bluuebunny/crossref_metadata_2025_split huggingface dataset:
IMPACT OF COVID-19 ON PEDIATRIC SURGERY
Authors: Núñez García B , Álvarez García N , Jiménez Gómez J , Betancourth Alvarenga J E , Esteva Miró C , Santiago Martínez S , Jiménez Arribas P , Güizzo J R 
Published: May 2021

Abstract

INTRODUCTION
The pandemic caused by the SARS-CoV-2 virus has led to an unprecedented situation, with population lockdowns, congestion of healthcare resources, cancellation of scheduled surgical activity, fear of contagion, and delays in patient care. The objective of this study was to analyze its impact on pediatric surgical activity at a reference healthcare facility.

MATERIAL AND METHODS
A comparative study of activity in the pediatric surgery environment at a Spanish reference healthcare facility was carried out. It included outpatient consultations, scheduled surgeries, and activity at the emergency department during the lockdown period in Spain (March-May 2020) vs. the same 2019 period. Number of consultations and surgeries, type of surgery performed and/or cancelled, and stage of the pathologies treated were collected.

RESULTS
A 98% decrease in scheduled surgeries, an 84% decrease in healthcare burden from the pediatric emergency department, a 55.24% decrease in urgent surgeries, an 82% decrease in outpatient activity at external consultations, and a 94% decrease in inter-hospital referrals, along with a 66% increase in urgent pathology severity, were found.

CONCLUSIONS
The COVID-19 pandemic cancelled virtually all pediatric surgery activity, which caused treatment delays in severe pathologies and increased morbidity in regular urgent procedures.
RESULTS OF THE IMPLEMENTATION OF A MULTIMODAL REHABILITATION SYSTEM IN ELECTIVE COLORECTAL SURGERY IN OUR CENTER
Authors: Pérez Prudencio E , Arango Bravo A , Rodríguez Morala A , Álvarez Rodríguez M , Fresnedo Pérez R M , Carrocera Cabal A C , Fernández Fernández J C , Albaladejo Magdalena J 
Published: May 2021

Abstract

INTRODUCTION
The results obtained from the establishment of a multimodal rehabilitation program in elective colorectal surgery by a multidisciplinary team at our center are presented. Protocols are carried out to achieve optimization of perioperative care and the analysis of the rates of complications and morbidity and mortality.

MATERIAL AND METHODS
Through a retrospective study, a control group of patients who underwent elective colorectal surgery prior to the implantation of the rehabilitation program, included during a period from May and October 2018, with a total of 68 patients, were compared with the group of optimized patients, who were operated between December 2018 and June 2019, with a total of 80 patients.

RESULTS
The readmission rate 30 days after discharge between the two groups is analyzed, showing a decrease in the multimodal rehabilitation group, with a readmission rate of 5.9%, compared to the control group, which was 8.8%. A decrease was observed in both surgical complications (35.3%) and medical complications (22.1%) in the multimodal rehabilitation group compared to the control group. A decrease in the mortality rate is observed in the multimodal rehabilitation group, being 1.5% with respect to the control group, which was 2.9%.

CONCLUSIONS
The multimodal rehabilitation system is a feasible and safe method that requires the implementation of protocols that must be carried out by a multidisciplinary team, and that presents satisfactory results with improved morbidity and mortality.
ENHANCERS OF LIVER REGENERATION IN ONCOLOGICAL SURGERY
Authors: Osorio Capitan M , Rose S , Novo Sukia I , Herrero de la Parte B , Ruiz Montesinos I , Garcia-Alonso I 
Published: May 2021

Abstract

INTRODUCTION
Chemotherapy hinders liver function and probably its regenerating capacity, forcing to delay it after surgery. Our objective has been to verify this effect in an experimental model and to see if a hepatotrophic agent can prevent it.

MATERIAL AND METHODS
Four groups of 6 WAG/RijHsd rats (males, 3-4 months) were submitted to ligation of the portal branch to the left lateral and left paramedian lobes. They were sacrificed 36 h later to quantify the percentage of liver corresponding to the ligated lobes (weight), the number of hepatocyte’s nuclei (nº/100 µm2) and their mean size (µm2). One group received no treatment (control); another folic acid (2.5 mg/kg ip, during surgery); other 5-Fluorouracil (5-FU 50 mg/kg ip 48 h before); and the fourth received folic&5-FU.

RESULTS
The animals treated with folic acid showed a greater number of hepatocyte’s nuclei (24.4 ± 2.77 vs 15.2 ± 1.51) and their mean size was also greater (121 ± 2.34 vs 111 ± 1.8). However, the reduction in weight of the ligated parenchyma was less than in control group (33.4 ± 1.08 vs 29.5 ± 1.08). 5-FU did not modify the number of nuclei (15.6 ± 18.4), although they were smaller in size (104 ± 1.7). The addition of folic acid to 5-FU increased the number of nuclei (21.7 ± 2.8) and normalized their size (111 ± 3.2).

CONCLUSIONS
5-FU exerts a depressant effect on livers regeneration, and folic acid overcomes it. Thus, folic acid could allow early application of chemotherapy without affecting liver regeneration.
DEVELOPMENT OF HUMAN DERIVED ACELLULAR DERMAL MATRIX: NOVEL TECHNIQUE IN PANDEMIC TIMES
Authors: Salinas Rámila F , Robla Costales D , Junquera Gutiérrez L M , Pevida López M , Llames S , Martínez Magide G , Sánchez Nuño C , Martín Suárez L 
Published: May 2021

Abstract

INTRODUCTION
Tissue support is capital to achieve good results in reconstructive and aesthetic surgery. Radiotherapy, infection and trauma among others are frequent predictors of surgery failure as they decrease tissue healing capacity. Tissue mobilization is not always an eligible option as raising comorbidities in general population and elder patients are often seen in daily practice. Furthermore, the possibility of sequels in donor zones makes many surgeons be reluctant to use flaps, especially in aesthetic surgery. In aesthetic breast surgery, ADMs provide well known benefits such as reduced capsule contracture rate and improved inframammary fold in breast augmentation procedures

METHODS
A decellularization protocol is proposed by our group to obtain biocompatible ADMs from cadaveric donors. An experimental animal study is designed to assess the histocompatibility of the samples and the influence of the storage method. Biomechanical tests are also done to evaluate tissue performance after decellularization.

RESULTS
Histopathological studies showed no signs of acute nor chronic inflammatory response in experimental group. Normal fibroblasts growth without early apoptosis signs are seen in samples. Biomechanical properties ensure optimal load and tensile strength for most reconstructive procedures.

CONCLUSIONS
Current protocol proposed by our group include all steps from harvesting samples from cadaveric donors till matrix storage after decellularization process. The result is a high valued biomaterial in terms of biocompatibility and security profile available in pandemic times. Local production of this biomaterial leads to cost minimization derived from harvesting and manufacturing matrices in our center and avoid out-of-stock and storage issues.
THREE CASES OF BOWEL OBSTRUCTION BY BROAD LIGAMENT HERNIA
Authors: Soto Dopazo M , Pérez Prudencio E , Arango Bravo A , Nuño Iglesias C , Mateos Palacios C , Sosa Rodríguez M V , Fernández Fernández J C 
Published: May 2021

Abstract

INTRODUCTION
Internal hernias caused by broad ligament defects are an infrequent cause of bowel obstruction. These defects may be congenital or acquired mainly by gynecological antecedents. Small bowel is the most common affected and the diagnosis is difficult due to nonspecific symptoms and absences of characteristic radiological signs.

MATERIAL AND METHODS
We report the cases of three women aged from 43 to 56 years old, who came to the emergency with abdominal pain, vomiting and bloating of hours duration. One patient has a history of laparoscopic appendectomy, the rest of them with no surgical history. In all of the cases, x-rays showed dilatation of small bowel loops and air-fluid levels and the abdominal TC revealed a generalized distention of bowel loops with transition point in the terminal ileum with no identifiable cause compatible with small bowel obstruction.

RESULTS
We decided to perform an urgent surgery with an exploratory laparotomy in one case and the rest by laparoscopic approach, finding an internal hernia occasioned by incarceration of small bowel through a broad ligament defect. In all cases, the hernia content was liberated without evidence of ischemia with no need for intestinal resection, and the defect was closed. All patients had a favourable postoperative course without complications.

DISCUSSION
Broad ligament defects are a rare cause of internal hernias. These are difficult to diagnose clinically as well as radiologically for an absence of characteristic signs. A high level of clinical suspicion allows early diagnosis and the treatment should be performed as soon as possible to reduce the chances of intestinal necrosis.
RISK FACTORS ASSOCIATED WITH POOR PROGNOSIS IN PATIENTS WITH SECONDARY PERITONITIS ADMITTED TO THE INTENSIVE CARE UNIT (ICU)
Authors: Abella Álvarez A , López de la Oliva Calvo L , Enciso Calderón V , Conejo Márquez I , San Miguel Méndez C , Cruz Cidoncha A , García Manzanedo S , Gordo Vidal F 
Published: May 2021

Abstract

INTRODUCTION
Secondary peritonitis is still associated mortality higher than 20% and the risk factors associated with mortality are different and variable according to the different studies. The objective is to analyse clinical, analytical, surgical, microbiological and physiological factors associated with poor prognosis, within a cohort of ICU patients with the diagnosis of secondary peritonitis.

MATERIAL AND METHODS
Retrospective single-centre observational cohort study from January 2015 to June 2018. Patients included suffered secondary peritonitis due to hollow viscera perforation. Multivariate analysis with binary backward stepwise logistic regression was performed. Odds ratio of the predictor variables of ICU mortality and bad prognosis are shown.

RESULTS
130 patients were recruited. Median age of 65 years (55-74). 45% were women. SAPS 3 median of 53.5 (43 - 65), ICU median stay 7 days (4 - 12) and ICU hospital stay 14 days (8 - 21). Readmission rate of 6.2%. ICU mortality 5.4% and hospital mortality 9.2%. In the multivariate analysis, endocrine comorbidity showed an OR 3.611 (CI 95%: 1.217-10.715; p = 0.021), need for mechanical ventilation OR 12.275 (CI 95%: 1.974-76.327; p = 0.007), need for parenteral nutrition OR 5.747 (CI 95%: 1. 565-21,101; p = 0.008), faecal peritonitis OR 2,908 (CI 95%: 1,176- 7,192; p = 0.021), need for new surgery after peritonitis OR 79,746 (CI 95%: 6,718- 946,643; p = 0.001) and SOFA at day 1 above 7 OR 6,939 (CI 95%: 2,208-21,814; p = 0.001). Microbiological variables showed no correlation with bad prognosis.

CONCLUSIONS
Clinical, physiological and surgical characteristics showed a relationship with poor prognosis of patients with secondary peritonitis. Microbiological variables didńt.
3D PRINTING PREOPERATIVE PLANNING AND CUSTOMIZED SURGICAL GUIDES ASSOCIATED WITH O-ARM NAVIGATION SYSTEM FOR MULTIPLANAR OSTEOTOMY OF COMPLEX PELVIC DEFORMITY
Authors: Fernández Álvarez M , Garcés Zarzalejo C , Adeba García M , Pernia Gomez P , A. Martínez Agüeros J , Estellés Marcos de León L , Busta Vallina B 
Published: May 2021

Abstract

INTRODUCTION
3D printing technology is penetrating the healthcare field at an astonishing rate. The reduction of its costs, makes it more accessible to everyone.

MATERIAL AND METHODS
35-year-old woman who had functional limitation in her right hip due to pelvic ring fracture in her childhood. She had dysmetria of lower limbs and femoral anteversion of 40 degrees. Imaging tests showed vicious consolidation of the right hemipelvis associated with antero-medial displacement.

RESULTS
Preoperative, we performed her 3D printing pelvic ring model. Osteotomies were digital planned (iliac crest, superior pubic ramus, incomplete of inferior pubic ramus, and semicircular of posterior column) and also how many degrees we would need for rotation the osteotomized fragment. Posterior column osteotomy was the most difficult, so we designed 3D surgical printing cutting guide able to being inserted into the iliac fossa. We used it to introduced four Kirschnner wires that leads us as a guide to avoid the greater sciatic notch. O-arm navigation system helped us make sure to achieve more precision. 3D printing pelvic ring model was sterilized to pre-contouring osteosynthesis plates. After two years of follow-up, good functional results were observed, without gait claudication either limb dysmetria. Her range of motion is 105 degrees of hip flexion, 20 degrees of internal hip rotation and 40 degrees of external hip rotation. Complete radiological consolidation was observed.

CONCLUSION
Digital planning and 3D printing technology allows to improve three-dimensional compression of bone pathology leading to a higher likelihood of a predictable ideal outcome compared to conventional techniques.
PERIOPERATIVE MANAGEMENT AND OUTCOME OF HIP FRACTURES DURING THE COVID-19 PANDEMIC
Authors: Camblor Valladares A , Lanuza Lagunilla L , Suárez-Anta Rodríguez P J , Meneses Gutiérrez A , García Arias A , Cabria Fernández J , Riera Campillo M , Mateo Negreira J 
Published: May 2021

Abstract

INTRODUCTION
The pandemic caused by the SARS-Cov-2 coronavirus has generated unprecedented pressure on healthcare systems. Higher mortality rates have been reported in elderly patients. Those with a hip fracture are especially vulnerable.

MATERIAL AND METHODS
Retrospective study in which we analyzed the management and associated perioperative complications rate in patients aged over 65 years who attended a tertiary hospital in Spain with hip fracture during the COVID-19 first alarm status decree . We compared the results with a cohort of similar patients treated during the same period in 2019.

RESULTS
A total of 102 hip fractures were recorded in 2019, with a mean age of 85 years. 87.5% were treated surgically in our hospital, with mean waiting time of 4.6 days and mean stay of 11.3 days.
In 2020, 107 hip fractures were recorded, with a mean age of 86 years. A total of 74.6% underwent surgery in our center, with a mean waiting time of 2.8 days and a mean hospital stay of 10.9 days. The rate of major complications and exitus was 8.9% and 6.7% respectively in 2019, and 9.4% and 7.8% in 2020.

CONCLUSIONS
The number of hip fractures increased despite the declaration of the state of alarm in comparison with the decrease in the rest of the trauma emergencies. During this period the mean waiting time for surgery was shorter. There was no relevant variation in the demographic characteristics of the patients, nor in the rate of complications and reported exitus.
IMPACT OF COVID-19 ON SURGICAL ACTIVITY OF AN ORTHOPAEDIC SURGERY AND TRAUMATOLOGY SERVICE IN A SECONDARY HOSPITAL
Authors: García Arias A , Lanuza Lagunilla L , García Cuello L , Suárez-Anta Rodríguez P , Camblor Valladares A , Meneses Gutiérrez A , Cabria Fernández J , Mateo Negreira J 
Published: May 2021

Abstract

INTRODUCTION
COVID-19 has changed the behavior of health care in the world, and consequently, it has affected surgical activity. Related to orthopedic surgery and traumatology, a decrease of up to a third has been observed according to published series. But a secondary center may need more adjustments than a first level one.

MATERIAL AND METHODS
Retrospective study, comparing data from the first Sate of Alarm (03/14/20 – 06/21/20) with the same period of 2019. The number of surgeries, hospitalizations and diagnoses were selected as primary outcomes, and injury mechanisms, kind of surgeries and differences in time to surgery as secondary outcomes.

RESULTS
Surgical activity went from 462 cases in 2019 to 190 cases in 2020 (59% less). The main reason for intervention during the State of Alarm was fractures, with 129 cases out of the total (compared to 167 in 2019); being orthopedics in 2019 (178 cases compared to 40).The most frequent fracture in both groups was the hip fracture, with 71 cases in 2019 compared to 59 in 2020.Accidents on public places, associated with sports practice and related to traffic, were reduced by 1/3.

CONCLUSIONS
A more striking reduction in surgical activity is observed than that reflected in other series, probably due to the case of programmed surgery. Perhaps in centers with greater capacity this measure is not that necessary. In the same circumstances, up to 50% of the ORTR staff could be used to treat other pathologies safely.
PROFILATIC TREATMENT WITH FOLIC ACID FOR LOWER LIMB ISCHAEMIA-REPERFUSION INJURY IN AGED RATS
Authors: Roa Esparza J , Rodeño Casado M , Cearra Guezuraga I , Iturrizaga S , Mar Medina C , García-Alonso I , Herrero de la Parte B 
Published: May 2021

Abstract

INTRODUCTION
Lower limb ischemia-reperfusion injury (IRI-LL) is a common major complication in orthopaedic surgery, especially in elderly patients. We previously demonstrated that folic acid reduced IRI-LL damage in 3–4-month-old rats. Current work analyses the effect of folic acid in the prevention of IRI-LL in elderly animals.

MATERIAL AND METHODS
Thirty-six 12-month-old male WAG/RijHsd rats were subjected to 3 hours of ischaemia. Eighteen animals received folic acid (2.5 mg/kg, ip) 20 minutes before the end of ischaemia period; the other half received the same volume of saline. Animals were sacrificed after 3 hours, 24 hours, and 14 days of reperfusion for biochemical (tissue damage markers and electrolytes), histopathological studies of gastrocnemius muscle, and daily assessment of limb function by Rotarod test, respectively.

RESULTS
The administration of folic acid prior to the end of ischaemia period reduced by 30-40% the increase in LDH and CK observed in non-treated animals (p &lt; 0.0001). When histological sections were analysed, folic acid was found to reduce by 20% the number of damaged muscle fibbers per field (60±17.1 vs 80.7±16.4, p &lt; 0.0001). Rotarod test revealed that folic acid also led to an improvement in muscle function, assessed by the time the animals spend running on the rod, when comparing to untreated animals.

CONCLUSIONS
The administration of folic acid, prior to the end of ischemic period, decreases the damaged induced by IRI-LL, also achieving a faster recovery of mobility.
INTRAOPERATIVE ICG FLUORESCENCE ANGIOGRAPHY: ANALYSIS OF FIRST RESULTS IN OUR SINGLE-CENTER
Authors: Soto Dopazo M , Pérez Prudencio E , Arango Bravo A , Nuño Iglesias C , Mateos Palacios C , Carrocera Cabal A C , Díaz González M D , Fernández Fernández J C 
Published: May 2021

Abstract

INTRODUCTION
Anastomosis dehiscence is one of the most serious complications in colorectal surgery, influenced by many factors, especially the anastomotic ischemia. Intraoperative Indocyanine Green (ICG) Fluorescence Angiography allows to assess the vascular perfusion of the ends anastomotic and anastomosis thus seeking to decrease the number of sutures failure.

MATERIAL AND METHODS
A retrospective and descriptive study of patients undergoing colorectal surgery in our centre using intraoperative indocyanine green fluorescence angiography. We analysed a total of 45 patients, including 40 cases of colorectal cancer and 5 cases with a benign pathology (4 diverticular disease and 1 Crohńs disease).

RESULTS
After administration of ICG, the site of resection was changed in 6 cases due to bad perfusion findings. 5 patients presented anastomotic leakage during the postoperative period. The medium hospital stay length was 10 days, increasing to 29,2 days medium stay in patients with postoperative dehiscence respect to 7’72 days in patients without postoperative complications. No deaths or adverse reactions associated with the ICG were detected.

CONCLUSIONS
The technique with ICG seems to be a promising tool for the colorectal surgery as a predictor of suture failure. It allows a reduction of hospital stay length and postoperative morbidity and mortality from this cause and it can serve as a good help for making decisions in the course of a surgery.
TOWARDS AN UNIFIED FRAMEWORK FOR VALIDATING DEEP LEARNING METHODS FOR COLORECTAL POLYPS: FIRST STEPS
Authors: Sánchez Peralta L F , Ortega Morán J F , Saratxaga Cr L , Pagador J B , Picón A , Mündermann L , Polo F , Sánchez Margallo F M 
Published: May 2021

Abstract

INTRODUCTION
Deep learning techniques have significantly contributed to the field of medical imaging analysis. In case of colorectal cancer, they have shown a great utility for increasing the adenoma detection rate at colonoscopy, but a common validation methodology is still missing. In this study, we present preliminary efforts towards the definition of a validation framework.

MATERIAL AND METHODS
Different models based on different backbones and encoder-decoder architectures have been trained with a publicly available dataset that contains white light and NBI colonoscopy videos, with 76 different lesions from colonoscopy procedures in 48 human patients. A computer aided detection (CADe) demonstrator has been implemented to show the performance of the models.

RESULTS
This CADe demonstrator shows the areas detected as polyp by overlapping the predicted mask on the endoscopic image. It allows selecting the video to be used, among those from the test set. Although it only present basic features such as play, pause and moving to the next video, it easily loads the model and allows for visualization of results. The demonstrator is accompanied by a set of metrics to be used depending on the aimed task: polyp detection, localization and segmentation.

CONCLUSIONS
The use of this CADe demonstrator, together with a publicly available dataset and predefined metrics will allow for an easier and more fair comparison of methods. Further work is still required to validate the proposed framework.
TREATMENT OF PRESSURE ULCERS IN PATIENTS WITH SPINAL CORD INJURY: CONVENTIONAL SURGERY vs. CELLULAR THERAPY
Authors: Burgos Gutiérrez C , Álvarez-Buylla Álvarez P , Álvarez Viejo M , Pérez López S , Pérez Basterrechea M , Bea Muñoz M , Pérez Arias A , De Vicente Rodríguez J C 
Published: May 2021

Abstract

INTRODUCTION
Relapse rates of pressure ulcers (PUs) are very high in spinal cord injured patients. That is the reason why alternative therapies, such as using stem cells derived from bone marrow, have been developed. The objective of our study is to compare this technique of infiltration - infusion of mononuclear cells with conventional surgery.

MATERIAL AND METHODS
A retrospective study was carried out in patients with spinal cord injuries who had PUs, category III / IV, in the pelvic area, during a 14-year follow-up period. One group was treated with conventional surgery and, in the other group, mononuclear cells were infused. The statistical analysis was done using the R program and level of significance used was &lt;0.05.

RESULTS
One hundred and forty-nine patients were registered, 42.3% in the conventional surgery group and 57.7% in the mononuclear cell group. There were no significant differences in terms of ulcer healing in the first six months, but 6 months and one year post-treatment, it were found significant differences. At 6 months, no patient in the conventional surgery group presented dehiscence of the wound and, one year after surgery, only 3.17% recurred in the conventional group In addition, it was shown that there was a statistically significant relationship between days of hospitalization and type of bacterial contamination and the intervention group.

CONCLUSIONS
Use of bone marrow mononuclear cell infusion-infiltration is an alternative treatment for PUs during the first 6 months, instead of conventional surgery. However, in the medium-long term, conventional surgery is more effective.