Aplicaciones clínicas, experimentales y resultados del uso de diferentes dispositivos de aspiración en la cirugía intrarrenal retrógrada. Revisión sistemática / Experimental and clinical applications and outcomes of using different forms of suction in retrograde intrarenal surgery. Results from a systematic review

Objetivo Identificar los últimos avances en los dispositivos de aspiración para la cirugía retrógrada intrarrenal (CRIR) y la ureteroscopia en el tratamiento de la litiasis, y evaluar los resultados de su aplicación. Procedimiento El 4 de enero de 2023 se realizó una búsqueda bibliográfica sistemática en Scopus, PubMed y EMBASE. Solo se incluyeron artículos en inglés; se aceptaron estudios en la población pediátrica y estudios en adultos. Se excluyeron los estudios duplicados, los informes de casos, las cartas al editor y los resúmenes de congresos. Hallazgos principales Se seleccionaron 21 trabajos. Se han propuesto varios sistemas de aspiración para la CRIR: a través de la vaina de acceso ureteral o directamente por el endoscopio. La inteligencia artificial también puede desempeñar un papel, monitorizando los valores de la presión y del flujo de irrigación. Todas las técnicas propuestas mostraron resultados perioperatorios satisfactorios en cuanto a tiempo quirúrgico, tasa libre de cálculos (TLC) y fragmentos residuales. Además, la reducción de la presión intrarrenal (mediante la aspiración) también se asoció a una tasa de infección menor. Incluso los estudios que incluyen cálculos renales con un diámetro de 20mm o superior informan de una mayor TLC y una reducción de las complicaciones postoperatorias. Sin embargo, la falta de parámetros bien establecidos para la presión de la aspiración y el flujo de líquido impide la estandarización del procedimiento. Conclusión Como ha sido demostrado en los estudios incluidos, el uso de dispositivos de aspiración en el tratamiento quirúrgico de los cálculos urinarios favorece la obtención de una TLC mayor y reduce las complicaciones infecciosas. La CRIR con sistema de aspiración podría sustituir a la técnica tradicional, gracias a sus ventajas asociadas al control de la presión intrarrenal y aspiración del polvo fino. (AU)

Objective To identify the latest advances in suction devices and evaluate their effect in Retrograde intrarenal surgery (RIRS) and ureteroscopy for stones. Basic procedures A systematic literature search was performed on 4th January 2023 using Scopus, PubMed, and EMBASE. Only English papers were included; both pediatric and adult studies were accepted. Duplicate studies, case reports, letters to the editor, and meeting abstracts were excluded. Main findings Twenty-one papers were selected. Several methods have been proposed for suction use in RIRS, such as through the ureteral access sheath or directly to the scope. Artificial intelligence can also regulate this system, monitoring pressure and perfusion flow values. All the proposed techniques showed satisfactory perioperative results for operative time, stone-free rate (SFR), and residual fragments. Moreover, the reduction of intrarenal pressure (induced by aspiration) was also associated with a lower infection rate. Even the studies that considered kidney stones with a diameter of 20mm or higher reported higher SFR and reduced postoperative complications. However, the lack of well-defined settings for suction pressure and fluid flow prevents the standardization of the procedure. Conclusion Aspiration device in the surgical treatment of urinary stones favours a higher SFR, reducing infectious complications, as supported by the included studies. RIRS with a suction system provided to be a natural successor to the traditional technique, regulating intrarenal pressure and aspirating fine dust. (AU)

Experimental and clinical applications and outcomes of using different forms of suction in retrograde intrarenal surgery. Results from a systematic review.

OBJECTIVE: To identify the latest advances in suction devices and evaluate their effect in Retrograde intrarenal surgery (RIRS) and ureteroscopy for stones. BASIC PROCEDURES: A systematic literature search was performed on 4th January 2023 using Scopus, PubMed, and EMBASE. Only English papers were included; both pediatric and adult studies were accepted. Duplicate studies, case reports, letters to the editor, and meeting abstracts were excluded. MAIN FINDINGS: Twenty-one papers were selected. Several methods have been proposed for suction use in RIRS, such as through the ureteral access sheath or directly to the scope. Artificial intelligence can also regulate this system, monitoring pressure and perfusion flow values. All the proposed techniques showed satisfactory perioperative results for operative time, stone-free rate (SFR), and residual fragments. Moreover, the reduction of intrarenal pressure (induced by aspiration) was also associated with a lower infection rate. Even the studies that considered kidney stones with a diameter of 20 mm or higher reported higher SFR and reduced postoperative complications. However, the lack of well-defined settings for suction pressure and fluid flow prevents the standardization of the procedure. CONCLUSION: Aspiration device in the surgical treatment of urinary stones favours a higher SFR, reducing infectious complications, as supported by the included studies. RIRS with a suction system provided to be a natural successor to the traditional technique, regulating intrarenal pressure and aspirating fine dust.

Effect of the racial group and body condition score at calving on production performance and metabolic profile of buffaloes during the transition period.

This study evaluated the body condition score (BCS) at calving and breed (B) effects on milk composition, yield, performance, physiological parameters, hemogram, blood metabolites, and urinary metabolites in the transition and early lactation periods of Mediterranean (MED) and Murrah (MUR) buffaloes. Twenty MED and fifteen MUR buffaloes were distributed into four experimental treatments, in a completely randomized design, considering their racial groups and BCS (LBCS = low; HBCS = high): LBCS MED (N = 9); HBCS MED (N = 11); LBCS MUR (N = 8); HBCS MUR (N = 7). Animals were monitored during the last 21 days of gestation and first 56 days postpartum and kept under the same management and feeding conditions. During data collection, milk composition, yield, performance, physiological parameters, hemogram, blood metabolites, and urinary metabolites were evaluated. Higher milk production and fat-corrected milk were observed in MED than MUR buffaloes. Breed effects were observed on body weight, rectal temperature, glucose, urea, calcium (Ca) concentrations, and BCS effects on total protein, albumin, urea, and Ca. There were BCS effects on hematocrit, neutrophils, eosinophils, and interactions between B × BCS for lymphocytes and platelets. There were breed effects on urinary concentrations of chlorine, uric acid, and interactions between weight (W) × B on chlorine and urea. The MED buffaloes can be considered the most prepared to undergo physiological changes, including the BCS value at calving, indicating higher physiological health. Besides, this study demonstrates more considerable preparation for the calving, regardless of the body condition score at calving.

Calcium and magnesium ion removal from water feeding a steam generator by chemical precipitation and flotation with micro and nanobubbles.

This work summarises the results of calcium and magnesium ion removal from raw water feeding an industrial steam generation system. The cations were precipitated with sodium phosphate before separation of the solids by dissolved air flotation, with micro and nanobubbles. Studies were done at bench scale and validated at pilot scale (raw water feed = 1 m3 h-1; air-to-solids ratio = 0.046 mg of air mg-1 of solids; residence time = 11 min). Results indicated that chemical precipitation followed by flotation significantly improved the quality of the boiler water. Best results were obtained after precipitating the cations with 50 mg L-1 of sodium phosphate at pH 11.5 and flotation with a saturation pressure (P sat) of 4 bar, a recycling ratio of 30% and a sodium oleate concentration of 20 mg L-1 as an hydrophobizing reagent. The latter assisted the adhesion of the nanobubbles (100-500 nm) generated at 4 bar with a numeric concentration of about 2.5 × 108 NBs mL-1. At pilot scale, the total hardness in the solution decreased by 80%; the residual calcium and phosphate ion concentrations were 12 and 2 mg L-1 respectively. This cell was designed including lamellae and perforate plate to improve the superficial loading capacity (up to 9 m h-1). The results were explained by chemical and interfacial phenomena and it is believed that this technique has great potential in water softening processes.

Osteopenia-osteoporosis discrimination in postmenopausal women by 1H NMR-based metabonomics.

This is a report on how 1H NMR-based metabonomics was employed to discriminate osteopenia from osteoporosis in postmenopausal women, identifying the main metabolites associated to the separation between the groups. The Assays were performed using seventy-eight samples, being twenty-eight healthy volunteers, twenty-six osteopenia patients and twenty-four osteoporosis patients. PCA, LDA, PLS-DA and OPLS-DA formalisms were used. PCA discriminated the samples from healthy volunteers from diseased patient samples. Osteopenia-osteoporosis discrimination was only obtained using Analysis Discriminants formalisms, as LDA, PLS-DA and OPLS-DA. The metabonomics model using LDA formalism presented 88.0% accuracy, 88.5% specificity and 88.0% sensitivity. Cross-Validation, however, presented some problems as the accuracy of modeling decreased. LOOCV resulted in 78.0% accuracy. The OPLS-DA based model was better: R2Y and Q2 values equal to 0.871 (p<0.001) and 0.415 (p<0.001). LDA and OPLS-DA indicated the important spectral regions for discrimination, making possible to assign the metabolites involved in the skeletal system homeostasis, as follows: VLDL, LDL, leucine, isoleucine, allantoin, taurine and unsaturated lipids. These results indicate that 1H NMR-based metabonomics can be used as a diagnosis tool to discriminate osteoporosis from osteopenia using a single serum sample.

Effects of seasonality on drosophilids (Insecta, Diptera) in the northern part of the Atlantic Forest, Brazil.

Seasonality is an important aspect associated with population dynamic and structure of tropical insect assemblages. This study evaluated the effects of seasonality on abundance, richness, diversity and composition of an insect group, drosophilids, including species native to the Neotropical region and exotic ones. Three preserved fragments of the northern Atlantic Forest were surveyed, where temperatures are above 20 °C throughout the year and rainfall regimes define two seasons (dry and rainy). As opposed to other studies about arthropods in tropical regions, we observed that abundance of drosophilids was significantly higher in the dry season, possibly due to biological aspects and the colonization strategy adopted by the exotic species in these environments. Contrarily to abundance, we did not observe a seasonal pattern for richness. As for other parts of the Atlantic Forest, the most representative Neotropical species (Drosophila willistoni, D. sturtevanti, D. paulistorum and D. prosaltans) were significantly more abundant in the rainy season. Among the most abundant exotic species, D. malerkotliana, Zaprionus indianus and Scaptodrosophila latifasciaeformis were more importantly represented the dry season, while D. simulans was more abundant in the rainy period. The seasonality patterns exhibited by the most abundant species were compared to findings published in other studies. Our results indicate that exotic species were significantly more abundant in the dry season, while native ones exhibited an opposite pattern.

Focal therapy for prostate cancer: current status and future perspectives.

Focal therapy is a relatively new and extremely attractive option of treatment for prostate cancer. It has been described as the "middle approach" between active surveillance and radical treatment, aiming to destroy the tumor itself or the region containing the tumor in order to preserve surrounding non-cancerous tissue. The goal is to maintain disease control at acceptable levels, while preserving erectile, urinary, and rectal function. While a lot of technologies have been described for delivering targeted therapy to the prostate, such as cryoablation, high intensity focused ultrasound, photodynamic therapy, irreversible electroporation and laser, the key point is the patient selection. Recent advances in mpMRI and the introduction of new biopsy techniques that use MR images as a guidance, have significantly improved localization of the tumor lesions and the detection rate, evolving prostate biopsy toward targeted rather than systematic biopsies. The future challenge to clinicians is to precisely risk-stratify patients to differentiate between those who would profit from focal treatment and who would not. Forthcoming research efforts should pursue to identify molecular, genetic, and imaging characteristics that distinguish aggressive prostate tumors from indolent lesions.

Migration mesh mimicking bladder malignancy after open inguinal hernia repair.

Despite the benefits of using surgical meshes to repair abdominal and inguinal hernias, there are increasing reports of mesh migration into the gastrointestinal and urinary tracts-a complication that cannot be overlooked or neglected. Resolution of such cases can be difficult and depends on the degree of migration and the anatomical site involved. The present paper reports the case of a 68-year-old patient undergoing a trans-ureteral resection of a possible bladder malignancy diagnosed following clinical and radiological evaluation. During the procedure (cytoscopy), it was found that migration of a mesh was mimicking the urological disease initially suspected. A polypropylene mesh had been inserted into the right inguinal region 20 years previously to repair an inguinal hernia. This is one of only a few case reports on mesh migration presenting as a suspected bladder malignancy.

Liver transplantation using University of Wisconsin or Celsior preserving solutions in the portal vein and Euro-Collins in the aorta.

INTRODUCTION: Orthotopic liver transplantation (OLT) is today the gold standard treatment of the end-stage liver disease. Different solutions are used for graft preservation. Our objective was to compare the results of cadaveric donor OLT, preserved with the University of Wisconsin (UW) or Celsior solutions in the portal vein and Euro-Collins in the aorta. METHODS: We evaluated retrospectively 72 OLT recipients, including 36 with UW solution (group UW) and 36 with Celsior (group CS). Donors were perfused in situ with 1000 mL UW or Celsior in the portal vein of and 3000 mL of Euro-Collins in the aortia and on the back table managed with 500 mL UW or Celsior in the portal vein, 250 mL in the hepatic artery, and 250 mL in the biliary duct. We evaluated the following variables: donor characteristics, recipient features, intraoperative details, reperfusion injury, and steatosis via a biopsy after reperfusion. We noted grafts with primary nonfunction (PNF), initial poor function (IPF), rejection episodes, biliary duct complications, hepatic artery complications, re-OLT, and recipient death in the first year after OLT. RESULTS: The average age was 33.6 years in the UW group versus 41 years in the CS group (P = .048). There was a longer duration of surgery in the UW group (P = .001). The other recipient characteristics, ischemia-reperfusion injury, steatosis, PNF, IPF, rejection, re-OLT, and recipient survival were not different. Stenosis of the biliary duct occured in 3 (8.3%) cases in the UW group and 8 (22.2%) in the CS (P = .19) with hepatic artery thrombosis in 4 (11.1%) CS versus none in the UW group (P = .11). CONCLUSION: Cadaveric donor OLT showed similar results with organs preserved with UW or Celsior in the portal vein and Euro-Collins in the aorta.

Mitochondria-dependent apoptosis in yeast.

Mitochondrial involvement in yeast apoptosis is probably the most unifying feature in the field. Reports proposing a role for mitochondria in yeast apoptosis present evidence ranging from the simple observation of ROS accumulation in the cell to the identification of mitochondrial proteins mediating cell death. Although yeast is unarguably a simple model it reveals an elaborate regulation of the death process involving distinct proteins and most likely different pathways, depending on the insult, growth conditions and cell metabolism. This complexity may be due to the interplay between the death pathways and the major signalling routes in the cell, contributing to a whole integrated response. The elucidation of these pathways in yeast has been a valuable help in understanding the intricate mechanisms of cell death in higher eukaryotes, and of severe human diseases associated with mitochondria-dependent apoptosis. In addition, the absence of obvious orthologues of mammalian apoptotic regulators, namely of the Bcl-2 family, favours the use of yeast to assess the function of such proteins. In conclusion, yeast with its distinctive ability to survive without respiration-competent mitochondria is a powerful model to study the involvement of mitochondria and mitochondria interacting proteins in cell death.

Dietary sodium intake induced myenteric neuron hypertrophy in Wistar rats.

In the present study we investigated the effect of salt intake on myenteric neuron size of the colon of adult male Wistar rats. The animals were placed on either a high-salt (HS; 8%; 12 animals) or a low-salt diet (LS; 0.15%; 12 animals) for 15 or 52 weeks and blood pressure was measured. The sizes of myenteric neurons of the distal colon from both groups were measured. No difference in neuron size was observed between the HS and LS groups after 15 weeks. After 52 weeks on HS, neuron size was increased (P<0.005) when compared with the LS group. The rats also presented hypertension, which was significantly different at 52 weeks (142 +/- 11 vs 119 +/- 7 mmHg). These results suggest that a long time on an HS diet can significantly increase myenteric nerve cell size.

Dietary sodium intake induced myenteric neuron hypertrophy in Wistar rats

In the present study we investigated the effect of salt intake on myenteric neuron size of the colon of adult male Wistar rats. The animals were placed on either a high-salt (HS; 8 percent; 12 animals) or a low-salt diet (LS; 0.15 percent; 12 animals) for 15 or 52 weeks and blood pressure was measured. The sizes of myenteric neurons of the distal colon from both groups were measured. No difference in neuron size was observed between the HS and LS groups after 15 weeks. After 52 weeks on HS, neuron size was increased (P<0.005) when compared with the LS group. The rats also presented hypertension, which was significantly different at 52 weeks (142 +/- 11 vs 119 +/- 7 mmHg). These results suggest that a long time on an HS diet can significantly increase myenteric nerve cell size.

Primary aortoduodenal fistulas in minimally aneurysmal aortas: imaging diagnosis.

We report on the utility of computed tomography (CT) in making the diagnosis of primary aortoduodenal fistulas in two cases presenting with massive gastrointestinal hemorrhage. In both cases, the clinical presentation was insidious, no pulsatile abdominal mass was palpated, and endoscopy findings were inconclusive. CT showed minimally aneurysmal aortas communicating with larger areas of contained rupture and pseudoaneurysm stretching adjacent small bowel.

[Prevalence of use of medicines during pregnancy and its relationship to maternal factors]. / Prevalência do uso de medicamentos na gravidez e relações com as características maternas.

INTRODUCTION: There is in Brazil a growing use of industrially produced medicines even during the female reprodutive cycle. During pregnancy two organisms are exposed to the effects of medicines but in the foetus this may result in toxicities with possible irreversible lesions. The present study aims at verifying the prevalence of the use of medicines during pregnancy in the studied population and its relationship with maternal characteristics, the pharmacological groups used and the source of prescription. METHODS: The use of medication was evaluated among 1,620 women that gave birth in five public, private and contracted hospitals in the city of S. Paulo between July and September 1993. RESULTS AND CONCLUSIONS: The relation between maternal schooling and kind of assistance in hospitals has revealed social inequality in the access to the several kinds of delivery assistance services. The prevalence of use of at least one medicine was 97.6% with an average of 4.2 drugs per woman. The prevalence of use of drugs by medical prescription and self-medication were 94.9% and 33.5%, respectively. The most used medications, excluding vitamins, mineral salts and vaccines, were analgesics, antacids, antispasmodics and antemetics. Users of the largest number of medicines were, characteristically, over 29, married, of university level, salaried workers and had access to private health services. Medical assistance had a facilitating role in access to the use of drugs during the gestational period of the population studied. Women need to be made aware of the potential risks they expose their foetuses to when using so many medicines. Physicians should reflect on their role in contributing to the solution to this problem.

MRI of a hibernoma.

Hibernomas are benign tumors derived from brown fat that most often present as painless, slowly enlarging masses in the interscapular region. Because these lesions have a heterogeneous appearance and contain fat, they mimic liposarcomas on CT and MR, requiring biopsy for definitive diagnosis.

[Histomorphometric analysis of the bone tissue in patients with non-insulin-dependent diabetes (DMNID)]. / Análise histomorfométrica do tecido ósseo do paciente diabético não insulino-dependente (DMNID).

The effects of long-term diabetes mellitus on mineral metabolism and bone integrity remain ill defined. Several studies have shown that patients with insulin-dependent diabetes mellitus (IDDM) have reduced bone mass. However, the effect of non-insulin-dependent diabetes mellitus (NIDDM) on bone mass has been controversial. Quantitative histologic assessments were completed in iliac crest bone samples obtained from 26 patients (13 male and 13 female) with non-insulin-dependent diabetes mellitus (NIDDM) and normal renal function (serum creatinine 1.00 +/- 0.04 mg/dl). The mean age was 67.42 +/- 2.74 yrs, range 50-89 yrs. For the control group the bone samples were taken from 20 non-diabetic subjects (11 male and 9 female) with a mean age of 57.95 +/- 3.96 yrs, range 33-91 yrs, n.s, that had suffered sudden or violent death. Significant lower values were present in the diabetic group for bone volume (p < 0.0001), osteoid volume (p < 0.005), osteoid thickness (p < 0.0001), cortical thickness (p < 0.05) and osteoblast surface (p < 0.05). Linear regression analysis revealed significant positive correlations of osteoid volume with osteoid thickness and osteoid surface in both groups. Our results suggest that the mechanism(s) underlying diabetic osteopenia may involve decreased bone turnover as reflected in a paucity of osteoblasts and diminished quantities of osteoid. A proeminent additional feature was a reduction in the cortical thickness.

[Clinical aspects and treatment of spontaneous carotid artery-cavernous sinus fistula]. / Klinik und Therapie spontaner Carotis-Sinus cavernosus-Fisteln.

21 patients, who fulfilled the clinical and angiographic criteria of a spontaneous carotid cavernous fistula (CCF), were studied at the Alfried Krupp Hospital, Essen, Germany, between 1980 and 1988. Of these patients, 4 had direct shunts between the internal carotid artery and the cavernous sinus and 17 patients had unilateral or bilateral dural shunts between meningeal branches of the internal and/or external carotid artery and the cavernous sinus. The most common initial symptoms were eye redness, bruit and headache. 6 of 12 patients with double vision had mechanical disorders of eye movement. A rapid irreversible loss of vision occurred in 2 patients. In 9 of 21 patients either progressive visual deterioration, proptosis or severe orbital pain necessitated prompt institution of treatment. All direct fistulas could be occluded by the use of the detachable balloon technique. 5 patients with dural CCF were successfully treated with particle embolization of the external carotid artery blood supply. In dural CCF not requiring emergent treatment, combined carotid artery and jugular vein compression was preferred and resulted in complete cure or sufficient improvement in all but one patient. We recommend this method as the first stage of treatment in dural CCF with uncomplicated course.

Computerised axial tomography in traction injuries of the brachial plexus.

Severe traction injuries may damage the brachial plexus at any level from the spinal cord to the axillary outlet. Investigation aims to determine the level of the injury for each of the nerves, trunks or cords, with particular reference to obtaining firm evidence of any intradural (pre-ganglionic) damage. We report the results of computerised axial tomography of the cervical spine in comparison with conventional myelography and with surgical exploration of the plexus. CT scanning with contrast enhancement greatly improves diagnostic accuracy, particularly at C5 and C6 root levels.

Longitudinal evaluation of a patient with arteriovenous fistulas. Use of FRC-TLC shunt technique.

A patient with a brain abscess was found to have multiple pulmonary arteriovenous fistulas. Differences in arterial blood gas levels at low and high lung volumes were used to quantify shunting. Using this technique one can objectively follow progression, remission, or stabilzation of pulmonary arteriovenous fistulas.