A harmonized database of European forest simulations under climate change.

Process-based forest models combine biological, physical, and chemical process understanding to simulate forest dynamics as an emergent property of the system. As such, they are valuable tools to investigate the effects of climate change on forest ecosystems. Specifically, they allow testing of hypotheses regarding long-term ecosystem dynamics and provide means to assess the impacts of climate scenarios on future forest development. As a consequence, numerous local-scale simulation studies have been conducted over the past decades to assess the impacts of climate change on forests. These studies apply the best available models tailored to local conditions, parameterized and evaluated by local experts. However, this treasure trove of knowledge on climate change responses remains underexplored to date, as a consistent and harmonized dataset of local model simulations is missing. Here, our objectives were (i) to compile existing local simulations on forest development under climate change in Europe in a common database, (ii) to harmonize them to a common suite of output variables, and (iii) to provide a standardized vector of auxiliary environmental variables for each simulated location to aid subsequent investigations. Our dataset of European stand- and landscape-level forest simulations contains over 1.1 million simulation runs representing 135 million simulation years for more than 13,000 unique locations spread across Europe. The data were harmonized to consistently describe forest development in terms of stand structure (dominant height), composition (dominant species, admixed species), and functioning (leaf area index). Auxiliary variables provided include consistent daily climate information (temperature, precipitation, radiation, vapor pressure deficit) as well as information on local site conditions (soil depth, soil physical properties, soil water holding capacity, plant-available nitrogen). The present dataset facilitates analyses across models and locations, with the aim to better harness the valuable information contained in local simulations for large-scale policy support, and for fostering a deeper understanding of the effects of climate change on forest ecosystems in Europe.

[Relevance of clinical and serum parameters on severe urinary sepsis after renal obstruction.] / Importancia de los parámetros clínicos y analíticos de la sepsis grave en la uropatía obstructiva.

INTRODUCTION: Urosepsis is an underdiagnosed entity with high morbidity and mortality and significant associated costs. The delay in diagnosis leads to an increased risk of multiorgan failure and death. Although its prognosis is better than that of other sepsis, the mortality rate is 20 - 40%. OBJECTIVE: Describe the obstructive uropathy cases (OU) that are complicated by severe sepsis (SS) and identify early biomarkers of SS. MATERIAL AND METHODS: Observational and prospective study of 65 patients with urgent high OU. All patients were evaluated at three different times (0, 24 and 48 hours). An SS predictor model has been constructed and a multivariate risk analysis has been carried out. RESULTS: 64.61% (n=42) developed SS (NSS: n=13). The only statistically significant variables in the 3 moments evaluated and that obtained a good area under the curve [AUROC (>0.70)] were the elevation of neutrophils, procalcitonin, and decrease of bicarbonate. At the time of patient admission, the variable that best predicted SS was the elevation of procalcitonin (AUROC:0.919). SS risk factors (p<0.005) were the history of cancer immunosuppression, and/or urinary tract surgeries, complete UO and high blood values of lactate, potassium and decrease of bicarbonate. The potassium-lactate combination on admission predicted SS with a probability function of 0.805. CONCLUSIONS: There is an analytical profile maintained over the time characteristic of SS that allows anearly identification of patients with OU subsidiary of been complicated with SS.

INTRODUCCIÓN: La Sepsis urinaria obstructiva (SUO) es una entidad infradiagnosticada con una elevada morbimortalidad e importantes costes asociados. El retraso en su diagnóstico condiciona un mayor riesgo de fracaso multiorgánico y fallecimiento. Aunque su pronóstico es mejor que el de otros focos de sepsis, su mortalidad es del 20 - 40%. OBJETIVO: Describir los cuadros de uropatía obstructiva (UO) que se complican con sepsis grave (SG) e identificarlos biomarcadores diagnósticos de SG en la UOde forma precoz.MATERIAL Y MÉTODOS: Estudio observacional y prospectivo de 72 pacientes con UO alta ingresados de manera urgente en el Servicio de Urología del Hospital Clínico Universitario de Valladolid. Todos los pacientes del estudio fueron evaluados en tres momentos diferentes (0, 24 y 48 horas). Se ha creado un modelo predictor de SG y se ha realizado un análisis multivariante de riesgo. RESULTADOS: El 64,61% de los pacientes (n=42) desarrolló SG (NSG: n=13). Las únicas variables estadísticamente significativas en los tres momentos evaluados y que obtenían una buena área bajo la curva [AUROC (>0,70)] fueron la elevación de neutrófilos y procalcitonina y la disminución de bicarbonato. En el momento del ingreso la variable que mejor predecía SG fue la elevación de procalcitonina (AUROC: 0,919). Los factores de riesgo de SG (p<0,05) fueron los antecedentes de cáncer, la inmunosupresión y/o cirugías de vías urinarias, la UO completa y los valores elevados en sangre de lactato y potasio y la disminución del bicarbonato en la gasometría venosa. La combinación potasio-lactato al ingreso predecía SG con una función de probabilidad de 0,805. CONCLUSIONES: Existe un perfil analítico, mantenido en el tiempo, característico de SG que permite la identificación precoz de los pacientes con UO subsidiarios de complicarse con SG.

Importancia de los parámetros clínicos y analíticos de la sepsis grave en la uropatía obstructiva / Relevance of clinical and serum parameters on severe urinary sepsis after renal obstruction

INTRODUCCIÓN: La Sepsis urinaria obstructiva (SUO) es una entidad infradiagnosticada con una elevada morbimortalidad e importantes costes asociados. El retraso en su diagnóstico condiciona un mayor riesgo de fracaso multiorgánico y fallecimiento. Aunque su pronóstico es mejor que el de otros focos de sepsis, su mortalidad es del 20 - 40%. OBJETIVO: Describir los cuadros de uropatía obstructiva (UO) que se complican con sepsis grave (SG) e identificarlos biomarcadores diagnósticos de SG en la UOde forma precoz. MATERIAL Y MÉTODOS: Estudio observacional y prospectivo de 72 pacientes con UO alta ingresados de manera urgente en el Servicio de Urología del Hospital Clínico Universitario de Valladolid. Todos los pacientes del estudio fueron evaluados en tres momentos diferentes (0, 24 y 48 horas). Se ha creado un modelo predictor de SG y se ha realizado un análisis multivariante de riesgo. RESULTADOS: El 64,61% de los pacientes (n=42) desarrolló SG (NSG: n=13). Las únicas variables estadísticamente significativas en los tres momentos evaluados y que obtenían una buena área bajo la curva [AUROC (>0,70)] fueron la elevación de neutrófilos y procalcitonina y la disminución de bicarbonato. En el momento del ingreso la variable que mejor predecía SG fue la elevación de procalcitonina (AUROC: 0,919). Los factores de riesgo de SG (p < 0,05) fueron los antecedentes de cáncer, la inmunosupresión y/o cirugías de vías urinarias, la UO completa y los valores elevados en sangre de lactato y potasio y la disminución del bicarbonato en la gasometría venosa. La combinación potasio-lactato al ingreso predecía SG con una función de probabilidad de 0,805. CONCLUSIONES: Existe un perfil analítico, mantenido en el tiempo, característico de SG que permite la identificación precoz de los pacientes con UO subsidiarios de complicarse con SG

INTRODUCTION: Urosepsis is an underdiagnosed entity with high morbidity and mortality and significant associated costs. The delay in diagnosis leads to an increased risk of multiorgan failure and death. Although its prognosis is better than that of other sepsis, the mortality rate is 20 - 40%. OBJECTIVE: Describe the obstructive uropathy cases (OU) that are complicated by severe sepsis (SS) and identify early biomarkers of SS. MATERIAL AND METHODS: Observational and prospective study of 65 patients with urgent high OU. All patients were evaluated at three different times (0, 24 and 48 hours). An SS predictor model has been constructed and a multivariate risk analysis has been carried out. RESULTS: 64.61% (n=42) developed SS (NSS: n=13). The only statistically significant variables in the 3 moments evaluated and that obtained a good area under the curve [AUROC (>0.70)] were the elevation of neutrophils, procalcitonin, and decrease of bicarbonate. At the time of patient admission, the variable that best predicted SS was the elevation of procalcitonin (AUROC: 0.919). SS risk factors (p < 0.05) were the history of cancer, immunosuppression, and/or urinary tract surgeries, complete UO and high blood values of lactate, potassium and decrease of bicarbonate. The potassium-lactate combination on admission predicted SS with a probability function of 0.805. CONCLUSIONS: There is an analytical profile maintained over the time characteristic of SS that allows an early identification of patients with OU subsidiary of been complicated with SS

Synthesis of Calcium Aluminates from Non-Saline Aluminum Dross.

The present work examines the synthesis of tricalcium aluminate (for use as a synthetic slag) from the non-saline dross produced in the manufacture of metallic aluminum in holding furnaces. Three types of input drosses were used with Al2O3 contents ranging from 58 to 82 wt %. Calcium aluminates were formed via the mechanical activation (reactive milling) of different mixtures of dross and calcium carbonate, sintering at 1300 °C. The variables affecting the process, especially the milling time and the Al2O3/CaO molar ratio, were studied. The final products were examined via X-Ray diffraction (XRD), scanning electron microscopy (SEM), transmission electron microscopy (TEM) and Raman spectroscopy. The reactive milling time used was 5 h in a ball mill, for a ball/dross mass ratio of 6.5. For a molar relationship of 1:3 (Al2O3/CaO), sintered products with calcium aluminate contents of over 90% were obtained, in which tricalcium aluminate (C3A) was the majority compound (87%), followed by C12A7 (5%).

El programa actual de la formación en España. Comisión nacional de especialidad / The current urological training program in Spain. Urology National Specialty Commission

Objetivo: La Ley 44/2003 de Ordenación de profesiones sanitarias creó el Consejo Nacional de Especialidades en Ciencias de la Salud y las Comisiones Nacionales de las Especialidades en Ciencias de la Salud. Métodos: Revisión de las principales normas legales implicadas en la Formación Especializada y papel de la Comisión Nacional de Especialidad. Discusión: La Ley 44/2003 regula la formación de los profesionales sanitarios y establece el procedimiento para la creación por la Comisión Nacional de Especialidad y su posterior aprobación y publicación en el BOE de los programas formativos de las especialidades. El acceso a la formación especializada se realizará con la convocatoria anual y de carácter nacional de examen MIR. El Ministerio de Sanidad fija los criterios de acreditación de los centros y unidades docentes, y la Comisión Nacional de Especialidad, como órgano asesor, emite un informe favorable o desfavorable sobre las nuevas peticiones de acreditación. El RD 183/2008 desarrolla la figura del tutor, la evaluación formativa junto con el Libro del Residente y cómo serán las rotaciones externas. Conclusiones: Para poder entender el sistema de formación en la especialidad de Urología debemos conocer las normas que lo regulan, siendo la más importante la 44/2003. La Comisión Nacional de Especialidad es un órgano consultivo del Ministerio, cuya función principal es la de elaborar el programa formativo de Urología y establecer los criterios de evaluación de los especialistas en formación (AU)

Objectives: 44/2003 Law involved the creation of the National Council of Specialties in Health Sciences and the National Commissions of the Specialties in Health Sciences. Methods: Analysis of the main laws implicated in Specialized Training and the role of the National Specialty Commission.Discussion: 44/2003 Law regulates the training of health professionals and establishes the procedure for the training programs creation by the National Specialty Commission and its later approval and publication in the BOE. Access to specialized training will be carried out with the annual and national MIR exam. The Health Ministry establishes the criteria for educational centers accreditation, and the National Specialty Commission issues a favorable or unfavorable report as advisor about new accreditation requests. 183/2008 RD develops the tutor figure, the formative evaluation through the Resident’s Book and how will be like the external rotations. Conclusions: to understand the Urology's specialty training system we must know the laws that regulate it, being the most important the 44/2003 Law. The National Specialty Commission is an advisory party of the Ministry, whose main function is to elaborate the Urology training program and to establish the evaluation criteria of the specialists in formation (AU)

[The current urological training program in Spain. Urology National Specialty Commission.] / El programa actual de la formación en España. Comisión nacional de especialidad.

OBJECTIVES: 44/2003 Law involved the creation of the National Council of Specialties in Health Sciences and the National Commissions of the Specialties in Health Sciences. METHODS: Analysis of the main laws implicated in Specialized Training and the role of the National Specialty Commission. DISCUSSION: 44/2003 Law regulates the training of health professionals and establishes the procedure for the training programs creation by the National Specialty Commission and its later approval and publication in the BOE. Access to specialized training will be carried out with the annual and national MIR exam. The Health Ministry establishes the criteria for educational centers accreditation, and the National Specialty Commission issues a favorable or unfavorable report as advisor about new accreditation requests. 183/2008 RD develops the tutor figure, the formative evaluation through the Resident's Book and how will be like the external rotations. CONCLUSIONS: to understand the Urology's specialty training system we must know the laws that regulate it, being the most important the 44/2003 Law. The National Specialty Commission is an advisory party of the Ministry, whose main function is to elaborate the Urology training program and to establish the evaluation criteria of the specialists in formation.

Factores pronósticos en cáncer renal con trombo en vena. Análisis de supervivencia / Prognostic factors in renal cancer with venous thrombus survival analysis

OBJETIVO: Analizar el tratamiento quirúrgico en el cáncer renal con trombo venoso a distintos niveles, así como las complicaciones perioperatorias y los diversos factores pronósticos relacionados a supervivencia global, cáncer específica y libre de enfermedad. MÉTODOS: Estudio descriptivo retrospectivo de 42 casos de cáncer renal con trombo venoso entre 2005 y 2015. El nivel alcanzado por el trombo se estableció según la clasificación de la Clínica Mayo. Las complicaciones postoperatorias se estadificaron según la clasificación de Clavien-Dindo. RESULTADOS: Predominio masculino con media de edad de 65,7 años. El 16,6% correspondieron a tumores con trombo de nivel II. En el 58,9% se realizó un abordaje subcostal. En 2 pacientes se estableció hipotermia con parada cardíaca y circulación extracorpórea. En 3 pacientes se realizó resección de lesiones metastásicas durante la nefrectomía radical. La necesidad de reintervención fue del 2,3% mientras que, la mortalidad perioperatoria fue del 4,7%. El 30% debutaron con metástasis al diagnóstico. Veinte pacientes progresaron a 15,5 meses (3-55). La supervivencia global fue de 60 meses. La mortalidad cáncer específica fue del 75%. La supervivencia libre de enfermedad fue del 30% a 55 meses. CONCLUSIONES: El tratamiento quirúrgico del cáncer renal con trombo venoso precisa un manejo multidisciplinar. La técnica quirúrgica seleccionada varía en función del nivel del trombo tumoral. El estadiaje tumoral es el factor pronóstico de mayor importancia. El nivel del trombo influye en el pronóstico, teniendo una supervivencia mayor aquellos pacientes con trombo confinado en vena renal (pT3a) frente a los tumores con trombo en aurícula (pT3c)

OBJECTIVES: To analyze surgery for renal cancer with venous thrombus at different levels, perioperative complications and prognostic factors associated to overall, cancer-specific and disease-free survival. MATERIAL AND METHODS: Retrospective analysis of 42 cases of renal cancer with venous thrombus performed between 2005 and 2015. The level reached by the thrombus was established according to the Mayo Clinic classification. Postoperative complications were staged according to Clavien-Dindo classification. RESULTS: Most frequent in males. Mean age 65.7 years. 16.6% were tumors with level II thrombus. Subcostal approach was performed in 58.9%. Extracorporeal circulation with cardiac arrest and hypothermia was established in 2 patients. Resection of metastatic disease was performed in 3 patients during radical nephrectomy. Reoperation was 2.3% while, perioperative mortality was 4.7%. 30% presented with metastases at diagnosis. Twenty patients progressed at 15.5 months (3-55). Overall survival was 60 months. The cancer-specific mortality was 75%. Disease-free survival was 30% at 55 months.CONCLUSIONS: Surgical treatment of renal cancer with venous thrombus requires a multidisciplinary management. The surgical technique varies according to the level reached by the venous thrombus. Tumor stage is the most important prognostic factor. Thrombus level influences prognosis, with longer survival for patients with tumor thrombus confined to the renal vein (pT3a) in comparison to tumors with thrombus in the atrium (pT3c)

[Prognostic factors in renal cancer with venous thrombus survival analysis.] / Factores pronósticos en cáncer renal con trombo en vena. Análisis de supervivencia.

OBJECTIVES: To analyze surgery for renal cancer with venous thrombus at different levels, perioperative complications and prognostic factors associated to overall, cancer-specific and disease-free survival. MATERIAL AND METHODS: Retrospective analysis of 42 cases of renal cancer with venous thrombus performed between 2005 and 2015. The level reached by the thrombus was established according to the Mayo Clinic classification. Postoperative complications were staged according to Clavien-Dindo classification. RESULTS: Most frequent in males. Mean age 65.7 years. 16.6% were tumors with level II thrombus. Subcostal approach was performed in 58.9%. Extracorporeal circulation with cardiac arrest and hypothermia was established in 2 patients. Resection of metastatic disease was performed in 3 patients during radical nephrectomy. Reoperation was 2.3% while, perioperative mortality was 4.7%. 30% presented with metastases at diagnosis. Twenty patients progressed at 15.5 months (3-55). Overall survival was 60 months. The cancer-specific mortality was 75%. Disease-free survival was 30% at 55 months. CONCLUSIONS: Surgical treatment of renal cancer with venous thrombus requires a multidisciplinary management. The surgical technique varies according to the level reached by the venous thrombus. Tumor stage is the most important prognostic factor. Thrombus level influences prognosis, with longer survival for patients with tumor thrombus confined to the renal vein (pT3a) in comparison to tumors with thrombus in the atrium (pT3c).

Thrombocytopenia after Aortic Valve Replacement with Perceval S Sutureless Bioprosthesis.

BACKGROUND AND AIM OF THE STUDY: Sutureless aortic bioprosthetic valves have become an alternative to conventional bioprostheses in high surgical risk cases. A significant decline in platelet count during the immediate postoperative period was observed in cases of Perceval S sutureless aortic valve implantation. The study aim was to determine how the reduction in platelet count after Perceval S prosthesis implantation compared to that after other bioprosthesis implants. METHODS: Between July 2011 and July 2014, a total of 77 isolated biological aortic valve replacements (AVRs) was performed at the authors' institution. These included 27 Perceval S prostheses (35.1%) and 50 Mitroflow prostheses (64.9%). Platelet counts and mean platelet volumes (MPVs) were determined on the day before surgery (T0) and at 24 h (T1), 48 h (T2) and 72 h (T3) after surgery. RESULTS: There were no significant differences in inhospital mortality (three Perceval S (11.1%) versus four Mitroflow 8%); p = 0.65), nor in morbidity between groups. A total of 16 patients (20.8%) had severe postoperative thrombocytopenia (<50×103/mm3). The incidence of severe thrombocytopenia was significantly higher (p = 0.046) in Perceval S patients (n = 9; 33.3%) than in Mitroflow patients (n = 7; 14%). The platelet count recovered in all patients with severe thrombocytopenia. In an adjusted-propensity multivariate logistic regression analysis, the Perceval S prosthesis was the major independent predictor of severe thrombocytopenia after AVR (OR 0.06, 95% CI: 0008-0.5, p = 0.009). CONCLUSION: Aortic bioprosthesis implantation with the Perceval S sutureless bioprosthesis appears to be associated with the occurrence of postoperative thrombocytopenia, though without any clinical implication for the patients. Prospective randomized trials are required to confirm these data.

[Small cell carcinoma of the bladder: Our experience]. / CARCINOMA DE CÉLULAS PEQUEÑAS DE VEJIGA.

OBJECTIVES: Small cell carcinoma of the bladder shows low incidence and poor survival; thus, treatment algorithms based on randomized studies are unavailable. The aim of the present study is to review our case series. METHODS: Observational retrospective study of 10 patients diagnosed with small cell carcinoma of the bladder between 2006 and 2013. RESULTS: Mean age was 65.7 years; There was only one female in the cohort. In all cases hematuria was the fist symptom. 4 cases presented high-grade papillary urothelial carcinoma with small cell carcinoma. Radical cystectomy was performed in 40% patients, in combination with chemotherapy, radiotherapy or both. Median survival was 330 days (IC 95%: 40.757- 619.243) and only one patient showed complete response. CONCLUSIONS: Even when small cell carcinoma of the bladder is a low incidence tumor, its prognosis is worse than that of urothelial carcinoma. Although further randomized studies are needed to best define treatment, this study shows that survival at local stages is optimized by neoadjuvant chemotherapy, followed by radical resection, as the literature suggests.

Carcinoma de células pequeñas de vejiga / Small cell carcinoma of the bladder: Our experience

OBJETIVO: El carcinoma vesical de células pequeñas presenta una baja incidencia y escasa supervivencia, por lo que no existen esquemas terapéuticos basados en estudios randomizados. Nos planteamos como objetivo revisar nuestra casuística. MÉTODOS: Estudio observacional retrospectivo de 10 pacientes diagnosticados de carcinoma de células pequeñas entre 2006 y 2013. RESULTADOS: La edad media fue de 65,7 años y sólo se presentó en una mujer de los 10 pacientes. Se relacionó en su totalidad con antecedentes de tabaquismo, siendo la forma de presentación la hematuria. 4 casos presentaban carcinoma urotelial de alto grado junto con el componente microcítico. Se realizó cistectomía radical en el 40% de los pacientes, recibiendo además tratamiento con quimioterapia, radioterapia o ambos. La mediana del tiempo de supervivencia fue de 330 días (IC 95%: 40,757 - 619,243). Sólo en un caso obtuvimos respuesta completa. CONCLUSIONES: El carcinoma de células pequeñas de vejiga es un tumor con baja incidencia pero de peor pronóstico que los tumores uroteliales. Aunque se necesiten más estudios randomizados para definir el mejor tratamiento, y nuestra casuística sea limitada, se ha publicado que los mejores resultados en cuanto a supervivencia en los estadios localizados se consiguen con quimioterapia neoayuvante seguida de cirugía radical

OBJECTIVES: Small cell carcinoma of the bladder shows low incidence and poor survival; thus, treatment algorithms based on randomized studies are unavailable. The aim of the present study is to review our case series. METHODS: Observational retrospective study of 10 patients diagnosed with small cell carcinoma of the bladder between 2006 and 2013. RESULTS: Mean age was 65.7 years; There was only one female in the cohort. In all cases hematuria was the fist symptom. 4 cases presented high-grade papillary urothelial carcinoma with small cell carcinoma. Radical cystectomy was performed in 40% patients, in combination with chemotherapy, radiotherapy or both. Median survival was 330 days (IC 95%: 40.757- 619.243) and only one patient showed complete response. CONCLUSIONS: Even when small cell carcinoma of the bladder is a low incidence tumor, its prognosis is worse than that of urothelial carcinoma. Although further randomized studies are needed to best define treatment, this study shows that survival at local stages is optimized by neoadjuvant chemotherapy, followed by radical resection, as the literature suggests

Primary and metastatic renal hemangiopericytoma.

OBJECTIVE: Haemangiopericytoma is an uncommon perivascular tumor that occurs more frequently in soft tissues and is extremely rare in the kidney. METHODS: We report two cases: The first one is the case of a 57-year-old man with bilateral metastatic renal haemangiopericytoma which appeared 18 years after removal of a meningeal haemangiopericytoma. The second is a 29-year-old woman with a primary kidney haemangiopericytoma that was casually found in a nephrectomy piece. RESULTS: In the first case, radical left nephrectomy and right renal mass radiofrequency ablation were performed. The patient had an uneventful postoperatory recovery. He remained disease-free 22 months after surgery but two new lesions appeared that were treated with radiofrequency ablation. The second case was a casual finding, a small tumor that had been totally resected. CONCLUSIONS: Haemangiopericytoma is a rare tumor with an uncertain clinical behaviour. Long-term follow up is important as local recurrences and metastases can develop years after initial treatment.

Hemangiopericitoma renal primario y metastásico / Primary and metastatic renal hemangiopericytoma

OBJETIVO: El hemangiopericitoma es un raro tumor perivascular que aparece sobre todo en los tejidos blandos y que es muy inusual en el riñón. MÉTODO: Se describen dos casos. Caso 1: Varón de 57 años con un hemangiopericitoma renal bilateral metastásico que tuvo lugar 18 años después de la exéresis de un hemangiopericitoma meníngeo. Caso 2: Mujer de 29 con un hemangiopericitoma renal primario hallado de forma casual en la pieza de nefrectomía por una pionefrosis. RESULTADOS: En el primer caso se realizó una nefrectomía radical izquierda y ablación con rediofrecuencia de la masa renal derecha. El postoperatorio cursó sin complicaciones y no hubo signos de enfermedad durante 22 meses, hasta que aparecieron nuevas lesiones en riñón derecho, que fueron tratadas nuevamente con radiofrecuencia. El segundo caso fue un tumor de hallazgo casual, de escaso tamaño y totalmente resecado en la pieza quirúrgica. CONCLUSIONES: El hemangiopericitoma es un tumor raro y de comportamiento incierto, que requiere un seguimiento a largo plazo. La recidiva local y las metástasis pueden aparecer años después del tratamiento del tumor primario

OBJECTIVE: Haemangiopericytoma is an uncommon perivascular tumor that occurs more frequently in soft tissues and is extremely rare in the kidney. METHODS: We report two cases: The first one is the case of a 57-year-old man with bilateral metastatic renal haemangiopericytoma which appeared 18 years after removal of a meningeal haemangiopericytoma. The second is a 29-year-old woman with a primary kidney haemangiopericytoma that was casually found in a nephrectomy piece. RESULTS: In the first case, radical left nephrectomy and right renal mass radiofrequency ablation were performed. The patient had an uneventful postoperatory recovery. He remained disease-free 22 months after surgery but two new lesions appeared that were treated with radiofrequency ablation. The second case was a casual finding, a small tumor that had been totally resected. CONCLUSIONS: Haemangiopericytoma is a rare tumor with an uncertain clinical behaviour. Long-term follow up is important as local recurrences and metastases can develop years after initial treatment

Urinary incontinence during pregnancy and postpartum. Associated risk factors and influence of pelvic floor exercises.

OBJECTIVES: To determine the prevalence of urinary incontinence (UI) before pregnancy, in the third trimester and postpartum. To analyze its influence on quality of life and associated potential risk factors and the efficacy of pelvic floor exercises. METHODS: Prospective study in 413 pregnant women. The modified ICIQ-SF incontinence questionnaire was given to the pregnant women at the end of the third quarter. This questionnaire was administered by telephone at 3 and 6 months postpartum. The influence of several risk factors for UI in pregnancy and postpartum were analyzed. Patients with persistent UI at 6 months postpartum were trained to do pelvic floor exercises. RESULTS: Patients with UI before pregnancy were excluded from the study. UI in the third trimester was 31%. Analyzed risk factors did not condition a higher percentage of UI. Prevalence of UI was 11.3% at 3 months postpartum and 6.9% at 6 months. 70% of the incontinent patients already had it during pregnancy and it appeared de novo post-delivery in 30% of the patients. Prevalence of UI after delivery was higher in women with UI in pregnancy and lower in caesarean cases. Most women improved with pelvic floor exercises. CONCLUSIONS: Analysed risk factors did not significantly increase UI in pregnancy. Prevalence of UI after delivery is higher in women with UI in pregnancy and lower in caesarean cases. Postpartum pelvic floor exercises for three months in patients with persistent stress UI at 6 months postpartum clearly improved the degree of continence.

Effectiveness and safety of different azacitidine dosage regimens in patients with myelodysplastic syndromes or acute myeloid leukemia.

We investigated the effectiveness and tolerability of azacitidine in patients with World Health Organization-defined myelodysplastic syndromes, or acute myeloid leukemia with 20-30% bone marrow blasts. Patients were treated with azacitidine, with one of three dosage regimens: for 5 days (AZA 5); 7 days including a 2-day break (AZA 5-2-2); or 7 days (AZA 7); all 28-day cycles. Overall response rates were 39.4%, 67.9%, and 51.3%, respectively, and median overall survival (OS) durations were 13.2, 19.1, and 14.9 months. Neutropenia was the most common grade 3-4 adverse event. These results suggest better effectiveness-tolerability profiles for 7-day schedules.

Incontinencia urinaria en embarazo y postparto. Factores de riesgo asociados e influencia de los ejercicios del suelo pélvico / Urinary incontinence during pregnancy and postpartum. Associated risk factors and influence of pelvic floor exercises

OBJETIVO: Determinar la prevalencia de incontinencia urinaria (IU) previa a la gestación, en el tercer trimestre y en el postparto. Analizar su influencia en la calidad de vida, los posibles factores de riesgo y la eficacia de los ejercicios del suelo pélvico. MÉTODOS: Estudio prospectivo a 413 gestantes. Se entregó el cuestionario de incontinencia ICIQ-SF modificado a las gestantes al final del tercer trimestre y a los 3 y 6 meses postparto. Se analizó la influencia de varios factores de riesgo de IU en el embarazo y en el postparto. Las pacientes con persistencia de IU a los 6 meses del parto fueron instruidas para realizar ejercicios de suelo pélvico. RESULTADOS: Las pacientes con IU previa a la gestación fueron excluidas. La prevalencia de incontinencia en el tercer trimestre en gestantes fue del 31%. Ningún factor de riesgo condicionó un mayor porcentaje de IU. La prevalencia de IU fue de 11.3 % a los tres meses del parto y del 6.9% a los 6 meses. De las pacientes incontinentes un 70% ya la sufría en el embarazo y en el 30% apareció de novo tras el parto. El porcentaje de IU postparto fue más elevado en mujeres con IU en la gestación y más bajo en aquellas con cesárea. La mayoría de las mujeres mejoraron con ejercicios de suelo pélvico. CONCLUSIONES: Ningún factor de riesgo aumenta el riesgo de IU en gestantes de forma significativa. La prevalencia de IU tras el parto es mayor en aquellas mujeres con IU en el embarazo y más baja en aquellas con cesárea. La mayoría de las puerperas mejoraron con ejercicios de suelo pélvico

OBJECTIVES: To determine the prevalence of urinary incontinence (UI) before pregnancy, in the third trimester and postpartum. To analyze its influence on quality of life and associated potential risk factors and the efficacy of pelvic floor exercises. METHODS: Prospective study in 413 pregnant women. The modified ICIQ-SF incontinence questionnaire was given to the pregnant women at the end of the third quarter. This questionnaire was administered by telephone at 3 and 6 months postpartum. The influence of several risk factors for UI in pregnancy and postpartum were analyzed. Patients with persistent UI at 6 months postpartum were trained to do pelvic floor exercises. RESULTS: Patients with UI before pregnancy were excluded from the study. UI in the third trimester was 31%. Analyzed risk factors did not condition a higher percentage of UI. Prevalence of UI was 11.3% at 3 months postpartum and 6.9% at 6 months. 70% of the incontinent patients already had it during pregnancy and it appeared de novo post-delivery in 30% of the patients. Prevalence of UI after delivery was higher in women with UI in pregnancy and lower in caesarean cases. Most women improved with pelvic floor exercises. CONCLUSIONS: Analysed risk factors did not significantly increase UI in pregnancy. Prevalence of UI after delivery is higher in women with UI in pregnancy and lower in caesarean cases. Postpartum pelvic floor exercises for three months in patients with persistent stress UI at 6 months postpartum clearly improved the degree of continence

Left ventricular assist devices in patients with end-stage heart failure: suggestion of an alternative treatment based on clinically well-known concepts.

Encouraging results were obtained by using left ventricular assist devices (LVADs) in patients with end-stage heart failure (HF) that exhibits extremely high mortality and who were not candidates for heart transplantation. By using this so-called destination therapy (DT), a substantial percentage of these patients achieved sufficient improvement in cardiac function to permit the explantation of the device. The combination of mechanical and pharmacological therapy increased the frequency and durability of myocardial recovery as compared with other therapeutic approaches. Although cardiac transplantation, LVADs, and cardiac resynchronization therapy have provided a major advance in DT, their limitations stimulate the search for alternative therapies. We discuss the limitations of these 3 treatment options for end-stage HF. Also, we propose and discuss the possible advantages of a new intracorporeal procedure that works continuously as intraaortic balloon counterpulsation without an extracorporeal or intracorporeal computer-controlled mechanism.