Setting a shared development agenda: prioritizing the sustainable development goals in the Dominican Republic with fuzzy-LMAW.

The sustainable development goals (SDGs) were established by the United Nations as an international call to eradicate poverty, safeguard the environment, and guarantee that everyone lives in peace and prosperity by 2030. The SDGs aim to balance growth and sustainability in three dimensions: social, economic and environmental. However, in the post-pandemic era, when resources for public development policies are scarce, nations face the problem of prioritizing which SDGs to pursue. A lack of agreement is one of the determinants of low performance levels of the SDGs, and multicriteria decision analysis tools can help in this task, which is especially relevant in developing countries that are falling behind in achieving the SDGs. To test the feasibility and appropriateness of one of these tools, the Fuzzy Logarithm Methodology of Additive Weights, we apply it to prioritize the SDGs in the Dominican Republic, to see if the priorities established are consistent. Seventeen experts were surveyed, and the main result was that Decent work and economic growth was the most important goal for the country. Our findings, consistent with the literature, show the path to similar applications in other developing countries to enhance performance levels in the achievement of the SDGs.

Techno-Economic Analysis of the Optimum Configuration for Supercritical Carbon Dioxide Cycles in Concentrating Solar Power Systems.

There is a general agreement among researchers that supercritical carbon dioxide (sCO2) cycles will be part of the next generation of thermal power plants, especially in concentrating solar power (CSP) plants. While certain studies focus on maximizing the efficiency of these cycles in the hope of achieving a reduction in electricity costs, it is important to note that this assumption does not always hold true. This work provides a comprehensive analysis of the differences between minimizing the cost and maximizing the efficiency for the most remarkable sCO2 cycles. The analysis considers the most important physical uncertainties surrounding CSP and sCO2 cycles, such as turbine inlet temperature, ambient temperature, pressure drop and turbomachinery efficiency. Moreover, the uncertainties related to cost are also analyzed, being divided into uncertainties of sCO2 component costs and uncertainties of heating costs. The CSP system with partial cooling (sometimes with reheating and sometimes without it) is the cheapest configuration in the analyzed cases. However, the differences in cost are generally below 5% (and sometimes neglectable), while the differences in efficiency are significantly larger and below 15%. Besides the much lower efficiency of systems with simple cycle, if the heating cost is low enough, their cost could be even lower than the cost of the system with partial cooling. Systems with recompression cycles could also achieve costs below systems with partial cooling if the design's ambient temperature and the pressure drop are low.

Exclusión pilórica con dispositivo Ovesco (over-the-scope) en caso de fístula yeyunal en obstrucción duodenal de etiología maligna / Pyloric Exclusion with Ovesco (Over-the-scope-clip) Device for Jejunal Fistula in Duodenal Obstruction of Malignant Etiology

Resumen Se reporta el caso de un hombre de 25 años con diagnóstico de tumor de células germinales no seminomatoso que ingresó a urgencias por cuadro clínico de dolor abdominal difuso asociado con distensión y múltiples episodios eméticos. Ante la sospecha clínica de obstrucción intestinal se realizó una tomografía abdominal contrastada que mostró una obstrucción en la tercera porción duodenal por compresión extrínseca ocasionada por múltiples conglomerados retroperitoneales. Se decidió el tiempo quirúrgico para una derivación gastrointestinal en la que se realizó una gastroyeyunoanastomosis por técnica convencional; hacia el quinto día posoperatorio presentó un deterioro clínico dado por episodios febriles, dolor abdominal y taquicardia. Se realizó una nueva tomografía abdominal que reportó una colección intraabdominal en el flanco izquierdo de 12 x 12 x 5 cm secundaria a proceso fistuloso yeyunal, se realizó un manejo de la colección con drenaje percutáneo por radiología intervencionista y alojamiento de catéteres de drenaje, y se realizó una esofagogastroduodenoscopia con el fin de ejecutar una técnica de exclusión pilórica con dispositivo Ovesco (over-the-scope) como manejo de la fístula yeyunal, con la que se obtuvo éxito técnico. Durante el posoperatorio se realizó como seguimiento una radiografía de vías digestivas que confirmó la no continuidad pilórica con adecuada permeabilidad de la gastroyeyunoanastomosis, y una tomografía abdominal contrastada que mostró una disminución de la colección intraabdominal sin extravasaciones del medio de contraste. El desenlace favorable de este caso sugiere la utilidad del dispositivo Ovesco en casos de fístulas del tracto gastrointestinal proximal, sobre todo en aquellos pacientes con múltiples comorbilidades o mal estado general que se favorecen de procedimientos mínimamente invasivos que disminuyan el riesgo de desenlace fatal.

Abstract A 25-year-old man diagnosed with a non-seminomatous germ cell tumor was admitted to the emergency department for diffuse abdominal pain associated with bloating and multiple emetic episodes. Due to the clinical suspicion of intestinal obstruction, a contrasted abdominal tomography was performed, showing an obstruction in the third duodenal portion resulting from extrinsic compression caused by multiple retroperitoneal conglomerates. Surgical time was scheduled for a gastric bypass surgery where gastrojejunostomy was performed using conventional technique. On the fifth postoperative day, he presented clinical deterioration due to febrile episodes, abdominal pain, and tachycardia. A new abdominal tomography was performed, reporting an intra-abdominal collection of pus on the left flank of 12 x 12 x 5 cm secondary to the jejunal fistula process. Hence, percutaneous drainage management of the collection was performed by interventional radiology and drainage catheter placement. In addition, an EGD was performed to conduct a pyloric exclusion technique with an Ovesco (over-the-scope-clip) device for managing the jejunal fistula, which was technically successful. A gastrointestinal tract X-ray was performed as a follow-up during the postoperative stage, showing no pyloric continuity with adequate patency of the gastrojejunostomy. In addition, a contrasted abdominal CT scan showed a decrease in the intra-abdominal collection without extravasation of the contrast medium. This case outcome suggests the Ovesco device may be helpful in proximal GI fistulas cases, especially in patients with multiple comorbidities or poor general conditions who may benefit from minimally invasive procedures decreasing the risk of fatal outcomes.

Techno-Economic Optimization of CSP Plants with Free-Falling Particle Receivers.

Particle receivers are one of the candidates for the next generation of CSP plants, whose goal is to reduce the levelized cost of electricity (LCOE) to 0.05 $/kWh. This paper presents a techno-economic analysis to study if a CSP system with free-falling particle receiver can achieve this goal. The plant analyzed integrates two ground-based bins to store the excess energy and a supercritical CO2 cycle to generate electricity. The model used for the analysis presents several upgrades to previous particle systems models in order to increase its fidelity, accuracy, and representativeness of an actual system. The main upgrades are the addition of off-design conditions during the annual simulations in all the components and an improved receiver model validated against CFD simulations. The size of the main components is optimized to obtain the system configuration with minimum LCOE. The results show that particle CSP systems can reduce the LCOE to 0.056 $/kWh if the configuration is composed of 1.61 × 106 m2 of heliostats, a 250 m high tower with a 537 m2 falling particle curtain, and 16 h thermal energy storage.

How Will COVID-19 Impact on the Governance of Global Health in the 2030 Agenda Framework? The Opinion of Experts.

In 2015, the 2030 Agenda was formally adopted by the United Nations, establishing a set of 17 Sustainable Development Goals (SDGs). SDG 3 seeks to promote Global Health and the quality of public health systems in developing countries. The achievement of these goals requires the commitment of all signing countries, but the COVID-19 crisis is changing the behavior of the main stakeholders in the international arena. What do the experts think about these changes? Could these changes threaten the 2030 Agenda and Global Health? To answer these questions, we conduct a content analysis of 152 documents written by experts from the 15 main think tanks on international development policy. The results point out that the new scenario brought about by the pandemic is hindering the necessary cooperation between countries to achieve global health goals and to guarantee public health coverage in developing countries. To deal with these challenges, more delegation of powers to international organizations and a reform of the international cooperation system are needed. With this analysis, we launch a warning about potential weaknesses of the institutional design of the 2030 Agenda in order for it to survive in a post-COVID-19 world and remain a valid instrument to promote health worldwide.

Intestinal failure functional classification type associated with an extended length of stay at the intestinal failure unit, Central Hospital in Chihuahua, Mexico.

BACKGROUND: Intestinal failure (IF) was first defined as "a reduction in the functioning gut mass below the minimal amount necessary for adequate digestion and absorption." In our environment, there are no statistical data for IF in adult patients' extended length of stay (LOS), nor the economic impact that it implies. OBJECTIVE: The objective of the study was to describe the association between the IF type and extended LOS. METHODS: Patients admitted to our IF Unit between March 2016 and March 2018 were enrolled. We conducted a 2-year retrospective cross-sectional study. RESULTS: From the total of 53 patients, 35% corresponded to type I IF, 58.5% to type II IF, and 7.5% to type III IF. The mean LOS, according to the type of functional IF was 51 days for type I, 77.48 days for type II, and 68.25 days for type III. The mean LOS for the three IF types was 67.79 days. CONCLUSION: Extended LOS occurs in an important proportion of patients with IF, resulting in increased morbidity and mortality, as well as in costs and associated side effects. Future research should focus on economic studies, to know the economic impact that this subject entails for our health systems.

ANTECEDENTES: En nuestro entorno no existen datos estadísticos sobre la falla intestinal en adultos, su estancia hospitalaria prolongada (EHP) ni el impacto económico que implica. OBJETIVO: Describir la asociación entre el tipo de falla intestinal y la estancia hospitalaria prolongada en pacientes de la unidad de falla intestinal del Hospital Central del Estado Chihuahua, México. MÉTODO: Se realizó un estudio transversal retrospectivo con un total de 53 participantes durante el periodo de marzo de 2016 a marzo de 2018. RESULTADOS: De los 53 pacientes, el 35% tuvieron falla intestinal tipo I, el 58.5% tipo II y el 7.5% tipo III. La media de estancia fue de 51 días para la falla intestinal tipo I, 77,48 días para la tipo II y 68,25 días para la tipo III. La media de estancia hospitalaria para los tres tipos de insuficiencia intestinal fue de 67,79 días. CONCLUSIONES: La estancia hospitalaria prolongada ocurre en una proporción importante de pacientes con falla intestinal, lo que resulta en un aumento de la morbilidad, la mortalidad y los costos. Investigaciones futuras deberían centrarse en la realización de estudios económicos para conocer el impacto que esta cuestión tiene para nuestros sistemas de salud.

Monitoring System Analysis for Evaluating a Building's Envelope Energy Performance through Estimation of Its Heat Loss Coefficient.

The present article investigates the question of building energy monitoring systems used for data collection to estimate the Heat Loss Coefficient (HLC) with existing methods, in order to determine the Thermal Envelope Performance (TEP) of a building. The data requirements of HLC estimation methods are related to commonly used methods for fault detection, calibration, and supervision of energy monitoring systems in buildings. Based on an extended review of experimental tests to estimate the HLC undertaken since 1978, qualitative and quantitative analyses of the Monitoring and Controlling System (MCS) specifications have been carried out. The results show that no Fault Detection and Diagnosis (FDD) methods have been implemented in the reviewed literature. Furthermore, it was not possible to identify a trend of technology type used in sensors, hardware, software, and communication protocols, because a high percentage of the reviewed experimental tests do not specify the model, technical characteristics, or selection criteria of the implemented MCSs. Although most actual Building Automation Systems (BAS) may measure the required parameters, further research is still needed to ensure that these data are accurate enough to rigorously apply HLC estimation methods.

Complicaciones más frecuentes de la colecistectomía laparoscópica electiva en el Hospital Médico Quirúrgico en el período de enero a diciembre 2015 / Most frequent complications of elective laparoscopic cholecystectomy at the Surgical Medical Hospital in the period from January to December 2015

La colecistectomía por videolaparoscopía es el tratamiento preferido para la litiasis biliar ya que reduce la estancia hospitalaria, permite un reintegro laboral precoz, supone un menor dolor postoperatorio, y las cicatrices operatorias son mínimas. Sin embargo, esta cirugía no está exenta de resultados adversos y con el creciente uso de esta técnica se han presentado nuevas complicaciones propias del procedimiento. El marcador más frecuentemente utilizado para medir la calidad de una cirugía sigue siendo la incidencia de complicaciones postoperatorias, por lo que es necesario que el cirujano cuente con el registro actualizado de las principales complicaciones y se encuentre preparado para enfrentarlas. En el Instituto Salvadoreño del Seguro Social se ha descrito una tasa de complicaciones del 31% en 1997 y 7.25% en el año 2000, pero no se ha descrito el tipo de complicación presentada ni el tratamiento que se utilizó en cada paciente; es hasta 2011 donde se estudió la lesión de vía biliar como complicación observando una incidencia de 0.4%. El objetivo principal de esta investigación es: Describir las complicaciones postquirúrgicas más frecuentes que se presentan en pacientes post colecistectomías laparoscópicas realizadas de manera electiva en el Hospital Médico Quirúrgico en el período de enero a diciembre 2015. El estudio fue transversal, descriptivo; la información se obtuvo de los expedientes clínicos de los pacientes, en el período ya establecido y se clasificaron las complicaciones de acuerdo al tratamiento realizado según la escala de Clavien-Dindo. La incidencia global de complicaciones post colecistectomía laparoscópica electiva fue del 9.43%; se observaron con mayor frecuencia en el grupo etario entre 18 y 33 años, y se presentaron más complicaciones en hombres que en mujeres. La mayoría de complicaciones fueron grado I y II de la escala de Clavien-Dindo siendo las más frecuente náuseas y vómitos, presentándose de manera temprana en las primeras 72 horas

Caffeine improves muscular performance in elite Brazilian Jiu-jitsu athletes.

Scientific information about the effects of caffeine intake on combat sport performance is scarce and controversial. The aim of this study was to investigate the effectiveness of caffeine to improve Brazilian Jiu-jitsu (BJJ)-specific muscular performance. Fourteen male and elite BJJ athletes (29.2 ± 3.3 years; 71.3 ± 9.1 kg) participated in a randomized double-blind, placebo-controlled and crossover experiment. In two different sessions, BJJ athletes ingested 3 mg kg(-1) of caffeine or a placebo. After 60 min, they performed a handgrip maximal force test, a countermovement jump, a maximal static lift test and bench-press tests consisting of one-repetition maximum, power-load, and repetitions to failure. In comparison to the placebo, the ingestion of the caffeine increased: hand grip force in both hands (50.9 ± 2.9 vs. 53.3 ± 3.1 kg; respectively p < .05), countermovement jump height (40.6 ± 2.6 vs. 41.7 ± 3.1 cm; p = .02), and time recorded in the maximal static lift test (54.4 ± 13.4 vs. 59.2 ± 11.9 s; p < .01).The caffeine also increased the one-repetition maximum (90.5 ± 7.7 vs. 93.3 ± 7.5 kg; p = .02), maximal power obtained during the power-load test (750.5 ± 154.7 vs. 826.9 ± 163.7 W; p < .01) and mean power during the bench-press exercise test to failure (280.2 ± 52.5 vs. 312.2 ± 78.3 W; p = .04). In conclusion, the pre-exercise ingestion of 3 mg kg(-1) of caffeine increased dynamic and isometric muscular force, power, and endurance strength in elite BJJ athletes. Thus, caffeine might be an effective ergogenic aid to improve physical performance in BJJ.

Management of end-stage erectile dysfunction and stress urinary incontinence after radical prostatectomy by simultaneous dual implantation using a single trans-scrotal incision: surgical technique and outcomes.

Stress urinary incontinence (SUI) and end-stage erectile dysfunction (ED) after radical prostatectomy (RP) can decrease a patient's quality of life (QoL). We describe a surgical technique involving scrotal incision for simultaneous dual implantation of an artificial urinary sphincter (AUS) and an inflatable penile prosthesis (IPP). Patients with moderate to severe SUI (>3 pads per day) and end-stage ED following RP were selected for dual implantation. An upper transverse scrotal incision was made, followed by bulbar urethra dissection and AUS cuff placement. Through the same incision, the corpora cavernosa was exposed, and an IPP positioned. Followed by extraperitoneal reservoirs placement and pumps introduced in the scrotum. Short-term, intra- and post-operative complications; continence status and erectile function; and patient satisfaction and QoL were recorded. A total of 32 patients underwent dual implantation. Early AUS-related complications were: AUS reservoir migration and urethral erosion. One case of distal corporal extrusion occurred. No prosthetic infection was reported. Over 96% of patients were socially the continent (≤1 pad per day) and > 95% had sufficient erections for intercourse. Limitations of the study were the small number of patients, the lack of the control group using a perineal approach for AUS placement and only a 12 months follow-up. IPP and AUS dual implantation using a single scrotal incision technique is a safe and effective option in patients with SUI and ED after RP. Further studies on larger numbers of patients are warranted.

Caffeine-containing energy drink improves physical performance in female soccer players.

There is little information about the effects of caffeine intake on female team-sport performance. The aim of this study was to investigate the effectiveness of a caffeine-containing energy drink to improve physical performance in female soccer players during a simulated game. A double-blind, placebo controlled and randomized experimental design was used in this investigation. In two different sessions, 18 women soccer players ingested 3 mg of caffeine/kg in the form of an energy drink or an identical drink with no caffeine content (placebo). After 60 min, they performed a countermovement jump (CMJ) and a 7 × 30 m sprint test followed by a simulated soccer match (2 × 40 min). Individual running distance and speed were measured using GPS devices. In comparison to the placebo drink, the ingestion of the caffeinated energy drink increased the CMJ height (26.6 ± 4.0 vs 27.4 ± 3.8 cm; P < 0.05) and the average peak running speed during the sprint test (24.2 ± 1.6 vs 24.5 ± 1.7 km/h; P < 0.05). During the simulated match, the energy drink increased the total running distance (6,631 ± 1,618 vs 7,087 ± 1,501 m; P < 0.05), the number of sprints bouts (16 ± 9 vs 21 ± 13; P < 0.05) and the running distance covered at >18 km/h (161 ± 99 vs 216 ± 103 m; P < 0.05). The ingestion of the energy drink did not affect the prevalence of negative side effects after the game. An energy drink with a dose equivalent to 3 mg of caffeine/kg might be an effective ergogenic aid to improve physical performance in female soccer players.

[Sexual dysfunction secondary to urethral stricture and urethroplasty]. / Disfunciones sexuales secundarias a la estenosis uretral y a la uretroplastia.

OBJECTIVES: Urethral stenosis is a complex pathology that severely affects the quality of life of patients who suffer it. There are multiple therapeutic options, the main objective of which is to eliminate obstruction and improve symptoms, and consequently maintain or improve the quality of life of the patient. The objective of this article is to perform a systematic review of the literature with the aim to evaluate the results regarding the sexual sphere after urethral surgery. METHODS: We performed a bibliographic search in PubMed, identifying studies that analyzed the results in sexual function after various types of urethroplasties. Preference have been given to those articles evaluating sexual function both preoperative and postoperative, to determine the degree of involvement conditioned by surgery. Fourteen articles have been selected, including those making reference to sexual function (sexual desire, erectile and ejaculatory function). RESULTS: A total of 14 studies were selected to perform the analysis; they were divided into two groups depending of the perspective they have to evaluate results: Use of validated tests for data collection before and after surgery and a second group analyzing more qualitative features of the stenosis making the evaluation of results this way. Site of stenosis is not uniformly distributed in these articles, with predominance of those performing anterior urethra surgery. They have a comprehensive analysis of the various features that may affect directly or indirectly the result of the operation both in the short and long term. CONCLUSIONS: Most articles conclude that specific standardized tools are necessary for this type of pathology, with the aim of obtain results that are more adjusted to urethral surgery. Patient perception of the results of urethroplasty is a parameter that has gained great importance lately. Globally the results of postoperative sexual function are very satisfactory, mainly in young patients. It is important to globally analyze the results and surgical techniques currently in use with the aim to minimize deleterious effects on sexual function; moreover taking into account that the objective of surgery is to try to improve the patient's quality of life.

Disfunciones sexuales secundarias a la estenosis uretral y a la uretroplastia / Sexual dysfunction secondary to urethral stricture and urethroplasty

OBJETIVO: La estenosis de uretra es una patología compleja que afecta de manera importante a la calidad de vida de los pacientes que la padecen. Existen múltiples opciones de tratamiento, cuyo objetivo principal es eliminar la obstrucción y mejorar los síntomas que acarrea, consecuentemente manteniendo o mejorando la calidad de vida del paciente. El objetivo de este artículo es hacer una revisión sistemática de la literatura con el fin de evaluar los resultados en relación a la esfera sexual tras la cirugía de uretra. MÉTODOS: Se ha realizado una búsqueda bibliografíca en Pubmed, identificando estudios que analizaban los resultados obtenidos en la función sexual tras diversos tipos de uretroplastias. Se ha dado preferencia a aquellos artículos que evalúan la función sexual tanto pre como postoperatoriamente, para determinar el grado de afectación condicionado por la cirugía. Se han seleccionado catorce artículos, incluyendo aquellos que hacen referencia a la función sexual (deseo sexual, función eréctil y eyaculatoria). RESULTADOS: Un total de catorce estudios fueron seleccionados para realizar dicho análisis, pudiendo ser divididos en dos grupos en función de la perspectiva con la que evalúan los resultados; uso de test validados para recogida de datos antes y después de la cirugía, y un segundo grupo que analiza aspectos mas cualitativos de la estenosis y de esta manera evalúa los resultados. La localización de la estenosis se reparte de manera no uniforme dentro de dichos artículos, predominando aquellos que realizan cirugía de uretra anterior. Se analizan exhaustivamente los distintos aspectos que pueden afectar de manera directa o indirecta al resultado quirúrgico tanto a corto como largo plazo. CONCLUSIONES: La mayoría de los artículos concluyen que son necesarios herramientas estandarizadas específicas para este tipo de patología, con el fin de obtener resultados mas adaptados a la cirugía de uretra. La percepción del paciente en cuanto a los resultados de la uretroplastia es un parámetro que ha cobrado gran importancia en los últimos tiempos. Globalmente los resultados con respecto la función sexual postoperatoria son muy satisfactorios, sobretodo en pacientes jóvenes. Es importante analizar de manera global los resultados y las técnicas quirúrgicas empleadas en la actualidad con el fin de minimizar los efectos deletéreos sobre la función sexual, más aun teniendo en cuenta que se trata de una cirugía cuyo objetivo es intentar mejorar la calidad de vida del paciente

OBJECTIVES: Urethral stenosis is a complex pathology that severely affects the quality of life of patients who suffer it. There are multiple therapeutic options, the main objective of which is to eliminate obstruction and improve symptoms, and consequently maintain or improve the quality of life of the patient. The objective of this article is to perform a systematic review of the literature with the aim to evaluate the results regarding the sexual sphere after urethral surgery. METHODS: We performed a bibliographic search in PubMed, identifying studies that analyzed the results in sexual function after various types of urethroplasties. Preference have been given to those articles evaluating sexual function both preoperative and postoperative, to determine the degree of involvement conditioned by surgery. Fourteen articles have been selected, including those making reference to sexual function (sexual desire, erectile and ejaculatory function). RESULTS: A total of 14 studies were selected to perform the analysis; they were divided into two groups depending of the perspective they have to evaluate results: Use of validated tests for data collection before and after surgery and a second group analyzing more qualitative features of the stenosis making the evaluation of results this way. Site of stenosis is not uniformly distributed in these articles, with predominance of those performing anterior urethra surgery. They have a comprehensive analysis of the various features that may affect directly or indirectly the result of the operation both in the short and long term. CONCLUSIONS: Most articles conclude that specific standardized tools are necessary for this type of pathology, with the aim of obtain results that are more adjusted to urethral surgery. Patient perception of the results of urethroplasty is a parameter that has gained great importance lately. Globally the results of postoperative sexual function are very satisfactory, mainly in young patients. It is important to globally analyze the results and surgical techniques currently in use with the aim to minimize deleterious effects on sexual function; moreover taking into account that the objective of surgery is to try to improve the patient's quality of life

Acute phase Peyronie's disease management with traction device: a nonrandomized prospective controlled trial with ultrasound correlation.

INTRODUCTION: Outcome data of penile traction therapy (PTT) for the acute phase (AP) of Peyronie's disease (PD) have not been specifically studied. AIM: The aim of this study was to assess the effectiveness of a penile extender device for the treatment of patients with AP of PD. METHODS: A total of 55 patients underwent PTT for 6 months and were compared with 41 patients with AP of PD who did not receive active treatment ("no intervention group" [NIG]). MAIN OUTCOMES MEASURES: Pre- and posttreatment variables included degree of curvature, penile length and girth, pain by 0-10 cm visual analog scale (VAS), erectile function (EF) domain of the International Index of Erectile Function questionnaire, Erection Hardness Scale, Sexual Encounter Profile 2 question, and penile sonographic evaluation (only patients in the intervention group). RESULTS: The mean curvature decreased from 33° at baseline to 15° at 6 months and 13° at 9 months with a mean decrease 20° (P < 0.05) in the PTT group. VAS score for pain decreased from 5.5 to 2.5 after 6 months (P < 0.05). EF and erection hardness also improved significantly. The percentage of patients who were not able to achieve penetration decreased from 62% to 20% (P < 0.03). In the NIG, deformity increased significantly, stretched flaccid penile length decreased, VAS score for pain increased, and EF and erection hardness worsened. PTT was associated with the disappearance of sonographic plaques in 48% of patients. Furthermore, the need for surgery was reduced in 40% of patients who would otherwise have been candidates for surgery and simplified the complexity of the surgical procedure (from grafting to plication) in one out of every three patients. CONCLUSIONS: PTT seems an effective treatment for the AP of PD in terms of pain reduction, penile curvature decrease, and improvement in sexual function.

[Patient with testosterone deficit syndrome after radical prostatectomy]. / Paciente con síndrome de déficit de testosterona tras prostatectomía radical.

Testosterone Deficiency Syndrome is associated with age. Recent studies advocate for the safety of hormonal treatment with testosterone in patients with history of Prostate Cancer (PC) ,once disease-free survival is confirmed. A total of five publications describe 110 patients treated with testosterone replacement therapy, having a history of PC, who had undergone radical prostatectomy (RP). Only one patient had biochemical recurrence during replacement therapy. Testosterone replacement therapy must be indicated in selected patients with history of low risk localized prostate cancer treated satisfactorily who are symptomatic and have good oncological control. The testosterone levels to achieve should be the minimum effective to obtain a symptomatic response. Adequate information on the benefits and potential risks must be understood and accepted by the patient.

[Patient with testosterone deficit syndrome and erectile dysfunction non-responder to PDE-5 inhibitors]. / Paciente con sdt y ed no respondedor a inhibidores de la 5PDE.

Androgens play an essential role in the corporo-venous occlusive mechanism that provokes erection. Accordingly to various studies based on animal models,testosterone deficit syndrome causes an endothelial disorder in the corpora cavernosa with diminished secretion of NO, alteration of penile smooth muscle and tunica albuginea structure, and increase of the number of adipocytes within the erectile tissue, which favors fibrosis and impairs erection. All these alterations are reversible with the exogenous administration of androgens. There are not enough studies to get definitive conclusions about androgen supply improving erectile dysfunction in patients with hypogonadism. Studies have been published in which seems that exogenous testosterone could be useful in the treatment of this type of patients. Nevertheless,in most published randomized double blind studies comparing with placebo, testosterone supply does not provide greater benefit on erectile dysfunction than PDE-5 Inhibitors exclusively. All studies coincide in the need to optimize the treatment with PDE-5 Inhibitors since they do have proven to be effective for the treatment of erectile dysfunction in patients with testosterone deficit syndrome.

Paciente con SDT tras prostatectomía radical / Patient with testosterone deficit syndrome after radical prostatectomy

El síndrome de déficit de testosterona (SDT) define un cuadro clínico y bioquímico asociado a la edad que produce un detrimento en la calidad de vida de estos pacientes. Estudios recientes abogan por la seguridad del tratamiento hormonal con testosterona en pacientes con historia de cáncer de próstata (CP) al no haberse demostrado inducción de este tumor. Un total de cinco publicaciones presentan resultados de 110 pacientes tratados con testosterona con historia de CP intervenidos mediante prostatectomía radical (PR). Solo un paciente presentó recidiva bioquímica durante el tratamiento sustitutivo. La terapia de reemplazamiento con testosterona ha de ser indicada en pacientes seleccionados que se encuentren sintomáticos y con historia de cáncer localizado de bajo riesgo tratado de manera satisfactoria y buen control oncológico. Las cifras de testosterona a alcanzar y mantener serán las mínimas eficaces que permitan obtener una respuesta sintomática. Una correcta y adecuada información de los beneficios y potenciales riesgos han de ser entendidos y aceptados por el paciente (AU)

Testosterone Deficiency Syndrome is associated with age. Recent studies advocate for the safety of hormonal treatment with testosterone in patients with history of Prostate Cancer (PC), once disease-free survival is confirmed. A total of five publications describe 110 patients treated with testosterone replacement therapy, having a history of PC, who had undergone radical prostatectomy (RP). Only one patient had biochemical recurrence during replacement therapy. Testosterone replacement therapy must be indicated in selected patients with history of low risk localized prostate cancer treated satisfactorily who are symptomatic and have good oncological control. The testosterone levels to achieve should be the minimum effective to obtain a symptomatic response. Adequate information on the benefits and potential risks must be understood and accepted by the patient (AU)

Paciente con SDT y DE no respondedor a 5IPDE / Patient with testosterone deficit syndrome and erectile dysfunction non-responder to PDE-5 inhibitors

Los andrógenos juegan un papel fundamental en el mecanismo corporo-venooclusivo que provoca la erección. Según diversos estudios basados en modelos animales, el déficit de testosterona provoca una alteración del endotelio de los cuerpos cavernosos con disminución de secreción de NO, alteración en la estructura del músculo liso y la túnica albugínea del pene y aumento de la cantidad de adipocitos en el tejido eréctil lo que favorece la fibrosis y dificulta la erección. Todas estas alteraciones son reversibles con la administración exógena de andrógenos. No existen estudios suficientes que permitan extraer conclusiones definitivas sobre que el aporte de andrógenos en pacientes con hipogonadismo mejore la función eréctil. Se han publicado estudios en los que parece que la testosterona exógena podría ser útil en el tratamiento de este tipo de pacientes. Sin embargo en la mayoría de estudios aleatorizados doble ciego y comparados con placebo publicados, la administración de testosterona no aporta mayor beneficio sobre la función eréctil que el tratamiento con inhibidores de la fosfodiesterasa 5 (PDE5) exclusivamente. En lo que coinciden todos los estudios es en la necesidad de optimizar el tratamiento con inhibidores de la PDE5 ya que éstos sí han demostrado ser efectivos para el tratamiento de la disfunción eréctil en pacientes con síndrome de déficit de testosterona (AU)

Androgens play an essential role in the corporo-venous occlusive mechanism that provokes erection. Accordingly to various studies based on animal models, testosterone deficit syndrome causes an endothelial disorder in the corpora cavernosa with diminished secretion of NO, alteration of penile smooth muscle and tunica albuginea structure, and increase of the number of adipocytes within the erectile tissue, which favors fibrosis and impairs erection. All these alterations are reversible with the exogenous administration of androgens. There are not enough studies to get definitive conclusions about androgen supply improving erectile dysfunction in patients with hypogonadism. Studies have been published in which seems that exogenous testosterone could be useful in the treatment of this type of patients. Never screetheless, in most published randomized double blind studies comparing with placebo, testosterone supply does not provide greater benefit on erectile dysfunction than PDE-5 Inhibitors exclusively. All studies coincide in the need to optimize the treatment with PDE-5 Inhibitors since they do have proven to be effective for the treatment of erectile dysfunction in patients with testosterone deficit syndrome (AU)

Running demands and heart rate response in rugby union referees.

The aim of this study was to examine the match physical demands and exercise intensity associated with men rugby union refereeing using global positioning system technology. Ten male rugby union referees (age, 37.1 ± 5.9 years; body mass, 83.7 ± 4.8 kg; height, 175.5 ± 6.2 cm) were analyzed 2-4 times during a total of 30 national level matches. The average total distance covered by the referees throughout the game was 6,322.2 ± 564.9 m. As a percentage of total distance, 37.3% (2,356.9 ± 291.3 m) was spent walking, 24.1% (1,524.4 ± 229.4 m) jogging, 10.4% (656.2 ± 130.7 m) running at low intensity, 17.6% (1,110.3 ± 212.2 m) at medium intensity, 5.5% (347.1 ± 27.1 m) at high intensity, and 5.2% (328.1 ± 230.3 m) at sprint. A significant decrease (p < 0.05) in running performance was observed between the first and the second halves in the last 3 speed zones. When the total distance traveled during consecutive 10-minute periods was compared, there was a significantly greater distance covered in the first 10 minutes of the game (876.3 ± 163 m) compared with 50-60 minutes (679.8 ± 117.6 m), 60-70 minutes (713.03 ± 122.3 m), and 70-80 minutes (694.2 ± 125.7 m; all p < 0.05). The average heart rate responses were similar (p > 0.05) in the first (157 ± 7 b · min; 85% HRmax) and second half (155 ± 7 b · min; 84% HRmax). This study provides evidence of reduced high-intensity running toward the end of the game. These findings offer important information to design better training strategies adapted to the requirements and demands of rugby union refereeing.

[Simultaneous double prosthesis implant more artificial urinary sphincter via transscrotal: surgical technique]. / Implante doble simultáneo de prótesis de pene mas esfínter urinario artificial por via transescrotal: técnica quirúrgica.

Moderate-severe urinary incontinence and refractory-to-treatment erectile dysfunction after radical prostatectomy are two entities causing an important loss of quality of life to patients. The double implant of penile prosthesis and artificial urinary sphincter is a safe and effective option in these cases. This article describes preoperative considerations and the most important technical steps to do it satisfactorily.