarios simulated in Uva/Padova virtual software illustrate that this proposal is suitable to maintain blood glucose levels within normoglycemic values (70-115 mg/dL); furthermore, this level remains less than 250 mg/dL during the postprandial event. A comparison between a simple neural IOC (NIOC) and the proposed NF-IOC is carried out using the analysis for control variability named CVGA chart included in the Uva/Padova software. This analysis highlights the improvement of the NF-IOC treatment, proposed in this article, on the NIOC approach because each subject is located inside safe zones for the entire duration of the simulation.

Trends in hospitalisation for ischaemic stroke in young adults in the region of Murcia (Spain) between 2006 and 2014.

INTRODUCTION: Recent studies conducted in Europe and the United States suggest upward trends in both incidence and hospitalisation rates for ischaemic stroke in young adults; however, data for Spain are scarce. This study analyses the trend in hospitalisation due to ischaemic stroke in adults aged under 50 years in the region of Murcia between 2006 and 2014. METHOD: We performed a retrospective study of patients discharged after hospitalisation due to cerebrovascular disease (CVD); data were obtained from the regional registry of the Minimum Basic Data Set. Standardised rates were calculated, disaggregated by age and CVD subtype. Time trends were analysed using joinpoint regression to obtain the annual calculated standardised rate and the annual percentage of change (APC). RESULTS: A total of 27 064 patients with CVD were discharged during the 9-year study period. Ischaemic stroke was the most frequent subtype (61.0%). In patients aged 18 to 49 years, the annual number of admissions due to ischaemic stroke increased by 26%, and rates by 29.2%; however, the joinpoint regression analysis showed no significant changes in the trend (APC = 2.74%, P ≥ .05). By contrast, a downward trend was identified in individuals older than 49 (APC = -1.24%, P < .05). CONCLUSIONS: No significant changes were observed in the rate of hospitalisation due to ischaemic stroke among young adults, despite the decline observed in older adults. Identifying the causes of these disparate trends may be beneficial to the development of specific measures targeting younger adults.

Closure of Iterative Laparotomy in Patients With Previous Mesh Reinforcement a Cohorts' Study. Short-Term Results.

Purpose: Due to extension of prophylactic mesh indications use will become more common to find patients receiving an iterative laparotomy (IL) over a previous reinforced abdominal wall. The aim of this study was to analyze outcomes after IL in patients with previous mesh reinforcement. Methods: This study was a prospective secondary analysis of midline laparotomy closure performed from July 2017 to July 2018 registered in PHACPA study (NCT02658955). IL were included and surgery characteristics and outcomes analyzed. We compared two groups: with (PreM) or without previous prophylactic onlay mesh reinforcement (PreS) Subgroups' analysis, risk factors for complications and survival free hernia analysis were performed. Results: 121 IL were analyzed. Only obesity was associated with higher SSO (OR 2.6; CI 95% 1.02-6.90; p = 0.04) There were 15 incisional hernias (IH) (14.4%). Group with previous mesh reinforcement (pre M) had a higher statistically significative incidence of IH (OR = 1.21; CI 95% 1.05-1.39; p = 0.015). Use of slowly absorbable suture (OR = 0.74; CI 95% 0.60-0.91; p = 0.001), USP 2/0 suture (OR, 0.31; 95% CI, 0.10-0.94; p = 0.033), and small bites technique (OR = 0.81; CI 95% 0.72-0.90; p = 0.011) were associated with less IH. Conclusion: IL has a high percentage of complications and IH. In case of IL without previous reinforcement, a mesh can help to reduce IH. Our data cannot clearly support any technique to close an IL with previous mesh.