Are Radial Pressure Waves Effective for the Treatment of Moderate or Mild to Moderate Erectile Dysfunction? A Randomized Sham Therapy Controlled Clinical Trial.

INTRODUCTION: Radial wave therapy is commercialized as an option for the management of erectile dysfunction. However, the mechanism of action of the radial waves differs substantially from shock waves, so the evidence gathered for shock wave therapy cannot be extrapolated, and there are very few clinical trials with the radial wave. AIM: To assess the efficacy and safety of radial wave therapy compared with sham therapy for the treatment of moderate and mild to moderate erectile dysfunction. METHODS: A randomized, double-blind, sham-controlled clinical trial was realized. Eighty patients with moderate erectile dysfunction, without sickle cell anemia, anticoagulation treatment, comorbidities, or conditions associated with secondary erectile dysfunction were included. The efficacy and safety were assessed at 6 and 10 weeks after randomization. Patients were randomized 1:1 to 1 of 2 arms: (i) 6 weekly sessions of radial wave therapy (RW group) or (ii) 6 weekly sessions of sham therapy (control group). All patients received sildenafil 25 mg. OUTCOME: The primary outcome was the mean change in the International Index of Erectile Function - Erectile Function (IIEF-EF) domain score at 6 weeks after randomization. RESULTS: Eighty men were randomized. The average baseline IIEF-EF score was 16.3 (Standard Deviation - SD 3.2), and the median baseline Erection Hardness Score (EHS) was 3 (IQR 1). At 6 weeks after randomization, the mean change in the IIEF-EF score was 3.4 (95% confidence interval [CI] 1.5-5.2) in the RW group and 4.2 (95% CI 2.5-5.9) in the control group. No differences were observed between groups (P value =.742). No change was observed in the median EHS score in the evaluations. No serious adverse events occurred in 2 (5%) patients after radial wave therapy, and in 1 (2.5%) patient after sham therapy. CLINICAL IMPLICATIONS: Knowledge of the effectiveness of radial waves protocols used for the treatment of moderate erectile dysfunction, helps doctors and patients in making decisions about the use of this therapy. STRENGTHS & LIMITATIONS: One strength is conducting the study with high methodological standards to minimize risk biases. Our results are limited to the evaluation of 1 specific protocol in moderate and mild to moderate erectile dysfunction. CONCLUSIONS: No difference was found in this study between men with moderate and mild to moderate erectile dysfunction treated with radial waves and men treated with placebo sham therapy. Studies with different protocols of radial waves are necessary. Sandoval-Salinas C, Saffon JP, Martínez JM, et al. Are Radial Pressure Waves Effective for the Treatment of Moderate or Mild to Moderate Erectile Dysfunction? A Randomized Sham Therapy Controlled Clinical Trial. J Sex Med 2022;19:738-744.

Locating Ships Using Time Reversal and Matrix Pencil Method by Their Underwater Acoustic Signals.

This paper presents a technique, based on the matrix pencil method (MPM), for the compression of underwater acoustic signals produced by boat engines. The compressed signal, represented by its complex resonance expansion, is intended to be sent over a low-bit-rate wireless communication channel. We demonstrate that the method can provide data compression greater than 60%, ensuring a correlation greater than 93% between the reconstructed and the original signal, at a sampling frequency of 2.2 kHz. Once the signal was reconstituted, a localization process was carried out with the time reversal method (TR) using information from four different sensors in a simulation environment. This process sought to achieve the identification of the position of the ship using only passive sensors, considering two different sensor arrangements.

Acinetobacter Baumannii Multiresistente y su Relación con la Producción de Biopelículas

Resumen Introducción: Acinetobacter baumannii es la bacteria Gram negativa asociada a infecciones intrahospitalarias por su gran facilidad de supervivencia en condiciones adversas y el desarrollo de multirresistencia a diversos antimicrobianos. Durante años se han registrado brotes hospitalarios en diferentes países asociados a esta bacteria, lo que aumentó el interés de estudio de las biopelículas y los genes involucrados en su producción, debido a que se demostró una asociación a la resistencia antibiótica. Objetivos: Establecer relacion entre la multirresistencis a los diferentes antibioticos y la formacion de biopeliculas en aislamientos de Acinetobacter baumannii. Métodos: Se estudió cepas de Acinetobacter baumannii utilizando reacción en cadena de la polimerasa (PCR) en tiempo real para la detección de genes bap, csuE, ompA, oxa-51 de 191 muestras, de igual manera se realizó la cuantificación de la biopelícula formada siguiendo la técnica descrita por Badmasti y Azizi. Resultados: Se realizó este estudio sobre 191 cepas de Acinetobacter baumannii provenientes de dos centros hospitalarios para la identificación de genes asociados a las biopelículas y posterior cuantificación de acuerdo a la técnica descrita por Badmasti y Azizi. Demostrando una asociación entre las biopelículas y la resistencia bacteriana de Acinetobacter baumannii. Conclusiones: Los resultados demostraron una asociación positiva entre la cantidad de biopelícula formada y la resistencia antibiótica, bacterias formadoras fuertes de biopelículas presentan mayor resistencia a los carbapenems. En cuanto a los genes, el gen ompA demostró una asociación con la cantidad de biofilm producido, bap y csuE son genes involucrados en el primer paso de formación de biofilm, pero no se asocian con la cantidad formada por la bacteria.

Abstract Introduction: Acinetobacter baumannii is the Gram-negative bacterium associated with hospital infections due to its great ease of survival in adverse conditions and the development of multi-resistance to various antimicrobials. For years, hospital outbreaks have been registered in different countries associated with this bacterium, which increased the interest in studying biofilms and the genes involved in their production, since an association with antibiotic resistance was demonstrated. Objectives: To establish a relationship between multiresistance to different antibiotics and biofilm formation in Acinetobacter baumannii isolates. Methods: acinetobacter baumannii strains were studied using real-time polymerase chain reaction (PCR) for the detection of bap, csuE, ompA, oxa-51 genes from 191 samples, in addition to the quantification of the biofilm formed following the technique described by Badmasti and Azizi. Results: this study was carried out on 191 Acinetobacter baumannii strains from two hospital centers for the identification of genes associated with biofilms and subsequent quantification according to the technique described by Badmasti and Azizi. Demonstrating an association between biofilms and Acinetobacter baumannii bacterial resistance. Conclusions: the results demonstrated a positive association between the amount of biofilm formed and antibiotic resistance. Strong biofilm-forming bacteria show greater resistance to carbapenems. Regarding the genes, the ompA gene showed an association with the amount of biofilm produced, bap and csuE are genes involved in the first step of biofilm formation, but they are not associated with the amount formed by the bacteria

Prevalence of mastitis in dairy herds in Eastern Antioquia / Prevalencia de mastitis en siete hatos lecheros del oriente antioqueño / Prevalência da mastite em sete rebanhos leiteiros na região leste da Antioquia

Seven dairy cattle farms from eastern Antioquia were tested for mastitis in a cross-sectional study with a non-probabilistic convenience sampling procedure. Each udder quarter of 290 lactating cows was evaluated through the California Mastitis Test in order to determine the prevalence of subclinical mastitis. Milk from positive quarters underwent somatic cell count (SCC), cell culture and antibiotic sensitivity tests. The prevalence of subclinical mastitis per quarter was 19.9% (228 quarters). Only 11 quarters (0.95%) had clinical mastitis. The average SCC for all quarters was 1,105,733 cells/mL. Streptococcus dysgalactiae was the most common bacteria observed (29.5%) in the 226 cultures evaluated, followed by coagulasenegative staphylococci (CNS, 23%), and Staphylococcus aureus (10.3%). The frequency of contagiouspathogens and environmental pathogens was 37.8% and 49.3%, respectively. This study confirms that mastitis remains elevated in this region, suggesting a continuous lack of milking hygiene and education of farm personnel.

Se realizó un estudio descriptivo de corte, y se hizo un muestreo no probabilístico de conveniencia, en siete fincas de ganado de leche localizadas en el oriente antioqueño. Se evaluó cada cuarto de 290 vacas en producción láctea mediante la realización del California Mastitis Test (CMT) con el fin de determinar la prevalencia de mastitis por cuarto y por vaca. A la leche proveniente de los cuartos positivos mayores a trazas, se les realizó recuento de células somáticas (RCS), cultivo y antibiograma. La prevalencia de mastitis subclínica por cuarto fue de 19.9% (228 cuartos) y 11 cuartos (0.95%) presentaron mastitis clínica. El promedio del RCS para todos los cuartos fue de 1.105.733 céls/ml. En los 226 cultivos, Streptococcus dysgalactiae fue la bacteria más común (29.5%), le siguieron estafilococos coagulasa negativo (ECN) (23%) y Staphylococcus aureus (10.3%). La frecuencia de patógenos contagiosos fue 37.8%, entre tanto que la de ambientales fue 49.3%.

Foi realizado um estudo de corte, e se realizou uma amostragem não probabilística em sete fazendas de gado leiteiro localizado no leste da Antioquia. Foram avaliados trimestralmente 290 vacas em produção de leite mediante a implementação do California Mastitis Test (CMT) para determinar a prevalência de mastite subclínica em cada quarto da vaca. Nos quartos positivos foi realizada a contagem de células somáticas (CCS) no leite, o cultivo microbiológico e análises de sensibilidade. A prevalência de mastite subclínica por quarto foi de 19.9% (228 quartos) e 11 (0.95%) apresentaram mastite clínica. A CCS média para todas os quartos foi 1.105.733 células / ml. Em 226 cultivos, o Streptococcus dysgalactiae foi a bacteria mais comum (29.5%), seguido por estafilococus coagulase negativo (ECN) (23%) e Staphylococcus aureus (10.3%). A reqüência de agentes patogénicos contagiosos foi de 37.8% e patógenos ambientais foi de 49.3%.

Efecto de tibolona en el mioma uterino en pacientes tratadas con análogos de la hormona liberadora de gonadotropinas / Effect of tibolone on uterine fibroids in patients treated with gonadotropin-releasing hormone analogues

Objetivos: Evaluar la eficacia de tibolona, una molécula sintética con acción hormonal como terapia hormonal complementaria en la miomatosis uterina. Tibolona se ha mostrado eficaz en el tratamiento hormonal sustitutivo en la menopausia. Su débil acción estrogénica no debe modificar los efectos conseguidos en el útero miomatoso tras la administración de agonistas de la hormona liberadora de gonadotropinas, manteniendo la reducción del volumen uterino inducido por ellos. Material y métodos: Un total de 125 pacientes en edad fértil o premenopáusicas, con ciclos menstruales regulares, diagnosticadas de miomatosis uterina y candidatas a tratamiento quirúrgico, fueron incluidas en un estudio prospectivo y aleatorizado, en el que se ensayaron 5 protocolos terapéuticos previos a la cirugía: grupo 1 o grupo control, 3 viales de acetato de goserelina depot, 3,6 mg; grupo 2, 3 dosis de acetato de goserelina depot, asociada a tibolona (2,5 mg diarios) desde el primer vial de goserelina hasta la intervención quirúrgica; grupo 3, 3 dosis de acetato de goserelina depot, asociada a tibolona desde el segundo vial de goserelina hasta la intervención quirúrgica; grupo 4, 2 dosis de acetato de goserelina depot asociada a tibolona desde el segundo vial de goserelina hasta la intervención quirúrgica, y grupo 5, 3 dosis de acetato de goserelina depot asociada a estrógenos conjugados equinos, 0,625 mg, desde el segundo vial de goserelina hasta la intervención quirúrgica. Se evaluó ecográficamente la modificación del tamaño uterino y de los valores séricos de gonadotropinas y estradiol con los diferentes protocolos de tratamiento. Las diferencias se consideraron estadísticamente significativas para un valor de p < 0,05. Resultados: Las reducciones medias del volumen uterino (%) fueron mayores en los 3 primeros grupos de tratamiento (­30,1 ± 16,7; ­26,4 ± 21,2; ­25,1 ± 22,5; ­15,6 ± 23 y ­5,5 ± 15,1, respectivamente), con diferencias estadísticamente significativas respecto a este parámetro al comparar cada grupo con el grupo control (grupo 1). Las concentraciones medias de estradiol sérico (pg/ml) fueron, asimismo, inferiores en los 3 primeros grupos (26,2 ± 11,2; 45,7 ± 49,1; 35,9 ± 20,3; 97,9 ± 110,3; 111,4 ± 63,2, respectivamente) y estas diferencias fueron significativas. Conclusiones: La terapia hormonal complementaria con tibolona influye mínimamente en la disminución del tamaño del útero miomatoso promovido por 3 dosis de goserelina depot

Objectives: To evaluate de effectiveness of tibolone, a synthetic steroid, as add-back therapy in patients diagnosed with leiomyoma. Tibolone has been demonstrated to be effective in inhibiting menopausal symptoms and in preventing post-menopausal bone loss. Its low estrogenic profile should not compromise the efficacy of gonadotropin-releasing hormone analogue (goserelin) in reducing the volume of uterine fibroids. Material and methods: A group of 125 pre-menopausal women (with regular menstrual cycle) diagnosed with uterine leiomyomata suitable for surgical treatment were recruited in a randomized, prospective study that evaluated 5 treatment regimens: group 1 (control group), three doses of goserelin acetate depot (3.6 mg); group 2, 3 doses of goserelin acetate depot associated with tibolone (2.5 mg daily) from the first dose of goserelin until surgery; group 3, 3 doses of goserelin acetate depot associated with tibolone from the second dose of goserelin until surgery; group 4, 2 doses of goserelin acetate depot associated with tibolone from the second dose of goserelin until surgery, and group 5, 3 doses of goserelin acetate depot associated with conjugated equine estrogens (0.625 mg daily) from the second dose of goserelin until surgery. Modification of uterine size was evaluated with ultrasound examination and serum levels of gonadotrophins and estradiol were evaluated with the different treatment protocols. Differences were considered significant when p < 0.05. Results: The mean reductions in uterine volume (%) were greater in the first 3 treatment groups (­30.1 ± 16.7; ­26.4 ± 21.2; ­25.1 ± 22.5; ­15.6 ± 23 y ­5.5 ± 15.1, respectively) and the differences were statistically significant when each group was compared with the control group (group 1). The mean concentrations of serum estradiol (pg/ml) were also significantly lower in the first 3 groups (26.2 ± 11.2; 45.7 ± 49.1; 35.9 ± 20.3; 97.9 ± 110.3; 111.4 ± 63.2, respectively). Conclusions: Add-back tibolone therapy does not significantly compromise the effect of goserelin acetate in patients with uterine fibroids

La variabilidad en las mediciones ecográficas de la longitud céfalo-nalga y de la translucencia nucal. Problemas en un programa de cribado / Variability in ultrasonographic measurements of crown-rump length and nuchal translucency. Problems in a screening program

Objetivo: Describir cómo transcurre el aprendizaje en la medición de la translucencia nucal (TN), la evolución de la precisión de las mediciones de ésta y la de la longitud céfalo-nalga (LCN) durante la fase inicial de un programa de cribado y en los 2 años posteriores de desarrollo. Material y métodos: Fase de aprendizaje, basada en la discusión de la metodología, la observación de imágenes y en la práctica no controlada de mediciones de la TN, analizada sobre 6 observadores en sus 100 primeras exploraciones. Evolución de la precisión de 3 observadores en las siguientes 3.601 ecografías. Análisis de las diferencias que se mantienen en las mediciones de la LCN y de la TN cuando los 3 observadores alcanzan su mejor nivel de precisión. Resultados: Con la fase de aprendizaje 4 de los 6 observadores consiguen mediciones con una desviación media sobre el modelo inferior al 10%. La continuidad en las exploraciones muestra que la precisión aumenta hasta que se han realizado unas 350 exploraciones, cuando se estabiliza, y 2 observadores presentan desviaciones inferiores a ± 5%, mientras que el tercero mantiene una infraestimación de un 10%. En la fase de mayor precisión, mientras las diferencias son escasas entre 2 observadores, el tercero presenta una sobrestimación de 2 mm en la medida de la LCN y una infraestimación de 0,1 mm en la TN, lo que conlleva unas tasas menores de cribados positivos. Conclusiones: Las desviaciones detectadas en las medidas de la TN, respecto al modelo de referencia, y en las de la LCN aconsejan que, junto con el habitual seguimiento de la eficacia de los programas de cribado, se auditen las desviaciones de las mediciones que se realizan

Objective: To describe the learning curve in nuchal translucency and crown-rump length measurements and changes in the accuracy of these measurements during the initial phase of a screening program and during the following 2 years. Material and methods: The learning phase was based on discussion of the methodology for performing the measurements, with observation and discussion of images, followed by a second period, with observation of the accuracy of 6 operators in their first 100 measurements. Changes in the accuracy of 3 operators in an additional 3,601 examinations were assessed. Differences in accuracy between the 3 operators were analyzed when maximal accuracy was achieved. Results: In the first 100 observations, 4 of the 6 operators showed deviation from the model of less than 10%. Accuracy increased until 350 examinations had been performed and then stabilized. Two operators showed deviations of less than ± 5% while a third maintained a difference of 10% below the model. When maximal accuracy was reached, differences between 2 operators were negligible, while the third operator overestimated crown-rump length by 2 mm and underestimated nuchal translucency by 0.1 mm, which translates into a lower proportion of patients with a positive screening result. Conclusions: The deviations detected in nuchal translucency measurements with respect to the reference model, as well as those in crown-rump length, indicate the advisability of auditing the accuracy of sonographic measurements in addition to routine assessment of the effectiveness of screening programs. The model proposed by Nicolaides is suitable for our environment since deviations, which mainly occur in the extreme values of crown-rump length, can be explained by inadequate methodology in the performance of the measurements. Therefore, personalized references need not be prepared. Rather, the methodology should be improved

Posibilidades y limitaciones de una ecografía en la semana 12-13 de gestación: la translucencia nucal en el cribado del síndrome de Down / Possibilities and limitations of ultrasonography in weeks 12-13 of gestation: nucal translucency in screening for Down syndrome

Objetivo: Presentar las posibilidades diagnósticas de una ecografía practicada a la población general de gestantes alrededor de la semana 12. Presentar la técnica de su realización. Material y métodos: Estudio de los artículos relevantes aparecidos entre 1985 y 2001, obtenidos del Medline o citados en otros artículos. Resultados: La aportación más valiosa de esta ecografía es el cribado del síndrome de Down y la definición de la corionicidad en la gestación múltiple, pero también establecer la edad gestacional con precisión e identificar muchas malformaciones. Conclusiones: La ecografía de la semana 12 debe convertirse en una exploración habitual para todas las gestantes. Sus objetivos y características hacen necesario el consentimiento informado y la evaluación continuada de su eficacia diagnóstica (AU)