Drivers of species knowledge across the tree of life.

Knowledge of biodiversity is unevenly distributed across the Tree of Life. In the long run, such disparity in awareness unbalances our understanding of life on Earth, influencing policy decisions and the allocation of research and conservation funding. We investigated how humans accumulate knowledge of biodiversity by searching for consistent relationships between scientific (number of publications) and societal (number of views in Wikipedia) interest, and species-level morphological, ecological, and sociocultural factors. Across a random selection of 3019 species spanning 29 Phyla/Divisions, we show that sociocultural factors are the most important correlates of scientific and societal interest in biodiversity, including the fact that a species is useful or harmful to humans, has a common name, and is listed in the International Union for Conservation of Nature Red List. Furthermore, large-bodied, broadly distributed, and taxonomically unique species receive more scientific and societal attention, whereas colorfulness and phylogenetic proximity to humans correlate exclusively with societal attention. These results highlight a favoritism toward limited branches of the Tree of Life, and that scientific and societal priorities in biodiversity research broadly align. This suggests that we may be missing out on key species in our research and conservation agenda simply because they are not on our cultural radar.

Home modeling after penile prosthesis implantation in the management of residual curvature in Peyronie's disease.

The aim of this study was to study the clinical effectiveness of a structured home modeling (HM) protocol in Peyronie's disease (PD) patients who have residual curvature up to 45° after inflatable penile prosthesis (PP) placement. A total of 92 patients with PD and coexistent refractory erectile dysfunction received inflatable PP. If residual curvature after manual modeling (MM) was more than 45°, incision-grafting was performed. If curvature was <45° after MM, patients were instructed to perform HM daily for 6 months, after 4 weeks from PP implantation. The mean preoperative penile curvature was 39.4 ± 5.7° (30-60). Sixteen (17.4%) patients required incision-grafting and the remaining 76(82.6%) patients followed HM protocol. The mean postoperative residual curvature after MM was 29.7 ± 3.2° (5-50). Sixty-five (85.5%) patients who underwent HM had 10° or less residual curvature after 3 months and 72 (94.7%) patients had 10° or less residual curvature after 6 months. Seventy (92.1%) patients responded as satisfied or very satisfied on the questionnaire with the outcome after 6 months. HM of the penis over Inflatable PP may straighten the penis without the need for an additional surgical maneuver in vast majority of the PD patients having residual curvature of <45°.

Complications of robot assisted radical prostatectomy.

The urology community has adopted robot-assisted radical prostatectomy (RARP) as the most preferred surgical therapeutic approach in the management of localized prostate cancer. Safety and potential complications of RARP should be clearly known prior to attempting the surgery. The complications have been categorized as anesthesia & patient positioning related, vascular, non-vascular and delayed. European Associationof Urology guidelines recommend the use of Clavien-Dindo grading to report surgical complications.The median rate of over all complications of RARP is12.6%, with a range of 3.1-42%. Most of the complications are minor (Clavien-Dindo grades 1 and 2). With a dedicated approach, increasing experience, being aware of possible complications, and strict adherence to safety measures, most complications are preventable. RARP is a safe and reproducible technique.

ARTICULO SOLO EN INGLES.La comunidad urológica ha adoptado la prostatectomía radical asistida por robot (PRAR) como el abordaje terapéutico preferido en el tratamiento del cáncer de próstata localizado. La seguridad y las complicaciones potenciales de la PRAR deben ser claramente conocidas antes de intentar la cirugía. Las complicaciones se han clasificado como relacionadas con la anestesia y la colocación del paciente, vasculares, no vasculares y diferidas. Las guías clínicas de la Asociación Europea de Urología recomiendan utilizar la escala de Clavien-Dindo para comunicar las complicaciones. La tasa media global de complicaciones de la PRAR es del 12,6%, con un rango entre 3,1- 42%. La mayoría de complicaciones son menores (Clavien-Dindo grados 1-2). Con un abordaje dedicado, el aumento de la experiencia, conocer las posibles complicaciones y una estricta adherencia a las medidas de seguridad hacen que la mayoría de complicaciones sean prevenibles. La PRAR es una técnica segura y reproducible.

Complications of robot assisted radical prostatectomy / Complicaciones de la prostatectomía radical asistida por robot

The urology community has adopted robot-assisted radical prostatectomy (RARP) as the most preferred surgical therapeutic approach in the management of localized prostate cancer. Safety and potential complications of RARP should be clearly known prior to attempting the surgery. The complications have been categorized as anesthesia & patient positioning related, vascular, non-vascular and delayed. European Association of Urology guidelines recommend the use of Clavien-Dindo grading to report surgical complications. The median rate of overall complications of RARP is 12.6%, with a range of 3.1-42%. Most of the complications are minor (Clavien-Dindo grades 1 and 2). With a dedicated approach, increasing experience, being aware of possible complications, and strict adherence to safety measures, most complications are preventable. RARP is a safe and reproducible technique

La comunidad urológica ha adoptado la prostatectomía radical asistida por robot (PRAR) como el abordaje terapéutico preferido en el tratamiento del cáncer de próstata localizado. La seguridad y las complicaciones potenciales de la PRAR deben ser claramente conocidas antes de intentar la cirugía. Las complicaciones se han clasificado como relacionadas con la anestesia y la colocación del paciente, vasculares, no vasculares y diferidas. Las guías clínicas de la Asociación Europea de Urología recomiendan utilizar la escala de Clavien-Dindo para comunicar las complicaciones. La tasa media global de complicaciones de la PRAR es del 12,6%, con un rango entre 3,1- 42%. La mayoría de complicaciones son menores (Clavien-Dindo grados 1-2). Con un abordaje dedicado, el aumento de la experiencia, conocer las posibles complicaciones y una estricta adherencia a las medidas de seguridad hacen que la mayoría de complicaciones sean prevenibles. La PRAR es una técnica segura y reproducible

Our experience in liver transplantation in patients over 65 yr of age.

OBJECTIVES: The aim of this study was to analyze short- and long-term results of liver transplantation (LT) in patients over 65 yr. MATERIAL AND METHODS: Between 1996 and 2004, 386 patients underwent 415 LT at our center. The main indication for LT was post-necrotic cirrhosis in 59%, followed by hepatocellular carcinoma (HCC) over cirrhosis in 33%. Half of the patients (53%) were hepatitis C virus (HCV) +. Overall, 72 patients were >65 yr of age. Actuarial survival, causes of mortality and postoperative complications were compared between groups: patients under and over 65 yr. Risk factors for poor outcome in patients over 65 yr were also analyzed. RESULTS: The older group had more patients at Child A stage, more HCC as an indication for LT and more HCV (+) patients, p < 0.05. No differences were observed in donor and surgery characteristics, except for lower multi-transfusion and higher incidence of grafts with steatosis in the older group (p < 0.05). Actuarial survival at one, three, five and 10 yr was 82%, 75%, 72%, and 70% for the <65 yr group vs. 77%, 66%, 55%, and 55% for the >65 yr group (p = 0.03). Main causes of mortality in patients >65 yr were recurrence of underlying disease and medical causes. In the older age group, fewer infections (p = ns) and rejections (p = 0.017) occurred in the postoperative period. Risk factor for poor outcome in the group of patients over 65 yr in multivariate analyses was pre-LT renal insufficiency (odds ratio 3.5, p = 0.002, 95% confidence interval 1.58-7.82). CONCLUSION: Results in patients >65 yr are comparable to those <65 yr if older LT candidates are carefully selected. Overimmunosuppression should be avoided in older candidates, as its effects could worsen the pre-existing diseases common in elderly patients.

Herniation of renal pelvis and ureteropelvic junction resulting from superior lumbar triangle hernia.

A 79-year-old female admitted as a result of respiratory insufficiency due to pneumonia presented with a painful swelling in the left lumbar region and acute ureteral colic pain. The diagnosis of Grynfeltt's bilateral hernia was made by means of CT, which revealed herniation in the left side of the renal pelvis and proximal ureter.

Receptores de bajo peso: ¿derecho a partición? / No disponible

No disponible

A prospective randomized trial comparing tacrolimus and steroids with tacrolimus monotherapy in liver transplantation: the impact on recurrence of hepatitis C.

The aim of this prospective randomized trial was to study the efficacy and safety of tacrolimus monotherapy (TACRO) and compare it with our standard treatment of tacrolimus plus steroids (TACRO + ST) after liver transplant (LT). Furthermore, the impact of steroid-free immunosuppression on outcome of hepatitis C virus (HCV) was analysed. Between 1998 and 2000, 60 patients (mean age: 57 years) were included in the study and randomized to receive TACRO (n = 28) or TACRO + ST (n = 32). Indication for LT was postnecrotic cirrhosis in all cases (58.3% were HCV-positive). Mean follow-up was 44 months. Survival, incidence of rejection, infection and side-effects were compared between the two groups. In patients with HCV infection, incidence and severity of acute hepatitis C, long-term outcome of recurrent hepatitis C and survival were studied in an intention-to-treat analysis or in the real group analysis (real-TACRO versus real-TACRO + ST). Patient survival at 1, 3 and 5 years, tacrolimus pharmacokinetics, incidence of rejection infections and side-effects were similar. In patients with HCV, the incidence and severity of graft hepatitis C tended to be lower in TACRO (47%) compared with TACRO + ST (67%) (P = NS), and also in real-TACRO (42%) compared with real-TACRO + ST (61%) (P = NS). A poor outcome considered as evolution to cirrhosis at 3 years was observed in one (9%) living patient in real-TACRO and nine (45%) in real-TACRO + ST (P = 0.04). Patient survival at 1, 3 and 5 years was 92%, 92% and 73% for real-TACRO and 78%, 61% and 51% for real TACRO + ST (P = 0.07). Steroid-free immunosuppression appears to be safe and efficacious. The main advantage of this regimen could be in HCV patients, as recurrence of hepatitis in the graft was less severe in the group of patients in whom steroids could be avoided completely.

[Acute myocardial failure in a young man: Q-fever myocarditis]. / Insuficiencia cardíaca aguda en varón joven: miocarditis por fiebre Q.

Coxiella burnetii myocarditis is a rare but severe clinical form of acute Q fever. We report the case of a 40-year-old man hospitalized for acute febrile syndrome. Forty-eight hours later, he presented dyspnea, orthopnea, and paroxysmal nocturnal dyspnea; cardiac auscultation revealed a third sound and echocardiography showed a diffusely hypokinetic and dilated left ventricle (30% ejection fraction). Serological studies showed antibodies against phase-II C. burnetii antigens (IgG titer 1:320 and IgM 1:50). The patient was treated with losartan, furosemide, and clarithromycin, resulting in rapid improvement. Six months after admission, the echocardiographic changes had completely disappeared.

Insuficiencia cardíaca aguda en varón joven: miocarditis por fiebre Q / Acute myocardial failure in a young man: Q-fever myocarditis

La miocarditis por Coxiella burnetii constituye una forma infrecuente pero grave de presentación de fiebre Q aguda.Presentamos un caso de miocarditis por fiebre Q en un varón de 40 años que ingresó con síndrome febril y a las 48 h comenzó con disnea, ortopnea y disnea paroxística nocturna, se detectó un tercer ruido cardíaco y la ecocardiografía reveló un ventrículo izquierdo dilatado con hipocinesia difusa y fracción de eyección del 30 por ciento. El estudio serológico puso de manifiesto anticuerpos frente antígenos en fase II de C. burnetii a título de IgG 1:320 e IgM 1:50. La evolución con tratamiento con losartán, furosemida y claritromicina fue favorable, y la ecocardiografía al cabo de 6 meses puso de manifiesto la resolución completa de las alteraciones (AU)

Current practice regarding the use of fatty livers: a trans-Atlantic survey.

A strong association exists between the presence of steatosis in a donor liver for transplantation and the development of primary nonfunction in the recipient. Despite this, appraisal of the donor remains one of the least scientific aspects of the transplantation process, and many centers base their practice on subjective opinion, rather than objective data. We conducted this survey to illuminate controversial issues and highlight the variation of opinion and practice policies both between and within the United Kingdom and the United States. A simple, anonymous, one-page, 10-question survey with tick-box answers was sent to every practicing liver transplant surgeon in the United Kingdom. The same form was sent by E-mail to liver transplant surgeons in the United States with a current E-mail address listed in the American Society of Transplant Surgeons registry. In the United Kingdom, 16 of 19 surgeons polled responded (84.2%) and thus were considered representative. From the United States, there were 78 respondents from 52 centers, representing all 11 United Network for Organ Sharing regions. We found that current practice policies differ not only between nations, but also among centers in each country. US surgeons generally follow a more conservative approach, with greater emphasis on histological assessment. Dichotomous opinions exist on the significance of microvesicular steatosis in both countries. Most evident from this survey is that more research in the field is required to help answer these questions and allow for the safe use of all viable livers.