European Hernia Society guidelines on management of rectus diastasis

Rectus diastasis; Hernia; GuidelinesDiástasis del recto; Hernia; PautasDiàstasi del recte; Hèrnia; PautesBackground The definition, classification and management of rectus diastasis (RD) are controversial in the literature and a variety of different surgical treatments have been described. This article reports on the European Hernia Society (EHS) Clinical Practice Guideline for RD. Method The Guideline group consisted of eight surgeons. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach and the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument were used. A systematic literature search was done in November 2018 and updated in November 2019 and October 2020. Nine Key Questions (KQs) were formulated. Results Literature reporting on the definition, classification, symptoms, outcomes and treatments was limited in quality, leading to weak recommendations for the majority of the KQs. The main recommendation is to define RD as a separation between rectus muscles wider than 2 cm. A new classification system is suggested based on the width of muscle separation, postpregnancy status and whether or not there is a concomitant hernia. Impaired body image and core instability appear to be the most relevant symptoms. Physiotherapy may be considered before surgical management. It is suggested to use linea alba plication in patients without concomitant hernia and a mesh-based repair of RD with concomitant midline hernias. Conclusion RD should be defined as a separation of rectus muscles wider than 2 cm and a new classification system is suggested

Correction : Ventral hernia repair in high-risk patients and contaminated fields using a single mesh: proportional meta-analysis

The use of mesh is a common practice in ventral hernia repair (VHR). Lack of consensus on which prosthetic material works better in different settings remains. This meta-analysis aims to summarize the available evidence on hernia recurrence and complications after repair with synthetic, biologic, or biosynthetic/bioabsorbable meshes in hernias grade 2-3 of the Ventral Hernia Working Group modified classification. A literature search was conducted in January 2021 using Web of Science (WoS), Scopus, and MEDLINE (via PubMed) databases. Randomized Controlled Trials (RCTs) and observational studies with adult patients undergoing VHR with either synthetic, biologic, or biosynthetic/bioabsorbable mesh were included. Outcomes were hernia recurrence, Surgical Site Occurrence (SSO), Surgical Site Infection (SSI), 30 days re-intervention, and infected mesh removal. Random-effects meta-analyses of pooled proportions were performed. Quality of the studies was assessed, and heterogeneity was explored through sensitivity analyses. 25 articles were eligible for inclusion. Mean age ranged from 47 to 64 years and participants' follow-up ranged from 1 to 36 months. Biosynthetic/bioabsorbable mesh reported a 9% (95% CI 2-19%) rate of hernia recurrence, lower than synthetic and biologic meshes. Biosynthetic/bioabsorbable mesh repair also showed a lower incidence of SSI, with a 14% (95% CI 6-24%) rate, and there was no evidence of infected mesh removal. Rates of seroma were similar for the different materials. This meta-analysis did not show meaningful differences among materials. However, the best proportions towards lower recurrence and complication rates after grade 2-3 VHR were after using biosynthetic/slowly absorbable mesh reinforcement. These results should be taken with caution, as head-to-head comparative studies between biosynthetic and synthetic/biologic meshes are lacking. Although, biosynthetic/bioabsorbable materials could be considered an alternative to synthetic and biologic mesh reinforcement in these settings. The online version contains supplementary material available at 10.1007/s10029-022-02668-

Miradas colectivas del departamento de Cundinamarca, Bogotá y municipio de Soacha

En este documento se hace una síntesis de las diversas problemáticas a intervenir en las diferentes familias y comunidades seleccionadas por el grupo. Se tratan temas relacionados con la violencia familiar, la falta de comunicación, la violación de derechos e incluso la falta de conciencia de vivir en comunidad.This document expose a summaries about various issues to be addressed in the different families and communities selected by the group. Topics related to family violence, no communication, violation of rights and even lack of awareness of living in community

Rare-EDIFICA-SOS: recuperación arquitectónica de lo inconcluso-obsoleto, desde una rehabilitación más sostenible

...ante el conjunto de edificios existentes que, por razones energéticas, históricas, estéticas o económicas, han dejado de ser considerados como eficientes desde el punto de vista de la habitabilidad contemporánea [obsoletos]... ...ante el conjunto de edificios en los cuales el hecho arquitectónico no ha llegado a ser completado, por razones ciertamente relacionadas con la deriva económico-social de los años precedentes, dando lugar a “elefantes blancos” varados a lo largo y ancho de la geografía andaluza [inconclusos]... ...ante el conjunto de edificios e inmuebles concluidos pero no habitados (o bien, habitados de manera a-legal), dando lugar a consideraciones y problemáticas sociales de imperiosa actualidad [quiméricos]... ...se habrán de conjeturar una serie de factores que, a la postre, repercutirán en la viabilidad de la conservación, reparación, consolidación, transformación, reforma, rehabilitación o, en definitiva, de su recuperación optimizada, con la premisa de que las construcciones a considerar constarán –en su mayoría- de condiciones tecnológicas, estructurales, constructivas y de materialidad distintas a las usuales hoy en día. Bajo tales consideraciones, el principal objetivo del trabajo de investigación sería la detección del conjunto de edificaciones obsoletas, inconclusas y quiméricas en Andalucía y su clasificación por grados de obsolescencia y falta de terminación, así como estado de ocupación para, tras una estratégica diagnosis sobre oportunidades de recuperación (en las que podría englobarse la viabilidad de nuevos usos o la aplicación de nuevas formas de gestión de la habitabilidad contemporánea), diseñar finalmente propuestas que permitan la recuperación de las edificaciones a través soluciones constructivas sostenibles para un ámbito característico (el hábitat mediterráneo), relacionadas con la envolvente del edificio y su rehabilitación energética....given the set of existing buildings that, for energetic, historical, aesthetic or economic reasons, are no longer considered efficient from the point of view of contemporary habitability [obsolete]... ...given the set of buildings in which the architectonic fact has not become completed, for reasons certainly related with the economic-social results from previous years, resulting white elephants stranded, in this case along the andalusian geography [inconclusive]... ...given the sets of constructed building uninhabited or habited but without the normal and legal consideration and social issues [chimeric]......then, a whole set of factors, that ultimately will have an impact on the viability of the maintenance, repair, consolidation, transformation, reform, rehabilitation or, definitively, its optimized recovery, will have to be surmised, with the premise that the constructions considered will feature, mostly, with technological, structural, constructive and materials conditions different from the actual. Under the above considerations, the main aim of the research would be the detection of the set of obsolete, inconclusive and chimeric buildings in Andalusia and its classification by degree of obsolescence, failure to complete and occupation status to, after a strategic diagnosis about opportunities recovery (in which could be encompassed the viability of new uses or the application of new management of contemporary habitability), design proposals that allow the recovery of buildings through sustainable constructional solutions for a characteristic mediterranean habitat, related to the building envelope and its energy rehabilitation

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

CIBERER : Spanish national network for research on rare diseases: A highly productive collaborative initiative

Altres ajuts: Instituto de Salud Carlos III (ISCIII); Ministerio de Ciencia e Innovación.CIBER (Center for Biomedical Network Research; Centro de Investigación Biomédica En Red) is a public national consortium created in 2006 under the umbrella of the Spanish National Institute of Health Carlos III (ISCIII). This innovative research structure comprises 11 different specific areas dedicated to the main public health priorities in the National Health System. CIBERER, the thematic area of CIBER focused on rare diseases (RDs) currently consists of 75 research groups belonging to universities, research centers, and hospitals of the entire country. CIBERER's mission is to be a center prioritizing and favoring collaboration and cooperation between biomedical and clinical research groups, with special emphasis on the aspects of genetic, molecular, biochemical, and cellular research of RDs. This research is the basis for providing new tools for the diagnosis and therapy of low-prevalence diseases, in line with the International Rare Diseases Research Consortium (IRDiRC) objectives, thus favoring translational research between the scientific environment of the laboratory and the clinical setting of health centers. In this article, we intend to review CIBERER's 15-year journey and summarize the main results obtained in terms of internationalization, scientific production, contributions toward the discovery of new therapies and novel genes associated to diseases, cooperation with patients' associations and many other topics related to RD research