Puigvert Foundation

Posterior urethral valves are the leading cause of congenital bladder outlet obstruction in boys and can result in long-term lower urinary tract dysfunction and reduced quality of life. Sexual and reproductive consequences in this population are poorly described and understood. The purpose of this systematic review (SR) was to assess the long-term sexual functions and fertility outcomes in patients treated in the pediatric age for posterior urethral valve (PUV). A SR was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, Embase, and Scopus were searched for studies reporting sexual or reproductive outcomes in individuals with a history of PUV. The primary outcomes were prevalence and nature of sexual dysfunctions and fertility issues. Risk of bias was assessed using ROBINS-I or the Newcastle-Ottawa Scale, as appropriate. Eleven studies (2 non-randomized comparative studies and 9 case series) including 2723 individuals met the inclusion criteria. Most patients exhibited preserved erectile function, ejaculatory function was variably reported with most individuals described normal ejaculation. Semen analysis, reported in 7 studies, revealed normal parameters in approximately half of the cohorts, though abnormalities were noted in patients with renal impairment or complex urological histories. Paternity rates varied widely (6%-58%) and were lower in individuals with renal dysfunction or urinary incontinence. Only one study used validated tools to assess quality of life, showing negative impact in domains related to continence and renal status. Most males treated for PUV during childhood reach adulthood with preserved sexual and reproductive potential. Given the heterogeneity and methodological limitations of the current literature, prospective studies using standardized outcome measures are needed to better define long-term risks and inform clinical follow-up.

Work-related musculoskeletal disorders are a growing concern in surgical practice, particularly in the context of robot-assisted surgery. Physical strain can significantly impact the well-being and performance of surgeons and surgical staff. This study aimed to evaluate the prevalence and severity of surgical strain among urologists using different available surgical platforms. An anonymized, web-based survey was conducted between March and October 2024 using the REDCap platform. Distributed via professional networks and social media, the survey collected data on demographics, surgical experience, platform usage, and self-reported physical discomfort. Statistical analysis included Mann-Whitney U and Chi-squared tests, with P<0.05 considered significant. A total of 427 urologists participated. Most console surgeons (up to 83% for one robotic system variant) reported some level of physical discomfort. Discomfort was also reported by 83% of open surgeons and 80% of bedside assistants, the latter of whom had the highest incidence of injury (53%) from robotic arms. A noteworthy subset of survey respondents required physiotherapy (13-15%), medical (6-11%), or surgical (2-3.8%) interventions due to physical strain. No significant differences were observed by age or sex among console users. Ergonomic strain is prevalent among urologic surgeons, regardless of surgical platform, with bedside assistants particularly vulnerable. These findings underscore the need for ergonomic training, physical conditioning, and design improvements in surgical systems to safeguard surgeon health and maintain procedural efficacy.

Kidney diseases are among the fastest-growing global health burdens, with chronic kidney disease (CKD) projected to become the third leading cause of death by 2050. Despite this, therapeutic innovation remains limited: no European Medicines Agency (EMA)-approved treatment exists for acute kidney injury (AKI), and no drugs have demonstrated survival benefits in patients on dialysis. Randomised controlled clinical trials (RCTs), although pivotal for advancing care, face persistent challenges in nephrology, including patient heterogeneity, multimorbidity, high dropout rates, and small populations in rare diseases. In Europe, these intrinsic obstacles are compounded by fragmented implementation of the Clinical Trials Regulation (536/2014), excessive safety reporting demands, and lack of nephrology-specific guidance, discouraging academic-led initiatives and limiting pragmatic research. The Coalition for Reducing Bureaucracy in Clinical Trials, a broad alliance of medical societies and patient advocates, has recently published the 'Clinical research in Europe: putting quality and patient safety first' recommendations calling for regulatory harmonisation, simplified safety reporting, and patient-centred consent. The European Renal Association (ERA), a member of the Coalition and contributor to the report, fully supports these recommendations. Implementing such measures is critical to fostering efficient, high-quality nephrology trials in Europe and delivering urgently needed, evidence-based, life-saving and safe therapies for patients with kidney disease.

Endothelial dysfunction is central to COVID-19 pathophysiology, contributing to vascular complications and disease progression. However, the mechanisms driving disease evolution and response to endothelial-targeted therapies remain unclear. This study characterizes endothelial activation throughout the course of acute COVID-19 and evaluates the response to potential therapeutic agents.Serum samples from patients admitted due to moderate to severe COVID-19 pneumonia were prospectively collected on three study time points (+1 day, +4 days and +10 days). Human microvascular endothelial cells were cultured in medium supplemented with pooled serum within the same disease stage, with or without defibrotide, apixaban, or tocilizumab. Endothelial activation was assessed by immunofluorescence and quantitative mRNA expression of adhesion molecules, extracellular matrix (ECM) proteins, and innate immunity receptors. ECM reactivity was evaluated using a platelet adhesion assay. Intracellular signaling pathways were analyzed by immunoblotting.One-hundred and two patients were included. Compared to healthy donor plasma, patient plasma induced upregulation of Vascular cell adhesion molecule-1, Toll-like receptor 4, and von Willebrand factor in endothelial cells. This effect decreased over admission days and in response to drugs. Similarly, ECM reactivity was highest at admission and declined as the disease progressed. Vascular-endothelial cadherin was mildly downregulated, but its expression was unaffected by drug treatment in vitro. Defibrotide mitigated COVID-19 serum induced p38MAPK and Erk activation but enhanced Akt phosphorylation.Serum from severe COVID-19 patients induces a proinflammatory and prothrombotic endothelial phenotype, which can be modulated by endothelial-targeted therapies. These findings support the potential clinical value of endothelial-directed treatments.

Background/objective: The palmaris longus muscle is a variable and often inconsistent muscle in the anterior compartment of the forearm. This fusiform-shaped muscle originates at the medial epicondyle of the humerus bone following a long and narrow tendon that inserts at the palmar aponeurosis. That tendon is used in reconstructive surgery, and for this reason, detailed information from an ultrasound is used to detect the tendon and the possible variations in the muscle. The present study aimed to investigate the palmaris longus muscle and its variations through ultrasound, anatomical, and histological analysis with clinical and surgical applications. Methods: A total of 72 upper limbs from 33 females and 39 males, 32 right and 40 left, were evaluated in ultrasound, anatomical, and histological studies. The main objective was to prove the existence of the palmaris longus muscle and its variations, as well as to measure the tendon for surgical applications. Results: Ultrasound analysis showed that it is possible to determine the existence of the muscle (76.4%) and its variations (23.6%), as well as its absence (15.3%). The anatomical results proved the ultrasound results. The width of the tendon was between 0.4 and 0.38 mm. by ultrasound and anatomical analysis. Also, normal palmaris longus tendons were not a direct cause of compression of the median nerve. Conclusions: It is important to confirm the existence and possible variations in the palmaris longus muscle and tendon through ultrasound before surgical reconstruction and for clinical diagnostics.

Chronic renal disease has been associated with an increase in cardiovascular morbidity and mortality. It is currently a very frequent disorder in which calcium and phosphate metabolism and myocardial hypertrophy play an outstanding role, and it constitutes an independent risk factor for cardiovascular disease. Previous clinical studies have demonstrated the consequences of the alteration in renal function on the increase of cardiovascular risk. Patients with moderate to severe renal chronic disease have an exponential increase in cardiovascular mortality, even before developing renal failure. The present study summarizes the information of basic research on the cardio-renal axis, and establishes the need of animal models to study the factors interrelated with this axis.

Osteoporosis and fragility fractures are among the most prevalent and clinically significant complications in patients with chronic kidney disease (CKD), particularly in stages G4-G5 and in those undergoing dialysis (G5D). These skeletal disorders are associated with markedly increased morbidity and mortality, including a 2- to 9-fold higher risk of hip fractures compared to the general population, prolonged hospitalization, functional decline, and excess postoperative mortality. Despite this substantial burden, CKD-associated osteoporosis remains underrecognized and undertreated. Limited inclusion of CKD patients in pivotal osteoporosis trials and the absence of high-evidence guidance in clinical guidelines have contributed to a persistent therapeutic gap. PTH analog agents such as teriparatide and abaloparatide have demonstrated robust efficacy in increasing bone mass and reducing fracture risk in the general population. However, their use in CKD remains limited. PTH analog are poorly prescribed in patients with CKD stage G3 and remain off-label for stages G4-G5D, despite the high prevalence of adynamic bone disease across all stages of CKD. Abaloparatide, a selective PTH1 receptor agonist, exerts potent anabolic effects with a lower incidence of hypercalcemia than teriparatide and may offer a favourable safety profile in carefully selected patients. Preliminary data suggest preservation of bone microarchitecture and potential benefits in low-turnover bone disease, although evidence in CKD is still limited. This narrative review examines current evidence on abaloparatide's potential role in CKD, emphasizing its mechanism of action, efficacy, safety, and relevance for patients with low bone turnover and high fracture risk.

Minimizar las pérdidas y el desperdicio alimentario en la cadena agroalimentaria es un reto clave en las políticas europeas y los Objetivos de Desarrollo Sostenible. La falta de registros oficiales y datos fiables dificulta que se realicen actuaciones eficaces. Este artículo propone una metodología basada en los códigos CNAE agilizando el diagnóstico del problema en un territorio y muestra su aplicación en la Comunitat Valenciana (España). La metodología mejora las directrices de la UE sobre medición del desperdicio alimentario, facilita su replicabilidad en otras regiones y ofrece recomendaciones para que los territorios diseñen agendas que prevengan y reduzcan estas pérdidas.