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Articles publicats en revistes (Cirurgia i Especialitats Medicoquirúrgiques)

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    Quantitative Study of Elbow Ligaments in Modern Humans (Homo sapiens) and Common Chimpanzees (Pan troglodytes)
    (John Wiley & Sons, 2026-07-24) Potau Ginés, Josep Maria; Casado, Aroa; Rodríguez Corbera, Patricia; García-Cuesta, Marcel; Ciurana, Neus; Paz, Félix Jesús de; Barbosa, Mercedes; San José, Isabel; Cabo, Roberto; Pastor, Francisco
    Objectives We have analyzed the elbow ligaments in humans and chimpanzees in order to identify differences that may be related to the use of the upper limbs in these two species. Specifically, we expected to find adaptations to arboreal locomotion and knuckle-walking in chimpanzees and adaptations to non-weight-bearing manual activities in humans. Materials and Methods We dissected seven upper limbs from extant humans and seven from common chimpanzees and performed anatomical and qualitative analyses of the elbow ligaments. Subsequently, we calculated the absolute and relative size of the mass of these ligaments in the two species. Results The anatomical description of the elbow ligaments was very similar in the two species. The quantitative analysis found a relatively larger anterior fascicle of the ulnar collateral ligament (UCL) in humans and a relatively larger lateral ulnar collateral ligament (LUCL) in chimpanzees. Discussion The different ways humans and chimpanzees use their upper limbs could explain the quantitative differences we observed in the elbow ligaments. We can thus hypothesize that the more developed anterior fascicle of the UCL in humans may be related to a more pronounced carrying angle in the upper limb and to the valgus forces acting on the elbow during manual tasks. In contrast, the larger LUCL in chimpanzees may help stabilize the elbow during arboreal locomotion and during the support phase of knuckle-walking.
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    Rapid identification of a Serratia marcescens outbreak in a neonatal intensive care unit by third-generation long-read nanopore sequencing
    (BioMed Central, 2025-06-04) Henares, Desiree; Cubero, Meritxell; Martínez de Albéniz, Irene; Arranz Betegón, Angela; Rocafort, Mercedes; Brotons, Pedro; Perez-Argüello Amaresh; Troyano Maria José; Gené, Amadeu; Lluansí, Aleix; Iriondo Sanz, Martín; Jordán García, Iolanda; Fortuny, Clàudia; Urrea, Mireia; Muñoz Almagro, Carmen
    Background Serratia marcescens is a frequent cause of outbreaks in high-risk hospital settings such as neonatal intensive care units (NICU). This study investigated a potential S. marcescens outbreak in the NICU of a reference children’s hospital using Whole Genome Sequencing (WGS). Additionally, it assessed the performance of third-generation sequencing for the rapid and accurate identification and characterization of the outbreak’s clonal strain. Methods A prospective study was conducted from September 8th to November 12th 2021, following a sharp increase in invasive S. marcescens infections in the NICU of University Children’s Hospital Sant Joan de Déu (Barcelona, Spain). This study included all patients admitted to NICU and other hospital wards from whom S. marcescens was isolated in any sample type. Nanopore sequencing was performed on S. marcescens isolates. Genomic characterization included phylogenetic analyses and detection of antimicrobial resistance genes. Results Twenty-nine patients (16 NICU and 13 non-NICU patients) infected/colonized by S. marcescens were detected during the study period, accounting for a total of 61 isolates. The genomic characterization was performed on 24 isolates from 14 NICU-patients and 10 isolates from eight non-NICU patients. Phylogenetic analyses evidenced three clusters of closely related strains; cluster I (n = 22), II (n = 2) and III (n = 5). The remaining isolates (n = 5) did not cluster. Cluster I contained most isolates from NICU patients (20/24), and most isolates from NICU-patients with confirmed invasive disease (7/8). Cluster II contained two isolates from two NICU-patients, one presenting with invasive disease. The resistance gene blaSRT was found in 97% of S. marcescens isolates (33/34). All isolates exhibited the amikacin-tobramycin aac(6’) resistance gene and three multi-drug efflux pumps genes; sdeY, sdeB and smfY. The tetracycline tet(41) resistance gene was found in non-clustered isolates (4/34). The first results were available less than one month after the outbreak’s alarm, and complete genomic study after two months. Conclusion Two clonal strains were co-circulating in the NICU setting, with one being the major strain responsible for the outbreak. Rapid molecular characterization with nanopore sequencing confirmed the outbreak. It revealed the phylogenetic relationships among isolates and their antimicrobial potential. This approach enabled effective contextualization of the outbreak and allowed for monitoring its progression.
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    Discovery of Donor-Derived Exosomal DNA as an Exploratory Biomarker of Kidney Graft Rejection: A Cross-Sectional Study
    (Frontiers Media, 2026-03-18) Cuadrado Payán, Elena; Ramírez Bajo, María José; Bañón Maneus, Elisenda; Rovira Juárez, Jordi; Hierro García, Natalia; Serrano Jorcano, Daniel; Argudo, María; Montagud Marrahi, Enrique; Rodríguez Espinosa, Diana; Arana, Carolt; Molina Andújar, Alícia; Gonzalez Rojas, Ángela; Esforzado Armengol, Núria; Torregrosa, Vicens; Ventura Aguiar, Pedro; Broseta, José Jesús; González Roca, Eva; Palou Rivera, Eduard; Diekmann, Fritz; Cucchiari, David; Revuelta, Ignacio
    Circulating donor DNA has emerged as a valuable tool for clinical decision-making in kidney transplantation. While most studies focus on cell-free DNA, the role of donor DNA associated with extracellular vesicles (EVs) remains unexplored. To address this, we analyzed donor-derived exosomal DNA (dd-exoDNA) in 100 kidney transplant recipients (KTR) undergoing surveillance or indicated biopsies. Serum exosomes were isolated using precipitation-based technology, and dd-exoDNA was analyzed via digital PCR targeting donor/recipient HLA-DRB1 mismatches. Dd-exoDNA levels were higher in rejection versus non-rejection (2.66 [0.56-7.10] ×10-3 vs. 0.69 [0.28-1.71] ×10-3, p = 0.004) and were associated with Banff score items: glomerulitis ≥1 (p = 0.037), peritubular capillaritis ≥1 (p = 0.040), and tubulitis ≥2 (p = 0.043). In multivariate analysis, dd-exoDNA remained independently associated with rejection, although with wide confidence intervals (OR [95%CI] 3.68 [1.32-10.26], P = 0.013). Exploratory threshold analyses suggested moderate discriminative performance. These findings indicate that donor DNA associated with circulating EVs may offer complementary information to existing biomarkers, warranting validation in external cohorts and comparison with established assays.
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    Living-Donor Kidney Transplantation: Comparison of Robotic-Assisted Versus Conventional Open Technique
    (Frontiers Media, 2025-11-21) Musquera i Felip, Mireia; Prudhomme, Thomas; Ajami, Tarek; Martínez, Carmen; Carbonell Vayá, Enrique J.; Munni, Maria; Leon, Maria; López de Mesa Rodriguez, Byron; Roca, Ingrid; Vilaseca, Antoni; Ribal, María José; Segura, Natalia; Diekmann, Fritz; Revuelta, Ignacio; Tena Blanco, Beatriz ; Monsalve, Concepción; Peri Cusí, Lluís; Alcaraz Asensio, Antonio
    The aim was to compare intraoperative, postoperative and functional outcomes of patients undergoing living donor RAKT versus OKT. A retrospective analysis of all living donor’s kidney transplantation performed in a tertiary center between 2013 and 2024 comparing RAKT with OKT was performed. All recipients in the OKT group were eligible for a RAKT. A total of 400 patients (200 RAKT and 200 OKT) were included. Recipients were younger in the RAKT cohort (48.0 versus 51.5 years, p = 0.045). Median operative time was significantly longer in the RAKT group (185.5 versus 120.0 min, p < 0.0001). Intraoperative complications rate was similar in both study group. A significantly higher proportion of recipients receiving OKT undergone post-operative surgical complications (p < 0.0001) and major post-operative complications (8.0% versus 19.5%, p = 0.001). Seven patients required graft nephrectomy during the early post-operative period (of whom all were in the RAKT group). Median length of hospitalization was significantly longer in the OKT group (7.0 versus 9.0 days, p < 0.0001). 1-, 3- and 5-years patient and graft survival were comparable between the RAKT and OKT cohorts. The postoperative opioid requirement was not evaluated. Our analysis confirms the safety and efficacy of RAKT in the setting of living donors, in comparison to conventional OKT.
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    Artificial intelligence in thoracic surgery consultations: evaluating the concordance between a large language model and expert clinical decisions
    (Frontiers Media, 2025-11-17) Déniz Armengol, Carlos; Marcè, Judith; Macía, Ivan; Rivas Doyague, Francisco; Muñoz, Ana; Paradela, Marina; García, Sonia; Moreno, Camilo; Serratosa, Inés; García, Marta; Rodríguez-Martos, Tania; Ojanguren, Amaia
    Background: Artificial intelligence (AI) and large language models (LLMs) are increasingly used in clinical workflows, but their real-world application in thoracic surgery decision-making remains underexplored. Methods: This retrospective observational study assessed the concordance between diagnostic and therapeutic recommendations generated by Scholar GPT (based on GPT-4) and decisions made by board-certified thoracic surgeons. All outpatient consultations over one week in a tertiary care hospital were included. Each case was evaluated using a 6-point concordance scale (0–5), developed to quantify agreement in diagnosis and treatment planning. This was a retrospective observational, single-centre analysis; two independent thoracic surgeons assigned the concordance score. We report descriptive statistics and used t-tests/ANOVA for continuous variables and chi-square tests for categorical variables. Given the exploratory design, no a priori sample-size calculation or power analysis was performed. Results: A total of 81 consultations were analysed. The mean concordance score was 3.67 ± 1.17. High concordance (scores 4–5) occurred in 56.8% of cases, particularly in oncological diagnoses such as mediastinal and pleural tumours. Lower concordance was observed in complex or functional conditions like metastatic lung disease and thoracic outlet syndrome. No significant differences were found between consultation modalities or visit types. Conclusion: Scholar GPT demonstrated promising alignment with surgeon decisions in structured oncologic cases but showed variability in complex scenarios. While AI may assist in streamlining outpatient workflows, its use should remain complementary to expert clinical judgment. These findings are exploratory and should be interpreted with caution given the small sample size and single-centre, one-week design.
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    Influence of spine biomechanics and sagittal balance on the outcome of lumbar discectomy
    (Frontiers Media, 2025-02-12) Poblete Carrizo, José Martín; Reyes-Martínez, Javier; Gonzalez-Díaz, Joaquín; Mosteiro Cadaval, Alejandra; Torné, Ramón; Di Somma, Alberto; Ríos, José; Enseñat Nora, Joaquim; Fuster i Obregon, Salvador
    Purpose: Spine biomechanics, particularly sagittal balance and spino-pelvic angulation are determinant factors in the understanding of lumbar degenerative disease. These concepts translated into objective measurements are progressively being integrated into clinical practice. The present study explores them as prognostic factors in patients undergoing lumbar microdiscectomy, which could help identify those at higher risk of surgical failure. Methods: Prospective analysis of patients treated with lumbar microdiscectomy (n = 52) and healthy control subjects (n = 45) in a single tertiary centre. Follow up of 12 and 24 months after surgery, with radicular and lumbar pain evaluation according to the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Comparison of several objective spinal biomechanic factors, measured by a single experienced radiologist. Assessment of spinal sagittal balance as a prognostic factor after lumbar discectomy. Results: Compared to healthy individuals, patients with symptomatic lumbar disc herniation showed lower thoracic kyphosis (39.03 vs. 34.42° p = 0.034), lower thoraco-lumbar transition T10-L2 angulation (6.79 vs. 2.08° p = 0.005), lower lumbar lordosis (59.54 vs. 48.36° p < 0.001) and lumbo-sacral angulation L4-S1 (40.20 vs. 29.16° p < 0.001), lower pelvic incidence (54.71vs 49.86° p = 0.014) and lower sacral slope (42.07 vs. 33.34° p < 0.001). Sagittal balance (SVA) was negative in healthy subjects −3.09 mm and positive lumbar-disc patients 15.04 (p = 0.013). Noteworthy, the radicular and lumbar pain and disability outcomes 12 and 24 months after surgery were significantly better in the group with normal sagittal balance (ODI 14.52 vs. 40.06 p < 0.001; radicular VAS 2.74 vs. 5.58 p < 0.001; lumbar VAS 3.61 vs. 4.06 p < 0.001). Conclusion: Lumbar degenerative disc disease represents a major burden for healthcare systems; thus, its management is determinant. Lumbar discectomy shows overall positive results, with a significant reduction of pain and disability in the majority of cases. However, a subgroup of patients, still not well defined, may experience persistent pain after the intervention. The use of objective measurements of sagittal balance may help identify these patients for which simple discectomy may not suffice and contribute to treatment planification.
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    Risk stratification and anal cancer screening in immunocompetent women with genital HPV: Value of multicentric HSIL and performance of HPV-based screening
    (Wiley, 2026-08-15) Matas, Isabel; Torné Bladé, Aureli; Saco, Adela; Martí Delgado, Cristina; Cardiel, Ada; Rakislova, Natalia; Marimon, Lorena; Glickman, Ariel; Victoria, Ingrid; Alos, Silvia; Lopez-Diaz, Jesús; Fusté, Pere; Ordi i Majà, Jaume; Pino Saladrigues, Marta del
    The incidence of anal squamous cell carcinoma (ASCC) is rising, and women with genital human papillomavirus (HPV) infection or HPV-associated high-grade squamous intraepithelial lesions (HSIL) are at high risk of developing ASCC. We conducted a cross-sectional study including 354 immunocompetent women referred for anal evaluation because of HPV infection or HSIL of the lower genital tract between 2019 and 2024. Participants were categorized according to the genital site affected by HSIL (uterine cervix, vagina, vulva/perineum/perianal region, or multicentric disease), and a control group of 99 immunocompetent women with genital HPV infection and/or low-grade SIL was included. All patients underwent anal high-risk HPV testing, liquid-based cytology, and high-resolution anoscopy when indicated. Overall, high-risk HPV infection and HSIL were identified in the anal canal in 62.5% and 5.6% of women, respectively. Women with multicentric disease showed a higher prevalence of anal HSIL compared with the control group (6/29, 20.7%, vs. 2/99, 2.0%; p = .031), and the other genital HSIL groups (11/182, 6.0% for cervical; 0/13, 0%, for vaginal; 1/31, 3.2% for vulvar HSIL; p = .003). Genital HSIL, particularly multicentric disease, was a strong marker of anal involvement. No HSIL/AIN occurred among women with a negative anal high-risk HPV test. Anal high-risk HPV testing alone showed optimal sensitivity (100%) and negative predictive value (100%) for the diagnosis of HSIL/AIN, whereas cytology alone had lower sensitivity (68.4%). Combining both tests did not improve accuracy and resulted in excessive referrals. High-risk HPV testing alone appears to be the most efficient approach for anal screening in women with genital HSIL.
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    Robust framework for adaptive field-of-view automatic segmentation in vaginal brachytherapy for endometrial cancer
    (sciencedirect, 2026-05-18) Casamitjana, Adrià; Gómez Fresco, Ana María; Candela Juan, Cristian; Tudela Fernández, Raúl; Sala Llonch, Roser; Moreno López, Sara; Noorian, Faegheh; Rovirosa Casino, Angeles; Niñerola Baizán, Aida; Herreros, Antonio
    Background and purpose: The lack of robust automatic tools for segmentation in vaginal brachytherapy (VBT) limits efficiency and reproducibility in clinical practice. We aimed to develop a framework for automatic segmentation of the clinical target volume (CTV) and organs of interest (OOIs) for endometrial cancer patients that undergo vaginal cuff brachytherapy. Material and methods: We developed a three-step framework based on nnUNet and adapted to our context to segment the CTV/OOIs on pre-treatment computed tomography (CT) scans. Our method was adaptive to different contouring protocols used in clinical practice, where images were partly labelled, by either providing labels within a region of interest and/or considering only a subset of present structures. A dataset of 289 patients treated between 2014 and 2021 was used for model development (139/35/115 for training, validation and testing). Results: The Dice similarity coefficient of the CTV was 87.7%, while OOI Dice coefficients were 72.6%, 88.9%, 86.3% for the small bowel, bladder and rectum, respectively. The average absolute D2cm3 deviations were 27.5(±58.7), 25.5(±21.0), and 21(±19.1) cGy for the small bowel, bladder and rectum, respectively. The average absolute D90 % deviation was 17.0(±19.6) cGy. Clinical transferability was assessed using a 1-4 scale, achieving a median of 4 for the CTV, 3 for bladder and rectum, and 2 for the small bowel. Conclusions: Our method segmented the CTV and OOIs from CT scans with high quality and reliable dose calculations within the relevant range. Our framework outperformed state-of-the-art methods and potentially could help reduce complexity and time in VBT protocols. Keywords: Artificial intelligence in oncology; Automatic segmentation; Dosimetry evaluation; Endometrial cancer; Vaginal cuff brachytherapy.
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    Time-course evolution of counterfactual thinking after early pregnancy loss
    (Nature Publishing Group, 2026-03-19) Mallorquí, Aida; Pauta, Montse; Cardona, Gemma; Álvarez Martín, Claudia; Paz y Miño, Fernanda; Nogué, Laura; Segú, Xavier; Ardiles-Ruesjas, Victoria; Rodríguez Fornells, Antoni; Borrell i Vilaseca, Antoni
    Counterfactual thinking (CT), the tendency to consider how events might have been different, is a common cognitive process following negative life events. This longitudinal study examines the prevalence and time-course evolution of CT immediately after early pregnancy loss. A sample of 119 women who experienced early pregnancy loss completed an online psychological assessment measuring traumatic impact, trait rumination, and CT presence, frequency, and content. The survey was administered at one week, one month, and four months post-loss. CT was highly prevalent (72%) and decreased over time. 99% of CT had an upward focus, imagining a better outcome than reality. Moreover, 91.6% were also self-referential, perceived as dependent on one’s own behaviors and emotions, frequently involving a heightened sense of personal responsibility for the loss. Rumination and traumatic impact predicted counterfactual thinking frequency over time, identifying psychological risk patterns. Findings support the idea that CT may serve an adaptive function by helping to process the loss and support future goal setting, including subsequent pregnancy. However, in individuals with high traumatic impact and rumination, CT may contribute to prolonged distress. Integrating psychological care alongside physical healthcare is essential to promoting long-term well-being after early pregnancy loss.
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    Impact of Surgery for Deep Infiltrative Endometriosis before In Vitro Fertilization: A Systematic Review and Meta-analysis
    (Elsevier, 2021) Casals Soler, Gemma; Carrera, María; Domínguez, José Antonio; Abrao, Mauricio Simoes; Carmona Herrera, Francisco
    The aims of this systematic review and meta-analysis were to compare reproductive outcomes in patients who underwent surgery for deep infiltrative endometriosis (DIE) before in vitro fertilization (IVF) with those in patients who underwent IVF without a previous surgery for DIE, to analyze data according to different types of surgery (complete or incomplete) or subgroups of patients (DIE with or without bowel involvement), and to assess surgical and IVF complications and data regarding safety concerns.
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    Monoamine neurotransmitters in early epileptic encephalopathies: New insights into pathophysiology and therapy
    (Wiley, 2022-01-31) Juliá Palacios, Natalia; Molina Anguita, Cristina; Sigatulina Bondarenko Maria; Cortès Saladelafont, Elisenda; Aparicio, Javier; Cuadras, Daniel; Horvath, Gabriella; Fons, Carmen; Artuch Iriberri, Rafael; García Cazorla, Àngels
    Aim: To study neurotransmitter status in children with early epileptic and developmental and epileptic encephalopathy (DEE) and to explore the clinical response to dopaminergic and serotoninergic therapies in a group of patients. Method: Two hundred and five patients (111 males [54.1.%] and 94 females [45.9%], mean age 10 months at the onset of epilepsy [SD 1year 1month], range 0–3year) with epileptic encephalopathy/DEE were recruited, including those with West syndrome, Ohtahara syndrome, early myoclonic encephalopathy, epilepsy of infancy with migrating focal seizures, myoclonic encephalopathy in non-progressive disorders, infantile spasms, Doose syndrome, Lennox–Gastaut syndrome, Landau–Kleffner syndrome, and those unclassified. Cerebrospinal fluid (CSF) neurotransmitter studies and patients' medical records were reviewed. Additionally, we present clinical data of 10 patients with low CSF neurotransmitter levels who received dopaminergic/serotoninergic treatments. Results: Abnormal neurotransmitter values were identified in 68 (33%) patients. 5-Hydroxyindoleacetic acid (5-HIAA) deficit was the most prevalent alteration (91%). Low CSF 5-HIAA levels were significantly higher in 1- to 3-year-old children. A negative significant correlation was found between 5-HIAA levels and epilepsy duration before CSF study (Spearman's ρ=−0.191, p=0.007). Abnormalities in deep grey matter were associated with low levels of CSF homovanillic acid and 5-HIAA. Ten patients with low CSF neurotransmitter levels received dopamine and/or serotonin therapies. Six of them showed initial decrease of seizure frequency and severity and maintained improvement in some neurodevelopmental skills. Interpretation: A considerable number of patients showed neurotransmitter abnormalities. Age at seizure onset and duration of epilepsy before CSF study were the principal factors related to neurotransmitter depletion. Early monoamine supplementation would seem advisable as a neuroprotective strategy.
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    Laparoscopic Debulking of Enlarged Pelvic Nodes during Surgical Para-aortic Staging in Locally Advanced Cervical Cancer: A Retrospective Comparative Cohort Study
    (Elsevier, 2021-12-01) Díaz Feijoo, Berta; Acosta, Úrsula; Torné Bladé, Aureli; Gil Ibañez, Blanca; Hernández, Agustín; Domingo, Santiago; Gil Moreno, Antonio
    Patients Total of 381 women with locally advanced cervical cancer and International Federation of Gynecology and Obstetrics 2018 stage IIIC 1r (radiologic) and higher who received primary treatment with chemoradiotherapy. Interventions Patients underwent pelvic lymph node debulking and para-aortic lymphadenectomy (group 1), only para-aortic lymphadenectomy (group 2), or no lymph node surgical staging (group 3). On the basis of pelvic node histology, group 1 was subdivided as negative (group 1A) or positive (group 1B). Measurements and Main Results False positives and negatives of imaging tests, disease-free survival, overall survival, and postoperative complications were evaluated. In group 1, pelvic lymph node involvement was 43.3% (71 of 164), and aortic involvement was 24.4% (40 of 164). In group 2, aortic nodes were positive in 29.7% (33 of 111). Disease-free survival and overall survival were similar in the 3 groups (p = .95) and in groups 1A and 1B (p = .25). No differences were found between groups 1 and 2 in intraoperative (3.7% vs 2.7%, p = .744), early postoperative (8.0% vs 6.3%, p = .776), or late postoperative complications (6.1% vs 2.7%, p = .252). Fewer early and late complications were attributed to radiotherapy in group 1A than in the others (p = .022). Conclusion Laparoscopic pelvic lymph node debulking during para-aortic staging surgery in patients with locally advanced cervical cancer with suspicious nodes allows for the confirmation of metastatic lymph nodes without affecting survival or increasing surgical complications. This information improves the selection of patients requiring boost irradiation, thus avoiding overtreatment of patients with negative nodes.
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    NADPH oxidase 1/4 dual inhibition impairs transforming growth factor-beta protumorigenic effects in cholangiocarcinoma cancer-associated fibroblasts
    (Springer Nature, 2025-08-18) Amengual, Josep; González Sánchez, Ester; Yáñez Bartolome, Mariana; Sererols Viñas, Laura; Ravichandra, Aashreya; Guiton, Celia; Fusté, Noel P.; Alay, Ania; Hijazo Pechero, Sara; Martín Mur, Beatriz; Gut, Marta; Esteve Codina, Anna; Cantos Cortes, Ana; Espinosa Sotelo, Rut; Ramos, Emilio; Serrano Piñol, M. Teresa; Calvo, Mariona; Laquente, Berta; Ferrer i Jané, Joan; Pons, Gabriel; Méndez Lucas, Andrés; Dooley, Steven; Ilyas, Sumera I.; Vallette, Marie; Aoudjehane, Lynda; Lequoy, Marie; Fouassier, Laura; Coulouarn, Cédric; Affò, Silvia; Scheiter, Alexander; Calvisi, Diego F.; Tian, Tian V.; Fabregat Romero, Isabel; Vaquero Rodríguez, Javier
    Transforming growth factor beta (TGF-β) signalling has become an attractive therapeutic target due to its pro-tumorigenic actions on epithelial cells and its immunosuppressive effects in the tumour microenvironment. In intrahepatic cholangiocarcinoma (iCCA), a highly aggressive malignancy of the biliary tract with poor prognosis, the latest clinical trials using TGF-β inhibitors have failed indicating that the specific actions carried out by TGF-β in iCCA are yet not well delineated. Here, we show that TGF-β signalling is highly active in iCCA and exerts a prominent suppressor effect on tumour cell lines and organoids established from iCCA metastases biopsies, that relies on a functional canonical SMAD2/3/4 signalling. Thus, TGF-β inhibitors promote, instead of inhibiting, tumour cell growth. In this context, a promising strategy is to target intracellular proteins downstream the TGF-β receptors accounting only for TGF-β pro-tumorigenic actions. NADPH oxidase 4 (NOX4), a downstream mediator of the TGF-β signalling pathway, is strictly expressed in cancer-associated fibroblasts (CAF) of iCCA and acts in concert with NOX1 to regulate CAF functions. Use of a dual NOX4/NOX1 inhibitor impaired CAF actions and reduced tumour growth in vitro and in two different in vivo iCCA experimental models. Collectively, our findings reveal an actionable way to specifically target TGF-β pro-tumorigenic actions in CAF from iCCA without undesirable side effects on tumour cells, suggesting a potentially bright future for dual NOX4/NOX1 inhibitors in the clinics, alone or in combination with other therapies.
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    Combined heart and liver transplantation for Uhl’s anomaly: a case report.
    (Elsevier B.V., 2020) Landi, Filippo ; Sandoval, Elena ; Martinez, Julia ; Blasi Ibáñez, Annabel ; Arguis Giménez, María José ; Colmenero, Jordi; Montserrat, Silvia ; García-Álvarez, Ana ; Martinez, Daniel; Dos, Laura ; Riquelme, Francisco; Quintana, Eduard; Castellà Pericàs, Manuel ; Fondevila Campo, Constantino
    Background Uhl's anomaly is an extremely rare congenital heart defect characterized by absence of the right ventricle myocardium and preserved left ventricular myocardium. Although the disease has a poor prognosis and is generally fatal in the perinatal period, some patients may reach adulthood. Methods We describe a case of Uhl's anomaly complicated with heart failure and decompensated cardiac cirrhosis in a 42-year-old man treated by combined heart-liver transplant. Results The patient underwent heart transplant using the bicaval technique followed by subsequent liver transplant with the piggyback technique without venovenous bypass. Total ischemia time was 108 minutes for the heart and 360 and 25 minutes of cold and warm ischemia, respectively, for the liver. No intraoperative complications occurred. The patient was discharged without severe complications on postoperative day 22. Pathologic examination of the organs reported advanced cirrhosis of the liver and severe dilated myocardiopathy of right ventricle with absence of myocardium and a normal left ventricle. Twenty-seven months after the transplant the patient has been free from hospital admissions, with normal function of both transplanted organs.
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    Analysis of maturation features in fetal brain ultrasound via artificial intelligence for the estimation of gestational age
    (Elsevier Inc., 2021-11-01) Burgos Artizzu, Xavier P.; Coronado-Gutiérrez, D.; Valenzuela Alcaraz, Brenda I.; Vellvé, Kilian; Eixarch Roca, Elisenda; Crispi Brillas, Fàtima; Bonet Carné, Elisenda; Bennasar Sans, Mª del Mar; Gratacós Solsona, Eduard
    Optimal prenatal care relies on accurate gestational age dating. After the first trimester, the accuracy of current gestational age estimation methods diminishes with increasing gestational age. Considering that, in many countries, access to first trimester crown rump length is still difficult owing to late booking, infrequent access to prenatal care, and unavailability of early ultrasound examination, the development of accurate methods for gestational age estimation in the second and third trimester of pregnancy remains an unsolved challenge in fetal medicine.
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    Spontaneous non-traumatic dislocation of the hip as a complication of screw-plate fixation of a femoral neck fracture
    (Elsevier B.V., 2021) Combalia, Maite; Muñoz Mahamud, Ernesto; Febles Oviedo, J. L.; Fernández-Valencia, J. A. (Jenaro-Ángel); Combalía Aleu, Andrés
    Femoral neck fractures are commonly seen in elderly population as a cause of a trivial fall. In younger patients it usually occurs following high energy trauma. Dynamic hip screw (DHS) is one of the most common type of internal fixation although intramedullary fixation devices have been introduced in the treatment in the last decade not without controversy [1,2]. Described complications are failure of fixation, cut-out, malunion, non-union, disengagement of lag screw and side plate, cut-in, intrapelvic migration, vascular injuries, etc. Despite its technical complexity, fixation of these fractures is done every day all over the world with recent evidence supporting selection of DHS in favor of intramedullary nailing2. Dislocation of the hip following a DHS is a very rare complication. There are only a few cases described in literature, some of them associated with infection. We present a case of a spontaneous non-traumatic dislocation of the hip as a complication of screw-plate fixation of a femoral neck fracture and an exhaustive review of literature discussing the possible causes of this rare complication.
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    Prevalence of supratentorial anomalies assessed by magnetic resonance imaging in fetuses with open spina bifida
    (John Wiley & Sons, 2021-08-15) Trigo, Lucas; Eixarch Roca, Elisenda; Bottura, I.; Dalaqua, M.; Barbosa, A. A.; Catte, L. de; Demaerel, P.; Dymarkowski, S.; Deprest, Jan; Lapa, Denise Araújo; Aertsen, Michael; Gratacós Solsona, Eduard
    Objectives To determine the prevalence of brain anomalies at the time of preoperative magnetic resonance imaging (MRI) assessment in fetuses eligible for prenatal open spina bifida (OSB) repair, and to explore the relationship between brain abnormalities and features of the spinal defect. Methods This was a retrospective cross-sectional study, conducted in three fetal medicine centers, of fetuses eligible for OSB fetal surgery repair between January 2009 and December 2019. MRI images obtained as part of the presurgical assessment were re-evaluated by two independent observers, blinded to perinatal results, to assess: (1) the type and area of the defect and its anatomical level; (2) the presence of any structural central nervous system (CNS) anomaly and abnormal ventricular wall; and (3) fetal head and brain biometry. Binary regression analyses were performed and data were adjusted for type of defect, upper level of the lesion (ULL), gestational age (GA) at MRI and fetal medicine center. Multiple logistic regression analysis was performed in order to identify lesion characteristics and brain anomalies associated with a higher risk of presence of abnormal corpus callosum (CC) and/or heterotopia. Results Of 115 fetuses included, 91 had myelomeningocele and 24 had myeloschisis. Anatomical level of the lesion was thoracic in seven fetuses, L1–L2 in 13, L3–L5 in 68 and sacral in 27. Median GA at MRI was 24.7 (interquartile range, 23.0–25.7) weeks. Overall, 52.7% of cases had at least one additional brain anomaly. Specifically, abnormal CC was observed in 50.4% of cases and abnormality of the ventricular wall in 19.1%, of which 4.3% had nodular heterotopia. Factors associated independently with higher risk of abnormal CC and/or heterotopia were non-sacral ULL (odds ratio (OR), 0.51 (95% CI, 0.26–0.97); P = 0.043), larger ventricular width (per mm) (OR, 1.23 (95% CI, 1.07–1.43); P = 0.005) and presence of abnormal cavum septi pellucidi (OR, 3.76 (95% CI, 1.13–12.48); P = 0.031). Conclusions Half of the fetuses assessed for OSB repair had an abnormal CC and/or an abnormal ventricular wall prior to prenatal repair. The likelihood of brain abnormalities was increased in cases with a non-sacral lesion and wider lateral ventricles. These findings highlight the importance of a detailed preoperative CNS evaluation of fetuses with OSB. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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    Spike-based COVID-19 immunization increases antibodies to nucleocapsid antigen
    (Elsevier, 2021-10-25) Izquierdo, Luis; Aguilar, Ruth; Moncunill Piñas, Gemma; Dobaño, Carlota, 1969-; Jiménez, Alfons; Rubio Bodí, Rocío; Alonso, Selena; Ramírez Morros, Anna; Vidal, Marta; Vidal Alaball, Josep; Ruiz Comellas, Anna; Garcia Basteiro, Alberto
    Antibodies to the nucleocapsid (N) antigen are suggested to be used to monitor infections after COVID-19 vaccination, as first generation subunit vaccines are based on the spike (S) protein. We used multiplex immunoassays to simultaneously measure antibody responses to different fragments of the SARS-CoV-2 S and N antigens for evaluating the immunogenicity of the mRNA-1273 (Spykevax) and the BNT162b2 (Comirnaty) vaccines in 445 health care workers. We report a >4-fold increase post-vaccination of IgG levels to the full length (N FL) and C-terminus of N (N CT) in 5.2% and 18.0% of individuals, respectively, and of IgA in 3.6% (N FL) and 9.0% (N CT) of them. The increase in IgG levels and avidity was more pronounced after Spykevax than Comirnaty vaccination (36.2% vs 13.1% for N CT, and 10.6% vs 3.7% for N FL). Data suggest the induction of cross-reactive antibodies against the N CT region after administering these S-based vaccines, and this should be taken into account when using N seropositivity to detect breakthroughs.
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    Evaluación del impacto de la disfunción olfativa post-COVID-19 en la calidad de vida: comparación de cuestionarios específicos
    (Elsevier España, 2026-03-19) Rovira Martínez, Carlota; Campos Motamayor, Mariana; Sansa Perna, Aina; Yuste, Elios; Gelabert, Laura; Haro Licer, Josep de; Cardesin Revilla, Alda; Caballero Borrego, Miguel
    [spa] Antecedentes y objetivo La disfunción olfativa post-COVID-19 persiste en muchos pacientes y afecta significativamente la calidad de vida. El objetivo principal fue evaluar la función olfativa con pruebas psicofísicas (BAST-24) y cuestionarios de calidad de vida. Como objetivos secundarios, se analizó la correlación entre los cuestionarios y explorar la relación entre medidas subjetivas y psicofísicas. Material y métodos Se realizó un estudio prospectivo en 86 adultos con disfunción olfativa ≥ 6 meses tras infección por SARS-CoV-2. Se recogieron datos clínico-demográficos, y puntuaciones de la Escala Visual Analógica para el olfato (EVA-olfato) y de los cuestionarios de calidad de vida SNOT-22, svQOD-NS y QVOLF. La función olfativa se evaluó con el BAST-24 (detección, identificación y memoria olfativa). Se usaron estadísticos descriptivos, coeficiente de correlación de Spearman y prueba de Mann-Whitney U (p < 0,05). Resultados La edad media fue 49 años (DE = 14; IC95% 46,0-52,0); el 76,7% eran mujeres. Según la EVA, el 90,7% presentó hiposmia y el 8,1% anosmia. Las puntuaciones medias (DE) fueron: EVA 6 (2), SNOT-22 26 (20), svQOD-NS 4 (4) y QVOLF 127 (50), sugiriendo impacto moderado en la calidad de vida. BAST-24: detección 91% (22), identificación 52% (25) y memoria 35% (20). QVOLF y svQOD-NS mostraron fuerte correlación (ρ = 0,797; p < 0,001) mientras que SNOT-22 correlacionó moderadamente con ambos. No hubo correlaciones significativas entre cuestionarios y BAST-24. Conclusiones QVOLF y svQOD-NS son más sensibles que SNOT-22 para evaluar la disfunción olfativa. La ausencia de correlación con pruebas psicofísicas resalta la necesidad de combinar ambas para una evaluación integral. [eng] Background and objectives Post-COVID-19 olfactory dysfunction persists in many patients and significantly affects quality of life. The primary objective was to evaluate olfactory function using psychophysical tests (BAST-24) and quality-of-life questionnaires. Secondary objectives included analysing correlations between questionnaires and the relationship between subjective and psychophysical measures. Materials and methods A prospective study was conducted including 86 adults with olfactory dysfunction ≥ 6 months after SARS-CoV-2 infection. Clinical and demographic data and scores from the Visual Analog Scale for smell (VAS-smell) and the SNOT-22, svQOD-NS, and QVOLF questionnaires were collected. Olfactory function was assessed using the BAST-24 (detection, identification, and olfactory memory). Descriptive statistics, Spearman's correlation coefficient, and the Mann-Whitney U test were used (p < 0.05). Results Mean age was 49 years (SD = 14); 76.7% were women. According to the VAS, 90.7% had hyposmia and 8.1% anosmia. Mean scores (SD) were: VAS 6 (2), SNOT-22 26 (20), svQOD-NS 4 (4), and QVOLF 127 (50), suggesting a moderate impact on quality of life. BAST-24 scores: detection 91% (22), identification 52% (25), and memory 35% (20). QVOLF and svQOD-NS showed a strong correlation (ρ = 0.797; p < 0.001), while SNOT-22 correlated moderately with both. No significant correlations were found between any questionnaire and BAST-24. Conclusions QVOLF and svQOD-NS questionnaires are more sensitive than SNOT-22 for assessing olfactory dysfunction. The lack of correlation with psychophysical tests highlights the need to combine both approaches for a comprehensive evaluation.
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    A direct auditory subcortical route to the amygdala associated with fear in humans
    (The Society for Neuroscience, 2026-04-15) Kosteletou-Kassotaki, Emmanouela; Cinca-Tomás, Martina T.; Varriano, Federico; Soria, Guadalupe; Prats Galino, Alberto; Domínguez-Borràs, Judith
    Rapid and efficient fear processing is essential for survival. In vision, this function is supported by a well-characterized subcortical pathway consisting of direct projections from the pulvinar of the thalamus to the amygdala in the human brain. In contrast, the existence of an analogous shortcut for fear in audition has been demonstrated in nonhuman animals but remains unconfirmed in humans. To address this question, we used probabilistic streamline tractography and fixel-based analysis on diffusion-weighted images from Human Connectome Project participants of either sex to reconstruct candidate auditory subcortical pathways and examine their associations with affective and auditory behavioral measures. Our findings revealed a robust white matter tract connecting the inferior colliculus to basolateral amygdala via the medial geniculate body (MGB) of the thalamus. Remarkably, higher fiber density in this tract was associated with better hearing ability in noise and increased self-reported fearfulness, supporting its role in auditory and affective function. Conversely, a control analysis of the core thalamocortical pathway from ventral MGB to primary auditory cortex, representing the main route for auditory processing, was associated with auditory ability but not with affective measures. These findings provide previously unreported evidence for an auditory colliculo-geniculo-amygdala "low road" in humans, aligning with evolutionarily conserved pathways for fear described in nonhuman species.