Probability distribution for heat exchange in plastic deformation.

Fluctuation theorems allow one to obtain equilibrium information from nonequilibrium experiments. The probability distribution function of the relevant magnitude measured along the irreversible nonequilibrium trajectories is an essential ingredient of fluctuation theorems. In small systems, where fluctuations can be larger than average values, probability distribution functions often deviate from being Gaussian, showing long tails, mostly exponential, and usually strongly asymmetric. Recently, the probability distribution function of the van Hove correlation function of the relevant magnitude was calculated, instead of that of the magnitude itself. The resulting probability distribution function is highly symmetric, obscuring the application of fluctuation theorems. Here, the discussion is illustrated with the help of results for the heat exchanged during plastic deformation of aluminum nanowires, obtained from molecular dynamics calculations. We find that the probability distribution function for the heat exchanged is centrally Gaussian, with asymmetric exponential tails further out. By calculating the symmetry function we show that this distribution is consistent with fluctuation theorems relating the differences between two equilibrium states to an infinite number of nonequilibrium paths connecting those two states.

Clinical and biochemical correlates of male hypogonadism in type 2 diabetes.

The origin of hypogonadism, a condition including both symptoms and biochemical criteria of androgen deficiency, in type 2 diabetes is poorly known. In a cross-sectional study of 267 unselected patients, we analyzed the potential correlation of several clinical and biochemical variables as well as chronic micro- and macrovascular diabetic complications with hypogonadism. Hypogonadism was present in 46 patients (17.2%) using a cutoff of total testosterone 10.4 nmol/L and in 31 (11.6%) with a cutoff of 8 nmol/L. Among these patients, hypogonadotropic hypogonadism was the most prevalent form (82.6%). Compared to eugonadal subjects, hypogonadal men had significantly lower glomerular filtration rate (67.1 ± 23.4 vs. 78.4 ± 24.6 mL/min/1.73 m2 , p = 0.005) and higher prevalence of chronic kidney disease (43.5% vs. 20.4%, p = 0.002), abnormal liver function tests (26.7% vs. 12%, p = 0.019), and psychiatric treatment (23.9% vs. 10.4%, p = 0.025). Total testosterone levels correlated inversely with age (R = -0.164, p = 0.007), fasting blood glucose (R = -0.127, p = 0.037), and triglycerides (R = -0.134, p = 0.029) and directly with glomerular filtration rate (R = 0.148, p = 0.015). Calculated free testosterone and bioavailable testosterone correlated directly with hemoglobin (R = 0.171, p = 0.015 and R = 0.234, p = 0.001, respectively). Multivariate logistic regression analysis, after adjusting for relevant confounding variables, showed that age >60 years (OR = 3.58, CI 95% = 1.48-8.69, p = 0.005), body mass index >27 kg/m2 (OR = 2.85, CI 95% = 1.14-7.11, p = 0.025), hypertriglyceridemia (OR = 2.16, CI 95% = 1.05-4.41, p = 0.035), glomerular filtration rate <60 mL/min/1.73 m2 (OR = 2.51, CI 95% = 1.19-5.29, p = 0.015), and abnormal liver function tests (OR = 3.57, CI 95% = 1.48-8.60, p = 0.005) were independently associated with male hypogonadism. Although older age, body mass index, and hypertriglyceridemia have been previously related to hypogonadism, our results describe that chronic kidney disease and abnormal liver function tests are independently correlated with hypogonadism in type 2 diabetic men.

Type A ganglion cysts of the radiocapitellar joint may involve compression of the superficial radial nerve.

INTRODUCTION: Two types of ganglion cysts at the elbow have been described depending on their anatomic location. Type A ganglion cyst is located proximal to the arcade of Frohse, and type B distal to it. Compressive neuropathies of the radial nerve at the level of the radial tunnel may lead to two different clinical entities with different clinical manifestations. These different conditions depend on which branch is involved. Although compression of the deep motor branch due to a ganglion cyst has been previously described, affection of the superficial sensory branch is considered much rarer. The aim of this study was to describe a series of patients in which painful and dysesthetic symptoms arose from superficial radial nerve compression due to type A ganglion cysts coming from the radiocapitellar joint. METHODS: A review of currently available literature about the disease was carried out. The clinical, histological and radiological records of a series of eight cases (seven patients) with compression of the superficial radial nerve diagnosed and treated between 2008 and 2011 were retrospectively reviewed. All patients complained of pain and dysesthesia at the lateral aspect of the elbow. All patients were initially diagnosed and managed as lateral epicondylitis. Persistence of the symptoms was evidenced in all patients after a course of six months of non-operative management. Magnetic resonance imaging was performed and revealed the presence of a mass compatible with a ganglion cyst coming from the radiocapitellar joint, pushing up the superficial sensory branch of the radial nerve and compressing it against the extensor carpi radialis brevis. Surgical excision was performed in all cases. RESULTS: Histology confirmed the diagnosis of ganglion cysts. Histological findings consisted of dense fibrous tissue, with no synovial or epithelial lining and mucoid material with foamy macrophages. The mean follow-up after surgical excision was 28months (range 24-30). The symptoms subsided in all cases. No complications were registered during the follow-up. CONCLUSION: Type A ganglion cysts of the radiocapitellar joint may involve compression of the superficial radial nerve. Our series of eight cases may suggest that this pathology might not be as rare as it was thought before. This evidence may be useful for the orthopaedic population, who may have another differential diagnosis when managing cases of painful symptoms located in the lateral aspect of the elbow. TYPE OF STUDY: Therapeutic study. LEVEL OF EVIDENCE: IV.

Plurihormonal Cosecretion by a Case of Adrenocortical Oncocytic Neoplasm.

Adrenocortical oncocytic neoplasms (oncocytomas) are extremely rare; only approximately 159 cases have been described so far. The majority are nonfunctional and benign. We describe an unusual case of a functional oncocytoma secreting an excess of glucocorticoids (cortisol) and androgens (androstenedione and DHEAS), a pattern of plurihormonal cosecretion previously not reported in men, presenting with endocrine manifestations of Cushing's syndrome. The neoplasm was considered to be of uncertain malignant potential (borderline) according to the Lin-Weiss-Bisceglia criteria.

Comparative study for the efficacy and safety of percutaneous nefhrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) for the treatment of 2-3,5 cm kidney stones. / Estudio comparativo de eficacia y seguridad de la nefrolitotomía percutánea (NLPC) y la cirugía retrógrada intrarrenal (CRIR) para litiasis renales de 2-3,5 cm.

OBJECTIVES: Retrograde intrarenal surgery (RIRS) has become an important alternative for the treatment of kidney stones due to its increased safety and efficiency. The purpose of this study is to compare efficacy and safety features of RIRS against percutaneous nephrolithotomy (PCNL) for the treatment of 2 - 3.5 cm kidney stones. METHODS: 142 cases (106 RIRS and 36 PCNL) encompassing 2 - 3.5 cm kidney stones that have been treated in our center between December 2009 and December 2011 have been considered. Demographic variables, stone characteristics, surgical stay and surgical time have been evaluated. Additionally, the complication prerate and success rate after one and two procedures (retreatment) have also been assessed. Student's T, Mann-Whitney U y Chi² - V Cramer (p=0.05) tests were used for statistical analysis. RESULTS: There are not statistically significant differences in demographic or stone variables. The calculated mean surgical time was lower for PCNL (85 min) than for RIRS (112 min). Mean hospital stay was statistically significantly shorter in RIRS (16 h vs. 98 h in RIRS, p=0.001). PCNL exhibited a higher global complication rate of 19.4% vs. 6.6% for RIRS (p=0.001). PCNL also showed a higher successful rate (80.6% vs. 73.6% for RIRS), although this difference was not statistically significant (p=0.40). When comparing the success rate after a second procedure, PCNL results in 94.3% vs. 93.5% for RIRS (p=0.88). CONCLUSION: RIRS was found to be a safe and efficient procedure with a short hospital stay. Overall, RIRS can be considered as an alternative to PCNL for the treatment of renal stones smaller than 3.5 cm.

Acute high-grade acromioclavicular joint injuries treatment: Arthroscopic non-rigid coracoclavicular fixation provides better quality of life outcomes than hook plate ORIF.

INTRODUCTION: Treatment of acute high-grade acromioclavicular joint (ACJ) injuries with metal hardware alters the biomechanics of the ACJ, implying a second surgery for hardware removal. The period during which the plate is present involves functional limitations, pain and a risk factor for the development of hardware-related-injuries. Arthroscopy-assisted procedures compared to open-metal hardware techniques offer: less morbidity, the possibility to treat associated lesions and no need for a second operation. The aim was to compare the Quality of life (QoL) of patients with acute high-grade ACJ injuries (Rockwood grade III-V), managed arthroscopically with a non-rigid coracoclavicular (CC) fixation versus the QoL of patients managed with a hook plate, 24 months or more after their shoulder injury. PATIENTS AND METHODS: A retrospective revision of high-grade ACJ injuries managed in three institutions was performed. Patients treated by means of an arthroscopy-assisted CC fixation or by means of a hook plate were included. The inclusion period was between 2008 and 2012. The QoL was evaluated at the last follow-up visit by means of the SF36, the visual analog scale (VAS), the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the Constant score and the global satisfaction (scale from 0 to 10). The presence of scapular dyskinesis and remaining vertical instability were evaluated. Comparison between groups was performed. RESULTS: Thirty-one patients were included: 20 arthroscopy-group (ARTH group: 3 Rockwood III, 3 IV and 14 V) and 11 hook plate-group (HOOK group: 5 Rockwood III and 6 V). The mean age was 36 [25-52] year-old for the ARTH group and 41 [19-55] for the HOOK group (P=0.185). The mean results of the questionnaires were: (1) physical SF36 score (ARTH group 58.24±2.16 and HOOK group 53.70±4.33, P<0.001); (2) mental SF36 score (ARTH group 56.15±2.21 and HOOK group 53.06±6.10, P=0.049); (3) VAS (ARTH group 0.40±0.50 and HOOK group 1.45±1.51, P=0.007); (4) DASH (ARTH group 2.98±2.03 and HOOK group 4.79±5.60, P=0.200); (5) Constant score (ARTH group 95.30±2.45 and HOOK group 91.36±6.84, P=0.026); (6) global satisfaction (ARTH group 8.85±0.93 and HOOK group 8.00±1.18, P=0.035). There was evidence of scapular dyskinesis in 15% (3/20) of the patients of the ARTH group and in 18% (2/11) of the patients of the HOOK group (P=1.000). Remaining vertical ACJ instability was observed in 40% (8/20) of the patients of the ARTH group and in 36.36% (4/11) of the patients of the HOOK group (P=1.000). CONCLUSION: Patients with acute high-grade ACJ injuries managed arthroscopically with a non-rigid CC fixation seem to have a better QoL than patients managed with a hook plate. LEVEL OF EVIDENCE: Level IV therapeutic; retrospective comparative study.

Resultados de la cirugía retrógrada intrarrenal en el tratamiento de litiasis renales mayores de 2 cm / Results of retrograde intrarenal surgery in the treatment of renal stones greater than 2 cm

Objetivo: Analizar los resultados de la cirugía retrógrada intrarrenal (CRIR) en pacientes con litiasis ≥ 2 cm tratados en nuestro centro. Material y métodos: Revisión retrospectiva de 106 pacientes con litiasis renales ≥ 2 cm sometidos a RIRS (período comprendido entre enero de 2009 y diciembre de 2011). Los procedimientos se realizaron bajo anestesia general utilizando como fuente de fragmentación el láser Holmium (Litho 30 W Quantasystem) y ureteroscopios flexibles (Storz Flex X2, Olympus P5) a través de vainas de acceso ureteral.Se analizan variables demográficas (edad, antecedentes patológicos, tratamientos antiagregantes o anticoagulantes, tratamiento de litiasis, IMC, ASA), variables de litiasis tratada (tamaño, número, unidades Hounsfield, composición bioquímica) y variables intra y postoperatorias (tiempo quirúrgico, número de pulsos, estancia hospitalaria, complicaciones) con la realización de un análisis descriptivo de las mismas. Para definir nuestros resultados consideramos éxito la ausencia completa de restos litiásicos o residuales < 5 mm en las pruebas de imagen posteriores. Resultados: La media de tamaño de las litiasis tratadas fue de 2,46 cm, siendo la litiasis única en el 87,7% de los casos. La localización más frecuente de la litiasis fue la pelvis renal (44%) seguida del cáliz inferior (39%). La tasa de complicaciones postoperatoria fue del 6,7%, siendo todas de escasa relevancia. El porcentaje de éxito con un único procedimiento fue de un 79,4%, alcanzando el 94,1% con retratamiento. Conclusión: La CRIR es una alternativa válida para el tratamiento de litiasis renales ≥ 2 cm por su alta tasa de éxito y escasas complicaciones si se realiza en centros especializados

Objective: To analyze the results of retrograde intrarenal surgery (RIRS) in patients with ≥2 cm stones treated in our center. Material and methods: A retrospective review of 106 patients with renal calculi underwent RIRS ≥2 cm (period January 2009-December 2011). The procedures were performed under general anesthesia as a source of fragmentation using the holmium laser (30 W Litho Quanta system) and flexible ureteroscopes (X2 Flex Storz, Olympus P5) through ureteral access sheaths. It discusses demographic variables (age, medical history, antiplatelet or anticoagulant treatment, treatment of urolithiasis, BMI, ASA), treated stones variables (size, number, Hounsfield units, biochemical composition) and intra-and postoperative variables (operative time, number of pulses, hospital stay, complications) with the completion of a descriptive analysis of the same. To define our results we consider success to the complete absence of fragments or residual <5 mm posterior imaging tests. Results: The mean stone size was 2.46 cm treated, being the only stone in 87.7% of cases. The most frequent location was the renal pelvis stones (44%) followed by the lower calyx (39%).The postoperative complication rate was 6.7%, with all of little relevance. The success rate with a single procedure was 79.4% to 94.1% with retreatment. Conclusion: RIRS is a valid alternative for the treatment of kidney stones ≥ 2 cm for its high success rate and few complications if performed in specialized centers

Estudio comparativo entre nefrolitotomía percutánea en decúbito supino frente cirugía endoscópica intrarrenal combinada con instrumento flexible / A Comparative Study of Percutaneous Nephrolithotomy in Supine Position and Endoscopic Combined Intrarenal Surgery With Flexible Instrument

Objetivo: Comparar los resultados obtenidos en la nefrolitotomía percutánea tras la introducción del ureteroscopio/nefroscopio flexible (cirugía endoscópica intrarrenal combinada [CEIRC]) con nefrolitomías con solo nefroscopio rígido (nefrolitotomía percutánea estándar [NLPC]). Material y método: Estudio retrospectivo de 171 NLPC en posición de Galdakao realizadas entre enero de 2005 y diciembre de 2011. Comparamos los resultados obtenidos en aquellos procedimientos en los que se realizó CEIRC con aquellos en los solo se utilizó nefroscopio rígido (NLPC). Se estimó el éxito específico y el global, el porcentaje de carga litiásica eliminada, los días de estancia hospitalaria y las complicaciones derivadas. Definimos el éxito por la ausencia completa de litiasis o la presencia de residual < 5 mm. Diferenciamos el éxito específico, el conseguido solo con la cirugía percutánea, y el éxito global, el alcanzado tras una segunda línea de tratamiento. Resultados: En 73 procedimientos (42,4%) se realizó CEIRC con endoscopios flexibles, mientras que 98 (57,6%) fueron NLPC. Ambos grupos fueron comparables en cuanto a parámetros demográficos y características de las litiasis. Las tasas de éxito en el primer procedimiento y de éxito global fueron superiores para el grupo de CEIRC (75,3 vs 40,8% y 93,1 vs 74,5%), siendo las diferencias estadísticamente significativas (p < 0,05). No se encontraron diferencias estadísticamente significativas en cuanto a las complicaciones (28,8 vs 28,3%; p = 0,86) o los días de estancia hospitalaria (4,5 vs 5,0; p = 0,18). Conclusiones: El uso de ureteroscopio/nefroscopio flexible en la NLPC (CEIRC) mejora las tasas de éxito y de eliminación de carga litiásica, permitiendo en la mayoría de casos realizar la cirugía con un acceso único

Objective: To compare the results obtained in percutaneous nephrolithotomy after introduction of flexible ureteroscopy/nephroscopy (endoscopic combined intrarenal surgery - ECIRS) with nephrolitomies with only rigid nephroscopy (standard percutaneous nephrolithotomy; sPCNL). Materials and methods: A retrospective study of 171 sPCNL in Galdakao position performed between January 2005 and December 2011 was conducted. We compared the results obtained in those procedures in which endoscopic combined intrarenal surgery (ECIRS) was performed with those in which only the rigid nephroscopy (sPCNL) was used. Specific and global success, percentage of lithiasic load eliminated, days of hospital stay and complications derived were calculated. We defined success by complete absence of lithiasis or residual presence of <5 mm. We differentiated specific success, that only achieved with percutaneous surgery, from global success, or that achieved after a second line of treatment. Results: In 73 procedures (42.4%) ECIRS was performed with flexible endoscopy while in 98 (57.6%) it was done with sPCNL. Both groups were comparable in regards to demographic parameters and characteristics of the lithiasis. The success rates in the first procedure and global success were superior for the ECIRS group (75.3% vs. 40.8% and 93.1% vs. 74.5%), the differences being statistically significant (P < 0.05). No statistically significant differences were found in regards to the complications (28.8% vs. 28.3%; P = .086) or days of hospital stay (4.5 vs. 5.0; P = 0.18). Conclusions: Use of the flexible ureteroscopy/nephroscopy in sPCNL (ECIRS) improves the success rates and elimination of lithiasic load, making it possible to perform the surgery with a single access in most of the cases

Testosterone replacement therapy in hypogonadal men is associated with increased expression of LAMP-2 (CD107b) by circulating monocytes and dendritic cells.

BACKGROUND: Accumulated experimental data indicates that androgen therapy has effects on inflammation and protects from autoimmune disorders. Despite this, the in vivo effects of testosterone replacement therapy on human antigen-presenting cells-for example, monocytes and dendritic cells- remain unknown. OBJECTIVE, DESIGN AND PATIENTS: We monitored the effects of testosterone replacement therapy on the number and the functionality -as assessed by the expression of CD107b (lysosome-associated membrane protein 2, LAMP-2)- of resting and in vitro-stimulated peripheral blood (classical and nonclassical) monocytes and dendritic cells (myeloid and plasmacytoid) from hypogonadal men. RESULTS: Our results show that testosterone replacement therapy induces overexpression of CD107b by circulating monocytes and dendritic cells from hypogonadal men, both under resting (i.e. nonstimulated) conditions and after in vitro stimulation. CD107b overexpression mostly involved monocytes and in vitro stimulation with CpG oligodeoxynucleotides. Of note, a strong correlation was found between CD107b expression on monocytes and serum gonadotrophins levels. CONCLUSION: These results support the existence of an effect of testosterone therapy, and potentially also of gonadotrophins, on circulating antigen-presenting cells.

A comparative study of percutaneous nephrolithotomy in supine position and endoscopic combined intrarenal surgery with flexible instrument.

OBJECTIVE: To compare the results obtained in percutaneous nephrolithotomy after introduction of flexible ureteroscopy/nephroscopy (endoscopic combined intrarenal surgery - ECIRS) with nephrolitomies with only rigid nephroscopy (standard percutaneous nephrolithotomy; sPCNL). MATERIAL AND METHOD: A retrospective study of 171 sPCNL in Galdakao position performed between January 2005 and December 2011 was conducted. We compared the results obtained in those procedures in which endoscopic combined intrarenal surgery (ECIRS) was performed with those in which only the rigid nephroscopy (sPCNL) was used. Specific and global success, percentage of lithiasic load eliminated, days of hospital stay and complications derived were calculated. We defined success by complete absence of lithiasis or residual presence of<5mm. We differentiated specific success, that only achieved with percutaneous surgery, from global success, or that achieved after a second line of treatment. RESULTS: In 73 procedures (42.4%) ECIRS was performed with flexible endoscopy while in 98 (57.6%) it was done with sPCNL. Both groups were comparable in regards to demographic parameters and characteristics of the lithiasis. The success rates in the first procedure and global success were superior for the ECIRS group (75.3% vs 40.8% and 93.1% vs 74.5%), the differences being statistically significant (P<.05). No statistically significant differences were found in regards to the complications (28.8% vs 28.3% P=.86) or days of hospital stay (4.5 vs 5.0 P=.18). CONCLUSIONS: Use of the flexible ureteroscopy/nephroscopy in sPCNL (ECIRS) improves the success rates and elimination of lithiasic load, making it possible to perform the surgery with a single access in most of the cases.

Results of retrograde intrarenal surgery in the treatment of renal stones greater than 2 cm.

OBJECTIVE: To analyze the results of retrograde intrarenal surgery (RIRS) in patients with ≥2 cm stones treated in our center. MATERIAL AND METHODS: A retrospective review of 106 patients with renal calculi underwent RIRS ≥2 cm (period January 2009-December 2011). The procedures were performed under general anesthesia as a source of fragmentation using the holmium laser (30 W Litho Quantasystem) and flexible ureteroscopes (X2 Flex Storz, Olympus P5) through ureteral access sheaths. It discusses demographic variables (age, medical history, antiplatelet or anticoagulant treatment, treatment of urolithiasis, BMI, ASA), treated stones variables (size, number, Hounsfield units, biochemical composition) and intra-and postoperative variables (operative time, number of pulses, hospital stay, complications) with the completion of a descriptive analysis of the same. To define our results we consider success to the complete absence of fragments or residual <5 mm posterior imaging tests. RESULTS: The mean stone size was 2.46 cm treated, being the only stone in 87.7% of cases. The most frequent location was the renal pelvis stones (44%) followed by the lower calyx (39%). The postoperative complication rate was 6.7%, with all of little relevance. The success rate with a single procedure was 79.4% to 94.1% with retreatment. CONCLUSION: RIRS is a valid alternative for the treatment of kidney stones ≥2 cm for its high success rate and few complications if performed in specialized centers.

Tratamiento de las complicaciones hemorrágicas de la nefrolitotomía percutánea en posición de Galdakao / Treatment of hemorrhagic complications of percutaneous nephrolithotomy in Galdakao position

Objetivo: La nefrolitotomía percutánea (NLPC) es una técnica con buenos resultados para el tratamiento de la litiasis renal, sin embargo, las complicaciones hemorrágicas derivadas de la misma puedes ser graves si no son diagnosticadas y tratadas eficazmente. El objetivo de este estudio es evaluar las complicaciones hemorrágicas derivadas de la nefrolitotomía percutánea en posición de Galdakao y su manejo terapéutico. Material y métodos: Estudio longitudinal retrospectivo de 172 NLPC realizadas en el Hospital La Ribera entre enero de 2005 y diciembre de 2011, analizando sus complicaciones hemorrágicas y el tratamiento establecido para su resolución. Resultados: Presentaron complicaciones hemorrágicas 20 pacientes (11,6%). El requerimiento transfusional de esta serie fue de 8,1% y la causa más frecuente de transfusión el hematoma perirrenal post-operatorio (7,5%). Hubo 6 lesiones arteriales (3,5%), 5 de ellas tratadas satisfactoriamente con arteriografía y embolización selectiva de la lesión. Conclusiones: Las lesiones arteriales por NLPC son poco frecuentes pero pueden ser graves. La posibilidad de realizar de manera urgente arteriografía y embolización selectiva, ante el diagnóstico de una lesión vascular tras NLPC, permite el tratamiento de la hemorragia de una manera eficaz y segura sin riesgo para la unidad renal afectada (AU)

Objetive: Percutaneous Nephrolithotomy (PCNL) is a technique with good results for the treatment of kidney stones, however, bleeding complications derived can be serious if not diagnosed and treated effectively. The aim of this study is to assess bleeding complications resulting from PCNL in Galdakao position and therapeutic management. Material and methods: Retrospective-longitudinal study of 172 PCNL performed in La Ribera Hospital between January 2005 and December 2011, analyzing their bleeding complications and the treatment provided for resolution. Results: Had bleeding complications 20 patients (11.6%). The need for transfusion in this series was 8.1% and the most common cause of blood transfusion the presence of postoperative retroperitoneal (7.5%). There were 6 arterial injuries (3.5%), 5 of them successfully treated with angiography and arterial selective embolization. Conclusions: The arterial injuries following PCNL are rare but can be serious. The possibility of an urgent arteriography and selective embolization to the diagnosis permits an effective and safe treatment of bleeding without risk to the affected renal unit (AU)

Estudio de factores predictivos para complicaciones tras nefrolitotomía percutánea ajustado a la clasificación de Clavien / Study of Predictive Factors for Complications After Percutaneous Nephrolithotomy According to the Clavien Classification

Objetivo: Establecer factores predictivos de complicaciones en nefrolitotomía percutánea (NLPC) utilizando el sistema de Clavien modificado. Material y método: Estudio retrospectivo en el que se incluyen 172 NLPC en posición de Galdakao realizadas en el Hospital La Ribera entre enero de 2005 y diciembre de 2011. Se clasifican las complicaciones derivadas de estos procedimientos utilizando el sistema de Clavien modificado. Se realiza un análisis univariante (test Chi-cuadrado y V de Cramer) y multivariante (regresión logística) de factores predictivos de estas complicaciones (p < 0,05). Resultados: En 49 de los 172 procedimientos se detectaron complicaciones (28,5%). Las complicaciones más frecuentes fueron de grado 1 (9,9%), 12 complicaciones (6,9%) fueron clasificadas como grado 2 por requerir tratamiento médico adicional, 6 como grado 3A (3,5%), 7 como grado 3B (4,1%), 2 como 4A (1,1%), 4 como 4B (2,3%) y una como 5 (0,6%). En el análisis univariante el cultivo de orina positivo previo a la intervención, las litiasis complejas y el tamaño mayor de 40 mm de las mismas mostraron una asociación estadísticamente significativa con la aparición de complicaciones (p < 0,05). El cultivo positivo (OR: 2,96) y las litiasis complejas (OR: 3,03) demostraron ser variables independientes de predicción de complicaciones en el análisis multivariante. Conclusiones: El sistema de Clavien permite utilizar un lenguaje común para clasificar las complicaciones, expresando el grado de las mismas según la complejidad del tratamiento requerido para su resolución. La positividad del urinocultivo preoperatorio y las litiasis complejas demostraron ser factores predictivos de estas complicaciones en nuestra serie (AU)

Objective: Set predictors of complications in percutaneous nephrolithotomy (PCNL) using the modified Clavien system. Material and methods: Retrospective study included 172 PCNL in Galdakao position made in the La Ribera Hospital between January 2005 and December 2011. They classified the complications of these procedures using the modified Clavien system. We performed a univariate analysis (Chi2 Test and Cramer's V) and multivariate (logistic regression) of predictors of these complications (P <0 .05). Results: In 49 of the 172 procedures complications were detected (28.5%).The most frequent complications were grade 1 (9.9%), 12 complications (6.9%) were classified as grade 2 by requiring additional medical treatment, 6 as grade 3A (3.5%), 7 as grade 3B (4.1%), 2 and 4A (1.1%), 4 and 4B (2.3%) and one and 5 (0.6%). In the univariate analysis, positive urine culture before surgery, the stones complex and larger than 40 mm of the same, showed a statistically significant association with the occurrence of complications (P < .05). The positive culture (OR: 2.96) and complex stones (OR: 3.03) proved to be independent variables predicting complications in multivariate analysis. Conclusions: Clavien system allows a common language for classifying complications, expressing the degree of the same as the complexity of treatment required for resolution. The preoperative urine culture positivity and complex stone proved predictors of these complications in our serie (AU)

El suero de pacientes con enfermedad arterial periférica activa el sistema inmunitario innato a través de los receptores Toll-Like 4 de las células endoteliales / The serum of patients with peripheral arterial disease activates the inate immune system through Toll-Like 4 receptors of the endothelial cells

Introducción: La activación de los receptores de la inmunidad innata induce un viraje fenotípico proinflamatorio de la célula endotelial provocando la síntesis de moléculas de adhesión y la liberación de citocinas por el endotelio. Objetivos: Nuestro objetivo es determinar la activación del sistema inmunitario innato a través de los receptores Toll-Like 4 (TLR4) tras la exposición de células endoteliales humanas previamente sanas a suero humano de pacientes con enfermedad arterial periférica. Pacientes y métodos: Estudio experimental traslacional. Se obtuvo suero de 30 pacientes y de 15 sujetos sanos pareados por edad y sexo. Se determinaron los niveles de proteína C reactiva (hsPCR). Las muestras de suero se incubaron en cultivo celular de endotelio de aorta humana. Se analizó la expresión génica de los receptores TLR4 en el cultivo tras su estimulación con suero. Resultados: Los niveles de hsPCR fueron mayores en pacientes que en sujetos sanos (0,92 ± 0,4 vs. 0,46 ± 0,04 log10-mg/dl, p < 0,0001) y en pacientes con isquemia crítica frente a pacientes claudicantes (1,27 ± 0,4 vs. 0,74 ± 0,2 log10-mg/dl, p = 0,01). La expresión de TLR4 fue mayor tras la exposición del cultivo al suero de pacientes que tras la exposición al suero de sujetos sanos (X10-log10-QR: 1,59 ± 0,4 vs. 1,09 ± 0,3, p < 0,0001) sin diferencias en función de la situación clínica (X10-log10-QR: 1,81 ± 0,5 [isquemia crítica] vs. 1,50 ± 0,4 [claudicación intermitente], p = 0,16). Conclusiones: El suero de pacientes con enfermedad arterial periférica induce una transformación genotípica proaterosclerótica de la célula endotelial a través de los receptores de membrana TLR4 de la inmunidad innata (AU)

Introduction: The activation of the innate immunity induces a pro-inflammatory phenotypic shift of endothelial cells triggering the synthesis of adhesion molecules and the release of cytokine factors by the endothelium. Objectives: The aim of the study is to determine the activation of the innate immune system through the «Toll-Like 4» receptor (TLR4) after the exposure of previously healthy human endothelial cells to serum of peripheral arterial disease patients. Patients and methods: Experimental translational study. Serum was obtained from 30 patients and 15 healthy subjects age and sex matched. The serum levels of C-reactive protein (hsCRP) were measured. All samples were incubated in cell culture of human aortic endothelial cells. The genomic expression of TLR4 receptor by cell culture after serum stimulation was analysed. Results: Levels of hsCRP were higher in patients than in healthy subjects (0.92 ± 0.4 vs. 0.46 ± 0.04 log10-mg/dl P < 0.0001), and in critical limb ischemia patients than in claudication patients (1.27 ± 0.4 vs. 0.74 ± 0.2 log10-mg/dl, P = 0.01). The expression of TLR4 was higher after the exposure of cell culture to patient's serum than after the exposure to healthy subjects serum (X10-log10-RQ: 1.59 ± 0,4 vs. 1.09 ± 0.3, P < .0001). There were no differences of TLR4 expression according to clinical severity (X10-log10-RQ: 1.81 ± 0,5 [critical limb ischemia] vs. 1.50 ± 0,4 [intermittent claudication], P = 0.16). Conclusions: The serum of peripheral arterial disease patients induces a genotypic pro-atherosclerotic shift of endothelial cells through TLR4 membrane receptors of the innate immunity (AU)

Incontinencia urinaria en mujeres de Mallorca: prevalencia y calidad de vida / Urinary Incontinence in Mallorcan Women: Prevalence and Quality of Life

Objetivos: Estimar la prevalencia poblacional de incontinencia urinaria (IU) en mujeres mayores de 30 años de Mallorca, su distribución por edad y tipo de incontinencia y su repercusión en la calidad de vida. Material y métodos: Estudio descriptivo transversal, poblacional, en muestra aleatoria de 673 mujeres de la población adscrita al Hospital Son Llàtzer y a los 14 centros de salud de su sector de influencia. Tras invitación a participar en el estudio, fueron entrevistadas telefónicamente y en consulta por sus enfermeras de atención primaria, cumplimentando un cuestionario con las versiones españolas del ICIQ-SF y EuroQol-5D. Se estimó la prevalencia, los tipos de IU y su severidad (ICIQ-SF de 0 a 21 puntos), los antecedentes y la calidad de vida de mujeres con y sin incontinencia. Resultados: Un 24% (IC 95% = 20,9-27,5%) sufría incontinencia, y la prevalencia aumentaba de manera significativa con la edad. El tipo de IU más frecuente fue de esfuerzo (45%), seguido de mixta (29%), de urgencia (19,4%) y continua (6,5%). En las mujeres incontinentes la puntuación total media del ICIQ-SF fue de 9,2; un 25,2% correspondía a IU moderada-severa. La mayor puntuación del ICIQ-SF fue en la IU mixta y continua. Las mujeres incontinentes presentaron peor calidad de vida en todas las dimensiones del EuroQol-5D, observando una mayor afectación en aquellas mujeres con IU mixta y continua. Conclusiones: Una de cada 4 mujeres sufre IU y tienen peor calidad de vida. La prevalencia aumenta con la edad, la mitad es de esfuerzo y una cuarta parte moderada-grave (AU)

Goals: To estimate the prevalence, age distribution, impact on quality of life and type of urinary incontinence (UI) in women over 30 years in Mallorca (Spain). Material and methods: Cross-sectional descriptive study on a randomized sample of 673 women in the health district affiliated to Son Llàtzer Hospital and the 14 Community Health Centres on its area of influence. Following an invitation to participate in the study, women were interviewed twice by their Community Nurse, through the phone and face-to-face. Every interview comprised the completion of the Spanish versions of the ICIQ-SF and EuroQol-5D questionnaires. Prevalence, type and severity (ICIQ-SF) of UI, previous health history and quality of life of women suffering from and free from UI were all estimated. Results: 24% (CI 95% = 20.9-27.5%) of women suffered from UI and prevalence increased significantly with age. Most frequently identified type of UI was stress incontinence (45%) followed by mixed incontinence (29%), urge incontinence (19.4%) and continuous incontinence (6.5%). For women suffering from UI, ICIQ-SF mean total score was 9.2, 25.2% of these suffering from moderate to severe UI. Women suffering from mixed or continuous UI scored highest at ICIQ-SF. Women suffering from UI showed worse quality of life in every dimension of EuroQol-5D. Quality of life was especially poor for women suffering from mixed or continuous UI .Conclusions: One in four women suffers from UI. UI prevalence increases with age. Half of identified women suffered from stress UI. A fourth of identified incontinences were described as moderate to severe. Women suffering from UI showed worse quality of life (AU)

Urinary incontinence in Mallorcan women: prevalence and quality of life.

GOALS: To estimate the prevalence, age distribution, impact on quality of life and type of urinary incontinence (UI) in women over 30 years in Mallorca (Spain). MATERIAL AND METHODS: Cross-sectional descriptive study on a randomized sample of 673 women in the health district affiliated to Son Llàtzer Hospital and the 14 Community Health Centres on its area of influence. Following an invitation to participate in the study, women were interviewed twice by their Community Nurse, through the phone and face-to-face. Every interview comprised the completion of the Spanish versions of the ICIQ-SF and EuroQol-5D questionnaires. Prevalence, type and severity (ICIQ-SF) of UI, previous health history and quality of life of women suffering from and free from UI were all estimated. RESULTS: 24% (CI 95%=20.9-27.5%) of women suffered from UI and prevalence increased significantly with age. Most frequently identified type of UI was stress incontinence (45%) followed by mixed incontinence (29%), urge incontinence (19.4%) and continuous incontinence (6.5%). For women suffering from UI, ICIQ-SF mean total score was 9.2, 25.2% of these suffering from moderate to severe UI. Women suffering from mixed or continuous UI scored highest at ICIQ-SF. Women suffering from UI showed worse quality of life in every dimension of EuroQol-5D. Quality of life was especially poor for women suffering from mixed or continuous UI. CONCLUSIONS: One in four women suffers from UI. UI prevalence increases with age. Half of identified women suffered from stress UI. A fourth of identified incontinences were described as moderate to severe. Women suffering from UI showed worse quality of life.