Non-fatal suicide behaviours across phases in the COVID-19 pandemic: a population-based study in a Catalan cohort.

BACKGROUND: The COVID-19 pandemic has been extensively discussed in the context of its effect on mental health. Although global suicide rates have remained stable during the pandemic, the specific effect on non-fatal suicide behaviours during and after the pandemic remains underexplored. This study aims to investigate patterns of non-fatal suicide behaviours before, during, and after the pandemic. METHODS: In this cohort study, we used data from all hospitals in Catalonia, Spain, collected through the Catalan Suicide Risk Code, which is a specifically designed suicide attempt surveillance protocol, involving a face-to-face, in-depth psychiatric evaluation, after a Catalan resident presents any suicide risk behaviour in any public health-care setting. This evaluation centralises data from suicide registries across the territory. We included non-fatal suicide behaviours, meaning suicidal ideation or attempts that did not result in death, and excluded self-harm behaviours not judged to be linked with suicidal ideation. We considered three periods: the pre-confinement period (Jan 1, 2018, to the enforcement of the lockdown in Spain on March 14, 2020); the confinement period (March 14, 2020, to the end of lockdown on June 21, 2020); and the post-confinement period (June 21, 2020, to Dec 31, 2022). We used Bayesian structural time series models to assess the effect of pandemic phases on non-fatal suicide behaviours, and we ran stratified analyses by sex and age to identify distinct patterns among demographic cohorts. FINDINGS: We obtained 26 482 records from Jan 1, 2018, to Dec 31, 2022. The mean age was 37·94 years (SD 18·07), and the sample included 17 584 (66·4%) women and 8898 (33·6%) men. Data on ethnicity were not collected. Temporal trends showed a mild increase in non-fatal suicide behaviours from Jan 1, 2018, to March 13, 2020; a reduction during the confinement period; and a subsequent rise after confinement. Bayesian models suggested a significant causal effect of lockdown easing, resulting in a 50·77% increase in non-fatal suicide behaviours (95% credible interval [CrI] 26·62-76·58; p<0·0001). Stratified analyses indicated that the easing of lockdown resulted in a significant increase in non-fatal suicide behaviours among women (25·92%; 6·71-44·72; p=0·011) and among individuals aged 18 years and younger (72·75%; 38·81-108·11; p<0·0001). INTERPRETATION: This study provides a comprehensive examination of non-fatal suicide behaviours in Catalonia, Spain, emphasising the dynamics of different COVID-19 pandemic phases. The initial reduction during strict lockdown aligns with Joiner's Interpersonal Theory of Suicide, whereas the post-confinement rise reflects complex factors, including social isolation and economic challenges. Sex-specific and age-specific analyses underscore distinct vulnerabilities, emphasising the need for targeted preventive strategies. FUNDING: Centro de Investigación Biomédica en Red de Salud Mental annual budget of G21, Agència de Gestió d'Ajuts Universitaris i de Recerca of the Generalitat de Catalunya. TRANSLATIONS: For the Catalan and Spanish translations of the abstract see Supplementary Materials section.

Medical grade 3D printable bioabsorbable PLDL/Mg and PLDL/Zn composites for biomedical applications.

Medical grade PLDL, PLDL/Mg and PLDL/Zn filaments were manufactured by a dual extrusion method and used to prepare coupons and scaffolds with controlled porosity by fused filament fabrication. The mechanical properties, degradation mechanisms and biological performance were carefully analyzed. It was found that the presence of 4 vol.% of Mg and Zn particles did not substantially modify the mechanical properties but accelerated the degradation rate of PLDL. Moreover, the acidification of the pH due to degradation of the PLDL was reduced in the presence of metallic particles. Finally, cell adhesion and proliferation were excellent in the medical grade PLDL as well as in the polymer/metal composites. These results demonstrate the potential of bioabsorbable metal/polymer composites to tailor the mechanical properties, degradation rate and biocompatibility for specific clinical applications.

The Rising Importance of Stock-Linked Assets in the Black-White Wealth Gap.

Studies have examined the racial disparities in household characteristics, homeownership, and familial transfer as primary drivers of the Black-White wealth gap in the United States. This study assesses the importance of stock-linked assets in generating wealth inequality. As financial assets become a growing component of household portfolios, the Black-White wealth gap is increasingly associated with the racial disparity in stock-linked assets. Using data from the Survey of Consumer Finances and the Panel Study of Income Dynamics, this study shows that the contribution of stock-linked assets to the Black-White wealth gap has expanded in both absolute and relative terms, surpassing those of homeownership and business equity. Furthermore, a substantial disparity in financial wealth exists even for otherwise similar Black and White households. Although the disparity is larger among those with more economic resources, a gap remains among those with less. Lastly, our analysis shows that the combination of lower ownership levels and lower returns on financial wealth among Black households could account for a quarter of the Black-White wealth accumulation gap, net of differences in current net worth and household characteristics. Our findings suggest that considering financial assets is critical for understanding contemporary racial wealth inequality.

Design and Construction of an Experimental Setup to Enhance Mineral Weathering through the Activity of Soil Organisms.

Enhanced weathering (EW) is an emerging carbon dioxide (CO2) removal technology that can contribute to climate change mitigation. This technology relies on accelerating the natural process of mineral weathering in soils by manipulating the abiotic variables that govern this process, in particular mineral grain size and exposure to acids dissolved in water. EW mainly aims at reducing atmospheric CO2 concentrations by enhancing inorganic carbon sequestration. Until now, knowledge of EW has been mainly gained through experiments that focused on the abiotic variables known for stimulating mineral weathering, thereby neglecting the potential influence of biotic components. While bacteria, fungi, and earthworms are known to increase mineral weathering rates, the use of soil organisms in the context of EW remains underexplored. This protocol describes the design and construction of an experimental setup developed to enhance mineral weathering rates through soil organisms while concurrently controlling abiotic conditions. The setup is designed to maximize weathering rates while maintaining soil organisms' activity. It consists of a large number of columns filled with rock powder and organic material, located in a climate chamber and with water applied via a downflow irrigation system. Columns are placed above a fridge containing jerrycans to collect the leachate. Representative results demonstrate that this setup is suitable to ensure the activity of soil organisms and quantify their effect on inorganic carbon sequestration. Challenges remain in minimizing leachate losses, ensuring homogeneous ventilation through the climate chamber, and avoiding flooding of the columns. With this setup, an innovative and promising approach is proposed to enhance mineral weathering rates through the activity of soil biota and disentangle the effect of biotic and abiotic factors as drivers of EW.

Bioabsorbable WE43 Mg alloy wires modified by continuous plasma electrolytic oxidation for implant applications. Part II: Degradation and biological performance.

The corrosion, mechanical degradation and biological performance of cold-drawn WE43 Mg wires were analyzed as a function of thermo-mechanical processing and the presence of a protective oxide layer created by continuous plasma electrolytic oxidation (PEO). It was found that the corrosion properties of the non-surface-treated wire could be optimized by means of thermal treatment within certain limits, but the corrosion rate remained very high. Hence, strength and ductility of these wires vanished after 24 h of immersion in simulated body fluid at 37 °C and, as a result of that rather quick degradation, direct tests did not show any MC3T3-E1 preosteoblast cell attachment on the surface of the Mg wires. In contrast, surface modification of the annealed WE43 Mg wires by a continuous PEO process led to the formation of a homogeneous oxide layer of ≈8 µm and significantly improved the corrosion resistance and hence the biocompatibility of the WE43 Mg wires. It was found that a dense layer of Ca/P was formed at the early stages of degradation on top of the Mg(OH)2 layer and hindered the diffusion of the Cl- ions which dissolve Mg(OH)2 and accelerate the corrosion of Mg alloys. As a result, pitting corrosion was suppressed and the strength of the Mg wires was above 100 MPa after 96 h of immersion in simulated body fluid at 37 °C. Moreover, many cells were able to attach on the surface of the PEO surface-modified wires during cell culture testing. These results demonstrate the potential of thin Mg wires surface-modified by continuous PEO in terms of mechanical, degradation and biological performance for bioabsorbable wire-based devices.

Adjuvant Treatment for Protocadherin 19 (PCDH19) Syndrome.

Protocadherin 19 (PCDH19) syndrome is inherited as an X-linked pattern and affects mainly females. This syndrome is caused by a mutation in the PCDH19 gene encoding for the protocadherin protein. It is characterized by refractory seizures during febrile episodes with neuropsychiatric manifestations. There is no consensus on the treatment of PCDH19. We conducted a literature review to investigate the main drugs used for this syndrome, and to evaluate the best possible course of adjuvant treatment for these patients. We used an advanced PubMed search strategy with the following inclusion criteria: a) full-text papers, b) English Language, and c) studies conducted in humans. Exclusion criteria: a) literature reviews, b) systematic reviews, and c) metanalysis. We gathered 26 observational papers to conduct this literature review on clobazam and bromide which have been shown to reduce seizures by 50%. Corticosteroids improved neurological symptoms during the episodes in a few patients. Nevertheless, they recurred after a few months. Preliminary results of ganaxolone, which is still under study, demonstrated a reduction of 60% in seizure episodes. A ketogenic diet has been studied to treat several refractory epilepsies, including PCDH19; it has promising results as effective adjuvant therapy in the resolution of status epilepticus, suggesting it could be used as part of the treatment in early childhood. Stiripentol was given as adjuvant therapy in a patient with PCDH19 epilepsy resulting in the most extended period of seizure-free episodes, but more studies must be performed to assess its efficacy.

Mine Water for the Generation and Storage of Renewable Energy: A Hybrid Hydro-Wind System.

Mine water is normally considered as waste that has to be managed. However, new applications are increasingly being sought for the water that floods mining voids, especially in relation to its use as an energy resource. The worldwide energy market, within the current transition framework, is searching for creative approaches to produce and store clean energy. In particular, underground pumped hydroelectric energy storage systems (UPHS) constitute efficient and flexible alternatives to deal with intermittent renewable energy sources. In this work, a UPHS is designed using the mine water and the voids of a closed coal mine in Asturias (North-west Spain) as a lower reservoir. Moreover, this system is combined with a wind energy generation facility and the efficiency of the hybrid system is evaluated. With an investment cost of EUR 193 M, a 40 MW UPHES joined to a 60 MW wind farm would generate benefits of about EUR 54 M in 40 years. The reduction in CO2 emissions (29,000 equivalent tons per year) and the social benefits in a traditional mining area are other intangible advantages of this system.

Firm Size and Employment during the Pandemic.

Previous studies have established that firm size is associated with a wage premium, but the wage premium has declined in recent decades. The authors examine the risk for unemployment by firm size during the initial outbreak of coronavirus disease 2019 in the United States. Using both yearly and state-month variation, the authors find greater excess unemployment among workers in small enterprises than among those in larger firms. The gaps cannot be entirely attributed to the sorting of workers or to industrial context. The firm size advantage is most pronounced in sectors with high remotability but reverses in the sectors most affected by the pandemic. Overall, these findings suggest that firm size is linked to greater job security and that the pandemic may have accelerated prior trends regarding product and labor market concentration. They also point out that the initial policy responses did not provide sufficient protection for workers in small and medium-sized businesses.

Reproductive aspects of Grapsus grapsus (Decapoda: Grapsidae) on islands of the southeastern Gulf of California / Aspectos reproductivos de Grapsus grapsus (Decapoda: Grapsidae) en islas del sureste del Golfo de California

ABSTRACT Objective. The sex ratio, proportion of ovigerous females, length at sexual maturity and fecundity of Grapsus grapsus crabs in the Lobos, Venados and Pajaros islands (southeastern Gulf of California) were analyzed. Materials and methods. Sampling was conducted monthly between March 2011 and February 2012, during the night at low tide. Thirty crabs were collected in a quadrant (25 m2) at each sampling site on each island. cw (mm) and w (g) were determined. The sex ratio and size at sexual maturity (cw50%) were estimated, and for ovigerous females, embryonic stages and fecundity (gravimetric method) were determined. Results. The sex ratio (M:F) was 1:1.3. The average size at sexual maturity (cw50%) was 34.9 mm. The majority of females were ovigerous (71.3%), and 48% of the embryos of ovigerous females were at the red-orange phase. Egg diameter ranged from 1.1 to 5 µm, with an average of 2.05 µm. The mean fecundity was 24339.3 eggs. The maximum and minimum weight of ovigerous females was 69.9 and 15.2 g. Conclusions. The studied characteristics of sex ratio, proportion of ovigerous females, length at sexual maturity and fecundity of G. grapsus, indicate the effective administration and management of this resource in this area.

RESUMEN Objetivo. Se analizó la proporción de sexos, hembras ovígeras, talla de primera madurez sexual y fecundidad del cangrejo roca Grapsus grapsus en islas Lobos, Venados y Pájaros (sureste del Golfo de California). Material y métodos. Los muestreos fueron mensuales entre marzo 2011 y febrero 2012, las colectas fueron nocturnas durante la bajamar, se obtuvieron en un cuadrante (25 m2) por isla 30 organismos al azar, se les determinó el AN (mm) y PT (g). Se estimó la proporción de sexos y talla de primera madurez sexual (AN50%), se analizaron en hembras grávidas, las fases embrionarias y la fecundidad (método gravimétrico). Resultados. La proporción de M:H fue 1:1.3. La talla media de primera madurez fue AN50% 34.9 mm. Es evidente la presencia de hembras ovígeras (71.3%) y todas las fases embrionarias, la fase rojo-naranja fue la mayor representada en 48%. La variación del diámetro del huevo fue 1.1 a 5 µm y el promedio de 3.05 µm. La fecundidad media fue 24339.3 cigotos. El máximo y mínimo peso de hembras ovígeras fue 69.9 y 15.2 g, respectivamente. Conclusiones. Con base a las características biológicas del recurso tales como la proporción de sexos, hembras ovígeras, talla de primera madurez sexual y fecundidad en la población de G. grapsus, representa un efecto favorable en su posterior administración y manejo de este recurso en esta zona.

Single-Port Laparoscopic Cholecystectomy Assisted with Neodymium Magnets: Initial Prospective Experience with 60 Cases.

Introduction: Laparoscopic cholecystectomy (LC) is the gold standard performed by the majority of surgeons worldwide, and the use of single-port cholecystectomy remains a matter of debate. Single-port magnetic-assisted cholecystectomy (SPMAC) was described as an alternative because of its ability for proper triangulation and the advantage of reducing port surgery. The objective of this study is to describe the initial experience of SPMAC and evaluate the surgical learning curve. Materials and Methods: A prospective cohort was conducted between February 2017 and August 2018; 60 patients completed the inclusion criteria. Variables analyzed were gender, age, body mass index, American Society of Anesthesiologist (ASA) classification, operative time, hospital stay, intraoperative bleeding, and conversion rate. Postoperative pain was measured with a visual analogue scale (VAS). Aesthetic perception was measured by the cosmetic visual analogue scale (CVAS). The postoperative complications were graded according to Clavien-Dindo classification, and the cumulative sum (CUSUM) model was used for evaluating the learning curve. Results: The mean operatory time was 56.1 minutes. With regard to the postoperative pain variable, the VAS value was 2 out of 10 in 78.33% of patients. With regard to aesthetic satisfaction, CVAS was reported to be 10 out of 10 in 96.67% of patients. Conversion rate was 0%. The learning curve of operative time was reached at the 22nd patient, according to the CUSUM chart. Conclusions: SPMAC is feasible and effective; in our consideration, an acceptable learning curve considering benign gallbladder pathology is one of the most prevalent in general surgery. Further comparative studies with conventional LC and SPMAC need to be performed to conduct a proper comparison.

Microbiota composition of the dorsal patch of reproductive male Leptonycteris yerbabuenae.

Bacteria and other types of microbes interact with their hosts in several ways, including metabolic pathways, development, and complex behavioral processes such as mate recognition. During the mating season, adult males of the lesser long-nosed agave pollinator bat Leptonycteris yerbabuenae (Phyllostomidae: Glossophaginae) develop a structure called the dorsal patch, which is located in the interscapular region and may play a role in kin recognition and mate selection. Using high-throughput sequencing of the V4 region of the 16S rRNA gene, we identified a total of 2,847 microbial phylotypes in the dorsal patches of eleven specimens. Twenty-six phylotypes were shared among all the patches, accounting for 30 to 75% of their relative abundance. These shared bacteria are distributed among 13 families, 10 orders, 6 classes and 3 phyla. Two of these common bacterial components of the dorsal patch are Lactococcus and Streptococcus. Some of them-Helcococcus, Aggregatibacter, Enterococcus, and Corynebacteriaceae-include bacteria with pathogenic potential. Half of the shared phylotypes belong to Gallicola, Anaerococcus, Peptoniphilus, Proteus, Staphylococcus, Clostridium, and Peptostreptococcus and specialize in fatty acid production through fermentative processes. This work lays the basis for future symbiotic microbe studies focused on communication and reproduction strategies in wildlife.

Cartílago de tiburón: una panacea oncológica más / Shark cartilage: another oncological panacea

Resumen El cáncer es la tercera causa de muerte después de las enfermedades cardiovasculares y diabetes (mellitus); ante tan desolador panorama epidemiológico, es esperable que surjan multitud de terapias "curativas" no convencionales, biológicas y no biológicas. Entre las terapias biológicas se encuentra el cartílago de tiburón, cuyos defensores de su consumo se basan en la falsa premisa de que "los tiburones no tienen cáncer", y cuando son confrontados, alegan teorías conspiranoicas. Aunque se ha demostrado la existencia de un factor inhibidor de angiogénesis en el producto, los ensayos clínicos no han sido concluyentes en cuanto a un efecto benéfico neto en pacientes oncológicos. Pero el mercadeo popular de la sustancia es un negocio de varios millones de dólares anuales. Es prudente que los médicos tengan conocimiento incluso de los posibles efectos colaterales para proporcionar información a los pacientes.

Abstract Cancer is the third cause of death after cardiovascular diseases and diabetes mellitus. In the face of such a devastating epidemiological panorama, it is expected that a multitude of non-conventional, biological and non-biological "curative" therapies will emerge. Among the biological therapies is the shark cartilage, whose defenders of its use are based on the false premise that "sharks do not have cancer", and when confronted, they claim conspiracy theories. Although the presence of an inhibitory factor of angiogenesis in the product has been demonstrated, clinical trials have not been conclusive as to a net beneficial effect in oncological patients. But the popular marketing of the substance is a business of several million dollars a year. It is prudent that doctors have knowledge, including possible side effects, to provide information to patients.

Caso Clínico: Fractura de Tobillo Weber B, Tratamiento Quirúrgico con Doble Sistema Tightrope® / Case Report: Weber B Ankle Fracture, Surgical Treatment with Double Tightrope® Fixation System

INTRODUCCIÓN: Las fracturas de tobillo representan un motivo frecuente de visita a los servicios de emergencias, constituyen el 25 % de las fracturas de miembro inferior. Al manejarse inadecuadamente pueden generar artrosis, por lo que adquiere importancia el manejo adecuado y oportuno que permita recuperar la movilidad temprana. CASO CLÍNICO: Paciente femenino de 17 años de edad, deportista (danza profesional), sinantecedentes patológicos de importancia, acudió al servicio de emergencias por sufrir caída de 2 metros de altura, mientras practicaba deporte, sufriendo trauma directo en miembro inferior izquierdo. Al examen físico el tobillo izquierdo se evidenció deformidad, dolor a la digitopresión, imposibilidad de apoyar el pie, inestabilidad de la articulación tibioperónea indicando lesión de la sindesmosis, tumefacción, equimosis, pulso pedio y tibial posterior presente, llenado capilar normal, y sensibilidad distal conservada. El diagnóstico fue fractura de tobillo tipo B de Weber. EVOLUCIÓN: Se realizó una reducción con osteosíntesis «tercio de caña¼ y fijación interna mediante doble sistema Tightrope®, luego del procedimiento permaneció 4 semanas con yeso cerrado, evidenciándose un adecuado proceso consolidativo en los controles radiográficos posteriores. Luego de un mes de terapia física presentó recuperación de la movilidad y negó presentar dolor o sensación de disconfort; el resultado funcional fue satisfactorio y luego de dos meses retomó su actividad regular. CONCLUSIÓN: El manejo activo con cirugía y fijación mediante sistema Tightrope® en fracturas de tobillo constituye una opción de tratamiento alternativa y eficaz en lugar de clavos sindesmales. En pacientes deportistas o con alta demanda de actividad física evita una reintervención quirúrgica y permite un retorno precoz a las actividades habituales.(AU)

BACKGROUND: Ankle fractures are a frequent reason of consult at emergency services. They represent 25 % of lower limb fractures. If are not handled properly it may lead to arthrosis, so the proper and timely treatment are important for early recovery of mobility. CASE REPORT: A 17-year old female patient, athlete and with no important medical precedents who attended to emergency department after suffering a 2-meter fall, she suffered direct trauma in lower left limb. Left ankle was painful and had swelling, ecchymosis and functional impotence. Diagnosis was Weber B ankle fracture. EVOLUTION: An open reduction with double Tightrope® fixation system was performed. She stood with a closed plaster for 4 weeks after procedure. Subsequent radiographic controls showed an adequate consolidation process. Mobility was recovered after one month of physical therapy, she did not refer pain or discomfort so the functional outcome was satisfactory. CONCLUSION: Active surgical management and fixation with Tightrope® system on ankle fractures is a fair option of treatment. It avoids reoperation and allows an early return to regular activities in athletes or in those patients with a high demand of physical activity./AU)

Complete mitochondrial genome of the Devil Ray, Mobula thurstoni (Lloyd, 1908) (Myliobatiformes: Myliobatidae).

The Devil Ray (Mobula thurstoni) is a species with global distribution and is an important species in conservation terms, here we present its complete mitochondrial genome assembled with Illumina sequencing data. The circular genome was 17,610 bp in length, and consists of 13 protein-coding, two ribosomal RNAs (rRNAs), and 22 transfer RNA (tRNA) genes. Base composition is 30.7% A, 29.1% T, 26.5% C, and 13.7% G, and 40.2% GC content. Protein-coding genes present two start codon (ATG and GUG) and seven stop codon (UAA, AUA, UUU, UUA, AAU, CCU, and UAG). The control region possesses the highest A + T (66.6%) content among all mitochondrial regions. These data would contribute to the evolutionary studies of this genus, where there has been recent reclassification.

Colecistectomía laparoscópica híbrida transumbilical: "un trócar" asistido con imanes y pinza curva. Resolviendo inconvenientes en puerto único. Reporte de 90 casos en Venezuela / Transumbilical hybrid laparoscopic cholecystectomy: "a trocar" assisted with magnets and curved clip. Solving problems in single port. Report of 90 cases in Venezuela

Objetivo: Describir la técnica híbrida de colecistectomía laparoscópica con "trócar" umbilical único y óptica con canal operatorio asistido con imanes y pinza de tracción curva, resaltando las ventajas que permiten vencer inconvenientes frecuentes en el puerto único, presentando nuestra experiencia en 90 casos realizada en los departamentos de Cirugía General de hospitales privados. Métodos: Estudio prospectivo, observacional. Se utiliza solo 1 trócar de 12 mm, introduciéndolo a través de una incisión transumbilical única con una media de 1,5 cm para su desempeño. Se combina el uso de la óptica con canal de trabajo, de la técnica CL1P con la asistencia de dispositivos magnéticos Imanlap para la tracción cefálica del fondo vesicular y un grasper de tracción "curva y rígida" que se introduce por la misma incisión umbilical, para la bolsa de Hartmann, diseñado originalmente para su uso en dispositivos multivalvulares de puerto único. Fueron operados 90 pacientes con la técnica híbrida desde febrero de 2011 hasta el 31 de diciembre de 2013. Se excluyeron casos de coledocolitiasis, cáncer y pacientes con cirugías abdominales previas. Se analizó edad, sexo, índice de masa corporal (IMC), tiempo quirúrgico, estancia hospitalaria, complicaciones, índice de conversión y resultado estético. Resultados: Predominó el sexo femenino (5 a 1). La edad promedio fue de 42 años. El tiempo quirúrgico promedio fue de 48 minutos. El IMC promedio fue 29. Hubo adición de trócares en 8 pacientes (9 %), no hubo conversiones a técnica abierta. El tiempo de hospitalización fue de 24 horas. Sin cicatriz abdominal visible en 82 pacientes en los que se completó el procedimiento por un trócar (91%). La morbilidad fue 3,69 %, mortalidad 0 %. Conclusión: La técnica híbrida es aplicable en el 91% de los pacientes con patología vesicular. La combinación de la técnica híbrida permite superar los inconvenientes atribuidos al puerto único, logrando reproducir por una sola incisión los resultados obtenidos por el abordaje tradicional con menor invasión(AU)

Objective: To describe the hybrid technique of laparoscopic cholecystectomy with "trocar" umbilical single and optical with operative channel assisted with magnets and curve drive clip, highlighting the advantages that allow you to overcome disadvantages in the single port, presenting our experience in 90 cases carried out in the departments of General Surgery of private hospitals. Methods: Prospective, observational study. It was used only 1 trocar of 12 mm, by inserting it through a unique transumbilical incision with an average of 1.5 cm for their performance. Combines the use of optics with working channel, CL1P technique with the assistance of IMANLAP magnetic devices for cephalic traction of the vesicular Fund and a grasper of traction "curve and rigid" introduced by the same umbilical incision, the bag of Hartmann, originally designed for use in multivalvulares single-port devices. 90 patients with the hybrid technique were operated from February 2011 until December 31, 2013. It was excluded cases of choledocholithiasis, cancer and patients with previous abdominal surgery. Age, sex, index of body mass (IMC), surgical time, hospital stay, complications, index of conversion and esthetic result were analyzed. Results: Female predominated (5 to 1). The average age was 42 years. The average surgical time was 48 minutes. The average BMI was 29. Addition of trocars in 8 patients (9%), there were no conversions to open technique. Hospitalization time was 24 hours. No abdominal scar visible in 82 patients that the procedure was completed by a trocar (91%). Morbidity was 3.69%, 0% mortality. Conclusion: The hybrid technique is applicable in 91% of patients with gallbladder disease. The combination of hybrid technique overcomes disadvantages attributed to the single port, managing to reproduce the results obtained by the traditional approach with a less invasion by a single incision(AU)

Transvaginal liver surgery using a tethered magnet and a laparoscopic rein.

INTRODUCTION: A novel technique was used to remove a large liver cyst via culdolaparoscopy. CASE DESCRIPTION: We used laparoscopic instruments, a gastroscope, a laparoscopic rein, and magnets. The magnets consist of an external magnet and a specially modified tethered neodymium internal magnet, safe for use in transvaginal endoscopic surgery. DISCUSSION: These technologies offer some advantages when they are used together: magnets and the rein to aid in exposure, traction-retraction, and triangulation. Previous reports have been published on the removal of benign liver lesions transvaginally, but none to date has involved the use of magnets. This article reports on the role of magnets and reins in an incision reduction approach to the removal of a liver cyst.

Magnetic-assisted single-port sleeve gastrectomy.

BACKGROUND: Sleeve gastrectomy is a recent, purely restrictive procedure in bariatric surgery that has shown results similar to gastric bypass over the short and middle term. At the same time, single-port access surgery has fostered the development of new techniques and methods seeking better cosmetic results and less postoperative pain, while maintaining the satisfactory results obtained by the standard laparoscopic approach. One of the problems associated to single-access surgery is the lack of traction and the difficulties to retract the liver. The authors' aim was to try to avoid additional trocars or sutures in order to perform pure single-incision surgery, using 2 magnetic forceps. METHODS: The authors present the case of a 51-year-old morbidly obese female (body mass index = 44.82) who underwent a pure single-access laparoscopic sleeve gastrectomy with no additional trocars or sutures and assisted by 2 neodymium magnetic forceps: one to retract the liver and the other to retract the stomach in order to provide sufficient triangulation for adequate exposure of the surgical field during dissection. RESULTS: The procedure was completed in 120 minutes. No preoperative or postoperative complications were recorded, and the patient was discharged 2 days after surgery. CONCLUSION: Single-port access sleeve gastrectomy assisted by magnetic forceps is feasible and safe in the hands of experienced laparoscopic surgeons, solving one of the problems associated to this type of surgery, that is, the need for an additional trocar and needles or sutures to retract the liver and stomach in order to perform the operation.

Initial experience with magnet-assisted single trocar appendectomy in children.

BACKGROUND: Single-incision laparoscopic surgery (SILS) is increasingly being used to treat acute appendicitis. Existing SILS techniques suffer from inefficient triangulation and poor ergonomics. In an effort to improve on existing SILS techniques, we developed the magnet-assisted single trocar (MAST) appendectomy. SUBJECTS AND METHODS: We retrospectively analyzed all MAST appendectomies performed between March 2010 and February 2011. Outcomes included demographics, diagnosis, operative time, hospital stay, and complications. RESULTS: Twenty-three MAST appendectomies were performed in 10 boys and 13 girls. The mean age at operation was 12.22 years (range, 5-19 years), and the mean weight was 46.5 kg (range, 25-82 kg). At presentation the mean white blood cell count was 15,000 with 74% polymorphonuclear neutrophils. The mean operative time was 61 minutes (range, 20-105 minutes), and length of stay was 3.6 days (range, 1-7 days). In total, 4 operations (17%) required one additional 5-mm trocar to complete the operation, and none was converted to an open operation. There were no intraoperative complications, nor were there any wound infections. CONCLUSIONS: MAST appendectomy is safe and effective in children. Magnetic instruments provide excellent triangulation and improve ergonomics. This technique uses a single 12-mm trocar and can be performed without the aid of a surgical assistant.

Bladeless direct optical trocar insertion in laparoscopic procedures on the obese patient.

BACKGROUND: Recently, we have shown advantages of a direct optical entry (DOE) using a bladeless trocar in comparison with the open Hasson technique (OHT) in older reproductive-age women with previous operations, as well as in comparison with Veress needle entry in reproductive-age and postmenopausal women. OBJECTIVES: A prospective multicenter randomized study to determine whether the DOE is feasible for establishing safe and rapid entry into the abdomen in comparison with those of the OHT in reproductive-age obese women. METHODS: Two types of surgical techniques were blindly applied in 224 obese reproductive-age women with benign neoplastic diseases of ovary and uterus. Namely, laparoscopic entry into the abdomen in 108 patients was performed by DOE and in 116 women by OHT. Following parameters (entry time in seconds needed to establish the intra-abdominal vision after pneumoperitoneum, blood loss, occurrence of vascular and/or bowel injuries) were compared during surgery as main outcomes. RESULTS: Main baseline characteristics of patients, including age (36.1 ± 4.5 vs 35.7 ± 5.8), body mass index (34.9 ± 5.1 vs 35.1 ± 4.9 kg/m(2)), and parity (2.1 ± 0.4 vs 1.9 ± 0.9), were not significantly different between the DOE and OHT groups (P > .05). While intraoperative parameters such as the entry time (71.9 ± 3.7 vs 215.1 ± 6.2 seconds) and blood loss value (9.7 ± 6.1 vs 12.2 ± 2.9 mL) were significantly reduced in the DOE group in comparison with those of OHT group (respectively, P < .0001 and < .01), there were also trends to slight decrease of the occurrence of the minor injuries, manifested as omental small vessels rupture (0 of 108 vs 4 of 116) and punctures and pinches of jejunal serosa (0 of 108 vs 3 of 116) in patients of the DOE group in comparison with those of OHT group (respectively, P = .0515 and = .0925). CONCLUSIONS: DOE reduced entry time and blood loss with trends to slightly decrease of the occurrence of the minor vascular and bowel injuries, thus enabling a possible alternative to OHT in obese women; however, further larger trials need to confirm the possible additional benefits of a DOE.

Surgical management of neurovascular bundle in uterine fibroid pseudocapsule.

The uterine fibroid pseudocapsule is a fibro-neurovascular structure surrounding a leiomyoma, separating it from normal peripheral myometrium. The fibroid pseudocapsule is composed of a neurovascular network rich in neurofibers similar to the neurovascular bundle surrounding a prostate. The nerve-sparing radical prostatectomy has several intriguing parallels to myomectomy. It may serve either as a useful model in modern fibroid surgical removal, or it may accelerate our understanding of the role of the fibrovascular bundle and neurotransmitters in the healing and restoration of reproductive potential after intracapsular myomectomy. Surgical innovations, such as laparoscopic or robotic myomectomy applied to the intracapsular technique with magnification of the fibroid pseudocapsule surrounding a leiomyoma, originated from the radical prostatectomy method that highlighted a careful dissection of the neurovascular bundle to preserve sexual functioning after prostatectomy. Gentle uterine leiomyoma detachment from the pseudocapsule neurovascular bundle has allowed a reduction in uterine bleeding and uterine musculature trauma with sparing of the pseudocapsule neuropeptide fibers. This technique has had a favorable impact on functionality in reproduction and has improved fertility outcomes. Further research should determine the role of the myoma pseudocapsule neurovascular bundle in the formation, growth, and pathophysiological consequences of fibroids, including pain, infertility, and reproductive outcomes.