Abstract Background Several studies have shown that robot-assisted laparoscopic radical prostatectomy (RALP) is feasible, with favorable complication rates and short hospital times. However, the ...early recovery of urinary continence remains a challenge to be overcome. Objective We describe our technique of periurethral retropubic suspension stitch during RALP and report its impact on early recovery of urinary continence. Design, setting, and participants We analyze prospectively 331 consecutive patients who underwent RALP, 94 without the placement of suspension stitch (group 1) and 237 with the application of the suspension stitch (group 2). Surgical procedure The only difference between the groups was the placement of the puboperiurethral stitch after the ligation of the dorsal venous complex (DVC). The periurethral retropubic stitch was placed using a 12-in monofilament polyglytone suture on a CT-1 needle. The stitch was passed from right to left between the urethra and DVC, and then through the periostium on the pubic bone. The stitch was passed again through the DVC, and then through the pubic bone in a figure eight, and then tied. Measurements Continence rates were assessed with a self-administered validated questionnaire (Expanded Prostate Cancer Index Composite EPIC) at 1, 3, 6, and 12 mo after the procedure. Continence was defined as the use of no absorbent pads or no leakage of urine. Results and limitations In group 1, the continence rate at 1, 3, 6, and 12 mo postoperatively was 33%, 83%, 94.7%, and 95.7%, respectively; in group 2, the continence rate was 40%, 92.8%, 97.9%, and 97.9%, respectively. The suspension technique resulted in significantly greater continence rates at 3 mo after RALP ( p = 0.013). The median/mean interval to recovery of continence was also statistically significantly shorter in the suspension group (median: 6 wk; mean: 7.338 wk; 95% confidence interval CI: 6.387–8.288) compared to the nonsuspension group (median: 7 wk; mean: 9.585 wk; 95% CI: 7.558–11.612; log rank test, p = 0.02). Conclusions The suspension stitch during RALP resulted in a statistically significantly shorter interval to recovery of continence and higher continence rates at 3 mo after the procedure.
Abstract Background Widespread use of prostate-specific antigen screening has resulted in younger and healthier men being diagnosed with prostate cancer. Their demands and expectations of surgical ...intervention are much higher and cannot be adequately addressed with the classic trifecta outcome measures. Objective A new and more comprehensive method for reporting outcomes after radical prostatectomy, the pentafecta , is proposed. Design, setting, and participants From January 2008 through September 2009, details of 1111 consecutive patients who underwent robot-assisted radical prostatectomy performed by a single surgeon were retrospectively analyzed. Of 626 potent men, 332 who underwent bilateral nerve sparing and who had 1 yr of follow-up were included in the study group. Measurements In addition to the traditional trifecta outcomes, two perioperative variables were included in the pentafecta: no postoperative complications and negative surgical margins. Patients who attained the trifecta and concurrently the two additional outcomes were considered as having achieved the pentafecta. A logistic regression model was created to evaluate independent factors for achieving the pentafecta. Results and limitations Continence, potency, biochemical recurrence–free survival, and trifecta rates at 12 mo were 96.4%, 89.8%, 96.4%, and 83.1%, respectively. With regard to the perioperative outcomes, 93.4% had no postoperative complication and 90.7% had negative surgical margins. The pentafecta rate at 12 mo was 70.8%. On multivariable analysis, patient age ( p = 0.001) was confirmed as the only factor independently associated with the pentafecta. Conclusions A more comprehensive approach for reporting prostate surgery outcomes, the pentafecta , is being proposed. We believe that pentafecta outcomes more accurately represent patients’ expectations after minimally invasive surgery for prostate cancer. This approach may be beneficial and may be used when counseling patients with clinically localized disease.
Display omitted
The objective of this study was to characterize and evaluate a wild inedible cotton waste as feedstock for bioenergy production. The conversion of organics of cotton stem into ...bioenergy could serve the dual role of renewable energy production and waste reduction. Composition analysis demonstrated that cotton stem is a suitable feedstock for both bioethanol and biogas production. Anaerobic digestion of cotton stem achieved 40.35% total biogas with 12.76% increased net CH4 volume compared to co-digestion of cotton stem with buffalo dung. Undigested cotton stem residues from anaerobic digestion were directly subjected to sequential alkali-acid pretreatment for conversion into ethanol with a yield of 325Lt−1 or 50% of theoretical yield. Mechanical and thermal energy consumption for pretreatment were determined the efficiency of sugar recoveries and net energy production values. Overall 2.88±0.25GJ more energy production in sequential anaerobic digestion-simultaneously saccharification fermentation (SSF) over direct SSF of cotton stem waste was observed.
To critically review perioperative outcomes, positive surgical margin (PSM) rates, and functional outcomes of several large series of retropubic radical prostatectomy (RRP), laparoscopic RP (LRP), ...and robot-assisted radical prostatectomy (RARP) currently available in the literature.
A Medline database search was performed from November 1994 to May 2009, using medical subject heading search terms "prostatectomy" and "Outcome Assessment (Health Care)" and text words "retropubic," "robotic," and "laparoscopic." Only studies with a sample size of 250 or more patients were considered. Weighted means were calculated for all outcomes using the number of patients included in each study as the weighing factor.
We identified 30 articles for RRP, 14 for LRP, and 14 for RARP. The mean intraoperative and postoperative RRP transfusion rates for RRP, LRP, and RARP were 20.1%, 3.5%, and 1.4%, respectively. The weighted mean postoperative complication rates for RRP, LRP, and RARP were 10.3% (4.8% to 26.9%), 10.98% (8.9 to 27.7%), and 10.3% (4.3% to 15.7%), respectively. RARP revealed a mean overall PSM rate of 13.6%, whereas LRP and RRP yielded a PSM of 21.3% and 24%, respectively. The weighted mean continence rates at 12 month follow-up for RRP, LRP, and RARP were 79%, 84.8%, and 92%, respectively. The weighted mean potency rates for patients who underwent unilateral or bilateral nerve sparing, at 12 month follow-up, were 43.1% and 60.6% for RRP, 31.1% and 54% for LRP, and 59.9% and 93.5% for RARP.
RRP, LRP, and RARP performed in high-volume centers are safe options for treatment of patients with localized prostate cancer, presenting similar overall complication rates. LRP and RARP, however, are associated with decreased operative blood loss and decreased risk of transfusion when compared with RRP. Our analysis including high-volume centers also showed lower weighted mean PSM rates and higher continence and potency rates after RARP compared with RRP and LRP. However, the lack of randomized trials precludes definitive conclusions.
Menstruation is a natural physiological process that requires proper management. Unlike other normal bodily processes, menstruation is linked with religious and cultural meanings that can affect the ...perceptions of young girls as well as the ways in which the adults in the communities around them respond to their needs.
This review aims to answer the following questions: (1) how knowledgeable are adolescent girls in low- and middle-income countries about menstruation and how prepared are they for reaching menarche, (2) who are their sources of information regarding menstruation, (3) how well do the adults around them respond to their information needs, (4) what negative health and social effects do adolescents experience as a result of menstruation, and (5) how do adolescents respond when they experience these negative effects and what practices do they develop as a result?
Using a structured search strategy, articles that investigate young girls' preparedness for menarche, knowledge of menstruation and practices surrounding menstrual hygiene in LMIC were identified. A total of 81 studies published in peer-reviewed journals between the years 2000 and 2015 that describe the experiences of adolescent girls from 25 different countries were included.
Adolescent girls in LMIC are often uninformed and unprepared for menarche. Information is primarily obtained from mothers and other female family members who are not necessarily well equipped to fill gaps in girls' knowledge. Exclusion and shame lead to misconceptions and unhygienic practices during menstruation. Rather than seek medical consultation, girls tend to miss school, self-medicate and refrain from social interaction. Also problematic is that relatives and teachers are often not prepared to respond to the needs of girls.
LMIC must recognize that lack of preparation, knowledge and poor practices surrounding menstruation are key impediments not only to girls' education, but also to self-confidence and personal development. In addition to investment in private latrines with clean water for girls in both schools and communities, countries must consider how to improve the provision of knowledge and understanding and how to better respond to the needs of adolescent girls.
A young female patient from Ahmedabad city presented with acute febrile illness and bicytopenia (leukopenia and thrombocytopenia). She returned to India after recent visit to East Africa. Human ...African Trypanosomiasis (Sleeping sickness) was diagnosed by identification of Trypanosoma brucei rhodesiense in peripheral blood smear. She treated successfully with suramin. In India, we account this as second case of HAT after first report before 18 years in the published literature.
Background: The purpose of this study was to evaluate the effectiveness of an interdisciplinary home-based feeding program, which is a unique service delivery model. Methods: Data were provided on ...oral intake, tube feeding elimination, and weight for patients who were dependent on tube feedings (n = 78). Weight data were collected for patients who showed failure to thrive (n = 49). Number of foods consumed and percentage of solids were collected for patients who were liquid-dependent (n = 23), and number of foods consumed were collected for patients who were food-selective (n = 61). Results: Data were analyzed using paired sample t-test with 95% confidence interval. For patients dependent on tube feedings, 81% achieved tube feeding elimination. Tube elimination was achieved after 8 months of treatment on average. All failure-to-thrive patients showed weight gain from baseline to discharge. For liquid-dependent patients, there was an increase in foods consumed from 2 foods at admission to 32 foods at discharge. For food selective patients, there was an increase from 4 foods at admission to 35 foods at discharge. For all dependent variables, results showed statistical significance and a large-sized effect. Conclusions: These data show that an intensive interdisciplinary home-based program can be successful in treating complex feeding problems in children.
Dyes & dyes intermediates are one of the important and critically polluted industrial sectors, generating a large environmental liability. Therefore characterization of microbial community structure ...and diversity of contaminated soils helps to optimize the bioremediation strategies and performance. This study investigated the roles of environmental variables and contamination levels in shaping microbial community structure at an abandoned aged. In total, 20 bacterial and 4 fungal phyla were identified across soils with different physiochemical properties and concentration of the contaminants. Taxonomic analysis revealed the Proteobacteria, Firmicutes, Ascomycota and Basidiomycota represented the lineages and accounted for 49.5%–51.2%, 5.1%–15.3%, 2.5%–3.8% and 1.6%–2.1% of the total population, respectively. Microbial community (site 1) achieved decolorization rate of 972 ± 1.21 mg dyes kgsoil−1d−1 after 15d and 692 ± 1.4 mg kg-soil−1d−1 COD removal rate after 30 day of the experiment. Microbial community mineralized intermediates, 4-amino benzenesulfonate, 6-amino naphthalene sulfonate and benzene/naphthalene sulfonate in TCA cycle and stimulate the growth of selected soil bacteria, primary nutrient as well as plant growth of contaminated soil.
Display omitted
•In-situ degradation of dye contaminated soil by indigenous microbial consortium.•Characterization of microbial community of different contaminated soil and wastewater sample.•Achieved 972 ± 1.21 mg dyes kg soil−1 d−1 rate of decolorization and 692 ± 1.4 mg kg-soil−1 d−1 COD removal.•Degradation intermediates of dyes & dyes intermediates are also identified.•Treated soil was found to stimulate the growth of selected soil bacteria, nutrient and plant growth.
Rice output has grown globally, yet abiotic factors are still a key cause for worry. Salinity stress seems to have the more impact on crop production out of all abiotic stresses. Currently one of the ...most significant challenges in paddy breeding for salinity tolerance with the help of QTLs, is to determine the QTLs having the best chance of improving salinity tolerance with the least amount of background noise from the tolerant parent. Minimizing the size of the QTL confidence interval (CI) is essential in order to primarily include the genes responsible for salinity stress tolerance. By considering that, a genome-wide meta-QTL analysis on 768 QTLs from 35 rice populations published from 2001 to 2022 was conducted to identify consensus regions and the candidate genes underlying those regions responsible for the salinity tolerance, as it reduces the confidence interval (CI) to many folds from the initial QTL studies. In the present investigation, a total of 65 MQTLs were extracted with an average CI reduced from 17.35 to 1.66 cM including the smallest of 0.01 cM. Identification of the MQTLs for individual traits and then classifying the target traits into correlated morphological, physiological and biochemical aspects, resulted in more efficient interpretation of the salinity tolerance, identifying the candidate genes and to understand the salinity tolerance mechanism as a whole. The results of this study have a huge potential to improve the rice genotypes for salinity tolerance with the help of MAS and MABC.
PDF
