Outcomes of an enhanced recovery after radical cystectomy program in a prospective multicenter study: compliance and key components for success.

OBJECTIVE: To investigate the effect of an Enhanced Recovery After Surgery (ERAS) program on complications and length of stay (LOS) after radical cystectomy (RC) and to assess if the number and type of components of ERAS play a key role on the decrease of surgical morbidity. MATERIALS AND METHODS: We analyzed the data of 277 patients prospectively recruited in 11 hospitals undergoing RC initially managed according to local practice (Group I) and later within an ERAS program (Group II). Two main outcomes were defined: 90-day complications rate and LOS. As secondary variables we studied 90-day mortality, 30-day readmission and transfusion rate. RESULTS: Patients in Group II had a higher use of ERAS measures (98.6%) than those in Group I (78.2%) (p < 0.05). Patients in Groups I and II experienced similar complications (70.5% vs. 66%, p = 0.42). LOS was not different between Groups I and II (12.5 and 14 days, respectively, p = 0.59). The risk of having any complication decreases for patients having more than 15 ERAS measures adopted [RR = 0.815; 95% confidence interval (CI) 0.667-0.996; p = 0.045]. Avoidance of transfusion and nasogastric tube, prevention of ileus, early ambulation and a fast uptake of a regular diet are independently associated with the absence of complications. CONCLUSIONS: Complications and LOS after RC were not modified by the introduction of an ERAS program. We hypothesize that at least 15 measures should be applied to maximize the benefit of ERAS.

Relevance of age at slaughter on meat quality of turkeys stunned with CO2.

1. The objective of this work was to determine the effect of slaughter age and stunning method on the quality of turkey meat from poultry processing plants. 2. One hundred B.U.T. Premium turkeys were divided into 4 groups of 25 animals according to slaughter age (15 or 17 weeks) and CO2 stunning procedure (G1 stepwise: step1: 30% CO2, 15 s; step 2: 55% CO2, 40 s; step 3: 70% CO2, 45 s; G2: progressive increase of the CO2 concentration at a rate of 0.8% per s for 100 s). The quality of the breast meat was determined in fillets taken at different post-mortem times. 3. There were differences between the stunning groups for several variables (pH: 6.01 ± 0.01 and 5.95 ± 0.02; a*: -1.84 ± 0.05 and -2.21 ± 0.04; b*: 4.99 ± 0.15 and 4.68 ± 0.16; drip loss: 0.85 ± 0.02 and 0.71 ± 0.02 for G1 and G2, respectively), while no significant differences were found for L*, cooking loss and texture analysed with a Warner Bratzler Shear Force cell (WBSF). 4. Slaughter age had a significant effect on all the parameters studied (pH: 6.01 ± 0.01 and 5.95 ± 0.01; a*: -2.21 ± 0.05 and -1.88 ± 0.05, b*: 5.50 ± 0.17 and 4.42 ± 0.15; drip loss: 0.71 ± 0.02 and 0.86 ± 0.02, cooking loss: 12.56 ± 0.22 and 14.69 ± 0.16 for turkeys slaughtered at 15 and 17 w, respectively) except on L* and WBSF. 5. The ageing of the meat affected pH, colour values, drip loss and WBSF, with differing degrees of evolution: mean values of L* (39.36 ± 0.35. 45.77 ± 0.20 and 46.30 ± 0.24, for 20 min, 24 h and 7 d post mortem, respectively) and drip loss (0.75 ± 0.03 and 0.84 ± 0.02 for 24 h and 7 d post mortem, respectively) increased, those of a* (-1.77 ± 0.08, -1.94 ± 0.07 and -2.22 ± 0.05 for 20 min, 24 h and 7 d post mortem, respectively) and WBSF decreased (3.73 ± 0.06 and 2.63 ± 0.04 for 24 h and 7 d post mortem, respectively), those of pH decreased in the first 24 h and remained stable for the next 6 d (6.19 ± 0.02, 5.87 ± 0.01 and 5.88 ± 0.01), and those of b* increased in the first 24 h post-mortem and remained stable for the next 6 d (3.26 ± 0.31, 5.86 ± 0.16 and 5.47 ± 0.08). 6. The results revealed no critical differences between stunning methods, and suggest that animals slaughtered at 15 weeks present higher quality meat than those slaughtered at 17 weeks.

Influence of carbon dioxide stunning procedure on quality of turkey meat.

1. The objective of this study was to evaluate the effect of sex and gas stunning on quality attributes of turkey breast meat. 2. One hundred B.U.T. Premium turkeys (50 males and 50 females) were divided into four groups of 25 animals and subjected to one of two CO2 stunning procedures: G1 stepwise (step 1: 30% CO2, 15 s; step 2: 55% CO2, 40 s; step 3: 70% CO2, 45 s) or G2 fixed concentration (80% CO2, 100 s). The pH and meat colour at 20 min post-mortem, and pH, colour (L*, a*, b*), water holding capacity (WHC), drip loss (DL), cooking loss (CL) and Warner-Bratzler shear force (WBSF) in breast samples at 24 h and 7 d post-mortem were assessed. 3. There were significant differences between stunning groups for pH, meat colour and CL, whereas no significant differences were found for DL and WBSF. Sex had a significant effect on pH and b* and ageing of meat affected pH, colour coordinates, DL and WBSF. 4. It was concluded that the G2 treatment affected negatively the pH value and colour coordinates. However, G2 stunning affected positively the WHC parameters. Female turkeys had better results than males for pH, and the colour of female turkey breast meat was less yellow than male breast meat.

Effects of peripheral FAAH blockade on NTG-induced hyperalgesia--evaluation of URB937 in an animal model of migraine.

BACKGROUND: Systemic nitroglycerin (NTG) activates brain nuclei involved in nociceptive transmission as well as in neuroendocrine and autonomic functions in rats. These changes are considered relevant for migraine because NTG consistently provokes spontaneous-like migraine attacks in migraineurs. Several studies have suggested a relationship between the endocannabinoid levels and pain mediation in migraine. URB937, a peripheral inhibitor of fatty acid amide hydrolase (FAAH)-the enzyme that degrades anandamide, produces analgesia in animal models of pain, but there is no information on its effects in migraine. AIM: We evaluated whether URB937 alters nociceptive responses in the animal model of migraine based on NTG administration in male rats, using the tail flick test and the plantar and orofacial formalin tests, under baseline conditions and after NTG administration. Furthermore, we investigated whether URB937 affects NTG-induced c-Fos expression in the brain. RESULTS: During the tail flick test, URB937 showed an antinociceptive effect in baseline conditions and it blocked NTG-induced hyperalgesia. URB937 also proved effective in counteracting NTG-induced hyperalgesia during both the plantar and orofacial formalin tests. Mapping of brain nuclei activated by NTG indicates that URB937 significantly reduces c-Fos expression in the nucleus trigeminalis caudalis and the locus coeruleus. CONCLUSIONS: The data suggest that URB937 is capable of changing, probably via indirect mechanisms, the functional status of central structures that are important for pain transmission in an animal model of migraine.

Evidence of an Off-Resonant Electronic Transport Mechanism in Helicenes.

Helical molecules have been proposed as candidates for producing spin-polarized currents, even at room conditions, due to their chiral asymmetry. However, describing their transport mechanism in single molecular junctions is not straightforward. In this work, we show the synthesis of two novel kinds of dithia[11]helicenes to study their electronic transport in break junctions among a series of three helical molecules: dithia[n]helicenes, with n = 7, 9, and 11 molecular units. Our experimental measurements and clustering-based analysis demonstrate low conductance values that remain similar across different applied voltages and molecules. Additionally, we assess the length dependence of the conductance for each helicene, revealing an exponential decay characteristic of off-resonant transport. This behavior is primarily attributed to the misalignment between the energy levels of the molecule-electrodes system. The length dependence trend described above is supported by ab initio calculations, further confirming an off-resonant transport mechanism.

[Impact of the implementation of the international best practice guidelines programme (BPSO®) on health outcomes in a public hospital]. / Impacto de la implantación del programa internacional de Guías de Buenas Prácticas (BPSO®) en los resultados de salud en un hospital público.

OBJECTIVE: To analyze the impact on patient health outcomes after implementing 4 Good Practice Guidelines (GPG) in a level II public university hospital. METHOD: A quasi-experimental pre-post study was carried out at the Hospital Universitario Fundación Alcorcón, belonging to the Servicio Madrileño de Salud (SERMAS) of the Community of Madrid. Anonymized patient health indicator data from February 2018 to December 2022 from a total of 4853 patient records were analyzed. Inclusion criteria all patients defined in the scope of each GBP. The sample analyzed was patients discharged in the last 5 working days of the month for all GBPs, except in Ostomy and Stroke, for which 100% of patients discharged during the month were included. RESULTS: The main results were: incidence of pressure injury from 2.70% (2017) to 1.03% (2022); stoma marking from 66.67% (2017) to 75% (2022); exclusive breastfeeding from 50% (2017) to 61.54% (2022); neurological assessment on admission from 75.56% (2017) to 85.60% (2022). CONCLUSIONS: The implementation of the GBPs led to an improvement in the health indicators of patients admitted to the target units. Improvements were observed in both process and outcome indicators.

Characterization of two different melatonin binding sites in peripheral tissues of the teleost Tinca tinca.

The aim of the present study was to localize and characterize 2-iodo-melatonin ([(125)I]Mel) binding sites in peripheral tissues of the teleost Tinca tinca. A wide distribution of [(125)I]Mel binding sites in peripheral locations of the tench is found, with highest densities being measured in the heart, gills and kidney, and low density of [(125)I]Mel binding sites in gastrointestinal tract, spleen, liver and gonads. Saturation, kinetics, and pharmacological approaches revealed the presence of, at least, two different [(125)I]Mel binding sites in the tench peripheral tissues. The unique characterized subtype in the heart fulfils all the criteria for a canonical melatonin receptor belonging to MT(1) family (the binding is saturable, reversible, and inhibited by GTP analogs), and gives support for the presence of a functional melatonin receptor in the heart of the tench. In contrast, kinetic and pharmacological studies in the kidney revealed the preponderance of a melatonin binding site belonging to the MT(3)-like receptor subtype. Moreover, the decrease of specific binding in both, heart and kidney membranes, and the decrease of affinity in the kidney, produced by the addition of a non-hydrolysable GTP analog, and sodium cations suggest the presence of G(i/o)-proteins (that mediate inhibition of cAMP formation) coupled to such melatonin binding sites. Our results also point to different G(i/o)-proteins involved in the underlying mechanism of melatonin binding sites activation in the kidney. Additionally, the kinetics of [(125)I]Mel binding in kidney membrane preparations is a highly thermosensitive process, being necessary to perform the assays at 4 °C since the equilibrium was not reached at 25 °C assay temperature. The time needed to complete association of [(125)I]Mel at such low temperature is only 15s, whereas 100s is required to displace [(125)I]Mel specific binding by the unlabeled melatonin in kidney membranes. Present results support previous reports on melatonin effects in the regulation of different physiological functions in teleost (as cardiovascular physiology and osmoregulation) acting through peripheral specific receptors.

Population based study of morbidity and mortality rates associated to radical prostatectomy cases in Spain.

INTRODUCTION: There is no population-based study that accounts for the number of radical prostatectomies (RP) carried out in Spain, nor regarding the morbidity and mortality of this intervention. Our objective is to study the morbidity and mortality of RP in Spain from 2011 to 2015 and to evaluate the geographic variation. MATERIAL AND METHODS: We designed a retrospective observational study of all patients submitted to RP in Spain during five consecutive years (2011-2015). The data was extracted from the «Conjunto Mínimo Básico de Datos¼ (CMBD). We have evaluated geographic variations in terms of morbidity and hospital stay, and the impact of the mean annual surgical volume for each center on these variables. RESULTS: Between 2011-2015, a total of 37,725 RPs were performed in 221 Spanish public hospitals. The mean age of the series was 63.9±3.23 years. Of all RPs, 50% were performed through an open approach, and 43.4% have been operated on in hospitals with <500 beds. We observed an important variability in the distribution of the cases operated on in the different regions. The regions that perform more RPs are Andalusia, Catalonia, Galicia, and Madrid. Our study shows a complication rate of 8.6%, with hemorrhage and the need for transfusion being the most frequent (5.3 and 4%, respectively). There are significant differences in bleeding rates and hospital stay among regions, which are maintained after adjusting for patient characteristics and type of hospital. When studying the annual surgical volume of each hospital, we find that the impact on the rate of hemorrhage or transfusion is linear; however, hospital stay remains stable at around 5 days from 60 RPs/year. CONCLUSIONS: In national terms, morbidity and mortality rates after RP are comparable to those described in the literature. This study reveals a clear dispersion in the hospitals that carry out this intervention, showing clear differences in terms of morbidity and hospital stay between the different regions.

The Influence of Snow Properties on Speed and Gait Choice in the Svalbard Rock Ptarmigan (Lagopus muta hyperborea).

Substrate supportiveness is linked to the metabolic cost of locomotion, as it influences the depth to which the foot of a moving animal will sink. As track depth increases, animals typically reduce their speed to minimize any potential energetic imbalance. Here, we examine how self-selected speed in the Svalbard rock ptarmigan is affected by snow supportiveness and subsequent footprint depth measured using thin-blade penetrometry and 3D photogrammetry, respectively. Our findings indicate that snow supportiveness and footprint depth are poor predictors of speed (r 2 = 0.149) and stride length (r 2 = 0.106). The ptarmigan in our study rarely sunk to depths beyond the intertarsal joint, regardless of the speed, suggesting that at this relatively shallow depth any increased cost is manageable. 3D reconstructions also indicate that the ptarmigan may exploit the compressive nature of snow to generate thrust during stance, as a trend toward greater foot rotations in deeper footprints was found. It remains unclear whether the Svalbard ptarmigan are deliberately avoiding unsupportive snowy substrates. However, if they do, these results would be consistent with the idea that animals should choose routes that minimize energy costs of locomotion.

La firmeza del sustrato se asocial al costo metabólico de la locomoción ya que influencia cuán profundo las extremidades de un animal se hunden al moverse. A medida hundimiento aumenta, usualmente los animales reducen su velocidad para minimizar potenciales desbalances energéticos. En este estudio examinamos cómo la velocidad de la perdiz de la roca de Svalbard es afectada por la firmeza del sustrato y la profundidad de hundimiento de sus patas, usando penetrometría y fotogrametría 3D, respectivamente. Nuestros resultados indican que la firmeza de la nieve y la profundidad de hundimiento de las patas no son buenos predictores de la velocidad (r 2 = 0.149) y de la longitud de la zancada (r 2 = 0.106). La profundidad de las huellas de las perdices de nuestro estudio rara vez sobrepasó la altura de la articulación intertarsal, independientemente de la velocidad de locomoción, sugiriendo que a profundidades relativamente menores los costos energéticos son manejables. Las reconstrucciones 3D también indican que las perdices podrían aprovechar la naturaleza compresiva de la nieve para generar suficiente empuje durante la fase de soporte, ya que se encontró una tendencia hacia mayores rotaciones de la pata en huellas más profundas. Es incierto si las perdices de Svalbard deliberadamente evitan áreas con nieve más blanda. Sin embargo, si lo hacen, estos resultados serían consistentes con la idea de que los animales deberían seleccionar rutas que minimizan los gastos energéticos en locomoción.

The anatomical limits and oncological benefit of lymphadenectomy in muscle invasive bladder cancer. / Límites anatómicos y beneficio oncológico de la linfadenectomía en el cáncer urotelial de vejiga con infiltración muscular.

BACKGROUND: Lymphadenectomy is part of standard treatment for muscle invasive bladder cancer. The objective of this review is to provide an up-to-date review on the available scientific evidence in this field. ACQUISITION OF EVIDENCE: We conducted a literature review in PubMed of relevant articles up to the present (2016). We found a systematic review published in 2014 that included the comparative studies published up to that year, and we updated the review with new relevant publications since that date. SYNTHESIS OF THE EVIDENCE: The number of lymph nodes is not the best indicator for determining the quality of the lymphadenectomy given that the number can vary depending on numerous factors that depend not only on the surgeon but also on the patient and on the pathologist. The definition of standard anatomical territories and a meticulous extraction of the lymph nodes in these territories are more reproducible than the numbers of nodes removed. The optimal extension of lymphadenectomy is a topic of debate. The evidence published to date indicates that any extension of lymphadenectomy is better than not performing it, although it appears that limited lymphadenectomy is insufficient for the oncological control of the disease and that superextended lymphadenectomy provides no oncological benefit versus extended lymphadenectomy. CONCLUSIONS: Despite a certain amount of controversy in terms of the optimal extension of lymphadenectomy, performing lymphadenectomy in all cases appears to be recommendable according to the available evidence. Extended lymphadenectomy provides greater oncological benefit than more limited dissections, while more extensive lymphadenectomies are not recommended.

Resultados de la implementación de un programa multidisciplinar de cesación tabáquica combinando vareniclina y terapia conductual en la farmacia comunitaria / Results of the implementation of a multidisciplinary smoking cessation programme combining varenicline and behavioural therapy in community pharmacies

Objetivo: evaluar los resultados de la implementación de un programa multidisciplinar médico-farmacéutico de cesación tabáquica combinando vareniclina y terapia conductual.Métodos: el médico de atención primaria valoró la dependencia y motivación del paciente para dejar de fumar mediante los test de Fagerström y Richmond, respectivamente. Los pacientes candidatos a entrar en el programa recibían la prescripción de vareniclina, si era necesaria, y se incorporaban a un programa de terapia conductual de tres meses de seguimiento en la farmacia comunitaria. Para el abordaje de la terapia conductual, el farmacéutico comunitario desarrolló una guía estructurada en 8 visitas y materiales de soporte para el paciente. El seguimiento de los pacientes se realizó en la farmacia comunitaria y el farmacéutico solo derivó a los pacientes a la consulta de atención primaria cuando aparecieron efectos adversos graves. Se recogió el historial de tabaquismo de los pacientes y sus comorbilidades, el tratamiento farmacológico recibido y sus efectos secundarios.Resultados: se incluyeron 26 pacientes. La puntuación media del test de Richmond fue de 8,31 (DE 1,54). La puntuación media del test de Fagerström fue de 5,73 (DE 2,10). La salud fue el principal motivo para dejar de fumar. Los pacientes recibieron vareniclina como tratamiento farmacológico para dejar de fumar, 21 pacientes (80,8 %) completaron las 12 semanas de tratamiento. Del total de la muestra, 18 pacientes (69,2 %) se mantuvieron sin fumar durante 3 meses. Los efectos secundarios observados más frecuentes fueron insomnio y diarrea. La terapia conductual llevada a cabo por el farmacéutico ayudó a mantener la adherencia al tratamiento farmacológico y la motivación durante el proceso de cesación tabáquica. (AU)

Variability in complications and operative mortality after radical cystectomy in Spain. / Variabilidad en las complicaciones y la mortalidad quirúrgica tras cistectomía radical en España.

BACKGROUND: In the literature, mortality for radical cystectomy (RC) varies between 2.3% and 7.5%. In Spain, there are no published general data on morbidity and mortality. OBJECTIVE: To identify the complications and mortality of RC in Spain through an analysis of all procedures performed over a 3-year period and to study the geographic variability of these results. MATERIAL AND METHODS: We identified patients who underwent RC in the Spanish National Health System between 2011 and 2013 based on the minimum basic data set. We analysed the complications and mortality during hospitalisation and at 30, 60 and 90 days. We compared these results in the various autonomous communities, adjusted them by age, Charlson score and sex and subsequently added the hospital size. RESULTS: We studied 7999 patients who underwent RC in 197 hospitals of the Spanish National Health System. The mean age of the series was 67.2±9.8 years. The median stay was 15 days (IQR, 11-24). Some 47.2% of the patients had complications. The mean mortality in-hospital and at 30, 60 and 90 days was 4.7, 2.9, 5 and 6.2%, respectively. There was considerable variability in the mortality at 90 days among the communities (3.8-9.1%). When adjusting by the patient and hospital characteristics, there were still significant geographic variations (3.8-11.5%). CONCLUSIONS: RC mortality in Spain at 90 days is similar to the rate in the literature. There are significant geographic variations unexplained by the characteristics of the patients or by those of the hospitals in which these operations were performed.

Influence of the location and number of metastases in the survival of metastatic prostatic cancer patients. / Influencia de la localización y del número de metástasis en la supervivencia de los pacientes con cáncer de próstata metastásico.

INTRODUCTION: The prognosis of patients diagnosed with metastatic prostate cancer seems to be modulated by factors such as the number and site of metastases. Our objective is to evaluate survival outcomes according to the number and site of metastases in our series of metastatic patients over the last 15 years. MATERIALS AND METHODS: A retrospective analysis was performed on patients diagnosed between 1998 and 2014. We analyzed overall survival and progression-free survival, depending on the number and location of metastases on patients with newly diagnosed metastatic prostate cancer. Other potential prognostic factors were also evaluated: age, clinical stage, PSA at diagnosis, Gleason, PSA nadir, time till PSA nadir and first-line or second-line treatment after progression. RESULTS: We analyzed a series of 162 patients. The mean age was 72.7yr (SD: 8.5). The estimated median overall survival was 3.9 yr (95% CI 2.6-5.2). The overall survival in patients with only lymph node metastases was 7 yr (95% CI 4.1-9.7), 3.9 (95%CI 2.3-5.5) in patients with only bone metastases, 2.5 yr (95% CI 2-2.3) in lymph nodes and bone metastases, and 2.2 yr (95% CI 1.4-3) in patients with visceral metastases (P<.001). In multivariate analysis, the location of metastasesis significantly associated with overall survival and progression-free survival. The number of metastases showed no association with survival. CONCLUSIONS: The site of metastases has a clear impact on both overall survival and progression-free survival. Patients with only lymph node involvement had a better prognosis. The number of metastases showed no significant impact on survival in our series.

The 67P/Churyumov-Gerasimenko observation campaign in support of the Rosetta mission.

We present a summary of the campaign of remote observations that supported the European Space Agency's Rosetta mission. Telescopes across the globe (and in space) followed comet 67P/Churyumov-Gerasimenko from before Rosetta's arrival until nearly the end of the mission in September 2016. These provided essential data for mission planning, large-scale context information for the coma and tails beyond the spacecraft and a way to directly compare 67P with other comets. The observations revealed 67P to be a relatively 'well-behaved' comet, typical of Jupiter family comets and with activity patterns that repeat from orbit to orbit. Comparison between this large collection of telescopic observations and the in situ results from Rosetta will allow us to better understand comet coma chemistry and structure. This work is just beginning as the mission ends-in this paper, we present a summary of the ground-based observations and early results, and point to many questions that will be addressed in future studies.This article is part of the themed issue 'Cometary science after Rosetta'.

Cohort study comparing prostate photovaporisation with XPS 180W and HPS 120W laser.

INTRODUCTION AND OBJECTIVE: Prostate photovaporisation with Greenlight laser for the surgical treatment of benign prostate hyperplasia has rapidly evolve to the new XPS 180W. We have previously demonstrated the safety and efficacy of the HPS 120W. The aim of this study was to assess the functional and safety results, with a year of follow-up, of photovaporisation using the XPS 180W laser compared with its predecessor. MATERIAL AND METHODS: A cohort study was conducted with a series of 191 consecutive patients who underwent photovaporisation between 1/2008 and 5/2013. The inclusion criteria were an international prostate symptom score (IPSS) >15 after medical failure, a prostate volume <80 cm(3) and a maximum flow <15 mL/s. We assessed preoperative and intraoperative variables (energy used, laser time and total surgical time), complications, catheter hours, length of stay and functional results (maximum flow, IPSS, prostate-specific antigen and prostate volume) at 3, 6 and 12 months. We analysed the homogeneity in preoperative characteristics of the 2 groups through univariate analysis techniques. The postoperative functional results were assessed through an analysis of variance of repeated measures with mixed models. RESULTS: A total of 109 (57.1%) procedures were performed using HPS 120W, and 82 (42.9%) were performed using XPS. There were no differences between the preoperative characteristics. We observed significant differences both in the surgical time and effective laser time in favour of the XPS system. This advantage was 11% (48 ± 15.7 vs. 53.8 ± 16.2, p<.05) and 9% (32.8 ± 11.7 vs. 36 ± 11.6, p<.05), respectively. There were no statistically significant differences in the rest of the analysed parameters. CONCLUSION: The technical improvements in the XPS 180W system help reduce surgical time, maintaining the safety and efficacy profile offered by the HPS 120W system, with completely superimposable results at 1 year of follow-up.

Diagnostic yield and complications of extended lymphadenectomy versus limited lymphadenectomy combined with radical prostatectomy.

BACKGROUND: Lymphadenectomy for prostate cancer (PC) is the most reliable procedure for detecting lymphatic metastases. The optimal extension of this procedure is still a topic of debate. OBJECTIVE: To analyse the diagnostic performance and complications of extended lymphadenectomy (ELD) and limited lymphadenectomy (LLD) in a series of patients with high-risk PC who underwent radical prostatectomy (RP). MATERIAL AND METHODS: A retrospective study was conducted on patients with high d'Amico risk who underwent RP with lymphadenectomy between 1999 and 2014. A comparative analysis was performed of the diagnostic capacity of lymphatic metastases of ELD and LLD and of postoperative complications at 90 days. RESULTS: Ninety-three patients were analysed, 20 (21.5%) and 73 (78.5%) of whom underwent ELD and LLD, respectively. The mean age of the series was 65.26 years (SD, 5.51). The median follow-up was 1.51 (0.61-2.29) years in the ELD group and 5.94 (3.61-9.10) in the LLD group. The median number of nodes obtained was 13 (9-23) in the ELD group compared with 5 (2-8) in the LLD group (p <.001). The percentages of patients with positive nodes in the ELD and LLD groups were 35% and 5.47%, respectively (p <.001). The overall complication rate at 90 days was 35.5% (33 patients). In the ELD group, 12 patients (60%) had complications, compared with 21 patients (28.8%) in the LLD group (p=.016), with no significant differences in severity according to the Clavien scale (p=.73). CONCLUSIONS: In our series, the detection of metastatic nodes was significantly greater with ELD. ELD increases the number of complications, with no differences compared with LLD in severity according to the modified Clavien scale.

Changes in Gleason score grading on serial follow-up biopsies in prostate cancer patients undergoing active surveillance.

INTRODUCTION: Active surveillance for prostate cancer has grown systematically in the recent years with more robust mid-term outcomes. However, changes in Gleason score during serial biopsies are not detailed in many of these reports. OBJECTIVES: To evaluate changes in Gleason score on follow-up biopsies in low-risk prostate cancer in patients undergoing AS program in our center. MATERIAL AND METHODS: Series of patients diagnosed of prostate cancer between 2004 and 2013 have been analyzed. The inclusion criteria were: PSA ≤ 10 ng/ml + Gleason ≤ 6 + T1c/T2a + ≤ 2 positive cores, and no more than 50% of affected core. The pathology of each of the biopsies was analyzed. RESULTS: We studied a series of 175 patients undergoing AS. Mean follow-up was 3.96 years (SD 2.4). Follow-up biopsies with Gleason scores ≥ 7 were: 5.72% in the first biopsy, 7.39% and 7.41% in subsequent biopsies. By contrast, in 42.03% of cases did not show evident tumor involvement in the first biopsy, 40.74% and 51.85% in the second and third biopsies respectively. Median stay in the AS program was: 90.99 months (95% CI: 53.53-128.46) in patients with first positive biopsy vs. 96.66 months (95% CI: 63.19-130.13) in those without evidence of tumor. CONCLUSIONS: In our series the pathological data of the first 3 biopsies remain stable in terms of the positive biopsy rate, Gleason score, or indication of active treatment proportions. Those patients who do not show evidence of malignancy in the first follow-up biopsy are less likely to need active treatment than the other patients in the series.

NPY receptors and opioidergic system are involved in NPY-induced feeding in goldfish.

The present study evaluated the effects of both intraperitoneal (i.p. ) and intracerebroventricular administration of selective Y(1) [(Leu(31), Pro(34))-NPY] and Y(2) [(Pro(13), Tyr(36))-NPY (13-36)] receptor agonists on food intake in satiated goldfish. Food intake (FI) was significantly increased by central administration of the Y(1) agonist (1 microg), but not by the Y(2) agonist, at 2 h postinjection. The feeding increase induced by (Leu(31), Pro(34))-NPY was in a similar magnitude to that obtained after ICV injection of the neuropeptide Y, and both feeding stimulations were reversed by the NPY (27-36), a general NPY antagonist. The i.p. administration of the agonists either did not significantly modify (Y(2) agonist) or decreased (Y(1) agonist) food intake in goldfish. These data indicate that it is the Y(1)-like (similar to Y(1) and/or Y(5)) receptor, and not Y(2), that is involved in the central modulation of the feeding behavior in goldfish. We also investigated the possible involvement of opioid peptides as mediators of the NPY stimulatory action on food intake in goldfish. The ICV administration of naloxone (10 microg), a general opioid antagonist, blocked the NPY-induced feeding in goldfish, suggesting that the opioidergic system is involved in feeding regulation by NPY.

Neuropeptide Y has a stimulatory action on feeding behavior in goldfish (Carassius auratus).

The purpose of the present study was to elucidate the possible role of neuropeptide Y (NPY) in the feeding regulation in fish. We examined the effects of intracerebroventricular (i.c.v.) or intraperitoneal (i.p.) neuropeptide Y administration on food intake in satiated goldfish, at different time intervals postinjection (0-2, 2-8 and 0-8 h). Food intake was significantly increased by i.c.v. administered neuropeptide Y (1 microg) at 2 h postinjection, while no significant differences in food intake were observed after i.p. treatment. The neuropeptide Y receptor antagonist, neuropeptide Y-(27-36), totally counteracted the stimulatory action of neuropeptide Y on feeding. The possible involvement of neuropeptide Y in the eating behavior evoked by food deprivation has been investigated. Food deprivation by either 24 or 72 h significantly increased feeding, and the neuropeptide Y receptor antagonist attenuated such feeding stimulation. From our findings, we suggest, first, that neuropeptide Y is involved in feeding central regulation in goldfish, acting via specific neuropeptide Y receptors, and second, that hypothalamic neuropeptide Y would be released in response to food deprivation, contributing to generate the consequent eating behavior stimulation in Carassius auratus.

[Gastric collision tumor with osseous metaplasia]. / Tumor de colisión gástrico con metaplasia osea.

Neuroendocrine cells are frequently found in gastric tumours, although they rarely make up more than one third of the total number of tumour cells. When juxtapositioning of the two kinds of tumour cells occurs a "collision tumour" is formed. These have been described to occur with varying frequency throughout the digestive tract. They are uncommon in the stomach. We describe a case, of a gastric collision tumour in which an adenocarcinoma coexisted with a carcinoide tumour and there were zones of bony metaplasia in the transition area between the two tumors. Positive CEA, VIP, beta-HCG and TSH on inmunohistochemical analysis was found.