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The Endourological Society, the premier urologic society encompassing endourology, robotics, and focal surgery, is composed of a diverse group of1300 urologists. However, limited information has been collected about society members. Recognizing this need, a survey was initiated to capture data regarding current member practices, as well as help the Society shape the future direction of the organization. Presented herein is the inaugural Endourological Society census report as the beginning of a continued effort for global improvement in the field of endourology. Using a REDCap

To determine factors associated with failure of same-day trial of void (SDTOV) following holmium laser enucleation of the prostate (HoLEP).HoLEP is increasingly utilized for patients with benign prostatic hyperplasia. Advancements in technology have improved operative efficiency and hemostasis making same-day, catheter-free discharge possible.We conducted a retrospective review on 190 patients undergoing HoLEP from July, 2021 to January, 2022 by a single center. We assessed pre- and intra-operative variables associated with our primary outcome: failure of same-day catheter removal. Post-operative complications and outcomes at a ≤7 days and 3-month follow up were examined. Continuous and categorical variables were analyzed using unpaired t-tests (Mann Whitney) and chi-square, respectively. Univariate and multivariable logistic regression models were fitted to examine the associations of failed SDTOV.Of 190 candidates for a SDTOV, 90% (171/190) were successful. We found no difference between SDTOV success and failures with regards to age, comorbidities, presence of pre-operative urinary retention, anesthesia factors, operative time, volume resected, enucleation time, and morcellation time (all P0.05). Pre-operatively, 26.3% (50/190) were on antiplatelet and 6.3% (12/190) were on anticoagulation. While pre-operative antiplatelet therapy was not associated with SDTOV failure (P=0.78), pre-operative anticoagulation use was (4.7% vs. 21.1%, P=0.021). Patients who continued anticoagulation through surgery had the highest rate of SDTOV failure (2.3% (4/171) vs. 15.8% (3/19), P=0.023). For those with successful SDTOV, 4.1% (7/171) required catheterization following discharge. At 3 months, no patient required catheterization.On the day of surgery, patients eligible for SDTOV successfully voided 90% of the time. History of preop anticoagulation, whether continued or held, increased SDTOV failure.

Treatment of struvite kidney stones requires complete surgical stone removal combined with antibiotic therapy to eliminate urinary tract infections and preventive measures to reduce stone recurrence. The optimal duration of antibiotic therapy is unknown. We sought to determine if 2- or 12-weeks of antibiotics post percutaneous nephrolithotomy (PNL) for infection stones resulted in better outcomes for stone recurrence and positive urine cultures.This multi-center, prospective randomized trial evaluated patients with the clinical diagnosis of infection stones. Patients were randomized to 2- or 12-weeks of postoperative oral antibiotics (nitrofurantoin or culture-specific antibiotic) and included if residual fragments were ≤4 mm on computed tomography imaging after PNL. Imaging and urine analyses were performed at 3-, 6-, and 12-months post-procedure.Thirty-eight patients were enrolled and randomized to either 2-weeks (n = 20) or 12-weeks (n = 18) of antibiotic therapy post-PNL. Eleven patients were excluded due to residual fragments4 mm, and 3 patients were lost to follow-up. The primary outcome was the stone-free rate (SFR) at 6 months post-PNL. At 3-, 6-, and 12-months follow-up, SFRs were 72.7% versus 80.0%, 70.0% versus 57.1%, 80.0% versus 57.1% (p = ns), between 2- and 12-week-groups, respectively. At 3-, 6-, and 12-months follow-up, positive urine cultures were 50.0% versus 37.5%, 50.0% versus 83.3%, and 37.5% versus 100% between 2- and 12-week groups, respectively (p = ns).For patients with stone removal following PNL, neither 2-weeks nor 12-weeks of postoperative oral antibiotics is superior to prevent stones and recurrent positive urine cultures.

Neste texto, proponho recuperar e problematizar abordagens teóricas, para pensar as relações estabelecidas entre identidades culturais e cidadania no contexto contemporâneo de intensos processos sociais de midiatização, buscando refletir as ações comunicativas dos sujeitos enquanto práticas que renovam os processos contemporâneos de constituição da cidadania, no âmbito comunicacional. No percurso dessa reflexão, inicialmente, articulo concepções de Braga (2012), Fausto Neto (2008) e Gomes (2019) sobre as implicações da midiatização e da digitalização trazidas pela “sociedade de midiatização” para os processos sociais contemporâneos. Logo, busco em autores como Maldonado (2011), Cortina (2005) e Martin-Barbero (2014), as contribuições necessárias para transcender a concepção moderna e liberal de cidadania, incorporando dimensões compreensivas e constitutivas de maneira a trabalhar problemáticas como hibridações, diásporas, miscigenações nos processos comunicacionais. Finalmente, examino potencialidades e complexidades trazidas à luz por perspectivas que incorporam a cultura sob vista das complexidades sociais e da heterogeneidade da produção simbólica que as culturas apresentam como retornos às novas demandas e táticas de embate.

Pergunta de Pesquisa: As intoxicações por agrotóxicos no estado de Alagoas estão sendo notificadas? Objetivo geral e específico respectivamente: Realizar um levantamento das intoxicações por agrotóxicos no estado de Alagoas no período de 2010 a 2017. Analisar os dados obtidos sobre as intoxicações por agrotóxicos. Hipótese: A falta de notificação de intoxicação por agrotóxicos. Tipo de estudo: Estudo descritivo, retrospectivo e método quantitativo auxiliado por metodologia de revisão de bibliografias. Local. Sistema Nacional de Informações Toxicológicas (Sinitox), Centros de Informações Toxicológicas (CIT). Amostra. Ficha de notificação e atendimento. Variáveis. Primária: Atendimento a intoxicações causadas por agrotóxicos. Secundárias: Trabalhadores agrícolas, tempo de exposição. Método estatístico. Escolheu-se a amostra por conveniência, sendo a mesma denominada censitária.

A importância do cavalo no acompanhamento do homem e na sua evolução é de grande notoriedade pública; o animal transmite uma sensação de força e poder. Por sua vez, numa abordagem interdisciplinar, a equoterapia visa proporcionar ao praticante resultados positivos ao nível da melhoria do equilíbrio, tônus muscular e ainda um grande desenvolvimento dos aspetos psicológicos e sociais, ajudando na consciência e alinhamento corporal, coordenação motora, auto controle. Confiança e acima de tudo auto-estima. O transtorno do espectro do autismo (TEA) é uma condição do neurodesenvolvimento caracterizada por comprometimento em três áreas: aptidões de interação social, aptidões de comunicação e presença de estereótipos. Este trabalho nasceu da minha experiência com o projeto de Expansão da Unipampa: Equoterapia, Educação e Himarang: Uma Pernada a Dianteira. O objetivo desta pesquisa foi demonstrar os benefícios que os profissionais com TEA obtêm ao praticar a equoterapia. Esta é uma revisão da literatura pois analisa estudos relevantes que subsidiam a tomada de decisões e melhorias na prática clínica. De 2008 a 2018, foram realizadas buscas nos sites scielo, lilacs e pubmed. e livros técnicos. Os idiomas selecionados incluem português, espanhol e inglês Palavras-chave selecionadas: passeios a cavalo, chá, benefícios. De artigos e livros lidos foram recrutadas 20 pessoas, selecionadas de acordo com os objetivos propostos neste artigo. Como resultado, os seguintes benefícios da equoterapia foram encontrados para praticantes com transtornos do espectro do Autismo: Desenvolvimento de uma figura corporal. Melhorar a postura e o equilíbrio. coordenação motora, estruturação espacial, que ajuda a se posicionar no ambiente em que se vive e a estabelecer relações; A orientação temporal, que molda a organização de acordo com sua rotina, desenvolve a consciência do tempo de cada ação. O ritmo, o movimento e o balanço do cavalo têm um efeito calmante e caloroso sobre o praticante, acalmando o praticante com TEA que pode ter hábitos como morder, puxar o cabelo, hiperatividade, sensibilidade a determinados timbres, etc. A interação com os cavalos desenvolvem novas formas de comunicação, socialização, confiança e autoestima. Após a realização desta revisão bibliográfica, fica claro apontar a melhora positiva que a prática da equoterapia vem experimentando entre os praticantes com TEA. Devido ao grande número de estímulos fornecidos ao praticante, graças ao uso do cavalo como instrumento fisioterapêutico.

Zusammenfassung Hintergrund und Fragestellung Die Severe acute respiratory syndrome coronavirus type 2(SARS-CoV-2)-Pandemie hat die Ausbildung von Medizinstudierenden grundlegend verändert. Die Notwendigkeit von Kontaktbeschränkungen und die damit einhergehende Forderung nach Distanzunterricht hat dazu geführt, dass innerhalb kurzer Zeit digitale Lehrformate umgesetzt werden mussten. Ziel dieser Arbeit war die Auswertung der studentischen Evaluationsergebnisse für virtuellen Unterricht im Fach Hals-Nasen-Ohren-Heilkunde während der SARS-CoV-2-Pandemie und ein Vergleich mit den zuvor erhobenen Evaluationsergebnissen unter Präsenzbedingungen. Material und Methoden Untersucht wurden die Evaluationsergebnisse für die Blockpraktika im Wintersemester 2020/21 und im Sommersemester 2021, die in einem virtuellen Format mit kurzer Präsenzphase durchgeführt wurden, sowie die der komplett im konventionellen Präsenzformat durchgeführten Praktika von Sommersemester 2018 bis Wintersemester 2019/20. Die anonyme Befragung der Studierenden bezog sich auf verschiedene Aspekte der Lehrveranstaltung, wie z. B. Organisation, Didaktik und Lernatmosphäre. Ergebnisse Von 16 abgefragten Kategorien zeigten 14 (87,5%) signifikant bessere Evaluationsergebnisse für die virtuellen Praktika verglichen mit den zuvor im Präsenzformat durchgeführten Praktika. Diese sehr positive Bewertung des digitalen Lehrangebots zeigte im Pandemieverlauf über die Dauer von zwei Semestern keine signifikante Änderung. Schlussfolgerung Die vorliegenden Daten belegen die hohe Akzeptanz eines digitalen Lehrangebots im Fach HNO-Heilkunde für Studierende. Auch wenn unerlässliche Bestandteile der ärztlichen Ausbildung, wie der Unterricht am Patienten und das Erlernen klinisch-praktischer Fertigkeiten, weiterhin nur im Präsenzformat realisiert werden können, legen die Ergebnisse nahe, dass digitale Elemente auch nach der SARS-CoV-2-Pandemie eine Rolle im Medizinstudium spielen könnten.

The COVID-19 pandemic has led to an urgent need in emerging economies to quickly identify vulnerable populations that do not live within access of a health facility for testing and vaccination. This access information is critical to prioritize investments in mobile and temporary clinics. To meet this need, the World Bank team sought to develop an open-source methodology that could be quickly and easily implemented by government health departments, regardless of technical and data collection capacity. The team explored use of readily available open-source and licensable data, as well as non-intensive computational methodologies. By bringing together population data from Facebook’s Data for Good program, travel-time calculations from Mapbox, road network and point-of-interest data from the OpenStreetMap (OSM), and the World Bank’s open-source GOSTNets network routing tools, we created a computational framework that supports efficient and granular analysis of road-based access to health facilities in two pilot locations—Indonesia and the Philippines. Our findings align with observed health trends in these countries and support identification of high-density areas that lack sufficient road access to health facilities. Our framework is easy to replicate, allowing health officials and infrastructure planners to incorporate access analysis in pandemic response and future health access planning.

Holmium laser enucleation of prostate (HoLEP) is an effective surgical procedure in men with BPH. Due to the increase in the use of medical therapy for BPH related lower urinary symptoms more octogenarians are presenting in a delayed fashion with significant symptoms and urinary retention. We evaluate the feasibility and safety of octogenarians undergoing HoLEP.We performed a retrospective review of HoLEPs at our institution from July 2018 to December 2019. Patients were stratified into two groups based on age: 80 and ≥ 80.A total of 458 patients were identified, with 74 (16.2%) ≥ 80. In patients ≥ 80, prostate volume was higher (p 0.0005), there was a higher rate of antiplatelet/anticoagulation (p = 0.029) use, and a lower rate of alpha-blocker use (p = 0.0016). As expected, ASA scores which correlate with increasing number of concomitant diseases were greater in the ≥ 80 cohort (p = 0.016). There was no significant difference in intraoperative complications (p = 0.14), 90 day complication (p = 0.34), readmission rates (p = 0.425) or emergency room visits between groups (p = 0.15).Despite higher medical comorbidities and increased rates of anticoagulation in octogenarians, there is no increase in operative or postoperative complication rates. Age alone should not be used as exclusion criteria for HoLEP.

Semipermeable gloves might be an alternative to cotton gloves in management of hand dermatoses.To compare acceptance and tolerability of gloves made of cotton or a semipermeable Sympatex membrane in patients with hand dermatoses and their effect on skin lesions when worn overnight.A total of 199 patients with work-related symmetrical hand dermatoses were asked to wear a cotton glove (COT) on one hand and a Sympatex glove underneath a cotton glove (SYM/COT) on the other hand for 19 consecutive nights. The severity of skin lesions was regularly examined. A questionnaire on acceptance and tolerability was used in a subset of 126 patients.Data on skin lesions were available for 183 participating patients (92%). The severity did not differ substantially between hands covered with SYM/COT or COT over time. Questionnaire data were available for 120 patients (95%). SYM/COT received better ratings regarding climate conditions while COT showed superiority in wearing comfort, practicality and appearance.Both SYM/COT and COT were well tolerated and accepted in patients with hand dermatoses. Hence, SYM/COT may serve as suitable alternative for COT as comfort gloves supporting therapeutic efforts. The observed slight differences may influence the decision when selecting the glove type.

Introduction Holmium Laser Enucleation of the Prostate (HoLEP) is a size-independent treatment option for the management of benign prostatic hypertrophy. While advancements in laser technology have led to clinical improvements in the enucleation portion of HoLEP, the morcellation aspect of HoLEP is often the rate-limiting step. We sought to compare efficiency and surgeon satisfaction in four commercial morcellators. Methods This was an ex vivo study comparing four commercial morcellators: the Wolf Piranha, the Lumenis VersaCut, the JenaSurgical MultiCut Solo, and the Hawk Morcellator. Four surgeons with significant experience performing HoLEPs participated. Surgeons tested each device to morcellate two different prostate models 1) morcellating as much microwave-cooked chicken breast in 10 minutes and 2) timed morcellation of bull testicles. Surgeons completed subjective surveys after each morcellator trial. Objective outcomes included: morcellation efficiency (g/min morcellated) and aspiration power (time to aspirate 1 L of saline). Means of continuous variables were compared using ANOVA. Categorical variables were compared using chi-square tests. Statistical analyses were performed using SAS 9.4 (2019). Results Comparing subjective outcomes, the Piranha was chosen as the safest morcellator (p=0.0058). The least safe morcellator was thought to be the MultiCut by 75% of surgeons (p=0.046). The Piranha was chosen as the most effective morcellator by 75% of surgeons (p=0.046). Comparing objective parameters between the morcellators, the Piranha had the fastest aspiration time (43.50±10.34 s, p=0.0116). There were no significant differences in morcellation efficiency when using chicken breast (p=0.3096). However, when comparing the morcellation efficiency using bull testicles, the Piranha had the highest efficiency at 39.68±3.57 g/min (p=0.0268). Conclusion In this ex-vivo study comparing four different commercially available morcellators, the Piranha had the highest aspiration power. No significant differences were found in morcellation efficiency using microwave-cooked chicken breast. The Piranha was felt to be the safest and most effective morcellator.

To provide an overview of how surgical benign prostatic hyperplasia (BPH) procedures are compensated in the United States and the implications of the current reimbursement system on the care of patients.The resource-based relative value care system is Medicare's current reimbursement model. There is strong evidence that the current system does not adequately account for complex care. Consequently, for BPH surgical procedures, treatment options best suited for complex patients are not adequately reimbursed which may have implications on healthcare delivery and outcomes.Inadequate reimbursement for certain BPH procedures may disincentivize the care of complex patients. Procedures such a holmium laser enucleation of the prostate are well suited for complex patients but have a steep learning curve. The incentive to learn and offer such procedures to complex patients may be unfairly influenced by reimbursement levels, which in the end penalizes patients and the treatments available to them.

To define risk factors and perioperative outcomes for matrix stones and compare these outcomes with struvite and calcium stone cohorts.A retrospective cohort study comparing matrix stones (n=32), struvite stones (n=23) and a matched, calcium stone control group (n=32) was performed. Two-way ANOVA was used to compare the groups for continuous variables. Chi-square tests were used to compare categorical variables. Significance was set at P.05. All statistical tests were performed using R (v1.73).We identified no differences in age, gender, or BMI between the three groups. Matrix and struvite stones were more likely to have a history of prior stone surgery and recurrent UTIs compared to calcium stones (P=.027 and P.001, respectively). Struvite stones were more likely to present as staghorn calculi compared to matrix or calcium stones (56.5% vs 21.7% vs 18.8%, P=.006). There were no significant differences in postoperative stone free rates (P=.378). No significant differences in postoperative infectious complications were identified. Matrix stones were more likely to have Candida on stone culture compared to the struvite or calcium stones (P.0001).Matrix and struvite stones were more likely have a history of stone surgery and preoperative recurrent UTIs. Struvite stones were more likely to present as staghorn calculi. Matrix stones were more likely to have Candida present in stone cultures. However, no difference in postoperative infectious outcomes or stone free rates were identified. Further study with larger cohorts is necessary to distinguish matrix stone postoperative outcomes from struvite and calcium stones.

Introduction:Ureteral stents are commonly placed after ureteroscopy. We examined the rate of cystoscopy-based stent removal (CBSR) following ureteroscopy for stone disease and its economic ...

Background Limited research has focused on success with hospital discharge on the same day of surgery after holmium laser enucleation of the prostate (HoLEP). Objective To determine the success of same-day discharge in our HoLEP cohort and factors associated with this approach. Design, setting, and participants A retrospective review of our prospectively maintained HoLEP database demonstrated that 473 adult males underwent HoLEP from July 2018 to December 2019 at a tertiary referral center and high-volume HoLEP hospital. Patients were divided into groups according to planned inpatient admission (PIA), successful same-day discharge (SDD), or unplanned admission (UA). Outcome measurements and statistical analysis The PIA, SDD, and UA groups were assessed for differences in preoperative demographic data, perioperative surgical data, and postoperative follow-up data. SDD and UA were then compared to determine if any specific factors predicted UA, including univariate and multivariate logistic regression analyses. Results and limitations Age (p = 0.0049), use of anticoagulation (p = 0.037), American Society of Anesthesiologists score of 3–4 (p = 0.0017), and enucleation time (p=0.0178) were significantly higher in the PIA group. Morcellation time (p = 0.0059) and the rate of bedside catheter irrigation (p = 0.04) were higher in the UA group. The SDD group had the highest rate of successful voiding trial (p = 0.0001). Among the three groups, there was no difference in the rate of postoperative complications (p = 0.141). In a comparison of the SDD and UA groups, morcellation time (p = 0.041), the rate of bedside clot evacuation (p = 0.004), and successful voiding trial (p = 0.003) all favored SDD. There was no difference in 90-d complications (p = 0.536). A limitation is the retrospective nature of this study. Conclusions HoLEP can be successfully performed as day surgery without an increase in postoperative complications. HoLEP as day surgery is possible for any patient who does not require admission for medical comorbidities. Patient summary Same-day discharge (SDD) after holmium laser enucleation of the prostate (HoLEP) is possible and is successful in 87.4% of patients. Patients with longer morcellation times and with post-procedure hematuria with clots are more likely to have an unplanned admission. Use of a 120-W modulated-pulse laser resulted in a higher rate of SDD success. The culture change to day surgery is time-intensive owing to education of the postsurgical care units and clinic staff, and in our experience took approximately 9 mo to seamlessly integrate SDD as our HoLEP standard of care.

Supplementary Figures 1-6 from B7-H3 Ligand Expression by Prostate Cancer: A Novel Marker of Prognosis and Potential Target for Therapy

B7 coregulatory ligands can be aberrantly expressed in human disease. In the context of cancer, these ligands may act as antigen-specific inhibitors of T-cell–mediated antitumoral immunity. We recently reported that B7-H1 expression by carcinomas of the kidney and bladder portends aggressive disease and diminished survival. The expression of these proteins in prostate cancer, however, has not been investigated. We evaluated B7-H3 and B7-H1 protein expression in the pathologic specimens of 338 men treated for clinically localized prostate cancer between 1995 and 1998 with radical retropubic prostatectomy. Expression levels of B7-H3 in prostate cancer were correlated with pathologic indicators of aggressive cancer as well as clinical outcome. We report that B7-H3 is uniformly and aberrantly expressed by adenocarcinomas of the prostate, high-grade prostatic intraepithelial neoplasia, and four prostate cancer cell lines, whereas B7-H1 is rarely expressed. B7-H3 is expressed by benign prostatic epithelia, although at a more reduced level relative to neoplastic tissue. Increasing levels of B7-H3 intensity correlate with worsening clinicopathologic features of prostate cancer. Marked B7-H3 intensity, present in 67 (19.8%) specimens, confers a >4-fold increased risk of cancer progression after surgery (risk ratio, 4.42; P < 0.001). A survey of normal tissues revealed that B7-H3 is expressed within the liver, urothelium, and fetal kidney. In summary, B7-H3 is aberrantly expressed in all prostate cancers and represents an independent predictor of cancer progression following surgery. Moreover, B7-H3 encompasses a novel diagnostic and potential therapeutic target for the clinical management of prostate cancer and, perhaps, other malignancies as well. [Cancer Res 2007;67(16):7893–900]

Brazil has a very large biological variety, which is an almost inexhaustible source of substances of pharmacological and biotechnological interest. Several studies have demonstrated the presence of bioactive peptides in insect hemolymph and their potential use as therapeutic agents. However, few data are available regarding molecules extracted from insects with anti-apoptotic action. The objective of this work was to identify and isolate proteins from the hemolymph of caterpillars of theMegalopygidaefamily with pharmacological and biotechnological interest. Two species of this family were studied,Podalia sp and Megalopyge albicolis. Cytotoxicity tests on Vero and Sf-9 cells revealed that the hemolymph of both caterpillars was cytotoxic only at concentrations greater than 5%v/v. In the anti-apoptotic activity assays, it was verified that the supplementation of cell cultures with only 1% of hemolymph v/v is sufficient to inhibit cell death by apoptosis induced by different inducers such as terbutyl, actinomycin D, hydrogen peroxide, or even by nutrient depletion. For this study, cells were stained with trypan blue, crystal violet, and fluorescent markers to cytoskeleton (actin and tubulin), mitochondria membrane electric potential (JC-1), and apoptosis marker (acridine orange and ethidium). The protein responsible for anti-apoptotic action was isolated through gel filtration chromatography, using an AKTA purifier high-resolution liquid chromatography system. The hemolymph was fractionated into 3 pools forPodalia spand 6 pools forM. abicolis. In the antiapoptotic tests, semi-purified hemolymph from both caterpillars showed anti-apoptotic effect in VERO and SF-9 cells, pre-treated with only 1% v/v of hemolymph and induced to death by different and apoptotic inductors. Was observed that the molecule with anti-apoptotic effect is present in pool 3 in both hemolymphs. This protector effect blocked and attenuated the disruption of the cytoskeleton (actin filaments), being that the protective effect also was observed on the integrity of the mitochondrial membrane of SF-9 cells pre-treated with both hemolymphs and treated with the apoptosis inducer Terbutil at concentrations of 25 to 100μM. By acting on the mitochondrial pathway of death by apoptosis, a pathway that can cause disorders and diseases neurodegenerative such as Parkinson’s and Alzheimer’s diseases, substances present in the hemolymph of these and others caterpillars could be good candidates in studies for the treatment of these diseases.

Holmium laser enucleation of the prostate (HoLEP) is one of only two AUA guideline-recommended prostate size-independent surgeries for benign prostate hyperplasia (BPH). The significant variation in gland size treated results in a wide range of enucleation and morcellation times. We sought to understand the effect of prostate size on HoLEP efficiency to better educate patients and improve operative room utilization. After IRB approval, we identified patients from 1 July 2016 to 1 January 2020 who underwent HoLEP by two endourologists. Our primary objectives were to assess the effects of increasing increments (25 g) of mean enucleated prostate tissue weight on enucleation and morcellation efficiency (g/min). One-way Kruskal–Wallis ANOVA with Dunn’s post hoc test was used, with significant p &lt, 0.05. We included 675 HoLEPs with all comers mean tissue weight resected of 72.1 g (Range 1–448 g), energy used 110.00 kJ (10.73–340 kJ), enucleation time 48.6 min (5–151 min), and morcellation time 10.1 min (0.5–113 min). Average enucleation efficiency increased with increasing prostate size categories (e.g., &lt, 25 g–0.48 g/min, &gt, 325 g–3.91 g/min) (K-W ANOVA p = 0.004, Dunn’s post hoc p = 0.004). The combined average enucleation and morcellation efficiency was ≥5 g/min between 55 and 271 g. Inefficiency for cases &lt, 55 g was driven by enucleation, while &gt, 271 g case inefficiency was driven by morcellation. Increasing tissue weight at the time of HoLEP is associated with a linear relationship of increasing enucleation and decreasing morcellation efficiencies.

Introduction:Holmium laser enucleation of the prostate (HoLEP) is a size-independent treatment option for the treatment of benign prostatic hyperplasia. HoLEP has been shown to have excelle...

Embora haja uma certa convergência e sobreposição de conteúdos e metodologias, quando buscamos caracterizar os estudos da Comunicação, ainda há uma certa sombra que nebula os limites e eixos do campo. Tal característica tem na origem e no desenvolvimento dos estudos uma grande influência visto os intensos fluxos e diálogos com áreas afins que, por vezes, embaralha tentativas disciplinares. No presente texto trago reflexões sobre o tema, para perceber criticamente a disciplinarização das ciências humanas e sociais e adotar o pensamento complexo enquanto paradigma histórico e epistemológico das Ciências da Comunicação. Faço isso a partir de uma revisão bibliográfica de autores que trazem diferentes perspectivas quanto à origem do campo (TÉTU, 2002; PROULX, 2014; BOURE, 2015; RÜDIGER, 2019) e, posteriormente, apresento alternativas possíveis (FERREIRA, 2004; LOPES, 2007; BRAGA, 2008; SODRÉ, 2013) para pensar o campo sem recair em armadilhas de buscar determinações definitivas e binárias e se adote uma visão mais sistêmica da constelação cooperativa e dialética que configura a área, considerando sua multiplicidade e complexidade.

IntroductionThe use of 5-alpha reductase inhibitors (5-ARIs) has been shown to improve lower urinary tract symptoms (LUTS) and decrease prostate size in men with benign prostate hyperplasia (BPH). 5-ARI therapy could increase prostate tissue density through increased collagen deposition and contraction of stromal/epithelial components. Increased tissue density could prolong morcellation times, but the effects of preoperative 5-ARI exposure on morcellation efficiency during Holmium Laser Enucleation of the Prostate (HoLEP) are not well described. Herein, we examine outcomes after HoLEP of patients on pre-operative 5-ARIs.MethodsA retrospective review of patients undergoing HoLEP by an expert surgeon from Jan – Oct 2021 was performed. Student t-tests and chi-square tests were performed for continuous and categorical variables, respectively. Matched-pair analysis was performed using SPSS v28 (IBM, 2022). A p-value ResultsA total of 322 patients underwent HoLEP during the study period and 84 patients had pre-operative 5-ARI exposure. Patients in the 5-ARI group had larger preoperative prostate size (p = 0.016). Morcellation time was longer (p=0.01), specimen weight was higher (p=0.02), and morcellation efficiency (p=0.02) was lower in the 5-ARI group. After matching, there were 67 patients in each chort (total 134) and these associations for size, morcellation time, specimen weight, and morcellation efficiency were no longer seen (p=0.8, 0.6, 0.5, and 0.7, respectively). Furthermore, no associations between 5-ARI and post-operative admissions or ED visits were noted.ConclusionIn this retrospective study, preoperative use of 5-ARIs did not affect enucleation or morcellation efficiency. Thus, preoperative 5-ARI therapy does not appear to alter outcomes after HoLEP.

Holmium laser enucleation of the prostate (HoLEP) is a size-independent surgical option for treating benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) with excellent, durable functional outcomes. The prevalence of LUTS secondary to BPH and prostate cancer both increase with age, although the two diseases develop independently. Urologists often face a diagnostic dilemma, as men with LUTS secondary to BPH might also present with an elevated PSA and, therefore, need a diagnostic work-up to exclude prostate cancer. Nevertheless, ~15% of men with a negative elevated PSA work-up will undergo HoLEP and will be diagnosed with incidental prostate cancer at the time of HoLEP. Indeed, prostate cancer is often found in men undergoing HoLEP, and this situation can be challenging to manage. Variables associated with the detection of incidental prostate cancer, strategies to reduce incidental prostate cancer, as well as the natural history and management of this condition have been extensively studied, but further work in this area is still needed.

The skin is the largest organ of the human body and has several functions such as barrier against external agents, the maintenance of temperature and homeostatic functions. Skin ageing is a natural process that can be influenced by environmental factors, intrinsic skin factors and lifestyle. UV light plays an important role in skin ageing and can cause spots, requiring the use of depigmenting agents. Nowadays, there is a great demand for ingredients that prevent skin ageing, with natural agents occupying a promising position. Among the natural agents, polyphenols, such as resveratrol and piceatannol, found in grapes, passion fruits and other fruits, have a huge relevance. Great benefits of piceatannol have been reported, so thus, this work focuses specifically on a review of the literature regarding the application of this polyphenol in skin care products. This polyphenol can be used in a wound-healing, or as anti-ageing, antioxidant, anti-acne and skin whitening, among other effects.

No Brasil, em especial no município de Blumenau em Santa Catarina, os desastres naturais localizados como os deslizamentos de encostas e as inundações mais do que eventos naturais, transformaram-se em verdadeiras catástrofes. Responsáveis por expressivos danos e perdas, de caráter social, econômico e ambiental, os desastres naturais tem tido recorrências e os impactos sucessivamente mais intensos. Todo assentamento humano é influenciado por seu sítio físico, sobre o qual também age em uma relação bidirecional. No caso da bacia hidrográfica do Ribeirão Garcia em Blumenau – SC, a interação entre a ação da sociedade e a ação do meio ocorre com maior intensidade em função da força dos elementos naturais que compõem a bacia hidrográfica. Com o objetivo de ampliar o entendimento sobre os processos de inundação o presente trabalho busca caracterizar e analisar a evolução histórica da estrutura fundiária e urbanística da bacia hidrográfica do Ribeirão Garcia e sua relação com as inundações.

Introduction: Currently, there are multiple intracorporeal lithotripters available for use in percutaneous nephrolithotomy (PCNL). This study aimed to evaluate the efficiency of two novel lithotripters: Trilogy and ShockPulse-SE. Materials and Methods: This is a prospective multi-institutional randomized trial comparing outcomes of PCNL using two novel lithotripters between February 2019 and June 2020. The study assessed objective measures of stone clearance time, stone clearance rate, device malfunction, stone-free rates, and complications. Device assessment was provided through immediate postoperative survey by primary surgeons. Results: There were 100 standard PCNLs completed using either a Trilogy or ShockPulse-SE lithotrite. Using quantitative Stone Analysis Software to estimate stone volume, the mean stone volume was calculated at 4.18 ± 4.79 and 3.86 ± 3.43 cm3 for the Trilogy and ShockPulse-SE groups, respectively. Stone clearance rates were found to be 1.22 ± 1.67 and 0.77 ± 0.68 cm3/min for Trilogy vs ShockPulse-SE (p = 0.0542). When comparing Trilogy to ShockPulse-SE in a multivariate analysis, total operative room time (104.4 ± 48.2 minutes vs 121.1 ± 59.2 minutes p = 0.126), rates of secondary procedures (17.65% vs 40.81%, p = 0.005), and device malfunctions (1.96% vs 34.69%, p

Background With the heterogeneous distribution of novel surgical technologies and variable physician training, there is a need to re-evaluate contemporary outcomes of percutaneous nephrolithotomy (PCNL) for complex staghorn stones. Objective To evaluate contemporary outcomes of guideline-supported treatment for patients with staghorn kidney stones using single-access PCNL in multiple North American centers. Design, setting and participants We performed a multi-institutional retrospective review of staghorn stones managed from January 1, 2017 to January 1, 2019, inclusive. We excluded patients with more than a single percutaneous access per renal unit and those who underwent a concomitant contralateral procedure. Outcome measurements and statistical analysis Safety (Clavien-Dindo complications) and efficacy in terms of a strictly defined stone-free rate were examined for single-access PCNL performed on staghorn stones with a Guy’s stone score of 3–4. Results and limitations We evaluated 301 patients meeting the inclusion criteria with an average age of 57 yr (range 18–87). All stones had a Guy’s stone score of 3 (36.2%) or 4 (63.8%). The mean (± standard deviation) stone burden was 191.4 ± 49.8 mm2. Of the 297 patients (98.6%) who underwent computed tomography on postoperative day 1, 132 (44.4%) showed no residual stone, 111 (37.3%) had a largest fragment Conclusions Single-access PCNL for complex staghorn stones is safe and effective. High stone-free rates with minimal morbidity are achievable with current techniques. Patient summary This study confirms that single-access percutaneous nephrolithotomy provides excellent outcomes in the treatment of complex kidney stones. This surgical technique has both safe and effective outcomes that are reproducible across multiple centers in North America.

Background: Holmium laser enucleation of the prostate (HoLEP) is a highly effective procedure for benign prostatic hyperplasia that is size independent and has been recommended for patients necessi...

To compare perioperative outcomes between Holmium laser enucleation of the prostate (HoLEP), open simple prostatectomy (OSP), and robotic simple prostatectomy (RSP) for large prostates (80 cc).A retrospective study of 340 patients who underwent HoLEP (n=209), OSP (n=66), or RSP (n=65) at a large academic medical center between January 2013 - September 2021 was performed. Length of stay (LOS), operative time, catheter duration, estimated blood loss (EBL), blood transfusion, and 30-day ED visits and readmissions were compared between the three groups. Univariate analyses consisted of ANOVA with Tukey's corrections and Chi-square tests. Linear and multivariate logistic regression was also performed. All tests were two-sided and a p-value0.05 was pre-determined to be statistically significant. Analyses were performed with SAS v9.4.HoLEP was found to have the shortest: operative time (1.4 vs 2.7 vs 3.8h), LOS (0.65 vs 4.2 vs 2.6d), and catheter duration (0.38 vs 9.9 vs 11.2d) compared to OSP and RSP, respectively (all p0.0001). HoLEP also had the lowest EBL (66 vs 795 vs 326 mL, p0.0001). HoLEP and RSP had a lower risk of blood transfusion compared to OSP (p0.0001). These associations remained significant on multivariable analyses.HoLEP is a minimally invasive treatment option for large prostates that was found to have shorter operative time, LOS, and catheter duration as well as lower EBL compared to OSP and RSP.