How to measure intra-renal pressure during flexible URS: Historical background, technological innovations and future perspectives

INTRODUCTION

High intrarenal pressure (IRP) is a potential risk factor for infectious complications related to URS. Methods to lower IRP have been described. However, it is still not possible to assess live IRP values during URS. The objective of this study was to perform a systematic review of the literature regarding endoscopic methods to measure IRP during URS.

METHODS

A systematic search and review of Medline, PubMed and Scopus was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta Analysis (PRISMA) checklist and a narrative synthesis of the study results was performed.

RESULTS

A total of 19 articles were included in the review. Four non invasive (i.e. endoscopic) methods to measure IRP were reported: ureteral catheter, sensor wire, pressure sensor proximal to an irrigation system and a novel ureteral access sheath that integrates suction, irrigation, and IRP measurement.

CONCLUSIONS

We provide here a comprehensive overview of the reported clinical measuring systems of IRP during URS. The ideal system has not been developed yet, but urologists will be able to measure IRP during their daily practice soon. The implications of having this type of data during surgery remains unknown. Systems that could integrate irrigation, suction, IRP and temperature seems to be ideal.

Does gender influence retrograde intrarenal surgery (RIRS) outcomes? Data from the Flexible Ureteroscopy Outcomes Registry (FLEXOR)

INTRODUCTION AND OBJECTIVES

As well established flexible ureteroscopy (RIRS). There is still no evidence if gender can have any influence on the outcomes and complication when performing. This study aims to evaluate the role that gender has in performing flexible ureteroscopy from a large series of patients.

METHODS

This study retrospectively analyzed patients who underwent RIRS for renal stones from January 2018 to August 2021 within the multicentric FLEXOR registry. Demographics, stone characteristics, perioperative findings, results and complications were analyzed and compared between gender groups.

RESULTS

A total of 6669 patients were included, 66.1% were male and 33.9% were female. Stone characteristics was comparable between groups. Female patients had significant higher fever and positive urine culture rates (12% vs. 8% and 37% vs. 34%). Also, females had a slight longer hospital stay (3.8 vs. 3.5 days; P < 0.001) and more residual fragments after the procedure (23.03% vs. 20.97 (P = 0.032). Overall complications were slightly significantly higher in women (15.74% vs. 14% (P = 0.042)) mainly at the expense of fever rates (6.9% vs. 5.7%) whereas the risk of sepsis was similar in both groups. A multivariate analysis showed that larger stone size, multiple and lower pole stones seem to have a negative impact in the incidence of residual stones and complications.

CONCLUSION

Our real life global study reflects that female gender may have a correlation with a slightly increased residual fragment rate and overall low grade complications. However, women can safely be treated with RIRS with no increased the rate of sepsis with appropriate care.

A land untouched by dentistry - singapore brings dental care to afghanistan

In 2007, the Singapore Armed Forces deployed a Dental Project Team (DPT) to the capital city of the Bamiyan Province in Afghanistan. The team set up the province's first modern dental facility. Besides providing primary dental care to the 60,000 population there, the Singaporeans also trained and prepared a team of Afghan dentist and dental assistants. The Afghan dental team took over the dental clinic and continued to provide care when it was time for the DPT to depart for home. Braving challenging security and austere living conditions, the DPT completed its mission successfully.

P4-17-07: The Shifting Landscape of Metastatic Breast Cancer to the CNS

Introduction: Improved survival following the diagnosis of breast cancer, in conjunction with new therapies and diagnostics has potentially altered the characteristics and course of patients presenting with CNS involvement.

Methods: Review of clinical and radiographic records of women presenting to a tertiary medical center with the new diagnosis of CNS metastatic disease from breast cancer. This was a retrospective review from patients identities obtained from two prospective databases Results: There were 88 women analyzed who were treated over the period 1/2003-2/2010, average age 56.9. At the time of initial presentation of CNS disease, 68% of patients had multiple brain metastases, 17% had a solitary metastasis and 15% had only leptomeningeal disease (LMD). The median survival for all patients from the time of diagnosis of breast disease was 50.0 months, and 9.7 months from diagnosis of CNS involvement. The only factor related to overall survival was estrogen receptor positive (ER+) pathology (57.6 v. 38.2 months, p=.02 log-rank); those related to survival post CNS diagnosis were presentation with LMD (p=.004, HR= 3.1, Cox regression) and triple negative hormonal/HER2 status (p=.02, HR= 2.3, Cox regression). Patients with either had a median survival of 3.1 months (no patients in common). Of the 75 patients who initially presented with metastatic brain lesions, 20 (26%) subsequently developed LMD in the course of their disease (median 10.4 months), following which survival was grim (1.8 months median). Of note was that HER2+ status was protective in regard to late development of LMD (14.7 vs. 42.3%, p=.03, Chi-square). Symptoms of LMD were most commonly lower extremity weakness (14/33), followed by cranial nerve deficits (11/33).

Conclusion: Treatment of patients with metastatic brain disease from breast cancer should be tailored to the patient's hormonal status (as it markedly effects survival) and practitioners must be vigilant for the development of LMD, especially as it often presents with non-descript complaints such as back pain.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-17-07.

Comparison of two commercially available mouth rinses on gingival inflammation, pain and acceptability after third molar surgery

A randomized clinical trial was carried out to compare the difference in the effects of using two different mouth rinses on healing after surgical removal of wisdom teeth. One mouth rinse contained chlorhexidine with alcohol whereas the other was chlorhexidine without alcohol. Twenty-one patients without any medical conditions underwent surgical removal of their 3rd molars by the same operator on both the sides. Data were analysed by the non-parametric function test. Significant differences were shown in the pain score and the number of inflammation sites (p > 0.05). There was no significant difference in the acceptability of the two mouth rinses. In this study, nonalcohol chlorhexidine mouth rinse seemed better than an alcohol-containing chlorhexidine mouth rinse in diminishing patients' post-operative pain and wound inflammation. Non-alcohol chlorhexidine mouth rinse had similar properties without the adverse effects of alcohol, such as dryness of the mouth and addiction. Likewise, they were less likely to result in alcohol-induced pain.

The medical, social, and functional profile of Parkinson's disease patients

The study looked at the medical, social, and functional aspects of 34 patients with idiopathic Parkinson's Disease (PD). Eighty-five percent were above 55 years and 35% were over 70 years. Twenty-four (71%) were males. Most patients had Stage II disease. Overall functional state of the patient correlated closely with the stage of Parkinson's disease. Patients were likely to be dependent if their disease severity was stage III or more. Eighteen (53%) patients would require a carer to be present at least part of the day and 3 (9%) patients would require a carer most of the time. Domestic chores such as meal preparation, housework, and shopping were also affected in most of those who were previously active in these tasks. Ten patients had given up work due to their Parkinson's disease. The lack of knowledge of the disease was shown both in the carers and the patients. Twenty-nine of the patients had no knowledge of the disease, and only one carer had superficial knowledge of the disease. The major social problems associated with the disease were loss of social contact, behavioural problems, family members under strain and communication problems within the family. Since Parkinson's Disease is a chronic illness, with associated disabilities, it is important that the physician should aim for a multidisciplinary approach. Patient and carer education should be given emphasis, and the many everyday functional problems addressed. Advice on life-style management and aids to overcome disabilities may help improve quality of life of the patient and reduce carer's stress.

Cognitive and emotional reactions to daily events: the effects of self-esteem and self-complexity

In this article we examine the effects of self-esteem and self-complexity on cognitive appraisals of daily events and emotional lability. Subjects (n = 67) participated in a 2-week diary study; each day they made five mood ratings, described the most positive and negative events of the day, and rated these two events on six appraisal measures. Neither self-esteem nor self-complexity was related to an extremity measure of mood variability. Both traits were negatively related to measures assessing the frequency of mood change, although the effect of self-complexity dissipated when self-esteem was taken into account. Self-esteem (but not self-complexity) was also related to event appraisals: Subjects with low self-esteem rated their daily events as less positive and as having more impact on their moods. Subjects with high self-esteem made more internal, stable, global attributions for positive events than for negative events, whereas subjects low in self-esteem made similar attributions for both types of events and viewed their negative events as being more personally important than did subjects high in self-esteem. Despite these self-esteem differences in subjects' views of their daily events, naive judges (n = 63) who read the event descriptions and role-played their appraisals of them generally did not distinguish between the events that had been experienced by low self-esteem versus high self-esteem diary subjects.

Calorie and nutrient intakes of elderly and young subjects measured under identical conditions

The calorie and nutrient intakes of elderly and young healthy males and females were monitored for four days at the MIT Clinical Research Center. Subjects were free to select foods for meals and snacks from among a variety of high protein and high carbohydrate foods; when necessary, fat was added to make the foods isocaloric. The elderly subjects consumed significantly fewer calories, carbohydrates, and fat than the young subjects, both absolutely and when adjusted for differences in body weight (p less than .001). Mealtime protein intake when adjusted for body weight was similar among males of both age groups and significantly greater than the intakes of both young and elderly females (p less than .001). However, young males consumed more protein from snacks than young females or older adults and thus exhibited the highest daily protein intakes. The two age groups differed significantly in their pattern of food intake from meals and snacks. Elderly adults consumed almost 85% of their total calories from meals, whereas the younger adults consumed about 72% (p less than .001) from meals. Both groups snacked mainly on carbohydrate-rich foods. The elderly subjects consumed significantly fewer snacks than the young; their daily average consumption was 2.2 and that of the young, 4.5 (p less than .001). The persistence of different patterns of food intake between young and elderly individuals when measured under identical clinical conditions suggests that age per se, in addition to age-associated lifestyle changes, may affect eating behavior.

Energy expenditure and intake in infants born to lean and overweight mothers

We investigated the contributions of low energy expenditure and high energy intake to excessive weight gain in infants born to overweight mothers. The subjects were infants of 6 lean and 12 overweight mothers, recruited soon after birth. Total energy expenditure and metabolizable energy intake were measured with a new doubly labeled water method over a period of seven days when the infants were 3 months of age, and the postprandial metabolic rate was measured by indirect calorimetry when the infants were 0.1 and 3 months of age. The results were related to weight gain in the first year of life. No significant difference was observed between infants who became overweight by the age of one year (50 percent of infants born to overweight mothers) and those who did not, with respect to weight, length, skinfold thicknesses, metabolic rate at 0.1 and 3 months of age, and metabolizable energy intake at 3 months. However, total energy expenditure at three months of age was 20.7 percent lower in the infants who became overweight than in the other infants (means +/- SE, 256 +/- 27 and 323 +/- 12 kJ per kilogram of body weight per day; P less than 0.05). This difference could account for the mean difference in weight gain. These data suggest that reduced energy expenditure, particularly on physical activity, was an important factor in the rapid weight gain during the first year of life in infants born to overweight mothers.

Changes in mood after carbohydrate consumption among obese individuals

Two groups of obese individuals who consume excessive calories primarily as snack foods have been identified. Carbohydrate cravers consume most or all snacks as carbohydrate-rich foods despite the equal accessibility of protein-rich snacks. Noncarbohydrate cravers consume about equal amounts of protein- and carbohydrate-rich snack foods. Using standardized self-report questionnaires, we measured mood before and 2 h after consumption of a high-carbohydrate lunch (104 g CHO). Responses to the meal differed significantly: noncarbohydrate cravers reported feeling considerably less alert, more fatigued and sleepy, while carbohydrate cravers described little or no change in these aspects of mood. Moreover, noncarbohydrate cravers experienced an increase in depression, while carbohydrate cravers reported feeling less depressed. Findings suggest that snacking habits of obese individuals may be related to subsequent mood states.

Variables associated with peripartum traits in dairy cows. III. Effect of diets and disorders on certain blood traits

BLood samples were collected from 89 Holstein cows on days 220 and 250 of gestation, within 24 hr prepartum and postpartum and on day 30 postpartum. Balanced diets which contained either chopped hay (29 cows), hay crop silage (HCS; 30 cows) or corn silage (CS; 30 cows) were fed from day 220 of gestation to day 30 postpartum. The purpose was to determine if variations in certain blood traits were indicative of peripartum and postpartum disorders. The blood traits evaluated were concentrations of plasma total protein, whole blood hemoglobin, packed cell volume, and white blood cells, and serum glutamic oxalacetic transaminase (SGOT), glucose, urea nitrogen, calcium, inorganic phosphorus, magnesium, potassium and sodium. No blood trait was useful to predict a disorder prior to its visual signs with one possible exception. Serum glucose and calcium were lower and SGOT and magnesium were higher peripartum which was prior to death of three cows from fat cow syndrome.