Real-world implementation of North American and SIOP strategies for the treatment of Wilms tumor in Uruguay.

Wilms tumor has been selected as an index tumor by the WHO Global Initiative for Childhood Cancer with the aim to improve cure rates worldwide. Nevertheless, there is a scarcity of published data on outcomes beyond those of the major cooperative groups. Therefore, we conducted a retrospective analysis including all patients with Wilms tumor treated at our referral center in Uruguay between 1995 and 2020. Treatment consisted of North American (NA) strategies in 23 cases (1995-2004), followed by the SIOP strategy in 35 cases thereafter. Staging included: I-II = 28, III = 7, IV = 14, and V = 9. There were no major surgical or medical complications; however, a delay in the administration of local radiotherapy was observed (median of 21 days after surgery). There were no cases of toxicity- or surgery-related deaths or treatment abandonment. Five-year probability of overall survival was 0.72 and 0.92 for the NA and SIOP groups, respectively. We conclude that outcomes were better for the SIOP strategy with no unexpected toxicities and high treatment compliance in both strategies. Timely implementation of radiotherapy was challenging.

Philadelphia-negative chronic myeloproliferative neoplasm follow-up: when the phone rings. Changes during the COVID-19 pandemic and patient satisfaction. Experience in 30 health centers in Spain.

The SARS-CoV-2 pandemic has favored the expansion of telemedicine. Philadelphia-negative chronic myeloproliferative neoplasms (Ph-MPN) might be good candidates for virtual follow-up. In this study, we aimed to analyze the follow-up of patients with Ph-MPN in Spain during COVID-19, its effectiveness, and acceptance among patients. We present a multicenter retrospective study from 30 centers. Five hundred forty-one patients were included with a median age of 67 years (yr). With a median follow-up of 19 months, 4410 appointments were recorded. The median of visits per patient was 7 and median periodicity was 2.7 months; significantly more visits and a higher frequency of them were registered in myelofibrosis (MF) patients. 60.1% of visits were in-person, 39.5% were by telephone, and 0.3% were videocall visits, with a predominance of telephone visits for essential thrombocythemia (ET) and polycythemia vera (PV) patients over MF, as well as for younger patients (< 50 yr). The proportion of phone visits significantly decreased after the first semester of the pandemic. Pharmacological modifications were performed only in 25.7% of the visits, and, considering overall management, ET patients needed fewer global treatment changes. Telephone contact effectiveness reached 90% and only 5.4% required a complementary in-person appointment. Although 56.2% of the cohort preferred in-person visits, 90.5% of our patients claimed to be satisfied with follow-up during the pandemic, with an 83% of positive comments. In view of our results, telemedicine has proven effective and efficient, and might continue to play a complementary role in Ph-MPN patients' follow-up.

Bio-Inspired Autonomous Navigation and Formation Controller for Differential Mobile Robots.

This article proposes a decentralized controller for differential mobile robots, providing autonomous navigation and obstacle avoidance by enforcing a formation toward trajectory tracking. The control system relies on dynamic modeling, which integrates evasion forces from obstacles, formation forces, and path-following forces. The resulting control loop can be seen as a dynamic extension of the kinematic model for the differential mobile robot, producing linear and angular velocities fed to the mobile robot's kinematic model and thus passed to the low-level wheel controller. Using the Lyapunov method, the closed-loop stability is proven for the non-collision case. Experimental and simulated results that support the stability analysis and the performance of the proposed controller are shown.

Observer-Based Time-Variant Spacing Policy for a Platoon of Non-Holonomic Mobile Robots.

This paper presents a navigation strategy for a platoon of n non-holonomic mobile robots with a time-varying spacing policy between each pair of successive robots at the platoon, such that a safe trailing distance is maintained at any speed, avoiding the robots getting too close to each other. It is intended that all the vehicles in the formation follow the trajectory described by the leader robot, which is generated by bounded input velocities. To establish a chain formation among the vehicles, it is required that, for each pair of successive vehicles, the (i+1)-th one follows the trajectory executed by the former i-th one, with a delay of τ(t) units of time. An observer is proposed to estimate the trajectory, velocities, and positions of the i-th vehicle, delayed τ(t) units of time, consequently generating the desired path for the (i+1)-th vehicle, avoiding numerical approximations of the velocities, rendering robustness against noise and corrupted or missing data as well as to external disturbances. Besides the time-varying gap, a constant-time gap is used to get a secure trailing distance between each two successive robots. The presented platoon formation strategy is analyzed and proven by using Lyapunov theory, concluding asymptotic convergence for the posture tracking between the (i+1)-th robot and the virtual reference provided by the observer that corresponds to the i-th robot. The strategy is evaluated by numerical simulations and real-time experiments.

[Prevalence and associated factors of frailty in adults over 70 years in the community]. / Prevalencia y factores asociados de fragilidad en adultos mayores de 70 años en la comunidad.

OBJECTIVE: To estimate the prevalence and analyze the factors associated with frailty syndrome, in adults ≥70 years old, belonging to a health center in Asturias. DESIGN: Observational cross-sectional study. PARTICIPANTS: Adults ≥70 years of age. SITE: Health Centre of Llano (Asturias). MAIN MEASUREMENTS: Frailty was defined by the presence of ≥3 criteria of Fried's frailty phenotype. Secondary variables: sociodemographic characteristics, health status, functional status, cognitive-affective status and social risk. A bivariate analysis and logistic regression were performed. RESULTS: Four hundred eight participants were included, with a mean age of 79.8 (SD 6.6), 59.1% female. The prevalence of frailty was 27.7% and 44.9% for pre-frailty. The sociodemographic profile is that of a woman (77%), of high age (>84 years) (50.4%), without studies (65.5%), widow (48.7%) with low economic status (47.8%) and at social risk (OR: 3.3; 95% CI: 2.5-4). Factors that were statistically associated with frailty syndrome were: high comorbidity (OR: 2.7; 95% CI: 1.5-5), polypharmacy (OR: 1.9; 95% CI: 1.3-3), perception of quality of life with health (OR: 0.95; 95% CI: 0.93-0.97), impaired ambulation (OR: 17.9; 95% CI: 7.1-45.3), support for walking (OR: 10.5; 95% CI: 4.7-23.4), high risk of falls (OR: 6.4; 95% CI: 3.8-10.8), ABVD (OR: 4; 95% CI: 2.4-6.6), AIVD (OR: 9.7; 95% CI: 4.7-20), disability (OR: 37.7; 95% CI: 52.2-274.5), cognitive impairment (OR: 4.1; 95% CI: 1.8-9.3) and depression (OR: 4.8; 95% CI: 2.7-8.7). CONCLUSIONS: Frailty is a multifactorial syndrome, with a high prevalence in those over 70 years of age, in which, in addition to Fried's criteria of frailty, aspects of health, functional, cognitive-affective and social status must be analyzed.

Use of eltrombopag for patients 65 years old or older with immune thrombocytopenia.

BACKGROUND: Eltrombopag is useful for immune thrombocytopenia (ITP). However, results of clinical trials may not accurately mirror clinical practice reality. Here we evaluated eltrombopag for primary and secondary ITP in our ≥65-year-old population. METHODS: A total of 106 primary ITP patients (16 with newly diagnosed ITP, 16 with persistent ITP, and 74 with chronic ITP) and 39 secondary ITP patients (20 with ITP secondary to immune disorders, 7 with ITP secondary to infectious diseases, and 12 with ITP secondary to lymphoproliferative disorders [LPD]) were retrospectively evaluated. RESULTS: Median age of our cohort was 76 (interquartile range, IQR, 70-81) years. 75.9% of patients yielded a platelet response including 66.2% complete responders. Median time to platelet response was 14 (IQR, 8-21) days. Median time on response was 320 (IQR, 147-526) days. Sixty-three adverse events (AEs), mainly grade 1-2, occurred. The most common were hepatobiliary laboratory abnormalities (HBLAs) and headaches. One transient ischemic attack in a newly diagnosed ITP and two self-limited pulmonary embolisms in secondary ITP were the only thrombotic events observed. CONCLUSION: Eltrombopag showed efficacy and safety in ITP patients aged ≥65 years with primary and secondary ITP. However, efficacy results in LPD-ITP were poor. A relatively high number of deaths were observed.

Sensory evaluation of low-fat yoghurt produced with microbial transglutaminase and comparison with physicochemical evaluation.

BACKGROUND: Low-fat or non-fat yoghurts are popular nowadays. However, their texture is not good and they show considerable syneresis with time. The aim of this research was to evaluate the effect of the application of transglutaminase (TG) to low-fat yoghurt to determine if similar sensory properties to those of full-fat yoghurt can be obtained. Methods of adding TG (prior or simultaneous with fermentation), dose, and TG origin were evaluated. Correlations between sensory and physicochemical parameters were assessed. RESULTS: The results showed no significant differences between TG addition methods in terms of the quantitative and qualitative sensory attributes studied. Simultaneous addition of TG was preferred to speed up the process. A dose of 1 U g-1 was selected as optimal. Few differences were detected due to the origin of the TG. They were not significant although some differences were observed in terms of density, bitterness, and syneresis compared with low and full-fat yoghurts. CONCLUSION: The results showed that sensory parameters cannot be associated with only one physicochemical parameter in yoghurt evaluation. Transglutaminase can be used as a substitute for stabilizers in the production of low-fat yoghurt, maintaining good sensory properties and avoiding initial syneresis. © 2018 Society of Chemical Industry.

Physicochemical evaluation of low-fat yoghurt produced with microbial transglutaminase.

BACKGROUND: Currently consumers demand low-fat or non-fat yoghurt but their physical properties are less attractive than those of full-fat yoghurt. It was reported that microbial transglutaminase (TG) can be used in the production of low-fat yoghurt. The aim of this work was to evaluate the effect of TG on low-fat yoghurt to improve their physicochemical and textural properties to approach to those of full-fat yoghurt. Two TG application methods (addition before fermentation or simultaneous addition with the starter), three dose levels and TG origin were evaluated. Results were compared with commercial low-fat and full-fat yoghurts. RESULTS: No significant differences between application methods were observed. Simultaneous addition of TG was preferred because additional time-consuming steps are not required. The best dose was 1 U TG g-1 of protein that allowed a firmness higher (4.25 N) than that of commercial low-fat (3.05 N) and full-fat (4.43 N) yoghurts to be achieved. This implies that intermediate values of TG will permit the same firmness as commercial yoghurts to be obtained. It was observed some differences by the TG origin may be due to excipients. CONCLUSION: TG may be used to replace stabilizers in the production of low-fat yoghurt as it improves texture and avoids initial syneresis. © 2018 Society of Chemical Industry.

Eltrombopag safety and efficacy for primary chronic immune thrombocytopenia in clinical practice.

BACKGROUND: Eltrombopag is effective and safe in chronic immune thrombocytopenia (ITP). However, clinical trials may not accurately reflect what happens in clinical practice. We evaluated the efficacy and safety of eltrombopag in primary chronic ITP in a real-world setting. METHODS: A total of 164 primary patients with chronic ITP from 40 Spanish centers, who had been treated with eltrombopag, were retrospectively evaluated. RESULTS: The median age of our cohort (72% women) was 63 yr (interquartile range, IQR, 45-75 yr). The median time with ITP diagnosis was 81 months (IQR, 30-192 months). The median number of therapies prior to eltrombopag was 3 (IQR, 2-4). At the time of eltrombopag start, 45 patients (30%) were receiving concomitant treatment for ITP. Forty-six patients (30%) had bleeding signs/symptoms the month before the treatment started. The median platelet count at eltrombopag initiation was 22 × 10(9) /L (IQR, 8-39 × 10(9) /L). A total of 135 patients (88.8%) achieved a platelet response. The median time to platelet response was 12 d (95% CI, 9-13 d). Maintained platelet response rate during the 15-month period under examination was 75.2%. Twenty-eight patients (18.4%) experienced adverse events, mainly grades 1-2. CONCLUSION: Eltrombopag is highly effective and well tolerated in unselected patients with primary chronic ITP.

[Why, and How, Undertake Mixed Methods Design in Health Research: A Concrete Experience]. / Por qué y cómo realizar diseños multimétodo en investigación en salud.

Summary: The use of mixed methods to address health problems generates more knowledge of reality to get a more complete analysis of the problem under investigation. This is based on the fact that answers to the questions posed are as subjective as the individuals themselves. In that way, it is necessary quantitative and qualitative data for comprehensiveness (a more realistic and comprehensive approach to the object of the study). Objective: Reflect on this methodology through a practical example. Synthesis: We explain, through Participatory Education Program Focused on Colorectal Cancer Surgery Patient (mixed methods research project: multistrand, sequential and mixed in each of its three phases), what is this methodology and its advantages. The second phase of the study emerges from the results of the first one, and so on. At the end of the study a metaresult, that gives meaning and response to the study in its entirety, arises. Conclusion: Despite the challenges, mixed methods gives us a more accurate perspective of the phenomenon of study; it helps us to formulate the problem statement and the most appropriate way to study it; and finally, the scientific inferences obtained are more solidly supported.

Prevalence of hepatitis C antibodies in the population aged 16-80 years in the Community of Madrid 2008-2009.

Together with AIDS, the burden of hepatitis C virus (HCV) in Spain heads the list of communicable diseases in terms of impact on public health. The aim of this study was to estimate the prevalence of HCV antibodies in the Community of Madrid, assess changes in recent years and analyse associated risk factors. Descriptive cross-sectional study of a target population consisting of Community of Madrid residents aged 16-80 years old. Two-stage cluster sampling was performed, with stratification by socioeconomic status and percentage immigrant population. The sampling frame consisted of public blood extraction centers attached to the Madrid Health Service. Seroprevalence of HCV antibodies, prevalence ratios by age groups in comparison with 1999 survey data and prevalence association with risk factors were assessed using a logistic regression model. Prevalence of HCV antibodies for the age group 16-80 years was 1.8% (95% CI: 1.3-2.5). The age group with the highest prevalence was 41-60 years. In comparison with the 1999 survey, prevalence fell for the age groups 21-30 and 31-40 years and increased for the age group 41-60. Statistically significant associations were found for age, education, history of hepatitis C and consultation regarding liver problems. Seroprevalence of HCV antibodies in the Community of Madrid is similar to that shown in other regions of Spain. It is increasing in older age groups as the population at risk ages. Incidence of hepatitis C may be decreasing considering the decrease in the seroprevalence in the population younger than 40 related to the previous serosurvey.

Successful discontinuation of eltrombopag after complete remission in patients with primary immune thrombocytopenia.

Eltrombopag is effective and safe in immune thrombocytopenia (ITP). Some patients may sustain their platelet response when treatment is withdrawn but the frequency of this phenomenon is unknown. We retrospectively evaluated 260 adult primary ITP patients (165 women and 95 men; median age, 62 years) treated with eltrombopag after a median time from diagnosis of 24 months. Among the 201 patients who achieved a complete remission (platelet count >100 × 10(9) /l), eltrombopag was discontinued in 80 patients. Reasons for eltrombopag discontinuation were: persistent response despite a reduction in dose over time (n = 33), platelet count >400 × 10(9) /l (n = 29), patient's request (n = 5), elevated aspartate aminotransferase (n = 3), diarrhea (n = 3), thrombosis (n = 3), and other reasons (n = 4). Of the 49 evaluable patients, 26 patients showed sustained response after discontinuing eltrombopag without additional ITP therapy, with a median follow-up of 9 (range, 6-25) months. These patients were characterized by a median time since ITP diagnosis of 46.5 months, with 4/26 having ITP < 1 year. Eleven patients were male and their median age was 59 years. They received a median of 4 previous treatment lines and 42% were splenectomized. No predictive factors of sustained response after eltrombopag withdrawal were identified. Platelet response following eltrombopag cessation may be sustained in an important percentage of adult primary ITP patients who achieved CR with eltrombopag. However, reliable markers for predicting which patients will have this response are needed.

Predictive factors of occupational noise-induced hearing loss in Spanish workers: A prospective study.

The purpose of our study was to identify the main factors associated with objective noise-induced hearing loss (NIHL), as indicated by abnormal audiometric testing, in Spanish workers exposed to occupational noise in the construction industry. We carried out a prospective study in Tenerife, Spain, using 150 employees exposed to occupational noise and 150 age-matched controls who were not working in noisy environments. The variables analyzed included sociodemographic data, noise-related factors, types of hearing protection, self-report hearing loss, and auditory-related symptoms (e.g., tinnitus, vertigo). Workers with pathological audiograms had significantly longer noise-exposure duration (16.2 ± 11.4 years) relative to those with normal audiograms (10.2 ± 7.0 years; t = 3.99, P < 0.001). The vast majority of those who never used hearing protection measures had audiometric abnormalities (94.1%). Additionally, workers using at least one of the protection devices (earplugs or earmuffs) had significantly more audiometric abnormalities than those using both protection measures simultaneously (Chi square = 16.07; P < 0.001). The logistic regression analysis indicates that the use of hearing protection measures [odds ratio (OR) = 12.30, confidence interval (CI) = 4.36-13.81, P < 0.001], and noise-exposure duration (OR = 1.35, CI = 1.08-1.99, P = 0.040) are significant predictors of NIHL. This regression model correctly predicted 78.2% of individuals with pathological audiograms. The combined use of hearing protection measures, in particular earplugs and earmuffs, associates with a lower rate of audiometric abnormalities in subjects with high occupational noise exposure. The use of hearing protection measures at work and noise-exposure duration are best predictive factors of NIHL. Auditory-related symptoms and self-report hearing loss do not represent good indicators of objective NIHL. Routine monitoring of noise levels and hearing status are of great importance as part of effective hearing conservation programs.

Vitamin K antagonist-associated intracerebral hemorrhage: lessons from a devastating disease in the dawn of the new oral anticoagulants.

BACKGROUND: Intracerebral hemorrhage (ICH) is the most feared complication associated with vitamin K antagonists (VKAs). We performed a retrospective study on the clinicoradiologic characteristics that influence its outcome. METHODS: We reviewed the clinical histories and neuroimaging studies of all patients attended at the Hospital Universitario Central de Asturias in 2010-2011 who had an ICH while being on VKA and analyzed the differential characteristics between patients with acceptable versus poor outcomes attending to 3 end points: death, poor outcome (modified Rankin Scale [mRS] score ≥ 4) at discharge, and poor outcome 3 months later. Additionally, CHA2DS2-VASc and HAS-BLED scores (validated tools for prediction of the risk of stroke and major hemorrhage, respectively, in patients with atrial fibrillation) were calculated to assess a priori risk-benefit balance for anticoagulant therapy. RESULTS: Eighty patients entered the sample (median age of 79 years). A priori annual risk of major bleeding surpassed ischemic stroke risk-without anticoagulation-only in 4. Fifty percent of the patients had an initial Glasgow Coma Scale (GCS) score lower than 13; in 51.3%, initial international normalized ratio was above their therapeutic range. Median hematoma size was 24.75 cc(3); relevant growth (≥33%) occurred in 29.4% of patients with a second computed tomography scan. On multivariable analysis, overall in-hospital mortality (47.5%) was related to prior antiplatelet therapy (P = .008), GCS (P = .001), and perilesional edema size (P = .036). Baseline mRS (P = .058) and National Institutes of Health Stroke Scale (NIHSS) scores (P = .008) were associated with poor outcome at discharge (77.5%). Initial NIHSS (P = .005) and glycemia (P = .038) predicted 3-month poor outcome (68.3%). VKA reversal was performed in almost all patients, which prevented assessment of its therapeutic value. CONCLUSIONS: VKA-associated ICH presents in a particularly vulnerable population and has a poor prognosis that may be reliably predicted by several clinicoradiologic features.

Leader-follower formation control based on non-inertial frames for non-holonomic mobile robots.

A chain formation strategy based on mobile frames for a set of n differential drive mobile robots is presented. Considering two consecutive robots in the formation, robots Ri and Ri+1. It is intended that robot Ri+1 follows the delayed trajectory, τ units of time, of the leader robot Ri. In this way, the follower robot Ri+1 becomes the leader robot for robot Ri+ 2 in the formation and so on. With this formation policy, the trailing distance between two consecutive robots varies accordingly to the velocity of the Ri leader robot. Mobile frames are located on the body of the vehicles, in such a way that the position of robot Ri is determined with respect to the frame located on Ri+1 robot. The strategy relies on the fact that the general leader robot R1 describes any trajectory generated by bounded linear v1(t) and angular ω1(t) velocities. For the remaining vehicles in the string, the strategy considers a desired trajectory for the follower robot Ri+1 obtained by an estimation of the delayed trajectory of the leader robot Ri. This desired estimated trajectory is obtained under the knowledge of the actual and past input velocities of the Ri robot. To formally prove the convergence of the formation strategy, the equations describing the time variation of the relative posture between any pair of consecutive vehicles in the formation are obtained, and a feedback law based on local measurements is proposed to get the convergence of robot Ri+1 to the delayed trajectory, τ units of time, of the trajectory previously described by robot Ri. Lyapunov techniques are considered for this fact. The effectiveness of the chain formation solution is evaluated by means of numerical simulations and real time experiments showing an adequate convergence.

Plasma-Based Scaffold Containing Bone-Marrow Mononuclear Cells Promotes Wound Healing in a Mouse Model of Pressure Injury.

Pressure injuries, or pressure ulcers, are a common problem that may lead to infections and major complications, besides being a social and economic burden due to the costs of treatment and hospitalization. While surgery is sometimes necessary, this also has complications such as recurrence or wound dehiscence. Among the newer methods of pressure injury treatment, advanced therapies are an interesting option. This study examines the healing properties of bone marrow mononuclear cells (BM-MNCs) embedded in a plasma-based scaffold in a mouse model. Pressure ulcers were created on the backs of mice (2 per mouse) using magnets and assigned to a group of ulcers that were left untreated (Control, n = 15), treated with plasma scaffold (Plasma, n = 15), or treated with plasma scaffold containing BM-MNC (Plasma + BM-MNC, n = 15). Each group was examined at three time points (3, 7, and 14 days) after the onset of treatment. At each time point, animals were subjected to biometric assessment, bioluminescence imaging, and tomography. Once treatment had finished, skin biopsies were processed for histological and wound healing reverse transcription polymerase chain reaction (RT-PCR) array studies. While wound closure percentages were higher in the Plasma and Plasma + BM-MNC groups, differences were not significant, and thus descriptive data are provided. In all individuals, the presence of donor cells was revealed by immunohistochemistry on posttreatment onset Days 3, 7, and 14. In the Plasma + BM-MNC group, less inflammation was observed by positron emission tomography-computed tomography (PET/CT) imaging of the mice at 7 days, and a complete morphometabolic response was produced at 14 days, in accordance with histological results. A much more pronounced inflammatory process was observed in controls than in the other two groups, and this persisted until Day 14 after treatment onset. RT-PCR array gene expression patterns were also found to vary significantly, with the greatest difference noted between both treatments at 14 days when 11 genes were differentially expressed.

Improving the Gleason grading accuracy of transrectal ultrasound-guided biopsy.

BACKGROUND: Transrectal ultrasound (TRUS)-guided prostate biopsy is the technique of choice for the assessment of clinical suspicion of prostate cancer (PC) based on abnormal digital rectal examination (DRE) and/or elevated or rising levels of prostate-specific antigen (PSA). PURPOSE: To identify factors involved in TRUS-guided prostate biopsy, which can be modified by radiologists in order to improve Gleason score (GS) accuracy, and to assess the influence of clinical variables. MATERIAL AND METHODS: We carried out a retrospective review of the records of 185 patients with PC treated surgically at our hospital between 2005 and 2008. Biopsy schemes were classified according to the number of cores (≤7, 8-9, 10-11, 12-15) and the needle length (11, 16, 20 mm). Clinical characteristics - age, family history of PC, DRE, PSA levels, and sonographic data - and prostatectomy GS (pGS) were collected. RESULTS: Non-random concordance between biopsy Gleason score (bGS) and pGS was obtained for 36% of patients (P < 0.001). Under- and over-staging were 30% and 4%, respectively. Concordance was correlated with the core number (45% for ≤7, 54% for 8-9, 85% for 10-11, and 80% for 12-15; P < 0.001), but not with the needle length. The concordance rate showed a seven-fold increase when 10-11 cores were obtained (95% CI, 2-18; P < 0.001) compared to those cases in which the core number obtained was ≤7. Among clinical variables, only PSA correlated with concordance, showing an inverse relationship. CONCLUSION: The Gleason correlation values were not improved when 12 or more cores were collected. These values reached a plateau beyond that number of samples. Therefore, when determining treatment strategies, physicians must consider the biopsy scheme used since it has proven to be a predictor of the accuracy of the PC grading system.

Selection/control concurrent optimization of BLDC motors for industrial robots.

This paper aims to concurrently select and control off-the-shelf BLDC motors of industrial robots by using a synergistic model-based approach. The BLDC motors are considered with trapezoidal back-emf, where the three-phase (a,b,c) dynamics of motors are modeled in a mechatronic powertrain model of the robot for the selection and control problem, defining it as a multi-objective dynamic optimization problem with static and dynamic constraints. Since the mechanical and electrical actuators' parameters modify the robot's performance, the selection process considers the actuators' parameters, their control input, operational limits, and the mechanical output to the transmission of the robot joints. Then, three objective functions are to be minimized, the motor's energy consumption, the tracking error, and the total weight of installed motors on the robot mechanism. The control parameterization approach via a cascade controller with PI controllers for actuators' voltage and a PID controller for actuators' torque is used to solve the multi-objective dynamic optimization problem. Based on simulations of the closed-loop system, a Pareto front is obtained to examine trade-offs among the objective functions before implementing any actuators in the existing robotic system. The proposed method is tested on an experimental platform to verify its effectiveness. The performance of an industrial robot with the actuators originally installed is compared with the results obtained by the synergic approach. The results of this comparison show that 10.85% of electrical power can be saved, and the trajectory tracking error improved up to 57.41% using the proposed methodology.

Stem cell and tissue engineering approaches in pressure ulcer treatment.

CONTEXT: Pressure ulcers or injuries, arise from ischemic damage to soft tissues induced by unrelieved pressure over a bony prominence. They are usually difficult to treat with standard medical therapy and often they recur. In the search for better treatment options, promising alternative forms of treatment are today emerging. Within the field of regenerative medicine, ongoing research on advanced therapies seeks to develop medicinal products based on gene therapy, somatic cell therapy, tissue-engineering and combinations of these. OBJECTIVE: The main objective is to perform an overview of experimental and clinical developments in somatic cell therapy and tissue engineering targeting the treatment of pressure injuries. METHODS: Searching terms as "PRESSURE ULCER", "STEM CELL THERAPY", "TISSUE ENGINEERING" or "WOUND HEALING" were used in combination or alone, including publications refered to basic and clinical research and focusing on articles showing results obtained in a clinical context. A total of 80 references are cited, including 23 references published in the 3 last years. RESULTS: The results suggest that this form of treatment could be an interesting option in patients with difficult-to-treat ulcers as spinal cord injury patients. CONCLUSION: This field of regenerative medicine is very broad and further research is warranted.

[Hormonal treatment in biochemical recurrence after radical prostatectomy]. / Tratamiento hormonal en la recidiva bioquímica tras prostatectomía radical.

To date, the role of hormonal therapy (HT) after biochemical failure, when to initiate it, the therapeutic scheme and duration remains controversial due to the absence of well designed randomized trials analyzing the overall survival of patients. In clinical practice, the most widely spread treatment in this scenario is hormonal therapy with LH-RH analogues. However, the scientific support for this issue is very weak. We are extrapolating the benefits proven for early vs delayed HT in advanced prostate cancer, to asymptomatic patients presenting just an increase in PSA. These patients usually have a long time disease-history until development of metastasis. It should also be noticed the harmful secondary effects acquired with the time of employment of hormotherapy. Probably patients suffering a Gleason score >8 and PSA doubling time <12 months could obtain a benefit from an early castration treatment, even more if they are young (grade 2c). Except in selected cases of local treatment as radiotherapy, the decision for early or delayed hormonal therapy should be taken carefully with patient consensus. The alternatives for hormonal treatment to preserve sexual function, as intermittent treatment, antiandrogen monotherapy, or antiandrogen plus 5 alpha reductase inhibitors, are very attractive in this scenario. However due to the short time experience with these modalities of treatment should be evaluated with caution.