Laparoscopic and robotic pyeloplasty as minimally invasive alternatives to the open approach for the treatment of uretero-pelvic junction obstruction in infants: a multi-institutional comparison of outcomes and learning curves.

BACKGROUND: Since the development of minimally invasive surgery (MIS), laparoscopic and robotic approaches have been widely adopted. However, little has been published detailing the learning curve of MIS, especially in infants. OBJECTIVE: To quantify the learning curve of laparoscopic (LP) and robot-assisted laparoscopic pyeloplasty (RAL-P) for treatment of uretero-pelvic junction obstruction (UPJO) in infants evidenced by number of cases, operative time, success and complications. PATIENTS AND METHODS: Between 2009 and 2017, we retrospectively reviewed pyeloplasty cases for treatment of UPJO in infants at three academic institutions. The primary outcome was success. Secondary outcomes were UPJO recurrence, complications, and operative time as a surrogate of skill acquisition. Continuous variables were analyzed by t test, Welch-test, and one-way ANOVA. Non-continuous variables were analyzed by Chi-squared test or Fisher's exact test. Learning curves (LC) were studied by r-to-z transformation and CUSUM. RESULTS: Thirty-nine OP, 26 LP, and 39 RAL-P had mean operative times (OT) of 106, 121, and 151 min, respectively. LCs showed plateau in OT after 18 and 13 cases for LP and RAL-P, respectively. RAL-P showed a second phase of further improvements after 37 cases. At 16 months follow-up, there were similar rates of success and complications between the three groups. CONCLUSIONS: Despite different duration of learning phases, proficiency was achieved in both LP and RAL-P as evidenced by stabilization of operative time and similar success rates and complications to OP. Before and after achievement of proficiency, LP and RAL-P can be safely learned and implemented for treatment of UPJO in infants.

Multi-Sensor Data Fusion for Real-Time Surface Quality Control in Automated Machining Systems.

Multi-sensor data fusion systems entail the optimization of a wide range of parameters related to the selection of sensors, signal feature extraction methods, and predictive modeling techniques. The monitoring of automated machining systems enables the intelligent supervision of the production process by detecting malfunctions, and providing real-time information for continuous process optimization, and production line decision-making. Monitoring technologies are essential for the reduction of production times and costs, and an improvement in product quality, discarding the need for post-process quality controls. In this paper, a multi-sensor data fusion system for the real-time surface quality control based on cutting force, vibration, and acoustic emission signals was assessed. A total of four signal processing methods were analyzed: time direct analysis (TDA), power spectral density (PSD), singular spectrum analysis (SSA), and wavelet packet transform (WPT). Owing to the nonlinear and stochastic nature of the process, two predictive modeling techniques, multiple regression and artificial neural networks, were evaluated to correlate signal parametric characterization with surface quality. The results showed a high correlation of surface finish with cutting force and vibration signals. The signal processing methods based on signal decomposition in a combined time and frequency domain (SSA and WPT) exhibited better signal feature extraction, detecting excitation frequency ranges correlated to surface finish. The artificial neural network model obtained the highest predictive power, with better behavior for the whole data range. The proposed on-line multi-sensor data fusion provided significant improvements for in-process quality control, with excellent predictive power, reliability, and response times.

[Reliability and validity of the Acquired healthy lifestyle assessment scale (E-VEVSA) in adults from Albacete and Murcia (Spain)]. / Fiabilidad y validez de la Escala de valoración del estilo de vida saludable adquirido (E-VEVSA) en adultos de Albacete y Murcia (España).

BACKGROUND: Lifestyle is a theoretical construct that is formed by the life habits of a subject. The analysis and objective quantification of lifestyle can have a great impact on people's health, as well as on the evolution of its status over the years. The objective of this research has been the validation of the Acquired Healthy Lifestyle Assessment Scale (E-VEVSA) in Spanish adults. METHOD: On an initial sample for the exploratory tests of 248 subjects and a final sample for the confirmatory tests of 780 subjects, aged between 22 and 72 years of age. Exploratory and confirmatory psychometric tests were carried out based on the Cronbach's alpha statistic (reliability) and exploratory factorial analysis with oblique rotation (oblimin) and confirmatory with varimax rotation (construct validity), which resulted in an instrument made up of 52 items and structured in 7 dimensions: individual responsibility in health care (9 items), habits of physical-sports practice (6 items), health habits in social relationships (10 items), habit of tobacco and alcohol consumption (9 items), habit of healthy eating (7 items), psychological health habits (6 items) and daily rest and sleep habits (5 items). RESULTS: All the items explained a total variance of 66.87% and a Cronbach's alpha of .894, with the partial alpha of each dimension or factor being above .700. CONCLUSIONS: The results show psychometric tests that confirm the validity of the E-VEVSA scale as a useful instrument to measure the healthy lifestyle acquired among adults.

Effects of whole-body vibration and resistance training on knee extensors muscular performance.

Whole-body vibration (WBV) is being promoted as an efficient complement to resistance training. The aim of this study was to investigate the effects of an 8-week program of WBV in combination with resistance training on knee extensors muscular performance. A group of 29 young adults (25 men, 4 women; age 21.8 ± 1.5) performed a WBV plus resistance training program (WBV + RES) or an identical exercise program in absence of vibration (placebo plus resistance training, PL + RES). Participants were evaluated for anthropometry, muscle strength (half-squat three repetition maximum, 3RM), knee extensors isokinetic dynamometry (180° and 60° s(-1)) and counter-movement jump (CMJ). After the intervention, percent body fat significantly decreased 2.1% only in WBV + RES (P < 0.001), while muscle mass significantly increased in both groups (P < 0.01): 2.2 and 2.8 kg in PL + RES and WBV + RES, respectively. No significant differences were observed in isokinetic strength or CMJ, and 3RM significantly increased in both groups (P < 0.001): 64.2 kg (52% of baseline) in PL + RES, and 46.9 kg (43%) in WBV + RES. The addition of WBV to resistance training during 8 weeks, in recreationally active young adults, did not result in a larger muscular performance improvement compared to an identical exercise program in absence of vibration. Muscle mass also seemed to be equally affected with or without vibration, yet body fat could be exclusively decreased by WBV. Further research is required to clarify whether WBV, as a complement to resistance training, produces additional specific benefits.

Update on smoking. Alternatives for the management of patients with cardiovascular risk.

Smoking is the leading cause of morbidity and mortality worldwide and is clearly involved as a cardiovascular risk factor. Smoking has different effects on the cardiovascular system, such as a decrease in nitric oxide, increased inflammatory response, increased adhesion of pro-atherogenic molecules, lipid disturbances, generation of oxidative stress and endothelial dysfunction as can be shown in different biomarkers modifications. Despite the aids currently available for smoking cessation, many smokers are unwilling or unable to achieve this. So alternative tools with potential harm reduction, such as non-combustion tobacco products, could be an option due to the better results they had shown on cardiovascular risk factors. This has led these devices to be taken into account as a risk-modifying tobacco product according to the FDA.

68Ga-PSMA-11 PET/CT in patients with occult biochemical recurrence of prostate carcinoma and negative 18F-Choline PET/CT. Preliminary assessment of its clinical use.

OBJECTIVE: To assess the clinical usefulness of 68Ga-PSMA PET/CT studies in patients with occult biochemical recurrence of prostate carcinoma, with negative or inconclusive radiologic and 18 F-Choline PET/CT imaging studies. MATERIAL AND METHODS: Retrospective descriptive study. The first 14 patients with a history of prostate carcinoma, treated with curative intent and presenting suspicion of biochemical recurrence with low PSA values (<3 ng/mL) were selected. Imaging studies, prostate ultrasound, pelvic CT and/or MRI were negative, and all of them had a negative or inconclusive 18F-Choline PET/CT. All patients were referred to 68 Ga-PSMA-11 PET/CT. PROTOCOL: Dose 2.2 M Bq/kg. 20 mg furosemide at start. PET/CT images from skull base to proximal third of thighs at 60 min, and late images at 3 h if needed. RESULTS: The 68 Ga-PSMA-11 PET/CT was able to localize the occult biochemical recurrence in 9 of the 14 patients (64.2%), and it affected the therapeutic attitude in all of them. Four patients (28.5%) obtained a negative or inconclusive 68 Ga-PSMA-11 PET/CT and continued under vigilant approach with PSA controls and imaging studies according to the clinical guidelines. These patients had the lowest PSA values (less than 1 ng/mL). One of the 68 Ga-PSMA-11 PET/CT studies was inconclusive, reporting the presence of a doubtful right iliac adenopathy. CONCLUSION: 68 Ga-PSMA-11 PET/CT allows an early diagnosis, with low PSA values, of occult biochemical recurrence of prostate carcinoma, even in patients with negative 18 F-Choline PET/CT.

Effect of boar seminal dose type (cervical compared with post-cervical insemination) on cooling curve, sperm quality and storage time.

Seminal doses used for cervical and post-cervical artificial insemination (CAI and PCAI, respectively) vary in volume, the number of spermatozoa and packaging. The aim was to evaluate the outcomes when there was use of routine processing procedures for CAI- and PCAI-doses. Two different types of seminal doses were processed: 1) CAI: 2.7 × 109 sperm/80 ml; 2) PCAI: 1.5 × 109 sperm/45 ml. In Experiment 1, the cooling curve of seminal doses during processing occurred in two phases: 1st) At room temperature (23.4 ±â€¯0.5 °C) from 0 (just after packaging) to 120 min; 2nd) At refrigeration (15.7 ±â€¯0.8 °C) from 121-240 min. For the PCAI-doses, the time required to reach room temperature was 47 min compared to 107 min for CAI-doses (decreasing velocity of 0.093 °C/min and 0.048 °C/min, respectively). During refrigeration, for the PCAI-doses the time required to reach the desired preservation temperature was 20 min less than for CAI-doses (PCAI: 90 min, 0.074 °C/min; CAI: 110 min, 0.066 °C/min). In Experiment 2, sperm motility, kinetic parameters and acrosome damage for both types of doses were evaluated at 0, 24, 48 and 72 h of refrigeration. Also, morphology, pH, and osmolality were assessed at 0 and 72 h. Values for all these did not differ between CAI- and PCAI-doses. In conclusion, PCAI-doses took less time than CAI-doses to reach the desired temperature, but sperm quality was similar for CAI- and PCAI-doses during storage. Nevertheless, the different cooling curves should be taken into consideration for further investigation.

Validity of tests performed to diagnose acute abdominal pain in patients admitted at an emergency department.

OBJECTIVE: To determine the real importance of anamnesis, physical examination, and various tests in the assessment of acute abdominal pain. METHODS: A retrospective observational study with patients complaining of abdominal pain at the Emergency Department, Altiplano Health Area (Murcia) was performed. In our study we considered the following variables: socio-demographic data, history of previous surgery, symptoms, place and type of pain. Imaging tests were labeled as positive, negative, or inconclusive for assumed diagnoses, which were retrospectively assessed by an external radiologist who was unaware of the patient s final diagnosis. RESULTS: Our study includes 292 patients with a mean age of 45.49 years; 56.8% of these patients were women. Regarding the frequency of the different acute abdomen diagnoses, appendicitis was the main cause (approx. 25%), followed by cholecystitis (10%). We found a significant diagnostic correlation between pain location in the right hypochondrium (RHC) and a diagnosis with cholecystitis. This location was also significant for acute appendicitis (up to 74%). Regarding clinical signs, we only observed a significant correlation between fever and viscera perforation, and between Murphy s sign and cholecystitis. Sensitivity and specificity found in relation to the psoas sign were similar to those seen in other series, 16 and 95% respectively, and slightly lower than the Blumberg or rebound sign, which we found to be around 50 and 23%, respectively. CONCLUSIONS: a) Anamnesis and physical examination offer limited accuracy when assessing acute abdomen; b) ultrasound scans offer a low diagnostic agreement index for appendicitis; and c) laparoscopy may prove useful for diagnosis, and is also a possible treatment for acute abdominal pain despite its low diagnostic efficiency.

[Influence of a programme of therapeutic exercise on different clinical indicators related to dyslipidaemia in adult subjects aged between 26 to 73 years with a cardiovascular risk factor]. / Influencia de un programa de ejercicio físico terapéutico en diferentes indicadores clínicos relacionados con la dislipidemia en sujetos adultos de 26 a 73 años con algún factor de riesgo cardiovascular.

INTRODUCTION: A sedentary lifestyle is indicated in the international literature as one of the main causes for the onset of some cardiovascular risk factors. OBJECTIVE: To assess the effect of a therapeutic physical exercise programme on different clinical indicators related to dyslipidaemia (total cholesterol, HDL and LDL) in sedentary subjects with a cardiovascular risk factor. METHOD: Intervention study with before-and-after evaluation of a sample of 340 patients (132 males and 208 females) referred from the 2 primary care centres of the municipality of Molina de Segura (Murcia), and who participated in a 30-week programme of physical exercise combining muscle-conditioning work circuits with other cardio-respiratory resistance workouts. Regarding the clinical indicators, the health professionals collected in the medical history the health indicators corresponding to the biological evolution of the process for which the subjects studied had started the physical exercise programme. RESULTS: The statistical analyses showed a significant improvement (p<.005) in the LDL indicator and a non-significant improvement in total and HDL cholesterol indicators after a 3-month exercise programme of 3 weekly sessions. CONCLUSIONS: The prescription of physical exercise in dyslipidaemic subjects from primary care centre should be evaluated as a resource for improving the clinical indicators specific to their pathology.

Morphological changes in the porcine cervix: A comparison between nulliparous and multiparous sows with regard to post-cervical artificial insemination.

In recent decades, new artificial insemination (AI) methods, such as post-cervical AI (PCAI), have been developed in pig. PCAI involves crossing the cervix to deposit the sperm in the uterine body. Although PCAI application in sows is frequent, its application in nulliparous (gilts) females it is still limited due to the difficulty of passing through the cranial part of the cervical lumen. We hypothesized that ageing and parity would modify the cervical canal, facilitating the introduction of AI devices through the cervix. The aim was to compare the morphology of the uterus at different levels between multiparous and nulliparous females. Morphological analysis of the uterus pointed to a longer cervix (25.9 ±â€¯4.6 vs. 21.6 ±â€¯3.3 cm, p < 0.001) and greater length of the part of the reproductive tract involved in PCAI (from rima vulvae to the last cervical cushion) (56.2 ±â€¯6.0 vs. 50.3 ±â€¯5.2 cm, p < 0.001) in multiparous sows compared with nulliparous animals. As regards the structure of the vaginal and uterine parts of the cervix (the part in contact with the vagina and uterine body, respectively), the cross-sectional area, perimeter and total thickness were greater in the uterine part of multiparous than of nulliparous animals (area: 4.07 ±â€¯1.46 vs. 2.46 ±â€¯0.56 cm2, p < 0.01; perimeter: 8.50 ±â€¯1.44 cm vs. 6.28 ±â€¯0.92 cm, p < 0.001; thickness: 10.79 ±â€¯0.96 vs. 8.35 ±â€¯0.62 mm, p < 0.05), but not in the vaginal part. The tissue content analysed in histological cross-sections also showed differences between female groups, a greater content of connective tissue (58.86 ±â€¯10.78 vs. 67.60 ±â€¯13.38%, p < 0.001) and a lower amount of muscle fibres (39.79 ±â€¯10.24 vs. 30.66 ±â€¯13.69%, p < 0.001) being observed in multiparous sows. Finally, silicone casts of the cervical lumen revealed differences between the two groups in the size and shape of the ridges in the lumen trajectory. Parity, which is also influenced by ageing, determines important changes in the size, structure and tissue content of the cervix wall, as well as in the morphology of the cervical canal, which may be responsible for the different levels of performance of PCAI in the female populations. Therefore, the future design of AI strategies and catheters should take into consideration the morphological variations of the cervix lumen, which will depend on age and parity of the females.

Post-cervical artificial insemination in porcine: The technique that came to stay.

The porcine industry is of great importance worldwide, and so any technological innovation in one or more of the associated production areas is of interest for meat production. Among such innovations in the reproduction area, post-cervical or intrauterine artificial insemination (PCAI) has emerged as a new approach in artificial insemination (AI). PCAI is gradually replacing traditional cervical insemination (CAI), particularly in countries with intensive pig production industries. This type of insemination, which deposits the semen in the body of the uterus (as opposed to traditional cervical deposition), is increasingly used in the field due to its simplicity and the numerous advantages that it provides at production level (e.g. reduced number of sperm, less time required to perform insemination and faster genetic improvement) and, consequently, from an economic point of view. In addition, since its inception, PCAI has been combined with other reproductive biotechnologies, such as the use of frozen-thawed sperm, fixed-time AI or sperm-mediated gene transfer. However, despite its wide acceptance and application, new approaches for increasing the efficiency of PCAI are constantly being sought, such as the adjustment and standardization in sperm numbers, the conservation of the PCAI semen dose, its association with other biotechnologies (sex-sorted sperm) or its efficacy in young (nulliparous and primiparous) females.

T7 RNA polymerase studied by force measurements varying cofactor concentration.

RNA polymerases carry out the synthesis of an RNA copy from a DNA template. They move along DNA, incorporate nucleotide triphosphate (NTP) at the end of the growing RNA chain, and consume chemical energy. In a single-molecule assay using the T7 RNA polymerase, we study how a mechanical force opposing the forward motion of the enzyme along DNA affects the translocation rate. We also study the influence of nucleotide and magnesium concentration on this process. The experiment shows that the opposing mechanical force is a competitive inhibitor of nucleotide binding. Also, the single-molecule data suggest that magnesium ions are involved in a step that does not depend on the external load force. These kinetic results associated with known biochemical and mutagenic data, along with the static information obtained from crystallographic structures, shape a very coherent view of the catalytic cycle of the enzyme: translocation does not take place upon NTP binding nor upon NTP cleavage, but rather occurs after PPi release and before the next nucleotide binding event. Furthermore, the energetic bias associated with the forward motion of the enzyme is close to kT and represents only a small fraction of the free energy of nucleotide incorporation and pyrophosphate hydrolysis.

[Outcome of Henoch-Schönlein nephropathy in pediatric patients. Prognostic factors]. / Evolución de la nefropatía de Schönlein-Henoch en pacientes pediátricos. Factores pronósticos.

OBJECTIVE: To analyze epidemiological, clinical and laboratory data, renal survival curve and short-term (2 years) and long-term (5 years) prognostic factors in children with nephropathy secondary to Henoch-Schönlein purpura (HSP). MATERIALS AND METHODS: Retrospective analitic cohort study. Clinical records of 100 children diagnosed with HSP at H.I.U. La Fe from 1975-2006 were reviewed. Statistical analysis was by univariate and multivariate analysis. RESULTS: In 67% of cases, nephropathy coincided with onset of the disease and most commonly manifested hematuria with nonnephrotic proteinuria. 35% of patients were biopsied. The most common histology was mesangial proliferation (46%). Clinical stages at diagnosis were stage B: 63%, stage C: 33%; stage D: 4%. Mean follow-up was 5.25 +/- 0.76 years. Renal data at 5 years: Clinical stages: stage A: 49%, stage B: 27%, stage C: 0%, and stage D: 5%. Renal transplant: 5%. Renal survival curve (Kaplan-Meier) at 5 years: 95%. Prognostic factors: The univariate analysis showed that the prognostic factors of poor renal prognosis in both the short and long-term were age greater than 8 years, number of purpura relapses greater than 4 and presence of stage VI histology. The multivariate analysis showed that only the number of relapses was a short-term prognostic factor. CONCLUSION: 1) The clinical and laboratory data reviewed were similar to those reported in the literature. 2) The renal survival curve at 5 years was 95%. 3) Age, number of relapses and histology were prognostic factors. 4) The multivariate analysis showed that only the number of relapses was a short-term prognostic factor.

Simulation in paediatric urology and surgery, part 2: An overview of simulation modalities and their applications.

Surgical training has changed radically in the last few decades. The traditional Halstedian model of time-bound apprenticeship has been replaced with competency-based training. In our previous article, we presented an overview of learning theory relevant to clinical teaching; a summary for the busy paediatric surgeon and urologist. We introduced the concepts underpinning current changes in surgical education and training. In this next article, we give an overview of the various modalities of surgical simulation, the educational principles that underlie them, and potential applications in clinical practice. These modalities include; open surgical models and trainers, laparoscopic bench trainers, virtual reality trainers, simulated patients and role-play, hybrid simulation, scenario-based simulation, distributed simulation, virtual reality, and online simulation. Specific examples of technology that may be used for these modalities are included but this is not a comprehensive review of all available products.

Evidence-based treatment of multicystic dysplastic kidney: a systematic review.

OBJECTIVES: There is a lack of a standardised protocol for the investigation and non-operative management of paediatric multicystic dysplastic kidney (MCDK). Institutional protocols for non-operative management remain essentially ad hoc. The primary outcome of this systematic review is to establish the incidence of hypertension associated with an MCDK. The secondary outcome is to determine the malignancy risk associated with an MCDK. The tertiary outcome is to assess the rate of MCDK involution. Subsequent to these, an evidence-based algorithm for follow-up is described. METHODOLOGY: A systematic review of all relevant studies published between 1968 and April 2017 was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were identified by specific inclusion and exclusion criteria, all of which included data relevant to the primary, secondary and tertiary outcomes. Hypertension was defined as systolic blood pressure greater than the 95th centile for gender, age and height centile. Subset analysis was performed for hypertension associated with an MCDK. RESULTS: The primary outcome measure revealed a 3.2% (27/838) risk of developing hypertension associated with an MCDK. The secondary outcome measure noted a 0.07% malignancy risk (2/2820). The tertiary outcome measure established that 53.3% (1502/2820) had evidence of involution of the dysplastic kidney. A total of 44 cohort studies (2820 patients) were analysed. CONCLUSION: Given the low risk of hypertension and malignancy, which is similar to the general population, the current conservative non-operative pathway is an appropriate management strategy. An algorithm to help support clinicians with ongoing management is proposed.

Paediatric cystolitholapaxy through the Mitrofanoff/Monti channel.

INTRODUCTION: Bladder calculi are a known complication of bladder augmentation. Open cystolithotomy remains the preferred option for treating large or multiple stones. Increasingly, however, minimal access techniques have been used. Reports of Mitrofanoff cystolitholapaxy are rare and have been limited to adults. This study presented a two centre series of children treated by cystolitholapaxy via the Mitrofanoff/Monti channel. MATERIALS AND METHODS: With institutional approval the current study retrospectively reviewed and identified 14 patients, on a prospective database, who underwent Mitrofanoff cystolitholapaxy to treat bladder calculi at two independent institutions in the UK and Chile between 2004 and 2016. It looked at patient demographics, surgical technique, stone clearance and recurrence, as well as leak or catheterisation difficulties of the Mitrofanoff/Monti channel post-procedure. RESULTS: Fourteen patients underwent Mitrofanoff cystolitholapaxy during the period 2004-2016. One patient was excluded due to lack of follow-up. The remaining 13 patients were aged 5-22 (median 14) years at the time of the procedure. Their underlying diagnoses were four neuropathic bladders, four bladder exstrophy, four cloacal exstrophy and one posterior urethral valve. Patients underwent augmentation cystoplasty at a median age of 5 (range 1-15) years, using ileum in 10 and sigmoid colon in three. The channel for clean intermittent catheterisation was an appendix Mitrofanoff in nine and a Monti channel in four. An Amplatz sheath was placed through the Mitrofanoff to allow safe access to the bladder for treating the stones (see Summary Table). Recurrent stones were treated using the same technique. Stone and channel outcomes were analysed for each procedure. There were 22 procedures in 13 patients; five (38%) patients had recurrent stones. Median time to recurrence was 6 months. There were no immediate complications. Stone clearance was confirmed by ultrasound and abdominal x-ray at 3-6 months after the procedure. Median follow-up was 15 (range 3-53) months. There were no leaks or difficulties catheterising the channel on follow-up. DISCUSSION: This was the first series of Mitrofanoff/Monti cystolitholapaxy for the treatment of calculi in augmented bladders of paediatric patients. Previous concerns about damaging the continence mechanism of the conduit appeared to be unwarranted. The use of an Amplatz sheath protected the continence system from repeated instrumentation, and permitted free backflow of irrigation and rapid clearance of stone fragments. Recurrence of stones occurred in 38%, which was in keeping with rates reported in the wider literature. CONCLUSION: Mitrofanoff cystolitholapaxy was safe, and with appropriate care did not result in leakage or difficulty catheterising.

[Analysis of clinical relevance applied to 3methods of reducing weight in overweight or obesity followed-up for one year]. / Análisis de relevancia clínica aplicado a 3métodos de reducción de peso en pacientes con sobrepeso u obesidad seguidos durante un año.

OBJECTIVE: To analyse the effect of the use/implementation of 3methods to reduce weight in overweight or obese patients during one year of follow up. MATERIAL AND METHODS: The design corresponds to a double-blind, randomised, controlled clinical trial with 3arms, and 12 months of follow-up. Patients were randomised into 3intervention groups: obesity motivational intervention, with a nurse previously trained in motivational intervention by expert psychologists (G1; n=60); lower intensity consultation, non-motivational group, with digital platform support (G2; N=61), and a third group that received recommendations for weight loss and follow-up in Primary Care Clinic (G3; n=59). Anthropometric variables (weight, height, and abdominal-waist circumference) were measured, and the percentage of patients who managed to reduce their weight ≥5% was considered as the main measurement of treatment effectiveness. RESULTS: All groups significantly decreased body weight at the end of the study, with a reduction in G1 (-5.6kg) followed by G2 (-4.3kg), and G3 (-1.7kg), with an overall mean: -3.9kg. The indicators of clinical relevance were in G1/G3: relative risk (RR): 4.99 (95% CI: from 2.71 to 9.18); relative risk reduction (RRR): 399.1% (171.3 to 818.0); Absolute risk reduction (RAR): 65.3% (from 51.5 to 79.1) and NNT: 2 (from 2 to 2). In the G2/G3 groups: RR: 3.01 (from 1.57 to 5.76); RRR: 200.5% (from 57.0 to 475.5); RAR: 32.8% (from 16.9 to 48.7) and NNT: 4 (from 3 to 6). In the G1/G2 groups: RR: 1.66 (from 1.25 to 2.20); RRR: 66.1% (from 25.3 to 120.1); RAR: 32.5% (from 16.6 to 48.4) and NNT: 4 (from 3 to 7). CONCLUSIONS: All 3groups were able to reduce weight. Although the group with motivational intervention achieved the greatest decrease, as well as the most favourable clinical relevance indicators.

Do anterior catheterizable urinary channels have fewer complications than posterior channels? An international cohort study.

OBJECTIVE: Appendicovesicostomy (APV) and Monti ileovesicostomy (Monti) are durable catheterizable channels. While subfascial revision rates vary by channel type, a channel implanted in the anterior (vs posterior) aspect of the bladder may have a lower subfascial revision risk, due to decreased channel mobility and better fascial fixation. The present study aimed to compare long-term durability of anteriorly compared to posteriorly implanted APV and Monti channels in a large international cohort. MATERIALS AND METHODS: A retrospective cohort study was conducted on patients aged ≤21 years and who underwent APV or Monti surgery with an open technique at three high-volume centers (1990-2015). The following were noted: patient demographics, stomal and subfascial revisions, stomal location, channel placement (anterior/posterior), and channel type - APV, spiral Monti to umbilicus (SMU), other Monti channels. Survival analysis and Cox proportional hazards regression were used to separately examine the three channel groups. RESULTS: Of the 675 patients who met inclusion criteria, 387 had an APV (71.3% anterior), 53 had an SMU (13.2% anterior) and 235 had other Monti channels (42.1% anterior). Median age at surgery was 8.8 years for APV (median follow-up: 5.5 years), 9.2 years for other Monti (follow-up: 6.6 years) and 7.9 years for SMU (follow-up: 9.0 years). Patients originated from the USA (67.9%), Argentina (26.4%) and Chile (5.8%). Overall, 76 stomal and 77 subfascial revisions occurred. Risk of stomal revision was 9.3-12.0% at 5 years of follow-up, and was similar between channel types or location (P = 0.57). Risk of subfascial revision at 5 years was 7.4% for APV, 12.7% for all other Monti channels and 25.9% for SMU (P = 0.001). On survival analysis, stomal and subfascial revision rates were similar between anterior and posterior channels for APV (P ≥ 0.16), other Monti channels (P ≥ 0.62) and SMU (P ≥ 0.43) (Summary Fig.). On multivariate regression, channel configuration was not associated with stomal or subfascial revision for APV (P ≥ 0.18) or other Monti channels (P ≥ 0.64). Sex, age, diagnosis, country and stomal location were not associated with revision risk (P ≥ 0.06). DISCUSSION: Contrary to the hypothesis, subfascial revision rates were no different between anterior and posterior channels. Given that many reported outcomes related to genitourinary reconstruction occur rarely and require prolonged follow-up, collaborative research in this area should be encouraged. CONCLUSIONS: The study demonstrated durable long-term results with the APV and Monti techniques in an international cohort. Risks of stomal and subfascial complications were not significantly different between anteriorly and posteriorly implanted channels. As previously reported, Monti channels, particularly SMU, were more prone to undergoing subfascial revisions.

[Influence of diet and lifestyle in colorectal cancer]. / Influencia de la dieta y los estilos de vida en el cáncer colorrectal.

OBJECTIVE: to assess the relationship between different colorectal cancer risk factors in Albacete province. MATERIAL AND METHOD: the incidence and prevalence of CC (colorectal cancer) in Albacete province during the years from 1992 to 1999 were calculated using data from the Surgery and Anatomical Pathology Departments of hospitals located in the province, both public ("Complejo Hospitalario Universitario de Albacete" and "Hospital Comarcal de Hellín") and private ("Recoletas", "Sanatorios del Rosario" and "Santa Cristina"), and the provincial archives of the National Cancer Registry. Subsequently, the same calculation was made for each of the 33 Health Areas into which the province is organized. The three Health Areas with the highest incidence, and the three with the lowest incidence, of CC were selected for the study. By means of a systematic randomization of persons over 50 years, 445 persons were selected for the study using the census of the 25 villages and towns located in the high and low CC incidence areas. Subsequently we carried out the survey in these two zones: high and low incidence areas. Data were collected in Dbase IV, and the statistical analysis was carried out with the statistical package SPSS 10.1 for Windows. RESULTS: during the period studied 531 new cases of CC were registered, of which 291 (54.99%) were men. Mean rate was 15.9 per 100,000 persons/year. Highest incidence areas included Elche de la Sierra (30.2 per 100,000 persons/year), followed by Alcadozo (28.3), and Ontur (26.9). Lowest incidence areas were Ossa de Montiel (5.9), Munera (5.1), and Balazote (6.5). Out of 450 participants 414 (92%) filled out the questionnaire correctly. Variables including some kind of alcohol use (beer, wine, and coffee with brandy) are significantly associated with CC and multiply by more than one the risk for this disease. Some qualitative variables with statistically significant association increase, while some decrease, the risk of CC. For example, associated pathologies multiplies the risk of CC by 0.6, physical exercise by 0.3, moderate intake of alcohol by 0.5, olive oil intake by 0.7, and water intake by 0.3. Furthermore, a high intake of alcohol multiplies the risk of CC by 1.8, eggs and omelette by 2.95, pasta and rice by 2.15, blue fish by 1.8, meat and cold meats by 1.6, and having a first- or second-degree relative with cancer by 3. CONCLUSIONS: there is a significant relationship between colorectal cancer and familial cancer, physical activity, and the ingestion of alcohol, water, pasta, rice, and eggs.