Gender perspective in the implementation of hygiene in cardiology intensive care.

INTRODUCTION: Hygiene in critical patients is an essential daily care, provided under safe conditions, to promote comfort and maintain the integrity of skin and mucous membranes, however, it can generate feelings of dependence and vulnerability in patients. The aim of this post hoc study is to know the differences in satisfaction and lived experience regarding bed hygiene in an intensive care unit according to biological sex and gender perspective. METHODS: Observational, descriptive and prospective study in which an ad hoc questionnaire was administered to 148 conscious and oriented patients of legal age. The questionnaire was completed 24-48 hours after admission to the unit, once the initial bed hygiene had been performed. RESULTS: Males experienced conformism (51%), embarrassment (31%) and relief (9%); Women felt conformism (35.4%), embarrassment (18.8%) and relief (29.2%) (p < 0.05). Women experienced a feeling of cleanliness in 89.1% compared to 56.1% of men (p < 0.05). Men were offered to wash their genitals in 72.9% compared to 35.7% of women (p < 0.05). 34.3% of men would prefer a family member to assist them during hygiene (62.9% by their wives), compared to 27.1% of women who would prefer a family member (84.6% by their daughters). CONCLUSION: Women tolerate bed hygiene better than men and appreciate more the feeling of cleanliness. Women are identified as caregivers, both professionally and in the family, and patients prefer them to collaborate in the performance of hygiene, being wives preferred by men and daughters preferred by women.

Cirugía en directo: estudio de seguridad tras 17 ediciones de cirugía retroperitoneoscópica / Live surgery: Safety study after 17 editions of retroperitoneoscopic surgery

Introducción: La cirugía en directo se ha convertido en una excelente herramienta para la formación médica. Pese a ello, existe controversia sobre la seguridad de los pacientes que participan.ObjetivoAnalizar los resultados de las cirugías en directo realizadas en 17 cursos consecutivos de retroperitoneoscopia organizados en nuestro centro, en los cuales se intervinieron nefrectomías parciales (NP), nefrectomías radicales (NR) y nefroureterectomías (NU).Material y métodosRevisión realizada desde enero del 2010 a octubre del 2017 de todas las cirugías en directo ejecutadas por un equipo quirúrgico experto en los cursos de retroperitoneoscopia, comparadas con un grupo control de cirugías llevadas a cabo de forma ordinaria y que fue emparejado en relación con la edad, el índice de masa corporal y las comorbilidades (1:1 por cada NR y 1:2 por cada NP y NU).ResultadosSe analizaron 21 cirugías en directo (ocho NP, siete NR y seis NU) con una mediana de seguimiento global de 38 meses. No se observaron diferencias significativas entre las cirugías de los cursos y los controles en cuanto a las variables perioperatorias (tiempo quirúrgico, sangrado operatorio y complicaciones intraoperatorias) ni en las complicaciones postoperatorias y los días de ingreso. Tampoco encontramos diferencias en la tasa de recidiva en los tres grupos (NP: 0% vs. 6,3%, p = 0,47, NU: 33,3% vs. 66,7%, p = 0,180, NR: 0% vs. 28,6%, p = 0,127).ConclusiónLa cirugía en directo realizada, por cirujanos expertos, en un ambiente adecuado y con pacientes idóneos no representa un riesgo añadido de complicaciones para estos y permite mantener los mismos resultados oncológicos. (AU)

Introduction: Live surgery has become an excellent tool for medical training. Despite this, there is controversy about the safety of the patients involved.ObjectiveTo analyze the results of live surgeries performed in 17 consecutive retroperitoneoscopy courses organized in our center. Procedures performed were partial nephrectomy (PN), radical nephrectomy (RN) and nephroureterectomy (NU).Material and methodsReview from January 2010 to October 2017 of all live surgeries carried out by an expert surgical team in the retroperitoneoscopy courses, compared with a control group of surgeries performed in standard conditions. A matching (1:1 for each RN and 1:2 for each PN and NU) according to age, body mass index and comorbidities was performed.ResultsTwenty-one live surgeries were analyzed (eight PN, seven RN and six NU) with a global median follow-up of 38 months. No significant differences were observed between both groups in terms of perioperative variables (operative time, operative bleeding and intraoperative complications) or of postoperative complications and length of hospital stay. Likewise, there were no differences between recurrence rates (PN: 0% vs. 6.3%, p = 0.47, NU: 33.3% vs. 66.7%, p = 0.180, RN: 0% vs. 28.6%, p = 0,127).ConclusionsLive surgery in the hands of expert surgeons in a suitable environment and with well-selected patients does not increase the risk of complications and allows maintaining the same oncological outcomes. (AU)

Beneficios perioperatorios progresivos de la laparoscopia y su combinación con un programa Enhanced recovery after surgery (ERAS) en la cistectomía radical con derivación urinaria heterotópica / Progressive perioperative benefits of laparoscopy in combination with an ERAS (Enhanced Recovery After Surgery) protocol in radical cystectomy with ileal conduit

Introducción: Aunque en los últimos años la laparoscopia y los protocolos de rehabilitación multimodal Enhanced recovery after surgery (ERAS) han demostrado mejorar la recuperación postoperatoria en la cistectomía radical (CR), la eficacia clínica de su asociación aún sigue en estudio. Nuestro objetivo es analizar los posibles beneficios obtenidos de la CR laparoscópica (CRL) y su posterior combinación con ERAS (ERAS-CRL) frente a la CR abierta (CRA).Material y métodosAnalizamos 187CR consecutivas con derivación urinaria heterotópica realizadas en nuestro centro, de las cuales 139 cumplieron los criterios de inclusión: 47CRA, 39CRL (ambas con protocolo convencional) y 52 ERAS-CRLResultadosNo se encontraron diferencias significativas en cuanto a edad, sexo, IMC y ASA entre los 3 grupos. ERAS-CRL obtuvo una estancia hospitalaria más corta que CRL y CRA (mediana 8 [7-10]) vs. 13 [10-17] vs. 15 [13-19,5] días, respectivamente; p<0,001). ERAS-CRL también tuvo una estancia más corta en la UCI y menos días de sonda nasogástrica (p<0,001). Las complicaciones postoperatorias y los reingresos fueron similares en los 3 grupos. La ausencia de complicaciones, una edad más joven y ERAS fueron factores independientes relacionados con una menor estancia hospitalaria, mientras que ERAS fue el único factor independiente asociado con un menor reingreso a los 90 días.ConclusionesAunque la CRL presentó beneficios perioperatorios respecto a la CRA, los resultados fueron mejores tras la implementación de un programa ERAS, siendo el impacto de este último más importante que la técnica quirúrgica utilizada. (AU)

Introduction: Although in the recent years, laparoscopy and Enhanced Recovery After Surgery (ERAS) protocols have improved postoperative recovery in radical cystectomy (RC), the clinical efficacy of their association remains unclear. Our objective is to analyze the possible benefits obtained from laparoscopic RC (LRC) and its subsequent combination with an ERAS (ERAS-LRC) protocol compared to open RC (ORC).Material and methodsWe analyzed 187 consecutive RCs with ileal conduit performed in our center, of which 139 met the inclusion criteria: 47 ORC, 39 LRC (both with conventional protocol) and 52 ERAS-LRCs.ResultsNo significant differences were found regarding age, sex, BMI and ASA score between groups. ERAS-LRC obtained a shorter length of stay than LRC and ORC (median 8 [7-10]) vs. 13 [10-17] vs. 15 [13-19.5] days, respectively; P<.001). ERAS-LRC had a shorter stay in the ICU and less days of nasogastric tube (P<.001). Postoperative complications and readmission rates were similar among groups. Multivariate logistic regression showed that absence of complications, younger age and ERAS behaved as independent factors for shorter hospital stay, while ERAS was the only independent factor of lower readmission rate at 90 days.ConclusionsAlthough LRC presented perioperative benefits compared to ORC, the results were better after the implementation of an ERAS protocol. ERAS protocol had stronger impact on recovery than the surgical approach of the procedure. (AU)

Progressive perioperative benefits of laparoscopy in combination with an ERAS (Enhanced Recovery After Surgery) protocol in radical cystectomy with ileal conduit. / Beneficios perioperatorios progresivos de la laparoscopia y su combinación con un programa Enhanced recovery after surgery (ERAS) en la cistectomía radical con derivación urinaria heterotópica.

INTRODUCTION: Although in the recent years, laparoscopy and Enhanced Recovery After Surgery (ERAS) protocols have improved postoperative recovery in radical cystectomy (RC), the clinical efficacy of their association remains unclear. Our objective is to analyze the possible benefits obtained from laparoscopic RC (LRC) and its subsequent combination with an ERAS (ERAS-LRC) protocol compared to open RC (ORC). MATERIAL AND METHODS: We analyzed 187 consecutive RCs with ileal conduit performed in our center, of which 139 met the inclusion criteria: 47 ORC, 39 LRC (both with conventional protocol) and 52 ERAS-LRCs. RESULTS: No significant differences were found regarding age, sex, BMI and ASA score between groups. ERAS-LRC obtained a shorter length of stay than LRC and ORC (median 8 [7-10]) vs. 13 [10-17] vs. 15 [13-19.5] days, respectively; P<.001). ERAS-LRC had a shorter stay in the ICU and less days of nasogastric tube (P<.001). Postoperative complications and readmission rates were similar among groups. Multivariate logistic regression showed that absence of complications, younger age and ERAS behaved as independent factors for shorter hospital stay, while ERAS was the only independent factor of lower readmission rate at 90 days. CONCLUSIONS: Although LRC presented perioperative benefits compared to ORC, the results were better after the implementation of an ERAS protocol. ERAS protocol had stronger impact on recovery than the surgical approach of the procedure.

Live surgery: Safety study after 17 editions of retroperitoneoscopic surgery. / Cirugía en directo: estudio de seguridad tras 17 ediciones de cirugía retroperitoneoscópica.

INTRODUCTION: Live surgery has become an excellent tool for medical training. Despite this, there is controversy about the safety of the patients involved. OBJECTIVE: To analyze the results of live surgeries performed in 17 consecutive retroperitoneoscopy courses organized in our center. Procedures performed were partial nephrectomy (PN), radical nephrectomy (RN) and nephroureterectomy (NU). MATERIAL AND METHODS: Review from January 2010 to October 2017 of all live surgeries carried out by an expert surgical team in the retroperitoneoscopy courses, compared with a control group of surgeries performed in standard conditions. A matching (1:1 for each RN and 1:2 for each PN and NU) according to age, body mass index and comorbidities was performed. RESULTS: Twenty-one live surgeries were analyzed (eight PN, seven RN and six NU) with a global median follow-up of 38 months. No significant differences were observed between both groups in terms of perioperative variables (operative time, operative bleeding and intraoperative complications) or of postoperative complications and length of hospital stay. Likewise, there were no differences between recurrence rates (PN: 0% vs. 6.3%, p = 0.47, NU: 33.3% vs. 66.7%, p = 0.180, RN: 0% vs. 28.6%, p = 0,127). CONCLUSIONS: Live surgery in the hands of expert surgeons in a suitable environment and with well-selected patients does not increase the risk of complications and allows maintaining the same oncological outcomes.

Urine Extracellular Vesicle GATA2 mRNA Discriminates Biopsy Result in Men with Suspicion of Prostate Cancer.

PURPOSE: Prostate specific antigen has limited performance in detecting prostate cancer. The transcription factor GATA2 is expressed in aggressive prostate cancer. We analyzed the predictive value of urine extracellular vesicle GATA2 mRNA alone and in combination with a multigene panel to improve detection of prostate cancer and high risk disease. MATERIALS AND METHODS: GATA2 mRNA was analyzed in matched extracellular vesicles isolated from urines before and after prostatectomy (16) and paired urine and tissue prostatectomy samples (19). Extracellular vesicle GATA2 mRNA performance to distinguish prostate cancer and high grade disease was tested in training (52) and validation (165) cohorts. The predictive value of a multigene score including GATA2, PCA3 and TMPRSS2-ERG (GAPT-E) was tested in both cohorts. RESULTS: Confirming its prostate origin, urine extracellular vesicle GATA2 mRNA levels decreased significantly after prostatectomy and correlated with prostate cancer tissue GATA2 mRNA levels. In the training and validation cohort GATA2 discriminated prostate cancer (AUC 0.74 and 0.66) and high grade disease (AUC 0.78 and 0.65), respectively. Notably, the GAPT-E score improved discrimination of prostate cancer (AUC 0.84 and 0.72) and high grade cancer (AUC 0.85 and 0.71) in both cohorts when compared with each biomarker alone and PT-E (PCA3 and TMPRSS2-ERG). A GAPT-E score for high grade prostate cancer would avoid 92.1% of unnecessary prostate biopsies, compared to 61.9% when a PT-E score is used. CONCLUSIONS: Urine extracellular vesicle GATA2 mRNA analysis improves the detection of high risk prostate cancer and may reduce the number of unnecessary biopsies.

Impacto del estudio basal con ecografía doppler en pacientes con cáncer de próstata previo a prostatectomía radical / Impact of the baseline study with penile doppler ultrasound in patients with prostate cancer before radical prostatectomy

Introducción: La disfunción eréctil peneana tiene una prevalencia alta entre los 40-70 años, por lo que es importante su valoración basal antes de la prostatectomía radical. Material y métodos: Se ha evaluado la función eréctil (FE) de 112 pacientes con cáncer de próstata previamente a la prostatectomía radical, mediante el dominio de la FE del Índice Internacional de Función Eréctil (IIEF), el test Erectile Hardness Score (EHS) y una ecografía doppler de pene (EDP). Se recogieron comorbilidades, el índice de Charlson y se administró el test de calidad de vida de la EORTC QLQ C-30 y PR-25. Resultados: Un 50,9% de la población tenían una FE normal usando el cuestionario IIEF y un 75,9% conseguían una erección grado 3-4 en el EHS. Únicamente el 28,6% presentaban una EDP normal, y el 51,8% mostraron insuficiencia arterial. Encontramos una asociación significativa (p < 0,0001) entre el IIEF categorizado y el valor de EHS. Se encontró una asociación significativa (p = 0,005) entre la presencia en la EDP (normal vs. patológico) y el EHS (3-4 vs. 1-2). Solo el 35,3% de los pacientes con un EHS de 3-4 tenían una EDP normal. También encontramos una asociación significativa (p = 0,043) entre la EDP y la FE valorada según el IIEF (≥ 26vs.< 26). Únicamente tenían una EDP normal el 38,6% de los pacientes con IIEF ≥ 26. Conclusiones: Es importante una valoración global de la FE para poder valorar las expectativas de recuperación de dicha función tras la cirugía y no reducirla únicamente a test autoadministrados, pudiendo jugar un papel importante la EDP

Introduction: Given the high prevalence of erectile dysfunction in male population between 40-70 years old and the effect of radical prostatectomy on this domain, it is important to perform a baseline study. Material and methods: Prior radical prostatectomy, erectile function has been assessed prospectively in 112 prostate cancer patients using the erectile function (EF) domain of the International Index of Erectile Function (EF-IIEF), Erectile Hardness Score (EHS) and a penile doppler ultrasound (PDUS). Comorbidities and Charlson index were collected. The EORTC QLQ C-30 and PR-25 tests were administered. Results: According to EF-IIEF questionnaire, 50.9% of patients showed normal EF and EHS grade 3-4 erection was achieved in the 75.9%. PDUS was normal only in 28.6% of patients and 51.8% showed arterial insufficiency. We found a significant association (P < .0001) between categorized EF-IIEF (normal, mild/moderate/severe) and the EHS value. Between PDUS (normal vs. pathologic) and EHS (3-4 vs. 1-2) statistically significant association (P = .005) was found. Just 35.3% of patients with EHS 3-4 showed normal PDUS. Correlation between the PDUS and the EF-IIEF (≥2 6 vs.< 26) was statistically significant (P = .043). Moreover, only 38.6% of patients with EF-IIEF ≥ 26 had a normal PDUS. Conclusions: In order to predict EF recovery after surgery, global assessment is required. Solely self-administered tests are not enough. In this baseline study, PDUS can play an important role

Impact of the baseline study with penile doppler ultrasound in patients with prostate cancer before radical prostatectomy. / Impacto del estudio basal con ecografía doppler en pacientes con cáncer de próstata previo a prostatectomía radical.

INTRODUCTION: Given the high prevalence of erectile dysfunction in male population between 40-70 years old and the effect of radical prostatectomy on this domain, it is important to perform a baseline study. MATERIAL AND METHODS: Prior radical prostatectomy, erectile function has been assessed prospectively in 112 prostate cancer patients using the erectile function (EF) domain of the International Index of Erectile Function (EF-IIEF), Erectile Hardness Score (EHS) and a penile doppler ultrasound (PDUS). Comorbidities and Charlson index were collected. The EORTC QLQ C-30 and PR-25 tests were administered. RESULTS: According to EF-IIEF questionnaire, 50.9% of patients showed normal EF and EHS grade 3-4 erection was achieved in the 75.9%. PDUS was normal only in 28.6% of patients and 51.8% showed arterial insufficiency. We found a significant association (P<.0001) between categorized EF-IIEF (normal, mild/moderate/severe) and the EHS value. Between PDUS (normal vs. pathologic) and EHS (3-4 vs. 1-2) statistically significant association (P=.005) was found. Just 35.3% of patients with EHS 3-4 showed normal PDUS. Correlation between the PDUS and the EF-IIEF (≥26 vs.<26) was statistically significant (P=.043). Moreover, only 38.6% of patients with EF-IIEF≥26 had a normal PDUS. CONCLUSIONS: In order to predict EF recovery after surgery, global assessment is required. Solely self-administered tests are not enough. In this baseline study, PDUS can play an important role.

Curative radiation therapy for very elderly bladder cancer patients with localized disease

Purpose: To report the outcomes of a cohort of very elderly muscle-invasive bladder cancer (MIBC) patients treated with contemporary 3D-conformal radiation therapy (3D-CRT) with or without concurrent chemotherapy, after transurethral resection of bladder tumor (TURBT). Methods: From February 2010 to January 2014, a total of 41 patients older than 75 years, with T2-3 N0-1 high-grade MIBC, a Karnofsky index (KI) of at least 90% and/or a Barthel scale score of at least 95, were treated with TURBT followed by radiotherapy (RT) with or without chemotherapy, and were prospectively followed-up. Results: The mean age of patients was 82 years (range 76-88). Median follow-up was 47 months for surviving patients. Mean Charlson Comorbidity Index (CCI) score was 5 points. 28 patients (68.29%) were T2N0. All received 3D-CRT to a mean dose of 60 Gy (range 48.6-66 Gy), and chemotherapy was delivered to 34 patients (83%). Cause-specific survival (CSS) was 86 and 78.8% at 1 and 5 years, respectively. Patients achieving a complete response lived longer (48 vs 14 m, p = 0.036) than those with a progressive disease, who were more likely to die from cancer than from other causes (HR 3.865, IC95% 1.562-9.562). Dead patients had a longest treatment time (mean 56.78 vs 48.91 days, p = 0.019) than survivors. Conclusion: RT with contemporary 3D-CRT techniques after TURBT for MIBC in elderly patients is feasible and well-tolerated. Achieving a maximal response and shortening the total radiation treatment time may improve outcomes and quality of life

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Nefrectomía parcial laparoscópica: estudio comparativo entre la vía transperitoneal y la vía retroperitoneal / Laparoscopic partial nephrectomy: Comparative study of the transperitoneal pathway and the retroperitoneal pathway

Introducción: La nefrectomía parcial laparoscópica es el tratamiento recomendado en aquellos tumores con un tamaño inferior a 4 cm en los cuales sea factible. Dependiendo de la localización del tumor se considerará la vía transperitoneal (VTP) o la vía retroperitoneal directa(VRP). Objetivo: Comparar las nefrectomías parciales VTP y VRP realizadas entre 2007-2016. Material y métodos: Estudio retrospectivo de 71 pacientes sometidos a VTP (42) y VRP (29). Se han evaluado características propias de los pacientes y del tumor, incluyendo la complejidad tumoral (PADUA, RENAL,C-index). Se compararon variables perioperatorias, incluyendo las complicaciones, entre ambas vías. Resultados: No encontramos diferencias en cuanto a edad, género, Charlson o IMC. Encontramos una mayor proporción de pacientes con cirugía mayor abdominal previa en la VRP (7,1 vs. 24,1%; p = 0,043). No hallamos diferencias en el tamaño, en la lateralidad ni la polaridad, ni en la complejidad de los tumores en ninguno de los scores evaluados. Encontramos diferencias significativas en la localización del tumor (anterior/medio/posterior) entre la VTP y la VRP (54,8/31/14,3 vs. 3,4/13,8/82,8%; p < 0,001). No encontramos diferencias en el tiempo quirúrgico ni en los días de estancia. La VTP presentó una menor apertura de la vía urinaria (4,8 vs. 27,6%; p = 0,007) y un mayor porcentaje de pacientes con renorrafia hemostática (47,6 vs. 17,2%; p = 0,008). No se encontró diferencia en la necesidad de isquemia caliente, en los cambios en la hemoglobina ni en el filtrado glomerular. La tasa de complicaciones es similar entre ambas series. Conclusión Ambas vías muestran resultados similares en cuanto a la preservación de la función renal, las complicaciones y los resultados oncológicos. A pesar de ello, consideramos que es recomendable conocer ambas técnicas y adaptar el tipo de acceso al caso clínico

Introduction: Laparoscopic partial nephrectomy is the recommended treatment for tumours smaller than 4 cm in cases where it is feasible. Depending on the location of the tumour, the transabdominal or direct retroperitoneal pathway may be considered. Objective: To compare the transperitoneal (TPPN) and direct retroperitoneal (RPPN) partial nephrectomies performed between 2007 and 2016. Material and methods: A retrospective study was conducted on 71 patients who underwent TPPN (42) or direct RPPN (29) partial nephrectomy. We evaluated the characteristics of the patients and tumours, including tumour complexity (PADUA, RENAL, C-index). We compared perioperational variables, including the complications between the 2 pathways. Results: We found no differences in terms of age, sex, Charlson's score and BMI. A larger proportion of patients in the direct RPPN group had prior major abdominal surgery (7.1 vs. 24.1%; P = .043). There were no differences in tumour size, laterality, polarity or complexity in any of the assessed scores. There were significant differences in tumour location (anterior/middle/posterior) between the TPPN and RPPN groups (54.8/31/14.3 vs. 3.4/13.8/82.8%; P < .001). There were no differences in the surgical time or length of stay. The TPPN group had a smaller urinary tract opening (4.8 vs. 27.6%; P = .007) and a higher percentage of haemostatic renorrhaphy (47.6 vs. 17.2%; P = .008). There were no differences in the need for warm ischaemia, in the changes in haemoglobin levels or in the glomerular filtration rate. The complication rates were similar for the two series. Conclusion: The two pathways show similar results in terms of renal function preservation, complications and oncological results. However, we recommend understanding both techniques and adapting the access type to the clinical case

Correction to: Curative radiation therapy for very elderly bladder cancer patients with localized disease.

In the original version of this article the figure captions of Figs. 1 and 2 were interchanged.

Curative radiation therapy for very elderly bladder cancer patients with localized disease.

PURPOSE: To report the outcomes of a cohort of very elderly muscle-invasive bladder cancer (MIBC) patients treated with contemporary 3D-conformal radiation therapy (3D-CRT) with or without concurrent chemotherapy, after transurethral resection of bladder tumor (TURBT). METHODS: From February 2010 to January 2014, a total of 41 patients older than 75 years, with T2-3 N0-1 high-grade MIBC, a Karnofsky index (KI) of at least 90% and/or a Barthel scale score of at least 95, were treated with TURBT followed by radiotherapy (RT) with or without chemotherapy, and were prospectively followed-up. RESULTS: The mean age of patients was 82 years (range 76-88). Median follow-up was 47 months for surviving patients. Mean Charlson Comorbidity Index (CCI) score was 5 points. 28 patients (68.29%) were T2N0. All received 3D-CRT to a mean dose of 60 Gy (range 48.6-66 Gy), and chemotherapy was delivered to 34 patients (83%). Cause-specific survival (CSS) was 86 and 78.8% at 1 and 5 years, respectively. Patients achieving a complete response lived longer (48 vs 14 m, p = 0.036) than those with a progressive disease, who were more likely to die from cancer than from other causes (HR 3.865, IC95% 1.562-9.562). Dead patients had a longest treatment time (mean 56.78 vs 48.91 days, p = 0.019) than survivors. CONCLUSION: RT with contemporary 3D-CRT techniques after TURBT for MIBC in elderly patients is feasible and well-tolerated. Achieving a maximal response and shortening the total radiation treatment time may improve outcomes and quality of life.

Laparoscopic partial nephrectomy: Comparative study of the transperitoneal pathway and the retroperitoneal pathway. / Nefrectomía parcial laparoscópica: estudio comparativo entre la vía transperitoneal y la vía retroperitoneal.

INTRODUCTION: Laparoscopic partial nephrectomy is the recommended treatment for tumours smaller than 4cm in cases where it is feasible. Depending on the location of the tumour, the transabdominal or direct retroperitoneal pathway may be considered. OBJECTIVE: To compare the transperitoneal (TPPN) and direct retroperitoneal (RPPN) partial nephrectomies performed between 2007 and 2016. MATERIAL AND METHODS: A retrospective study was conducted on 71 patients who underwent TPPN (42) or direct RPPN (29) partial nephrectomy. We evaluated the characteristics of the patients and tumours, including tumour complexity (PADUA, RENAL, C-index). We compared perioperational variables, including the complications between the 2 pathways. RESULTS: We found no differences in terms of age, sex, Charlson's score and BMI. A larger proportion of patients in the direct RPPN group had prior major abdominal surgery (7.1 vs. 24.1%; P=.043). There were no differences in tumour size, laterality, polarity or complexity in any of the assessed scores. There were significant differences in tumour location (anterior/middle/posterior) between the TPPN and RPPN groups (54.8/31/14.3 vs. 3.4/13.8/82.8%; P<.001). There were no differences in the surgical time or length of stay. The TPPN group had a smaller urinary tract opening (4.8 vs. 27.6%; P=.007) and a higher percentage of haemostatic renorrhaphy (47.6 vs. 17.2%; P=.008). There were no differences in the need for warm ischaemia, in the changes in haemoglobin levels or in the glomerular filtration rate. The complication rates were similar for the two series. CONCLUSION: The two pathways show similar results in terms of renal function preservation, complications and oncological results. However, we recommend understanding both techniques and adapting the access type to the clinical case.

Simulation of arsenic retention in constructed wetlands.

The software RCB-arsenic was developed previously to simulate the metalloid behavior in a constructed wetland (CW). The model simulates water flow and reactive transport by contemplating the major processes of arsenic (As) retention inside of CW. The objective of this study was to validate the RCB-arsenic model by simulating the behavior of horizontal flow CW for As removal from water. The model validation was made using data from a 122-day experiment. Two CWs prototypes were used: one planted with Eleocharis macrostachya (CW_planted) and another one unplanted (CW_unplanted) as a control. The prototypes were fed with synthetic water prepared using well water and sodium arsenite (NaAsO2). In the RCB-arsenic model, a CW prototype was represented using a 2D mesh sized in accordance with the experiment. For simulation of As retention in CW, data addition was established in two stages that considered the mechanisms in the system: (1) aqueous complexation, precipitation/dissolution, and adsorption on granular media and (2) retention by plants: uptake (absorption) and rhizofiltration (adsorption). Simulation of As outlet (µg/L) in stage_1 was compared with CW_unplanted; the experimental mean was 40.79 ± 7.76 and the simulated 39.96 ± 6.32. As concentration (µg/L) in stage_2 was compared with CW_planted, the experimental mean was 9.34 ± 4.80 and the simulated 5.14 ± 0.72. The mass-balance simulation and experiment at 122 days of operation had a similar As retention rate (94 and 91%). The calibrated model RCB-arsenic adequately simulated the As retention in a CW; therefore, it constitutes a powerful tool of design.

Effects of oral antioxidant treatment upon the dynamics of human sperm DNA fragmentation and subpopulations of sperm with highly degraded DNA.

The primary aim of this study was to determine the effect of oral antioxidant treatment (1500 mg of l-Carnitine; 60 mg of vitamin C; 20 mg of coenzyme Q10; 10 mg of vitamin E; 10 mg of zinc; 200 µg of vitamin B9; 50 µg of selenium; 1 µg of vitamin B12) during a time period of 3 months upon the dynamics of sperm DNA fragmentation following varying periods of sperm storage (0 h, 2 h, 6 h, 8 h and 24 h) at 37 °C in a cohort of 20 infertile patients diagnosed with asthenoteratozoospermia. A secondary objective was to use the sperm chromatin dispersion test (SCD) to study antioxidant effects upon a specific subpopulation of highly DNA degraded sperm (DDS). Semen parameters and pregnancy rate (PR) were also determined. Results showed a significant improvement of DNA integrity at all incubation points (P < 0.01). The proportion of DDS was also significantly reduced (P < 0.05). Semen analysis data showed a significant increase in concentration, motility, vitality and morphology parameters. Our results suggest that antioxidant treatment improves sperm quality not only in terms of key seminal parameters and basal DNA damage, but also helps to maintain DNA integrity. Prior administration of antioxidants could therefore promote better outcomes following assisted reproductive techniques.

Impacto de las actuaciones farmacéuticas realizadas en un servicio de farmacia hospitalaria / Impact of the pharmaceutical performances in a department of hospital pharmacy

Objetivo: Describir las actuaciones farmacéuticas realizadas en un servicio de farmacia hospitalaria, evaluando su grado de aceptación por parte del personal médico y valorando su significación clínica. Método: Estudio descriptivo y retrospectivo de las actuaciones farmacéuticas realizadas mediante un impreso oficial desde el sistema de distribución de medicamentos en dosis unitarias del servicio de farmacia de un hospital universitario. Variables recogidas: datos sociodemográficos del paciente y datos farmacoterapéuticos de la actuación farmacéutica. La información se registró en una base de datos Microsoft Office Excel®. Para tipificar las actuaciones y valorar su significación o impacto clínico (idoneidad de la actuación farmacéutica) se empleó el método Iaser® modificado y adaptado. Para evaluar el grado de aceptación se utilizó el sistema informático de gestión del servicio de farmacia. El procesamiento estadístico se realizó mediante el programa SPSS®. Resultados: Se registraron 484 actuaciones farmacéuticas durante los 6 meses de duración del estudio. Los grupos ATC mayoritarios de los fármacos implicados fueron: J-antiinfecciosos (37%), C-cardiovascular (23%) y A-digestivo (19%). El grado de aceptación fue casi del 50%. Los motivos más frecuentes de actuación farmacéutica fueron la modificación de la dosis/pauta/vía de administración por una posología inadecuada (39,5%) y plantear alguna alternativa terapéutica debido a un medicamento no incluido en la Guía Farmacoterapéutica (33,1%). En cuanto a la idoneidad de las citadas actuaciones, el 75% se consideraron significativas. Conclusiones: La validación de las prescripciones médicas por parte del farmacéutico permite detectar problemas relacionados con los medicamentos y prevenir y/o resolver resultados negativos asociados a la medicación. Los resultados obtenidos nos indican que sería necesario establecer medidas de mejora para incrementar el grado de aceptación por el personal médico facultativo, como la implantación de un sistema de comunicación más eficaz. La colaboración dentro de un equipo clínico multidisciplinario es necesaria para mejorar la calidad asistencial y garantizar la seguridad de los pacientes (AU)

Objectives: The aim of this study was to describe the pharmacist performances undertaken in a Department of Hospital Pharmacy, to assess the degree of acceptance by the medical staff and to evaluate their clinical significance. Methods: A retrospective and descriptive study about the pharmacist performances done in official form from the Drug Distribution System of medications in Unitary Doses of the Pharmacy Department at the University Hospital. The variables collected were: demographic data of patients and the pharmacotherapy of pharmacist performances. The information was registered into a Microsoft Office Excel® database. A modified and adapted Iaser ® methodology was employed to define the interventions and assess their significance and clinical impact. To evaluate the degree of acceptance, a computerized system of the Pharmacy Department was used. Processing Statistics: SPSS®. Results: A total of 484 pharmacist performances were recorded during the 6 months the study lasted. Major ATC groups of drugs involved were: J-Anti-infective (37%), C-Cardiology (23%) and ADigestive (19%). The degree of acceptance was almost of 50%. The most frequent causes of action were modifications of drug dose / schedule / route of administration for inadequate dosage (39.5%) or suggesting different therapeutical alternatives due to the absence of the drug in the pharmaceutical guide (33.1%). 75% of the pharmacist performances were considered significant. Conclusions: The validation of medical orders by the pharmacist detects drug-related problems and can prevent and resolve negative outcomes associated with medication. The results indicate that it would be necessary to introduce measures of improvement to increase the degree of acceptance by the physician, such as the implantation of more efficient communication systems. The collaboration between a patient care team is absolutely necessary to improve the quality of our health services and ensure the patients safety (AU)

The use of isotonic fluid as maintenance therapy prevents iatrogenic hyponatremia in pediatrics: a randomized, controlled open study.

OBJECTIVES: Hypotonic fluids are widely used in pediatrics. Several articles have reported the risk of iatrogenic hyponatremia secondary to this practice. We primarily intend to determine whether the use of isotonic fluids prevents hyponatremia and, secondly, whether these fluids increase the incidence of adverse events. STUDY DESIGN: One hundred twenty-two pediatric patients hospitalized in intensive care unit requiring maintenance fluid therapy were randomized to receive isotonic fluids (isotonic group, NaCl = 140 mEq/L) or hypotonic fluids (hypotonic group, NaCl <100 mEq/L). Electrolyte blood concentration, glycaemia, and blood pressure were measured at 0, 6, and 24 hrs after the beginning of fluid therapy. Plasma creatinine, urine specific gravity, and urine electrolyte concentration were measured at 6 hrs. Standard intention-to-treat analysis and Bayesian analysis were conducted to assess the probability of hyponatremia and hypernatremia in each group. RESULTS: At the time of admission to hospital, no differences in natremia or the percentage of hyponatremia were found between groups. At 24 hrs, the percentage of hyponatremia in the hypotonic group was 20.6% as opposed to 5.1% in the isotonic group (p = 0.02). No differences in the number of adverse events other than hyponatremia were observed between groups. CONCLUSIONS: The use of hypotonic fluids increases the risk of hyponatremia when compared with isotonic fluids at 24 hrs following infusion (number needed to harm [confidence interval 95%] = 7[4;25]). In our sample, the use of isotonic fluids did not increase the incidence of adverse events compared with hypotonic fluids.

LAMA2 gene analysis in a cohort of 26 congenital muscular dystrophy patients.

Congenital muscular dystrophy type 1A (MDC1A) is caused by mutations in the LAMA2 gene encoding laminin-alpha2. We describe the molecular study of 26 patients with clinical presentation, magnetic resonance imaging and/or laminin-alpha2 expression in muscle, compatible with MDC1A. The combination of full genomic sequencing and complementary DNA analysis led to the particularly high mutation detection rate of 96% (50/52 disease alleles). Besides 22 undocumented polymorphisms, 18 different mutations were identified in the course of this work, 14 of which were novel. In particular, we describe the first fully characterized gross deletion in the LAMA2 gene, encompassing exon 56 (c.7750-1713_7899-2153del), detected in 31% of the patients. The only two missense mutations detected were found in heterozygosity with nonsense or truncating mutations in the two patients with the milder clinical presentation and a partial reduction in muscle laminin-alpha2. Our results corroborate the previous few genotype/phenotype correlations in MDC1A and illustrate the importance of screening for gross rearrangements in the LAMA2 gene, which may be underestimated in the literature.