SARS-CoV-2 induces mitochondrial dysfunction and cell death by oxidative stress/inflammation in leukocytes of COVID-19 patients.

The inflammation and activation of the immune system induced by SARS-CoV-2 are mediated by a pro-oxidant microenvironment that can induce cytotoxic effects that enhance tissue damage, favoring organic deterioration. We investigated whether the induction of oxidative stress and inflammation by COVID-19 infection could inhibit mitochondrial function and cause cellular damage in leukocytes. We evaluated levels of oxidative/inflammation markers and their correlation with mitochondrial function and leukocyte cell death in COVID-19 patients at two moments: viremia and severe sepsis with multi-organ failure. COVID-19 induces increased oxidative stress and inflammation markers that activate cellular damage processes. In the viremia stage, an increase in peroxide, nitric oxide, carbonylated proteins, and IL-6 was observed, which was correlated with a marked inhibition of mitochondrial function, decreased cell viability, early apoptosis, necrosis, and leukocytes-reactivity. The severe sepsis stage with multi-organ failure also showed a further increase in levels of peroxide, carbonylated proteins, and IL-6, with a slight decrease in nitric oxide. This oxidative process and inflammation were correlated with less inhibition of mitochondrial function, decreased cell viability and an increase in late apoptosis, and morphology changes evidencing damage in the leukocytes. SARS-CoV-2 induced damage promotes levels of oxidative stress and inflammation markers and mitochondrial dysfunction that potentiate morphological changes and cell death in leukocytes. These processes explain the rapid changes in the immune system, and that present an initial over-activation and early massive death due to SARS-CoV-2 infection, promoting endothelial-alveolar damage that would cause multi-organ failure, sustained by oxidative stress and inflammation.

Methodology Proposal of EMG Hand Movement Classification Based on Cross Recurrence Plots.

Dealing with electromyography (EMG) signals is often not simple. The nature of these signals is nonstationary, noisy, and high dimensional. These EMG characteristics make their predictability even more challenging. Cross recurrence plots (CRPs) have demonstrated in many works their capability of detecting very subtle patterns in signals often buried in a noisy environment. In this contribution, fifty subjects performed ten different hand movements with each hand with the aid of electrodes placed in each arm. Furthermore, the nonlinear features of each subject's signals using cross recurrence quantification analysis (CRQA) have been performed. Also, a novel methodology is proposed using CRQA as the mainstream technique to detect and classify each of the movements presented in this study. Additional tools were presented to determine to which extent this proposed methodology is able to avoid false classifications, thus demonstrating that this methodology is feasible to classify surface EMG (SEMG) signals with good accuracy, sensitivity, and specificity. Lastly, the results were compared with traditional machine learning methods, and the advantages of using the proposed methodology above such methods are highlighted.

EEG data collection using visual evoked, steady state visual evoked and motor image task, designed to brain computer interfaces (BCI) development.

A set of electroencephalogram (EEG) data from 29 subjects obtained from a study, in which the subjects performed a set of tests based on visual stimuli and motor images of the hands is presented. Three types of data are provided in this article: (1) Signals based on visual events (VEP), (2) signals based on steady state visual events (SSVEP) and (3) signals based upon Motor Imagery (MI). Several research projects have used this data to test the detection of visual stimuli, classification and selection of characteristics of brain signals, EEG preprocessing and for optimization processes based on heuristic algorithms and algorithms based upon collective animal intelligence. The data was acquired using an Emotiv Epoc + portable EEG with 14 data channels and two reference channels.

Vitamin D deficiency and seasonal variation over the years in São Paulo, Brazil.

Brazil is a tropical/subtropical geographic area with elevated ultraviolet (UV) radiation. We report very high prevalence of vitamin D deficiency in a large database of Brazilian subjects and show seasonal and reciprocal relationship between vitamin D and parathyroid hormone (PTH) over the years in this tropical area. INTRODUCTION: We aim to examine the prevalence of vitamin D deficiency, characterize the temporal relationship between 25-hydroxyvitamin D levels (25(OH)D) and intact PTH (iPTH) according to seasons, and investigate potential associations between 25(OH)D levels and extra-skeletal outcomes in a Brazilian population. METHODS: We retrospectively determined population weekly mean concentrations of unpaired 25(OH)D and iPTH using 39,004 laboratory results of Brazilian individuals of both genders aged 2 to 95 years. The 25(OH)D and iPTH distributions were normalized, and the means fit with a sinusoidal function. Potential associations between 25(OH)D serum levels and inflammatory markers, fasting glucose, HbA1c and Homeostasis Model Assessment index (HOMA) were examined. RESULTS: Of the samples, 33.9 % had 25(OH)D serum concentrations lower than 20 ng/mL, while the vast majority (70.7 %) were found to be vitamin D deficient or insufficient (<30 ng/mL). Vitamin D deficiency was significantly higher during the winter as compared to the summer (38.4 % <20 ng/mL and 75.5 % <30 ng/mL versus 23.3 % <20 ng/mL and 62.5 % <30 ng/mL, respectively; p < 0.001). Seasonal variation was observed for both 25(OH)D and iPTH. 25(OH)D peaks occurred in March and troughs in September. iPTH levels showed an inverted pattern of peaks and troughs with a delay of 1 ± 5 week. 25(OH)D was significantly associated with inflammatory markers but not with glucose homeostasis. CONCLUSIONS: A sinusoidal interrelationship has been detected between vitamin D and PTH in this tropical population. A large percentage of the individuals showed vitamin D deficiency. Public health strategies are needed to better understand and manage this very high and apparently contradictory prevalence of vitamin D deficiency.

FPGA-based architecture for real-time data reduction of ultrasound signals.

This paper describes a novel method for on-line real-time data reduction of radiofrequency (RF) ultrasound signals. The approach is based on a field programmable gate array (FPGA) system intended mainly for steel thickness measurements. Ultrasound data reduction is desirable when: (1) direct measurements performed by an operator are not accessible; (2) it is required to store a considerable amount of data; (3) the application requires measuring at very high speeds; and (4) the physical space for the embedded hardware is limited. All the aforementioned scenarios can be present in applications such as pipeline inspection where data reduction is traditionally performed on-line using pipeline inspection gauges (PIG). The method proposed in this work consists of identifying and storing in real-time only the time of occurrence (TOO) and the maximum amplitude of each echo present in a given RF ultrasound signal. The method is tested with a dedicated immersion system where a significant data reduction with an average of 96.5% is achieved.

[Last will and testament: decision-making at the end of one's life]. / Testamento vital. La toma de decisiones en el final de la vida.

Current medical practice has made great progress over the past century which permits people to live longer and better than before. But this improvement has not been transferred to the field of death. To die with dignity today is a privilege only a few have. Those close to death claim their right to a death with dignity. Their petition usually goes unheard by the medical profession. The patients' autonomous law, which regulates last will and testaments or anticipated final wishes, is a step in this direction. The objective of this article is to publicize the current legal regulations related to last wills and testaments or last wishes by means of a critical review of the existing legislation.

Testamento vital. La toma de decisiones en el final de la vida / Last will and testament: decision-making at the ende of one´s life

La medicina actual ha realizado grandes progresos en el último siglo consiguiendo que se viva más tiempo y mejor que antes. Pero este avance no se ha trasladado al campo de la muerte. El buen morir es hoy privilegio de unos pocos. El moribundo reclama su derecho a un fin digno. Su petición es, habitualmente, desoída por los profesionales sanitarios. La Ley de Autonomía del paciente, con la regulación del Testamento Vital o Voluntades anticipadas supone un giro en este sentido. El objetivo del presente artículo es dar a conocer la normativa actualmente vigente relacionada con el testamento vital o últimas voluntades mediante una revisión crítica de la legislación existente

Current medical practice has made great process over the past century which permits people to live longer and better than before. But this improvement has not been transferred to the field of death. To die with dignity today is a privilege only a few have. Those close to death claim their right to a death with dignity. Their petition usually goes unheard by the medical profession. The patients´ autonomous law, which regulates last will and testaments or anticipated final wishes, is a step in this direction. The objective of this article is to publicize the current legal regulations related to ast wills and testaments or last wishes by means of a critical review of teh existing legislation

Tolerance of pain during transrectal ultrasound-guided biopsy of the prostate: risk factors.

Transrectal ultrasound-guided needle biopsy of the prostate is routinely performed to diagnose prostate cancer. We performed a prospective study to assess the pain and identify risk factors of pain during prostate biopsy. Prospectively, 131 patients were enrolled. Transrectal ultrasound-guided needle prostate biopsies were performed without any anesthesia. Pain was assessed by using an immediate postbiopsy anonymous questionnaire including a linear visual analog scale (VAS). Six factors were studied (age, prostate volume, cores number, operator, previous biopsy and first core location). Most of the patients tolerated the biopsy with acceptable discomfort. Among the risk factors studied, only first core location influenced the pain. Apex biopsy first was more painful. We recommend starting biopsy with the base.

[Ureteral replacement with non-modelled isoperistaltic ileoplasty]. / Remplacement urétéral par iléoplastie isopéristaltique non modelée.

OBJECTIVES: To study the long-term morbidity and efficacy of ureteroileoplasty in a retrospective series of 18 patients. MATERIALS AND METHODS: 12 men and 6 women with a mean age of 50 years underwent ureteroileoplasty with unilateral replacement in 15 patients and bilateral replacement in 3 patients. A total of 21 units renoureteral units were repaired by this technique. The pelvic ureter was replaced in 16 renoureteral units, the lumbar ureter was replaced in 1 case and the entire ureter was replaced in 4 cases. The commonest ureteral lesions were strictures secondary to ureteroscopy or ureterolithotomy (40%). All patients had normal renal function, except for one patient with serum creatinine of 224 mumol/l. RESULTS: With a mean follow-up of 25 months (range: 3 to 64 months) all ureteroileoplasties were patent with no major morbidity. Only the patient with preoperative renal failure developed hyperchloraemic acidosis with deterioration of her renal function. CONCLUSION: In the absence of renal failure, ureteroileoplasty is an operation with low morbidity achieving good medium-term results.

[CT-guided percutaneous fine needle biopsy of solid tumors of the kidney]. / Les biopsies percutanées à l'aiguille fine des tumeurs solides du rein sous guidage tomodensitométrique.

OBJECTIVE: This study was designed to evaluate the reliability and the role of percutaneous needle biopsy in the diagnosis of renal masses. MATERIALS AND METHODS: 85 biopsies were performed in 74 patients (mean age: 62 +/- 14 years). The median tumour diameter was 4.44 +/- 2.53 cm. Biopsies were performed with an 18G ASAP* needle with CT guidance. 2 to 4 cores were obtained per patients. All biopsies were performed as an outpatient procedure. RESULTS: Biopsies were uninterpretable in 15 cases (17%) (13 with normal or no renal tissue and 2 necrotic samples). A benign lesion was detected in 8 cases (4 fibrous lesions, 4 infectious lesions). In 3 cases, biopsies were suspicious of cancer, which was confirmed on definitive histology. In 59 cases, biopsies were neoplastic: 6 benign tumours (4 oncocytomas, 1 angiomyolipoma, 1 cystadenoma), 42 renal cell carcinomas (RCC) (conventional: 32, chromophobe: 3, tubulopapillary: 7), 5 urothelial carcinomas, 3 metastases, 2 lymphomas and 1 sarcoma. The median Fürhman grade was 2. 30 RCC were operated. The correlation coefficient for the biopsy and pathology histological type was 0.90. The median pathological Fürhman grade was 2. The biopsy results modified therapeutic management in 38% of cases. There was no morbidity, post-biopsy medical management was never required. CONCLUSION: Biopsy of renal masses is reliable for evaluation of the histological type. The introduction of the CT scope should increase the accuracy of biopsies. The morbidity is low compared to that of diagnostic surgery.

Retrograde Acucise endopyelotomy: long-term results.

PURPOSE: We evaluated the long-term outcome of retrograde endopyelotomy with the Acucise cutting balloon as a first-line treatment of ureteropelvic junction obstruction (UPJO) in 36 patients (median age 44 years). PATIENTS: Twenty-three patients had a primary UPJO. The median follow-up in the series was 24 (6-42) months. RESULTS: Success, defined as a subjective and objective improvement, was obtained in 27 (75%). In multivariate analysis, only the presence of a crossing vessel (45% v. 81%) was a significant covariate for success. The success rates for primary and secondary UPJO were 74% and 77% respectively. The grade of obstruction had no impact on results. The median time to the nine failures was 3 months, and no failure occurred more than 6 months after the endopyelotomy. In 75% of the failures with no crossing vessel, redo retrograde Acucise endopyelotomy was successful. CONCLUSION: Retrograde Acucise endopyelotomy is an efficient long-term treatment of UPJO with low morbidity. This technique is a reasonable choice for first-line treatment of UPJO.

[Role of flexible mini-ureteroscopes in diseases of the upper urinary tract]. / Rôle des mini-urétéroscopes flexibles dans la pathologie du haut appareil urinaire.

INTRODUCTION: The management of upper urinary tract disease has been improved by miniaturization of endoscopes. Our objective was to assess the value of flexible mini-ureteroscopes for the diagnosis and treatment of upper urinary tract lesions. PATIENTS AND METHODS: 33 consecutive patients (mean age: 49 +/- 16 years; 23 men) underwent first-line flexible ureteroscopy for upper urinary tract disease, consisting of: stones: 21, filling defect: 6, stenosis: 3, haematuria: 2, positive cytology: 1 and situated in the kidney + renal pelvis: 14 or ureter: 19. The 21 stones were situated in: the calyx: 5, renal pelvis: 1, lumbar ureter: 8, iliac ureter: 3, pelvic ureter: 4. Their mean dimensions were 9.7 +/- 4 x 5.3 +/- 2.3 mm. Previous treatment had failed for 13 stones. There 7.5 F flexible ureteroscopes of various brands were used. RESULTS: All patients were operated under general anaesthesia. Antegrade ureteroscopy was performed in 2 patients. Advancement of the ureteroscope was considered to be difficult in 5 cases, including the 2 antegrade cases. 13 stones were fragmented by hydroelectric waves. The mean duration of ureteroscopy was 40 +/- 15 min. The mean hospital stay was 2.8 +/- 1 days. There was no intraoperative or perioperative morbidity. Ureteroscopy was considered to be successful in 27 cases (82%) and a failure in 6 cases: fragmentation: 3 and progression: 3. Fifteen patients were reviewed after more than one month (3 +/- 2 months) with no morbidity. CONCLUSION: Ureteroscopy with flexible mini-ureteroscopes is an effective, reproducible and minimally traumatic diagnostic and therapeutic technique. It is particularly useful for lesions situated above the iliac vessels and is indicated for diagnostic assessment and stones, but also upper tract malformations and strictures.

Effect of digital rectal examination on serum complexed and free prostate-specific antigen and percentage of free prostate-specific antigen.

OBJECTIVES: To evaluate the effects of digital rectal examination (DRE) on serum total, calculated complexed, and free prostate-specific antigen (PSA) and the free/total PSA ratio and factors affecting variations of PSA. METHODS: Serum total and free PSA and the percent free PSA ratio were determined in 91 urologically referred men (mean age 64 +/- 9 years) before and 30 minutes after DRE, with the Hybritech Tandem-R assay. Complexed PSA was calculated as the difference between total and free PSA. DRE effects on PSA were analyzed comparing pre-DRE and post-DRE values and by calculating the difference between pre-DRE and post-DRE PSA and the post/pre-DRE geometric ratio as a coefficient of variation. RESULTS: Thirty minutes after DRE, the increase in total, calculated complexed, and free PSA and the percent free PSA ratio was statistically significant. The difference between post-DRE and pre-DRE values of serum total, calculated complexed, and free PSA and percent free PSA was +0.9, +0.3, and +0.6 ng/mL and + 10%, respectively. The post/pre-DRE ratio of serum total, calculated complexed, and free PSA and percent free PSA was x1.5, x1.22, and x2.5 and x1.7, respectively. Patient age, DRE findings, prostate volume, prostate histologic features, and the initial value of total PSA had no statistically significant effect on the change of percent free PSA after DRE. The initial percent free PSA had a statistically significant effect on the change of percent free PSA after DRE. The values of calculated complexed PSA before and after DRE were significantly higher in patients with a prostate volume greater than 40 cc, prostate cancer on biopsy, and an initial free/total PSA ratio greater than 18%. CONCLUSIONS: In this study, DRE significantly increased total, calculated complexed, and free PSA and percent free PSA. The increase of PSA immediately after DRE was mainly due to the increase of free PSA. The change of percent free PSA after DRE depended on the initial percentage of free PSA. Complexed PSA seems less sensitive to DRE, and its changes after DRE were clinically modest. Free PSA measurement should be done before DRE and percent free PSA should be used only when the venipuncture is done before the DRE.

Kinetics of postbiopsy levels of serum free prostate-specific antigen and percent free prostate-specific antigen.

OBJECTIVES: We evaluated the effects of transrectal ultrasound-guided biopsy of the prostate on serum total and free prostate-specific antigen (PSA) and the free/total PSA ratio and factors affecting variations in PSA levels. METHODS: Serum total and free PSA levels and the free/total PSA ratio were determined in 48 men (mean age 66+/-7 years) before and 1 hour, 8 days, and 30 days after prostate biopsy. At least six cores were taken using a biopsy gun with an 18-gauge needle. The coefficient of variation of PSA was calculated as the postbiopsy/prebiopsy PSA ratio. Changes in PSA levels and the coefficient of variation were studied. RESULTS: Fifteen (31%) of 48 men had adenocarcinoma on biopsy. Total and free PSA values were significantly increased 1 hour and 8 days after biopsy, and both returned to baseline 30 days after biopsy. The free/total PSA ratio was significantly increased (55%) 1 hour after biopsy and significantly decreased (12%) 8 days after biopsy. Thirty days after biopsy, the median of the free/total PSA ratio (18%) was not significantly different from the prebiopsy ratio (16%). The median of the coefficient of variation of the free/total PSA ratio was 3, 0.7, and 1 at 1 hour, 8 days, and 30 days after biopsy, respectively. Age, prostate volume, number of cores, and digital rectal examination and histologic findings were not significantly associated with variation in percent free PSA. Variation in percent free PSA at day 8 was associated with prebiopsy total PSA value and the free/total PSA ratio. CONCLUSIONS: Prostate biopsy dramatically alters the percent free PSA. The free/total PSA ratio was decreased 8 days after biopsy and returned to prebiopsy levels in 75% of patients at 1 month after biopsy. Measurement of free PSA levels and the free/total PSA ratio should not be done within 4 weeks of prostate biopsy.

[Acucise endoureterotomy for distal ureteral stenosis in a renal transplant patient]. / Endourétérotomie Acucise pour sténose de l'uretère distal chez un transplanté rénal.

The treatment of ureteric strictures in renal transplantation used to be surgical, but has recently benefited from progress in endourology. The authors report the case of a renal transplant recipient who developed late stricture of the ureterovesical reimplantation of the transplant. After percutaneous nephrostomy, which restored good renal function, retrograde endoureterotomy was performed using an Acucise ureterotome balloon, followed by ureteric modelling on a 7F double J stent for 2 months. With a follow-up of 18 months, renal function was normal and ultrasonography showed residual hypotonia of the transplant cavities and no vesicorenal reflux was detected by retrograde voiding cystourethrography. Acucise retrograde endoureterotomy can constitute a simple endourological treatment for late ureteric strictures in renal transplantation.

[Malignant histiocytofibroma of the bladder. A case report]. / Histiocytofibrome malin de la vessie. A propos d'un cas.

Malignant histiocytofibroma of the bladder is a rare (16 cases reported in the literature) and very aggressive sarcoma. It is sometimes associated with a haematological malignancy. The authors report a case of malignant histiocytofibroma of the bladder in a 72-year-old haemodialysed woman with a poor general status. She had a history of chemotherapy and radiotherapy for gastrointestinal lymphoma 6 years previously. Treatment consisted of palliative cystectomy for bladder pain and haematuria. A massive pelvic and abdominal wall recurrence occurred two months after cystectomy and the patient died. The authors review the 16 cases of malignant histiocytofibroma of the bladder reported in the literature. Histiocytofibroma is a tumour which requires aggressive treatment with a combination of radical surgery and systemic chemotherapy.

Comparison by SPECT of renal scars after extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy.

Some renal calculi are borderline indications for either extracorporeal shock wave lithotripsy (ESWL) or percutaneous nephrolithotomy (PCNL). Our purpose was to quantify by single photon emission computed tomography (SPECT) the parenchymal lesions of these two procedures to make the choice easier. The SPECT study was done before and 30 days after the stone treatment. The scan was carried out 10 hours after injection of 99mTc-DMSA using a GE400 rotative gamma camera, which data were reconstructed in three planes. The local uptake and scar of the treated area were evaluated in 22 patients with symptomatic kidney stones without previous treatment or renal failure. Twelve patients (mean stone size 12 x 9 mm) were treated on a piezoelectric (EDAP LT-01) lithotripter (mean shock wave number 3420), and ten patients (mean stone size 24 x 17 mm) were treated by PCNL (32F Amplatz sheath in a lower calix). There were no complications, and the stone-free rate at day 30 was 50% in both groups. In the ESWL group, all of the kidneys demonstrated a loss of local uptake, whereas 7 of the 10 in the PCNL group did so. In the ESWL group, 4 of the 12 kidneys had a local loss exceeding 4% but only 2 of 10 kidneys in the PCNL group. There were 7 scars in the treated area in the ESWL group and 6 in the PCNL group. Extracorporeal lithotripsy does not seem to be a nontraumatic procedure for the kidney. For stones that would require several sessions of ESWL, the use of PCNL must be preferred.