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Objetivo Analizar el nivel de concordancia de la Post-Ureteroscopic Lesion Scale (PULS), y examinar las consecuencias de su aplicación en la práctica clínica con datos estadísticos más fiables que los utilizados en el trabajo original. Métodos Se realizaron 14 ureteroscopias (URS) y 14 micro-ureteroscopias (micro-URS) en 14 cerdos hembra. Todos los procedimientos se grabaron en vídeo y se realizó un análisis anatomopatológico en cada uréter. Dieciséis urólogos (9 endourólogos y 7 urólogos generales) y 4 médicos internos residentes evaluaron las lesiones ureterales según la escala PULS, con grados 0, 1 y ≥2. La concordancia se calculó mediante porcentajes, el Coeficiente W de Kendall, el índice kappa de Fleiss y el alfa de Krippendorff. La concordancia entre evaluadores se calculó con la Correlación de Spearman y el Coeficiente kappa de Cohen. Resultados El porcentaje de concordancia fue del 11,1%. Los coeficientes se clasificaron como bajos o muy bajos, y encontramos una mayor concordancia entre los evaluadores más inexpertos. Por otro lado, no hubo acuerdo entre el 50% de los evaluadores. Conclusiones La baja concordancia entre evaluadores, la especificidad de la PULS y la correlación clínico/patológica sugieren dificultades del uso de esta escala y una curva de aprendizaje probablemente larga. (AU)

Objective To analyze the level of agreement of the Post-Ureteroscopic Lesion Scale (PULS) and the consequences on its application in clinical practice with more reliable statistical data than the one used in the original work. Methods 14 URS and 14 micro-URS were performed in 14 female porcine model. All the procedures were video recorded and an anatomopathological analysis was performed in each ureter. Sixteen urologists (9 endourologists and 7 general urologists) and 4 residents evaluated the ureteral lesions according to the PULS, with degrees 0, 1 and ≥2. The agreement was calculated with percentages, Kendall's W coefficient and the indicators Fleiss’ Kappa and Krippendorff's Alpha, while the inter-rater agreement was calculated with Spearman's correlation and Cohen's Kappa. Results The percent of agreement was 11.1%. The coefficients were likewise classified as low or very low, with the greatest agreement found among the inexperienced. Also, 50% of the raters did not agree with the rest. Conclusions The low inter-rater agreement, the specificity of the PULS and the clinical-pathological correlation suggests that this scale is not simple, and probably has a long learning curve. (AU)

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OBJECTIVE: To analyze the level of agreement of the Post-Ureteroscopy Lesion Scale (PULS) and the consequences on its application in clinical practice with more reliable statistical data than the one used in the original work. METHODS: 14 URS and 14 micro-URS were performed in 14 female porcine model. All the procedures were video recorded and an anatomopathological analysis was performed in each ureter. Sixteen urologists (9 endourologists and 7 general urologists) and 4 residents evaluated the ureteral lesions according to the PULS, with degrees 0, 1 and ≥2. The agreement was calculated with percentages, Kendall's W coefficient and the indicators Fleiss' Kappa and Krippendorff's Alpha, while the inter-rater agreement was calculated with Spearman's correlation and Cohen's Kappa. RESULTS: The percent of agreement was 11.1%. The coefficients were likewise classified as low or very low, with the greatest agreement found among the inexperienced. Also, 50% of the raters did not agree with the rest. CONCLUSIONS: The low inter-rater agreement, the specificity of the PULS and the clinical-pathological correlation suggests that this scale is not simple, and probably has a long learning curve.

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Introducción y objetivos: La alta prevalencia del síndrome del túnel carpiano (STC), y la evidencia de no ser meramente una compresión local, implica considerar nuevos tratamientos. El catastrofismo asociado al dolor se relaciona con la intensidad del dolor en enfermedades con dolor crónico. Los objetivos planteados son evaluar los efectos que tiene la terapia del espejo (TE) en el dolor y la funcionalidad de las extremidades superiores, determinar si el catastrofismo se relaciona con la intensidad del dolor y comprobar si es un factor pronóstico de los efectos de la TE en los pacientes con STC bilateral. Material y métodos: Ensayo clínico aleatorizado, doble ciego. Participaron 18 sujetos que fueron divididos en 2 grupos: TE y grupo control. Realizaron un tratamiento de 8 semanas con ejercicios de dificultad progresiva, pero solo el grupo TE tuvo el feedback visual del espejo. Se evaluó el dolor (cuestionario del dolor McGill) y la funcionalidad de las extremidades superiores (cuestionario de discapacidad hombro, brazo y mano DASH) al inicio, la 2.a-4.a-8.a semana y el catastrofismo asociado al dolor (cuestionario del catastrofismo asociado al dolor) a nivel basal. Resultados: Se observó disminución del dolor (p=0,038), pero no mejoría de la funcionalidad de las extremidades superiores (p=0,062). Se encontró relación estadísticamente significativa entre el catastrofismo y la intensidad del dolor (p=0,018). Conclusiones: La TE disminuye el dolor, pero no mejora la función en las extremidades superiores; el catastrofismo se relaciona con la intensidad del dolor pero no es un factor pronóstico de los efectos de la TE en los pacientes con STC bilateral

Introduction and objectives: The high prevalence of carpal tunnel syndrome (CTS), and the evidence that it is not merely local compression, implies that new treatments should be considered. Pain catastrophizing is associated with diseases that involve chronic pain. The aims of this study were to assess the effects of mirror therapy (MT) on pain and upper extremity functionality, determine whether catastrophizing is related to the intensity of pain, and identify it as a prognostic factor for the effects of MT in patients with bilateral CTS. Material and methods: Double-blind randomized trial. The 18 participants were divided into two groups: MT and control group. All the participants underwent eight-week treatment with progressive difficulty exercises but only the MT group had visual feedback from the mirror. Pain (McGill pain questionnaire) and disability (Disabilities of the arm, shoulder and hand questionnaire DASH) were assessed at baseline, at the 2nd-4th-8th weeks, and pain-related catastrophizing (Pain catastrophizing questionnaire) was assessed at baseline. Results: A decrease in pain was observed (P=.038), but no improvement in the functionality of the upper limbs (P=.062). A statistically significant relationship was found between catastrophizing and intensity of pain (P=.018). Conclusions: MT decreases pain but does not improve upper limb function, catastrophizing is related to pain intensity, but it is not a prognostic factor after treatment with MT in patients with bilateral CTS

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La asociación entre prolapso de órganos pélvicos y uropatía obstructiva es conocida, pero en raras ocasiones alcanza el grado de provocar secundariamente un cuadro de insuficiencia renal aguda o crónica graves. Se presenta el caso de una mujer de 79 años que consultó en urgencias por sintomatología secundaria a insuficiencia renal aguda. A la exploración se evidenció prolapso uterino grado IV. Las pruebas complementarias revelaron ureterohidronefrosis bilateral grados III/IV, sepsis urinaria e insuficiencia renal aguda. El diagnóstico y la reducción del prolapso uterino mediante un pesario de Hodge facilitó la resolución del cuadro clínico originado por la uropatía obstructiva

Although the association between pelvic organ prolapse and obstructive uropathy is well known, it occasionally causes severe acute or chronic renal failure. A 79-year-old woman presented to the emergency department complaining of gastrointestinal and neurological symptoms. Physical examination showed a grade IV uterine prolapse. Additional assessments revealed bilateral hydronephrosis grades III/IV, urinary sepsis and acute renal failure. The diagnosis and reduction of uterine prolapse by a Hodge pessary played a key role in resolving the symptoms caused by obstructive uropathy

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The aim of this study was to identify a possible relationship between haemodynamic variables, auditory evoked potentials (AEP) and inspired fraction of isoflurane (ISOFl). Two different models (isoflurane and mean arterial pressure) were identified using the fuzzy inductive reasoning (FIR) methodology. A fuzzy model is able to identify non-linear and linear components of a causal relationship by means of optimization of information content of available data. Nine young female patients undergoing hysterectomy under general anaesthesia were included. Mean arterial pressure (MAP), heart rate (HR), end-tidal expired carbon dioxide (CO2ET), AEP and ISOFl were monitored with a sampling time of 10 s. The AEP was extracted using an autoregressive model with exogenous input (ARX model) which decreased the processing time compared with a moving time average. The AEP was mapped into a scalar, termed the depth of anaesthesia index (DAI) normalized to 100 when the patient was awake and descending to an average of 25 during loss of consciousness. The FIR methodology identified those variables among the input variables (MAP, HR, CO2ET, DAI or ISOFl) that had the highest causal relation with the output variables (ISOFl and MAP). The variables with highest causal relation constitute the ISOFl and MAP models. The isoflurane model predicted the given anaesthetic dose with a mean error of 12.1 (SD 10.0)% and the mean arterial pressure model predicted MAP with a mean error of 8.5 (7.8)%.

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The cardiovascular system is composed of the hemodynamical system and the central nervous system (CNS) control. Whereas the structure and functioning of the hemodynamical system are well known and a number of quantitative models have already been developed that capture the behavior of the hemodynamical system fairly accurately, the CNS control is, at present, still not completely understood and no good deductive models exist that are able to describe the CNS control from physical and physiological principles. The use of qualitative methodologies may offer an interesting alternative to quantitative modeling approaches for inductively capturing the behavior of the CNS control. In this paper, a qualitative model of the CNS control of the cardiovascular system is developed by means of the fuzzy inductive reasoning (FIR) methodology. FIR is a fairly new modeling technique that is based on the general system problem solving (GSPS) methodology developed by G.J. Klir (Architecture of Systems Problem Solving, Plenum Press, New York, 1985). Previous investigations have demonstrated the applicability of this approach to modeling and simulating systems, the structure of which is partially or totally unknown. In this paper, five separate controller models for different control actuations are described that have been identified independently using the FIR methodology. Then the loop between the hemodynamical system, modeled by means of differential equations, and the CNS control, modeled in terms of five FIR models, is closed, in order to study the behavior of the cardiovascular system as a whole. The model described in this paper has been validated for a single patient only.

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Control of the depth of anaesthesia is a difficult undertaking. Progress has been made during recent years by use of different methodologies and monitoring systems that suggest the safe amount of an anaesthetic drug, considering the condition of an individual patient. Despite these improvements, anaesthetists still rely heavily on personal experience when suggesting the anaesthetic dosage during surgical operations. The purposes of this paper are twofold. One is a description of the design of an anaesthetic agent control system using a qualitative modelling and simulation methodology called Fuzzy Inductive Reasoning (FIR). A comparison with a system developed for the same application using a neural network approach is also presented. The second purpose is a discussion of the problem of separating system-generic from patient-specific behaviour in the context of inductive modeling using the FIR methodology. In order to be useful, the model generated by FIR should reflect upon system-generic behavioural characteristics exclusively, while suppressing patient-specific behavioural patterns. A technique based on combining knowledge obtained from different patients is designed that makes it possible to derive a single model characterizing a specific class of similar patients undergoing similar operations, preserving the common characteristics of all these patients while filtering out the specific behavioural patterns of any one of the individual patients from whom the data were obtained.

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OBJECTIVES: 1) To make an integrated evaluation of the cognitive status, functional capacity, chronic disorders and social situation of the over-75 age group. 2) To find this group's self-perception of their health. DESIGN: A descriptive crossover study. SETTING: The Gòtic Health District in Barcelona. PARTICIPANTS: 316 people were included in the study. They were chosen by simple randomised sampling from the over-75s seen at the centre (n = 1,625). MEASUREMENTS AND MAIN RESULTS: To assess cognitive status, the Pfeiffer Short Portable Mental Status Questionnaire was used; for functional capacity, the Katz Index; and for chronic disorders, the medical records were reviewed. A questionnaire was used to find patients' social situation and assessed social relationships, social resources used and architectonic barriers. Self-perception of health status was evaluated using the Nottingham Health Profile. Prevalence of cognitive deterioration was 29.7%. 39.4% of patients were dependent in one or more basic activities of their daily life. 90.8% had a chronic disorder, the most frequent being AHT, arthrosis, obesity and dyslipemias. 28.3% lived alone and 26.7% used social services. CONCLUSIONS: We think this kind of assessment is useful in primary care. It would provide an integrated diagnosis (clinical, functional, medical and social) of elderly patients.

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