Implications of taxonomic misidentification for future invasion predictions: Evidence from one of the most harmful invasive marine algae.

Invasive species have been a focus of concern in recent decades, becoming more problematic due to the cumulative impacts of climate change. Understanding the interactions among stress factors is essential to anticipate ecosystems' responses. Hereby, robust modeling frameworks must be able to identify the environmental drivers of invasion and forecast the current and future of their potential distribution. These studies are essential for the management of invasions and to be prepared for the future we are facing. Here we demonstrate that taxonomic misidentifications may lead to absolutely erroneous predictions, by using as an example one of the worst invasive species in the Mediterranean Sea (Lophocladia lallemandii), which has been misidentified for three decades and now is correctly identified. Consequently, and bearing in mind overall trends in species misidentification due to the loss of taxonomic expertise and the presence of cryptic species, among others, attempts to understand and predict species involved in invasion processes must always first consider taxonomic studies.

27 years of benthic and coral community dynamics on turbid, highly urbanised reefs off Singapore.

Coral cover on reefs is declining globally due to coastal development, overfishing and climate change. Reefs isolated from direct human influence can recover from natural acute disturbances, but little is known about long term recovery of reefs experiencing chronic human disturbances. Here we investigate responses to acute bleaching disturbances on turbid reefs off Singapore, at two depths over a period of 27 years. Coral cover declined and there were marked changes in coral and benthic community structure during the first decade of monitoring at both depths. At shallower reef crest sites (3-4 m), benthic community structure recovered towards pre-disturbance states within a decade. In contrast, there was a net decline in coral cover and continuing shifts in community structure at deeper reef slope sites (6-7 m). There was no evidence of phase shifts to macroalgal dominance but coral habitats at deeper sites were replaced by unstable substrata such as fine sediments and rubble. The persistence of coral dominance at chronically disturbed shallow sites is likely due to an abundance of coral taxa which are tolerant to environmental stress. In addition, high turbidity may interact antagonistically with other disturbances to reduce the impact of thermal stress and limit macroalgal growth rates.

Micro-ureteroscopia: Experiencia inicial en el tratamiento endoscópico de litiasis de uréter pelviano / Micro-ureteroscopy: Initial experience in the endoscopic treatment of pelvic ureteral lithiasis

Objetivos: Presentar el primer caso de litiasis ureteral resuelto mediante un nuevo abordaje endoscópico que denominamos micro-ureteroscopia (m-URS) y que pretende reducir el daño ureteral que se produce por el instrumental convencional. Material y métodos: Seleccionamos a una paciente de 53 años de edad con una litiasis de 16 mm en el uréter distal derecho. Para el acceso endoscópico empleamos la vaina de 4,8 Fr del set de micro-Perc y fragmentamos la litiasis con una fibra láser de 230 μ. Resultados: Se consiguió la fragmentación por completo de la litiasis. Colocamos un catéter JJ debido al importante edema ureteral. El tiempo quirúrgico fue de 156 min y la estancia posquirúrgica de 24 h. No hubo complicaciones, los requerimientos de analgesia fueron mínimos y la paciente quedó libre de litiasis residuales. Conclusiones: La m-URS es una técnica factible, sencilla y eficaz en el tratamiento de litiasis ureteral pelviana en mujeres, que optimiza la mínima invasión con unos resultados que pueden ser equiparables a las técnicas endoscópicas convencionales en cuanto a la facilidad del acceso y la calidad de visión endoscópica sin afectar la capacidad resolutiva. Se requiere de estudios más potentes y de un mayor desarrollo tecnológico para definir el rol definitivo de este procedimiento. Las mayores limitaciones actuales residen en el tratamiento de litiasis en el uréter proximal o en varones. Podría ser una buena alternativa también en pacientes pediátricos

Objectives: To present to report the first case of ureteral lithiasis resolved using a new endoscopic approach, which we call microureteroscopy (m-URS) and attempts to reduce the ureteral damage caused by conventional instrumentation. Material and methods: We selected a 53-year-old patient with a 16-mm calculus in the right distal ureter. For endoscopic access, we used a 4.8 Fr sheath from the microperc set and fragmented the stone with a 230-micron laser fiber. Results: Complete fragmentation of the stone was achieved. We placed a JJ catheter due to significant ureteral edema. The surgical time and postsurgical stay were 156 minutes and 24 hours, respectively. There were no complications, the requirements for analgesia were minimal, and the patient was free of residual stones. Conclusions: The m-URS technique is feasible, simple and effective for the treatment of pelvic ureteral lithiasis in women and optimizes minimal invasion, with results that can be comparable to conventional endoscopic techniques in terms of ease of access and quality of endoscopic vision without affecting the resolution capacity. Larger studies and greater technological development is needed to define the definitive role of this procedure. Currently, its major limitations lie in the treatment of proximal ureter lithiasis and in the treatment of men. This technique could also be a viable alternative for pediatric patients

Déficit congénito de lactasa: identificación de una nueva mutación / Congenital lactase deficiency: Identification of a new mutation

No disponible

Adenomectomía laparoscópica extraperitoneal «sin nudos» / «Knotless» Laparoscopic Extraperitoneal Adenomectomy

Introducción: La adenomectomía laparoscópica es una cirugía factible y efectiva. Progresivamente simplificamos el procedimiento empleando sutura barbada, mediante una técnica que denominamos adenomectomía laparoscópica «sin nudos». Presentamos un estudio prospectivo multicéntrico descriptivo que refleja eficacia y seguridad de dicha técnica en una situación de práctica clínica real reproducible. Métodos: Un total de 26 pacientes con hipertrofia prostática benigna de gran tamaño (> 80 cc) fueron sometidos a adenomectomía laparoscópica «sin nudos». Se trata de una técnica laparoscópica extraperitoneal con 4 trocares basada en la enucleación controlada y hemostática del adenoma empleando bisturí ultrasónico, sección uretral precisa bajo visión asistida por una bujía uretral, trigonización empleando sutura barbada que cubre la pared posterior de la celda prostática, capsulorrafia con sutura barbada y extracción del adenoma morcelado a través de la incisión umbilical. Resultados: La mediana de la edad fue de 69 (54-83) años, el volumen prostático 127 (89-245) cc, el tiempo operatorio 136 (90-315) min, el sangrado estimado 200 (120-500) cc, la estancia hospitalaria 3 (2-6) días. Todos los pacientes presentaron mejoría funcional objetivada por uroflujometría, cuestionario de IPSS y calidad de vida. Hubo complicaciones en 6 pacientes, 5 fueron menores. Conclusiones: La adenomectomía laparoscópica «sin nudos» es un procedimiento de escasa complejidad que combina las ventajas de la cirugía abierta (resultados funcionales duraderos y extracción completa del adenoma) con los procedimientos laparoscópicos (disminución del sangrado y de transfusiones, menor estancia hospitalaria, morbilidad y complicaciones relacionadas con la pared abdominal). El empleo de bisturí ultrasónico y sutura barbada simplifica el procedimiento y permite realizar la técnica de forma segura y hemostática

Introduction: Laparoscopic adenomectomy is a feasible and effective surgical procedure. We have progressively simplified the procedure using barbed sutures and a technique we call «knotless» laparoscopic adenomectomy. We present a prospective, multicenter, descriptive study that reflects the efficacy and safety of this technique in an actual, reproducible clinical practice situation. Methods: A total of 26 patients with benign prostatic hyperplasia of considerable size (> 80 cc) underwent «knotless» laparoscopic adenomectomy. This is an extraperitoneal laparoscopic technique with 4 trocars based on the controlled and hemostatic enucleation of the adenoma using ultrasonic scalpels, precise urethral sectioning under direct vision assisted by a urethral plug, trigonization using barbed suture covering the posterior wall of the fascia, capsulorrhaphy with barbed suture and extraction of the morcellated adenoma through the umbilical incision. Results: The median patient age was 69 (54-83) years, the mean prostate volume was 127 (89-245) cc, the mean operative time was 136 (90-315) min, the mean estimated bleeding volume was 200 (120-500) cc and the hospital stay was 3 (2-6) days. All patients experienced improved function in terms of uroflowmetry and International Prostate Symptom Score and quality of life questionnaires. There were complications in 6 patients, 5 of which were minor. Conclusions: «Knotless» laparoscopic adenomectomy is a procedure with low complexity that combines the advantages of open surgery (lasting functional results and complete extraction of the adenoma) with laparoscopic procedures (reduced bleeding and need for transfusions, shorter hospital stays and reduced morbidity and complications related to the abdominal wall). The use of ultrasonic scalpels and barbed sutures simplifies the procedure and enables a safe and hemostatic technique

Micro-ureteroscopy: Initial experience in the endoscopic treatment of pelvic ureteral lithiasis.

OBJECTIVES: To present to report the first case of ureteral lithiasis resolved using a new endoscopic approach, which we call microureteroscopy (m-URS) and attempts to reduce the ureteral damage caused by conventional instrumentation. MATERIAL AND METHODS: We selected a 53-year-old patient with a 16-mm calculus in the right distal ureter. For endoscopic access, we used a 4.8 Fr sheath from the microperc set and fragmented the stone with a 230-micron laser fiber. RESULTS: Complete fragmentation of the stone was achieved. We placed a JJ catheter due to significant ureteral edema. The surgical time and postsurgical stay were 156minutes and 24hours, respectively. There were no complications, the requirements for analgesia were minimal, and the patient was free of residual stones. CONCLUSIONS: The m-URS technique is feasible, simple and effective for the treatment of pelvic ureteral lithiasis in women and optimizes minimal invasion, with results that can be comparable to conventional endoscopic techniques in terms of ease of access and quality of endoscopic vision without affecting the resolution capacity. Larger studies and greater technological development is needed to define the definitive role of this procedure. Currently, its major limitations lie in the treatment of proximal ureter lithiasis and in the treatment of men. This technique could also be a viable alternative for pediatric patients.

"Knotless" laparoscopic extraperitoneal adenomectomy.

INTRODUCTION: Laparoscopic adenomectomy is a feasible and effective surgical procedure. We have progressively simplified the procedure using barbed sutures and a technique we call "knotless" laparoscopic adenomectomy. We present a prospective, multicenter, descriptive study that reflects the efficacy and safety of this technique in an actual, reproducible clinical practice situation. METHODS: A total of 26 patients with benign prostatic hyperplasia of considerable size (>80cc) underwent "knotless" laparoscopic adenomectomy. This is an extraperitoneal laparoscopic technique with 4 trocars based on the controlled and hemostatic enucleation of the adenoma using ultrasonic scalpels, precise urethral sectioning under direct vision assisted by a urethral plug, trigonization using barbed suture covering the posterior wall of the fascia, capsulorrhaphy with barbed suture and extraction of the morcellated adenoma through the umbilical incision. RESULTS: The median patient age was 69 (54-83)years, the mean prostate volume was 127 (89-245)cc, the mean operative time was 136 (90-315)min, the mean estimated bleeding volume was 200 (120-500)cc and the hospital stay was 3 (2-6)days. All patients experienced improved function in terms of uroflowmetry and International Prostate Symptom Score and quality of life questionnaires. There were complications in 6 patients, 5 of which were minor. CONCLUSIONS: "Knotless" laparoscopic adenomectomy is a procedure with low complexity that combines the advantages of open surgery (lasting functional results and complete extraction of the adenoma) with laparoscopic procedures (reduced bleeding and need for transfusions, shorter hospital stays and reduced morbidity and complications related to the abdominal wall). The use of ultrasonic scalpels and barbed sutures simplifies the procedure and enables a safe and hemostatic technique.

La Unidad de Cirugía sin Ingreso: la gestión basada en procesos / No disponible

En septiembre de 2006 se puso en funcionamiento en nuestro centro una nueva área de atención quirúrgica, integrada en el propio complejo hospitalario. Es una nueva estructuración de los espacios quirúrgicos que forma parte de la estrategia de la organización en su tarea de mejora continua en la atención al paciente. Se trata de un área de Cirugía Mayor Ambulatoria denominada Unidad de Cirugía sin Ingreso, y su gestión se ha estructurado en base a la gestión por procesos. Describiremos en este trabajo la metodología empleada para poner en marcha esta unidad y los pasos necesarios para el control de la mejora continua. Creemos que el desarrollo metodológico del subproceso de Unidad de Cirugía sin Ingreso ha sido muy satisfactorio, tanto en cuanto a la metodología aplicada, como por la experiencia del trabajo en equipo (AU)

In September 2006 our center started a new surgical care area, integrated in the hospital premises. As a new structuration of the surgical spaces, it is a part of the organization’s strategy towards continuous improvement in patient care. It is a Major Ambulatory Surgery area known as Outpatient Surgery Unit, and it’s being managed under the methodology of process management. This paper describes the methodology used to set up this unit, and the necessary steps for monitoring continuous improvement. We believe that the methodological development of the Outpatient Surgery Unit subprocess has been very satisfactory, regarding both the applied methodology and the experience of teamwork (AU)

Un caso de rotura subcapsular del bazo en el parto / A case of subcapsular splenic rupture during labour

Se presenta un caso clínico de laceración subcapsular del bazo en el puerperio inmediato. Esta entidad es de gran dificultad diagnóstica tras el parto, dada su gran rareza clínica. Un punto muy importante es su sospecha y una rápida actuación al respecto para evitar una alta tasa de morbimortalidad

We report a case of subcapsular splenic rupture in the immediate postpartum period. Because of its rarity, this entity is difficult to diagnose. Key points are a high index of suspicion and rapid active management to avoid a high rate of morbidity and mortality

Oocyte donor selection from 554 candidates.

Oocyte donation is a technique in full expansion in the field of human reproduction. The main problem with this technique is the shortage of oocytes. In our programme, prospective donors are selected from anonymous, well-informed university students over 18 years of age, who give their informed consent in writing. Before being accepted as donors, the candidates' personal and family medical histories were taken and they were given a gynaecological examination, genital ultrasonography, and analysed for syphilis, acquired immune deficiency syndrome, hepatitis B and C, coagulation factor VIII, fetal haemoglobin and karyotype. The donors received economic compensation of about 750 euros. Over the last 6 years, 554 medical histories have been taken. Fifty-eight candidates (10.5%) were rejected because of previous family or personal pathologies. Only 243 out of 496 (49%) continued the study. Sixteen candidates (7%) were rejected as a result of gynaecological problems and ultrasonographic results; and 12 (4.9%) as a result of their blood test results; 215 donors were accepted (38.8% of the original population). Other options for recruiting oocyte donors are commented on and we argue that the methodology described here is the most suitable one.

Human immunodeficiency virus type 1--serodiscordant couples can bear healthy children after undergoing intrauterine insemination.

OBJECTIVE: To use semen from men who were seropositive for human immunodeficiency virus type 1 (HIV-1) to inseminate their partners without infecting them. DESIGN: Prospective study. SETTING: Private practice. PATIENT(S): Sixty-three HIV-1-seropositive men and their HIV-1-seronegative female partners. INTERVENTION(S): The men provided 107 semen samples that were prepared with the use of the Percoll and swim-up techniques. The presence of HIV-1 was determined in the fraction of motile spermatozoa obtained after washing. If HIV-1 was not detected. IUI was performed in stimulated cycles. MAIN OUTCOME MEASURE(S): Human immunodeficiency virus type 1 RNA and DNA were detected with the use of the polymerase chain reaction technique modified for spermatozoa. RESULT(S): One hundred seven semen samples were washed. Human immunodeficiency virus type 1 was not detected in 101 samples (94.4%) and was detected in 6 samples (5.6%). In the latter cases, IUI was not performed. One hundred one IUI procedures were performed in 63 women. Thirty-one pregnancies resulted, for a pregnancy rate of 30.7% per cycle and 49.2% per inseminated woman. Thirty-seven healthy children were born. The results of tests for the detection of HIV-1 and antibodies to HIV-1 in the inseminated women were negative. CONCLUSION(S): On the basis of these results, testing for HIV-1 with the use of the polymerase chain reaction technique on the semen fraction obtained after washing appears to prevent infection in the inseminated woman. This method makes it possible to help HIV-1-seropositive men to have children without infecting their female partners.

La laparoscopia como técnica de recuperación ovacitaria en nuestro programa de F.I.V.-T.E / The laparoscopy by technic of ovacitary recuperation in our program of F.I.V.-T.E

Los autores describen detalladamente la técnica utilizada y los resultados logrados en 142 ciclos monitorizados, desde enero de 1983 hasta mayo de 1985. Se destaca la minuciosidad con que explican las maniobras que realizan para jerarquizar a la laparoscopía como técnica de "recuperación ovocitaria" en un programa de fertilización in vitro, tema sobre el cual concentran su atención (AU)

La laparoscopia como técnica de recuperación ovacitaria en nuestro programa de F.I.V.-T.E / The laparoscopy by technic of ovacitary recuperation in our program of F.I.V.-T.E

Los autores describen detalladamente la técnica utilizada y los resultados logrados en 142 ciclos monitorizados, desde enero de 1983 hasta mayo de 1985. Se destaca la minuciosidad con que explican las maniobras que realizan para jerarquizar a la laparoscopía como técnica de "recuperación ovocitaria" en un programa de fertilización in vitro, tema sobre el cual concentran su atención