Articles publicats en revistes (Cirurgia i Especialitats Medicoquirúrgiques)

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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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Towards a point of care approach for intra-amniotic infection or early delivery using minimally invasive prediction models in women with preterm labor.
(Elsevier Inc., 2026-03-27) Cobo, Teresa; Boada, David; Burgos Artizzu, Xavier P. ; Goya, María; Vergara Gómez, Andrea; Kacerovsky, Marian; Ferrero Martinez, Sílvia ; Filella Pla, Xavier; Sellarés, Anna; González, Bernardino; Mouriz, Natalia; Mohedano, Noah; Ampurdanes, Queralt; Roldán, Eva; Barco, Ester del; Murillo Bravo, Clara; Hidalgo, Judit; Garbí, Sandra; Musilova, Ivana; Fabregat Bolufer, Aleix B. ; Palacio, Montse; Gratacós Solsona, Eduard
Among women with preterm labor and intact membranes, those with intra-amniotic infection or inflammation represent the highest risk group of spontaneous delivery and worse adverse outcome. Identification of this group requires amniocentesis, which is perceived as too invasive by both patients and physicians. This study aimed to develop a minimally invasive prediction model for intra-amniotic infection or early delivery, thereby better stratifying patients (low or high-risk) and rationalizing the use of amniocentesis limiting the indications to the highest-risk group of spontaneous preterm delivery. We performed external validation of 4 prediction models using data from 2022-2024 of women diagnosed with preterm labor below 34 weeks admitted to the Hospital Clinic, Hospital Sant Joan de Déu, and the Hospital Vall Hebron in Barcelona (Spain), and the Hradec Kralove University Hospital, in Kradec Kralove (Czech Republic), who underwent amniocentesis to rule in/out intra-amniotic infection or inflammation. Different prediction models, including ultrasound (US) transvaginal cervical length, serum C-reactive protein (CRP), vaginal IL-6, vaginal pH, vaginal lactic acid, and vaginal Lactobacillus genus, were validated in these patients. Diagnostic performance was done in 114 women with PTL below 34 weeks, 42 (36.8%) of whom had intra-amniotic infection or spontaneous delivery within 7 days. The areas under the curve (AUC) of the different models ranged from ranging from 84 (95% confidence interval (CI) 78.8-89.2%) to 89.9% (88.4-91.4%), sensitivities ranging from 78.6 (33/42) to 90.5% (38/42). and specificities from 70.8% (51/72) to 84.7% (61/72). The most feasible and efficient model was formed by combining US cervical length, serum CRP and vaginal IL-6, showing an AUC of 84% with a sensitivity of 78.6% (33/42), specificity of 84.7% (61/72), positive predictive value of 75% (33/44), and negative predictive value of 87.1% (61/70). We developed minimally invasive models to screen women at high risk of intra-amniotic infection or early delivery and guide the selective use of amniocentesis, thereby improving both antenatal counseling and the clinical management of high-risk patients.
Lymphocyte exhaustion in hepatocellular carcinoma: a dynamic evolution across disease stages
(Frontiers Media, 2025-06-06) Fuster, Carla; Corominas, Josep; Marsal García, Aida; Llarch, Neus; Iserte, Gemma; Sanduzzi Zamparelli, Marco; Forner González, Alejandro; Ferrer Fàbrega, Joana; Holguin Arce, Víctor Emilio; Morales, Albert; Saavedra Morales, Anny Carolina; Reig, María; Boix i Ferrero, Loreto; Marí, Montserrat; Diaz Lorca, Maria Alba
Background: Immune checkpoint inhibitors (ICIs) have transformed cancer therapy. However, their efficacy in hepatocellular carcinoma (HCC) is limited, highlighting the need to further explore immune microenvironments and novel biomarkers. This study examined lymphocyte populations and immune checkpoint dynamics in early, advanced, and post-progression HCC to better understand immune dynamics in HCC and to help identify predictive biomarkers and immune modulation strategies.Methods: Tumoral and non-tumoral liver tissues were analyzed from HCC patients across early (n=25), advanced (n=22), and advanced-beyond-progression (n=15) stages. Lymphocyte profiling was performed using immunohistochemistry and flow cytometry, focusing on NK cells, T cells, and immune exhaustion markers. An exploratory analysis of this profile and its association with disease progression and recurrence was conducted.Results: Early HCC exhibited higher liver-resident NK (lrNK) cell densities in non-tumor regions, which diminished with advanced stages. Increased CD56+ cell infiltration in the tumor core was associated with recurrence. Tumor region showed elevated PD-1, NKG2A, and CD39 expression in CD4+ and CD8+ T cells, indicating progressive immune exhaustion. Advanced HCC stages demonstrated altered NK cell phenotypes, with reduced cytotoxic activation (CD16) and increased residency markers (CXCR6/CD69) in tumor-isolated lymphocytes.Conclusions: Progressive immune exhaustion and dysregulation of lrNK and T cells in HCC reflect the evolution of the immune microenvironment originating in the tumor and leaking into the non-tumoral liver, progressively diminishing the cytotoxic capacity of NK and T cells. CD56+ cell density and immune checkpoint profiles are potential biomarkers for therapeutic response and disease monitoring, underscoring the need for personalized immunotherapy strategies.
Intraoperative Nerve Action Potential Amplitude and Functional Recovery After Selective Ulnar-to-Musculocutaneous Nerve Transfer (Oberlin Technique)
(MDPI, 2026-04-01) Ortega Hernández, Diana Marcela; Casado Rodríguez, Aroa; Fernández-Conejero, Isabel; Tarnawski Español, Guillermo José; Miró, Júlia; Casañas Sintes, Joaquin; Llusá Pérez, Manuel
Background: Predicting functional recovery after selective nerve transfer remains challenging. Intraoperative nerve action potential (NAP) recording is widely used to confirm axonal continuity in peripheral nerve surgery; however, its quantitative prognostic value in selective nerve transfer has not been clearly established. This study evaluated whether intraoperative donor fascicle NAP amplitude predicts functional recovery following selective ulnar-to-musculocutaneous nerve transfer (Oberlin procedure) for restoration of elbow flexion. Methods: This retrospective exploratory observational study included 20 patients who underwent selective ulnar-to-musculocutaneous nerve transfer (Oberlin procedure) with standardized intraoperative neurophysiological mapping and quantitative donor fascicle NAP recording. Functional outcome specific to elbow flexion was assessed at last follow-up using the Medical Research Council (MRC) grading system. Time to first electromyographic evidence of biceps reinnervation was recorded. Associations between intraoperative NAP amplitude and functional, temporal, and clinical variables were analyzed using Spearman’s rank correlation coefficient and non-parametric tests. Results: Donor NAP amplitude demonstrated substantial interindividual variability (range 60–400 µV; median 137.5 µV, IQR 87.5–200 µV). No significant associations were observed between NAP amplitude and final MRC grade (ρ = −0.103; p = 0.666), time to electromyographic reinnervation (days: ρ = −0.123; p = 0.617), patient age, or time from injury to surgery. A moderate negative correlation between NAP amplitude and lesion severity was observed but did not reach statistical significance in this small cohort (ρ = −0.419; p = 0.0659). In contrast, shorter time to electromyographic reinnervation was significantly associated with improved final functional outcome (ρ = −0.559; p = 0.013). No patient reported postoperative hand weakness. Conclusions: In this exploratory cohort, intraoperative donor NAP amplitude was not associated with time to electromyographic reinnervation or final elbow flexion strength following selective ulnar-to-musculocutaneous nerve transfer. Although intraoperative NAP mapping remains essential to confirm axonal continuity and conduction viability of the donor fascicle, NAP amplitude did not demonstrate prognostic value in this cohort and should be interpreted cautiously as an isolated predictor of functional recovery, particularly given the limited sample size and exploratory design. These findings suggest that recovery after selective nerve transfer may be influenced by broader biological determinants, including regenerative timing, rather than by isolated intraoperative amplitude metrics.
Intraoperative FCU CMAP Amplitude During Oberlin Nerve Transfer: Association with Reinnervation Timing and Functional Outcomes
(MDPI, 2026-04-01) Ortega Hernández, Diana Marcela; Fernández-Conejero, Isabel; Casado Rodríguez, Aroa; Tarnawski Español, Guillermo José; Miró, Júlia; Casañas Sintes, Joaquin; Llusá Pérez, Manuel
Background/Objectives: Selective transfer of an ulnar nerve fascicle to the motor branch of the musculocutaneous nerve (Oberlin technique) is widely used to restore elbow flexion following upper brachial plexus injury. Intraoperative neurophysiological mapping allows quantitative recording of compound muscle action potentials (CMAPs) during donor fascicle selection; however, its prognostic relevance remains unclear. This study evaluated whether intraoperative flexor carpi ulnaris (FCU) CMAP amplitude is associated with time to electromyographic reinnervation of the biceps brachii and with final functional outcomes. Methods: A retrospective observational study was conducted including patients who underwent selective nerve transfer to the biceps brachii between 2006 and 2025 at two tertiary referral centers. Donor fascicles were selected using intraoperative neurophysiological mapping with quantitative CMAP recordings from three ulnar-innervated muscles. Primary outcomes were time to electromyographic evidence of reinnervation and final elbow flexion strength assessed using the British Medical Research Council grading system. Associations were analyzed using nonparametric statistical methods. Results: Twenty patients met the inclusion criteria. Higher intraoperative FCU CMAP amplitudes were associated with a shorter time to electromyographic reinnervation (Spearman ρ = −0.572, p = 0.0106). No association was observed between CMAP amplitude and final elbow flexion strength (Spearman ρ = −0.168, p = 0.479), or between time to reinnervation and final functional outcome (Spearman ρ = −0.276, p = 0.253). A positive association was found between the injury-to-surgery interval and intraoperative CMAP amplitude (Spearman ρ = 0.681, p = 0.000943). Conclusions: The intraoperative FCU CMAP amplitude facilitates objective donor fascicle selection and is associated with earlier electromyographic reinnervation. Nevertheless, it was not associated with final elbow flexion strength in this cohort and should be interpreted as a technical adjunct rather than a standalone prognostic indicator. Functional recovery following nerve transfer appears to reflect multifactorial biological and temporal determinants beyond a single intraoperative neurophysiological measurement. These findings should be interpreted cautiously given the limited sample size.
Diminished anticipatory pleasure predicts anhedonia in women with endometrisois: a case-control study
(BioMed Central, 2026-03-19) Mallorquí, Aida; Segura, Emma; Magí, Cristina; Quintas Marquès, Lara; Gracia, Meritxell; Courbiere, Blandine; Carmona Herrera, Francisco; Martínez Zamora, María Ángeles
Anhedonia, a diminished response to pleasurable stimuli extensively studied in mental disorders and chronic pain, has been reported as prevalent among patients with deep endometriosis. Anhedonia is considered a multifaceted transdiagnostic construct involving cognitive, affective, and behavioral processes related to the anticipation and experience of pleasure. In this study, we aim to expand on previous findings by exploring the presence of anhedonia in patients with ultrasound diagnosed (UD) endometriosis compared to a control group, and by examining how its anticipatory and consummatory components contribute to the loss of pleasure in this condition.
Nanomotor-Assisted Intravesical Chemotherapy for Bladder Tumor Reduction and Suppression of Early Tumor Regrowth
(American Chemical Society, 2026-05-06) Vilaseca, Antoni; Llop Talaverón, Josep Manuel; Sánchez-López, Sònia; Fichna, Kristin; Crespo Cuadrado, Maria; Konuparamban, Acsah; Di Carlo, Valerio; Esporrín Ubieto, David; Macías Tarrío, Irene; Jutglar Soler, Oriol; Chen, Shuqin; Gómez Martínez, María; Bakenecker, Anna C.
Nanoparticles are widely used in nanomedicine for controlled drug delivery and improved bioavailability. However, their effectiveness is often limited by passive diffusion, especially in confined, fluid-filled environments like the bladder, where rapid drug clearance and uneven distribution reduce therapeutic impact. These challenges contribute to high recurrence in bladder cancer despite intravesical chemotherapy. To address this limitation, we present urease-powered nanomotors (NM) based on mesoporous silica nanoparticles loaded with Mitomycin C (MMC), the standard chemotherapeutic for nonmuscleinvasive bladder cancer. These NM useurea present in urine to induce motion and drug dispersion. In vitro, NM showed 2.3-fold higher uptake in mouse bladder cancer cells than passive nanoparticles and achieved the efficacy of free MMC (577.5 μg/mL) at a 20-fold lower dose (30 μg/mL). In vivo, a single intravesical dose reduced tumor volumes by 83% and prevented early tumor regrowth, demonstrating the potential of NM-based delivery for bladder cancer therapy.

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