Estudio poblacional de casuística y morbimortalidad de la prostatectomía radical en España / Population based study of morbidity and mortality rates associated to radical prostatectomy cases in Spain

Introducción: No existe ningún estudio poblacional que contabilice en número de prostatectomías radicales (PR) realizadas España, ni la morbimortalidad de dicha intervención.Nuestro objetivo es estudiar la morbimortalidad de la PR en España desde el 2011 al 2015 y evaluar la variabilidad geográfica. Material y métodos: Diseñamos un estudio observacional retrospectivo de todos los pacientes intervenidos de PR en España durante cinco años consecutivos (2011-2015) a partir de los datos registrados en el Conjunto Mínimo Básico de Datos (CMBD).Hemos estudiado la distribución del número de casos y la variabilidad intercomunitaria en términos de morbilidad y de estancia hospitalaria, así como el impacto del volumen quirúrgico medio anual por cada centro en dichas variables. Resultados: Entre los años 2011-2015 se han realizado un total de 37.725 PR en 221 hospitales españoles públicos del sistema nacional de salud. La edad media de la serie fue 63,9 ± 3,23 años. El 50% de las PR se han realizado por vía abierta, y un 43,4% se han intervenido en hospitales de < 500 camas. Encontramos una gran variabilidad en la distribución de los casos intervenidos en las distintas Comunidades Autónomas (CCAA Las comunidades que realizan un mayor número de prostatectomías son Andalucía, Cataluña, Galicia y Madrid. La tasa de complicaciones a nivel nacional es de 8,6%, siendo las más frecuentes la hemorragia y necesidad de transfusión (5,3 y 4%, respectivamente). Encontramos importantes diferencias en las tasas de hemorragia y en la estancia hospitalaria entre las distintas CCAA, que se mantienen tras ajustar por las características del paciente y del tipo de hospital. Al estudiar el volumen quirúrgico anual de cada hospital vemos que el impacto en la tasa de hemorragia o transfusión es lineal sin embargo en la estancia a partir de 60 PR/año la estancia se mantiene estable en torno a cinco días. (AU)

Introduction: There is no population-based study that accounts for the number of radical prostatectomies (RP) carried out in Spain, nor regarding the morbidity and mortality of this intervention.Our objective is to study the morbidity and mortality of RP in Spain from 2011 to 2015 and to evaluate the geographic variation. Material and methods: We designed a retrospective observational study of all patients submitted to RP in Spain during five consecutive years (2011-2015). The data was extracted from the «Conjunto Mínimo Básico de Datos» (CMBD).We have evaluated geographic variations in terms of morbidity and hospital stay, and the impact of the mean annual surgical volume for each center on these variables. Results: Between 2011-2015, a total of 37,725 RPs were performed in 221 Spanish public hospitals. The mean age of the series was 63.9 ± 3.23 years. Of all RPs, 50% were performed through an open approach, and 43.4% have been operated on in hospitals with < 500 beds. We observed an important variability in the distribution of the cases operated on in the different regions. The regions that perform more RPs are Andalusia, Catalonia, Galicia, and Madrid. Our study shows a complication rate of 8.6%, with hemorrhage and the need for transfusion being the most frequent (5.3 and 4%, respectively). There are significant differences in bleeding rates and hospital stay among regions, which are maintained after adjusting for patient characteristics and type of hospital. When studying the annual surgical volume of each hospital, we find that the impact on the rate of hemorrhage or transfusion is linear; however, hospital stay remains stable at around 5 days from 60 RPs/year (AU)

Population based study of morbidity and mortality rates associated to radical prostatectomy cases in Spain.

INTRODUCTION: There is no population-based study that accounts for the number of radical prostatectomies (RP) carried out in Spain, nor regarding the morbidity and mortality of this intervention. Our objective is to study the morbidity and mortality of RP in Spain from 2011 to 2015 and to evaluate the geographic variation. MATERIAL AND METHODS: We designed a retrospective observational study of all patients submitted to RP in Spain during five consecutive years (2011-2015). The data was extracted from the «Conjunto Mínimo Básico de Datos¼ (CMBD). We have evaluated geographic variations in terms of morbidity and hospital stay, and the impact of the mean annual surgical volume for each center on these variables. RESULTS: Between 2011-2015, a total of 37,725 RPs were performed in 221 Spanish public hospitals. The mean age of the series was 63.9±3.23 years. Of all RPs, 50% were performed through an open approach, and 43.4% have been operated on in hospitals with <500 beds. We observed an important variability in the distribution of the cases operated on in the different regions. The regions that perform more RPs are Andalusia, Catalonia, Galicia, and Madrid. Our study shows a complication rate of 8.6%, with hemorrhage and the need for transfusion being the most frequent (5.3 and 4%, respectively). There are significant differences in bleeding rates and hospital stay among regions, which are maintained after adjusting for patient characteristics and type of hospital. When studying the annual surgical volume of each hospital, we find that the impact on the rate of hemorrhage or transfusion is linear; however, hospital stay remains stable at around 5 days from 60 RPs/year. CONCLUSIONS: In national terms, morbidity and mortality rates after RP are comparable to those described in the literature. This study reveals a clear dispersion in the hospitals that carry out this intervention, showing clear differences in terms of morbidity and hospital stay between the different regions.

Resultados de la implementación de un programa multidisciplinar de cesación tabáquica combinando vareniclina y terapia conductual en la farmacia comunitaria / Results of the implementation of a multidisciplinary smoking cessation programme combining varenicline and behavioural therapy in community pharmacies

Objetivo: evaluar los resultados de la implementación de un programa multidisciplinar médico-farmacéutico de cesación tabáquica combinando vareniclina y terapia conductual.Métodos: el médico de atención primaria valoró la dependencia y motivación del paciente para dejar de fumar mediante los test de Fagerström y Richmond, respectivamente. Los pacientes candidatos a entrar en el programa recibían la prescripción de vareniclina, si era necesaria, y se incorporaban a un programa de terapia conductual de tres meses de seguimiento en la farmacia comunitaria. Para el abordaje de la terapia conductual, el farmacéutico comunitario desarrolló una guía estructurada en 8 visitas y materiales de soporte para el paciente. El seguimiento de los pacientes se realizó en la farmacia comunitaria y el farmacéutico solo derivó a los pacientes a la consulta de atención primaria cuando aparecieron efectos adversos graves. Se recogió el historial de tabaquismo de los pacientes y sus comorbilidades, el tratamiento farmacológico recibido y sus efectos secundarios.Resultados: se incluyeron 26 pacientes. La puntuación media del test de Richmond fue de 8,31 (DE 1,54). La puntuación media del test de Fagerström fue de 5,73 (DE 2,10). La salud fue el principal motivo para dejar de fumar. Los pacientes recibieron vareniclina como tratamiento farmacológico para dejar de fumar, 21 pacientes (80,8 %) completaron las 12 semanas de tratamiento. Del total de la muestra, 18 pacientes (69,2 %) se mantuvieron sin fumar durante 3 meses. Los efectos secundarios observados más frecuentes fueron insomnio y diarrea. La terapia conductual llevada a cabo por el farmacéutico ayudó a mantener la adherencia al tratamiento farmacológico y la motivación durante el proceso de cesación tabáquica. (AU)

The Influence of Snow Properties on Speed and Gait Choice in the Svalbard Rock Ptarmigan (Lagopus muta hyperborea).

Substrate supportiveness is linked to the metabolic cost of locomotion, as it influences the depth to which the foot of a moving animal will sink. As track depth increases, animals typically reduce their speed to minimize any potential energetic imbalance. Here, we examine how self-selected speed in the Svalbard rock ptarmigan is affected by snow supportiveness and subsequent footprint depth measured using thin-blade penetrometry and 3D photogrammetry, respectively. Our findings indicate that snow supportiveness and footprint depth are poor predictors of speed (r 2 = 0.149) and stride length (r 2 = 0.106). The ptarmigan in our study rarely sunk to depths beyond the intertarsal joint, regardless of the speed, suggesting that at this relatively shallow depth any increased cost is manageable. 3D reconstructions also indicate that the ptarmigan may exploit the compressive nature of snow to generate thrust during stance, as a trend toward greater foot rotations in deeper footprints was found. It remains unclear whether the Svalbard ptarmigan are deliberately avoiding unsupportive snowy substrates. However, if they do, these results would be consistent with the idea that animals should choose routes that minimize energy costs of locomotion.

La firmeza del sustrato se asocial al costo metabólico de la locomoción ya que influencia cuán profundo las extremidades de un animal se hunden al moverse. A medida hundimiento aumenta, usualmente los animales reducen su velocidad para minimizar potenciales desbalances energéticos. En este estudio examinamos cómo la velocidad de la perdiz de la roca de Svalbard es afectada por la firmeza del sustrato y la profundidad de hundimiento de sus patas, usando penetrometría y fotogrametría 3D, respectivamente. Nuestros resultados indican que la firmeza de la nieve y la profundidad de hundimiento de las patas no son buenos predictores de la velocidad (r 2 = 0.149) y de la longitud de la zancada (r 2 = 0.106). La profundidad de las huellas de las perdices de nuestro estudio rara vez sobrepasó la altura de la articulación intertarsal, independientemente de la velocidad de locomoción, sugiriendo que a profundidades relativamente menores los costos energéticos son manejables. Las reconstrucciones 3D también indican que las perdices podrían aprovechar la naturaleza compresiva de la nieve para generar suficiente empuje durante la fase de soporte, ya que se encontró una tendencia hacia mayores rotaciones de la pata en huellas más profundas. Es incierto si las perdices de Svalbard deliberadamente evitan áreas con nieve más blanda. Sin embargo, si lo hacen, estos resultados serían consistentes con la idea de que los animales deberían seleccionar rutas que minimizan los gastos energéticos en locomoción.

Outcomes of an enhanced recovery after radical cystectomy program in a prospective multicenter study: compliance and key components for success.

OBJECTIVE: To investigate the effect of an Enhanced Recovery After Surgery (ERAS) program on complications and length of stay (LOS) after radical cystectomy (RC) and to assess if the number and type of components of ERAS play a key role on the decrease of surgical morbidity. MATERIALS AND METHODS: We analyzed the data of 277 patients prospectively recruited in 11 hospitals undergoing RC initially managed according to local practice (Group I) and later within an ERAS program (Group II). Two main outcomes were defined: 90-day complications rate and LOS. As secondary variables we studied 90-day mortality, 30-day readmission and transfusion rate. RESULTS: Patients in Group II had a higher use of ERAS measures (98.6%) than those in Group I (78.2%) (p < 0.05). Patients in Groups I and II experienced similar complications (70.5% vs. 66%, p = 0.42). LOS was not different between Groups I and II (12.5 and 14 days, respectively, p = 0.59). The risk of having any complication decreases for patients having more than 15 ERAS measures adopted [RR = 0.815; 95% confidence interval (CI) 0.667-0.996; p = 0.045]. Avoidance of transfusion and nasogastric tube, prevention of ileus, early ambulation and a fast uptake of a regular diet are independently associated with the absence of complications. CONCLUSIONS: Complications and LOS after RC were not modified by the introduction of an ERAS program. We hypothesize that at least 15 measures should be applied to maximize the benefit of ERAS.

Relevance of age at slaughter on meat quality of turkeys stunned with CO2.

1. The objective of this work was to determine the effect of slaughter age and stunning method on the quality of turkey meat from poultry processing plants. 2. One hundred B.U.T. Premium turkeys were divided into 4 groups of 25 animals according to slaughter age (15 or 17 weeks) and CO2 stunning procedure (G1 stepwise: step1: 30% CO2, 15 s; step 2: 55% CO2, 40 s; step 3: 70% CO2, 45 s; G2: progressive increase of the CO2 concentration at a rate of 0.8% per s for 100 s). The quality of the breast meat was determined in fillets taken at different post-mortem times. 3. There were differences between the stunning groups for several variables (pH: 6.01 ± 0.01 and 5.95 ± 0.02; a*: -1.84 ± 0.05 and -2.21 ± 0.04; b*: 4.99 ± 0.15 and 4.68 ± 0.16; drip loss: 0.85 ± 0.02 and 0.71 ± 0.02 for G1 and G2, respectively), while no significant differences were found for L*, cooking loss and texture analysed with a Warner Bratzler Shear Force cell (WBSF). 4. Slaughter age had a significant effect on all the parameters studied (pH: 6.01 ± 0.01 and 5.95 ± 0.01; a*: -2.21 ± 0.05 and -1.88 ± 0.05, b*: 5.50 ± 0.17 and 4.42 ± 0.15; drip loss: 0.71 ± 0.02 and 0.86 ± 0.02, cooking loss: 12.56 ± 0.22 and 14.69 ± 0.16 for turkeys slaughtered at 15 and 17 w, respectively) except on L* and WBSF. 5. The ageing of the meat affected pH, colour values, drip loss and WBSF, with differing degrees of evolution: mean values of L* (39.36 ± 0.35. 45.77 ± 0.20 and 46.30 ± 0.24, for 20 min, 24 h and 7 d post mortem, respectively) and drip loss (0.75 ± 0.03 and 0.84 ± 0.02 for 24 h and 7 d post mortem, respectively) increased, those of a* (-1.77 ± 0.08, -1.94 ± 0.07 and -2.22 ± 0.05 for 20 min, 24 h and 7 d post mortem, respectively) and WBSF decreased (3.73 ± 0.06 and 2.63 ± 0.04 for 24 h and 7 d post mortem, respectively), those of pH decreased in the first 24 h and remained stable for the next 6 d (6.19 ± 0.02, 5.87 ± 0.01 and 5.88 ± 0.01), and those of b* increased in the first 24 h post-mortem and remained stable for the next 6 d (3.26 ± 0.31, 5.86 ± 0.16 and 5.47 ± 0.08). 6. The results revealed no critical differences between stunning methods, and suggest that animals slaughtered at 15 weeks present higher quality meat than those slaughtered at 17 weeks.

Límites anatómicos y beneficio oncológico de la linfadenectomía en el cáncer urotelial de vejiga con infiltración muscular / The anatomical limits and oncological benefit of lymphadenectomy in muscle invasive bladder cancer

Introducción: La linfadenectomía es parte del tratamiento estándar del cáncer vesical con infiltración de la muscular. El objetivo de esta revisión es dar una visión actualizada de la evidencia científica disponible en este campo. Adquisición de la evidencia: Se realizó una revisión en Pubmed de la literatura relevante hasta la actualidad (2016). Se encontró una revisión sistemática publicada en 2014 que incluía los estudios comparativos publicados hasta ese momento, y se actualizó con las nuevas publicaciones relevantes desde esa fecha. Síntesis de la evidencia: El número de ganglios no es el mejor indicador para determinar la calidad de la linfadenectomía, puesto que puede variar en función de múltiples factores dependientes no solo del cirujano, sino también del propio paciente y del patólogo. Es más reproducible la definición de territorios anatómicos estándares y una meticulosa extracción de los ganglios en estos territorios. La extensión óptima de la linfadenectomía es un tema controvertido. La evidencia publicada hasta el momento dice que cualquier extensión de linfadenectomía es mejor que no realizarla, si bien parece que la linfadenectomía limitada es insuficiente para el control oncológico de la enfermedad y que la linfadenectomía superampliada, no aporta un beneficio oncológico frente a la linfadenectomía ampliada. Conclusiones: A pesar de existir cierta controversia en cuanto a la extensión óptima de la linfadenectomía, según la evidencia disponible parece recomendable realizar linfadenectomía en todos los casos. La linfadenectomía ampliada aporta un mayor beneficio oncológico que las disecciones más limitadas, desaconsejándose linfadenectomías más amplias

Background: Lymphadenectomy is part of standard treatment for muscle invasive bladder cancer. The objective of this review is to provide an up-to-date review on the available scientific evidence in this field. Acquisition of evidence: We conducted a literature review in PubMed of relevant articles up to the present (2016). We found a systematic review published in 2014 that included the comparative studies published up to that year, and we updated the review with new relevant publications since that date. Synthesis of the evidence: The number of lymph nodes is not the best indicator for determining the quality of the lymphadenectomy given that the number can vary depending on numerous factors that depend not only on the surgeon but also on the patient and on the pathologist. The definition of standard anatomical territories and a meticulous extraction of the lymph nodes in these territories are more reproducible than the numbers of nodes removed. The optimal extension of lymphadenectomy is a topic of debate. The evidence published to date indicates that any extension of lymphadenectomy is better than not performing it, although it appears that limited lymphadenectomy is insufficient for the oncological control of the disease and that superextended lymphadenectomy provides no oncological benefit versus extended lymphadenectomy. Conclusions: Despite a certain amount of controversy in terms of the optimal extension of lymphadenectomy, performing lymphadenectomy in all cases appears to be recommendable according to the available evidence. Extended lymphadenectomy provides greater oncological benefit than more limited dissections, while more extensive lymphadenectomies are not recommended

The 67P/Churyumov-Gerasimenko observation campaign in support of the Rosetta mission.

We present a summary of the campaign of remote observations that supported the European Space Agency's Rosetta mission. Telescopes across the globe (and in space) followed comet 67P/Churyumov-Gerasimenko from before Rosetta's arrival until nearly the end of the mission in September 2016. These provided essential data for mission planning, large-scale context information for the coma and tails beyond the spacecraft and a way to directly compare 67P with other comets. The observations revealed 67P to be a relatively 'well-behaved' comet, typical of Jupiter family comets and with activity patterns that repeat from orbit to orbit. Comparison between this large collection of telescopic observations and the in situ results from Rosetta will allow us to better understand comet coma chemistry and structure. This work is just beginning as the mission ends-in this paper, we present a summary of the ground-based observations and early results, and point to many questions that will be addressed in future studies.This article is part of the themed issue 'Cometary science after Rosetta'.

Influencia de la localización y del número de metástasis en la supervivencia de los pacientes con cáncer de próstata metastásico / Influence of the location and number of metastases in the survival of metastatic prostatic cancer patients

Introducción: En los pacientes con cáncer de próstata metastásico el pronóstico de la enfermedad podría estar modulado por factores como son la localización y el número de metástasis. Nuestro objetivo es evaluar la supervivencia de los pacientes en función de estos factores en nuestra serie en los últimos 15 años. Material y métodos: Estudio retrospectivo de pacientes diagnosticados entre 1998 y 2014. Calculamos la supervivencia global y la supervivencia libre de progresión, en función del número de metástasis y la localización de las mismas. Analizamos otros posibles factores pronósticos: edad, estadio clínico, PSA, Gleason, PSA nadir, tiempo hasta PSA nadir y tratamientos de primera línea o segunda línea tras la progresión. Resultados: Evaluamos a 162 pacientes con una edad media de 72,7 años (DE: 8,5). La supervivencia global fue de 3,9 años (IC95%: 2,6-5,2) Según la localización de las metástasis la supervivencia global fue de 7 años (IC95%: 4,1-9,7) para los pacientes con metástasis ganglionares; 3,9 años (IC95%: 2,3-5,5) en caso de metástasis óseas; 2,5 años (IC95%: 2-2,9) para metástasis óseas y ganglionares; y 2,2 años (IC95%: 1,4-3) en pacientes con metástasis viscerales (p<0,001).En el análisis multivariante, la localización de las metástasis se asoció significativamente con la supervivencia global y libre de progresión. El número de metástasis no presentó impacto en la supervivencia.Conclusiones: La localización de las metástasis tiene una clara influencia tanto en la supervivencia global como en la supervivencia libre de progresión, siendo los pacientes con afectación exclusivamente ganglionar los que presentan mejor pronóstico. El número de metástasis no tiene un efecto significativo en la supervivencia de nuestra serie

Introduction: The prognosis of patients diagnosed with metastatic prostate cancer seems to be modulated by factors such as the number and site of metastases. Our objective is to evaluate survival outcomes according to the number and site of metastases in our series of metastatic patients over the last 15 years. Materials and methods: A retrospective analysis was performed on patients diagnosed between 1998 and 2014. We analyzed overall survival and progression-free survival, depending on the number and location of metastases on patients with newly diagnosed metastatic prostate cancer. Other potential prognostic factors were also evaluated: age, clinical stage, PSA at diagnosis, Gleason, PSA nadir, time till PSA nadir and first-line or second-line treatment after progression. Results: We analyzed a series of 162 patients. The mean age was 72.7yr (SD: 8.5). The estimated median overall survival was 3.9 yr (95% CI 2.6-5.2). The overall survival in patients with only lymph node metastases was 7 yr (95% CI 4.1-9.7), 3.9 (95%CI 2.3-5.5) in patients with only bone metastases, 2.5 yr (95% CI 2-2.3) in lymph nodes and bone metastases, and 2.2 yr (95% CI 1.4-3) in patients with visceral metastases (P<.001). In multivariate analysis, the location of metastasesis significantly associated with overall survival and progression-free survival. The number of metastases showed no association with survival. Conclusions: The site of metastases has a clear impact on both overall survival and progression-free survival. Patients with only lymph node involvement had a better prognosis. The number of metastases showed no significant impact on survival in our series

Variabilidad en las complicaciones y la mortalidad quirúrgica tras cistectomía radical en España / Variability in complications and operative mortality after radical cystectomy in Spain

Introducción: En la literatura la mortalidad de la cistectomía radical (CR) varía entre 2,3 y 7,5%. En España no hay publicados datos generales de morbimortalidad. Objetivo: Identificar las complicaciones y mortalidad de la CR en España mediante un análisis de la totalidad de los procedimientos realizados en 3 años. Estudiar la variabilidad geográfica de estos resultados. Material y métodos: Identificamos a los pacientes intervenidos de CR en España en el sistema nacional de salud entre 2011 y 2013 a partir del conjunto mínimo básico de datos. Analizamos las complicaciones, la mortalidad durante el ingreso y a 30, 60 y 90 días. Comparamos estos resultados en las distintas CCAA, ajustamos por edad, Charlson y sexo, y posteriormente añadimos el tamaño del hospital. Resultados: Estudiamos a 7.999 pacientes intervenidos mediante CR en 197 hospitales del Sistema Nacional de Salud. La edad media de la serie fue 67,2 años ± 9,8. La mediana de la estancia fue de 15 días (RIQ: 11-24). El 47,2% de los pacientes presentaron complicaciones. La mortalidad media hospitalaria, a 30, 60 y a 90 días fue del 4,7; 2,9; 5 y 6,2%, respectivamente. Existe una gran variabilidad en la mortalidad a 90 días entre las CCAA (3,8-9,1%). Al ajustar por las características del paciente y del hospital, siguen observándose importantes variaciones geográficas (3,8-11,5%). Conclusiones: La mortalidad de la CR en España a 90 días es similar a la de la literatura. Existen importantes variaciones geográficas no explicables por las características de los pacientes ni por las de los hospitales en los que se realizan estas intervenciones

Background: In the literature, mortality for radical cystectomy (RC) varies between 2.3% and 7.5%. In Spain, there are no published general data on morbidity and mortality. Objective: To identify the complications and mortality of RC in Spain through an analysis of all procedures performed over a 3-year period and to study the geographic variability of these results. Material and methods: We identified patients who underwent RC in the Spanish National Health System between 2011 and 2013 based on the minimum basic data set. We analysed the complications and mortality during hospitalisation and at 30, 60 and 90 days. We compared these results in the various autonomous communities, adjusted them by age, Charlson score and sex and subsequently added the hospital size. Results: We studied 7999 patients who underwent RC in 197 hospitals of the Spanish National Health System. The mean age of the series was 67.2 ± 9.8 years. The median stay was 15 days (IQR, 11-24). Some 47.2% of the patients had complications. The mean mortality in-hospital and at 30, 60 and 90 days was 4.7, 2.9, 5 and 6.2%, respectively. There was considerable variability in the mortality at 90 days among the communities (3.8-9.1%). When adjusting by the patient and hospital characteristics, there were still significant geographic variations (3.8-11.5%). Conclusions: RC mortality in Spain at 90 days is similar to the rate in the literature. There are significant geographic variations unexplained by the characteristics of the patients or by those of the hospitals in which these operations were performed

Influence of carbon dioxide stunning procedure on quality of turkey meat.

1. The objective of this study was to evaluate the effect of sex and gas stunning on quality attributes of turkey breast meat. 2. One hundred B.U.T. Premium turkeys (50 males and 50 females) were divided into four groups of 25 animals and subjected to one of two CO2 stunning procedures: G1 stepwise (step 1: 30% CO2, 15 s; step 2: 55% CO2, 40 s; step 3: 70% CO2, 45 s) or G2 fixed concentration (80% CO2, 100 s). The pH and meat colour at 20 min post-mortem, and pH, colour (L*, a*, b*), water holding capacity (WHC), drip loss (DL), cooking loss (CL) and Warner-Bratzler shear force (WBSF) in breast samples at 24 h and 7 d post-mortem were assessed. 3. There were significant differences between stunning groups for pH, meat colour and CL, whereas no significant differences were found for DL and WBSF. Sex had a significant effect on pH and b* and ageing of meat affected pH, colour coordinates, DL and WBSF. 4. It was concluded that the G2 treatment affected negatively the pH value and colour coordinates. However, G2 stunning affected positively the WHC parameters. Female turkeys had better results than males for pH, and the colour of female turkey breast meat was less yellow than male breast meat.

The anatomical limits and oncological benefit of lymphadenectomy in muscle invasive bladder cancer. / Límites anatómicos y beneficio oncológico de la linfadenectomía en el cáncer urotelial de vejiga con infiltración muscular.

BACKGROUND: Lymphadenectomy is part of standard treatment for muscle invasive bladder cancer. The objective of this review is to provide an up-to-date review on the available scientific evidence in this field. ACQUISITION OF EVIDENCE: We conducted a literature review in PubMed of relevant articles up to the present (2016). We found a systematic review published in 2014 that included the comparative studies published up to that year, and we updated the review with new relevant publications since that date. SYNTHESIS OF THE EVIDENCE: The number of lymph nodes is not the best indicator for determining the quality of the lymphadenectomy given that the number can vary depending on numerous factors that depend not only on the surgeon but also on the patient and on the pathologist. The definition of standard anatomical territories and a meticulous extraction of the lymph nodes in these territories are more reproducible than the numbers of nodes removed. The optimal extension of lymphadenectomy is a topic of debate. The evidence published to date indicates that any extension of lymphadenectomy is better than not performing it, although it appears that limited lymphadenectomy is insufficient for the oncological control of the disease and that superextended lymphadenectomy provides no oncological benefit versus extended lymphadenectomy. CONCLUSIONS: Despite a certain amount of controversy in terms of the optimal extension of lymphadenectomy, performing lymphadenectomy in all cases appears to be recommendable according to the available evidence. Extended lymphadenectomy provides greater oncological benefit than more limited dissections, while more extensive lymphadenectomies are not recommended.

Variability in complications and operative mortality after radical cystectomy in Spain. / Variabilidad en las complicaciones y la mortalidad quirúrgica tras cistectomía radical en España.

BACKGROUND: In the literature, mortality for radical cystectomy (RC) varies between 2.3% and 7.5%. In Spain, there are no published general data on morbidity and mortality. OBJECTIVE: To identify the complications and mortality of RC in Spain through an analysis of all procedures performed over a 3-year period and to study the geographic variability of these results. MATERIAL AND METHODS: We identified patients who underwent RC in the Spanish National Health System between 2011 and 2013 based on the minimum basic data set. We analysed the complications and mortality during hospitalisation and at 30, 60 and 90 days. We compared these results in the various autonomous communities, adjusted them by age, Charlson score and sex and subsequently added the hospital size. RESULTS: We studied 7999 patients who underwent RC in 197 hospitals of the Spanish National Health System. The mean age of the series was 67.2±9.8 years. The median stay was 15 days (IQR, 11-24). Some 47.2% of the patients had complications. The mean mortality in-hospital and at 30, 60 and 90 days was 4.7, 2.9, 5 and 6.2%, respectively. There was considerable variability in the mortality at 90 days among the communities (3.8-9.1%). When adjusting by the patient and hospital characteristics, there were still significant geographic variations (3.8-11.5%). CONCLUSIONS: RC mortality in Spain at 90 days is similar to the rate in the literature. There are significant geographic variations unexplained by the characteristics of the patients or by those of the hospitals in which these operations were performed.

Influence of the location and number of metastases in the survival of metastatic prostatic cancer patients. / Influencia de la localización y del número de metástasis en la supervivencia de los pacientes con cáncer de próstata metastásico.

INTRODUCTION: The prognosis of patients diagnosed with metastatic prostate cancer seems to be modulated by factors such as the number and site of metastases. Our objective is to evaluate survival outcomes according to the number and site of metastases in our series of metastatic patients over the last 15 years. MATERIALS AND METHODS: A retrospective analysis was performed on patients diagnosed between 1998 and 2014. We analyzed overall survival and progression-free survival, depending on the number and location of metastases on patients with newly diagnosed metastatic prostate cancer. Other potential prognostic factors were also evaluated: age, clinical stage, PSA at diagnosis, Gleason, PSA nadir, time till PSA nadir and first-line or second-line treatment after progression. RESULTS: We analyzed a series of 162 patients. The mean age was 72.7yr (SD: 8.5). The estimated median overall survival was 3.9 yr (95% CI 2.6-5.2). The overall survival in patients with only lymph node metastases was 7 yr (95% CI 4.1-9.7), 3.9 (95%CI 2.3-5.5) in patients with only bone metastases, 2.5 yr (95% CI 2-2.3) in lymph nodes and bone metastases, and 2.2 yr (95% CI 1.4-3) in patients with visceral metastases (P<.001). In multivariate analysis, the location of metastasesis significantly associated with overall survival and progression-free survival. The number of metastases showed no association with survival. CONCLUSIONS: The site of metastases has a clear impact on both overall survival and progression-free survival. Patients with only lymph node involvement had a better prognosis. The number of metastases showed no significant impact on survival in our series.

Influencia de bajas concentraciones de oxígeno sobre los cultivos de blastocistos / Influence of low oxygen concentrations on blastocyst culture

En la mayoría de laboratorios de Reproducción Asistida el cultivo de embriones humanos se realiza a concentraciones atmosféricas de oxígeno (20 % de O2), cuando realmente las concentraciones fisioló- gicas son menores. Hasta el momento no está claro si estas diferencias suponen o no un beneficio para el desarrollo embrionario. El beneficio o daño puede ocurrir en cualquier momento del ciclo: desde el estadio de ovocito maduro hasta su desarrollo a blastocisto. El objetivo de este trabajo es determinar si el cultivo embrionario a diferentes concentraciones de O2 supone algún beneficio en las tasas de fecundación y división, así como en la proporción de blastocistos obtenidos de buena calidad, e indirectamente en la tasas de utilización de estos (los que transferimos y los que se congelan), y en las tasas de implantación y gestación. Realizamos 292 ciclos de cultivo embrionario hasta blastocisto, 139 ciclos en incubadores con concentración del 5 % de O2 y 153 ciclos en incubadores al 20 %. Siendo ambos grupos homogéneos en cuanto al número medio de ovocitos obtenidos, de ovocitos maduros y número total de embriones, no se observaron diferencias significativas en las tasas de fecundación y división. Aunque el número medio total de blastocistos obtenidos fue similar en ambos grupos (4,8 vs 5,1; p=0,349), el porcentaje de blastocistos de buena calidad fue superior en el grupo de los cultivados a bajas proporciones de O2 (29,6 % vs 36,1 %; p <0,05), siendo estas diferencias significativas. También se encontraron diferencias en la tasa de utilización (33,2 % vs 38,1 %; p< 0,05), siendo superior en el grupo cultivado a bajas concentraciones. Dada la tendencia a transferir un solo blastocisto, siempre y cuando disponemos de al menos uno de buena calidad, no se observaron diferencias significativas en la tasa de implantación, de gestación ni de embarazos a término. Con esto podemos concluir que el cultivo a bajas concentraciones de O2 mejora la cantidad de blastocistos de buena calidad obtenidos, por lo que al disponer de una mayor cantidad de estos podremos proporcionar a nuestros pacientes más posibilidades de éxito en sus ciclos. Habría que ampliar el estudio incluyendo los ciclos de criotransferencias para así poder determinar si efectivamente esto se ve reflejado en las tasas de implantación, gestación y embarazo acumulado

In most assisted reproduction laboratories, cultivation of human embryos is performed using atmospheric concentrations of oxygen (20 % O2), when the true physiological concentrations are lower. So far it is unclear whether these differences in the concentration of O2 represent a benefit for embryonic development or not. The benefit or harm can occur at any time during the cycle: from the mature oocyte stage until the blastocyst development. The objective of this work is to determine if the embryo culture at different concentrations of O2 entails any increase in the rates of fertilization and division, as well as the proportion of good quality blastocysts obtained, and indirectly in their use rates (those transferred and those frozen) and also implantation and pregnancy rates. We performed 292 cycles of embryonic culture until blastocyst, 139 cycles in incubators with an O2 concentration of 5% and 153 cycles in incubators with an O2 concentration of 20%. Despite both groups being homogeneous in the average number of oocytes, mature oocytes and total number of embryos, no significant differences were observed among the fertilization and division. Although the total average number of blastocysts obtained was similar in both groups (4.8 vs 5.1; p = 0.349), the percentage of good quality blastocysts was higher in the group cultivated at low rates of O2 (29.6% vs 36.1%; p< 0.05), these being significant differences. We also found differences in the use rate (33.2% vs 38.1%; p < 0.05), with the group cultivated at low concentrations being higher. Given the trend towards a single blastocyst transfer, and provided we have at least one good quality blastocyst, no significant differences were observed in the implantation, pregnancy or full-term pregnancies. To sum up, we can conclude that embryo cultures with low concentrations of O2 improves the amount of good quality blastocysts obtained. Thus, having more blastocyst available we are able to provide our patients with more chances of success in their treatment. We should expand the study with the inclusion of cryotransfer cycles, in order to determine if these findings are indeed reflected in the implantation, pregnancy and cumulative pregnancy rates

Rentabilidad diagnóstica y complicaciones de la linfadenectomía ampliada frente a la limitada asociada a prostatectomía radical / Diagnostic yield and complications of extended lymphadenectomy versus limited lymphadenectomy combined with radical prostatectomy

Introducción: La linfadenectomía en el cáncer de próstata (CP) es el procedimiento más fiable para la detección de metástasis linfáticas. La extensión óptima de la misma aún es un tema en debate. Objetivo: Analizar el rendimiento diagnóstico y las complicaciones de la linfadenectomía ampliada (LFDNA) y limitada (LFDNL) en una serie de pacientes con CP de alto riesgo sometidos a prostatectomía radical (PR). Material y métodos: Estudio retrospectivo de pacientes con CP de alto riesgo de D’Amico sometidos a PR con linfadenectomía entre 1999- 2014. Análisis comparativo de la capacidad de diagnóstico de metástasis linfáticas de la LFDNA y LFDNL y de las complicaciones postoperatorias a 90 días. Resultados: Se analizaron 93 pacientes, 20 (21,5%) sometidos a LFDNA y 73 (78,5%) a LFDNL. La edad media de la serie fue de 65,26 años (DE 5,51). La mediana de seguimiento fue de 1,51 (0,61-2,29) años en el grupo de LFDNA y 5,94 (3,61-9,10) en LFDNL. La mediana de ganglios obtenidos fue de 13 (9-23) en las LFNDA vs. 5 (2-8) en las limitadas (p < 0,001) y el porcentaje de pacientes con ganglios positivos obtenidos fue de 35 y 5,47% respectivamente (p < 0,001). El porcentaje global de complicaciones a 90 días fue 35,5% (33 pacientes). Del grupo de LFDNA 12 pacientes (60%) presentaron complicaciones, frente a 21 (28,8%) en LFDNL (p = 0,016), sin encontrar diferencias significativas en la gravedad según la escala de Clavien (p = 0,73). Conclusiones: En nuestra serie, la detección de ganglios metastásicos ha sido significativamente superior en la LFDNA. La LFDNA aumenta el número de complicaciones, sin encontrar diferencias con la LFDNL en la gravedad según la escala de Clavien modificada

Background: Lymphadenectomy for prostate cancer (PC) is the most reliable procedure for detecting lymphatic metastases. The optimal extension of this procedure is still a topic of debate. Objective: To analyse the diagnostic performance and complications of extended lymphadenectomy (ELD) and limited lymphadenectomy (LLD) in a series of patients with high-risk PC who underwent radical prostatectomy (RP). Material and methods: A retrospective study was conducted on patients with high d’Amico risk who underwent RP with lymphadenectomy between 1999 and 2014. A comparative analysis was performed of the diagnostic capacity of lymphatic metastases of ELD and LLD and of postoperative complications at 90 days. Results: Ninety-three patients were analysed, 20 (21.5%) and 73 (78.5%) of whom underwent ELD and LLD, respectively. The mean age of the series was 65.26 years (SD, 5.51). The median follow-up was 1.51 (0.61–2.29) years in the ELD group and 5.94 (3.61–9.10) in the LLD group. The median number of nodes obtained was 13 (9–23) in the ELD group compared with 5 (2–8) in the LLD group (p < .001). The percentages of patients with positive nodes in the ELD and LLD groups were 35% and 5.47%, respectively (p < .001). The overall complication rate at 90 days was 35.5% (33 patients). In the ELD group, 12 patients (60%) had complications, compared with 21 patients (28.8%) in the LLD group (p = .016), with no significant differences in severity according to the Clavien scale (p = .73). Conclusions: In our series, the detection of metastatic nodes was significantly greater with ELD. ELD increases the number of complications, with no differences compared with LLD in severity according to the modified Clavien scale

Estudio de cohortes comparando fotovaporización prostática con láser XPS 180 W y HPS 120 W / Cohort study comparing prostate photovaporisation with XPS 180 W and HPS 120 W laser

Introducción y objetivo: La fotovaporización prostática con láser Greenlight, para el tratamiento quirúrgico de la hiperplasia benigna de próstata ha evolucionado rápidamente hasta el nuevo XPS 180 W. Demostramos anteriormente la eficacia y seguridad con el HPS 120 W. El objetivo de este estudio ha sido evaluar los resultados funcionales y de seguridad, con un año de seguimiento, de la fotovaporización mediante el XPS 180 W comparándolo con su predecesor. Material y métodos: Estudio de cohortes sobre una serie de 191 pacientes consecutivos sometidos a fotovaporización entre 01/2008 y 05/2013. Los criterios de inclusión fueron un IPSS >15 tras fracaso médico, un volumen prostático < 80cc y un flujo máximo <15 ml/s. Se evaluaron variables preoperatorias, intraoperatorias (energía empleada, tiempo de láser y tiempo total de la cirugía), complicaciones, horas de sonda, estancia y resultados funcionales (flujo máximo, IPSS, PSA y volumen prostático) a 3, 6 y 12 meses. Se analiza la homogeneidad en las características preoperatorias de los dos grupos mediante técnicas de análisis univariante. Los resultados funcionales postoperatorios se evalúan mediante análisis de la varianza de medidas repetidas con modelos mixtos. Resultados: Se realizaron 109 (57,1%) procedimientos mediante HPS 120 W y 82 (42,9%) mediante XPS. No se encontraron diferencias entre las características preoperatorias. Se observaron diferencias significativas tanto en el tiempo quirúrgico como en el tiempo efectivo de láser a favor del sistema XPS, siendo esta ventaja de un 11% (48 ± 15,7 vs. 53,8 ± 16,2, p < 0,05), y de un 9% (32,8 ± 11,7 vs. 36 ± 11,6, p < 0,05), respectivamente. En el resto de los parámetros analizados no se encontraron diferencias estadísticamente significativas. Conclusión: Las mejorías técnicas del sistema XPS 180 W permiten reducir el tiempo quirúrgico manteniendo el perfil de seguridad y eficacia que ofrecía el sistema HPS 120 W con unos resultados totalmente superponibles con un año de seguimiento

Introduction and objective: Prostate photovaporisation with Greenlight laser for the surgical treatment of benign prostate hyperplasia has rapidly evolve to the new XPS 180 W. We have previously demonstrated the safety and efficacy of the HPS 120 W. The aim of this study was to assess the functional and safety results, with a year of follow-up, of photovaporisation using the XPS 180 W laser compared with its predecessor. Material and methods: A cohort study was conducted with a series of 191 consecutive patients who underwent photovaporisation between 1/2008 and 5/2013. The inclusion criteria were an international prostate symptom score (IPSS) >15 after medical failure, a prostate volume < 80 cc and a maximum flow <15 mL/s. We assessed preoperative and intraoperative variables (energy used, laser time and total surgical time), complications, catheter hours, length of stay and functional results (maximum flow, IPSS, prostate-specific antigen and prostate volume) at 3, 6 and 12 months. We analysed the homogeneity in preoperative characteristics of the 2 groups through univariate analysis techniques. The postoperative functional results were assessed through an analysis of variance of repeated measures with mixed models. Results: A total of 109 (57.1%) procedures were performed using HPS 120 W, and 82 (42.9%) were performed using XPS. There were no differences between the preoperative characteristics. We observed significant differences both in the surgical time and effective laser time in favour of the XPS system. This advantage was 11% (48 ± 15.7 vs. 53.8 ± 16.2, p< .05) and 9% (32.8 ± 11.7 vs. 36 ± 11.6, p< .05), respectively. There were no statistically significant differences in the rest of the analysed parameters. Conclusion: The technical improvements in the XPS 180 W system help reduce surgical time, maintaining the safety and efficacy profile offered by the HPS 120 W system, with completely superimposable results at 1 year of follow-up

Diagnostic yield and complications of extended lymphadenectomy versus limited lymphadenectomy combined with radical prostatectomy.

BACKGROUND: Lymphadenectomy for prostate cancer (PC) is the most reliable procedure for detecting lymphatic metastases. The optimal extension of this procedure is still a topic of debate. OBJECTIVE: To analyse the diagnostic performance and complications of extended lymphadenectomy (ELD) and limited lymphadenectomy (LLD) in a series of patients with high-risk PC who underwent radical prostatectomy (RP). MATERIAL AND METHODS: A retrospective study was conducted on patients with high d'Amico risk who underwent RP with lymphadenectomy between 1999 and 2014. A comparative analysis was performed of the diagnostic capacity of lymphatic metastases of ELD and LLD and of postoperative complications at 90 days. RESULTS: Ninety-three patients were analysed, 20 (21.5%) and 73 (78.5%) of whom underwent ELD and LLD, respectively. The mean age of the series was 65.26 years (SD, 5.51). The median follow-up was 1.51 (0.61-2.29) years in the ELD group and 5.94 (3.61-9.10) in the LLD group. The median number of nodes obtained was 13 (9-23) in the ELD group compared with 5 (2-8) in the LLD group (p <.001). The percentages of patients with positive nodes in the ELD and LLD groups were 35% and 5.47%, respectively (p <.001). The overall complication rate at 90 days was 35.5% (33 patients). In the ELD group, 12 patients (60%) had complications, compared with 21 patients (28.8%) in the LLD group (p=.016), with no significant differences in severity according to the Clavien scale (p=.73). CONCLUSIONS: In our series, the detection of metastatic nodes was significantly greater with ELD. ELD increases the number of complications, with no differences compared with LLD in severity according to the modified Clavien scale.

Cohort study comparing prostate photovaporisation with XPS 180W and HPS 120W laser.

INTRODUCTION AND OBJECTIVE: Prostate photovaporisation with Greenlight laser for the surgical treatment of benign prostate hyperplasia has rapidly evolve to the new XPS 180W. We have previously demonstrated the safety and efficacy of the HPS 120W. The aim of this study was to assess the functional and safety results, with a year of follow-up, of photovaporisation using the XPS 180W laser compared with its predecessor. MATERIAL AND METHODS: A cohort study was conducted with a series of 191 consecutive patients who underwent photovaporisation between 1/2008 and 5/2013. The inclusion criteria were an international prostate symptom score (IPSS) >15 after medical failure, a prostate volume <80 cm(3) and a maximum flow <15 mL/s. We assessed preoperative and intraoperative variables (energy used, laser time and total surgical time), complications, catheter hours, length of stay and functional results (maximum flow, IPSS, prostate-specific antigen and prostate volume) at 3, 6 and 12 months. We analysed the homogeneity in preoperative characteristics of the 2 groups through univariate analysis techniques. The postoperative functional results were assessed through an analysis of variance of repeated measures with mixed models. RESULTS: A total of 109 (57.1%) procedures were performed using HPS 120W, and 82 (42.9%) were performed using XPS. There were no differences between the preoperative characteristics. We observed significant differences both in the surgical time and effective laser time in favour of the XPS system. This advantage was 11% (48 ± 15.7 vs. 53.8 ± 16.2, p<.05) and 9% (32.8 ± 11.7 vs. 36 ± 11.6, p<.05), respectively. There were no statistically significant differences in the rest of the analysed parameters. CONCLUSION: The technical improvements in the XPS 180W system help reduce surgical time, maintaining the safety and efficacy profile offered by the HPS 120W system, with completely superimposable results at 1 year of follow-up.

Cambios en el grado de Gleason en las biopsias de seguimiento de pacientes con cáncer de próstata en programa de vigilancia activa / Changes in Gleason score grading on serial follow-up biopsies in prostate cancer patients undergoing active surveillance

Introducción: Las series publicadas sobre vigilancia activa (VA) son cada vez más numerosas. La variación del Gleason a lo largo de las biopsias de seguimiento no se detalla en muchas de estas publicaciones. Objetivos: Evaluar los cambios en el grado de Gleason de las biopsias de seguimiento en pacientes con cáncer de próstata de bajo riesgo en programa de VA. Material y métodos: Análisis de pacientes diagnosticados entre 2004 y 2013. Criterios de inclusión: PSA ≤ 10 ng/ml, Gleason ≤ 6, T1c/T2a, ≤ 2 cilindros positivos, afectación máxima del cilindro de un 50%. Se analizaron los datos anatomopatológicos de cada una de las biopsias. Resultados: Serie de 175 pacientes incluidos en vigilancia activa con media de seguimiento de 3,96 años (DE: 2,4). Las tasas de Gleason ≥ 7 en las biopsias de seguimiento fueron: 5,72% en la primera biopsia, 7,39% y 7,41% en las biopsias sucesivas. Por el contrario, no se evidenció afectación tumoral en el 42,03% de los casos en la primera biopsia, 40,74% y 51,85% en segunda y terceras biopsias respectivamente. La mediana de permanencia en el programa en los pacientes con la primera biopsia positiva fue 90,99 meses (IC 95%: 53,53-128,46) vs 96,66 meses (IC 95%: 63,19-130,13) en aquellos sin evidencia de malignidad. Conclusiones: En nuestra serie las 3 primeras biopsias se mantienen con unas proporciones estables en cuanto a positividad de la biopsia, grado de Gleason o indicación de tratamiento activo. Los pacientes que en la primera biopsia de seguimiento no tienen evidencia de malignidad tienen menor probabilidad de necesitar tratamiento activo que el resto de la serie

Introduction: Active surveillance for prostate cancer has grown systematically in the recent years with more robust mid-term outcomes. However, changes in Gleason score during serial biopsies are not detailed in many of these reports. Objectives: To evaluate changes in Gleason score on follow-up biopsies in low-risk prostate cancer in patients undergoing AS program in our center. Material and methods: Series of patients diagnosed of prostate cancer between 2004 and 2013 have been analyzed. The inclusion criteria were: PSA ≤ 10 ng/ml + Gleason ≤ 6 + T1c/T2a + ≤ 2 positive cores, and no more than 50% of affected core. The pathology of each of the biopsies was analyzed. Results: We studied a series of 175 patients undergoing AS. Mean follow-up was 3.96 years (SD 2.4). Follow-up biopsies with Gleason scores ≥ 7 were: 5.72% in the first biopsy, 7.39% and 7.41% in subsequent biopsies. By contrast, in 42.03% of cases did not show evident tumor involvement in the first biopsy, 40.74% and 51.85% in the second and third biopsies respectively. Median stay in the AS program was: 90.99 months (95% CI: 53.53-128.46) in patients with first positive biopsy vs. 96.66 months (95% CI: 63.19-130.13) in those without evidence of tumor. Conclusions: In our series the pathological data of the first 3 biopsies remain stable in terms of the positive biopsy rate, Gleason score, or indication of active treatment proportions. Those patients who do not show evidence of malignancy in the first follow-up biopsy are less likely to need active treatment than the other patients in the series