Abordaje perineal de fístulas rectouretrales tras prostatectomía radical laparoscópica / Perineal approach for rectourethral fistulae after radical laparoscopic prostatectomy

Objetivo: Describir nuestra experiencia con el abordaje perineal para el tratamiento de las fístulas rectouretrales (FRU) tras prostatectomía radical laparoscópica. Materiales y métodos: Realizamos un estudio retrospectivo desde el año 2012 al 2015 presentando 5 casos de FRU tras prostatectomía radical laparoscópica. Todos los casos requirieron cirugías abdominales mayores entre la prostatectomía radical laparoscópica y el tratamiento de la FRU a causa de complicaciones varias. En ningún caso se indicó radioterapia previa o posterior a la reparación. Se realizó abordaje perineal en los 5 casos como primera opción. Un caso requirió una segunda intervención con abordaje combinado (abdominal y perineal) por persistencia de la fístula. Resultados: Tras un mínimo de 12 meses de seguimiento en los 5 casos se ha resuelto la FRU. 2 pacientes presentaron incontinencia urinaria y uno estenosis de la anastomosis que requirió uretrotomía interna. El resto no ha mostrado complicaciones a largo plazo. Conclusión: El abordaje perineal permite un campo quirúrgico sano en pacientes multioperados, obteniendo altas tasas de resolución de la fístula

Objective: To describe our experience with the perineal approach to treat rectourethral fistulae (RUF) after radical laparoscopic prostatectomy. Materials and methods: We performed a retrospective study from 2012 to 2015 presenting 5 cases of RUF after radical laparoscopic prostatectomy. All cases required major abdominal surgery between the radical laparoscopic prostatectomy and the RUF treatment due to various complications. In no case was radiation therapy indicated prior to or after the repair. A perineal approach was performed in the 5 cases as the first option. One case required a second operation with a combined approach (abdominal and perineal) due to persistent fistulae. Results: After a minimum of 12 months of follow-up, 5 cases had resolved the RUF. Two patients presented urinary incontinence, and one patient had an anastomotic stricture that required internal urethrotomy. The other patients had no long-term complications. Conclusion: The perineal approach provides a healthy surgical field in patients who undergo multiple operations, achieving high rates of resolution of the fistulae

Perineal approach for rectourethral fistulae after radical laparoscopic prostatectomy.

OBJECTIVE: To describe our experience with the perineal approach to treat rectourethral fistulae (RUF) after radical laparoscopic prostatectomy. MATERIALS AND METHODS: We performed a retrospective study from 2012 to 2015 presenting 5 cases of RUF after radical laparoscopic prostatectomy. All cases required major abdominal surgery between the radical laparoscopic prostatectomy and the RUF treatment due to various complications. In no case was radiation therapy indicated prior to or after the repair. A perineal approach was performed in the 5 cases as the first option. One case required a second operation with a combined approach (abdominal and perineal) due to persistent fistulae. RESULTS: After a minimum of 12 months of follow-up, 5 cases had resolved the RUF. Two patients presented urinary incontinence, and one patient had an anastomotic stricture that required internal urethrotomy. The other patients had no long-term complications. CONCLUSION: The perineal approach provides a healthy surgical field in patients who undergo multiple operations, achieving high rates of resolution of the fistulae.

An antibody reactivity-based assay for diagnosis of invasive candidiasis using protein array.

The increased incidence of invasive candidiasis and of patients at risk requires early diagnosis and treatment to improve prognosis and survival. The aim of this study was to set up a ten-protein array-based immunoassay to assess the IgG antibody responses against ten well-known immunogenic C. albicans proteins (Bgl2, Eno1, Pgk1, Pdc11, Fba1, Adh1, Als3, Hwp1, Hsp90 and Grp2) in 51 patients with invasive candidiasis (IC) and in 38 culture-negative controls (non-IC). Antibody levels were higher against Bgl2, Eno1, Pgk1, Als3, Hwp1 and Grp2, than against Adh1, Pdc11, Fba1 and Hsp90, irrespectively of the patient group considered. Moreover, the IgG levels against Bgl2, Eno1, Pgk1 and Grp2 were significantly higher in IC than in non-IC patients. Furthermore, the ROC curves generated by the analysis of the antibody responses against Bgl2, Grp2 and Pgk1 displayed AUC values above 0.7, thus discriminating IC and non-IC patients. According to these results, the employment of the microarray immunoassay (a rapid, sensitive and multiparametric system), in parallel with conventional diagnostics, can help to spot IC patients. This ultimately will allow to initiate an early, focused and optimized antifungal therapy.

Variability in glutenin subunit composition of Mediterranean durum wheat germplasm and its relationship with gluten strength.

The allelic composition at five glutenin loci was assessed by one-dimensional sodium dodecyl sulphate polyacrylamide gel electrophoresis (1D SDS-PAGE) on a set of 155 landraces (from 21 Mediterranean countries) and 18 representative modern varieties. Gluten strength was determined by SDS-sedimentation on samples grown under rainfed conditions during 3 years in north-eastern Spain. One hundred and fourteen alleles/banding patterns were identified (25 at Glu-1 and 89 at Glu-2/Glu-3 loci); 0·85 of them were in landraces at very low frequency and 0·72 were unreported. Genetic diversity index was 0·71 for landraces and 0·38 for modern varieties. All modern varieties exhibited medium to strong gluten type with none of their 13 banding patterns having a significant effect on gluten-strength type. Ten banding patterns significantly affected gluten strength in landraces. Alleles Glu-B1e (band 20), Glu-A3a (band 6), Glu-A3d (bands 6 + 11), Glu-B3a (bands 2 + 4+15 + 19) and Glu-B2a (band 12) significantly increased the SDS-value, and their effects were associated with their frequency. Two alleles, Glu-A3b (band 5) and Glu-B2b (null), significantly reduced gluten strength, but only the effect of the latter locus could be associated with its frequency. Only three rare banding patterns affected gluten strength significantly: Glu-B1a (band 7), found in six landraces, had a negative effect, whereas banding patterns 2 + 4+14 + 15 + 18 and 2 + 4+15 + 18 + 19 at Glu-B3 had a positive effect. Landraces with outstanding gluten strength were more frequent in eastern than in western Mediterranean countries. The geographical pattern displayed from the frequencies of Glu-A1c is discussed.

Relevance study of bare and coated zero valent iron nanoparticles for lindane degradation from its by-product monitorization.

Zero-valent iron nanoparticles (NZVI) as well as polymer-stabilized nanoparticles were synthesized and used for lindane (γ-hexachlorocyclohexane) degradation in aqueous solution. To study the effectiveness of the different coated nanoparticles, simple and rapid analytical methods have been developed to measure and to detect lindane and its by-products. For the monitorization of lindane degradation solid-phase extraction (SPE) was used, while volatile by-products formation measurement was carried out by headspace-solid phase microextraction (HS-SPME) followed by GC/MS. The SPE-GC/MS method provides low detection limits (0.2 µg L(-1)), high recovery (above 95%) and it is a valuable tool for kinetic studies of the degradation process for each polymer used, while HS-SPME-GC/MS has proved to be an effective tool for the extraction and evaluation of volatile degradation by-products.

Production of carcinogenic acetaldehyde by Candida albicans from patients with potentially malignant oral mucosal disorders.

OBJECTIVES: Production of carcinogenic acetaldehyde by Candida has been suggested to contribute to epithelial dysplasia and oral carcinogenesis. Oral lichen planus (OLP), oral lichenoid lesion (OLL) and oral leukoplakia (OL) are potentially carcinogenic oral diseases where colonisation by Candida is common, but acetaldehyde production by Candida has not been studied. STUDY DESIGN: Acetaldehyde production in ethanol (11 mM), glucose (100 mM), ethanol-glucose (11 mM and 100 mM) or red wine (1200 mM ethanol) incubation by Candida albicans from patients with OLL (n = 6), OLP (n = 16), OL (n = 6) and controls (n = 6) was measured by gas chromatography. Participants completed a questionnaire regarding their smoking habits and alcohol consumption. RESULTS: All Candida albicans isolates produced potentially carcinogenic levels of acetaldehyde (>100 µM) in all incubations containing ethanol. The control group isolates produced the highest acetaldehyde levels. Isolates from smokers produced more acetaldehyde in all incubations than those from non-smokers. The difference was significant in ethanol-glucose incubation. Isolates from patients who were both smokers and drinkers produced the highest amounts when incubated in ethanol, ethanol-glucose and wine. CONCLUSIONS: Candida albicans isolated from potentially carcinogenic oral diseases can produce mutagenic amounts of acetaldehyde. Cigarette smoking and alcohol consumption may favour adaptational changes resulting in the upregulation of candidal acetaldehyde metabolism.

Prospective study in critically ill non-neutropenic patients: diagnostic potential of (1,3)-ß-D-glucan assay and circulating galactomannan for the diagnosis of invasive fungal disease.

Diagnosis of invasive fungal disease (IFD) in patients under intensive care is challenging. Circulating biomarkers, (1,3)-ß-D-glucan (BG) and galactomannan (GM), were prospectively assessed in 98 critically ill patients at risk of IFD. There were 11 cases of invasive aspergillosis (IA; 4 proven and 7 probable), 9 cases of proven invasive candidiasis (IC), 1 case of mixed proven IC and probable IA, 1 case of proven zygomycosis, and 1 case of mixed mycelial proven IFD. In all IA cases there was no significant difference when the area under the receiver operating characteristic curve (AUC) of GM (0.873 [95%CI, 0.75-0.99]) and BG (0.856 [95% CI, 0.71-0.99]) were compared (p = 0.871). The AUC for BG in IC and for the rest of the IFD cases was 0.605 (95% CI, 0.39-0.82) and 0.768 (95% CI, 0.63-0.90) respectively. Positive BG (40%) predated blood culture (n = 3) and abdominal pus (n = 1) a mean of 3.25 days before Candida was grown. In patients with IFD caused by molds, BG appeared a mean of 5.65 days before culture results. For the diagnosis of patients at risk of IC, BG has shown a high NPV (94.5%), with positive results also predating blood cultures in 30% of patients. In conclusion, early BG results permit a timely initiation of antifungal therapy in patients at risk of IFD.

A prospective comparison of galactomannan in bronchoalveolar lavage fluid for the diagnosis of pulmonary invasive aspergillosis in medical patients under intensive care: comparison with the diagnostic performance of galactomannan and of (1→ 3)-ß-d-glucan chromogenic assay in serum samples.

Diagnosis of fungal pneumonia (FP) in critically ill patients is challenging. Circulating biomarkers for the diagnosis of FP have limitations and the combination of different assays in serum samples and directly from the target organ may further improve the diagnosis of FP. We prospectively assessed the diagnostic utility of paired galactomannan (GM) in bronchoalveolar lavage fluid (BAL) and serum GM and (1→3)-ß-D-glucan (BG) assays in critically ill patients at risk of FP. Patients with FP were classified according to European Organisation for Research and Treatment of Cancer-Mycoses Study Group criteria, with modifications. Out of 847 admissions, 51 patients were eligible. There were nine invasive aspergillosis (IA) cases (four proven, five probable), three proven Pneumocysitis jirovecii pneumonia (PJP) cases and one mixed FP case (probable IA and proven PJP). The diagnostic accuracy as given by the area under the receiver operating characteristic curve in IA cases (proven and probable) for GM in BAL was 0.98 (95% CI, 0.94-1.00), whilst for GM and BG in serum it was 0.85 (95% CI, 0.74-0.96) and 0.815 (95% CI, 0.66-0.96), respectively. For IA cases (proven and probable) AUC for GM in BAL was significantly higher than GM and BG in serum (p 0.025 and p 0.032, respectively). In one of four proven and one of six probable IA cases, GM in serum remained negative, whereas GM in BAL was positive. In patients with IA, GM (90%) and BG (80%) appeared a mean of 4.3 days (range, 1-10 days) before Aspergillus was cultured. GM detection in BAL appears to improve the diagnosis of IA in critical patients.

RM del esfínter urinario artificial Flow-Secure® tras Prostatectomía radical / MRI of the Flow-SecureTM urinary sphincter

No disponible

Utilidad de la inhibina B en el manejo del varón infértil / Utility of inhibin B in the management of male infertility

Introducción: La inhibina B (INHB) es una hormona producida por las células de Sertoli que ejerce un feedback negativo sobre la secreción de la FSH. En este estudio analizamos su valor diagnóstico como marcador de la espermatogénesis y su valor pronóstico para la recuperación espermática en las azoospermias. Material y métodos: Entre junio de 2003 y abril de 2007 atendimos 504 varones infértiles en nuestro Gabinete de Fertilidad. Hasta mayo de 2006 determinamos la INHB solo a los pacientes con un recuento espermático <10M/ml, a partir de esa fecha a todos por motivo de estudio. En total realizamos 158 determinaciones mediante enzimoinmunoanálisis, considerando cifras normales entre 80–300pg/ml. Correlacionamos los valores obtenidos con los de otras hormonas, con el recuento espermático y, en el caso de las azoospermias (24 pacientes) con el éxito o no de la recuperación espermática de los testículos para la inyección intracitoplasmática de espermatozoides. Resultados: Se observó una correlación significativa de la INHB con la FSH (r=−0,469; p<0,001) y con la LH (r=−0,399; p<0,001), pero no con la testosterona, la prolactina, el estradiol y la SHBG. La concentración espermática se correlacionó mejor con la INHB (r=0,247; p<0,003) que con la FSH (r: −0,157; p<0,052). La INHB y la FSH estuvieron alteradas en el 57,6 y en el 42,1% de las azoospermias, respectivamente, en el 42,1 y en el 11,1% de las oligospermias severas (0–2M/ml) y en el 5 y en el 3,3% de las oligospermias (>2M/ml) y normozoospermias. En las azoospermias el valor predictivo positivo para la recuperación espermática fue de un 81,8% para una INHB normal y de un 76,6% para una FSH normal. El valor predictivo negativo para la ausencia de recuperación fue de un 61,6% para una INHB baja y de un 63,6% para una FSH alta. Conclusiones: Existe una correlación inversa entre los niveles de la INHB y los de la FSH y la LH. La INHB se correlaciona mejor que la FSH con la concentración espermática. En las azoospermias y las oligospermias (<2M/ml) un descenso de la INHB es más sensible para detectar el daño testicular que un aumento de la FSH. La INHB predice mejor que la FSH la recuperación espermática para la inyección intracitoplasmática de espermatozoides, aunque el éxito nunca puede asegurarse (AU)

Introduction: Inhibin B (INHB) is an hormone produced by Sertoli's cells that exercises a negative feedback on FSH secretion. In this study we analyze its diagnostic value as a marker of spermatogenesis and its prognostic value for testicular sperm extraction in azoospermic patients. Material and methods: Between June 2003 and April 2007 we studied 504 infertile males in our Fertility Department. Until May 2006 we determined INHB only in patients with a sperm count <10M/ml. Since then INHB was determined in every patient due to the present study. 158 determinations were finally performed using enzymoimmunoassay considering normal values between 80 and 300pg/ml. We correlated INHB values with other hormones, spermatic count and, in case of azoospermia (24 patients), with success/failure of surgical sperm retrieval from testes (TESE) to use for intracytoplasmatic sperm injection (ICSI). Results: A significant correlation was observed between INHB and FSH (r=−0.469, p<0.001) and LH (r=−0.399, p<0.001) but not with testosterone, prolactin, estradiol and SHBG. Sperm count was better correlated with INHB (r=0.247; p<0.003) than with FSH (r: −0.157; p<0.052). INHB and FSH were altered in 57.6% and 42.1% of azoospermia respectively, 42.1% and 11.1% in severe oligospermia (0–2M/ml) and 5% and 3.3% in oligospermia (>2M/ml) and normozoospermia. In azoospemic patients PPV for success in testicular sperm extraction was 81.8 % for normal INHB and 76.6% for normal FSH. NPV for failure of sperm retrieval was 61.6% for low INHB and 63.6% for high FSH. Conclusions: An inverse correlation exists between INHB and FSH and LH levels. INHB correlates better than FSH with sperm count. In azoospermia and oligospermia (<2M/ml), low INHB is more sensitive to detect testicular damage than high FSH. Normal INHB level predicts better than FSH the success of testicular sperm extraction for ICSI, although the favourable outcome can never be assured (AU)

[Utility of inhibin B in the management of male infertility]. / Utilidad de la inhibina B en el manejo del varón infértil.

INTRODUCTION: Inhibin B (INHB) is an hormone produced by Sertoli's cells that exercises a negative feedback on FSH secretion. In this study we analyze its diagnostic value as a marker of spermatogenesis and its prognostic value for testicular sperm extraction in azoospermic patients. MATERIAL AND METHODS: Between June 2003 and April 2007 we studied 504 infertile males in our Fertility Department. Until May 2006 we determined INHB only in patients with a sperm count <10M/ml. Since then INHB was determined in every patient due to the present study. 158 determinations were finally performed using enzymoimmunoassay considering normal values between 80 and 300pg/ml. We correlated INHB values with other hormones, spermatic count and, in case of azoospermia (24 patients), with success/failure of surgical sperm retrieval from testes (TESE) to use for intracytoplasmatic sperm injection (ICSI). RESULTS: A significant correlation was observed between INHB and FSH (r=-0.469, p<0.001) and LH (r=-0.399, p<0.001) but not with testosterone, prolactin, estradiol and SHBG. Sperm count was better correlated with INHB (r=0.247; p<0.003) than with FSH (r: -0.157; p<0.052). INHB and FSH were altered in 57.6% and 42.1% of azoospermia respectively, 42.1% and 11.1% in severe oligospermia (0-2M/ml) and 5% and 3.3% in oligospermia (>2M/ml) and normozoospermia. In azoospemic patients PPV for success in testicular sperm extraction was 81.8 % for normal INHB and 76.6% for normal FSH. NPV for failure of sperm retrieval was 61.6% for low INHB and 63.6% for high FSH. CONCLUSIONS: An inverse correlation exists between INHB and FSH and LH levels. INHB correlates better than FSH with sperm count. In azoospermia and oligospermia (<2M/ml), low INHB is more sensitive to detect testicular damage than high FSH. Normal INHB level predicts better than FSH the success of testicular sperm extraction for ICSI, although the favourable outcome can never be assured.

Multi-channel receptors based on thiopyrylium functionalised with macrocyclic receptors for the recognition of transition metal cations and anions.

We report herein the synthesis and characterization of a family of ligands containing different cation binding sites covalently connected to a thiopyrylium signalling reporter. The receptors L1-L6 are able to signal the presence of certain metal cations via three different channels; i.e. electrochemically, fluorogenically and chromogenically. An acetonitrile solution of L1-L6 shows a bright blue colour due to a charge-transfer band in the 575-585 nm region. The colour variation in acetonitrile of L1-L6 in the presence of the metal cations Ag+, Cd2+, Cu2+, Fe3+, Hg2+, Ni2+, Pb2+ and Zn2+ has been studied. A selective hypsochromic shift of the blue band was found for the systems L4-Pb2+ and L5-Hg2+. Additionally, L1-L6 are poorly fluorescent but coordination with certain metal cations induces an enhancement of the fluorescence at ca 500 nm. For instance, the presence of Cu2+ and Fe3+ induced a remarkable 42-fold and 45-fold enhancement in the emission intensity of L1 centred at 500 nm, respectively. Also remarkable was the 18-fold enhancement observed for L4 and L5 in the presence of Fe3+ and Cu2+, respectively. The electrochemical behaviour of receptors L1-L6 was studied in acetonitrile using platinum as a working electrode and [Bu4N][BF4] as a supporting electrolyte. This family of receptors showed a one-electron reversible redox process at ca. -0.46 V versus sce attributed to the reduction of the thiopyrylium group. A moderate anodic shift in the presence of certain metal cations was observed. The effect in the UV-visible spectra of acetonitrile solutions of receptor L1-L6 in the presence of anions was also studied. A remarkable bleaching was found in the presence of cyanide.

Effects of ascertainment bias and marker number on estimations of barley diversity from high-throughput SNP genotype data.

The capability of molecular markers to provide information of genetic structure is influenced by their number and the way they are chosen. This study evaluates the effects of single nucleotide polymorphism (SNP) number and selection strategy on estimates of germplasm diversity and population structure for different types of barley germplasm, namely cultivar and landrace. One hundred and sixty-nine barley landraces from Syria and Jordan and 171 European barley cultivars were genotyped with 1536 SNPs. Different subsets of 384 and 96 SNPs were selected from the 1536 set, based on their ability to detect diversity in landraces or cultivated barley in addition to corresponding randomly chosen subsets. All SNP sets except the landrace-optimised subsets underestimated the diversity present in the landrace germplasm, and all subsets of SNP gave similar estimates for cultivar germplasm. All marker subsets gave qualitatively similar estimates of the population structure in both germplasm sets, but the 96 SNP sets showed much lower data resolution values than the larger SNP sets. From these data we deduce that pre-selecting markers for their diversity in a germplasm set is very worthwhile in terms of the quality of data obtained. Second, we suggest that a properly chosen 384 SNP subset gives a good combination of power and economy for germplasm characterization, whereas the rather modest gain from using 1536 SNPs does not justify the increased cost and 96 markers give unacceptably low performance. Lastly, we propose a specific 384 SNP subset as a standard genotyping tool for middle-eastern landrace barley.