Large and non-spherical seeds are less likely to form a persistent soil seed bank.

There is some evidence that seed traits can affect the long-term persistence of seeds in the soil. However, findings on this topic have differed between systems. Here, we brought together a worldwide database of seed persistence data for 1474 species to test the generality of seed mass-shape-persistence relationships. We found a significant trend for low seed persistence to be associated with larger and less spherical seeds. However, the relationship varied across different clades, growth forms and species ecological preferences. Specifically, relationships of seed mass-shape-persistence were more pronounced in Poales than in other order clades. Herbaceous species that tend to be found in sites with low soil sand content and precipitation have stronger relationships between seed shape and persistence than in sites with higher soil sand content and precipitation. For the woody plants, the relationship between persistence and seed morphology was stronger in sites with high soil sand content and low precipitation than in sites with low soil sand content and higher precipitation. Improving the ability to predict the soil seed bank formation process, including burial and persistence, could benefit the utilization of seed morphology-persistence relationships in management strategies for vegetation restoration and controlling species invasion across diverse vegetation types and environments.

Anatomical outcomes and complications of sacrocolpopexy using Surelift Uplift mesh: A multicentric observational study.

OBJECTIVE: The study evaluated the anatomical and functional outcomes, as well as the safety data of laparoscopic sacrocolpopexy (LSC) for pelvic organ prolapse (POP) using a lightweight macroporous mesh. METHODS: A multicentric observational study was developed including five expert centers between March 2011 and December 2019. Inclusion criteria were female patients with symptomatic ≥stage II POP (POP-Q classification), who underwent a LSC. A lightweight and macroporous mesh device (Surelift Uplift) was used. Baseline anatomical positions were evaluated using POP-Q stage. The anatomical outcomes and procedural complications were assessed during the postoperative period. Primary outcomes were anatomical success, defined as POP-Q stage ≤I, and subjective success, defined as no bothersome bulge symptoms, and no repeat surgery or pessary use for recurrent prolapse. RESULTS: A total of 325 LSCs were analyzed with a median patient age of 66 (interquartile range [IQR] 61-73). After a median follow-up of 68 months (IQR 46.5-89), anatomical success was found in 88.9%, whereas subjective success was seen in 98.5% of the patients. Recurrent prolapse presented as cystocele (1.5%). Reported complications were bladder (4.6%) or rectum lesions (0.6%), de novo urinary incontinence (12.9%), and mesh extrusion (1.2%). CONCLUSIONS: LSC provides significant clinical improvement and excellent anatomical results, with a low risk of serious complications for women with ≥2 grade POP in a real clinical practice setting.

Spatial variability in herbaceous plant phenology is mostly explained by variability in temperature but also by photoperiod and functional traits.

Whereas temporal variability of plant phenology in response to climate change has already been well studied, the spatial variability of phenology is not well understood. Given that phenological shifts may affect biotic interactions, there is a need to investigate how the variability in environmental factors relates to the spatial variability in herbaceous species' phenology by at the same time considering their functional traits to predict their general and species-specific responses to future climate change. In this project, we analysed phenology records of 148 herbaceous species, which were observed for a single year by the PhenObs network in 15 botanical gardens. For each species, we characterised the spatial variability in six different phenological stages across gardens. We used boosted regression trees to link these variabilities in phenology to the variability in environmental parameters (temperature, latitude and local habitat conditions) as well as species traits (seed mass, vegetative height, specific leaf area and temporal niche) hypothesised to be related to phenology variability. We found that spatial variability in the phenology of herbaceous species was mainly driven by the variability in temperature but also photoperiod was an important driving factor for some phenological stages. In addition, we found that early-flowering and less competitive species characterised by small specific leaf area and vegetative height were more variable in their phenology. Our findings contribute to the field of phenology by showing that besides temperature, photoperiod and functional traits are important to be included when spatial variability of herbaceous species is investigated.

How can we improve the quality of health care in hospital attendance of medically complex children? / ¿Cómo podemos mejorar la calidad de la atención hospitalaria de los pacientes crónicos complejos en pediatría?

Hospital care of medically complex children (MCC) is increasing, although its real prevalence in Spain is unknown. OBJECTIVE: to analyze hospital admissions and outpatient follow-up of MCC in order to identify strategies to improve the quality of care of MCC. PATIENTS AND METHOD: An analytical, observational, and retrospective study was carried out. We included MCC who were admitted to Pediatric Hospitalization in the last 5 years, in a tertiary hospital without a specific unit for MCC. Clinical data related to their underlying pathology, outpatient visits, and hospital admissions were collected. A multivariate study was carried out to describe risk factors of the need for technological support and to predict prolonged admissions and the hospital consultation rate. RESULTS: 99 MCC (55.6% males) aged 3.9 (2-8) years were included. 41.4% of MCC required technological support at home and presented the highest number of comorbidities, hospital admissions, and care by different specialists (p < 0.01). Older MCC (p < 0.01) with underlying digestive disease (p < 0.04) and respiratory comorbidity (p < 0.04) presented a longer mean hospital stays. Younger patients with more admissions, longer average stay, and a lack of follow-up by the link nurse were associated with a greater number of annual consultations (p < 0.05). CONCLUSIONS: MCC require a high number of annual consultations and have long hospital stays. The creation of specialized consultations for MCC, multidisciplinary care, and the participation of the link nurse are strategies to improve the quality of care for MCC in hospitals without specific MCC units.

Habitat-based biodiversity responses to macroclimate and edaphic factors in European fen ecosystems.

Understanding large-scale drivers of biodiversity in palustrine wetlands is challenging due to the combined effects of macroclimate and local edaphic conditions. In boreal and temperate fen ecosystems, the influence of macroclimate on biodiversity is modulated by hydrological settings across habitats, making it difficult to assess their vulnerability to climate change. Here, we investigate the influence of macroclimate and edaphic factors on three Essential Biodiversity Variables across eight ecologically defined habitats that align with ecosystem classifications and red lists. We used 27,555 vegetation plot samples from European fens to assess the influence of macroclimate and groundwater pH predictors on the geographic distribution of each habitat type. Additionally, we modeled the relative influence of macroclimate, water pH, and water table depth on community species richness and composition, focusing on 309 plant specialists. Our models reveal strong effects of mean annual temperature, diurnal thermal range, and summer temperature on biodiversity variables, with contrasting differences among habitats. While macroclimatic factors primarily shape geographic distributions and species richness, edaphic factors emerge as the primary drivers of composition for vascular plants and bryophytes. Annual precipitation exhibits non-linear effects on fen biodiversity, with varying impact across habitats with different hydrological characteristics, suggesting a minimum requirement of 600 mm of annual precipitation for the occurrence of fen ecosystems. Our results anticipate potential impacts of climate warming on European fens, with predictable changes among habitat types and geographic regions. Moreover, we provide evidence that the drivers of biodiversity in boreal and temperate fens are closely tied to the ecological characteristics of each habitat type and the dispersal abilities of bryophytes and vascular plants. Given that the influence of macroclimate and edaphic factors on fen ecosystems is habitat specific, climate change research and conservation actions should consider ecological differentiation within functional IUCN ecosystems at continental and regional scales.

Global seed dormancy patterns are driven by macroclimate but not fire regime.

Seed dormancy maximizes plant recruitment in habitats with variation in environmental suitability for seedling establishment. Yet, we still lack a comprehensive synthesis of the macroecological drivers of nondormancy and the different classes of seed dormancy: physiological dormancy, morphophysiological dormancy and physical dormancy. We examined current geographic patterns and environmental correlates of global seed dormancy variation. Combining the most updated data set on seed dormancy classes for > 10 000 species with > 4 million georeferenced species occurrences covering all of the world's biomes, we test how this distribution is driven by climate and fire regime. Seed dormancy is prevalent in seasonally cold and dry climates. Physiological dormancy occurs in relatively dry climates with high temperature seasonality (e.g. temperate grasslands). Morphophysiological dormancy is more common in forest-dominated, cold biomes with comparatively high and evenly distributed precipitation. Physical dormancy is associated with dry climates with strong seasonal temperature and precipitation fluctuations (e.g. deserts and savannas). Nondormancy is associated with stable, warm and wetter climates (e.g. tropical rain forest). Pyroclimate had no significant effect on the distribution of seed dormancy. The environmental drivers considered in this study had a comparatively low predictive power, suggesting that macroclimate is just one of several global drivers of seed dormancy.

Is detrusor underactivity associated with voiding dysfunction after single incision sling surgery?

BACKGROUND: Some women experience voiding dysfunction after stress urinary incontinence (SUI) surgery. We explore if detrusor underactivity (DU) found in urodynamic study (UDS) prior to SUI surgery using an adjustable single incision sling (SIS) may be related to voiding dysfunction after surgery. METHODS: This is a prospective, diagnostic, transversal, single center study comparing voiding dysfunction after SUI surgery with a SIS (Altis®; Coloplast, Humlebæk, Denmark) between women with DU (cases) or normal detrusor (controls). Inclusion criterium was women ≥18 years with SUI/mixed UI (stress predominant) operated between June 2013 and December 2020. Exclusion criteria were: women without UDS prior to surgery or without voiding phase in the P/Q, previous incontinence surgery, POP stage ≥2, neurogenic conditions, other pelvic floor surgery. Urinary symptoms were assessed using structured questions evaluating storage/voiding symptoms. Patients were divided into two groups according to projected Isovolumetric Pressure Index (PIP1) with 30-75 cmH2O indicating normal contractility. RESULTS: A total of 139 women were included, 29 (20.9%) in DU group and 110 (79.1%) in control group. Control and DU groups have shown similar objective (75.5% vs. 71.4% P=0.66) and subjective (85.4% vs. 96.1% P=0.22) success rates, respectively, without statistical differences. Voiding symptoms increased after surgery in both groups (+20.7% DU group vs. +8.1% normal group, P=0.29). More voiding symptoms (persistent/de novo) were found in DU group vs. normal group, but without statistically significant differences. CONCLUSIONS: According to our results, the presence of DU previous to SUI surgery with a SIS (Altis®, Coloplast) has no impact on objective and subjective success rates. On the other hand, patients with preoperative DU showed higher proportion of voiding dysfunction but no statistical difference.

Neuroanatomy of the crocodylomorph Portugalosuchus azenhae from the late cretaceous of Portugal.

We present the first detailed braincase anatomical description and neuroanatomical study of Portugalosuchus azenhae, from the Cenomanian (Late Cretaceous) of Portugal. This eusuchian crocodylomorph was originally described as a putative Crocodylia and one of the oldest representatives of this clade; however, its phylogenetic position remains controversial. Based on new data obtained from high resolution Computed Tomography images (by micro-CT scan), this study aims to improve the original description of this taxon and also update the scarce neuroanatomical knowledge of Eusuchia and Crocodylia from this time interval, a key period to understand the origin and evolution of these clades. The resulting three-dimensional models from the CT data allowed a detailed description of its well-preserved neurocranium and internal cavities. Therefore, it was possible to reconstruct the cavities of the olfactory region, nasopharyngeal ducts, brain, nerves, carotid arteries, blood vessels, paratympanic sinus system and inner ear, which allowed to estimate some neurosensorial capabilities. By comparison with other crocodylomorphs, these analyses showed that Portugalosuchus, back in the Cenomanian, already displayed an olfactive acuity, sight, hearing and cognitive skills within the range of that observed in other basal eusuchians and crocodylians, including extant species. In addition, and in order to test its disputed phylogenetic position, these new anatomical data, which helped to correct and complete some of the original observations, were included in one of the most recent morphology-based phylogenies. The position of Portugalosuchus differs slightly from the original publication since it is now located as a "thoracosaurid" within Gavialoidea, but still as a crocodylian. Despite all this, to better contrast these results, additional phylogenetic analyses including this new morphological character coding together with DNA data should be performed.

Theoretical performance of progressive addition lenses with poorly measured individual parameters.

PURPOSE: The aim of this paper was to present a theoretical study of how poorly measured individual parameters affect the optical performance of progressive addition lenses (PALs). Modern progressive lenses can be prescribed based on parameters such as vertex distance, pantoscopic and wrap angles. These parameters can be measured from the lens wearer using specific devices; however, not all of them can be measured with the same precision, and the impact of measurement errors on the lens performance is still unknown. METHODS: Data from 1900 patients were used to simulate the performance of four PAL designs with different degrees of complexity: perfect individual design, individual design with induced errors in the individual parameters, optimised design and conventional/basic design. For each patient and design, a quality metric was calculated to describe the optical performance of the lens. RESULTS: The design having the best performance was the perfect individual design, followed by the individual design with induced errors, the optimised design and finally the conventional/basic design. CONCLUSIONS: Individual designs with measurement errors have better optical performance than lenses with less complexity, such as the optimised or conventional designs. This knowledge is useful for the eye care professional to make informed choices when dispensing these lenses.

Low availability of functional seed trait data from the tropics could negatively affect global macroecological studies, predictive models and plant conservation.

BACKGROUND: Plant seeds have many traits that influence ecological functions, ex situ conservation, restoration success and their sustainable use. Several seed traits are known to vary significantly between tropical and temperate regions. Here we present three additional traits for which existing data indicate differences between geographical zones. We discuss evidence for geographical bias in availability of data for these traits, as well as the negative consequences of this bias. SCOPE: We reviewed the literature on seed desiccation sensitivity studies that compare predictive models to experimental data and show how a lack of data on populations and species from tropical regions could reduce the predictive power of global models. In addition, we compiled existing data on relative embryo size and post-dispersal embryo growth and found that relative embryo size was significantly larger, and embryo growth limited, in tropical species. The available data showed strong biases towards non-tropical species and certain families, indicating that these biases need to be corrected to perform truly global analyses. Furthermore, we argue that the low number of seed germination studies on tropical high-mountain species makes it difficult to compare across geographical regions and predict the effects of climate change in these highly specialized tropical ecosystems. In particular, we show that seed traits of geographically restricted páramo species have been studied less than those of more widely distributed species, with most publications unavailable in English or in the peer-reviewed literature. CONCLUSIONS: The low availability of functional seed trait data from populations and species in the tropics can have negative consequences for macroecological studies, predictive models and their application to plant conservation. We propose that global analyses of seed traits with evidence for geographical variation prioritize generation of new data from tropical regions as well as multi-lingual searches of both the grey- and peer-reviewed literature in order to fill geographical and taxonomic gaps.

Dataset on the environmental and social footprint of the University of the Basque Country UPV/EHU.

The organisational life cycle assessment (O-LCA) and the social organisational life cycle assessment (SO-LCA) of the University of the Basque Country UPV/EHU were conducted. The data presented in this paper support the calculation of the environmental and social footprint of the University of the Basque Country UPV/EHU for year 2016 [1], and may be used as a reference for future calculations of the environmental and social footprint of higher education institutions and other organisations. This dataset provides detailed information on the UPV/EHU and the boundaries considered; on the compilation and quantification of the life cycle inventory (LCI) -which included a transport survey conducted in summer 2018-; and on the modelling process followed for the calculation of the environmental and social footprints, based on the ecoinvent 3.3 database [2] and PSILCA-based Soca v1 add-on [3, 4], and carried out with the openLCA free software [5]. The dataset also includes the life cycle impact assessment (LCIA) results provided by the CML (baseline, 2015) [6] and ReCiPe (endpoint (H), 2008) [7] LCIA methods and post-processed social impacts provided by the Social Impacts Weighting Method [3], disaggregated by subprocesses and impact locations. Data is provided for the reference year (2016), and some aggregated data is also provided for alternative scenarios that were explored in order to check pathways to reduce social and environmental impacts of the academic activity of the UPV/EHU [1].

Climate shapes the seed germination niche of temperate flowering plants: a meta-analysis of European seed conservation data.

BACKGROUND AND AIMS: Interactions between ecological factors and seed physiological responses during the establishment phase shape the distribution of plants. Yet, our understanding of the functions and evolution of early-life traits has been limited by the scarcity of large-scale datasets. Here, we tested the hypothesis that the germination niche of temperate plants is shaped by their climatic requirements and phylogenetic relatedness, using germination data sourced from a comprehensive seed conservation database of the European flora (ENSCOBASE). METHODS: We performed a phylogenetically informed Bayesian meta-analysis of primary data, considering 18 762 germination tests of 2418 species from laboratory experiments conducted across all European geographical regions. We tested for the interaction between species' climatic requirements and germination responses to experimental conditions including temperature, alternating temperature, light and dormancy-breaking treatments, while accounting for between-study variation related to seed sources and seed lot physiological status. KEY RESULTS: Climate was a strong predictor of germination responses. In warm and seasonally dry climates the seed germination niche includes a cold-cued germination response and an inhibition determined by alternating temperature regimes and cold stratification, while in climates with high temperature seasonality opposite responses can be observed. Germination responses to scarification and light were related to seed mass but not to climate. We also found a significant phylogenetic signal in the response of seeds to experimental conditions, providing evidence that the germination niche is phylogenetically constrained. Nevertheless, phylogenetically distant lineages exhibited common germination responses under similar climates. CONCLUSION: This is the first quantitative meta-analysis of the germination niche at a continental scale. Our findings showed that the germination niches of European plants exhibit evolutionary convergence mediated by strong pressures at the macroclimatic level. In addition, our methodological approach highlighted how large datasets generated by conservation seed banking can be valuable sources to address questions in plant macroecology and evolution.

Regeneration from seed in herbaceous understorey of ancient woodlands of temperate Europe.

BACKGROUND AND AIMS: European ancient woodlands are subject to land use change, and the distribution of herbaceous understorey species may be threatened because of their poor ability to colonize isolated forest patches. The regeneration niche can determine the species assembly of a community, and seed germination traits may be important descriptors of this niche. METHODS: We analysed ecological records for 208 herbaceous species regarded as indicators of ancient woodlands in Europe and, where possible, collated data on seed germination traits, reviewed plant regeneration strategies and measured seed internal morphology traits. The relationship between plant regeneration strategies and ecological requirements was explored for 57 species using ordination and classification analysis. KEY RESULTS: Three regeneration strategies were identified. Species growing in closed-canopy areas tend to have morphological seed dormancy, often requiring darkness and low temperatures for germination, and their shoots emerge in early spring, thus avoiding the competition for light from canopy species. These species are separated into two groups: autumn and late winter germinators. The third strategy is defined by open-forest plants with a preference for gaps, forest edges and riparian forests. They tend to have physiological seed dormancy and germinate in light and at higher temperatures, so their seedlings emerge in spring or summer. CONCLUSION: Seed germination traits are fundamental to which species are good or poor colonizers of the temperate forest understorey and could provide a finer explanation than adult plant traits of species distribution patterns. Seed dormancy type, temperature stratification and light requirements for seed germination are important drivers of forest floor colonization patterns and should be taken in account when planning successful ecological recovery of temperate woodland understories.

Seed ecology of European mesic meadows.

BACKGROUND AND AIMS: European mesic meadows are semi-natural open habitats of high biodiversity and an essential part of European landscapes. These species-rich communities can be a source of seed mixes for ecological restoration, urban greening and rewilding. However, limited knowledge of species germination traits is a bottleneck to the development of a competitive native seed industry. Here, we synthesize the seed ecology of mesic meadows. METHODS: We combined our own experimental data with data obtained from databases to create a combined dataset containing 2005 germination records of 90 plant species from 31 European countries. We performed a Bayesian meta-analysis of this dataset to test the seed germination response to environmental cues including scarification, stratification, temperature, alternating temperature and light. We also used multivariate ordination to check the relationship between seed traits (germination and morphology) and species ecological preferences, and to compare the seed ecology of mesic meadows with that of other herbaceous plant communities from the same geographic area. KEY RESULTS: The seed ecology of mesic meadows is characterized by (1) high seed germinability when compared with other herbaceous plant communities; (2) low correspondence between seed traits and species ecological preferences; and (3) a deep phylogenetic separation between the two major families, Poaceae and Fabaceae. Poaceae produce many light seeds that respond to gap-detecting germination cues (alternating temperatures and light); Fabaceae produce fewer heavy seeds, which need scarification to break their physical dormancy. CONCLUSIONS: High germinability of meadow seeds will reduce their capacity to form persistent seed banks, resulting in dispersal limitations to passive regeneration. For centuries, human activities have shaped the regeneration of meadows, leading to a loss of seed dormancy and decoupling seeds from seasonal cycles, as has been found in many domesticated species. The same anthropic processes that have shaped semi-natural mesic meadows have left them dependent on continued human intervention for their regeneration, highlighting the importance of active restoration via seed supply.

Global DNA methylation and cellular 5-methylcytosine and H4 acetylated patterns in primary and secondary dormant seeds of Capsella bursa-pastoris (L.) Medik. (shepherd's purse).

Despite the importance of dormancy and dormancy cycling for plants' fitness and life cycle phenology, a comprehensive characterization of the global and cellular epigenetic patterns across space and time in different seed dormancy states is lacking. Using Capsella bursa-pastoris (L.) Medik. (shepherd's purse) seeds with primary and secondary dormancy, we investigated the dynamics of global genomic DNA methylation and explored the spatio-temporal distribution of 5-methylcytosine (5-mC) and histone H4 acetylated (H4Ac) epigenetic marks. Seeds were imbibed at 30 °C in a light regime to maintain primary dormancy, or in darkness to induce secondary dormancy. An ELISA-based method was used to quantify DNA methylation, in relation to total genomic cytosines. Immunolocalization of 5-mC and H4Ac within whole seeds (i.e., including testa) was assessed with reference to embryo anatomy. Global DNA methylation levels were highest in prolonged (14 days) imbibed primary dormant seeds, with more 5-mC marked nuclei present only in specific parts of the seed (e.g., SAM and cotyledons). In secondary dormant seeds, global methylation levels and 5-mC signal where higher at 3 and 7 days than 1 or 14 days. With respect to acetylation, seeds had fewer H4Ac marked nuclei (e.g., SAM) in deeper dormant states, for both types of dormancy. However, the RAM still showed signal after 14 days of imbibition under dormancy-inducing conditions, suggesting a central role for the radicle/RAM in the response to perceived ambient changes and the adjustment of the seed dormancy state. Thus, we show that seed dormancy involves extensive cellular remodeling of DNA methylation and H4 acetylation.

Impact of the COVID-19 Lockdown in a European Regional Monitoring Network (Spain): Are We Free from Pollution Episodes?

The impact of the lockdown, during the period from March to June in 2020, upon the air quality of the Basque Country in northern Spain is analyzed. The evaluation accounts for the meteorology of the period. Daily and sub-daily analysis of aerosol and ozone records show that the territory was repeatedly affected by episodes of pollutants from outer regions. Three episodes of PM10 and ten of PM2.5 were caused by transported anthropogenic European sulfates, African dust, and wildland fires. The region, with a varied orographic climatology, shows high and diverse industrial activity. Urban and interurban road traffic of the region decreased by 49% and 53%, respectively, whereas industrial activity showed a lower reduction of 20%. Consequently, the average concentrations of NO2 in the cities during the period fell to 12.4 µg·m-3 (-45%). Ozone showed up to five exceedances of the WHOAQG for the daily maximum 8-h average in both rural and urban sites, associated with transport through France and the Bay of Biscay, under periods of European blocking anticyclones. However, averages showed a moderate decrease (-11%) in rural environments, in line with the precursor reductions, and disparate changes in the cities, which reproduced the weekend effect of their historical records. The PM10 decreased less than expected (-10% and -21%, in the urban and rural environments, respectively), probably caused by the modest decrease of industrial activity around urban sites and favorable meteorology for secondary aerosol formation, which could also influence the lower changes observed in the PM2.5 (-1% and +3% at the urban and rural sites, respectively). Consequently, in a future low NOx traffic emission scenario, the inter-regional PM and ozone control will require actions across various sectors, including the industry and common pollution control strategies.

The seed germination spectrum of alpine plants: a global meta-analysis.

Assumptions about the germination ecology of alpine plants are presently based on individual species and local studies. A current challenge is to synthesise, at the global level, the alpine seed ecological spectrum. We performed a meta-analysis of primary data from laboratory experiments conducted across four continents (excluding the tropics) and 661 species, to estimate the influence of six environmental cues on germination proportion, mean germination time and germination synchrony; accounting for seed morphology (mass, embryo : seed ratio) and phylogeny. Most alpine plants show physiological seed dormancy, a strong need for cold stratification, warm-cued germination and positive germination responses to light and alternating temperatures. Species restricted to the alpine belt have a higher preference for warm temperatures and a stronger response to cold stratification than species whose distribution extends also below the treeline. Seed mass, embryo size and phylogeny have strong constraining effects on germination responses to the environment. Globally, overwintering and warm temperatures are key drivers of germination in alpine habitats. The interplay between germination physiology and seed morphological traits further reflects pressures to avoid frost or drought stress. Our results indicate the convergence, at the global level, of the seed germination patterns of alpine species.

[Reconstructive surgery protocol recommendations during COVID-19 pandemia.] / Recomendaciones de actuación en cirugía reconstructiva urológica durante la pandemia Covid-19.

OBJECTIVES: Offer some recommendations or guidelines during the evolution of the COVID-19 pandemic in terms of diagnosis, treatment and follow-upin the field of Reconstructive Urology. MATERIAL AND METHOD: The document is based on the evidence on SARS/Cov-2 and the authors' experience in managing COVID-19 in their institutions, including specialists from Andalusia, Madrid, Cantabria,the Valencian Community and Catalonia. A web and PubMed search was performed using "SARS-CoV-2", "COVID-19", "COVID-19 Urology", "COVID19 urology complications", "COVID-19 reconstructive surgery".A narrative review of the literature was carried out (5/17/2020) and after the nominal group technique modified due to the extraordinary restrictions, a first draft was made to unify criteria and reach a quick consensus. Finally, a definitive version was made, agreed by all the authors (5/22/2020). RESULTS: The authors defined the following surgical priorities for Urological Reconstructive Surgery: Emergency/Urgency (life-threatening or emergencies still in anormal situation), Elective Urgency/High priority (potentially dangerous pathology if postponed for more than 1month), Elective Surgery/Intermediate priority (pathology with little probability of being dangerous but it is recommended not to delay more than 6 months), Delayed surgery/Low priority (non-dangerous pathology if it is postponed for more than 6 months). According to this classification, the Working Group agreed on the distribution of the different surgical scenarios of Reconstructive Urology. In addition, consensus was reached on recommendations regarding the diagnosis and follow-up of pathology in the field of Reconstructive Urology. CONCLUSIONS: Tools should be implemented to facilitate the gathering of the medical visit and diagnostic tests. Redistribution of surgical procedures based on priority degrees is necessary during the pandemic and transition period. The use of telemedicine is essential forfollow-up, by computer, telephone or videoconference.

OBJETIVOS: Establecer unas recomendaciones o guía de actuación durante la evolución de la pandemia COVID-19 en cuanto al diagnóstico, tratamiento y seguimiento en el campo de la Urología Reconstructiva.MATERIAL y MÉTODO: El documento se basa en la evidencia sobre SARS/Cov-2 y la experiencia de los autores en el manejo de COVID-19 en sus instituciones, incluyendo especialistas de Andalucía, Madrid, Cantabria, Comunidad Valenciana y Cataluña. Se realizó una búsqueda web y en PubMed utilizando "SARS-CoV-2", "COVID-19", "COVID-19 Urology", "COVID19 urology complications", "COVID-19 reconstructive surgery". Se realizó una revisión narrativa de  la literatura (17/5/2020) y tras la técnica de grupo nominal modificada debido a las restricciones extraordinarias, se realizó un primer borrador para unificar criterios y llegar a un rápido consenso. Finalmente, se realizó una versión definitiva, consensuada por todos los autores el 22/5/2020. RESULTADOS: Los autores definieron para la Cirugía Urológica Reconstructiva las siguientes prioridades quirúrgicas: Emergencia/Urgencia (Riesgo vital o urgencias aún en situación de normalidad), Urgencia Electiva/Alta prioridad (Patología potencialmente peligros asi se pospone más de 1 mes), Cirugía Electiva/Prioridad intermedia (Patología con poca probabilidad de ser peligrosa pero se recomienda no retrasar más de 6 meses), Cirugía demorable/Baja prioridad (Patología no peligrosa si se pospone más de 6 meses). Acorde a esta clasificación, el Grupo de Trabajo consensuó la distribución de los diferentes escenarios quirúrgicos de la Urología Reconstructiva. Además, se llegó a consenso sobre recomendaciones en cuanto al diagnóstico y seguimiento de la patología en el ámbito de la Urología Reconstructiva. CONCLUSIONES: Deben implementarse mecanismos que faciliten la agrupación de la visita médica y pruebas diagnósticas. La redistribución de los procedimientos quirúrgicos en función de los grados de prioridad es imprescindible durante el periodo de pandemia y de transición. El empleo de la telemedicina es necesario para el seguimiento, mediante vía informática, telefónica o videoconferencia.