Incidental diagnosis of bladder cancer in a national observational study in spain.

INTRODUCTION: Bladder cancer (BC) is a common malignancy in Spain. The aims of this study were: to identify the proportion of patients diagnosed with BC incidentally or after symptomatic presentation in a contemporary period in Spain; to compare demographic, clinical, and pathologic characteristics between these groups. METHODS: This was a retrospective analysis of a multi-centre observational study of 26 hospitals in the Spanish National Health System of all BCs newly diagnosed in 2011. The study represented 21.5% of the Spanish population and hospitals were selected in proportion to Spain's regions to ensure a representative sample. Patients were categorized by whether the cancer was diagnosed incidentally or after symptomatic presentation and baseline demographic, pathologic, and clinical characteristics were analyzed. RESULTS: 2472 were newly diagnosed with BC at the 26 participating Spanish hospitals with 308 (12.5%) of cases diagnosed incidentally and 2164 (87.5%) diagnosed after symptomatic presentation. No differences were observed between patients diagnosed incidentally vs. symptomatically in terms of demographics or measured co-morbidities. Compared to symptomatically diagnosed bladder tumours, those diagnosed incidentally were more likely to have a papillary appearance, to be significantly smaller, and less likely to have positive/suspicious cytology. Additionally, incidentally diagnosed bladder tumours were less likely to be muscle-invasive (11.7% vs. 25.0%, p < 0.01) nor aggressive at pathology, with 33.6% Grade 3 compared to 50.1%, (p < 0.01). CONCLUSIONS: We identified a significant percentage (12.5%) of new bladder cancer diagnosis made incidentally in a representative sample of the Spanish population. These tumours exhibited less aggressive pathologic characteristics than their symptomatic counterparts.

Impact of immunosuppression treatment on the improvement in graft survival after deceased donor renal transplantation: a long-term cohort study

We analyzed graft half-life and attrition rates in 1045 adult deceased donor kidney transplants from 1986-2001, with follow-up to 2011, grouped in two periods (1986-95 vs. 1996-01) according to immunosuppression. The Kaplan-Meier curve showed a significant increase in graft survival during 1996-2001. The uncensored real graft half-life was 10.25 years in 1986-95 and the actuarial was 14.58 years in 1996-2001 (P<0.001). The attrition rates showed a significantly greater graft loss in 1986-95, even excluding the first year from the analysis. The decline in renal function was significantly less pronounced in 1996-2001, indicating better preservation of renal function, despite the increase in donor age and stroke as the cause of donor death. The parsimonious Cox multivariate model showed donor age, acute rejection, panel reactive antibody, cold ischemia time and delayed graft function were significantly associated with a higher risk of graft loss. In contrast, the risk of graft loss fell by 21% in 1996-2001 compared with 1986-95. A similar reduction (25%) was observed when MMF treatment was entered into the multivariate model instead of study period. Long-term graft survival improved significantly in 1996-2001 compared to 1986-1995 despite older donor age. Modern immunosuppression could have contributed to the improved kidney transplant outcome (AU)

Análisis de la vida media del injerto y de su tasa de pérdida en 1045 transplantes de donantes cadáver adultos entre 1986 y 2001, con seguimiento hasta 2011, clasificados en dos periodos en función de la inmunosupresión: 1986-1995 y 1996-2001. La curva de Kaplan-Meier mostró un aumento significativo de la supervivencia del injerto durante el periodo 1996-2001. La vida media real no censurada del injerto fue de 10,25 años en 1986-1995 y la actuarial fue de 14,58 años en 1996-2001 (p < 0,001). La tasa de pérdida del injerto fue significativamente mayor en 1986-1995, incluso con la exclusión del primer año del análisis. En 1996-2001, la disminución de la función renal fue menos pronunciada, observándose una mejor conservación a pesar de que los donantes tenían más edad y de que habían fallecido por accidente cardiovascular. El modelo parsimonioso multivariante de Cox reveló que la edad del donante, el rechazo agudo, el panel de anticuerpos reactivos, el tiempo de isquemia fría y la función retrasada del injerto se asociaban de forma significativa a un mayor riesgo de pérdida del injerto. Sin embargo, el riesgo de pérdida del injerto se vio reducido en un 21% en 1996-2001 en comparación con el periodo 1986-1995. Se observó una reducción similar (25%) al incluir el tratamiento con MMF en el modelo multivariante en lugar del periodo de estudio. La supervivencia del injerto a largo plazo mejoró significativamente en 1996-2001 frente al periodo 1986-1995, a pesar de que los donantes tenían más edad. Por lo tanto, la inmunosupresión moderna podría haber contribuido a la mejora de los resultados del transplante renal (AU)

Impact of immunosuppression treatment on the improvement in graft survival after deceased donor renal transplantation: a long-term cohort study.

We analyzed graft half-life and attrition rates in 1045 adult deceased donor kidney transplants from 1986-2001, with follow-up to 2011, grouped in two periods (1986-95 vs. 1996-01) according to immunosuppression. The Kaplan-Meier curve showed a significant increase in graft survival during 1996-2001. The uncensored real graft half-life was 10.25 years in 1986-95 and the actuarial was 14.58 years in 1996-2001 (P<0.001). The attrition rates showed a significantly greater graft loss in 1986-95, even excluding the first year from the analysis. The decline in renal function was significantly less pronounced in 1996-2001, indicating better preservation of renal function, despite the increase in donor age and stroke as the cause of donor death. The parsimonious Cox multivariate model showed donor age, acute rejection, panel reactive antibody, cold ischemia time and delayed graft function were significantly associated with a higher risk of graft loss. In contrast, the risk of graft loss fell by 21% in 1996-2001 compared with 1986-95. A similar reduction (25%) was observed when MMF treatment was entered into the multivariate model instead of study period. Long-term graft survival improved significantly in 1996-2001 compared to 1986-1995 despite older donor age. Modern immunosuppression could have contributed to the improved kidney transplant outcome.

Optimización de donantes expandidos con el trasplante birrenal: estudio caso-control / Optimising expanded donor organs through dual kidney transplantation: a case-control study

Antecedentes: El perfil clínico de los donantes fallecidos se está transformando velozmente hacia un incremento de donantes con criterios expandidos (DCE), por lo que el número de riñones descartados para trasplante está creciendo. Con la finalidad de optimizar el aprovechamiento de riñones de DCE que individualmente podrían aportar una masa renal insuficiente, se ha sugerido su utilización como TX doble o birrenal (TXB). Pacientes y métodos: En un estudio de casos y controles, se analiza la experiencia de un único hospital entre mayo de 2007 y marzo de 2011. Los criterios para decidir TX único o doble quedaron definidos en un protocolo en el que la puntuación de la biopsia era un factor importante, pero no exclusivo, ya que se tenía en cuenta también la edad, los antecedentes del donante, el tamaño de los riñones y el aclaramiento de creatinina. Durante este intervalo se han trasplantado 80 riñones de donantes mayores de 65 años. De ellos, 40 han sido como trasplantes únicos (TXS) y otros 40 como TXB. Resultados: La edad media de los donantes para TXS fue de 68,7 ± 3,0 años y la de los TXB de 74,2 ± 4,3 años (p < 0,001), con predominio de mujeres en TXB (75%) respecto al TXS (40%) (p < 0,001). No se apreciaron diferencias entre ambos grupos respecto a filtrado glomerular o proteinuria. Los riñones derivados para TXB presentaban mayor puntuación en la biopsia que los de TXS (2,95 ± 1,01 vs. 1,8 ± 1,04; p < 0,001). Los receptores de TXB fueron de mayor edad que los de TXS, no encontrando diferencias entre grupos respecto a isquemia fría, retraso de la función del injerto, complicaciones hemorrágicas o reintervenciones. Sin embargo, los receptores de TXB alcanzaron mejor aclaramiento de creatinina en los cortes de 1, 3, 6 y 12 meses, aunque sólo resultara estadísticamente significativo a los 6 meses (53,4 ± 19,5 ml/min vs. 44,5 ± 15,6 ml/min; p < 0,05). La (..) (AU)

Introduction: In order to take full advantage of ECD kidneys, which may not provide sufficient renal mass if used individually, it has been suggested that such organs be used in dual or bilateral kidney transplantation (DTx). Patients and method: We analysed the experience in a single hospital between May 2007 and March 2011 in a case-control study. Criteria for determining whether to perform single or dual Tx were defined in a protocol in which the biopsy score was important, but not the only factor. Donor's age, medical history, kidney size and creatinine clearance were also considered. During this time period, 80 kidneys from donors over age 65 were transplanted. Single transplants (STx) accounted for 40 of the organs, and another 40 were used in DTx. Results: Mean donor age for STx was 68.7±3.0 years; for DTx, it was 74.2±4.3 years (P<.001), with more female donors for DTx (75%) than for STx (40%) (P<.001). There were no differences between groups with regard to glomerular filtration rate or proteinuria. Kidneys assigned to DTx received higher biopsy scores than those assigned to STx (2.95±1.01 vs 1.8±1.04; P<.001). DTx recipients were older than STx recipients. There were no differences between the groups regarding cold ischaemia time, delayed graft function, haemorrhagic complications (..) (AU)

Optimising expanded donor organs through dual kidney transplantation: a case-control study.

INTRODUCTION: In order to take full advantage of ECD kidneys, which may not provide sufficient renal mass if used individually, it has been suggested that such organs be used in dual or bilateral kidney transplantation (DTx). PATIENTS AND METHOD: We analysed the experience in a single hospital between May 2007 and March 2011 in a case-control study. Criteria for determining whether to perform single or dual Tx were defined in a protocol in which the biopsy score was important, but not the only factor. Donor's age, medical history, kidney size and creatinine clearance were also considered. During this time period, 80 kidneys from donors over age 65 were transplanted. Single transplants (STx) accounted for 40 of the organs, and another 40 were used in DTx. RESULTS: Mean donor age for STx was 68.7 ± 3.0 years; for DTx, it was 74.2 ± 4.3 years (P<.001), with more female donors for DTx (75%) than for STx (40%) (P<.001). There were no differences between groups with regard to glomerular filtration rate or proteinuria. Kidneys assigned to DTx received higher biopsy scores than those assigned to STx (2.95 ± 1.01 vs 1.8 ± 1.04; P<.001). DTx recipients were older than STx recipients. There were no differences between the groups regarding cold ischaemia time, delayed graft function, haemorrhagic complications or re-surgeries. However, DTx recipients achieved better creatinine clearance at 1, 3, 6 and 12 months, although the difference was only statistically significant at 6 months (53.4 ± 19.5ml/min vs 44.5 ± 15.6ml/min; P<.05). Renal artery thrombosis appeared in 2 STx patients and in both kidneys of 1 DTx patient. Another 2 patients in the DTx group each lost 1 kidney due to thrombosis and ureteral necrosis respectively, but were able to remain dialysis-free. Graft survival at 3 years was 90% for both groups. During the study period 3 patients died (2 in the STx group and 1 in the DTx group). CONCLUSIONS: Our preliminary experience indicates that DTx provides good results in terms of survival and renal function data, despite surgery being more complicated and the organs having characteristics that probably make them unsuitable for STx. The decision to perform DTx makes using ECD kidneys easier, and it should be based on a combination of pre-transplant histological criteria and the donor's clinical characteristics.

Diseño de un sistema para medir los movimientos mandibulares SAMM-III (Tercera etapa) / Design of a system to measure mandibular movements- SAMM-III (phase three)

El propósito del estudio fue continuar con el desarrollo del Sistema de Análisis de Movimiento Mandibular SAMM-III y patronar su nueva versión SAMM-III. Se utilizaron dos soportes intraorales en alambre, un sistema emisor de luz conformado por 4 diodos emisores de luz (Leds), dos cámaras de video, un aplicativo software en Labview 5.1 para la adquisición de al imagen y otro en Matlab 5.3 para su procesamiento. Se construyó un simulador de movimiento mandibular a partir del cual se realizó el patronamiento del SAMM-III, de manera estática y dinámica. En ambos tipos de patronamiento se evaluaron la velocidad de muestreo (cuadrosis), la distancia Leds- cámara, distancia entre los leds y el número de partículas (4 leds).con el software desarrollado en Matlab 5.1 se obtuvieron trazados de las trayectorias realizadas por el simulador, curvas de velocidad y un modelo matemático para predecir las curvas de desplazamiento vs tiempo del movimiento mandibular.

Evaluación de la elasticidad labial en 26 individuos con variaciones en la proyección anteroposterior de su dentición / Evaluation of the labial elasticity in 26 patient with variations in anteroposterior projection its tooth eruption

En la ortodoncia clínica se le hace un gran énfasis a la hipo o hiperáctividad de los labios y su efecto sobre la posición dental. Este estudio evaluó el comportamiento de la elasticidad labial en sujetos con variaciones en la proyección anteroposterior de su dentición: 9 clase I, 9 con biprotrusión dentoalveolar y 8 con clase II división 2. Mediante un análisis de cluster se realizó una estratificación de la muestra teniendo en cuenta la variable elasticidad y a los 3 grupos obtenidos se les realizó un test de Manova. Al evaluar la agrupación realizada según la elasticidad, y al observar que las evidentes maloclusiones quedaron mezcladas en los tres grupos de elasticidad, se puede concluir que la clasificación tradicional de Angle parece arbitraria desde el punto de vista dinámico.