Comparison of bipolar radiofrequency thermotherapy and transurethral prostate resection in treatment of benign prostate hyperplasia.

OBJECTIVES: Lower urinary tract symptoms due to benign prostatic hyperplasia in men increase with aging. Risks related to anesthesia and surgery have led a search for alternative treatments. Bipolar radiofrequency (RF) thermotherapy is one of the methods adopted in patients with high surgical risks. The aim of this study is to compare the effect of bipolar RF thermotherapy and transurethral resection of the prostate (TURP) methods on voiding symptoms and on post-operative complication rates especially in patients carrying high surgical risks. METHODS: Pre-operative, post-operative 1st and 6th month International Prostate Symptom Score (IPSS), Qmax, quality of life, prostate volumes, and postoperative complications of the patients underwent TURP and RF for benign prostatic hyperplasia (BPH) were compared. RESULTS: In the RF group, the pre-operative median IPSS was 30, prostate volume 41.5 cc, post-void residual (PVR) 80 ml, and Qmax is 5.85 ml/s.; In the TURP group, these were 29, 40 cc, 85 ml, and 5.3 ml/sec, respectively. In the Bipolar RF group, post-operative 1st- and 6th-month median values were IPSS 18, 21; prostate volume 40, 40; PVR 40, 35; Qmax 10.9, 9.15 and in the TURP group IPSS 9, 8; prostate volume 20, 20; PVR 30, 10; Qmax 17.25, 19.1, respectively. CONCLUSION: Bipolar RF thermotherapy is an applicable treatment method for BPH patients with high surgical risks.

OBJETIVOS: La termoterapia bipolar por radiofrecuencia es uno de los métodos adoptados en pacientes con alto riesgo quirúrgico. El objetivo de este estudio es comparar el efecto de la termoterapia de radiofrecuencia bipolar y los métodos de RTUP en los síntomas de vaciado y en las tasas de complicaciones posoperatorias, especialmente en pacientes con alto riesgo quirúrgico. MÉTODOS: Se compararon el IPSS, el Qmax, la calidad de vida, los volúmenes de próstata y las complicaciones posoperatorias de los pacientes sometidos a RTUP y RF para la HBP preoperatorios, posoperatorios al primer y sexto mes. RESULTADOS: En el grupo de RF, la mediana preoperatoria del IPSS fue de 30, el volumen prostático de 41.5 cc, el PVR de 80 ml y el Qmax de 5.85 ml/seg.; En el grupo RTUP estos fueron 29, 40 cc, 85 ml y 5.3 ml/seg, respectivamente. En el grupo de RF bipolar, los valores medianos postoperatorios del primer y sexto mes fueron IPSS 18, 21; volumen de próstata 40, 40; PVR 40, 35; Qmax 10.9, 9.15 y en el grupo TURP IPSS 9, 8; volumen de próstata 20, 20; PVR 30, 10; Qmax 17.25, 19.1, respectivamente. CONCLUSIÓN: La termoterapia de RF bipolar es un método de tratamiento aplicable para pacientes con HPB con alto riesgo quirúrgico.

A genetic history of continuity and mobility in the Iron Age central Mediterranean.

The Iron Age was a dynamic period in central Mediterranean history, with the expansion of Greek and Phoenician colonies and the growth of Carthage into the dominant maritime power of the Mediterranean. These events were facilitated by the ease of long-distance travel following major advances in seafaring. We know from the archaeological record that trade goods and materials were moving across great distances in unprecedented quantities, but it is unclear how these patterns correlate with human mobility. Here, to investigate population mobility and interactions directly, we sequenced the genomes of 30 ancient individuals from coastal cities around the central Mediterranean, in Tunisia, Sardinia and central Italy. We observe a meaningful contribution of autochthonous populations, as well as highly heterogeneous ancestry including many individuals with non-local ancestries from other parts of the Mediterranean region. These results highlight both the role of local populations and the extreme interconnectedness of populations in the Iron Age Mediterranean. By studying these trans-Mediterranean neighbours together, we explore the complex interplay between local continuity and mobility that shaped the Iron Age societies of the central Mediterranean.

Density separation of petrous bone powders for optimized ancient DNA yields.

Density separation is a process routinely used to segregate minerals, organic matter, and even microplastics, from soils and sediments. Here we apply density separation to archaeological bone powders before DNA extraction to increase endogenous DNA recovery relative to a standard control extraction of the same powders. Using nontoxic heavy liquid solutions, we separated powders from the petrous bones of 10 individuals of similar archaeological preservation into eight density intervals (2.15 to 2.45 g/cm3, in 0.05 increments). We found that the 2.30 to 2.35 g/cm3 and 2.35 to 2.40 g/cm3 intervals yielded up to 5.28-fold more endogenous unique DNA than the corresponding standard extraction (and up to 8.53-fold before duplicate read removal), while maintaining signals of ancient DNA authenticity and not reducing library complexity. Although small 0.05 g/cm3 intervals may maximally optimize yields, a single separation to remove materials with a density above 2.40 g/cm3 yielded up to 2.57-fold more endogenous DNA on average, which enables the simultaneous separation of samples that vary in preservation or in the type of material analyzed. While requiring no new ancient DNA laboratory equipment and fewer than 30 min of extra laboratory work, the implementation of density separation before DNA extraction can substantially boost endogenous DNA yields without decreasing library complexity. Although subsequent studies are required, we present theoretical and practical foundations that may prove useful when applied to other ancient DNA substrates such as teeth, other bones, and sediments.

ISSLS PRIZE in Clinical Science 2023: comparison of degenerative MRI features of the intervertebral disc between those with and without chronic low back pain. An exploratory study of two large female populations using automated annotation.

OBJECTIVES: The relationship of degeneration to symptoms has been questioned. MRI detects apparently similar disc degeneration and degenerative changes in subjects both with and without back pain. We aimed to overcome these problems by re-annotating MRIs from asymptomatic and symptomatics groups onto the same grading system. METHODS: We analysed disc degeneration in pre-existing large MRI datasets. Their MRIs were all originally annotated on different scales. We re-annotated all MRIs independent of their initial grading system, using a verified, rapid automated MRI annotation system (SpineNet) which reported degeneration on the Pfirrmann (1-5) scale, and other degenerative features (herniation, endplate defects, marrow signs, spinal stenosis) as binary present/absent. We compared prevalence of degenerative features between symptomatics and asymptomatics. RESULTS: Pfirrmann degeneration grades in relation to age and spinal level were very similar for the two independent groups of symptomatics over all ages and spinal levels. Severe degenerative changes were significantly more prevalent in discs of symptomatics than asymptomatics in the caudal but not the rostral lumbar discs in subjects < 60 years. We found high co-existence of degenerative features in both populations. Degeneration was minimal in around 30% of symptomatics < 50 years. CONCLUSIONS: We confirmed age and disc level are significant in determining imaging differences between asymptomatic and symptomatic populations and should not be ignored. Automated analysis, by rapidly combining and comparing data from existing groups with MRIs and information on LBP, provides a way in which epidemiological and 'big data' analysis could be advanced without the expense of collecting new groups. LEVEL OF EVIDENCE I: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

Northeastern Asian and Jomon-related genetic structure in the Three Kingdoms period of Gimhae, Korea.

The genetic history of prehistoric and protohistoric Korean populations is not well understood because only a small number of ancient genomes are available. Here, we report the first paleogenomic data from the Korean Three Kingdoms period, a crucial point in the cultural and historic formation of Korea. These data comprise eight shotgun-sequenced genomes from ancient Korea (0.7×-6.1× coverage). They were derived from two archeological sites in Gimhae: the Yuha-ri shell mound and the Daesung-dong tumuli, the latter being the most important funerary complex of the Gaya confederacy. All individuals are from between the 4th and 5th century CE and are best modeled as an admixture between a northern China Bronze Age genetic source and a source of Jomon-related ancestry that shares similarities with the present-day genomes from Japan. The observed substructure and proportion of Jomon-related ancestry suggest the presence of two genetic groups within the population and diversity among the Gaya population. We could not correlate the genomic differences between these two groups with either social status or sex. All the ancient individuals' genomic profiles, including phenotypically relevant SNPs associated with hair and eye color, facial morphology, and myopia, imply strong genetic and phenotypic continuity with modern Koreans for the last 1,700 years.

Genome-scale sequencing and analysis of human, wolf, and bison DNA from 25,000-year-old sediment.

Cave sediments have been shown to preserve ancient DNA but so far have not yielded the genome-scale information of skeletal remains. We retrieved and analyzed human and mammalian nuclear and mitochondrial environmental "shotgun" genomes from a single 25,000-year-old Upper Paleolithic sediment sample from Satsurblia cave, western Georgia:first, a human environmental genome with substantial basal Eurasian ancestry, which was an ancestral component of the majority of post-Ice Age people in the Near East, North Africa, and parts of Europe; second, a wolf environmental genome that is basal to extant Eurasian wolves and dogs and represents a previously unknown, likely extinct, Caucasian lineage; and third, a European bison environmental genome that is basal to present-day populations, suggesting that population structure has been substantially reshaped since the Last Glacial Maximum. Our results provide new insights into the Late Pleistocene genetic histories of these three species and demonstrate that direct shotgun sequencing of sediment DNA, without target enrichment methods, can yield genome-wide data informative of ancestry and phylogenetic relationships.

A genetic history of the pre-contact Caribbean.

Humans settled the Caribbean about 6,000 years ago, and ceramic use and intensified agriculture mark a shift from the Archaic to the Ceramic Age at around 2,500 years ago1-3. Here we report genome-wide data from 174 ancient individuals from The Bahamas, Haiti and the Dominican Republic (collectively, Hispaniola), Puerto Rico, Curaçao and Venezuela, which we co-analysed with 89 previously published ancient individuals. Stone-tool-using Caribbean people, who first entered the Caribbean during the Archaic Age, derive from a deeply divergent population that is closest to Central and northern South American individuals; contrary to previous work4, we find no support for ancestry contributed by a population related to North American individuals. Archaic-related lineages were >98% replaced by a genetically homogeneous ceramic-using population related to speakers of languages in the Arawak family from northeast South America; these people moved through the Lesser Antilles and into the Greater Antilles at least 1,700 years ago, introducing ancestry that is still present. Ancient Caribbean people avoided close kin unions despite limited mate pools that reflect small effective population sizes, which we estimate to be a minimum of 500-1,500 and a maximum of 1,530-8,150 individuals on the combined islands of Puerto Rico and Hispaniola in the dozens of generations before the individuals who we analysed lived. Census sizes are unlikely to be more than tenfold larger than effective population sizes, so previous pan-Caribbean estimates of hundreds of thousands of people are too large5,6. Confirming a small and interconnected Ceramic Age population7, we detect 19 pairs of cross-island cousins, close relatives buried around 75 km apart in Hispaniola and low genetic differentiation across islands. Genetic continuity across transitions in pottery styles reveals that cultural changes during the Ceramic Age were not driven by migration of genetically differentiated groups from the mainland, but instead reflected interactions within an interconnected Caribbean world1,8.

Author Correction: The spread of steppe and Iranian-related ancestry in the islands of the western Mediterranean.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

The spread of steppe and Iranian-related ancestry in the islands of the western Mediterranean.

Steppe-pastoralist-related ancestry reached Central Europe by at least 2500 BC, whereas Iranian farmer-related ancestry was present in Aegean Europe by at least 1900 BC. However, the spread of these ancestries into the western Mediterranean, where they have contributed to many populations that live today, remains poorly understood. Here, we generated genome-wide ancient-DNA data from the Balearic Islands, Sicily and Sardinia, increasing the number of individuals with reported data from 5 to 66. The oldest individual from the Balearic Islands (~2400 BC) carried ancestry from steppe pastoralists that probably derived from west-to-east migration from Iberia, although two later Balearic individuals had less ancestry from steppe pastoralists. In Sicily, steppe pastoralist ancestry arrived by ~2200 BC, in part from Iberia; Iranian-related ancestry arrived by the mid-second millennium BC, contemporary to its previously documented spread to the Aegean; and there was large-scale population replacement after the Bronze Age. In Sardinia, nearly all ancestry derived from the island's early farmers until the first millennium BC, with the exception of an outlier from the third millennium BC, who had primarily North African ancestry and who-along with an approximately contemporary Iberian-documents widespread Africa-to-Europe gene flow in the Chalcolithic. Major immigration into Sardinia began in the first millennium BC and, at present, no more than 56-62% of Sardinian ancestry is from its first farmers. This value is lower than previous estimates, highlighting that Sardinia, similar to every other region in Europe, has been a stage for major movement and mixtures of people.

Artificial intelligence and radiomics in pulmonary nodule management: current status and future applications.

Artificial intelligence (AI) has been present in some guise within the field of radiology for over 50 years. The first studies investigating computer-aided diagnosis in thoracic radiology date back to the 1960s, and in the subsequent years, the main application of these techniques has been the detection and classification of pulmonary nodules. In addition, there have been other less intensely researched applications, such as the diagnosis of interstitial lung disease, chronic obstructive pulmonary disease, and the detection of pulmonary emboli. Despite extensive literature on the use of convolutional neural networks in thoracic imaging over the last few decades, we are yet to see these systems in use in clinical practice. The article reviews current state-of-the-art applications of AI and in detection, classification, and follow-up of pulmonary nodules and how deep-learning techniques might influence these going forward. Finally, we postulate the impact of these advancements on the role of radiologists and the importance of radiologists in the development and evaluation of these techniques.

Pulmonary nodules: Assessing the imaging biomarkers of malignancy in a "coffee-break".

INTRODUCTION: Although nodule volumetry is a recognized biomarker of malignancy in pulmonary nodules (PNs), caution is needed in its interpretation because of variables such as respiratory volume variation and inter-scan variability of up to 25%. CT Texture Analysis (CTTA) is a potential independent biomarker of malignancy but inter-scan variability and respiratory volume variation has not been assessed. METHODS: In this prospective cohort study, 40 patients (20 with an indeterminate PN and 20 with pulmonary metastases) underwent two LDCTs within a 60-min period (the "Coffee-break") with the aim of assessing the repeatability of CTTA and semi-automated volume measurements. Texture features were extracted from each automatic contoured region surrounding the PN. Patients were also randomized to two inspiratory control groups: normal breath hold, and controlled lung volume to study the influence of inspiratory control on these measurements. RESULTS: The mean difference in volume between the two scans was 6.3%,SD:29.9%. The textural features displayed 95% CI below ±17.8%, and were less variable than nodule volume (95%CI ±â€¯28.9%). All features had high repeatability, calculated by the concordance correlation coefficient, (0.84 ≤ CCC ≤ 0.99). All measurements were more repeatable for the controlled lung volume group than the normal breath-hold group. CONCLUSION: CTTA repeatability was comparable to automatic volumetric measurements, and appears to be improved using controlled volume breath holding.

A retrospective validation study of three models to estimate the probability of malignancy in patients with small pulmonary nodules from a tertiary oncology follow-up centre.

AIM: To estimate the probability of malignancy in small pulmonary nodules (PNs) based on clinical and radiological characteristics in a non-screening population that includes patients with a prior history of malignancy using three validated models. MATERIALS AND METHODS: Retrospective data on clinical and radiological characteristics was collected from the medical records of 702 patients (379 men, 323 women; range 19-94 years) with PNs ≤12 mm in diameter at a single centre. The final diagnosis was compared to the probability of malignancy calculated by one of three models (Mayo, VA, and McWilliams). Model accuracy was assessed by receiver operating characteristics (ROC). The models were calibrated by comparing predicted and observed rates of malignancy. RESULTS: The area under the ROC curve (AUC) was highest for the McWilliams model (0.82; 95% confidence interval [CI]: 0.78-0.91) and lowest for the Mayo model (0.58; 95% CI: 0.55-0.59). The VA model had an AUC of (0.62; 95% CI: 0.47-0.64). Performance of the models was significantly lower than that in the published literature. CONCLUSIONS: The accuracy of the three models is lower in a non-screening population with a high prevalence of prior malignancy compared to the papers that describe their development. To the authors' knowledge, this is the largest study to validate predictive models for PNs in a non-screening clinically referred patient population, and has potential implications for the implementation of predictive models.

Microleakage of 4 post-luting cements evaluated by the computerized fluid filtration method.

PURPOSE: The aim of this study was to evaluate the microleakage of 4 fiber post-luting systems using the computerized fluid filtration method. METHODS: 60 extracted human mandibular permanent premolar teeth were used for the study. The teeth were instrumented with Hedstroem files up to size 60, post spaces were prepared and then Unicore fiber posts were cemented using 4 luting systems. Group1: Duolink, Group 2: Resinomer, Group 3: Fuji Plus, Group 4: Multilink Sprint, Group 5: Positive Control, and Group 6: Negative Control. The samples were stored in distilled water for 2 weeks and then microleakage was evaluated. Data were analyzed with 1 way-ANOVA and Dunett T3 tests (P<.05). Groups 2 and 3 significantly exhibited higher microleakage values than groups 1 and 4 (P<.05). RESULTS: Resin cements used with total etch-bonding systems demonstrated lower microleakage values than the other cements. CONCLUSIONS: Reduction of steps in dentin conditioning of resin luting cements may have a promoting effect on microleakage.

Conservative treatment and follow-up of type III dens invaginatus using cone beam computed tomography.

Dens invaginatus is a well-recognized phenomenon, and its endodontic treatment poses a challenge, especially for peri-invagination lesions with vital pulp. Here we describe the outcome of conservative treatment and follow-up in a case of type III dens invaginatus. Cone-beam computed tomography was used for diagnosis and follow-up. Pulp vitality was preserved with endodontic treatment of only an invaginated canal. At the 24-month follow-up examination, the tooth was asymptomatic and repair of the lesion was evident radiographically. This case was managed successfully with endodontic treatment of the invagination. (J Oral Sci 56, 307-310, 2014).

Comparative micro-computed tomography evaluation of apical root canal transportation with the use of ProTaper, RaCe and Safesider systems in human teeth.

The aim of this study was to compare apical centring ability of nickel titanium (NiTi) ProTaper, RaCe and mainly stainless steel Safesider systems using micro-computed tomography. Thirty freshly extracted mandibular molars with two separate mesial canals and separate foramina were used for the study. Mesial roots were embedded in acrylic resin and instrumented with the ProTaper, RaCe or Safesider systems. Root canal transportation and centring ability of the instruments were evaluated using superimposed micro-computed tomography images of the apical 4 mm of the roots taken at 1 mm intervals. One-way analysis of variance and post hoc Tukey's tests were performed to compare apical transportations. Significant differences were observed between groups at the apical 1, 2 and 3 mm levels (P < 0.05). The reciprocating Safesider system transported root canals significantly more than the other two NiTi systems in the apical 1 mm level (P = 0.001) and more than RaCe system in the apical 2 mm level (P = 0.003). The ProTaper instruments caused more apical root canal transportation than did RaCe instruments at apical 3 mm (P = 0.045). NiTi instrumentation systems showed better centring ability than the mainly stainless steel Safesider system because of the flexible structure of the NiTi alloy.

In vitro bonding effectiveness of new self-adhering flowable composite to calcium silicate-based material.

The purpose of this study was to compare in vitro bonding effectiveness of Vertise Flow (VF), a new self-adhering flowable composite (FC), and Ultimate Flow (UF), a conventional FC, to BioAggregate (BA), and to investigate whether the use of self-etch or etch-andrinse adhesive improved the bond strength of VF to BA. Shear bond strengths of FC to BA were measured for this reason. Data were analyzed using Wilcoxon and Mann-Whitney U-tests (p=0.05). There were significant differences of bond strengths after 24- and 72-h (p<0.05, p<0.001). After 72-h, self-adhering FC may be used successfully with BA and no other adhesive, as an alternative to the combined use of conventional FC and self-etch adhesives. The use of etch-and-rinse adhesives with self-adhering FC may improve adhesion to BA.

Evaluation of the effectiveness of Er:YAG laser and conventional periodontal treatment in a patient with acute streptococcal gingivitis: a 2-year follow-up.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of Er:YAG laser and conventional periodontal therapy in the treatment of acute streptococcal gingivitis both clinically and microbiologically. BACKGROUND DATA: This case report describes a 2-year follow-up of a 30-year-old, female, chronic periodontitis patient, presenting severe gingival inflammation, sensitivity, pain, and acute gingival lesions that were treated with Er:YAG laser and conventional hand and ultrasonic instruments. MATERIALS AND METHODS: Before the initial periodontal treatment, microbiological samples were taken from the lesion sites with sterile paper points from the sulcuses bilaterally, and excisional biopsies were obtained from the lesions. Following diagnostic tests, the lesions were identified as acute streptococcal gingivitis. Following the measurement of clinical indices, initial periodontal therapy was performed with Er:YAG laser on the right side and conventional hand and ultrasonic instruments on the left side, which were performed as two sessions at weekly intervals. As an adjunct to mechanical periodontal therapy, 500 mg amoxicillin was prescribed t.i.d. for a week. RESULTS: Microbiological samples grew mostly Streptococcus sp. and black pigmented obligate anaerobic bacteria. The histopathological examination revealed acanthosis, papillomatosis, and spongiotic lesions in the keratinized stratified squamous epithelium; infiltration of polymorphonuclear neutrophils, lymphocytes, and macrophages and plasma cells in the connective tissue; infiltration and accumulation of polymorphonuclear neutrophils in the epithelium, especially in the spongiotic lesions; and formation of microabscess-like clusters. After the initial periodontal treatment, clinical and microbiological measurements were repeated and reductions in clinical indices and the number of microorganisms were observed. both treatment modalities gave similar results, and no recurrences were observed during the 2-year follow-up. CONCLUSION: Er:YAG laser seems to be promising and as effective as conventional periodontal therapy in the treatment of acute streptococcal gingivitis.

Adipocyte/macrophage fatty acid binding proteins control integrated metabolic responses in obesity and diabetes.

Fatty acid binding proteins (FABPs) are cytosolic fatty acid chaperones whose biological role and mechanisms of action are not well understood. Here, we developed mice with targeted mutations in two related adipocyte FABPs, aP2 and mal1, to resolve their role in systemic lipid, glucose, and energy metabolism. Mice lacking aP2 and mal1 exhibited a striking phenotype with strong protection from diet-induced obesity, insulin resistance, type 2 diabetes, and fatty liver disease. These mice have altered cellular and systemic lipid transport and composition, leading to enhanced insulin receptor signaling, enhanced muscle AMP-activated kinase (AMP-K) activity, and dramatically reduced liver stearoyl-CoA desaturase-1 (SCD-1) activity underlying their phenotype. Taken together with the previously reported strong protection against atherosclerosis, these results demonstrate that adipocyte/macrophage FABPs have a robust impact on multiple components of metabolic syndrome, integrating metabolic and inflammatory responses in mice and constituting a powerful target for the treatment of these diseases.

Mycological and cytological examination of oral candidal carriage in diabetic patients and non-diabetic control subjects: thorough analysis of local aetiologic and systemic factors.

In this study, 55 diabetic patients and 45 non-diabetic control subjects were examined to determine oral candidal carriage state. The influence of some local aetiologic and systemic factors such as: salivary flow rate and pH, heredity, alcohol drinking, smoking habits, antimicrobial therapy, wearing of denture, burning sensation, dry mouth, taste alteration and tooth brushing habit on candidal carriage rate were investigated. Imprint culture, cytological smears and biochemical tests were used. Oral carrier rate and density of Candida species were non-significantly higher in the diabetic patients than in the non-diabetic control subjects. This increase was confirmed cytologically too. In both groups, Candida albicans was found to be a predominant species on tongue dorsum. Cigarette and alcohol habits of men were higher while tooth brushing habit was less than in women in diabetic and control groups. Salivary flow rate and pH values of diabetic patients were significantly lower while serum glucose values were significantly higher than of non-diabetic controls. The rate of diabetic patients suffering from dry mouth and having diabetic heredity in the family were significantly higher than control subjects. The candidal colonization was higher and keratinization was lower while diabetic treatment tended from diet and oral antidiabetic towards insulin. The decrease in salivary pH, the increase in serum glucose and wearing denture were correlated with the increased rate and density of C. albicans in both groups. Keratinization was also accompanied with the increase in leucocytes. In diabetic group, positive correlations were found between antimicrobial therapy and C. glabrata carriage; the increase in leucocytes and C. albicans carriage; the increase in keratinization and alcohol habit; serum glucose and smoking habit; dry mouth complaint and antimicrobial therapy. There was a negative correlation between salivary flow rate and C. albicans carriage. In control group a positive correlation was found between antimicrobial therapy and keratinization.