Telemedicine and smart working: Spanish adaptation of the European Association of Urology recommendations

Introducción

La telemedicina ofrece un soporte clínico remoto utilizando herramientas tecnológicas. Puede facilitar la atención médica al tiempo que reduce las visitas innecesarias a la consulta. La pandemia COVID-19 ha provocado un cambio brusco en nuestra práctica urológica diaria convirtiéndose en algo muy necesario el acto de la teleconsulta.

Objetivo

Proporcionar recomendaciones prácticas para el uso efectivo de herramientas tecnológicas en telemedicina.

Materiales y métodos

Se realizó una búsqueda en la literatura en la plataforma Medline hasta abril de 2020; seleccionamos los artículos más relevantes relacionados con «telemedicina» y «trabajo inteligente» que podrían proporcionar información útil.

Resultados

La telemedicina se refiere al uso de la información electrónica y a las herramientas de telecomunicaciones para proporcionar apoyo clínico remoto a la atención médica. El trabajo inteligente es un modelo de trabajo que utiliza tecnologías nuevas o existentes para mejorar el rendimiento. La telemedicina se está convirtiendo en una herramienta útil y necesaria durante la pandemia COVID-19 e incluso más allá de la misma. Es hora de que formalicemos y demos el lugar que se merece a la telemedicina en nuestra práctica clínica y es nuestra responsabilidad adaptar y conocer todas las herramientas y posibles estrategias para su implementación de una manera óptima, garantizar una atención de calidad a los pacientes y que dicha atención sea percibida por pacientes y familiares como de alto nivel.

Conclusiones

La telemedicina facilita la atención clínica urológica especializada a distancia y resuelve problemas como las limitaciones en la movilidad o el traslado de los pacientes, reduce las visitas innecesarias a las clínicas y es útil para reducir el riesgo de transmisión viral de la COVID-19.

Renal transplantation using vascular conduit reconstruction in deceased kidneys with multiple renal arteries and short renal veins

BACKGROUND

Transplantation of kidneys with vascular anatomical variants remains a challenge. Due to its varying success in regard to graft function after transplantation, these organs have been frequently discarded assuming in advance an unaffordable rate of vascular complications.

PATIENTS AND METHODS

We performed three kidney transplants using organs from deceased donors harboring vascular variants (multiple arteries and short veins), including an unsplittable horseshoe kidney. Different grafts harvested from the same donor aorta, common iliac artery, and inferior vena cava, were used to reconstruct the initial vascular configuration by creating single arterial and venous conduits aimed to simplify the vascular anastomoses in the recipient.

RESULTS

No post-operative complications were recorded. Warm ischemia times remained comparable to single artery renal allografts. No delayed graft function was noted in any case, and every patient regained normal renal function after transplantation.

CONCLUSIONS

Vascular reconstruction using arterial and venous grafts harvested from the same deceased donor may result a helpful tool to simplify vascular anastomoses during transplantation surgery, thus avoiding their discard in advance, minimizing perioperative complications, and enabling normal graft function rates in the long-term follow-up. The successful outcome obtained by using this approach would help to expand the donor criteria for the inclusion of organs containing vascular anatomical variants.

The situation of infection in the elderly in Spain: a multidisciplinary opinion document

Infection in the elderly is a huge issue whose treatment usually has partial and specific approaches. It is, moreover, one of the areas where intervention can have the most success in improving the quality of life of older patients. In an attempt to give the widest possible focus to this issue, the Health Sciences Foundation has convened experts from different areas to produce this position paper on Infection in the Elderly, so as to compare the opinions of expert doctors and nurses, pharmacists, journalists, representatives of elderly associations and concluding with the ethical aspects raised by the issue. The format is that of discussion of a series of pre-formulated questions that were discussed by all those present. We begin by discussing the concept of the elderly, the reasons for their predisposition to infection, the most frequent infections and their causes, and the workload and economic burden they place on society. We also considered whether we had the data to estimate the proportion of these infections that could be reduced by specific programmes, including vaccination programmes. In this context, the limited presence of this issue in the media, the position of scientific societies and patient associations on the issue and the ethical aspects raised by all this were discussed.

Statistical control of processes applied to geometric uncertainties for CTV expansion margins determination in prostate cancer patients treated with VMAT: a prospective study in 57 patients

PURPOSE

To study the control graphs applicability for the geometric uncertainties of VMAT treatments in prostate cancer patients, and their use to verify the hypothesis of the data obtained randomness, to apply the margins of Van Herk expression.

MATERIAL AND METHODS

During the first 5 days of treatment, and then once a week, a Kv CBCT was performed, compared with the simulation CT and adjusted the displacements, to determine the inter-fraction errors. Immediately after radiation therapy, another CBCT was performed (for intra-fraction errors). With these data, the X, R position control charts have been made. The patients, not maintained the deviations within the charts control limits, were called "anomalies". Then, we compared the deviations and margins calculated with the van Herk expression for all patients and for those without anomalies.

RESULTS

The margins determined show appreciable differences if there were calculated for the total set of patients or for the set of them without anomalies in the control charts. For the overall set of patients, the lateral, longitudinal, and vertical margins were 0.45 cm, 0.52 cm, 0.56 cm, while for the set of patients without anomalies were 0.29 cm, 0.35 cm, and 0.38 cm.

CONCLUSIONS

The use of control charts allows tracking geometric deviations both inter and intra-fraction, variability real-time control and to detect situations in which it can change for non-random reasons, and require immediate investigation. Maintaining geometric deviations in the control state decreases the margins needed to administer a high dose to CTV in a high percentage of cancer prostate patients.

Three-piece inflatable penile prosthesis: Ectopic reservoir placement

INTRODUCTION

The complications associated to the placement of the reservoir are infrequent but potentially serious. Therefore, technical alternatives have been developed for the performance of the procedure in different locations (ectopic). The aim of this review is to revise the evidence available on the different options for the ectopic placement of the reservoir.

MATERIAL AND METHOD

Narrative review based on a bibliographical search limited to PubMed- indexed relevant manuscripts, in Spanish or English, for the period 2000-2019, using «penile prosthesis», «ectopic reservoir», radical prostatectomy», «radical cystectomy», «pelvic radiotherapy», and «renal transplantation» as key words. Non original articles and reviews were not considered eligible. A total of 11 manuscripts were included.

RESULTS

Pelvic alterations after surgery and/or radiotherapy increase the difficulty in the placement of the prosthesis reservoir. In order to minimize the risk of complications, different modifications have been performed on the devices, and technical innovations have been developed for the submuscular placement of the reservoir. The available evidence regarding the functionality and complications of these techniques is limited to single institution, low volume, and retrospective series with short follow-up periods. The functionality seems to be adequate using the adapted devices. The complications are infrequent and mild in severity.

CONCLUSIONS

Although the available evidence is still limited, the ectopic placement of the reservoir may be considered a safe, effective, and reproducible technique. In addition, it may result particularly useful in cases of altered pelvic anatomy.

Marginal Fermi Liquid in Twisted Bilayer Graphene

Linear resistivity at low temperatures is a prominent feature of high-T_{c} superconductors which has also been found recently in twisted bilayer graphene. We show that due to an extended van Hove singularity (VHS), the T-linear resistivity can be obtained from a microscopic tight-binding model for filling factors close to the VHS. The linear behavior is shown to be related to the linear energy dependence of the electron quasiparticle decay rate which implies the low-energy logarithmic attenuation of the quasiparticle weight. These are distinctive features of a marginal Fermi liquid, which we also see reflected in the respective low-temperature logarithmic corrections of the heat capacity and the thermal conductivity, leading to the consequent violation of the Wiedemann-Franz law. We also show that there is a crossover at T∼6  K from the marginal Fermi liquid regime to a regime dominated by excitations on the Dirac cone right above the VHS that also yields a linear resistivity albeit with smaller slope, in agreement with experimental observations.

ASXL1 mutation as a surrogate marker in acute myeloid leukemia with myelodysplasia-related changes and normal karyotype

Acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) are poor outcome leukemias. Its diagnosis is based on clinical, cytogenetic, and cytomorphologic criteria, last criterion being sometimes difficult to assess. A high frequency of ASXL1 mutations have been described in this leukemia. We sequenced ASXL1 gene mutations in 61 patients with AML-MRC and 46 controls with acute myeloid leukemia without other specifications (AML-NOS) to identify clinical, cytomorphologic, and cytogenetic characteristics associated with ASXL1 mutational status. Mutated ASXL1 (ASXL1+) was observed in 31% of patients with AML-MRC compared to 4.3% in AML-NOS. Its presence in AML-MRC was associated with older age, a previous history of myelodysplastic syndrome (MDS) or myelodysplastic/myeloproliferative neoplasms (MDS/MPN), leukocytosis, presence of micromegakaryocytes in bone marrow, lower number of blasts in bone marrow, myelomonocytic/monocytic morphological features and normal karyotype. ASXL1 mutation was not observed in patients with myelodysplastic syndrome-related cytogenetic abnormalities or TP53 mutations. Differences in terms of overall survival were found only in AML-MRC patients without prior MDS or MDS/MPN and with intermediate-risk karyotype, having ASXL1+ patients a worst outcome than ASXL1-. We conclude that the ASXL1 mutation frequency is high in AML-MRC patients being its presence associated with specific characteristics including morphological signs of dysplasia. This association raises the possible role of ASXL1 as a surrogate marker in AML-MRC, which could facilitate the diagnosis of patients within this group when the karyotype is normal, and especially when the assessment of multilineage dysplasia morphologically is difficult. This mutation could be used as a worst outcome marker in de novo AML-MRC with intermediate-risk karyotype.

Thrust stand based on a single point load cell for impulse measurements from plasma thrusters

We introduce a simple thrust stand for the direct measurement of the millinewton impulses or thrusts delivered by small thrusters intended for in-space electric propulsion. The thruster under test, with a weight below 1.5 kg, is disposed on a horizontal platform and its impulse is measured as an overweight by using a strain gauge cell physically protected from the ambient plasma and vacuum conditions. This system provides ten thrust readings per second with noise peak to peak amplitudes of 0.10-0.18 mN. The calibration procedures to verify its dynamic response to time dependent thrusts in the range of 0-15 mN using control weights as well as its minimum thrust sensitivity δT_s = 0.3 mN are discussed. Additionally, its simple conception permits a plain data reduction and analysis of steady state and low frequency thrust transients. This thrust stand was employed under low pressure and plasma ambient conditions to measure the steady impulses delivered by the Alternative Low Power Hybrid Ion Engine (ALPHIE) of 0.4-4.0 mN with absolute errors ΔT = ±0.3 mN. Finally, the experimental results show that a control electric voltage governs the ALPHIE thruster throttle.

Plants and gall hosts of the Tirimbina Biological Reserve, Sarapiqui, Costa Rica: Combining field sampling with herbarium records

There has been an increasing number of inventories of gall-inducing arthropods in the Neotropics. Nonetheless, very few inventories have been carried out in areas where the flora is well documented, and records of galls from herbaria and sites outside the study area have seldom been utilized. In this study we provide a checklist of the native vascular plants of a 345 ha forest reserve in the Caribbean lowlands of Costa Rica and document which of these plants were found to harbor galls. The gall surveys were carried out between November 2013 and December 2016. We also cross-checked our plant list with the previous gall records from elsewhere in the country and searched for galls on herbarium specimens of dicots reported from the reserve. In total, we recorded 143 families and 1174 plant species, of which 401 were hosts of galls. Plant hosts of galls were found in the following non-mutually exclusive categories: 209 in our field sampling, 257 from previous records, and 158 in herbarium specimens. Of our field records of galls, 77 were new for the country, 77 were also found in the herbarium and 110 had been previously recorded in the country. Herbarium specimens and previous records are good indicators of potential gall hosts but around one quarter (40/158) of the gall records in the herbarium were ambiguous as to whether the tissue alteration was a gall or not. Plant family size was related to number of gall hosts, but most dicot families have similar proportions of gall host species. We concluded that more than a third of the native plants in the reserve are gall hosts, but this number increased to 44.93 % when only dicots were considered. Our results demonstrate the utility of providing complete plant inventories when conducting gall inventories, and of using herbarium specimens and previous galls studies to infer gall diversity in a specific area.

Kohn-Luttinger Superconductivity in Twisted Bilayer Graphene

We show that the recently observed superconductivity in twisted bilayer graphene (TBG) can be explained as a consequence of the Kohn-Luttinger (KL) instability which leads to an effective attraction between electrons with originally repulsive interaction. Usually, the KL instability takes place at extremely low energy scales, but in TBG, a doubling and subsequent strong coupling of the van Hove singularities (vHS) in the electronic spectrum occurs as the magic angle is approached, leading to extended saddle points in the highest valence band with almost perfect nesting between states belonging to different valleys. The highly anisotropic screening induces an effective attraction in a p-wave channel with odd parity under the exchange of the two disjoined patches of the Fermi line. We also predict the appearance of a spin-density wave instability, adjacent to the superconducting phase, and the opening of a gap in the electronic spectrum from the condensation of spins with wave vector corresponding to the nesting vector close to the vHS.

Melatonin expression in periodontitis and obesity: An experimental in-vivo investigation

BACKGROUND AND OBJECTIVE

Melatonin deficiency has been associated with obesity and systemic inflammation. This study aims to evaluate whether melatonin could interfere with the mechanisms of co-morbidity linking obesity and periodontitis.

MATERIAL AND METHODS

Twenty-eight male Wistar rats were randomly divided in 4 groups: control group (Con) (fed with standard diet); high-fat diet group (HFD) (fed with a diet containing 35.2% fat); Con group with induced periodontitis (Con-Perio) and HFD group with induced periodontitis (HFD-Perio). To induce periodontitis, the method of oral gavages with Porphyromonas gingivalis ATCC W83K1 and Fusobacterium nucleatum DMSZ 20482 was used. Circulating melatonin levels were analyzed by multiplex immunoassays. Periodontitis was assessed by alveolar bone loss (micro-computed tomography and histology) and by surrogate inflammatory outcomes (periodontal pocket depth, modified gingival index and plaque dental index).

RESULTS

Plasma melatonin levels were significantly decreased (P < .05) in the obese rats with periodontitis when compared with controls or with either obese or periodontitis rats. Alveolar bone loss increased 27.71% (2.28 µm) in HFD-Perio group compared with the Con group. The histological analysis showed marked periodontal tissue destruction with osteoclast activity, particularly in the HFD-Perio group. A significant negative correlation (P < .05) was found between periodontal pocket depth, modified gingival index and circulating melatonin levels.

CONCLUSION

Obese and periodontitis demonstrated significantly lower melatonin concentrations when compared with controls, but in obese rats with periodontitis these concentrations were even significantly lower when compared with either periodontitis or obese rats. These results may indicate that melatonin deficiency could be a key mechanism explaining the co-morbidity effect in the association between obesity and periodontitis.

A Raman study of the pressure-induced densification of SiO2-based glass-ceramics

Here we report a structural characterization study of glass-ceramics as a function of pressure by Raman spectroscopy. We selected a glass-ceramics of Li₂O-Al₂O₃-nSiO₂ (n  ≈  8) doped with ZrO₂ and TiO₂. This composition induces slight structural modification in Si-O and Si-O-Si bonds in the glass matrix that are crucial to stabilize metastable hexagonal SiO₂ (β-quartz) solid-solution nano crystals corresponding to γ-LiAlSi₂O₆. This structure yields a more compact β-quartz-type phase that eventually stabilizes it in wider pressure range than pure SiO₂. Raman spectroscopy allows to unravel at least two pressure-induced structural phase transitions at about 6 and 15 GPa that could not be previously revealed by x-ray diffraction. We show that the phase-transition sequence can tentatively be described in terms of SiO₂-type structure as: β-quartz  →  Coesite I  →  Coesite II. The measured transition pressures are consistent with the larger cell volume attained in the γ-LiAlSi₂O₆ yielding a wider metastability pressure range of the β-quartz-type phase.

Biodegradable multi-walled carbon nanotubes trigger anti-tumoral effects

Carbon nanotubes are of huge biotechnological interest because they can penetrate most biological barriers and, inside cells, can biomimetically interact with the cytoskeletal filaments, triggering anti-proliferative and cytotoxic effects in highly dividing cells. Unfortunately, their intrinsic properties and bio-persistence represent a putative hazard that relapses their application as therapies against cancer. Here we investigate mild oxidation treatments to improve the intracellular enzymatic digestion of MWCNTs, but preserving their morphology, responsible for their intrinsic cytotoxic properties. Cell imaging techniques and confocal Raman spectroscopic signature analysis revealed that cultured macrophages can degrade bundles of oxidized MWCNTs (o-MWCNTs) in a few days. The isolation of nanotubes from these phagocytes 96 hours after exposure confirmed a significant reduction of approximately 30% in the total length of these filaments compared to the control o-MWCNTs extracted from the cell culture medium, or the intracellular pristine MWCNTs. More interestingly, in vivo single intratumoral injections of o-MWCNTs triggered ca. 30% solid melanoma tumour growth-inhibitory effects while displaying significant signs of biodegradation at the tumoral/peri-tumoral tissues a week after the therapy has had the effect. These results support the potential use of o-MWCNTs as antitumoral agents and reveal interesting clues of how to enhance the efficient clearance of in vivo carbon nanotubes.

Spirocercosis in red fox (Vulpes vulpes) in a natural reserve located in a meso-Mediterranean area

Spirocerca lupi Rudolphi 1809 (Nematoda Spirocercidae) has an indirect cycle involving intermediate and paratenic hosts, having domestic or wild canids as the main definitive hosts. The most frequent pathology affecting dogs is a granulomatous tumor-like growth containing adults in the oesophagus and aorta. There are very few references about the presence of nodules in the stomach. There is scant information about the epidemiology of this disease in wild red foxes in meso-Mediterranean areas. In this work we report on the natural infection of wild red foxes by Spirocerca lupi and the damage produced in the stomach wall in an area where contact with other potential definitive hosts (canids) is very rare. From July 2015 to November 2016, 61 red foxes were sampled. 18.03% of the stomach walls examined had nodules containing Spirocerca lupi adults and eggs. The prevalence of infection was similar for young and adult groups (23.81 and 18.18%; χ2 = 0.25; df = 1; P = 0.6171) and it was higher in females than in males (25.81 versus 10.00%, χ² = 2.58; df = 1; P = 0.1082). The red fox population in the area seems to be well established judging from their age distribution and the fact that they could be captured all year round. It would appear that in the absence of other main definitive host S. lupi population is able to survive just parasitizing red foxes. Pathologic effects of this parasite on red foxes seems to show some differences related to domestic dogs. These results also indicates as predator control programs can maintain suitable host populations with reduced level of infection.

Characterising the rural-urban gradient through the participatory mapping of ecosystem services: insights for landscape planning

The application of the ecosystem services (ES) framework in landscape planning has become particularly relevant in rural-urban gradients since it allows for the integration of the complex interactions between ES supply and demand. This framework might be a powerful tool to inform landscape planning and decision-making intended to maintain the current and future flow of ES. In this study, we developed a process of participatory mapping of ES in a rural-urban gradient in southern Spain, which comprises the Sierra Nevada mountain range, the Granada valley and the city of Granada. First, we interviewed 21 key stakeholders from different professional sectors and gradient zones. These stakeholders prioritised nine ES in terms of their importance for local human well-being and their vulnerability to current drivers of change. Then, a workshop was organised in which 23 local actors shared their experience and knowledge regarding ES in the studied landscape. Sorted into five groups (composed of stakeholders with different profiles), the participants spatially mapped the most important supply and demand areas for the nine ES previously prioritised. The results show that the city of Granada has a very high demand for ES and a very low supply, while the Sierra Nevada mountain range and the valley of Granada appear to be very important ES supply areas. According to 95% of the stakeholders that attended the workshop, participatory mapping of ES is a very important (69%) or an important (26%) methodology to elicit the views and perceptions of the population, to identify the main conflicts and potential solutions for the territory and to visualise the high dependence of urban areas on the ES provided by adjacent rural areas. Our results also highlight the importance of incorporating the analysis of ES flows to inform landscape planning at the regional scale. Participatory mapping of ES can enhance decision-making regarding the maintenance of human well-being and the sustainability of social-ecological systems.

Surface and 3D Quantum Hall Effects from Engineering of Exceptional Points in Nodal-Line Semimetals

We show that, under a strong magnetic field, a 3D nodal-line semimetal is driven into a topological insulating phase in which the electronic transport takes place at the surface of the material. When the magnetic field is perpendicular to the nodal ring, the surface states of the semimetal are transmuted into Landau states which correspond to exceptional points, i.e., branch points in the spectrum of a non-Hermitian Hamiltonian which arise upon the extension to complex values of the momentum. The complex structure of the spectrum then allows us to express the number of zero-energy flat bands in terms of a new topological invariant counting the number of exceptional points. When the magnetic field is parallel to the nodal ring, we find that the bulk states are built from the pairing of surfacelike evanescent waves, giving rise to a 3D quantum Hall effect with a flat level of Landau states residing in parallel 2D slices of the 3D material. The Hall conductance is quantized in either case in units of e^{2}/h, leading in the 3D Hall effect to a number of channels growing linearly with the section of the surface and opening the possibility to observe a macroscopic chiral current at the surface of the material.

Blend design tools for Medium Combustion Plants (MCP) firing biomass wastes

A feasible alternative for agricultural or forestry waste management is the operation of a distributed network of sustainable Medium Combustion Plants (MCPs). However, one of the main factors that hinder its development is the propensity to operational problems derived from corrosion, slagging and fouling characteristics of both bottom and fly ashes. Therefore, a cost-effective approach for these multi-product MCP could be based on predictive tools for an optimal formulation of a fuel blend. This work focuses on the assessment of the ability of these methods to provide guidance for preventing ash-related operational problems and to provide fuel-blending rules. The more widespread tools pertain to two types: compositional classification based on chemical analysis of laboratory ashes, and thermodynamic prediction of the most likely species and phases. Both criterion numbers and compositional maps are ranking methods based on the chemical analysis at a given ashing temperature. Thermodynamic equilibrium modeling is not constrained by any difference in the physical conditions of the MCP compared to those in the laboratory. Both kind of prediction tools have been validated in an MCP firing olive tree pruning residues as well as its typical blends in order to mimic a plausible pattern of fuels along a full year operating campaign. An intensive experimental campaign encompasses plant monitoring and off-line analysis of the ashes along the process line. Interpretation of compositional plots has revealed to be potentially sensitive to ashing temperature. Here are presented examples showing how this variable could lead to either insignificant differences or to a substantial disparity in the a priori fuel diagnosis. Some inconsistencies have been observed between the predictions based on criterion numbers, even for the same fuel and for ranking rules specifically formulated for biomasses. Moreover, it does not match consistently with the information obtained from phase diagrams. Therefore, their use should be limited to the case of a well-established selection of a fuel index for a well-defined fuel provided empirical evidence of an enough good description of the ash behavior, which is not the most frequent case. Thermodynamic equilibrium calculations allow a more precise prediction of the main species in the condensed phase, without the constraint of the ashing temperature. Elemental closure of main ash-forming elements with the chemical analysis of the process ashes presents small differences, and their proximity localization on the phase diagrams denote similar prediction between predicted and process ashes.