Negative Pressure Wound Therapy After Intestinal Anastomosis: A Risk Factor Analysis for Dehiscence.

INTRODUCTION: Negative pressure wound therapy (NPWT) is part of the temporary abdominal closure in the treatment of patients with traumatic, inflammatory, or vascular disease. However, the use of NPWT when performing an intestinal anastomosis has been controversial. This study aimed to describe the patients managed with NPWT therapy and identify the risk factors for anastomotic dehiscence when intestinal anastomosis was performed. METHODS: A single-center cohort study with prospectively collected databases was performed. Patients who required NPWT therapy from January 2014 to December 2018 were included. Patients were stratified according to the performance of intestinal anastomosis and according to the presence of dehiscence. Bivariate and multivariate analyses were performed for anastomotic dehiscence and mortality. RESULTS: A total of 97 patients were included. Median age was 52 y old [interquartile range 24.5-70]. Male patients corresponded to 75.6% (n = 34) of the population. Delayed fascial closure was performed in 80% (n = 36). The risk of anastomotic dehiscence was higher in females (odds ratio (OR) 11.52 [confidence interval (CI) 1.29-97.85], P = 0.030), delayed fascial closure (OR 18.18 [CI 2.02-163.5], P = 0.010) and use of vasopressors (OR 12.04 [CI 1.22-118.47], P = 0.033). NPWT pressures >110 mmHg were evidenced in the dehiscence group with statistically significant value (OR 1.2 [0.99-2.26] p 0.04) CONCLUSIONS: There is still controversy in the use of NPWT when performing intestinal anastomosis. According to our data, the risk of dehiscence is higher in females, delayed fascial closure, use of vasopressors, and NPWT pressures >110 MMHG.

Strategies to improve cost effectiveness of robotic assisted laparoscopic radical prostatectomy in emerging economies.

To assess the cost-effectiveness of the robotic-assisted laparoscopic radical prostatectomy (RALRP) compared to open radical prostatectomy (ORP) for localized prostate cancer from a healthcare perspective in Colombia. A systematic review was conducted in Embase, Scopus, Web of Science, PubMed, and Cochrane CENTRAL databases, to identify relevant publications up to January 2020 to summarize clinical outcomes related to effectiveness of robot-assisted and open radical prostatectomy. A tree decision model was designed given the clinical outcomes and possibilities of complication and success. Outcomes were defined as complications according to Clavien - Dindo classification and success measured as urethral stricture rate. Cost was divided into two categories: surgical procedure and complications. Incremental cost-effectiveness ratio (ICER) was calculated and a deterministic sensitivity analysis was performed to evaluate the impact of the uncertainty on the conclusions of the model. A 90-day horizon was defined. Direct medical costs associated with RALRP were $6.511 ($ 5.127- $8.138), and for ORP were $4.476 ($2.170-$ 6.511). The average cost for complication management was rated at $ 327 for RALRP and $ 382 for ORP, based on an augmented risk of post-operative urethral stricture in the ORP group (2.4% vs 10.8%). ICER was calculated in USD $18.987. The cost of RALRP has to be reduced to around USD 5.345 to achieve an ICER under 1 GDP making the intervention feasible. Using a 3 GDP per capita threshold, the implementation of RALRP could be cost-effective for the treatment of localized prostate cancer in emerging economies. Bolder measures including the use of one needle carrier, three robotic arms, and a shorten hospitalization program of 24 h, can save around $1000 for each patient, achieving the goal cost of $5345 needed for a favorable ICER.

Metabolic studies and calculi analysis in urinary lithiasis, how to stop recurrence? / Estudios metabólicos y análisis del cálculo en litiasis urinaria, ¿cómo detener la recurrencia?

Urinary lithiasis is the most frequent urological consultation to the emergency room due to renoureteral colic. Complications include hematuria, anuria due to bilateral or unilateral obstruction in solitary kidney, and sepsis. Recurrence occurs in up to 50% of patients after 5 years from the first episode, and those will need metabolic studies and calculi analysis. Pharmacological management and dietary measures will prevent new episodes. We aim to describe each metabolic disorder associated with its respective type of calculi, and its management based on prevention of recurrence of urinary lithiasis.

La litiasis urinaria es la consulta urológica más frecuente para la sala de emergencias debido al cólico renoureteral. Las complicaciones incluyen hematuria, anuria debido a la obstrucción bilateral o unilateral en el riñón solitario y la sepsis. La recurrencia ocurre en hasta el 50% de los pacientes después de 5 años desde el primer episodio, y aquellos paciente requieren estudios metabólicos y análisis del cálculo. El manejo farmacológico y las modificaciones dietéticas evitarán nuevos episodios. Nuestro objetivo es describir cada trastorno metabólico asociado con su respectivo tipo de cálculo y su manejo basado en la prevención de la recurrencia de la litiasis urinaria.

Radical Nephrectomy in Renal Cell Carcinoma with Venous Tumoral Thrombus: Long-term Outcomes and Overall Survival / Nefrectomía radical en carcinoma de células renales con trombo tumoral venoso: Desenlaces a largo plazo y supervivencia global

Objective To describe the five-year overall survival (OS) and perioperative morbidity of patients with renal cell carcinoma (RCC) with venous tumor thrombus (VTT) treated through radical nephrectomy and thrombectomy. Materials and Methods We evaluated a cohort of 530 patients with a diagnosis of RCC from January 2009 to December 2019, and found VTT in 42 of them; these 42 patients composed the study sample. The patients were stratified according to the Neves Thrombus Classification (NTC). The baseline and perioperative characteristics, as well as the follow-up, were described. The Kaplan-Meier curve and its respective Cox regression were applied to present the 5-year OS and the OS stratified by the NTC. Results The average age of the sample was of 63.19 ± 10.7 years, and there were no differences regarding gender. In total, VTT was present in 7.9% of the patients. According to the NTC, 30.9% of the cases corresponded to level I, 21.4%, to level II, 26.1%, to level III, and 21.4%, to level IV. The 5-year OS was of 88%. For level-I and level-II patients, the 5-year OS was of 100%, and of only 38% among level-IV patients. Complications, mostly minor, occurred in 57% of the cases. Conclusions Radical nephrectomy with thrombectomy is a morbid procedure; however, most complications are minor, and the five-year mortality is null for patients in NTC levels I and II, and low for levels III and IV, and it may be even lower in level-III patients when standardizing transesophageal echocardiogram intraoperatively and routinary extracorporeal bypass. Thus, we recommend considering this surgery as the first-line management in patients with RCC and VTT.

Objetivo Describir la supervivencia global (SG) a los cinco años y la morbilidad perioperatoria de pacientes con carcinoma de células renales (CCR) con trombo tumoral venoso (TTV) tratados por nefrectomía radical y trombectomía. Materiales y Métodos Se evaluó una cohorte de 530 pacientes con diagnóstico de CCR entre enero de 2009 y diciembre de 2019, y se encontró TTV en 42 de ellos; esos 42 pacientes compusieron la muestra de este estudio. Los pacientes fueron estratificados según la clasificación de trombos de Neves (CTN). Se describieron las características basales y perioperatorias de los pacientes, así como el seguimiento. Se aplicaron la curva de Kaplan-Meier y su respectiva regresión de COX para presentar la SG a los 5 años y la SG estratificada por CTN. Resultados La edad promedio de la muestra fue de 63,19 ± 10,7 años, sin diferencia respecto a género. El TTV estuvo presente en el 7,9% de los pacientes. Según la CTN, el 30,9% de los casos correspondía al nivel I, el 21,4%, al nivel II, el 26,1%, al nivel III, y el 21,4%, al nivel IV. La SG a los 5 años fue del 88%. Para los niveles I y II, la SG a los 5 años fue del 100%, y, para el nivel IV del 38%. Las complicaciones, menores en su mayoría, ocurrieron en el 57% de los casos. Conclusiones La nefrectomía radical con trombectomía es un procedimiento mórbido; sin embargo, la mayoría de las complicaciones son menores, y la mortalidad a los 5 años es nula cuando en los pacientes de niveles I y II en la CYN, y baja en los niveles III y IV, y puede ser incluso menor en los pacientes de nivel III al estandarizar el ecocardiograma transesofágico intraoperatorio y el baipás extracorpóreo rutinario. Por ello, recomendamos considerar esta cirugía como manejo de primera línea en pacientes con CCR y TTV.

Effective intracorporeal space in robot-assisted multiquadrant surgery in a pediatric inanimate model.

Pediatric robot-assisted surgery is technically challenging, but it is becoming the most desirable approach for most of the pediatric urological abdominal surgical procedures. Distance between ports has been adopted based on adult surgery experience. Currently, there is scarce information and literature about effective trocar position and distance between ports for highly complex pediatric multiquadrant surgery. The aim of this study is to evaluate the most effective way of port placement for pediatric multiquadrant robot-assisted surgery using an inanimate model. Two inanimate models simulating the abdominal area of an older infant were created: model (1) 33.3 × 29.6 × 11.5 cm and model (2) 15 × 13 × 8 cm. A simulation of a robot-assisted laparoscopic Mitrofanoff procedure was performed in both models simulating appendix procurement and subsequent anastomosis to the bladder dome. In the first model, the simulation was performed in two ways: (a) adult trocars were placed with a distance of 4 cm between them and placed longitudinally and (b) ports were placed by triangulating the camera 2 cm in a cephalic fashion. In the second model, (a) scenario was used as described above (c) single port crossing the arms. Volume of the first model was 11,335.32 cm3. Simulation (b) reached higher percentage of volumes without arm clash (30.19 vs. 41.92%, p = 0.021). In the second model with a volume of 1560 cm3, simulation (a) reached a volume percentage of 65.15% without arm clash and allowing the multiquadrant advance, while simulation (c) could not be performed due to arm collision and the inability to advance and see the four quadrants. Triangulation and increasing the distance away from the point of interest improve intracorporeal EWS for multiquadrant complex pediatric surgery.

Obesity as a risk factor for poor outcomes after sling surgery in women with stress urinary incontinence: A systematic review and meta-analysis.

PURPOSE: Obesity is one of the main risk factors for stress urinary incontinence (SUI) and has also been associated with worse surgical outcomes. However, the literature is heterogeneous and inconclusive. The goal of this study was to perform a systematic review and meta-analysis to evaluate cure rates and perioperative complications in obese women. MATERIALS AND METHODS: A literature search of OVID, MEDNAR, Embase, Scopus, Web of Science, PubMed, and CENTRAL databases was conducted. Randomized controlled trials comparing cure rates and failure of treatment in normal and obese patients, who underwent mid-urethral sling surgery, were identified. A systematic review of subjective and objective cure rates, and complications was performed. Meta-analyses of dichotomous data under the random-effects model were applied using Review Manager 5.3. Nonrandomized comparative studies and gray literature were excluded. RESULTS: A total of 219 studies were identified. Four randomized controlled trials were included for evaluation. The risk of bias evaluation was performed according to the Cochrane Handbook for Systematic Reviews of Interventions. One study was excluded due to missing data on the outcomes. Patients were stratified according to their body mass index as obese (>30 kg/m2 ) and nonobese (<30 kg/m2 ). Complications could not be meta-analyzed. The meta-analysis of subjective (risk ratio [RR] = 1.69 [95% confidence interval [CI]: 1.32-2.16]) and objective (RR = 1.62 [95% CI: 1.26-2.07]) cure rates disfavored obese women. CONCLUSIONS: This meta-analysis shows that obesity is a risk factor for the nonsuccessful treatment of SUI with tension-free mid-urethral sling. Differences in regards to the surgical approach and its association with obesity could not be established with the current evidence.

A survey of positive airway pressure therapy preparedness and outcomes following Hurricane Irma in patients with obstructive sleep apnea.

STUDY OBJECTIVES: Clinical benefit from positive pressure therapy is dependent on treatment adherence. Extreme weather events, such as floods, hurricanes, and tornadoes, can contribute to nonadherence by electricity loss and mandatory evacuation. We aimed to evaluate the concerns and behaviors of regular positive airway pressure users surrounding the extreme weather event Hurricane Irma. METHODS: A questionnaire on positive pressure concerns surrounding Hurricane Irma was completed by 117 patients with pre-hurricane objectively confirmed treatment adherence as defined by Medicare. Responses were tabulated to identify concerns and behavior in preparation for and after Hurricane Irma. Cloud-based monitoring, available on 50 (43%) cases, was used to determine the effect of self-reported electricity loss on treatment adherence before and after the storm. Quantitative use data pre- and post-Hurricane Irma was compared by t test with P < .05 considered statistically significant. RESULTS: Post-hurricane 78 (67%) patients were unable to use treatment with mean duration of 4.3 days. Of these, snoring, choking, and sleepiness were reported in 64%, 19%, and 42%, respectively. Loss of electricity was identified as the cause of missed treatment in 71 patients. In those with cloud monitoring, mean 14-day pre- and post-hurricane use differed by 8 minutes (P =.056). Cloud-monitored cases with loss of electricity had a decline in mean use of 33 minutes for the first 7 days post-hurricane. There was a trend towards increased use post-hurricane in those that retained electricity. Many patients expressed dissatisfaction with the availability of preparedness guidelines. CONCLUSIONS: Although common, loss of electricity was not the sole disruptor of positive pressure use after extreme weather events. Regular users of positive airway pressure experience both disruption in patterns of use and concerns regarding preparedness for extreme weather events.

Functional outcomes and safety of GreenLight photovaporization of the prostate in the high-risk patient with lower urinary tract symptoms due to benign prostatic enlargement.

AIMS: Photovaporization of the prostate (PVP) with GreenLight Laser is a surgical treatment for lower urinary tract symptoms. It is considered safe in elderly patients with comorbidities, however, the evidence is inconclusive. The objective of this study is to evaluate the efficacy and safety outcomes of PVP according to the American Society of Anesthesiologists Physical Status (ASAPS). METHODS: A cohort of 675 patients who underwent PVP between 2012 and 2018 was evaluated. Patients were classified according to their ASAPS as low (I and II) and high risk (III and IV). Surgical characteristics and improvement of symptoms and Quality of Life (QoL) were evaluated. RESULTS: The median age of high-risk group was higher than low-risk group. The high-risk group had more history of anticoagulation, antiaggregation, urinary catheterization, urinary retention and urethral stricture. Longer times of hospitalization (23.7 [interquartile range {IQR} = 18.9-41.35] vs 21.8 hours [IQR = 18.7-26.6], P = .008) and catheterization (19.55 [IQR = 15.6-35.57] vs 17.67 hours [IQR = 14.76-22.5], P = .004) were found in the high-risk group. Conversion and bleeding control were not different between groups. In the follow-up, improvement of International Prostate Symptoms Score (IPSS) and QoL was significant in all patients when compared before and after surgery scores (P < .001). There were no difference between groups for QoL, however, IPSS was lower for the low-risk group (8 [IQR = 4-14.5] vs 5 [2-12], P = .001). CONCLUSION: PVP with GreenLight Laser is a safe and efficient procedure for all patients despite their comorbidities, with comparable middle-term outcomes which makes it a standard treatment for the entire aging population, improving their QoL.

Predicting the Probability of Lymph Node Involvement with Prostate Cancer Nomograms: Can We Trust the Prediction Models? / Predicción de la probabilidad de compromiso ganglionar con nomogramas para cáncer de próstata. ¿Podemos confiar en los modelos de predicción

Introduction Prediction of lymph node involvement (LNI) is of paramount importance for patients with prostate cancer (PCa) undergoing radical prostatectomy (RP). Multiple statistical models predicting LNI have been developed to support clinical decision-making regarding the need of extended pelvic lymph node dissection (ePLND). Our aim is to evaluate the prediction ability of the best-performing prediction tools for LNI in PCa in a Latin-American population. Methods Clinicopathological data of 830 patients with PCa who underwent RP and ePLND between 2007 and 2018 was obtained. Only data from patients who had ≥ 10 lymph nodes (LNs) harvested were included (n = 576 patients). Four prediction models were validated using this cohort: The Memorial Sloan Kettering Cancer Center (MSKCC) web calculator, Briganti v.2017, Yale formula and Partin tables v.2016. The performance of the prediction tools was assessed using the area under the receiver operating characteristic (ROC) curve (AUC). Results The median age was 61 years old (interquartile range [IQR] 56­66), the median Prostate specific antigen (PSA) was 6,81 ng/mL (IQR 4,8­10,1) and the median of LNs harvested was 17 (IQR 13­23), and LNI was identified in 53 patients (9.3%). Predictions from the 2017 Briganti nomogram AUC (0.85) and the Yale formula AUC (0.85) were the most accurate; MSKCC and 2016 Partin tables AUC were both 0,84. Conclusion There was no significant difference in the performance of the four validated prediction tools in a Latin-American population compared with the European or North American patients in whom these tools have been validated. Among the 4 models, the Briganti v.2017 and Yale formula yielded the best results, but the AUC overlapped with the other validated models.

Introducción La predicción del compromiso ganglionar es de suma importancia en pacientes con cáncer de próstata (CaP) que se van a someter a prostatectomía radical (PR). Múltiples modelos estadísticos se han desarrollado para predecir el riesgo de compromiso ganglionar y facilitar las decisiones clínicas de realizar o no linfadenectomía pélvica ampliada (LPA). Nuestro objetivo es evaluar la habilidad de predicción de las mejores herramientas de predicción de compromiso ganglionar en CaP en una población latinoamericana. Métodos Se evaluaron los datos clínico-patológicos de 830 pacientes con CaP sometidos a PR y LPA entre el 2007­2018. Solo se analizaron os pacientes con 10 o más ganglios extraídos (n = 576). Cuatro modelos de predicción fueron validados en esta cohorte: el modelo de la calculadora online del Memorial Sloan Kettering Cancer Center (MSKCC), el Briganti v.2017, la fórmula de Yale, y tablas de Partin v.2016. Se evaluó el desempeño de los modelos con curvas de características operativas del receptor (COR) y el área bajo la curva (ABC). Resultados La mediana de edad fue 61 años (rango intercuartílico [RI]: 56­66), mediana de Prostate specific antigen (PSA) 6,81 ng/mL (RI: 4,8­10,1), y mediana de ganglios extraídos 17 (RI: 13­23); se documentó compromiso ganglionar en 53 pacientes (9.3%). La habilidad de predicción del nomograma de Briganti v.2017 ABC (0,85) y la fórmula de Yale ABC (0,85) fueron las más precisas. El modelo del MSKCC y las tablas de Partin v.2016 mostraron AUC de 0,84 ambos. Conclusiones No encontramos diferencia estadisticamente significativa en el desempeño de los cuatro modelos de predicción validados en esta población latinoamericana comparada con pacientes norteamericanos o europeos en los que estas herramientas fueron desarrolladas. Entre los 4 modelos, el nomograma de Briganti v.2017 y la fórmula de Yale mostraron los mejores resultados; sin embargo, el AUC se sobrepone con los otros modelos validados.

Prevalence of Bladder and Bowel Dysfunction in the Outpatient Clinic of Pediatric Urology and Nephrology / Prevalencia de la disfunción de la vejiga y del intestino en la consulta ambulatoria de urología y nefrología pediátrica

Zoom Image Abstract Objective Bladder and bowel dysfunction (BBD) is defined as the presence of functional alterations in both organs. The correct diagnosis and treatment prevent the exposure of patients to multiple antibiotic treatments, invasive procedures and radiological studies. The aim of the present study was to estimate the prevalence of BBD in the outpatient clinic of pediatric urology and nephrology. Methods A prospective cohort composed of 334 patients aged between 5 and 18 years was evaluated. The Pediatric Lower Urinary Tract Symptom Score (PLUTSS) was applied. A score higher than 8 was considered as significant urinary symptomatology. Moreover, the Bristol Stool Scale and the Rome IV Criteria for functional constipation and fecal incontinence were used. Patients with organic pathologies were excluded. The risk factors were evaluated using logistic regression models. Results The median age was 9 years old (interquartile range [IQR]: 6­13). The PLUTSS questionnaire was significant in 16.5% of the kids, constipation was found in 31.9%, and fecal incontinence, in 4%. The prevalence of BBD was of 27.8%. The female gender (odds ratio [OR]: 2.47; p = 0.002) and psychological disorders (OR: 4.637; p = 0.024) were considered risk factors. The evaluation of the PLUTSS questionnaire showed relevance regarding incontinence (OR: 3.059; p = 0.038), enuresis (OR: 8.532; p < 0.001); intermittent flow (OR: 9.211; p = 0.004), frequency (OR: 6.73; p = 0.005), and constipation (OR: 34.46; p < 0.001). Conclusions The prevalence of BBD is of 27.8% in the outpatient clinic. It is important to prevent associated complications and the exposure to multiple antibiotic treatments, as well as invasive and imaging procedures, which also generate high costs to the health system.

Resumen Objetivo El síndrome de disfunción de la vejiga y del intestino (DVI) se define como la presencia de alteraciones funcionales en ambos órganos. El correcto diagnóstico y tratamiento previene la exposición de los pacientes a múltiples manejos antibióticos, procedimientos invasivos y estudios radiológicos. El objetivo de este estudio es estimar la prevalencia de DVI en la consulta ambulatoria de urología y nefrología pediátrica. Métodos Se evaluó una cohorte prospectiva de 334 pacientes de 5 a 18 años. Se aplicó el cuestionario de Puntuación de Síntomas del Tracto Urinario Inferior (Pediatric Lower Urinary Tract Symptom Score, PLUTSS), cuyo resultado mayor a 8 fue considerado significativo. Adicionalmente, se usó la Escala de Heces de Bristol (Bristol Stool Scale) y los Criterios Roma IV (Rome IV Criteria) para estreñimiento e incontinencia fecal. Los factores de riesgo se evaluaron bajo modelos de regresión logística. Resultados La edad mediana fue de 9 años (rango intercuartil [RIC]: 6­13). El cuestionario PLUTSS fue significativo en 16,5% de los niños, y se observó estreñimiento en 31,9%, e incontinencia fecal en 4%. La prevalencia de DVI fue de 27,8%. El sexo femenino (razón de probabilidades [RP]: 2.47; p = 0.002) y desordenes psicológicos (RP: 4.637; p = 0.024) fueron considerados factores de riesgo. La evaluación del cuestionario PLUTSS mostró relevancia en incontinencia (RP: 3.059; p = 0.038), enuresis (RP: 8.532; p < 0.001), flujo intermitente (RP: 9.211; p = 0.004), frecuencia (RP: 6.73; p = 0.005), y estreñimiento (RP: 34.46; p < 0.001). Conclusiones La prevalencia de DVI fue de 27.8% en la consulta ambulatoria. Es importante prevenir complicaciones asociadas y la exposición a múltiples tratamientos antibióticos, procedimientos invasivos e imagenológicos, que adicionalmente generan altos costos al sistema de salud.

Performance of the TWIST Score in Patients with Testicular Torsion that Present to the Emergency Department / Desempeño del puntaje TWIST en pacientes con torsión testicular que se presentan al Departamento de Emergencias

Objective Testicular torsion (TT) is an emergency with an incidence of 1:1,500 in patients < 18 years old. Irreversible changes in the testicular parenchyma may happen. The Testicular Workup for Ischemia and Suspected Torsion (TWIST) questionnaire evaluates signs and symptoms to determine the risk of TT and improve the time of management. The aim of the present study was to compare the intraoperative findings of patients with TT with the result of the preoperative TWIST questionnaire. Methods A cohort of 33 pediatric patients that consulted to the emergency room was evaluated. The TWIST questionnaire was applied in the first approach. Imaging studies, time to the operating room (OR) and intraoperative findings were evaluated. Theoretical and real findings were compared. Results The median age was 13 years old (interquartile range [IQR] 10­15 years old). Edema and scrotal inflammation was the most frequent finding (42.4%), followed by testicular induration (21.2%), nausea and vomiting (15.2%), and horizontal testicle and absence of cremasteric reflex (9.1%). The TWIST stratification was 3% high-risk, 18.2% intermediate-risk and 78.8% low-risk. Testicular Doppler ultrasound was performed in 93.9% of the patients: vascular congestion was found in 21.9%. A total of 30.3% of the kids were taken to surgery after 163 minutes (±116.5). Intraoperative diagnosis of TT was confirmed in the high-risk patient, in 33.3% of the intermediate-risk, and in 50% of the low-risk. The receiver operating characteristic (ROC) curve showed an accuracy of 60% (p = 0.602). Conclusions The TWIST questionnaire in the first approach allows to take the high-risk patients im

Objetivo La torsión testicular (TT) es una emergencia con incidencia de 1:1.500 en pacientes menores de 18 años. Pueden ocurrir cambios irreversibles en el parénquima testicular. El cuestionario TWIST evalúa signos y síntomas para determinar el riesgo de TT y mejorar los tiempos de atención. El objetivo de este estudio fue comparar los hallazgos intraoperatorios de los pacientes con el resultado del TWIST preoperatorio. Métodos Se evaluó una cohorte de 33 pacientes pediátricos que consultaron al Departamento de Emergencias. Se aplicó el cuestionario TWIST en la primera aproximación. Estudios imagenológicos, tiempo de entrada a salas de cirugía y hallazgos intraoperatorios también fueron evaluados. Se compararon los hallazgos teóricos y reales. Resultados La mediana de edad fue de 13 años (rango intercuartil [RIQ]: 10­15). Edema e inflamación escrotal fueron los hallazgos principales, (42,4%) seguidos de induración testicular (21,2%), náusea y vómito (15,2%), y testículo horizontal y ausencia del reflejo cremastérico (9,1%). Estratificación TWIST: 3% alto riesgo, 18,2% intermedio, y 78,8% bajo. Se realizó Doppler testicular en 93,9% de los pacientes: se encontró congestión vascular en 21,9%. Se operaron 30,3% de niños tras 163 minutos (± 116,5). En el intraoperatorio se confirmó TT en el paciente de alto riesgo, en 33,3% de intermedio, y en 50% de bajo riesgo. La curva de característica operativa del receptor (COR) evidencia una exactitud de 60% (p = 0.602). Conclusiones El cuestionario TWIST en la primera aproximación es útil para operar inmediatamente pacientes de alto riesgo. Sin embargo, no ofrece un alto nivel de confianza para el diagnóstico de TT en pacientes de intermedio y bajo riesgo.

Computational search for UV radiation resistance strategies in Deinococcus swuensis isolated from Paramo ecosystems.

Ultraviolet radiation (UVR) is widely known as deleterious for many organisms since it can cause damage to biomolecules either directly or indirectly via the formation of reactive oxygen species. The goal of this study was to analyze the capacity of high-mountain Espeletia hartwegiana plant phyllosphere microorganisms to survive UVR and to identify genes related to resistance strategies. A strain of Deinococcus swuensis showed a high survival rate of up to 60% after UVR treatment at 800J/m2 and was used for differential expression analysis using RNA-seq after exposing cells to 400J/m2 of UVR (with >95% survival rate). Differentially expressed genes were identified using the R-Bioconductor package NOISeq and compared with other reported resistance strategies reported for this genus. Genes identified as being overexpressed included transcriptional regulators and genes involved in protection against damage by UVR. Non-coding (nc)RNAs were also differentially expressed, some of which have not been previously implicated. This study characterized the immediate radiation response of D. swuensis and indicates the involvement of ncRNAs in the adaptation to extreme environmental conditions.

How can I get a renal access if I do not have an ultrasound and cannot opacify the collecting system? Another use of the hydrophilic guide wire.

It is well-known that fluoroscopic guidance is the most commonly used imaging technique for percutaneous access to the kidney. However, we might encounter difficulties when attempting to establish the limits of the collecting system for a percutaneous puncture, especially in places where the use of ultrasound guidance in the operating room is limited. We aim to describe the use of a hydrophilic guide wire to delimit the collecting system when this becomes difficult with conventional techniques.

Dystrophic Calcification of the Bladder after Photovaporization of the Prostate with GreenLightTM Laser 180 W: A Case Report.

A 69-year-old patient who underwent photovaporization of the prostate (PVP) with GreenLightTM Laser presented chronic abdominal pain, in the following and after 7 months, an abdominal MRI showed a bladder mass and the cystoscopy revealed an 8 cm of diameter grayish mass of the anterior wall and the dome. Malignancy, infectious, and granulomatous diseases were ruled out. Biopsy showed necrotic tissue and dystrophic calcification (DC) with crystals and Gram-positive cocci, so a transurethral resection was intended failed due to the mass hard consistency and size. The patient was taken to partial cystectomy and the pain resolved. DC is defined as inappropriate deposits of calcium phosphate salts in previously damaged tissue by different forms of trauma: burns, radiotherapy, and surgery. We suggest the DC process is linked to a previous thermal lesion of the bladder during PVP and believe future studies of association can be relevant.

Influence of thermoplasticized starch on physical-chemical properties of new biodegradable carriers intended for forest industry.

In this work, the influence of different concentrations of thermoplasticized starch on thermal, mechanical, biodegradation and phytotoxic properties of biodegradable blend carrier composed of poly(lactic acid) and poly(butylene adipate­co­terephtalate) was investigated. The results showed that the addition of poly(butylene adipate­co­terephtalate) increased elasticity of PLA materials, whereas the presence of thermoplasticized starch promoted higher biodegradation rate of the investigated materials. Moreover, the prepared materials did not show phytotoxic effect on plant, thus proving potential application in forest industry as a biodegradable carrier for multiplication of plants.

Helping the helpers: mindfulness training for burnout in pediatric oncology--a pilot program.

BACKGROUND: Burnout, a syndrome of emotional exhaustion, depersonalization, and diminished feelings of accomplishment, is common among pediatric oncology staff. This study explores a mindfulness-based course (MBC) to decrease burnout in a multidisciplinary group of pediatric oncology staff members in the United States and Israel. MATERIALS AND METHODS: Forty-eight participants, mostly nurses, were randomized to either the MBC intervention or a control group. MBC participants received eight weekly sessions of mindfulness education. The primary outcome studied was burnout. Secondary outcomes studied included depression and perceived stress. RESULTS: Nearly 100% of the subjects exhibited signs of burnout at baseline and MBC did not result in any significant improvement in scores on burnout, perceived stress or depression scales. Qualitative analysis of diaries kept by subjects revealed reduced stress, improved inner peace, compassion and joy, better focus and self-awareness and less somatic symptoms in the intervention arm. CONCLUSIONS: Burnout is a major problem in pediatric oncology staff. Mindfulness practices can be taught in the workplace and may be a useful component of a multidimensional strategy to reduce burnout in this population.

Endothelio-mesenchymal interaction controls runx1 expression and modulates the notch pathway to initiate aortic hematopoiesis.

Hematopoietic stem cells (HSCs) are produced by a small cohort of hemogenic endothelial cells (ECs) during development through the formation of intra-aortic hematopoietic cell (HC) clusters. The Runx1 transcription factor plays a key role in the EC-to-HC and -HSC transition. We show that Runx1 expression in hemogenic ECs and the subsequent initiation of HC formation are tightly controlled by the subaortic mesenchyme, although the mesenchyme is not a source of HCs. Runx1 and Notch signaling are involved in this process, with Notch signaling decreasing with time in HCs. Inhibiting Notch signaling readily increases HC production in mouse and chicken embryos. In the mouse, however, this increase is transient. Collectively, we show complementary roles of hemogenic ECs and mesenchymal compartments in triggering aortic hematopoiesis. The subaortic mesenchyme induces Runx1 expression in hemogenic-primed ECs and collaborates with Notch dynamics to control aortic hematopoiesis.

Assessment of styling performance in hair gels and hair sprays by means of a new two-point stiffness test.

A new two-point bending stiffness method on flat hair strands was developed and validated after application of hair styling gels and hair styling sprays. A special mold was used to align single hair fibers after applying the formulations to the hair. The styling gels used contain different commercially available thickeners and styling polymers, e.g., carbomer, acrylates/beheneth-25 methacrylate copolymer, Polyquaternium-86, PVP, VP/VA copolymers, and VP/methacrylamide/vinylimidazole copolymer. Evaluation of hair sprays was performed after spray application on flat hair strands. Commercially available hair styling resins were used, e.g. acrylates/t-butylacrylamide copolymer, octylacrylamide/acrylates/butylaminoethyl methacrylate copolymer, and VP/VA copolymer (30:70). The new stiffness test method provided the best correlation with practically relevant sensory assessments on hair strands and a panel test in which styling gels were evaluated. However, we did not observe a correlation between the new stiffness method on flat hair strands and practical assessments in hair spray application. We postulate that different polymer/hair composites are responsible for these discrepancies. Hairs on model heads for half-side testing are spot-welded after spray application, while hairs are seam-welded in the stiffness test after alignment of single hair fibers. This alignment is necessary to achieve reproducible results.