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Background: Stone nomogram by Micali et al., able topredict treatment failure of shock-wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) in the management of single 1-2 cm renal stones, was developed on 2605 patients and showed a high predictive accuracy, with an area under ROC curve of 0.793 at internal validation. The aim of the present study is to externally validate the model to assess whether it displayed a satisfactory predictive performance if applied to different populations., Methods: External validation was retrospectively performed on 3025 patients who underwent an active stone treatment from December 2010 to June 2021 in 26 centers from four countries (Italy, USA, Spain, Argentina). Collected variables included: age, gender, previous renal surgery, preoperative urine culture, hydronephrosis, stone side, site, density, skin-to-stone distance. Treatment failure was the defined outcome (residual fragments >4 mm at three months CT-scan)., Results: Model discrimination in external validation datasets showed an area under ROC curve of 0.66 (95% 0.59-0.68) with adequate calibration. The retrospective fashion of the study and the lack of generalizability of the tool towards populations from Asia, Africa or Oceania represent limitations of the current analysis., Conclusions: According to the current findings, Micali's nomogram can be used for treatment prediction after SWL, RIRS and PNL; however, a lower discrimination performance than the one at internal validation should be acknowledged, reflecting geographical, temporal and domain limitation of external validation studies. Further prospective evaluation is required to refine and improve the nomogram findings and to validate its clinical value.

Context: Controversy exists regarding the therapeutic benefit of suction use during percutaneous nephrolithotripsy (PCNL)., Objective: To review and highlight the options available in the use of suction for PCNL, and to discuss their strengths and limitations., Evidence Acquisition: A systematic literature search was performed using Scopus, EMBASE, and PubMed. Thirty four studies were included. There was one ex vivo study. Among clinical studies, 24 used a vacuum/suctioning sheath and nine a handpiece suction device/direct-in-scope suction. The suction technique was employed in standard, mini-PCNL, supermini-PCNL, and enhanced supermini‑PCNL techniques., Evidence Synthesis: Handpiece suction devices demonstrated better safety and efficiency in treating large stones than nonsuction PCNL and in a much shorter time. Trilogy and ShockPulse-SE were equally effective, safe, and versatile for standard PCNL and mini-PCNL. The heavier handpiece makes Trilogy less ergonomically friendly. Laser suction handpiece devices can potentiate laser lithotripsy by allowing for better laser control with simultaneous suction of small fragments and dust. Integrated suction-based sheaths are available in reusable and disposable forms for mini-PCNL only. Mini-PCNL with suction reported superior outcomes for operative time and stone-free rate to mini-PCNL. This also helped minimize infectious complications by a combination of intrarenal pressure reduction and faster aspiration of irrigation fluid reducing the risk of sepsis, enhance intraoperative vision, and improve lithotripsy efficiency, which makes it a very attractive evolution for PCNL., Conclusions: Suction devices in PCNL are reforming the way PCNL is being done. Adding suction to mini-PCNL reduces infectious complications and improves the stone-free rate. Our review shows that despite the limited evidence, suction techniques appear to improve PCNL outcomes., Patient Summary: In this review, we looked at the intra- and perioperative outcomes of percutaneous nephrolithotripsy (PCNL) with the addition of suction. With better stone fragmentation and fewer postoperative infections, this technology is very useful particularly for mini-PCNL., (Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Objective: To identify the latest advances in suction devices and evaluate their effect in Retrograde intrarenal surgery (RIRS) and ureteroscopy for stones., Basic Procedures: A systematic literature search was performed on 4th January 2023 using Scopus, PubMed, and EMBASE. Only English papers were included; both pediatric and adult studies were accepted. Duplicate studies, case reports, letters to the editor, and meeting abstracts were excluded., Main Findings: Twenty-one papers were selected. Several methods have been proposed for suction use in RIRS, such as through the ureteral access sheath or directly to the scope. Artificial intelligence can also regulate this system, monitoring pressure and perfusion flow values. All the proposed techniques showed satisfactory perioperative results for operative time, stone-free rate (SFR), and residual fragments. Moreover, the reduction of intrarenal pressure (induced by aspiration) was also associated with a lower infection rate. Even the studies that considered kidney stones with a diameter of 20 mm or higher reported higher SFR and reduced postoperative complications. However, the lack of well-defined settings for suction pressure and fluid flow prevents the standardization of the procedure., Conclusion: Aspiration device in the surgical treatment of urinary stones favours a higher SFR, reducing infectious complications, as supported by the included studies. RIRS with a suction system provided to be a natural successor to the traditional technique, regulating intrarenal pressure and aspirating fine dust., (Copyright © 2023 AEU. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: To analyze the internal consistency of the Voice Handicap Index (VHI) for evaluating the vocal handicap of individuals with dysphonia., Methods: This is a systematic review. Studies with a cross-sectional design and including a population of individuals with dysphonia, which validated the VHI and analyzed its internal consistency, were included. The following electronic databases were searched: Cochrane Library, EMBASE, LILACS, and PubMed, including Medline, Scopus, and Web of Science. A manual search was performed in gray literature through the Biblioteca Digital Brasileira de Teses e Dissertações and ProQuest Dissertation & Theses. In addition, the list of references of studies selected in the electronic search was mapped, and an expert in the area was consulted. Two reviewers blindly and independently conducted the selection, data extraction, and analysis of the risk of bias, the certainty of the evidence, and good psychometric measures. A meta-analysis was performed with a random effects model using the JAMOVI 2.3.2 software., Results: Forty-nine studies were analyzed. In risk of bias assessment, the studies were classified as having inadequate structural validity and very good internal consistency. The analysis of good psychometric properties indicated indeterminate structural validity and insufficient internal consistency. The overall value of Cronbach's alpha was estimated at 0.94, thus suggesting a very good internal consistency. However, there was high heterogeneity. The level of certainty of the evidence was too low for internal consistency., Conclusion: The VHI proved to be a consistent and reliable patient-reported outcome measure to evaluate voice handicap in individuals with dysphonia; however, studies are heterogeneous, and the certainty of evidence is very low., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the prevalence of signs and symptoms related to temporomandibular disorders (TMD) and orofacial pain in patients with indication for orthognathic surgery., Methods: The search was carried out in seven electronic databases and gray literature. Studies that evaluated the frequency of signs and symptoms related to TMD and orofacial pain were included. The risk of bias was assessed using the Joanna Briggs Critical Appraisal tool. A meta-analysis of proportions with a random effect model was performed and the GRADE tool judged the certainty of evidence., Results: After searching the databases, 1859 references were retrieved, 18 of which were selected for synthesis. The prevalence of individuals with at least one TMD symptom was 51% [CI95% = 44-58%], and 44% of the subjects had temporomandibular joint click/crepitus [CI95% = 37-52%]. Additionally, 28% exhibited symptoms related to muscle disorders [CI95% = 22-35%], 34% had disc displacement with or without reduction [CI95% = 25-44%], and 24% had inflammatory joint disorders [CI95% = 13-36%]. The prevalence of headache was 26% [CI95% = 8-51%]. The certainty of evidence was considered very low., Conclusion: Approximately 1 in 2 patients with dentofacial deformity presents some sign and symptom related to TMD. Myofascial pain and headache may be present in approximately a quarter of patients with dentofacial deformity., Clinical Relevance: A multidisciplinary treatment is necessary for these patients, involving a professional with expertise in the management of TMD., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Pelvic fracture urethral injury (PFUI) occurs in up to 10% of pelvic fractures. There is mixed evidence supporting early endoscopic urethral realignment (EUR) over suprapubic tube (SPT) placement and delayed urethroplasty. Some studies show decreased urethral obstruction with EUR, while others show few differences. We hypothesized that EUR would reduce the rate of urethral obstruction after PFUI., Methods: Twenty-six US medical centers contributed patients following either an EUR or SPT protocol from 2015 to 2020. If retrograde cystoscopic catheter placement failed, patients were included and underwent either EUR or SPT placement based on their institution's assigned treatment arm. Endoscopic urethral realignment involved simultaneous antegrade/retrograde cystoscopy to place a catheter across the urethral injury. The primary endpoint was development of urethral obstruction. Fisher's exact test was used to analyze the relationship between PFUI management and development of urethral obstruction., Results: There were 106 patients with PFUI; 69 (65%) had complete urethral disruption and failure of catheter placement with retrograde cystoscopy. Of the 69 patients, there were 37 (54%) and 32 (46%) in the EUR and SPT arms, respectively. Mean age was 37.0 years (SD, 16.3 years) years, and mean follow-up was 463 days (SD, 280 days) from injury. In the EUR arm, 36 patients (97%) developed urethral obstruction compared with 30 patients (94%) in the SPT arm ( p = 0.471). Urethroplasty was performed in 31 (87%) and 29 patients (91%) in the EUR and SPT arms, respectively ( p = 0.784)., Conclusion: In this prospective multi-institutional study of PFUI, EUR was not associated with a lower rate of urethral obstruction or need for urethroplasty when compared with SPT placement. Given the potential risk of EUR worsening injuries, clinicians should consider SPT placement as initial treatment for PFUI when simple retrograde cystoscopy is not successful in placement of a urethral catheter., Level of Evidence: Therapeutic/Care Management; Level III., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Radiomics in uro-oncology is a rapidly evolving science proving to be a novel approach for optimizing the analysis of massive data from medical images to provide auxiliary guidance in clinical issues. This scoping review aimed to identify key aspects wherein radiomics can potentially improve the accuracy of diagnosis, staging, and grading of renal and bladder cancer., Material and Methods: A literature search was performed in June 2022 using PubMed, Embase, and Cochrane Central Controlled Register of Trials. Studies were included if radiomics were compared with radiological reports only., Results: Twenty-two papers were included, 4 were pertinent to bladder cancer, and 18 to renal cancer. Radiomics outperforms the visual assessment by radiologists in contrast-enhanced computed tomography (CECT) to predict muscle invasion but are equivalent to CT reporting by radiologists in predicting lymph node metastasis. Magnetic resonance imaging (MRI) radiomics outperforms radiological reporting for lymph node metastasis. Radiomics perform better than radiologists reporting the probability of renal cell carcinoma, improving interreader concordance and performance. Radiomics also helps to determine differences in types of renal pathology and between malignant lesions from their benign counterparts. Radiomics can be helpful to establish a model for differentiating low-grade from high-grade clear cell renal cancer with high accuracy just from contrast-enhanced CT scans., Conclusions: Our review shows that radiomic models outperform individual reports by radiologists by their ability to incorporate many more complex radiological features., Competing Interests: The authors declare no conflicts of interest., (Copyright by Polish Urological Association.)

Objective: To determine patient outcomes across a range of pelvic fracture urethral injury (PFUI) severity. PFUI is a devastating consequence of a pelvic fracture. No study has stratified PFUI outcomes based on severity of the urethral distraction injury., Methods: Adult male patients with blunt-trauma-related PFUI were followed prospectively for a minimum of six months at 27 US medical centers from 2015-2020. Patients underwent retrograde cystourethroscopy and retrograde urethrography to determine injury severity and were categorized into three groups: (1) major urethral distraction, (2) minor urethral distraction, and (3) partial urethral injury. Major distraction vs minor distraction was determined by the ability to pass a cystoscope retrograde into the bladder. Simple statistics summarized differences between groups. Multi-variable analyses determined odds ratios for obstruction and urethroplasty controlling for urethral injury type, age, and Injury Severity Score., Results: There were 99 patients included, 72(72%) patients had major, 13(13%) had minor, and 14(14%) had partial urethral injuries. The rate of urethral obstruction differed in patients with major (95.8%), minor (84.6%), and partial injuries (50%) (P < 0.001). Urethroplasty was performed in 90% of major, 66.7% of minor, and 35.7% of partial injuries (P < 0.001)., Conclusion: In PFUI, a spectrum of severity exists that influences outcomes. While major and minor distraction injuries are associated with a higher risk of developing urethral obstruction and need for urethroplasty, up to 50% of partial PFUI will result in obstruction, and as such need to be closely followed., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Fish parasite communities can be directly influenced by characteristics of host species. However, little is known about the host-parasite relationships in commercially important fish of the southeastern Atlantic. To address this knowledge gap, a comparative analysis of the parasite communities of three sympatric Clupeiformes was conducted. Cetengraulis edentulus (Engraulidae), Opisthonema oglinum (Clupeidae) and Sardinella brasiliensis (Clupeidae) were collected from an estuarine lagoon near Rio de Janeiro, Brazil. Prevalence, abundance and aggregation were estimated for infrapopulations; richness, diversity, evenness and dominance for infracommunities. The three component communities were compared using both quantitative and qualitative components. Canonical discriminant analysis was used to determine if a host population could be characterised by the component community of its parasites. Multivariate models revealed that host species, a proxy for diet and phylogenetic relationships, was the main factor influencing the composition of parasite infracommunities. Diet was found to be the main factor shaping the communities of endoparasites, in which digeneans were dominant and best indicator of host population. Ectoparasites (copepods, isopods and monogeneans) displayed strong host-specificity with some species restricted to a single host population. The similarity of the component communities of the two clupeid populations demonstrated the influence of host phylogeny. Parasite infracommunities exhibited low diversity and high dominance, with many taxa restricted to a single host species (specialists) and few occurring in more than one (generalists). Host phylogeny and by extension, diet, morphology and coevolution with parasites appear to be important factors in determining the host-parasite relationships of clupeiform fish in the southeastern Atlantic., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This study evaluated the anatomical factors that influence the virtual planning of zygomatic implants by using cone-beam computerized tomography (CBCT) scans. CBCT scans of 268 edentulous patients were transferred to specialized implant planning software for the following measurements: maxillo-sinus concavity size (small, medium, and large), zygoma width, implant insertion angle, implant length, and implant apical anchorage. Concavity sizes found were as follows: 34.95% small, 52.30% medium, and 7.35% large. The mean insertion angle was 43.2 degrees, and the average implant apical anchorage was 9.1 mm. The most frequent implant length was 40 mm. Significant differences were found when the different types of concavities in relation to the installation angle, the distance of the apical portion of the implant in contact with the zygomatic bone, and the lateral-lateral thickness of the zygomatic bone were compared (P < .001). Medium-sized maxillary sinus concavity presented greater apical anchorage of the implant (9.7 mm) and was the most frequent type (52.30%). The zygomatic bone is a viable site for zygomatic fixtures, and the use of specialized implant planning software is an important tool to achieve predictable outcomes for zygomatic implants and allows good visualization of the relation between implants and anatomical structures.

Purpose: Delineate retrospectively and prospectively the incidence and characteristics of transient ST-segment elevation during transseptal puncture., Methods: The study retrospectively evaluated 307 patients from January 1, 2015, to December 31, 2017, and prospectively evaluated 231 patients from January 1, 2018, to July 31, 2019., Results: The presence of ST-segment elevation was significantly higher in the prospective sample than in the retrospective sample (5.2% vs. 1.3%, p < 0.05). Between the two groups, there was no significant difference in age, sex, comorbidities, left atrial volume index, and the etiology of atrial fibrillation among patients with ST-segment alteration. In all patients, the ST-segment elevation was observed in the inferior wall derivations, except for one patient with ST elevation in lead I, AVL, V1-V4 during the septal puncture, associated with sinus bradycardia and reversed hypotension with intravenous fluids. Comparative analysis of the systolic and diastolic arterial pressure and the minimum heart rate during the phenomenon demonstrated more severity in the retrospectively evaluated population than in the prospective population. There was a significant association between the occurrence of ST-segment elevation > 2 mm and the presence of symptoms. In these patients, coronary angiography showed no alterations. Atropine was administered to one patient who presented with junctional bradycardia after the puncture. This medication reversed the situation., Conclusion: ST-segment elevation is a short-term phenomenon that can occur during transseptal catheterization without clinically evident symptoms. The catheter ablation procedure can be safely concluded despite the occurrence of the phenomenon., (© 2021. Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Syphilis is a sexually transmitted disease (STD) caused by Treponema pallidum subspecies pallidum. In 2016, it was declared an epidemic in Brazil due to its high morbidity and mortality rates, mainly in cases of maternal syphilis (MS) and congenital syphilis (CS) with unfavorable outcomes. This paper aimed to mathematically describe the relationship between MS and CS cases reported in Brazil over the interval from 2010 to 2020, considering the likelihood of diagnosis and effective and timely maternal treatment during prenatal care, thus supporting the decision-making and coordination of syphilis response efforts., Methods: The model used in this paper was based on stochastic Petri net (SPN) theory. Three different regressions, including linear, polynomial, and logistic regression, were used to obtain the weights of an SPN model. To validate the model, we ran 100 independent simulations for each probability of an untreated MS case leading to CS case (PUMLC) and performed a statistical t-test to reinforce the results reported herein., Results: According to our analysis, the model for predicting congenital syphilis cases consistently achieved an average accuracy of 93% or more for all tested probabilities of an untreated MS case leading to CS case., Conclusions: The SPN approach proved to be suitable for explaining the Notifiable Diseases Information System (SINAN) dataset using the range of 75-95% for the probability of an untreated MS case leading to a CS case (PUMLC). In addition, the model's predictive power can help plan actions to fight against the disease., (© 2022. The Author(s).)

Introduction: Lithotripsy during retrograde intrarenal surgery (RIRS) can be achieved either by fragmentation and extraction or dusting with spontaneous passage. We aimed to perform a systematic review on the safety and stone-free rate after RIRS by comparing the techniques of dusting vs fragmentation/extraction., Material and Methods: This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. The inverse variance of the mean difference and 95% Confidence Interval (CI), Categorical variables were assessed using Cochran-Mantel-Haenszel Method with the random effect model and reported as Odds Ratio (OR) and 95% CI. Statistical significance was set at p <0.05., Results: There were 1141 patients included in 10 studies. Stone size was up to 2.5 cm All studies used holmium laser for lithotripsy. Meta-analysis showed no significant difference in surgical time (MD -5.39 minutes 95% CI -13.92-2.31, p = 0.16), postoperative length of stay (MD -0.19 days 95% CI -0.60 - -0.22, p=0.36), overall complications (OR 0.98 95% CI 0.58-1.66, p = 0.95), hematuria (OR 1.01 95% CI 0.30-3.42, p = 0.99), postoperative fever (OR 0.70 95% CI 0.41-1.19, p = 0.19) and sepsis (OR 1.03 95% CI 0.10-10.35, p = 0.98), immediate (OR 0.40 95% CI 0.13-1.24, p = 0.11) and overall stone-free rate (OR 0.76 95% CI 0.43-1.32, p = 0.33), and retreatment rate (OR 1.35 95% CI 0.57-3.20, p = 0.49) between the groups., Conclusions: This systematic review infers that urologists can safely use either option of fragmentation and basket extraction or dusting without extraction to achieve similar outcomes as both techniques are similar for efficacy and safety., Competing Interests: Rodrigo Donalisio da Silva is a consultant for Lumenis. Jeremy Yuen-Chun Teoh had honorarium/lecture for: Astellas, Boston Scientific, Combat Medical, Ferring, Ipsen, Janssen, Olympus, Sanofy. Jeremy Yuen-Chun Teoh is a consultant for: Astellas, Combat Medical, Ferring, Janssen, MRI PRO. Jeremy Yuen-Chun Teoh had research grant from: Baxter, Janssen, Storz, Olympus, Bristol-Meyers Squibb, Merck Sharp & Dohme. The remaining authors declare that they have no conflict of interest., (Copyright by Polish Urological Association.)

Mosquito surveillance is an essential component of mosquito control and mosquito traps are a universally employed tool to monitor adult populations. The objective of this paper was to evaluate the new modular Biogents BG-Pro mosquito trap (BGP) and compare its performance to 4 widely used traps for adult mosquitoes: the BG-Sentinel (BGS), the BG Mosquitaire (BGM), the CDC miniature light trap (CDC), and the encephalitis vector survey trap (EVS). One semi-field and 9 field Latin square trials were performed in 7 countries. Results showed that the collection performance of the BGP was equivalent to or exceeded that of the BGS, BGM, CDC, and EVS traps in head-to-head comparisons. The BGP uses 35% less power than the CDC and 75% less than the BGS and BGM. This lower power consumption allows it to run at 5 V for 2 days using a small lightweight 10,000-mAh rechargeable power bank. The BG-Pro is an excellent alternative for the surveillance of mosquito species that are usually monitored with BG-Sentinel, CDC, or EVS traps., (Copyright © 2021 by The American Mosquito Control Association, Inc.)

Objective: To understand the preference and role of 'hybrid' urological meetings compared to face-to-face and online meetings during and after COVID-19 pandemic. The secondary outcome was finding out the most preferable webinar setting., Methods: An online global survey was done between June 06 and July 05, 2020, using SurveyMonkey. The target participants were urology healthcare providers. The survey was disseminated via mailing lists and the Twitter platform., Results: A total of 526 urology providers from 56 countries responded to the survey and it was completed by 73.3%. Participants' overall experience was better in a face-to-face meeting, followed by a hybrid and webinar only meeting. While opportunities for networking was identified as high in face-to-face meeting, online webinars were more cost effective, and learning opportunity and reach of audience was higher for hybrid meetings. For online webinar format, Zoom platform was used by 73% and majority (69%) saw it on their laptop or desktop. The preference was for a 1-hour webinar in the evenings with 3-5 speakers. Urology residents rated face-to-face meetings to have better cost-effectiveness when compared to consultants. Post COVID-19, more than half of all respondents would prefer hybrid meetings compared to the other formats., Conclusion: While there will be a place for face-to-face meetings, COVID-19 situation has led to a preference towards hybrid meetings which is ideal for a global reach in the future. It is plausible that most urological associations will move towards a hybrid model for their meetings., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Background: To describe our experience with outpatient transperineal biopsy (TPB) without antibiotics compared to transrectal biopsy (TRB) with antibiotics and bowel preparation. The literature elicits comparable cancer detection, time, and cost between the two. As antibiotic resistance increases, antimicrobial stewardship is imperative., Methods: In our retrospective review, we compared the TPB to TRB in our institution for outpatient prostate biopsies with local anesthesia from June 1st, 2017 to June 1st, 2019. Patients had negative urinalysis on day of procedure. Patients presenting with symptoms concerning for UTI followed by positive urine culture were determined to have a UTI., Results: Two hundred twenty-two patients met inclusion criteria. Age, race, BMI, pre-procedure PSA, history of UTI, BPH or other GU history were similar between both groups. Two TPB patients (1.8%) had post-procedure UTI; one received oral antibiotics and one received a dose of intravenous and subsequent oral antibiotics. There were no sepsis events or admissions. Six TRB patients (5.4%) had post-procedure UTI; five received oral antibiotics, and one received intravenous antibiotics and required admission for sepsis. One TPB patient (0.9%) had post-procedure retention and required catheterization, while four TRB patients (3.6%) had retention requiring catheterization. No significant difference noted in cancer detection between the two groups., Conclusion: Outpatient TPB without antibiotic prophylaxis/bowel prep is comparable to TRB in regard to safety and cancer detection. TPB without antibiotics had a lower infection and retention rate than TRB with antibiotics. Efforts to reduce antibiotic resistance should be implemented into daily practice. Future multi-institutional studies can provide further evidence for guideline changes., (© 2021. The Author(s).)

In this work, ultrasound-assisted electrocatalytic hydrogenation (US-ECHSA) of safrole was carried out in water medium, using sacrificial anode of nickel. The ultrasonic irradiation was carried out at frequency of 20 kHz ± 500 Hz with a titanium cylindrical horn (MS 73 microtip; Ti-6AI-4V alloy; 3.0 mm diameter). The optimal conditions were analyzed by statistical experimental design (fractional factorial). The influence of the sonoelectrochemical reactor design was also investigated by using computational fluid dynamics as simulation tool. Among the five parameters studied: catalyst type, use of β-cyclodextrin as inverse phase transfer catalyst, sonoelectrochemical reactor design, ultrasound mode and the temperature of the solution, only the last three were significant. The hydrogenation product, dihydrosafrole, reached 94% yield, depending on the experimental conditions applied. Data of computational fluid dynamics showed that a wing shape tube added to the sonoelectrochemical reactor can work as a cooling apparatus, during the electrochemical process. The reactional solution temperature diminishes 14 °C when compared to the four-way-type reactor. Cooper cathode, absence of β-cyclodextrin, four-way-type reactor, ultrasound continuous mode (14 W) and absence of temperature control were the most effective reaction parameters for the safrole hydrogenation using US-ECHSA method. The proposed approach represents an important contribution for understanding the hydrodynamic behavior of sonoelectrochemical reactors designs and, consequently, for the reducing of the experimental costs inherent to the sonoelectrochemical process., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Competing Interests: None declared.

Xenarthrans-anteaters, sloths, and armadillos-have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, 10 anteaters, and 6 sloths. Our data set includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the southern United States, Mexico, and Caribbean countries at the northern portion of the Neotropics, to the austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n = 5,941), and Cyclopes sp. have the fewest (n = 240). The armadillo species with the most data is Dasypus novemcinctus (n = 11,588), and the fewest data are recorded for Calyptophractus retusus (n = 33). With regard to sloth species, Bradypus variegatus has the most records (n = 962), and Bradypus pygmaeus has the fewest (n = 12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other data sets of Neotropical Series that will become available very soon (i.e., Neotropical Carnivores, Neotropical Invasive Mammals, and Neotropical Hunters and Dogs). Therefore, studies on trophic cascades, hunting pressure, habitat loss, fragmentation effects, species invasion, and climate change effects will be possible with the Neotropical Xenarthrans data set. Please cite this data paper when using its data in publications. We also request that researchers and teachers inform us of how they are using these data., (© 2019 The Authors. Ecology © 2019 The Ecological Society of America.)

Purpose: The objective of this systematic review was to assess the three-dimensional changes in bone tissue after immediate installation of a single implant in a fresh extraction socket in the anterior maxilla., Methods: After defining a strategy, an electronic search was carried out using the databases PubMed, Embase, LILACS, Web of Science, Cochrane, and Scopus. In addition, the gray literature was also researched using Google Scholar and ProQuest. Two reviewers independently screened for eligible studies, assessed the methodological quality, and extracted the data. The inclusion criteria were observational studies and experimental studies that assessed bone response after the immediate installation of a single implant in a fresh extraction socket, immediately loaded or not, in the region between the maxillary canines. Studies were included in any language, with no publication date restrictions and with a minimum of 6 months of follow-up after the surgical procedure., Results: From a total of 3272 articles, only 12 studies met the inclusion criteria and were selected for the review. Bone remodeling after immediate installation of a dental implant was assessed using standardized periapical radiographs and cone beam computed tomography (CBCT)., Conclusion: It can be concluded that bone remodeling occurs after tooth extraction and immediate implant installation.

Respiratory syncytial virus (RSV) is the most common etiologic agent in severe infections of the lower respiratory tract in children with a high mortality rate. However, there are still no licensed vaccines for RSV. In this study, we investigated a putative vaccine based on M 209-223 peptide. Mice vaccinated with M 209-223 peptide expanded M 209-223 -specific effector CD4 + T cells upon infection. Vaccination resulted in increased numbers of regulatory T cells (Treg) and Th1 cells, and decreased numbers of Th2 cells. In addition, vaccination with M 209-223 peptide, protected mice from infection and prevented lung inflammation, leading to increase in IL-10 and IFN-γ production by lung CD4 + T cells. Treg depletion with anti-CTLA4 antibodies abrogated protection induced by peptide vaccination. Our results support vaccination with M 209-223 peptide as an important strategy to generate protection, both systemic and local, by memory RSV-specific CD4 + T cells in mice. Contrarily to inactivated RSV particles, M 209-223 peptide vaccination is capable of not only promoting viral clearance, but also reducing inflammatory processes in lungs upon infection., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Transitional cell carcinoma is the most common type of bladder cancer in the United States. This case report discusses the finding of primary bladder carcinoid tumor (also called well-differentiated neuroendocrine tumor) in a woman with gross hematuria. With only 15-20 reported cases, primary bladder carcinoid is rare and the approach to treatment is unclear. There have been two muscle-invasive cases reported which required more extensive treatment plans. The patient presented in this case underwent complete transurethral resection of the tumor with the recommendation of surveillance cystoscopy every 3 months.

The objective of this study was to compare the surgical, oncological, and functional outcomes of laparoscopic and percutaneous cryoablation for the treatment of small renal masses. A systematic review of the literature was performed through March 2016 using PubMed, Scopus, and Ovid databases. Article selection proceeded according to the search strategy on the basis of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Only studies that compared laparoscopic and percutaneous kidney cryoablation were included in the meta-analysis. Eleven retrospective comparative studies were identified and selected for the analysis, including 1725 cases: 804 (46.6%) percutaneous and 921 (53.4%) laparoscopic cryoablations. Percutaneous cryoablation was performed more frequently for posterior tumors (P < .001), whereas laparoscopy was more common for endophytic lesions (P = .01). The length of follow-up was longer for laparoscopy (P < .001). Percutaneous cryoablation was associated with a significantly shorter hospital stay (P < .001). A lower likelihood of residual disease was recorded for laparoscopic (P = .003), whereas tumor recurrence rate favored percutaneous cryoablation (P = .02). The 2 procedures were similar for recurrence-free survival (P = .08), and overall survival (P = .51). No significant difference was found in postoperative estimated glomerular filtration rate (P = .78). Laparoscopic and percutaneous kidney cryoablation offer similar favorable oncological outcomes with minimal effect on renal function. The percutaneous access can offer shorter hospital stay and faster recovery, which can be appealing in an era of cost restraint., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Tuberculosis remains an important disease which mainly affects the majority of vulnerable individuals in society, who are subjected to poor living conditions and difficulties to access the services of public health. Under these circumstances, the present study aims to understand patients' perception in relation to the influence of individual and social vulnerabilities on the adherence to tuberculosis treatment., Methods: A qualitative descriptive cross sectional study was conducted in one large municipality at the state of Paraíba, Northeast of Brazil. The study subjects, who were residents of the study site, covered all tuberculosis cases diagnosed between March and June 2015. The sample was defined by the criteria of response saturation. All interviews were audio recorded, and data analysis was developed through the hermeneutic dialectic method and the theory of Generative Route Sense. The project was approved by the Research Ethics Committee of the University of São Paulo (USP)., Results: A total of 13 individuals were interviewed and the responses were identified into two analytical categories: the difficulties they had and the enabling factors they could mention during their tuberculosis treatment. Patients brought up social exclusion as an obstacle to treatment adherence, which, along with stigmatization, weakened their link with family members and health professionals. Moreover, economic precariousness was a major hindrance to the maintenance of a proper diet and transportation access to health centers. However, social support and directly observed treatment helped to break down barriers of prejudice and to promote individual and family empowerment. Finally, patients also reported that their will to live and faith gave them the strength to continue with the treatment., Conclusions: According to patients in this study, social support and the strengthening of links with family members and health professionals may reduce social exclusion and other difficulties they face, thus encouraging them to the adhere to tuberculosis treatment.

Drug-induced liver injury (DILI) is a major cause of acute liver failure (ALF), where hepatocyte necrotic products trigger liver inflammation, release of CXC chemokine receptor 2 (CXCR2) ligands (IL-8) and other neutrophil chemotactic molecules. Liver infiltration by neutrophils is a major cause of the life-threatening tissue damage that ensues. A GRPR (gastrin-releasing peptide receptor) antagonist impairs IL-8-induced neutrophil chemotaxis in vitro. We investigated its potential to reduce acetaminophen-induced ALF, neutrophil migration, and mechanisms underlying this phenomenon. We found that acetaminophen-overdosed mice treated with GRPR antagonist had reduced DILI and neutrophil infiltration in the liver. Intravital imaging and cell tracking analysis revealed reduced neutrophil mobility within the liver. Surprisingly, GRPR antagonist inhibited CXCL2-induced migration in vivo, decreasing neutrophil activation through CD11b and CD62L modulation. Additionally, this compound decreased CXCL8-driven neutrophil chemotaxis in vitro independently of CXCR2 internalization, induced activation of MAPKs (p38 and ERK1/2) and downregulation of neutrophil adhesion molecules CD11b and CD66b. In silico analysis revealed direct binding of GRPR antagonist and CXCL8 to the same binding spot in CXCR2. These findings indicate a new potential use for GRPR antagonist for treatment of DILI through a mechanism involving adhesion molecule modulation and possible direct binding to CXCR2., (© 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Purpose: This study aimed to describe the clinical case of implant placement in the nasopalatine canal as an aid for atrophic maxilla rehabilitation., Case Report: The surgical procedure was carried out in 2 stages, the first part consisted of a surgery to lift the maxillary sinus membrane associated with the xenogeneic bone placement and the second part consisted of the surgery for the implants placement, both under local anesthesia. A number of seven osseointegrated implants were placed in the maxilla, one was anchored in the nasopalatine canal region after having its neurovascular content emptied by means of the use of drill threads of the implant system. After 5 months, the implant reopening was carried out, followed by the molding, manufacturing and placement of the protocol-type prosthesis. The case has a 4-year follow-up without any painful symptomatology., Conclusion: The implant placed in the nasopalatine canal region is a viable option to assist in the rehabilitation with implant-supported prostheses in atrophic maxilla.

Atta capiguara is a grass-cutting ant species frequently found in Cerrado biome. However, little is known about the giant nest architecture of this ant. In this study, we investigated the architecture of three A. capiguara nests from a fragment of Cerrado in Botucatu, São Paulo, Brazil. Casts were made of the nests by filling them with cement to permit better visualization of internal structures such as chambers and tunnels. After excavation, the depth and dimensions (length, width, and height) of the chambers were measured. The results showed the shape of Atta capiguara nests consisting of mounds of loose soil with unique features resembling a conic section. The fungus chambers were found distant from the mound of loose soil and were spaced apart and distributed laterally at the soil profile. The waste chambers were located beneath the largest mound of loose soil. Both the fungus and waste chambers were separated and distant. Our study contributes to a better understanding of the so far unknown nest architecture of the grass-cutting ant A. capiguara .

Norovirus is the most important cause of viral gastroenteritis outbreaks worldwide. Recently, a novel GII.17 norovirus variant emerged and caused epidemics in Asian countries, replacing the GII.4 Sydney 2012 strain in hospitalized cases. In this study we describe the emergence of this novel NoV GII.17&#95;2014 strain in Brazil., (Copyright © 2016 Elsevier B.V. All rights reserved.)

This study investigated the presence of norovirus (NoV) GI and GII in environmental samples from the northern region of Brazil. Water samples were collected monthly (November 2008/October 2010) from different sources and sewage and concentrated by the adsorption-elution method. The NoV investigation used molecular methods followed by sequencing reactions. The general positivity for NoV was 33.9% (57/168). Considering the results obtained only in the semi-nested RT-PCR (reverse transcription polymerase chain reaction) and only in the TaqMan ® real-time PCR, the rates were 26.8% (45/168) and 27.4% (46/168), respectively, being for NoV GI 22.2% (10/45) and 19.6% (9/46); for GII 17.8% (8/45) and 15.2% (7/46); and for GI + GII 60% (27/45) and 65.2% (30/46), respectively. Different GI (GI.1, GI.4, GI.7 and GI.8) and GII (GII.4, GII.6, GII.9, GII.12 and GII.14) genotypes were detected. These results demonstrated the NoV was disseminated in the waters of Belém city due to a lack of sanitation that allowed the discharge of contaminated effluents into these aquatic ecosystems.

To assess the stability of mandible position after orthognathic surgery for correction of class III skeletal malocclusion. Twenty adult males, aged 18 to 40 years, with Angle class III skeletal malocclusion underwent preoperative orthodontic treatment for elimination of dental compensations followed by combined maxillomandibular surgery with rigid internal fixation. Lateral cephalograms from each patient, obtained in the natural head position before surgery, immediately after surgery, and at 6-month follow-up, were retrieved from the files of the Pontifical Catholic University of Rio Grande do Sul outpatient Oral and Maxillofacial Surgery clinic and compared. Comparison of craniometric landmark measurements showed that the precision of mandibular setback was compromised in the horizontal plane, with a mean mandibular relapse of 37.75% at point B and 45.85% at point Pg. Improved intercuspation and adaptation of the musculature to the new position of the jaws after orthognathic surgery lead to counterclockwise rotation of the mandible, ultimately displacing the mandible more anteriorly than desired.

This study evaluates, for the first time, the antibiofilm, antimicrobial and antiparasitic potential of crude extract and fractions of stems of Equisetum hyemale against several infectious agents (bacteria, fungi, Mycobacterium and Trypanosomes) by broth microdilution technique and investigates the phenolic composition of the plant by high performance liquid chromatography. The crude extract and fractions showed antimicrobial activity, as they were capable of inhibiting the growth of bacteria in minimal inhibitory concentrations (MICs) ranging from 52.4 mg/mL to 3.27 mg/mL. For Candida species, the MICs ranged from 52.4 mg/mL to 6.5 mg/mL, and for Mycobacterium species from 2.5 mg/mL to 0.625 mg/mL. The dichloromethane fraction was able to reduce 83% of Pseudomonas aeruginosa biofilm formation and 51% of Candida albicans biofilms. The n-butanol fraction presents an important protozoal effect, reducing 100% of Trypanosoma evansi trypomastigotes after 9 h of exposure. The HPLC analysis revealed that the major substances are rosmarinic acid in dichloromethane fraction (7.38 ± 0.08 mg/g FS) and chlorogenic acid in ethyl acetate fraction (8.4 ± 0.26 mg/g FS). The crude extract and fractions of E. hyemale can be both useful and effective agents as a sustainable alternative for the treatment and prevention of several infectious agents., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Aeollanthus suaveolens species popularly known as catinga de mulata belongs to the Lamiaceae family. In the Amazon region, it is used in folk medicine for the treatment of gastritis, convulsions of epileptic origin, stomach pain and diarrhea in the form of tea and juice. Essential oils have analgesic, anti-inflammatory, and antimicrobial activity. This study evaluated the chemical composition of the A. suaveolens essential oil, and its cytotoxic, antimicrobial and antioxidant activity on Artemia salina Leach. The plant species was collected in Fazendinha district in the city of Macapa-AP. The essential oil obtained from the process was performed by hydrodistillation and identification of components by gas chromatography coupled with mass spectrometer. The antioxidant activity was evaluated by the kidnapping method of 2,2- diphenyl -1-picrilhidrazil radical, while the cytotoxic activity was assessed using saline A. and the microbiological activity was carried out by microdilution method with Escherichia coli, Salmonella sp. and Staphylococcus aureus bacteria. In a chromatographic analysis, the major constituents found in the essential oil of A. suaveolens were (E) -β-farnesene (37.615%), Linalool (33.375%), α-Santalene (3.255%) and linalyl acetate (3.222%). The results showed that the Escherichia coli and Salmonella sp. bacteria were more susceptible to MIC 50 mg.mL-1 when compared with the Staphylococcus aureus bacterium MIC 100 mg.mL-1. With respect to MBC concentration of 100 mg.mL-1 it was sufficient to inhibit the growth of E. coli. The essential oil did not show antioxidant activity, however, has a high cytotoxic activity against the A. salina, LC50 8.90 μg.mL-1., Competing Interests: The authors have declared that no competing interests exist.

Sapoviruses (SaVs) are responsible for acute gastroenteritis in humans, especially children and the elderly. In Brazil, data on SaVs infections are very limited, especially in Northern Brazil. Here, we investigated the occurrence of SaVs in samples from hospitalized children under ten years old that presented acute gastroenteritis. Positive samples were genotyped and phylogenetic analysis was performed using prototype strains sequences obtained from GenBank database. In total, 156 fecal samples were screened by RT-PCR for SaVs. A positivity rate of 3.8% (6/156) was found in children under three years of age. Four genotypes were detected: GI.I, GI.2 and GII.2?-GII.4?/GII.4, suggesting a possible inter-genotypes recombination. Most infections (83.3%) occurred between August and September. The positivity was similar to that found in other countries and genotyping demonstrated the presence of distinct genotypes. To our knowledge, this is the first study reporting the circulation of SaVs in Manaus, state of Amazonas, Amazon region, Brazil.

As life expectancy increases, a larger number of elderly people require dental health care attention for implant-supported rehabilitation, with the aim of restoring the function and aesthetics of the oral cavity. Most of these patients have lost their teeth long time ago, causing a severe bone resorption and maxillary sinus pneumatization. Therefore, the current study aims to demonstrate, through the description of the clinical case, the treatment with zygomatic implants as an option for treating severely atrophic maxillas. In this clinical study, the patient presented, in the clinical and image evaluation, severe alveolar bone atrophy, with height and thickness loss, in addition to a high-level pneumatization of the maxillary sinus, bilaterally. The classical zygomatic fixation technique was suggested, with 2 anterior conventional implants and 2 zygomatic implants in the posterior region with the placement of implant-supported prosthesis with immediate loading. The patient was monitored for 7 years and did not present pain complaints, absence of infection, or implant loss. Based on this clinical case study, it was concluded that the zygomatic implants are satisfactory options to aid the implant-supported rehabilitation of atrophic maxillas.

Objectives:: to analyze the integrated community therapy model for the empowerment of people living with fibromyalgia and discuss the impact of this interdisciplinary intervention in the health-disease process and self-care., Method:: a participatory-approach qualitative study, developed in 2015 with 11 participants at the Laboratory of Physiology Applied to Physical Education of the Rio de Janeiro State University, RJ. Data production comprised World Café, participant observation and semi-structured interview. The analysis was performed according to Bardin, through data triangulation in dialogue with the relevant literature., Results:: the integrated community therapy group is a driving force in building and expanding knowledge about fibromyalgia and in self-care empowerment., Conclusion:: this group strategy proved to be an interdisciplinary praxis tool that enables the development of solidary care networks. Thus, shared knowledge was generated, transformed into a listening and reflection environment to manage personal and family obstacles.

Objective: to verify causes of inactivity in the Home Delivery Medicament Program, as referred by users from a Primary Health Care Service in São Paulo, comparing them to the causes registered in the program and analyzing them in the theoretical model Concept of Access to Health., Methods: cross-sectional study, interviewing 111 inactive users; and documentary study in the program records., Results: half of the users did not know the condition of inactivity. Discrepancies were found between the user's and the program's information, observing different levels of agreement: Absence of physician and administrative staff member 0%; Transfer to other service 25%; Death 50%; Option to quit 50%; Address change 57% and Change in therapeutic schedule 80%. The users' feeling of accepting the program was observed. In the health access concept, inactivity can be explained in the information dimension, in the degree of asymmetry between the patient's and the health professional's knowledge, identified through the indicators: education, knowledge and information sources., Conclusions: due to the low education level, the user does not assimilate the information on the steps of the program flowchart, does not return for the assessment that guarantees its continuity. Consequently, (s)he stops receiving the medication and spends a long time without treatment, increasing the cardiovascular risk of hypertensive (92% of the sample), diabetic (44%) and dyslipidemic patients (31%).

Bucrates lanista, the most southerly distributed species in the genus Bucrates Burmeister, was originally described from Brazil based on a female collected in the state of Rio Grande do Sul, but the species has not been recorded since 1918. In this work, we report that B. lanista inhabits the Pantanal Wetland in the state of Mato Grosso do Sul and, for the first time, describe the male. Individuals of B. lanista are gregarious and present a brown/green color dimorphism; this behavior and color variation are also observed in species of closely related genera. Individuals from the Pantanal vary slightly from those of Rio Grande do Sul. The karyotype was determined to be 2n♂ = 21 = 20 + X0 and 2n♀ = 22 = 20 + XX. The X chromosome is metacentric and the largest of the complement, and all of the autosomes are submetacentrics. All chromosomes solely present telomeric (TTAGG)n repeats at their ends, and some chromosomes present positive and negative DAPI bands.

Subcapsular hematoma is an uncommon complication after ureteroscopy and laser lithotripsy. We report on a 38-year-old male with an 8 mm lower pole stone who underwent a left ureteroscopy and laser lithotripsy. The stone was successfully fragmented. Several hours after being discharged home, the patient returned complaining of back pain and hematuria. He was hemodynamically stable. Laboratory exams were normal. A CT study showed a crescent renal subcapsular hematoma surrounding the left kidney. The patient was admitted to the ward for conservative treatment. No additional intervention was necessary. Most subcapsular hematomas tend to resolve spontaneously.

Background: The present study aimed to direct detect Mycobacterium bovis in milk (n = 401) and blood (n = 401) samples collected from 401 dairy cows of 20 properties located in the state of Pernambuco, Brazil, by real-time quantitative PCR (qPCR) targeting the region of difference 4 (RD4). Risk factors possibly associated with bovine tuberculosis (BTB) were also evaluated., Results: Of the 802 samples analyzed, one milk (0.25%) and eight blood (2%) samples were positive for M. bovis in the qPCR and their identities were confirmed by sequencing. Animals positive for M. bovis were found in six (30%) of the 20 properties visited. None of the risk factors evaluated were statistically associated with BTB., Conclusions: M. bovis DNA was detected in one milk sample what may pose a risk to public health because raw milk is commonly consumed in Brazil.

Objective: To evaluate force decay between intermaxillary orthodontic elastics with and without latex in the oral medium at different time intervals., Materials and Methods: Intermaxillary orthodontic elastics with and without latex [1/8″ (3.2mm), 1/4″ (6.35mm), and 5/16″ (7.94mm) in diameter] were evaluated 'clinically'. For this purpose, 26 patients served as hosts for the elastics during the evaluation period. Initially, 52 thermoplasticized plates 1mm thick were made according to the patients' mould. Then, the orthodontic accessories were bonded to the plates, which kept the elastics distended throughout the experimental period. The force released by the elastics at this distance was evaluated at 0, 12, and 24 hours. Statistical analyses were performed using the Friedman, Wilcoxon, and Mann-Whitney tests (significance set at 5 per cent)., Results: Elastics with and without latex presented with permanent deformation and increasing internal diameter throughout the entire period. Elastics with latex, 1/8″ (3.2mm) in diameter, sustained higher levels of force than those without latex. Elastics measuring 1/4″ (6.35mm) and 5/16″ (7.94mm) in diameter without latex sustained higher levels of force at 0 and 12 hours compared to those with latex. At the end of the experiment (24 hours), no significant difference was observed between the elastics (P > 0.05)., Limitations: This study only evaluated three time intervals: 0, 12, and 24 hours. If the behaviour was evaluated at different time intervals, different behaviours of these materials might be revealed., Conclusion: Elastics with latex 1/8″ in diameter sustained a higher level of final force than the corresponding type without latex. The 1/4 and 5/16 elastics with and without latex were not different at the end of the evaluation period., (© The Author 2015. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Introduction: For decades, the monopolar transurethral resection of the prostate has been established as the minimally invasive surgical treatment for patients with benign prostatic hyperplasia (BPH). In recent years, new technologies and devices emerged to reduce the morbidity and improve outcomes for this treatment approach. Bipolar energy introduced the use of saline irrigation and laser technology increased the urological armamentarium to treat BPH. We performed a systematic review of the literature regarding bipolar technology for the treatment of BPH., Materials and Methods: A MEDLINE database search using the PRISMA methodology. Selected literature was restricted to articles published in English and published between 2005 and 2015. Articles regarding techniques using bipolar energy were included, while manuscripts that used a different technique, hybrid techniques, or techniques other than bipolar resection, bipolar vaporization, and bipolar enucleation were excluded., Results: The use of bipolar energy in the endoscopic treatment of BPH presented a significant reduction in operative time, perioperative complications, shorter catheterization time, reduced number of blood products transfused, and shorter hospital stay compared to standard techniques. Postoperative outcomes showed that bipolar energy was safe and offered significant outcome improvement when compared to traditional monopolar transurethral resection of the prostate (TURP)., Conclusion: The use of bipolar energy in the surgical treatment of patients with BPH is safe and is associated with improvements in perioperative outcomes. Short and mid-term functional outcomes are comparable to standard techniques, but long term functional outcomes need better clinical evaluation.

Focal therapy is a relatively new and extremely attractive option of treatment for prostate cancer. It has been described as the "middle approach" between active surveillance and radical treatment, aiming to destroy the tumor itself or the region containing the tumor in order to preserve surrounding non-cancerous tissue. The goal is to maintain disease control at acceptable levels, while preserving erectile, urinary, and rectal function. While a lot of technologies have been described for delivering targeted therapy to the prostate, such as cryoablation, high intensity focused ultrasound, photodynamic therapy, irreversible electroporation and laser, the key point is the patient selection. Recent advances in mpMRI and the introduction of new biopsy techniques that use MR images as a guidance, have significantly improved localization of the tumor lesions and the detection rate, evolving prostate biopsy toward targeted rather than systematic biopsies. The future challenge to clinicians is to precisely risk-stratify patients to differentiate between those who would profit from focal treatment and who would not. Forthcoming research efforts should pursue to identify molecular, genetic, and imaging characteristics that distinguish aggressive prostate tumors from indolent lesions.

Current surgical safety guidelines and checklists are generic and are not specifically tailored to address patient issues and risk factors in surgical subspecialties. Patient safety in surgical subspecialties should be templated on general patient safety guidelines from other areas of medicine and mental health but include and develop specific processes dedicated for the care of the surgical patients. Safety redundant systems must be in place to decrease errors in surgery. Therefore, different surgical subspecialties should develop a specific curriculum in patient safety addressing training in academic centers and application of these guidelines in all practices. Clearly, redundant safety systems must be in place to decrease errors in surgery, in analogy to safety measures in other high-risk industries. Specific surgical subspecialties are encouraged to develop a specific patient safety curriculum that address training in academic centers and applicability to daily practice, with the goal of keeping our surgical patients safe in all disciplines. The present review article is designed to outline patient safety practices that should be adapted and followed to fit particular specialties.