Hospital Universitario Infanta Sofía

Ocular syphilis in the Iberian Peninsula shows a wide clinical spectrum and frequent posterior segment involvement. Most patients achieved favourable serological and visual outcomes. These findings support the effectiveness of standard therapies and highlight the need for early diagnosis, especially in high-risk populations.

812 Background: Muscle-invasive bladder carcinoma (MIBC) is associated with high recurrence and mortality rates, and current neoadjuvant chemotherapy (NACT) regimens offer limited efficacy and considerable toxicity. These limitations underscore the need for reliable biomarkers to improve treatment management and patient outcomes. Metaproteomics profiling allows for the simultaneous characterisation of human and microbial proteins within tumors, offering a new perspective on patient-microbiota interactions in cancer. Our group has identified three microbiota-related metaproteomics clusters (Microbiota1-3) associated with response to NACT in MIBC. Our objective is to evaluate the prognostic relevance in terms of disease-free survival (DFS) of these microbiota-related metaproteomics clusters. Methods: Fifty-eight FFPE transurethral resection (TURBT) samples from patients diagnosed with MIBC were analyzed using data-independent acquisition (DIA) mass spectrometry. Protein identification was performed against a custom database including the human proteome and bacterial proteomes from bacteria genera identified by 16S rRNA gene sequencing in the same samples. After quality control, bacterial and human proteins were analyzed using Perseus software and probabilistic graphical models (PGMs) to identify functional relationships. Patients were classified into three metaproteomic clusters (Microbiota1-3) according to their tumor microbiota protein profiles by hierarchical clustering. Disease-free survival (DFS) was estimated by the Kaplan-Meier method and compared among clusters using the log-rank (Mantel-Cox) test. Results: Kaplan-Meier analysis revealed significant differences in DFS between the three defined metaproteomics subtypes (Microbiota1-3) (p=0.01). Patients classified as Microbiota3 had the most favorable DFS and a lower proportion of relapse events, with median DFS not reached during the follow-up period. This group was previously associated with a higher proportion of responders to NACT, consistent with the favorable DFS observed. In contrast, Microbiota2 was associated with earlier relapse and shorter DFS (median DFS: 23 months), in line with its higher proportion of non-responders to NACT. Conclusions: To our knowledge, this is the first metaproteomics study focused in biomarker discovery using FFPE samples from bladder carcinoma patients. Distinct MIBC metaproteomics profiles are associated with differential DFS following NACT. The identification of these three microbiota-related proteomics clusters highlights the potential prognostic relevance of the tumor-associated microbiota. These findings support metaproteomics as a promising approach for refining patient stratification and guiding future biomarker-driven strategies in bladder cancer.

<h3>Background and Importance</h3> Chemotherapy desensitisation (CD) enables safe re-administration of oncological drugs in patients with previous hypersensitivity reactions (HSR). These reactions often lead to discontinuation of first-line therapies, so implementing CD protocols allows patients to receive optimal therapy while minimising risk. However, evidence in routine clinical practice remains limited. In our hospital, CD is performed according to the standard Boston (Castells et al.) 12-step, 3-bag rapid desensitisation protocol, with progressive concentrations of 1:100, 1:10, 1:1. All infusions are prepared and verified by the Hospital Pharmacy Service. <h3>Aim and Objectives</h3> The primary endpoint was to evaluate the safety and tolerance of CD, defined as the completion of planned cycles. The secondary endpoint was to analyse the relationship between allergy testing and the indication for desensitisation. <h3>Material and Methods</h3> Observational, descriptive and retrospective study including patients with HSR to chemotherapy who subsequently received CD, between January 2012-July 2025, in a university hospital. Variables included age, sex, tumour type, drug desensitised, HSR type, cycles prior to HSR, tolerance (based on cycles under CD and reason for discontinuation) and allergy testing results. <h3>Results</h3> 106 patients were included (mean age 58±12.6 years), 89 women (84%), 17 men (16%). Tumour distribution was breast (31.1%), gynaecological (31.1%), digestive (27.4%), pulmonary (7.5%), head and neck (1.9%) and sarcoma (0.9%). The most frequently desensitised drugs were paclitaxel (45.4%), oxaliplatin (24.5%), carboplatin (14.1%), docetaxel (9.4%), cisplatin (4.7%), others (&lt;1% each). 96 patients (90.6%) suffered an immediate HSR, 10 patients (9.4%) a delayed HSR. Mean cycles prior to HSR were 2±1.8, mean cycles under CD were 4±3.2. Regarding tolerance, 42 patients (39.6%) successfully completed the planned cycles, 11 (10.4%) discontinued due to HSR despite desensitisation, and 53 (50%) interrupted the treatment due to progression or death. Concerning allergy testing, 95 patients (89.6%) were tested before CD, with only 16 (16.8%) positives. <h3>Conclusion and Relevance</h3> CD showed to be a safe strategy, enabling patients with HSR to continue first-line treatments. The low correlation between allergy test results and indication for CD supports its use based on clinical judgement rather than test positivity. These findings emphasise the value of structured desensitisation protocols and highlight the essential role of hospital pharmacists in ensuring treatment continuity and safety. <h3>Conflict of Interest</h3> No conflict of interest

Background: Hybrid vaginal-assisted natural orifice transluminal endoscopic hysterectomy (VANH) combines vaginal surgery with laparoscopic assistance, offering a minimally invasive option in patients with prior pelvic surgery or altered anatomy where standard vaginal hysterectomy may be unfeasible. Methods: We present a video-based technical report of a VANH performed in a 43-year-old woman with symptomatic adenomyosis, previous cesarean section, and extensive pelvic adhesions. The procedure begins with a purely vaginal phase: anterior and posterior colpotomy and transection of uterine pedicles. Following this, an Alexis retractor is introduced transvaginally through the colpotomies, establishing communication with the peritoneal cavity. Pneumoperitoneum is created via transvaginal insufflation. The hysterectomy is completed using standard endoscopic instruments inserted through the Alexis port, under simultaneous laparoscopic guidance via a single umbilical trocar. The vaginal cuff is closed vaginally. Results: The procedure was completed without complications. Total operative time was 80 minutes, with minimal blood loss. The patient was discharged within 24 hours. The video demonstrates step-by-step execution of this hybrid approach, with emphasis on anatomical orientation, safe energy use, and team coordination between the vaginal and laparoscopic phases. Conclusions: Hybrid VANH with transvaginal pneumoperitoneum and laparoscopic assistance is a safe, effective alternative for complex hysterectomy. It allows reduced abdominal port use while preserving visual control and access. This Video 1 serves as a practical educational resource for advanced gynecological surgeons. Video 1: This video demonstrates a hybrid VANH performed on a patient with a suspected challenging pelvic anatomy. Laparoscopic assistance improved spatial orientation and facilitated safe dissection. The dual visualization is a valuable training aid for surgeons learning the VANH technique. VANH, vaginal-assisted natural orifice transluminal endoscopic hysterectomy.

Level of Education (LoE) is widely used as an indicator of cognitive reserve and is associated with risk of dementia. The aim of the present study was to know the influence of the LoE on cognitive function (CF) in patients with Parkinson´s disease (PD). Controls and PD patients from the Spanish cohort COPPADIS with a disease duration from symptoms onset ≤ 5years, who were recruited from January/2016 to November/2017 (baseline visit; V0) and evaluated at 2 (V2), 4 (V4) and 5 (V5) years of follow-up were included. Regarding LoE, patients were classified as with primary, secondary and university education. CF was assessed using the Parkinson´s Disease Cognitive Rating Scale (PD-CRS). General linear model (GLM) repeated measure was used to test for changes in the CF. A p value ≤ 0.005 was considered significant. Three hundred and ninety-nine PD patients (61.9 ± 8.9years old; 58.4% males) and 207 controls (61 ± 8.3years old; 49.8% males) were included. From V0 to V5, significant differences were observed in PD patients in global and fronto-subcortical (p < 0.0001 in all visits) between LoE groups but not in posterior-cortical (p > 0.05 in all visits) CF. LoE was associated with the change from V0 to V5 in the PD-CRS total score and fronto-subcortical sub-score (p < 0.0001) in PD patients but not in controls. After adjustment for many covariates, primary education was not a predictor of PD dementia (PD-CRS < 65) at V5 (OR = 3.31; p = 0.194). Cognitive function in Parkinson's disease is influenced by the level of education.