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There is no population-based study that accounts for the number of radical prostatectomies (RP) carried out in Spain, nor regarding the morbidity and mortality of this intervention. Our objective is to study the morbidity and mortality of RP in Spain from 2011 to 2015 and to evaluate the geographic variation.We designed a retrospective observational study of all patients submitted to RP in Spain during five consecutive years (2011-2015). The data was extracted from the «Conjunto Mínimo Básico de Datos» (CMBD). We have evaluated geographic variations in terms of morbidity and hospital stay, and the impact of the mean annual surgical volume for each center on these variables.Between 2011-2015, a total of 37,725 RPs were performed in 221 Spanish public hospitals. The mean age of the series was 63.9±3.23 years. Of all RPs, 50% were performed through an open approach, and 43.4% have been operated on in hospitals with500 beds. We observed an important variability in the distribution of the cases operated on in the different regions. The regions that perform more RPs are Andalusia, Catalonia, Galicia, and Madrid. Our study shows a complication rate of 8.6%, with hemorrhage and the need for transfusion being the most frequent (5.3 and 4%, respectively). There are significant differences in bleeding rates and hospital stay among regions, which are maintained after adjusting for patient characteristics and type of hospital. When studying the annual surgical volume of each hospital, we find that the impact on the rate of hemorrhage or transfusion is linear; however, hospital stay remains stable at around 5 days from 60 RPs/year.In national terms, morbidity and mortality rates after RP are comparable to those described in the literature. This study reveals a clear dispersion in the hospitals that carry out this intervention, showing clear differences in terms of morbidity and hospital stay between the different regions.

Background: Papillary urothelial neoplasm of low malignant potential (PUN-LMP) was introduced as a noninvasive, noncancerous lesion and a separate grade category in 1998. Subsequently, PUN-LMP was reconfirmed by World Health Organization (WHO) 2004 and WHO 2016 classifications for urothelial bladder tumors. Objectives: To analyze the proportion of PUN-LMP diagnosis over time and to determine its prognostic value compared to Ta-LG (low-grade) and Ta-HG (high-grade) carcinomas. To assess the intraobserver variability of an experienced uropathologist assigning (WHO) 2004/2016 grades at 2 time points. Materials and methods: Individual patient data of 3,311 primary Ta bladder tumors from 17 hospitals in Europe and Canada were available. Transurethral resection of the tumor was performed between 1990 and 2018. Time to recurrence and progression were analyzed with cumulative incidence functions, log-rank tests and multivariable Cox-regression stratified by institution. Intraobserver variability was assessed by examining the same 314 transurethral resection of the tumorslides twice, in 2004 and again in 2018. Results: PUN-LMP represented 3.8% (127/3,311) of Ta tumors. The same pathologist found 71/314 (22.6%) PUN-LMPs in 2004 and only 20/314 (6.4%) in 2018. Overall, the proportion of PUN-LMP diagnosis substantially decreased over time from 31.3% (1990-2000) to 3.2% (2000-2010) and to 1.1% (2010-2018). We found no difference in time to recurrence between the three WHO 2004/2016 Ta-grade categories (log-rank, P = 0.381), nor for LG vs. PUN-LMP (log-rank, P = 0.238). Time to progression was different for all grade categories (log-rank, P < 0.001), but not between LG and PUN-LMP (log-rank, P = 0.096). Multivariable analyses on recurrence and progression showed similar results for all 3 grade categories and for LG vs. PUN-LMP. Conclusions: The proportion of PUN-LMP has decreased to very low levels in the last decade. Contrary to its reconfirmation in the WHO 2016 classification, our results do not support the continued use of PUN-LMP as a separate grade category in Ta tumors because of the similar prognosis for PUN-LMP and Ta-LG carcinomas. (C) 2019 Elsevier Inc. All rights reserved.

Objective To assess compliance with the antibiotic prophylaxis protocol for patients who underwent renal surgery and its effect on the incidence of surgical wound infection. Material and methods We performed a prospective cohort study and assessed the overall compliance and each aspect of the antibiotic prophylaxis (start, administration route, antibiotic of choice, duration and dosage) and reported the compliance rates. The qualitative variables were compared with the chi-squared test, and the quantitative variables were compared with Student's t-test. We studied the effect of antibiotic prophylaxis compliance on the incidence of surgical wound infection in renal surgery, with the relative risk. Results The study included 266 patients, with an overall compliance rate of 90.6%. The major cause of noncompliance (3.8%) was the start of the prophylaxis, and the incidence rate of surgical wound infections was 3.4%. We found no relationship between antibiotic prophylaxis noncompliance and surgical wound infections (RR = 0.26; 95% CI: 0.1–1.2; p > 0.05). Laparoscopic surgery had a lower incidence of surgical wound infections than open surgery (RR = 0.10; 95% CI: 0.01–0.79). Conclusions The antibiotic prophylaxis compliance was high. The incidence of surgical site infection was low, and there was no relationship between the incidence of surgical site infection and antibiotic prophylaxis compliance. The incidence of infection was lower in laparoscopic surgery.

Chemical signals play a decisive role in communication in many mammal species. In red deer (Cervus elaphus), the dark ventral patch has recently been described as a male chemical signal involved in intrasexual competition. Morphological specializations of the hair of this area might contribute to retaining the volatile compounds found here. In this study, we examined differences in the ultrastructure between hair associated with the dark ventral patch and hairs from the dorsolateral region of the body as a control. We obtained a gallery of images from a scanning electron microscope to study the possible variation in the detailed anatomy as well as the surface and pattern of cuticular scales of hairs of the two body regions examined. In addition, we used a 2D-3D microscope to measure hair diameter (thickness) and the shape and size of the cuticular scales. We found that the hairs of the dark ventral patch were narrower than those from the dorsolateral region. We also found a different cuticular scale pattern of the dark ventral patch hairs, suggesting a possible specialization for the retention of compounds associated with this chemical signal. Moreover, some intersexual differences in hair morphology also support this idea. This study shows, for the first time, the differentiation of hairs related to the dark ventral patch, which contributes to our better understanding of this chemical communication in red deer., Ministerio de Economía, Industria y Competitividad, Gobierno de España. Grant Numbers: CGL2013‐48122‐P, CGL2016‐77052‐P.

Resumen Introduccion En los pacientes con cancer de prostata metastasico el pronostico de la enfermedad podria estar modulado por factores como son la localizacion y el numero de metastasis. Nuestro objetivo es evaluar la supervivencia de los pacientes en funcion de estos factores en nuestra serie en los ultimos 15 anos. Material y metodos Estudio retrospectivo de pacientes diagnosticados entre 1998 y 2014. Calculamos la supervivencia global y la supervivencia libre de progresion, en funcion del numero de metastasis y la localizacion de las mismas. Analizamos otros posibles factores pronosticos: edad, estadio clinico, PSA, Gleason, PSA nadir, tiempo hasta PSA nadir y tratamientos de primera linea o segunda linea tras la progresion. Resultados Evaluamos a 162 pacientes con una edad media de 72,7 anos (DE: 8,5). La supervivencia global fue de 3,9 anos (IC95%: 2,6-5,2) Segun la localizacion de las metastasis la supervivencia global fue de 7 anos (IC95%: 4,1-9,7) para los pacientes con metastasis ganglionares; 3,9 anos (IC95%: 2,3-5,5) en caso de metastasis oseas; 2,5 anos (IC95%: 2-2,9) para metastasis oseas y ganglionares; y 2,2 anos (IC95%: 1,4-3) en pacientes con metastasis viscerales (p En el analisis multivariante, la localizacion de las metastasis se asocio significativamente con la supervivencia global y libre de progresion. El numero de metastasis no presento impacto en la supervivencia. Conclusiones La localizacion de las metastasis tiene una clara influencia tanto en la supervivencia global como en la supervivencia libre de progresion, siendo los pacientes con afectacion exclusivamente ganglionar los que presentan mejor pronostico. El numero de metastasis no tiene un efecto significativo en la supervivencia de nuestra serie.

Introduction The prognosis of patients diagnosed with metastatic prostate cancer seems to be modulated by factors such as the number and site of metastases. Our objective is to evaluate survival outcomes according to the number and site of metastases in our series of metastatic patients over the last 15 years. Materials and methods A retrospective analysis was performed on patients diagnosed between 1998 and 2014. We analyzed overall survival and progression-free survival, depending on the number and location of metastases on patients with newly diagnosed metastatic prostate cancer. Other potential prognostic factors were also evaluated: age, clinical stage, PSA at diagnosis, Gleason, PSA nadir, time till PSA nadir and first-line or second-line treatment after progression. Results We analyzed a series of 162 patients. The mean age was 72.7 yr (SD: 8.5). The estimated median overall survival was 3.9 yr (95% CI 2.6–5.2). The overall survival in patients with only lymph node metastases was 7 yr (95% CI 4.1–9.7), 3.9 (95% CI 2.3–5.5) in patients with only bone metastases, 2.5 yr (95% CI 2–2.3) in lymph nodes and bone metastases, and 2.2 yr (95% CI 1.4–3) in patients with visceral metastases (p In multivariate analysis, the location of metastasesis significantly associated with overall survival and progression-free survival. The number of metastases showed no association with survival. Conclusions The site of metastases has a clear impact on both overall survival and progression-free survival. Patients with only lymph node involvement had a better prognosis. The number of metastases showed no significant impact on survival in our series.

Herbivory is a major factor affecting both the performance and the fitness of the species composing a plant community and, ultimately, conditioning its temporal and spatial dynamics. Coastal dunes are a typical example of primary succession where different biotic and abiotic factors determine plant species occurrence; however, the effect of insect herbivory herein has remained little explored. To address this matter, we combined an observational study along a successional gradient with a green-house experiment to determine the occurrence and the impact of plant-aphid interactions. We focused on the species Schizaphis rufula, a widespread and abundant aphid associated with dune grasses in early stages of primary succession in Europe. Firstly, we studied aphid infestation rates on the dune grass Ammophila arenaria along a succession gradient in three locations of the North Sea coast to address the relationship between plant community composition and aphid occurrence; secondly, we tested the effect of aphid herbivory on a set of dune species typical for the different stages of succession. We found that the degree of aphid infestation was inversely correlated with the degree of dune fixation. The results of the experiment showed that aphid multiplication was significantly higher and its effect more pronounced on two early successional grass species, i.e. A. arenaria and Leymus arenarius. Here aphid multiplication resulted in a severe decrease in plant biomass; in late successional grass species, there was limited multiplication and no effect on biomass. The results of the field survey and the green-house experiment indicate that aphids show a clear preference for plants from early successional stages and, moreover, they have a greater impact on these plant species. All this supports the hypothesis of aphid herbivory as a driving factor of primary succession in coastal dunes.

Resumen Introduccion La linfadenectomia en el cancer de prostata (CP) es el procedimiento mas fiable para la deteccion de metastasis linfaticas. La extension optima de la misma aun es un tema en debate. Objetivo Analizar el rendimiento diagnostico y las complicaciones de la linfadenectomia ampliada (LFDNA) y limitada (LFDNL) en una serie de pacientes con CP de alto riesgo sometidos a prostatectomia radical (PR). Material y metodos Estudio retrospectivo de pacientes con CP de alto riesgo de D’Amico sometidos a PR con linfadenectomia entre 1999- 2014. Analisis comparativo de la capacidad de diagnostico de metastasis linfaticas de la LFDNA y LFDNL y de las complicaciones postoperatorias a 90 dias. Resultados Se analizaron 93 pacientes, 20 (21,5%) sometidos a LFDNA y 73 (78,5%) a LFDNL. La edad media de la serie fue de 65,26 anos (DE 5,51). La mediana de seguimiento fue de 1,51 (0,61-2,29) anos en el grupo de LFDNA y 5,94 (3,61-9,10) en LFDNL. La mediana de ganglios obtenidos fue de 13 (9-23) en las LFNDA vs. 5 (2-8) en las limitadas (p El porcentaje global de complicaciones a 90 dias fue 35,5% (33 pacientes). Del grupo de LFDNA 12 pacientes (60%) presentaron complicaciones, frente a 21 (28,8%) en LFDNL (p = 0,016), sin encontrar diferencias significativas en la gravedad segun la escala de Clavien (p = 0,73). Conclusiones En nuestra serie, la deteccion de ganglios metastasicos ha sido significativamente superior en la LFDNA. La LFDNA aumenta el numero de complicaciones, sin encontrar diferencias con la LFDNL en la gravedad segun la escala de Clavien modificada.

Background Lymphadenectomy for prostate cancer (PC) is the most reliable procedure for detecting lymphatic metastases. The optimal extension of this procedure is still a topic of debate. Objective To analyze the diagnostic performance and complications of extended lymphadenectomy (ELD) and limited lymphadenectomy (LLD) in a series of patients with high-risk PC who underwent radical prostatectomy (RP). Material and methods A retrospective study was conducted on patients with high d’Amico risk who underwent RP with lymphadenectomy between 1999 and 2014. A comparative analysis was performed of the diagnostic capacity of lymphatic metastases of ELD and LLD and of postoperative complications at 90 days. Results Ninety-three patients were analyzed, 20 (21.5%) and 73 (78.5%) of whom underwent ELD and LLD, respectively. The mean age of the series was 65.26 years (SD, 5.51). The median follow-up was 1.51 (0.61–2.29) years in the ELD group and 5.94 (3.61–9.10) in the LLD group. The median number of nodes obtained was 13 (9–23) in the ELD group compared with 5 (2–8) in the LLD group (p

Introduction and objective Prostate photovaporisation with Greenlight laser for the surgical treatment of benign prostate hyperplasia has rapidly evolve to the new XPS 180 W. We have previously demonstrated the safety and efficacy of the HPS 120 W. The aim of this study was to assess the functional and safety results, with a year of follow-up, of photovaporisation using the XPS 180 W laser compared with its predecessor. Material and methods A cohort study was conducted with a series of 191 consecutive patients who underwent photovaporisation between 1/2008 and 5/2013. The inclusion criteria were an international prostate symptom score (IPSS) >15 after medical failure, a prostate volume We assessed preoperative and intraoperative variables (energy used, laser time and total surgical time), complications, catheter hours, length of stay and functional results (maximum flow, IPSS, prostate-specific antigen and prostate volume) at 3, 6 and 12 months. We analyzed the homogeneity in preoperative characteristics of the 2 groups through univariate analysis techniques. The postoperative functional results were assessed through an analysis of variance of repeated measures with mixed models. Results A total of 109 (57.1%) procedures were performed using HPS 120 W, and 82 (42.9%) were performed using XPS. There were no differences between the preoperative characteristics. We observed significant differences both in the surgical time and effective laser time in favor of the XPS system. This advantage was 11% (48 ± 15.7 vs. 53.8 ± 16.2, p Conclusion The technical improvements in the XPS 180 W system help reduce surgical time, maintaining the safety and efficacy profile offered by the HPS 120 W system, with completely superimposable results at 1 year of follow-up.

Resumen Introduccion y objetivo La fotovaporizacion prostatica con laser Greenlight, para el tratamiento quirurgico de la hiperplasia benigna de prostata ha evolucionado rapidamente hasta el nuevo XPS 180 W. Demostramos anteriormente la eficacia y seguridad con el HPS 120 W. El objetivo de este estudio ha sido evaluar los resultados funcionales y de seguridad, con un ano de seguimiento, de la fotovaporizacion mediante el XPS 180 W comparandolo con su predecesor. Material y metodos Estudio de cohortes sobre una serie de 191 pacientes consecutivos sometidos a fotovaporizacion entre 01/2008 y 05/2013. Los criterios de inclusion fueron un IPSS >15 tras fracaso medico, un volumen prostatico Se analiza la homogeneidad en las caracteristicas preoperatorias de los dos grupos mediante tecnicas de analisis univariante. Los resultados funcionales postoperatorios se evaluan mediante analisis de la varianza de medidas repetidas con modelos mixtos. Resultados Se realizaron 109 (57,1%) procedimientos mediante HPS 120 W y 82 (42,9%) mediante XPS. No se encontraron diferencias entre las caracteristicas preoperatorias. Se observaron diferencias significativas tanto en el tiempo quirurgico como en el tiempo efectivo de laser a favor del sistema XPS, siendo esta ventaja de un 11% (48 ± 15,7 vs. 53,8 ± 16,2, p Conclusion Las mejorias tecnicas del sistema XPS 180 W permiten reducir el tiempo quirurgico manteniendo el perfil de seguridad y eficacia que ofrecia el sistema HPS 120 W con unos resultados totalmente superponibles con un ano de seguimiento.

The world population is ageing, and life expectancy is increasing. This situation will have a great impact on the management of patients with prostate cancer, especially in those of low risk, susceptible to a conservative management under active surveillance (AS). Regarding these patients' profile, it is necessary to answer the following questions: ¿for how long to continue with the AS scheme?, ¿which tests will be required?, ¿is it possible to carry out a transition to observation with oncological safety? The objective of this work is to analyse those patients with prostatic cancer who have been in AS with 75 years of age or more and assess the safety of the observation in an AS series with a long follow-up.We analysed our prospective cohort of AS patients between the years 1999 and 2018,including those who had been in follow-up with 75 years or more. They were offered treatment with curative intent when there were progression criteria and transition to observation under the urologist's decision. Some intermediate risk patients were included in the analysis. Comorbidity changes were analysed with the Charlson comorbidity index at entry and exit of AS. The progression and mortality of the patients were studied according to the management they received.From 347 AS patients, 90 patients fulfilled the afore mentioned criteria and 15 (16.7%) were intermediate risk. The median follow-up was 6.4 years and 73 (81.1%) had low comorbidity (Charlson2).There were 40 (44.4%) patients who left AS, 17 (18.9%) of them went to observationand the rest, 21 (23.3%), received curative treatment. There was a significant difference in comorbidity, measured by the Charlson index, at entry and exit of AS (P.05) among patients receiving active treatment and the ones submitted to observation.No case of cancer-specific death or progression was observed in the observation group.The transition from an active surveillance management to observation of prostate cancer elderly patients, as well as the decision to carry out a treatment with curative intent, seems controversial. In our series, this transition in patients older than 75 years does not increase the oncological risk.

To assess compliance with the antibiotic prophylaxis protocol for patients who underwent renal surgery and its effect on the incidence of surgical wound infection.We performed a prospective cohort study and assessed the overall compliance and each aspect of the antibiotic prophylaxis (start, administration route, antibiotic of choice, duration and dosage) and reported the compliance rates. The qualitative variables were compared with the chi-squared test, and the quantitative variables were compared with Student's t-test. We studied the effect of antibiotic prophylaxis compliance on the incidence of surgical wound infection in renal surgery, with the relative risk.The study included 266 patients, with an overall compliance rate of 90.6%. The major cause of noncompliance (3.8%) was the start of the prophylaxis, and the incidence rate of surgical wound infections was 3.4%. We found no relationship between antibiotic prophylaxis noncompliance and surgical wound infections (RR=0.26; 95%CI: 0.1-1.2; P.05). Laparoscopic surgery had a lower incidence of surgical wound infections than open surgery (RR=0.10; 95%CI: 0.01-0.79).The antibiotic prophylaxis compliance was high. The incidence of surgical site infection was low, and there was no relationship between the incidence of surgical site infection and antibiotic prophylaxis compliance. The incidence of infection was lower in laparoscopic surgery.

Introduction Active surveillance for prostate cancer has grown systematically in the recent years with more robust mid-term outcomes. However, changes in Gleason score during serial biopsies are not detailed in many of these reports. Objectives To evaluate changes in Gleason score on follow-up biopsies in low-risk prostate cancer in patients undergoing AS program in our center. Materials and methods Series of patients diagnosed of prostate cancer between 2004 and 2013 have been analyzed. The inclusion criteria were: PSA ≤ 10 ng/ml + Gleason ≤ 6 + T1c/T2a + ≤ 2 positive cores, and no more than 50% of affected core. The pathology of each of the biopsies was analyzed. Results We studied a series of 175 patients undergoing AS. Mean follow-up was 3.96 years (SD 2.4). Follow-up biopsies with Gleason scores ≥ 7 were: 5.72% in the first biopsy, 7.39% and 7.41% in subsequent biopsies. By contrast, 42.03% of cases did not show evident tumor involvement in the first biopsy, 40.74% and 51.85% in the second and third biopsies respectively. Median stay in the AS program was: 90.99 months (CI 95%: 53.53–128.46) in patients with first positive biopsy vs. 96.66 months (CI 95%: 63.19–130.13) in those without evidence of tumor. Conclusions In our series the pathological data of the first 3 biopsies remain stable in terms of the positive biopsy rate, Gleason score, or indication of active treatment proportions. Those patients who do not show evidence of malignancy in the first follow-up biopsy are less likely to need active treatment than the other patients in the series.

Resumen Introduccion Las series publicadas sobre vigilancia activa (VA) son cada vez mas numerosas. La variacion del Gleason a lo largo de las biopsias de seguimiento no se detalla en muchas de estas publicaciones. Objetivos Evaluar los cambios en el grado de Gleason de las biopsias de seguimiento en pacientes con cancer de prostata de bajo riesgo en programa de VA. Material y metodos Analisis de pacientes diagnosticados entre 2004 y 2013. Criterios de inclusion: PSA ≤ 10 ng/ml, Gleason ≤ 6, T1c/T2a, ≤ 2 cilindros positivos, afectacion maxima del cilindro de un 50%. Se analizaron los datos anatomopatologicos de cada una de las biopsias. Resultados Serie de 175 pacientes incluidos en vigilancia activa con media de seguimiento de 3,96 anos (DE: 2,4). Las tasas de Gleason ≥ 7 en las biopsias de seguimiento fueron: 5,72% en la primera biopsia, 7,39% y 7,41% en las biopsias sucesivas. Por el contrario, no se evidencio afectacion tumoral en el 42,03% de los casos en la primera biopsia, 40,74% y 51,85% en segunda y terceras biopsias respectivamente. La mediana de permanencia en el programa en los pacientes con la primera biopsia positiva fue 90,99 meses (IC 95%: 53,53-128,46) vs 96,66 meses (IC 95%: 63,19-130,13) en aquellos sin evidencia de malignidad. Conclusiones En nuestra serie las 3 primeras biopsias se mantienen con unas proporciones estables en cuanto a positividad de la biopsia, grado de Gleason o indicacion de tratamiento activo. Los pacientes que en la primera biopsia de seguimiento no tienen evidencia de malignidad tienen menor probabilidad de necesitar tratamiento activo que el resto de la serie.

Objectives To determine the causes of death and risk factors in systemic sclerosis (SSc). Methods Between 2000 and 2011, we examined the death certificates of all French patients with SSc to determine causes of death. Then we examined causes of death and developed a score associated with all-cause mortality from the international European Scleroderma Trials and Research (EUSTAR) database. Candidate prognostic factors were tested by Cox proportional hazards regression model by single variable analysis, followed by a multiple variable model stratified by centres. The bootstrapping technique was used for internal validation. Results We identified 2719 French certificates of deaths related to SSc, mainly from cardiac (31%) and respiratory (18%) causes, and an increase in SSc-specific mortality over time. Over a median follow-up of 2.3 years, 1072 (9.6%) of 11 193 patients from the EUSTAR sample died, from cardiac disease in 27% and respiratory causes in 17%. By multiple variable analysis, a risk score was developed, which accurately predicted the 3-year mortality, with an area under the curve of 0.82. The 3-year survival of patients in the upper quartile was 53%, in contrast with 98% in the first quartile. Conclusion Combining two complementary and detailed databases enabled the collection of an unprecedented 3700 deaths, revealing the major contribution of the cardiopulmonary system to SSc mortality. We also developed a robust score to risk-stratify these patients and estimate their 3-year survival. With the emergence of new therapies, these important observations should help caregivers plan and refine the monitoring and management to prolong these patients' survival. ©Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Resumen Objetivo Evaluar la seguridad del alta hospitalaria a las 24 h tras prostatectomia radical laparoscopica y determinar posibles factores asociados con estancias hospitalarias mas prolongadas. Material y metodos Estudio retrospectivo de pacientes con diagnostico clinico de cancer de prostata localizado, intervenidos consecutivamente entre mayo de 2007 y diciembre de 2010 mediante prostatectomia radical laparoscopica. Los pacientes fueron dados de alta en menos de 24 h en el caso de cumplir los siguientes requisitos: ausencia de complicaciones medicas, debito del drenaje menor de 50 cc, tolerancia oral normal, no hematuria significativa por sonda vesical y buena recuperacion funcional del paciente. Realizamos un analisis de regresion logistica para evaluar las posibles variables asociadas con ingreso mayor de 24 h. Resultados Se analizaron un total de 266 pacientes. La mediana de seguimiento fue de 34 meses. Ochenta (30,1%) pacientes fueron dados de alta en menos de 24 h.La estancia media (DE) de la serie global fue de 2,9 dias (3,08). En el analisis univariado solo las variables HTA, preservacion de haces neurovasculares y la realizacion de linfadenectomia resultaron estadisticamente diferentes entre ambos grupos (alta 24 h). En el analisis multivariado solo la HTA con OR de 1,98 (IC 95%: 1,13-3,47) p = 0,016 y la realizacion de linfadenectomia con OR de 2,56 (IC 95%: 1,18-5,56) p = 0,017 resultaron ser variables predictivas independientes para estancias hospitalarias mayores de 24 h. Conclusiones El alta temprana de los pacientes intervenidos mediante PRL es factible y seguro. En nuestra serie la realizacion de linfadenectomia y la HTA fueron factores asociados a una estancia hospitalaria mas prolongada.

Objective To assess the safety of hospital discharge 24 h after laparoscopic radical prostatectomy and to identify possible factors associated with longer hospital stays. Materials and methods Retrospective study of patients diagnosed with localized prostate cancer who underwent laparoscopic radical prostatectomy consecutively between May 2007 and December 2010. Those patients who met the following requirements were discharged in less than 24 h: absence of complications, drainage debit minor than 50 cc, normal oral tolerance, no significant bladder haematuria and good functional recovery. Logistic regression analysis was conducted in order to assess the possible associated variables with longer hospital stays. Results A total of 266 patients were analyzed. The follow-up median was 34 months. Eighty patients (30.1%) were discharged in less than 24 h. Average stay (SD) of all series was 2.9 days (3.08). Solely HTA, neurovascular bundles sparing and the development of lymphadenectomy were statistically significant between both groups in univariate analysis (discharge 24 h). In multivariate analysis, only HTA (OR = 1.98 [CI 95%: 1.13–3.47], P = .016) and lymphadenectomy performance (OR = 2.56 [CI 95%: 1.18–5.56] P = .017) were independent predictive variables of hospital stays longer than 24 h. Conclusions Early hospital discharge of patients who underwent LRP is feasible and safe. In our series, the lymphadenectomy performance and the HTA were associated factors for longer hospital stay.

Resumen Objetivo Determinar si existen diferencias en cuanto a seguridad oncologica tras prostatectomia radical (factores anatomonopatologicos y recidiva bioquimica) en funcion de los criterios de inclusion empleados en 2 protocolos de vigilancia activa (VA). Material y metodos Cuatrocientos cuarenta y dos pacientes con cancer de prostata (CP) localizado sometidos a prostatectomia radical laparoscopica en nuestro centro entre agosto de 2003 y diciembre de 2009. Seleccionamos pacientes con CP de bajo riesgo, potenciales candidatos a un programa de vigilancia activa. Se dividieron los pacientes en 2 grupos; grupo i : cumplian los criterios mas estrictos descritos por Epstein (dPSA ii : cumplian criterios mas laxos descritos por Klotz (PSA ≤ 10 o Resultados De los 442 pacientes un 48%(213 pacientes) habrian sido potenciales candidatos a un programa de VA. Del total de pacientes operados el 17% (76 pacientes) cumplian criterios segun Epstein y un 48%(213 pacientes) segun Klotz. Comparando los pacientes de ambos grupos no existieron diferencias estadisticamente significativas en la presencia de pT3 (7,9 vs 10,8%) p = 0,55, margenes positivos (22,4 vs 28,3%) p = 0,41, ni recidiva bioquimica a 3 anos (5,3 vs 5,6%) p = 0,86. Conclusiones En nuestra serie, en pacientes teoricamente candidatos a inclusion en un programa de vigilancia activa, no encontramos diferencias en cuanto a porcentaje de pacientes con estadio patologico pT3, margenes positivos ni recidiva bioquimica en funcion de los criterios clinicos de inclusion empleados.

Objective To determine whether there are differences in the oncological outcomes after radical prostatectomy (adverse patology and biochemical recurrence) based on clinical selection criteria used in two active surveillance (AS) protocols. Materials and methods 442 patients diagnosed with localized prostate cancer (CP) underwent radical prostatectomy at our institution between August 2003 and December 2009. We selected patients with low-risk CP, which could have been included in an AS program. Patients were divided into two groups: group i, those who met the most strict surveillance criteria described by Epstein (PSAD

Resumen Objetivos Evaluar la aceptacion del seguimiento activo por los pacientes en nuestro entorno asistencial y describir los resultados clinicos de un programa de vigilancia activa en pacientes con cancer de prostata de bajo riesgo. Material y metodos Estudio prospectivo de pacientes incluidos en programa de vigilancia activa en nuestro centro entre 2004 y 2012. Los criterios de inclusion fueron: PSA Resultados En el ano 2011, del total de pacientes potenciales candidatos, tan solo un 17% de los mismos rechazo la inclusion en un programa de vigilancia y fue tratado de forma activa. Analizamos una serie de 144 pacientes incluidos en nuestro protocolo de vigilancia activa. La media de seguimiento fue de 3,22 anos (DE: 2,08). Ciento diez pacientes (76,3%) permanecen en seguimiento activo, con una mediana estimada de supervivencia libre de tratamiento tras el diagnostico de 6,9 anos (IC 95%: 6,2-7,6%). El porcentaje de pacientes que permanecen libres de tratamiento a 2 y 5 anos fue de 96,3% (IC 95%: 92,8-99,8%) y 70,9% (IC 95%: 59,3-85,5%) respectivamente. Treinta y cuatro pacientes (23,6%) precisaron tratamiento curativo. La media de tiempo hasta el tratamiento fue de 4,6 anos (DE: 2,3). Conclusiones La vigilancia activa en pacientes altamente seleccionados con cancer de prostata de bajo riesgo es una alternativa terapeutica valida de tratamiento y aceptada por los pacientes de nuestro entorno.

Resumen Introduccion La prevalencia de escoliosis en la enfermedad de Charcot-Marie-Tooth (CMT) se estima entre el 10 y el 38%. El objetivo del estudio es analizar la prevalencia de deformidades raquideas asociadas al CMT en nuestra poblacion, y los datos epidemiologicos y clinicos de los pacientes. Material y metodos Se realizo un estudio descriptivo retrospectivo de 30 pacientes afectos de CMT, valorados entre enero de 2001 y diciembre de 2010. Se analizo el sexo, la edad de diagnostico y el subtipo de CMT, la edad de aparicion de la escoliosis, las caracteristicas de la curva, la evolucion y el tratamiento. Resultados El 46,7% de los ninos presento escoliosis. La edad media de aparicion de la escoliosis fue 10,21 anos y la magnitud media de la curva en el momento del diagnostico fue de 13,85°. Un 42,85% eran toracolumbares, y el 50% asociaban cifosis. Se valoro la evolucion en los pacientes con un seguimiento superior a 3 anos y Risser ≥ 3, de los que el 50% presento progresion. Se indico tratamiento ortesico a 5 pacientes y ninguno preciso tratamiento quirurgico. Se observo mayor incidencia de escoliosis en los varones, un 78,5%, y en los pacientes que habian sido intervenidos de deformidad de los pies, un 62,5%, sin que exista relacion estadisticamente significativa en ninguno de los 2 casos. Conclusiones La prevalencia de escoliosis en CMT es muy superior a la de la poblacion general. Son curvas de amplio radio y con frecuencia asocian cifosis. No encontramos rapida progresion y los pacientes responden al tratamiento ortesico. Deben identificarse precozmente mediante exploracion sistematica del raquis.

Objectives To evaluate the acceptance of active monitoring by patients treated in our healthcare community and to report the clinical results of an active surveillance program in patients with low-risk prostate cancer. Materials and methods Prospective study of patients enrolled in an active surveillance program at our center between 2004 and 2012. The inclusion criteria were PSA Results In 2011, only 17% of the total number of potential candidate patients rejected their inclusion in a surveillance program and were treated actively. We analyzed a series of 144 patients included in our active surveillance protocol. The mean follow-up time was 3.22 years (SD 2.08). A total of 110 patients (76.3%) remained under active monitoring, with an estimated median treatment-free survival after diagnosis of 6.9 years (95% CI: 6.2–7.6). The percentage of patients who remained free of treatment at 2 and 5 years was 96.3% (95% CI: 92.8–99.8%) and 70.9% (95% CI: 59.3–85.5%), respectively. Thirty-four patients (23.6%) required curative treatment. The mean time to treatment was 4.6 years (SD 2.3). Conclusions Active surveillance of highly selected patients with low-risk prostate cancer is a valid alternative therapy that is accepted by patients in our community.

We report the case of a 55 year-old man who consulted for pruritic bullous lesions of three months onset located on the body, hands and scalp. After ruling out various illnesses to justify the situation described, it was thought that the cause could be pharmacological. The patient had been on treatment with hydrochlorothiazide for several years due to hypertension. The lesions improved with the withdrawal of diuretic therapy, and the introduction of oral corticosteroids.

The prognosis of patients diagnosed with metastatic prostate cancer seems to be modulated by factors such as the number and site of metastases. Our objective is to evaluate survival outcomes according to the number and site of metastases in our series of metastatic patients over the last 15 years.A retrospective analysis was performed on patients diagnosed between 1998 and 2014. We analyzed overall survival and progression-free survival, depending on the number and location of metastases on patients with newly diagnosed metastatic prostate cancer. Other potential prognostic factors were also evaluated: age, clinical stage, PSA at diagnosis, Gleason, PSA nadir, time till PSA nadir and first-line or second-line treatment after progression.We analyzed a series of 162 patients. The mean age was 72.7yr (SD: 8.5). The estimated median overall survival was 3.9 yr (95% CI 2.6-5.2). The overall survival in patients with only lymph node metastases was 7 yr (95% CI 4.1-9.7), 3.9 (95%CI 2.3-5.5) in patients with only bone metastases, 2.5 yr (95% CI 2-2.3) in lymph nodes and bone metastases, and 2.2 yr (95% CI 1.4-3) in patients with visceral metastases (P.001). In multivariate analysis, the location of metastasesis significantly associated with overall survival and progression-free survival. The number of metastases showed no association with survival.The site of metastases has a clear impact on both overall survival and progression-free survival. Patients with only lymph node involvement had a better prognosis. The number of metastases showed no significant impact on survival in our series.

We present the case of a patient with chronic low back pain with an unfavourable progression despite the prescribed pharmacological treatment. The patient had symptoms associated with compression of the sciatic nerve in an atypical area. As it passed through the piriformis muscle, it was diagnosed as piriformis muscle syndrome. This diagnosis was based on the clinical signs and symptoms and the determination of the tests performed, with the imaging tests being absolutely normal. Treatment is basically with non-steroidal anti-inflammatory drugs, muscle relaxants and stretching exercises of this muscle.

Body condition-dependent dispersal strategies are common in nature. Although it is obvious that environmental constraints may induce a positive relationship between body condition and dispersal, it is not clear whether positive body conditional dispersal strategies may evolve as a strategy in metapopulations. We have developed an individual-based simulation model to investigate how body condition-dispersal reaction norms evolve in metapopulations that are characterized by different levels of environmental stochasticity and dispersal mortality. In the model, body condition is related to fecundity and determined either by environmental conditions during juvenile development (adult dispersal) or by those experienced by the mother (natal dispersal). Evolutionarily stable reaction norms strongly depend on metapopulation conditions: positive body condition dependency of dispersal evolved in metapopulation conditions with low levels of dispersal mortality and high levels of environmental stochasticity. Negative body condition-dependent dispersal evolved in metapopulations with high dispersal mortality and low environmental stochasticity. The latter strategy is responsible for higher dispersal rates under kin competition when dispersal decisions are based on body condition reached at the adult life stage. The evolution of both positive and negative body condition-dependent dispersal strategies is consequently likely in metapopulations and depends on the prevalent environmental conditions.

To report our experience with a select group of patients with low-risk tumors included in an observation and monitoring program after the diagnosis of recurrence.We performed a prospective cohort study in patients diagnosed with recurrent, nonmuscle-invasive bladder cancer maintained under an active surveillance protocol. The inclusion criteria were papillary tumors with negative cytology findings, previous nonmuscle-invasive tumor (Stage pTa, pT1a), grade 1-2, size1 cm, and number of tumors5. No symptomatic patients or those with carcinoma in situ or grade 3 tumors were included. A retrospective analysis of a control group of patients with clinical characteristics similar to those of the patients on active surveillance, but who underwent transurethral resection immediately after the recurrence was diagnosed was also performed.The data from 64 patients (70 observation events) were analyzed. The mean patient age was 66.7 years. The median follow-up was 38.6 months. The median time patients remained in observation was 10.3 months. The tumor histologic features before observation were Stage pTa in 77.1%, Stage pT1a in 22.9%, grade 1 in 67.1%, and grade 2 in 23%. After 10.3 months, 93.5% of the patients had not progressed in stage and 83.8% had not progressed in grade. None of the patients experienced progression to muscle-invasive disease. A comparison between the rates of progression in the study and control groups showed no statistically significant difference.Patients with recurrent, small (1 cm), nonmuscle-invasive bladder tumors can be safely offered monitoring under an active surveillance protocol, with a minimal risk of progression in either grade or stage, thus reducing the amount of surgical intervention they might undergo throughout their life.

A survey for plant-root parasites in Tara National Park, Serbia, revealed the widespread occurrence of Trichodoridae, present in nearly one-third of the samples. Several species appeared to belong to the Trichodorus aequalis species complex sensu Loof (1973). The taxonomic value of the observed variations in diagnostic features within this species complex is discussed. A new species Trichodorus pseudobursatus n. sp. is described. It is characterised by males with a nearly straight habitus, two ventromedian cervical papillae anterior to the secretory-excretory pore, medium-sized and mostly straight spicules with wider manubrium continuous with the blade; blade with a smooth narrower part with a few bristles at mid-spicule, followed by a wider striated posterior part devoid of bristles. Females are characterised by a large, well developed pear-shaped vagina with medium-sized, rounded triangular and well separated vaginal sclerotised pieces in lateral optical view. In addition to the diagnostic morphological features, differentiation of the new species from other Serbian morphotypes of the Trichodorus sparsus species complex was supported by canonical discriminant analyses (CDA). Additional information is provided for T. sparsus and three T. aff. sparsus morphotypes from Serbia. The discovery of the genus Trichodorus in Serbia represents a new geographical record.

Lymphadenectomy for prostate cancer (PC) is the most reliable procedure for detecting lymphatic metastases. The optimal extension of this procedure is still a topic of debate.To analyse the diagnostic performance and complications of extended lymphadenectomy (ELD) and limited lymphadenectomy (LLD) in a series of patients with high-risk PC who underwent radical prostatectomy (RP).A retrospective study was conducted on patients with high d'Amico risk who underwent RP with lymphadenectomy between 1999 and 2014. A comparative analysis was performed of the diagnostic capacity of lymphatic metastases of ELD and LLD and of postoperative complications at 90 days.Ninety-three patients were analysed, 20 (21.5%) and 73 (78.5%) of whom underwent ELD and LLD, respectively. The mean age of the series was 65.26 years (SD, 5.51). The median follow-up was 1.51 (0.61-2.29) years in the ELD group and 5.94 (3.61-9.10) in the LLD group. The median number of nodes obtained was 13 (9-23) in the ELD group compared with 5 (2-8) in the LLD group (p.001). The percentages of patients with positive nodes in the ELD and LLD groups were 35% and 5.47%, respectively (p.001). The overall complication rate at 90 days was 35.5% (33 patients). In the ELD group, 12 patients (60%) had complications, compared with 21 patients (28.8%) in the LLD group (p=.016), with no significant differences in severity according to the Clavien scale (p=.73).In our series, the detection of metastatic nodes was significantly greater with ELD. ELD increases the number of complications, with no differences compared with LLD in severity according to the modified Clavien scale.

Prostate photovaporisation with Greenlight laser for the surgical treatment of benign prostate hyperplasia has rapidly evolve to the new XPS 180W. We have previously demonstrated the safety and efficacy of the HPS 120W. The aim of this study was to assess the functional and safety results, with a year of follow-up, of photovaporisation using the XPS 180W laser compared with its predecessor.A cohort study was conducted with a series of 191 consecutive patients who underwent photovaporisation between 1/2008 and 5/2013. The inclusion criteria were an international prostate symptom score (IPSS)15 after medical failure, a prostate volume80 cm(3) and a maximum flow15 mL/s. We assessed preoperative and intraoperative variables (energy used, laser time and total surgical time), complications, catheter hours, length of stay and functional results (maximum flow, IPSS, prostate-specific antigen and prostate volume) at 3, 6 and 12 months. We analysed the homogeneity in preoperative characteristics of the 2 groups through univariate analysis techniques. The postoperative functional results were assessed through an analysis of variance of repeated measures with mixed models.A total of 109 (57.1%) procedures were performed using HPS 120W, and 82 (42.9%) were performed using XPS. There were no differences between the preoperative characteristics. We observed significant differences both in the surgical time and effective laser time in favour of the XPS system. This advantage was 11% (48 ± 15.7 vs. 53.8 ± 16.2, p.05) and 9% (32.8 ± 11.7 vs. 36 ± 11.6, p.05), respectively. There were no statistically significant differences in the rest of the analysed parameters.The technical improvements in the XPS 180W system help reduce surgical time, maintaining the safety and efficacy profile offered by the HPS 120W system, with completely superimposable results at 1 year of follow-up.

Resumen Tratamiento De La Inestabilidad Vesical (Vejiga Hiperactiva No Neurogena) En Ninos, Con Tolterodina Introduccion La vejiga hiperactiva (VHA) se engloba dentro de las disfunciones miccionales no neurogenas, cuya prevalencia ha sido bien definida en la poblacion general, no asi en la edad pediatrica. Las manifestaciones clinicas son variadas y tiene especial importancia en los ninos su asociacion con otras patologias como la enuresis, el reflujo vesico-ureteral (RVU) y las infecciones de repeticion. El tratamiento fundamental se realiza con farmacos anticolinergicos. La eficacia del cloruro de oxibutinina ha sido suficientemente contrastada, sin embargo la dosificacion y los efectos secundarios, aunque escasos en los ninos, son motivo de interrupcion del tratamiento. Objetivos Como alternativa para el tratamiento de la VHA se ha utilizado la tolterodina en adultos con eficacia, sin embargo su uso no ha sido suficientemente valorado en ninos. Deseamos determinar la eficacia y tolerabilidad de dicho farmaco en la poblacion infantil afecta de VHA. Material Y Metodos Estudio retrospectivo de 72 ninos diagnosticados de VHA no neurogena y virgenes de tratamiento. En todos los casos se practico un protocolo diagnostico de patologia urologica concomitante asi como estudio urodinamico (EUD) y exploracion neurologica. En un grupo de estos pacientes se realizo EUD post-tratamiento. Resultados La edad media fue de 10,9 anos y fueron evaluados entre 4 y 31 meses tras iniciar el tratamiento. Hubo curacion demostrada con cistomanometria en el 67% de los casos, 14% mejoraron y un 19% no presento variacion en el EUD. Segun los criterios del International Children´s Continence Society (ICCS) aplicados a los ninos sin EUD post-tratamiento, el 51% se curaron, un 27% mejoro y finalmente un 22% no tuvo mejoria Ningun paciente tuvo que suspender el tratamiento por efectos secundarios. Conclusiones La tolerancia y efectividad de la tolterodina es buena en la poblacion pediatrica y constituye una alternativa a los clasicos anticolinergicos en el tratamiento de la VHA.

Resumen El estres profesional o sindrome de burnout es un trastorno de frecuente incidencia entre los profesionales de enfermeria, que conlleva unos costes considerables en el ambito personal, laboral y social. En este trabajo realizamos un estudio de diseno transversal, mediante encuestas, sobre la relacion del nivel de burnout con variables de tipo personal, laboral y organizativo, en una muestra de 150 enfermeros/as (85 DUE y 65 auxiliares), pertenecientes a 5 unidades clinicas en 4 centros hospitalarios de la provincia de Badajoz. Nuestros resultados revelan que factores como el bajo nivel de satisfaccion laboral, una actitud disfuncional de excesiva necesidad de aprobacion y una insuficiente valoracion social percibida por el enfermero/a se relacionan con mayores niveles de estres profesional

Active surveillance for prostate cancer has grown systematically in the recent years with more robust mid-term outcomes. However, changes in Gleason score during serial biopsies are not detailed in many of these reports.To evaluate changes in Gleason score on follow-up biopsies in low-risk prostate cancer in patients undergoing AS program in our center.Series of patients diagnosed of prostate cancer between 2004 and 2013 have been analyzed. The inclusion criteria were: PSA ≤ 10 ng/ml + Gleason ≤ 6 + T1c/T2a + ≤ 2 positive cores, and no more than 50% of affected core. The pathology of each of the biopsies was analyzed.We studied a series of 175 patients undergoing AS. Mean follow-up was 3.96 years (SD 2.4). Follow-up biopsies with Gleason scores ≥ 7 were: 5.72% in the first biopsy, 7.39% and 7.41% in subsequent biopsies. By contrast, in 42.03% of cases did not show evident tumor involvement in the first biopsy, 40.74% and 51.85% in the second and third biopsies respectively. Median stay in the AS program was: 90.99 months (95% CI: 53.53-128.46) in patients with first positive biopsy vs. 96.66 months (95% CI: 63.19-130.13) in those without evidence of tumor.In our series the pathological data of the first 3 biopsies remain stable in terms of the positive biopsy rate, Gleason score, or indication of active treatment proportions. Those patients who do not show evidence of malignancy in the first follow-up biopsy are less likely to need active treatment than the other patients in the series.

One of the key challenges in science and technology is the evaluation of knowledge generated in either one or the other. This paper presents a case study where the use of acquired knowledge -in the form of lessons learned-applied to process improvement, meets the target of reduction of production costs for secondary -recycled-aluminium, and how this means that an intangible (knowledge embodied in software) can become tangible (a reduction in production costs), thus eligible to be reported in the company's balance sheet.