Design and Validation of a Non-biological 3D Printed Pelvocalyceal System (RIRS Box) for Simulation-based Training of Flexible Ureteroscopy: A Stage 2A Surgical Innovation Study

@#In the field of Urology, flexible ureterorenoscopy (fURS) remains a challenging skill for junior residents to develop due to its steep learning curve. Hence, training models were incorporated into simulation-based training to allow for novice trainees to overcome the learning curve without potentially compromising patient outcomes and minimize complications. OBJECTIVE: To describe the design and test the validity of a non-biological three-dimensional (3D) model of the pelvocalyceal system as a tool for simulation-based training for flexible ureterorenoscopy METHODS: This was a prospective, quasi-experimental, surgical innovation research stage 2a study conducted in a tertiary government hospital. The retrograde intrarenal surgery (RIRS) box was composed of four siliconized pelvocalyceal systems which were 3D printed using computed tomography urograms of actual patients. Thirty-two urologists were asked to perform flexible ureteroscopy using the RIRS box and were given a questionnaire to assess face and content validity using the Likert scale. RESULTS: The RIRS Box training model showed good face and content validity. The 3D printed pelvocalyceal system was judged to have a close anatomical resemblance to an actual calyceal system. While performing fURS, the RIRS box provided similar pelvocalyceal visualization and instrument handling as in an actual procedure. Majority of participants considered the training model useful for training (75%) and believed that it may improve the RIRS technique (46.8%). CONCLUSION: The RIRS Box training model may help urologists improve the manner in which they acquire technical knowledge and skills necessary in performing fURS.

Design and validation of a non-biological 3D printed pelvocalyceal system (RIRS BOX) for simulation-based training of flexible ureteroscopy: A stage 2A surgical innovation study

@#In the field of Urology, flexible ureterorenoscopy (fURS) remains a challenging skill for junior residents to develop due to its steep learning curve. Hence, training models were incorporated into simulation-based training to allow for novice trainees to overcome the learning curve without potentially compromising patient outcomes and minimize complications.@*OBJECTIVE@#To describe the design and test the validity of a non-biological three-dimensional (3D) model of the pelvocalyceal system as a tool for simulation-based training for flexible ureterorenoscopy.@*METHODS@#This was a prospective, quasi-experimental, surgical innovation research stage 2a study conducted in a tertiary government hospital. The retrograde intrarenal surgery (RIRS) box was composed of four siliconized pelvocalyceal systems which were 3D printed using computed tomography urograms of actual patients. Thirty-two urologists were asked to perform flexible ureteroscopy using the RIRS box and were given a questionnaire to assess face and content validity using the Likert scale.@*RESULTS@#The RIRS Box training model showed good face and content validity. The 3D printed pelvocalyceal system was judged to have a close anatomical resemblance to an actual calyceal system. While performing fURS, the RIRS box provided similar pelvocalyceal visualization and instrument handling as in an actual procedure. Majority of participants considered the training model useful for training (75%) and believed that it may improve the RIRS technique (46.8%).@*CONCLUSION@#The RIRS Box training model may help urologists improve the manner in which they acquire technical knowledge and skills necessary in performing fURS.

Viabilidade da técnica de transposição uretral pré-púbica mediante secção peniana em cadáveres de cães / Viability of the prepubic urethral transposition technique by penile section in dog cadavers

Descreve-se a viabilidade da técnica cirúrgica de transposição uretral pré-púbica em cadáveres de cães machos, adultos, advindos de um hospital veterinário, a fim de se avaliar a manutenção da luz uretral a partir de um desvio uretral pré-púbico, descrevendo-se detalhadamente a abordagem e as estruturas anatômicas envolvidas. A técnica consistiu inicialmente da orquiectomia, seguida de celiotomia retroumbilical, tração vesical cranial, secção transversa da uretra membranosa a 1cm caudal à próstata, espatulação e reparo da borda livre. A seguir, divulsão e secção do pênis 1,5cm caudal ao osso peniano, espatulação da borda uretral peniana e transposição desta em direção à cavidade abdominal, fazendo-se anastomose por meio de sutura interrompida simples à uretra membranosa. Foi mensurado o comprimento uretral desde o meato externo até o início da uretra prostática em dois momentos: pré e pós-transposição. Ao final, avaliou-se, por meio de uretrografia retrógrada de contraste positivo, o diâmetro e o selamento na anastomose uretral e o fluxo do contraste até a bexiga. A transposição uretral pré-púbica é uma técnica cirúrgica exequível, anatomicamente compatível com a espécie canina e capaz de manter o diâmetro uretral e o fluxo do contraste de forma satisfatória, com manutenção estética externa idêntica a um cão macho orquiectomizado.(AU)

We describe the viability of the surgical technique of pre-pubic urethral transposition in cadavers of adult male dogs, coming from a veterinary hospital to evaluate the maintenance of urethral light from a prepubic urethral deviation, describing in detail the approach and anatomical structures involved. The technique consisted initially of orchiectomy, followed by retroumbilical celiotomy, cranial vesical traction, transverse section of the membranous urethra at 1cm caudal to prostate, spatulation and free edge repair. Next, the penis divulsion and section 1.5cm caudal to the penile bone, spreading the penile urethral border and transposing it towards the abdominal cavity, making an anastomosis of simple interrupted suture to the membranous urethra. The dogs had the urethral length measured from the external meatus to the beginning of the prostatic urethra at two moments: pre-transposition and post-transposition. Postoperative retrograde urethrography was used to evaluate the diameter and sealing of the urethral anastomosis and contrast flow to the bladder. In conclusion, the prepubic urethral transposition is a feasible surgical technique, anatomically compatible with the canine species and able to maintain the urethral diameter and contrast flow satisfactorily, with an external esthetic maintenance identical to an orchiectomized male dog.(AU)

Vivências educativas na idade adulta madura: uma abordagem bioecológica / The educational experience for adults of eja: one ecological approach / La experiencia educativa para los adultos de eja: un enfoque bioecológica

Esta pesquisa teve por objetivo compreender os sentidos que os estudantes adultos maduros atribuíram à retomada da educação formal na educação de jovens e adultos (EJA) e as suas percepções sobre as mudanças decorrentes desse percurso educativo. Utilizou o método de estudo de caso coletivo, tendo como sujeitos quatro adultos, masculinos, com mais de 45 anos. Realizaram-se entrevista semiestruturada e construção da linha do tempo da história escolar de cada sujeito, além de observações em sala de aula e análise do projeto político-pedagógico da escola para a EJA. As informações foram submetidas à análise textual discursiva, dialogando com os estudos de Urie Bronfenbrenner e Peter Jarvis. Os resultados apontaram para a emergência de duas categorias reveladoras dos sentidos atribuídos à vivência educativa na EJA, refletindo mudanças cognitivas, comportamentais, psicossociais e de hábitos de vida dos entrevistados. Essa produção de sentidos foi mediada por intercomunicações constantes entre micro, meso, exo e macrossistema, representadas pelas relações recíprocas e o apoio social e afetivo na retomada do processo de educação formal. A perspectiva teórica adotada pretendeu trazer um novo viés na forma de abordar o educando adulto da EJA, destacando, numa abordagem sistêmica do desenvolvimento, o empoderamento individual e coletivo por meio das relações educativas assim como as potencialidades do ato educativo para os adultos maduros.

The aim of this study is to understand the meaning that mature adult students ascribed to their return to formal education at the Youth and Adult Education (EJA) and their perception of the changes arising from this educational path. The method selected was the collective case study and the subjects were four male individuals over 45 years old. Semi-structured interviews were carried out along with the creation of a timeline of educational history of each student, classroom observations and analysis of the school's Political Pedagogical Project for EJA. The information collected was submitted to Textual Analysis of Discourse, articulating studies of Urie Bronfenbrenner and Peter Jarvis. The results indicated the emergence of two categories that revealed the meanings attributed to the respondents' educational experiences at EJA, reflecting cognitive, behavioral, psychosocial and living habits changes. This production of meanings was mediated by constant intercom among micro, meso, exo, and macrosystems represented by reciprocal relationships and the social and affective support in the return to formal education. The theoretical perspective taken intended to present a new approach to EJA adult students, through a systematic approach for the development, emphasizing the individual and collective empowerment by means of the educational relationships as well as the potential of the educational act for mature adults.

Esta investigación tuvo como objetivo comprender los significados que los alumnos adultos maduros han atribuido a la reanudación de la educación formal en la educación de jóvenes y adultos (EJA) y sus percepciones sobre los cambios resultantes de este proceso educativo. Hemos utilizado el método de estudio de caso colectivo, teniendo como sujetos cuatro adultos, masculinos, con más de 45 años. Se realizaron entrevistas parcialmente estructuradas y la construcción de la línea de tiempo de la historia escolar de cada sujeto, así como observaciones en clase y el análisis de los Proyectos Políticos y Pedagógicos de la escuela para adultos. Las informaciones han sido sometidas al Análisis del Discurso Textual, dialogando con los estudios de Urie Bronfenbrenner y Peter Jarvis. Los resultados señalaron la aparición de dos categorías, revelando los significados atribuidos a la experiencia de la educación en la EJA, reflejando los cambios cognitivos, conductuales, psicosociales y los hábitos del estilo de vida de los encuestados. Esta producción de sentidos era influenciada por las intercomunicaciones constantes, entre micro, meso y exo-y macrosistema, representados por las relaciones recíprocas y el apoyo social y afectivo en la reanudación del proceso de educación formal. La perspectiva teórica adoptada desea traer una nueva visión a la forma de abordar al estudiante adulto de EJA, destacando, en un enfoque sistémico para el desarrollo, la potenciación individual y colectivamente por medio de relaciones educativas, así como el potencial del acto educativo para los adultos maduros.

Evaluación de la actividad biológica de extractos de semillas de Crotalaria pallida (cascabelito) sobre el modelo Drosophila melanogaster / Evaluation of the biological activity of extracts from Crotalaria pallida (streaked rattlepod) seeds using the Drosophila melanogaster model

Introducción: la búsqueda de metabolitos de origen natural, con actividad biológica promisoria, particularmente la actividad insecticida, es un blanco interesante en las investigaciones sobre productos naturales. Objetivos: evaluar la bioactividad de extractos de diferente polaridad de semillas de Crotalaria pallida Aiton sobre el modelo biológico Drosophila melanogaster. Métodos: la bioactividad de los extractos de diferente polaridad de semillas secas de C. pallida se evalúo por ingestión en el modelo biológico; permitiendo purificar y determinar la estructura química del principio activo usando RMN. Resultados: la bioactividad expresada resultó de dos tipos; uno causó la inhibición de los estados larvarios, evidenciada con la disminución del número de pupas de los tratamientos con respecto a los controles no tratados, la relación dosis-respuesta permitió calcular una CI 50 de 156,47 ppm; el otro efecto inhibió el paso pupa-adulto, disminuyendo el número de adultos de los tratamientos frente a los controles, estableciéndose una CI50 de 7,95 ppm. Con el uso de diferentes ensayos de RMN se determinó el alcaloide usaramina como responsable de esta actividad biológica. Conclusiones : la bioactividad de los extractos de polaridad media/baja permitió el aislamiento de un metabolito con actividad insecticida promisoria, manifestada con la inhibición del normal desarrollo del ciclo de vida de D. melanogaster, el extracto no exhibe actividad sobre la oviposición, en el intervalo de concentraciones evaluado; a bajas concentraciones inhibe la eclosión de pupas y a altas concentraciones afecta el desarrollo de las larvas; actividades que se mantienen al probar el metabolito purificado.

Introduction: the search for metabolites of natural origin with promising biological -particularly insecticidal- activity, is an interesting target for research about natural products. Objectives: evaluate the bioactivity of extracts of varying polarity from Crotalaria pallida Aiton seeds using the Drosophila melanogaster biological model. Methods: an evaluation was conducted of the bioactivity of extracts of varying polarity from dry C. pallida seeds by ingestion into the biological model, with the purpose of purifying and determining the chemical structure of the active principle through NMR spectroscopy. Results: two types of bioactivity were expressed. One caused inhibition of larval stages, evidenced in a smaller number of pupae in treatment controls with respect to non-treatment controls. The dose-response relationship allowed estimation of a CI50 of 156.47 ppm. The other effect inhibited progress from pupa to adult, reducing the number of adults in the treatment vs. control groups, with an CI50 of 7.95 ppm. With the use of various NMR assays, it was determined that the alkaloid usaramine was responsible for this biological activity. Conclusions: the bioactivity of extracts of medium / low polarity permitted the isolation of a metabolite with promising insecticidal activity, manifested in the inhibition of the normal development of the life cycle of D. melanogaster. The extract does not show any activity on oviposition in the concentration range studied. At low concentrations it inhibits the eclosion of pupae, whereas at high concentrations it affects larval development. Both activities remained when the purified metabolite was tested.

Friction of calcium phosphate brackets to stainless steel wire / 대한치과교정학회지

OBJECTIVE: Esthetic brackets which resemble the color of natural teeth have been widely used. But the frictional resistance of ceramic brackets, a typical esthetic bracket, is greater than that of metal brackets. The purpose of this study was to measure the frictional resistance of the new calcium phosphate brackets (CPB) which were recently developed and to evaluate its clinical usability by comparing the frictional differences of CPB with metal brackets and metal slot inserted ceramic brackets. METHODS: Experimental groups were CPB (Hyaline II, Tomy, Tokyo, Japan), metal bracket (Kosaka, Tomy, Tokyo, Japan) and metal slot inserted ceramic bracket (Clarity, 3M Unitek, Monrovia, CA, USA). All of the brackets had 0.022-inch slot sizes. The brackets were tested with 0.019 x 0.025 inch stainless steel wire (3M Unitek, Monrovia, CA, USA). A biologic model was used to simulate the situation which would occur during orthodontic treatment with fixed appliances. Retraction force was applied at a speed of 5 mm/min for 30 seconds. The frictional resistance was measured on a universal testing machine (Instron 4467, Instron, Norwood, MA, USA). RESULTS: CPB showed significantly higher friction than metal brackets (p < 0.05) and lower friction than metal slot inserted ceramic brackets (p < 0.01). CONCLUSIONS: CPB can be considered to be a useful orthodontic esthetic bracket with respect to frictional resistance, as its friction is remarkably lower than that of metal slot inserted ceramic brackets.