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Introduction: Adequate treatment of acute postoperative pain is one of the quality requirements in ambulatory surgery and its suboptimal management is associated with delayed discharge, unplanned admissions and late admissions after home discharge. The aim of the present study was to learn about the organizational strategy for the management of postoperative pain in ambulatory surgery units (ASU) in Spain., Methods: A cross-sectional, multicenter study was carried out based on an electronic survey on aspects related to the management of acute postoperative pain in different ASUs in our country., Results: We recruited 133 ASUs of which 85 responded to the questions on the management of postoperative pain. Of the ASUs that responded, 80% had specific protocols for pain management and 37.6% provided preoperative information on the analgesic plan. The assessment of postoperative pain is carried out in 88.2% of the ASUs in the facility and only 56.5% at home. All ASUs use multimodal analgesia protocols; however, 68.2% report the use of opioids for the treatment of moderate to severe pain. Home invasive analgesia strategies are minimally used by the surveyed ASUs., Conclusions: The DUCMA study highlights that the practice of pain treatment in day surgery remains a challenge in our country and is not always in agreement with national guidelines. The results suggest the need to establish strategies to improve clinical practice and homogenize pain management in ambulatory surgery., (Copyright © 2024 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Birds and ants co-occur in most terrestrial ecosystems and engage in a range of interactions. Competition, mutualism and predation are prominent examples of these interactions, but there are possibly many others that remain to be identified and characterized. This study provides quantitative estimates of the frequency of toe amputations resulting from ant bites in a population of migratory red-necked nightjars ( Caprimulgus ruficollis ) monitored for 15 years (2009-2023) in S Spain, and identifies the attacker(s) based on taxonomic analyses of ant-mandible remains found on injured toes. Less than 1% of examined adults ( N  = 369) missed one or more toes. The analysis of ant remains identified African army ants ( Dorylus sp.) as the primary cause of toe amputations in nightjars and revealed that body parts of the attacker may remain attached to the birds even after intercontinental migration. No cases of severe damage were observed in juveniles ( N  = 269), apart from the mandible of a Messor barbarus - a local ant species - attached to one of the teeth of the characteristic comb of the medial toe of nightjars. The incidence of ant-bite damage may appear unimportant for nightjar populations, but this might not be true if only birds that manage to survive their injuries and potential complications (e.g. severe bleeding and sepsis from opportunistic infections) return from the tropics. More field studies, ideally in tropical areas, that incorporate routine examination of ant-induced injuries into their protocols are needed to understand the true incidence and eco-evolutionary implications of antagonistic ant-bird interactions., Competing Interests: The authors declare that there are no conflicts of interest related to this study., (© 2024 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.)

Wildfires play a determinant role in the composition and structure of animal communities, especially for groups closely associated with the vegetation and soil, such as bees or ants. The effects of fire on animal communities depend on the functional traits of each group. Here, we assessed the impacts of fire and time since fire on the taxonomic and functional responses of ant and bee communities. We sampled 35 pine forests in Andalusia (southern Spain) that had experienced fire in the past (0 to 41 years ago). Specifically, we explored whether a) fire increased taxonomic and functional diversity and changed community composition in communities in the short term and b) fire influence (increase or decrease) on ant communities would be dependent on time since fire. We found that ant and bee taxonomic richness increased regardless of time since fire. Different approaches gave the same result, such as taxonomic diversity indexes (ant abundance, ant richness and ant Shannon diversity index), the changes in species richness in ant and bee communities, as well as the higher number of ant and bee species prone to the burned habitat than to the unburned habitat, using the I habitat Index. Besides environmental variables (such as the effects of different Pinus species or elevation), time since fire changed the taxonomic composition of ant communities and the functional composition of bee communities. Moreover, six of the 13 ant functional traits explored differed between burned and unburned areas, with the degree of difference declining as time since fire increased. For example, burned areas contained ant communities with more ground-nesting species and strictly diurnal species, functional traits that are characteristic of open areas. In contrast, other traits persisted in burned areas over the long term, notably a higher degree of worker polymorphism and species monogyny. Our study shows how much short- and long-term effects of fire on ant and bee communities differ; while richness increases in the long-term, some functional traits are also filtered in the short-term. We suggest that fire in Mediterranean coniferous ecosystems could have a positive effect on these groups and should not be overlooked., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: Kidney procurement procedure must be carried out following a standardized technique in order to optimize kidney grafts for their subsequent implantation., Objectives: Review of the available literature on kidney procurement procedure., Material and Methods: Narrative review of the available evidence on deceased donor kidney procurement technique after a search of relevant manuscripts indexed in PubMed, EMBASE and Scielo written in English and Spanish., Results: Deceased donor kidney procurement can be divided into two groups, donation after brain death (DBD) and donation after circulatory death (DCD). Kidney procurement in DBD frequently includes other chest and/or abdominal organs, requiring multidisciplinary surgical coordination. During the harvesting procedure, the renal vascular pedicle must remain intact for subsequent implantation and reduced ischemia time., Conclusions: Adequate execution and perfect knowledge of the technique for surgical removal and anatomy reduces the rate of graft losses associated to inadequate harvesting techniques., (Copyright © 2022 AEU. Published by Elsevier España, S.L.U. All rights reserved.)

Porcine reproductive and respiratory syndrome virus (PRRSV) causes significant economic losses to the swine industry worldwide. Little is known regarding the epidemiology of this infection in tropical countries. To address this problem in Costa Rica, a seroepidemiological study was carried out in two phases. In the first phase, a pilot study was conducted in nine farms with the clinical diagnosis of PRRSV. In total, 265 pig serum samples were collected from animals ranging in age from 1 to 15 weeks of age. This study aimed to establish the duration of maternal immunity in piglets, to identify the period of viremia, and to determine when seroconversion occurs. In the second phase, a cross-sectional serology study was performed on a representative sample of the Costa Rican national herds in the second phase. The twenty-five selected farms represent all provinces and were classified according to herd size (100 to 2000 sows). In each farm, pigs aged 8, 10, and 12 weeks were sampled, as well as gilts based on the pilot study. In total 1281 pigs were sampled across all 25 farms. The aim of the cross-sectional study was to quantify the seroprevalence of PRRSV in Costa Rican pig farms and to describe its geographical distribution in this tropical country. The prevalence of positive farms was 44% (11/25), and these farms were located in six of the seven provinces of Costa Rica. Overall, 58% (344/596) of the pigs were seropositive to PRRSV. The age of the pigs and the ecozone where farms were located were significantly related with PRRSV seroprevalence in animals and herds, respectively., (© 2021. The Author(s).)

In Latin American and Caribbean countries, the main concern of public health care managers has been traditionally placed on problems related to funding, payment mechanisms, and equity of access. However, more recently, there is a growing interest in improving the levels of efficiency and reducing costs in the provision of health services. In this paper we focus on measuring the technical efficiency and productivity change of public hospitals in Panama using bootstrapped Malmquist indices, which allows us to assess the statistical significance of changes in productivity, efficiency, and technology. Specifically, we are interested in comparing the performance of hospitals belonging to the two different management schemes coexisting in the country, the Social Security Fund (SSF) and the Ministry of Health (MoH). Our dataset includes data about 22 public hospitals (11 for each model) during the period between 2005 and 2015. The results showed that the productivity growth of hospitals belonging to the SSF has been much higher than that of the hospitals belonging to the Ministry of Health over the evaluated period (almost 4% compared to 1.5%, respectively). The main explanation for these divergences is the superior growth of technological change in the former hospitals, especially in the final years of the evaluated period.

The use of three-dimensional (3D) printing for biomedical applications has expanded exponentially in recent years. However, the current portfolio of 3D printable inks is still limited. For instance, only few protein matrices have been explored as printing/bioprinting materials. Here, we introduce the use of zein, the primary constitutive protein in maize seeds, as a 3D printable material. Zein-based inks were prepared by dissolving commercial zein powder in ethanol with or without polyethylene glycol (PEG400) as a plasticizer. The rheological characteristics of our materials, studied during 21 days of aging/maturation, showed an increase in the apparent viscosity as a function of time in all formulations. The addition of PEG400 decreased the apparent viscosity. Inks with and without PEG400 and at different maturation times were tested for printability in a BioX bioprinter. We optimized the 3D printing parameters for each ink formulation in terms of extrusion pressure and linear printing velocity. Higher fidelity structures were obtained with inks that had maturation times of 10 to 14 days. We present different proof-of-concept experiments to demonstrate the versatility of the engineered zein inks for diverse biomedical applications. These include printing of complex and/or free-standing 3D structures, tablets for controlled drug release, and scaffolds for cell culture.

Introduction: Pelvic kidney is a rare congenital anomaly. The ectopic kidney is more susceptible to developing lithiasis. The management of this type of lithiasis is a challenge. The objective of this paper was to conduct a review of available literature on the treatment of stone in ectopic kidney., Material and Methods: Description of a case of transperitoneal laparoscopic pyelolithotomy for the treatment of inferior calyceal lithiasis in a right pelvic kidney. A literature review was performed by using Pubmed. The following terms and combination terms were searched: "pelvic ectopic kidney", "ureterorenoscopy", "extracorporeal lithotripsy", "PCNL", "pyelolithotomy". We incluyed original articles, meta-analysis, review and case reports., Results: 130 articles were excluded by title or duplication. 62 abstracts articles and them 50 full text articles were evaluated. Stone free rate were 75% (SLW), 85% (URSf), 85%-90% (PCNL) and 100% (laparoscopic pyelolithotomy). The literature on treatment on pelvic kidney is poor., Conclusion: Factors such stone size, density and location, and upper urinary tract abnormalities, influence the choice of therapeutic approach (retrograde, percutaneous and/or laparoscopic/robotic). Laparoscopic pyelolithotomy is a safe and minimally invasive treatment option for large kidney stones with unfavorable anatomy for the endoscopic approach., (Copyright © 2021 AEU. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Worldwide, Porcine Reproductive and Respiratory Syndrome (PRRS) is among the diseases that cause the highest economic impact in modern pig production. PRRS was first detected in Costa Rica in 1996 and has since then severely affected the local swine industry. Studies of the molecular characterization of circulating strains, correlation with clinical records, and associations with pathogens associated with Porcine Respiratory Disease Complex (PRDC) have not been done in Costa Rica., Results: Sequencing and phylogenetic analysis of ORF5 proved that PRRSV-2 was the only species detected in all locations analyzed. These sequences were grouped into three clusters. When comparing samples from San Jose, Alejuela, and Puntarenas to historical isolates of the previously described lineages (1 to 9), it has been shown that these were closely related to each other and belonged to Lineage 5, along with the samples from Heredia. Intriguingly, samples from Cartago clustered in a separate clade, phylogenetically related to Lineage 1. Epitope analysis conducted on the GP5 sequence of field isolates from Costa Rica revealed seven peptides with at least 80% amino acid sequence identity with previously described and experimentally validated immunogenic regions. Previously described epitopes A, B, and C, were detected in the Santa Barbara-Heredia isolate., Conclusions: Our data suggest that the virus has three distinct origins or introductions to the country. Future studies will elucidate how recently introduced vaccines will shape the evolutionary change of circulating field strains.

The present report was designed to determine the antioxidant and antigenotoxic effects of phaseolin (isolated from Phaseolus vulgaris ) against mouse colon and liver damage induced by azoxymethane (AOM) and its colon chemopreventive effect. Eight groups with 12 mice each were utilized for an eight-week experiment: the control group was intragastrically (ig) administered 0.9% saline solution; the positive control group was intraperitoneally (ip) injected with 7.5 mg/kg AOM twice a week (weeks three and four of the experiment); three groups were ig administered each day with phaseolin (40, 200, and 400 mg/kg); and three groups were ig administered phaseolin daily (40, 200, and 400 mg/kg) plus 7.5 mg/kg AOM twice a week in weeks three and four of the experiment. The results showed that phaseolin did not produce oxidative stress, DNA damage, or aberrant crypts; in contrast, 100% inhibition of lipoperoxidation, protein oxidation, and nitrites induction generated by AOM was found in both organs, and DPPH radical capture occurred. The two highest phaseolin doses reduced DNA damage induced by AOM in both organs by more than 90% and reduced the AOM-induced aberrant crypts by 84%. Therefore, our study demonstrated the strong in vivo antioxidant, antigenotoxic, and chemopreventive potential of phaseolin.

Health risks due to NO 2 exposure commonly exceed acceptable levels in modern societies. Among the measures to reduce such risks, photocatalytic materials present a promising technology. However, while the pollutant remediation of such materials has been extensively validated in laboratory studies, the performance under real world environmental exposure conditions is still subject to controversy. Indeed, a comparison of available in-situ monitoring studies manifests non-conclusive and highly scattered results regarding the photocatalytic effectiveness observed. The reasons for this behaviour must be carefully explored in order to prevent non-efficient photocatalytic applications from being put into practice on a larger scale. This paper presents a comprehensive large-scale study for assessing the photocatalytic NO 2 remediation by active pavements in a street of Madrid (Spain), comprising different in-situ monitoring techniques. The discussion is enriched by relating the obtained results to those of other large-scale studies. The discrepancies between these results may be traced back to different circumstances, among them the distance between the active pavement and the pollutant concentration sampling inlet, as well as to significant site-specific and time-dependent variations of pollutant concentrations and climatic parameters. Under due consideration of these influences, for materials with relatively high initial effectiveness, it was concluded that in most such applications, the average NO 2 removal effectiveness, if evaluated at a typical inlet height of Air Quality Stations (3 m), will not exceed a value of 4% (averaged over a sufficiently large number of measurement points in the area of application and a sustained amount of time, i.e. several months). When considering more realistic human exposure conditions (lower heights and daytime), it might be justified to assume somewhat higher average effectiveness., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Air pollution in large cities produces numerous diseases and even millions of deaths annually according to the World Health Organization. Pollen exposure is related to allergic diseases, which makes its prediction a valuable tool to assess the risk level to aeroallergens. However, airborne pollen concentrations are difficult to predict due to the inherent complexity of the relationships among both biotic and environmental variables. In this work, a stochastic approach based on supervised machine learning algorithms was performed to forecast the daily Olea pollen concentrations in the Community of Madrid, central Spain, from 1993 to 2018. Firstly, individual Light Gradient Boosting Machine (LightGBM) and artificial neural network (ANN) models were applied to predict the day of the year (DOY) when the peak of the pollen season occurs, resulting the estimated average peak date 149.1 ± 9.3 and 150.1 ± 10.8 DOY for LightGBM and ANN, respectively, close to the observed value (148.8 ± 9.8). Secondly, the daily pollen concentrations during the entire pollen season have been calculated using an ensemble of two-step GAM followed by LightGBM and ANN. The results of the prediction of daily pollen concentrations showed a coefficient of determination (r 2 ) above 0.75 (goodness of the model following cross-validation). The predictors included in the ensemble models were meteorological variables, phenological metrics, specific site-characteristics, and preceding pollen concentrations. The models are state-of-the-art in machine learning and their potential has been shown to be used and deployed to understand and to predict the pollen risk levels during the main olive pollen season.

The limited evidence available suggests that the interaction between chemical pollutants and biological particles may intensify respiratory diseases caused by air pollution in urban areas. Unlike air pollutants, which are routinely measured, records of biotic component are scarce. While pollen concentrations are daily surveyed in most cities, data related to airborne bacteria or fungi are not usually available. This work presents the first effort to understand atmospheric pollution integrating both biotic and abiotic agents, trying to identify relationships among the Proteobacteria, Actinobacteria and Ascomycota phyla with palynological, meteorological and air quality variables using all biological historical records available in the Madrid Greater Region. The tools employed involve statistical hypothesis contrast tests such as Kruskal-Wallis and machine learning algorithms. A cluster analysis was performed to analyse which abiotic variables were able to separate the biotic variables into groups. Significant relationships were found for temperature and relative humidity. In addition, the relative abundance of the biological phyla studied was affected by PM 10 and O 3 ambient concentration. Preliminary Generalized Additive Models (GAMs) to predict the biotic relative abundances based on these atmospheric variables were developed. The results (r = 0.70) were acceptable taking into account the scarcity of the available data. These models can be used as an indication of the biotic composition when no measurements are available. They are also a good starting point to continue working in the development of more accurate models and to investigate causal relationships., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Photocatalytic technology implemented in construction materials is a promising solution to contribute to alleviate air quality issues found in big cities. Photocatalysis has been proved able to mineralise most harmful contaminants. However, important problems associated with monitoring the efficiency of these solutions under real conditions still remain, including the lack of affordable analytical tools to measure NO x concentrations with enough accuracy. In this work, two pilot scale demonstration platforms were built at two different locations to assess the photocatalytic NO X removal efficiency of ten selected materials exposed outdoors for AQmesh low-cost sensor PODs were used to measure ground-level to measure NO and NO 2 concentrations during nearly one year. The pollutant removal efficiency of the materials was then calculated based on a comparison with simultaneously concentration measurements carried-out on reference, non-active materials. It was found that the NO 2 removal efficiency presented large variations across the seasons, with maxima during the warmer months, while NO efficiencies were comparatively steadier. Statistical analysis delivered evidence that the efficiencies significantly depend on different meteorological variables (irradiance and relative humidity) besides NO, NO 2 ambient concentrations. Lower efficiencies were observed for higher concentration levels and vice versa. The influence of water vapour could be related to two different effects: a short-term contribution by the instantaneous air humidity and a long-term component associated with the hygroscopic state of the material. The contribution of wind to the pollutant removal efficiencies was principally related to the humidity of air masses moving above the location and to the advection of pollutants from specific emission sources., Competing Interests: Declaration of competing interest, (Copyright © 2020 Elsevier B.V. All rights reserved.)

Introduction: Radical cystectomy (RC) with pelvic lymphadenectomy is the treatment of choice in patients with muscle invasive bladder cancer (MIBC)., Objective: To identify clinical and pathological variables that influence global mortality (GM) and cancer specific mortality (CSM) in patients with urothelial bladder tumor (UBT) treated with RC. METHODS: Retrospective analysis of 517 patients diagnosed with UBT and treated with RC between 1986 and 2009. Demographic, clinical, surgical and pathological variables, as well as complications and evolution after RC were collected. A comparative analysis was carried out with Chi square and ANOVA test. Survival analysis was performed with the Kaplan-Meier method and the long-rank test. Univariate and multivariate analysis were performed using Cox regression to identify independent predictors of GM and CSM. RESULTS: 91% of the patients were males with a median age of 66 years. The most frequent local pathological stage was pT3 (32.6%), with lymph node involvement in 23.8% of the patients. After a median follow-up of 34 months, 170 patients were alive and 311 had died from any cause (63.5%), being UBT the cause of death in 225 patients (45%). Rates of global survival and cancer specific survival at 5 and 10 years were 45%/34.3% and 52.5%/46.6% respectively. On the multivariate analysis age ( p = 0.004), ASA ( p = 0.000), the existence of hydronephrosis ( p = 0.01), pT ( p = 0.000) and pN ( p = 0.003) were identified as independent predictors of GM, as well as pT ( p = 0.000) and pN ( p = 0.002) for CSM. CONCLUSIONS: Age, anesthetic risk, presence of hydronephrosis, pT and pN stage were identified as independent predictors of GM, as well as pT and pN stage for CSM.

We present a novel ligand, 5-norbornene-2-nonanoic acid, which can be directly added during established quantum dot (QD) syntheses in organic solvents to generate "clickable" QDs at a few hundred nmol scale. This ligand has a carboxyl group at one terminus to bind to the surface of QDs and a norbornene group at the opposite end that enables straightforward phase transfer of QDs into aqueous solutions via efficient norbornene/tetrazine click chemistry. Our ligand system removes the traditional ligand-exchange step and can produce water-soluble QDs with a high quantum yield and a small hydrodynamic diameter of approximately 12 nm at an order of magnitude higher scale than previous methods. We demonstrate the effectiveness of our approach by incubating azido-functionalized CdSe/CdS QDs with 4T1 cancer cells that are metabolically labeled with a dibenzocyclooctyne-bearing unnatural sugar. The QDs exhibit high targeting efficiency and minimal nonspecific binding., (© 2018 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Enhancing photoluminescent emission (PL) in the near-infrared-infrared (NIR-IR) spectral region has broad applications from solar energy conversion to biological imaging. We show that self-assembled molecular dye J-aggregates (light-harvesting nanotubes, LHNs) can increase the PL emission of NIR PbS quantum dots (QDs) in both liquid and solid media more than 8-fold, promoted primarily by a long-range antenna effect and efficient Förster resonance energy transfer (FRET) from donor to acceptor. To create this composite material and preserve the optical properties of the nanocrystals, we performed an in situ ligand substitution followed by a functionalization reaction using click-chemistry. This resulted in PbS QDs soluble in an aqueous environment compatible with the molecular J-aggregates (LHNs). Theoretical and experimental results demonstrate that long-range diffusive exciton transport in LHNs enables efficient energy transfer to low concentrations of QDs despite there being no direct binding between molecular donors and QD acceptors. This suggests a broad application space for mixed light harvesting and photophysically active nanocomposite materials based on self-assembling molecular aggregates.

The use of visible/NIR-emitting gold nanoclusters (Au NCs), previously proposed for in vivo imaging, has been limited to some extent by low quantum yields (QYs) and the limited penetration of visible light in tissue. Here we report short wavelength infrared (SWIR, λ = 1-2 μm) emitting Au NCs with a good photoluminescence QY for this wavelength range (0.6% to 3.8% for λ em = 1000 to 900 nm) and excellent stability under physiological conditions. We show that surface ligand chemistry is critical to achieving these properties. We demonstrate the potential of these SWIR-emitting Au NCs for in vivo imaging in mice. The Au NCs have a hydrodynamic diameter that is small (∼5 nm) enough that they exhibit a rapid renal clearance, and images taken in the SWIR region show better resolution of the blood vessels than in the NIR region.

Medical imaging is routine in the diagnosis and staging of a wide range of medical conditions. In particular, magnetic resonance imaging (MRI) is critical for visualizing soft tissue and organs, with over 60 million MRI procedures performed each year worldwide. About one-third of these procedures are contrast-enhanced MRI, and gadolinium-based contrast agents (GBCAs) are the mainstream MRI contrast agents used in the clinic. GBCAs have shown efficacy and are safe to use with most patients; however, some GBCAs have a small risk of adverse effects, including nephrogenic systemic fibrosis (NSF), the untreatable condition recently linked to gadolinium (Gd) exposure during MRI with contrast. In addition, Gd deposition in the human brain has been reported following contrast, and this is now under investigation by the US Food and Drug Administration (FDA). To address a perceived need for a Gd-free contrast agent with pharmacokinetic and imaging properties comparable to GBCAs, we have designed and developed zwitterion-coated exceedingly small superparamagnetic iron oxide nanoparticles (ZES-SPIONs) consisting of ∼3-nm inorganic cores and ∼1-nm ultrathin hydrophilic shell. These ZES-SPIONs are free of Gd and show a high T 1 contrast power. We demonstrate the potential of ZES-SPIONs in preclinical MRI and magnetic resonance angiography.

Objective: To evaluate the technical efficiency of primary care units operating in the Basque Health Service during the period 2010-2013, corresponding to the implementation of a care integration strategy by health authorities., Methods: This study included 11 of the 12 primary care units in the Basque Health Service during the period 2010-2013. Data envelopment analysis (DEA) was used to assess the technical efficiency of the units. In particular, we applied the extension DEA windows to analyse all units as if they were in a single period (33 observations) as well as a conditional model, which allowed incorporation of the effect of the characteristics of the population covered. The outputs considered were a quality index based on fulfilment of different requirements related to primary care delivery and the rate of avoidable hospitalizations (treated as an undesirable output). The inputs used were the number of physicians, the number of nurses and the costs of prescriptions. The morbidity index was included as an exogenous variable., Results: The results showed that the efficiency of all the units improved during the study period. However, this improvement was not greater in the units incorporated in the integrated healthcare organisation., Discussion: In a context of global transformation of care delivery in the Basque country in the study period, primary care units increased their efficiency. However, this effect was not larger in vertically integrated primary care providers., (Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.)

The optimization of photoluminescence spectral linewidths in semiconductor nanocrystal preparations involves minimizing both the homogeneous and inhomogeneous contributions to the ensemble spectrum. Although the inhomogeneous contribution can be controlled by eliminating interparticle inhomogeneities, far less is known about how to synthetically control the homogeneous, or single-nanocrystal, spectral linewidth. Here, we use solution photon-correlation Fourier spectroscopy (S-PCFS) to measure how the sample-averaged single-nanocrystal emission linewidth of CdSe core and core/shell nanocrystals change with systematic changes in the size of the cores and the thickness and composition of the shells. We find that the single-nanocrystal linewidth at room temperature is heavily influenced by the nature of the CdSe surface and the epitaxial shell, which have a profound impact on the internal electric fields that affect exciton-phonon coupling. Our results explain the wide variations, both experimental and theoretical, in the magnitude and size dependence in previous reports on exciton-phonon coupling in CdSe nanocrystals. Moreover, our findings offer a general pathway for achieving the narrow spectral linewidths required for many applications of nanocrystals.

Chemical oxidation of under-charged Pb atoms reduces the density of trap states by a factor of 40 in films of colloidal PbS quantum dots for devices. These emissive sub-bandgap states are a byproduct of several standard ligand-exchange procedures. X-ray photoelectron spectro-scopy measurements and density function theory simulations demonstrate that they are associated with under-charged Pb., (© 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Objective: The main objective of this study is to determine whether gender affects global mortality and functional outcome after severe traumatic brain injury (TBI)., Methods: This retrospective cohort study included 629 patients with severe TBI (14.9% female) admitted to the ICU of a university hospital. Patients were split into gender groups to study potential differences in global mortality and functional outcome at ICU discharge and 6 months post-trauma using the GOS. The following variables were analysed: age, intracranial injury, injury mechanism, injury severity, factors contributing to secondary brain injury, monitoring level, treatment, complications, length of stay in the ICU and cause of death., Results: No differences were found between gender groups in neuromonitoring level or surgical procedures. Women had higher APACHE II scores, a higher incidence of pre-hospital hypotension, anaemia and transfusion and higher mortality rates in the ICU (OR = 1.74; 95% CI = 1.09-2.77) and 6 months post-trauma (OR = 1.65; 95% CI = 1.02-2.67). There were no significant differences in functional outcome at ICU discharge or 6 months post-injury. The multivariate analysis did not show gender as an independent predictive factor in mortality after severe TBI., Conclusion: In this study, gender was not found to be an independent predictor for poorer outcome after severe TBI.

Radioguided surgery can be a useful technique in the localization of neuroendocrine tumors. It detects more and smaller lesions compared to pre-surgical imaging and intraoperative digital palpation by the surgeon. It detects residual lesions and also indicates the shortest access route to the lesion. Nevertheless, its use has not become widespread because of technical difficulties. There is a limited number of published series, a lack of standardized protocol because of the great variability regarding type of radiopharmaceutical, dose of radiotracer, timing between injection and surgery. In this paper, we review these issues, describing the experience of different authors in diverse tumors., (Copyright © 2014 Elsevier España, S.L.U. and SEMNIM. All rights reserved.)

Magneto-fluorescent particles have been recognized as an emerging class of materials that exhibit great potential in advanced applications. However, synthesizing such magneto-fluorescent nanomaterials that simultaneously exhibit uniform and tunable sizes, high magnetic content loading, maximized fluorophore coverage at the surface and a versatile surface functionality has proven challenging. Here we report a simple approach for co-assembling magnetic nanoparticles with fluorescent quantum dots to form colloidal magneto-fluorescent supernanoparticles. Importantly, these supernanoparticles exhibit a superstructure consisting of a close-packed magnetic nanoparticle 'core', which is fully surrounded by a 'shell' of fluorescent quantum dots. A thin layer of silica coating provides high colloidal stability and biocompatibility, and a versatile surface functionality. We demonstrate that after surface pegylation, these silica-coated magneto-fluorescent supernanoparticles can be magnetically manipulated inside living cells while being optically tracked. Moreover, our silica-coated magneto-fluorescent supernanoparticles can also serve as an in vivo multi-photon and magnetic resonance dual-modal imaging probe.

Objectives: To identify risk factors for progression in patients with invasive bladder carcinoma who were pT0/pT1/pTa after cystectomy., Methods: We analyzed the clinical records of 97 post-cystectomy pT0/pT1/pTa patients for the following variables: hydronephrosis, carcinoma in situ (CIS), lymphovascular invasion, history of non-muscular invasive disease, residual tumor in the specimen and lymphatic invasion (pN). pN+patients were excluded from definitive analysis. The quantitative and qualitative variables were analyzed using standard statistics. The chi-square test was used to analyze associations between categorical variables. Univariate Cox proportional hazard regression analysis (enter method) was performed. The Kaplan-Meier method was used to evaluate survival and the log-rank test to assess differences between groups. Statistical significance was set at p<0.05. The analysis was performed using SPSS version 15.0., Results: The study sample included 97 cases. The specimen was staged at T2 in 97% of patients after transurethral resection (TUR); After cystectomy, the specimen was staged as pT0 (R0) in 44.3% and pT1/Ta (R1) in 55.7%. Median follow-up was 47 months. Lymph node metastasis were detected in 5.2% of patients (pN+rpar; and had a negative impact on survival (p=0.02). Overall survival was 59.8% and cancer-specific survival 76.6%. Univariate analysis showed a relationship between tumor progression and the presence of CIS (p < 0.001), lymphovascular invasion (p=0.049), and hydronephrosis(p < 0.001). In the multivariate analysis, only the presence of CIS in the transurethral resection was associated with reduced cancer-specific survival (HR 100.5; 95% CI, 10.8 to 933.1; pp<0.001)., Conclusions: Although the prognosis of stage pT0/pT1/pTa carcinoma in the cystectomy specimen is excellent, some patients experience progression. The presence of CIS in the transurethral resection was an independent predictor of recurrence in these cases.

Purpose: To examine the predictive value of an early transcranial Doppler ultrasound (TCD) study performed in the emergency department in patients with spontaneous subarachoniod hemorrhage (SAH) in good neurological condition, in order to know which patients are at high risk of developing delayed cerebral ischemia (DCI)., Design: A descriptive observational study was carried out involving a period of 3 years., Setting: Critical Care and Emergency Department., Patients: The study consecutively included patients with SAH of grade I-III on the Hunt and Hess scale., Variables of Interest: DCI (decrease of 2 points in GCS or focal deficit), Mean Velocity (MV) of middle cerebral arteries (MCA), Lindegaard Index (IL). Sonographic vasospasm pattern (SVP) was considered if MCA-MV>120cm/sc and IL>3., Results: The mean age of the 122 patients was 54.1±13.7 years; 57.3% were women. SVP was detected in 24 patients (19.7%), although high velocities patterns (HVP) were present in 38 patients (31.1%). DCI developed in 21 patients (MV183+/-49cm/sc), all with previous SVP. In this group MV increased 22+/-5cm/sc/day during the first 3 days. The group without HVP (84 patients/MV of 67+/-16.6cm/sc), compared with DCI group, showed differences in highest MV (p<0.001), and also ΔMV/day (8.30+/-4,5cm/sc Vs 22+/-5cm/sc) during the first 3 days (p=0.009). In our series, ROC analysis selected the best cut-off value for ΔMV/day as 21cm/sc (p<0.001)., Conclusion: During the first 3 days, an increase of 21cm/s/24h in MCA-MV was associated with the development of symptomatic vasospasm. TCD is a useful tool for the early detection of patients at risk of DCI after SAH., (Copyright © 2011 Elsevier España, S.L. and SEMICYUC. All rights reserved.)

Introduction: Aposematism is a defense system against predators consisting of the toxicity warning using conspicuous coloration. If the toxin production and aposematic coloration is costly, only individuals in good physical condition could simultaneously produce abundant poison and striking coloration. In such cases, the aposematic coloration not only indicates that the animal is toxic, but also the toxicity level of individuals. The costs associated with the production of aposematic coloration would ensure that individuals honestly indicate their toxicity levels. In the present study, we examine the hypothesis that a positive correlation exists between the brightness of warning coloration and toxicity level using as a model the paper wasp (Polistes dominula)., Results: We collected wasps from 30 different nests and photographed them to measure the brightness of warning coloration in the abdomen. We also measured the volume of the poison gland, as well as the length, and the width of the abdomen. The results show a positive relationship between brightness and poison-gland size, which remained positive even after controlling for the body size and abdomen width., Conclusion: The results suggest that the coloration pattern of these wasps is a true sign of toxicity level: wasps with brighter colors are more poisonous (they have larger poison glands).

Aim: To evaluate the ocular surface symptoms and signs associated with preservative-free 0.0015% tafluprost in patients with glaucoma or ocular hypertension (OHT)., Methods: Prospective non-interventional, multicentre, observational study on 134 patients, naive or on previous treatment with another prostaglandin analogue. In each visit (V1 baseline visit, V2 at 1 month and V3 at 3 months), patients evaluated five ocular surface symptoms as: absent, mild, moderate and severe. Parallelly, the ophthalmologist assessed the tear break-up time, keratitis, conjunctival hyperaemia, blepharitis, Schirmer test and tear meniscus., Results: Patients with OHT (n=71, 53%) experienced a statistically significant improvement of all symptoms: stinging/burning/irritation, itching, foreign body sensation, tearing and dryness sensation at V3, while glaucoma patients improved all symptoms at both V2 and V3. In patients with OHT, all signs except Schirmer test improved and the decrease in hyperaemia was statistically significant. Eyes with glaucoma ameliorated the keratitis, hyperaemia and tear meniscus at V2 and V3 and the break-up time and blepharitis at V3. In the subset of patients with previous treatment (n=79, 58.9%), patients with OHT presented significant improvement of hyperaemia, yet the rest of signs did not decrease significantly or remained unchanged, while in patients with glaucoma all signs improved significantly at both visits. The intraocular pressure (IOP) drop in naive eyes was 22.2% (24.7-19.7 mm Hg) in OHT and 29.5% (33.7-25.3 mm Hg) in glaucoma eyes. In previously treated eyes, no statistically significant change in IOP was found., Conclusion: Preservative-free tafluprost is a well tolerated hypotensive agent that can be used in eyes with surface problems and in naive eyes.

The potential of superparamagnetic iron oxide nanoparticles (SPIONs) in various biomedical applications, including magnetic resonance imaging (MRI), sensing, and drug delivery, requires that their surface be derivatized to be hydrophilic and biocompatible. We report here the design and synthesis of a compact and water-soluble zwitterionic dopamine sulfonate (ZDS) ligand with strong binding affinity to SPIONs. After ligand exchange, the ZDS-coated SPIONs exhibit small hydrodynamic diameters, and stability with respect to time, pH, and salinity. Furthermore, small ZDS coated SPIONs were found to have a reduced nonspecific affinity (compared to negatively charged SPIONs) toward serum proteins; streptavidin/dye functionalized SPIONs were bioactive and thus specifically targeted biotin receptors., (© 2011 American Chemical Society)

Unlabelled: To evaluate the pathological variables predictive of biochemical recurrence after radical prostatectomy and their implications for decision making in the adjuvant setting., Methods: 684 patients with localized prostate cancer who were treated with radical prostatectomy between 1996 and 2007. Before surgery they were classified according to D'Amico risk groups for recurrence. Following prostatectomy the following variables were collected: Gleason score, pathological stage, capsular invasion, surgical margins, perineural invasion and percentage of involvement in the piece. Univariate analysis was performed and subsequently adjusted using a Cox proportional hazards model (method enter)., Results: The median follow up of the series was 61 months. 29.1% of patients had biochemical recurrence. Overall mortality of the series was 4.9% and cancer-specific mortality 1.2%. In univariate analysis the Gleason score of surgical specimens, capsular invasion, perineural invasion, involvement of surgical margins, pathological stage and percentage of involvement of the piece had statistically significant (p <0.001) relation with biochemical recurrence. In multivariate analysis, a Gleason score ≥ 8 in the surgical specimen (HR = 3.08), existence of affected surgical margins (HR = 2.98), pT3 stage (HR = 1.61) and involvement of more than 50% of the piece by cancer (HR = 3.39) were identified as independent predictors of biochemical recurrence. Stratifying by independent predictors of biochemical recurrence (pT, Gleason score and margin), patients with at least 2 of these factors had an incidence of biochemical recurrence at 5 years exceeding 50%., Conclusions: Patients who have a Gleason score ≥ 8, positive margins, pT3 tumour or a percentage of >50% after prostatectomy have an increased risk of biochemical recurrence. Patients with at least 2 predictors of relapse have a probability of recurrence over 50% in the first 5 years of recurrence and should therefore be candidates for adjuvant radiotherapy.

Purpose: We compared the outcome of second and third kidney allografts with that of the first kidney allograft in pediatric recipients., Materials and Methods: We classified 173 cadaveric kidney recipients into 2 groups. Group 1 comprised 120 first transplants and group 2 comprised 53 retransplants, including 43 second and 10 third transplants. We compared demographic characteristics and survival in groups 1 and 2., Results: Group 1 consisted of 78 boys and 42 girls with a mean ± SD age of 11.5 ± 4.2 years. Group 2 consisted of 37 boys and 16 girls with a mean age of 10.4 ± 4.7 years. One, 5, 10 and 15-year graft survival rates were 78.7%, 64.3%, 54.5% and 50.7% for first transplants vs 82.8%, 57.8%, 57.8% and 41.3%, respectively, for retransplants (p = 0.757). Patient survival at 1, 5 and 15-year was 95.8%, 89.6%, 84.9% in the first transplant group vs 93.6%, 93.6% and 93.6%, respectively, in the retransplant group (p = 0.0.63). Graft survival was significantly higher in patients who did vs did not receive calcineurin inhibitors in the 2 groups (p = 0.02)., Conclusions: Kidney retransplantation in the pediatric population can yield excellent long-term outcomes, especially in patients treated with calcineurin inhibitors., (Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Purpose: To recognize clinical and pathological variables that influence in bladder cancer specific mortality in patients with transitional bladder cancer treated with radical cystectomy., Material and Method: Retrospective analysis of 333 patients with transitional bladder cancer treated with radical cystectomy. Variables included during pre-cystectomy, peri-cystectomy and post-cystectomy period were analyzed. Four groups were defined based on pathological state: a) Organ-confine bladder cancer without lymph node metastasis (pT0-2, pN0); b) Extravesical desease without lymph node metastasis (pT3-4, pN0); c) Bladder cancer with lymph node metastasis (pT0-4, pN+); d) No data of lymph node affection (pT0-4, pNx). Univariate analysis and two models of multivariate analysis were performed including the risk group as a variable in one the latest., Results: Mean follow up was 52.6 +/- 51 (2-221) months with a median of 31 months. Pathological state pT0 was observed in 7.2% of the patients, 12% were pT1, 26.7% pT2, 34.5% pT3 and 10.5% pT4. Lymph node metastasis was detected in 20.7% of the patients. Lymph node metastasis increased according to pathological state rises. Five and 10 years specific survival was 57% and 54% respectively., Conclusions: Local pathological state, lymph node status and risk groups were independent predictive factors for bladder cancer specific survival. Risk group association is a reliable method to predict bladder cancer specific survival and to identify the suitable patient group to get benefit from adjuvant therapy.

Objective: To assess early pituitary function in a sequential cohort of critical care patients after severe traumatic brain injury (TBI)., Design: This was a prospective observational study. The pituitary function was always tested on the third day after TBI., Setting: Neurocritical intensive care unit (ICU) in a University hospital., Patients: A total of 136 adult patients with severe TBI (range, 16-65 years) enrolled over a 2 year and 9 month period having a stay in the ICU treated than 48 hours., Intervention: None. MEASUREMENTS AND DATA COLLECTED: The following data were recorded within the first 72 hours after injury: demographic variables, injury severity, neuromonitoring data, systemic secondary brain insults, use of vasoactive drugs and type of TBI according to the computerized tomography (CT) scan findings. Pituitary function was evaluated by measurement of both the pituitary and target organ hormones, with the exception of the somatotrophic function, which was assessed by measurement of basal serum values of insulin-like growth factor-I (IGF-I)., Results: Pituitary dysfunction was observed in 101 patients (74.2%). Seventy-nine patients (58%) had impairment of only one pituitary axis, the axes being affected as follows: gonadotropic 63.7% (87 patients), thyrotropic 8.8% (12 patients) and corticotropic 0.7% (1 patient). Low IGF-1 plasmatic levels in accordance to the patient's age were observed in 90 patients (66.7%). However, only 26 of them had a value below 90 ng/ml., Conclusions: Our data show that pituitary dysfunction occurs early and with high frequency after severe TBI, but the real significance of these findings still needs to be elucidated.

Primary Objective: To determine whether cognitive and behavioural disorders observed in TBI patients are due to hormonal deficits or to the brain injury itself., Research Design: Transversal, between-group design., Methods and Procedures: Studied 22 severe TBI patients (GCS < 8): 11 had isolated GH deficiency and 11 did not. Prepared detailed clinical reports on patients and performed physical examinations, standard biochemical and full blood count analysis. Patients underwent neuropsychological assessment and hormonal evaluation 6 months after TBI diagnosis., Results: TBI patients with GH deficiency show greater deficits in attention, executive functioning, memory and emotion than those without GH deficiency., Conclusions: Results show GH-related cognitive impairment in patients who develop GH deficiency after TBI and suggest that treatment of GH deficiency would improve cognition. The clinical importance of these findings should be established to better understand the nature, magnitude and meaning of GH-related cognitive impairment in patients who develop GH deficiency after TBI.

Introduction and Objectives: The improvements in the management of newborns with myelomeningocele (MMC) have obtained a big increase in survival, allowing them to get longevity like never before, but data regarding urologic diseases during adult age are still missing. We herein evaluate the features of urinary lithiasis in adults born with MMC and the therapies used for its treatment., Material and Method: We review 52 patients diagnosed at birth of MMC, between 18 and 40 years old, treated in our institution, with a mean follow-up of 6.7 years., Results: 10 patients (19.2%) were diagnosed of urolithiasis. Three developed kidney calculi and one of them, with 7 more patients, developed bladder calculi (15.3%). The neurological level was < or = L2 in 3 cases, L2-S1 in 5, and > or = S1 in the other two. The type of neurogenic dysfunction of inferior urinary tract was multiple lesion of lower motor neurone in 6 cases, upper motor neurone in 1 case, multiple mixed lesion in 1 case and in case it was impossible to determine. Two patients had a bladder augmentation procedure and one of these with other 3 patients had a non-functional AMS-800 artificial urinary sphincter. Bladder stones were treated endoscopically in 14 procedures and by suprapubic cystolithotomy in 4 procedures, combined with removal of AMS-800 in 3 of them. One patient spontaneously passed a small stone. In one case, 2 ESWL and 2 percutaneous nephrolithotomies were needed. Three patients developed multiple recurrences during follow-up., Conclusions: Urinary lithiasis is common in adults with MMC. Some distinct features of these patients, together with their anatomical configuration and some therapies used in them, cause diagnostic, therapeutic and prophylaxis issues for the calculi they may develop.

To analyze the various techniques of transrectal ultrasound guided biopsy of the prostate described in the literature, as well as the anesthesia modalities for its performance. The diagnostic yield of the classic sextant biopsy, described 16 years ago and considered the standard technique ever since, has been overcome by the extended biopsy techniques (greater number of cores from more prostatic areas in each biopsy). Although their intra-study yield is better than sextant biopsy, the scarce randomized studies have not demonstrated a statistically significant improvement. These new techniques of extended biopsy significantly increase the rate of minor complications, not the major. It has not been demonstrated an increase in either the perception of pain or the diagnosis of non-significant tumors. Any anesthetic technique employed diminishes significantly the perception of pain by the patient. The periprostatic nerve blockage with infiltration of lidocaine is better than the rest of the techniques. The best technique of infiltration and the most effective lidocaine dose are to be defined yet. These techniques do not increase complications and only prolong the procedure briefly.

Objectives: To determine the correlation between blood lactic acid levels in the first 48 hours and outcome, in hemodynamically stable patients, with moderate or severe head injury (HI), and to investigate the risk factors associated with abnormal lactate levels., Material and Methods: A prospective observational study, in 210 adults patients with moderate or severe head injury. When the patients were hemodynamically stable, blood lactate concentrations were measured once on admission, twice daily during the first 2 days and once daily until lactate levels were normalized. The whole group 210 patients were divided into 2 groups. Group 1: (LA < 2.2 mmol/L) patients without occult hypoperfussion (OH), and group 2: (LA >or= 2.2 mmol/L) patients with OH., Results: One hundred and fifteen patients (57.76%) were categorized as group 1, and 95 patients (45.24%) as group 2. In the univariate analysis of risk factors for blood lactate >or=2.2 mmol/L the following variables showed statistical significance: severity of the head injury measured by several scales [Glasgow Coma Scale (GCS), Injury Severity Score (ISS), Revised Trauma Score (RTS) and Acute Physiology and Chronic Health Evaluation (APACHE) II], arterial hypotension, hypoxemia, anaemia, hyperglucemia, hypothermia, a greater incidence of norepinephrine infusion, and the higher percentage of type II lesions in the head computerized tomography at admission showed in the group 1 (53.91% vs. 38.94%) (p<0.03). In the multiple logistic regression analysis only two variables were risk independently associated with elevated blood lactate concentration: APACHE II in the first 24 hours: OR 1.12 (95% IC 1.06--1.196; p<0.0001) and the first 48-hours total fluid infusion volumes: OR 1.09 (95% IC 1.021,16; p < 0.0001). The infection rate (63.2% vs 47.8%, p=0.026), and length of ICU stay [mediana (percentil 25--75)] [13.29 (7.11--21.22) days vs. 8.78 (4.40--16.72) days; p<0.018] were significantly higher in patients with blood lactate >or=2.2 mmol/L (group 2). Although, the percentage of intracranial hypertension and mortality was higher in the group 2, there was no significant difference. In the multivariate analysis, the increase of blood lactate concentration, was not independently associated as a risk factor with studied complications., Conclusions: The presence of OH in patients with moderate or severe head injury, with postres uscitation arterial pressure, according to present recommendations, is associated with a more severe head injury, showed by APACHE II and the total fluid infusion volumes in the first 48 hours. OH in head injury increases the infection rate and length of ICU stay.

Secondary brain insults predominantly due to hypotension are frequent among patients with fatal traumatic brain injury. We assessed the correlation between different systemic secondary brain insults and brain death in 404 patients admitted to our intensive care unit (ICU) after severe traumatic brain injury. We collated data on hypoxemia and hypotension prior to as well as the occurrence of hypoxemia, hypotension, shock, anemia, hyperglycemia, and hyperthermia within the first 24 hours after ICU admission. We also considered both the presence of extracranial injuries and the category of traumatic brain injury using computerized tomography. The 59 patients (14.6%) who developed brain death, were significantly older than patients without a fatal neurological outcome (46.1 +/- 22 vs 29.5 +/- 14.9 years; P < .0001). Intracranial mass lesions, whether surgically evacuated were more frequent among brain-dead patients. The systemic secondary brain insults significantly associated with brain death were hypoxemia, hypotension, shock, anemia, and hyperglycemia within the first 24 hours after ICU admission. After multivariate analysis, the factors that independently predicted brain death were the occurrence of shock (odds ratio [OR], 6.74; 95% confidence interval [CI], 2.85-15.84; P = .001) and older age (OR, 1.05; 95% CI, 1.03-1.07; P = .003). In conclusion, early shock seems to be the major systemic secondary brain insult associated with brain death in patients with severe traumatic brain injury. Prevention of or correction of shock might help to either decrease the occurrence of a fatal neurological outcome or in brain-dead patients to preserve organs in better condition for procurement.

A 38 years old man with the only past medical history of bilateral orchiopexy 15 years ago is diagnosed of left primary seminal vesicle abscess. The patient is sent to our emergency service with an ultrasound finding of either dilated vas deferent or seminal vesicle abscess with hiperecogenic material inside it. The examination was performed after a 5 month history of purulent ejaculation. The diagnose of seminal vesicle abscess is confirmed by TRUS and, in the same procedure, drainage of the abscess was completed by needle-aspiration puncture. After this treatment the patient stay 12 hours at the observation room with intravenous antibiotics and is discharged home with oral antibiotics. We are interested in this case because of the low incidence of this pathology and the easy diagnosis and treatment by TRUS.

Objective: The objective was to determine whether the age of patients with mild head injury and skull fracture influences the level of risk for acute intracranial injuries., Method: A study was conducted of 156 patients with skull fracture, 60 children (aged <14 years) and 96 adults, detected among 5,097 consecutive patients with mild head injury (Glasgow Coma Scale [GCS] score of 15-14 points) arriving at the Emergency Department of a Level I University Hospital Trauma Center during 1998. Acute intracranial injuries were defined as traumatic brain injuries identified by cranial computed tomography scan, excluding pneumocephalus., Results: Compared with the children, this risk of intracranial injury was 13 times greater in the adults aged 14-54 years and 16 times greater in the over-54-year-olds. Besides age over 14 years (p<0.0001), compound skull fracture (p<0.001), and a GCS score of 14 (p<0.001) were factors significantly associated with intracranial injury in the logistic regression analysis., Conclusions: Skull fracture in mild head injury implies a greater risk of intracranial injury in adults than in children.

We report a 62 years old kidney transplant (KT) patient who was diagnosed of localized prostatic cancer (PC) after 6 years of the implant. Transrectal prostatic High Intensity Focused Ultrasound (HIFU) was applied. Results have been satisfactory, achieving pathologic and biochemical success. The discharge was completed at 24 hs, the morbidity was minimal. We have not found any reference in the literature on the appliance of HIFU in PC KT patients. We think that HIFU may represent a good alternative for these patients.

Introduction: Higher and lower cerebral perfusion pressure (CPP) thresholds have been proposed to improve brain tissue oxygen pressure (PtiO2) and outcome. We study the distribution of hypoxic PtiO2 samples at different CPP thresholds, using prospective multimodality monitoring in patients with severe traumatic brain injury., Methods: This is a prospective observational study of 22 severely head injured patients admitted to a neurosurgical critical care unit from whom multimodality data was collected during standard management directed at improving intracranial pressure, CPP and PtiO2. Local PtiO2 was continuously measured in uninjured areas and snapshot samples were collected hourly and analyzed in relation to simultaneous CPP. Other variables that influence tissue oxygen availability, mainly arterial oxygen saturation, end tidal carbon dioxide, body temperature and effective hemoglobin, were also monitored to keep them stable in order to avoid non-ischemic hypoxia., Results: Our main results indicate that half of PtiO2 samples were at risk of hypoxia (defined by a PtiO2 equal to or less than 15 mmHg) when CPP was below 60 mmHg, and that this percentage decreased to 25% and 10% when CPP was between 60 and 70 mmHg and above 70 mmHg, respectively (p < 0.01)., Conclusion: Our study indicates that the risk of brain tissue hypoxia in severely head injured patients could be really high when CPP is below the normally recommended threshold of 60 mmHg, is still elevated when CPP is slightly over it, but decreases at CPP values above it.