Supine versus Prone Percutaneous Nephrolithotomy for Complex Stones: A Multicenter Randomized Controlled Trial.

PURPOSE: High-quality evidence comparing supine to prone percutaneous nephrolithotomy (PCNL) for the treatment of complex stones is lacking. This study aimed to compare the outcomes of supine position (SUP) and prone position (PRO) PCNL. MATERIALS AND METHODS: A noninferior randomized controlled trial was performed according to the CONSORT (Consolidated Standards for Reporting Trials) criteria. The inclusion criteria were patients over 18 years of age with complex stones. SUP was performed in the Barts flank-free modified position. Except for positioning, all the surgical parameters were identical. The primary outcome was the difference in the success rate on the first postoperative day (POD1) between groups. The secondary outcome was the difference in the stone-free rate (SFR) on the 90th postoperative day (final SFR). A noninferiority margin of 15% was used. Demographic, operative, and safety variables were compared between the groups. Statistical significance was set at p <0.05. RESULTS: Overall, 112 patients were randomized and their demographic characteristics were comparable. The success rates on POD1 were similar (SUP: 62.5% vs PRO: 57.1%, p=0.563). The difference observed (-5.4%) was lower than the predefined limit. The final SFRs were also similar (SUP: 55.4% vs PRO: 50.0%, p=0.571). SUP had a shorter operative time (mean±SD 117.9±39.1 minutes vs 147.6±38.8 minutes, p <0.001) and PRO had a higher rate of Clavien ≥3 complications (14.3% vs 3.6%, p=0.045). CONCLUSIONS: Positioning during PCNL for complex kidney stones did not impact the success rates; consequently, both positions may be suitable. However, SUP might be associated with a lower high-grade complication rate.

Effects of Chemical Insecticide Residues and Household Surface Type on a Beauveria bassiana-Based Biopesticide (Aprehend®) for Bed Bug Management.

The biopesticide Aprehend, containing spores of the entomopathogenic fungus Beauveria bassiana, is a biological control agent for the management of the common bed bug (Cimex lectularius L.) (Hemiptera: Cimicidae). The spores are applied in strategically placed barriers, which bed bugs walk across as they search for a bloodmeal. Application of chemical insecticides by the general public and professional pest managers is common, which means that Aprehend may be sprayed on existing insecticide residues. We evaluated the effect of chemical residues, of 22 different chemical insecticides on different household surface types. We found that residues from 12 chemical pesticides significantly reduced spore viability measured 5 weeks after application in comparison to the control. However, efficacy of Aprehend, as measured by bed bug mortality and mean survival time after exposure to sprayed surfaces, seven weeks after application was not impacted detrimentally. Furthermore, in some cases, efficacy of old chemical residues was enhanced by the combination of chemical and Aprehend seven weeks after application. Surface type also played a role in the relative efficacy of all products and combinations, particularly as the residues aged.

Persistence and Lethality of a Fungal Biopesticide (Aprehend) Applied to Insecticide-impregnated and Encasement-type Box Spring Covers for Bed Bug Management.

The newly developed fungal biopesticide Aprehend, containing spores of Beauveria bassiana, is the first biological control agent to be incorporated into management programs to control the common bed bug (Cimex lectularius L.) (Hemiptera: Cimicidae). Aprehend is sprayed as barriers where bed bugs are likely to walk and pick up spores as they search for a bloodmeal. A key application target for Aprehend is the box spring, which may be covered by encasement-type or insecticide-impregnated covers. Since some insecticides can reduce the persistence of fungal spores, we tested the efficacy and spore germination percentages of Aprehend when applied to the two types of box spring covers. We found that spore germination was about 11% lower on the permethrin-impregnated ActiveGuard cover than on the encasement-type AllerEase cover. However, bed bugs exposed for 15 min to Aprehend on the two box spring covers suffered similarly high levels of mortality irrespective of the cover material. Thus, there was no inhibitory or additive effect of the ActiveGuard cover on bed bug mortality. Lastly, overall mortality was higher if bed bugs were exposed to Aprehend-treated ActiveGuard than the ActiveGuard cover alone. Our findings indicate that if pest managers are using ActiveGuard covers in combination with Aprehend, best practice would be to use ActiveGuard on mattresses and apply Aprehend directly to the box spring or to a box spring covered by an encasement-type cover.

Interrelationships among Jumping Power, Sprinting Power and Pubertal Status after Controlling for Size in Young Male Soccer Players.

This study examined power output on jumping and sprinting tests in young soccer players of differing pubertal status, while controlling for body size with allometric scaling exponents. A total of 46 males aged 12-18 years (14.17 years) were divided into three groups: pre-pubescent ( n = 12), pubescent ( n = 22), and post-pubescent ( n = 12). Participants performed a series of tests, including the squat jump (SJ), countermovement jump (CMJ), and 10-meter and 30-meter sprint test protocols. The Post-PUB group was older ( F = 112.411, p < 0.001), more experienced in competitive soccer ( F = 8.055, p = 0.001), taller ( F = 28.940, p < 0.001), and heavier ( F = 20.618, p < 0.001), when compared to peers in the other groups. Mean differences in jumping and sprinting performances suggested a significant effect for pubertal status on performance in the 10-meter sprint (large effect size, F = 8.191, p < 0.001) and 30-meter sprint (large effect size, F = 8.093, p < 0.001) after allometric scaling. Power output derived from SJ (small effect size, F = 0.536, p = 0.001) and CMJ (small effect size, F = 1.058, p = 0.356) showed no significant differences across players of varying pubertal status. Biological maturation showed a large effect on maximal power output for sprints, but not for jumps, when the effect of body size was adjusted by statistically derived allometric exponents in young male soccer players.

Susceptibility of insecticide-resistant bed bugs (Cimex lectularius) to infection by fungal biopesticide.

BACKGROUND: Bed bugs are a public health concern, and their incidence is increasing worldwide. Bed bug infestations are notoriously difficult to eradicate, further exacerbated by widespread resistance to pyrethroid and neonicotinoid insecticides. This study evaluated the efficacy of the newly developed fungal biopesticide Aprehend™, containing Beauveria bassiana, against insecticide-resistant bed bugs. RESULTS: Overall mortality for the Harold Harlan (insecticide-susceptible) strain was high (98-100%) following exposure to Aprehend™ or Suspend SC (deltamethrin). The mean survival times (MSTs) for Harold Harlan bed bugs were 5.1 days for Aprehend™ and 4.8 and 3.0 days for the low and high concentrations of Suspend SC respectively. All three strains of pyrethroid-resistant bed bugs were susceptible to infection by B. bassiana, resulting in MSTs of <6 days (median = 4 days) and >94% overall mortality. Conversely, mortality of the three insecticide-resistant strains after exposure to Suspend SC was only 16-40%. CONCLUSION: These results demonstrate that Aprehend™ is equally effective against insecticide-susceptible and insecticide-resistant bed bugs and could provide pest control operators with a promising new tool for control of bed bugs and insecticide resistance management. © 2017 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Energy substrate utilization with and without exogenous carbohydrate intake in boys and men exercising in the heat.

Little is known about energy yield during exercise in the heat in boys compared with men. To investigate substrate utilization with and without exogenous carbohydrate (CHOexo) intake, seven boys [11.2 ± 0.2 (SE) yr] and nine men (24.0 ± 1.1 yr) cycled (4 × 20-min bouts) at a fixed metabolic heat production (Hp) per unit body mass (6 W/kg) in a climate chamber (38°C and 50% relative humidity), on two occasions. Participants consumed a 13C-enriched 8% CHO beverage (CARB) or placebo beverage (CONT) in a double-blinded, counterbalanced manner. Substrate utilization was calculated for the last 60 min of exercise. CHOexo oxidation rate (2.0 ± 0.3 vs. 2.5 ± 0.2 mg·kg fat-free mass-1·min-1, P = 0.02) and CHOexo oxidation efficiency (12.8 ± 0.6 vs. 16.0 ± 0.9%, P = 0.01) were lower in boys compared with men exercising in the heat. Total carbohydrate (CHOtotal), endogenous CHO (CHOendo), and total fat (Fattotal) remained stable in boys and men (P > 0.05) during CARB, whereas CHOtotal oxidation rate decreased (P < 0.001) and Fattotal oxidation rate increased over time similarly in boys and men during CONT (P < 0.001). The relative contribution of CHOexo to total energy yield increased over time in both groups (P < 0.001). In conclusion, endogenous substrate metabolism and the relative contribution of fuels to total energy yield were not different between groups. The ingestion of a CHO beverage during exercise in the heat may be as beneficial for boys as men to spare endogenous substrate.

Thermoregulation in boys and men exercising at the same heat production per unit body mass.

PURPOSE: Child-adult thermoregulatory comparisons may be biased by differences in metabolic heat production ([Formula: see text]). We compared thermoregulatory responses of boys and men exercising at two intensities prescribed to elicit either a fixed [Formula: see text] per unit body mass (BM) or a fixed absolute [Formula: see text]. METHODS: Ten boys (10-12 years) and 10 men (19-25 years) performed 4 × 20-min cycling at a fixed [Formula: see text] per BM (W kg(-1)) at 35 °C and 35 % relative humidity (MENREL). Men also cycled (MENABS) at the same absolute [Formula: see text] (in W) as the boys. RESULTS: [Formula: see text] was lower in boys compared with MENREL, but similar to MENABS (mean ± SD, 233.6 ± 38.4, 396.5 ± 72.3, 233.6 ± 34.1 W, respectively, P < 0.001). Conversely, [Formula: see text] per unit BM was similar between boys and MENREL, and lower in MENABS (5.7 ± 1.0, 5.6 ± 0.8 and 3.3 ± 0.3 W kg(-1), respectively; P < 0.001). The change in rectal temperature was similar between boys and MENREL (0.6 ± 0.2 vs. 0.7 ± 0.2 °C, P = 0.92) but was lower in MENABS (0.3 ± 0.2 °C, P = 0.004). Sweat volume was lower in boys compared to MENABS (500 ± 173 vs. 710 ± 150 mL; P = 0.041), despite the same evaporative heat balance requirement (E req) (199.1 ± 34.2 vs. 201.0 ± 32.7 W, P = 0.87). CONCLUSION: Boys and men demonstrated similar thermoregulatory responses to 80 min of exercise in the heat performed at a fixed [Formula: see text] per unit BM. Sweat volume was lower in boys compared to men, despite similarities in absolute [Formula: see text] and E req.

[Levels of beta-endorphin in response to exercise and overtraining]. / Níveis de beta-endorfina em resposta ao exercício e no sobretreinamento.

Overtraining (OT) is a complex and multifactorial sport phenomenon, and there is no independent marker that can diagnose OT. Interestingly, some symptoms of OT are related to beta-endorphin (beta-end(1-31)) effects. Some of its effects, such as analgesia, increasing lactate tolerance, and exercise-induced euphoria, are important for training. These effects can be reverted by detraining or OT, which may cause decrease in performance, reduced load tolerance, and depression. The main stimulus for beta-end(1-31) secretion is to exercise because its secretion is volume/intensity dependent for both aerobic and anaerobic exercise. Excess training, however, may reduce beta-end(1-31) concentrations, thus altering its beneficial effects. Therefore, beta-end(1-31) could be used as an additional OT marker, mainly because its effects are strongly related to OT symptoms.

Níveis de beta-endorfina em resposta ao exercício e no sobretreinamento: [revisão] / Levels of beta-endorphin in response to exercise and overtraining: [review]

O sobretreinamento (ST) é um fenômeno esportivo complexo e multifatorial; e atualmente não existe nenhum marcador independente que possa diagnosticá-lo. Interessantemente, alguns sintomas do ST apresentam relação com os efeitos da b-endorfina (b-end1-31). Alguns de seus efeitos são importantes para o treinamento, como analgesia, maior tolerância ao lactato e euforia do exercício. Esses efeitos podem ser revertidos por destreinamento ou por ST, ocasionando diminuição no desempenho, redução da tolerância à carga e depressão. O exercício físico é o principal estímulo da b-end1-31, pois sua secreção é volume/intensidade dependente, tanto para exercícios aeróbios quanto anaeróbios. No entanto, o treinamento excessivo pode diminuir suas concentrações, alterando assim seus efeitos benéficos para o treinamento. Portanto, a b-end1-31 poderia ser utilizada como um marcador adicional de ST, principalmente porque seus efeitos apresentam extensa relação com os sintomas do ST.

Overtraining (OT) is a complex and multifactorial sport phenomenon, and there is no independent marker that can diagnose OT. Interestingly, some symptoms of OT are related to b-endorphin (b-end1-31) effects. Some of its effects, such as analgesia, increasing lactate tolerance, and exercise-induced euphoria, are important for training. These effects can be reverted by detraining or OT, which may cause decrease in performance, reduced load tolerance, and depression. The main stimulus for b-end1-31 secretion is to exercise because its secretion is volume/intensity dependent for both aerobic and anaerobic exercise. Excess training, however, may reduce b-end1-31 concentrations, thus altering its beneficial effects. Therefore, b-end1-31 could be used as an additional OT marker, mainly because its effects are strongly related to OT symptoms.

Leptin and body composition in healthy postmenopausal women.

BACKGROUND: Leptin has been proposed to be involved in central control of adiposity and fat distribution but the role of this peptide is controversial. The aim of our study was to test the relationship between serum leptin and body composition, fat distribution, and some biochemical markers such as fasting insulinemia and lipoproteins in a population of healthy Italian postmenopausal women. METHODS: One hundred and twenty-three postmenopausal women (62.1+/-8.7 years) were evaluated. Body composition (fat and lean mass) was assessed by dual-energy X-ray absorptiometry (DXA). Two regions of interest were determined for regional fat analysis. Serum leptin and insulinemia were measured by radioimmunoassay, lipoproteins with colorimetric methods and apolipoproteins nephelometrically. RESULTS: Plasma leptin levels are strongly related to total fat mass, in grams (r=0.73, p<0.001) or as a percentage of soft tissue (r=0.75, p<0.001), and to adiposity, calculated as ratio between lean and fat mass (r=0.76, p<0.001). A significant correlation was also found between serum leptin and central fat distribution (r=0.29, p<0.01). As concerns biochemical markers, serum leptin was significantly related to fasting insulin (r=0.38, p<0.001), total cholesterol (r=0.29, p<0.01), Apolipoprotein-B (r=0.35, p<0.001), and triglycerides (r=0.22, p<0.05). When corrected for total fat mass, the partial correlation coefficients remain significant for percentage of total body fat (r=0.27, p<0.01), adiposity (r=0.23, p<0.01), and fat proportion in android region (r=0.18, p<0.05). CONCLUSIONS: These data indicate that leptin levels are related to adiposity and fasting insulin levels; indeed fast insulin mantains significant correlation with leptin (r=0.23, p<0.01) after controlling for fat mass. Android distribution of fat mass in elderly women is associated with leptin concentration.

Prevalence of undiagnosed coeliac syndrome in osteoporotic women.

OBJECTIVES: The aims of the study were to quantify the prevalence of asymptomatic coeliac disease (CD) in a cohort of osteoporotic females, and to investigate the features of bone loss. DESIGN AND SUBJECTS: We studied 255 women (mean age 66.6 +/- 8.5 SD) with primary osteoporosis (WHO diagnostic criteria). After the first CD screening with the measure of serum IgG antigliadin antibodies (IgG-AGA), 53 women showed a positive test: antibodies to tissue transglutaminase (TG-ab) were subsequently determined to confirm the diagnosis of CD. Bone metabolism was evaluated by: serum and urinary calcium, serum and urinary phosphate, serum alkaline phosphatase, urinary crosslaps, serum 25(OH)D and serum parathyroid hormone. RESULTS: High levels of IgG-AGA and TG-ab were observed in 24 patients with a prevalence of serological disease of 9.4%. These women were characterized, in comparison with the other patients, by a statistically significant reduction in serum 25(OH)D (17.8 +/- 7.2 vs. 55.1 +/- 20.3 nmol L(-1), P < 0.01) together with a significant increase of iPTH (65.1 +/- 29.7 vs. 35.1 +/- 20.0 pg mL(-1); P < 0.01). Patients with high TG-ab levels showed also slightly raised values of urinary crosslaps (288 +/- 88 vs. 270 +/- 90 microm mol(-1) Cr). In IgG-AG positive patients a statistically significant inverse correlation was found between 25(OH)D serum levels and log-transformed TG-ab values (r: -0.95, P < 0.001). Intestinal biopsies were obtained in 10 TG-ab positive women and verified CD in six patients. CONCLUSIONS: These data support the hypothesis that patients with undiagnosed celiac disease develop high remodelling processes related to calcium malabsorption, secondary hyperparathyroidism and unavailability of vitamin D with a consequent more marked bone loss.

Influence of insulin-like growth factor-1 and leptin on bone mass in healthy postmenopausal women.

This study examines the influence of circulating insulin-like growth factor-1 (IGF-1) and serum leptin on bone mass as well as modulation of bone mass during skeletal development. Moreover, an inverse relationship between IGF-1 and leptin is reported. To evaluate the effects of serum IGF-1 and serum leptin on bone mass in healthy postmenopausal women, and the possible role of IGF-1 in leptin production, we studied a population of 123 women, aged 39-82 years. Bone mineral density (BMD) was determined by whole-body dual-energy X ray absorptiometry, which also enables measurement of body composition. Bone metabolism was assessed by measuring serum total alkaline phosphatase (TAP) and urinary hydroxyproline/creatinine (HP/Cr) excretion. IGF-1 correlated significantly with age (r = -0.28, p < 0.01) and years since menopause (r = -0.24, p < 0.01). A negative correlation was also found with weight and body mass index (r = -0.15, p < 0.05 and r = -0.19, p < 0.05, respectively). Leptin values were strongly correlated with weight (r = 0.7, p < 0.01), BMI (r = 0.7, p < 0.01), fat mass (r = 0.77, p < 0.01), and lean mass (r = 0.39, p < 0.01); a significant correlation was found with total body BMD (r = 0.29, p < 0.01), TAP (r = 0.15, p < 0.05), and HP/Cr (r = 0.18, p < 0.05). After adjustment for BMI, the significance of these relationships disappeared, demonstrating the lack of effect of serum leptin on BMD and bone turnover independent of body weight. On the other hand, the relationship between BMD and fat mass remained statistically significant after adjusting for serum leptin (r = 0.15, p < 0.05). Controlling for BMI eliminated the significant inverse correlation between IGF-1 and leptin; significant differences in leptin levels were found among women in the lower and higher quartile of IGF-1, suggesting that leptin production may be inhibited only at high values of serum IGF-1. We conclude that serum IGF-1 and serum leptin have no direct effect on bone mass and bone turnover.

Age-related changes in body composition of healthy and osteoporotic women.

OBJECTIVES: The study was carried out to assess age-related changes of body composition and to evaluate the influence of lean and fat mass in bone mineral density of healthy and osteoporotic women. METHODS: 166 healthy women in premenopause (43.2 +/- 6.7 years), 591 healthy postmenopausal women (59.9 +/- 8.1 years) and 373 women with established involutive osteoporosis (66.2 +/- 7.8 years) were evaluated: bone mineral density (BMD) and soft tissue composition (fat mass, lean mass) were measured by a total body Lunar DPX device. RESULTS: no difference in lean mass was appreciated between the groups. Fat mass was significantly lower in premenopausal women (19.5 +/- 6.5 kg) and osteoporotic patients (18.8 +/- 5.2 kg) than in postmenopausal healthy women (21.8 +/- 5.7 kg). In premenopause weight, soft tissue mass and fat mass increased with age (P < 0.05). In postmenopause, lean mass decreased significantly in healthy women (P < 0.05). Fat mass was lower in the osteoporotics than in normals. Total BMD correlated significantly with fat and lean mass in all groups (P < 0.01). BMD/height ratio correlated significantly with fat mass (P < 0.01), not with lean mass. CONCLUSIONS: BMD is closely related to fat mass in healthy premenopausal and postmenopausal women, and in osteoporotic patients; osteoporotic patients and healthy premenopausal women are characterized by a lower fat mass than healthy postmenopausal women; fat mass may be considered one of the determinants of bone mass also in involutive osteoporosis.

Idiopathic avascular necrosis of the scaphoid. A case report.

Avascular necrosis of the carpal scaphoid is a common disorder after a trauma, i.e. a fracture or mild and repetitive injury. Sometime it can be associated with a systemic disease or chronic steroid intake. Rarely avascular necrosis is found in the absence of a known etiology and so termed "idiopathic". We report a case of idiopathic avascular necrosis of the scaphoid. A painful wrist of six months' duration was observed in a 62-year-old housewife. No history of trauma or steroid administration could be elicited. X-ray showed an osteolytic area with irregular edges surrounded by a ring of osteosclerosis at the proximal pole of the left scaphoid. This datum was confirmed by the magnetic resonance imaging.

[Methodological basis and clinical applications of total-body densitometry]. / Basi metodologiche e applicazioni cliniche della densitometria "total body".

With the advent of dual-energy x-ray absorptiometry (DXA) total body scans can be done in only 10-20 minutes rather than the 60-80 minutes required by dual-photon absorptiometry (DPA). The DXA approach replace the Gd153 radionuclide source of DPA and provides substantially greater output intensity. The higher radiation flux achievable provides several advantages over conventional DPA: this makes total body scans routinely accessible. The measures of the entire skeleton and its major subregions cut down the problems of representativeness and relocation. The short term precision (coefficient of variation) was 0.5% for total body-bone mineral density (BMD) and about 1% for regional-BMD. We studied 885 women; study cohort consisted of 161 healthy postmenopausal women, 357 healthy postmenopausal women and 367 osteoporotic women with one or more vertebral crushes. The results indicate that bone mass begin decreasing during the last period of the premenopausal phase; the advent of menopause brings about a dramatic reduction of both total body and single area BMD: this phenomenon is particularly marked in subjects with osteoporosis. The single most important factor in determining BMD changes, is years since menopause. In order to assess the ability of DXA total body to distinguish women with postmenopausal osteoporosis of variable radiological degress from healthy postmenopausal women, we studied 330 postmenopausal females aged 42-85 years. There were 63 healthy women who were considered controls (Group 1).(ABSTRACT TRUNCATED AT 250 WORDS)

[An autopsy study of patients who died at the Medical Clinic of the University of Siena from 1986 to 1989]. / Studio autoptico nei pazienti deceduti nella Clinica medica dell'Università di Siena dal 1986 al 1989.

In the past twenty years autopsies are performed much less frequently in the elderly than in younger patients. The clinical diagnostic error rate documented by autopsy studies ranges from 6% to 68%. We analyzed the clinical and autopsy records of 214 patients who died from 1 January 1986 to 31 December 1989 at our Institute to determine the accuracy of clinical cause of death with respect to the pathologic cause of death. The most common cause of death were bronchopneumonia (25.2%) followed by gastroenteric and lung cancer (20%), cerebrovascular accident (15.8%), myocardial infarction (8%) and pulmonary embolism (7.4%). Pulmonary embolism was correctly classified only in 25% of patients. The most accurately diagnosed condition were neoplastic diseases (88%) and cerebrovascular accident (84.8%) while bronchopneumonia were correctly diagnosed antemortem in 72.2% of the patients studied. Our data suggest that advances in diagnostic technology have not reduced the value of the autopsy and that a goal-directed autopsy remains a vital component in the assurance of good medical care.

Metabolic effects of rectal administration of unmodified eel calcitonin in humans.

To evaluate the metabolic effects of unmodified eel calcitonin, nine normal subjects and eleven patients with Paget's disease of the bone entered the study. Eel calcitonin was administered via rectal mucosa at the dosage of 100 and 200 MRCU. Plasma calcium, plasma phosphate and plasma cAMP were measured at a baseline and after 10, 20, 30, 60, 90, 120, 180, 240 min. Rectal administration of 100 MRCU of eel calcitonin decreased plasma calcium and phosphate levels in normal subjects; the hypocalcaemic and hypophosphatemic effects were more marked and statistically significant in Paget's disease patients. Using 200 MRCU of eel calcitonin, statistically significant reductions in plasma calcium levels were observed in controls and in Paget's disease patients. Plasma phosphate decreased after rectal administration of the hormone, but not significantly. A slight but not significant increase in plasma cAMP was observed in normal subjects after the administration of 200 MRCU. These data demonstrate that eel calcitonin administered via rectal mucosa can exert some of the known biologic effects of the peptide.