To assess long-term effectiveness, complications, and outcomes of primary obstructive megaureter (POM) treated by endoscopic balloon dilation (EBD) in the largest series reported.
Hundred POM in 92 ...consecutive patients were treated by EBD between years 2004 and 2016. A total of 79 POM (73 patients) with more than 18 months of follow-up after treatment have been analyzed. EBD of the vesicoureteral junction was performed with semicompliant high-pressure balloon catheters (2.7FG) with minimum balloon diameter of 5 mm, followed by temporary Double-J stent placement. Follow-up protocol included periodical clinical reviews, US and MAG-3 renogram scans.
Median age at surgery was 4 months (15 days-3.6 years), with median operating time of 20 min (10-60) and hospital stay of 1 day (1-7). Initial renal function was preserved in all patients with significant improvement in renal drainage on the MAG-3 diuretic renogram after endoscopic treatment (
< 0.001
-test). Significant post-operative differences were observed in hydronephrosis grade and ureteral diameter that were maintained in the long-term (
< 0.001
-test). Endoscopic approach of POM had a long-term success rate of 87.3%, with a mean follow-up of 6.4 ± 3.8 years. Secondary VUR was found in 17 cases (21.5%), being successfully treated by endoscopic subureteral injection in 13 (76.4%). Nine cases developed long-term re-stenosis (12.2%) that were successfully treated with a new EBD in 8. Endoscopic management of POM failed in 10 cases (12.7%) that required ureteral reimplantation. Five were early failures (4 intraoperative technical problems and 1 double-J stent migration with severe re-stenosis), and 5 long-term (4 persistent VUR and 1 re-stenosis recurrence).
EBD has shown to be an effective treatment of POM with few complications and good outcomes at long-term follow up. Main complication was secondary VUR that could also be treated endoscopically with a high success rate. In our opinion, EBD may be considered first-line treatment in POM.
Inflammatory pseudo tumor (IP) is an infrequent process with benign evolution in most cases whose etiology and pathogenesis are unknown. It usually affects young men and children, in whom the ...macroscopic lesion can mimic a malignant process, which is ruled out after biopsy. Therefore, the diagnosis of certainty is histological and treatment consists of corticosteroids, leaving resection for cases in which biopsy is not possible or in which it produces local complications. We present a case of an inflammatory pseudo tumor with special corticodependence that began as a long-term periodic fever and splenic focal lesion that required splenectomy for its diagnosis and that, after decreasing the corticosteroid regimen, presented recurrences at the cerebellar and systemic level requiring the association of various immunosuppressants and rituximab to achieve remission. As a result of this case, we have performed an analysis of all the pseudo tumors diagnosed in adults in the hospitals of the province of Malaga, and it has been compared with that described in the bibliography.
Known conceptual and technical limitations of mainstream environmental health data analysis have directed research to new avenues. The goal is to deal more efficiently with the inherent uncertainty ...and composite space-time heterogeneity of key attributes, account for multi-sourced knowledge bases (health models, survey data, empirical relationships etc.), and generate more accurate predictions across space-time. Based on a versatile, knowledge synthesis methodological framework, we introduce new space-time covariance functions built by integrating epidemic propagation models and we apply them in the analysis of existing flu datasets. Within the knowledge synthesis framework, the Bayesian maximum entropy theory is our method of choice for the spatiotemporal prediction of the ratio of new infectives (RNI) for a case study of flu in France. The space-time analysis is based on observations during a period of 15 weeks in 1998–1999. We present general features of the proposed covariance functions, and use these functions to explore the composite space-time RNI dependency. We then implement the findings to generate sufficiently detailed and informative maps of the RNI patterns across space and time. The predicted distributions of RNI suggest substantive relationships in accordance with the typical physiographic and climatologic features of the country.
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CEKLJ, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The management of recurrent pyeloureteral junction obstruction (PUJO) is controversial, as there is no suitable technique for its correction. Percutaneous endopyelotomy shows better results in ...recurrent PUJO compared to primary PUJO. Micro-percutaneous approaches reduce damage to renal parenchyma and facilitate access to renal pelvis.
To present our experience in the use of this minimally invasive technique for the treatment of recurrent PUJO.
A retrospective study was performed collecting data of patients with recurrent PUJO treated in our hospital using the percutaneous approach between July 2014 and January 2018.
Micropercutaneous access was performed in all patients.
In Valdivia position, a 5 or 6 mm high-pressure ballon is placed in the renal pelvis under cystoscopic and fluoroscopic guidance. The 4.8 or 8 Fr microperc puncture needle is placed into the pelvicalyceal system. Endopyelotomy is performed with a laser fiber or monopolar hook on a high-pressure balloon. To improve the exposure of the cutting area, the high-pressure balloon is placed at the pyeloureteral junction. Double J stent is left for weeks.
The ages of the patients were 4, 8 and 18 months, and 2 and 4 years.
All patients had previously undergone pyeloplasty due to pyeloureteral junction obstruction.
Operative time was 50 ± 21 min. Hospital stay after surgery was 24 h and hematuria disappeared within the 24 postoperative hours.
The number of patients with recurrent PUJO is small, making it difficult to establish a standard surgical approach for failed pyeloplasty. Redo pyeloplasty is considered the gold standard by some authors but alternative methods, such as endourological techniques, may also have a role in the treatment of failed pyeloplasty.
The percutaneous approach has shown very good results in this treatment and the miniaturization of percutaneous surgery has improved with the micropercutaneus access.
We consider micropercutaneous approach helped with a high pressure balloon in the pyeloureteral junction is an alternative and minimally invasive technique that has shown good results in our small cases series.
However, we must take into account the limitation of the study considering the low number of patients. We need prospective studies to support our results.
Micropercutaneous endopyelotomy is a fairly effective technique to treat recurrent UPJO after failed pyeloplasty in children. In our experience, it reduces kidney damage without increasing complications.Summary TableStudy data.Table 1PatientsGenderAge pyeloplasty (months)SymptomsaUltrasoundaPercutaneous pyeloplasty age (months)Microperc diameterEvolutionFollow up (months)1M2HypertensionAP pelvis: 30 mm48 FrNo symptoms AP pelvis: 15 mm272F4UTIsAP pelvis: 30 mm84.8 FrNo symptoms AP pelvis: 5 mm383F5UTIsAP pelvis: 22 mm184.8 FrNo symptoms AP pelvis: 12 mm234F10UTIsAP pelvis: 39 mm248 FrNo symptoms AP pelvis: 20 mm605M6UTIsAP pelvis: 30 mm488 FrNo symptoms AP pelvis: 15 mm36aafter first pyeloplasty.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
25.
Audit research: Some reflections Gonzalo-Angulo, José A.; Garvey, Anne M.
Revista de contabilidad,
July-December 2018, 2018-07-00, 20180701, 2018-07-01, Volume:
21, Issue:
2
Journal Article
Peer reviewed
Open access
...professional firms are transformed into lucrative businesses, and their leaders acquire a consultants' mentality, whose main objective is to obtain profits (Zeff, 2003:280). ...the sixth subject ...of the call for papers by EAR mentions the topic of small audit firms, which are now subject to special consideration in the rules and also by regulators and standard setters. ...the background to this conception is that market discipline can replace independence: that is, if the market discipline is functioning correctly, then perhaps there is no need for auditor rotation, nor for co-audits, nor for the prohibition of offering non-audit services while performing the audit engagement. ...the research work of Ruiz-Barbadillo, Gómez-Aguilar and Biedma (2005), with objective data on the number of qualification paragraphs in audit reports, obtained the unexpected result that the longer a company was audited by the same firm the more likely it was that the audit report would be qualified.
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The treatment of nitrogen-deficient agriculture wastewater, arising from the vegetable and fruit processing, is a significant problem that limits the efficiency of its biological treatment. This ...study evaluates the effectiveness of the symbiotic co-culture of Azospirillum brasilense and Scenedesmus sp., under two nitrogen levels (8.23 mg L−1 and 41.17 mg L−1) and mixing systems (aeration and magnetic stirring), aiming to simultaneously use the N-deficient media for their growth while producing biomass for biofuels. Microalgae growth and biomass composition, in terms of protein, carbohydrate and fatty acid contents, were evaluated at the end of the exponential growth phase (15 days after inoculation). Results show that the symbiotic co-culture of microalgae-bacteria can be effectively performed on nitrogen-deficient media and has the potential to enhance microalgae colony size and the fatty acid content of biomass for biofuels. The highest biomass concentration (103 ± 2 mg·L−1) was obtained under aeration, with low nitrogen concentration, in the presence of A. brasilense. In particular, aeration contributed to, on average, a higher fatty acid content (48 ± 7% dry weight (DW)) and higher colony size (164 ± 21 µm2) than mechanical stirring (with 39 ± 2% DW and 134 ± 21 µm2, respectively) because aeration contribute to better mass transfer of gases in the culture. Also, co-culturing contributed in average, to higher colony size (155 ± 21 µm2) than without A. brasilense (143 ± 21 µm2). Moreover, using nitrogen deficient wastewater as the culture media can contribute to decrease nitrogen and energy inputs. Additionally, A. brasilense is approved and already extensively used in agriculture and wastewater treatment, without known environmental or health issues, simplifying the biomass processing for the desired application.
Nonlinear optical loop mirrors (NOLMs) are used in modern fiber optic devices and optical communications. In this study, we present numerical analyses of the multiple variables involved in the ...operation of an NOLM in low- and high-power transmissions. The Jones matrix formalism was used to model linear and circular polarization inputs. We used three-dimensional (3D) plots to identify the characteristics required in the experimental operation of the NOLM. These characteristics, including the critical power, low- and high-power transmission, and dynamic range, depend on parameters such as the fiber loop length, input power, angle of retarder plate, and input polarization. A standard single-mode fiber (SMF-28) with high twist loop lengths of 100, 300, and 500 m and input powers of 0–100 W was simulated. Three-dimensional surface graphics provided a comprehensive view of the NOLM transmission and considerably enhanced the optimal transmission by manipulating adjustable device components including the power and polarization control plates. Optimal transmission facilitates its use in integrating ultrafast pulse generation, optical signal processing, optical communication systems, and photonic integrated circuit applications.
The emergence and re‐emergence of disease epidemics is a complex question that may be influenced by diverse factors, including the space–time dynamics of human populations, environmental conditions, ...and associated uncertainties. This study proposes a stochastic framework to integrate space–time dynamics in the form of a Susceptible‐Infected‐Recovered (SIR) model, together with uncertain disease observations, into a Bayesian maximum entropy (BME) framework. The resulting model (BME‐SIR) can be used to predict space–time disease spread. Specifically, it was applied to obtain a space–time prediction of the dengue fever (DF) epidemic that took place in Kaohsiung City (Taiwan) during 2002. In implementing the model, the SIR parameters were continually updated and information on new cases of infection was incorporated. The results obtained show that the proposed model is rigorous to user‐specified initial values of unknown model parameters, that is, transmission and recovery rates. In general, this model provides a good characterization of the spatial diffusion of the DF epidemic, especially in the city districts proximal to the location of the outbreak. Prediction performance may be affected by various factors, such as virus serotypes and human intervention, which can change the space–time dynamics of disease diffusion. The proposed BME‐SIR disease prediction model can provide government agencies with a valuable reference for the timely identification, control, and prevention of DF spread in space and time.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
This paper is concerned with the modeling of infectious disease spread in a composite space-time domain under conditions of uncertainty. We focus on stochastic modeling that accounts for basic ...mechanisms of disease distribution and multi-sourced in situ uncertainties. Starting from the general formulation of population migration dynamics and the specification of transmission and recovery rates, the model studies the functional formulation of the evolution of the fractions of susceptible-infected-recovered individuals. The suggested approach is capable of: a) modeling population dynamics within and across localities, b) integrating the disease representation (i.e. susceptible-infected-recovered individuals) with observation time series at different geographical locations and other sources of information (e.g. hard and soft data, empirical relationships, secondary information), and c) generating predictions of disease spread and associated parameters in real time, while considering model and observation uncertainties. Key aspects of the proposed approach are illustrated by means of simulations (i.e. synthetic studies), and a real-world application using hand-foot-mouth disease (HFMD) data from China.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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