Purpose
To report the results of a randomized controlled trial comparing outcomes between medium power (MP) and high power (HP) laser settings for HoLEPs.
Methods
The primary objective was to compare ...the enucleation efficiency (EE) of HP- HoLEP (80–100 W) with MP-HoLEP (50 − 60 W). The secondary objectives were to compare treatment efficacy and safety between both groups. To show a 25% difference in EE, a sample size of 45 individuals per treatment arm was required (alpha = 0.05; Beta = 0.80). Patients demographic and perioperative factors were analyzed, including EE, hemoglobin drop, duration of catheterization, and length of hospital stay. The surgical outcome was evaluated with AUA symptom score, maximum flow rate, postvoid residual urine, and complications to assess differences between MP and HP HoLEP at baseline, 3 months, 1, and 5 years. Quantitative outcomes were compared with independent sample
t
tests (2-tailed) and qualitative outcomes were compared with chi-square tests.
Results
Preoperative data with the exception of indication for surgery were comparable in both treatment arms. There was no statistically significant difference in enucleation efficiency between the HP-HoLEP and MP-HoLEP laser setting (0.97 ± 0.47 vs. 0.85 ± 0.47 gm/min,
p
= 0.209). MP laser settings did not increase perioperative or postoperative complications and resulted in durable outcome comparable with HP laser settings at 5-year follow-up.
Conclusions
MP-HoLEP is safe and efficient and does not compromise the outcome for HoLEPs when compared with HP-HoLEP.
To evaluate the safety and efficacy of performing Holmium laser enucleation of the prostate (HoLEP) for the treatment of bladder outlet obstruction secondary to an enlarged prostate within 6-weeks of ...a transrectal ultrasound (TRUS) guided prostate biopsy.
We performed a retrospective review of patients who underwent a HoLEP at our institution, excluding any patients with a confounding urologic history and compared patients who underwent a TRUS-guided 6- or 12-core prostate biopsy, and then underwent a HoLEP within 6 weeks (study group) with all other patients (control group). Our primary outcomes were enucleation efficiency (EE) and perioperative complication rate. Our secondary outcomes included postoperative drop in hemoglobin, duration of catheterization, length of hospital stay, voiding metrics at 1 and 6 months and rate of incidental prostate cancer diagnosed on histopathological examination of prostate specimens after HoLEP. To test for differences between the study and control groups, we performed independent sample t-test (2-tailed) and chi-square tests for quantitative and qualitative variables, respectively. P values of < 0.05 were considered statistically significant.
552 patients met inclusion criteria and 84 patients underwent prostate biopsy within a period of 45 days prior to HoLEP. Enucleation efficiency was higher in the study group (P = 0.00). There was no significant difference between the 2 groups regarding perioperative complications, postoperative voiding outcomes, or rate of incidental prostate cancer detection.
TRUS prostate biopsy performed within 6 weeks of HoLEP does not negatively impact operative difficulty or treatment outcome.
Vitiligo is characterized by an autoimmune response targeting melanocytes, thus resulting in skin depigmentation. There are several genetic components involved in the development of vitiligo, of ...which various gene polymorphisms are currently considered as risk factors. For example, the CTLA4 (T-lymphocyte antigen 4) +49A/G (rs231775) and CT60 (rs3087243) gene variants have been associated with a predisposition for autoimmune diseases in different populations; however, their involvement in the development of vitiligo remains controversial.
We evaluated the association between vitiligo and the CTLA4 +49A/G (rs231775) and CT60 (rs3087243) gene variants in a Mexican population.
A total of 116 vitiligo patients and 117 control subjects from northeast Mexico were included in the study and analyzed through PCR-RFLP to determine whether there is an association between vitiligo and CTLA4 +49A/G (rs231775) and CT60 (rs3087243) gene variants.
No statistical difference was observed for both gene polymorphisms between vitiligo patients and controls (p > 0.05). Otherwise, vitiligo activity, family history of vitiligo, personal history of autoimmune diseases, or sex did not show any difference (p > 0.05).
As suggested by the analysis of a northeastern Mexican population, the CTLA4 +49A/G (rs231775) and CT60 (rs3087243) gene variants do not constitute a risk factor in the development of vitiligo.
Abstract The duration of pregnancy varies between 40+0 and 41+3 weeks. Conventionally, and essentially arbitrarily, a pregnancy is considered to be “prolonged” after 41+0 weeks, but the infant is not ...considered “post-term” until 42+0 weeks (Professional consensus). A term birth thus occurs during the period from 37+0 to 41+6 weeks. In France, prolonged pregnancies (≥41+0 weeks) involve 15–20% of pregnant women, and post-term pregnancies (≥42+0 weeks) approximately 1%. The frequency of post-term pregnancies is very heterogeneous: in Europe and the United States, it ranges from 0.5% to 10% according to country. In prolonged pregnancies, the cesarean section rate—especially the emergency cesarean rate—is multiplied by approximately 1.5 (grade B). From 370–6 to 430–6 weeks, the risk of perinatal mortality increases regularly, from 0.7‰ to 5.8‰. Meconium aspiration syndrome is responsible for substantial morbidity and mortality, and its incidence increases regularly between 38+0 and 42+6 weeks, from 0.24‰ to 1.42‰ (grade B). Similarly, the risks of neonatal acidosis (grade B), 5-min Apgar scores less than 7 (grade B) and admissions to neonatal intensive care (grade B) increase progressively between 38+0 and 42+6 weeks. These risks appear to double for post-term growth-restricted newborns (grade C). Ultrasound dating of the pregnancy makes it possible to reduce the risk that it will be incorrectly considered prolonged and that labor will therefore be induced unnecessarily. To harmonize practices, if the crown-rump length (CRL) is correctly measured (this measurement should be taken between 11+0 and 13+6 weeks, when CRL should measure from 45 to 84 mm), ultrasound dating based on it should be used to determine the official date pregnancy began, regardless of its difference from the date assumed by the patient or estimated based on the date of the last menstrual period. This rule does not apply to pregnancies by IVF, for which the date pregnancy began is defined by the date of oocyte retrieval (Professional consensus). From 370–6 to 430–6 weeks, the risk of perinatal mortality increases regularly and there is no threshold at which a clear increase in perinatal mortality becomes visible. Fetal monitoring by cardiotocography (CTG) that begins at 41+0 weeks would cover approximately 20% of women and reduce perinatal morbidity compared with monitoring that begins at 42+0 weeks (grade C). The frequency recommended for this monitoring ranges between two and three times a week (Professional consensus). For ultrasonography assessment, measurement of the largest fluid pocket is recommended, because measurement of the amniotic fluid index (that is, the sum of the four quadrants) is accompanied by more diagnoses of oligohydramnios, inductions of labor, and cesareans for fetal distress without any improvement in neonatal prognosis (grade A). The practice of assessing the Manning biophysical score increases the number of diagnoses of oligohydramnios and fetal heart rage (FHR) abnormalities and generates an increase in the rates of inductions and cesareans without improving neonatal prognosis. The use of this biophysical score in monitoring prolonged pregnancies is therefore not recommended (grade B). In the absence of a specific disorder, induction of labor can be proposed in patients between 41+0 and 42+6 weeks (grade B). Nonetheless, the choice of prolongation beyond above 42+0 weeks appears to involve an increase in fetal risk, which must be explained to the patient and balanced against the potential disadvantages of induction (Professional consensus). Stripping the membranes can reduce the duration of pregnancy by increasing the number of patients going into labor spontaneously during the week afterward (grade B). Compared to an expectant approach, it does not increase the cesarean section rate (grade A). It reduces recourse to induction by 41% at 41+0 weeks and by 72% at 42+0 weeks (grade B), without increasing the risk of either membrane rupture or maternal or neonatal infection (grade B). Used as a tampon or vaginal gel, prostaglandins E2 (PGE2) are an effective method of inducing labor (grade A). They can be used to induce labor successfully, regardless of cervical ripeness (grade A). If misoprostol is chosen, the lowest dose is to be preferred, starting with a vaginal dose of 25 μg every 3–6 h (grade A). For misoprostol, more powerful studies remain necessary for better defining the doses, routes of administration, tolerance and indications. Misoprostol at any dose is contraindicated in women with uterine scars (grade B). Placement of an intracervical Foley catheter is an effective mechanical means of inducing labor, with less uterine hyperstimulation than prostaglandins and no increase in the cesarean section rate (grade A). Nonetheless, as the risk of infection might be increased, this technique requires more robust evaluation before entering general practice (grade B). In cases of meconium-stained amniotic fluid, pharyngeal aspiration before delivery of the shoulders is not recommended (grade A). The team managing a post-term newborn with meconium-stained amniotic fluid at birth must know how to perform intubation and, if the intubation is not helpful, endotracheal aspiration (grade C) and ventilation with a mask. Routine endotracheal intubation of a vigorous newborn is not recommended (grade A).
Introduction. Physiological maturity is the accumulation of the maximum dry matter content, the milk line and the black layer affect the corn seed, as morphological factors of the degree of ...maturation. The milk line is related to the solidification of starch, and the black layer with the cessation of the translocation of soluble substances from the plant to the grain. The moisture content is related to the physiological maturity and the harvest opportunity associated with the maximum quality of the product. Objective. To determine seeds physiological maturity, through morphological markers and moisture content, and its physiological quality relationship. Materials and methods. The study was carried out at Colegio de Postgraduados, Campus Montecillo during the months of September-October, 2021. By weekly sampling cobs of experimental cv. (Amarillo × V-54A) F6 genotype, seeds from the apex were taken, middle section and basis. In function by its moisture content, the milk line, black layer, and the relationship of these factor with physiological quality (germination and vigor- accelerated aging and cold tests) were determined. Results. Moisture content was below than referred in literature (35 %), also, physiological maturity was defined visually by milk line and black layer; on the other hand, as sampling were done, there was an increase in seed germination with the less moisture content; what vigor refers, a better response was detected by accelerated aging test. Conclusions. As the moisture content decreased, germination increased. The morphological markers allowed to determine the time in which the maize seed reached the physiological maturity and with it, the maximum quality.
Introducción. La madurez fisiológica es la acumulación del máximo contenido de materia seca; inciden la línea de leche y la capa negra en la semilla de maíz, como factores morfológicos del grado de maduración. La línea de leche se relaciona con la solidificación del almidón, y la capa negra con el cese de la translocación de sustancias solubles de la planta hacia el grano. El contenido de humedad está relacionado con la madurez fisiológica y a la oportunidad de cosecha asociada con la máxima calidad. Objetivo. Determinar la madurez fisiológica de las semillas por medio de marcadores morfológicos y el contenido de humedad, y su relación con la calidad fisiológica. Materiales y métodos. El estudio se llevó a cabo en el Colegio de Postgraduados, Campus Montecillo en los meses de septiembre y octubre del 2021. Se realizaron muestreos semanales en mazorcas del cultivar experimental (Amarillo x V-54) F6, se tomaron semillas correspondientes a las áreas ápice, media y baja de la mazorca. En función del contenido de humedad se determinó la línea de leche, la capa negra, y la relación de estos factores con la calidad fisiológica (germinación y vigor, envejecimiento acelerado y prueba de frío). Resultados. El contenido de humedad de semillas maduras fue inferior al reportado en la literatura (35 %), también, se logró corroborar a nivel visual la madurez fisiológica por medio de la línea de leche y la capa negra; la germinación se incrementó conforme se avanzó en los muestreos con el menor contenido de humedad y, respecto al vigor, se detectó una mejor repuesta en el envejecimiento acelerado. Conclusiones. En la medida que el contenido de humedad disminuyó, la germinación incrementó. Los marcadores morfológicos permitieron determinar el tiempo en que la semilla de maíz alcanzó la madurez fisiológica, y con ello la máxima calidad
Indocyanine green (ICG) angiography is a procedure that uses a fluorescent dye for a variety of medical diagnostics, including the real-time examination of blood flow in tissue. Herein, we report a ...case in which ICG angiography was used to assess the viability of a sternocleidomastoid (SCM) muscle flap during post-parotidectomy facial reconstruction. To our knowledge, this is the first report documenting the intraoperative use of ICG for the evaluation of SCM flap perfusion. ICG angiography may prove beneficial for cases involving complex reconstructions and suspected organ hypoperfusion.
Humanity is currently experiencing one of the short periods of transition thanks to novel sensing solutions for smart cities that bring the future to today. Overpopulation of cities demands the ...development of solid strategic plannings that uses infrastructure, innovation, and technology to adapt to rapid changes. To improve mobility in cities with a larger and larger vehicle fleet, a novel sensing solution that is the cornerstone of a smart parking system, the smart vehicular presence sensor (SPIN-V, in its Spanish abbreviation), is presented. The SPIN-V is composed of a small single-board computer, distance sensor, camera, LED indicator, buzzer, and battery and devoted to obtain the status of a parking space. This smart mobility project involves three main elements, namely the SPIN-V, a mobile application, and a monitoring center, working together to monitor, control, process, and display the parking space information in real-time to the drivers. In addition, the design and implementation of the three elements of the complete architecture are presented.
Secondary/persistent infections are present in teeth with previous root canal treatment, and a great variety of anaerobic microorganisms has been observed in these infections. The antibiotics ...prescription is occasional; however, in some cases, it is essential, particularly when the general health condition of the patient is compromised. The aims of this study were to identify the associated microorganisms in diagnosis of persistent or secondary apical periodontitis and to evaluate the susceptibility level to the antibiotics most used. Fifteen patients with persistent or secondary apical periodontitis requiring endodontic re-treatment were included. Microbiological samples were taken from the root canals and incubated in thioglycollate under anaerobic conditions. Anaerobic CDC agar (formulated by the Center for Disease Control and Prevention) was employed as a culture medium and the microorganisms were identified using the API system. The microorganisms were subjected to antibiograms with three different antibiotics. Twenty-six microorganisms were identified, the most common genus was
Enterococcus
(26.8%),
Streptococcus
(19.22%),
Aerococcus
(19.1%), and
Clostridium
(11.4%). 48% of them were susceptible to amoxicillin, with 28% of resistance. For clavulanic acid/amoxicillin, the susceptibility occurred in 32%, with 28% of resistance; and for clindamycin, the susceptibility was present in 40%, with 52% of resistance. The most frequently detected associated microorganism for secondary infections was genus
Enterococcus
, which exhibited high resistance to the studied antibiotics.
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