Análisis de cuestionario de salud y desarrollo de cuestionario de satisfacción en pacientes tratados con litotricia extracorpórea por ondas de choque (SATISLIT) / Health questionnaire analysis and development of satisfaction questionnaire for patients treated with extracorporeal shock wave lithotripsy (SATISLIT)

INTRODUCCIÓN: Debido a la ausencia de instrumentos específicos para estudiar la esfera psicosocial de los pacientes que reciben litotricia extracorpórea por ondas de choque (LEOC), el objetivo es desarrollar un cuestionario de satisfacción respecto al tratamiento recibido con LEOC a partir de un cuestionario de salud ya diseñado y validado previamente. MATERIAL Y MÉTODOS: El diseño del cuestionario de satisfacción se realizó en 5 fases a partir de una escala de salud en pacientes tratados con LEOC (ESPTL) ya validada previamente, utilizando una muestra total de 135 pacientes tratados en nuestro centro a los que se entrevistó por vía telefónica. En la fase 1 se realizó análisis descriptivo de la serie y de las puntuaciones de los 8 ítems de ESPTL. En la fase 2 se compararon las puntuaciones de ESPTL según sexo con U-Mann Whitney, estudiando la correlación con la edad mediante Rho de Spearman en la fase 3. En la fase 3 se compararon las puntuaciones de los factores de ESPTL según el sexo y se analizó la correlación con la edad al igual que en las fases 2 y 3 con la puntuación global. En la fase 5 se obtuvo la subescala de satisfacción-SATISLIT- y se realizó análisis descriptivo, comparación según sexo, correlación con la edad y modelo de regresión lineal con respecto a ESPTL. RESULTADOS: Ciento treinta y cinco pacientes, 85 (63%) hombres, 50 (37%) mujeres. Mediana (mínimo-máximo) de edad 56 (27-79) y puntuación ESPTL 31 (8-39). Diferencias en puntuación global ESPTL entre hombres y mujeres (p < 0,001), así como en los ítems 1 (p = 0,029), 3 (p = 0,002), 6 (p = 0,006), 7 (p = 0,005) y 8 (p = 0,025). Correlación no significativa de ESPTL con la edad. Significativa en ítems 2, 4, 5 y 8 pero correlación muy débil (< 0,2). Cuatrofactores con 2 ítems cada uno, con diferencias estadísticamente significativas según sexo en F2 (p = 0,001), F3 (p = 0,007) y F4 (p = 0,001). Correlación significativa con la edad únicamente en F1 y F3 pero muy débil (< 0,2). Mediana (mínimo-máximo) SATISLIT 18 (4-20). Diferencias estadísticamente significativas según sexo (p = 0,001). Correlación no significativa con la edad (p = 0,836). Regresión lineal de SATISLIT con respecto a ESPTL significativa (p < 0,001). CONCLUSIONES: El trabajo realizado a partir de un cuestionario validado de salud ha proporcionado un nuevo instrumento de evaluación de la satisfacción tras tratamiento con LEOC llamado SATISLIT. Serán necesarios futuros estudios de validación externa y validación temporal para contrastar su verdadera utilidad clínica

INTRODUCTION: Due to the absence of specific instruments to study the psychosocial sphere of patients undergoing extracorporeal shock wave lithotripsy (SWL), the objective of this study is to develop a satisfaction questionnaire regarding the SWL treatment from a health questionnaire which was already designed and had been previously validated. MATERIAL AND METHODS: The design of the satisfaction questionnaire was carried out in 5 phases, based on a previously validated health scale in patients treated with SWL (ESPTL), including a total cohort of 135 patients treated at our center who received a phone interview. Phase 1: descriptive analysis of the series and scores of the 8 items of ESPTL. Phase 2: U-Mann Whitney comparison of ESPTL based on the patients' sex. Phase 3: study of ESPTL correlation with age using Spearman's Rho. Phase 4: grouping by factors of ESPTL, comparison by sex and correlation with age, as performed in phases 2 and 3 with the global score. Phase 5: obtaining the satisfaction subscale -SATISLIT-, descriptive analysis, comparison according to sex, correlation with age and linear regression model of SATISLIT with respect to ESPTL. RESULTS: 135 patients, 85(63%) men, 50(37%) women. Median (minimum-maximum) age 56 (27-79) and ESPTL score 31 (8-39). Differences in global ESPTL score between men and women (p < .001), as well as in items 1 (p =.029), 3 (p = .002), 6 (p = .006), 7 (p = .005) and 8 (p = .025). Non-significant correlation of ESPTL regarding age. Significant correlation in items 2, 4, 5 and 8 but, very weak (< 0.2).4 factors, each one with 2 items, with statistically significant differences regarding sex in F2 (p = .001), F3 (p =.007) and F4 (p = .001). Significant correlation with age only in F1 and F3, but very weak (< 0.2). Median (minimum-maximum) SATISLIT 18 (4-20). Statistically significant differences regarding patients' sex (p =.001). Non- significant correlation with age (p =.836). Significant linear regression of SATISLIT with respect to ESPTL (p < .001). CONCLUSIONS: Based on validated health questionnaire, the present work has provided a new instrument called SATISLIT for assessing patients' satisfaction after treatment with SWL. Future studies with external and temporal validation will be necessary to contrast its real clinical usefulness

Health questionnaire analysis and development of satisfaction questionnaire for patients treated with extracorporeal shock wave lithotripsy (SATISLIT). / Análisis de cuestionario de salud y desarrollo de cuestionario de satisfacción en pacientes tratados con litotricia extracorpórea por ondas de choque (SATISLIT).

INTRODUCTION: Due to the absence of specific instruments to study the psychosocial sphere of patients undergoing extracorporeal shock wave lithotripsy (SWL), the objective of this study is to develop a satisfaction questionnaire regarding the SWL treatment from a health questionnaire which was already designed and had been previously validated. MATERIAL AND METHODS: The design of the satisfaction questionnaire was carried out in 5 phases, based on a previously validated health scale in patients treated with SWL (ESPTL), including a total cohort of 135 patients treated at our center who received a phone interview. Phase 1: descriptive analysis of the series and scores of the 8 items of ESPTL. Phase 2: U-Mann Whitney comparison of ESPTL based on the patients' sex. Phase 3: study of ESPTL correlation with age using Spearman's Rho. Phase 4: grouping by factors of ESPTL, comparison by sex and correlation with age, as performed in phases 2 and 3 with the global score. Phase 5: obtaining the satisfaction subscale -SATISLIT-, descriptive analysis, comparison according to sex, correlation with age and linear regression model of SATISLIT with respect to ESPTL. RESULTS: 135 patients, 85(63%) men, 50(37%) women. Median (minimum-maximum) age 56 (27-79) and ESPTL score 31 (8-39). Differences in global ESPTL score between men and women (p <.001), as well as in items 1 (p =.029), 3 (p =.002), 6 (p =.006), 7 (p =.005) and 8 (p =.025). Non-significant correlation of ESPTL regarding age. Significant correlation in items 2, 4, 5 and 8 but, very weak (<0.2). 4 factors, each one with 2 items, with statistically significant differences regarding sex in F2 (p =.001), F3 (p =.007) and F4 (p =.001). Significant correlation with age only in F1 and F3, but very weak (<0.2). Median (minimum-maximum) SATISLIT 18 (4-20). Statistically significant differences regarding patients' sex (p =.001). Non- significant correlation with age (p =.836). Significant linear regression of SATISLIT with respect to ESPTL (p <.001). CONCLUSIONS: Based on validated health questionnaire, the present work has provided a new instrument called SATISLIT for assessing patients' satisfaction after treatment with SWL. Future studies with external and temporal validation will be necessary to contrast its real clinical usefulness.

Severe childhood trauma and clinical and neurocognitive features in schizotypal personality disorder.

OBJECTIVE: Literature suggests that childhood trauma increases vulnerability for schizophrenia-spectrum disorders, including schizotypal personality disorder (SPD). Yet, it remains unexplored whether childhood trauma predicts symptom load and the level of neurocognitive functioning in SPD. METHOD: We included 225 individuals with SPD and 127 healthy controls. Childhood trauma was evaluated using the Childhood Trauma Questionnaire, and schizotypal traits were assessed using the Schizotypal Personality Questionnaire. Standard neurocognitive assessments covered six cognitive domains. RESULTS: All types of reported childhood trauma were significantly associated with SPD, in a linear fashion. Severe sexual abuse showed the greatest magnitude of association with higher cognitive-perceptual load (e.g., ideas of reference, odd belief or magical thinking); severe emotional neglect was associated with interpersonal scores (e.g., excessive social anxiety, constricted affect) within the SPD group. SPD individuals who reported severe trauma showed worse cognitive functioning (i.e., working memory, verbal/visual learning and memory, as well as verbal fluency). CONCLUSIONS: Particular severe childhood trauma types were associated with higher cognitive-perceptual and interpersonal symptoms in SPD, along with worse cognitive functioning. These findings highlight the need for clinicians to enquire about childhood trauma in SPD patients, since unaddressed early adverse experiences may carry long-term negative consequences.

The Effects of Aquatic Plyometric Training on Repeated Jumps, Drop Jumps and Muscle Damage.

The purpose of this study was to compare the effects of land- vs. aquatic based plyometric training programs on the drop jump, repeated jump performance and muscle damage. Sixty-five male students were randomly assigned to one of 3 groups: aquatic plyometric training group (APT), plyometric training group (PT) and control group (CG). Both experimental groups trained twice a week for 10 weeks performing the same number of sets and total jumps. The following variables were measured prior to, halfway through and after the training programs: creatine kinase (CK) concentration, maximal height during a drop jump from the height of 30 (DJ30) and 50 cm (DJ50), and mean height during a repeated vertical jump test (RJ). The training program resulted in a significant increase (P<0.01-0.001) in RJ, DJ30, and DJ50 for PT, whereas neither APT nor CG reached any significant improvement APT showed likely/possibly improvements on DJ30 and DJ50, respectively. Greater intra-group Effect Size in CK was found for PT when compared to APT. In conclusion, although APT seems to be a safe alternative method for reducing the stress produced on the musculoskeletal system by plyometric training, PT produced greater gains on reactive jumps performance than APT.

Predicción de efectividad de litotricia extracorpórea por ondas de choque en cálculos del tracto urinario. Grupos de riesgo para precisar retratamiento / Predicting the effectiveness of extracorporeal shock wave lithotripsy on urinary tract stones. Risk groups for accurate retreatment

Introducción: La litotricia extracorpórea por ondas de choque (LEOC) es un tratamiento no invasivo, seguro y efectivo para las litiasis del tracto urinario cuya efectividad varía según la localización y el tamaño del cálculo, entre otros factores; en ocasiones es necesario realizar varias sesiones. El objetivo es tratar de predecir el éxito o fracaso conociendo previamente las variables influyentes. Material y métodos: Analizamos a 211 pacientes con TAC previa entre aquellos tratados mediante LEOC entre los años 2010 y 2014. Se estudian las variables influyentes en la necesidad de retratamiento utilizando modelos de regresión logística binaria (estudio uni- y multivariado): densidad máxima, diámetro máximo, área, localización, desintegración y distancia del panículo adiposo. Con las variables influyentes se ha diseñado un modelo de riesgo valorando con regresión logística todas las posibles combinaciones (IBM SPSS versión 20.0). Resultados: Las variables de influencia independiente en la necesidad de retratamiento son: densidad máxima >864UH, diámetro máximo >7,5mm y localización pielocalicial. Utilizando estas variables, el mejor modelo incluye 3grupos de riesgo con probabilidades de necesitar retratamiento significativamente diferentes: grupo 1-bajo riesgo (0 variables) con 20,2%, grupo 2-riesgo intermedio (1-2 variables) con 49,2% y grupo 3-alto riesgo (3 variables) con 62,5%. Conclusiones: La densidad, el diámetro máximo y la localización pielocalicial del cálculo son factores determinantes en la efectividad del tratamiento con LEOC. Con estas variables, que se pueden obtener antes de la decisión terapéutica, el modelo de riesgo diseñado permite una aproximación precisa de cara a elegir el tratamiento más adecuado para cada caso en particular

Introduction: Extracorporeal shock wave lithotripsy (ESWL) is a non-invasive, safe and effective treatment for urinary tract lithiasis. Its effectiveness varies depending on the location and size of the stones as well as other factors; several sessions are occasionally required. The objective is to attempt to predict its success or failure, when the influential variables are known beforehand. Material and methods: We analysed 211 patients who had had previous CT scans and were treated with ESWL between 2010 and 2014. The influential variables in requiring retreatment were studied using binary logistic regression models (univariate and multivariate analysis): maximum density, maximum diameter, area, location, disintegration and distance from the adipose panniculus. With the influential variables, a risk model was designed by assessing all possible combinations with logistic regression (version 20.0 IBM SPSS). Results: The independent influential variables on the need for retreatment are: maximum density > 864 HU, maximum diameter > 7.5 mm and pyelocaliceal location. Using these variables, the best model includes 3risk groups with a probability of requiring significantly different retreatment: group 1-low risk (0 variables) with 20.2%; group 2-intermediate risk (1-2 variables) with 49.2%; and group 3-high risk (3 variables) with 62.5%. Conclusions: The density, maximum diameter and pyelocaliceal location of the stones are determinant factors in terms of the effectiveness of treatment with ESWL. Using these variables, which can be obtained in advance of deciding on a treatment, the designed risk model provides a precise approach in choosing the most appropriate treatment for each particular case

Predicting the effectiveness of extracorporeal shock wave lithotripsy on urinary tract stones. Risk groups for accurate retreatment. / Predicción de efectividad de litotricia extracorpórea por ondas de choque en cálculos del tracto urinario. Grupos de riesgo para precisar retratamiento.

INTRODUCTION: Extracorporeal shock wave lithotripsy (ESWL) is a non-invasive, safe and effective treatment for urinary tract lithiasis. Its effectiveness varies depending on the location and size of the stones as well as other factors; several sessions are occasionally required. The objective is to attempt to predict its success or failure, when the influential variables are known beforehand. MATERIAL AND METHODS: We analysed 211 patients who had had previous CT scans and were treated with ESWL between 2010 and 2014. The influential variables in requiring retreatment were studied using binary logistic regression models (univariate and multivariate analysis): maximum density, maximum diameter, area, location, disintegration and distance from the adipose panniculus. With the influential variables, a risk model was designed by assessing all possible combinations with logistic regression (version 20.0 IBM SPSS). RESULTS: The independent influential variables on the need for retreatment are: maximum density >864HU, maximum diameter >7.5mm and pyelocaliceal location. Using these variables, the best model includes 3risk groups with a probability of requiring significantly different retreatment: group 1-low risk (0 variables) with 20.2%; group 2-intermediate risk (1-2 variables) with 49.2%; and group 3-high risk (3 variables) with 62.5%. CONCLUSIONS: The density, maximum diameter and pyelocaliceal location of the stones are determinant factors in terms of the effectiveness of treatment with ESWL. Using these variables, which can be obtained in advance of deciding on a treatment, the designed risk model provides a precise approach in choosing the most appropriate treatment for each particular case.

Effects of velocity loss during resistance training on athletic performance, strength gains and muscle adaptations.

We compared the effects of two resistance training (RT) programs only differing in the repetition velocity loss allowed in each set: 20% (VL20) vs 40% (VL40) on muscle structural and functional adaptations. Twenty-two young males were randomly assigned to a VL20 (n = 12) or VL40 (n = 10) group. Subjects followed an 8-week velocity-based RT program using the squat exercise while monitoring repetition velocity. Pre- and post-training assessments included: magnetic resonance imaging, vastus lateralis biopsies for muscle cross-sectional area (CSA) and fiber type analyses, one-repetition maximum strength and full load-velocity squat profile, countermovement jump (CMJ), and 20-m sprint running. VL20 resulted in similar squat strength gains than VL40 and greater improvements in CMJ (9.5% vs 3.5%, P < 0.05), despite VL20 performing 40% fewer repetitions. Although both groups increased mean fiber CSA and whole quadriceps muscle volume, VL40 training elicited a greater hypertrophy of vastus lateralis and intermedius than VL20. Training resulted in a reduction of myosin heavy chain IIX percentage in VL40, whereas it was preserved in VL20. In conclusion, the progressive accumulation of muscle fatigue as indicated by a more pronounced repetition velocity loss appears as an important variable in the configuration of the resistance exercise stimulus as it influences functional and structural neuromuscular adaptations.

Effect of Low- vs. Moderate-Load Squat Training on Strength, Jump and Sprint Performance in Physically Active Women.

This study aimed to analyze the effects of resistance training (RT) load on neuromuscular performance. Twenty-seven physically active women were randomly distributed into 3 groups: a low-load group (LLG); a moderate-load group (MLG); and a control group (CG). The RT consisted of full squat exercise with a low load (40-60% 1RM, LLG) or a moderate load (65-80% 1RM, MLG). Sprint times (T10, T20, and T10-20), countermovement jump (CMJ), estimated one-repetition maximum (1RMest) and velocity attained against the first (FMPV) and the last load (LMPV) common to both tests were assessed pre- and post-test. Both experimental groups showed significant (P<0.05-0.001) improvements in all variables, except MLG for T10-20 and FMPV. The LLG achieved significantly (P<0.05-0.001) greater percent changes than CG in all variables except in T10 and T10-20, while MLG presented significantly (P<0.05-0.001) higher improvements than CG in T10, 1RMest and LMPV. The LLG presented a possibly better effect than MLG in T10-20, T20 and1RMest. In addition, LLG obtained a higher degree of transfer than MLG in all variables except in T10. These results suggest that a low-load training program produces similar or more beneficial effects on neuromuscular performance than moderate-load training.

Short-term Recovery Following Resistance Exercise Leading or not to Failure.

This study analyzed the time course of recovery following 2 resistance exercise protocols differing in level of effort: maximum (to failure) vs. half-maximum number of repetitions per set. 9 males performed 3 sets of 4 vs. 8 repetitions with their 80% 1RM load, 3×4(8) vs. 3×8(8), in the bench press and squat. Several time-points from 24 h pre- to 48 h post-exercise were established to assess the mechanical (countermovement jump height, CMJ; velocity against the 1 m·s(-1) load, V1-load), biochemical (testosterone, cortisol, GH, prolactin, IGF-1, CK) and heart rate variability (HRV) and complexity (HRC) response to exercise. 3×8(8) resulted in greater neuromuscular fatigue (higher reductions in repetition velocity and velocity against V1-load) than 3×4(8). CMJ remained reduced up to 48 h post-exercise following 3×8(8), whereas it was recovered after 6 h for 3×4(8). Significantly greater prolactin and IGF-1 levels were found for 3×8(8) vs. 3×4(8). Significant reductions in HRV and HRC were observed for 3×8(8) vs. 3×4(8) in the immediate recovery. Performing a half-maximum number of repetitions per set resulted in: 1) a stimulus of faster mean repetition velocities; 2) lower impairment of neuromuscular performance and faster recovery; 3) reduced hormonal response and muscle damage; and 4) lower reduction in HRV and HRC following exercise.

Effects of Combined Resistance Training and Plyometrics on Physical Performance in Young Soccer Players.

This study aimed to determine the effects of combined resistance training and plyometrics on physical performance in under-15 soccer players. One team (n=20) followed a 6-week resistance training program combined with plyometrics plus a soccer training program (STG), whereas another team (n=18) followed only the soccer training (CG). Strength training consisted of full squats with low load (45-60% 1RM) and low-volume (2-3 sets and 4-8 repetitions per set) combined with jumps and sprints twice a week. Sprint time in 10 and 20 m (T10, T20, T10-20), CMJ height, estimated one-repetition maximum (1RMest), average velocity attained against all loads common to pre- and post-tests (AV) and velocity developed against different absolute loads (MPV20, 30, 40 and 50) in full squat were selected as testing variables to evaluate the effects of the training program. STG experienced greater gains (P<0.05) in T20, CMJ, 1RMest, AV and MPV20, 30, 40 and 50 than CG. In addition, STG showed likely greater effects in T10 and T10-20 compared to CG. These results indicate that only 6 weeks of resistance training combined with plyometrics in addition to soccer training produce greater gains in physical performance than typical soccer training alone in young soccer players.

Factores influyentes en la respuesta al rescate con radioterapia tras prostatectomía radical / Influential Factors in the Response to Salvage Radiotherapy After Radical Prostatectomy

Objetivo: Analizar en los pacientes prostatectomizados con posterior progresión bioquímica (PB) y tratados con radioterapia de rescate (RTP) los factores influyentes en la respuesta. Material y métodos: Analizamos 313 pacientes con cáncer de próstata pT2/pT3 que reciben tratamiento de rescate por PB (de una serie de 1.310 pacientes operados entre 1989-2012). De los 313 pacientes 159 (50,8%) reciben solo deprivación androgénica (DA), 63 (20,1%) radioterapia (RTP) más DA concomitante y 91 (29,1%) solo RTP, de los cuales 57 (62,6%) mantienen respuesta completa y 34 (37,4%) fracaso del tratamiento. Resultados: Estudio del grupo tratado solo con RTP de rescate: 91 pacientes son tratados con RTP de rescate. Mediana de seguimiento 6,4 años. Mediana hasta progresión 11 meses. La supervivencia libre de progresión bioquímica post-RTP (SLPBPR) es de 68 ± 7% y 30 ± 10% en 5 y 10 años y la mediana de SLPBPR 7,3 años (6,3-8,3). En el análisis multivariado presentan influencia independiente en la respuesta: el PSA inicial (HR: 1,08; IC 95%: 1,01-1,1; p = 0,02) con mejor punto de corte PSA > 20 ng/ml (HR: 13,6; IC 95%: 2,1-86; p = 0,005) y PSA pre-RTP (HR: 1,9; IC 95%: 1,2-3,3 p=0,009), mejor punto de corte PSA preRTP de 0,92 ng/ml (HR: 4,5; IC95% 1,3-15,6; p = 0,01). SLPBPR a 5 años 81 ± 9% frente a 58 ± 9% con PSA inicial < 20 o > 20 ng/ml (p=0,03). SLPBPR a 5 años 93 ± 5% frente a 53 ± 10% según PSA pre-RTP < 0,9 o > 0,9 ng/ml (p = 0,02). Conclusiones: En los pacientes prostatectomizados tratados con RTP de rescate el PSA preoperatorio > 20 ng/ml y el PSA preRTP > 0,92 ng/ml tienen influencia independiente en la respuesta

Objective: To analyze the influential factors in the response in prostatectomized patients with subsequent biochemical relapse (BCR) and treated with salvage radiotherapy (RTP). Material and methods: We analyzed 313 patients with pT2/pT3 prostate cancer who were receiving salvage therapy due to biochemical relapse (from a series of 1,310 radical prostatectomies between 1989-2012). Of the 313 patients; 159 (50.8%) only received androgen deprivation (AD), 63 (20.1%) Radiotherapy (RTP) plus concomitant AD and 91 (29.1%) only RTP. Of these, 57 (62.6%) have maintained complete response and 34 (37.4%) had failure response with post-RTP BCR. Results: Study of the group treated exclusively with salvage RTP. Ninety-one patients were treated with salvage RTP. Median follow-up was 6.4 years and median to recurrence 11 months. Post-RTP biochemical relapse-free survival (PRBRFS) was 68 ± 7% and 30 ± 10% in 5 to 10 years. Median PRBRFS was 7.3 years (6.3-8.3). Initial PSA (HR: 1.08; 95% CI: 1.01-1.1 P = .02) with best PSA cut-off point PSA > 20 ng/ml (HR: 13.6; 95% CI: 2.1-86 P = .005) and PSA pre-RTP (HR: 1.9; 95% CI: 1.2-3.3; P = .009), best PSA cut-off point PSA preRTP 0.92 ng/ml (HR: 4.5; 95% CI: 1.3-15.6; P = .01) showed independent influence in the response in the multivariate study. PRBRFS at 5 years, 81 ± 9% versus 58 ± 9% with initial PSA < 20 or > 20 ng/ml (P = .03). PRBRFS at 5 years, 93 ± 5% versus 53 ± 10% according to PSA pre-RTP < 0.9 or > 0.9 ng/ml (P = .02). Conclusions: In patients treated with salvage RTP after radical prostatectomy, the preoperative PSA > 20 ng/ml and PSA preRTP > 0.92 ng/ml shows an independent influence on the response

Effect of movement velocity during resistance training on neuromuscular performance.

This study aimed to compare the effect on neuromuscular performance of 2 isoinertial resistance training programs that differed only in actual repetition velocity: maximal intended (MaxV) vs. half-maximal (HalfV) concentric velocity. 21 resistance-trained young men were randomly assigned to a MaxV (n=10) or HalfV (n=11) group and trained for 6 weeks using the full squat exercise. A complementary study (n=8) described the acute metabolic and mechanical response to the protocols used. MaxV training resulted in a likely more beneficial effect than HalfV on squat performance: maximum strength (ES: 0.94 vs. 0.54), velocity developed against all (ES: 1.76 vs. 0.88), light (ES: 1.76 vs. 0.75) and heavy (ES: 2.03 vs. 1.64) loads common to pre- and post-tests, and CMJ height (ES: 0.63 vs. 0.15). The effect on 20-m sprint was unclear, however. Both groups attained the greatest improvements in squat performance at their training velocities. Movement velocity seemed to be of greater importance than time under tension for inducing strength adaptations. Slightly higher metabolic stress (blood lactate and ammonia) and CMJ height loss were found for MaxV vs. HalfV, while metabolite levels were low to moderate for both conditions. MaxV may provide a superior stimulus for inducing adaptations directed towards improving athletic performance.

Influential factors in the response to salvage radiotherapy after radical prostatectomy.

OBJECTIVE: To analyze the influential factors in the response in prostatectomized patients with subsequent biochemical relapse (BCR) and treated with salvage radiotherapy (RTP). MATERIAL AND METHODS: We analyzed 313 patients with pT2/pT3 prostate cancer who were receiving salvage therapy due to biochemical relapse (from a series of 1,310 radical prostatectomies between 1989-2012). Of the 313 patients; 159 (50.8%) only received androgen deprivation (AD), 63 (20.1%) Radiotherapy (RTP) plus concomitant AD and 91 (29.1%) only RTP. Of these, 57 (62.6%) have maintained complete response and 34 (37.4%) had failure response with post-RTP BCR. RESULTS: Study of the group treated exclusively with salvage RTP. Ninety-one patients were treated with salvage RTP. Median follow-up was 6.4 years and median to recurrence 11 months. Post-RTP biochemical relapse-free survival (PRBRFS) was 68 ± 7% and 30 ± 10% in 5 to 10 years. Median PRBRFS was 7.3 years (6.3-8.3). Initial PSA (HR: 1.08; 95% CI: 1.01-1.1 P=.02) with best PSA cut-off point PSA>20 ng/ml (HR: 13.6; 95% CI: 2.1-86 P=.005) and PSA pre-RTP (HR: 1.9; 95% CI: 1.2-3.3; P=.009), best PSA cut-off point PSA preRTP 0.92 ng/ml (HR: 4.5; 95% CI: 1.3-15.6; P=.01) showed independent influence in the response in the multivariate study. PRBRFS at 5 years, 81 ± 9% versus 58 ± 9% with initial PSA <20 or >20 ng/ml (P=.03). PRBRFS at 5 years, 93 ± 5% versus 53 ± 10% according to PSA pre-RTP <0.9 or >0.9 ng/ml (P=.02). CONCLUSIONS: In patients treated with salvage RTP after radical prostatectomy, the preoperative PSA>20 ng/ml and PSA preRTP>0.92 ng/ml shows an independent influence on the response.

Evolución del tipo de paciente candidato a prostatectomía radical a lo largo de 2 décadas (1989-2009) / Course of the Type of Patient who is Candidate for Radical Prostatectomy Over 2 Decades (1989-2009)

Objetivo: Conocer los cambios que ha experimentado el perfil de paciente candidato a prostatectomía radical a lo largo de las últimas 2 décadas en nuestra institución. Material y métodos: Analizamos retrospectivamente una serie de 1.132 pacientes con cáncer de próstata estadio T1-T2, sometidos a prostatectomía radical durante el periodo 1989-2009. La serie se divide en 5 grupos homogéneos en cuanto al número de pacientes y ordenados cronológicamente. Se emplea la supervivencia libre de progresión bioquímica (SLPB) como criterio pronóstico principal. Resultados: A pesar de los cambios en el diagnóstico y tratamiento de la enfermedad, desde el punto de vista del pronóstico (SLPB) apreciamos 2 grupos diferentes de pacientes: los primeros 250 intervenidos y el resto. El punto de corte cronológico se sitúa en esta serie en 1999. Encontramos diferencias significativas en la mayoría de las variables clínico-patológicas como nivel de PSA al diagnóstico (p < 0,001), porcentaje de tumores palpables (p < 0,001), estadio clínico (p < 0,001), Gleason en la biopsia prostática (p = 0,004), grupos de riesgo de D’Amico (p < 0,001), estadio patológico (p < 0,001) y porcentaje de pacientes con afectación ganglionar (p < 0,001). No obstante, no se detectan diferencias de significación estadística en el Gleason del espécimen de prostatectomía (p = 0,06) y en el porcentaje de márgenes quirúrgicos (p = 0,6). Conclusiones: Este estudio analiza una muestra amplia de pacientes procedente de toda la geografía española y presenta algunos datos importantes que reflejan la evolución que ha sufrido el cáncer de próstata localizado, tanto en lo que respecta al diagnóstico como al pronóstico, en nuestro país en los últimos 20 años (AU)

Objective: To know the changes that there has experienced the profile of patient candidate to prostatectomía radically throughout last 2 decades in our institution. Material and methods: We analyze retrospectively a series of 1.132 patients with prostate cancer stadium T1-T2, submitted to radical prostatectomy during the period 1989-2009. The series divides in five homogeneous groups as for the number of patients and arranged chronologically. There uses the free survival of biochemical progression (SLPB) as criterion principal forecast. Results: In spite of the changes in the diagnosis and treatment of the disease, from the point of view of the forecast (SLPB) we estimate two groups different from patients: the first 250 controlled ones and the rest. The point of chronological cut places in this series in 1.999. We find significant differences in the majority of the clinical - pathological variables as PSA's level to the diagnosis (P <0,001), percentage of palpable tumors (P <0,001), clinical stadium (P <0,001), Gleason in the prostate biopsy (P =0,004), groups at risk of D’Amico (P <0,001), pathological stadium (P <0,001) and percentage of patients mincingly ganglionar (P <0,001). Nevertheless, there are not detected differences of statistical significance in the Gleason of the specimen of prostatectomy (P =0,06) and in the percentage of surgical margins (P =0,6). Conclusions: This study analyzes a patients’ wide proceeding sample from the whole Spanish geography and presents some important information that reflect the evolution that has suffered the cancer of prostate located, so much regarding the diagnosis as to the forecast, in our country in the last 20 years (AU)

Course of the type of patient who is candidate for radical prostatectomy over 2 decades (1989-2009).

OBJECTIVE: To know the changes experienced by the patient profile candidate for radical prostatectomy over the last 2 decades in our institution.. MATERIAL AND METHODS: We analyze retrospectively a series of 1.132 patients with prostate cancer stadium T1-T2, submitted to radical prostatectomy during the period 1989-2009. The series divides in five homogeneous groups as for the number of patients and arranged chronologically. There uses the free survival of biochemical progression (SLPB) as criterion principal forecast. RESULTS: In spite of the changes in the diagnosis and treatment of the disease, from the point of view of the forecast (SLPB) we estimate two groups different from patients: the first 250 controlled ones and the rest. The point of chronological cut places in this series in 1.999. We find significant differences in the majority of the clinical-pathological variables as PSA's level to the diagnosis (P <0,001), percentage of palpable tumors (P <0,001), clinical stadium (P <0,001), Gleason in the prostate biopsy (P =0,004), groups at risk of D'Amico (P <0,001), pathological stage (P <0,001), and percentage of patients with lymph node (P <0,001). Nevertheless, there are not detected differences of statistical significance in the Gleason of the specimen of prostatectomy (P =0,06) and in the percentage of surgical margins (P =0,6). CONCLUSIONS: This study analyzes a patients' wide proceeding sample from the whole Spanish geography and presents some important information that reflect the evolution that has suffered the cancer of prostate located, so much regarding the diagnosis as to the forecast, in our country in the last 20 years.

New immunosuppressive therapies and surgical complications after renal transplantation.

BACKGROUND: To analyze the association between the principal immunosuppressive drugs (mycophenolate mofetil, calcineurin inhibitors and mammalian target of rapamycin [mTOR] inhibitors) used in the routine management of kidney transplant patients and the development of postoperative surgical complications. MATERIALS AND METHODS: We analyzed 415 kidney transplants, studying the influence of various immunosuppressive regimens on the main postoperative surgical complications. RESULTS: The mean follow-up for the entire group was 72.8 months (± 54.2 SD). Patients treated with myeophonolate mofetil (MMF) and cyclosporine (n = 121) experienced a higher frequency of wound eventration odds ratio [OR], 5.2; 95% confidence interval [CI], 1.2-23.5; P = .03) compared with azathioprine and cyclosporine (n = 71). Compared with transplant recipients treated with tacrolimus and MMF (n = 181), transplant recipients treated with cyclosporine and MMF (n = 121) had a significantly greater frequency of wound eventration (OR, 3.7; 95% CI, 1.5-9.5; P = .005), urologic (OR, 2; 95% CI; 1.02-3.9; P = .04), wound (OR; 2.2; 95% CI; 1.07-4.6; P = .03), late (OR, 1.7; 95% CI; 1.01-3.03; P = .04), and Clavien grade 3 surgical complications (OR; 1.9; 95% CI, 1.1-3.37; P = .01). Patients treated with mTOR inhibitors (n = 26) had higher rates of lymphocele (OR, 3.6; 95% CI, (1.1-11.4; P = .002) compared with those who received tacrolimus (n = 197). CONCLUSIONS: New immunosuppressive drugs have improved short-term functional results; however, in some cases they seem to increase surgical complications rates.

[Radical prostatectomy for high risk localized prostate cancer. Prognosis and study of influential variables]. / Cáncer de próstata localizado de alto riesgo tratado mediante prostatectomía radical. Pronóstico y estudio de variables influyentes.

BACKGROUND: To study the biochemical progression-free survival (BPFS) achieved by a group of high risk patients in accordance with D'Amico's classification treated with radical prostatectomy. To identify the clinical-pathological variables which are influential in biochemical progression-free survival and, if possible, use them to design a prognostic model. MATERIAL AND METHODS: The study involves 232 patients, out of a series of 1,054, diagnosed with clinically localized prostate cancer, qualified as high risk on D'Amico's classification (PSA>20 ng/ml or Gleason score 8-10 or T3) treated with radical prostatectomy. The BPFS is studied and the clinical-pathological variables obtained (PSA, Gleason score of the biopsy and of the piece, clinical and pathological study, unilateral or bilateral affectation, margins of the prostatectomy piece, Ki-67 expression) are analyzed to identify whether they influenced the BPFS. Contingency tables and tables for survival analysis: Kaplan-Meyer, log-rank and Cox models were used for the statistical study. RESULTS: Descriptive study: PSA: 23.3 ng/ml (median); cGleason 2-6: 33%; 7: 13%; 8-10: 54%; T2: 58%; Bilateral affectation in the diagnostic biopsy: 59%; RNM T2: 60%; RNM T3: 40%. pGleason 2-6: 24%; 7: 28%; 8-10: 48%; pT2: 43%; pT3a: 30%; pT3b: 27%; Affected margin: 51%; N1:13%. Progression-free survival: with a mean and median follow-up of 64 months; 53% show biochemical progression. The median until progression: 42 months. Progression-free survival at 5 and 10 years is 43±3% and 26±7%. The multivariate study (Cox models) shows that the variables that are independently influential in the BPFS are the affectation of margins (HR: 3.5; 95% IC.1.9-6.7; p<0001); and Ki67 >10% (HR: 2.3; 95% IC: 1.2-4.3; P: 0.009). Risk groups: using the two influential variables and employing Cox models, three risk groups emerged as the best model: Group 1 (0 variables present); Group 2 (1 variable); Group 3 (2 variables). The progression-free survival is 69±8%; 27±6% and 18±11% at 5 years. The differences amongst the three groups are significant. CONCLUSION: The high risk group according to the D'Amico classification is heterogeneous in relation to biochemical progression and can be broken down into three risk groups using the two independently influential variables (affected margins and Ki67 percentage).

Tumor neuroectodérmico renal primitivo. A propósito de un caso / Primitive neuroectodermal tumour of the kidney. A case report

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¿Existe un intervalo de tiempo de isquemia fría seguro para el injerto renal? / Is there a Safe Cold Ischemia Time Interval for the Renal Graft?

Objetivo: Se pretende caracterizar la verdadera relación del tiempo de isquemia fría (TIF) con la supervivencia del injerto, así como con los principales eventos del postrasplante. Material y métodos: Analizamos 378 trasplantes renales, estudiando la relación del TIF con la supervivencia del injerto mediante un análisis univariado según el modelo de COX, y buscando el mejor punto de corte mediante el método de Kaplan-Meier y test de log-rank. La relación entre TIF y los principales eventos del postrasplante fue estudiada con la regresión logística binaria. Resultados: La media de seguimiento de todo el grupo fue de 77,8 meses (± 51 DE) y el TIF medio de 14,8 horas (± 5,1 DE). El análisis univariado revela que el TIF no se relaciona con la supervivencia del injerto como variable continua (OR=1,04; IC 95% 0,9-1,08; p>0,05). Al establecer el punto de corte en las 18 horas encontramos diferencias en la supervivencia actuarial. La supervivencia a los 5 años es del 91% con TIF < 18h frente a 84% con TIF > 18h. Cada hora de isquemia fría incrementó un 10% el riesgo de retraso en la función del injerto (OR=1,1; IC 95%:1,05-1,15; p<0,001) y también condicionó mayor incidencia de rechazo agudo (41,5% vs. 55,3%; p=0,02) y menor tiempo hasta el primer episodio de rechazo (72,6 días±137 vs. 272,2 días±614,8; p=0,023) a partir de las 18 horas. Con el resto de eventos del postrasplante, tales como complicaciones quirúrgicas o ingresos hospitalarios, el TIF no pareció estar relacionado (p>0,05). Conclusiones: En nuestra experiencia una isquemia fría menor de 18 horas no parece afectar negativamente la supervivencia del injerto (AU)

Objective: It is aimed to characterize the true relationship of the cold ischemia time (CIT) with graft survival and with the principal post-transplantation events. Material and methods: We analyzed 378 kidney transplants, studying the relationship of the CIT with graft survival using a univariate analysis according to the COX model and seeking the optimum cutoff according to the Kaplan-Meier method and log-rank test. The relationship between CIT and the principal events of the post-transplant was studied using the binary logistic regression. Results: The mean follow-up of all the group was 77.8 months (± 51 SD) and the mean CIT was 14.8hours (± 5.1 SD). The univariate analysis revealed that the CIT was not related with the graft survival as a continuous variable (OR=1.04; 95% CI: 0.9-1.08; p>0.05). On establishing the cutoff at 18hours, we found differences in the actuarial survival. Survival at 5 years was 91% with CIT < 18h versus 84% with CIT >18h. Each hour of cold ischemia increased risk of delay in the graft function by 10% (OR=1.1; 95% CI: 1.05-1.15; p<0.001) and also conditioned a greater incidence of acute rejection (41.5% vs. 55.3%; p=0.02) and less time to the first rejection episode (72.6 days±137 vs. 272.2 days±614.8; p=0.023) after 18hours. The CIT did not seem to be related (p<0.05) with the rest of the post-transplantation events, such as surgical complications or hospital admissions. Conclusions: In our experience, cold ischemia under 18hours does not seem to negatively affect graft survival (AU)

[Is there a safe cold ischemia time interval for the renal graft?]. / ¿Existe un intervalo de tiempo de isquemia fría seguro para el injerto renal?

OBJECTIVE: It is aimed to characterize the true relationship of the cold ischemia time (CIT) with graft survival and with the principal post-transplantation events. MATERIAL AND METHODS: We analyzed 378 kidney transplants, studying the relationship of the CIT with graft survival using a univariate analysis according to the COX model and seeking the optimum cutoff according to the Kaplan-Meier method and log-rank test. The relationship between CIT and the principal events of the post-transplant was studied using the binary logistic regression. RESULTS: The mean follow-up of all the group was 77.8 months (± 51 SD) and the mean CIT was 14.8 hours (± 5.1 SD). The univariate analysis revealed that the CIT was not related with the graft survival as a continuous variable (OR=1.04; 95% CI: 0.9-1.08; p>0.05). On establishing the cutoff at 18 hours, we found differences in the actuarial survival. Survival at 5 years was 91% with CIT < 18 h versus 84% with CIT >18 h. Each hour of cold ischemia increased risk of delay in the graft function by 10% (OR=1.1; 95% CI: 1.05-1.15; p<0.001) and also conditioned a greater incidence of acute rejection (41.5% vs. 55.3%; p=0.02) and less time to the first rejection episode (72.6 days±137 vs. 272.2 days±614.8; p=0.023) after 18 hours. The CIT did not seem to be related (p<0.05) with the rest of the post-transplantation events, such as surgical complications or hospital admissions. CONCLUSIONS: In our experience, cold ischemia under 18 hours does not seem to negatively affect graft survival.