Comparing extracorporeal shock wave lithotripsy and ureteroscopy laser lithotripsy for treatment of urinary stones smaller than 2 cm: a cost‑utility analysis in the Spanish clinical setting

Purpose To analyze the efciency and cost-utility profle of ureteroscopy versus shock wave lithotripsy for treatment of reno-ureteral stones smaller than 2 cm. Methods Patients treated for urinary stones smaller than 2 cm were included in this study (n=750) and divided into two groups based on technique of treatment. To assess the cost-utility profle a sample of 48 patients (50% of each group) was evaluated. Quality of life survey (Euroqol 5QD-3L) before-after treatment was applied, Markov model was designed to calculate quality of life in each status of the patients (stone or stone-free with and without double-J stent) and to estimate the incremental cost-utility. Monte carlo simulation was conducted for a probabilistic sensitivity analysis. Chi-square was used for comparing qualitative variables and T student's for continuous variables. Results Shock wave lithotripsy group had 408 (54.4%) and ureteroscopy group had 342 (45.6%) patients. Of them, 56.3% were treated for renal stones and 43.7% for ureteral stones. Ureteroscopy produced slightly higher overall quality of patients' life, but produced a signifcant higher overall cost per quality-adjusted life year (QALY) than shock wave lithotripsy, exceeding the cost-utility threshold (20,000 /QALY). Sensitivity analysis confrmed results in 93.65% of cases. Diference was maintained in subgroup analysis (ureteral vs renal stones). Conclusions Results suggest that in our clinical setting shock wave lithotripsy has better cost-utility profle than ureteroscopy for treatment of reno-ureteral stones less than 2 cm, but excluding waiting times, in ideal clinical setting, ureteroscopy would have better cost-utility profle than shock wave lithotripsy

Reduction of ureteral stent encrustation by modulating the urine pH and inhibiting the crystal film with a new oral composition: a multicenter, placebo controlled, double blind, randomized clinical trial

Background: Encrustation of ureteral double J stents is a common complication that may affect its removal. The aim of the proposed study is to evaluate the efficacy and safety of a new oral composition to prevent double J stent encrustation in indwelling times up to 8 weeks. Methods: A double-blinded, multicenter, placebo-controlled trial was conducted with 105 patients with indwelling double J stents enrolled across 9 public hospitals in Spain. The patients were randomly assigned (1:1) into intervention (53 patients) or placebo (52 patients) groups for 3 to 8 weeks and both groups self-monitored daily their morning urine pH levels. The primary outcome of analysis was the degree of stent ends encrustation, defined by a 4-point score (0 - none; 3 - global encrustation) using macroscopic and electron microscopy analysis of crystals, after 3 to 8-w indwelling period. Score was exponentially transformed according to calcium levels. Secondary endpoints included urine pH decrease, stent removal, and incidence of adverse events. Results: The intervention group benefits from a lower global encrustation rate of stent ends than placebo group (1% vs 8.2%; p < 0.018). Mean encrustation score was 85.12 (274.5) in the placebo group and 18.91 (102.27) in the intervention group (p < 0.025). Considering the secondary end points, treated patients reported greater urine pH decreases (p = 0.002). No differences in the incidence of adverse events were identified between the groups. Conclusions: Our data suggest that the use of this new oral composition is beneficial in the context of ureteral double J indwelling by decreasing mean, as well as global encrustation

Aplicación de un dispositivo wearable en la medida de la huella de carbono personal

[ES] Este trabajo tiene como objetivo el desarrollo y validación de un sistema que permita cuantificar la huella de carbono individual. La metodología propuesta se basa en la detección del medio de transporte, haciendo uso de los datos proporcionados por un dispositivo wearable, para calcular la huella de carbono que un desplazamiento en ese medio genera. Para ello, el dispositivo se conecta mediante Bluetooth Low Energy a una aplicación móvil que permite la captura y exportación de datos, los cuales son analizados en un ordenador. En primer lugar, se explican conceptos relacionados con la huella de carbono y se contextualiza la situación ambiental actual. A continuación, se realiza un análisis de las tecnologías disponibles actualmente, eligiendo las más idóneas para el proyecto. Posteriormente, se explica el funcionamiento de cada una de las partes que componen la aplicación móvil. Asimismo, se explica el proceso seguido para el entrenamiento, mediante técnicas de machine learning, de los modelos que clasifican los datos capturados y la metodología empleada para estimar la huella de carbono. Finalmente, se exponen los resultados obtenidos tanto para la aplicación móvil como para los modelos entrenados. De los modelos entrenados se concluye que, al aumentar el número de medios de transporte a diferenciar, peores rendimientos se obtienen.[EN] The objective of this project is to develop and validate a system that allows to quantify the individual carbon footprint. The proposed methodology is based on the detection of the means of transport, using the data provided by a wearable device, to calculate the carbon footprint that a journey in that means of transport produces. In order to do this, the device is connected via Bluetooth Low Energy to an app that allows to capture and export data, which are analyzed on a computer. First, concepts related to the carbon footprint and the current environmental context are introduced. Next, an analysis of the current available technologies is carried out, choosing the most suitable ones for the project. Afterwards, the working of each of the parts that make up the mobile application is explained. It is also explained the process followed for the training, by means of machine learning techniques, of the models that classify the captured data and the used methodology for estimating the carbon footprint. Finally, the results obtained for both the app and the trained models are introduced. From the trained models, it is possible to conclude that the higher the number of means of transport to classify, the worse the performances of the models.Budía García, A. (2021). Aplicación de un dispositivo wearable en la medida de la huella de carbono personal. Universitat Politècnica de València. http://hdl.handle.net/10251/171475TFG

Kidney Transplant: Survival Analysis and Prognostic Factors after 10 Years of Follow-Up

The aim of this work is to analyse recipient and graft survival after kidney transplant in a three-year cohort and to identify predictive factors with up to 10 years of follow-up. Methods: retrospective consecutive cohort study of 250 kidney transplant recipients operated between 2010 and 2012. Multiorganic transplants and both dead-donor and living-donor transplants were included. Data were collected from electronic health records. A survival analysis was conducted using the Kaplan-Meier method and a Cox proportional-hazards multivariate model. Results: mean follow-up was 8.1 ± 3.2 years. Graft survival at 2, 5 and 10 years was 89.0%, 85.1% and 78.4% respectively. The multivariate model identified the following risk factors for graft loss: diabetic nephropathy (HR 3.2 CI95% [1.1–9.4]), delayed graft function (3.8 [2.0–7.4]), chronic kidney rejection (3.7 [1.2–11.4]), and early surgical complications (2.6 [1.4–5.1]). Conversely, combined transplant was found to be a protective factor for graft loss (0.1 [0.0–0.5]). Recipient patient survival was 94.3%, 90.0% and 76.6% at 2, 5 and 10 years respectively. The model identified the following mortality risk factors: older recipient age (1.1 [1.1–1.2]), combined transplant (7.6 [1.7–34.5]) and opportunistic infections (2.6 [1.3–5.0]). Conclusions: 10-year recipient and graft survival were 76.6% and 78.4% respectively. Main mortality risk factors were older recipient age, opportunistic infections and multiorganic transplant. Main graft loss risk factors were diabetic nephropathy, delayed graft function, chronic kidney rejection and early surgical complications

Reduction of ureteral stent encrustation by modulating the urine pH and inhibiting the crystal film with a new oral composition: a multicenter, placebo controlled, double blind, randomized clinical trial.

Encrustation of ureteral double J stents is a common complication that may affect its removal. The aim of the proposed study is to evaluate the efficacy and safety of a new oral composition to prevent double J stent encrustation in indwelling times up to 8 weeks. A double-blinded, multicenter, placebo-controlled trial was conducted with 105 patients with indwelling double J stents enrolled across 9 public hospitals in Spain. The patients were randomly assigned (1:1) into intervention (53 patients) or placebo (52 patients) groups for 3 to 8 weeks and both groups self-monitored daily their morning urine pH levels. The primary outcome of analysis was the degree of stent ends encrustation, defined by a 4-point score (0 - none; 3 - global encrustation) using macroscopic and electron microscopy analysis of crystals, after 3 to 8-w indwelling period. Score was exponentially transformed according to calcium levels. Secondary endpoints included urine pH decrease, stent removal, and incidence of adverse events. The intervention group benefits from a lower global encrustation rate of stent ends than placebo group (1% vs 8.2%; p  Our data suggest that the use of this new oral composition is beneficial in the context of ureteral double J indwelling by decreasing mean, as well as global encrustation. This trial was registered at www.clinicaltrials.gov under the name "Combined Use of a Medical Device and a Dietary Complement in Patient Urinary pH Control in Patients With an Implanted Double J Stent" with date 2nd November 2017, code NCT03343275, and URL