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- Identificación de miRNAs en humor acuoso y su utilización como biomarcadores del glaucoma pseudoexfoliativo(2026) García Villanueva, Carolina; Pinazo Durán, Maria Dolores; Pérez Torregrosa, Vicente-Tomás; García Feijóo, Julián; Escola de DoctoratEl glaucoma es una neuropatía óptica crónica caracterizada por la degeneración progresiva de las células ganglionares de la retina y sus axones, primera causa de ceguera irreversible mundial. De elevada heterogeneidad clínica y genética, PIO elevada el principal factor de riesgo modificable. El síndrome pseudoexfoliativo representa el principal factor de riesgo identificable para el glaucoma secundario de ángulo abierto o glaucoma pseudoexfoliativo (GPEX). Es un trastorno sistémico de la matriz extracelular asociado al envejecimiento, caracterizado por el depósito progresivo de material fibrilar en diversas estructuras oculares, cuya acumulación en las vías de drenaje del humor acuoso favorece el aumento de la PIO y desarrollo de GPEX. Sin embargo, actualmente no es posible predecir qué pacientes con PEX progresarán a glaucoma. El humor acuoso constituye una matriz biológica de gran interés para la identificación de biomarcadores moleculares. En este contexto, los microARNs (miRNAs), reguladores epigenéticos de la expresión génica, y la metabolómica, que analiza los metabolitos resultantes del metabolismo celular, representan herramientas prometedoras para comprender la fisiopatología del glaucoma y desarrollar nuevas estrategias diagnósticas y terapéuticas. El objetivo principal de este trabajo es analizar la expresión de moléculas y genes en muestras de HA obtenidas en el curso de la cirugía programada de pacientes con GPAA o GPEX y compararlos con aquellos que padecen el PEX (sin glaucoma) y con sujetos operados de cirugía no complicada de cataratas, considerados grupo control (GC) con el fin de identificar biomarcadores para el diagnóstico precoz del GPEX. El estudio es multicéntrico, multidisciplinar, observacional, analítico, de corte transversal, en 265 participantes, con el propósito de determinar la firma de los miRNAs y las características metabolómicas del HA de los cuatro grupos de estudio, para establecer una nueva forma de diagnóstico molecular preclínico e identificar pacientes con PEX y mayor riesgo de desarrollar el GPEX, contribuyendo al desarrollo de nuevas bioterapias. A todos los participantes se les realizó examen oftalmológico completo y extracción de HA en el curso de la cirugía programada de segmento anterior que se procesó para analizar y cuantificar la expresión de miRNAs y metabolitos en los cuatro grupos mediante secuenciación de próxima generación, y espectroscopía 1H NMR, respectivamente. La NGS proporcionó un total de 455 miRNAs, (130 en el GPEX, y 18 con expresión diferencial entre grupos). Las concentraciones de miR-122a-5p, -146a-5p y -320a-3p mediante RT qPCR mostraron AUC notables y tendencia a la sobreexpresión en el síndrome PEX y GPEX. Sus genes diana más consistentes con la fisiopatogenia de PEX y GPEX, implican expresión de metaloproteinasas y glutamato, y vías TFGb, MAPK y Rho/ROCK. El análisis metabolómico del HA aportó diversos metabolitos discriminantes entre el síndrome PEX-GPEX vs el GPAA-GC: aminoácidos y derivados y productos del metabolismo lipídico y glucídico. La vía metabólica de mayor impacto fue la biosíntesis de fenilalanina, tirosina y triptófano. Futuros estudios con muestra más amplia y características más refinadas podrían reforzar estos hallazgos y contribuir al desarrollo de herramientas de diagnóstico precoz más precisas y accesibles, así como al descubrimiento de nuevas bioterapias GPEX
- Occlusal conditions, postural control and plantar parameters in adults and growing subjects: a systematic review of objective assessment methods(2026) Carda-Navarro, Isabel; Sánchez-Albero, Ana; Guinot-Barona, Clara; García-Miralles, Esther; Marqués-Martínez, Laura; Aura, Juan IgnacioObjective: To evaluate whether occlusal conditions are associated with global postural control and plantar parameters when assessed using objective posturographic and pressure-based methods, with particular attention to differences between adult populations and growing subjects. Methods: A systematic review was conducted following PRISMA 2020 guidelines. Searches were performed in PubMed/MEDLINE, Scopus, Embase, CINAHL, and Web of Science up to October 2025. Observational and experimental studies in humans assessing occlusal conditions in relation to instrument-based postural or plantar outcomes were included. Study selection, data extraction, and risk of bias (JBI) were conducted independently by two reviewers. Due to heterogeneity, findings were synthesized qualitatively. Certainty of evidence was evaluated using GRADE. Results: Seven studies were included. Outcomes comprised center-of-pressure metrics, postural sway, weight distribution, plantar pressure patterns, and balance performance. In adults, findings were inconsistent: under natural static conditions one study found no association while another reported significant static differences, and the remaining positive findings emerged mainly under experimental or task-specific conditions. The two studies in growing subjects yielded conflicting results (one larger study largely null, one positive), so the evidence does not support a more consistent association in this subgroup. Risk of bias related mainly to confounding and participant selection, and certainty of evidence was low to very low. Conclusions: Current evidence does not support a consistent relationship between occlusal conditions and global postural control. The two studies in growing subjects yielded conflicting findings, and the small number of studies, methodological heterogeneity, and low to very low certainty of the evidence preclude establishing a pediatric association or drawing firm clinical inferences.
- Effects of motor Imagery on skin conductance and pelvic floor sensorimotor condition: a randomised controlled trial(2025) Cuenca Martínez, Ferran; Rubio-Baños, Ana Isabel; Fuentes Aparicio, Laura; Sempere Rubio, NúriaABSTRACT. The main aim was to assess the effects of motor imagery (MI) plus pelvic floor musculature (PFM) isometric exercises (IE) on skin conductance and pelvic floor sensorimotor condition. Thirty healthy women were randomised into two groups: MIþIE (n¼15), and sham-MIþIE (CG) group (n¼15). A pre- and post-intervention evaluation was conducted. Regarding the skin conductance, significant betweengroup differences were found in favour of MIþIE in the imagination phase with a large effect size (mean differences (MD)¼1.79 lS, p¼0.037, d¼0.82). This greater sympathetic activation in the MIþIE group was accompanied by significantly greater hypoalgesia on presumed referral area of menstrual pain compared with the CG with a moderate effect size (MD ¼ 0.722 Kg/cm2, p¼0.048, d¼0.76). Finally, regarding the PFM strength, significant between-group differences were also found in favour of MIþIE compared with the CG with a large effect size (MD ¼ 64.9 g, p¼0.035, d¼0.81). The results showed that adding MI to an IE program resulted in statistically greater improvements in pelvic floor sensorimotor function than IE alone in a single session and this should be considered clinically. Finally, one of the neurophysiological mechanisms by which the greater hypoalgesia generated in the experimental group could be explained through the activation of the sympathetic-excitatory system
- Influence of Early Feeding Practices on Oral Microbiota Composition During Infancy and Potential Implications for Early Childhood Caries: A Systematic Review(2026) Ibor-Miguel, Marta; Pérez-Sánchez, Davinia; Marqués-Martínez, Laura; Aura, Juan Ignacio; Guinot-Barona, Clara; García-Miralles, EstherBackground: Early feeding practices are among the most influential determinants of the infant oral microbiota during the first years of life. Breastfeeding provides bioactive components¿immunoglobulins, human milk oligosaccharides (HMOs), and commensal bacteria¿that may shape microbial colonisation patterns with long-term implications for oral health. However, the nature, magnitude, and clinical relevance of these effects remain poorly characterised, particularly with regard to early childhood caries (ECC) risk. Objectives: The primary objective was to evaluate the association between early feeding practices and oral microbiota composition during infancy. A secondary exploratory ob-jective was to assess whether feeding-associated microbiota differences had been linked to subsequent dental caries outcomes. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. PubMed, Scopus, Web of Science, and Embase were searched from January 2010 to June 2026. Eligible studies compared at least two feeding groups and measured oral microbiota directly using culture-independent meth-ods (16S rRNA gene sequencing, metagenomics, or quantitative PCR targeting multiple taxa). Study selection, data extraction, and risk of bias assessment using the ROBINS-E tool were performed independently. Qualitative synthesis was conducted given clinical and methodological heterogeneity. Results: Of 8582 records identified, 12 studies met the inclusion criteria (sample size range: 12-448 participants; age range at microbiota assessment: 2 days-14 years, although eligibility was based on feeding exposure during infancy; six countries). Most included studies reported differences in oral microbiota com-position associated with feeding type. During the first months of life, breastfed infants generally showed lower oral microbial diversity and higher abundance of Lactobacillus, the Streptococcus mitis group and Bifidobacterium compared with formula-fed infants, who exhibited greater alpha diversity, higher transmission of maternal oral bacteria, and higher abundance of Prevotella and Actinomyces. Effects were most pronounced in the first three months of life and attenuated by 12 months in most cohorts. Only one study reported subsequent dental caries outcomes after early-life microbiota assessment, finding that Streptococcus cristatus abundance at three months was associated with dental caries at nine years of age, and that longer breastfeeding duration (≥12 months) was associated with a distinct microbiota profile and lower caries rates in this single available longitudinal study. Risk of bias was low in two studies, moderate in six, and high in four. Publication bias could not be formally evaluated. Conclusions: Early feeding practices are associated with measurable differences in oral microbiota composition during infancy, particularly during the first months of life. However, evidence linking these microbiota differences to subse-quent dental caries outcomes remains extremely limited, with only one included study assessing later caries development. Therefore, the clinical significance of feeding-associated microbiota profiles remains uncertain and should be investigated through well-designed prospective longitudinal studies.
- Exploring real-world lumbar posture behaviour. A whole day comparison of individuals with low back pain and healthy controls(2026) McClintock, Frederick; Callaway, Andrew; Clark, Carol; Muñoz Gómez, Elena; Alqhtani, Raee; Williams, JonathanBackground: Previous research of lumbar posture on individuals with low back pain (LBP) has produced conflicting findings compared to control groups. This research has been limited by environmental or task constraints. Real-world postural behaviour across an entire day remains poorly understood. This study examined whole-day lumbar posture characteristics in people with and without LBP using wearable sensors. Methods: 13 people with LBP and 11 healthy controls volunteered for this study. A three-accelerometer setup was used to measure real-world lumbar posture classifying sitting and standing. Data were normalised to individual maximum ranges. Differences in measures of mean posture, variability, fidgeting, and posture-use frequency distributions, were derived. Findings: An average of 350 min of data per person was available for analysis. Overall, between group differences were small. LBP demonstrated more flexed posture use in standing and a more flexed sitting frequency distribution. Interpretation: Real-world posture behaviour was similar between individuals with and without LBP. Where differences were determined they related to temporal components such as frequencies which are masked with traditional postural estimates. These findings suggest that posture-pain relationships may vary substantially between individuals, emphasising the need for person-specific analysis in future research.
- Discrepancies and associations among chronological age, dental age, and cervical vertebral maturation in growing orthodontic patients: a cross-sectional study in a Spanish orthodontic clinical sample(2026) Galán-López, Lidia; Liceras-Viñoles, Rita; Sanz-Orrio-Soler, Icíar; Guinot-Barona, Clara; García-Miralles, Esther; Aura, Juan IgnacioBackground: Biological maturation varies substantially among children of the same chronological age, which may affect growth-based orthodontic decisions. Methods: In this cross-sectional study, 120 patients aged 8 to 16 years were evaluated using routine or- thodontic diagnostic records. Chronological age was compared with dental age estimated using the Nolla and Demirjian methods, and skeletal maturation was assessed using cervical vertebral maturation stages (CVMS). Associations with sex, BMI, BMI-for-age z-score, and menarcheal status in females were exam- ined. Results: Both dental methods systematically overestimated chronological age. Mean discrepancies were + 0.59 years for the Nolla method (95% CI: 0.39-0.79; Cohen's dz = 0.52) and + 1.09 years for the Demir- jian method (95% CI: 0.87-1.31; Cohen's dz = 0.89) (both P < 0.001). Female participants exhibited a higher proportion of pubertal and postpubertal CVMS than males (Cramer's V = 0.41; P < 0.001), although sex differences in dental age discrepancies were small (Cohen's d ≤0.14). BMI and BMI-for-age z-scores were positively correlated with dental age discrepancies ( ρ= 0.27-0.31) and CVMS stage ( ρ= 0.35-0.36) (all P ≤0.003), indicating small-to-moderate associations. Menarcheal status was not significantly associ- ated with CVMS ( P = 0.727) or dental age discrepancies ( P > 0.05). Conclusions: Chronological age alone provides an incomplete estimate of biological maturation. Dental age estimation and CVM assessment offer com plementary but nonequivalent information, and their interpre- tation should consider sex and basic anthropometric context.
- From green extraction to clean-label formulation: natural deep eutectic solvents as multifunctional extraction-formulation systems for agri-food valorization(2026) Gómez-Urios, Clara; Paños-Huertas, Mario; Castillo-Esteve, Ines; Cortés, Clara; Blesa Jarque, Jesús; Esteve Más, María JoséThe transition toward sustainable agri-food systems requires efficient strategies for the valorization of bioactive compounds from food-processing byproducts. In this context, Natural Deep Eutectic Solvents (NADES) have emerged as promising alternatives to conventional organic solvents, offering tailored physicochemical properties, low volatility, and compatibility with food-grade components. This review analyzes recent advances (2015-2025) in the use of NADES for the extraction, stabilization, and direct incorporation of bioactive compounds from agri-food residues. The available data indicate that NADES frequently achieve higher extraction yields of polyphenols, flavonoids, and anthocyanins than conventional solvents, particularly when combined with intensification technologies such as ultrasound- and microwave-assisted extraction. In addition to extraction efficiency, NADES provide protective microenvironments that enhance the stability and bioavailability of sensitive compounds. Their potential for solvent recycling and direct integration into food matrices represents a significant advantage over traditional extraction workflows by reducing solvent removal steps and environmental impact. Applications in beverages, bakery products, emulsions, edible coatings, and encapsulated systems demonstrate the feasibility of NADES-based extracts for clean-label functional foods without compromising sensory acceptance. However, challenges related to viscosity, process standardization, techno-economic feasibility, and regulatory evaluation remain key factors influencing industrial implementation. Overall, NADES can be considered multifunctional extraction-formulation platforms that support the transition from conventional solvent-based extraction toward integrated and sustainable agri-food valorization strategies.
- Energy‑efficient ultrasound‑assisted extraction of phenolic compounds from orange peel using COSMO‑RS‑Guided selection of NADES(2026) Gómez-Urios, Clara; Cortés, Clara; López-Malo, Daniel; Esteve Más, María José; Blesa Jarque, JesúsOrange peel (OP) is a relevant by-product of the citrus industry, rich in phenolic compounds and ascorbic acid (AA), but its sustainable valorization requires green and efficient extraction strategies. In this study, six natural deep eutectic solvents (NADES) selected via COSMOTherm solubility modelling were evaluated for the recovery of bioactive compounds from OP using ultrasound-assisted extraction (UAE) followed by a stirring treatment. The influence of sonication time (5-15 min), ultrasound power (100-400 W), and stirring time (0-45 min) was assessed by quantifying total phenolic content (TPC), AA, and antioxidant capacity, while monitoring energy consumption to ensure process sustainability. NADES showed solvent-dependent extraction behavior, with most systems following a rise-plateau pattern, indicating extraction equilibrium at 20-30 min of stirring, whereas prolonged treatment (45 min) offered minimal or inconsistent improvement despite markedly higher energy input. Considering extractive performance and energy efficiency, optimal conditions were defined as 10 min UAE at 100 W followed by 40 min stirring. Method validation under these conditions included the quantification of individual phenolic compounds and AA by HPLC-UV/VIS and antioxidant assessment by FRAP and ORAC. Among solvents, MA:Glu and LA:Glu yielded the highest concentrations of phenolic compounds and antioxidant activity, while the extraction profiles confirmed the selectivity of NADES toward flavanones such as hesperidin and naringin. Overall, the study demonstrates that tailored NADES-UAE combinations constitute an effective and sustainable approach for recovering high-value antioxidants from orange peel, contributing to circular economy strategies and green extraction technologies.
- Parental oral health knowledge and sociodemographic influences in children aged 2-12 years: a cross‑sectional study in Valencia, Spain(2026) Borrell-García, Carla; Mestanza-Tocto, Sofía; Boo Gordillo, Paula; Marqués-Martínez, Laura; García-Miralles, Esther; Aura, Juan IgnacioPurpose The present study aimed to assess parental knowledge of paediatric oral health among parents and guardians of children aged 2-12 years in Valencia, Spain, and to analyse its association with key sociodemographic variables. Methods A cross-sectional study was conducted with 208 parents and guardians of children attending a university dental clinic in Spain. A validated self-administered 20-item questionnaire was used to evaluate oral health knowledge. Descriptive statistics and one-way ANOVA with Tukey post hoc tests were applied to compare mean knowledge scores across sociodemographic groups. The significance level was set at p < 0.05. Results Parental education level was significantly associated with oral health knowledge. Parents with university education (17.01 ± 1.86) and vocational training (16.71 ± 2.09) scored higher than those with secondary school (15.78 ± 2.34), basic education (13.09 ± 2.77), or no education (13.30 ± 2.41). No significant difference was observed by gender (p = 0.394). Age group was also associated with knowledge (F(2,195) = 7.55, p = 0.001), with the highest scores observed among parents aged 41-50 years (17.45 ± 1.97). Conclusions Parental oral health knowledge was associated with educational attainment and age, while no gender differences were observed. These results suggest the value of developing targeted educational approaches for younger parents and those with lower education levels.
- Clinical Reliability of AI-Based Cephalometric Analysis Using WebCeph: A Comparative Agreement Study(2026) Azari-Mehr, Ali; Bisbal-Puchades, Ángela; Marqués-Martínez, Laura; Carmona-Santamaría, María; García-Miralles, Esther; Aura, Juan Ignacio; Guinot-Barona, ClaraBackground/Objectives: Artificial intelligence has accelerated cephalometric analysis by enabling rapid and standardized measurements. However, whether these automated outputs can be considered clinically interchangeable with expert manual tracing remains unresolved, particularly for routinely used analyses such as Steiner. Methods: A compara-tive experimental study was conducted on 100 lateral cephalometric radiographs analysed using two parallel approaches: expert manual tracing and fully automated analysis with the WebCeph platform. Seven Steiner variables (SNA, SNB, ANB, 1-NA, 1-NB, interincisal angle, and FMA) were evaluated. Paired t-tests were used to assess differences between methods, while agreement was evaluated using intraclass correlation coefficients and Bland-Altman analysis. Particularly low agreement was observed for clinically relevant parameters such as ANB and FMA. Results: Six of the seven variables showed statistically significant differences between methods. Automated measurements systematically tended to overestimate both skeletal and dental parameters. Agreement was inconsistent and fre-quently poor, with ICC values ranging from 0.01 to 0.60 for clinically relevant variables such as ANB and FMA. Importantly, small or non-significant mean differences did not translate into acceptable agreement. Bland-Altman analysis confirmed the presence of systematic bias and wide limits of agreement, especially for dental measurements. Conclusions: De-spite its speed and automation, WebCeph does not achieve clinically acceptable agreement with expert manual tracing across several key cephalometric variables. The observed discrepancies¿particularly in parameters critical for sagittal and vertical diagnosis¿may compromise clinical interpretation and treatment planning. These findings support the use of AI-based cephalometric analysis as an adjunctive tool rather than a substitute for clinician-guided evaluation.
- Exploring Cultural and Technological Gaps: A Qualitative Study of Spanish and Colombian Nursing Students' Views on Digital Health Leadership(2026) Navarro Martínez, Olga; Cuartero Monteagudo, Noemí; Camacho-Rodríguez, Doriam Esperanza; Leyva-Moral, Juan-ManuelIntroduction: Nurse-led digital transformation requires cultural competence. Because caregivers' cultural beliefs shape digital practices, understanding these perspectives during university training is vital. This study analyzes the beliefs of nursing students in Spain and Colombia regarding health technology implementation to identify gaps influencing future digital leadership. Methodology: This qualitative descriptive study included 208 students. Data collection involved playful, reflective workshops using interactive tools. Thematic analysis was used to analyze the data guided by a transcultural nursing framework. Results: Four main themes emerged: digital empowerment as culture care accommodation in patient data management; nurses as agents balancing technology and humanistic care; improved communication and collaboration via digital tools; and multifaceted barriers, including cultural, educational, and systemic challenges to technology integration. Discussion: The findings emphasize the need for culturally competent digital leadership in nursing education. Bridging these specific cultural and technological gaps is essential to foster equitable, culturally congruent care in digital environments.
- Diagnostic overshadowing in mental health: a mixed-methods systematic review of its impact on health inequities and system-level responses(2026) Navarro Martínez, Olga; Martínez-Martínez, ConcepciónBackground Individuals with mental disorders experience higher morbidity and mortality than the general population, primarily due to co-occurring physical illnesses. Diagnostic overshadowing (DO) defined as the misattribution of physical symptoms to mental illness exacerbates health inequities and compromises universal health coverage goals. Subject To advance understanding of the impact of DO, we aim to explore the perspectives of both mental health service users and healthcare professionals. Methods A mixed-methods systematic review was conducted. Comprehensive searches were performed in MEDLINE/PubMed, Web of Science, PsycInfo, and CINAHL up to September 2025. Methodological quality was assessed using the Mixed Methods Appraisal Tool. A convergent integrated approach, following the JBI methodology for mixed-methods systematic reviews and implemented through JBI SUMARI, was employed for synthesis and integration. The review adhered to PRISMA guidelines, and the protocol is registered in PROSPERO (CRD42024523764). Results Seven integrated findings on DO were identified, with frequencies ranging from 5.9% to 52.9%. The most prevalent were environmental facilitators of DO misattribution, clinical practices of premature physical-to-mental attribution, and physical consequences of DO. Factors that promote identification or prevention, stereotypes specifically undermining physical symptom credibility, emotional consequences of poor care, and professional challenges in providing adequate care were less frequent. Conclusion DO is a relevant and recurring problem in mental health care. In this sense, DO emerges from the interaction between stigma, clinical complexity, and highly demanding environments. The evidence also indicates that some clinical and organizational factors may either increase or reduce risk.
- The influence of pain presence on pelvic floor and sexual dysfunctions, and pain intensity-related variables in women using the menstrual cup: A cross-sectional survey(2024) Fuentes Aparicio, Laura; Cuenca Martínez, Ferran; Cortés Amador, Sara Isabel; Eroles-Tena, Elena; Millán-González, Coral; Sempere Rubio, NúriaObjective: The aim was to assess the influence of pain during menstrual cup use on pelvic floor and sexual dysfunctions. In addition, we wanted to assess its impact on variables related to pain intensity during menstrual cup use such as insertion, removal, during menstruation, during sexual intercourse or the presence of pelvic pain. Methods: This study was a cross-sectional survey. The study included 566 women who fulfilled the inclusion criteria. Women were categorised into two primary groups: women with no pain and women with pain. Results: Regarding pelvic floor dysfunction, the independent samples t-test showed significant between-group differences (t(564) = −3.50, mean differences (MD) = −8.86 (−13.8 to −3.89), p < 0.001). With respect to sexual dysfunction, no significant between-group differences were found with the exception of the pain subscale (t(564) = 2.59, MD = 0.27 (0.48-0.06), p = 0.01. Regarding pain-related variables, we found statistically significant between-groups differences on all analysed variables. Conclusions: In conclusion, the results showed that women who use the menstrual cup and have pain showed worse scores on the pelvic floor dysfunction questionnaire, where it also seems that greater pain intensity was associated with worse questionnaire scores. However, we found no significant differences in sexual dysfunction except for the pain subscale between women who did and did not report pain in menstrual cup use. Finally, women who reported pain from menstrual cup use showed significantly greater pain intensity when inserting and removing the menstrual cup, during menstruation, during sexual intercourse and showed higher levels of pelvic pain although these differences are clinically slight.
- Virtual, augmented, mixed, and immersive technologies for prenatal and childbirth education: Scoping review(2026) Pardini, Susanna; Navarro Martínez, Olga; Mayora Ibarra, ÓscarBackground: Virtual, augmented, mixed, and other immersive technologies, collectively referred to as extended reality (XR), are increasingly used to enhance experiential learning in health education. By creating interactive 3-dimensional or 360° environments, these technologies allow expectant parents to engage in realistic prenatal and childbirth scenarios, promoting emotional preparedness, knowledge acquisition, and confidence. Although XR has been widely studied in clinical training, its application in prenatal and childbirth education for parents remains less systematically explored. Objective: This scoping review aims to map and synthesize the current evidence on the use of virtual, augmented, mixed, and immersive technologies in prenatal and childbirth education, highlighting their educational benefits, methodological approaches, and implementation challenges. Methods: A comprehensive search was conducted across Scopus, Web of Science, PubMed, CINAHL, IEEE Xplore, APA PsycINFO, and APA PsycArticles from inception to October 16, 2025. Search terms included 'virtual reality,' 'augmented reality,' 'mixed reality,' 'extended reality,' and 'immersive technology,' combined with prenatal and childbirth education descriptors. Studies were included if they applied immersive or XR technologies to deliver prenatal or childbirth education for expectant parents. Screening and data extraction were performed independently by 2 reviewers following PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The review was registered on Open Science Framework (OSF). Results: From 1861 records, 11 studies from 8 countries were included, spanning randomized controlled, quasi-experimental, feasibility, and qualitative designs. Interventions comprised head-mounted display-based virtual reality, 360° video, and mixed reality simulations. Outcomes covered psychological, physiological, educational, and experiential domains. Most studies reported feasibility and high engagement, with encouraging signals for reduced anxiety and improved birth preparedness and, in some cases, reductions in pain and intrapartum indicators. No serious adverse events were reported; nausea and discomfort were infrequent and transient. Thematic analysis identified 5 recurring themes: enhanced birth preparedness, realism and presence as a key mechanism, usability barriers and the need for guided facilitation, motivational and educational potential, and limited partner inclusion. Methodological quality was heterogeneous, with small samples, nonstandardized measures, and short follow-up. Conclusions: Evidence for XR in prenatal education is promising yet preliminary. Rigorous multicenter studies with standardized outcomes, longer follow-up, and greater partner involvement, alongside attention to equitable access and digital literacy, are needed to support integration into maternity care pathways.
- Analysis of nociceptive pain and related psychosocial factors in women with endometriosis: a cross-sectional study(2025) Arnal Gómez, Anna; Arranz Martín, Beatriz; Monzani, Lucas; Martínez-Aleixandre, Celia; Hortelano-Molina, Adriana; Fuentes Aparicio, LauraObjectives: The purpose of this study was to explore the associations and compare differences in abdominal and lumbar pain pressure thresholds, pelvic floor state, and pain- and movement-related psychosocial factors in women with and without endometriosis. Methods: A cross-sectional study was conducted on women (18 to 50 years). Participants with endometriosis (EG) were compared to age-matched counterparts without endometriosis (CG). Clinical symptoms were recorded, and pain pressure thresholds (PPT) and pelvic floor muscles (PFM) tone and strength were measured. Psychosocial factors such as catastrophizing, kinesiophobia, sexual function, and health-related quality of life were assessed. Univariate and multivariate analyses of covariance were conducted. Results: In total, 46 participants were analyzed (EG: 22; CG: 24). After isolating the effect of the participants' psychosocial factors, statistically significant differences between the groups regarding pain were still observed (P <.05; η2>0.14). EG participants had lower PPT in all abdominal and lumbar measurements (P<.05; d>0.8). Sexual function and quality of life were significantly lower (P <.05; d>0.8), while catastrophizing and kinesiophobia were significantly higher (P <.05; d≥0.8) in the EG compared to CG. Conclusions: After isolating the effect of the psychological factors, pain remained a specific symptom of endometriosis. Woman with endometriosis had lower PPT in the lumbar and abdominal muscles, engaged more frequently in catastrophizing, kinesiophobia, and reported significantly lower quality of life. These findings underscore the need for a multidimensional approach that addresses both the physical and psychological aspects of women with endometriosis.
- Does neoadjuvant doxorubicin drug-eluting bead transarterial chemoembolization improve survival in patients undergoing liver transplant for hepatocellular carcinoma?(2017) Dorcaratto, Dimitri; Udupa, Venkatesh; Hogan, Niamh M.; Brophy, David P.; McCann, Jeffrey W.; Maguire, Donal D.; Geoghegan, Justin; Cantwell, Colin P.; Hoti, EmirPURPOSE: We aimed to compare the overall (OS) and disease-free survival (DFS) of patients undergoing orthotopic liver transplant (OLT) for hepatocellular carcinoma who did and did not have neoadjuvant doxorubicin drug-eluting bead transarterial chemoembolization (DEB-TACE). METHODS: This is a retrospective study of 94 patients with HCC transplanted between 2000 and 2014 in a single tertiary center. Pre- and postoperative features, DFS and OS were compared between patients who received pre-OLT DEB-TACE (n=34, DEB-TACE group) and those who did not (n=60, non-TACE group). Radiologic and histologic response to neoadjuvant treatment as well as its complications were also studied. RESULTS: There were no significant differences in post-transplantation DFS and OS rates between groups (5-year DFS: 70% in DEB-TACE group vs. 63% in non-TACE group, P = 0.454; 5-year OS: 70% in DEB-TACE group vs. 65% in non-TACE group, P = 0.532). The DEB-TACE group had longer OLT waiting time compared with the non-TACE group (110 vs. 72 days; P = 0.01). On univariate and multivariate analyses, alpha-fetoprotein (AFP) levels >500 ng/mL prior to OLT were associated with decreased OS and DFS regardless of neoadjuvant approach (hazard ratio of 6, P = 0.001 and 5.5, P = 0.002, respectively). CONCLUSION: Patients who underwent neoadjuvant DEB-TACE and OLT for hepatocellular carcinoma had no statistically different OS or DFS at 3 and 5 years from patients undergoing OLT alone.
- Long-term effectiveness of irreversible electroporation in a murine model of colorectal liver metastasis(2017) Sánchez-Velázquez, Patricia; Dorcaratto, Dimitri; Burdío, FernandoIrreversible electroporation (IRE) has recently gained in popularity as an ablative technique, however little is known about its oncological long-term outcomes. To determine the long-time survival of animals treated with a high dose of IRE and which histological changes it induces in tumoral tissue, IRE ablation was performed in forty-six athymic-nude mice with KM12C tumors implanted in the liver by applying electric current with different voltages (2000 V/cm, 1000 V/cm). The tumors were allowed to continue to grow until the animals reached the end-point criteria. Histology was harvested and the extent of tumor necrosis was semi-quantitatively assessed. IRE treatment with the 2000 V/cm protocol significantly prolonged median mouse survival from 74.3 ± 6.9 days in the sham group to 112.5 ± 15.2 days in the 2000 V/cm group. No differences were observed between the mean survival of the 1000 V/cm and the sham group (83.2 ± 16.4 days, p = 0.62). Histology revealed 63.05% ± 23.12 of tumor necrosis in animals of the 2000 V/cm group as compared to 17.50% ± 2.50 in the 1000 V/cm group and 25.6% ± 22.1 in the Sham group (p = 0.001). IRE prolonged the survival of animals treated with the highest electric field (2000 V/cm). The animals in this group showed significantly higher rate of tumoral necrosis.
- Weight loss and quality of life in patients surviving 2 years after gastric cancer resection(2017) Climent, María C.; Munarriz, Marina; Blazeby, Jane M.; Dorcaratto, Dimitri; Ramón, José Manuel; Carrera, María José; Fontané, Laia; Grande, Luís; Pera, ManuelBackground Malnutrition is common in patients undergoing gastric cancer resection, leading to weight loss, although little is known about how this impacts on health-related quality of life (HRQL). This study aimed to explore the association between HRQL and weight loss in patients 2 years after curative gastric cancer resection. Methods Consecutive patients undergoing curative gastric cancer resection and surviving at least 2 years without disease recurrence were recruited. Patients completed the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the specific module for gastric cancer (STO22) before and 2 years postoperatively and associations between HRQL scores and patients with and without ≥ 10% body weight loss (BWL) were examined. Results A total of 76 patients were included, of whom 51 (67%) had BWL ≥10%. At 2 years postoperatively, BWL ≥10% was associated with deterioration of all functional aspects of quality of life, with persistent pain (21.6%), diarrhoea (13.7%) and nausea/vomiting (13.7%). By contrast, none of the patients with BWL <10% experienced severe nausea/vomiting, pain or diarrhoea. Conclusions Disabling symptoms occurred more frequently in patients with ≥10% BWL than in those with <10% BWL, with a relevant negative impact on HRQL. A cause-effect relationship between weight loss and postoperative outcome remains unsolved.
- Efectividad de la profilaxis antibiótica por vía oral e intravenosa versus vía intravenosa en cirugía colorrectal sin preparación mecánica intestinal(2026) Santarrufina Martínez, Sandra; Gómez Abril, Segundo Ángel; Martínez-Pérez, Aleix; Escola de DoctoratIntroducción y objetivo La infección del sitio quirúrgico (ISQ) constituye una de las complicaciones postoperatorias más frecuentes y clínicamente relevantes en cirugía colorrectal, con impacto en la morbimortalidad, la prolongación de la estancia hospitalaria, el retraso en el inicio de terapias adyuvantes y el incremento del gasto sanitario. La fuga anastomótica (FA), aunque menos frecuente, representa una de las complicaciones más graves, asociada a reintervenciones, ostomías permanentes y peor pronóstico oncológico. Aunque la profilaxis antibiótica intravenosa (PAiv) forma parte de la práctica estándar, en los últimos años ha resurgido el interés por la profilaxis antibiótica oral (PAo) como intervención complementaria para reducir la carga bacteriana intraluminal, principal fuente de contaminación del campo quirúrgico. Sin embargo, su implementación se ha visto limitada por la creencia tradicional de que su efectividad depende necesariamente de su combinación con la preparación mecánica intestinal (PMI), una práctica cada vez más cuestionada por su escaso beneficio demostrado. En este contexto, el presente estudio tiene como objetivo principal evaluar la efectividad de la profilaxis antibiótica oral añadida a la vía intravenosa, en comparación con la administración exclusiva de antibióticos intravenosos, en la prevención de la ISQ en pacientes con cáncer de colon sometidos a resección quirúrgica electiva sin empleo de PMI. Método Estudio prospectivo, observacional y unicéntrico, desarrollado entre 2018 y 2021, que incluyó 305 pacientes intervenidos por cáncer de colon en un entorno de práctica clínica habitual. Los pacientes se distribuyeron en dos cohortes consecutivas según el régimen profiláctico recibido: profilaxis antibiótica intravenosa exclusiva (grupo control; no ATB VO) frente a la combinación de profilaxis antibiótica oral e intravenosa (grupo experimental; ATB VO). La variable principal fue la incidencia de ISQ, clasificada según criterios de los Centers for Disease Control and Prevention. Como variables secundarias se analizaron la FA, la gravedad de las complicaciones según Clavien-Dindo, la estancia hospitalaria, la mortalidad postoperatoria precoz, los reingresos y los efectos adversos relacionados con el uso de antibióticos. Se llevó a cabo análisis multivariante para identificar factores de riesgo independientes y ajustar posibles variables de confusión. Resultados Los resultados mostraron una reducción significativa de la ISQ en el grupo ATB VO (5,2 %) en comparación con el grupo control (21,7 %; p < 0,001). Esta asociación se mantuvo en el análisis multivariante, en el que la ausencia de PAo se identificó como un factor de riesgo independiente (OR ajustado: 5,24; IC95%: 2,26–12,16; p < 0,001). De forma análoga, se observó una disminución significativa en la incidencia de FA en el grupo ATB VO (3,3 % frente a un 14,6 %; p < 0,001), con un efecto protector igualmente independiente en el análisis ajustado (OR: 5,42; IC95%: 2,35–12,52; p < 0,001). La reducción afectó principalmente a dehiscencias clínicamente relevantes, la mayoría de grado C. El grupo que recibió PAo presentó además una reducción significativa de la estancia hospitalaria (2 días). No se observaron diferencias significativas en la tasa global de complicaciones, reintervenciones, reingresos ni mortalidad, aunque todas estas variables mostraron una tendencia favorable en el grupo ATB VO. Otros predictores independientes de ISQ y FA fueron el sexo masculino y un tiempo quirúrgico superior a 140 minutos, mientras que la cirugía abierta se asoció de forma independiente con mayor riesgo de FA. El perfil de seguridad de los antibióticos orales fue favorable, con una tasa de eventos adversos baja (2 %) y sin repercusiones clínicas relevantes. Cabe destacar que el grupo ATB VO presentaba un perfil basal más desfavorable (mayor edad y comorbilidad), lo que refuerza la robustez de los hallazgos. Conclusiones La PAo añadida a la PAiv se asoció de forma independiente con una reducción significativa tanto de la ISQ como de la FA en cirugía de colon electiva sin PMI. Se trata de una intervención segura, bien tolerada, de bajo coste y fácilmente integrable en protocolos perioperatorios actuales. Estos resultados respaldan la incorporación sistemática de la PAo dentro de estrategias multimodales de prevención y apoyan la necesidad de futuros ensayos clínicos aleatorizados que consoliden esta evidencia y orienten la actualización de las guías clínicas.
- Irreversible electroporation of the liver: is there a safe limit to the ablation volume?(2016) Sánchez-Velázquez, Patricia; Dorcaratto, Dimitri; Burdío, FernandoIrreversible electroporation is a fast-growing liver ablation technique. Although safety has been well documented in small ablations, our aim is to assess its safety and feasibility when a large portion of liver is ablated. Eighty-seven mice were subjected to high voltage pulses directly delivered across parallel plate electrodes comprising around 40% of mouse liver. One group consisted in 55 athymic-nude, in which a tumor from the KM12C cell line was grown and the other thirty-two C57-Bl6 non-tumoral mice. Both groups were subsequently divided into subsets according to the delivered field strength (1000 V/cm, 2000 V/cm) and whether or not they received anti-hyperkalemia therapy. Early mortality (less than 24 hours post-IRE) in the 2000 V/cm group was observed and revealed considerably higher mean potassium levels. In contrast, the animals subjected to a 2000 V/cm field treated with the anti-hyperkalemia therapy had higher survival rates (OR = 0.1, 95%CI = 0.02-0.32, p < 0.001). Early mortality also depended on the electric field magnitude of the IRE protocol, as mice given 1000 V/cm survived longer than those given 2000 V/cm (OR = 4.7, 95%CI = 1.8-11.8, p = 0.001). Our findings suggest that ionic disturbances, mainly due to potassium alterations, should be warned and envisioned when large volume ablations are performed by IRE.
