Arredondo-Montero, J. (Javier)
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- Flow cytometric characterization of cecal appendix lymphocyte subpopulations in children: a pilot study(Springer, 2023) Ros-Briones, R. (Raquel); Martin-Calvo, N. (Nerea); López, A. (Andrés); Arredondo-Montero, J. (Javier); Hurtado-Ilzarbe, G. (Guillermina); Lopez-Andres, N. (Natalia); Antona, G. (Giuseppa)Introduction: Scientific literature regarding the characterization of lymphocyte subpopulations of the cecal appendix is sparse, with few precedents limited to immunohistochemical techniques. Methods: We conducted a prospective pilot study to characterize lymphocyte subpopulations of the cecal appendix in children. Participants were divided into three groups: (1) patients without histological acute appendiceal inflammation, (2) patients with histological uncomplicated acute appendicitis, and (3) patients with histological complicated acute appendicitis (gangrenous, perforated). A fresh sample of the base of the appendix was taken from all patients and a flow cytometric study was performed. Quantitative variables were compared using Kruskal-Wallis test and Mann-Whitney U test. Results: This study included 57 patients divided into Group 1 (n = 5), Group 2 (n = 37), and Group 3 (n = 15). Median values (IQR) of the percentage of B-lymphocytes were 67.8 [66.8-68.1] in group 1, 61.15 [53.74-66.4] in group 2, and 52.1 [33-62.02] in group 3 (p = 0.02). Median values (IQR) of the percentage of NK-lymphocytes were 0.26 [0.2-0.3] in group 1, 0.55 [0.37-0.66] in group 2, and 0.84 [0.35-1.45] in group 3 (p = 0.008). Median values (IQR) of the percentage of T-lymphocytes were 31.9 [31.7-33.1] in group 1, 37.68 [32.15-45.69] in group 2, and 46.9 [37.03-67] in group 3 (p = 0.02). Pair comparisons of groups 2 and 3 also showed significant differences in the percentage of B lymphocytes (p = 0.03) and NK-lymphocytes (p = 0.02). Conclusions: Significant differences in lymphocyte subpopulations were identified according to the histologic grade of the cecal appendix. More specifically, a lower percentage of B-lymphocytes and a higher percentage of T- and NK-lymphocytes were observed in cases of acute appendicitis. These findings must be confirmed and their etiopathogenic, diagnostic, and prognostic implications elucidated in future studies with larger sample sizes.
- Flow cytometric characterization of cecal appendix lymphocyte subpopulations in children: a pilot study(2023) Ros-Briones, R. (Raquel); Martin-Calvo, N. (Nerea); Torres-López, A. (Andrea); Arredondo-Montero, J. (Javier); Hurtado-Ilzarbe, G. (Guillermina); Lopez-Andres, N. (Natalia); Antona, G. (Giuseppa)IntroductionScientific literature regarding the characterization of lymphocyte subpopulations of the cecal appendix is sparse, with few precedents limited to immunohistochemical techniques.MethodsWe conducted a prospective pilot study to characterize lymphocyte subpopulations of the cecal appendix in children. Participants were divided into three groups: (1) patients without histological acute appendiceal inflammation, (2) patients with histological uncomplicated acute appendicitis, and (3) patients with histological complicated acute appendicitis (gangrenous, perforated). A fresh sample of the base of the appendix was taken from all patients and a flow cytometric study was performed. Quantitative variables were compared using Kruskal-Wallis test and Mann-Whitney U test.ResultsThis study included 57 patients divided into Group 1 (n = 5), Group 2 (n = 37), and Group 3 (n = 15). Median values (IQR) of the percentage of B-lymphocytes were 67.8 [66.8-68.1] in group 1, 61.15 [53.74-66.4] in group 2, and 52.1 [33-62.02] in group 3 (p = 0.02). Median values (IQR) of the percentage of NK-lymphocytes were 0.26 [0.2-0.3] in group 1, 0.55 [0.37-0.66] in group 2, and 0.84 [0.35-1.45] in group 3 (p = 0.008). Median values (IQR) of the percentage of T-lymphocytes were 31.9 [31.7-33.1] in group 1, 37.68 [32.15-45.69] in group 2, and 46.9 [37.03-67] in group 3 (p = 0.02). Pair comparisons of groups 2 and 3 also showed significant differences in the percentage of B lymphocytes (p = 0.03) and NK-lymphocytes (p = 0.02).ConclusionsSignificant differences in lymphocyte subpopulations were identified according to the histologic grade of the cecal appendix. More specifically, a lower percentage of B-lymphocytes and a higher percentage of T- and NK-lymphocytes were observed in cases of acute appendicitis. These findings must be confirmed and their etiopathogenic, diagnostic, and prognostic implications elucidated in future studies with larger sample sizes.
- Leucine-Rich Alpha-2-Glycoprotein as a non-invasive biomarker for pediatric acute appendicitis: a systematic review and meta-analysis(2023) Pérez-Riveros, B.P. (Blanca Paola); Rico-Jiménez, M. (María); Martin-Calvo, N. (Nerea); Arredondo-Montero, J. (Javier); Lopez-Andres, N. (Natalia); Emilio-Bueso, Ó. (Óscar)The aim of this study was to analyze the diagnostic performance of Leucine-Rich Alpha-2-Glycoprotein (LRG1) in pediatric acute appendicitis (PAA). We conducted a systematic review of the literature in the main databases of medical bibliography. Two independent reviewers selected the articles and extracted relevant data. Methodological quality was assessed using the QUADAS2 index. A synthesis of the results, standardization of the metrics and 4 random-effect meta-analyses were performed. Eight studies with data from 712 participants (305 patients with confirmed diagnosis of PAA and 407 controls) were included in this review. The random-effect meta-analysis of serum LRG1 (PAA vs control) resulted in a significant mean difference (95% CI) of 46.76 ¿g/mL (29.26-64.26). The random-effect meta-analysis for unadjusted urinary LRG1 (PAA vs control) resulted in a significant mean difference (95% CI) of 0.61 ¿g/mL (0.30-0.93). The random-effect meta-analysis (PAA vs control) for urinary LRG1 adjusted for urinary creatinine resulted in a significant mean difference (95% CI) of 0.89 g/mol (0.11-1.66). Conlusion: Urinary LRG1 emerges as a potential non-invasive biomarker for the diagnosis of PAA. On the other hand, due to the high between-study heterogeneity, the results on serum LRG1 should be interpreted with caution. The only study that analyzed salivary LRG1 showed promising results. Further prospective studies are needed to confirm these findings. What is Known: ¿ Pediatric acute appendicitis continues to be a pathology with a high rate of diagnostic error. ¿ Invasive tests, although useful, are a source of stress for patients and their parents. What is New: ¿ LRG1 emerges as a promising urinary and salivary biomarker for the noninvasive diagnosis of pediatric acute appendicitis.
- A bilateral whitish lesion on the mucosa of the cheek(Elsevier, 2022) Bronte-Anaut, M. (Mónica); Fernández-Seara, M.P. (María del Pilar); Guarch-Troyas, R. (Rosa); Arredondo-Montero, J. (Javier); Antona, G. (Giuseppa); Ruiz-de-Azúa, Y. (Yerani); Peñafiel-Freire, D.M. (Diego Mauricio)An 8-year-old girl with no medical history presented with a bilateral whitish lesion on the mucosa of the cheek, evident since early childhood. There was no relevant family history, and her parents had not presented similar lesions. They reported a progressive growth of the lesion in the last months, for which she had been evaluated by maxillofacial surgery, the lesion being oriented as a frictional keratosis. However, the use of occlusal splint was not associated with any improvement. She was otherwise asymptomatic. Physical examination revealed a bilateral, whitish, well-demarcated cheek mucosal plaque, which partially coincided with the dental occlusion line. The lesion did not detach with scratching (Figure 1). No other alterations were observed in the oral cavity or in the systematic physical examination.
- Diagnostic performance of serum pentraxin-3 in pediatric acute appendicitis: a prospective diagnostic validation study(Springer, 2022) Bronte-Anaut, M. (Mónica); Ros-Briones, R. (Raquel); Martin-Calvo, N. (Nerea); Bardají-Pascual, C. (Carlos); Arredondo-Montero, J. (Javier); Rivero-Marcotegui, A. (Adriana); Fernández-Celís, A. (Amaya); Lopez-Andres, N. (Natalia); Antona, G. (Giuseppa)Introduction Pediatric acute appendicitis (PAA) is a pathology with a high rate of diagnostic error. The search for new diagnostic tools is justified by the high morbidity and healthcare costs associated with diagnostic error. Methods We designed a prospective study to validate serum pentraxin-3 (PTX3) as a diagnostic tool in PAA. Participants were divided into three groups: (1) patients with no underlying pathology (2) patients with non-surgical abdominal pain and (3) patients with a confirmed diagnosis of PAA. For further analyses, patients in group 3 were divided into complicated or uncomplicated PAA. Quantitative variables were expressed as medians and interquartile ranges and categorical variables as percentages. Quantitative variables were compared using the Kruskal–Wallis test and the Mann–Whitney U test. Diagnostic performance was evaluated with ROC curves. Results This study included 215 patients divided into group 1 (n : 63), group 2 (n : 53) and group 3 (n : 99). Median serum PTX3 values were 2.54 (1.70–2.95) ng/mL, 3.29 (2.19–7.64) ng/mL and 8.94 (6.16–14.05) in groups 1, 2 and 3, respectively (p : 0.001). Patients with complicated PAA showed significantly higher values than patients with uncomplicated PAA (p = 0.04). The AUC (group 2 vs. 3) was 0.77 (95/100 CI 0.69–0.85) and the best cut-off point was at 7.28 ng/mL, with a sensitivity of 61.3/100 and a specificity of 73.1/100. The AUC (complicated vs. uncomplicated PAA) was 0.65 (95/100 CI 0.54–0.77) and the best cut-off point was 12.33 ng/mL, with a sensitivity of 51.72/100 and a specificity of 72.73/100. Conclusions The diagnostic ability of serum PTX3 in PAA is only moderate and therefore it cannot be considered a definitive diagnostic test. The discriminatory ability of PTX3 between complicated and uncomplicated PAA is poor. These findings, which contrast with those reported to date, should be validated with future properly designed prospective studies.
- Metastasis of spindle cell malignant melanoma in gallbladder(Springer, 2022) Bronte-Anaut, M. (Mónica); Martin-Calvo, N. (Nerea); Recreo-Baquedano, A.C. (Ana Cristina); Arredondo-Montero, J. (Javier)Malignant melanoma is an aggressive neoplasm with a high tendency to metastasize. Gastrointestinal metastases, although described in the literature, are infrequent. We present the case of a 51-year-old male patient with a surfcial spreading melanoma stage IIIc with BRAF mutation who presented a gallbladder outgrowth lesion, compatible with a polyp. A signifcant growth of the lesion was observed in subsequent TC studies and a laparoscopic cholecystectomy was performed. The anatomopathological study of the specimen confrmed the diagnosis of gallbladder metastasis due to epithelioid and spindle cell malignant melanoma. The presence of a gallbladder lesion in the context of a patient diagnosed with melanoma should establish the diagnostic suspicion of metastasis, and an early extension study and laparoscopic cholecystectomy should be considered. The palliative surgical approach to avoid hepatobiliary symptomatology can be considered.
- Pediatric splenic torsion in an orthotopic spleen without fixation elements(Elsevier, 2022) Bronte-Anaut, M. (Mónica); Ros-Briones, R. (Raquel); Bardají-Pascual, C. (Carlos); Arredondo-Montero, J. (Javier); Moreno-Ibérico, M.A. (Maria Alejandra); Antona, G. (Giuseppa)A 4-year-old girl presented with acute left upper quadrant abdominal pain and anorexia of 4 days’ duration. She had no relevant medical history and no trauma history was reported. Findings of the physical examination showed abdominal guarding and peritoneal irritation in the left upper quadrant. The rest of the examination was normal.
- Ulnar distribution pattern may be predominant in upper extremity lymphatic malformations(Springer, 2023) López-Gutiérrez, J.C. (Juan Carlos); Muñoz-Serrano, A.J. (Antonio Jesús); Martin-Calvo, N. (Nerea); Arredondo-Montero, J. (Javier); Delgado-Miguel, C. (Carlos)The locoregional distribution patterns of lymphatic malformations (LM) in the upper extremity have not been described in the scientific literature. Twelve patients were diagnosed with a LM in their upper extremities between 1998 and 2021 at our center. In all cases, these were isolated malformations. Nine patients (75%) presented an ulnar distribution pattern of the LM, two (16.7%) presented a radial distribution pattern, and one (8.3%) presented involvement of both territories. We found no statistically significant differences in any sociodemographic or clinical variable between patients with ulnar or radial LM distribution patterns. In this work, we found that the ulnar distribution pattern was more frequent than the radial distribution pattern in upper extremity LM. Furthermore, we observed that LM in the radial territory appeared as lesions limited to the distal segment of the upper limb (thumb and distal radius). This is a small retrospective case series and therefore, these findings should be interpreted with caution. Larger sample size studies are necessary to validate and characterize this finding.
- Discriminatory capacity of serum interleukin-6 between complicated and uncomplicated acute appendicitis in children: a prospective validation study(Springer, 2022) Bronte-Anaut, M. (Mónica); Ros-Briones, R. (Raquel); Martin-Calvo, N. (Nerea); Bardají-Pascual, C. (Carlos); Arredondo-Montero, J. (Javier); Rivero-Marcotegui, A. (Adriana); Fernández-Celís, A. (Amaya); Lopez-Andres, N. (Natalia); Antona, G. (Giuseppa)Background: Serum interleukin-6 (IL-6) has a moderate diagnostic performance in pediatric acute appendicitis (PAA). The evidence regarding its capacity to discern between complicated and uncomplicated PAA is scarce. Methods: We designed a prospective observational study to validate serum IL-6 as a marker for diagnostic classification between complicated and uncomplicated PAA. This study included 205 patients divided into three groups: (1) patients who underwent major outpatient surgery (n = 57); (2) patients with non-surgical abdominal pain (NSAP) in whom the diagnosis of PAA was excluded (n = 53), and (3) patients with a confirmed diagnosis of PAA (n = 95). The PAA patients were further classified as uncomplicated or complicated PAA. IL-6 concentration was determined in all patients at diagnosis. Comparative statistical analysis was performed using the Mann-Whitney U test, the Fisher exact test and the Kruskall Wallis test. The area under the receiver operating characteristic curves (AUC) were calculated. Results: Median (interquartile range, IQR) serum IL-6 values were 2 pg/mL (2.0-3.4) in group 1, 3.9 pg/mL (2.4-11.9) in group 2, and 23.9 pg/mL (11.1-61.0) in group 3 (P < 0.001). Among the participants in group 3, those with uncomplicated PAA had median (IQR) serum IL-6 values of 17.2 pg/mL (8.5-36.8), and those with complicated PAA had 60.25 pg/mL (27.1-169) serum IL-6 (P < 0.001). At the cut-off point of 19.55 pg/mL, the AUC for the discrimination between patients in group 2 vs. 3 was 0.83 [95% confidence interval (CI) 0.76-0.90], with a sensitivity of 61.3% and a specificity of 86.8. The AUC for the discrimination between patients with uncomplicated and complicated PAA was 0.77 (95% CI 0.68-0.86) and the cut-off point was 25.90 pg/mL, with a sensitivity and specificity of 84.6% and 65.6%, respectively. Conclusions: Serum IL-6 has a good performance in discerning between complicated and uncomplicated PAA. A score including clinical and radiological variables may increase the diagnostic performance of this molecule.
- Pop-off mechanisms as renoprotective mediators in children with posterior urethral valves: A systematic review and meta-analysis(Elsevier, 2024) Pérez-Riveros, B.P. (Blanca Paola); Rico-Jiménez, M. (María); Martin-Calvo, N. (Nerea); Arredondo-Montero, J. (Javier); Emilio-Bueso, Ó. (Óscar)Background: Pop-off mechanisms are potential pressure-relieving mediators in patients diagnosed with posterior urethral valves (PUV). This systematic review aimed to synthesize the existing evidence regarding the protective effect of pop-off mechanisms on renal function in children with PUV. Methods: We conducted a systematic review of the literature that involved an extensive search in the main databases of the medical bibliography. Three independent reviewers selected the relevant articles. Methodological quality was rated using the Newcastle Ottawa Scale index. We used random meta-analyses to compare different outcomes (serum creatine, Nadir serum creatinine, and Chronic Kidney Disease) between children with PUV and pop-off mechanisms and those with PUV without pop-off mechanisms. Results: 10 studies with data from 896 participants were included in this review. Seven articles reported serum creatinine values for each group and 3 of them found significant differences between groups. The random-effects meta-analysis for serum creatinine showed significant lower mean (diff = -52.88 μmol/L [95 % CI -73.65 to -32.11]) in the group of children with pop-off mechanisms, and the random-effects meta-analysis for Nadir serum creatinine showed a marginally significantly lower mean in the group of children with pop-off mechanisms (diff = -12.00 μmol/L [95 % CI -24.04 to 0.04]). The random-effect meta-analysis for Chronic Kidney Disease resulted in a significant risk reduction for the group of children with pop-off mechanisms (odds ratio = 0.48 [95 % CI 0.23 to 0.98]). Conclusions: Children with PUV and pop-off mechanisms show better renal function and lower risk of Chronic Kidney Disease than those with PUV without pop-off mechanisms suggesting these mechanisms may act as renoprotective mediators. The high heterogeneity between studies in the assessment of renal function and long-term outcomes calls for a cautious interpretation of these findings. Future studies that stratify by different types of pop-off mechanisms and use standardized metrics, such as Nadir creatinine, are needed.