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ObjetiveTo analyze the effects of the implementation of an ERAS program in patients undergoing pulmonary resection in a tertiary university hospital on the rates of complications and readmission and the length of stay.Methodsambispective cohort study, with a prospective arm of patients undergoing thoracic surgery within an ERAS program versus a retrospective arm of patients before the implementation of the protocol. We recluited 50 patients per arm. The primary outcome was the number of patients with 30-day surgical complications. Secondary outcome included ERAS adherence, no-surgical complications, mortality, readmission, reintervention rates, pain and hospital lenght of stay. We performed a multivariate logistic analysis to study the association of coutcomes with ERAS adherence.ResultsWe found no difference between the two groups in surgical complications [Standard 18 (36%) vs 12 (24%], p =0.19]. ERAS group was significantly lower only in its readmission rate [Standard 15 (30%) vs 6 (12%], p =0.03]. In multivariate analyses, ERAS adherence was the only factor associated with a reduction in surgical complications [OR (95%CI) = 0.02 (0.00, 0.59), p = 0.03] and length of stay [HR (95%CI) = 18.5 (4.39, 78.4), p < 0.001].ConclusionsERAS program was able to decrease the readmission rate at our centre significantly. The adherence to the ERAS protocol influenced the reduction of surgical complications and length of stay.

Appendiceal neoplasms; Carcinoid tumor; Treatment outcome Neoplasias apendiculares; Tumor carcinoide; Resultado del tratamiento Neoplàsies apendiculars; Tumor carcinoide; Resultat del tractament Appendiceal neuroendocrine tumors (aNETs) are an uncommon neoplasm that is relatively indolent in most cases. They are typically diagnosed in younger patients than other neuroendocrine tumors and are often an incidental finding after an appendectomy. Although there are numerous clinical practice guidelines on management of aNETs, there is continues to be a dearth of evidence on optimal treatment. Management of these tumors is stratified according to risk of locoregional and distant metastasis. However, there is a lack of consensus regarding tumors that measure 1-2 cm. In these cases, some histopathological features such as size, tumor grade, presence of lymphovascular invasion, or mesoappendix infiltration must also be considered. Computed tomography or magnetic resonance imaging scans are recommended for evaluating the presence of additional disease, except in the case of tumors smaller than 1 cm without additional risk factors. Somatostatin receptor scintigraphy or positron emission tomography with computed tomography should be considered in cases with suspected residual or distant disease. The main point of controversy is the indication for performing a completion right hemicolectomy after an initial appendectomy, based on the risk of lymph node metastases. The main factor considered is tumor size and 2 cm is the most common threshold for indicating a colectomy. Other factors such as mesoappendix infiltration, lymphovascular invasion, or tumor grade may also be considered. On the other hand, potential complications, and decreased quality of life after a hemicolectomy as well as the lack of evidence on benefits in terms of survival must be taken into consideration. In this review, we present data regarding the current indications, outcomes, and benefits of a colectomy.

Purpose: (a) To measure the change in cognition, the improvement of speech perception, and the subjective benefit in people under and over 60 years following cochlear implantation. (b) To assess the relationship between cognition, demographic, audiometric, and subjective outcomes in both age groups. Methods: 28 cochlear implant (CI) users were assigned to the < 60y group and 35 to the ≥ 60y group. Cognition was measured using the Repeatable Battery for the Assessment of Neuropsychological Status for Hearing impaired individuals (RBANS-H); subjective benefit was measured using the Nijmegen Cochlear Implant Questionnaire (NCIQ); the Glasgow Benefit Inventory (GBI); the Hearing Implant Sound Quality Index (HISQUI19); Speech, Spatial and Qualities of Hearing Scale (SSQ12); and the Hospital Anxiety and Depression Scale (HADS). Results: Prior to surgery: the RBANS-H total score positively correlated with the domains “Advanced sound”, “Self-esteem”, and “Social functioning” of NCIQ, and negatively with HADS scores. 12 months post-implantation: the RBANS-H total score increased in the < 60y (p = 0.038) and in the ≥ 60y group (p < 0.001); speech perception and subjective outcomes also improved; RBANS-H total score positively correlated with “Self-esteem” domain in NCIQ. Age and the RBANS-H total score correlated negatively in the ≥ 60y group (p = 0.026). Conclusions: After implantation, both age groups demonstrated improved cognition, speech perception and quality of life. Their depression scores decreased. Age was inversely associated with cognition., This work was supported by a grant (PI16/00079) from Programa Estatal de Generación de Conocimiento y Fortalecimiento del Sistema Español de I+D+I, ISCiii, Spain. The authors would like to thank the subjects for their participation, and Angelina Gurkina for their medical writer assistance

To systematically review the evidence about the effect of neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) with pure urothelial carcinoma (pUC) in radical cystectomy (RC) candidates affected by variant histology (VH) bladder cancer. Methods: A review of the current literature was conducted through the Medline and National Center for Biotechnology Information (NCBI) PubMed, Scopus databases in May 2020. The updated Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for this systematic review. Keywords used were ‘bladder cancer’, ‘bladder carcinoma’, ‘bladder tumour’ and ‘bladder cancer variants’ and ‘neoadjuvant chemotherapy’. Only original articles in English published after 2000 and reporting oncological outcomes a series of more than five patients with VH were included. We excluded series in which the oncological outcomes of patients with pUC and VH were undistinguishable. The literature search identified 2231 articles. A total of 51 full-text articles were assessed for eligibility, with 17 eventually considered for systematic review, for a cohort of 450,367 patients, of which 5010 underwent NAC + RC. The median age at initial diagnosis ranged from 61 to 71 years. Most patients received cisplatin-gemcitabine, methotrexate-vinblastine-adriamycin-cisplatin, or carboplatin-based chemotherapy. Only one study reported results of neoadjuvant immunotherapy. The median follow-up ranged from 1 to 120 months. The results showed that squamous cell carcinoma (SCC) is less sensitive to NAC than pUC and that SCC predicts poorer prognosis. NAC was found to be a valid approach in treating small cell carcinoma and may have potential benefit in micropapillary carcinoma. Conclusions: NAC showed the best oncological outcomes in small cell variants and micropapillary carcinoma, while NAC survival benefit for SCC and adenocarcinoma variants needs further studies. Drawing definite considerations on the efficacy of NAC in VH is complicated due to the heterogeneity of present literature. Present results need to be confirmed in randomised controlled trials

Tesis Doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Cirugía. Fecha de Lectura: 31-01-2023

Purpose: Malnutrition is a common problem among pancreatic cancer (PC) patients that negatively impacts on their quality of life (QoL) and clinical outcomes. The main objective of this consensus is to address the role of Medical Nutrition Therapy (MNT) into the comprehensive therapeutic management of PC patients. Methods: A Spanish multidisciplinary group of specialists from the areas of Medical Oncology; Radiation Oncology; Endocrinology and Nutrition; and General Surgery agreed to assess the role of MNT as part of the best therapeutic management of PC patients. Results: The panel established different recommendations focused on nutritional screening and nutritional screening tools, MNT strategies according to PC status, and MNT in palliative treatment. Conclusions: There is an unmet need to integrate nutritional therapy as a crucial part of the multimodal care process in PC patients. Health authorities, health care professionals, cancer patients, and their families should be aware of the relevance of nutritional status and MNT on clinical outcomes and QoL of PC patients, Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. Logistics of the meetings and the assistance with the medical writing have been provided by unrestricted Grant from Baxter Laboratories

Tesis Doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Cirugía. Fecha de Lectura: 18-10-2022

Tesis Doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Cirugía. Fecha de Lectura: 04-10-2022, Para determinar el valor pronóstico del volumen metabólico tumoral (MTV) y de la glicólisis total de la lesión (TLG) en el cáncer epidermoide localmente avanzado de cabeza y cuello (CCyC), hemos realizado un estudio dividido en tres fases. En primer lugar, hemos realizado una revisión sistemática de los artículos publicados entre el 1 de enero del 2013 y el 31 de diciembre del 2018 estudiando la asociación entre el MTV y el TLG en la supervivencia en el CCyC. Con los resultados de la revisión, realizamos un metaanálisis incluyendo un total de 1.512 casos, donde hemos encontrado una relación estadísticamente significativa e independiente entre estas variables y la supervivencia. En segundo lugar, determinamos la asociación entre el MTV y el TLG con la supervivencia de 62 pacientes con cáncer epidermoide localmente avanzado de cabeza y cuello tratados con protocolos de radioterapia con intención radical en el Hospital Universitario Puerta de Hierro, Majadahonda, España. Hemos encontrado una asociación estadísticamente significativa e independiente entre estas variables metabólicas y la supervivencia de nuestros pacientes. En tercer lugar, y para determinar una manera práctica de utilizar el potencial predictivo del MTV y el TLG, realizamos diversos estudios comparativos. Hemos comparado dos métodos de medición relevantes, determinando que, en nuestra población, el método de umbral basado en el hígado como zona de referencia selecciona mejor a los pacientes con riesgo de recidiva y muerte comparado con el método de umbral absoluto. Asimismo, las mediciones del TLG han tenido mejor capacidad pronóstica que el MTV en la mayoría de los modelos. Además, observamos que adicionar la medición del metabolismo de las adenopatías afectadas a la de la tumoración primaria mejora la capacidad pronóstica de estas variables. En conclusión, los resultados de este estudio sugieren que el MTV y el TLG funcionan como buenos factores pronósticos en los pacientes con cáncer epidermoide localmente avanzado de cabeza y cuello, ya que valores elevados predicen una peor supervivencia. A pesar de sus limitaciones, estas variables ofrecen información valiosa pretratamiento que puede ayudar a seleccionar a los pacientes que se beneficiarían de un seguimiento más estrecho, con potenciales aplicaciones en la selección y modificación de los protocolos de tratamiento actuales

Tesis Doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Cirugía. Fecha de Lectura: 29-09-2022, La cesárea ha sido asociada a un síndrome doloroso crónico postoperatorio denominado dolor crónico postcesárea (DCPC). La incidencia del DCPC oscila entre el 6 y el 18% en los diferentes estudios. El objetivo principal de este estudio fue describir la incidencia de DCPC en el Hospital Universitario La Paz, así como describir sus características e identificar factores de riesgo demográficos, quirúrgicos y/o anestésicos. Realizamos un estudio prospectivo descriptivo observacional mono-céntrico con pacientes intervenidas de cesárea urgente o programada en la maternidad del Hospital Universitario La Paz. Se reclutaron un total de 597 pacientes desde mayo de 2017 hasta septiembre de 2018. La información demográfica fue obtenida a través de la historia clínica y una entrevista personal. Los datos quirúrgicos y anestésicos fueron recogidos durante la cesárea directamente por el investigador. La información sobre el dolor y la analgesia postoperatoria se obtuvo al alta de la unidad de reanimación, a las 24 horas, a la semana, a los 3 y a los 12 meses de la cirugía a través del cuestionario de dolor neuropático de 2 items (DN2), la escala numérica del dolor (NRS) y el cuestionario BPI (Brief Pain Inventory). Nuestra incidencia de DCPC fue del 6,2 % a los tres meses y del 1% a los 12 meses. A las 24 horas postoperatorias, la intensidad del dolor aumentó considerablemente con respecto al alta de Reanimación. Una semana después de la intervención un número importante de pacientes de nuestra cohorte refirió dolor al movimiento de intensidad significativa, con un NRS> 5. Este porcentaje disminuyó drásticamente a los 3 meses comparado con el periodo postoperatorio precoz. Tanto a los 3 como a los 12 meses después de la cesárea, todas las pacientes sólo consumían analgésicos de primer escalón de la Organización Mundial de la Salud. Todas las pacientes que cumplieron criterios de DCPC a los 3 meses después de la cirugía, declararon que el dolor tenía una influencia negativa en las actividades de su vida diaria. Un año después, el dolor no tuvo repercusión en la puntuación obtenida en el Cuestionario BPI (Brief Pain Inventory). Se identificaron como factores de riesgo de DCPC a los 3 meses: una puntuación de dolor en movimiento mayor de 5/10 en la escala NRS (OR [95% CI]: 2,38 [1,233; 4,644]) una semana después de la cesárea y una puntuación de DN2 igual o mayor de 3 (OR [95% CI]: 3,586 [1,624; 8,048]) una semana después de la cesárea. La exteriorización uterina (OR [95% CI]: 2,969 [1,176; 7,791]) y la menor edad gestacional (DCPC: 36,9+3,4 semanas; no DCPC: 38,1+2,6 semanas; p=0,008) destacaron como factores de riesgo pre- e intra-operatorio de DCPC. El DN2 >3, la exteriorización uterina y la edad gestacional fueron identificados como factores de riesgo independientes de DCPC en análisis multivariado

Purpose: This paper aimed to present daily-practice recommendations for the management of diabetic macular edema (DME) patients based on available scientific evidence and the clinical experience of the consensus panel. Methods: A group of Spanish retina experts agreed to discuss different aspects related with the clinical management of DME patients. Results: Panel was mainly focused on therapeutic objectives in DME management; definition terms; and role of biomarkers as prognostic and predictive factors to intravitreal treatment response. The panel recommends to start DME treatment as soon as possible in those eyes with a visual acuity less than 20/25 (always according to the retina unit capacity). Naïve patient was defined, in a strict manner, as a patient who, up to that moment, had never received any treatment. A refractory DME patient may be defined as the one who did not achieve a complete resolution of the disease, regardless of the treatment administered. Different optical coherence tomography biomarkers, such as disorganization of the retinal inner layers, hyperreflective dots, and cysts, have been identified as prognostic factors. Conclusion: This document has sought to lay down a set of recommendations and to identify key issues that may be useful for the daily management of DME patients., Logistic for writing services has been provided by Allergan, an AbbVie company. Allergan did not participate in either data analysis or redaction of the manuscript.

Despite different criteria to diagnose a prosthetic joint infection (PJI), aetiological diagnosis of the causing microorganism remains essential to guide treatment. Molecular-biology-based PJI diagnosis is progressing (faster, higher specificity) in different techniques, from the experimental laboratory into clinical use. Multiplex polymerase chain reaction techniques (custom-made or commercial) provide satisfactory results in clinical series of cases, with specificity close to 100% and sensitivity over 70–80%. Next-generation metagenomics may increase sensitivity while maintaining high specificity. Molecular biology techniques may represent, in the next five years, a significant transformation of the currently available microbiological diagnosis in PJI. Cite this article: EFORT Open Rev 2021;6:93-100. DOI: 10.1302/2058-5241.6.200118

Tesis Doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Cirugía. Fecha de Lectura: 27-06-2022, Introducción: La litiasis urinaria sigue siendo una patología con gran interés en la actualidad. A pesar de la evolución de los litotriptores la Litotricia Extracorpórea por Ondas de Choque requiere de un buen control del dolor. Objetivos Comparar la eficacia de 4 diferentes pautas analgésicas que incorporan la música y el óxido nitroso durante el tratamiento de la litiasis renal mediante litotricia extracorpórea por ondas de choque (LEOC) ambulatoria Material y métodos Se realizó un estudio unicéntrico, longitudinal, prospectivo, aleatorizado, abierto y de grupos paralelos. Se incluyeron pacientes con litiasis renal, y fueron aleatorizados a: Grupo A (analgesia basal: midazolam (1mg), fentanilo (0,05mg) y dexketoprofeno (50mg)), Grupo B (analgesia basal y óxido nitroso), Grupo C (analgesia basal y música) y Grupo D (analgesia basal, óxido nitroso y música). Para la medición del dolor se utilizó una Escala Visual Analógica desde 0 (no dolor) hasta 100 (máximo dolor imaginable). El grado de satisfacción del paciente se valoró mediante cuestionario tipo Likert. Se registraron datos epidemiológicos de los pacientes, relacionados con la litiasis, clínicos previos y de la sesión de LEOC, dolor medido mediante EVA antes de la sesión, durante la sesión (el máximo), al finalizar y al alta. También se recogieron datos de eficacia y complicaciones, asi como evaluación subjetiva del paciente del tratamiento y su satisfacción. El procedimiento de LEOC se realizó con un Litotriptor Storz Modulith SLX-F2®. Se aplicaron un máximo de 4000 ondas a una frecuencia de 1,5 Hz. Resultados Se incluyeron 80 pacientes (20 por grupo). Ninguna de las pautas de analgesia demostró ser superior a las demás para el control del dolor durante la sesión de LEOC. Los pacientes menores de 50 años presentaron valores en la EVA significativamente superiores en la EVA máxima. Solo un 13,75% de los pacientes requirieron analgesia de rescate. Un 77,5% describieron su experiencia como buena, muy buena o excelente, independientemente del grupo asignado. Conclusiones La adición de óxido nitroso y/o música no supuso una mejora estadísticamente significativa respecto a la pauta basal analgésica de midazolam, fentanilo y dexketoprofeno, sin embargo, el grado de satisfacción de los pacientes fue muy alto

Tesis Doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Cirugía. Fecha de Lectura: 16-06-2022

Tesis Doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Cirugía. Fecha de Lectura: 10-06-2022

Tesis Doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Cirugía. Fecha de Lectura: 24-05-2022

Coronavirus disease 19 (COVID-19) patients usually require long periods of mechanical ventilation and sedation, which added to steroid therapy, favours a predisposition to the development of delirium and subsequent mental health disorders, as well as physical and respiratory sequelae. The aim of this study was to determine the prevalence of post-intensive care syndrome (PICS) at 3 months after hospital discharge, in a cohort of mechanically ventilated patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). An ambispective, observational study was conducted in three hospitals with intensive care unit (ICU) follow-up clinics. We studied adults who survived a critical illness due to SARS-CoV-2 infection requiring invasive mechanical ventilation. A physical (muscle strength and pulmonary function), functional [12-Item Short Form Health Survey (SF-12), and Barthel score], psychological [hospital anxiety and depression (HADS) and posttraumatic stress disorder symptom severity scales], and cognitive [Montreal cognitive assessment (MoCA) test] assessment were performed. A total of 186 patients were evaluated at 88 days (IQR 68–121) after hospital discharge. Mean age was 59 ± 12 years old, 126 (68%) patients were men, and median length of mechanical ventilation was 14 days (IQR 8–31). About 3 out of 4 patients (n = 139, 75%) met PICS criteria. Symptoms of cognitive and psychiatric disorders were found in 59 (32%) and 58 (31%) patients, respectively. Ninety-one (49%) patients had muscle weakness. Pulmonary function tests in patients with no respiratory comorbidities showed a normal pattern in 93 (50%) patients, and a restrictive disorder in 62 (33%) patients. Also, 69 patients (37%) were on sick leave, while 32 (17%) had resumed work at the time of assessment. In conclusion, survivors of critical illness due to SARS-CoV-2 infection requiring mechanical ventilation have a high prevalence of PICS. Physical domain is the most frequently damaged, followed by cognitive and psychiatric disorders. ICU follow-up clinics enable the assistance of this vulnerable population, This study did not receive any funding or fnancial support. JMA and JV are funded by Grants from the Instituto de Salud Carlos III, Spain (CB06/06/1088, PI19/00141).

Tesis Doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Cirugía. Fecha de Lectura: 06-05-2022, El tejido adiposo se ha revelado como la fuente ideal de MSC. Sin embargo, al desarrollar ASC para uso clínico, es importante considerar los efectos de los diferentes depósitos de grasa y también el efecto de la variabilidad del donante. El objetivo de este estudio es comparar dos orígenes de células madre mesenquimales derivadas de tejido adiposo (epiplón y subcutáneo) de dos patologías (obesidad mórbida y cáncer) versus donantes sanos

Artículo con numerosos autores, sólo se recogen el primero y los pertenecientes a la UAM, Background and study aim: Advanced therapy medicinal products (ATMP) frequently lack of clinical data on efficacy to substantiate a future clinical use. This study aims to evaluate the efficacy to heal long bone delayed unions and non-unions, as secondary objective of the EudraCT 2011-005441-13 clinical trial, through clinical and radiological bone consolidation at 3, 6 and 12 months of follow-up, with subgroup analysis of affected bone, gender, tobacco use, and time since the original fracture. Patients and methods: Twenty-eight patients were recruited and surgically treated with autologous bone marrow derived mesenchymal stromal cells expanded under Good Manufacturing Practices, combined to bioceramics in the surgical room before implantation. Mean age was 39 ±13 years, 57% were males, and mean Body Mass Index 27 ±7. Thirteen (46%) were active smokers. There were 11 femoral, 4 humeral, and 13 tibial non-unions. Initial fracture occurred at a mean ±SD of 27.9 ±31.2 months before recruit- ment. Efficacy results were expressed by clinical consolidation (no or mild pain if values under 30 in VAS scale), and by radiological consolidation with a REBORNE score over 11/16 points (value of or above 0.6875). Means were statistically compared and mixed models for repeated measurements estimated the mean and confidence intervals (95%) of the REBORNE Bone Healing scale. Clinical and radiological con- solidation were analyzed in the subgroups with Spearman correlation tests (adjusted by Bonferroni). Results: Clinical consolidation was earlier confirmed, while radiological consolidation at 3 months was 25.0% (7/28 cases), at 6 months 67.8% (19/28 cases), and at 12 months, 92.8% (26/28 cases including the drop-out extrapolation of two failures). Bone biopsies confirmed bone formation surrounding the bioce- ramic granules. All locations showed similar consolidation, although this was delayed in tibial non-unions. No significant gender difference was found in 12-month consolidation (95% confidence). Higher consoli- dation scale values were seen in non-smoking patients at 6 ( p = 0.012, t -test) and 12 months ( p = 0.011, t -test). Longer time elapsed after the initial fracture did not preclude the occurrence of consolidation. Conclusion: Bone consolidation was efficaciously obtained with the studied expanded hBM-MSCs com- bined to biomaterials, by clinical and radiological evaluation, and confirmed by bone biopsies, with lower consolidation scores in smokers, This research received funding from the European Union’s Sev- enth Framework Programme ( FP7/FP7-HEALTH-2009 ) with the RE- BORNE Project (under G.A. 241876), and the European Union’s Horizon 2020 Programme ( H2020-SC1 2016-2017 ), with the OR- THOUNION Project (under G.A. 7333288)

La patología de la aorta supone un reto para la medicina. Tanto a nivel diagnóstico, como terapéutico,el volumen de variables implicado ha hecho que dicha patología sea abordada por una ingente cantidad de especialistas. El manejo quirúrgico de dichas patologías implica un esfuerzo extraordinario por parte de muchos profesionales, dada la complejidad técnica y tecnológica empleada. A lo largo de estos a˜nos,dichos esfuerzos están dando sus frutos en forma de mejoras de resultados, gracias a un abordaje sis-temático y protocolizado en el seno de un grupo de expertos (Comités de aorta o “Aortic team”) en el que se han de implicar cardiólogos, cirujanos cardíacos, cirujanos vasculares, anestesiólogos y radiólogos, principalmente. En este documento, consensuado entre los grupos de trabajo de Aorta de las sociedades españolas de Anestesiología (SEDAR) y Cirugía Torácica-cardiovascular (SECTCV) se busca difundir los modos de trabajo más consensuados entre los centros de mayor actividad del país por parte de ambas especialidades, en lo que al tratamiento quirúrgico se refiere de la patología de aorta ascendente y arco aórtico se refiere, así como del tratamiento de la disección aguda de aorta. Somos conscientes de la evolución constante de la terapéutica, lo cual sin duda puede hacer cuestionables algunas opiniones aquí expresadas y que sin duda irán modificándose en futuras ediciones, tThe pathology of the aorta is a challenge for medicine. Diagnostic and therapeutica move a huge volumeof variables. This has let this pathology to be addressed by a big number of specialists. The surgicalmanagement of these pathologies implies an extraordinary effort on the part of many professionals,given the technical and technological complexity employed. Throughout these years, these efforts arepaying off in the form of improved results, thanks to a systematic and protocolized approach within agroup of experts (Aortic Committees or “Aortic team”) in which they have to involve cardiologists, cardiacsurgeons, vascular surgeons, anesthesiologists and radiologists, mainly.In this document, agreed between the Aorta working groups of the Spanish societies of Anesthesiology(SEDAR) and Thoracic-Cardiovascular Surgery (SECCE), it is sought to disseminate the most agreed work-ing modes among the centers of greatest activity in the country by both specialties, as far as surgicaltreatment is concerned with ascending aortic and aortic arch pathology, as well as the treatment of acuteaortic dissection.We are aware of the constant evolution of therapeutics, which can undoubtedly make some of the opinionsexpressed here questionable and that will undoubtedly be modified in future editions.This document aims to be a working tool for the different professionals involved in the treatment of aorticpathology.

Tesis Doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Cirugía. Fecha de Lectura: 08-04-2022

Tesis Doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Cirugía. Fecha de Lectura: 06-04-2022

Tesis Doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Cirugía. Fecha de Lectura: 25-03-2022

The role of HCV on the HIV reservoir is controversial since the reduction on HIV-DNA levels after HCV eradication with IFNα/RBV treatment seems to be the result of drugs instead of HCV clearance. We assessed whether HCV eradication can decrease HIV-DNA content in HIV/HCV-coinfected patients treated with direct-acting antivirals, DAAs (IFNα/RBV-free regimens). Cell-associated HIV-DNA was measured by ddPCR in 25 HIV-monoinfected and 25 HIV/HCV-coinfected patients. There were no differences in HIV-DNA levels between groups neither at baseline nor at 12 weeks after DAAs treatment completion. Our results indicate that HCV does not appear to influence the HIV reservoir size and suggest the lack of an anti-HIV action for DAAs, Tis work was supported by projects PI14/00518, RD16/0025/0013 integrated into the State Plan for Scientifc and Technical Research and Innovation from the General Sub-Directorate for research assessment and promotion, Spanish Carlos III Institute of Health (ISCIII) co-funded by the European Regional Development Fund (ERDF). Maria A Navarrete-Muñoz was funded by the Spanish Directorate General for Research and Technological of the “Comunidad de Madrid” [grant: IND2018/BMD9651]. Norma Rallón is supported by the Miguel Servet program funded by the Spanish Health Institute Carlos III [grant: CPII19/00025]

Colorectal cancer cells can transfer the oncogene KRAS to distant cells, predisposing them to malignant transformation (Genometastasis Theory). This process could contribute to liver metastasis; besides, hepatic progenitor cells (HPCs) have been found to be involved in liver malignant neoplasms. The objective of this study is to determine if mouse HPCs—Oval cells (OCs)—are susceptible to incorporate Kras GAT (G12D) mutation from mouse colorectal cancer cell line CT26.WT and if OCs with the incorporated mutation behave like malignant cells. To achieve this, three lines of OCs in diferent conditions were exposed to CT26.WT cells through transwell co-culture for a week. The presence of KrasG12D and capacity to form tumors were analyzed in treated samples by droplet digital PCR and colony-forming assays, respectively. The results showed that the KrasG12D mutation was detected in hepatic culture conditions of undiferentiated OCs and these cells were capable of forming tumors in vitro. Therefore, OCs are susceptible to malignant transformation by horizontal transfer of DNA with KrasG12D mutation in an undiferentiated condition associated with the liver microenvironment. This study contributes to a new step in the understanding of the colorectal metastatic process, Tis study was supported by Conchita Rábago Foundation, Madrid, Spain by a doctoral scholarship to Rocío Olivera-Salazar, Instituto de Salud Carlos III (ISCIII), European Regional Development Fund (ERDF) (PI20/01052), Instituto de Salud Carlos III (ISCIII), and Spanish Network of Cell Terapy (TerCel) (RD16/0011/0013).

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Cirugía. Fecha de lectura: 24-01-2022

Tesis Doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Cirugía. Fecha de Lectura: 17-01-2022

Tesis Doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Cirugía. Fecha de Lectura: 22-03-2022

BACKGROUND: Darvadstrocel is an expanded allogeneic adipose-derived mesenchymal stem cell therapy for the treatment of complex perianal fistulas in patients with Crohn’s disease. Safety and efficacy outcomes from the clinical trial known as “Adipose derived mesenchymal stem cells for induction of remission in perianal fistulizing Crohn’s disease,” or ADMIRE-CD (NCT01541579), from up to 52 weeks posttreatment were previously reported. Here, the outcomes from an extended 104-week follow-up are reported. OBJECTIVE: The goal of this study was to assess the long-term safety and efficacy of darvadstrocel at 2 years post-treatment in patients with Crohn’s disease and complex perianal fistulas. DESIGN: This was a phase 3 double-blind randomized controlled study (ADMIRE-CD) in patients with perianal fistulizing Crohn’s disease. SETTINGS: This study extension was conducted in multiple hospitals across 7 European countries and Israel. PATIENTS: Forty patients entered the extended follow-up period: 25 patients in the darvadstrocel treatment group and 15 in the control group. INTERVENTIONS: Darvadstrocel or saline solution (control group) was administered once, locally, after fistula tract curettage and internal opening closure (with previous seton placement). All patients were permitted to continue ongoing medical treatments for fistulas. MAIN OUTCOME MEASURES: Treatment-emergent serious adverse events were recorded through week 104. Clinical remission, defined as closure of all treated external openings that were draining at baseline despite gentle finger compression, was assessed at week 104. RESULTS: Of 40 patients, 37 completed the extended follow-up. Through week 104, 7 treatment-emergent serious adverse events were reported, of which 4 occurred between weeks 52 and 104. At week 104, clinical remission was reported in 14/25 (56%) patients in the darvadstrocel group and 6/15 (40%) patients in the control group. LIMITATIONS: Limitations include the small number of patients who entered the extended follow-up period, and no imaging examinations were performed at the 104-week time point. CONCLUSIONS: Darvadstrocel was well tolerated and clinical remission after treatment with darvadstrocel may be sustained for up to 104 weeks in patients with perianal fistulizing Crohn’s disease, This study was sponsored by Takeda Pharmaceuticals International Co. Medical writing support was provided by Sally McTaggart, PhD, of Oxford PharmaGenesis, Oxford, UK, and was funded by Takeda Pharmaceuticals International Co

Tesis Doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Cirugía. Fecha de Lectura: 30-06-2022, Esta tesis ha sido posible gracias a la financiación del ISCIII en la convocatoria de Proyectos de Investigación en Salud del año 2017 (PI17/01233)

Tesis Doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Cirugía. Fecha de Lectura: 03-02-2022, Se están incorporando en las máquinas de anestesia nuevos software para la realización de maniobras de reclutamiento pulmonar (MR) automatizadas. Hasta la fecha, no existen publicaciones acerca de la evaluación de la eficacia y seguridad de estas MR automatizadas en la población neonatal. Objetivo: Proponemos evaluar la eficacia y seguridad de la MR automatizada de escalones múltiples del software FLOW-i 4.3 Anesthesia System®. Diseño: Se estudiaron 8 lechones a los que se realizó MR automatizada con el software FLOW-i 4.3 Anesthesia System®. Se llevó a cabo una MR de escalones múltiples, en ventilación controlada por presión (PCV), con aumentos consecutivos de PEEP y driving pressure constante (15 cmH2O). Las presiones objetivo fueron Ppico de 30 cmH2O y PEEP de 15 cmH2O. Todos los animales fueron monitorizados a nivel hemodinámico con el sistema PiCCO®. Se recogieron parámetros respiratorios de: SatO2, FiO2, etCO2, Ppico, Pmeseta, PEEP, Cdyn y Cst. Se evaluó la eficacia mediante la mejora de parámetros de intercambio gaseoso (PaO2, PaCO2) y mecánica pulmonar (Cdyn y Cst). Se evaluó la seguridad certificando la precisión del software, la estabilidad hemodinámica y la ausencia de eventos adversos respiratorios a lo largo de la MR. Resultados: Todas las MR se llevaron a cabo tal como fueron programadas y no ocurrieron eventos adversos (hemodinámicos ni respiratorios) que obligaran a pararlas. No observamos diferencias significativas en los datos de intercambio gaseoso aunque sí se objetivó un aumento del 33% en la Cdyn y del 24% en la Cst tras la realización de la MR. Conclusiones: Concluimos que la MR automatizada de escalones múltiples del software FLOW-i 4.3 Anesthesia System® es segura y eficaz en un modelo animal neonatal sano. No observamos eventos adversos respiratorios ni hemodinámicos durante el transcurso de la MR en PCV de múltiples escalones consecutivos (hasta PEEP 15cmH2O/Ppico 30 cmH2O)

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Cirugía. Fecha de lectura: 13-12-2021

Purpose: We aimed to establish correlations between the clinical features of a cohort of Usher syndrome (USH) patients with pathogenic variants in MYO7A, type of pathogenic variant, and location on the protein domain. Methods: Sixty-two USH patients from 46 families with biallelic variants in MYO7A were examined for visual and audiological features. Participants were evaluated based on self-reported ophthalmological history and ophthalmological investigations (computerized visual field testing, best-corrected visual acuity, and ophthalmoscopic and electrophysiological examination). Optical coherence tomography and fundus autofluorescence imaging were performed when possible. Auditory and vestibular functions were evaluated. Patients were classified according to the type of variant and the protein domain where the variants were located. Results: Most patients displayed a typical USH1 phenotype, that is, prelingual severe-profound sensorineural hearing loss, prepubertal retinitis pigmentosa (RP) and vestibular dysfunction. No statistically significant differences were observed for the variables analysed except for the onset of hearing loss due to the existence of two USH2 cases, defined as postlingual sensorineural hearing loss, postpubertal onset of RP, and absence of vestibular dysfunction, and one atypical case of USH. Conclusion: We were unable to find a correlation between genotype and phenotype for MYO7A. However, our findings could prove useful for the assessment of efficacy in clinical trials, since the type of MYO7A variant does not seem to change the onset, severity or course of visual disease., This project was financially supported by the Center for Biomedical Network Research on Rare Diseases (CIBERER), FIS (PI16/00425, PI16/00539 and IIS‐FJD Biobank PT13/0010/0012). LG‐M and IPR were supported by the Río Hortega and predoctoral Programs (CM16/00126 and FI17/00192, respectively) from Institute of Health Carlos III (ISCIII, Spanish Ministry of the Economy, Industry and Competitiveness), Regional Government of Madrid (CAM, B2017/BMD37), and Regional Government of the Valencian Community (PROMETEU/2018/135), with partial support from the European Regional Development Fund (ERDF). Additional support was received from the Ramon Areces Foundation, the University Chair UAM‐IIS‐FJD of Genomic Medicine, ONCE Foundation and the Spanish National Organization of the Blind (ONCE). Drafting of this manuscript was possible thanks to the UshTher project (Clinical trial of gene therapy with dual AAV vectors for retinitis pigmentosa in patients with Usher syndrome type IB), which has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 754848. The authors are grateful to the families that participated in this study and to the colleagues who referred patients to us. We also thank the Genetics and Ophthalmology Departments of Fundación Jimenez Diaz University Hospital (FJD, Madrid) and Asunción Giménez, Cristina Villaverde, and Ignacio Mahillo for their technical assistance.

The biological mechanisms involved in aseptic loosening include inflammation-associated and bone resorption-associated processes. Coordinated cellular actions result in biochemical imbalances with devastating consequences for the joint. Given that this condition is not known for showing systemic signs, we investigated whether circulating levels of inflammation-related proteins are altered in patients with aseptic loosening. Our study included 37 patients who underwent revision surgery due to hip osteolysis and aseptic loosening and 31 patients who underwent primary total hip arthroplasty. Using antibody arrays, we evaluated the serum levels of 320 proteins in four patients from each group. The results showed differences in insulin-like growth factor-binding protein 1 (IGFBP-1) concentrations, which we then quantified using enzyme-linked immunosorbent assay tests in all study patients. The results confirmed that serum IGFBP-1 concentrations were higher in the revision surgery patients than in the hip arthroplasty patients. In vitro studies showed that exposure of human osteoblasts to titanium particles induced an IGFBP-1 release that further increased when exposure to particles was performed in media conditioned by human M1 macrophages. These findings suggest that elevated serum IGFBP-1 levels in patients with aseptic loosening can arise from increased local IGFBP-1 production in the inflammatory environment of the periprosthetic bed., This work was supported by Grant RTI2018-095159-B-I00 from the Spanish Ministry of Science, Innovation and Universities (MCINN) and Grant PI18/00643 from Instituto de Salud Carlos III (ISCIII)-Fondo Europeo de Desarrollo Regional (FEDER) and the Spanish Ministry of Economy and Competitiveness (MINECO-AES). LS is supported by a Miguel Servet contract from ISCIII-MINECO-AES-FEDER-FSE. NV is supported by Program I2 from the Regional Government of Madrid. The authors are indebted to Fatima Bensiamar (IdiPAZ and CIBER-BBN) for her excellent technical assistance with the cell culture experiments and gene expression analysis and to the Cell Culture Core Facilities of IdiPAZ.

Purpose: Although metabolic tumor volume (MTV) and total lesion glycolysis (TLG) have shown good prognostic value in head and neck cancer (HNC), there are still many issues to resolve before their potential application in standard clinical practice. The purpose of this study was to compare the discrimination ability of two relevant segmentation methods in HNC and to evaluate the potential benefit of adding lymph nodes’ metabolism (LNM) to the measurements. Methods: We retrospectively analyzed a recently published database of 62 patients with HNC treated with chemoradiotherapy. MTV and TLG were measured using an absolute threshold of SUV2.5. Comparison analysis with previously published background-level threshold (BLT) results was done through Concordance index (C-index) in eight prognostic models. Results: BLT obtained better C-index values in five out of the eight models. The addition of LNM improved C-index values in six of the prognostic models. Conclusion: We found a potential benefit in adding LNM to the main tumor measurements, as well as in using a BLT for MTV segmentation compared to the most commonly used SUV2.5 threshold. Despite its limitations, this study suggests a practical and simple manner to use these parameters in standard clinical practice, aiming to help elaborate a general consensus, Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature

Tesis Doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Cirujía. Fecha de Lectura: 08-11-2021

Background This study aimed to measure the toxicity resulting from collagenase administration to the peritoneal cavity in a pig model as a preliminary step to break down the stroma surrounding tumors. Methods Eight pigs were treated with 2 different collagenase concentrations previously tested in rats by our group. Time and temperature were controlled using a peritoneal lavage system (PRS System, Combat Medical Ltd.) identical to that used in human surgeries through hyperthermic intraperitoneal chemotherapy (HIPEC); 2 additional pigs were treated with peritoneal lavage only. Samples of blood and peritoneal fluid were collected pre-treatment, immediately after treatment, and 24 h postoperatively. In addition, histological studies and blood collagenase levels were measured. Results No complications were observed during the surgeries. Intraoperative images evidenced the release of peritoneal tissue during collagenase treatment. After surgery, the animals showed no signs of pain. Diet and mobility were normal at 4 h postoperatively, and there were no significant differences in hematologic or biochemical parameters. Quantification of MMP1 and MMP2 in all samples as measured by absorbance showed no differences in blood collagenase levels between pre-treatment, post-treatment, and 24 h postoperatively. None of the animals treated with collagenase showed peritoneal adhesions during the second surgery. Histologically, peritoneal organs and serous structures did not show any microscopic alterations associated with collagenase treatment in any group. Conclusion Lavage of the peritoneal cavity with doses of up to 100,000 collagen digestion units/animal for 30 min is safe and removes connective tissue from the peritoneal cavity.

Introduction Controlled donation after circulatory-death donors (cDCD) are becoming a frequent source of lungs grafts worldwide. Conversely, lung transplantations (LTx) from uncontrolled donors (uDCD) are sporadically reported. We aimed to review our institutional experience using both uDCD and cDCD and compare to LTx from brain death donors (DBD). Methods This is a retrospective analysis of all LTx performed between January 2013- December 2019 in our institution. Donor and recipient characteristics were collected and univariate, multivariate and survival analyses were carried out comparing the three cohorts of donors. Results A total of 239 (84.7%) LTx were performed from DBD, 29 (10.3%) from cDCD and 14 (5%) from uDCD. There were no statistically significant differences in primary graft dysfunction grade 3 at 72 hours, 30- and 90-day mortality, need for extracorporeal membrane oxygenation after procedure, ICU and hospital length of stay, airway complications, CLAD incidence or survival at 1 and 3 years after transplant (DBD: 87.1% and 78.1%; cDCD: 89.7% and 89.7%; uDCD: 85.7% and 85.7%, respectively; p=0.42). Short- and mid-term outcomes are comparable between the three types of donors. Conclusions These findings may encourage and reinforce all types of donation after circulatory-death programmes as a valid and growing source of suitable organs for transplantation.

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Cirugía. Fecha de lectura: 15-10-2021

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Cirugía. Fecha de lectura: 27-09-2021

After recent observations that intrathecal administration of autologous bone marrow mesenchymal stromal cells (MSCs) increases cerebral metabolism in patients with severe traumatic brain injury (TBI), we examined this type of cell therapy in Alzheimer's type dementia. Three patients with clinical diagnosis of Alzheimer's disease received every 3 months 100million autologous MSCs by intrathecal route, until a total dose of 300million. During cell therapy the patients showed arrest in neurological deterioration and two of them manifested clear improvement of previous symptoms. A global increase in cerebral glucose metabolism, measured using 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET), was observed after every administration of cell therapy. Our present findings suggest that intrathecal administrations of autologous MSCs can be a new strategy for the treatment of Alzheimer's dementia, We thank the institutions supporting the development of our cell therapy program, in particular Mapfre and Rafael del Pino Foundations

Background: Validated biomarkers in head and neck squamous cell carcinoma (HNSCC) are scarce. Methods: We retrospectively analyzed 62 patients with HNSCC treated with radiotherapy +/− concurrent chemotherapy. Pretreatment metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were measured in a 18F-FDG positron emission tomography using a liver dependent standardized uptake value threshold. Cox regression analyses were performed to find associations with disease-free survival (DFS) and overall survival (OS). Results: High values of MTV (>37 ml) were independently associated with a worse DFS (hazard ratio [HR] = 3.45; 95% confidence interval [CI], 1.52–7.84) and OS (HR = 3.27; 95% CI, 1.41–7.57). Similar results were found for high values of TLG (>247 g) for DFS (HR = 3.32; 95% CI, 1.44–7.65) and OS (HR = 3.42; 95% CI, 1.45–8.07). Conclusions: MTV and TLG can be considered as independent prognostic factors for DFS and OS in patients with HNSCC. Considering how easily obtainable they are, they may be useful for predicting clinical outcomes in these patients

An increased risk of cardiovascular morbidity has been reported in lithiasic patients. In this context, endothelial dysfunction (ED), an earlier status of atherogenesis, has been identified in hyperoxaluria rat models of urolithiasis. Objective: The purpose of this study was to determine the endothelial vascular function in patients with urolithiasis in relation to systemic inflammatory, oxidative stress, and vascular function serum markers. Methods: A cross-sectional study was performed between 27 urolithiasic patients, matched for age and sex, with 27 healthy patients. Endothelial function was assessed by measuring flow-mediated dilation (Celermajer method). Fasting blood was collected to determine metabolic parameters (glucose and lipid profile), along with serum CRP, IL-6, MDA, ADMA, and VCAM-1. Results: Both the control and urolithiasis groups were homogenous in anthropometric, exploration, and general laboratory measures. Flow-mediated dilation (%FMD) was 11.85% (SE: 2.78) lower in the lithiasis group (p < 0.001). No significant differences were achieved between groups when CRP, IL-6, MDA, ADMA, and VCAM-1 were compared, although slightly higher values of CRP, ADMA, and VCAM-1 were detected in the lithiasic group. A correlation was not reached in any of the serum markers when they were related to flow-mediated values, although a slight negative correlation trend was observed in MDA, VCAM-1, and IL-6 values. Conclusions: Endothelial dysfunction constitutes an important disorder related to urolithiasis patients. It must be considered as an early feature responsible for future cardiovascular events. Our study did not find a significant association between inflammatory, oxidative stress, endothelial serum markers, and flow-mediated dilation., Puerta de Hierro-Segovia de Arana Research Institute

This article belongs to the Special Issue Three-Dimensional Culture Systems in Cancer Research., [Simple Summary]: Colorectal cancer is one of the most frequent and lethal types of cancer. Despite advances in recent decades, our knowledge of this disease is still limited, and novel and better therapies are needed. Organoids were recently developed as a new system to culture normal and tumor cells obtained from patients subjected to surgery or endoscopic tests. Organoids are being used to dissect the molecular and genetic bases of colorectal cancer initiation and progression. In this review, we describe how patient-derived organoids can be generated, and their use to investigate in depth the tumorigenic process. We show how this system has allowed the study of colorectal tumorigenesis features for the first time, including immunotherapy, interplay with microorganisms and, more importantly, assays of drug treatments at an individualized level. Additionally, we summarize the most recent developments of what is known as organoid technology directed towards personalized medicine., [Abstract]: Organoids were first established as a three-dimensional cell culture system from mouse small intestine. Subsequent development has made organoids a key system to study many human physiological and pathological processes that affect a variety of tissues and organs. In particular, organoids are becoming very useful tools to dissect colorectal cancer (CRC) by allowing the circumvention of classical problems and limitations, such as the impossibility of long-term culture of normal intestinal epithelial cells and the lack of good animal models for CRC. In this review, we describe the features and current knowledge of intestinal organoids and how they are largely contributing to our better understanding of intestinal cell biology and CRC genetics. Moreover, recent data show that organoids are appropriate systems for antitumoral drug testing and for the personalized treatment of CRC patients., The work in the authors’ laboratory is funded by the Agencia Estatal de Investigación (PID2019-104867RB-I00/AEI/10.13039/501100011033), the Ministerio de Ciencia e Innovación (SAF2017-90604-REDT/NuRCaMeIn), and the Instituto de Salud Carlos III—Fondo Europeo de Desarrollo Regional (CIBERONC/CB16/12/00273, CIBERONC/CB16/12/00398 and ICI20/00057).

Our purpose was to identify mutations responsible for non-syndromic congenital cataracts through the implementation of next-generation sequencing (NGS) in our center. A sample of peripheral blood was obtained from probands and willing family members and genomic DNA was extracted from leukocytes. DNA was analyzed implementing a panel (OFTv2.1) including 39 known congenital cataracts disease genes. 62 probands from 51 families were recruited. Pathogenic or likely pathogenic variants were identified in 32 patients and 25 families; in 16 families (64%) these were de novo mutations. The mutation detection rate was 49%. Almost all reported mutations were autosomal dominant. Mutations in crystallin genes were found in 30% of the probands. Mutations in membrane proteins were detected in seven families (two in GJA3 and five in GJA8). Mutations in LIM2 and MIP were each found in three families. Other mutations detected affected EPHA2, PAX6, HSF4 and PITX3. Variants classified as of unknown significance were found in 5 families (9.8%), affecting CRYBB3, LIM2, EPHA2, ABCB6 and TDRD7. Mutations lead to different cataract phenotypes within the same family, This research was funded by ONCE grant number 2020/0197782 and by FIS grant number PI18-1234-ISCIII

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Cirugía. Fecha de lectura: 14-04-2021

IntroductionSpain is one of the countries with the lowest rates of revascularisation and highest ratio of percutaneous coronary intervention (PCI) to coronary artery bypass grafting (CABG).ObjectivesTo investigate the changes and trends in the two revascularisation procedures between 1998 and 2017 in Spain.DesignRetrospective cohort study. Analysis of in-hospital outcomes.SettingMinimum basic data set from the Spanish National Department of Health: mandatory database collecting information of patients who are attended in the Spanish public National Health System.Participants603 976 patients who underwent isolated CABG or PCI in the Spanish National Health System. The study period was divided in four 5-year intervals. Patients with acute myocardial infarction on admission were excluded.Primary and secondary outcomesWe investigated the volume of procedures nationwide, the changes of the risk profile of patients and in-hospital mortality of both techniques.ResultsWe observed a 2.2-fold increase in the rate of any type of myocardial revascularisation per million inhabitants-year: 357 (1998) to 776 (2017). 93 682 (15.5%) had a coronary surgery. PCI to CABG ratio rose from 2.2 (1998–2002) to 8.1 (2013–2017). Charlson’s index increased by 0.8 for CABG and 1 for PCI. The median annual volume of PCI/hospital augmented from 136 to 232, while the volume of CABG was reduced from 137 to 74. In the two decades, we detected a significant reduction of CABG in-hospital mortality (6.5% vs 2.6%, pConclusionWe detected a significant increase in the volume of revascularisations (particularly PCI) in Spain. Risk-adjusted in-hospital mortality was significantly reduced.

(1) Background: Surgical outcomes in free flap reconstruction of head and neck defects in cancer patients have improved steadily in recent years, however, correct anaesthesia management is also important. The aim of this study has been to show whether goal directed therapy can improve flap viability and morbidity and mortality in surgical patients. (2) Methods: we performed an observational case control study to analyse the impact of introducing a semi invasive device (Flo Trac®) during anaesthesia management to optimize fluid management. Patients were divided into two groups: one received goal directed therapy (GDT group) and the other conventional fluid management (CFM group). Our objective was to compare surgical outcomes, complications, fluid management, and length of stay between groups. (3) Results: We recruited 140 patients. There were no differences between groups in terms of demographic data. Statistically significant differences were observed in colloid infusion (GDT 53.1% vs. CFM 74.1%, p = 0.023) and also in intraoperative and postoperative infusion of crystalloids (CFM 5.72 (4.2, 6.98) vs. GDT 3.04 (2.29, 4.11), p &lt, 0.001), which reached statistical significance. Vasopressor infusion in the operating room (CFM 25.5% vs. GDT 74.5%, p &lt, 0.001) and during the first postoperative 24h (CFM 40.6% vs. GDT 75%, p &gt, 0.001) also differed. Differences were also found in length of stay in the intensive care unit (hours: CFM 58.5 (40, 110) vs. GDT 40.5 (36, 64.5), p = 0.005) and in the hospital (days: CFM 15.5 (12, 26) vs. GDT 12 (10, 19), p = 0.009). We found differences in free flap necrosis rate (CMF 37.1% vs. GDT 13.6%, p = 0.003). One-year survival did not differ between groups (CFM 95.6% vs. GDT 86.8%, p = 0.08). (4) Conclusions: Goal directed therapy in oncological head and neck surgery improves outcomes in free flap reconstruction and also reduces length of stay in the hospital and intensive care unit, with their corresponding costs. It also appears to reduce morbidity, although these differences were not significant. Our results have shown that optimizing intraoperative fluid therapy improves postoperative morbidity and mortality.

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Cirugía. Fecha de lectura: 18-03-2021

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Cirugía. Fecha de lectura: 17-03-2021

Introducción La prótesis total de cadera (PTC) en pacientes octogenarios presenta dificultades debido a las comorbilidades asociadas y al tipo de fijación. Nos preguntamos si los resultados de la PTC cementada son mejores que los de la PTC no cementada en pacientes mayores de 80 años. Material y métodos Fueron intervenidos de PTC 382 pacientes (441 caderas) de 80 o más años de edad entre 2004 y 2015. Se comparan 3 grupos: grupo 1, PTC cementada, 196 caderas; grupo 2, PTC no cementada con vástago de superficie rugosa, 121 caderas; grupo 3, PTC no cementada con vástago de recubrimiento poroso proximal, 124 caderas. En el grupo 1 la edad media, el grado de osteoporosis y el número de comorbilidades fue mayor. Se calculó la incidencia acumulada de cirugía de revisión y aflojamiento teniendo en cuenta la mortalidad como factor de riesgo por competencia. Resultados Las complicaciones médicas fueron similares entre los grupos. Hubo 3 fracturas periprotésicas, una en el grupo 2 y 2 en el grupo 3. El análisis mediante el riesgo por competencias mostró una incidencia acumulada de revisión por cualquier causa a los 10 años del 2,3% en el grupo 1, del 6%, en el grupo 2 y del 4,1% en el grupo 3, y por aflojamiento aséptico para el mismo período del 1,2% en el grupo 1, del 3,7% en el grupo 2 y del 0% en el grupo 3. Conclusiones La PTC presenta resultados fiables con bajas tasas de cirugía de revisión en pacientes octogenarios. La fijación no cementada es satisfactoria en pacientes octogenarios; sin embargo, el mayor número de fracturas periprotésicas empeoran los resultados, Introduction Total hip replacement (THR) is challenging in octogenarians due to associated comorbidities and controversy regarding fixation type. We ask whether cemented THR is superior to uncemented THR in patients above the age of 80 years. Material and methods A total of 382 patients (441 hips) aged 80 years or older who underwent THR between 2004 and 2015 were analysed. A cemented THR was implanted in 196 hips (group 1), an uncemented THR with a grit-blasted stem in 121 (group 2), or with a porous-coated stem in 124 (group 3). Patients in group 1 had a higher mean age, more comorbidities and osteoporotic bone. Survival analysis was calculated using cumulative incidence function to account for the competing risk of death. Results Medical complications rate was similar. There were 3 post-operative fractures: one in group 2 and 2 in group 3. Competing risk analysis showed that the cumulative incidence of revision for any cause was 2.3 in group 1, 6.0 in group 2 and 4.1 in group 3 at 10 years, and the cumulative incidence of revision for aseptic loosening was 1.2 in group 1, 3.7 in group 2 and 0 in group 3 at the same period. Conclusions THR presents an acceptable number of adverse events for octogenarian patients. Despite uncemented fixation was satisfactory, the higher peri-prosthetic fracture rate worsens results in this group