Parkinson's disease patients show delayed hemodynamic changes in primary motor cortex in fine motor tasks and decreased resting-state interhemispheric functional connectivity: a functional near-infrared spectroscopy study.

Significance: People with Parkinson's disease (PD) experience changes in fine motor skills, which is viewed as one of the hallmark signs of this disease. Due to its non-invasive nature and portability, functional near-infrared spectroscopy (fNIRS) is a promising tool for assessing changes related to fine motor skills. Aim: We aim to compare activation patterns in the primary motor cortex using fNIRS, comparing volunteers with PD and sex- and age-matched control participants during a fine motor task and walking. Moreover, inter and intrahemispheric functional connectivity (FC) was investigated during the resting state. Approach: We used fNIRS to measure the hemodynamic changes in the primary motor cortex elicited by a finger-tapping task in 20 PD patients and 20 controls matched for age, sex, education, and body mass index. In addition, a two-minute walking task was carried out. Resting-state FC was also assessed. Results: Patients with PD showed delayed hypoactivation in the motor cortex during the fine motor task with the dominant hand and delayed hyperactivation with the non-dominant hand. The findings also revealed significant correlations among various measures of hemodynamic activity in the motor cortex using fNIRS and different cognitive and clinical variables. There were no significant differences between patients with PD and controls during the walking task. However, there were significant differences in interhemispheric connectivity between PD patients and control participants, with a statistically significant decrease in PD patients compared with control participants. Conclusions: Decreased interhemispheric FC and delayed activity in the primary motor cortex elicited by a fine motor task may one day serve as one of the many potential neuroimaging biomarkers for diagnosing PD.

Sorption Behavior of Azo Dye Congo Red onto Activated Biochar from Haematoxylum campechianum Waste: Gradient Boosting Machine Learning-Assisted Bayesian Optimization for Improved Adsorption Process.

This work aimed to describe the adsorption behavior of Congo red (CR) onto activated biochar material prepared from Haematoxylum campechianum waste (ABHC). The carbon precursor was soaked with phosphoric acid, followed by pyrolysis to convert the precursor into activated biochar. The surface morphology of the adsorbent (before and after dye adsorption) was characterized by scanning electron microscopy (SEM/EDS), BET method, X-ray powder diffraction (XRD), and Fourier-transform infrared spectroscopy (FTIR) and, lastly, pHpzc was also determined. Batch studies were carried out in the following intervals of pH = 4-10, temperature = 300.15-330.15 K, the dose of adsorbent = 1-10 g/L, and isotherms evaluated the adsorption process to determine the maximum adsorption capacity (Qmax, mg/g). Kinetic studies were performed starting from two different initial concentrations (25 and 50 mg/L) and at a maximum contact time of 48 h. The reusability potential of activated biochar was evaluated by adsorption-desorption cycles. The maximum adsorption capacity obtained with the Langmuir adsorption isotherm model was 114.8 mg/g at 300.15 K, pH = 5.4, and a dose of activated biochar of 1.0 g/L. This study also highlights the application of advanced machine learning techniques to optimize a chemical removal process. Leveraging a comprehensive dataset, a Gradient Boosting regression model was developed and fine-tuned using Bayesian optimization within a Python programming environment. The optimization algorithm efficiently navigated the input space to maximize the removal percentage, resulting in a predicted efficiency of approximately 90.47% under optimal conditions. These findings offer promising insights for enhancing efficiency in similar removal processes, showcasing the potential of machine learning in process optimization and environmental remediation.

Fatty Acid-Binding Proteins Identification during the Evolution of Metabolic Syndrome: A Raman Spectroscopy-Based Approach.

Excess fat in abdominal deposits is a risk factor for multiple conditions, including metabolic syndrome (MetS); lipid metabolism plays an essential role in these pathologies; fatty acid-binding proteins (FABPs) are dedicated to the cytosolic transport of fat. FABP4, whose primary source is adipose tissue, is released into the circulation, acting as an adipokine, while FABP5 also accompanies the adverse effects of MetS. FABP4 and 5 are potential biomarkers of MetS, but their behavior during syndrome evolution has not been determined. Raman spectroscopy has been applied as an alternative method to disease biomarker detection. In this work, we detected spectral changes related to FABP4 and 5 in the serum at different points of time, using an animal model of a high-fat diet-induced MetS. FABP4 and 5 spectral changes show a contribution during the evolution of MetS, which indicates alteration to a molecular level that predisposes to established MetS. These findings place FABPs as potential biomarkers of MetS and Raman spectroscopy as an alternative method for MetS assessment.

Response to Comment on "Feasibility of Raman spectroscopy as a potential in vivo tool to screen for pre-diabetes and diabetes".

This letter aims to reply to Bratchenko and Bratchenko's comment on our paper "Feasibility of Raman spectroscopy as a potential in vivo tool to screen for pre-diabetes and diabetes." Our paper analyzed the feasibility of using in vivo Raman measurements combined with machine learning techniques to screen diabetic and prediabetic patients. We argued that this approach yields high overall accuracy (94.3%) while retaining a good capacity to distinguish between diabetic (area under the receiver-operating curve [AUC] = 0.86) and control classes (AUC = 0.97) and a moderate performance for the prediabetic class (AUC = 0.76). Bratchenko and Bratchenko's comment focuses on the possible overestimation of the proposed classification models and the absence of information on the age of participants. In this reply, we address their main concerns regarding our previous manuscript.

Feasibility of Raman spectroscopy as a potential in vivo tool to screen for pre-diabetes and diabetes.

In this article, we investigated the feasibility of using Raman spectroscopy and multivariate analysis method to noninvasively screen for prediabetes and diabetes in vivo. Raman measurements were performed on the skin from 56 patients with diabetes, 19 prediabetic patients and 32 healthy volunteers. These spectra were collected along with reference values provided by the standard glycated hemoglobin (HbA1c) assay. A multiclass principal component analysis and support vector machine (PCA-SVM) model was created from the labeled Raman spectra and was validated through a two-layer cross-validation scheme. Classification accuracy of the model was 94.3% with an area under the receiver operating characteristic curve AUC of 0.76 (0.65-0.84) for the prediabetic group, 0.86 (0.71-0.93) for the diabetic group and 0.97(0.93-0.99) for the control group. Our results suggest the feasibility of using Raman spectroscopy for the classification of prediabetes and diabetes in vivo.

Raman Spectroscopy Study of Skin Biopsies from Patients with Parkinson's Disease: Trends in Alpha-Synuclein Aggregation from the Amide I Region.

Parkinson's disease (PD) is one of the most common neurological pathologies with a high prevalence worldwide. PD is characterized by Lewy bodies, whose major component is the aggregates of α-synuclein (αSyn) protein. Interestingly, recent works have demonstrated that skin biopsy studies are a promising diagnostic tool for evaluating α-synucleinopathies. In this sense, this work focuses on the detection of αSyn in skin biopsies employing Raman spectroscopy, using three different approaches: (i) the in vitro Raman spectrum of α-synuclein, (ii) the ex vivo Raman spectra of human skin biopsies from healthy and Parkinson's disease patients, and (iii) theoretical calculations of the Raman spectra obtained from different model αSyn fragments using density functional theory (DFT). Significant differences in the intensity and location of Raman active frequencies in the amide I region were found when comparing healthy and PD subjects related to α-synuclein conformational changes and variations in their aggregation behavior. In samples from healthy patients, we identified well-known Raman peaks at 1655, 1664, and 1680 cm-1 associated with the normal state of the protein. In PD subjects, shifted Raman bands and intensity variations were found at 1650, 1670, and 1687 cm-1 associated with aggregated forms of the protein. DFT calculations reveal that the shape of the amide I Raman peak in model αSyn fragments strongly depends on the degree of aggregation. Sizable frequency shifts and intensity variations are found within the highly relevant 1600-1700 cm-1 domain, revealing the sensitivity of the amide I Raman band to the changes in the local atomic environment. Interestingly, we obtain that the presence of surrounding waters also affects the structure of the amide I band, leading to the appearance of new peaks on the low-frequency side and a notable broadening of the Raman spectra. These results strongly suggest that, through Raman spectroscopy, it is possible to infer the presence of aggregated forms of αSyn in skin biopsies, a result that could have important implications for understanding α-synuclein related diseases.

Co-Inoculation with Staphylococcus equorum and Lactobacillus sakei Reduces Vasoactive Biogenic Amines in Traditional Dry-Cured Sausages.

Dry-cured sausages are traditional in Mediterranean countries, and Paio do Alentejo (PA) is one of the most popular in South Portugal. The aim of the present work was to evaluate the effect of combined starters on the safety and quality of PA preserving its sensory quality. Physicochemical parameters, namely pH and water activity (aW), microbiological parameters, biogenic amines, color, texture, and sensory attributes were assessed. Three starter cultures were used, namely Staphylococcus equorum S2M7 and Lactobacillus sakei CV3C2, both separate and combined with the 2RB4 yeast strain at a concentration of 106 cfu/g. Dextrose 0.25% was added to the meat batter. Starters had a significant effect on the reduction of aW values (0.845 to 0.823). The treatment with L. sakei as well as the co-inoculation of L. sakei with S. equorum effectively reduced the L. monocytogenes counts to undetectable levels. Sausages co-inoculated with S. equorum S2M7/L. sakei CV3C2 showed a significant reduction in the content of vasoactive amines, namely tryptamine (26.21 to 15.70) and ß-phenylethylamine (4.80 to 3.69). Regarding texture, control PA showed higher hardness values, and the starters promoted the cohesiveness of the batter while reducing chewiness. The studied starters did not compromise the sensory characteristics of PA.

Raman Spectroscopy for Adipose Tissue Assessment in Rat Models of Obesity and Type 1 Diabetes.

Adipose tissue presents structural and functional changes in obesity and type 1 diabetes mellitus (T1DM). In obesity, the size and number of adipocytes and adipokine secretion increases. In T1DM, a loss of adipose tissue suggests changes in the metabolic activity of this tissue. A significant challenge is to find alternative noninvasive methods to evaluate molecular changes in adipose tissue related to obesity and T1DM. Recently, Raman spectroscopy and chemometrics techniques have emerged as a tool for biological tissue analysis. In this work, we propose the use of Raman spectroscopy to characterize spectral differences in adipose tissue from different rat groups (control, obese, and T1DM). The Raman spectra were analyzed using direct band analysis, ratiometric analysis, and chemometric methods (principal component analysis (PCA) and support vector machines (SVMs)). We found that the Raman spectra of obese rats showed significant spectral differences compared to control and diabetic groups related to fatty acids Raman bands. Also, the obese group has a significant decrease in the degree of unsaturation of lipids. The PCA-SVM models showed classification performance ranging from 71.43% to 71.79% accuracy for brown and white adipose tissue samples, respectively. In conclusion, the results demonstrate that Raman spectroscopy can be used as a nondestructive method to assess adipose tissue according to a metabolic condition.

Impact of a 25% Salt Reduction on the Microbial Load, Texture, and Sensory Attributes of a Traditional Dry-Cured Sausage.

Catalão is a Portuguese dry-cured traditional sausage, highly appreciated for its distinctive sensory properties. The aim of this study was to evaluate the impact of a 25% salt reduction on Catalão manufactured with either purebred Alentejano (Al) or crossbred Iberian × Duroc (IDr) pork meat, on its physicochemical and microbiological stability, texture parameters, and sensory attributes. No significant effect of salt reduction or genotype was observed for pH, aW, and microbiological parameters. PUFA content was significantly higher for Al Catalão, particularly due to the content in linoleic and linolenic fatty acids. IDr 3% NaCl samples had the highest mean n6/n3 PUFA ratio, and the highest mean values for the atherogenicity and thrombogenicity indices, showing that both genotype and salt content influence these nutritional indices. Texture profile of Catalão was significantly influenced by salt content and genotype. Al samples were less adhesive, cohesive, and easier to chew. Low-salt Catalão was harder, more adhesive, and less cohesive, with lower resilience and higher chewiness values. Regarding sensory attributes, salt content influenced the product aroma, with reduced-salt sausages being evaluated as significantly less aromatic. Overall, a 25% salt reduction did not have a significant impact on the quality, stability, and sensory evaluation of Catalão.

Autochthonous Starter Cultures Are Able to Reduce Biogenic Amines in a Traditional Portuguese Smoked Fermented Sausage.

Traditional smoked fermented sausages are highly appreciated in Portugal and are mostly manufactured according to traditional procedures. The aim of the present work was to evaluate the effect of autochthonous starter cultures on the safety and quality of a smoked fermented sausage, Painho da Beira Baixa (PBB), preserving its sensory quality. Physicochemical parameters, namely pH and water activity (aW), microbiological parameters, biogenic amines, colour, texture profile and sensory attributes were assessed. Different starters were selected based on our previous work. Staphylococcus equorum S2M7, Staphylococcus xylosus CECT7057, Lactobacillus sakei CV3C2, Lactobacillus sakei CECT7056 and a yeast strain (2RB4) were co-inoculated in meat batters at defined concentrations. Starters had a significant effect on the reduction of pH. Enterobacteria and Listeria monocytogenes were not detected in inoculated end-product sausages. Moreover, sausages inoculated with S. equorum S2M7/L. sakei CV3C2/yeast 2RB4 showed a significant reduction in the total content of biogenic amines. No significant differences between treatments were observed for colour and texture parameters, except for adhesiveness. The studied starters did not compromise the sensory characteristics of PBB. To our knowledge, this is the first comprehensive study on the quality and safety of this type of smoked fermented sausage from the central region of Portugal.

Dry-Cured Meat Products According to the Smoking Regime: Process Optimization to Control Polycyclic Aromatic Hydrocarbons.

The manufacturing of dry-cured meat products usually includes a smoking step. Polycyclic aromatic hydrocarbons (PAHs) are potentially carcinogenic chemical compounds that may result from smoking. The aim of the present study was to optimize the smoking regime of traditional dry-cured meat products in order to minimize the presence of PAHs. Dry-cured sausages were submitted to different smoking regimes: (A) no smoking; (B) 20 h effective smoking; (C) 60 h effective smoking; (D) effective smoking until reaching 38%-40% weight losses. Three independent batches were produced per smoking regime, and three samples per batch were analyzed. Microbiological, physicochemical, and sensory analyses were performed. The total PAHs content was generally low and did not differ significantly in meat products submitted to the four different smoking regimes. The PAH4 and benzo(α)pyrene levels were below the established legal limits in all analyzed dry-cured sausages. Nevertheless, non-smoked sausages always showed lower PAHs values for all PAHs groups.

Use of Raman spectroscopy to screen diabetes mellitus with machine learning tools: reply to comment.

We show the spectra of advanced glycation products in response to recent comments made by Bratchenko et al. Our results suggest that information retrieved by Raman spectroscopy is relevant to screening diabetic patients, however, the comparison carried out in our paper, between ANN and SVM, was not fair, because of the erroneous PCA selection procedure and different sources of variation present in the analysis.

What is the Main Processing Factor Influencing Staphylococcus Species Diversity in Different Manufacturing Units?

The microbiota of traditional dry-cured sausages and industrial environment was assessed to characterize the diversity of coagulase-negative staphylococci (CNS), and establish potential relationships with hygiene level or technological characteristics. Eight processing units from South Portugal were audited according to a checklist of requirements. Environmental and products' samples at different production stages were evaluated regarding hygiene and safety criteria. CNS were recovered, characterized, and their potential use as starters evaluated. Low genetic diversity was observed for Staphylococcus xylosus, whereas Staphylococcus equorum showed diverse genetic profiles. Staphylococcus xylosus predominated in products with a long period of cold smoking, Staphylococcus saprophyticus in products with a long period of hot smoking, Staphylococcus epidermidis in products with a short period of cold smoking, and S. equorum in nonsmoked products. Most S. xylosus were resistant to tetracycline, whereas S. equorum were susceptible. Antibioresistance restricted the selection of starters due to safety recommendations. PRACTICAL APPLICATION: The present manuscript highlighted a few staphylococci strains that could potentially be used as starter cultures in fermented meat products. These selected strains do not show resistance to antimicrobials, exhibit adequate technological features, and are well adapted to the industrial environments of meat processing industries using different processing technologies. Therefore, the selected strains ready to be used in the manufacturing of traditional fermented meat products to ensure safety, standardize product properties, and shorten ripening.

Improved Vancouver Raman Algorithm Based on Empirical Mode Decomposition for Denoising Biological Samples.

A novel method based on the Vancouver Raman algorithm (VRA) and empirical mode decomposition (EMD) for denoising Raman spectra of biological samples is presented. The VRA is one of the most used methods for denoising Raman spectroscopy and is composed of two main steps: signal filtering and polynomial fitting. However, the signal filtering step consists in a simple mean filter that could eliminate spectrum peaks with small intensities or merge relatively close spectrum peaks into one single peak. Thus, the result is often sensitive to the order of the mean filter, so the user must choose it carefully to obtain the expected result; this introduces subjectivity in the process. To overcome these disadvantages, we propose a new algorithm, namely the modified-VRA (mVRA) with the following improvements: (1) to replace the mean filter step by EMD as an adaptive parameter-free signal processing method; and (2) to automate the selection of polynomial degree. The denoising capabilities of VRA, EMD, and mVRA were compared in Raman spectra of artificial data based on Teflon material, synthetic material obtained from vitamin E and paracetamol, and biological material of human nails and mouse brain. The correlation coefficient (ρ) was used to compare the performance of the methods. For the artificial Raman spectra, the denoised signal obtained by mVRA (ρ>0.91) outperforms VRA (ρ>0.86) for moderate to high noise levels whereas mVRA outperformed EMD (ρ>0.90) for high noise levels. On the other hand, when it comes to modeling the underlying fluorescence signal of the samples (i.e., the baseline trend), the proposed method mVRA showed consistent results (ρ>0.94). For Raman spectra of synthetic material, good performance of the three methods (ρ=0.99 for VRA, ρ=0.93 for EMD, and ρ=0.99 for mVRA) was obtained. Finally, in the biological material, mVRA and VRA showed similar results (ρ=0.96 for VRA, ρ=0.85 for EMD, and ρ=0.91 for mVRA); however, mVRA retains valuable information corresponding to relevant Raman peaks with small amplitude. Thus, the application of EMD as a filter in the VRA method provides a good alternative for denoising biological Raman spectra, since the information of the Raman peaks is conserved and parameter tuning is not required. Simultaneously, EMD allows the baseline correction to be automated.

Use of Raman spectroscopy in the assessment of skin after CO2 ablative fractional laser surgery on acne scars.

BACKGROUND: Ablative fractional laser surgery is a common technique for treating acne scars. However, an in vivo and noninvasive analysis of the histologic variations between acne skin and the resulting resurfaced skin is needed in order to evaluate the wound healing process of the scars induced by the ablative fractional laser surgery. MATERIALS AND METHODS: Nine patients with acne scars underwent a single treatment with a CO2 ablative fractional laser surgery. Collagen presence on the resurfaced skin was noninvasively assessed by means of Raman spectroscopy and principal component analysis. RESULTS: Principal component analysis shows that all the patients presented a collagen regeneration on the resurfaced skin after the laser treatment. CONCLUSION: Collagen plays a crucial role in the wound healing process. By assessing the collagen presence on the skin, it was possible to quantify the regenerative effects of the ablative fractional laser in a noninvasive way.

Role of Starter Cultures on the Safety of Fermented Meat Products.

Starters are microbial cultures used to promote and conduct the fermentation of meat products. Bacteria, particularly lactic acid bacteria (LAB) and coagulase-negative staphylococci (CNS), as well as yeasts and molds, may be used as starters. They can increase the safety of fermented meat products by means of rapid matrix acidification or due to the production of antimicrobial substances, such as bacteriocins. Besides, starters may help to standardize product properties and shorten ripening times. Safety of fermented meat products may be jeopardized by microbiological, namely foodborne pathogens (Salmonella spp., Listeria spp., etc), and chemical hazards, particularly biogenic amines, nitrosamines, polycyclic aromatic hydrocarbons (PAH), and mycotoxins. Biogenic amines (BA) are potentially unsafe nitrogenous compounds that result from the decarboxylation of some amino acids. Some microorganisms may be responsible for their formation. Starters can cause a fast pH decrease, inhibiting the development of microorganisms with amino acid decarboxylative ability, thus preventing the accumulation of BA in fermented meat products. Besides, starters can compete with the autochthonous, non-starter microbiota throughout ripening and storage, thus reducing BA production. Some strains of Lactobacillus sakei and Lactobacillus plantarum have been shown to reduce the formation/accumulation of BA. On the other hand, Staphylococcus xylosus and Debaryomyces hansenii strains have been reported to degrade BA in food. PAH are organic compounds containing multiple aromatic rings and produced by the incomplete combustion of organic matter, such as the wood used for smoking meat. Mixed starters containing Lactobacillus spp., Gram-positive catalase-positive cocci and yeasts have been used in the manufacturing of traditional meat sausages. However, the effect of starters on reducing the accumulation of PAH is poorly understood. Starters may also be engaged in competitive exclusion, outcompeting the spoiling or deteriorating autochthonous microbiota. For example, Pediococcus acidilactici has been shown to inhibit Listeria monocytogenes in meat products. Additionally, the role of molds, such as Penicillium nalgiovense, in the competitive exclusion of undesired filamentous fungi, has also been demonstrated. Most of these undesired fungi produce mycotoxins, secondary metabolites capable of causing disease. The current review addresses the role of starters on the microbiological and chemical safety of fermented meat products.

Use of Raman spectroscopy to screen diabetes mellitus with machine learning tools.

Type 2 diabetes mellitus (DM2) is one of the most widely prevalent diseases worldwide and is currently screened by invasive techniques based on enzymatic assays that measure plasma glucose concentration in a laboratory setting. A promising plan of action for screening DM2 is to identify molecular signatures in a non-invasive fashion. This work describes the application of portable Raman spectroscopy coupled with several supervised machine-learning techniques, to discern between diabetic patients and healthy controls (Ctrl), with a high degree of accuracy. Using artificial neural networks (ANN), we accurately discriminated between DM2 and Ctrl groups with 88.9-90.9% accuracy, depending on the sampling site. In order to compare the ANN performance to more traditional methods used in spectroscopy, principal component analysis (PCA) was carried out. A subset of features from PCA was used to generate a support vector machine (SVM) model, albeit with decreased accuracy (76.0-82.5%). The 10-fold cross-validation model was performed to validate both classifiers. This technique is relatively low-cost, harmless, simple and comfortable for the patient, yielding rapid diagnosis. Furthermore, the performance of the ANN-based method was better than the typical performance of the invasive measurement of capillary blood glucose. These characteristics make our method a promising screening tool for identifying DM2 in a non-invasive and automated fashion.

A Semi-Pilot Photocatalytic Rotating Reactor (RFR) with Supported TiO2/Ag Catalysts for Water Treatment.

A four stage semi-pilot scale RFR reactor with ceramic disks as support for TiO2 modified with silver particles was developed for the removal of organic pollutants. The design presented in this article is an adaptation of the rotating biological reactors (RBR) and its coupling with the modified catalyst provides additional advantages to designs where a catalyst in suspension is used. The optimal parameter of rotation was 54 rpm and the submerged surface of the disks offer a total contact area of 387 M². The modified solid showed a decrease in the value of its bandgap compared to commercial titanium. The system has a semi-automatic operation with a maximum reaction time of 50 h. Photo-activity tests show high conversion rates at low concentrations. The results conform to the Langmuir heterogeneous catalysis model.

Evaluation of liver fibrosis using Raman spectroscopy and infrared thermography: A pilot study.

Liver fibrosis is a pathological process that can escalate to cirrhosis and then liver failure, a major public health concern that affect hundreds of millions of people in both developed and developing countries. Detection of liver fibrosis during its earlier stages is a matter of great importance which may allow prevention of development of cirrhosis in patients with chronic liver disease. In this work, Raman spectroscopy and thermography were evaluated to detect early pathological signs of liver fibrosis in rats in which liver fibrosis was induced using carbon tetrachloride. Results show that Raman spectra of healthy and fibrotic livers significantly differ among each other and can be classified by principal component analysis and discriminant analysis. The PCA-LDA method has a sensitivity of 100%, specificity 85% and diagnostic accuracy of 93.5%. Thermography also revealed characteristic temperature patterns for fibrotic livers compared to healthy livers. Current data suggest that Raman spectroscopy and thermography could be used to detect fibrosis in ex vivo liver samples.

Manejo del reflujo gastroesofágico en niños. Funduplicatura de Nissen convencional y por laparoscopia en los últimos 15 años en un centro especializado / Management of gastroesophageal reflux in children. Single centre experience in conventional and laparoscopic Nissen fundoplication in the last 15 years

INTRODUCCIÓN: La funduplicatura de Nissen (FN) es la técnica más utilizada y con mejores resultados para tratar el reflujo gastroesofágico en niños. El abordaje laparoscópico (FNL) es seguro, con baja morbilidad y alta tasa de éxito, aunque algunos casos precisan abordaje convencional (FNC) o abierto. Nuestro objetivo es comparar los resultados entre la FNC y la FNL en nuestro centro. MATERIAL Y MÉTODOS: Estudio retrospectivo de los pacientes < 14 años sometidos a FN entre 2000 y 2015. Comparamos ambos abordajes: complicaciones, estancia hospitalaria y seguimiento. RESULTADOS: Se realizaron 75 FN; 49 (65,3%) FNL, 23 (30,7%) FNC y 3 (4,0%) reconversiones. Se asoció gastrostomía por laparoscopia en el 10,7% y abierta en el 5,3%. El 10,7% portaban gastrostomía previamente a la FN. La edad media fue de 4 a˜nos, y el 68,7% fueron varones. El 36% presentaron algún grado de encefalopatía, el 14,7% hernia hiatal, el 5,4% antecedente de atresia esofágica intervenida y el 5,4% al menos un episodio aparentemente letal. No encontramos diferencias significativas en la duración de la intervención entre ambos abordajes. El 36% presentaron complicaciones, más frecuente en la FNC: OR = 3,30 (IC 95%: 1,1-9,6). La estancia disminuyó en 9 días en la FNL (IC 95%: 5,5-13,5). El seguimiento medio fue de 26 meses (IC 95%: 20,9-31,6), con 10,7% fallecimientos (5 insuficiencias respiratorias, una muerte súbita y 2 por su encefalopatía); el 4,2% precisaron nueva funduplicatura, el 15,8% mostraron mejoría sintomática y el 64,0%, ausencia de síntomas. CONCLUSIONES: La FNL es una técnica adecuada para el tratamiento del reflujo gastroesofágico, con menor morbilidad y menor estancia que la FNC, por lo que se recomienda como primera opción terapéutica

INTRODUCTION: Nissen fundoplication (NF) is the most used and effective technique for the treatment of gastroesophageal reflux in children. The laparoscopic approach (LNF) is safe, with low morbidity and high success rate, although some cases require a conventional approach (CNF). The aim of the study is to compare the results between LNF and CNF in our centre. MATERIAL AND METHODS: A retrospective review was performed on patients < 14 years after NF between 2000 and 2015. A comparison was made of the complications, hospital stay, and followup for both approaches. RESULTS: Of the total 75 NF performed, 49 (65.3%) were LNF, 23 (30.7%) CNF, and 3 (4.0%) reconversions. Concomitant laparoscopic gastrostomy was performed in 10.7%, and open gastrostomy in 5.3% of cases. Prior to NF, 10.7% had a gastrostomy. The mean age was 4 years and 68.7% were male. Of the diagnoses, 36% had encephalopathy, 14.7% hiatal hernia, 5.4% oesophageal atresia, and 5.4% an acute life-threatening event. No differences were found in operation time. More than two-thirds (36%) had complications, which were more frequent in the CNF (OR = 3.30, 95% CI: 1.1-9.6). The hospital-stay decreased by 9 days in the LNF (95% CI: 5.5-13.5). Mean follow-up was 26 months (95% CI: 20.9-31.6). Mortality during follow-up was of 5.3% (5 respiratory failure, 1 sudden cardiac death, and 2 due to complications of the encephalopathy), 4.2% required re-fundoplication, 15.8% had symptomatic improvement, and 64.0% had absence of symptoms. CONCLUSIONS: The LNF is an effective technique for the treatment of gastroesophageal reflux, with lower morbidity and shorter hospital stay than CNF. It is recommended as the first surgical option