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Resumen Contexto El desarrollo de protocolos ERAS (Enhanced Recovery After Surgery) en pacientes sometidos a cirugia mayor ha aportado beneficios perioperatorios en diversas disciplinas. En urologia, su principal aplicacion se centra en pacientes sometidos a cistectomia radical. Objetivo Revision sistematica de la literatura disponible de protocolos ERAS aplicados a pacientes intervenidos de cistectomia radical, tanto a nivel de resultados perioperatorios como en el analisis de su implementacion. Adquisicion de la evidencia Se realizo busqueda bibliografica en base de datos electronicas Pubmed, Embase, Cochrane y Scopus, utilizando los terminos «Cystectomy», «Enhanced Recovery After Surgery» y «Fast-Track». Se seleccionaron estudios aleatorizados y no aleatorizados que comparasen la implementacion de un protocolo ERAS en pacientes sometidos a cistectomia radical frente a un protocolo tradicional. Sintesis de la evidencia Se identificaron 869 articulos; 25 fueron seleccionados para el analisis final: 22 estudios no aleatorizados y 3 aleatorizados. No se detectaron diferencias en cuanto a caracteristicas demograficas entre los distintos estudios. Se identificaron diferencias estadisticamente significativas a favor del protocolo ERAS en tiempo de estancia hospitalaria, tasa de complicaciones mayores, tiempo a primera deambulacion y recuperacion intestinal. En el analisis de protocolos se detecto una alta variabilidad, tanto en numero de items como en metodo de implementacion. Conclusiones El caracter multidisciplinar y el numero de items de los protocolos ERAS conlleva una alta heterogeneidad en su implementacion. Se requieren mas estudios aleatorizados, estandarizacion a la hora de reportar y analizar resultados, asi como un analisis sistematico de la adherencia posterior para aumentar la comparabilidad entre grupos.

Context The development of ERAS (Enhanced Recovery After Surgery) protocols in patients undergoing major surgery has brought perioperative benefits in several disciplines. Its main application in urology is focused on patients undergoing radical cystectomy. Objective Systematic review of the available literature on ERAS protocols applied to patients undergoing radical cystectomy in terms of perioperative outcomes as well in the analysis of their implementation. Evidence acquisition A bibliographic search was conducted in the electronic databases PubMed, Embase, Cochrane and Scopus, using the terms ≪Cystectomy>>, ≪Enhanced Recovery After Surgery>> and ≪Fast-Track>>. Randomized and non-randomized studies that compared the implementation of an ERAS protocol versus a traditional protocol in patients undergoing radical cystectomy were selected. Evidence synthesis 869 articles were identified; 25 were selected for final analysis: 22 non-randomized and 3 randomized studies. No differences were observed in terms of demographic characteristics between studies. Statistically significant differences were identified in favor of the ERAS protocol: length of hospital stay, major complication rate, time to first ambulation and return of bowel function. In the analysis of protocols, a high variability was detected in the number of items and in the implementation method. Conclusions The multidisciplinary nature and the number of items of the ERAS protocols imply a high heterogeneity in their implementation. Further randomized studies, standardized reporting and analyzing results, as well as a systematic analysis of subsequent adherence are required to increase comparability between groups.

It is currently unknown whether the relationship between affluence of school neighbourhoods and prevalence of youth overweight/obesity is uniform across demographic subgroups and areal context in the United States.We examined association between school-neighbourhood income tertiles and school-level overweight/obesity (OVOB) prevalence, using data on body mass index of fifth, seventh, and nineth graders who attended public schools in California in 2001 and 2010 (n = 1 584 768), using multiple logistic regression models.Overall, OVOB prevalence was higher in lower-income school neighbourhoods, with a steeper income-OVOB gradient for girls. Among boys, the gradient became steeper in 2010 than 2000. Among Asian and White girls, the negative gradients were steepest in rural areas. For African-American students in all areas and Latino boys in rural areas, there was less clear evidence of inverse income-OVOB gradients. Addition of fast-food restaurant availability to the models did not change the observed inverse school-neighbourhood income-obesity gradients.The findings suggest the needs to investigate reasons for this variability with consideration to combinations of sociodemographic, economic, and environmental risk factors that may contribute to disparities in childhood obesity.

The original strategy applied by Langevin to Brownian movement problem is used to solve the case of a free particle under a harmonic potential. Such straightforward strategy consists in separating the noise termin the Langevin equation in order to solve a deterministic equation associated with the Mean Square Displacement (MSD). In this work, to achieve our goal we first calculate the variance for the stochastic harmonic oscillator and then the MSD appears immediately. We study the problem in the damped and lightly damped cases and show that, for times greater than the relaxation time, Langevin's original strategy is quite consistent with the exact theoretical solutions reported by Chandrasekhar and Lemons, these latter obtained using the statistical properties of a Gaussian white noise. Our results for the MSDs are compared with the exact theoretical solutions as well as with the numerical simulation.

Background: The postpartum period may be a vulnerable life stage for a woman's cardiometabolic health. We examined associations of exposure to common endocrine-disrupting chemicals (EDCs) during pregnancy with weight from delivery through 1 year postpartum among 199 women in Mexico City. Materials and Methods: During each trimester of pregnancy, we collected a urine sample to assay bisphenol A (BPA), mono-n-butyl phthalate (MnBP), mono-isobutyl phthalate (MiBP), monobenzyl phthalate (MBzP), mono-3-carboxypropyl phthalate (MCPP), mono-2-ethyl-5-carboxypentyl phthalate (MECPP), mono-2-ethyl-5-hydroxyhexyl phthalate (MEHHP), mono-2-ethylhexyl phthalate (MEHP), mono-2-ethyl-5-oxohexyl phthalate (MEOHP), and monoethyl phthalate (MEP). We calculated summary scores for di-2-ethylhexyl phthalate metabolites (ΣDEHP) and dibutyl phthalate metabolites (ΣDBP). We calculated the geometric mean of each EDC across pregnancy for use in the analysis. At delivery and three additional times during the first year postpartum, we measured the women's weight. We used mixed-effects linear regression models to estimate associations of each EDC with weight at delivery (kg) and weight change (kg/year) from delivery through 1 year postpartum. Covariates included urinary specific gravity, maternal age, parity, height, first trimester body mass index, and gestational age at enrollment. Results: Mean ± standard deviation weight change during the first postpartum year was −0.49 ± 4.04 kg. The EDCs were inversely associated with weight at delivery, but positively associated with weight change through 1 year postpartum. For example, each interquartile range of urinary ΣDEHP corresponded with 1.38 (95% confidence interval: 0.44–2.33) kg lower weight at delivery and 1.01 (0.41––1.61) kg/year slower rate of weight loss. We observed similar associations for other EDCs. Conclusions: Prenatal exposure to EDCs is associated with lower weight at delivery, but slower rate of weight loss through the first postpartum year.

INTRODUCTION: Endometriosis is a chronic inflammatory gynecologic disease affecting 5–10% of women of reproductive age of all ethnicities. Symptoms of this painful condition impact the physical, mental health, and quality of life of patients. Stigma is a social determinant of health documented to negatively impact people living with chronic conditions and have been associated with social exclusion, high levels of stress, and interference with medical care. The purpose of this study was to document stigma experiences among Latina women living with endometriosis. METHODS: A qualitative design using focus groups was implemented. Thematic analysis was conducted for data interpretation. A total of 50 women participated in five focus groups. RESULTS: The main theme “changuería” emerged as a label applied across multiple contexts and interactions in the lives of participants, suggesting that stigmatization is an ever-present barrier among women living with endometriosis. Participants reported that relatives, partners and health professionals perceive pain during menstruation as something women should be able to manage, producing a sense of inability to disclose the extent of suffering. CONCLUSION: These results highlight the importance of addressing stigma as a way to foster healthcare seeking and minimize its impact on physical, mental health, and wellbeing.

Objective To assess the diagnostic capability of PET/CT with [18F]F-Fluoromethylcholine in prostate cancer (PC) with biochemical recurrence and its therapeutic impact. Material and methods We included 108 patients, diagnosed with PC with biochemical criteria for recurrence. A PET/CT choline scan was performed by dynamic pelvic and whole body study at 60 min post-tracer injection. The relationship between the positive studies and the PSA value was analysed by classifying patients into three groups ( 2 ng/ml), and the diagnostic capacity was assessed with respect to pelvic MRI and the impact on the therapeutic decision. Results The location of recurrence was identified in 85 of 108 patients (78.7%): 34 local, 47 pelvic lymph nodes and 58 distant lesions, including retroperitoneal, mediastinal lymph nodes and distant organ lesions (bone and lung). Second tumors were diagnosed in 4 patients. No significant differences were found in the percentage of positive studies depending on primary treatment. Patients with PSA > 2 ng/ml showed a higher percentage of disease detection than patients with a lower PSA level, with significant differences (p Conclusions PET/CT with [18F]F-Fluoromethylcholine is a useful tool in the detection of locoregional and disseminated disease of PC treated with suspicion of recurrence, providing a change in therapeutic management in 62% of patients.

Resumen Objetivo Describir las medidas adoptadas dentro del plan de contingencia del COVID-19 respecto a la biopsia selectiva de ganglio centinela (BSGC) y analizar su impacto sobre la actividad asistencial. Metodologia Estudio cualitativo, descriptivo y retrospectivo de BSGC realizadas durante el periodo del 14/03 al 11/05 de 2020. Analisis de las medidas tomadas para minimizar las probabilidades de contagio y resultados de PCR de pacientes y personal. Comparativa de casos con los realizados en el mismo periodo de 2019. Actividad diaria de linfogammagrafia y de cirugia radioguiada (CRG) por indicacion medica. Calculo numerico y porcentual de CRG por hospital y recursos humanos diarios de medicina nuclear requeridos. Resultados Se realizaron 42 intervenciones con BSGC, un 31,1% menos que en 2019. La indicacion medica de cancer de mama experimento el mayor descenso de actividad (n = 18, 41,9%). Del total de CRG, Hospital Clinic realizo el 45,2%, Hospital Maternitat el 31,0%, Hospital Plato el 16,7% y Hospital Sant Joan de Deu el 7,1% restante. En relacion con los recursos humanos, la planificacion inicial se cumplio en un 77% de los dias. El total de los controles PCR a pacientes (n = 42) y personal de CRG (n = 9) dio resultado negativo. Conclusiones El COVID-19 influyo negativamente en la actividad asistencial de la BSGC del Hospital Clinic, pero fue compensado por una planificacion acertada, basada en el analisis previo de los procesos del procedimiento, que permitio adaptar los recursos de material y personal a las circunstancias cambiantes, otorgandole una flexibilidad que posibilito el cumplimiento de la programacion establecida.