An open-source low-cost wireless sensor system for acquisition of human movement data.

Several fields of research such as medicine, robotics, sports, informatics, etc., require the analysis of human movement. Traditional systems for acquisition and analysis of human movement data are based on video cameras or active sensors. However, those systems are limited to high-resource settings. Wearable devices allow monitoring subjects outside typical clinical or research environments. Here, we present an open source low-cost wireless sensor system for acquisition of human movement data. Our system consists of two main parts: a server that stores data and, one or more wearable sensor modules that collect movement data through Inertial Measurement Units (IMUs) and transmit them wirelessly to the server. As a proof of concept, we measured human gait activity. Our results show that our system with IMUs can acquire quantifiable movement data. Characteristics such as open source code and its low-cost, make our system a viable alternative for clinical or research.

Analixity: An open source, low-cost analysis system for the elevated plus maze test, based on computer vision techniques.

Manual analysis of behavioral tests in rodents involves inspection of video recordings by a researcher that assesses rodent movements to quantify parameters related with a behavior of interest. The assessment of the researcher during the quantification of such parameters can introduce variability among experimental conditions or among sessions of analysis. Here, we introduce Analixity, a video processing software for the elevated plus maze test (EPM), in which quantification of behavioral parameters is automatic, reducing the time spent in analysis and solving the variability problem. Analixity is an adaptable multiplatform open-source system. Analixity generates an Excel file with the quantified behavioral variables, such as time spent in open and closed arms and in the center zone, number of entries to each zone and total distance traveled during the test. For validation, we compared results obtained by Analixity with results obtained by manual analysis. We did not find statistically significant differences. In addition, we compared the results obtained by Analixity with results obtained by the commercial software ANY-maze. We did not find statistically significant differences in the quantification of parameters such as time spent in open arms, time spent in closed arms, time spent in center zone, number of closed arms, open arms entries, and anxiety index. We concluded that Analixity is an open-source software as reliable and effective as a commercial software.

[Prostatic high resolution micro-ultrasound (MUS) imaging.] / Ecografía de alta resolución prostática (microultrasonografía-ExactVuTM).

OBJECTIVE: Prostate cancer (PCa) diagnosis has improved with multiparametric magnetic resonance (mpMRI) and new more specific biomarkers. However, mpMRI has some limitations such as variability, long learning curve and high cost. More progress is needed in the PCa diagnosis scenario, and it is here where high resolution micro-ultrasound (MUS) imaging system emerge. MATERIAL AND METHODS: Retrospective study between February (2017-2018); including 96 patients with PCa suspicion, undergoing transrectal prostate biopsy guided by MUS. Procedure was performed by 2 urologists blinded to mpMRI results at first (92% available). PRI-MUS protocol was used to identify suspicious features. 2 core targeted biopsy of suspicious areas (PRIMUS >3) was completed first and then it was followed by a 12-core systematic biopsy and finally sampling of mpMRI targets if available. Data were collected reporting sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) to detect clinically significant PCa (csPCa) (Gleason score >7). RESULTS: Overall, MUS csPCa detection rate was 59.37%. 171 cores were registered, of them csPCa were distributed as follow: 1.2% PRI-MUS 1, 16.3% PRIMUS 2, 28% PRI-MUS 3, 39% PRI-MUS 4 and 15% PRI-MUS 5. Sensitivity in csPCa detection for PRI-MUS >3 was 82% with 93% NPV, but with low 39% specificity and 19% PPV. Comparing 79 patients with mpMRI available; sensitivity by area of MUS was 82% versus 30% of mpMRI, with 93% NPV versus 88%. Specificity and PPV were higher in mpMRI in comparison to MUS. CONCLUSIONS: Although this is a preliminary series, MUS is presented as an attractive imaging technique, cost-effective, easy to learn and with high efficacy in image- guided prostate biopsy. Overall PCa detection rate increases over conventional ultrasound; and offers high sensitivity and NPV in csPCa detection over mpMRI but with lower specificity.

OBJETIVO: El diagnóstico del cáncer de próstata (CaP) ha mejorado con la resonancia magnética multiparamétrica (RMmp) y nuevos biomarcadores más específicos. No obstante, la RMmp tiene unas limitaciones: variabilidad, larga curva de aprendizaje y coste elevado. Por ello se hacen necesarios más avances en el escenario diagnóstico, y es aquí donde irrumpen los microultrasonidos de alta resolución (MUS) 29 MHz.MATERIAL Y MÉTODOS: Entre Feb 2017-2018; 96 pacientes con sospecha de CaP; recibieron biopsia prostática transrectal guiada por MUS. Procedimiento realizado por 2 urólogos a los que se ocultó los resultados de la RMmp (disponible en 92%). Se empleó protocolo PRI-MUS; obteniendo 2 muestras de área sospechosa (PRIMUS >3) más biopsia sistemática. Se añadieron muestras adicionales de áreas PI-RADS >3. Se recogen datos de sensibilidad, especificidad y valor predictivo positivo (VPP) y negativo (VPN) para detectar CaP clínicamente significativo (CaPcs) (Gleason Score >7). RESULTADOS: La tasa de detección global de los MUS para CaPcs fue del 59,37%. Se registraron 171 cilindros positivos, de los cuales CaPcs fueron: 1,2% PRI-MUS 1, 16,3% PRI-MUS 2, 28% PRI-MUS 3, 39% PRI-MUS 4 y 15% PRI-MUS 5. La sensibilidad en la detección de CaPcs en PRI-MUS >3 fue del 82% con VPN 93%, pero con baja especificidad 39% y VPP del 19%. Comparando los 79 pacientes con RMmp; la sensibilidad por zona de los MUS fue del 82% frente al 30% de la RMmp, con un VPN del 93% frente al 88%. La especificidad y el VPP fueron superiores en la RMmp frente a MUS. CONCLUSIONES: Aunque la serie es preliminar, los MUS se presentan como una técnica de imagen coste- efectiva, sencilla de aprender y con alta eficacia en la biopsia prostática. La tasa de detección global de CaP duplica a la de los ultrasonidos convencionales; y ofrece alta sensibilidad y valor predictivo negativo en la detección de CaPcs frente a la RMmp.

Ecografía de alta resolución prostática (microultrasonografía-ExactVuTM) / Prostatic high resolution micro-ultrasound (MUS) imaging

Objetivo: El diagnóstico del cáncer de próstata (CaP) ha mejorado con la resonancia magnética multiparamétrica (RMmp) y nuevos biomarcadores más específicos. No obstante, la RMmp tiene unas limitaciones: variabilidad, larga curva de aprendizaje y coste elevado. Por ello se hacen necesarios más avances en el escenario diagnóstico, y es aquí donde irrumpen los microultrasonidos de alta resolución (MUS) 29 MHz. Material y métodos: Entre Feb 2017-2018; 96 pacientes con sospecha de CaP; recibieron biopsia prostática transrectal guiada por MUS. Procedimiento realizado por 2 urólogos a los que se ocultó los resultados de la RMmp (disponible en 92%). Se empleó protocolo PRI-MUS; obteniendo 2 muestras de área sospechosa (PRIMUS > 3) más biopsia sistemática. Se añadieron muestras adicionales de áreas PI-RADS > 3. Se recogen datos de sensibilidad, especificidad y valor predictivo positivo (VPP) y negativo (VPN) para detectar CaP clínicamente significativo (CaPcs) (Gleason Score > 7). Resultados: La tasa de detección global de los MUS para CaPcs fue del 59,37%. Se registraron 171 cilindros positivos, de los cuales CaPcs fueron: 1,2% PRI-MUS 1, 16,3% PRI-MUS 2, 28% PRI-MUS 3, 39% PRI-MUS 4 y 15% PRI-MUS 5. La sensibilidad en la detección de CaPcs en PRI-MUS > 3 fue del 82% con VPN 93%, pero con baja especificidad 39% y VPP del 19%. Comparando los 79 pacientes con RMmp; la sensibilidad por zona de los MUS fue del 82% frente al 30% de la RMmp, con un VPN del 93% frente al 88%. La especificidad y el VPP fueron superiores en la RMmp frente a MUS. Conclusiones: Aunque la serie es preliminar, los MUS se presentan como una técnica de imagen coste- efectiva, sencilla de aprender y con alta eficacia en la biopsia prostática. La tasa de detección global de CaP duplica a la de los ultrasonidos convencionales; y ofrece alta sensibilidad y valor predictivo negativo en la detección de CaPcs frente a la RMmp

Objective: Prostate cancer (PCa) diagnosis has improved with multiparametric magnetic resonance (mpMRI) and new more specific biomarkers. However, mpMRI has some limitations such as variability, long learning curve and high cost. More progress is needed in the PCa diagnosis scenario, and it is here where high resolution micro-ultrasound (MUS) imaging system emerge. Material and methods: Retrospective study between February (2017-2018); including 96 patients with PCa suspicion, undergoing transrectal prostate biopsy guided by MUS. Procedure was performed by 2 urologists blinded to mpMRI results at first (92% available). PRI-MUS protocol was used to identify suspicious features. 2 core targeted biopsy of suspicious areas (PRIMUS > 3) was completed first and then it was followed by a 12-core systematic biopsy and finally sampling of mpMRI targets if available. Data were collected reporting sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) to detect clinically significant PCa (csPCa) (Gleason score > 7). Results: Overall, MUS csPCa detection rate was 59.37%. 171 cores were registered, of them csPCa were distributed as follow: 1.2% PRI-MUS 1, 16.3% PRIMUS 2, 28% PRI-MUS 3, 39% PRI-MUS 4 and 15% PRI-MUS 5. Sensitivity in csPCa detection for PRI-MUS > 3 was 82% with 93% NPV, but with low 39% specificity and 19% PPV. Comparing 79 patients with mpMRI available; sensitivity by area of MUS was 82% versus 30% of mpMRI, with 93% NPV versus 88%. Specificity and PPV were higher in mpMRI in comparison to MUS. Conclusions: Although this is a preliminary series, MUS is presented as an attractive imaging technique, cost-effective, easy to learn and with high efficacy in image-guided prostate biopsy. Overall PCa detection rate increases over conventional ultrasound; and offers high sensitivity and NPV in csPCa detection over mpMRI but with lower specificity

How to build a robotic program.

OBJECTIVE: Advancements in the robotic surgical technology have revolutionized the standard of care for many surgical procedures. The purpose of this review is to focus on the different issues involved in developmental phase of starting a robotic program and to evaluate the important considerations in developing this program at a given healthcare institution. METHODS & RESULTS: Although every hospital might desire a robotic program, there are many requirements needed to uphold a successful and self-sustainable program in the current healthcare market. Patients' interest in robotic-assisted surgery has and continues to grow because of improved outcomes and decreased periods of hospitalization. Resulting market forces have created a solid foundation for the implementation of robotic surgery into surgical practice. A thorough market analysis, including that of competing entities and estimated surgical volume, is necessary prior to purchasing a robot. Another issue to be addressed is determining whether one has trained surgeons or the capability to recruit the appropriately trained surgeons to keep a robotics program afloat. Formally trained robotic surgeons have better patient outcomes and shorter operative times. An assessment of facilities and staff is also imperative prior to making such a substantial investment. Ultimately, after a well thought-out analysis, a decision must be made as to whether the institution can support and maintain a robotics program. CONCLUSIONS: Individual economic factors of local healthcare settings must be evaluated when planning for a new robotics program. The high cost of the robotic surgical platform is best offset with a large surgical volumen,interdisciplinary utilization of the technology may be the solution. A mature, experienced surgeon is integral to the success of a new robotics program. Define procedures to be performed, necessary training, staff involved,equipment, facilities, setting-up, economical resources and marketing are important issues to be teaken into account before acquiring a surgical robotic system.

ARTICULO SOLO EN INGLES. OBJETIVO: Los avances de la tecnología robótica quirúrgica han revolucionado el estándar de tratamiento en muchos procedimientos quirúrgicos. El objetivo de esta revisión está focalizado en los diferentes aspectos involucrados en la fase de desarrollo de inicio de un programa de robótica y en evaluar lasconsideraciones importantes para desarrollar este programa en un hospital determinado.MÉTODOS/RESULTADOS: Aunque todos los hospitales desearían tener un programa de cirugía robótica, son necesarios muchos requerimientos para mantener un programa de éxito y auto sostenible en el mercado de la salud actual. El interés de los pacientes por la cirugía asistida por robot ha aumentado y sigue creciendo debido a la mejora de los resultados y la disminución de los periodos de hospitalización. Las fuerzas de mercado resultantes han creado una base sólida para la implementación de la cirugía robótica en la práctica quirúrgica. Antes de la compra de un robot es necesario un análisis profundo del mercado, incluyendo las entidades que compiten y el volumen quirúrgico estimado. Otro aspecto a tratar es determinar si uno tiene cirujanos formados o la capacidad de reclutar los cirujanos apropiados ya formados para  mantener el programa de robótica a flote. Los cirujanos robóticos formados formalmente tienen mejores resultados en sus pacientes y tiempos de operación más cortos. También es imperativo un análisis de las instalaciones y el personal antes de hacer semejante inversión. Finalmente, después de un análisis bien pensado, se debe tomar la decisión de si la institución puede apoyar y mantener un programa robótico.CONCLUSIONES: Cuando se planea un nuevo programa de cirugía robótica se deben evaluar los factores económicos individuales del marco sanitario local. El alto coste de la plataforma de cirugía robótica está mejor compensada con un gran volumen quirúrgico y uso interdisciplinario de la tecnología. Un cirujano maduro, experimentado es parte integral del éxito de un nuevoprograma de cirugía robótica. Definir los procedimientos que se van a realizar, el entrenamiento necesario, el personal involucrado, el equipo, las nstalaciones, la puesta en marcha, los recursos económicos y el marketingson aspectos importantes a tener en cuenta antes de adquirir un sistema robótico quirúrgico.

How to build a robotic program / Como construir un programa de cirugía robótica

Objective: Advancements in the robotic surgical technology have revolutionized the standard of care for many surgical procedures. The purpose of this review is to focus on the different issues involved in developmental phase of starting a robotic program and to evaluate the important considerations in developing this program at a given healthcare institution. Methods & results: Although every hospital might desire a robotic program, there are many requirements needed to uphold a successful and self-sustainable program in the current healthcare market. Patients’ interest in robotic-assisted surgery has and continues to grow because of improved outcomes and decreased periods of hospitalization. Resulting market forces have created a solid foundation for the implementation of robotic surgery into surgical practice. A thorough market analysis, including that of competing entities and estimated surgical volume, is necessary prior to purchasing a robot. Another issue to be addressed is determining whether one has trained surgeons or the capability to recruit the appropriately trained surgeons to keep a robotics program afloat. Formally trained robotic surgeons have better patient outcomes and shorter operative times. An assessment of facilities and staff is also imperative prior to making such a substantial investment. Ultimately, after a well thought-out analysis, a decision must be made as to whether the institution can support and maintain a robotics program. Conclusions: Individual economic factors of local healthcare settings must be evaluated when planning for a new robotics program. The high cost of the robotic surgical platform is best offset with a large surgical volumen, interdisciplinary utilization of the technology may be the solution. A mature, experienced surgeon is integral to the success of a new robotics program. Define procedures to be performed, necessary training, staff involved, equipment, facilities, setting-up, economical resources and marketing are important issues to be teaken into account before acquiring a surgical robotic system

Objetivo: Los avances de la tecnología robótica quirúrgica han revolucionado el estándar de tratamiento en muchos procedimientos quirúrgicos. El objetivo de esta revisión está focalizado en los diferentes aspectos involucrados en la fase de desarrollo de inicio de un programa de robótica y en evaluar las consideraciones importantes para desarrollar este programa en un hospital determinado. Métodos/resultados: Aunque todos los hospitales desearían tener un programa de cirugía robótica, son necesarios muchos requerimientos para mantener un programa de éxito y auto sostenible en el mercado de la salud actual. El interés de los pacientes por la cirugía asistida por robot ha aumentado y sigue creciendo debido a la mejora de los resultados y la disminución de los periodos de hospitalización. Las fuerzas de mercado resultantes han creado una base sólida para la implementación de la cirugía robótica en la práctica quirúrgica. Antes de la compra de un robot es necesario un análisis profundo del mercado, incluyendo las entidades que compiten y el volumen quirúrgico estimado. Otro aspecto a tratar es determinar si uno tiene cirujanos formados o la capacidad de reclutar los cirujanos apropiados ya formados para mantener el programa de robótica a flote. Los cirujanos robóticos formados formalmente tienen mejores resultados en sus pacientes y tiempos de operación más cortos. También es imperativo un análisis de las instalaciones y el personal antes de hacer semejante inversión. Finalmente, después de un análisis bien pensado, se debe tomar la decisión de si la institución puede apoyar y mantener un programa robótico. Conclusiones: Cuando se planea un nuevo programa de cirugía robótica se deben evaluar los factores económicos individuales del marco sanitario local. El alto coste de la plataforma de cirugía robótica está mejor compensada con un gran volumen quirúrgico y uso interdisciplinario de la tecnología. Un cirujano maduro, experimentado es parte integral del éxito de un nuevo programa de cirugía robótica. Definir los procedimientos que se van a realizar, el entrenamiento necesario, el personal involucrado, el equipo, las instalaciones, la puesta en marcha, los recursos económicos y el marketing son aspectos importantes a tener en cuenta antes de adquirir un sistema robótico quirúrgico

[BCG therapy in NMIBC: How much and for how long?.] / Opciones terapeúticas tras fracaso de BCG.

Bladder cancer is the 9th most prevalent cancer in the world. It is divided into muscle invasive bladder cancer (MIBC) and non muscle invasive bladder cancer (NMIBC). Over 75% belong to the second group and it will be classified according to the risk of progression and recurrence. In high and intermediate risk tumors. There is indication for the use of bladder instillations with BCG as it reduces the number of recurrences and disease progression to MIBC. In spite of this, disease control is not possible in all cases and there could be recurrence or progression of the disease to MIBC. This article is a review of the therapeutic options of tumor recurrence after failure of BCG treatment.

Opciones terapeúticas tras fracaso de BCG / Therapetic options after BCG failure

El cáncer de vejiga es el 9º cáncer más prevalente en el mundo. Se divide en cáncer de vejiga músculo infiltrante (CVMI) y no músculo infiltrante (CVNMI). Más del 75% pertenece a este último grupo y será clasificado según el riesgo de progresión y recurrencia. En los tumores de alto riesgo y riesgo intermedio está indicado el uso de BCG mediante instilaciones vesicales debido a que disminuye el número de recidivas y la progresión de la enfermedad a CVMI. A pesar de ello no se logra controlar la enfermedad en todos los casos y nos encontramos ante recidivas tumorales o progresión de enfermedad a CVMI. Este trabajo consiste en una revisión de las opciones terapéuticas tras recidiva tumoral cuando ha fracasado el tratamiento con BCG

Bladder cancer is the 9th most prevalent cancer in the world. It is divided into muscle invasive bladder cancer (MIBC) and non muscle invasive bladder cancer (NMIBC). Over 75% belong to the second group and it will be classified according to the risk of progression and recurrence. In high and intermediate risk tumors. There is indication for the use of bladder instillations with BCG as it reduces the number of recurrences and disease progression to MIBC. In spite of this, disease control is not possible in all cases and there could be recurrence or progression of the disease to MIBC. This article is a review of the therapeutic options of tumor recurrence after failure of BCG treatment

Nuss Procedure for a Patient with Negative Haller Index.

Introduction Minimally invasive repair for pectus excavatum (MIRPE) is controversial in extremely severe cases of pectus excavatum (PE) and an open repair is usually favored. Our aim is to describe a case of a patient with an extremely severe PE that underwent a minimally invasive approach. Case report An 8-year-old girl with severe sternum depression was assessed. She had a history of exercise intolerance, nocturnal dyspnea, fatigue, and shortness of breath. Chest computed tomography showed that sternum depression was posterior to the anterior vertebral column; therefore, Haller and correction index could not be measured. Spirometry indicated an obstructive ventilation pattern (forced expiratory volume in 1 second = 74.4%), and echocardiogram revealed a dilated inferior vena cava, mitral valve prolapse with normal ventricular function. After multidisciplinary committee evaluation, a MIRPE approach was performed. All symptoms had disappeared at the 3-month postoperative follow-up; the desired sternum shape was achieved and normalization of cardiopulmonary function was observed. The Nuss bars were removed after a 2-year period. After 18-month follow-up, the patient can carry out normal exercise and is content with the cosmetic result. Conclusion Nuss procedure is feasible in our 8-year-old patient. In this case, both the Haller and correction index were not useful to assess the severity of PE. Therefore, under these circumstances, other radiologic parameters have to be taken into consideration for patient evaluation.

[Current status of extracorporeal shock wave lithotripsy in urinary lithiasis.] / Estado actual de la litotricia extracorpórea por ondas de choque en la litiásis urinaria.

Over the last decade, urinary lithiasis' prevalence has dramatically increased due to diet and lifestyle changes, growing 10.6% and 7.1% in men and women respectively. Extracorporeal shock wave lithotripsy has lost relevance in current practice due to endoscopic device development and unpredictability of results. Instrument miniaturization is leading to an increase of the percutaneous approach of increasingly smaller stones, while most flexible ureteroscopes durability and digitalization has allowed urologists to address larger stones. So that, decision algorithm is now impossible to define, but what is clear is that ESWL has declined worldwide. Can it disappear as a urinary lithiasis treatment modality? If we don't improve appropriate candidate selection and optimize disintegration efficiency, guidelines are going to replace the more "boring" ESWL by popular and more attractive endoscopes. Shock wave technology has evolved in the last two decades, however lithotripsy fundamental principle has not changed. ESWL has passed the test of time and centers dedicated to stone treatment should have a lithotripter in order to offer an appropriate balance in different options for different clinical situations. New developments will be focused on improvements in location (in-line navigation systems; Vision track system) and automatic ultrasound location on a robotic arm; monitoring and stone fixation, implementation of different focal sizes with new acoustic lenses, multitask working stations that allow endourological approach, coupling control (avoiding microbubbles) and low cost devices for different applications. On the other hand, optimizing outcomes by: slower pulse rates, ramping strategies and patient selection with soft stones, short stone-skin distance, low BMI and favorable collecting system anatomy, allow us to achieve better outcomes in shock wave treatments. SWL still represents a unique non invasive method of stone disease treatment with no anesthesia and low complication rates; and a high proportion of stones could still be treated with shock waves and remains among patient's first options. This update objective has been to review the evolution, identify shock wave new developments and clarify their impact on our daily practice in urinary stones treatment.

Estado actual de la litotricia extracorpórea por ondas de choque en la litiásis urinaria / Current status of extracorporeal shock wave lithotripsy in urinary lithiasis

En las últimas décadas la prevalencia de la enfermedad litiásica urinaria se ha incrementado dramáticamente debido al cambio de dieta y estilo de vida, creciendo un 10,6% y 7,1% en hombres y mujeres respectivamente. La litotricia extracorpórea ha perdido protagonismo en la actualidad debido al desarrollo tecnológico de los instrumentos endoscópicos y a la impredecibilidad de sus resultados. La miniaturización de los instrumentos esta derivando en un incremento del abordaje percutáneo en cálculos cada vez más pequeños; mientras que la mayor durabilidad y la digitalización de los ureteroscopios flexibles ha permitido a los urólogos abordar cálculos cada vez más grandes. De manera que el algoritmo de decisión terapéutica es ahora casi imposible de definir; pero lo que está claro es el descenso de la litotricia extracorpórea en todo el mundo. ¿Puede desaparecer como modalidad terapéutica de la litiásis?. Si no mejoramos la selección de los candidatos más adecuados y no optimizamos la eficacia desintegradora, las guías clínicas progresivamente van a sustituir a la más 'aburrida' litotricia extracorpórea, por los populares y más atractivos nuevos endoscopios. En las dos últimas décadas la tecnología de las ondas de choque ha evolucionado, sin embargo el principio fundamental de la litotricia no ha cambiado. La Litotricia extracorpórea ha superado la prueba del tiempo y los centros que se vayan a dedicar al tratamiento de la litiasis deberán contar con un litotriptor en aras a un adecuado equilibrio en las diferentes opciones a ofrecer en las diferentes situaciones clínicas. Las novedades se centrarán en mejoras en la localización (sistemas de navegación in-line y lateral (visión Track System ) y localización automática ultrasónica con brazo robótico; seguimiento y fijación del cálculo, implementación de diferentes tamaños focales con nuevas lentes acústicas que incrementan el área focal, estaciones de trabajo multifuncional para permitir abordaje endourológico, control del acoplamiento (evitando microburbujas) y dispositivos de bajo coste con diferentes aplicaciones. Por otro lado, la optimización del tratamiento mediante: el escalonado de dosis, la reducción de la frecuencia de ondas de choque, la selección de pacientes con litiasis no duras, con distancias piel-cálculo cortas, bajo índice de masa corporal y anatomía favorable del sistema colector, permitirá conseguir mejores resultados de las ondas de choque. La litotricia extracorpórea todavía representa el único método no invasivo de tratamiento litiásico, con baja tasa de complicaciones y que puede realizarse sin anestesia; y una proporción elevada de cálculos todavía pueden ser subsidiarios a tratamiento con ondas de choque y sigue vigente entre las primeras opciones de los pacientes. El objetivo de esta actualización ha sido revisar la evolución, identificar los nuevos desarrollos en el tratamiento con ondas de choque y clarificar su impacto en nuestra práctica clínica cotidiana en el tratamiento de la litiásis urinaria

Over the last decade, urinary lithiasis' prevalence has dramatically increased due to diet and lifestyle changes, growing 10,6% and 7,1% in men and women respectively. Extracorporeal shock wave lithotripsy has lost relevance in current practice due to endoscopic device development and unpredictability of results. Instrument miniaturization is leading to an increase of the percutaneous approach of increasingly smaller stones, while most flexible ureteroscopes durability and digitalization has allowed urologists to address larger stones. So that, decision algorithm is now impossible to define, but what is clear is that ESWL has declined worldwide. Can it disappear as a urinary lithiasis treatment modality? If we don´t improve appropriate candidate selection and optimize disintegration efficiency, guidelines are going to replace the more 'boring' ESWL by popular and more attractive endoscopes. Shock wave technology has evolved in the last two decades, however lithotripsy fundamental principle has not changed. ESWL has passed the test of time and centers dedicated to stone treatment should have a lithotripter in order to offer an appropriate balance in different options for different clinical situations. New developments will be focused on improvements in location (in-line navigation systems; Vision track system) and automatic ultrasound location on a robotic arm; monitoring and stone fixation, implementation of different focal sizes with new acoustic lenses, multitask working stations that allow endourological approach, coupling control (avoiding microbubbles) and low cost devices for different applications. On the other hand, optimizing outcomes by: slower pulse rates, ramping strategies and patient selection with soft stones, short stone-skin distance, low BMI and favorable collecting system anatomy, allow us to achieve better outcomes in shock wave treatments. SWL still represents a unique non invasive method of stone disease treatment with no anesthesia and low complication rates; and a high proportion of stones could still be treated with shock waves and remains among patient`s first options. This update objective has been to review the evolution, identify shock wave new developments and clarify their impact on our daily practice in urinary stones treatment

Assessment of the Effectiveness, Safety, and Reproducibility of Micro-Ureteroscopy in the Treatment of Distal Ureteral Stones in Women: A Multicenter Prospective Study.

PURPOSE: The aim of this study is to assess the effectiveness, safety, and reproducibility of the micro-ureteroscopy (m-URS) in the treatment of distal ureteral stones in women. MATERIALS AND METHODS: A multicenter, prospective observational study was designed and conducted between March and December 2015. We included women having at least one stone in the distal ureter and being a candidate for surgical treatment using the 4.85F sheath of MicroPerc®. Patients with clinical criteria and/or laboratory analysis indicating sepsis or coagulation alteration were excluded. RESULTS: Thirty-nine women were operated in eight hospitals. The profile of the patients was fairly homogeneous among hospitals. Only differences were found in age, preoperative stent, and the result of the previous urine culture. Immediate stone-free status was achieved in 88.2% and 100% 7 days after the procedure. 97.4% of patients did not present any complication in the postoperative period, with only one case with complication Clavien II. Postureteroscopic Lesion Scale (PULS) in 76.9% of patients did not show any injury, 20.5% had lesions grade 1, and grade 2 lesions 2.6%. As for the reproducibility of m-URS between hospitals, statistical analysis of the results showed differences between all the centers participating in the study. CONCLUSIONS: m-URS is an effective, safe, and reproducible technique that minimizes surgical aggression to the ureteral anatomy. Satisfactory and comparable results to "conventional" ureteroscopy were obtained in the treatment of distal ureteral stones in women, although clinical trials are needed. The reduction of the ureteral damage may reduce secondary procedures and increase the cost-effectiveness of the procedure.

Desorden del desarrollo sexual ovotesticular quimérico / Chimeric disorders of sex development ovotesticular

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How good is crude MDL for solving the bias-variance dilemma? An empirical investigation based on Bayesian networks.

The bias-variance dilemma is a well-known and important problem in Machine Learning. It basically relates the generalization capability (goodness of fit) of a learning method to its corresponding complexity. When we have enough data at hand, it is possible to use these data in such a way so as to minimize overfitting (the risk of selecting a complex model that generalizes poorly). Unfortunately, there are many situations where we simply do not have this required amount of data. Thus, we need to find methods capable of efficiently exploiting the available data while avoiding overfitting. Different metrics have been proposed to achieve this goal: the Minimum Description Length principle (MDL), Akaike's Information Criterion (AIC) and Bayesian Information Criterion (BIC), among others. In this paper, we focus on crude MDL and empirically evaluate its performance in selecting models with a good balance between goodness of fit and complexity: the so-called bias-variance dilemma, decomposition or tradeoff. Although the graphical interaction between these dimensions (bias and variance) is ubiquitous in the Machine Learning literature, few works present experimental evidence to recover such interaction. In our experiments, we argue that the resulting graphs allow us to gain insights that are difficult to unveil otherwise: that crude MDL naturally selects balanced models in terms of bias-variance, which not necessarily need be the gold-standard ones. We carry out these experiments using a specific model: a Bayesian network. In spite of these motivating results, we also should not overlook three other components that may significantly affect the final model selection: the search procedure, the noise rate and the sample size.

Exit strategies following percutaneous nephrolithotomy (PCNL): a comparison of surgical outcomes in the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study.

PURPOSE: To compare the characteristics and outcomes of exit strategies following percutaneous nephrolithotomy (PCNL) using the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study database. MATERIALS AND METHODS: Two matched data sets were prepared in order to compare stent only versus NT only and TTL versus NT only. Patients were matched on the exit strategy using the following variables: case volume of the center where they underwent PCNL, stone burden, the presence of staghorn stone, size of sheath used at percutaneous access, the presence of bleeding during surgery, and treatment success status. For categorical variables, percentages were calculated and differences between the four groups were tested by the chi-square test. RESULTS: The only significant difference reported between the matched pairs was between NT and stent only groups. NT only PCNL was associated with significantly longer operating times (p = 0.029) and longer hospital stay (p < 0.001) than stent only PCNL. CONCLUSIONS: Patients who undergo PCNL with less invasive exit strategy involving a stent only have shorter hospital stay than those who have postoperative NT. The intraoperative course is the primary driver of complications in PCNL and not necessarily the exit strategy.

[Vascular erectile dysfunction]. / Disfunción eréctil de origen vascular.

Vascular etiology is present in up to 60% of the patients with erectile dysfunction (ED). Both small vessel disease, such as that in diabetes mellitus, and arteriosclerosis of bigger size arteries, as in hypertension, cause arterial insufficiency and erectile dysfunction. Tobacco smoking alters the arterial hemodynamics in the penis, causing erectile dysfunction in a high percentage of advanced age smokers: pelvic arteries fibrosis and stenosis accelerates the existing arteriosclerosis. Venous occlusive dysfunction may be due to the decrease of corpora cavernosa compliance or tunica albuginea inherent anomalies. Vascular endothelial growth factor may play a role in the modulation of vascularization of the normal penile architecture. Various events, all of them important, may cause erectile dysfunction. Moreover, no cause can participate independently. A cascade of situations (including psychological factors as well as organic) may lead to erectile dysfunction. A continuous understanding of organic causes of erectile dysfunction will allow physicians to discover treatments for their correction, as well as to give confidence to the patient.

Disfunción eréctil de origen vascular / Vascular erectile dysfunction

La etiología vascular de la disfunción eréctil está presente en el 60% de los pacientes con DE. La enfermedad de pequeños vasos, como en la diabetes, y la arteriosclerosis de arterias de mayor tamaño, como en la hipertensión, causa insuficiencia arterial y disfunción eréctil.El tabaco altera la hemodinámica arterial del pene, causando disfunción eréctil en un alto porcentaje de fumadores de edad avanzada: la fibrosis y estenosis de las arterias pélvicas acelera la arteriosclerosis existente. La disfunción venoclusiva puede deberse a la disminución de la distensibilidad de cuerpos cavernosos o anormalidades inherentes en la albugínea.El factor de crecimiento vascular endotelial puede desempeñar un papel en la modulación de la vascularización de la arquitectura normal del pene.Distintos acontecimientos, todos ellos importantes, pueden causar disfunción eréctil. Además, ninguna causa puede participar de forma independiente. Una cascada de situaciones (incluidos los factores psicológicos, así como los orgánicos) pueden llevar a la disfunción eréctil. Una comprensión continuada de las causas orgánicas de la disfunción eréctil permitirá al médico descubrir tratamientos para su corrección, así como proporcionar seguridad al paciente(AU)

Vascular etiology is present in up to 60% of the patients with erectile dysfunction (ED). Both small vessel disease, such as that in diabetes mellitus, and arteriosclerosis of bigger size arteries, as in hypertension, cause arterial insufficiency and erectile dysfunction.Tobacco smoking alters the arterial hemodynamics in the penis, causing erectile dysfunction in a high percentage of advanced age smokers: pelvic arteries fibrosis and stenosis accelerates the existing arteriosclerosis. Venous occlusive dysfunction may be due to the decrease of corpora cavernosa compliance or tunica albuginea inherent anomalies.Vascular endothelial growth factor may play a role in the modulation of vascularization of the normal penile architecture. Various events, all of them important, may cause erectile dysfunction. Moreover, no cause can participate independently. A cascade of situations (including psychological factors as well as organic) may lead to erectile dysfunction. A continuous understanding of organic causes of erectile dysfunction will allow physicians to discover treatments for their correction, as well as to give confidence to the patient(AU)

[New position for laparoscopic pyeloplasty. Our experience]. / Nuevo posicionamiento para realizar la pieloplastia laparoscópica. Nuestra experiencia.

OBJECTIVES: To share our experience performing laparoscopic pyeloplasty and our contributions to this surgery. METHODS: Between March 2004 and January 2006 we have performed 12 laparoscopic pyeloplasties in 12 patients. We modified our technique as we found difficulties during operations. By the only modification of patient position we have achieved a significant improve in our technique. RESULTS: We describe how we performed the operation in the first cases and how we do it today, with the new position. We also describe the advantages observed. CONCLUSIONS: With our technique we achieve an important surgical time reduction, improvements in safety and reduction of surgical complications.