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Children and young people with CF (CYPwCF) get advice about using positive expiratory pressure (PEP) or oscillating PEP (OPEP) devices to clear sticky mucus from their lungs. However, little is known about the quantity (number of treatments, breaths, or sets) or quality (breath pressures and lengths) of these daily airway clearance techniques (ACTs) undertaken at home. This study used electronic pressure sensors to record real time breath-by-breath data from 145 CYPwCF (6-16y) during routine ACTs over 2 months. ACT quantity and quality were benchmarked against individual prescriptions and accepted recommendations for device use. In total 742,084 breaths from 9,081 treatments were recorded. Individual CYPwCF maintained consistent patterns of ACT quantity and quality over time. Overall, 60% of CYPwCF did at least half their prescribed treatments, while 27% did fewer than a quarter. About 77% of pre-teens did the right number of daily treatments compared with only 56% of teenagers. CYPwCF usually did the right number of breaths. ACT quality (recommended breath length and pressure) varied between participants and depended on device. Breath pressures, lengths and pressure-length relationships were significantly different between ACT devices. PEP devices encouraged longer breaths with lower pressures, while OPEP devices encouraged shorter breaths with higher pressures. More breaths per treatment were within advised ranges for both pressure and length using PEP (30-31%) than OPEP devices (1-3%). Objective measures of quantity and quality may help to optimise ACT device selection and support CYPwCF to do regular effective ACTs.

Coronary artery disease is a leading cause of morbidity and mortality worldwide. Acute coronary syndrome as a first presentation is common and patients with established disease have a high rate of recurrent ischemic events, despite antiplatelet therapy. Over the past several years, direct oral anticoagulants have become available and have been studied in patients with coronary artery disease. These medications directly inhibit either thrombin or factor Xa which contribute to atherothrombosis. This review will summarize the clinical data regarding the use of direct oral anticoagulants in different patient populations with coronary disease and the balance between protection against ischemia and bleeding. Additionally, the review will summarize the available data on the use of direct oral anticoagulants periprocedurally in patients undergoing percutaneous coronary intervention. The future direction of coronary artery disease and the role of direct oral anticoagulants will rely on further studies determining the optimal combination of antiplatelet and oral anticoagulant regimens that derive ischemic benefit without increased rates of bleeding. Additional upstream blockade of the coagulation cascade with factor XIIa and factor XIa inhibitors may also improve treatment in the future.

BACKGROUND Chromofungin (CHR: chromogranin-A 47-66) is a chromogranin-A derived peptide with anti-inflammatory and anti-microbial properties. Ulcerative colitis (UC) is characterized by a colonic decrease of CHR and a dysregulation of dendritic CD11c+ cells. AIM To investigate the association between CHR treatment and dendritic cells (DCs)-related markers in different immune compartments in colitis. METHODS A model of acute UC-like colitis using dextran sulphate sodium (DSS) was used in addition to biopsies collected from UC patients. RESULTS Intrarectal CHR treatment reduced the severity of DSS-induced colitis and was associated with a significant decrease in the expression of CD11c, CD40, CD80, CD86 and interleukin (IL)-12p40 in the inflamed colonic mucosa and CD11c, CD80, CD86 IL-6 and IL-12p40 within the mesenteric lymph nodes and the spleen. Furthermore, CHR treatment decreased CD80 and CD86 expression markers of splenic CD11c+ cells and decreased NF-κB expression in the colon and of splenic CD11c+ cells. In vitro, CHR decreased CD40, CD80, CD86 IL-6 and IL-12p40 expression in naïve bone marrow-derived CD11c+ DCs stimulated with lipopolysaccharide. Pharmacological studies demonstrated an impact of CHR on the NF-κB pathway. In patients with active UC, CHR level was reduced and showed a negative linear relationship with CD11c and CD86. CONCLUSION CHR has protective properties against intestinal inflammation via the regulation of DC-related markers and CD11c+ cells. CHR could be a potential therapy of UC.

Takotsubo syndrome is associated with life threatening arrhythmias, and the apical ballooning pattern is characterized by a peculiar QT prolongation and particularly high-risk of arrhythmias.The aim of the study was to determine the association of QT interval on electrocardiogram for ventricular arrhythmic complications in patients with apical ballooning Takotsubo syndrome in a diverse population at a large urban hospital in the U.S.We reviewed 105 cases of apical ballooning Takotsubo syndrome in patients admitted between 2011 and 2017. Two cardiologists reviewed the electrocardiograms to measure QT interval, adjusted for rate using the Fridericia formula (QTOf the 105 patients, 86 (82%) were female, and 34 (32%) were self-reported Black or African American. The mean age was 65 years (range: 58-72 years). Left ventricular ejection fraction was 25% (range: 25%-35%). Heart rate was 101 beats/min (range: 83-121 beats/min). Ten (11%) patients experienced a ventricular arrhythmic complication and had significantly longer QTIn a diverse population of patients with apical ballooning Takotsubo syndrome admitted to a large urban hospital in the United States, QT

The tendency of macrolide antibiotics to prolong the QT interval in certain patient populations is well documented. In contrast, limited reports exist of medication-induced deep T-wave inversions. We recently encountered a case of azithromycin-induced QT prolongation with concurrent deep TWI, an association that is rarely observed in clinical practice. As similar ECG changes can be seen with life-threatening conditions such as coronary ischemia and cerebral hemorrhage, comprehensive workup to rule out acute pathologies is critical when this pattern is recognized.

Direct current cardioversion (DCCV) is an increasingly prevalent procedure to disrupt abnormal rhythms and restore normal sinus rhythm. While considered a relatively safe procedure, complications can be severe. We add to the emerging research surrounding delayed presentations of cardiogenic shock post-DCCV. Together with a review of the current literature, we extrapolate that a combination of post-conversion cardiac shifts, myocardial stunning, and a unique cardioversion stress-induced cardiomyopathy contributed to this occurrence. To our knowledge, this represents one of only a few examples of delayed, non-arrhythmic, cardioversion-induced cardiogenic shock and the first to cause the combination of non-ST elevation myocardial infarction, acute liver injury, and acute kidney injury. Our case adds to the growing body of research highlighting this rare, but serious consequence of direct current cardioversion.

Background Patients with malignancy who experience metastasis to cardiac structures may exhibit ST-segment elevations and acute coronary syndrome (ACS) through poorly understood pathophysiologic mechanisms. We present a case in which vasodilator stress cardiovascular magnetic resonance provides unique insight into one such patient who suffered from recurrent episodes resembling ACS. Case summary A 58-year-old male with metastatic lung adenocarcinoma presented with refractory angina and dynamic inferior electrocardiogram changes. The patient was referred for adenosine stress cardiovascular magnetic resonance, revealing multiple territories of abnormal perfusion during rest with improvement during adenosine infusion. Subsequent computed tomography displayed tumour encasement of the right coronary artery. Taken together, vasodilator-responsive extrinsic compression of multiple epicardial coronary arteries was suspected. Outpatient oncology follow-up for chemoimmunotherapy initiation was arranged with the hope that reducing tumour burden might alleviate coronary compression. However, in the ensuing months, the patient’s disease advanced beyond the point of which his symptoms could be controlled medically, and he was ultimately enrolled in hospice care. Discussion Encasement of coronary arteries can result in anginal symptoms if their position impairs coronary arterial flow. The presented case highlights the unique manner in which these lesions might behave on stress cardiac magnetic resonance imaging. Clinicians who encounter such unusual findings on vasodilator stress imaging should consider metastatic lesions to the cardiac structures on the differential diagnosis.

Antiretroviral therapy (ART) has improved survival of patients living with HIV (PLWH); however, this has been accompanied by an increase in cardiovascular disease (CVD). Although preventative measures for CVD among the general population are well described, information is limited about CVD prevention among PLWH. The goal of this study was to characterize the prevalence of CVD in our population and to assess the use of primary and secondary prevention. We performed a retrospective review of PLWH receiving primary care at a large academic center in Miami, Florida. We characterized the prevalence of CVD, CVD risk, and the use of aspirin and statins for primary and secondary CVD prevention. A total of 985 charts were reviewed (45% women, 55% men). Average age was 52.2 years. Average CD4 count was 568 cells/microL. 92.9% were receiving ART, and 71% were virologically suppressed. The median 10-year ASCVD risk was 7.3%. The prevalence of CVD was 10.4% (N = 102). The odds of having CVD was lower in patients on ART (OR 0.47, 95% CI: 0.25–0.90, P = .02). The use of medications for primary and secondary prevention of CVD based on current guidelines was low: 15% and 37% for aspirin respectively, and 25% and 44% for statins. CVD risk and rates of CVD are high among PLWH and receiving ART could protect against CVD. However, the use of medications for primary and secondary prevention is low. Increased awareness of CVD risk-reduction strategies is needed among providers of PLWH to decrease the burden of CVD.

We discuss some old common knowledge puzzles and introduce a lot of new common knowledge puzzles.

Background Left ventricular assist devices (LVADs) play important roles in advanced heart failure (HF) management. In patients who experience myocardial recovery, the LVAD is often explanted via a resternotomy, which may negatively impact the newly recovered heart. We describe a case-series of LVAD discontinuation using a minimally invasive approach, focusing on thromboembolic phenomenon and infection rates in long-term follow-up. Methods Our study is a single-center, retrospective case series of patients with myocardial recovery after mechanical unloading with an LVAD. Patients underwent outflow graft ligation through a minimally invasive approach with driveline excision. Postdiscontinuation, patients obtained serial transthoracic echocardiograms for a minimum of 6 months and followed with our heart failure specialist. Results All 7 recovery patients had nonischemic cardiomyopathy and included 4 women (57%). Mean age was 44.3 ± 15.6 years. Median LVAD support duration was 454 (interquartile range, 326 to 1096) days. Intensive care unit length of stay and total length of stay were 3.4 ± 1.9 days and 6.3 ± 2.3 days, respectively. Blood transfusion rate was 0.86 ± 1.1 units. At a median follow-up of 874 (interquartile range, 864 to 1007) days, no patients developed thromboembolic phenomena despite use of aspirin only for prophylaxis. One patient experienced driveline infection, who had persistent driveline infection before procedure. Conclusions This minimally invasive approach for LVAD discontinuation through outflow graft ligation, driveline removal, and LVAD stoppage in setting of myocardial recovery avoids resternotomy risks. Despite leaving the LVAD in situ, there was no risk of thromboembolism or infection associated with residual hardware.

OBJECTIVE: Conventional cytology (CC) is a widely employed biomarker for the detection of bladder cancer, but due to its decreased sensitivity, liquid-based cytology (LBC) has been studied. Despite its improved cell-free background, decreased cell degeneration, and an automated slide preparation technique, it shows a variable rate of malignant cells detection. Thus, we did this study to compare the positivity of LBC with CC in eastern Indian population. MATERIAL AND METHODS: A total of 150 patients who underwent a transurethral resection of bladder tumor (June 2017 to December 2018) were enrolled. Pre-operative CC and LBC were processed from freshly voided urine samples. The malignant cells detection rate and influential factors were noted and compared. RESULTS: The detection of malignant cells by LBC was higher compared to CC (37.3% vs. 25.3%; p

BackgroundInflammation constitutes both positive and negative aspects to recovery following peripheral nerve injury. Following damage to the peripheral nervous system (PNS), immune cells such as macrophages play a beneficial role in creating a supportive environment for regrowing axons by phagocytosing myelin and axonal debris. However, a prolonged inflammatory response after peripheral nerve injury has been implicated in the pathogenesis of negative symptoms like neuropathic pain. Therefore, the post-injury inflammation must be carefully controlled to prevent secondary damage while allowing for regeneration. CRYAB (also known as alphaB-crystallin/HSPB5) is a small heat shock protein that has many protective functions including an immunomodulatory role in mouse models of multiple sclerosis, spinal cord injury, and stroke. Because its expression wanes and rebounds in the early and late periods respectively after PNS damage, and CRYAB null mice with sciatic nerve crush injury display symptoms of pain, we investigated whether CRYAB is involved in the immune response following PNS injury.MethodsSciatic nerve crush injuries were performed in age-matchedCryabknockout (Cryab−/−) and wildtype (WT) female mice. Nerve segments distal to the injury site were processed by immunohistochemistry for macrophages and myelin while protein lysates of the nerves were analyzed for cytokines and chemokines using Luminex and enzyme-linked immunosorbent assay (ELISA). Peritoneal macrophages from the two genotypes were also cultured and polarized into pro-inflammatory or anti-inflammatory phenotypes where their supernatants were analyzed for cytokines and chemokines by ELISA and protein lysates for macrophage antigen presenting markers using western blotting.ResultsWe report that (1) more pro-inflammatory CD16/32+macrophages are present in the nerves ofCryab−/−mice at days 14 and 21 after sciatic nerve crush-injury compared to WT counterparts, and (2) CRYAB has an immunosuppressive effect on cytokine secretion [interleukin (IL)-β, IL-6, IL-12p40, tumor necrosis factor (TNF)-α] from pro-inflammatory macrophages in vitro.ConclusionsCRYAB may play a role in curbing the potentially detrimental pro-inflammatory macrophage response during the late stages of peripheral nerve regeneration.

Additional file 1: Supplementary Fig. S1. Immunostaining of Iba1+ cells with CD68, iNOS and Arg1. Micrographs of CD68+ Iba1+ DAPI+ (a), iNOS+ Iba1+ DAPI+ (b) and Arg1+ Iba1+ DAPI+ (c) cells in sciatic nerves at 14 days post-injury in WT and Cryab-/- mice; bar = 20 μm.

Background: Inherent characteristics of patients with Obstructive Sleep Apnea (OSA), such as age, obesity, diabetes and hypertension increase the risk for cardiovascular diseases including heart failure (HF). Herein, we sought to elucidate if there is an increased likelihood of having heart failure with preserved ejection fraction (HFpEF) as OSA severity increases. Furthermore, we correlated a validated H2FpEF score system in this cohort with clinical and imaging findings for HFpEF. Results: Out of 585 charts reviewed from patients diagnosed with OSA, a total of 108 patients with a concomitant transthoracic echocardiogram (TTE) and electrocardiogram performed were identified. The median age was 59 years old with 55.6% being males and Hispanic predominance 64.5%. The comorbidities found in our cohort involved hypertension (63.9%), diabetes mellitus (30.6%), coronary artery disease (15.7%), HF (13%), atrial fibrillation (8.3%), and stroke (7.4%). Mean BMI was 32.48 kg/m 2 and average neck size 16.02 inches. TTE findings demonstrated an average ejection fraction of 58±7% and mean pulmonary artery systolic pressure of 24±10 mmHg. OSA severity distribution is shown in Table 1. No significant association was found between grade of severity of OSA with clinical diagnosis of HF, nor with diastolic dysfunction by TTE. The average probability of HFpEF by validated score was 50%, and the distribution of the score was the same across severity of OSA (p=0.260). Pearson’s correlation showed a significant positive relationship between age, BMI and PASP, and H2FpEF score (p Conclusion: Although patients with OSA might have a higher H2FpEF score due to inherent characteristics, the clinical diagnosis of HFpEF in our population was lower than expected by H2FpEF score, in which the degree of severity was not associated with a higher H2FpEF score.

Transcatheter aortic valve replacement (TAVR) has become a mainstay in treatment for patients with severe aortic stenosis who are considered high-risk surgical candidates. The use of TAVR in low-risk patients with severe aortic stenosis is being explored as an alternative to surgical aortic valve replacement (SAVR). Recent results from the Medtronic Evolut Low Risk trial and the Placement of Aortic Transcatheter Valves (PARTNER) 3 trial shed light on the use of TAVR in low-risk surgical candidates. The Evolut Low Risk trial compared TAVR with a self-expanding supra-annular bioprosthesis to SAVR in 1468 patients with severe aortic stenosis who were low surgical risk. Patients with a mean age of 74 and a mean Society of Thoracic Surgeons (STS) risk score of 1.9% were randomized to either TAVR or SAVR groups. Using the composite end point of death or disabling stroke at 24 months, the study found an incidence of 5.3% in the TAVR arm and 6.7% in the surgical arm. The Evolut Low Risk trial thus concluded that TAVR was statistically noninferior but not superior to SAVR (difference, −1.4 percentage points; 95% Bayesian credible interval for the difference, −4.9 to 2.1; posterior probability of noninferiority, >0.999). The PARTNER 3 trial assigned 1,000 patients with severe aortic stenosis and low surgical risk to either TAVR with transfemoral placement of balloon expandable valve or SAVR. Patients with a mean age of 73 and a mean STS score of 1.9% were randomized to either TAVR or SAVR groups. With respect to the primary endpoint of composite death from any cause, stroke, or rehospitalization, the study found an occurrence of 8.5% in TAVR and 15.1% in SAVR, confirming both noninferiority and superiority in the TAVR group [absolute difference, −6.6 percentage points; 95% confidence interval (CI), −10.8 to −2.5; P

Background Laparoscopic donor nephrectomy (LDN) is considered the gold standard for live donor nephrectomies owing to lesser pain, shorter hospitalization, and earlier return to normal activities, yet it remains a technically challenging surgery. Repetition of a highly skilled task such as LDN should lead to improved performance reflected in shorter surgery times and a decrease in adverse events. Methods The records of over 2524 LDNs from February 2004 to June 2019 were evaluated for duration of surgery (from incision time to clamping of the renal artery) and occurrence of complications. Results The mean duration of surgery ± SD from incision to clamp time for the first 100 cases at the inception of LDN was 166.13 ± 33.28 minutes whereas it was 124.59 ± 35.91 minutes for the best 100 consecutive cases in 2015 with a decrease of 41 minutes duration of surgery from incision to artery clamping. The adverse events were accessory renal artery injury (n = 10), splenic laceration (n = 2), bowel and mesocolon injuries (n = 12), venous or arterial clip slippage (n = 4), inferior vena cava tear (n = 2) pneumothorax (during stapler application, n = 1), missing gauze counts (n = 1), chylous ascites (n = 1), ureteric thermal injury (n = 2), and renal parenchyma injury (n = 3). Conclusions LDN is a technically demanding surgery where surgeon experience appears to affect operative metrics such as operative time. The occurrence of intraoperative complications appears to be acceptably low, although serious complications are a possibility.

Prediction of vortex induced vibration (VIV) and estimation of fatigue damage for subsea multi planar structures exposed to significant current condition is an important topic for subsea engineering. Due to the multi-planar characteristics of structure, the VIV induced stress states of subsea jumper are normally with the combination of flexural and bending stresses. Consequently, the associated fatigue is a multi-axial fatigue problem. In this study a novel energy-critical plane method by Farahani [1][2] has been used for fatigue assessment instead of the traditional method with utilizing the stress range and SN curve, for example the 1st principle stress method as recommended by DNVGL-RP-F105 (2017) [3]. By using this method, the phase change of the stress from different modes is considered. A case study based on previous jumper experiments by ExxonMobil is included. Fatigue results have been compared with DNVGL-RP-F105 (2017) [3] approach. Advantages of energy-critical plane approach have been discussed. Phase change between flexural and torsional stresses has been successfully captured and its effect on fatigue damage has been presented. Additionally, some discussions have been performed with respect to the application of DNVGL-RP-F105 (2017) [3] to calculate the VIV fatigue to subsea rigid jumpers.

BACKGROUND AND PURPOSE: An alteration in the communication between the innate and adaptive immune cells is a hallmark of ulcerative colitis (UC). Semaphorin‐3E (SEMA3E), a secreted guidance protein, regulates various immune responses. EXPERIMENTAL APPROACH: We investigated the expression of SEMA3E in colonic biopsies of active UC patients and its mechanisms in Sema3e (−/−) mice using an experimental model of UC. KEY RESULTS: SEMA3E level was decreased in active UC patients and negatively correlated with pro‐inflammatory mediators. Colonic expression of SEMA3E was reduced in colitic Sema3e (+/+) mice, and recombinant (rec‐) Plexin‐D1 treatment exacerbated disease severity. In vivo rec‐SEMA3E treatment restored SEMA3E level in colitic Sema3e (+/+) mice. In Sema3e (−/−) mice, disease severity was increased, and rec‐SEMA3E ameliorated these effects. Lack of Sema3e increased the expression of CD11c and CD86 markers. Colitic Sema3e (−/−) splenocytes and splenic CD11c(+) cells produced more IL‐12/23 and IFN‐γ compared to Sema3e (+/+), and rec‐SEMA3E reduced their release as much as NF‐κB inhibitors, whereas an NF‐κB activator increased their production and attenuated the effect of rec‐SEMA3E. Colitic Sema3e (−/−) splenic CD11c(+)/CD4(+)CD25(−) T‐cell co‐cultures produced higher concentrations of IFN‐γ and IL‐17 when compared to colitic Sema3e (+/+) splenic cell co‐cultures, and rec‐SEMA3E decreased these effects. In vitro, anti‐IL‐12p19 and ‐12p35 antibodies and rec‐IL‐12 and ‐23 treatment confirmed the crosstalk between CD11c(+) and CD4(+)CD25(−) T‐cells. CONCLUSION AND IMPLICATIONS: SEMA3E is reduced in colitis and modulates colonic inflammation by regulating the interaction between CD11c(+) and CD4(+)CD25(−) T‐cells via an NF‐κB‐dependent mechanism. Thus, SEMA3E could be a potential therapeutic target for UC patients.

Introduction Deceased donor kidney transplant are still not common across India. This study was done to assess various measures taken at a single center level to increase organ donation rate and to analyse the outcomes of transplants performed from these donors. Methods All deceased donor renal transplants performed from November 2011 to February 2017 were analysed for patient and death censored graft survival, rate of delayed graft function, rate of rejection and mortality. Kaplan Meir analysis for Survival Curves was used. Results Organ donation rate at our center improved from one donation every alternate year in 2004 to a peak of 44 donations in 2017. Patient survival was 93.42%, 89.44%, 85.53%, and death censored graft survival was 94.07%, 88.21%, and 82.86% at 1, 2 and 3 years respectively. Mean duration of hemodialysis pre transplantation was 34.6 ± 27.43 months. Conclusions This study has shown that steps taken at a single center level alone can also significantly improve organ donation rates. Employment of dedicated professionals including transplant surgeons and coordinators, developing a protocol-based approach for referral, and early counseling in triage along with regular audits can help to establish deceased donor program with acceptable outcomes elsewhere in the country.

The increased prevalence of major adverse cardiovascular events in Persons Living with HIV (PLWH) has been well documented. However, there remains a paucity of data relating to the epidemiology of valvular heart disease (VHD) in PLWH. We performed a retrospective analysis on the prevalence and

Since the advent of HIV therapy, there has been a decrease in HIV-related mortality, but an increased risk of coronary artery disease (CAD). Previous studies suggested that patients living with HIV (PLWH) underwent less cardiac procedures including cardiac catheterization (CC), compared to the

We have previously shown that PARP-1 inhibition provides protection against lung inflammation in the context of asthma and acute lung injury. Olaparib is a potent new generation PARP inhibitor that has been approved for human testing. The present work was designed to evaluate its beneficial potential against LPS-induced acute lung injury and acute kidney injury upon intratracheal administration of the endotoxin in mice. Administration of olaparib at different doses, 30 min after LPS treatment showed that single intraperitoneal injection of the drug at 5 mg/kg b.wt. reduced the total number of inflammatory cells particularly neutrophils in the lungs. This was associated with reduced pulmonary edema as the total protein content in the bronchoalveolar fluid was found to be decreased substantially. Olaparib provided strong protection against LPS-mediated secondary kidney injury as reflected by restoration of serum levels of urea, creatinine, and uric acid toward normal. The drug restored the LPS-mediated redox imbalance toward normal in lung and kidney tissues as assessed by measuring malondialdehyde and GSH levels. Finally, RT-PCR data revealed that olaparib downregulates the LPS-induced expression of NF-κB-dependent genes namely TNF-α, IL-1β, and VCAM-1 in the lungs without altering the expression of total p65NF-κB. Overall, the data suggest that olaparib has a strong potential to protect against LPS-induced lung injury and associated dysfunctioning of kidney in mice. Given the fact that olaparib is approved by FDA for human testing, our findings can pave the way for testing of the drug on humans inflicted with acute lung injury.

Spontaneous coronary artery dissection (SCAD) comprises 35% of all acute coronary syndrome (ACS) cases in patients younger than 60 years. Standard treatment for SCAD is not well studied. This condition has a strong female predominance (90-95%), even in those without traditional cardiac risk factors

Introduction: Office cystourethroscopy is one of the common and most frequent urological procedures. Pain and anxiety during the procedure might lead to noncompliance and incomplete cystoscopic examination. Negotiating cystoscope through external sphincter is the most painful and uncomfortable distressing part of cystoscopy. To overcome this, manual compression of irrigation bag during cystoscopy has been used and found to be helpful. Numerous other methods were also studied. Despite these, cystoscopy is still painful and causes anxiety in patients. External sphincter gets relaxed naturally during the act of micturition. Based on this principle, pain and anxiety were studied with voiding instruction during cystourethroscopy. Objective: To study the effect of voiding instruction on anxiety and pain during cystourethroscopy using the Hamilton Anxiety Rating Scale (HAM-A) and visual analogue scale (VAS), in a well-matched Eastern Indian male patient population in a prospective, randomized pattern. Methods: A total of 100 male patients were recruited from those who underwent cystourethroscopy examination in SSKM Hospital and were prospectively randomized into two groups: cystoscopy with or without voiding instruction. Pre- and postprocedure HAM-A score and postprocedure VAS score were recorded. Results: The mean postprocedural pain (VAS) score between voiding instructed and noninstructed groups reached statistical significance: 3.06 ± 1.98 (Range, 2–5) and 5.16 ± 2.86 (Range, 4–8), respectively (P < 0.001). Preprocedure HAM-A score was similar between both groups. Postprocedure median HAM-A score was statistically significantly lower (mean 17.86 ± 2.8 vs. 19.76 ± 3.12; P < 0.001) in voiding instructed group. Conclusion: Pain and anxiety level during cystourethroscopy examination in males can be significantly reduced when the patient is instructed to void during cystourethroscopy examination.

Background: Notable number of prostatic carcinoma patients presented with bladder outlet obstruction. Among various treatment options like antiandrogen therapy, catheterisation, laser therapy, prostatic stent and pTURP, pTURP offers expeditious relief of symptoms. As, there is paucity of literature regarding outcome and complication of pTURP in Indian context. So, author did single centre indication (of surgery) matched retrospective case control study to know functional outcomes and morbidity of pTURP in eastern Indian population.Methods: Author did retrospective review of 29 patients who underwent pTURP during study period (January 2013 to January 2018) after exclusion. Same number of TURP (for benign disease) patients were selected. Functional outcome and complications of pTURP were compared with TURP group. Author also tried to find factors associated with un-favourable outcomes.Results: Despite of older pTURP group patients, operative duration, post-operative hospital stay, post-operative catheter duration and post-op maximum urinary flow rate, were statistically similar to TURP group. However, statistically similar but clinically more complication was noted in pTURP arm in terms of failed voiding trial, incontinence and re-operation rate. One capsular tear was noted only in TURP arm. Eight patients developed unfavourable outcome (1 persistent incontinence, 5 needed re-surgery and 2 required re-catheterisation in follow up period). Higher PSA, longer operative time and hormone refractory metastatic prostatic carcinoma were found to be associated with unfavourable outcome.Conclusions: pTURP is safe and effective procedure to relieve bladder outlet obstruction. Hormone refractory status, higher PSA and prolonged operative time may be risk factors of poor outcome.

Laparoscopic donor nephrectomy (LDN) converted a retroperitoneal (RP) procedure into a transperitoneal (TP) operation with reports of bowel and solid organ injuries leading to mortality in occasional cases. Laparoscopic RP donor nephrectomy can reduce these risks but never became popular because of the muscle cutting approach. Lumbotomy incision can be used to approach retroperitoneum by incising fascial planes, eliminating disadvantages of the RP approach. This report compares the outcomes of the standard multiport TP LDN with translumbar laparoendoscopic single-site donor nephrectomy (LESS-DN).Between January 2016 and June 2017, 50 voluntary kidney donors out of 267 donors were randomized to undergo LESS-DN vs LDN. Donors with body mass index ≥30 kg/mThe RP group experienced lesser pain (VAS score 0.3 ± 0.3 vs 1.1 ± 0.0, p = 0.000), lesser analgesic requirement (186 ± 51.07 mg vs 254 ± 62.7 mg, p = 0.000), and faster convalescence (7.0 ± 3.0 days vs 10.7 ± 3.3 days, p = 0.00) related to smaller cumulative incision (7.8 ± 0.8 cm vs12.4 ± 2.0 cm, p = 0.00), and had reduced operative time (142 ± 26.2 minutes vs 170.8 ± 34.75 minutes, p = 0.001) and blood loss. Other recorded parameters were similar in both the groups.The single port RP approach significantly reduced postoperative pain and hastened recovery when compared with the TP approach. Converting to a RP approach presents an opportunity for surgeons to further reduce morbidity associated with the donor nephrectomy.

The efficacy of patent foramen ovale (PFO) closure devices for secondary prevention of cryptogenic strokes has long been a topic of uncertainty. However, new evidence derived from well-designed randomized controlled trials appears to suggest otherwise. We conducted a meta-analysis including recently

BACKGROUND: Ulcerative colitis (UC) is characterized by altered levels of chromogranin-A (CHGA) and a dysregulation of dendritic cells (DCs). CHGA, a prohormone protein, can be cleaved into several bioactive peptides including chromofungin (CHR: CHGA(47-66)) encoded by CHGA Exon-IV. Previously, we demonstrated that CHR is reduced in active UC patients and protects against intestinal inflammation through modulation of the macrophages plasticity. Thus, we hypothesized that CHR regulates other antigen presenting cells functions like DCs during the progression of colitis. AIMS: We aimed to investigate the association between CHR and DCs in patients with active UC, and underlay the effect of CHR treatment on DCs functions in dextran sulfate sodium (DSS)-induced colitis. METHODS: mRNA levels of CHR (CHGA Exon-IV) and its association with DCs markers (interleukin (IL)-23, IL-12p40, CD86, CD11C, CRR7, CD74, IL-12A) were quantified in colonic biopsies of patients with active UC and healthy individuals. Colitis was induced in C57BL/6 mice (7–8 weeks) by 5% DSS (wt./vol.) for 5 days. Intra-rectal administration of CHR (2.5 mg/kg/day) started one-day before induction of colitis and lasted for 6 days. Disease activity index (DAI), macroscopic and microscopic scores were assessed. Colonic levels of interleukin (IL)-23, IL-12p40, cluster of differentiation (CD) 86, CD11C, C-C chemokine receptor (CCR)7, CD74 and IL-12A were determined using ELISA and/or RT-qPCR. In-vitro, splenic CD11c(+) cells were isolated from naïve and colitic mice, cultured overnight in the presence or absence of CHR (10(–6) M) and CD40, CD80, and CD86 markers were quantified using flow cytometry. RESULTS: In patients with active UC, CHR level is reduced and showed a negative relationship with DCs markers; IL23 (r= -0.3725), IL12p40 (r= -0.3706), CD11C (r= - 0.4647), CRR7 (r= -0.3709), IL12A (r = -0.4253), CD86 (r= -0.6765), and CD74 (r= -0.3647). In-vivo, CHR treatment reduced the severity of the colitis and is associated with a significant decrease in colonic levels of IL-23, IL-12p40, and CD86, and without significant changes in the levels of CD11c, CCR7, CD74, and IL-12A. In-vitro, CHR treatment reduced CD40 and CD80 expression in splenic CD11c(+)cells isolated from colitic mice when compared with PBS-treated group. No differences were detected in the expression of CD86. CONCLUSIONS: CHR regulates the development of colitis, and modulates CD11c(+) cells markers of immune activation. Further studies are warranted to understand the possible effects of CHR on the crosstalk between CD11c(+) cells and T-cells. These findings provide the foundation of future potential therapeutic strategies in UC. FUNDING AGENCIES: Mindel and Tom Olenick Scholarship in Gastroenterology

The safety and reliability of air transportation depends on minimizing inspection and maintenance errors that occur in the aircraft maintenance system. Efforts have been invested to track maintenance errors. These efforts are reactive in nature: they analyze maintenance errors after their occurrence. There is a lack of standardization in the assessment of maintenance errors across the maintenance industry. Surveillance and auditing of maintenance activities are two important functions which help ensure airworthiness of an aircraft. A system that will document the processes and outcomes of these maintenance activities and will make this documentation more accessible will accomplish the goal of this research to reduce maintenance error. Such a system would then support robust and safer aircraft maintenance operations. Our research is developing a web-based surveillance and auditing tool (WebSAT) that promotes a standardized format for maintenance data collection, reduction and analysis to proactively identify the factors contributing to improper maintenance.