Cumulative morbidity of ureteroscopy for upper tract urothelial carcinoma.

OBJECTIVE: To assess complications after ureteroscopy (URS) for upper tract urothelial carcinoma (UTUC) management and to assess its postoperative cumulative morbidity burden using the Comprehensive Complication Index (CCI). MATERIALS AND METHODS: Single center retrospective study including patients submitted to URS for UTUC suspicion. URSs were both diagnostic and operative. Postoperative complications were recorded according to the EAU Guidelines and graded according to Clavien-Dindo Classification (CDC). The cumulative postoperative morbidity burden developed by patients experiencing multiple events was assessed using the CCI. Multivariable logistic regression (MLR) analyses identified factors independently associated with the development of any grade and major postoperative complications. RESULTS: Overall, 360 patients with UTUC suspicion were included with a total of 575 URSs performed. The cumulative number of all postoperative complications recorded was 111. In 86 (15%) procedures, patients experienced at least one postoperative complication, while 25 (4.3%) experienced more than one complication. Of these, 16 (14%) were severe (CDC ≥ IIIa). The most frequent type of complications were urinary (34%), bleeding (30%) and infectious (30%). The higher the CDC grade, the higher the median CCI, with a statistically significant increase in median CCI from CDC II to major complications. Patients who experienced intraoperative complications were at higher risk of developing any grade and major postoperative complications at MLR. CONCLUSIONS: Complications after ureteroscopy for UTUC are relatively uncommon events. Patients who experience intraoperative complications are at higher risk of developing postoperative complications. The comprehensive complication index appeared more representative of the cumulative postoperative morbidity rather than the Clavien-Dindo classification.

Cistectomía radical asistida por robot vs. cistectomía radical abierta: revisión sistemática de ensayos controlados aleatorizados / Robot-assisted vs. open radical cystectomy: Systematic review and meta-analysis of randomized controlled trials

Introducción En la última década se han puesto en marcha varios ensayos controlados aleatorizados (ECA) con el objetivo de evaluar la seguridad quirúrgica y la eficacia oncológica de la cistectomía radical asistida por robot (CRAR) frente a la cistectomía radical abierta (CRA) en pacientes con cáncer de vejiga. El objetivo del estudio fue realizar una revisión sistemática y un metaanálisis de ECA para comparar los resultados perioperatorios y oncológicos de ambas. Métodos Se realizó una búsqueda bibliográfica hasta julio de 2022 en las bases de datos PubMed/Medline, Embase y Web of Science. Se siguieron las directrices de la declaración PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) para identificar los estudios elegibles. Los criterios de evaluación fueron los resultados intraoperatorios, postoperatorios y oncológicos de la CRAR frente a la CRA. Resultados Un total de 8ECA con 1.024 pacientes cumplieron los criterios de inclusión. La CRAR se asoció con un tiempo quirúrgico mayor (media de 92,34 min, IC 95%: 83,83-100,84; p<0,001) y una tasa de transfusión de sangre menor (odds ratio [OR] 0,43; IC 95%: 0,30-0,61; p<0,001). No se observaron diferencias en cuanto a las complicaciones globales (p=0,28) ni graves (p=0,57) a los 90 días, la duración de la estancia hospitalaria (p=0,18), la recuperación de la función intestinal (p=0,67), la calidad de vida relacionada con la salud (p=0,86), la recurrencia (p=0,77) ni la progresión (p=0,49) de la enfermedad entre los 2abordajes. La principal limitación reside en el bajo número de pacientes incluidos en el 50% de los ECA revisados. Conclusiones Este estudio respalda la no inferioridad de la CRAR respecto a la CRA en términos de seguridad quirúrgica y resultados oncológicos. El beneficio de tasas reducidas de transfusión sanguínea obtenido con la CRAR debe sopesarse con relación a los costes derivados del procedimiento (AU)

Introduction Several randomized controlled trials (RCTs) have been launched in the last decade to examine the surgical safety and oncological efficacy of robot-assisted (RARC) vs. open radical cystectomy (ORC) for patients with bladder cancer. The aim of the study was to perform a systematic review and meta-analysis of RCTs to compare the perioperative and oncological outcomes of RARC vs. ORC. Methods A literature search was conducted through July 2022 using PubMed/Medline, Embase, and Web of Science databases. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. The outcomes were intraoperative, postoperative, and oncological outcomes of RARC vs. ORC. Results A total of 8RCTs comprising 1,024 patients met our inclusion criteria. RARC was associated with longer operative time (mean 92.34min, 95% CI: 83.83-100.84, P<0.001) and lower blood transfusion rate (Odds ratio [OR] 0.43, 95% CI: 0.30-0.61, P<0.001). No differences emerged in terms of 90-day overall (P=0.28) and major (P=0.57) complications, length of stay (P=0.18), bowel recovery (P=0.67), health-related quality of life (P=0.86), disease recurrence (P=0.77) and progression (P=0.49) between the 2approaches. The main limitation is represented by the low number of patients included in half of RCTs included. Conclusions This study supports that RARC is not inferior to ORC in terms of surgical safety and oncological outcomes. The benefit of RARC in terms of lower blood transfusion rate need to be balanced with the cost related to the procedure (AU)

[Ability of qSOFA1-lactate to predict 30-day mortality in patients seen for infection in the Emergency Department]. / Capacidad del qSOFA1-lactato para predecir mortalidad a 30 días en los pacientes atendidos por infección en urgencias.

OBJECTIVE: To evaluate lactate and the Quick Sepsis-Related Organ Failure Assessment (qSOFA) and compare their ability to predict 30-day mortality in patients treated for infection in emergency departments (ED). METHODS: Prospective multicenter observational cohort study. We enrolled a convenience sample of patients aged 18 years or older attended in 71 Spanish ED from October 1, 2019, to March 31, 2020. Each model's predictive power was analyzed with the area under the receiver operating characteristic curve (AUC), and its values of sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative (NPV). RESULTS: A total of 4439 patients with a mean (SD) age of 18 years were studied; 2648 (59.7%) were men and 459 (10.3%) died within 30 days. For 30-day mortality, the AUC-COR obtained with the qSOFA = 1 model plus 2 mmol/l lactate was 0.66 (95% CI, 0.63-0.69) with Se: 68%, Es: 70% and NPV:92%, while qSOFA = 1 obtained AUC-COR of 0.52 (95% CI, 0.49-0.55) with a Se:42%, Es:64% and NPV:90%. CONCLUSIONS: To predict 30-day mortality in patients presenting to the ED due to an episode of infection, the qSOFA =1 + lactate≥2 mmol/L model significantly improves the predictive power achieved individually by qSOFA1 and becomes very similar to qSOFA≥2.

Prevalence, risk factors and evolution of diabetes mellitus after treatment in primary aldosteronism. Results from the SPAIN-ALDO registry.

PURPOSE: To evaluate the prevalence, risk factors and evolution of diabetes mellitus (DM) after targeted treatment in patients with primary aldosteronism (PA). METHODS: A retrospective multicenter study of PA patients in follow-up at 27 Spanish tertiary hospitals (SPAIN-ALDO Register). RESULTS: Overall, 646 patients with PA were included. At diagnosis, 21.2% (n = 137) had DM and 67% of them had HbA1c levels < 7%. In multivariate analysis, family history of DM (OR 4.00 [1.68-9.53]), the coexistence of dyslipidemia (OR 3.57 [1.51-8.43]) and advanced age (OR 1.04 per year of increase [1.00-1.09]) were identified as independent predictive factors of DM. Diabetic patients were on beta blockers (46.7% (n = 64) vs. 27.5% (n = 140), P < 0.001) and diuretics (51.1% (n = 70) vs. 33.2% (n = 169), p < 0.001) more frequently than non-diabetics. After a median follow-up of 22 months [IQR 7.5-63.0], 6.9% of patients developed DM, with no difference between those undergoing adrenalectomy and those treated medically (HR 1.07 [0.49-2.36], p = 0.866). There was also no significant difference in the evolution of glycemic control between DM patients who underwent surgery and those medically treated (p > 0.05). CONCLUSION: DM affects about one quarter of patients with PA and the risk factors for its development are common to those of the general population. Medical and surgical treatment provides similar benefit in glycemic control in patients with PA and DM.

Robot-assisted vs. open radical cystectomy: systematic review and meta-analysis of randomized controlled trials.

INTRODUCTION: Several randomized controlled trials (RCTs) have been launched in the last decade to examine the surgical safety and oncological efficacy of robot-assisted (RARC) vs open radical cystectomy (ORC) for patients with bladder cancer. The aim of the study was to perform a systematic review and meta-analysis of RCTs to compare the perioperative and oncological outcomes of RARC vs ORC. METHODS: A literature search was conducted through July 2022 using PubMed/Medline, Embase, and Web of Science databases. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. The outcomes were intraoperative, postoperative, and oncological outcomes of RARC vs ORC. RESULTS: A total of eight RCTs comprising 1,024 patients met our inclusion criteria. RARC was associated with longer operative time (mean 92.34min, 95% CI 83.83-100.84, p<0.001) and lower blood transfusion rate (Odds ratio [OR] 0.43, 95% CI 0.30-0.61, p<0.001). No differences emerged in terms of 90-day overall (p=0.28) and major (p=0.57) complications, length of stay (p=0.18), bowel recovery (p=0.67), health-related quality of life (p=0.86), disease recurrence (p=0.77) and progression (p=0.49) between the two approaches. The main limitation is represented by the low number of patients included in half of RCTs included. CONCLUSIONS: This study supports that RARC is not inferior to ORC in terms of surgical safety and oncological outcomes. The benefit of RARC in terms of lower blood transfusion rate need to be balanced with the cost related to the procedure.

Percepción de utilidad entre profesionales sanitarios de un servicio de consultoría ética clínica / Healthcare workers’ perception of the usefulness of a healthcare ethics consultation service

Antecedentes y objetivo Los servicios de consultoría en ética clínica (CEC) surgen de los comités de ética para la asistencia sanitaria (CEAS) para atender conflictos éticos en tiempo real. Nuestro objetivo es conocer la percepción de utilidad de la CEC entre los profesionales sanitarios tras un año de su creación, así como evaluar los cambios de tendencia en el uso de la CEC y de los CEAS entre 2015 y 2021. Material y método Estudio observacional transversal mediante una encuesta estandarizada a los profesionales sanitarios de un hospital terciario urbano. Se compararon estos resultados con los de una encuesta idéntica realizada sobre la misma población en 2015. Resultados Participaron 213 profesionales (edad media 44 ± 11 años, 69% mujeres). Los profesionales conocían más la existencia de los CEAS que la CEC (94 vs. 61%; p<0,001). Un total de 45 encuestados (21%) habían consultado a la CEC desde su puesta en marcha; el 95% de ellos reconocían la utilidad de la consulta. Los facultativos conocían y utilizaban más la CEC que otros grupos profesionales. El grado de conocimiento sobre los CEAS en 2021 aumentó significativamente respecto a 2015 (94 vs. 76%; p<0,001). Se identificaron como áreas de mejora la necesidad de una mayor difusión del servicio, garantizar recursos institucionales para su mantenimiento y fomentar mayor participación de distintos profesionales. Conclusiones En los últimos años ha aumentado el conocimiento de los CEAS y de la CEC entre los profesionales sanitarios quienes consideran a la CEC útil para la atención de problemas éticos cotidianos (AU)

Background and objective Clinical ethics consultation services (CEC) have arisen from healthcare ethics committees (HEC) to address ethical conflicts in real-time. Our aim was to determine the perception of usefulness of a CEC service among healthcare workers one year after its creation as well as to assess changes in trends in the use of the CEC and HEC between 2015 and 2021. Material and method This observational, cross-sectional study was based on a standardized survey of healthcare workers at an urban tertiary care hospital. The results were also compared to those from an identical survey conducted in the same population in 2015. Results A total of 213 professionals participated (mean age 44±11 years, 69% women). The professionals were more familiar with the HEC than the CEC service (94 vs. 61%; p<0.001). Forty-five individuals (21%) had consulted the CEC since its implementation; 95% of them found the consultation useful. Physicians knew about and used the CEC more than other groups of professionals. The degree of knowledge of the HEC increased significantly by 2021 compared to 2015 (94 vs. 76%; p<0.001). Some areas for improvement identified were the need for greater dissemination of the service, guaranteeing institutional resources to maintain the service, and encouraging greater participation from different professional groups. Conclusions Knowledge of the institutional HEC and CEC services has increased in recent years among healthcare workers, who considered the CEC service to be useful for addressing ethical conflicts in daily practice (AU)

Differences in intraoperative and surgical outcomes between normotensive pheochromocytomas and sympathetic paragangliomas (PPGLs) and hypertensive PPGLs: results from the PHEO-RISK STUDY.

PURPOSE: To compare the intraoperative and surgical outcomes of normotensive pheochromocytomas and sympathetic paragangliomas (PPGLs), hypertensive PPGLs and non-PPGL adrenal lesions. METHODS: This a retrospective multicenter cohort study of patients with PPGLs from 18 tertiary hospitals. A control group of histologically confirmed adrenocortical adenomas (non-PPGL group) was selected to compare intraoperative and surgical outcomes with of the normotensive PPGLs. RESULTS: Two hundred and ninety-six surgeries performed in 289 patients with PPGLs were included. Before surgery, 209 patients were classified as hypertensive PPGLs (70.6%) and 87 as normotensive PPGLs. A higher proportion of normotensive PPGLs than hypertensive PPGLs did not receive alpha presurgical blockade (P = 0.009). When we only considered those patients who received presurgical alpha blockers (200 hypertensive PPGLs and 76 normotensive PPGLs), hypertensive PPGLs had a threefold higher risk of intraoperative hypertensive crisis (OR 3.0 [95% 1.3-7.0]) and of hypotensive episodes (OR 2.9 [95% CI 1.2-6.7]) than normotensive PPGLs. When we compared normotensive PPGLs (n = 76) and non-PPGLs (n = 58), normotensive PPGLs had a fivefold higher risk of intraoperative complications (OR 5.3 [95% CI 1.9-14.9]) and a six times higher risk of postoperative complications (OR 6.1 [95% CI 1.7-21.6]) than non-PPGLs. CONCLUSION: Although the risk of intraoperative hypertensive and hypotensive episodes in normotensive PPGLs is significantly lower than in hypertensive PPGLs, normotensive PPGLs have a greater risk of intraoperative and postoperative complications than non-PPGL adrenal lesions. Therefore, it is recommended to follow the standard of care for presurgical and anesthetic management of PPGLs also in normotensive PPGLs.

Healthcare workers' perception of the usefulness of a healthcare ethics consultation service.

BACKGROUND AND OBJECTIVE: Clinical ethics consultation services (CEC) have arisen from Healthcare Ethics Committees (HEC) to address ethical conflicts in real-time. Our aim was to determine the perception of usefulness of a CEC service among healthcare workers one year after its creation as well as to assess changes in trends in the use of the CEC and HEC between 2015 and 2021. MATERIALS AND METHODS: This observational, cross-sectional study was based on a standardized survey of healthcare workers at an urban tertiary care hospital. The results were also compared to those from an identical survey conducted in the same population in 2015. RESULTS: A total of 213 professionals participated (mean age 44 ± 11 years, 69% women). The professionals were more familiar with the HEC than the CEC service (94% vs 61%; p < 0.001). Forty-five individuals (21%) had consulted the CEC since its implementation; 95% of them found the consultation useful. Physicians knew about and used the CEC more than other groups of professionals. The degree of knowledge of the HEC increased significantly by 2021 compared to 2015 (94% v. 76%; p < 0.001). Some areas for improvement identified were the need for greater dissemination of the service, guaranteeing institutional resources to maintain the service, and encouraging greater participation from different professional groups. CONCLUSIONS: Knowledge of the institutional HEC and CEC services has increased in recent years among healthcare workers, who considered the CEC service to be useful for addressing ethical conflicts in daily practice.

Descripción de la experiencia de un servicio de consultoría en ética clínica en el período 2019-2021 / Description of the experience of a clinical ethics consultation service from 2019-2021

Introducción La consultoría en ética clínica (CEC) es un modelo útil de asesoría ética, pero con escasa implantación en Europa. En el presente artículo se comparte la experiencia de uno de los primeros servicios de consultoría ética en España. Material y métodos Estudio observacional retrospectivo de todas las consultas recibidas por el servicio de CEC del Hospital Universitario de La Princesa (Madrid, España) entre el 1 de septiembre de 2019 y el 31 de agosto de 2021. Se analizaron variables demográficas, logísticas y éticas de los casos. Resultados Se analizaron 63 casos, en los que se identificaron un total de 124 conflictos éticos. El 41% (n=26) de las consultas eran de carácter urgente y el 38% (n=24), preferentes. La evaluación inicial se realizó en menos de 24horas en 50 casos (79%). El servicio que consultó con mayor frecuencia fue Medicina Intensiva (9; 14%). Los medios de contacto preferidos fueron el busca (36; 57%), el sistema electrónico de historia clínica (13; 21%) o la conversación directa con el equipo consultor (7; 11%). Los problemas éticos más comunes estaban relacionados con la adecuación de medidas terapéuticas (24; 19%), el rechazo del tratamiento (19; 15%), la comunicación con el paciente o su familia (29; 23%) o la competencia del paciente (13; 11%). Conclusiones Los servicios de CEC proporcionan una asistencia rápida y eficiente para la resolución de problemas éticos en la práctica habitual. Su implementación en España es factible (AU)

Introduction Clinical ethics consultation services (CEC) are useful model for ethical counselling, albeit with scarce implementation in European countries. This article shares the experience of one of the first ethics consultation services in Spain. Materials and methods This work is a retrospective, observational study of all consultations received by the CEC service at La Princesa University Hospital (Madrid, Spain) from September 1, 2019 to August 31, 2021. The demographic, logistic, and ethical variables of the cases were analyzed. Results A total of 63 cases were analyzed in which a total of 124 ethical conflicts were identified. Forty-one percent of the cases (n=26) were emergency consultations and 38% (n=24) were preferential inquiries. An initial evaluation was performed with 24hours in 50 cases (79%). The department that consulted most often was the Intensive Care Unit (9; 14%). The preferred contact methods were via pager (36; 57%), the electronic medical record system (13; 21%), or direct conversations with consulting team (7; 11%). The most common ethical conflicts were those related to the adequacy of treatment measures (24; 19%), refusal of treatment (19; 15%), communication with the patient or his/her family (29; 23%), or the patient's capacity (13; 11%). Conclusion CEC services provide quick, efficient assistance for resolving ethical problems in daily practice. Their implementation in Spain is feasible (AU)

Utilidad del modelo 5MPB-Toledo para predecir bacteriemia en el paciente con infección del tracto urinario en el servicio de urgencias / Usefulness of the 5MPB-Toledo model to predict bacteremia in patients with urinary tract infections in the emergency department

Objetivo: Analizar la utilidad de un nuevo modelo predictivo de bacteriemia (5MPB-Toledo) en pacientes atendidos por infección del tracto urinario (ITU) en los servicios de urgencias (SU). Métodos: Estudio observacional, prospectivo y multicéntrico de los hemocultivos (HC) obtenidos en pacientes mayores de 18 años atendidos por ITU en 65SU desde el 1 de octubre de 2019 hasta el 30 de abril de 2020. Se analizó la capacidad predictiva del modelo con el área bajo la curva (ABC) de la característica operativa del receptor (COR) y se calculó el rendimiento diagnóstico del punto de corte elegido con su sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo. Resultados: Se incluyeron 1.499 episodios de HC extraídos. De ellos se consideraron como bacteriemias verdaderas 277 (18,5%) y como HC negativos 1.222 (81,5%). Entre los negativos 94 (6,3%) se consideraron contaminados. El ABC-COR del modelo fue de 0,937 (IC 95%: 0,926-0,949). El rendimiento diagnóstico del modelo con un PC≥5 puntos consigue una sensibilidad de 97,47% (IC 95%: 94,64-98,89), especificidad de 76,68% (IC 95%: 74,18-79,00), un valor predictivo positivo de 48,65% (IC 95%: 44,42-52,89) y un valor predictivo negativo de 99,26% (IC 95%: 98,41-99,67). Conclusión: El modelo 5MPB-Toledo podría ser útil para predecir bacteriemia en los pacientes adultos atendidos en el SU por un episodio de ITU (AU)

Objective: To analyze the usefulness of a new predictive model of bacteremia (5MPB-Toledo) in patients treated for urinary tract infection (UTI) in the emergency department (ED). Methods: Prospective and multicenter observational cohort study of the blood cultures (BC) ordered for patients with UTIs in 65 Spanish ED from October 1, 2019, to April 30, 2020. The predictive ability of the model was analyzed with the area under the Receiver Operating Characteristic curve (AUC-ROC). The diagnostic performance was calculated with the chosen cut-off point for sensitivity, specificity, positive predictive value, and negative predictive value. Results A total of 1,499 blood cultures were evaluated. True cases of bacteremia were confirmed in 277 (18.5%). The remaining 1,222 cultures (81.5%) were negative. Ninety-four (6.3%) were considered contaminated. The model's area under the ROC curve was 0.937 (95% CI, 0.926-0.949). The prognostic performance with a model's cut-off value of≥5 points achieved 97.47% (95% CI, 94.64-98.89) sensitivity, 76.68% (95% CI, 74.18-79.00) specificity, 48.65% (95% CI, 44.42-52.89) positive predictive value and 99.26% (95% CI, 98.41-99.67) negative predictive value. Conclusion: The 5MPB-Toledo score is useful for predicting bacteremia in patients with UTIs who visit the ED (AU)

Description of the experience of a clinical ethics consultation service from 2019 to 2021.

INTRODUCTION: Clinical ethics consultation services (CEC) are useful model for ethical counselling, albeit with scarce implementation in European countries. This article shares the experience of one of the first ethics consultation services in Spain. MATERIALS AND METHODS: This work is a retrospective, observational study of all consultations received by the CEC service at La Princesa University Hospital (Madrid, Spain) from September 1, 2019 to August 31, 2021. The demographic, logistic, and ethical variables of the cases were analyzed. RESULTS: A total of 63 cases were analyzed in which a total of 124 ethical conflicts were identified. Forty-one percent of the cases (n = 26) were emergency consultations and 38% (n = 24) were preferential inquiries. An initial evaluation was performed with 24 h in 50 cases (79%). The department that consulted most often was the Intensive Care Unit (9; 14%). The preferred contact methods were via pager (36; 57%), the electronic medical record system (13; 21%), or direct conversations with consulting team (7; 11%). The most common ethical conflicts were those related to the adequacy of treatment measures (24; 19%), refusal of treatment (19; 15%), communication with the patient or his/her family (29; 23%), or the patient's capacity (13; 11%). CONCLUSION: CEC services provide quick, efficient assistance for resolving ethical problems in daily practice. Their implementation in Spain is feasible.

Usefulness of the 5MPB-Toledo model to predict bacteremia in patients with urinary tract infections in the emergency department.

OBJECTIVE: To analyze the usefulness of a new predictive model of bacteremia (5MPB-Toledo) in patients treated for urinary tract infection (UTI) in the emergency department (ED). METHODS: Prospective and multicenter observational cohort study of the blood cultures (BC) ordered for patients with UTIs in 65 Spanish ED from November 1, 2019, to March 31, 2020. The predictive ability of the model was analyzed with the area under the Receiver Operating Characteristic curve (AUC-ROC). The diagnostic performance was calculated with the chosen cut-off point for sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS: A total of 1,499 blood cultures were evaluated. True cases of bacteremia were confirmed in 277 (18.5%). The remaining 1,222 cultures (81.5%) were negative. Ninety-four (6.3%) were considered contaminated. The model's area under the ROC curve was 0.937 (95% CI, 0.926-0.949). The prognostic performance with a model's cut-off value of ≥5 points achieved 97.47% (95% CI, 94.64-98.89) sensitivity, 76.68% (95% CI, 74.18-79.00) specificity, 48.65% (95% CI, 44.42-52.89) positive predictive value and 99.26% (95% CI, 98.41-99.67) negative predictive value. CONCLUSION: The 5MPB-Toledo score is useful for predicting bacteremia in patients with UTIs who visit the ED.

Implantación de un protocolo de recuperación precoz en artroplastia total de rodilla. Ensayo clínico aleatorizado / Implementation of a rapid recovery protocol in total knee arthroplasty. A randomized controlled trial

Introducción: Los programas de recuperación precoz (rapid recovery, RP) en artroplastia total de rodilla pueden mejorar la funcionalidad a la vez que se reducen los costes. El objetivo del estudio es comparar los resultados de un programa de rehabilitación precoz con nuestro protocolo habitual. Pacientes y métodos: Se realizó un ensayo clínico aleatorizado (NCT03823573) en pacientes operados de artroplastia total de rodilla. El grupo intervención (RP) recibió infiltración periarticular con levobupivacaína e inició deambulación supervisada a las 4-6 h tras la intervención. El grupo control (C) empleó drenaje y recibió un bloqueo femoral e inició la deambulación al retirar el drenaje. Los pacientes completaron un cuestionario Oxford Knee Score preoperatorio y a los 6 meses. La incidencia de trombosis venosa profunda asintomática se analizó mediante ecodoppler. El seguimiento mínimo fue de 6 meses. Resultados: Fueron incluidos 175 pacientes (92 pacientes en el grupo C y 83 en el RP). No hubo diferencias en sexo, edad, tipo de prótesis, descenso de hemoglobina, necesidad de transfusiones, balance articular activo al alta (C: 82,6°; RP: 85°) ni al finalizar el seguimiento (C: 105,1°; RP: 106,6°), mejoría del cuestionario (C: 17,5 puntos; RP: 19,3 puntos), satisfacción del paciente o reatenciones hospitalarias (C: 7,6%; RP: 10,8%). Se observó significación en el tiempo de isquemia (C: 81,29 min; RP: 85,35 min; p=0,03), necesidad de rescate con opioides (C: 19,7%; RP: 38,6%; p=0,007), estancia media (C: 3,84 días; RP: 2,54 días; p<0,0001) y demora en la deambulación (C: 2,46 días; RP: 0,23 días; p<0,0001). Conclusión: El protocolo RP puede reducir la estancia hospitalaria sin aumentar las complicaciones ni las reatenciones.(AU)

Background: Rapid recovery (RP) in total knee arthroplasty may increase the functionality while reducing costs. The aim of this study is to prove the benefits of a rapid recovery program compared to our classic protocol. Patients and methods: We performed a RCT (NCT03823573) in patients undergoing otal knee arthroplasty. Intervention group (RP protocol) received local infiltration of levo-bupivacaine in the periarticular tissue and supervized ambulation 4-6h after surgery. Control (C) group received a femoral nerve block with levo-bupivacaine, while a drain was used. Ambulation after its removal. All the patients completed an Oxford Knee Score prior to surgery and 6 months after discharge. An ecodoppler to assess the presence of deep vein thrombosis was made one month after discharge. Minimum follow-up was of 6 months. Results: A total of 175 patients were included in the trial (92 patients in the control group, 83 patients in the RP group). There were no differences in sex, age, implanted prosthesis, hemoglobin drop, need for transfusion, range of motion on discharge (C: 82.6°, RP: 85°) and at the end of the follow-up (C: 105.1, RP: 106.6), Oxford Knee Score improvement (C: 17.5 points; RP: 19.3 points), patient satisfaction or re-admissions at the emergency department (C: 7.6%; RP: 10.8%).Significancy was found on time of ischemia (C: 81.29min; RP: 85.35min; P=0.03), need for morphine shots (C: 19.7%; RP: 38.6%; P=0.007), hospital stay (C: 3.84 days; RP: 2.54 days, P<0.0001) and time until ambulation (C: 2.46 days; RP: 0.23 days; P<0.0001). Conclusion: Rapid recovery protocols can reduce hospital stay without increasing complications or need for re-admission.(AU)

[Translated article] Implementation of a rapid recovery protocol in total knee arthroplasty. A randomised controlled trial / Implantación de un protocolo de recuperación precoz en artroplastia total de rodilla. Ensayo clínico aleatorizado

Introducción: Los programas de recuperación precoz (rapid recovery, RP) en artroplastia total de rodilla pueden mejorar la funcionalidad a la vez que se reducen los costes. El objetivo del estudio es comparar los resultados de un programa de rehabilitación precoz con nuestro protocolo habitual. Pacientes y métodos: Se realizó un ensayo clínico aleatorizado (NCT03823573) en pacientes operados de artroplastia total de rodilla. El grupo intervención (RP) recibió infiltración periarticular con levobupivacaína e inició deambulación supervisada a las 4-6 h tras la intervención. El grupo control (C) empleó drenaje y recibió un bloqueo femoral e inició la deambulación al retirar el drenaje. Los pacientes completaron un cuestionario Oxford Knee Score preoperatorio y a los 6 meses. La incidencia de trombosis venosa profunda asintomática se analizó mediante ecodoppler. El seguimiento mínimo fue de 6 meses. Resultados: Fueron incluidos 175 pacientes (92 pacientes en el grupo C y 83 en el RP). No hubo diferencias en sexo, edad, tipo de prótesis, descenso de hemoglobina, necesidad de transfusiones, balance articular activo al alta (C: 82,6°; RP: 85°) ni al finalizar el seguimiento (C: 105,1°; RP: 106,6°), mejoría del cuestionario (C: 17,5 puntos; RP: 19,3 puntos), satisfacción del paciente o reatenciones hospitalarias (C: 7,6%; RP: 10,8%). Se observó significación en el tiempo de isquemia (C: 81,29 min; RP: 85,35 min; p=0,03), necesidad de rescate con opioides (C: 19,7%; RP: 38,6%; p=0,007), estancia media (C: 3,84 días; RP: 2,54 días; p<0,0001) y demora en la deambulación (C: 2,46 días; RP: 0,23 días; p<0,0001). Conclusión: El protocolo RP puede reducir la estancia hospitalaria sin aumentar las complicaciones ni las reatenciones.(AU)

Background: Rapid recovery (RP) in total knee arthroplasty may increase the functionality while reducing costs. The aim of this study is to prove the benefits of a rapid recovery program compared to our classic protocol. Patients and methods: We performed a RCT (NCT03823573) in patients undergoing otal knee arthroplasty. Intervention group (RP protocol) received local infiltration of levo-bupivacaine in the periarticular tissue and supervized ambulation 4-6h after surgery. Control (C) group received a femoral nerve block with levo-bupivacaine, while a drain was used. Ambulation after its removal. All the patients completed an Oxford Knee Score prior to surgery and 6 months after discharge. An ecodoppler to assess the presence of deep vein thrombosis was made one month after discharge. Minimum follow-up was of 6 months. Results: A total of 175 patients were included in the trial (92 patients in the control group, 83 patients in the RP group). There were no differences in sex, age, implanted prosthesis, hemoglobin drop, need for transfusion, range of motion on discharge (C: 82.6°, RP: 85°) and at the end of the follow-up (C: 105.1, RP: 106.6), Oxford Knee Score improvement (C: 17.5 points; RP: 19.3 points), patient satisfaction or re-admissions at the emergency department (C: 7.6%; RP: 10.8%).Significancy was found on time of ischemia (C: 81.29min; RP: 85.35min; P=0.03), need for morphine shots (C: 19.7%; RP: 38.6%; P=0.007), hospital stay (C: 3.84 days; RP: 2.54 days, P<0.0001) and time until ambulation (C: 2.46 days; RP: 0.23 days; P<0.0001). Conclusion: Rapid recovery protocols can reduce hospital stay without increasing complications or need for re-admission.(AU)

[Translated article] Implementation of a rapid recovery protocol in total knee arthroplasty. A randomised controlled trial.

BACKGROUND: Rapid recovery (RP) in total knee arthroplasty may increase the functionality while reducing costs. The aim of this study is to prove the benefits of a rapid recovery programme compared to our classic protocol. PATIENTS AND METHODS: We performed a RCT (NCT03823573) in patients undergoing otal knee arthroplasty. Intervention group (RP protocol) received local infiltration of levo-bupivacaine in the periarticular tissue and supervized ambulation 4-6h after surgery. Control (C) group received a femoral nerve block with levo-bupivacaine, while a drain was used. Ambulation after its removal. All the patients completed an Oxford Knee Score prior to surgery and 6 months after discharge. An ecodoppler to assess the presence of deep vein thrombosis was made 1 month after discharge. Minimum follow-up was of 6 months. RESULTS: A total of 175 patients were included in the trial (92 patients in the control group, 83 patients in the RP group). There were no differences in sex, age, implanted prosthesis, haemoglobin drop, need for transfusion, range of motion on discharge (C: 82.6°, RP: 85°) and at the end of the follow-up (C: 105.1, RP: 106.6), Oxford knee score improvement (C: 17.5 points; RP: 19.3 points), patient satisfaction or re-admissions at the emergency department (C: 7.6%; RP: 10.8%). Significancy was found on time of ischaemia (C: 81.29min; RP: 85.35min; p=.03), need for morphine shots (C: 19.7%; RP: 38.6%; p=.007), hospital stay (C: 3.84 days; RP: 2.54 days, p<.0001) and time until ambulation (C: 2.46 days; RP: 0.23 days; p<.0001). CONCLUSION: Rapid recovery protocols can reduce hospital stay without increasing complications or need for re-admission.

Genetic variants of antioxidant enzymes and environmental exposures as molecular biomarkers associated with the risk and aggressiveness of bladder cancer.

Bladder cancer (BC) is one of the top 10 most common tumours worldwide; however, no molecular markers are currently available for tumour management and follow-up. BC could benefit from molecular biomarkers in environmental disease, which provide mechanistic understanding of individual susceptibility to exposure-related cancers and allow characterizing genetic alterations in the molecular pathway for malignancy. This case-control study performed a molecular analysis in 99 BC and 125 controls. Buccal swabs were collected to assess SNPs in eleven genes coding for xenobiotic detoxification enzymes, cellular antioxidant defences, and hormone synthesis and signalling (NAT2 (rs1801280), GPX1 (rs1050450 and rs17650792), TXNRD1 (rs7310505), PRDX3 (rs3740562), PON1 (rs662), SOD1 (rs10432782), SOD2 (rs4880), CAT (rs1001179), CYP17A1 (rs743572) and ESR1 (rs746432)). A structured questionnaire was administered to study participants to assess environmental and dietary chemical exposures. Several miRNAs associated with BC and detoxification/antioxidant pathways were analysed in a subsample of the study population, including miR-93-5p, miR-221-3p, miR-126, miR-27a-3p, miR-193b, and miR-193a-5p. Levels of selected environmental pollutants (polycyclic aromatic hydrocarbons and endocrine disrupting chemicals) were determined in urine from a subsample of BC cases and controls. We found that CYP17A1, CAT, SOD1, ESR1, PON1, and GPX1 (rs17650792) were associated with BC risk. Furthermore, exposure to smoke and/or dust, and alcohol intake were identified as risk factors for BC. Increased urinary levels of benzo[a]pyrene and bisphenol A were observed in BC patients relative to controls, along with an increased expression of miR-193b, miR-27a and miR-93-5p in BC. Nevertheless, further studies with a larger sample size are warranted to confirm these exploratory results. This study also shows that the combination of genetic markers (PON1 and CYP17A1) and miRNA (miR-221-3p and miR-93-5p) open a new scenario in the use of non-invasive biomarkers in the stratification of BC to guide personalized medicine, which is extremely urged in the current clinical setting.

Implementation of a rapid recovery protocol in total knee arthroplasty. A randomized controlled trial. / Implantación de un protocolo de recuperación precoz en artroplastia total de rodilla. Ensayo clínico aleatorizado.

BACKGROUND: Rapid recovery (RP) in total knee arthroplasty may increase the functionality while reducing costs. The aim of this study is to prove the benefits of a rapid recovery program compared to our classic protocol. PATIENTS AND METHODS: We performed a RCT (NCT03823573) in patients undergoing otal knee arthroplasty. Intervention group (RP protocol) received local infiltration of levo-bupivacaine in the periarticular tissue and supervized ambulation 4-6h after surgery. Control (C) group received a femoral nerve block with levo-bupivacaine, while a drain was used. Ambulation after its removal. All the patients completed an Oxford Knee Score prior to surgery and 6 months after discharge. An ecodoppler to assess the presence of deep vein thrombosis was made one month after discharge. Minimum follow-up was of 6 months. RESULTS: A total of 175 patients were included in the trial (92 patients in the control group, 83 patients in the RP group). There were no differences in sex, age, implanted prosthesis, hemoglobin drop, need for transfusion, range of motion on discharge (C: 82.6°, RP: 85°) and at the end of the follow-up (C: 105.1, RP: 106.6), Oxford Knee Score improvement (C: 17.5 points; RP: 19.3 points), patient satisfaction or re-admissions at the emergency department (C: 7.6%; RP: 10.8%). Significancy was found on time of ischemia (C: 81.29min; RP: 85.35min; P=0.03), need for morphine shots (C: 19.7%; RP: 38.6%; P=0.007), hospital stay (C: 3.84 days; RP: 2.54 days, P<0.0001) and time until ambulation (C: 2.46 days; RP: 0.23 days; P<0.0001). CONCLUSION: Rapid recovery protocols can reduce hospital stay without increasing complications or need for re-admission.

[Influenza and cardiorespiratory events: a clinical-epidemiological review with a multidisciplinary point of view]. / Gripe y eventos cardiorrespiratorios: una revisión clínico-epidemiológica multidisciplinar.

There is accumulating evidence showing that influenza infection and cardiorespiratory diseases are closely associated. Influenza has been described as a triggering factor capable of both exacerbate underlying chronic diseases as well as inducing the appearance of new respiratory and cardiovascular events. Consequently, influenza infection and its associated comorbidity have a significant impact on the health system. In this document, we extensively reviewed the current literature to describe the most relevant data on the relationship between influenza infection and cardiorespiratory diseases. Likewise, we analyzed the possible pathophysiological mechanisms explaining the connection between influenza infection and cardiac and respiratory events. Finally, reviewed data has been put into perspective to highlight the importance of influenza vaccination as an effective measure in the prevention of cardiorespiratory diseases, especially in the population with underlying chronic diseases.

[Usefulness of the 5MPB-Toledo model to predict bacteremia in patients with community-acquired pneumonia in the Emergency Department]. / Utilidad del modelo 5MPB-Toledo para predecir bacteriemia en el paciente con neumonía adquirida en la comunidad en el Servicio de Urgencias.

OBJECTIVE: To analyse a new risk score to predict bacteremia in the patients with Community-acquired Pneumonia (CAP) in the emergency departments. METHODS: Prospective and multicenter observational cohort study of the blood cultures ordered in 74 Spanish emergency departments for patients with CAP seen from November 1, 2019, to March 31, 2020. The predictive ability of the model was analyzed with the area under the Receiver Operating Characteristic curve (AUC-ROC). The prognostic performance for true bacteremia was calculated with the chosen cut-off for getting the sensitivity, specificity, positive predictive value and negative predictive value. RESULTS: A total of 1,020 blood samples wered cultured. True cases of bacteremia were confirmed in 162 (15.9%). The remaining 858 cultures (84.1%) wered negative. And, 59 (5.8%) were judged to be contaminated. The model´s area under the receiver operating characteristic curve was 0.915 (95% CI, 0.898-0.933). The prognostic performance with a model´s cut-off value of ≥ 5 points achieved 97.5% (95% CI, 95.1-99.9) sensitivity, 73.2% (95% CI, 70.2-76.2) specificity, 40.9% (95% CI, 36.4-45.1) positive predictive value and 99.4% (95% CI, 99.1-99.8) negative predictive value. CONCLUSIONS: The 5MPB-Toledo score is useful for predicting bacteremia in the patients with CAP seen in the emergency departments.

Role of IGF2 in the Study of Development and Evolution of Prostate Cancer.

Prostate Cancer (PC) is commonly known as one of the most frequent tumors among males. A significant problem of this tumor is that in early stages most of the cases course as indolent forms, so an active surveillance will anticipate the appearance of aggressive stages. One of the main strategies in medical and biomedical research is to find non-invasive biomarkers for improving monitoring and performing a more precise follow-up of diseases like PC. Here we report the relevant role of IGF2 and miR-93-5p as non-invasive biomarker for PC. This event could improve current medical strategies in PC.