Efficacy and safety of halo-gravity traction in the treatment of spinal deformities: A systematic review of the literature / Eficacia y seguridad de la tracción de halo-gravedad en el tratamiento de las deformidades de columna: una revisión sistemática de la literatura

Objective: To determine, through a systematic review, the effects of halo gravity traction in spinal deformity. Methods: Prospective studies or case series of patients with scoliosis or kyphosis treated with cranial halo gravity traction (HGT) were included. Radiological outcomes were measured in the sagittal and/or coronal planes. Pulmonary function was also assessed. Perioperative complications were also collected. Results: Thirteen studies were included. Congenital etiology was the most frequent etiology observed. Most studies provided clinically relevant curve correction values in the sagittal and coronal planes. Pulmonary values improved significantly after the use of HGT. Finally, there were a pool of 83 complications in 356 patients (23.3%). The most frequent complications were screw infection (38 cases). Conclusions: Preoperative HGT appears to be a safe and effective intervention for deformity that allows correction prior to surgery. However, there is a lack of homogeneity in the published studies.(AU)

Objetivo: Determinar, mediante una revisión sistemática, los efectos de la tracción de halo-gravedad (HGT) en las deformidades de columna. Métodos: Se incluyeron estudios prospectivos o series de casos de pacientes con escoliosis o cifosis tratados con HGT. Los resultados radiológicos se midieron en los planos sagital y/o coronal. También se evaluó la función pulmonar. Finalmente, se recogieron las complicaciones perioperatorias. Resultados: Se incluyeron 13 estudios. La etiología congénita fue la más frecuente. La mayoría de los estudios proporcionaron valores de corrección de la curva clínicamente relevantes en los planos sagital y coronal. Los valores pulmonares mejoraron significativamente tras el uso de HGT. Por último, existieron 83 complicaciones en 356 pacientes, siendo la infección la más frecuente (38 casos). Conclusiones: La HGT mostró ser una intervención segura y eficaz para la deformidad, que permite la corrección antes de la cirugía. Sin embargo, existe una falta de homogeneidad en los estudios publicados.(AU)

[Artículo traducido] Eficacia y seguridad de la tracción de halo-gravedad en el tratamiento de las deformidades de columna: una revisión sistemática de la literatura / Efficacy and safety of halo-gravity traction in the treatment of spinal deformities: A systematic review of the literature

Objective: To determine, through a systematic review, the effects of halo gravity traction in spinal deformity. Methods: Prospective studies or case series of patients with scoliosis or kyphosis treated with cranial halo gravity traction (HGT) were included. Radiological outcomes were measured in the sagittal and/or coronal planes. Pulmonary function was also assessed. Perioperative complications were also collected. Results: Thirteen studies were included. Congenital etiology was the most frequent etiology observed. Most studies provided clinically relevant curve correction values in the sagittal and coronal planes. Pulmonary values improved significantly after the use of HGT. Finally, there were a pool of 83 complications in 356 patients (23.3%). The most frequent complications were screw infection (38 cases). Conclusions: Preoperative HGT appears to be a safe and effective intervention for deformity that allows correction prior to surgery. However, there is a lack of homogeneity in the published studies.(AU)

Objetivo: Determinar, mediante una revisión sistemática, los efectos de la tracción de halo-gravedad (HGT) en las deformidades de columna. Métodos: Se incluyeron estudios prospectivos o series de casos de pacientes con escoliosis o cifosis tratados con HGT. Los resultados radiológicos se midieron en los planos sagital y/o coronal. También se evaluó la función pulmonar. Finalmente, se recogieron las complicaciones perioperatorias. Resultados: Se incluyeron 13 estudios. La etiología congénita fue la más frecuente. La mayoría de los estudios proporcionaron valores de corrección de la curva clínicamente relevantes en los planos sagital y coronal. Los valores pulmonares mejoraron significativamente tras el uso de HGT. Por último, existieron 83 complicaciones en 356 pacientes, siendo la infección la más frecuente (38 casos). Conclusiones: La HGT mostró ser una intervención segura y eficaz para la deformidad, que permite la corrección antes de la cirugía. Sin embargo, existe una falta de homogeneidad en los estudios publicados.(AU)

Short versus long intramedullary nails for intertrochanteric hip fracture: Meta-analysis. / [Artículo traducido] Clavo corto versus clavo largo en la fractura intertrocantérica de cadera: metaanálisis.

OBJECTIVE: To compare short versus long intramedullary nails for intertrochanteric hip fractures in terms of efficacy and safety. METHODS: We included cohort studies and randomized clinical trials. The methodological quality of the studies was assessed by the Newcastle-Ottawa Scale. The meta-analysis was performed using the Review Manager 5.4. Heterogeneity was checked with the I2 test. A fixed effects model was adopted if there was no heterogeneity. RESULTS: Twelve studies were included. The reoperations rate was lower in the short nail group (OR: 0.58, 95%CI: 0.38-0.88) and there were no differences regarding the peri-implant fracture rate (OR: 1.77, 95%CI: 0.68-4.60). Surgery time and blood loss was significantly higher in the long nail group (MD: -12.44, 95%CI: -14.60 -10.28) (MD: -19.36, 95%CI: -27.24 -11.48). There were no differences in functional outcomes. CONCLUSIONS: The long nail showed a higher reoperation rate, blood loss and surgery time compared to the short nail. LEVEL OF EVIDENCE: III.

Prader-Willi syndrome in a large sample from Spain: general features, obesity and regular use of psychotropic medication.

BACKGROUND: Prader-Willi syndrome (PWS), a genetically determined disorder, the most frequent cause of early onset obesity, is associated with physical and cognitive dysfunctions and behavioural disturbances; these disturbances are frequently treated with psychotropic medication. The aim of this cross-sectional study was to describe the characteristics of the first large national sample of persons with PWS in Spain and analyse the relationships of those characteristics with key demographic and clinical factors, particularly with obesity and the regular use of psychotropic medication. METHODS: Participants were recruited among all members of the Spanish Prader-Willi Association who agreed to take part in the study and fulfilled its inclusion criteria. Family and patient demographic features, family size and birth order, intelligence quotient (IQ), anthropometric measures, lifestyle habits, behavioural disturbances (with the Aberrant Behavior Checklist) and clinical data, as well as use of psychotropic drugs and their side effects (with the UKU scale), were collected in genetically confirmed cases of PWS. Bivariate and logistic regression analyses were used for determining the associations of demographic and clinical factors with both obesity and the regular use of psychotropic medication. RESULTS: The cohort included 177 participants (aged 6-48 years), that is, 90 (50.8%) males and 87 (49.2%) females. Behavioural disturbances were present in a range of 75% to 93% of participants; psychotropic medication was prescribed to 81 (45.8%) of them. Number of siblings showed a direct correlation with IQ, especially among males, and inappropriate speech was more intense in only-child females. Obesity was, in parallel, strongly associated with ascending age and with not being currently under growth hormone (GH) treatment. Participants taking any psychotropic medication were characterised by more frequent age ≥30 years, high level of hyperactivity and a psychiatric diagnosis. CONCLUSIONS: Characterisation of persons with PWS in Spain confirms their physical and behavioural phenotype and supports the long-term application of GH therapy and the rational use of psychotropic medication.

Efficacy and safety of halo-gravity traction in the treatment of spinal deformities: A systematic review of the literature. / [Artículo traducido] Eficacia y seguridad de la tracción de halo-gravedad en el tratamiento de las deformidades de columna: una revisión sistemática de la literatura.

OBJECTIVE: To determine, through a systematic review, the effects of halo-gravity traction (HGT) in spinal deformity. METHODS: Prospective studies or case series of patients with scoliosis or kyphosis treated with cranial HGT were included. Radiological outcomes were measured in the sagittal and/or coronal planes. Pulmonary function was also assessed. Perioperative complications were also collected. RESULTS: Thirteen studies were included. Congenital etiology was the most frequent etiology observed. Most studies provided clinically relevant curve correction values in the sagittal and coronal planes. Pulmonary values improved significantly after the use of HGT. Finally, there were a pool of 83 complications in 356 patients (23.3%). The most frequent complications were screw infection (38 cases). CONCLUSIONS: Preoperative HGT appears to be a safe and effective intervention for deformity that allows correction prior to surgery. However, there is a lack of homogeneity in the published studies.

Short versus long intramedullary nails for intertrochanteric hip fracture: Meta-analysis.

OBJECTIVE: To compare short versus long intramedullary nails for intertrochanteric hip fractures in terms of efficacy and safety. METHODS: We included cohort studies and randomized clinical trials. The methodological quality of the studies was assessed by the Newcastle-Ottawa Scale. The meta-analysis was performed using the Review Manager 5.4. Heterogeneity was checked with the I2 test. A fixed effects model was adopted if there was no heterogeneity. RESULTS: Twelve studies were included. The reoperations rate was lower in the short nail group (OR 0.58, 95% CI 0.38-0.88) and there were no differences regarding the peri-implant fracture rate (OR 1.77, 95% CI 0.68-4.60). Surgery time and blood loss was significantly higher in the long nail group (MD -12.44, 95% CI -14.60 to (-10.28)) (MD -19.36, 95% CI -27.24 to (-11.48)). There were no differences in functional outcomes. CONCLUSIONS: The long nail showed a higher reoperation rate, blood loss and surgery time compared to the short nail.

Efficacy and safety of halo-gravity traction in the treatment of spinal deformities: A systematic review of the literature.

OBJECTIVE: To determine, through a systematic review, the effects of halo gravity traction in spinal deformity. METHODS: Prospective studies or case series of patients with scoliosis or kyphosis treated with cranial halo gravity traction (HGT) were included. Radiological outcomes were measured in the sagittal and/or coronal planes. Pulmonary function was also assessed. Perioperative complications were also collected. RESULTS: Thirteen studies were included. Congenital etiology was the most frequent etiology observed. Most studies provided clinically relevant curve correction values in the sagittal and coronal planes. Pulmonary values improved significantly after the use of HGT. Finally, there were a pool of 83 complications in 356 patients (23.3%). The most frequent complications were screw infection (38 cases). CONCLUSIONS: Preoperative HGT appears to be a safe and effective intervention for deformity that allows correction prior to surgery. However, there is a lack of homogeneity in the published studies.

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

Bemiparin as a long-term treatment for venous thrombosis in cancer patients: the ELEBAMA study.

INTRODUCTION: Low-molecular-weight heparin (LMWH) is the standard treatment for cancer-associated venous thromboembolism (VTE). There have been no specific studies evaluating bemiparin for VTE in people with cancer. The aim of this study is to evaluate the effects of bemiparin for long-term treatment of VTE in routine clinical practice. METHODS/PATIENTS: Prospective observational study. Consecutive patients with active cancer and VTE, under treatment with bemiparin for at least 6 months, were recruited. RESULTS: We included 89 patients. The 6- and 9-month cumulative VTE recurrence rates were 2.4% and 5.9%, respectively. The 6-month cumulative rate of major bleeding was 1.3%, and of clinically relevant non-major bleeding, 8%. CONCLUSIONS: The incidence of events in this study is lower than that reported in randomized trials. Bemiparin is effective and safe for the long-term treatment of cancer-associated VTE in routine clinical practice.

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.

Modelos de riesgo en pacientes con carcinoma de células renales localizado / Risk models for patients with localised renal cell carcinoma

Introducción: Realizamos un análisis retrospectivo de nuestra serie para evaluar los factores influyentes en la supervivencia libre de enfermedad (SLE) y en la supervivencia cáncer-específica (SCE) en pacientes con carcinoma de células renales (CCR) localizado y realizamos unos grupos de riesgo propios. Material y métodos: Entre enero de 1990 y diciembre de 2012 fueron operados 596 pacientes con CCR localizado (tanto de células claras como papilares o cromófobos). Se analizan las variables clinicopatológicas influyentes en la SLE y en la SCE mediante modelos de regresión de Cox y con ellas se diseñan grupos de riesgo de SLE y de SCE. Resultados: La mediana de seguimiento de la serie es de 5,96 años. Al final del estudio 112 pacientes (18,8%) evidenciaron recidiva de la enfermedad, siendo la SLE del 82%, 77% y 72% a 5, 10 y 15 años respectivamente. Los factores de influencia independiente en la SLE en el estudio multivariado fueron: grado de Furhman III-IV, hematuria, afectación vascular linfática, la presencia de necrosis tumoral y el estadio patológico pT3-pT4. Por otro lado, al final del estudio 57 pacientes (9,6%) fallecieron a causa del cáncer renal, siendo la SCE del 92%, 86% y 83% a 5, 10 y 15 años respectivamente. Los factores de influencia independiente en la SCE en el estudio multivariado fueron: Grado de Furhman III-IV, afectación de la grasa perirrenal y la presencia de necrosis tumoral. Conclusiones: Además del estadio patológico pT3-pT4 en pacientes con CCR localizado son importantes otros factores, como la presencia de hematuria y la afectación vascular linfática para la SLE; y especialmente relevantes el grado de Furhman III-IV y la presencia de necrosis tumoral tanto para la SLE como para la SCE

Introduction: We conducted a retrospective analysis of our series to assess the factors that influenced disease-free survival (DFS) and cancer-specific survival (CSS) for patients with localised renal cell carcinoma (RCC). We also created our own risk groups. Material and methods: Between January 1990 and December 2012, 596 patients underwent surgery for localised RCC (clear cell, papillary or chromophobe). Using Cox regression models, we analysed the clinical-pathological variables that influenced DFS and CSS and designed risk groups for DFS and CSS with the variables. Results: The median follow-up for the series was 5.96 years. By the end of the study, 112 patients (18.8%) had a recurrence of the disease, with DFS rates of 82%, 77% and 72% at 5, 10 and 15 years, respectively. The independent factors that influenced DFS in the multivariate study were the following: A Furhman grade of 3-4, haematuria, lymphocytic or vascular invasion, the presence of tumour necrosis and a disease stage pT3-pT4. Furthermore, by the end of the study, 57 patients (9.6%) died due to renal cancer, with CSS rates of 92%, 86% and 83% at 5, 10 and 15 years, respectively. The independent factors that influenced CSS in the multivariate study were the following: A Furhman grade of 3-4, perinephric fat invasion and the presence of tumour necrosis. Conclusions: Factors in addition to the disease stage pT3-pT4 in patients with localised RCC are important, such as the presence of haematuria and lymphocytic or vascular invasion for DFS. A Furhman grade of 3-4 and the presence of tumour necrosis are especially relevant for DFS and CSS

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

Risk models for patients with localised renal cell carcinoma. / Modelos de riesgo en pacientes con carcinoma de células renales localizado.

INTRODUCTION: We conducted a retrospective analysis of our series to assess the factors that influenced disease-free survival (DFS) and cancer-specific survival (CSS) for patients with localised renal cell carcinoma (RCC). We also created our own risk groups. MATERIAL AND METHODS: Between January 1990 and December 2012, 596 patients underwent surgery for localised RCC (clear cell, papillary or chromophobe). Using Cox regression models, we analysed the clinical-pathological variables that influenced DFS and CSS and designed risk groups for DFS and CSS with the variables. RESULTS: The median follow-up for the series was 5.96 years. By the end of the study, 112 patients (18.8%) had a recurrence of the disease, with DFS rates of 82%, 77% and 72% at 5, 10 and 15 years, respectively. The independent factors that influenced DFS in the multivariate study were the following: A Furhman grade of 3-4, haematuria, lymphocytic or vascular invasion, the presence of tumour necrosis and a disease stage pT3-pT4. Furthermore, by the end of the study, 57 patients (9.6%) died due to renal cancer, with CSS rates of 92%, 86% and 83% at 5, 10 and 15 years, respectively. The independent factors that influenced CSS in the multivariate study were the following: A Furhman grade of 3-4, perinephric fat invasion and the presence of tumour necrosis. CONCLUSIONS: Factors in addition to the disease stage pT3-pT4 in patients with localised RCC are important, such as the presence of haematuria and lymphocytic or vascular invasion for DFS. A Furhman grade of 3-4 and the presence of tumour necrosis are especially relevant for DFS and CSS.

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.

Shifted risk preferences in pathological gambling.

BACKGROUND: Pathological gambling (PG) is an impulse control disorder characterized by excessive monetary risk seeking in the face of negative consequences. We used tools from the field of behavioral economics to refine our description of risk-taking behavior in pathological gamblers. This theoretical framework allowed us to confront two hypotheses: (1) pathological gamblers distort winning probabilities more than controls; and (2) pathological gamblers merely overweight the whole probability range. Method Eighteen pathological gamblers and 20 matched healthy participants performed a decision-making task involving choices between safe amounts of money and risky gambles. The online adjustment of safe amounts, depending on participants' decisions, allowed us to compute 'certainty equivalents' reflecting the subjective probability weight associated with each gamble. The behavioral data were then fitted with a mathematical function known as the 'probability weighting function', allowing us to disentangle our two hypotheses. RESULTS: The results favored the second hypothesis, suggesting that pathological gamblers' behavior reflects economic preferences globally shifted towards risk, rather than excessively distorted probability weighting. A mathematical parameter (elevation parameter) estimated by our fitting procedure was found to correlate with gambling severity among pathological gamblers, and with gambling affinity among controls. CONCLUSIONS: PG is associated with a specific pattern of economic preferences, characterized by a global (i.e. probability independent) shift towards risky options. The observed correlation with gambling severity suggests that the present 'certainty equivalent' task may be relevant for clinical use.

Factores predisponentes, facilitadores y reforzantes respecto al tabaquismo en trabajadores sanitarios / Predisposing, enabling and reinforcing factors regarding smoking in healthcare workers

Objetivos: Ante la elevada prevalencia de tabaquismo que continúa existiendo entre el personal sanitario, se ha llevado a cabo este estudio a fi n de identifi car y analizar los Factores Predisponentes, Facilitadores y Reforzantes (PRECEDE) respecto al tabaquismo en trabajadores de un Hospital Universitario Valenciano. Métodos: Se ha realizado un estudio cualitativo transversal, basado en un cuestionario no estructurado sobre los factores que motivan el consumo de tabaco en una muestra aleatoria de 120 trabajadores del Hospital Universitario Dr. Peset, diferenciándose cuatro categorías (n=30): Nunca fumadores, Fumadores habituales, Ex Fumadores sin recaída y Fumadores tras recaída. Resultados: Los principales factores PRECEDE identifi - cados en cada grupo fueron: Nunca Fumadores: Predisponentes (Conocimiento, “sé que es perjudicial”), Facilitadores (entorno familiar no fumador) y Reforzantes (Experiencia, “lo probé y no me gustó”). Fumadores: Predisponentes (“fumar es mi vicio”), Facilitadores (situaciones de estrés) y Reforzantes (“me hace sentir bien”). Ex Fumadores sin Recaídas: Predisponentes (problemas de salud), Facilitadores (deporte, presión familiar y social) y Reforzantes (ahorro económico). Fumadores tras Recaída: Predisponentes (creencia “por uno no pasa nada”), Facilitadores (entorno de fumadores) y Reforzantes (sensación de calma). Conclusiones: Según el estudio realizado, es recomendable que los programas de educación sanitaria contra el tabaquismo en el ámbito hospitalario presten especial atención a los factores relacionados con falsas creencias todavía existentes en el personal sanitario, así como a los entornos de los fumadores (AU)

Objectives: Since a high prevalence of tobacco addiction continues existing among healthcare workers, this study has been carried out in order to identify and to analyze Predisposing, Enabling and Reinforcing factors (PRECEDE) regarding smoking habits in healthcare workers at a Valencian University Hospital. Methods: We performed a qualitative cross-sectional study based on a non-structured questionnaire about factors that motivate smoking habit. A random sample of 120 health-care workers from Dr Peset University Hospital were interviewed and distributed among four categories (n=30): Non-smokers, Smokers, Ex- Smokers without relapses and Smokers with relapse. Results: The most important PRECEDE factor for each group was: Never-smokers: Predisposing (Knowledge, “I know that smoking is detrimental to health”), Enabling (non-smoker’s family environments) and Reinforcing (Experience, “I tried it and I did not like it”). Smokers: Predisposing (“smoking is my vice”) Enabling (stressful situations) and Reinforcing (“it makes me feel good”). Ex-Smokers without Relapses: Predisposing (Health problems), Enabling (Sport, family Pressure and social Perception) and Reinforcing (Cost). Smokers after Relapse: Predisposing (Belief It’s just one cigarette), Enabling (smoker’s environment) and Reinforcing (sensation of calm). Conclusions: According to this study, health promotion programs against smoking in hospitals should pay special attention to factors related to false beliefs among healthcare workers and smoker’s settings (AU)

[Risk-taking in adolescence: A neuroeconomics approach]. / Approche neuroéconomique de la prise de risque à l'adolescence.

OBJECTIVE: Risk-taking behaviors represent the main cause of morbi-mortality in adolescence. Here, we analyze their neural correlates, based on a neuroeconomics approach. This approach postulates that risk-taking behaviors result from multiple decision-making biases that impair the selection of the most appropriate action among alternatives based on their subjective evaluation. Specifically, we investigate three important domains in value-based decision-making: risk aversion, loss aversion and intertemporal choice. LITERATURE FINDINGS: First, when people have to make a decision between two rewarding options, they will usually prefer the more certain, even possibly lower, option - a phenomenon called "risk aversion". Yet adolescent people have been found to be less averse to risk than adults. This observation was linked to hypoactivation in (1) the anterior insula, involved in negative emotion such as fear and disgust and (2) the anterior cingular and the posterior ventromedial prefrontal cortices, involved in the monitoring of conflict and error detection. Second, people are generally described as being more sensitive to the possibility of losing objects than to that of gaining the same objects - "loss aversion". Here, we suggest that adolescents may be less averse to losses than adults when estimating the prospects of gaining and losing objects. Indeed, adolescent people have been found to be more affected by reward (e.g. euphoria or social integration consecutive to drug absorption) and less affected by punishment (e.g. malaise after drug consumption) than adults. Whereas the former process is subserved by hyperactivations in regions involved in reward evaluation such as the nucleus accumbens, the latter has been proposed to be subserved by hypoactivations in regions involved in negative emotions such as the amygdala or the insular cortex. This lower sensitivity to losses compared to gains in adolescents could be another important mechanism underlying risk-taking behaviors. A third dimension of adolescents' decision-making biases is temporality. It has been shown that adolescents favor immediate over delayed prospects, reflecting how future consequences of their decisions are heavily discounted. For example, adolescents can fail in projecting the future benefits of having safe sex - and thereby avoiding the risk of sexually transmitted disease or pregnancy - being more interested in the immediate reward of having romantic uninterrupted sexual intercourse. This impairment in inhibiting the choice of the early alternative could be related to the hypofunctionality of the lateral prefrontal cortex. Importantly, these three biases in the evaluation of decisions by adolescents may be related to the maturation of two neuronal systems. On the one hand, the early reorganization of dopaminergic neurons in the motivational system, due to the brutal secretion of sex hormones (mostly estrogens, testosterone and oxytocin) at the beginning of puberty, impels adolescents toward thrill seeking. On the other hand, the slow maturation of the cognitive control system, mostly exerted by the prefrontal cortex, implies that these impulses cannot be appropriately regulated. CONCLUSIONS: Two important neurodevelopmental mechanisms are thought to play a key role in the genesis of risk-taking behaviors in adolescence: the brutal secretion of sex hormones at the beginning of puberty and the delayed maturation of cognitive control. As such, these behaviors can be considered as inevitable, even if other factors, like sex, heredity and precariousness, can enhance their frequency. The implications of these conclusions for the prevention of risk-taking behaviors in adolescence are discussed.

Portopulmonary hypertension and liver transplantation: hemodynamic consequences at reperfusion.

BACKGROUND: The absence of portopulmonary hypertension (PH) upon preoperative evaluation for liver transplantation (OLT) does not exclude the occasional occurrence of an acquired PH while awaiting a graft. We sought to estimate hemodynamic changes and right ventriculoarterial coupling during reperfusion. METHODS: We studied 11 cirrhotic patients diagnosed with mild PH, according to the current classification: mean pulmonary artery pressure (MPAP)-25 to 34 mm Hg. These patients underwent OLT, using the piggyback technique (group PH). None of them had exhibited criteria for PH on preoperative echocardiography. This cohort was compared with 20 consecutive cirrhotic patients with normal MPAP at OLT. We performed a complete hemodynamic profile using a pulmonary artery catheter (RVEF, Baxter-Edwards, Calif, USA) before and 5 minutes after reperfusion. The variables were MPAP and right ventricular (RV) end-diastolic volume index (RVEDVI). Using standard formulas we calculated RV stroke work index (RVSWI), RV end-systolic elastance (Ees), pulmonary effective elastance (Ea), and RV-arterial coupling efficiency as the Ees/Ea ratio. Systolic ventricular function was expressed as RVSWI versus RVEDVI. RESULTS: During the anhepatic phase, MPAP, Ees, Ea, and RVSWI were higher in the PH group; but RVEDVI was lower. After reperfusion the pressure (MPAP), contractility (RVSWI) and preload (RVEDVI) increased in both groups. However, afterload (Ea) decreased in the non-PH group; accordingly, Es/Ea increased only in these patients. DISCUSSION: At reperfusion, the expansion in preload and cardiac output, without a similar afterload decrease, is responsible for the steady increase in pressure. Our results have shown that in the PH patient group, systolic ventricular function improves during reperfusion by a Frank-Starling mechanism; however, ventricular-arterial uncoupling is maintained (Ees/Ea < 1) because ventricular contractility is not appropriately balanced by simultaneous declines in afterload.

Effects of rapid paracentesis on right ventricular-arterial coupling in liver transplantation.

BACKGROUND: In cirrhotic patients intra-abdominal pressure (IAP) changes markedly modify splanchnic and systemic hemodynamics. Previous studies have evaluated the effects of increased IAP on steady-state cardiac performance, showing that right ventricular (RV) function becomes more depressed than that of the left ventricular. We sought to evaluate the effects of paracentesis on RV function and ventricular-arterial coupling among cirrhotics undergoing liver transplantation (OLT). METHODS: Twelve cirrhotic patients undergoing OLT underwent hemodynamic profiles before and 5 minutes after paracentesis, employing a right ventricular ejection fraction catheter in the pulmonary artery. We studied heart rate, systolic pulmonary artery pressure, central venous pressure (CVP), stroke volume index (SVI), RV end-diastolic volume index (RVEDI), and RV ejection fraction. In addition RV stroke work index (RVSWI), RV end-diastolic compliance (RVEDC), RV end-systolic elastance (Ees), pulmonary artery effective elastance (Ea), and RV coupling efficiency (Ees/Ea ratio) were calculated employing standard formulas. RESULTS: After removal of mean ascites volume of 5.6 +/- 2.2 L (range 4.0 to 8.04 L), SVI, RVEDI, RVSWI, and RVEDC were significantly increased and conversely CVP, Ees, and Ea were decreased with an ea/ea ratio unchanged. CONCLUSIONS: Before paracentesis Ees/Ea is preserved by increased of RV contractility; after paracentesis the coupling was maintained.

Effects of dobutamine on right ventricular function and pulmonary circulation in pulmonary hypertension during liver transplantation.

INTRODUCTION: In the setting of orthotopic liver transplantation (OLT), pulmonary hypertension (PH) affects right ventricular (RV) function. When RV failure occurs, reducing RV afterload, optimizing RV preload, and preserving coronary perfusion through maintenance of systemic blood pressure are the primary goals of intraoperative treatment. PATIENTS AND METHODS: To verify the effect of dobutamine on RV function and RV-arterial coupling, we compared a group of 9 cirrhotic patients with mild PH treated with OLT to a group of 20 patients with normal mean pulmonary artery pressure (MPAP). All patients received dobutamine (5-10 microg/kg/min) to maintain a cardiac index (CI) >3 L/min/m(2), during the anhepatic phase. Hemodynamic profile, using a pulmonary artery catheter, was performed before and during dobutamine infusion, studying MPAP, CI, and RV end-diastolic volume index (RVEDVI). RV stroke work index (RVSWI), RV end-systolic elastance (Ees), pulmonary effective elastance (Ea), and RV-arterial coupling efficiency as the Ees/Ea ratio were also calculated. RESULTS: RV contractility (Ees and RVSWI) and afterload (Ea) were significantly higher among the PH group. In both groups, all the studied variables improved with dobutamine: RV contractility increased, afterload decreased, and thus Ees/Ea coupling markedly increased. CONCLUSION: Cirrhotic patients with mild PH who were undergoing OLT still have a reserve of RV contractile performance and pulmonary vasodilation.