Long term outcomes of one-stage augmentation anterior urethroplasty: a systematic review and meta-analysis

ABSTRACT Objective: The objective is to summarize and characterize the long-term success of anterior augmentation urethroplasty in published series. The current literature on AU consists largely of retrospective series reporting intermediate follow-up and incompletely characterize the long term outcomes of AU. Materials and Methods: A systematic literature review was performed consistent with PRISMA guidelines to characterize long-term outcomes of AU with a minimum upper limit follow-up of 100 months. Penile/preputial skin flaps and graft and oral mucosal graft urethroplasties were included. The primary outcome was stricture-free survival for one-stage AU. Secondary analysis evaluated differences in outcomes based on two failure definitions: the need for intervention versus presence of recurrent stricture on cystoscopy or urethrography. Hazard rates were induced from the reported failure rates of one-stage AU and fixed and random effect models were fitted to the data. Additional subset analysis, removing potential confounders (lichen sclerosus, hypospadias and penile skin graft), was performed. Results: Ten studies met inclusion criteria, and two studies reported separate outcomes for grafts and flaps, and thus were included separately in the analysis. The mean hazard rate across all studies was 0.0044, the corresponding survival rates at 1 year 0.948, 5 years 0.766, 10 years 0.587, and 15 years 0.45. Subset analysis of the 4 select and homogeneous studies noted 1, 5, 10, and 15 years survival rates of 0.97, 0.96, 0.74, and 0.63, respectively. Conclusions: The long-term success rates of augmentation urethroplasty are appear to be worse than previously appreciated and patients should be counseled accordingly.

Long term outcomes of one-stage augmentation anterior urethroplasty: a systematic review and meta-analysis.

OBJECTIVE: The objective is to summarize and characterize the long-term success of anterior augmentation urethroplasty (AU) in published series. The current literature on AU consists largely of retrospective series reporting intermediate follow-up and incompletely characterize the long term outcomes of AU. MATERIALS AND METHODS: A systematic literature review was performed consistent with PRISMA guidelines to characterize long-term outcomes of AU with a minimum upper limit follow-up of 100 months. Penile/preputial skin flaps and graft and oral mucosal graft urethroplasties were included. The primary outcome was stricture-free survival for one-stage AU. Secondary analysis evaluated differences in outcomes based on two failure definitions: the need for intervention versus presence of recurrent stricture on cystoscopy or urethrography. Hazard rates were induced from the reported failure rates of one-stage AU and fixed and random effect models were fitted to the data. Additional subset analysis, removing potential confounders (lichen sclerosus, hypospadias and penile skin graft), was performed. RESULTS: Ten studies met inclusion criteria, and two studies reported separate outcomes for grafts and flaps, and thus were included separately in the analysis. The mean hazard rate across all studies was 0.0044, the corresponding survival rates at 1 year 0.948, 5 years 0.766, 10 years 0.587, and 15 years 0.45. Subset analysis of the 4 select and homogeneous studies noted 1, 5, 10, and 15 years survival rates of 0.97, 0.96, 0.74, and 0.63, respectively. CONCLUSIONS: The long-term success rates of augmentation urethroplasty are appear to be worse than previously appreciated and patients should be counseled accordingly. Available at. https://www.intbrazjurol.com.br/pdf/aop/2019-0242RW.pdf.

Significant Excess of Electronlike Events in the MiniBooNE Short-Baseline Neutrino Experiment.

The MiniBooNE experiment at Fermilab reports results from an analysis of ν_{e} appearance data from 12.84×10^{20} protons on target in neutrino mode, an increase of approximately a factor of 2 over previously reported results. A ν_{e} charged-current quasielastic event excess of 381.2±85.2 events (4.5σ) is observed in the energy range 200

First Measurement of Monoenergetic Muon Neutrino Charged Current Interactions.

We report the first measurement of monoenergetic muon neutrino charged current interactions. MiniBooNE has isolated 236 MeV muon neutrino events originating from charged kaon decay at rest (K^{+}→µ^{+}ν_{µ}) at the NuMI beamline absorber. These signal ν_{µ}-carbon events are distinguished from primarily pion decay in flight ν_{µ} and ν[over ¯]_{µ} backgrounds produced at the target station and decay pipe using their arrival time and reconstructed muon energy. The significance of the signal observation is at the 3.9σ level. The muon kinetic energy, neutrino-nucleus energy transfer (ω=E_{ν}-E_{µ}), and total cross section for these events are extracted. This result is the first known-energy, weak-interaction-only probe of the nucleus to yield a measurement of ω using neutrinos, a quantity thus far only accessible through electron scattering.

Single perineal incision placement of artificial urinary sphincter with cadaveric correlation of sub-dartos pump placement

ABSTRACT Purpose We present a novel AUS implantation technique using a single perineal incision for single device placement or in combination with an inflatable penile prosthesis (IPP). Urinary and sexual dysfunction following the management of prostate cancer has a significant impact on the quality of life of our patients. While there are marginal changes in the prosthetic devices, we strive to reduce post-operative morbidity while maximizing efficacy. Materials and Methods We retrospectively reviewed the outcomes of 6 patients who underwent single perineal incision placement of a virgin AUS in 2014, 3 with simultaneous IPP placement. In all cases, the pressure regulating balloons (PRB) were placed in a high sub-muscular ectopic position and the pumps were placed into a sub-dartos pouch through the perineal incision, which was also validated using a cadaveric model. Results The mean patient age was 61 (SD, 7.5 years) with mean body mass index of 31 (SD, 5.9). The average pre-operative pad usage was 7.7 (SD 1.63) pads per day. The mean follow-up was 13.9 months (SD 9.45). Four out of the six patients reported utilizing ≤1 pad daily at follow-up. The one patient who was not initially dry required downsizing of his cuff to 3.5cm; the remaining patient was lost to follow-up. There were no identifiable perioperative or post-operative complications. Conclusions We present our initial report of using a single perineal incision for AUS implantation with a validated sub-dartos pump location, which is safe and effective for implantation of an AUS as a single or double implantation in well-selected patients.

Single perineal incision placement of artificial urinary sphincter with cadaveric correlation of sub-dartos pump placement.

PURPOSE: We present a novel AUS implantation technique using a single perineal incision for single device placement or in combination with an inflatable penile prosthesis (IPP). Urinary and sexual dysfunction following the management of prostate cancer has a significant impact on the quality of life of our patients. While there are marginal changes in the prosthetic devices, we strive to reduce post-operative morbidity while maximizing efficacy. MATERIALS AND METHODS: We retrospectively reviewed the outcomes of 6 patients who underwent single perineal incision placement of a virgin AUS in 2014, 3 with simultaneous IPP placement. In all cases, the pressure regulating balloons (PRB) were placed in a high sub-muscular ectopic position and the pumps were placed into a sub-dartos pouch through the perineal incision, which was also validated using a cadaveric model. RESULTS: The mean patient age was 61 (SD, 7.5 years) with mean body mass index of 31 (SD, 5.9). The average pre-operative pad usage was 7.7 (SD 1.63) pads per day. The mean follow-up was 13.9 months (SD 9.45). Four out of the six patients reported utilizing ≤1 pad daily at follow-up. The one patient who was not initially dry required downsizing of his cuff to 3.5cm; the remaining patient was lost to follow-up. There were no identifiable perioperative or post-operative complications. CONCLUSIONS: We present our initial report of using a single perineal incision for AUS implantation with a validated sub-dartos pump location, which is safe and effective for implantation of an AUS as a single or double implantation in well-selected patients.

Dark Matter Search in a Proton Beam Dump with MiniBooNE.

The MiniBooNE-DM Collaboration searched for vector-boson mediated production of dark matter using the Fermilab 8-GeV Booster proton beam in a dedicated run with 1.86×10^{20} protons delivered to a steel beam dump. The MiniBooNE detector, 490 m downstream, is sensitive to dark matter via elastic scattering with nucleons in the detector mineral oil. Analysis methods developed for previous MiniBooNE scattering results were employed, and several constraining data sets were simultaneously analyzed to minimize systematic errors from neutrino flux and interaction rates. No excess of events over background was observed, leading to a 90% confidence limit on the dark matter cross section parameter, Y=ε^{2}α_{D}(m_{χ}/m_{V})^{4}≲10^{-8}, for α_{D}=0.5 and for dark matter masses of 0.01

Patterns of sodium and potassium excretion and blood pressure in the African Diaspora.

Habitual levels of dietary sodium and potassium are correlated with age-related increases in blood pressure (BP) and likely have a role in this phenomenon. Although extensive published evidence exists from randomized trials, relatively few large-scale community surveys with multiple 24-h urine collections have been reported. We obtained three 24-h samples from 2704 individuals from Nigeria, Jamaica and the United States to evaluate patterns of intake and within-person relationships with BP. The average (±s.d.) age and weight of the participants across all the three sites were 39.9±8.6 years and 76.1±21.2 kg, respectively, and 55% of the total participants were females. Sodium excretion increased across the East-West gradient (for example, 123.9±54.6, 134.1±48.8, 176.6±71.0 (±s.d.) mmol, Nigeria, Jamaica and US, respectively), whereas potassium was essentially unchanged (for example, 46.3±22.9, 40.7±16.1, 44.7±16.4 (±s.d.) mmol, respectively). In multivariate analyses both sodium (positively) and potassium (negatively) were strongly correlated with BP (P<0.001); quantitatively the association was stronger, and more consistent in each site individually, for potassium. The within-population day-to-day variation was also greater for sodium than for potassium. Among each population group, a significant correlation was observed between sodium and urine volume, supporting the prior finding of sodium as a determinant of fluid intake in free-living individuals. These data confirm the consistency with the possible role of dietary electrolytes as hypertension risk factors, reinforcing the relevance of potassium in these populations.

Association of common DNA sequence variants at 33 genetic loci with blood lipids in individuals of African ancestry from Jamaica.

The relevance of loci associated with blood lipids recently identified in European populations in individuals of African ancestry is unknown. We tested association between lipid traits and 36 previously described single-nucleotide polymorphisms (SNPs) in 1,466 individuals of African ancestry from Spanish Town, Jamaica. For the same allele and effect direction as observed in individuals of European ancestry, SNPs at three loci (1p13, 2p21, and 19p13) showed statistically significant association (p < 0.05) with LDL, two loci (11q12 and 20q13) showed association with HDL cholesterol, and two loci (11q12 and 2p24) showed association with triglycerides. The most significant association was between a SNP at 1p13 and LDL cholesterol (p = 4.6 × 10(-8)). This SNP is in a linkage disequilibrium region containing four genes (CELSR2, PSRC1, MYBPHL, and SORT1) and was recently shown to relate to risk for myocardial infarction. Overall, the results of this study suggest that much of the genetic variation which influences blood lipids is shared across ethnic groups.

Progression from prehypertension to hypertension in a Jamaican cohort: incident hypertension and its predictors.

OBJECTIVES: To estimate the incidence of hypertension in people with and without prehypertension and determine the factors that predict progression to hypertension. METHODS: Data from a cohort of 25-74-year-old residents of Spanish Town, Jamaica, were analysed. All participants completed a structured questionnaire and had blood pressure (BP), anthropometric measurements and venous blood sampling performed by trained personnel. Blood Pressure was classified using the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC-7) criteria. RESULTS: 708 persons who had the required data and were not hypertensive at baseline were included in this analysis. Mean follow-up time was 4.1 years; 28.7% of prehypertensive participants developed hypertension compared to 6.2% of normotensive participants. The unadjusted incidence rate ratio (IRR [95% CI]) for progression among prehypertensive compared to normotensive participants was 4.62 [2.96, 7.43]. Among males, the rate of progression to hypertension was significantly higher for those 45-64 years old and those who were current smokers. Among females, progression was higher for age groups 25-44 years, 45-64 years, those who were overweight (BMI > or =25), obese (BMI > or =30) and current smokers. In multivariate models, prehypertension, female gender overweight status and older age remained significantly associated with progression to hypertension among the combined prehypertensive and normotensive groups. IRR [95% CI] were: prehypertension, 3.45 [2.18-5.45]; female gender 1.81 [1.12, 2.94]; overweight, 1.87 [1.15, 2.94]; age 45-64 years, 1.73 [1.08, 2.76]; age > 65 years 2.39 [1.31, 4.34]. CONCLUSIONS: Prehypertension is associated with a three-fold increase in the incidence of hypertension. Higher BMI, age and female gender also independently predict the development of hypertension.

Prevalence of the metabolic syndrome in Jamaican adults and its relationship to income and education levels.

OBJECTIVE: To estimate the prevalence of the metabolic syndrome in Jamaican adults and to evaluate its association with socio-economic status (SES). METHODS: A cross-sectional analysis was performed using data from a cohort study of persons, 25-74 years old, living in St Catherine, Jamaica, and who were evaluated between 1993 and 2001. Participants completed an interviewer administered questionnaire and had blood pressure and anthropometric measurements performed by trained observers. Venous blood was collected for measurement of fasting glucose and lipids. The metabolic syndrome was defined using the International Diabetes Federation (IDF) and American Heart Association/National Heart Lung and Blood Institute (AHA/NHLBI) criteria. Income and education were used as markers of SES. RESULTS: Data from 1870 participants (717 males 1153 females) were analysed. Prevalence of the metabolic syndrome was 21.1% (95% CI 19.2, 22.9%) using IDF criteria and 18.4% (95% CI 16.6, 20.2%) using the AHA/NHLBI criteria. Prevalence was higher among females (27.6% [IDF], 23.0% [AHA]) compared to males (10.6% [IDF], 11.0% [AHA]). The prevalence of the metabolic syndrome increased with age. Compared to males with primary/lower education, those with secondary and tertiary education had higher odds of having the metabolic syndrome after adjusting for age; odds ratio 3.12 (1.54, 6.34) and 2.61 (1.33, 5.11) respectively. High income was also associated with increased odds of having the metabolic syndrome among males, OR = 6.0 (2.22, 16.19) adjusting for age-group. There were no significant associations among women. CONCLUSION: The metabolic syndrome is common in Jamaica. Clinicians should look for this syndrome in their patients and take steps to treat the abnormalities identified.

Hypertension in Mexico and among Mexican Americans: prevalence and treatment patterns.

Increased social and economic integration across the US-Mexican borders has led to important new developments in public health. Lower levels of cardiovascular mortality have been observed among Mexican Americans (MAs) although few direct comparisons have been undertaken with Mexico. Using survey data in the respective countries we examined blood pressure (BP) levels, hypertension prevalence and patterns of awareness, treatment and control in Mexico and among MAs. A national representative sample of the adult population from Mexico collected in 2000 (N=49 294), and data on 8688 MA participants in the 1999-2004 National Health and Nutrition Examination survey from the United States were available for analysis. US-born MAs and those born in Mexico were analysed separately in the US data. Lack of direct standardization of methods between surveys necessitated statistical adjustment of BP values. Analyses were based on persons aged 25-64 in each country. Sex- and age-adjusted mean systolic/diastolic BPs were 122/80, 119/71 and 120/73 in Mexicans, immigrant MAs and US-born MAs, respectively. The prevalences of hypertension (BP > or = 140/90 or treatment) were 33, 17 and 22%. Hypertension control rates were 3.7, 32.1 and 37.9%, in the same groups. Awareness and treatment rates were 25 and 13% in Mexico and 54 and 46% among MAs in the United States, respectively. Hypertension appears to be more common in Mexico than among Mexican immigrants to the United States. Despite relatively low access to health insurance in the United States, hypertension control increased over the course of this migration.

Activity, adiposity and weight change in Jamaican adults / Actividad, adiposidad y cambio de peso en los adultos jamaicanos

OBJECTIVE: Populations in developing countries are particularly vulnerable to the development of obesity in the period of rapid transition to a more modernized lifestyle. We sought to determine the relationship between activity energy expenditure (AEE), adiposity and weight change in an adult population undergoing rapid socio-economic transition. METHODS: Total daily energy expenditure (TDEE) was measured using the doubly labelled water method, resting energy expenditure (REE) using indirect calorimetry and AEE calculated as the difference between TDEE and REE, in adults from a working class community in Spanish Town, Jamaica. During six years of follow-up, weight was measured between one and four times. Mixed effects regression modelling was used to test for association between components of the energy budget and weight change. RESULTS: Men (n = 17) weighed more but women (n = 18), had significantly more body fat, 38.5% vs 24.5%, respectively (p < 0.01). Men had higher levels of EE, particularly AEE after adjustment for body weight, 66.3 versus 46.4 kJ/kg.d for men and women, respectively (p < 0.001). At baseline, adjusted AEE was inversely associated with body fat in men and women, r = -0.46 and r = -0.48, respectively (p < 0.05). Mean rate of weight change was + 1.1 and + 1.2 kg/year for men and women, respectively. No component of EE, ie TDEE, REE or AEE, significantly predicted weight change in this small sample. CONCLUSIONS: These results suggest an important role for AEE in maintaining low levels of adiposity. The lack of association between EE and weight change, however, suggests populations in transition are at risk of obesity from environmental factors (eg dietary) other than simply declining physical activity levels.

OBJETIVO: Las poblaciones en los países en vía de desarrollo son particularmente vulnerables al desarrollo de la obesidad en el período de rápida transición a un estilo de vida más moderno. Buscamos determinar la relación entre el gasto energético por actividad (GEA), la adiposidad y el cambio de peso en una población adulta en proceso de rápida transición socio-económica. MÉTODOS: El gasto energético total diario (GETD) fue medido usando el método del agua doblemente marcada, gasto energético en reposo (GER) usando calorimetría indirecta y el GEA calculado como la diferencia entre GETD y GER, en adultos de una comunidad de clase obrera en Spanish Town, Jamaica. Durante seis años de seguimiento, el peso fue medido entre una y cuatro veces. Un modelo de regresión de efectos mixtos fue usado para probar la asociaciF3n entre los componentes del presupuesto de la energEDa y el cambio de peso. RESULTADOS: Los hombres (n = 17) pesaron más pero las mujeres (n = 18) teníEDan significativamente más grasa corporal, 38.5% frente a 24.5%, respectivamente (p < 0.01). Los hombres tenían niveles más altos de GE, particularmente GEA después del ajuste por peso corporal, 66.3 frente a 46.4 kJ/kg.d para los hombres y mujeres, respectivamente (p < 0.001). Al inicio, el GEA ajustado estaba inversamente asociado con la grasa del cuerpo en los hombres y mujeres, r = -0.46 y r = -0.48, respectivamente (p < 0.05). La tasa media de cambio de peso fue +1.1 y +1.2 kg/ano para los hombres y mujeres, respectivamente. Ningún componente de GE, es decir, GETD, GER o GEA, predijo significativamente el cambio de peso en esta muestra pequeña. CONCLUSIONES: Estos resultados sugieren un papel importante del GEA en cuanto a mantener niveles bajos de adiposidad. Sin embargo, la falta de asociación entre GE y cambio de peso, sugiere que las poblaciones en transición corren el riesgo de obesidad debido a factores ambientales (p.ej. dietéticos) distintos de la mera...

Activity, adiposity and weight change in Jamaican adults.

OBJECTIVE: Populations in developing countries are particularly vulnerable to the development of obesity in the period of rapid transition to a more modernized lifestyle. We sought to determine the relationship between activity energy expenditure (AEE), adiposity and weight change in an adult population undergoing rapid socio-economic transition. METHODS: Total daily energy expenditure (TDEE) was measured using the doubly labelled water method, resting energy expenditure (REE) using indirect calorimetry and AEE calculated as the difference between TDEE and REE, in adults from a working class community in Spanish Town, Jamaica. During six years of follow-up, weight was measured between one and four times. Mixed effects regression modelling was used to test for association between components of the energy budget and weight change. RESULTS: Men (n = 17) weighed more but women (n = 18), had significantly more body fat, 38.5% vs 24.5%, respectively (p < 0.01). Men had higher levels of EE, particularly AEE after adjustment for body weight, 66.3 versus 46.4 kJ/kg.d for men and women, respectively (p < 0.001). At baseline, adjusted AEE was inversely associated with body fat in men and women, r = -0.46 and r = -0.48, respectively (p < 0.05). Mean rate of weight change was + 1.1 and + 1.2 kg/year for men and women, respectively. No component of EE, ie TDEE, REE or AEE, significantly predicted weight change in this small sample. CONCLUSIONS: These results suggest an important role for AEE in maintaining low levels of adiposity. The lack of association between EE and weight change, however, suggests populations in transition are at risk of obesity from environmental factors (eg dietary) other than simply declining physical activity levels.

Egg and embryo abnormalities in the ostrich (Struthio camelus).

Ostrich hens reach sexual maturity at approximately 2.5 years, remaining fertile for about 40 years. Each hen commonly lays about 50 eggs a season. Selective breeding, good breeder nutrition, hygiene and correct incubator settings are important for good productivity (1). Unbalanced nutrition may result in mutifaceted nutrient deficiencies in embryo, including yolk sac pathology (2) and leg abnormalities (3)

Egg and embryo abnormalities in the ostrich (Struthio camelus).

Ostrich hens reach sexual maturity at approximately 2.5 years, remaining fertile for about 40 years. Each hen commonly lays about 50 eggs a season. Selective breeding, good breeder nutrition, hygiene and correct incubator settings are important for good productivity (1). Unbalanced nutrition may result in mutifaceted nutrient deficiencies in embryo, including yolk sac pathology (2) and leg abnormalities (3)

Relationship between blood pressure and physical activity assessed with stable isotopes.

Intrapopulation and interpopulation variation in blood pressure (BP) often reflects the joint effect of a complex set of risk factors, including lifestyle factors such as physical activity, diet, smoking and alcohol use. In this study, we set out to quantify the impact of habitual levels of physical activity on BP within and between three populations at contrasting levels of population risk of hypertension. Individuals were randomly sampled from communities in Nigeria (n=57), Jamaica (from Kingston, n=35) and the United States (from the Chicago area, n=32). Activity energy expenditure (AEE) (estimated from resting energy expenditure measured by indirect calorimetry and total expenditure measured with doubly labelled water) was used as an objective estimate of physical activity. In each of the three samples, there was a consistent negative correlation between BP and AEE. This negative association persisted after adjustment for age, sex and body fat (body mass index or percent fat mass). In multivariate models, adiposity was no longer a significant predictor of BP after accounting for low AEE. In conclusion these data suggest that habitual levels of physical activity may have a generalizable relationship with BP in populations with widely different social and environmental characteristics.

A randomized trial on sodium reduction in two developing countries.

Hypertension remains the most common cardiovascular risk factor in developing countries, yet the majority of patients have no access to pharmacological therapy. Population-wide preventive strategies, such as salt restriction, are an attractive alternative, but experience in resource-poor settings is limited. To address this question, we conducted a randomized crossover study of salt restriction in adults living in Nigeria and Jamaica in order to estimate the mean blood pressure (BP) response. After a 4-week run-in period to determine willingness to adhere to a low-salt diet, 56 Jamaicans and 58 Nigerians completed an 8-week crossover study of low-salt and high-salt intake. Baseline BPs were in the normotensive range (systolic=125 mmHg in Jamaica, 114 mmHg in Nigeria). Baseline urinary sodium excretion was 86.8 and 125.6 mEq/day in Nigeria and Jamaica, respectively. The mean difference between urinary sodium excretion at baseline and at the end of the 3-week low-sodium phase was 33.6 mEq/day in Nigeria and 57.5 mEq/day in Jamaica. During the high-sodium phase, mean change in urinary sodium excretion from baseline to week 3 was 35.0 and 5.5 mEq/day in Nigeria and Jamaica, respectively. The mean change in systolic BP ('high' vs 'low' sodium phase) was approximately 5 mmHg in both groups. This study suggests that the efficacy of sodium reduction in developing countries equals those noted in more affluent cultures. If promoted on a wide scale, sodium reduction could be used to treat persons with established hypertension, and more importantly, to prevent age-related increases in BP in poor communities.