Electromotive Drug Administration in the Porcine Renal Pelvis: First Report.

Introduction: Electromotive Drug Administration (EMDA) amplifies drug delivery deep into targeted tissues. We tested, for the first time, the ability of EMDA to deliver methylene blue into the urothelium of the renal pelvis. Materials and Methods: In an anesthetized female pig, both proximal ureters were transected two inches distal to the ureteropelvic junction. An 8F dual lumen catheter and a 5F fenestrated catheter with an indwelling silver wire were inserted into both renal pelvises following which methylene blue (0.1%) was infused at a rate of 5 mL/min for 20 minutes. In one pelvis, a 4 mA positive pulsed electrical current was applied to the silver wire. Results: In contrast to the control pelvis, the EMDA side macroscopically exhibited dense homogeneous staining; microscopy revealed penetration of methylene blue into the urothelium/lamina propria. Conclusion: In the porcine renal pelvis, application of EMDA increased the penetration of a charged molecule into the urothelium/lamina propria.

Electromotive Drug Administration in the Ureter in an In Vivo Animal Model: Initial Report.

Introduction: Electromotive drug administration (EMDA) delivers a drug deeply into targeted tissues, such as the bladder. EMDA has never been applied to the ureter. Methods: In four in vivo porcine ureters, a unique EMDA catheter containing a silver conducting wire was advanced for the infusion of methylene blue. In two ureters, a pulsed current was delivered through an EMDA machine, whereas the other two ureters served as a control. After 20 minutes of infusion, the ureters were harvested. Results: In the EMDA ureter, there was diffuse staining of the urothelium; penetration of methylene blue occurred in the lamina propria and muscularis propria. In the control ureter, there was only patchy staining of the urothelium. Conclusion: In this first report of ureteral EMDA, a charged molecule penetrated beyond the urothelium into the lamina propria and muscularis propria of the porcine ureter.

An ultra-sensitive NH3 gas sensor enabled by an ion-in-conjugated polycroconaine/Ti3C2Tx core-shell composite.

MXenes are emerging sensing materials due to their metallic conductivity and rich surface chemistry for analytes; they, however, suffer from poor stability. Incorporation with functional polymers can largely prevent the performance decay and enhance the sensing performance. Herein, we demonstrate a core-shell composite, Ti3C2Tx@croconaine (poly(1,5-diaminonaphthalene-croconaine), PDAC) prepared by a facile in situ polymerization reaction, suitable for NH3 detection. Compared to pristine Ti3C2Tx, the sensor made of a Ti3C2Tx-polycroconaine composite exhibits a significantly enhanced sensitivity of 2.8% ppm-1 and an estimated achievable limit of detection of 50 ppb. The improved sensing performance could be attributed to the presence of PDAC facilitating the adsorption of NH3 and changing the tunneling conductivity between Ti3C2Tx domains. Density functional theory (DFT) calculations reveal that the adsorption energy of NH3 on PDAC is the highest among the tested gases, which supports the selectivity of the sensor to this analyte. Benefiting from the protection conferred by the PDAC shell, the composite has a reliable operation period of at least 40 days. In addition, we demonstrated a flexible paper-based sensor of the Ti3C2Tx@PDAC composite, without attenuated performance upon mechanical deformation. This work proposed a novel mechanism and a feasible methodology to synthesize MXene-polymer composites with improved sensitivity and stability for chemical sensing.

Bioplastics and Carbon-Based Sustainable Materials, Components, and Devices: Toward Green Electronics.

The continuously growing number of short-life electronics equipment inherently results in a massive amount of problematic waste, which poses risks of environmental pollution, endangers human health, and causes socioeconomic problems. Hence, to mitigate these negative impacts, it is our common interest to substitute conventional materials (polymers and metals) used in electronics devices with their environmentally benign renewable counterparts, wherever possible, while considering the aspects of functionality, manufacturability, and cost. To support such an effort, in this study, we explore the use of biodegradable bioplastics, such as polylactic acid (PLA), its blends with polyhydroxybutyrate (PHB) and composites with pyrolyzed lignin (PL), and multiwalled carbon nanotubes (MWCNTs), in conjunction with processes typical in the fabrication of electronics components, including plasma treatment, dip coating, inkjet and screen printing, as well as hot mixing, extrusion, and molding. We show that after a short argon plasma treatment of the surface of hot-blown PLA-PHB blend films, percolating networks of single-walled carbon nanotubes (SWCNTs) having sheet resistance well below 1 kΩ/□ can be deposited by dip coating to make electrode plates of capacitive touch sensors. We also demonstrate that the bioplastic films, as flexible dielectric substrates, are suitable for depositing conductive micropatterns of SWCNTs and Ag (1 kΩ/□ and 1 Ω/□, respectively) by means of inkjet and screen printing, with potential in printed circuit board applications. In addition, we exemplify compounded and molded composites of PLA with PL and MWCNTs as excellent candidates for electromagnetic interference shielding materials in the K-band radio frequencies (18.0-26.5 GHz) with shielding effectiveness of up to 40 and 46 dB, respectively.

Antithrombotic Therapy in COVID-19: Systematic Summary of Ongoing or Completed Randomized Trials

Endothelial injury and microvascular/macrovascular thrombosis are common pathophysiologic features of coronavirus disease-2019 (COVID-19). However, the optimal thromboprophylactic regimens remain unknown across the spectrum of illness severity of COVID-19. A variety of antithrombotic agents, doses and durations of therapy are being assessed in ongoing randomized controlled trials (RCTs) that focus on outpatients, hospitalized patients in medical wards, and critically-ill patients with COVID-19. This manuscript provides a perspective of the ongoing or completed RCTs related to antithrombotic strategies used in COVID-19, the opportunities and challenges for the clinical trial enterprise, and areas of existing knowledge, as well as data gaps that may motivate the design of future RCTs.

A graphene/TiS3 heterojunction for resistive sensing of polar vapors at room temperature.

The room temperature polar vapor sensing behavior of a graphene-TiS3 heterojunction material and TiS3 nanoribbons is described. The nanoribbons were synthesized via chemical vapor transport (CVT) and their structure was investigated by scanning electron microscopy, high resolution transmission electron microscopy, energy dispersive X-ray spectroscopy, X-ray diffraction, Raman and Fourier transform infrared spectroscopies. The gas sensing performance was assessed by following the changes in their resistivities. Sensing devices were fabricated with gold contacts and with lithographically patterned graphene (Gr) electrodes in a heterojunction Gr-TiS3-Gr. The gold contacted TiS3 device has a rather linear I-V behavior while the Gr-TiS3-Gr heterojunction forms a contact with a higher Schottky barrier (250 meV). The I-V responses of the sensors were recorded at room temperature at a relative humidity of 55% and for different ethanol vapor concentrations (varying from 2 to 20 ppm). The plots indicate an increase in the resistance of Gr-TiS3-Gr due to adsorption of water and ethanol with a relatively high sensing response (~495% at 2 ppm). The results reveal that stable responses to 2 ppm concentrations of ethanol are achieved at room temperature. The response and recovery times are around 8 s and 72 s, respectively. Weaker responses are obtained for methanol and acetone. Graphical abstract Schematic representation of resistance sensor for detection of low concentration of ethanol vapor. The graphene and TiS3 nanoribbons were synthesized using chemical vapor deposition and chemical vapor transport technique respectively. The 2D graphene/TiS3 heterojunction device was fabricated to make a high response sensor due to their synergy effect.

Oligoprotective effect of metformin through the AMPK-dependent on restoration of mitochondrial hemostasis in the cuprizone-induced multiple sclerosis model.

Oxidative stress with mitochondrial defects has a central role in the development and deterioration of Multiple sclerosis (MS). According to new findings of the effects of metformin on mitochondrial function, has attracted a lot of attention. Furthermore, it is suggested that metformin exerts its beneficial influence through AMP-activated protein kinase (AMPK) pathway. In the current study, we investigated the possible protective effects of metformin on oxidative stress and mitochondrial function by activating the AMPK pathway in the cuprizone-induced demyelination. Mice were fed with cuprizone for 6 weeks. Animals simultaneously received metformin. After sacrificing animals, myelinations, and gliosis, changes in transcription factor and biochemical analysis were assessed. Transmission electron microscopy and luxol fast blue staining revealed that the myelinated axons within corpus callosum of cuprizone-induced demyelination animals increased after administration of metformin. Metformin also upregulated the expression of mitochondrial biogenesis genes. Furthermore, the biochemical analysis demonstrated that metformin ameliorated the oxidative stress induced by cuprizone. Immunohistochemistry analysis showed that astrogliosis and microgliosis were decreased after metformin administration while it enhanced the number of oligodendrocytes. Our data implicated that metformin exerts its therapeutic effects on MS by AMPK signaling improved mitochondrial homeostasis and protected oligodendrocytes.

Two-dimensional and volumetric airway changes after bimaxillary surgery for class III malocclusion.

OBJECTIVES: Any change in maxilla and mandible position can alter the upper airway, and any decrease in the upper airway can cause sleep disorders. Thus, it is necessary to assess airway changes after repositioning of the maxilla and mandible during orthognathic surgery. The purpose of this study was to evaluate linear and volumetric changes in the upper airway after bimaxillary surgery to correct class III malocclusion via cone-beam computed tomography (CBCT) and to identify correlations between linear and volumetric changes. MATERIALS AND METHODS: This was a prospective cohort study. CBCTs from 10 class III patients were evaluated before surgery and three months after. The Wilcoxon one-sample test was used to evaluate the differences in measurements before and after surgery. Spearman's rank correlation coefficient was used to test the correlation between linear and volumetric changes. RESULTS: The results show that the nasopharyngeal space increased significantly, and that this increase correlated with degree of maxillary advancement. No significant changes were found in volumes before and after surgery. A correlation was found between linear and volumetric oropharyngeal changes. CONCLUSION: Bimaxillary surgical correction of class III malocclusion did not cause statistically significant changes in the posterior airway space.

Two-dimensional and volumetric airway changes after bimaxillary surgery for class III malocclusion

OBJECTIVES: Any change in maxilla and mandible position can alter the upper airway, and any decrease in the upper airway can cause sleep disorders. Thus, it is necessary to assess airway changes after repositioning of the maxilla and mandible during orthognathic surgery. The purpose of this study was to evaluate linear and volumetric changes in the upper airway after bimaxillary surgery to correct class III malocclusion via cone-beam computed tomography (CBCT) and to identify correlations between linear and volumetric changes. MATERIALS AND METHODS: This was a prospective cohort study. CBCTs from 10 class III patients were evaluated before surgery and three months after. The Wilcoxon one-sample test was used to evaluate the differences in measurements before and after surgery. Spearman's rank correlation coefficient was used to test the correlation between linear and volumetric changes. RESULTS: The results show that the nasopharyngeal space increased significantly, and that this increase correlated with degree of maxillary advancement. No significant changes were found in volumes before and after surgery. A correlation was found between linear and volumetric oropharyngeal changes. CONCLUSION: Bimaxillary surgical correction of class III malocclusion did not cause statistically significant changes in the posterior airway space.

Electric and Photovoltaic Behavior of a Few-Layer α-MoTe2 /MoS2 Dichalcogenide Heterojunction.

Mo-based van der Waals heterojunction p-n diodes with p-type α-MoTe2 and n-type MoS2 are fabricated on glass, and demonstrate excellent static and dynamic device performances at a low voltage of 5 V, with an ON/OFF current ratio higher than 10(3) , ideality factors of 1.06, dynamic rectification at a high frequency of 1 kHz, high photoresponsivity of 322 mA W(-1) , and an external quantum efficiency of 85% under blue-light illumination.

High-gain subnanowatt power consumption hybrid complementary logic inverter with WSe2 nanosheet and ZnO nanowire transistors on glass.

A 1D-2D hybrid complementary logic inverter comprising of ZnO nanowire and WSe2 nanosheet field-effect transistors (FETs) is fabricated on glass, which shows excellent static and dynamic electrical performances with a voltage gain of ≈60, sub-nanowatt power consumption, and at least 1 kHz inverting speed.

Intra-operative stone culture as an independent predictor of systemic inflammatory response syndrome after percutaneous nephrolithotomy.

To evaluate the correlation between preoperative urine culture and stone culture findings during PCNL and choosing the appropriate antimicrobial treatment of patients with urinary tract infection or SIRS after PCNL. From April 2007 to March 2008, 51 patients aged 24-66 years underwent PCNL under general anesthesia. Statistical analysis was performed using SPSS software (v.18), the Kolmogorov-Smirnov test, Student's t test, and the Chi square or Fisher's exact tests. Before operation, 11 patients (21.6 %) had positive urine culture. Sixteen patients (31.4 %) had positive stone culture during operation. SIRS occurred in 13 patients (25.5 %). In female group (10 cases, 45.5 %), SIRS was significantly higher than male group (3 cases, 10.3 %) (P = 0.008). Positive stone culture was significantly more prevalent in cases with positive pre-operative urine culture than cases with negative pre-operative urine culture (P = 0.023). But positive stone culture in group with SIRS, was significantly more common than group without SIRS (P = 0.001). Also positive stone culture in female group had significantly higher than male group (P = 0.003). We found a significant, tenfold increase in the risk of developing SIRS after PNCL, only in patients with positive stone culture (OR = 9.96; 95 % CI = 2.37-41.85, P = 0.002). Positive stone culture is a significant predictor of SIRS after PCNL, regardless of other related factors. Therefore, in order to avoid using blind empirical antibiotic regimen and to reduce the risk of subsequent microbial resistance due to use of prevalent broad-spectrum antibiotics, it would be wise to choose appropriate antibiotic therapy based on the results of intraoperative stone culture.

Does sildenafil enhance the effect of tamsulosin in relieving acute urinary retention?

OBJECTIVE: To compare the safety and efficacy of combined therapy using sildenafil and tamsulosin for management of acute urinary retention (AUR) with tamsulosin alone in patients with benign prostate hyperplasia (BPH). MATERIALS AND METHODS: 101 patients were enrolled in a randomized placebo-controlled study from June 2009 to April 2012. Patients presenting with an initial episode of spontaneous AUR underwent urethral catheterization and then prospectively randomized to receive tamsulosin 0.4 mg plus sildenafil 50mg in group A and tamsulosin 0.4 mg plus placebo in group B for three days. Urethral catheter was removed three days after medical treatment and patient's ability to void assessed at the day after catheter removal and seven days later. Patients who voided successfully were followed at least for three months. RESULTS: Mean age of patients was 59.64 ± 3.84 years in group A and 60.56 ± 4.12 years in group B (p value = 0.92). Mean prostate volume and mean residual urine were comparable between both groups (p value = 0.74 and 0.42, respectively). Fifteen patients in group A (success rate: 70%) and nineteen patients in group B (success rate: 62.7%) had failed trial without catheter (TWOC) at 7th day following AUR (p value = 0.3). No significant difference was noted between both groups regarding the rate of repeated AUR at one month and three month follow-up period (p = 0.07 and p = 0.45, respectively). CONCLUSION: It seems that combination therapy by using 5-phosphodiesterase inhibitor and tamsulosin has no significant advantages to improve urinary retention versus tamsulosin alone.

Intermittent perirenal instillation of bupivacaine after tubeless percutaneous nephrolithotomy under spinal anesthesia: a double-blind, placebo-controlled clinical trial.

BACKGROUND AND PURPOSE: Pain at the surgery site is a common complaint in patients who experience percutaneous nephrolithotomy (PCNL). The aim of this double-blind, randomized clinical trial is evaluation of the effect of scheduled infusion of bupivacaine on postsurgical pain and narcotic consumption after tubeless PCNL under spinal anesthesia. PATIENTS AND METHODS: Forty patients were randomly divided into two groups. A small caliber fenestrated feeding tube was placed into the nephrostomy tract under direct vision in a manner in which its tip lied close to the renal capsule. The study group received infusion of diluted bupivacaine while physiologic saline was injected in the control group. Each patient was given the same dose every 6 hours until 24 hours after the surgical procedure. RESULTS: Mean pethidine injection was significantly lower in the group who underwent bupivacaine instillation (20.5±14.5 vs 3.97±2.4 mg: P=0.009). There was no significant difference between mean visual analogue scale (VAS) score in these two groups after 6 and 12 hours while it was significantly lower after 18 and 24 hours in the patients who had received bupivacaine. Mean time to the first analgesic request was significantly longer in the study group (11.35 vs 6.44 hours: P=0.001). CONCLUSION: Intermittent perirenal instillation of bupivacaine via the nephrostomy tract after PCNL decreases the need for more systemic narcotics and provides acceptable analgesia in the postoperative period.

Does sildenafil enhance the effect of tamsulosin in relieving acute urinary retention?

Objective To compare the safety and efficacy of combined therapy using sildenafil and tamsulosin for management of acute urinary retention (AUR) with tamsulosin alone in patients with benign prostate hyperplasia (BPH). Materials and Methods 101 patients were enrolled in a randomized placebo-controlled study from June 2009 to April 2012. Patients presenting with an initial episode of spontaneous AUR underwent urethral catheterization and then prospectively randomized to receive tamsulosin 0.4mg plus sildenafil 50mg in group A and tamsulosin 0.4mg plus placebo in group B for three days. Urethral catheter was removed three days after medical treatment and patient’s ability to void assessed at the day after catheter removal and seven days later. Patients who voided successfully were followed at least for three months. Results Mean age of patients was 59.64 ± 3.84 years in group A and 60.56 ± 4.12 years in group B (p value = 0.92). Mean prostate volume and mean residual urine were comparable between both groups (p value = 0.74 and 0.42, respectively). Fifteen patients in group A (success rate: 70%) and nineteen patients in group B (success rate: 62.7%) had failed trial without catheter (TWOC) at 7th day following AUR (p value = 0.3). No significant difference was noted between both groups regarding the rate of repeated AUR at one month and three month follow-up period (p = 0.07 and p = 0.45, respectively). Conclusion It seems that combination therapy by using 5-phosphodiesterase inhibitor and tamsulosin has no significant advantages to improve urinary retention versus tamsulosin alone. .

Evolution of laparoscopic live donor nephrectomy: a single-center experience with 1510 cases over 14 years.

OBJECTIVE: This study evaluated the outcomes of laparoscopic donor nephrectomy (LDN) and proposed modifications for kidney donation surgery. From February 1997 to February 2011, 1510 LDNs were performed. PATIENTS AND METHODS: Surgical modifications included a modified open access technique for entry into the abdominal cavity, using vascular clips for safe and cost-effective control of the renal pedicle, control of the lumbar veins, and adrenal vein using bipolar cautery instead of clips, and leaving the gonadal vein intact with the ureter. Kidneys were extracted by hand through a Pfannenstiel incision. Heparin was not used after the first 300 cases to prevent potential hemorrhagic complications. RESULTS: Although three major vascular injuries occurred using the closed access method that were managed successfully, no access-related complications occurred using the modified open access technique. Clip failure did not happen in any cases. Patient and graft survival at 1 year post-transplantation were 96.5% and 95.5%, respectively, and at 5 years post-transplantation were 95.3% and 89.5%, respectively. CONCLUSION: The proposed surgical modifications are based on 14 years of experience and 1510 cases, and make LDN simple, safe, and cost-effective. The excellent recipient and graft outcomes with minimal morbidity obtained further confirm that LDN can be considered as the gold standard for kidney donation surgery.

Gastrointestinal helminthes of green-winged teal (Anas crecca) from North Iran

<p><b>OBJECTIVE</b>To determine the helminth parasites of Anas crecca (A. crecca) in one of proper refuges of Iran, Fereydunkenar.</p><p><b>METHODS</b>A total number of one hundred thirty-six gastrointestinal tracts of green-winged teal (A. crecca) were collected from Fereydunkenar, Mazandaran province during September and October 2011. The gastrointestinal tracts were examined for helminth infection.</p><p><b>RESULTS</b>The total infection rate was 70.50% (96) that 68.96% (40) of males and 71.79% (56) of females shown helminthes infection. The examined A. crecca harbored one species of Nematoda, Cestoda and two species of Digenea which were as following: Contracaecum larvae (from stomach wall), Diorchis stefanskii (D. stefanskii) (from small intestine), Hypoderaeum conoideum (from small intestine) and Notocotylus attenuatus (N. attenuatus) (from caecum), respectively. There was no significant difference in the prevalence of infection between examined males and females ducks in Hypoderaeum conoideum, D. stefanskii and N. attenuatus (P>0.05) whereas a significant relationship was observed between males and females in Contracaecum larvae (P<0.05).</p><p><b>CONCLUSIONS</b>Based on the results of the present study, we conclude that A. crecca plays a prominent role in transmission of mentioned parasites. In addition, this is the first report of Contracaecum larvae, D. stefanskii and N. attenuatus from A. crecca in Iran.</p>

Percutaneous nephrolithotomy in high-risk patients: a single-center experience with more than 350 cases.

PURPOSE: To assess the surgical outcomes and peri- and postoperative complications following percutaneous nephrolithotomy (PCNL) in high- and low-risk patients according to the American Society of Anesthesiologists (ASA) score. MATERIALS AND METHODS: We reviewed the patient records of 2,281 cases older than 18 years who had undergone PCNL in the 3 previous years. The patients were divided into two groups: a low-risk group (ASA score 1, 2: 1,922 cases) and a high-risk group (ASA score 3, 4: 359 cases). RESULTS: Analysis of the location and size of the stone, number and type of access, surgical approach, post-PCNL serum hemoglobin and decrease in glomerular filtration rate revealed no significant difference between the two groups. The stone-free rate was similar in both groups and the hospital stay in the high-risk patients was significantly greater than in the low-risk cases. 95% of low-risk and 91% of high-risk cases had surgical complications compatible with grade ≤II (Clavien system) and overall distribution of different grades of surgical complications was similar between the two groups (p = 0.177). CONCLUSION: Success rate and surgical complications of PCNL in high-risk patients were comparable to low-risk patients. It seems that PCNL may be a safe and effective procedure even in high-risk patients.

Laparoscopic vesicovaginal fistula repair: report of five cases, literature review, and pooling analysis.

OBJECTIVE: This study assessed the safety and efficacy of laparoscopic repair of vesicovaginal fistula (VVF) by literature review and pooling analysis, and this is the first report of the experience of using this approach in a patient with a history of radiotherapy. SUBJECTS AND METHODS: Five patients with VVF, including one with a history of cervical cancer and radiation, underwent laparoscopic repair from August 2010 to December 2011 performed by the same experienced surgeon. RESULTS: The surgical procedure was uneventful in all of the patients, and no conversion to open surgery was required. Mean operation time was 134 minutes (range, 100-185 minutes). Mean blood loss was 300 mL (range, 250-370 mL), and no one required blood transfusion. Mean hospital stay was 4 days (range, 3-6 days). Laparoscopic repair was successful in 4 patients at the mean follow-up period of 8 months (range, 2-15 months), even in the patient with a history of radiotherapy. VVF recurred in 1 subject, who underwent repeat laparoscopic repair, and 2-month follow-up revealed no fistula. CONCLUSIONS: Laparoscopic surgery may be a good alternative to the open approach to manage even complicated VVF if it is performed by skilled surgeons.

Supine percutaneous nephrolithotomy: con.

Advocates of supine percutaneous nephrolithotomy (PCNL) consider several theoretical advantages for this procedure. Despite the potential advantages of the supine PCNL, the majority of urologists have remained reluctant to perform this technique. This reluctance may be related to successful outcomes of prone PCNL and technical difficulties associated with supine PCNL. Feasibility of supine PCNL has been shown in different series and the current evidence, although limited and not fully organized, implies the application of this technique for patients with simple stones who are at high anesthesiological risk. However, there is no convincing evidence to support performing supine PCNL in morbidly obese patients and those with complex and multiple stones. Further randomized clinical trials of large sample size and high methodological quality are required to recommend extensive application of supine PCNL as an alternative to prone PCNL.