bluuebunny/crossref_metadata_2025_split huggingface dataset:
COST-EFFECTIVENESS OF THE APPLICATION OF BOTULINUM TOXIN VERSUS BIOFEEDBACK AS TREATMENT IN PATIENTS WITH ANISMUS
Authors: Gómez Torres G A , Canales Aguirre A A , De la Cerda Trujillo L F , Herrera Rodríguez G L , Maciel Gutiérrez V M , Valenzuela Pérez J A , Hernández García F S 
Published: May 2021

Abstract

INTRODUCTION
Anismus is a pathology that is responsible for up to 50% of constipation cases, there are mainly 2 treatments: biofeedback and the use of botulinum toxin, with similar results. Does the application of botulinum toxin have a better cost-effectiveness index compared to biofeedback as a treatment in patients with anismus?
The objective is to establish whether the application of botulinum toxin as a treatment in patients with anismus represents a better cost-effectiveness index compared to biofeedback.

MATERIAL AND METHODS
A randomized prospective cost-effectiveness trial was conducted evaluating the effectiveness of biofeedback treatment compared to the application of botulinum toxin in patients with anismus. Patients were followed up at month 1, 3, and 6 after management.

RESULTS
A total of 9 patients were included, 4 in the botulinum toxin group and 5 in the biofeedback group. The efficacy of botulinum toxin was 75% at month 1 and 3 and 50% at month 6. The efficacy of biofeedback remained at 80% at 6 months. The expense for biofeedback treatment was $ 17,458.32 MXN compared to $ 7,846.08 MXN for botulinum toxin.

CONCLUSION
A decrease in the average cost of $ 9,612.24 MXN was obtained in favor of the use of botulinum toxin for the treatment of anismus.
MIXED REALITY APPLICATION FOR SURGICAL PLANNING IN VIDEO-ASSISTED PULMONARY LOBECTOMY
Authors: Sánchez-Margallo J A , Fernández Anzules R A , Plaza de Miguel C , Sánchez-Margallo F M 
Published: May 2021

Abstract

INTRODUCTION
The adoption of surgical planning systems could greatly simplify the performance of video-assisted thoracoscopic surgery and improve its safety.

MATERIAL AND METHODS
A new application for surgical planning in video-assisted thoracoscopic surgery was developed, making use of the HoloLens (v1) mixed reality device. The information was displayed in the form of interactive holograms, by means of gestural, visual or voice control. The application was validated during a video-assisted right upper lobectomy surgery, including systematic lymphadenectomy for squamous cell carcinoma in the right upper lobe.

RESULTS
No complications were shown during surgery. Prior to surgery, the system allowed the surgeon to access in real time the patient's medical history, review the computed tomography study, and visualize and manipulate a 3D model of the lung with its respective vascular and bronchial elements, as well as the tumor to be removed. The surgeon’s vision using the device was easily shared with the rest of the surgical team. The surgeon placed the holographic models with the surgical planning information behind the field of view of the operating table for possible reference during the procedure. The weight and heat generated by the device were considered ergonomic aspects to be improved.

CONCLUSIONS
The system provides real-time access to important patient information for surgical planning during video-assisted lobectomy surgery, without losing the sterility of the surgical act. The surgeon's view can be shared for communication and learning purposes, as well as recorded for later review of surgical complications.
GALLBLADDER ADENOCARCINOMA. CURRENT STATUS OF THE NEW FORECAST FACTORS AND THEIR IMPACT ON SURVIVAL. CASES AND CONTROLS STUDY
Authors: Camarero Rodríguez E , García-Botella A , Pizarro M J , Avellana R , de la Serna S , Pérez-Aguirre E , Díez-Valladares L , Torres A J 
Published: May 2021

Abstract

INTRODUCTION
We present the results after surgery for gallbladder adenocarcinoma in our centre. The Total Risk Score (TRS) is a useful index to predict the amount of residual disease that is observed in reinterventions with curative intent that are carried out in these tumors.

MATERIAL AND METHODS
Retrospective study of cases and controls. Review of 2019 patients who underwent cholecystectomy from 2012 to 2019 in a Hepatobiliopancreatic Surgery Unit. Exposure of a total of 75 patients for the study (15 cases versus 60 controls, 1: 4 ratio).

RESULTS
15 patients were diagnosed with gallbladder adenocarcinoma, 10 of which were incidental (66.7%).
Oncological resection was R0 in 93.33% of the cases and R1 in the remaining 6.67%.
TRS was low in 9% of cases, moderate in 45.45%, and high in another 45.45%.
The rate of reoperation with oncological intention is 60% in our series (9 patients), and residual disease was observed in 4 of them (44.4%). In 3 of the patients, an exploratory laparotomy was performed without associated resection due to the extent of the disease (33.3%). The percentage of R0 after reoperation was 77.7%. The median survival after surgery is 38.67 months (95% confidence interval (29.73 - 67.34).

CONCLUSIONS
The study of the pathological tissue results for the performance of revision surgery could guide the oncological attitude in the future if its validity is confirmed with more multicentre studies.
SURGICAL DIFFICULTY AND PELVIMETRY IN RECTAL CANCER. IS IT USEFUL?
Authors: Fernández Hevia M , García Alonso L , Alonso Batanero E , Ramos C , Suárez Sánchez A , Rodríguez García J I , García Flórez L J , Granero Trancón J E 
Published: May 2021

Abstract

INTRODUCTION
Different difficulty factors have been described in rectal cancer surgery as BMI, male gender, tumor height, neoadjuvant treatment or narrow pelvis. Pelvimetry is not a routine preoperative study in rectal cancer.

MATERIAL AND METHODS
Retrospective observational study in 228 patients. Operative time was evaluated as a difficult surgical parameter and its relationship with pelvimetric variables was studied.

RESULTS
Our average operative time was 255,4 ± 65,8 minutes. Significant results were found with regard to patients’ BMI, distance to the anal margin, type of approach, need for neoadjuvant therapy and the following pelvimetry parameters. In the univariate analysis, the parameters were pubis height, pelvis depth, angle of the right levator in coronal plane, the ratio of the pelvis inlet diameter with respect to its depth, the ratio of the angle promontory-S3-coccyx with respect to the angle S3-coccyx-lower border of the pubis and the ratio of the area of the mesorectum to the area of the pelvis in the sagittal plane. In multivariate analysis, the variables that most influenced the surgical time were the type of approach, the BMI, the location of the tumor, the intraoperative complications and the ratio of the mesorectum area to the area of the pelvis in the sagittal plane.

CONCLUSION
Pelvimetry is a simple tool that completes preoperative studies and also obtains better surgical planning in complex pelvises.
INFLAMMATORY MARKERS IN THE DIAGNOSIS OF COMPLICATED ACUTE APPENDICITIS
Authors: Michi Campos J , Merayo Álvarez M , García González L , Carrasco Aguilera B , Rodicio Miravalles J L , Díaz Vico T , Sanz Álvarez L , Granero Trancón J E 
Published: May 2021

Abstract

INTRODUCTION
Appendicitis constitutes one of the most frequent surgical emergencies. New inflammatory markers such as the neutrophil-lymphocyte ratio (NLR) have recently emerged, which are added to others such as leukocyte count and C-reactive protein (CRP), and whose role in the diagnosis of appendicitis remains unclear.

MATERIAL AND METHODS
We conducted an observational, descriptive, longitudinal and retrospective study of 484 adults appendectomized between April 2017 and May 2019 in a tertiary hospital. Sociodemographic, clinical, laboratory, imaging and surgical variables were collected.

RESULTS
32.2% of appendicitis were complicated. All patients had a complete blood count and basic biochemistry (98.5% with CRP). Complicated appendicitis had a mean of 14538 leukocytes, 12.4 CRP and 8.7 NLR, and uncomplicated appendicitis had 14667 leukocytes, 5 CRP and 10.7 NLR. When analyzing the relationship of inflammatory markers with the existence or not of complicated appendicitis, CRP yielded an area under the curve (AUC) of 73.1% (95% CI: 0.684-0.779, p &lt; 0.01), while leukocytes and NLR had 52.6% and 55.9%. The CRP cut-off point was determined to be 3.5 which presented a higher discriminative power to predict complicated appendicitis, with a sensitivity and specificity of 70.1% and 65.3% respectively.

CONCLUSIONS
Of the inflammatory markers studied, only CRP proved to be a valid parameter to help differentiate preoperatively those appendicitis uncomplicated from complicated appendicitis.
IMPLEMENTATION OF THE EVALUATION TO IMPROVE RESIDENT SURGICAL SKILLS
Authors: Cifrián Canales I , Rodríguez García J I , Suárez Sánchez A , Merayo Álvarez M , Alonso Batanero E , García Santos G , García Flórez L J , Granero Trancón J E 
Published: May 2021

Abstract

INTRODUCTION
A guided and structured learning process with an evaluation method is essential for resident training. A survey carried out in our department showed that the implementation of an objective evaluation of surgical skills is of great interest to residents.

MATERIAL AND METHODS
During 2020, a structured and objective evaluation of elemental procedures was implemented for first, third and fifth-year general surgery residents. The preoperative briefing is carried out to discuss the clinical case and plan the surgery. Then, the resident performs the surgical intervention, assisted by an expert surgeon who guides him according to his level and the difficulties encountered. A structured evaluation is carried out, using The American Board of Surgery model Operative Performance Rating System (OPRS). With the postoperative debriefing, the resident’s strengths and weaknesses are analyzed and self-reflected with the recording.

RESULTS
Eleven evaluations have been performed: 3 laparoscopic appendectomies (R1), 2 laparoscopic cholecystectomies (R3) and 3 laparoscopic sigmoidectomies (R5). In 3 of them, it was performed by 2 different evaluators (live and recorded surgery). Patient safety was not compromised. Participants indicated a high level of satisfaction and greater motivation in surgical learning.

CONCLUSION
Implementing this evaluation method in the current training programme of General and Digestive Surgery Residency is feasible and may be beneficial for the controlled development of their surgical skills.
LAPAROSCOPIC LIVER RESECTION VIA LAPAROSCOPY: EXPERIENCE IN OUR CENTRE
Authors: del Val Ruiz P , Sanz Navarro S , Carrasco Aguilera B , García Bernardo C , Miyar de Leon A , Solar García L , Diaz Vico T , Granero Trancón J E 
Published: May 2021

Abstract

INTRODUCTION
Laparoscopic liver surgery has undergone a great evolution in recent years, allowing increasingly complex resections without increasing complications and with evident postoperative benefits. Our purpose is to analyze our initial experience in this type of resection.

MATERIAL AND METHODS
We performed a retrospective observational study analyzing 41 patients who underwent liver resections by laparoscopy in our centre from March 2019 to January 2020.

RESULTS
The mean age of the patients was 64.5 years (SD 11) with a mean BMI of 27.56 (from 4.59). The most common surgical indication was colon cancer metastasis (41.4%), followed by hepatocarcinoma (36.6%) and usually single lesions (75.6%). The procedure passed without complications except in the case of 5 patients who required conversion to open surgery (12.5%) and 3 patients (7.5%) who required intraoperative transfusion. During the postoperative period 4 patients (9.8%) presented complications and all of them were classified as Clavien-Dindo II. We only reported 1 death (2.4%) in &gt; 90 days, which was not related to the reason for surgery. No reinterventions were necessary during admission and there were no readmissions in the first 30 days after discharge,

CONCLUSIONS
Laparoscopic liver surgery is technically demanding and requires previous experience in open surgery, as well as specific training, which makes a regulated implementation of the technique necessary.
USE OF LASER PHOTOCOAGULATION THROUGH ENDOBRONCHIAL APPROACH AS AN ALTERNATIVE TREATMENT FOR BRONCHIAL CARCINOID TUMOR.CASE REPORT
Authors: García González L A , Aragón Valverde F J , Pérez Méndez I P , Gutiérrez Pérez A B , Vaquero Cacho M , Ongay Ibáñez D , González Sánchez L 
Published: May 2021

Abstract

INTRODUCTION
Bronchial carcinoid tumor constitutes less than 5% of lung tumors. Eighty-five percent are histologically typical, located in the main airways, generally benign with malignant potential. Clinically they present with persistent cough, respiratory infections and wheezing. Radiologically they manifest as a smooth border mass with calcifications in 25% and obstruction of the main bronchi with atelectasis. The definitive diagnosis is histopathological.
According to current NCCN guidelines resection is the first line of treatment.

MATERIAL AND METHODS
Female, 37 years old, smoker, presents with dyspnea, dry cough and fever. Hypoxemia with absent VM in the left lung base. Chest RX/CT with increased density in LIL and hypercapillary nodule of 15x14mm in LMB that conditions stenosis of the lumen and atelectasis of the LSL. No adenopathies. Spirometry FVC 43% FEV1 44% FEV1/FVC 82%. Video/ecobronchoscopy with endobronchial lesion in LMB occupying 100% of the lumen cT1cN0.PA: carcinoid tumor.

RESULTS
In MDT, endobronchial approach with rigid bronchoscopy is decided, performing mechanical debridement in its entirety and laser photocoagulation with immediate bronchial repermeabilization. Spirometry FVC 67%; FEV1 66%; FEV1/FVC 98%. PA: typical carcinoid. Follow-up for 12 months with CT and bronchoscopy without evidence of recurrence.

CONCLUSION
According to Reuling, the endobronchial approach is a treatment alternative in intraluminal tumors &lt;20 mm, regardless of their histologic grade; likewise, Van der Heijden proposes it as the first line of therapy; however, more prospective studies with long-term follow-up are needed. Follow-up with CT and bronchoscopy is recommended to rule out local recurrences.
PATENTS OF MEDICAL-SURGICAL DEVICES IN SPAIN: WHAT, WHERE AND WHO INVENT AND PROTECT THEIR INVENTIONS?
Authors: Díaz Cortés R , Rodicio Miravalles J L , Rodríguez García J I 
Published: May 2021

Abstract

INTRODUCTION
Among the strategic lines of the EECTI document (Spanish Strategy for Science, Technology and Innovation 2021-2027) related with health, there is a subline that refers to: New diagnostic and therapeutic techniques. The objective is to analyze the patents of medical-surgical devices in the field of Minimally Invasive Surgery (MIS) in Spain.

MATERIAL AND METHODS
Data related to surgical devices in MIS and Laparoscopic Surgery are collected between January 2019 and December 2020 using the information from the Boletín de Vigilancia Tecnológica, documents obtained from collaboration between the OEPM and ITEMAS. They are extracted and analyzed in the patent application documents: the owner, the number of inventors by sex, Autonomous Community, type of device and health specialties where they are involved.

RESULTS
In the last two years, 16 patents of medical-surgical devices related to MIS have been published. In 7 cases (43.75%) the owner is an individual, in 6 cases a company (37.5%) and in 3 cases an institution (18.75%). 34 inventors are collected and only 6 (17.65%) of them are women. Most of them are for laparoscopic surgery devices related to specialties such as General and Digestive Surgery, Gynecology or Urology, and MIS instruments are mostly related to Traumatology and Orthopedic Surgery.

CONCLUSIONS
In recent years there are still few patents in Spain related to minimally invasive surgery. Most of the patents have private ownership, almost all with male inventors, from regions of the southeast of Spain and involving specialties that work in large cavities.
LAPAROSCOPIC APPROACH OF THE MAIN BILE DUCT IN TREATMENT OF CHOLEDOCHOLITHIASIS. EXPERIENCE OF A BILIO-PANCREATIC UNIT
Authors: Gil Vázquez P , Ferreras Martínez D , Gómez Pérez B , Sánchez-Bueno F 
Published: May 2021

Abstract

INTRODUCTION
The aim is to analyze the validity and safety of a new program of laparoscopic common bile duct exploration (LCBE) in the treatment of choledocholithiasis (CD), evaluating hospital stay and cost-effectiveness.

MATERIAL AND METHODS
Today, there is controversy over which is the best therapeutic option in choledocholithiasis: preoperative ERCP followed by laparoscopic cholecystectomy (LC) versus LCBE. We designed this prospective, non-randomized, single-center study with 118 patients (67 women and 51 men, a mean age of 69.8 ± 17.3 years old). Sixty-six patients began a two-stage management (ERCP + LC), failing to clean the bile duct by endoscopy in 15 cases. LCBE was performed in 59 patients (49 at the beginning and 11 after ERCP failure). Seven of them required conversion to open surgery.

RESULTS
LCBE approach was more effective in cleaning the bile duct than ERCP (88.1% vs 72.7%; p = 0.032) with no statistics differences in terms of postoperative morbidity or mortality. In the multivariate analysis, the LCBE was an independent factor in the reduction of hospital stay and the economic costs derived from the management of these patients, reducing it 6.13 days (CI95% 2.98 - 9.27; p &lt; 0.001) the hospital stay and 3,218.16€ (CI95% 1,082.4 - 5,354.8; p = 0.001) the costs respect to the classical approach, with an incremental cost-effectiveness index (CEI) of -209.

CONCLUSION
LCBE is an effective and safe technique. It significantly reduces hospital stay and costs derived from the management of the patients with choledocholithiasis.
Karyotype differentiation inAmeroglossum(Linderniaceae) and closely related genera endemic to Brazilian inselbergs
Authors: Santos Amanda S , Almeida Erton M , Felix Leonardo P , Guerra Marcelo 
Published: May 2021

AbstractAmeroglossum is composed of shrubs endemic to inselbergs in north-eastern Brazil, currently circumscribed in Linderniaceae. Chromosomal counts for this family are few, but quite variable, ranging from 2n = 14 to 60. We investigated the chromosomal numbers of 14 species of Linderniaceae with emphasis on Ameroglossum and analysed the distribution of heterochromatin and 5S and 35S rDNA sites for most species. We found 2n = 60 for the species of Ameroglossum (except Ameroglossum genaroanum with 2n = 64), Catimbaua and Isabelcristinia, 2n = 50 for Cubitanthus alatus and 2n = 28 for Torenia thouarsii and Vandellia diffusa. All of them had small, similar chromosomes and 5S and 35S rDNA sites overlapping with CMA+ bands. The species with 2n = 50–64 showed a single pair of 5S and 35S rDNA sites, V. diffusa had two pairs of 5S and one pair of 35S rDNA sites and T. thouarsii had two pairs of each. Furthermore, other CMA+ and DAPI+ bands have been seen in almost all species. The karyotypical similarities among the species of Ameroglossum, Catimbaua, Cubitanthus and Isabelcristinia suggest a close relationship between representatives of Linderniaceae typical of inselbergs.
Diffusion models reveal white matter microstructural changes with ageing, pathology and cognition
Authors: Raghavan Sheelakumari , Reid Robert I , Przybelski Scott A , Lesnick Timothy G , Graff-Radford Jonathan , Schwarz Christopher G , Knopman David S , Mielke Michelle M , Machulda Mary M , Petersen Ronald C , Jack Clifford R , Vemuri Prashanthi 
Published: May 2021

Abstract
White matter microstructure undergoes progressive changes during the lifespan, but the neurobiological underpinnings related to ageing and disease remains unclear. We used an advanced diffusion MRI, Neurite Orientation Dispersion and Density Imaging, to investigate the microstructural alterations due to demographics, common age-related pathological processes (amyloid, tau and white matter hyperintensities) and cognition. We also compared Neurite Orientation Dispersion and Density Imaging findings to the older Diffusion Tensor Imaging model-based findings. Three hundred and twenty-eight participants (264 cognitively unimpaired, 57 mild cognitive impairment and 7 dementia with a mean age of 68.3 ± 13.1 years) from the Mayo Clinic Study of Aging with multi-shell diffusion imaging, fluid attenuated inversion recovery MRI as well as amyloid and tau PET scans were included in this study. White matter tract level diffusion measures were calculated from Diffusion Tensor Imaging and Neurite Orientation Dispersion and Density Imaging. Pearson correlation and multiple linear regression analyses were performed with diffusion measures as the outcome and age, sex, education/occupation, white matter hyperintensities, amyloid and tau as predictors. Analyses were also performed with each diffusion MRI measure as a predictor of cognitive outcomes. Age and white matter hyperintensities were the strongest predictors of all white matter diffusion measures with low associations with amyloid and tau. However, neurite density decrease from Neurite Orientation Dispersion and Density Imaging was observed with amyloidosis specifically in the temporal lobes. White matter integrity (mean diffusivity and free water) in the corpus callosum showed the greatest associations with cognitive measures. All diffusion measures provided information about white matter ageing and white matter changes due to age-related pathological processes and were associated with cognition. Neurite orientation dispersion and density imaging and diffusion tensor imaging are two different diffusion models that provide distinct information about variation in white matter microstructural integrity. Neurite Orientation Dispersion and Density Imaging provides additional information about synaptic density, organization and free water content which may aid in providing mechanistic insights into disease progression.
On the potential origin and characteristics of cancer stem cells
Authors: Trosko James E 
Published: May 2021

Abstract
The ‘cancer stem cell’ hypothesis has pointed to a specific target for new cancer therapies. The hypothesis is based on the observation that only the ‘cancer stem cell’ among the other heterogeneous cancer cells can sustain the growth of the cancer. The goal is to identify biomarkers of ‘cancer stem cells’ to distinguish them from the ‘cancer non-stem cells’ and normal adult tissue-specific stem cells. This analyst posits a hypothesis that, although all cancers originated from a single cell, there exist two types of ‘cancer stem cells’ either by the ‘Stem Cell hypothesis’ or from the ‘De-differentiation hypothesis’. It is proposed that there exist two different ‘cancer stem cells’. Some ‘cancer stem cells’ (a) lack the expression of connexins or gap junction genes and lack any form of gap junctional intercellular communication (GJIC) or (b) they have the expressed connexin-coded proteins for functional GJIC but are dysfunctional by some expressed oncogene. This is consistent with the Loewenstein hypothesis that a universal characteristic of cancer cells is they do not have growth control, nor terminally differentiate. This review speculates the normal organ-specific adult stem cell, that is ‘initiated’, is the origin of the ‘cancer stem cells’ with expressed Oct4A gene and no expressed connexin genes; whereas the other cancer stem cell has no expressed Oct4A genes but expressed connexin gene, whose coded protein is dysfunctional. Hence. both types of ‘cancer stem cells’ lack GJIC, for two different reasons, the selective therapies have to be different for these different cell types.