Centro de Cirugía de Mínima Invasión Jesús Usón

MIS techniques achieved in the last decades have improved the quality of interventions and patient recovery, although there are still doubts about how they affect surgeons' health. This study aims to analyze the relationship between surgeon physiological and subjective stress parameters during laparoscopic and robot-assisted laparoscopic surgery (RALS) and the quality of surgical performance by means of wearable technology. This study was conducted in a simulation environment with tasks involving hand-eye coordination and technical surgical skills. Sixteen surgeons from three different surgical disciplines participated in this study using both a conventional laparoscopic technique and the Versius® robotic platform for RALS. Two wearable sensors were used to analyze surgeons' physiological stress, as well as a subjective questionnaire for stress assessment during surgical practice (SURG-TLX). The results of the data analysis showed that stress experienced was reduced in RALS when compared to conventional laparoscopy, and with it the percentage of errors committed. Novice surgeons performed better in most parameters compared to experienced microsurgeons. Surgeons without previous experience in laparoscopic surgery showed an improvement in their stress and surgical performance when using robot-assisted surgery.

Thoracic duct embolization (TDE) is a valuable minimally invasive treatment for chylous leaks. Pre-clinical evaluation of emerging embolic materials in appropriate animal models is crucial. This study aimed to establish and assess the technical feasibility of transvenous retrograde thoracic duct cannulation, a key component for TDE, in a porcine model. This prospective feasibility study, with institutional animal care committee approval, used five healthy female Large White pigs (mean weight, 50.2 ± 8.9kg). Under general anesthesia, interstitial lymphangiography of the left forelimb with Lipiodol was performed for guiding transvenous retrograde cannulation. Following percutaneous femoral vein access, retrograde thoracic duct cannulation was attempted using an angiographic catheter and microcatheter assembly. Post-mortem necropsy examined the thoracic duct junction anatomy. Interstitial lymphangiography visualized the thoracic duct terminus in three pigs. Selective venography consistently demonstrated the thoracic duct ampulla converging at the junction of the left internal and external jugular veins. The angiographic catheter successfully engaged the thoracic duct ampulla in all five cases. Subsequent microcatheter cannulation of the thoracic duct was achieved in three of five pigs. Necropsy confirmed the thoracic duct ampulla's location between and caudal to the junction of the left internal and external jugular veins. Transvenous retrograde cannulation of the thoracic duct is technically feasible in the porcine model, offering a platform for pre-clinical TDE research. Technical refinements are warranted to improve success rates.

To describe geometric muscle ultrasound normative values of Quadriceps Rectus Femoris (QRF) at mid-thigh in Spanish community-dwelling older adults. Secondary objectives included evaluating the associations between ultrasound measurements and physical function, muscle strength, frailty, and dependency in basic activities of daily living. Cross-sectional study. Outpatient clinics of Geriatric Departments at seven University Hospitals and three Primary care settings of Spain. 424 community-dwelling persons ≥70 years old. Ultrasound measurements were acquired using a Clarius® L7 HD3 probe. QRF thickness (QRFT), QRF area (QRFA), subcutaneous adipose thickness (SAT), total mid-thigh thickness (TTT), and pennation angle (PA) were calculated. Normative values are provided, and associations with comorbidity, dependency, strength, frailty and physical function are described. Mean age was 81.5 years (range 70-99), 66.7% were female. Mean Barthel index was 93 (SD 11), and mean FRAIL score was 1.1 (1.2). Mean SPPB was 8.7 (SD 2.9) and mean grip strength was 20.7 (8.0). Median values of QRFT, QRFA, SAT, TTT, and PA for women and men were 14.2 / 16.1mm, 5.4 / 6.4 cm2, 15.1 / 9.2mm, 41.1 / 40.1, and 10.0 / 10.6 respectively. Functional variables were strongly associated with QRFT, QRFA, and TTT in men, and PA with SPPB in both sexes. The ECOSARC-2 study provides normative values of geometric mid-thigh muscle ultrasound parameters in community-dwelling older adults. These values are essential for determining sex-specific cut-off points for conditions such as sarcopenia, frailty, malnutrition, and for predicting relevant outcomes.

The massive increase in stochastic renewable generation, expected in the context of the energy transition, poses challenges to the stability of the power grid. Battery energy storage can positively impact the penetration of distributed solar photovoltaic (PV) systems while positively impacting the whole grid’s hosting capacity in two different ways. First, it increases the amount of PV self-consumption and, therefore, increases the value of PV generation for prosumers. Second, batteries can provide ancillary services with particular value to frequency control. In this study, we analyze the techno-economic benefits and trade-offs for the prosumer and the grid associated with a pool of distributed storage systems, managed by an aggregator participating in the Swiss frequency control market. To this end, we apply a dispatch model to behind-the-meter batteries to quantify the added value of providing automatic and manual frequency restoration reserve (aFRR and mFRR) for prosumers. We find that the provision of aFRR and mFRR considerably increases the attractiveness of battery investments, in particular for large assets. However, the use of batteries for aFRR and mFRR brings along a reduction in total PV self-sufficiency, as well as a reduced battery lifetime, which should be taken into account by the prosumer at the moment of joining an aggregator, highlighting the duality between the prosumer’s self-sufficiency and financial revenue. • Combining residential PV-coupled batteries with aFRR and mFRR provision enhances private economic viability. • Important trade-offs between prosumer autonomy and financial incentives are detailed. • Allocating at least 50% of the battery to frequency control yields favorable returns on investment. • Self-consumption alone is not economically viable for the residential sector under current market conditions.

BackgroundHepatocellular carcinoma (HCC) remains a leading cause of cancer-related deaths worldwide, especially in advanced stages where limited treatment options result in poor prognosis. The immunosuppressive tumor immune microenvironment (TIME), characterized by low immune cell infiltration and exhaustion, limits immunotherapy efficacy. To address this, our study investigates the role of C-C motif chemokine ligand 3 (CCL3) in modulating the HCC TIME.MethodsWe analyzed CCL3 expression in human HCC samples from The Cancer Genome Atlas database, focusing on its correlation with inflammatory gene signatures and immune cell infiltration. High-dimensional single-cell RNA sequencing (scRNA-seq), flow cytometry, and multiplex immunofluorescence were used to investigate CCL3’s effects on macrophage function and T cell activation. The biological impact of CCL3 on macrophages was assessed using co-culture systems, confocal imaging, metabolite detection, and inhibition assays. Preclinical HCC models and ex vivo tumor fragment assays further explored how CCL3 modulates immune responses and enhances immune checkpoint blockade efficacy.ResultsOur study shows that CCL3 is suppressed in the tumor microenvironment and positively correlates with immune infiltration and inflammatory responses. Targeted liver delivery of rAAV-Ccl3 reprograms the immune microenvironment in HCC, promoting immune cell recruitment and tertiary lymphoid structure formation, thus suppressing tumor growth via immune engagement. Through scRNA-seq, flow cytometry, and multiplex immunofluorescence, we found that CCL3 enhances macrophage antigen uptake and activates cytotoxic T cells. In vivo and in vitro experiments confirmed that CCL3 facilitates T cell infiltration and upregulates MHC II expression on macrophages, enhancing antigen presentation. The CCL3-CCR5 pathway also boosts macrophage metabolism, increasing lysosomal activity and antigen uptake, thereby strengthening adaptive immune responses and increasing sensitivity to immune checkpoint blockade therapies in preclinical models.ConclusionsThis study highlights the pivotal role of CCL3 in reshaping the TIME and enhancing antitumor immunity in HCC. By promoting immune cell recruitment and enhancing antigen presentation, CCL3 demonstrates significant potential to improve the efficacy of immunotherapy, particularly in combination with immune checkpoint inhibitors. Targeting CCL3 may help to overcome the immunosuppressive TIME in HCC and improve patient outcomes.

Abstract Introduction Myocardial infarction (MI) remains a leading global cause of mortality and is commonly treated with Captopril, Spironolactone, and Bisoprolol. Emerging therapies, such as the secretome derived from cardiosphere-derived cells (S-CDCs), have shown potential in reducing MI scar size. This study aims to evaluate the potential therapeutic implications of S-CDCs in MI treatment, particularly in relation to the aforementioned standard drugs. Methods CDCs (n = 4) were isolated from cardiac explants of Large White pigs and cultured in DMEM with 1% ITS and antibiotics for four days. The conditioned medium was centrifuged and ultrafiltered (3 kDa) to obtain the S-CDCs. The content of S-CDCs, including miRNAs and genes, was analysed using transcriptomic and qPCR techniques. Bioinformatics tools were used to establish the interaction network (IN) of Captopril, Bisoprolol, and Spironolactone with their target genes through the String app within Cytoscape. miRTargetLink 2.0 was used to predict miRNA-gene interactions, and FunRich analysed the gene network. Finally, the content of S-CDCs was compared with previously identified miRNAs and genes, and an interaction network was generated using Cytoscape. Results Our findings show that S-CDCs contain six miRNAs that interact with target genes of Captopril and Spironolactone. Additionally, S-CDCs harbor genes that interact with those affected by the drugs, with a predominant influence from Spironolactone. Conclusion S-CDCs may mimic the effects of Captopril and Spironolactone, potentially simplifying MI treatment. However, further studies are necessary to validate these findings.

Abstract Introduction Myocardial infarction (MI) initiates an acute inflammatory response that is crucial for heart repair. However, an exaggerated inflammatory response can lead to adverse left ventricular remodeling and heart failure. The secretome of cardiosphere-derived cells (CDCs) offers promising immunomodulatory properties. This study seeks to determine the optimal timing for CDC secretome application by evaluating CD163 expression in monocytes and plasma levels post-MI to maximize its immunomodulatory properties. Methods CD163 expression in monocytes was evaluated under basal conditions and after MI at 24, 48, 72 hours, and one week post-MI. Plasma protein levels were also assessed at the same time points. Results The results indicate a decrease in CD163 expression in monocytes immediately following MI, with a progressive increase observed over the subsequent 72 hours. Plasma protein analysis revealed elevated levels of TNF-α and IL-6 within the first 24 hours post-MI, which then gradually declined. These findings suggest that the inflammatory response is most acute within the first 24 hours post-MI, characterized by high pro-inflammatory cytokine levels and reduced CD163 expression. Conclusion The application of CDC-derived secretome treatment could be more beneficial during the first 24 hours post-MI. This study highlights the importance of timing in the application of CDC-based therapies to optimize their immunomodulatory effects and improve outcomes in MI patients.