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Prior laser studies have demonstrated that as the temperature of a medium increases, the amount of energy delivered to the target increases. We sought to investigate the role of irrigation fluid temperature on Thulium fiber laser (TFL) urolith ablation. 360 calculi were divided in vitro according to chemical composition: calcium oxalate monohydrate (COM), cystine (CYS), struvite (STR), calcium phosphate (CAP), uric acid (UA), and calcium oxalate dihydrate (COD). A 200 μm TFL was placed directly on each stone, while immersed in 0.9% NaCl at four different temperatures (25 C, 37 C, 44 C, 60 C) and a single laser pulse administered at distinct energy settings (0.1 J, 0.5 J, 1.5 J). Optical coherence tomography assessed the resulting ablation cone volume. Mean stone volume and porosity were evaluated through ANOVA and Tukey post-hoc analysis. A multivariate generalized model for each composition accounted for the impact of fluid temperature and laser energy on stone ablation. Warmer fluid temperatures yielded greater ablation cone volumes for most energy settings, excluding UA stones. When accounting for chemical composition, higher tensile strength stones (COM, CYS) benefited most from warmer fluid in comparison to frangible stones (CAP, STR). The effects of increasing fluid temperature are modest relative to laser pulse energy as a large temperature increase (i.e. 7ºC) is equivalent to a minor energy increase (i.e. 0.1 J). For non-UA stones, TFL ablation efficiency increases with warmer irrigation fluid. The effect, albeit modest compared to laser pulse energy, was most notable for COM and CYS stones. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the total energy needed to ablate 1mm3 of stone volume (Joules/mm3) during flexible ureteroscopic lithotripsy using a low-power Ho:YAG laser device, as a proxy of lithotripsy efficacy. Patients and methods: We selected 30 patients submitted to flexible ureteroscopy for renal stones whose volume was bigger than 500 mm3. A 35 W Ho:YAG laser (Dornier Medilas H Solvo 35, Germany) was used for every procedure with a 272 µm laser fiber. We recorded laser parameters, the total energy delivered by the laser fiber, the time from the first laser pulse until the last one (lithotripsy time), and the active laser time as provided by the machine. We then estimated J/mm3 values and determinants, along with ablation speed (mm3/s), and laser activity (ratio between laser active time and lithotripsy time). Results: Median (IQR) stone volume and stone density were respectively 1599 (630–3502) mm3 and 1040 (753–1275) Hounsfield units (HU). In terms of laser parameters, median (IQR) energy and frequency were 0.6 (0.4–0.8) J and 15 (15–18) Hz. Median (IQR) total delivered energy and lithotripsy time were 37,050 (13,375–57,680) J and 68 (36–88) min, respectively. Median (IQR) J/mm3 and ablation speed were, respectively, 19 (14–24) J/mm3 and 0.7 (0.4–0.9) mm3/s. The laser was active during 84% (70–95%) of the total lithotripsy time. HU density > 1000 was associated with reduced efficacy. Conclusions: It is possible to perform laser lithotripsy using a low-power laser device with a virtually continuous laser activity. The estimation of the pre-operative parameters as well as the J/mm3 values are fundamental for a proper pre-operatory planning. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to evaluate the impact of 5-alpha-reductase inhibitors (5ARI) for prostate cancer (PCa) primary prevention on specific and overall mortality (primary outcomes), the incidence of PCa diagnosis and disease aggressiveness (secondary outcomes). Methods: We searched MEDLINE, EMBASE, Cochrane, ClinicalTrials and BVS through April 2018 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement to identify randomized clinical trials (RCT) and cohort studies (CS). We included articles with data on mortality or PCa incidence for men using 5ARI previously to PCa diagnosis. Results: Regarding the included studies, nine had data on mortality, 16 on PCa incidence and 12 on Gleason scores (GS). We found that the use of 5ARI had no impact on overall mortality (RR 0.93 95% CI 0.78–1.11) and PCa-related mortality (RR 1.35 95% CI 0.50–3.94), nor on high-grade PCa diagnosis (RR 1.06 95% CI 0.72–1.56). We identified a relative risk reduction of 24% in moderate-grade PCa diagnosis (RR 0.76 95% CI 0.59–0.98) and low-grade PCa diagnosis (RR 0.76 95% CI 0.59–0.97) Also, a reduction of 26% in overall PCa diagnosis was observed in the RCT subgroup analysis (RR 0.74 95% CI 0.65–0.84). Conclusion: 5ARI significantly reduced the risk of being diagnosed with PCa, not increasing high-grade disease, overall or cancer-specific mortality. Due to the relatively short mean follow-up of most studies, the mortality analysis is limited. [ABSTRACT FROM AUTHOR]

Low-dimensional organic conductors show a rich phase diagram, which has, despite all efforts, still some unexplored regions. Charge ordered phases present in many compounds of the (TMTTF) 2 X family are typically studied with their unique electronic properties in mind. An influence on the spin arrangement is, however, not expected at first glance. Here, we report temperature and angle dependent electron spin resonance (ESR) measurements on the quasi one-dimensional organic conductor (TMTTF) 2 NO 3 . We found that the (TMTTF) 2 NO 3 compound develops a peculiar anisotropy with a doubled periodicity ( a b ′ -plane) of the ESR linewidth below about T CO = (250 ± 10) K . This behavior is similar to observations in the related compounds (TMTTF) 2 X ( X = PF 6 , SbF 6 and AsF 6 ), where it has been attributed to relaxation processes of magnetically inequivalent sites in the charge-ordered state. For the structural analogous (TMTTF) 2 ClO 4 , known for the absence of charge order, such angular dependence of the ESR signal is not observed. Therefore, our ESR measurements lead us to conclude that a charge-order phase is stabilized in the title compound below T CO ≈ 250 K . [ABSTRACT FROM AUTHOR]

Purpose: This is a retrospective cohort study that evaluates the postoperative pain findings of a consecutive series of laparoscopic surgeries for deep endometriosis (DE).Methods: This multi-center retrospective cohort study was carried out in university hospitals (Istanbul, Turkey). Sixty-five patients diagnosed through bimanual gynecologic examination, gynecologic ultrasound or magnetic resonance imaging-confirmed endometrioma and DE together; who underwent a laparoscopic surgery between 2013 and 2019 by a team of gynecologists, colorectal surgeons, and a urologist were retrospectively evaluated. The data were collected in a specific database and analyzed for postoperative pain outcomes through a comparison with preoperative symptoms scored using a visual analogue score (VAS), and the British Society of Gynecologic Endoscopy (BSGE) pelvic pain questionnaire.Results: Sixty-five patients who met the criteria were included. The mean age of all patients was 35.0 ± 6.3 (range 22-50) years. The mean operative time was 121.3 ± 50.2 (range, 60-270) minutes. Preoperative and postoperative comparison of VAS scores for dysmenorrhea (8.57 vs. 2.91), dyspareunia (6.62 vs. 1.66), dyschezia (7.46 vs. 2.43), dysuria (5.67 vs. 1.34), chronic pelvic pain (4.11 vs. 1.22), and BSGE score (40.98 vs. 11.00) showed significantly reduced pain scores, respectively (p < 0.01).Conclusion: Laparoscopic management of DE is a valid treatment option in terms of reduced postoperative pain and increased quality of life according to pain score outcomes. To have more robust conclusions, a prospective cohort study with a larger sample size which evaluates patients who had segmental bowel resection and those who did not have segmental bowel resection is necessary. [ABSTRACT FROM AUTHOR]

Purpose of Review: Liver transplantation (LT) has been utilized in the last two decades for the treatment of selected patients with hepatocellular carcinoma (HCC). Currently, in most jurisdictions worldwide, only tumor size and number determine transplant candidacy, which may not sufficiently predict tumor behavior. Both tumor downstaging and expanding transplant criteria play an important role in expanding access to LT for HCC patients. Recent Findings: New downstaging protocols are emerging that incorporate response to locoregional therapies (LRT) among those that initially present beyond the accepted Milan criteria. In parallel, new serologic, histologic, and radiographic tools are being identified that may better predict outcomes after LT for HCC, in so-called extended criteria. The efforts of different jurisdictions worldwide in creating new treatment protocols have made it possible to evaluate and compare outcomes of patients over time. Summary: Improvements of LRT and expansion of the criteria for LT for HCC will both play a role in optimizing outcomes for patients with HCC. [ABSTRACT FROM AUTHOR]

Purpose: The primary purpose of this study was to assess the influence of a systematic multidisciplinary birth preparation program on satisfaction with childbirth experience. A secondary aim was to detect factors that affect the childbirth satisfaction.Methods: In this prospective study, 77 pregnant women who completed the 4-month birth preparation program (Group 1) and 75 women in the control group (Group 2) were asked to fill out two questionnaires with face-to-face interviews within 48 h after labor. One of the questionnaires was the translated form of Salmon's Item List German (SIL-Ger), and SIL-Ger scores ≥70 was accepted as a satisfactory experience.Results: There was no statistically significant difference between the groups in terms of sociocultural and intrapartum characteristics, and obstetric outcome parameters. The women who received antenatal education experienced significantly less pain (p = 0.01), had a better communication with midwife or obstetrician during delivery (p = 0.001), and participated more actively in decision-making before, during, and after childbirth (p < 0.001 for all). SIL score was significantly higher in Group 1 (105.7 ± 2.2 vs 80 ± 2.5, p < 0.01), and significantly more women had a SIL score ≥70 (96.1 vs 73.3%, p < 0.01). In multivariate logistic regression model, attending the birth preparation program and the level of pain perceived during labor were found to have a significant effect on the birth satisfaction.Conclusion: Systematic birth preparation program improves satisfaction with childbirth experience by enabling women to communicate better with healthcare providers and to participate in decision-making during labor, as well as by decreasing the perception of labor pain. [ABSTRACT FROM AUTHOR]

Objective: To compare the diagnostic accuracy of endocervical curettage (ECC) and endocervical brushing (EB) in patients referred for colposcopic evaluation for low grade squamous intraepithelial lesion. Materials and methods: A prospective, randomized, comparative trial was conducted in an Education and Research Hospital, Gynecologic Oncology Clinic. After exclusion of 40 subjects, 208 patients were randomly allocated into ECC ( n = 104) and EB ( n = 104) groups. A pathologist blinded to the specimen obtaining method evaluated all samples for the primary outcome of sampling adequacy. Secondary outcome measure was pain scores during the sampling was investigated by using visual analogue scale (VAS). Results: Ten samples from the ECC group (9.6 %) and 12 samples from the brushing group (12 %) contained scanty endocervical specimen ( p = 0.09). Evaluating samples for stroma; it was reported that brushing group had a statistically significantly higher percentage of specimens with no stroma (44 %) than ECC group (24 %) ( p = 0.003). Mean and standard deviation of VAS scores during the ECC and EB procedures were 2.55 ± 1.12 and 1.99 ± 0.87, respectively ( p < 0.001). Conclusion: Endocervical brushing was proved to be as accurate with respect to diagnostic yield as ECC but less painful, evaluating the endocervical canal. It can be an alternative for evaluation of the cervical canal pathology in patients with low grade cytologic abnormalities but devoid of the misinterpretation of stromal invasion; ECC should be preferred in patients with a suspicion of invasive disease. [ABSTRACT FROM AUTHOR]

The aim of the present study was to measure the treatment of menorrhagia and health-related quality of life (QoL) in Levonorgestrel-releasing intrauterine system (LNG-IUS) in Turkish women. We recruited 66 premenopausal women, aged 26–55 years, who had sought care in the previous year for menorrhagia. All patients were asked to complete a visual analog scale (VAS) form regarding pelvic pain, sexual life (libido) and general feeling of health. Patients filled the VAS form before LNG-IUS insertion and after 6 months. After the 6-month visit, PBAC score was condirebly decreased ( p < 0.001). Six (10%) of the 60 patients PBAC score was higher than 75. VAS score for pelvic pain decreased from baseline to 6-month follow-up (4.32–3.55), and the libido and general feeling of health increased (4.27–4.95 and 3.47–6.87, respectively). The LNG-IUS device in the trearment of menorrhagia has cost effective, less side effects and increse in the QoL. [ABSTRACT FROM AUTHOR]

The aim of the study was to evaluate the interobserver variability of modified Ferriman–Gallwey (mFG) hirsutism scores on each body area in a Turkish population. A cross-sectional study of simultaneous mFG scoring design was used. Observers did not make any interview with the subjects and were masked to the previous score results. Analyses included percentage of agreement, kappa coefficients, the Bland and Altman plot, confidence intervals, minimum and maximum kappa coefficients. The study was performed at a teaching and research hospital. Hundred and twenty-one Turkish women without any complaints of excessive body hair were studied. Interventions included two special trained physicians, simultaneous and independent mFG scoring. The main outcome measures were mFG scores in each body area. Agreement analysis demonstrated that the scores of the two physicians were quite concordant. The mean kappa value for nine body area was 0.744 and the highest kappa values from the upper back and the lowest kappa values from the upper lip revealed к = 0.847, к = 0.585, respectively. The highest (upper lip) and the lowest (arm) mean range scores for the two researchers among the 9 areas were 1.46–1.55 and 0.17–0.12, respectively. Only 68.6 and 67.8% of the mFG scores observed by each of the two observers were equal or below 8. The mFG scoring system was found to be clinically useful. The upper lip was observed to have the highest score of androgen sensitive area of the body as well as the highest interobserver variability. The cut-off value to establish the diagnosis of hirsutism should be population-specific. [ABSTRACT FROM AUTHOR]

The EUROGAMarray has been used to investigate the decay out of the yrast superdeformed (SD) band in Pb. Eigth single step decays from the lowest observed SD states to low-lying states at normal deformation (ND) have been identified. From this observation, the excitation energy (4877 ± 1.5 keV) and the spin (6) of the lowest observed SD state in Pb are established. [ABSTRACT FROM AUTHOR]