Background: The objective of this study is to investigate the influence of male age on human fertility, defined as the birth rate for a given population. Methods: Data from the Spanish National Statistics Institute (INE) for the year 2004 from a total of 454,753 newborn infants and sorted by male and female age groups were evaluated. In order to correct the influence of female age-related fertility, a different analysis was performed considering only women under 30 years of age. Results: From a demographic point of view, male fertility started to decline at 35–39 years of age. This decline is constant and follows an exponential pattern (slope –0.11 to –0.12). The trend persisted when the data were adjusted for every 1,000 men in the age group, as well as when only women under the age of 30 were considered. Male fertility showed a 21–23% annual decrease starting at the age of 39. Conclusion: An exponential decrease in human fertility which is independent of the woman’s age was observed with male aging. This decay is probably due to a downfall in male fecundity, closely related to a decline in sperm quality. However, social or behavioral causes for this trend cannot be excluded.
Introduction. The various surgical specialties in our center have used the simulation and experimental surgery resources available for their training tasks in minimally invasive surgery (MIS) in an individualized manner. With this learning model, a great dispersion of effort and expense was observed, so it was decided to create a unified program based on the following: shared learning, synergy among specialties, moderation of the economic cost, and rational use of the facilities.Objective. To describe and assess our consensually designed training program in order to consolidate a shared learning strategy that will enable our residents to acquire and perfect surgical skills in MIS.Materials and methods. The program consists of various increasingly complex phases implemented on a continuous basis throughout the period of specialized training in the virtual laboratory and experimental operating room. The assessment methods were based on quantifiable criteria: percentage of efficiency and completion time of the "McGill Inanimate System for Training and Evaluation of Laparoscopic Skills" (MISTELS) exercises at the beginning and end of the program. An economic study was also conducted.Results. 20 residents have completed the program. Mean times show a significant reduction in each of the exercises. The efficiency percentages at the end of the program were higher than at the beginning (p < 0.001). The cost of the program represented a saving of 67.89%.
Conclusion.The new MIS training program improved the quality of learning in a safe environment, establishing common criteria among the different specialties and an improved use of resources.
Aims: Laparoscopic cholecystectomy has been set as the 'gold standard' treatment for cholelithiasis, but unfortunately, it has also been associated with a higher incidence of iatrogenic lesions of the biliary tract (0.36%e0.47%). Although lesions repair must be preferably done at the same surgical time, this is not always possible because of its late diagnosis, and the fact that an expert surgeon is not always available. The goal of this study is to describe the features and results of the delayed surgical repair of the complete biliary tract sections (CBTS) (Strasberg E) at a reference center. Methods: A retrospective study was conducted with all patients presenting CBTS between January 2000 and April 2014 and followed up until November 2014. Patients with immediate intraoperative repair or those repaired in other centers were excluded. Biliary tract injuries were described according to the Bismuth-Strasberg, Hanover and the new ATOM classifications. Complications were defined following the Dindo-Clavien classification. Results: Twenty four patients were included in the study with a median follow up of 632 days (Range 180e4496). Preoperative angioCT was performed in all cases and MRI in 91.7%.An hepaticojejunostomy was performed in all cases associated with liver resection in 3 cases. Surgical morbidity rate was 50%, but 69.2% of them were mild (
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