The University Hospital Arnau de Vilanova (officially, Hospital Universitari Arnau de Vilanova in Catalan) is a public medical institution in Lleida, Catalonia, Spain, and the largest[citation needed] one in the surrounding area (terres de Lleida or terres de Ponent) and province.It was opened in 1956. Not to be confused with a hospital in Valencia called Hospital Arnau de Vilanova, the hospital in Lleida is run by the Catalan Health Institute (ICS) and has a total of 447 beds. Nowadays named after the Valencian physician Arnau de Vilanova, its first official name (in Francoist Spain) was Residencia Sanitaria General Moscardó and belonged, at first, to the Instituto Nacional de Previsión (INP) and then to INSALUD until 1981, when it was transferred to the Generalitat de Catalunya..
Parastomal hernia (PSH) repair following ureteroileostomy (Bricker’s technique) presents unique anatomical challenges, as short ileal conduits often preclude safe stoma lateralization. This study describes the open surgical technique and long-term outcomes of a retromuscular repair utilizing transversus abdominis release (TAR) and a keyhole mesh configuration. We conducted a retrospective analysis of a prospective institutional registry including all consecutive patients undergoing elective open PSH repair after ureteroileostomy between 2019 and 2023. All procedures utilized an open retromuscular keyhole mesh placement with a right-sided TAR. Primary outcomes included 30-day complications (Clavien–Dindo classification) and long-term recurrence. Fourteen male patients (mean age 75.4 years; mean BMI 28.0 kg/m2) were included. Concomitant midline hernias were present in 42.9
ABSTRACT Background Obesity management remains influenced by misconceptions about the disease, which compromise care quality. Introduction The OBEQUIDAD study explores the clinical management of people with obesity in Spain based on the perspectives of healthcare professionals involved in its treatment across different medical specialties. Methods A cross‐sectional online survey was conducted among endocrinologists, family and community medicine specialists, and internal medicine physicians actively treating people with obesity in Spain. The survey explored patient profiles, use of clinical practice guidelines, diagnostic approaches and therapeutic strategies, motivations for initiating obesity management interventions, and follow‐up practices. Results Among 352 respondents, 37% were family and community medicine specialists, 37% were endocrinologists, and 26% were internal medicine physicians. Most worked in the public sector (87%) and in non‐obesity specific medical consultations (82%). The most common patient profile attending for obesity included women (60%), individuals aged 40–64 years (51%) and people with Class I obesity (48%) who were diagnosed opportunistically (33%) or sought treatment themselves (31%). 95% of people with obesity have obesity‐related complications: dyslipidemia (55%), hypertension (52%) and type 2 diabetes mellitus (51%). Dietary and nutritional changes and increased physical activity were the most recommended obesity management interventions. The use of medical and surgical treatments was more frequent in Class II and III obesity, compared to Class I. Reducing the risk of cardiovascular complications and improving people with obesity's functional capacity and their quality of life were the main reasons to start obesity treatment. Conclusion Obesity management in Spain is mainly reactive, with care often initiated opportunistically or at the patient's request, often once comorbidities have developed. There is variability in the use of clinical practice guidelines, and treatment generally follows a stepwise approach.
PURPOSE:HER2DX is a validated genomic assay used to support treatment decisions in early-stage HER2-positive (HER2+) breast cancer. It provides three scores: relapse risk, likelihood of pathologic complete response (pCR), and ERBB2 mRNA expression. This study aimed to evaluate the association between HER2DX and histopathologic features and assess its relationship with pCR after neoadjuvant therapy. EXPERIMENTAL DESIGN:Patients with newly diagnosed stage I to III HER2+ breast cancer were analyzed based on available HER2DX results during routine care in Spain (January 2022-June 2025). Centralized HER2DX testing was performed on formalin-fixed, paraffin-embedded tumor samples. Histopathologic analysis included tumor grade, hormone receptor status, histologic subtype, Ki67 index, HER2 IHC score, stromal tumor-infiltrating lymphocytes (TIL), tertiary lymphoid structures, and spatial immune distribution. Univariate and multivariable logistic regression analyses were conducted to identify factors associated with pCR after neoadjuvant trastuzumab-based therapy. RESULTS:A total of 410 HER2+ tumors were analyzed, and 250 patients received neoadjuvant trastuzumab-based therapy with available surgical outcomes (36% achieved a pCR). HER2DX pCR scores were significantly associated with all eight histopathologic features, whereas relapse risk and ERBB2 scores were associated with five and two, respectively. TIL correlated with the immune/immunoglobulin signature (r = 0.59), and Ki67 with the proliferation signature (r = 0.50). The HER2DX pCR score remained the only independent predictor of pCR in multivariable analysis (OR, 1.77; 95% confidence interval, 1.08-2.97; P = 0.030). CONCLUSIONS:HER2DX reflects key biological and pathologic features of HER2+ breast cancer and independently predicts pCR, supporting its utility for individualized treatment decision-making.
Background Light's criteria remain the standard for distinguishing exudative from transudative pleural effusions, but require serum sampling and lack specificity. We assessed whether a pleural fluid-only approach could match the diagnostic accuracy. Methods We analysed 7280 diagnostic thoracenteses from a single centre, divided into derivation (n=5000) and validation (n=2280) cohorts. We compared Light's criteria with a triple (protein >3 g·dL−1, lactate dehydrogenase (LDH) >250 IU·L−1 or cholesterol >55 mg·dL−1) and a double (LDH >250 IU·L−1 or cholesterol >55 mg·dL−1) combination using sensitivity, specificity, likelihood ratios and area under the curve (AUC). AUCs were assessed using the DeLong method with multiple imputations from a mixed model. McNemar's test examined discordant classifications. Results The triple combination showed no significant AUC difference versus Light's criteria in either cohort and had equivalent sensitivity (99% versus 98% in derivation; both 98% in validation). In the derivation cohort, McNemar's test showed a small but statistically significant excess of false negative exudates with the triple combination (p<0.001), whereas no significant difference was found in the validation cohort (p=0.241). The triple combination correctly reclassified 19–20% of transudates misclassified by Light's criteria, while the reverse occurred in 11–14%. The double combination yielded the highest AUCs but missed more exudates, limiting its clinical safety. Conclusion A pleural fluid-only triple combination matches Light's criteria in diagnostic accuracy, avoids serum sampling and improves specificity with minimal sensitivity loss in one cohort. This approach may be a practical alternative for the initial classification of pleural effusion when blood sampling is unavailable or undesirable.
