Evaluating membrane bioreactor treatment for the elimination of emerging contaminants using different analytical methods.

Since wastewater treatment plants (WWTPs) were not originally designed to eliminate contaminants of emerging concern (CECs), alternative strategies like membrane bioreactor (MBR) technology are gaining importance in achieving effective CEC removal and minimising their environmental impact. In this study, composite wastewater samples were collected from the biggest WWTP in the Basque Country (Galindo, Biscay) and the performance of two secondary treatments (i.e. conventional activated sludge treatment, CAS, and MBR) was assessed. The combination of a suspect screening approach using liquid chromatography tandem high-resolution mass spectrometry (LC-HRMS) and multitarget analysis by gas chromatography-mass spectrometry (GC-MS) allowed the detection of approximately 200 compounds in the WWTP effluents. The estimated removal efficiencies (REs) revealed that only 16 micropollutants exhibited enhanced removal by MBR treatment (RE > 70% or 40 - 60%). The environmental risk posed by the non-eliminated compounds after both treatments remained similar, being anthracene, clarithromycin, bis(2-ethylhexyl) phthalate (DEHP) and dilantin the most concerning pollutants (RQ > 1). The Microtox® bioassay confirmed the MBR's efficiency in removing baseline toxicity, while suggesting a similar performance of CAS treatment. These minimal differences between treatments call into question the worthiness of MBR treatment and emphasise the need to seek more efficient alternative treatment methods.

Comprehensive micropollutant characterization of wastewater during Covid-19 crisis in 2020: Suspect screening and environmental risk prioritization strategy.

Micropollutants monitoring in wastewater can serve as a picture of what is consuming society and how it can impact the aquatic environment. In this work, a suspect screening approach was used to detect the known and unknown contaminants in wastewater samples collected from two wastewater treatment plants (WWTPs) located in the Basque Country (Crispijana in Alava, and Galindo in Vizcaya) during two weekly sampling campaigns, which included the months from April to July 2020, part of the confinement period caused by COVID-19. To that aim, high-resolution mass spectrometry was used to collect full-scan data-dependent tandem mass spectra from the water samples using a suspect database containing >40,000 chemical substances. The presence of > 80 contaminants was confirmed (level 1) and quantified in both WWTP samples, while at least 47 compounds were tentatively identified (2a). Among the contaminants of concern, an increase in the occurrence of some compounds used for COVID-19 disease treatment, such as lopinavir and hydroxychloroquine, was observed during the lockdown. A prioritization strategy for environmental risk assessment was carried out considering only the compounds quantified in the effluents of Crispijana and Galindo WWTPs. The compounds were scored based on the removal efficiency, estimated persistency, bioconcentration factor, mobility, toxicity potential and frequency of detection in the samples. With this approach, 33 compounds (e.g. amantadine, clozapine or lopinavir) were found to be considered key contaminants in the analyzed samples based on their concentration, occurrence and potential toxicity. Additionally, antimicrobial (RQ-AR) and antiviral (EDRP) risk of certain compounds was evaluated, where ciprofloxacin and fluconazole represented medium risk for antibiotic resistance (1 > RQ-AR > 0.1) in the aquatic ecosystems. Regarding mixture toxicity, the computed sum of toxic unit values of the different effluents (> 1) suggest that interactions between the compounds need to be considered for future environmental risk assessments.

Tropical milk production systems and milk quality: a review.

We reviewed information on dairy cattle production systems in the tropics, the factors involved, and their influence on milk composition. Genetic factors had greater influence on milk production; specialized breeds produced more milk, and there was an inverse relation between the content of fat, protein, total solids, and the amount of milk produced. Season was related to the availability of forage, and the type of grazing system. Greater pasture area increased individual production, while a greater supply of feed concentrate did not increase milk production. The number of calvings positively affected milk production through the fifth calving, with subsequent declines in production. Milk production increased to a maximum and then declined as lactation progressed. Specialized systems had higher production and better hygienic milk quality; milking and container equipment are critical for maintaining milk sanitary quality. Factor interaction is highly complex, preventing the generation of specific recommendations and general principles applicable to the specific conditions for each system.

Fecal incontinence and radiation dose on anal sphincter in patients with locally advanced rectal cancer (LARC) treated with preoperative chemoradiotherapy: a retrospective, single-institutional study

Background. The objective of the study is to determine the correlations among the variables of dose and the sphincter function (SF) in patients with locally advanced rectal cancer treated with preoperative capecitabine/radiotherapy followed by low anterior resection (LAR) + TME. Methods. We retrospectively reviewed 92 consecutive patients with LARC treated at our center with LAR from 2006 and more than 2 years free from disease. We re-contoured the anal sphincters (AS) of patients with the help of the radiologist. SF was assessed with the Wexner scale (0-20 points, being punctuation inversely proportional to annal sphincter functionality). All questionnaires were filled out between January 2010 and December 2012. Dosimetric parameters that have been studied include V20, V30, V40, V50, mean dose (Dmean), minimum dose (Dmin), D90 (dose received by 90% of the sphincter) and D98. Statistical analysis. The correlations among the variables of dose and SF were studied by the Spearman correlation coefficient. Differences in SF relating to maximum doses to the sphincter were assessed by the Mann-Whitney test. Results. Mean Wexner score was 5.5 points higher in those patients with V20 > 0 compared to those for which V20 = 0 (p = 0.008). In a multivariate regression model, results suggest that the effect of V20 on poor anal sphincter control is independent of the effect of distance, with an adjusted OR of 3.42. Conclusions. In order to improve the SF in rectal cancer treated with preoperative radiotherapy/capecitabine followed by conservative surgery, the maximum radiation dose to the AS should be limited, when possible, to <20 Gy (AU)

No disponible

Fecal incontinence and radiation dose on anal sphincter in patients with locally advanced rectal cancer (LARC) treated with preoperative chemoradiotherapy: a retrospective, single-institutional study.

BACKGROUND: The objective of the study is to determine the correlations among the variables of dose and the sphincter function (SF) in patients with locally advanced rectal cancer treated with preoperative capecitabine/radiotherapy followed by low anterior resection (LAR) + TME. METHODS: We retrospectively reviewed 92 consecutive patients with LARC treated at our center with LAR from 2006 and more than 2 years free from disease. We re-contoured the anal sphincters (AS) of patients with the help of the radiologist. SF was assessed with the Wexner scale (0-20 points, being punctuation inversely proportional to annal sphincter functionality). All questionnaires were filled out between January 2010 and December 2012. Dosimetric parameters that have been studied include V 20, V 30, V 40, V 50, mean dose (D mean), minimum dose (D min), D 90 (dose received by 90% of the sphincter) and D 98. STATISTICAL ANALYSIS: The correlations among the variables of dose and SF were studied by the Spearman correlation coefficient. Differences in SF relating to maximum doses to the sphincter were assessed by the Mann-Whitney test. RESULTS: Mean Wexner score was 5.5 points higher in those patients with V 20 > 0 compared to those for which V 20 = 0 (p = 0.008). In a multivariate regression model, results suggest that the effect of V 20 on poor anal sphincter control is independent of the effect of distance, with an adjusted OR of 3.42. CONCLUSIONS: In order to improve the SF in rectal cancer treated with preoperative radiotherapy/capecitabine followed by conservative surgery, the maximum radiation dose to the AS should be limited, when possible, to <20 Gy.

Revisión del uso de insulinas sintéticas en caninos como modelo de diabetes mellitus tipo 1 / Review of the use of synthetic insulins in caninesas a model of type 1 diabetes mellitus

Because there are not related to synthetic insulin types and their specific use in canine studies in Chile, it became a literature review of the insulins present in Chile most used in dogs, to analyze and discuss data on insulin therapy diabetes mellitus, deepening mainly in the disease either both in its etiology, and epidemiology in our country, which was demonstrated through characterization incidence of canine patients with endocrine diseases at the Veterinary Hospital of the University of Chile between 2012 and 2015. Given the importance of this disease in human endocrinology, it is that studying the effects of various insulins in dogs, can generate an appropriate model level research pharmacokinetics and pharmacodynamics of insulins available in our country, which constitutes the canine model as a suitablemodel of study for human medicine, and generate future scientific research.

Chronic airway obstruction after successful treatment of tuberculosis and its impact on quality of life.

SETTING: Tuberculosis (TB) clinic in Tijuana, México. BACKGROUND: Chronic airway obstruction (CAO) can be a sequella of pulmonary tuberculosis (PTB), independently of smoking history. OBJECTIVE: To determine the prevalence of CAO in subjects recently recorded as cured after treatment of PTB, and its impact on quality of life. DESIGN: Cross-sectional study. RESULTS: Overall, 34.3% of patients with a history of PTB had non-reversible CAO, defined as FEV1 <70% post-bronchodilator. Subjects with CAO had significantly more radiographic fibrocavitary sequellae on chest X-rays, more extensive changes (1.8 ± 0.8 affected quadrants vs. 1.3 ± 0.6, P = 0.04), more residual lung cavities (1.4 ± 0.8 vs. 0.5 ± 0.7, P = 0.002), and greater mediastinal retraction (42.4% vs. 16.7%, P = 0.026). The mean COPD Assessment Test score for subjects with CAO was 15.1 ± 10.4. The prevalence of irreversible CAO using the lower limit of normal criteria was higher (40%) than that calculated with fixed ratio criteria (34.3%). CONCLUSION: Functional abnormalities are frequently already present at the end of treatment for PTB; patients with CAO are often symptomatic and experience a significant impact on quality of life.

Adherencia a fesoterodina en mujeres con vejiga hiperactiva en la práctica clínica diaria / Adherence to fesoterodine in women with overactive bladder in routine clinical practice

Objetivos: Valorar a corto plazo la adherencia al tratamiento con fesoterodina e identificar las causas de la falta de adherencia o abandono en la práctica clínica diaria. El objetivo secundario fue estimar los resultados desde el punto de vista del paciente. Métodos: Este fue un estudio observacional, retrospectivo, y multicéntrico, llevado a cabo en una muestra poblacional de mujeres con vejiga hiperactiva (VH), en tratamiento con fesoterodina durante al menos 3 meses. La adherencia a la medicación se valoró mediante el test Morisky-Green. Los resultados desde el punto de vista del paciente fueron valorados empleando los cuestionarios cortos de incontinencia (ICIQ-SF) y vejiga hiperactiva (OAB-qSF) y la escala del beneficio del tratamiento (TBS). Resultados: Se incluyeron 120 mujeres con una edad media (desviación estándar [DE]) de 62,2 (12,0) años con VH grave según la puntuación media (DE) del ICIQ-SF (13,2 [4,0]). El 42,1% de las pacientes fueron consideradas cumplidoras con el tratamiento de fesoterodina. Las principales causas de incumplimiento/abandono indicadas por el 57,9% restantes fueron los efectos adversos (62,2%) y la falta de beneficio clínico (20,0%). Tanto el grado de enfermedad como las molestias debidas a los síntomas de la VH percibidas por los pacientes y el impacto en su calidad de vida mejoraron significativamente después de 3 meses del tratamiento con fesoterodina (p < 0,0001). La mayoría de los pacientes indicaron que sus problemas urinarios habían sufrido una gran mejora o habían mejorado. Conclusión: En la práctica clínica diaria un elevado porcentaje de pacientes fueron considerados cumplidores con el tratamiento de fesoterodina y percibieron los beneficios que dicho tratamiento proporcionaba después de 3 meses de iniciarlo. Sin embargo, más de la mitad de la población de estudio no cumplió o abandonó el tratamiento debido principalmente a intolerancia o falta de eficacia

Objectives: To assess the short-term compliance with fesoterodine treatment and to identify the reasons for lack of adherence and discontinuation in routine clinical practice. The secondary aim was to estimate the patient-reported outcomes. Methods: This was an observational retrospective, multicenter study conducted in a sample of women with overactive bladder on fesoterodine treatment for at least three months. Adherence to medication was assessed using the Morisky-Green test. Patient-reported outcomes were assessed using the Incontinence Questionnaire Short Form (ICIQ-SF), Overactive Bladder Questionnaire Short Form (OAB-qSF), and Treatment Benefit Scale (TBS). Results: One hundred and twenty women with a mean age [standard deviation (SD)] of 62.2 (12.0) years with severe OAB [mean (SD) ICIQ-SF score 13.2 (4.0)] were included. 42.1% of the patients were considered compliant with fesoterodine treatment. The main causes for non-compliance/discontinuation stated by the remaining 57.9% of the patients were adverse events (62.2%) and lack of clinical benefits (20.0%). The illness status as well as the patient-perceived bother occasioned by the OAB symptoms and their impact on the quality of life improved significantly after three months on fesoterodine treatment (p < 0.0001). Most of the patients stated that the current state of their urinary problems had greatly improved/ improved. Conclusion:In routine clinical practice, a high percentage of patients were adherent to fesoterodine and perceived the benefit that the treatment provided them three months after starting treatment. However, more than half of the study population failed to comply or discontinued the treatment mainly due to intolerance or lack of efficacy

Adherence to fesoterodine in women with overactive bladder in routine clinical practice.

OBJECTIVES: To assess the short-term compliance with fesoterodine treatment and to identify the reasons for lack of adherence and discontinuation in routine clinical practice. The secondary aim was to estimate the patient-reported outcomes. METHODS: This was an observational retrospective, multicenter study conducted in a sample of women with overactive bladder on fesoterodine treatment for at least three months. Adherence to medication was assessed using the Morisky-Green test. Patient-reported outcomes were assessed using the Incontinence Questionnaire Short Form (ICIQ-SF), Overactive Bladder Questionnaire Short Form (OAB-qSF), and Treatment Benefit Scale (TBS). RESULTS: One hundred and twenty women with a mean age [standard deviation (SD)] of 62.2 (12.0) years with severe OAB [mean (SD) ICIQ-SF score 13.2 (4.0)] were included. 42.1% of the patients were considered compliant with fesoterodine treatment. The main causes for non-compliance/discontinuation stated by the remaining 57.9% of the patients were adverse events (62.2%) and lack of clinical benefits (20.0%). The illness status as well as the patient-perceived bother occasioned by the OAB symptoms and their impact on the quality of life improved significantly after three months on fesoterodine treatment (p<0.0001). Most of the patients stated that the current state of their urinary problems had greatly improved/ improved. CONCLUSION: In routine clinical practice, a high percentage of patients were adherent to fesoterodine and perceived the benefit that the treatment provided them three months after starting treatment. However, more than half of the study population failed to comply or discontinued the treatment mainly due to intolerance or lack of efficacy.

Facile preparation of an immobilized surfactant-free palladium nanocatalyst for metal hydride trapping: a novel sensing platform for TXRF analysis.

In this work, a simple route for the synthesis of surfactant-free immobilized palladium nanoparticles (Pd NPs) and their use as effective nanocatalysts for metal hydride decomposition is described. A mixture of ethanol : water was used as the reducing agent. Ethanol was added in a large excess to reduce the ionic Pd and stabilize the obtained Pd NPs. Ethanol is adsorbed on the surface of Pd allowing steric stabilization. Freshly prepared Pd NPs were immobilized onto quartz substrates modified with 3-mercaptopropyltrimethoxysilane. Pd interacts with the thiol group of the alkoxysilane that is adsorbed on the surface of NPs without the dissociation of the S-H bond. Different parameters affecting the synthesis of Pd NPs and their immobilization onto quartz substrates were evaluated. A comprehensive characterization of the synthesized Pd NPs was carried out by transmission electron microscopy (TEM), whereas total reflection X-ray fluorescence (TXRF) spectrometry was applied in order to evaluate their catalytic activity for solid-gas reactions. Immobilized Pd NPs were applied as nanocatalysts for the dissociative chemisorption of arsine at room temperature, yielding the formation of As-Pd bonds. Quartz substrates coated with nanosized Pd could be used as novel sensing platforms for total reflection X-ray fluorescence analysis. Arsenic can be detected in situ in natural water with a limit of detection of 0.08 µg L(-1).

CLASIFICACIÓN DE LATIDOS DE CONTRACCIÓN VENTRICULAR PREMATURA BASADOS EN MÉTODOS DE APRENDIZAJE NO SUPERVISADO / CLASSIFICATION OF PREMATURE VENTRICULAR CONTRACTION BEATS BASED ON UNSUPERVISED LEARNING METHODS / CLASSIFICAÇÃO DE PREMATUROS BATIDAS CONTRAÇÃO VENTRICULAR BASEADO SUPERVISIONADO MÉTODOS DE APRENDIZAGEM

Las enfermedades cardiovasculares son la principal causa de mortalidad en el mundo, por lo que el desarrollo de algoritmos que detecten arritmias cardíacas en tiempo real se ha convertido en un campo de investigación importante. El desarrollo de estos algoritmos ha conllevado a la mejora de dispositivos cardiacos portátiles. Este artículo presenta el desempeño de dos algoritmos basados en aprendizaje de máquina no supervisado para la detección de latidos de contracción ventricular prematura en la señal ECG. Los latidos se extraen de las bases de datos del MIT-BIH, los cuales fueron pre-procesados y segmentados por el grupo de investigación de Dinámica Cardiovascular de la UPB. La Transformada Wavelet Discreta, el Análisis de Componentes Principales y un método híbrido propuesto son implementados para la extracción de características y reducción de dimensiones, a partir de los cuales se generan 8 espacios de características para la evaluación de los algoritmos. Kmeans y Mapas auto-organizados son desarrollados y comparados en términos de precisión y costo computacional. Se logró una especificidad del 96.22 % y una sensibilidad del 95.04 % con un tiempo de ejecución de 79.41µs por latido. Los resultados permiten concluir que estos métodos pueden implementarse en aplicaciones de detección de arritmias en tiempo real debido a su bajo costo computacional.

Cardiovascular diseases are the principal cause of mortality in the world, so that the development of algorithms that detect cardiac arrhythmias in real time has become an important field of research. The development of these algorithms has led to the improvement of wearable cardiac devices. This paper presents the performance of two algorithms based in unsupervised learning methods for the detection of Premature Ventricular Contraction in the ECG signal. The beats are extracted from MIT-BIH databases, which were preprocessed and segmented by the UPB’s Dynamic Cardiovascular research group. The Discrete Wavelet Transform (DWT), Principal Component Analysis (PCA) and a proposed hybrid method are implemented for the feature extraction and dimension reduction, from which 8 feature spaces are generated and tested. Kmeans and Self Organizing Maps are developed and compared in terms of accuracy and computational cost. Specificity of 96.22 % and sensitivity of 95.94% with 79.41µs per beat are accomplished. The results show that these methods can be implemented in applications of real time arrhythmia detection because of their low computational cost.

A doença cardiovascular é a principal causa de morte em todo o mundo, de modo que o desenvolvimento de algoritmos para detectar arritmias cardíacas, em tempo real, tornou-se um importante campo de pesquisa. O desenvolvimento desses algoritmos tem levado a melhores dispositivos cardíacos portáteis. Este artigo apresenta o desempenho dos dois com base na aprendizagem de máquina sem supervisão para detecção de batidas de contração ventriculares prematuras nos algoritmos de sinais de ECG. As batidas são extraídos das bases de dados do MIT-BIH, que foram pré-processados e segmentado pelo grupo da UPB Cardiovasculares Dynamics pesquisa. A Transformada Wavelet Discreta, Análise de Componentes Principais e uma abordagem híbrida proposta são implementadas para extração de características e redução de dimensão, a partir do qual 8 espaços de recursos para a avaliação dos algoritmos são gerados. Kmeans e mapas de auto-organização são desenvolvidos e comparados em termos de precisão e custo computacional. A especificidade de 96,22% e uma sensibilidade de 95,04% com um tempo de execução de 79.41µs por batida foi alcançado. Os resultados mostram que estes métodos podem ser implementados em aplicações de detecção de arritmia em tempo real, devido ao seu baixo custo computacional.

Pieloplastia laparoscópica: técnica y resultados en 80 procedimientos consecutivos / Laparoscopic Pyeloplasty: Technique and Results in 80 Consecutive Patients

Objetivo: Presentar nuestros resultados a largo plazo con la técnica de pieloplastia laparoscópica de Anderson-Hynes realizada por un solo cirujano. Material y métodos: Entre agosto de 1999 y diciembre de 2009 se operaron 79 pacientes (80 cirugías) por estenosis pieloureteral primaria. Se utilizó la técnica de Anderson-Hynes por vía transperitoneal. Los pacientes fueron evaluados con ultrasonido, urografía excretora y centelleograma renal dinámico (Mag-3). Se realizó un análisis prospectivo de la serie, revisando las características perioperatorias, complicaciones y resultados. Resultados: Se realizaron 80 pieloplastias laparoscópicas en 79 pacientes. El tiempo operatorio promedio fue de 93,2 min (60-180). En 38 de 82 (46,3%) unidades renales se encontró como hallazgo vasos polares en proximidad a la unión pieloureteral. Anomalías renales hubo en 4 pacientes (un doble sistema pieloureteral, un uréter retrocavo asociado, un riñón en herradura y un riñón pélvico). Ocurrieron complicaciones en 5 oportunidades (6,5%): sangrado postoperatorio inmediato que se manejó por vía laparoscópica (Clavien 3b), un vólvulo de ciego en el cual se realizó una hemicolectomía derecha con buena evolución postoperatoria (Clavien 3b), una sepsis urinaria (Clavien 4a) y una fístula urinaria de manejo médico (Clavien 3a). No hubo mortalidad en la serie ni conversión a cirugía abierta. Hubo recurrencia en 3 de 80 pieloplastias laparoscópicas (3,7%), las cuales fueron resueltas de la siguiente forma: endopielotomía percutánea en un caso, pieloplastia laparoscópica en un caso y pieloplastia robótica en otro caso. La tasa global de éxito primario fue de 96,3%. Conclusiones: Nuestros resultados con la pieloplastia laparoscópica transperitoneal se comparan favorablemente con aquellos logrados por la cirugía abierta. Creemos que la pieloplastia laparoscópica es una alternativa segura para el manejo de la obstrucción de la unión pieloureteral primaria

Objective: To present our long-term results with the Anderson-Hynes laparoscopic pyeloplasty, performed by a single surgeon. Materials and methods: Between August 1999 and December 2009, 79 patients (80 procedures) were operated for primary ureteropelvic junction obstruction. We use the Anderson-Hynes technique by a transperitoneal approach. Patients were evaluated with Ultrasound, Excretory urography and dynamic renal scintigraphy (Mag-3). The perioperative characteristics, complications and results were reviewed. Results: We performed 80 laparoscopic pyeloplasties in 79 patients. Mean operative time was 93.2 min (60-180). Crossing vessels were found in 38 of 82 (46.3%) renal units. Kidney abnormalities occurred in 4 patients (1 double ureteropelvic system, one associated retrocaval ureter, 1 horseshoe kidney and one pelvic kidney). Complications occurred in 5 procedures (6.5%): an immediately postoperative bleeding (Clavien 3b), 1 cecal volvulus (Clavien 3b), 1 urosepsis (Clavien 4th) and 1 urinary fistula (Clavien 3a). In this series there was neither mortality nor conversion to open surgery. There was recurrence in 3 out of 80 patients (3.7%). They were resolved as follows: 1 percutaneous antegrade endopyelotomy, 1 secondary laparoscopic pyeloplasty and 1 robotic pyeloplasty. There was a 96.3% of primary overall success rate. Conclusions: Our results show that laparoscopic pyeloplasty compares favorably with the result achieved by open surgery. We believe that laparoscopic pyeloplasty is a good surgical alternative for the management of primary ureteropelvic junction obstruction

Nefrectomía parcial laparoscópica: experiencia en 227 casos consecutivos / Laparoscopic partial nephrectomy: An experience in 227 cases

Objetivo: Analizar nuestra experiencia a largo plazo con la técnica de nefrectomía parcial laparoscópica (NPL) y revisar la literatura. Material y métodos: Entre junio de 1995 y junio de 2010 se efectuaron 227 nefrectomías parciales laparoscópicas. Los datos fueron registrados en forma prospectiva y se realizó una revisión retrospectiva de los datos demográficos y quirúrgicos, complicaciones perioperatorias, estancia hospitalaria, tasa de márgenes positivos y de recurrencia, y hallazgos histopatológicos. Resultados: La edad promedio fue de 56,4 años (18-87). El sangrado intraoperatorio promedio fue de 250 ml (10-1.800). El tiempo operatorio medio fue de 108,42 min (30-240) y la mediana de tiempo de isquemia caliente fue de 25 min (10-60). La tasa de complicaciones intraoperatorias fue de 2,64% (6/227), de las cuales 5 (2,2%) fueron por sangrado. La tasa de complicación postoperatoria fue de 5,72% (13/227), siendo también el sangrado la más frecuente en un 3% (7/227) de los casos. Según la clasificación de Clavien, el 1,32% (3/227), el 0,88% (2/227) y el 3,52% (8/227) fueron grado i , ii y iii b, respectivamente. La estancia hospitalaria media fue de 3,66 días (1-12). El carcinoma de células renales fue el hallazgo histopatológico más frecuente en el 74,6% (150 pacientes), presentando estadios clínicos T1a, T1b y T2 en el 90,74% (206/227), el 7,48% (17/227) y el 1,76% (4/227), respectivamente. No hubo conversión ni mortalidad relacionada con la cirugía. Hubo margen quirúrgico positivo en 4 pacientes (2,7%), sin recurrencia a largo plazo. En un seguimiento promedio de 27 meses hubo solo un caso de metástasis en los puertos y carcinomatosis peritoneal. Conclusión: La NPL es una alternativa segura y viable a la nefrectomía parcial abierta, entregando resultados oncológicos equivalentes y una morbilidad comparable a la cirugía tradicional en centros con experiencia

Objective: To evaluate our long-term experience with laparoscopic partial nephrectomy (LPN) and to review the literature. Material and methods: We performed a retrospective chart review, evaluating 227 consecutives laparoscopic partial nephrectomies performed between June 1995 and June 2010. Perioperative data were recorded along with clinical a oncological outcomes. Results: Mean age was 56.4 years (18-87) and clinical stages were T1a, T1b and T2 in 90.74% (206/227), 7.48% (17/227) and 1.76% (4/227), respectively. Median blood loss was 250 ml (10-1800). The mean operative time was 108.42 min (30-240) and median warm ischemia time was 25 min (10-60). The intraoperative complication rate was 2.64% (6/227), 5 (2.2%) secondary to bleeding. The postoperative complication rate was 5.72% (13/227) and bleeding is also the most frequent in 3% (7/227) of the cases. According to the Clavien classification, 1.32% (3/227), 0.88% (2/227) and 3.52% (8/227) were grade I, II and III b, respectively. The mean hospital stay was 3.66 days (1-12). Clear cell carcinoma was the most common histological finding in 74.6% (150 patients). TNM classification was T1a, T1b and T2 in 90.74% (206/227), 7.48% (17/227) and 1.76% (4/227), respectively. No conversion or mortality was reported. Positive surgical margins were found in 4 patients (2.7%), with no local recurrence after long-term follow-up. At a mean follow up of 27 months, one patient had port site and peritoneal recurrence. Conclusion: Laparoscopic partial nephrectomy is a safe and viable alternative to open partial nephrectomy, providing equivalent oncologic outcomes and comparable morbidity to the traditional approach in experienced centers

Laparoscopic partial nephrectomy: An experience in 227 cases.

OBJECTIVE: To evaluate our long-term experience with laparoscopic partial nephrectomy (LPN) and to review the literature. MATERIAL AND METHODS: We performed a retrospective chart review, evaluating 227 consecutives laparoscopic partial nephrectomies performed between June 1995 and June 2010. Perioperative were recorded along with clinical a oncological outcomes. RESULTS: Mean age was 56.4 years (18-87) and clinical stages were T1a, T1b and T2 in 90.74% (206/227), 7.48% (17/227) and 1.76% (4/227), respectively. Median blood loss was 250 mL (10-1800). The mean operative time was 108.42 minutes (30-240) and median warm ischemia time was 25 minutes (10-60). The intraoperative complication rate was 2.64% (6/227), 5 (2.2%) secondary to bleeding. The postoperative complication rate was 5.72% (13/227) and bleeding is also the most frequent in 3% (7/227) of the cases. According to the Clavien classification, 1.32% (3/227), 0.88% (2/227) and 3.52% (8/227) were grade I, II and IIIb, respectively. The mean hospital stay was 3.66 days (1-12). Clear cell carcinoma was the most common histological finding in 74.6% (150 patients). TNM clasification was T1a, T1b y T2 in 90.74% (206/227), 7.48% (17/227) and 1,76% (4/227), respectively. No conversion or mortality was reported. Positive surgical margins were found in 4 patients (2.7%), with no local recurrence after long-term follow-up. At a mean follow up of 27 months, one patient had port site and peritoneal recurrence. CONCLUSION: Laparoscopic partial nephrectomy is a safe and viable alternative to open partial nephrectomy, providing equivalent oncologic outcomes and comparable morbidity to the traditional approach in experienced centers.

Laparoscopic pyeloplasty: technique and results in 80 consecutive patients.

OBJECTIVE: To present our long-term results with the Anderson-Hynes laparoscopic pyeloplasty, performed by a single surgeon. MATERIAL AND METHODS: Between August 1999 and December 2009, 79 patients (80 procedures) were operated for primary ureteropelvic junction obstruction. We use the Anderson-Hynes technique by a transperitoneal approach. Patients were evaluated with Ultrasound, Excretory urography and dynamic renal scintigraphy (Mag-3). The perioperative characteristics, complications and results were reviewed. RESULTS: We performed 80 laparoscopic pyeloplasties in 79 patients. Mean operative time was 93.2 minutes (60-180). Crossing vessels were found in 38 of 82 (46.3%) renal units. Kidney abnormalities occurred in 4 patients (1 double ureteropelvic system, one associated retrocaval ureter, 1 horseshoe kidney and one pelvic kidney). Complications occurred in 5 procedures (6.5%): an immediately postoperative bleeding (Clavien 3b), 1 cecal volvulus (Clavien 3b), 1 urosepsis (Clavien 4th) and 1 urinary fistula (Clavien 3a). In this series there was neither mortality nor conversion to open surgery There was recurrence in 3 out of 80 patients (3.7%). They were resolved as follows: 1 percutaneous antegrade endopyelotomy, 1 secondary laparoscopic pyeloplasty and 1 robotic pyeloplasty. There was a 96.3%. of primary overall success rate. CONCLUSIONS: Our results show that laparoscopic pyeloplasty compares favorably with the result achieved by open surgery. We believe that laparoscopic pyeloplasty is a good surgical alternative for the management of primary ureteropelvic junction obstruction.

Performance in working memory and attentional control is associated with the rs2180619 SNP in the CNR1 gene.

Individual differences in cognitive performance are partly dependent, on genetic polymporhisms. One of the single-nucleotide polymorphisms (SNP) of the CNR1 gene, which codes for cannabinoid receptor 1 (CB1R), is the rs2180619, located in a regulatory region of this gene (6q14-q15). The alleles of the rs2180619 are A > G; the G allele has been associated with addiction and high levels of anxiety (when the G allele interacts with the SS genotype of the 5-HTTLPR gene). However, GG genotype is observed also in healthy subjects. Considering G allele as risk for 'psychopathological conditions', it is possible that GG healthy subjects do not be addicted or anxious, but would have reduced performance, compared to AA subjects, in attentional control and working memory processing. One hundred and sixty-four healthy young Mexican-Mestizo subjects (100 women and 64, men; mean age: 22.86 years, SD=2.72) participated in this study, solving a task where attentional control and working memory were required. GG subjects, compared to AA subjects showed: (1) a general lower performance in the task (P = 0.02); (2) lower performance only when a high load of information was held in working memory (P = 0.02); and (3) a higher vulnerability to distractors (P = 0.03). Our results suggest that, although the performance of GG subjects was at normal levels, a lower efficiency of the endocannabinoid system, probably due to a lowered expression of CB1R, produced a reduction in the performance of these subjects when attentional control and working memory processing is challenged.

Linfadenectomía lumboaórtica laparoscópica en tumor residual posquimioterapia en el cáncer testicular / Laparoscopic lumbar-aortic lymphadenectomy in residual post-chemotherapy tumours in testicular cancer

Introducción: La linfadenectomía lumboaórtica abierta (LALA) es el estándar de oro en el manejo de masas retroperitoneales posquimioterapia. La LALA laparoscópica (LALA-L) ha surgido los últimos años como una alternativa para el manejo de estos pacientes, con los eventuales potenciales beneficios de la mínima invasión. Objetivo: Exponer nuestra experiencia en el manejo laparoscópico (LALA-L) de las masas residuales posquimioterapia en pacientes con cáncer testicular avanzado. Material y métodos: Entre los años 1993 y 2009 43 pacientes fueron sometidos a LALA-L posquimioterapia. Se utilizó una técnica transperitoneal en todos los pacientes. Se evaluaron variables demográficas, perioperatorias y patológicas, así como también las complicaciones y el seguimiento. Resultados: En 17 pacientes se realizó una disección unilateral, mientras que 26 pacientes fueron sometidos a una disección retroperitoneal bilateral. Del primer grupo 4 pacientes recidivaron; el segundo grupo no presenta recidivas. Tras un seguimiento promedio de 21 meses la tasa de sobrevida global alcanza un 95%. Solo se registró un 9,3% de complicaciones perioperatorias. Conclusiones: La LALA-L es una alternativa quirúrgica técnicamente factible, en manos experimentadas, en el tratamiento de pacientes portadores de un cáncer testicular avanzado con masas residuales posquimioterapia. La disección realizada debe ser bilateral en pro de evitar las recidivas tumorales y prolongar la tasa de sobrevida de estos pacientes (AU)

Introduction: Open lumbar-aortic lymphadenectomy (OLAL) is the gold standard for treating post-chemotherapy retroperitoneal masses. Laparoscopic OLAL (L-OLAL) has emerged in recent years as an alternative for the handling of patients with these masses, with the additional potential benefits of minimal invasion. Objective: To present our experience with the laparoscopic handling (L-OLAL) of residual post-chemotherapy masses in patients with advanced testicular cancer. Material and methods: Between 1993 and 2009, 43 patients underwent post-chemotherapy L-OLAL. A transperitoneal technique was employed in all patients. We assessed demographic, perioperational and pathological variables, as well as complications and follow-up. Results: A unilateral dissection was performed in 17 patients, while 26 patients underwent a bilateral retroperitoneal dissection. In the first group, 4 patients relapsed. In the second group, there were no relapses. After an average follow-up of 21 months, the overall survival rate reached 95%. We recorded a rate of perioperative complications of only 9.3%. Conclusions: In experienced hands, L-OLAL is a technically feasible surgical alternative for the treatment of patients who are carriers of advanced testicular cancer with residual post-chemotherapy masses. The dissection performed should be bilateral to avoid tumour relapses and increase the survival rate of these patients (AU)

Laparoscopic lumbar-aortic lymphadenectomy in residual post-chemotherapy tumours in testicular cancer.

INTRODUCTION: Open lumbar-aortic lymphadenectomy (OLAL) is the gold standard for treating post-chemotherapy retroperitoneal masses. Laparoscopic OLAL (L-OLAL) has emerged in recent years as an alternative for the handling of patients with these masses, with the additional potential benefits of minimal invasion. OBJECTIVE: To present our experience with the laparoscopic handling (L-OLAL) of residual post-chemotherapy masses in patients with advanced testicular cancer. MATERIAL AND METHODS: Between 1993 and 2009, 43 patients underwent post-chemotherapy L-OLAL. A transperitoneal technique was employed in all patients. We assessed demographic, perioperational and pathological variables, as well as complications and follow-up. RESULTS: A unilateral dissection was performed in 17 patients, while 26 patients underwent a bilateral retroperitoneal dissection. In the first group, 4 patients relapsed. In the second group, there were no relapses. After an average follow-up of 21 months, the overall survival rate reached 95%. We recorded a rate of perioperative complications of only 9.3%. CONCLUSIONS: In experienced hands, L-OLAL is a technically feasible surgical alternative for the treatment of patients who are carriers of advanced testicular cancer with residual post-chemotherapy masses. The dissection performed should be bilateral to avoid tumour relapses and increase the survival rate of these patients.