A fuzzy description logic based IoT framework: Formal verification and end user programming.

The Internet of Things (IoT) has become one of the most popular technologies in recent years. Advances in computing capabilities, hardware accessibility, and wireless connectivity make possible communication between people, processes, and devices for all kinds of applications and industries. However, the deployment of this technology is confined almost entirely to tech companies, leaving end users with only access to specific functionalities. This paper presents a framework that allows users with no technical knowledge to build their own IoT applications according to their needs. To this end, a framework consisting of two building blocks is presented. A friendly interface block lets users tell the system what to do using simple operating rules such as "if the temperature is cold, turn on the heater." On the other hand, a fuzzy logic reasoner block built by experts translates the ambiguity of human language to specific actions to the actuators, such as "call the police." The proposed system can also detect and inform the user if the inserted rules have inconsistencies in real time. Moreover, a formal model is introduced, based on fuzzy description logic, for the consistency of IoT systems. Finally, this paper presents various experiments using a fuzzy logic reasoner to show the viability of the proposed framework using a smart-home IoT security system as an example.

Efficacy and Safety of Taulinoplasty Compared with the Minimally Invasive Repair of Pectus Excavatum Approach to Correct Pectus Excavatum.

Background: Minimally invasive repair of pectus excavatum (MIRPE) technique is the current most used surgical method for pectus excavatum (PE) correction. To avoid MIRPE-required invasion of the mediastinum or pleural cavity, we developed taulinoplasty approach as an alternative option for the reduction of the sunken chest. Materials and Methods: This is a single-center unblind nonrandomized prospective pilot study, involving 26 MIRPE and 23 taulinoplasty patients. The primary safety endpoint was the presence of surgical complications, and the primary efficacy endpoint was Haller index measured postoperatively in taulinoplasty patients. Secondary endpoints were intensive care unit (ICU) and hospital length of stay (LOS), duration of surgical procedure, and postoperative pain management. Chi-square, Mann-Whitney, or Student "t" tests were used for comparison as appropriate. Results: There were no difference in median age (14.5 and 14 years), Haller index (4.63 and 4.17), or comorbidities. MIRPE and taulinoplasty procedures showed no difference regarding major or minor surgical complications. The efficacy endpoint of taulinoplasty was measured 5.5 (1.5-12) months after the procedure, exhibiting a significant reduction in the Haller index [4.17 (3.7-4.7) at baseline and 3.7 (2.9-4.1) postoperatively, P = .03]. Taulinoplasty required less surgical time (60.4 ± 15.5 versus 70.7 ± 15.9 minutes, P < .01); shorter ICU and hospital LOS (P < .01, respectively); and required fewer days of peridural, intravenous, and oral analgesia (P < .01, respectively). Conclusions: In this pilot study, taulinoplasty technique was as safe as the MIRPE approach and effective for the correction of PE, reducing surgical time, ICU and hospital LOS, and achieving better postoperative pain control.

Arterial tortuosity syndrome: relevance in pediatric surgery. A case report. / El síndrome de tortuosidad arterial y su relevancia en cirugía pediátrica. A propósito de un caso.

INTRODUCTION: Arterial tortuosity syndrome (ATS) is an extremely rare autosomal recessive disorder of the connective tissue. It is characterized by tortuosity and elongation of medium and large arteries, with multiple disorders associated with the widespread involvement of the connective tissue. CASE REPORT: Newborn diagnosed with ATS, with multiple vascular malformations, hiatal hernia, and bilateral inguinal hernia. He underwent surgery at three months of age. The hiatal hernia was closed, and bilateral inguinal hernia repair was performed. The inguinal hernias required up to 4 surgeries as a result of recurrences.During follow-up, the patient had retrocardiac diaphragmatic hernia. It was operated on, with subsequent incisional hernia. 8 years later, he was admitted as a result of septic shock secondary to intestinal occlusion. Emergency surgery was scheduled, demonstrating gastric herniation in the right pleural cavity, with perforation of the fundus. The patient died at the ICU 24 hours later. DISCUSSION: The pediatric surgeon should be familiar with ATS, since it may cause multiple surgical pathologies, it is difficult to manage, and it is associated with a high risk of recurrence and complications.

INTRODUCCION: El síndrome de tortuosidad arterial (STA) es un trastorno autosómico recesivo del tejido conectivo muy infrecuente, caracterizado por tortuosidad y elongación de arterias de medio y gran calibre y múltiples trastornos derivados de la afectación generalizada del tejido conectivo. CASO CLINICO: Neonato diagnosticado de STA, con múltiples malformaciones vasculares, hernia de hiato y hernia inguinal bilateral. Intervenido a los tres meses, practicándose cierre de hernia de hiato y herniorrafia inguinal bilateral. Estas últimas requirieron hasta cuatro intervenciones por recidiva. Durante el seguimiento presentó hernia diafragmática retrocardiaca, siendo intervenida, con posterior eventración. A los ocho años ingresó por shock séptico secundario a oclusión intestinal. Se intervino urgente objetivando herniación gástrica en cavidad pleural derecha con perforación en fundus. El paciente falleció en la UCI tras 24 horas. COMENTARIOS: El cirujano pediátrico debe conocer el STA debido a la múltiple patología quirúrgica que puede presentar, difícil manejo, riesgo de recidiva y complicaciones.

El síndrome de tortuosidad arterial y su relevancia en cirugía pediátrica. A propósito de un caso / Arterial tortuosity syndrome: relevance in pediatric surgery. A case report

Introducción: El síndrome de tortuosidad arterial (STA) es untrastorno autosómico recesivo del tejido conectivo muy infrecuente,caracterizado por tortuosidad y elongación de arterias de medio y grancalibre y múltiples trastornos derivados de la afectación generalizadadel tejido conectivo. Caso clínico: Neonato diagnosticado de STA, con múltiples malfor-maciones vasculares, hernia de hiato y hernia inguinal bilateral.Intervenido a los tres meses, practicándose cierre de hernia de hiatoy herniorrafia inguinal bilateral. Estas últimas requirieron hasta cuatrointervenciones por recidiva. Durante el seguimiento presentó hernia diafragmática retrocardiaca,siendo intervenida, con posterior eventración.A los ocho años ingresó por shock séptico secundario a oclusiónintestinal. Se intervino urgente objetivando herniación gástrica en ca-vidad pleural derecha con perforación en fundus. El paciente fallecióen la UCI tras 24 horas. Comentarios: El cirujano pediátrico debe conocer el STA debidoa la múltiple patología quirúrgica que puede presentar, difícil manejo,riesgo de recidiva y complicaciones.(AU)

Introduction: Arterial tortuosity syndrome (ATS) is an extremelyrare autosomal recessive disorder of the connective tissue. It is charac-terized by tortuosity and elongation of medium and large arteries, withmultiple disorders associated with the widespread involvement of theconnective tissue. Clinical case: Newborn diagnosed with ATS, with multiple vascularmalformations, hiatal hernia, and bilateral inguinal hernia. He underwent surgery at three months of age. The hiatal hernia wasclosed, and bilateral inguinal hernia repair was performed. The inguinalhernias required up to 4 surgeries as a result of recurrences.During follow-up, the patient had retrocardiac diaphragmatic hernia.It was operated on, with subsequent incisional hernia.8 years later, he was admitted as a result of septic shock secondaryto intestinal occlusion. Emergency surgery was scheduled, demonstrating gastric herniation in the right pleural cavity, with perforation of thefundus. The patient died at the ICU 24 hours later. Discussion: The pediatric surgeon should be familiar with ATS,since it may cause multiple surgical pathologies, it is difficult to manage,and it is associated with a high risk of recurrence and complications.(AU)

Polyorchidism in pediatric patients: a case report and a literature review. / Poliorquidismo en la edad pediátrica: a propósito de un caso y revisión de la literatura.

Polyorchidism or testicular duplication is defined as the histologically confirmed presence of more than two testes. This is the case of a full left testicular duplication in an 11-year-old patient presenting with occasional pain in the left hemiscrotum. At physical exploration, a palpable scrotal mass was detected. An ultrasonography was performed, which revealed the presence of testicular duplicity. Diagnostic suspicion was confirmed by means of a nuclear MRI and a histopathological study following excision. Polyorchidism is a rare abnormality requiring a high degree of suspicion in the presence of an extratesticular mass. Most authors advocate conservative treatment and follow-up in the absence of pain, cryptorchidism, tumors, and unclear diagnosis.

El poliorquidismo o duplicación testicular se define como la presencia de más de dos testículos confirmados mediante histología. Se presenta un caso de duplicación testicular izquierda completa en un niño de 11 años de edad que consultó por dolor ocasional en el hemiescroto izquierdo. En su exploración física destacaba una masa escrotal palpable. Se practicó ecografía que reveló la presencia de una duplicidad testicular. La sospecha diagnóstica fue corroborada mediante resonancia magnética nuclear y el estudio histopatológico tras la exéresis, confirmó el diagnóstico. El poliorquidismo es una anomalía excepcional que require un alto índice de sospecha ante la presencia de una masa extratesticular. La mayoría de autores abogan por un tratamiento conservador y seguimiento si no causa dolor o si no existen dudas diagnósticas, criptorquidia o excepcionalmente, tumores.

Poliorquidismo en la edad pediátrica: a propósito de un caso y revisión de la literatura / Polyorchidism in pediatric patients: a case report and a literature review

El poliorquidismo o duplicación testicular se define como la presen-cia de más de dos testículos confirmados mediante histología.Se presenta un caso de duplicación testicular izquierda completaen un niño de 11 años de edad que consultó por dolor ocasional en elhemiescroto izquierdo. En su exploración física destacaba una masaescrotal palpable. Se practicó ecografía que reveló la presencia de unaduplicidad testicular. La sospecha diagnóstica fue corroborada medianteresonancia magnética nuclear y el estudio histopatológico tras la exére-sis, confirmó el diagnóstico.El poliorquidismo es una anomalía excepcional que require un altoíndice de sospecha ante la presencia de una masa extratesticular. La ma-yoría de autores abogan por un tratamiento conservador y seguimientosi no causa dolor o si no existen dudas diagnósticas, criptorquidia oexcepcionalmente, tumores.(AU)

Polyorchidism or testicular duplication is defined as the histologi-cally confirmed presence of more than two testes.This is the case of a full left testicular duplication in an 11-year-old patient presenting with occasional pain in the left hemiscrotum. Atphysical exploration, a palpable scrotal mass was detected. An ultra-sonography was performed, which revealed the presence of testicularduplicity. Diagnostic suspicion was confirmed by means of a nuclearMRI and a histopathological study following excision.Polyorchidism is a rare abnormality requiring a high degree ofsuspicion in the presence of an extratesticular mass. Most authors ad-vocate conservative treatment and follow-up in the absence of pain,cryptorchidism, tumors, and unclear diagnosis.(AU)

Antegrade endoscopic dilatation as an alternative approach to primary obstructive megaureter. / Dilatación endoscópica anterograda como abordaje alternativo del megauréter obstructivo primario.

OBJECTIVES: Congenital primary obstructive megaureter (POM) is caused by ureterovesical junction stenosis, reduced peristalsis, and the resulting dilatation. Even though ureteral re-implantation remains the current gold standard technique, retrograde dilatation is considered as an effective therapeutic alternative with good results and growing proponents - to the extent it has become the technique of choice in some healthcare facilities. The objective was to present an alternative approach for treatment purposes. MATERIALS AND METHODS: This is the case of a 5-month-old infant with POM and pyonephrosis requiring nephrostomy and intravenous antibiotic therapy. Endoscopic dilatation was carried out by means of a percutaneous drainage in an antegrade fashion and did not require cystoscopy. RESULTS: The procedure was uneventful. During follow-up, ureterohydronephrosis decreased, while ureteral dilatation persisted to a lesser extent with an adequate peristalsis and absence of secondary VUR. The patient has had no symptoms after an 11-month follow-up. CONCLUSIONS: POM antegrade dilatation is an effective alternative in selected patients as it makes the pathology disappear.

OBJETIVOS: El megauréter obstructivo primario congénito (MOP) se produce por la estenosis de la unión ureterovesical, disminución en la peristalsis y su consecuente dilatación. Aunque actualmente el gold standard para el tratamiento de esta entidad sigue siendo el reimplante ureteral, la dilatación retrógrada se considera una alternativa terapéutica eficaz con buenos resultados y que está ganando cada vez más adeptos, siendo en algunos centros la técnica de elección. El objetivo es presentar una alternativa de abordaje para su tratamiento. MATERIAL Y METODOS: Se presenta el caso de un lactante de 5 meses con MOP afecto de pionefrosis que precisa nefrostomía y antibioterapia endovenosa. La dilatación endoscópica se realizó a través del drenaje percutáneo de manera anterógrada sin necesidad de cistoscopia. RESULTADOS: El procedimiento se llevó a cabo sin incidencias. En el seguimiento se apreció una disminución de la ureterohidronefrosis, persistiendo la dilatación del uréter en menor grado con adecuada peristalsis y la ausencia de RVU secundario. Tras 11 meses de seguimiento, permanece asintomático. CONCLUSIONES: La dilatación anterógrada del MOP es una alternativa efectiva en pacientes seleccionados que permite la resolución de la patología.

Dilatación endoscópica anterograda como abordaje alternativo del megauréter obstructivo primario / Antegrade endoscopic dilatation as an alternative approach to primary obstructive megaureter

Objetivos: El megauréter obstructivo primario congénito (MOP)se produce por la estenosis de la unión ureterovesical, disminución enla peristalsis y su consecuente dilatación. Aunque actualmente el goldstandard para el tratamiento de esta entidad sigue siendo el reimplanteureteral, la dilatación retrógrada se considera una alternativa terapéuticaeficaz con buenos resultados y que está ganando cada vez más adeptos,siendo en algunos centros la técnica de elección. El objetivo es presentaruna alternativa de abordaje para su tratamiento. Material y métodos: Se presenta el caso de un lactante de 5 mesescon MOP afecto de pionefrosis que precisa nefrostomía y antibioterapiaendovenosa. La dilatación endoscópica se realizó a través del drenajepercutáneo de manera anterógrada sin necesidad de cistoscopia. Resultados: El procedimiento se llevó a cabo sin incidencias. Enel seguimiento se apreció una disminución de la ureterohidronefrosis,persistiendo la dilatación del uréter en menor grado con adecuada peristalsis y la ausencia de RVU secundario. Tras 11 meses de seguimiento,permanece asintomático. Conclusiones: La dilatación anterógrada del MOP es una alternativa efectiva en pacientes seleccionados que permite la resoluciónde la patología.

Objectives: Congenital primary obstructive megaureter (POM) iscaused by ureterovesical junction stenosis, reduced peristalsis, and theresulting dilatation. Even though ureteral re-implantation remains thecurrent gold standard technique, retrograde dilatation is considered asan effective therapeutic alternative with good results and growing proponents – to the extent it has become the technique of choice in somehealthcare facilities. The objective was to present an alternative approachfor treatment purposes Materials and methods. This is the case of a 5-month-old infantwith POM and pyonephrosis requiring nephrostomy and intravenousantibiotic therapy. Endoscopic dilatation was carried out by means ofa percutaneous drainage in an antegrade fashion and did not requirecystoscopy. Results: The procedure was uneventful. During follow-up, uretero-hydronephrosis decreased, while ureteral dilatation persisted to a lesserextent with an adequate peristalsis and absence of secondary VUR. Thepatient has had no symptoms after an 11-month follow-up. Conclusions: POM antegrade dilatation is an effective alternativein selected patients as it makes the pathology disappear.(AU)

Immediate impact of the COVID-19 pandemic on pediatric surgery: analysis of a tertiary healthcare facility. / Impacto inmediato de la pandemia por COVID-19 en cirugía pediátrica: análisis de un centro terciario.

INTRODUCTION: The pandemic caused by the SARS-CoV-2 virus has led to an unprecedented situation, with population lockdowns, congestion of healthcare resources, cancellation of scheduled surgical activity, fear of contagion, and delays in patient care. The objective of this study was to analyze its impact on pediatric surgical activity at a reference healthcare facility. MATERIAL AND METHODS: A comparative study of activity in the pediatric surgery environment at a Spanish reference healthcare facility was carried out. It included outpatient consultations, scheduled surgeries, and activity at the emergency department during the lockdown period in Spain (March-May 2020) vs. the same 2019 period. Number of consultations and surgeries, type of surgery performed and/or cancelled, and stage of the pathologies treated were collected. RESULTS: A 98% decrease in scheduled surgeries, an 84% decrease in healthcare burden from the pediatric emergency department, a 55.24% decrease in urgent surgeries, an 82% decrease in outpatient activity at external consultations, and a 94% decrease in inter-hospital referrals, along with a 66% increase in urgent pathology severity, were found. CONCLUSIONS: The COVID-19 pandemic cancelled virtually all pediatric surgery activity, which caused treatment delays in severe pathologies and increased morbidity in regular urgent procedures.

INTRODUCCION: La pandemia surgida como consecuencia del virus SARS-CoV-2 ha provocado una situación inaudita, el confinamiento de la población, el colapso de los recursos sanitarios, la suspensión de la actividad programada en los servicios quirúrgicos, el miedo al contagio y la demora en la atención de pacientes. El objetivo es analizar el impacto de esta situación en la actividad del Servicio de Cirugía Pediátrica de un centro de referencia. MATERIAL Y METODOS: Se ha realizado un estudio comparativo de la actividad realizada en el ámbito de Cirugía Pediátrica de un centro de referencia español, incluyendo consultas ambulatorias, cirugía programada y actividad en urgencias durante el periodo de confinamiento (marzo-mayo 2020) frente al mismo periodo de tiempo en 2019. Se recogen el número de consultas e intervenciones, el tipo de cirugía practicada y/o anulada y el grado de evolución de las patologías atendidas. RESULTADOS: Se ha registrado un descenso del 98% de las cirugías programadas, del 84% de la presión asistencial desde urgencias pediátricas, un 55,24% menos de cirugías urgentes y un 82% la actividad ambulatoria en Consultas Externas. Se ha registrado un descenso en los traslados interhospitalarios del 94% y un incremento del 66% de la gravedad de la patología urgente. CONCLUSIONES: La pandemia por COVID-19 ha supuesto la anulación de la práctica totalidad de la actividad del Servicio de Cirugía Pediátrica, con la consiguiente demora en el tratamiento de patologías graves y un aumento en la morbilidad de procesos urgentes habituales.

Impacto inmediato de la pandemia por COVID-19 en cirugía pediátrica: análisis de un centro terciario / Immediate impact of the COVID-19 pandemic on pediatric surgery: analysis of a tertiary healthcare facility

INTRODUCCIÓN: La pandemia surgida como consecuencia del virus SARS-CoV-2 ha provocado una situación inaudita, el confinamiento de la población, el colapso de los recursos sanitarios, la suspensión de la actividad programada en los servicios quirúrgicos, el miedo al contagio y la demora en la atención de pacientes. El objetivo es analizar el impacto de esta situación en la actividad del Servicio de Cirugía Pediátrica de un centro de referencia. MATERIAL Y MÉTODOS: Se ha realizado un estudio comparativo de la actividad realizada en el ámbito de Cirugía Pediátrica de un centro de referencia español, incluyendo consultas ambulatorias, cirugía programada y actividad en urgencias durante el periodo de confinamiento (marzo-mayo 2020) frente al mismo periodo de tiempo en 2019. Se recogen el número de consultas e intervenciones, el tipo de cirugía practicada y/o anulada y el grado de evolución de las patologías atendidas. RESULTADOS: Se ha registrado un descenso del 98% de las cirugías programadas, del 84% de la presión asistencial desde urgencias pediátricas, un 55,24% menos de cirugías urgentes y un 82% la actividad ambulatoria en Consultas Externas. Se ha registrado un descenso en los traslados interhospitalarios del 94% y un incremento del 66% de la gravedad de la patología urgente. CONCLUSIONES: La pandemia por COVID-19 ha supuesto la anulación de la práctica totalidad de la actividad del Servicio de Cirugía Pediátrica, con la consiguiente demora en el tratamiento de patologías graves y un aumento en la morbilidad de procesos urgentes habituales

INTRODUCTION: The pandemic caused by the SARS-CoV-2 virus has led to an unprecedented situation, with population lockdowns, congestion of healthcare resources, cancellation of scheduled surgical activity, fear of contagion, and delays in patient care. The objective of this study was to analyze its impact on pediatric surgical activity at a reference healthcare facility. MATERIALS AND METHODS: A comparative study of activity in the pediatric surgery environment at a Spanish reference healthcare facility was carried out. It included outpatient consultations, scheduled surgeries, and activity at the emergency department during the lockdown period in Spain (March 2020-May 2020) vs. the same 2019 period. Number of consultations and surgeries, type of surgery performed and/or cancelled, and stage of the pathologies treated were collected. RESULTS: A 98% decrease in scheduled surgeries, an 84% decrease in healthcare burden from the pediatric emergency department, a 55.24% decrease in urgent surgeries, an 82% decrease in outpatient activity at external consultations, and a 94% decrease in inter-hospital referrals, along with a 66% increase in urgent pathology severity, were found. CONCLUSIONS: The COVID-19 pandemic cancelled virtually all pediatric surgery activity, which caused treatment delays in severe pathologies and increased morbidity in regular urgent procedures

Applicability of Clavien-Dindo classification in Nuss procedure surgical complications. / Aplicabilidad de la clasificación Clavien-Dindo en las complicaciones quirúrgicas del procedimiento de Nuss.

OBJECTIVES: Nuss procedure is a safe surgery but not exempt from complications. Clavien-Dindo classification (1992) allows complications of any surgery to be recorded. Our objective was to prove its applicability in the study of Nuss procedure complications. MATERIAL AND METHODS: We present a retrospective series of PE patients undergoing surgery from January 2010 to January 2018. Nuss procedure associated morbidity prior to bar removal was studied. Complications were stratified according to Clavien-Dindo classification. RESULTS: A total of 31 patients were included. Mean age was 14.67 years (4-27 years), with a mean Haller index of 6.06 (3.35-14.14) and a mean correction index of 41.2% (16-87%). Clavien-Dindo classification I-IIIb mild complications were recorded in 35.48% of patients. Seroma was found in 4 patients (12%), of whom 1 had superinfection and 1 had wound dehiscence. In 6 patients, bar and/or stabilizer mobilization was noted, and in 1 patient, postoperative acute pulmonary edema (3%) was observed. Of the 11 patients with complications, only 6 required re-intervention -5 as a result of prosthesis mobilization, and 1 as a result of infection not resolved with intravenous antibiotic therapy. CONCLUSIONS: Clavien-Dindo classification is being increasingly used as a way of unifying surgical complication criteria by comparing results. Our study demonstrated that such classification is a feasible and reproducible method when it comes to reflecting Nuss procedure morbidity and comparing it with other groups.

OBJETIVOS: La intervención de Nuss es una cirugía segura pero no está exenta de complicaciones. La clasificación de Clavien-Dindo (1992) permite registrar complicaciones de cualquier operación. Nuestro objetivo es demostrar la aplicabilidad de dicha clasificación para el estudio de las complicaciones de la cirugía de Nuss. MATERIAL Y METODOS: Presentamos una serie retrospectiva de pacientes afectos de PE intervenidos entre enero 2010 y enero 2018 y su morbilidad asociada a la cirugía de Nuss hasta la retirada de la barra. Dichas complicaciones se agruparán mediante la clasificación de Clavien-Dindo. RESULTADOS: Se recogen un total de 31 pacientes. La media de edad fue 14,67 años (4-27 años), con una media de índices de Haller de 6,06 (3,35-14,14) y una media de índices de corrección de 41,2% (16-87%). Se observaron complicaciones leves I-IIIb de la clasificación de Clavien-Dindo en el 35,48% de los pacientes. Se constató seroma en 4 pacientes (12%), de los cuales 1 presentó sobreinfección y otro, dehiscencia de herida. En 6 pacientes se observó movilización de la barra y/o estabilizador y en 1 paciente, edema agudo de pulmón postoperatorio (3%). De los 11 pacientes que presentaron complicaciones, solo 6 requirieron reintervención: 5 de ellos por movilización de la prótesis y uno por infección no resuelta con antibioterapia endovenosa. CONCLUSIONES: La clasificación de Clavien-Dindo se emplea cada vez más como una forma de unificar los criterios de las complicaciones quirúrgicas permitiendo comparar los resultados obtenidos. Comprobamos que es perfectamente factible y reproducible para reflejar la morbilidad del procedimiento quirúrgico de Nuss y poder compararla con otros grupos.

Aplicabilidad de la clasificación Clavien-Dindo en las complicaciones quirúrgicas del procedimiento de Nuss / Applicability of Clavien-Dindo classification in nuss procedure surgical complications

OBJETIVOS: La intervención de Nuss es una cirugía segura, pero no está exenta de complicaciones. La clasificación de Clavien-Dindo (1992) permite registrar complicaciones de cualquier operación. Nuestro objetivo es demostrar la aplicabilidad de dicha clasificación para el estudio de las complicaciones de la cirugía de Nuss. MATERIAL Y MÉTODOS: Presentamos una serie retrospectiva de pacientes afectos de PE intervenidos entre enero de 2010 y enero de 2018 y su morbilidad asociada a la cirugía de Nuss hasta la retirada de la barra. Dichas complicaciones se agruparán mediante la clasificación de Clavien-Dindo. RESULTADOS: Se recogen un total de 31 pacientes. La media de edad fue 14,67 años (4-27 años), con una media de índices de Haller de 6,06 (3,35-14,14) y una media de índices de corrección del 41,2% (16-87%). Se observaron complicaciones leves I-IIIb de la clasificación de Clavien-Dindo en el 35,48% de los pacientes. Se constató seroma en cuatro pacientes (12%), de los cuales uno presentó sobreinfección y otro, dehiscencia de herida. En seis pacientes se observó movilización de la barra y/o estabilizador y en 1 paciente, edema agudo de pulmón posoperatorio (3%). De los 11 pacientes que presentaron complicaciones, solo seis requirieron reintervención: cinco de ellos por movilización de la prótesis y uno por infección no resuelta con antibioterapia endovenosa. CONCLUSIONES: La clasificación de Clavien-Dindo se emplea cada vez más como una forma de unificar los criterios de las complicaciones quirúrgicas, permitiendo comparar los resultados obtenidos. Comprobamos que es perfectamente factible y reproducible para reflejar la morbilidad del procedimiento quirúrgico de Nuss y poder compararla con otros grupos

OBJECTIVES: Nuss procedure is a safe surgery but not exempt from complications. Clavien-Dindo classification (1992) allows complications of any surgery to be recorded. Our objective was to prove its applicability in the study of Nuss procedure complications. MATERIALS AND METHODS: We present a retrospective series of PE patients undergoing surgery from January 2010 to January 2018. Nuss procedure associated morbidity prior to bar removal was studied. Complications were stratified according to Clavien-Dindo classification. RESULTS: A total of 31 patients were included. Mean age was 14.67 years (4-27 years), with a mean Haller index of 6.06 (3.35-14.14) and a mean correction index of 41.2% (16-87%). Clavien-Dindo classification I-IIIb mild complications were recorded in 35.48% of patients. Seroma was found in 4 patients (12%), of whom 1 had superinfection and 1 had wound dehiscence. In 6 patients, bar and/or stabilizer mobilization was noted, and in 1 patient, postoperative acute pulmonary edema (3%) was observed. Of the 11 patients with complications, only 6 required re-intervention -5 as a result of prosthesis mobilization, and 1 as a result of infection not resolved with intravenous antibiotic therapy. CONCLUSIONS: Clavien-Dindo classification is being increasingly used as a way of unifying surgical complication criteria by comparing results. Our study demonstrated that such classification is a feasible and reproducible method when it comes to reflecting Nuss procedure morbidity and comparing it with other groups

[Surgical treatment of primary hyperhidrosis and post-surgical satisfaction. Our 5-year experience]. / Tratamiento quirúrgico de la hiperhidrosis primaria y satisfacción postquirúrgica. Nuestra experiencia en 5 años.

INTRODUCTION: Primary palmar hyperhidrosis is a pathology that begins during childhood and can represent a significant reduction in the quality of life of adolescents. The current treatment of choice is thoracoscopic sympathicolysis. The aim of our study is to evaluate the results of surgery in paediatric patients. MATERIAL AND METHODS: Retrospective study of patients with primary palmar or palmo-axillary hyperhidrosis who underwent thoracoscopic sympathicolysis in our hospital during the last 5 years. RESULTS: We operated and included in the study 28 patients, 10 men and 18 women. Mean age was 13.8 (8-18) years. Bilateral thoracoscopic sympatholysis was performed with monopolar cautery, between T2-T4 ribs. Mean operative time was 63 minutes and mean hospitalisation time was 1.1 days. The incidence on intraoperative complications was zero. 2 patients presented postoperative subcutaneous emphysema. There were no other postoperative complications. 1 patient presented partial recurrence. In all the rest, sweating completely disappeared and they were totally satisfied with the surgery (96.42%). Temporary compensatory sweating appeared in 57.14% of the cases, a collateral effect that did not change their level of satisfaction. CONCLUSIONS: Palmar hyperhidrosis can be a major problem for socialization and quality of life for the child or adolescent who suffers it. Thoracoscopic sympatholysis in the pediatric patient is an effective treatment, highly resolutive and with low morbidity. Despite compensatory sweating, patients are highly satisfied with the results of surgical treatment.

INTRODUCCION: La hiperhidrosis primaria palmar es una patología que comienza ya en la niñez y puede representar una importante reducción de la calidad de vida del adolescente. El tratamiento de elección actual es la simpaticolisis toracoscópica. El objetivo de nuestro estudio es evaluar los resultados de la cirugía en pacientes pediátricos. MATERIAL Y METODOS: Hemos estudiado retrospectivamente los pacientes diagnosticados de hiperhidrosis palmar y/o palmoaxilar que han sido tratados en nuestro centro durante los últimos 5 años. RESULTADOS: En este periodo han sido tratados 28 pacientes (10 varones y 18 mujeres), con una edad media de 13,8 años (8-18 años). La simpaticolisis toracoscópica bilateral se practicó, con monopolar, entre los niveles T2-T4 con un tiempo quirúrgico medio de 63 minutos. La estancia media fue de 1,1 días. No se registraron neumotórax ni otras complicaciones intraoperatorias. Dos casos presentaron enfisema subcutáneo postoperatorio. No hubo otras complicaciones postoperatorias. Excepto un caso de recurrencia parcial, en el resto de pacientes la sudoración desapareció por completo y quedaron totalmente satisfechos con la cirugía (96,42%). Apareció sudoración compensatoria transitoria en el 57,14% de los casos, efecto colateral que no modificó su nivel de satisfacción. CONCLUSIONES: La hiperhidrosis palmar puede ser un problema importante para la sociabilización y la calidad de vida del niño o adolescente que la padece. La simpaticolisis toracoscópica en el paciente pediátrico es un tratamiento efectivo, altamente resolutivo y de escasa morbilidad. A pesar de la sudoración compensatoria, los pacientes están altamente satisfechos con los resultados del tratamiento quirúrgico.

[Caudal regional anesthesia: a safe anesthetic procedure for abdominal and inguinal surgery in newborns and toddlers]. / Anestesia caudal en neonatos y lactantes como procedimiento anestésico en cirugía abdominal y del canal inguinal: nuestra experiencia.

OBJECTIVES: Caudal anesthesia is a safe and effective technique in children. Some surgical procedures, such as abdominal or inguinal surgeries, could be performed avoiding general anesthesia in newborns and babies, reducing the risk of respiratory depression and neurotoxicity. Our objective is to analyze the experience in a tertial referral center. MATERIAL AND METHODS: We carried a retrospective study in patients under 1 year of age who underwent abdominal or inguinal procedures under caudal regional anesthesia, between 2016 and 2018. Demographics, diagnosis, comorbidity, surgical procedure, operation time, oral intake, perioperative complications and hospital stay were recorded. RESULTS: We included 87 patients under 1 year of age. In 56 patients (23 males, 33 females) surgery was performed under caudal anesthesia (37 scheduled, 19 urgent). Mean age was 2 months (0-11). Comorbidity: 25 associated prematurity, 3 severe tracheomalacia, 1 apnea and 8 bronchopulmonary dysplasia. Surgical procedures: 34 inguinal hernia repair, 9 incarcerated inguinal hernias, 5 neonatal testicular torsions, 8 pyloromyotomies. Mean operation time was 35 min (15-80) and mean anesthetic time 30 min (20-60). Oral intake started 2 h after surgery in 55 patients. Discharge was given in 24 h (12-36). Complications were not noticed. Any patient needed conversion to general anesthesia. CONCLUSIONS: Caudal anesthesia should be the anesthetic technique of choice in newborns and babies who undergo abdominal or inguinal surgeries, especially in those with comorbidity. This procedure could be performed safely, avoiding respiratory or neurological complications, with a fast recovery of patients and short hospital stay.

OBJETIVOS: La anestesia caudal es una técnica que permite la realización de diversos procedimientos quirúrgicos en neonatos y lactantes evitando complicaciones respiratorias y neurotoxicidad asociada a la anestesia general, permitiendo un inicio precoz de la ingesta y una menor estancia hospitalaria. Presentamos la experiencia en un centro terciario. MATERIAL Y METODOS: Estudio retrospectivo en neonatos y lactantes intervenidos de cirugía abdominal o inguinal (2016-2018) mediante anestesia caudal asociada a sedación. Se recogieron datos epidemiológicos, comorbilidad, procedimientos quirúrgicos, tiempo quirúrgico y anestésico, inicio de ingesta, estancia hospitalaria y complicaciones asociadas a la técnica. RESULTADOS: Se intervinieron 87 pacientes menores de 1 año en nuestro centro, en 56 (23 varones, 33 mujeres) se realizó cirugía bajo anestesia caudal (37 programadas,19 urgentes), edad media 2 meses (0-11). En 25 se asociaba prematuridad, 3 traqueomalacia severa, un paciente monitorización de apneas y 8 displasia broncopulmonar. Procedimientos: hernia inguinal no complicada (34), hernia inguinal incarcerada (9), torsión testicular (5), piloromiotomía (8). Tiempo medio de cirugía 35 minutos (15-80), tiempo anestésico de 30 min (20-60) y tiempo quirúrgico total 60 min (40-120). La ingesta se inicio a las 2 horas salvo un paciente que precisó antieméticos. El alta hospitalaria se produjo a las 24 horas (12-36). No se registraron complicaciones durante la realización de la anestesia caudal ni necesidad de conversión a anestesia general. CONCLUSIONES: Consideramos la anestesia caudal de elección en neonatos y lactantes en determinadas cirugías, con escasa morbilidad asociada. Permite un rápido inicio de la ingesta acortando la estancia hospitalaria y minimiza las complicaciones respiratorias y neurotoxicidad a largo plazo, incluso en pacientes prematuros con comorbilidad grave.

Tratamiento quirúrgico de la hiperhidrosis primaria y satisfacción postquirúrgica. Nuestra experiencia en 5 años / Surgical treatment of primary hyperhidrosis and post-surgical satisfaction. Our experience in 5 years

Introducción. La hiperhidrosis primaria palmar es una patología que comienza ya en la niñez y puede representar una importante reducción de la calidad de vida del adolescente. El tratamiento de elección actual es la simpaticolisis toracoscópica. El objetivo de nuestro estudio es evaluar los resultados de la cirugía en pacientes pediátricos. Material y métodos. Hemos estudiado retrospectivamente los pacientes diagnosticados de hiperhidrosis palmar y/o palmoaxilar que han sido tratados en nuestro centro durante los últimos 5 años. Resultados. En este periodo han sido tratados 28 pacientes (10 varones y 18 mujeres), con una edad media de 13,8 años (8-18 años). La simpaticolisis toracoscópica bilateral se practicó, con monopolar, entre los niveles T2-T4 con un tiempo quirúrgico medio de 63 minutos. La estancia media fue de 1,1 días. No se registraron neumotórax ni otras complicaciones intraoperatorias. Dos casos presentaron enfisema subcutáneo postoperatorio. No hubo otras complicaciones postoperatorias. Excepto un caso de recurrencia parcial, en el resto de pacientes la sudoración desapareció por completo y quedaron totalmente satisfechos con la cirugía (96,42%). Apareció sudoración compensatoria transitoria en el 57,14% de los casos, efecto colateral que no modificó su nivel de satisfacción. Conclusiones. La hiperhidrosis palmar puede ser un problema importante para la sociabilización y la calidad de vida del niño o adolescente que la padece. La simpaticolisis toracoscópica en el paciente pediátrico es un tratamiento efectivo, altamente resolutivo y de escasa morbilidad. A pesar de la sudoración compensatoria, los pacientes es-tán altamente satisfechos con los resultados del tratamiento quirúrgico

Introduction. Primary palmar hyperhidrosis is a pathology that begins during childhood and can represent a significant reduction in the quality of life of adolescents. The current treatment of choice is thoracoscopic sympathicolysis.The aim of our study is to evaluate the results of surgery in paediatric patients. Material and methods. Retrospective study of patients with primary palmar or palmoaxillary hyperhidrosis who underwent thoracoscopic sympathicolysis in our hospital during the last 5 years. Results. We operated and included in the study 28 patients, 10 men and 18 women. Mean age was 13.8 (8-18) years. Bilateral thoracoscopic sympatholysis was performed with monopolar cautery, between T2-T4 ribs. Mean operative time was 63 minutes and mean hospitalisation time was 1.1 days. The incidence on intraoperative complications was zero. 2 patients presented postoperative subcutaneous emphysema. There were no other postoperative complications.1 patient presented partial recurrence. In all the rest, sweating completely disappeared and they were totally satisfied with the surgery (96.42%). Temporary compensatory sweating appeared in 57.14% of the cases, a collateral effect that did not change their level of satisfaction. Conclusions. Palmar hyperhidrosis can be a major problem for socialization and quality of life for the child or adolescent who suffers it. Thoracoscopic sympatholysis in the pediatric patient is an effective treatment, highly resolutive and with low morbidity. Despite compensatory sweating, patients are highly satisfied with the results of surgical treatment

Anestesia caudal en neonatos y lactantes como procedimiento anestésico en cirugía abdominal y del canal inguinal: nuestra experiencia / Caudal regional anesthesia: a safe anesthetic procedure for abdominal and inguinal surgery in newborns and toddlers

Objetivos. La anestesia caudal es una técnica que permite la realización de diversos procedimientos quirúrgicos en neonatos y lactantes evitando complicaciones respiratorias y neurotoxicidad asociada a la anestesia general, permitiendo un inicio precoz de la ingesta y una menor estancia hospitalaria. Presentamos la experiencia en un centro terciario. Material y métodos. Estudio retrospectivo en neonatos y lactantes intervenidos de cirugía abdominal o inguinal (2016-2018) mediante anestesia caudal asociada a sedación. Se recogieron datos epidemiológicos, comorbilidad, procedimientos quirúrgicos, tiempo quirúrgico y anestésico, inicio de ingesta, estancia hospitalaria y complicaciones asociadas a la técnica. Resultados. Se intervinieron 87 pacientes menores de 1 año en nuestro centro, en 56 (23 varones, 33 mujeres) se realizó cirugía bajo anestesia caudal (37 programadas,19 urgentes), edad media 2 meses (0-11). En 25 se asociaba prematuridad, 3 traqueomalacia severa, un paciente monitorización de apneas y 8 displasia broncopulmonar. Procedimientos: hernia inguinal no complicada (34), hernia inguinal incarcerada (9), torsión testicular (5), piloromiotomía (8). Tiempo medio de cirugía 35 minutos (15-80), tiempo anestésico de 30 min (20-60) y tiempo quirúrgico total 60 min (40-120). La ingesta se inicio a las 2 horas salvo un paciente que precisó antieméticos. El alta hospitalaria se produjo a las 24 horas (12-36). No se registraron complicaciones durante la realización de la anestesia caudal ni necesidad de conversión a anestesia general. Conclusiones. Consideramos la anestesia caudal de elección en neonatos y lactantes en determinadas cirugías, con escasa morbilidad asociada. Permite un rápido inicio de la ingesta acortando la estancia hospitalaria y minimiza las complicaciones respiratorias y neurotoxicidad a largo plazo, incluso en pacientes prematuros con comorbilidad grave

Objectives. Caudal anesthesia is a safe and effective technique in children. Some surgical procedures, such as abdominal or inguinal surgeries, could be performed avoiding general anesthesia in newborns and babies, reducing the risk of respiratory depression and neurotoxicity. Our objective is to analyze the experience in a tertial referral center. Material and methods. We carried a retrospective study in patients under 1 year of age who underwent abdominal or inguinal procedures under caudal regional anesthesia, between 2016 and 2018. Demographics, diagnosis, comorbidity, surgical procedure, operation time, oral intake, perioperative complications and hospital stay were recorded. Results. We included 87 patients under 1 year of age. In 56 patients (23 males, 33 females) surgery was performed under caudal anesthesia (37 scheduled, 19 urgent). Mean age was 2 months (0-11). Comorbidity: 25 associated prematurity, 3 severe tracheomalacia, 1 apnea and 8 bronchopulmonary dysplasia. Surgical procedures: 34 inguinal hernia repair, 9 incarcerated inguinal hernias, 5 neonatal testicular torsions, 8 pyloromyotomies. Mean operation time was 35 min (15-80) and mean anesthetic time 30 min (20-60). Oral intake started 2 h after surgery in 55 patients. Discharge was given in 24 h (12-36). Complications were not noticed. Any patient needed conversion to general anesthesia. Conclusions. Caudal anesthesia should be the anesthetic technique of choice in newborns and babies who undergo abdominal or inguinal surgeries, especially in those with comorbidity. This procedure could be performed safely, avoiding respiratory or neurological complications, with a fast recovery of patients and short hospital stay

Interactions of Salmonella enterica subspecies enterica serovar Typhimurium with gut bacteria.

The aim of this study was to evaluate the impact of the gut microbiota on the growth and survival of S. Typhimurium. This was tested in two-species co-cultures and in mixed cultures with a simplified gut model microbiota. Subsequently, interactions between S. Typhimurium and human faecal bacteria were quantified in both batch and continuous culture systems simulating the human colon. The exponential growth of S. Typhimurium was halted when the population of Escherichia coli reached the maximum population density in a two-compartment co-culture system where the two species were separated by a 0.45 µm pore membrane. Furthermore, the growth of some gut bacteria such as Lactobacillus gasseri and Bifidobacterium bifidum was inhibited by the presence of S. Typhimurium in the other compartment. The survival of S. Typhimurium was severely affected in mixed batch cultures with human faecal samples; a reduction of 10(3)-10(4) cfu/ml in the concentration of S. Typhimurium was observed in these cultures. However, no effect on S. Typhimurium survival was observed in mixed batch cultures with a simplified gut model microbiota under the same conditions. The effect of human faecal samples on S. Typhimurium in a three-stage continuous culture was different to that obtained in batch cultures; its growth rather than survival was affected under these conditions. S. Typhimurium growth was inhibited, and the bacterium was therefore eliminated by the continuous flow of the medium. Depending upon culturing conditions, the gut microbiota caused either growth inhibition, inactivation or did not affect S. Typhimurium.

Resembling breast milk: influence of polyamine-supplemented formula on neonatal BALB/cOlaHsd mouse microbiota.

Infant microbiota is influenced by numerous factors, such as delivery mode, environment, prematurity and diet (breast milk or formula). In addition to its nutritional value, breast milk contains bioactive substances that drive microbial colonisation and support immune system development, which are usually not present in infant formulas. Among these substances, polyamines have been described to be essential for intestinal and immune functions in newborns. However, their effect on the establishment of microbiota remains unclear. Therefore, the aim of the present study was to ascertain whether an infant formula supplemented with polyamines has an impact on microbial colonisation by modifying it to resemble that in breast-fed neonatal BALB/c mice. In a 4 d intervention, a total of sixty pups (14 d old) were randomly assigned to the following groups: (1) breast-fed group; (2) non-enriched infant formula-fed group; (3) three different groups fed an infant formula enriched with increasing concentrations of polyamines (mixture of putrescine, spermidine and spermine), following the proportions found in human milk. Microbial composition in the contents of the oral cavity, stomach and small and large intestines was analysed by quantitative PCR targeted at fourteen bacterial genera and species. Significantly different (P< 0·05) microbial colonisation patterns were observed in the entire gastrointestinal tract of the breast-fed and formula-fed mice. In addition, our findings demonstrate that supplementation of polyamines regulates the amounts of total bacteria, Akkermansia muciniphila, Lactobacillus, Bifidobacterium, Bacteroides-Prevotella and Clostridium groups to levels found in the breast-fed group. Such an effect requires further investigation in human infants, as supplementation of an infant formula with polyamines might contribute to healthy gastrointestinal tract development.

Loss of culturability of Salmonella enterica subsp. enterica serovar Typhimurium upon cell-cell contact with human fecal bacteria.

Loss of culturability of Salmonella enterica subsp. enterica serovar Typhimurium has been observed in mixed cultures with anaerobic fecal bacteria under conditions that allow local interaction between cells, such as cell contact. A reduction of a population of culturable S. Typhimurium on the order of ∼10(4) to 10(5) CFU/ml was observed in batch anaerobic mixed cultures with fecal samples from different human donors. Culturability was not affected either in supernatants collected at several times from fecal cultures, when separated from fecal bacteria by a membrane of 0.45-µm pore size, or when in contact with inactivated fecal bacterial cells. Loss of culturability kinetics was characterized by a sharp reduction of several logarithmic units followed by a pronounced tail. A mathematical model was developed to describe the rate of loss of culturability as a function of the frequency of encounters between populations and the probability of inactivation after encounter. The model term F(S · F)(1/2) quantifies the effect of the concentration of both populations, fecal bacteria (F) and S. Typhimurium (S), on the loss of culturability of S. Typhimurium by cell contact with fecal bacteria. When the value of F(S · F)(1/2) decreased below ca. 10(15) (CFU/ml)(2), the frequency of encounters sharply decreased, leading to the deceleration of the inactivation rate and to the tailing off of the S. Typhimurium population. The probability of inactivation after encounter, P, was constant, with an estimated value of ∼10(-5) for all data sets. P might be characteristic of the mechanism of growth inhibition after a cell encounter.

Modelling Salmonella concentration throughout the pork supply chain by considering growth and survival in fluctuating conditions of temperature, pH and a(w).

We aim to predict the population density of Salmonella spp. through the pork supply chain under dynamic environmental conditions (pH, a(w) and temperature) that fluctuate from growth to survival/slow inactivation. To do this, the dependence of the probability of growth, and of the growth and inactivation rate on the temperature, pH and a(w) were modelled. Probabilistic and kinetic measurements, i.e. growth and survival curves, were collected from the ComBase database (www.combase.cc). Conditions at which selected data used to fit the models were generated covered wide ranges that are relevant to the pork supply chain. Probabilistic and kinetic models were combined to give predictions on the concentration of Salmonella spp. at any stage of the pork supply chain under fluctuating pH, a(w) and/or temperature. Models were implemented in a user-friendly computing tool freely available from http://www.ifr.ac.uk/safety/SalmonellaPredictions/. This program provides estimates on the population dynamics of Salmonella spp. at any stage of the pork supply chain and its predictive performance has been validated in several pork products.