Articles publicats en revistes (Cirurgia i Especialitats Medicoquirúrgiques)

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Attitudes toward uterus transplantation. An option for motherhood?
(Munksgaard, 2024-05-22) Rius, Mariona; Camacho, Marta; Tomás, Nerea; Díaz Feijoo, Berta; Castelo-Branco Flores, Camil; Borrás Capó, Aina; Tort, Jaume; Carmona Herrera, Francisco
Introduction: Uterus transplantation is a novel surgical procedure that allows women with absolute uterine factor infertility to carry a pregnancy and give birth. While previous studies have explored the attitudes of women with absolute uterine factor infertility toward uterus transplantation, none have surveyed and compare their views with other groups of interest (Morris syndrome women, relatives of Morris syndrome and Rokitansky syndrome women, infertile women and women of childbearing age) in the same sociocultural setting. The objective of this study was to evaluate attitudes and insights regarding uterus transplantation among women with Rokitansky syndrome and other groups of interest.Material and Methods: We designed a cross-sectional study including five groups of women: women with Rokitansky syndrome, women with Morris syndrome, relatives of women with Morris and Rokitansky syndrome, infertile women, and childbearing-agewomen. We conducted an online survey through the REDCap platform. The link was distributed by mail, telephone and in hospital outpatient visits. Baseline demographic information was assessed and information regarding motherhood preferences, attitude toward uterus transplantation, preferred uterus graft and perception of risk of the procedure was collected.Results: We obtained a total of 200 responses, with a mean participant age of 34.5 years (±9.8). Overall, 17.5% (n = 35) were women with Rokitansky syndrome, 5.5% (n = 11) Morris syndrome women, 21.5% (n = 43) infertile women, 26.5% (n = 53)relatives of Morris and Rokitansky syndrome women and 29% (n = 58) childbearing-age women. 71.5% of women with Rokitansky syndrome would undergo uterus transplantations ahead of adoption and surrogacy with no statistically significant differences found between groups. Overall, more than one-half (58%) would prefer deceased over living donor.
Mindfulness-based stress reduction intervention during pregnancy changes maternal brain
(Nature Publishing Group, 2025-07-01) Gomez, Yvan; Nakaki, Ayako; Conti, Allegra; Castro-Barquero, Sara; Gambosi, Benedetta; Casas, Irene; Genero, Mariona; Youssef, Lina; Benítez, Leticia; Encabo, Noelia; Casas Rodríguez, Rosa M.; Martín Asuero, Andrés; Oller Guzmán, Teresa; Morilla, Ivette; Martínez-Arán, Anabel, 1971-; Bargalló Alabart, Núria; Toschi, Nicola; Estruch Riba, Ramon; Vieta i Pascual, Eduard, 1963-; Crispi Brillas, Fàtima; Gratacós Solsona, Eduard; Crovetto, Francesca
Our aim is to evaluate the effect of a structured stress reduction intervention based on mindfulness during pregnancy on the maternal brain. We report a secondary analysis of IMPACT BCN, a randomized clinical trial including pregnant women randomly allocated to 8-week Mindfulness-Based Stress Reduction (n = 41) or usual care (without any intervention, n = 35). Maternal magnetic resonance (MR) was performed in the third trimester, cluster-wise analysis was used to assess cortical morphometric differences, and proton magnetic resonance spectroscopy (1H-MRS) to evaluate the metabolic characteristics. Mindfulness status was evaluated using the Five Facet Mindfulness Questionnaire (FFMQ). Results showed that participants from Stress reduction group had significantly larger surface areas in the right superior frontal region as compared to the Usual care group (90%CI: 0.023-0.029, p = 0.03). The1H-MRS revealed that Stress reduction group participants, had higher concentrations of myo-inositol (adjusted mean difference D 0.37 mol/L, 95%CI 0.05-0.69) as compared to Usual care. Participants who had high mindfulness on FFMQ facets of non-judgmental (D 358.5 mm2, 95%CI 53.5-663.6) and non-reactivity (D 362.3 mm2, 95%CI 18.8-705.7) had larger right superior frontal area. In conclusion, Mindfulness-Based Stress Reduction program during pregnancy has a significant effect on maternal brain structure and is associated with metabolite concentration changes.
Machine Learning Algorithms in Controlled Donation After Circulatory Death Under Normothermic Regional Perfusion: A Graft Survival Prediction Model
(Lippincott, Williams & Wilkins, 2025-07) Calleja Lozano, Rafael; Rivera Gavilán, Marcos; Guijo Rubio, David; Hessheimer, Amelia Judith; Rosa, Gloria de la; Gastaca, Mikel; Otero Ferreiro, Alejandra; Ramírez Romero, Pablo; Boscà Robledo, Andrea; Santoyo, Julio; Marín Gómez, Luís Miguel; Villar del Moral, Jesús; Fundora, Yilian; Lladó Garriga, Laura; Loinaz, Carmelo; Jiménez Garrido, Manuel; Rodríguez Laíz, Gonzalo; López Baena, José Ángel; Charco, Ramón; Varo, Evaristo; Rotellar Sastre, Fernando; Alonso, Ayaya; Rodríguez Sanjuan, Juan Carlos; Blanco-Fernández, Gerardo; Nuño, Javier; Pacheco Sánchez, David; Coll, Elisabeth; Domínguez Gil, Beatriz; Fondevila Campo, Constantino; Ayllón, María Dolors; Durán Martínez, Manuel; Ciria, Rubén; Gutiérrez, Pedro Antonio; Gómez Orellana, Antonio; Hervás Martínez, Cesar; Briceño, Javier
Background. Several scores have been developed to stratify the risk of graft loss in controlled donation after circulatory death (cDCD). However, their performance is unsatisfactory in the Spanish population, where most cDCD livers are recovered using normothermic regional perfusion (NRP). Consequently, we explored the role of different machine learning-based classifiers as predictive models for graft survival. A risk stratification score integrated with the model of end-stage liver disease score in a donor-recipient (D-R) matching system was developed. Methods. This retrospective multicenter cohort study used 539 D-R pairs of cDCD livers recovered with NRP, including 20 donor, recipient, and NRP variables. The following machine learning-based classifiers were evaluated: logistic regression, ridge classifier, support vector classifier, multilayer perceptron, and random forest. The endpoints were the 3- and 12-mo graft survival rates. A 3- and 12-mo risk score was developed using the best model obtained. Results. Logistic regression yielded the best performance at 3 mo (area under the receiver operating characteristic curve = 0.82) and 12 mo (area under the receiver operating characteristic curve = 0.83). A D-R matching system was proposed on the basis of the current model of end-stage liver disease score and cDCD-NRP risk score. Conclusions. The satisfactory performance of the proposed score within the study population suggests a significant potential to support liver allocation in cDCD-NRP grafts. External validation is challenging, but this methodology may be explored in other regions.
Automated quality control of small animal MR neuroimaging data
(The MIT Press, 2024-09-27) Kalantari, Aref; Shahbazi, Mehrab; Schneider, Marc; Raikes, Adam C.; Frazão, Victor Vera; Bhattrai, Avnish; Carnevale, Lorenzo; Diao, Yujian; Franx, Bart A. A.; Gammaraccio, Francesco; Goncalves, Lisa Marie; Lee, Susan; Leeuwen, Esther M. van; Michalek, Annika; Mueller, Susanne; Rivera Olvera, Alejandro; Padro, Daniel; Kotb Selim, Mohamed; Toorn, Annette van der; Varriano, Federico; Vrooman, Roël; Wenk, Patricia; Albers, H. Elliott; Boehm Sturm, Philipp; Budinger, Eike; Canals, Santiago; Santis, Silvia de; Diaz Brinton, Roberta; Dijkhuizen, Rick M.; Eixarch Roca, Elisenda; Forloni, Gianluigi; Grandjean, Joanes; Hekmatyar, Khan; Jacobs, Russell E.; Jelescu, Ileana; Kurniawan, Nyoman D.; Lembo, Giuseppe; Longo, Dario Livio; Sta Maria, Naomi S.; Micotti, Edoardo; Muñoz Moreno, Emma; Ramos Cabrer, Pedro; Reichardt, Wilfried; Soria, Guadalupe; Ielacqua, Giovanna D.; Aswendt, Markus
Magnetic resonance imaging (MRI) is a valuable tool for studying brain structure and function in animal and clinical studies. With the growth of public MRI repositories, access to data has finally become easier. However, filtering large datasets for potential poor-quality outliers can be a challenge. We present AIDAqc, a machine-learning-assisted automated Python-based command-line tool for small animal MRI quality assessment. Quality control features include signal-to-noise ratio (SNR), temporal SNR, and motion. All features are automatically calculated and no regions of interest are needed. Automated outlier detection for a given dataset combines the interquartile range and the machine-learning methods one-class support vector machine, isolation forest, local outlier factor, and elliptic envelope. To evaluate the reliability of individual quality control metrics, a simulation of noise (Gaussian, salt and pepper, speckle) and motion was performed. In outlier detection, single scans with induced artifacts were successfully identified by AIDAqc. AIDAqc was challenged in a large heterogeneous dataset collected from 19 international laboratories, including data from mice, rats, rabbits, hamsters, and gerbils, obtained with different hardware and at different field strengths. The results show that the manual inter-rater agreement (mean Fleiss Kappa score 0.17) is low when identifying poor-quality data. A direct comparison of AIDAqc results, therefore, showed only low-to-moderate concordance. In a manual post hoc validation of AIDAqc output, precision was high (>70%). The outlier data can have a significant impact on further postprocessing, as shown in representative functional and structural connectivity analysis. In summary, this pipeline optimized for small animal MRI provides researchers with a valuable tool to efficiently and effectively assess the quality of their MRI data, which is essential for improved reliability and reproducibility.
Machine learning-driven blood biomarker profiling and EGCG intervention in fetal alcohol spectrum disorder
(Elsevier España, 2025-09-04) Ramos-Triguero, Anna; Navarro Tapia, Elisabet; Vieiros, Melina; Martínez, Leopoldo; García Algar, Óscar; Andreu Fernández, Vicente
Fetal alcohol spectrum disorders (FASD) is a complex neurodevelopmental condition caused by prenatal alcohol exposure (PAE), often underdiagnosed due to heterogeneous symptoms and diagnostic challenges. This study aimed to identify serum-based biomarkers for early FASD diagnosis and assess the potential of epigallocatechin gallate (EGCG), a natural antioxidant found in green tea, in modulating markers related to FASD. Luminex immunoassays were employed to analyze serum samples from FASD patients, identifying seven predictive biomarkers involved in neuroinflammation and immune dysregulation: IL-10, IFNγ, CCL2, NGFβ, IL-1β, CX3CL1, and CXCL16. These biomarkers reflect key disruptions in brain health, particularly in neuroinflammation, which contributes to the cognitive, behavioral, and mental health challenges frequently observed in FASD patients, including memory deficits, attention problems, and emotional dysregulation. To enhance diagnostic precision, machine learning (ML) models were trained on these biomarker datasets, with Random Forest (RF) achieving the highest accuracy (0.89), sensitivity (0.92), specificity (0.83), and ROC AUC (0.88). Additionally, an open-label pilot study in children diagnosed with FASD showed significant restoration of the levels of IFNy, CX3CL1, IL-1β, IL-10, and NGFβ after 12 months of EGCG treatment, suggesting its potential role in mitigating neuroinflammatory responses and promoting neurogenesis. These findings underscore the value of integrating serum biomarkers with ML-driven approaches to advance FASD diagnostics, while also identifying EGCG as a promising intervention for neurodevelopmental and mental health impairments associated with the disorder.
The use of saliva and blood progesterone to profile the menstrual cycles of youth professional football players.
(Frontiers Media, 2024-08-21) Ferrer Vidal-Barraquer, Eva; Rodas Font, Gil; Casals Mercadal, Gregori; Trilla García, Antoni; Balagué-Dobón, Laura; González Ruiz, Juan Ramón; Ridley, Katherine; White, Richard; Burden, Richard J.
Background: Understanding individual ovarian hormone cycles and their relationship with health, performance and injuries is highly important to practitioners supporting female athletes. Venous blood sampling is the current gold standard for measuring the ovarian hormones, but the invasive nature of this method presents a major barrier in sport environments. Saliva analysis may offer an alternative method as it is non-invasive, allowing the sample to be collected “in situ”, with relative ease, necessary in applied sport environments. Objective: The aims of this study were: (i) To compare the concentration of progesterone between capillary blood and saliva, (ii) To assess the efficacy of weekly measurements of progesterone for determining if ovulation has occurred in elite eumenorrheic football players, and (iii) To establish a saliva criteria cut-off for establishing ovulation and assessing the sensitivity, specificity and accuracy values of the method. Methodology: Twenty-one professional and semi-professional, Spanish league female football players (18.6 ± 1.5 years, 58.1 ± 6.0 kg, 164.0 ± 4.8 cm) with natural menstrual cycles, completed the study. Capillary blood and saliva samples were collected from each participant on twelve occasions each separated by at least 7 days. All samples were collected in the morning, following an overnight fast. Results: According to luteal phase serum progesterone concentrations, 11 out of 21 (52%) players presented with menstrual irregularities (oligomenorrheic n = 6, anovulatory n = 4, amenorrhoeic n = 1). A significant correlation was observed between plasma and saliva progesterone in the estimated eumenorrheic group (r = 0.80, p = <0.001, 95% CI 0.72–0.86). The association between serum and saliva progesterone was weaker in the oligomenorrheic group (r = 0.47, p = <0.001, 95% CI 0.27–0.64) and was not present in the anovulatory or amenorrhoeic groups. Conclusions: Salivary measurements of progesterone are well correlated with capillary blood when taken during eumenorrheic menstrual cycles and presents a viable, non-invasive method of establishing characteristic progesterone fluctuations in applied sport settings. The strength of the association appears to be concentration dependent. A luteal phase saliva progesterone (P4) >50 pg/ml and >1.5× follicular baseline has good sensitivity, specificity, and accuracy to indicate ovulation compared to established criteria for serum progesterone.
Sentinel lymph node biopsy versus pelvic lymphadenectomy for early-stage cervical cancer: a retrospective institutional review
(Springer Verlag, 2025-07-31) Marina Martín, María Tiermes; Celada Castro, Cristina; Glickman, Ariel; Carreras Dieguez, Núria; Valenzuela Rodríguez, Andrea; Fusté, Pere; Saco, Adela; Vidal i Sicart, Sergi; Torné Bladé, Aureli; Díaz Feijoo, Berta
To evaluate the oncologic and survival outcomes in patients diagnosed with early-stage cervical cancer who underwent both sentinel lymph node (SLN) and pelvic lymphadenectomy (PLD) compared with those who underwent SLN alone at primary surgery. From 2001 to 2022, women who underwent SLN biopsy for nodal staging were recruited. The group of women who underwent SLN biopsy and PLD (SLN + PLD group) was compared with the group who underwent SLN mapping alone (SLN group). 210 patients were evaluated (98 and 112 in each group). The overall SLN detection rate was 97.6%. Lymph node involvement was detected in 23 patients (11%), and the rate of positive SLN increased from 6.2 to 11% after final pathological examination. At a median follow-up of 80 months, the recurrence and mortality rates were 6.2 and 2.4%, respectively. The 3-year progression-free survival (PFS) rate was 93.7 and 97.2%, and the overall survival (OS) rate was 98.9 and 99.0% in the SLN + PLD and SLN group, respectively. There were no significant differences in the Kaplan-Meier PFS (p = 0.471; HR 0.66; 95% CI 0.22-2.04) and OS (p = 0.228; HR 0.28; 95% CI 0.03-2.53) curves between the groups. Pending further confirmation from prospective trials, SLN biopsy appears to be an effective method of nodal assessment in early-stage cervical cancer. This technique does not appear to increase the risk of recurrence compared with complete PLD in selected patients and may offer a viable, less invasive alternative for accurate nodal staging.
Tuberculosis household contact tracing in children: axes of inequality, Barcelona 2003-2022
(Frontiers Media, 2025-05-29) Prieto García, Raquel; Millet, Joan-Pau; Soriano Arandes, Antoni; Espiau, María; Broto Cortés, Clàudia; Ronda, Mar; López Segura, Nuria; Noguera Julian, Antoni; Masdeu Corcoll, Eva; Domingo Jiménez, Cristina; Ros Samsó, Miriam; Marcos Arroita, Maria Isabel; Ospina Valencia, Jesús Edison; García Rebollo, Carmen; Simón Viván, Pere; Rius, Cristina
Children under 15 years of age living in the household of a tuberculosis case constitute a very vulnerable group to tuberculosis infection (TBI). The objective of this study was to determine the prevalence of TBI and the risk factors associated with presenting TBI in this group, considering sex, age, and migratory status as axes of inequality. A population-based, analytical, cross-sectional observational study was carried out in the city of Barcelona in the period 2003–2022. The study population was household contacts under 15 years of age with index cases of pulmonary TB reported to the Barcelona Public Health Agency in the period 2003–2022. The analyses were performed using Generalized Estimating Equations (GEE) to predict the risk of TBI among these cohabiting contacts and were stratified considering the inequality axes of sex and migratory status. A total of 1084 contacts under 15 years of age were studied from 693 cases of tuberculosis. TBI prevalence among contacts was 24.5%. The factors associated with the presence of TBI in the contacts were having a smear positive in the index case, being older than 5 years in the contacts ([5,10], [10–15]) and the case and the contact being migrants; smear positive when the index case was native women and being from a municipal district with a lower incidence of tuberculosis when the index case was native women and the men. The results of the study confirm the importance of carrying out contact tracing and follow-up of household children, especially if the index case is smear positive. Contact tracing should be carried out as soon as possible to assess the prescription of primary chemoprophylaxis and TBI treatment to avoid rapid TB progression in children.
Quantitative analysis of the carpal tunnel and its inner structures in primates
(Wiley, 2024-11-20) Rodríguez Corbera, Patricia; Casado, Aroa; Ciurana, Neus; García Sánchez, Marcel; Pastor, Francisco; Potau Ginés, Josep Maria
To explore the anatomical factors potentially involved in the high incidence of carpal tunnel syndrome in humans, we have quantified the anatomical variations of the carpal tunnel and its inner structures in humans, non-hominoid primates (monkeys), and hominoid primates (apes). In specimens of six humans, eight monkeys, and three apes, we assessed the size of the carpal tunnel, the tendons of the digit flexor muscles, and the median nerve. We compared the size of the carpal tunnel normalized by the wrist size, and the size of the median nerve and the tendons of the digit flexors normalized by the size of the carpal tunnel. Differences between humans and monkeys were calculated using the T test or Mann-Whitney U test, as appropriate. Data on the apes were not included in the statistical analyses due to the small sample size. The normalized size of the carpal tunnel was similar in all specimens. The normalized size of the tendons of the digit flexors was smaller in humans, while that of the median nerve was significantly larger. The median nerve was also larger in apes than in monkeys. The relatively larger median nerve observed in humans could suggest a greater vulnerability of the nerve to compression, which could predispose humans to carpal tunnel syndrome. However, the tendons of the digit flexor muscles were smaller in humans, and moreover, the proportional size of the median nerve was similar in apes, leading us to suggest that the factors predisposing humans to carpal tunnel syndrome must be sought beyond anatomical features and may be more closely related to functional or personal parameters.
Transorbital approach to the cavernous sinus: an anatomical study of the related cranial nerves.
(Frontiers Media, 2024-04-17) Mosteiro, Alejandra; Codes, Marta; Tafuto, Roberto; Manfrellotti, Roberto; Torales, Jorge; Enseñat Nora, Joaquim; Di Somma, Alberto; Prats Galino, Alberto
Background: The cavernous sinus (CS) is a demanding surgical territory, given its deep location and the involvement of multiple neurovascular structures. Subjected to recurrent discussion on the optimal surgical access, the endoscopic transorbital approach has been recently proposed as a feasible route for selected lesions in the lateral CS. Still, for this technique to safely evolve and consolidate, a comprehensive anatomical description of involved cranial nerves, dural ligaments, and arterial relations is needed. Objective: Detailed anatomical description of the CS, the course of III, IV, VI, and V cranial nerves, and C3-C7 segments of the carotid artery, all described from the ventrolateral endoscopic transorbital perspective. Methods: Five embalmed human cadaveric heads (10 sides) were dissected. An endoscopic transorbital approach with lateral orbital rim removal, anterior clinoidectomy, and petrosectomy was performed. The course of the upper cranial nerves was followed from their apparent origin in the brainstem, through the middle fossa or cavernous sinus, and up to their entrance to the orbit. Neuronavigation was used to follow the course of the nerves and to measure their length of surgical exposure. Results: The transorbital approach allowed us to visualize the lateral wall of the CS, with cranial nerves III, IV, V1-3, and VI. Anterior clinoidectomy and opening of the frontal dura and the oculomotor triangle revealed the complete course of the III nerve, an average of 37 (±2) mm in length. Opening the trigeminal pore and cutting the tentorium permitted to follow the IV nerve from its course around the cerebral peduncle up to the orbit, an average of 54 (±4) mm. Opening the infratrochlear triangle revealed the VI nerve intracavernously and under Gruber's ligament, and the extended petrosectomy allowed us to see its cisternal portion (27 ± 6 mm). The trigeminal root was completely visible and so were its three branches (46 ± 2, 34 ± 3, and 31 ± 1 mm, respectively). Conclusion: Comprehensive anatomic knowledge and extensive surgical expertise are required when addressing the CS. The transorbital corridor exposes most of the cisternal and the complete cavernous course of involved cranial nerves. This anatomical article helps understanding relations of neural, vascular, and dural structures involved in the CS approach, essential to culminating the learning process of transorbital surgery.
Discovering genes and microRNAs involved in human lung development unveils IGFBP3/miR-34a dynamics and their relevance for alveolar differentiation
(BioMed Central, 2024-08-26) Acosta Plasencia, Melissa; Castellano, Joan Josep; Díaz Sánchez, Tania; He, Yangyi; Marrades Sicart, Ramon Ma.; Navarro Ponz, Alfons
Background: During pseudoglandular stage of the human lung development the primitive bronchial buds are initially conformed by simple tubules lined by endoderm-derived epithelium surrounded by mesenchyme, which will progressively branch into airways and start to form distal epithelial saculles. For first time alveolar type II (AT2) pneumocytes appears. This study aims to characterize the genes and microRNAs involved in this differentiation process and decipher its role in the starting alveolar differentiation. Methods: Gene and microRNA profiling was performed in human embryonic lungs from 7 to 12 post conception weeks (pcw). Protein expression location of candidate genes were analyzed by immunofluorescense in embryonic lung tissue sections. mRNA/miRNA target pairs were identified using computational approaches and their expression was studied in purified epithelial/mesenchymal cell populations and in isolated tips and stalks from the bronchial tree. Additionally, silencing experiments in human embryonic lung mesenchymal cells and in human embryonic tip-derived lung organoids were performed, as well as organoid differentiation studies. AT2 cell markers were studied by qRT-PCR and by immunofluorescence. The TGFB-β phosphorylated pathways was analyzed with membrane protein arrays. Lung explants were cultured in air/liquid interface with/without peptides. Results: We identified 88 differentially expressed genes, including IGFBP3. Although IGFBP3 mRNA was detected in both epithelial and mesenchymal populations, the protein was restricted to the epithelium, indicating post-transcriptional regulation preventing IGFBP3 protein expression in the mesenchyme. MicroRNA profiling identified miR-34a as an IGFBP3 regulator. miR-34a was up-regulated in mesenchymal cells, and its silencing in human embryonic lung mesenchymal cells increased IGFBP3 levels. Additionally, IGFBP3 expression showed a marked downregulation from 7 to 12 pcw, suggesting its involvement in the differentiation process. The differentiation of human tip-derived lung embryonic organoids showed a drastic reduction in IGFBP3, supported by the scRNAseq data. IGFBP3 silencing in organoids activated an alveolar-like differentiation process characterized by stem cell markers downregulation and upregulation of AT2 markers. This process was mediated by TGFβ signalling inhibition and BMP pathway activation. Conclusions: The IGFBP3/miR-34a axis restricts IGFBP3 expression in the embryonic undifferentiated lung epithelium, and the progressive downregulation of IGFBP3 during the pseudoglandular stage is required for alveolar differentiation.
Digital health tools in juvenile idiopathic arthritis: a systematic literature review
(Springer Science and Business Media LLC, 2025-05-01) Antón López, Jordi; Montoro, Maria; Loza Santamaria, Estíbaliz; Otón Sánchez, Teresa; Ramirez, Susan; Benavent Nuñez, Diego
BackgroundNowadays, digital health technologies, including mobile apps, wearable technologies, social media, websites, electronic medical records, and artificial intelligence, are impacting disease management and outcomes. We aimed to analyse the characteristics and use of digital health tools in juvenile idiopathic arthritis (JIA).MethodsWe conducted a systematic review (SR) to identify articles examining the characteristics, use, and outcomes (feasibility, usability, and effectiveness) of digital health tools in JIA patients. A sensitive search strategy was performed in Medline, Embase, and Cochrane databases until December 2022 (later updated to March 2024). Two reviewers independently selected the studies and collected the data, including study quality. A descriptive analysis was performed.ResultsA total of 21 studies were included, one SR, six randomised controlled trials, four observational studies, four validation studies, one discovery and verification study, and five qualitative studies. Study quality was generally moderate. Most studies focused on patients with JIA (especially young people), but also on parents and health care professionals. Different digital health technologies were investigated, like websites, mobile apps, wearables, and telemedicine. The main objectives of the tools were self-management, symptom and quality of life monitoring, physical activity tracking, disease knowledge improvement, and medication monitoring. Different themes and contents were usually included in the same digital health tool, such as psychological health, lifestyle, intimacy, or shared decision-making. Tool development and validation processes were poorly or not at all described, and data regarding regulatory compliance, security, or privacy were scarce.ConclusionsThere is significant variability in the type, characteristics, objectives, and contents of digital health tools for JIA. They still show limitations and gaps, thus highlighting the need for better critical assessment and reporting.
A multimodal intervention program to improve sexual health and self-perceived quality of life in patients treated for cervical cancer: a randomized prospective study (PROVIDENCE trial).
(Korean Society of Gynecologic Oncology, 2025-01) Gil Ibáñez, Blanca; Carreras-Dieguez, Nuria; López, Gregorio; Sánchez Hoyo, Beatriz; Conti Nuño, Beatrice; Oliver Perez, Reyes; Castelo-Branco Flores, Camil; Marina, Tiermes; Torné Bladé, Aureli; Tejerizo, Álvaro; Díaz Feijoo, Berta
Background: Patients with cervical cancer treatment experience an impairment of sexual function and quality of life. This issue is usually underreported and undertreated, and evidence-based interventions are lacking. Prevention of sexual dysfunction is a crucial pillar in improving the quality of life of these patients. The primary objective of this trial is to evaluate the impact of a multimodal intervention, encompassing prevention of vaginal dysfunction and patient education, on sexual function and quality of life in cervical cancer survivors utilizing patient-reported outcome measurements. Methods: Multi-institutional, randomized clinical trial where patients will be randomized 1:2 at diagnosis of initial or locally advanced cervical cancer to control arm or intervention arm. After treatment, control arm patients will undergo standard follow-up by their referring physician. The multimodal intervention for patients in the intervention group includes application of vaginal estrogens plus hyaluronic-acid cream along with use of vaginal vibrator, systematic evaluation of the need of systemic hormone replacement therapy and treatment if needed, and access to online content about sexuality, nutrition, sports and lifestyle habits. Through 4 appointments (at diagnosis, 1, 6, and 12 months after treatment), sexual health, vaginal trophism and self-perceived quality of life of patients in both arms will be assessed with validated questionnaires as female sexual function index (FSFI), European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire 30, and Cx-24, Cervantes Scale, vaginal health index and vaginal thickness assessed by ultrasound. The major inclusion criteria will be patients aged ≥18 years with the International Federation of Gynecology and Obstetrics stage I-III cervical cancer treated with surgery and/or radiotherapy. The primary endpoint will be FSFI score 12 months after treatment, which will be compared between groups. Uni- and multivariate analysis will be performed to identify factors influencing sexual function recovery after treatment. The sample size will be of 120 eligible patients, who will be randomized to detect an improvement of 5.2 points in FSFI score. Complete accrual is estimated in March 2026. To date, the present study has no external funding.
The extent of aortic lymphadenectomy in locally advanced cervical cancer impacts on survival
(Korean Society of Gynecologic Oncology, 2021-01) Llueca, Antoni; Escrig, Javier; Gil Moreno, Antonio; Benito, Virginia; Hernández, Alicia; Díaz Feijoo, Berta; Spain-Gynecologic Oncology Group (GOG) Working Group
Objective: The prognostic impact of surgical paraaortic staging remains unclear in patients with locally advanced cervical cancer (LACC). The objective of our study was to evaluate the results of the surgical technique of preoperative aortic lymphadenectomy in LACC related to tumor burden and disease spread to assess its influence on survival. Methods: Data of 1,072 patients with cervical cancer were taken from 11 Spanish hospitals (Spain-Gynecologic Oncology Group [GOG] working group). Complete aortic lymphadenectomy surgery (CALS) was considered when the lymph nodes (LNs) were excised up to the left renal vein. The extent of the disease was performed evaluating the LNs by calculating the geometric means and quantifying the log odds between positive LNs and negative LNs. The Kaplan-Meier method was used to estimate the survival distribution. A Cox proportional hazards model was used to account for the influence of multiple variables. Results: A total of 394 patients were included. Pathological analysis revealed positive aortic LNs in 119 patients (30%). LODDS cut-off value of -2 was established as a prognostic indicator. CALS and LODDS <-2 were associated with better disease free survival and overall survival than suboptimal aortic lymphadenectomy surgery and LODDS ≥-2. In a multivariate model analysis, CALS is revealed as an independent prognostic factor in LACC. Conclusion: When performing preoperative surgical staging in LACC, it is not advisable to take simple samples from the regional nodes. Radical dissection of the aortic and pelvic regions offers a more reliable staging of the LNs and has a favorable influence on survival.
Potential strategies for prevention of tumor spillage in minimally invasive radical hysterectomy
(Korean Society of Gynecologic Oncology, 2020-09) Bebia, Vicente; Monreal Clua, Sonia; Pérez Benavente, Asunción; Franco Camps, Silvia; Díaz Feijoo, Berta; Gil Moreno, Antonio
Objective: The publication of a prospective and several retrospective studies describing a worse prognosis in patients affected with early-stage cervical cancer who underwent a minimally invasive radical hysterectomy has raised a high concern in what measures should be undertaken in order to revert these results. Potential strategies to prevent tumor spillage have been previously proposed. Methods: In this video, we describe nine strategies that should be addressed in future trials regarding this procedure. Results: These strategies are: 1. Fallopian tubes should be coagulated prior to start the surgery. 2. All sentinel lymph nodes and lymphadenectomy specimens should be obtained without lymph nodes fragmentation. 3. All surgical specimens should be extracted within a containment bag. 4. Uterine manipulators must never be used. 5. Prior to vaginal section, a closed knotted ligature should be placed around the vagina, proximal to the section line, and the remaining vaginal cavity profusely washed. 6. Once the vagina is opened, the surgical specimen should be extracted vaginally within a specimen retrieval bag. 7. After surgery, the pelvic cavity is profusely washed with physiological serum, and the vagina should be washed with iodopovidone diluted to 10%. 8. Port-site metastasis prevention measures should be performed. 9. Every action made to prevent tumor spillage should be recorded in the surgical report. Conclusion: As there is a biological rationale in these measures that would prevent tumor spillage and seeding, there is a need of prospectively exploring them within appropriate studies in order to determine their own oncological outcome.
Implications of extraperitoneal paraaortic lymphadenectomy to the left renal vein in locally advanced cervical cancer. A Spanish multicenter study.
(Elsevier, 2020-05-26) Díaz Feijoo, Berta; Franco Camps, Silvia; Torné Bladé, Aureli; Benito, Virginia; Hernández, Alicia; Lago, Víctor; Rovira, Ramón; Acosta, Úrsula; Agustí, Núria; Gil Moreno, Antonio; SEGO Spain-GOG Group
Objective: Paraaortic lymph node involvement is an important prognostic factor in locally advanced cervical cancer (LACC), but the anatomic limit of aortic lymphadenectomy is controversial. We assessed the impact of extraperitoneal paraaortic lymphadenectomy up to the left renal vein in patients with LACC undergoing pretherapeutic staging. Methods: A retrospective, multicenter study of patients with LACC stages FIGO 2009 IB2 and IIA2-IVA treated in 10 Spanish reference hospitals in gynecological oncology between 2000 and 2016. Sites of metastatic paraaortic lymph nodes above or below the inferior mesenteric artery were evaluated. Procedural-related intraoperative and early and late complications were assessed. Results: We included 634 patients undergoing paraaortic lymphadenectomy, in 616 (97.2%) of which the left renal vein was the upper limit of dissection (laparoscopy 592, robotic-assisted 24). The median surgical time was 150 min (interquartile range (IQR) 120-180), blood loss was 50 mL (range 20-80), and the length of stay was 2 days (range 2-3). Metastatic paraaortic involvement was found in 114 patients (18.5%), with infrarenal metastases in 73 (64%) of them. There were 11 patients (9.6%) with infrarenal metastases only, whereas in the remaining 62 (54.4%) patients concomitant infrarenal and inframesenteric metastases were observed. Intraoperative, early, and late postoperative complications occurred in 3.6%, 7.0%, and 4.5% of patients, respectively. Conclusions: In this study of patients with LACC undergoing surgical staging, paraaortic lymphadenectomy up to the left renal vein detected skip or isolated infrarenal metastasis in 9.6% of patients, with an acceptable surgical morbidity.
Surgical complications comparing extraperitoneal vs transperitoneal laparoscopic aortic staging in early stage ovarian and endometrial cancer.
(Elsevier, 2021-01) Chipirliu, Anca; Cabrera, Silvia; Díaz Feijoo, Berta; Bebia, Vicente; Hernández, Alicia; Gilabert Estellés, Juan; Franco Camps, Silvia; de la Torre, Javier; Segrist, Jaime; Pérez Benavente, Asunción; Gil Moreno, Antonio
Objective: To determine whether the extraperitoneal approach for paraaortic staging lymphadenectomy results in a lower rate of surgical complications compared to the transperitoneal approach, without compromising oncological outcomes. Methods: Prospective randomized multicenter study of patients with early endometrial or ovarian cancer undergoing paraaortic lymphadenectomy in 2010-2019. Patients were randomized to minimally invasive surgery (laparoscopy or robotic-assisted) using an extraperitoneal or a transperitoneal approach. The primary end point measure was a composite outcome that included developing one or more of the following surgical complications: bleeding during paraaortic lymphadenectomy ≥500 mL, any intraoperative complication related to paraaortic lymphadenectomy, severe postoperative complication (Dindo ≥ IIIA), impossibility to complete the procedure, or conversion to laparotomy. Results: There were 103 patients in the extraperitoneal group and 100 in the transperitoneal group. Differences in the composite outcome (transperitoneal 26.0% vs, extraperitoneal 18.4%; P = 0.195) were not found. Differences in the operative time, conversion to laparotomy, intraoperative bleeding, or survival were not observed. A higher number of lymph nodes were retrieved through the extraperitoneal approached (median, interquartile range [IQR] 12 [7-17] vs, 14 [10-19]: P = 0.026). Older age and greater body mass index (BMI) or waist-to-hip ratio (WHR) increased the risk for surgical complications independently of the laparoscopic approach. Conclusions: The extraperitoneal approach did not show differences regarding surgical and oncological parameters compared with the transperitoneal approach, although the number of aortic nodes retrieved was higher. The decision to use one or another laparoscopic route is a matter of the surgeon preference.
Postoperative Results After Patient Blood Management with Intravenous Iron Treatment Implementation for Preoperative Anemia: Prospective Cohort Study of 1294 Colorectal Cancer Patients
(MDPI, 2025-03-07) Centeno, Ana; Jericó, Carles; Bijelic, Lana; Deiros, M. Carmen; Biondo, Sebastián; Castellvi Valls, Jordi
Background: PA is frequent in CRC patients and known to be detrimental to surgical outcomes. PBM systems promote rational use of blood products and PA treatment with IVI, which could potentially improve postoperative results and the need for RBCT. Objective: To evaluate the effectiveness of Intravenous Iron (IVI) within a Patient Blood Management (PBM) pathway in Colorectal Cancer (CRC) patients with Preoperative Anemia (PA). To analyze surgical results after treatment and the need for Red Blood Cell Transfusion (RBCT) after surgery. Methods: Cohort study of CRC patients between 2012 and 2018, divided into groups: non-anemic patients (Hemoglobin Hb > 13 g/dL, Group 1), mildly anemic patients (Hb 12-13 mg/dL, Group 2), and patients treated with IVI (Hb < 12 mg/dL or Hb 12-13 mg/dL with risk factors, Group 3). Effectiveness of IVI treatment measured based on differences in Hb changes. Surgical complications were assessed and compared among groups, as well as the RBCT rate. The latter was also compared between Group 3 patients and those receiving preoperative RBCT. Results: Group 3 presented with a baseline Hb of 9.9 (+/- 1.5) mg/dL with an increase of 1.2 (+/- 1.9) mg/dL after treatment, which endured until discharge. Clavien-Dindo III-IV complications were 6.5%, and 30-day Mortality was 1.4% in all the series, without differences among Groups. RBCT rate in Group 3 patients was 21.6%, significantly lower than that of patients receiving preoperative RBCT (32.6%). Conclusions: IVI is a safe and effective measure for a fast PA correction in CCR patients and could potentially reduce postoperative RBCT rates.
Economic impact of ovarian stimulation antagonist protocol vs primed progesterone protocol in oocyte donor program: A retrospective study,
(ESG, 2024-12-27) Gonzalo, Josep; Castelo-Branco Flores, Camil; Garcia, Sandra; Devesa, Marta; Polyzos, Nikolaos P.
Objective: To assess the cost-effectiveness of two ovarian stimulation procedures comparing the use of FSH antagonists with the use of FSH progestin primed controlled ovarian stimulation in an oocyte donor program. Design: To calculate cost-effectiveness ratios (costs per outcome achieved) from clinical practices using a retrospective cohort single university center study carried out from 2012 to 2021. Main outcome measure(s): Cost-effectiveness ratios as cost per mature oocyte and cost per treatment. Results: According to the economic analysis, ovarian stimulation with FSH antagonist protocol increased statistically significantly the overall cost of the treatment as well as the cost per retrieved and effective oocyte. The cost of gonadotrophins per mature oocyte retrieved was 49.27 ± 17.94 € and the cost of medication per mature retrieved oocyte was 59.26 ± 28.01 €. In the FSH primed progesterone group, the cost of gonadotrophins per mature retrieved oocyte was 44.67 ± 16.65 € and the cost of medication per mature retrieved oocyte retrieved 44.91 ± 20.86 €. Conclusion: Cost-effectiveness is a compelling reason for an egg donation program. Progestins can present an effective and less expensive option for egg donation programs in terms of cost.
Beyond the pleasure of breastfeeding: Delving into the sexuality of lactating women
(ESG, 2024-03-04) Zayas Ros, María; Castelo-Branco Flores, Camil
Background and purpose: Exploration of sexuality during breastfeeding is scarce and often a silent aspect, leading to a lack of understanding. Breastfeeding is understood as part of a woman’s sexual development, discovering and connecting with a new person through the breast on a physical, hormonal, and emotional level. Recent studies discuss the pleasure some mothers experience while breastfeeding. The aim of this study was to explore this dimension and investigate more specific aspects of women’s sexuality during breastfeeding. Methods: This was a qualitative study with a phenomenological approach. The sample was obtained from breast-feeding and parenting groups in different districts of Barcelona, Spain. A total of 32 women breastfeeding and meeting inclusion and exclusion criteria were contacted. Of them, a sample of 18 participants was recruited, and data collection was through private individual structured interviews, later analyzed using the Giorgi methodology. Results: Virtually all women found breastfeeding pleasurable, and about half of the participants had experienced exciting sensations while nursing their newborns. Few had shared this experience before participating in this study. Conclusions: Addressing sexuality during this stage is essential to comprehend women’s experiences and create knowledge in this area. Sharing and informing contribute to the normalization and healthy experience of physiologicalprocesses within this field, sexuality during breastfeeding.

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