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Five 43-kg barrows [(Dutch Landrace x Yorkshire) x Yorkshire] were fitted with steered ileocecal valve cannulas to compare the effects of K-diformate (KDF), a specifically conjugated salt vs its molecular constituents, namely, formic acid and K-formate, as acidifiers in lysine-deficient diets on the apparent ileal (ID) and fecal digestibility, retention of nutrients, and manure production. The animals were randomly assigned to five dietary treatments according to a 5 x 5 Latin square design as follows: 1) control-no acidifier; 2) 1% KDF (= 0.65% K-formate + 0.35% formic acid, or 0.7% [HCO[O.sup.-]] + 0.3% [[K.sup.+]]); 3) 0.65% K-formate (= 0.35% [HCO[O.sup.-]] + 0.3% [[K.sup.+]]); 4) 0.35% formic acid (= 0.35% [HCO[O.sup.-]]); and 5) 1.3% K-formate (= 0.7% [HCO[O.sup.-]] + 0.6% [[K.sup.+]]). Diets were formulated with barley, wheat, soybean meal, and canola meal as major ingredients, and provided all nutrients at adequate levels, except for lysine (24% less than estimated requirement). Feeding level was equal to 2.5 x maintenance requirement (MR) for ME (MR = 418 kJ ME*B[W.sup.-0.75), and daily rations were given in two portions after mixing with water in a ratio of 1:2.5. Chromic oxide was used as an indigestible marker. No clinical health problems due to the dietary treatments were observed. Irrespective of the additive, there were no differences (P [less than or equal to] 0.10) in the ID of DM, OM, CP, or essential amino acids compared to the control, except for phenylalanine (P [less than or equal to] 0.05). Among nonessential AA, only the ID of tyrosine tended (P = 0.092) to increase (up to 3.9 percentage units). The fecal digestibility of ash and K were greater (P [less than or equal to] 0.001) in pigs fed supplemental K, irrespective of its source. The greater intake and fecal digestibility of K corresponded with greater (P [less than or equal to] 0.05) losses of K in urine. Body retention of N, Ca, total P, and K was similar (P [greater than or equal to] 0.10) among treatments. As estimated from a separate nonorthogonal analysis, supplemental K improved (P [less than or equal to] 0.05) body N by 3.7 percentage units compared to the control. The results of this study do not provide a clear explanation for the improved growth performance reported previously with KDF and its molecular constituents, and further research on their in vivo mode of action will require methodological refinement, especially with regard to the efficiency of AA utilization. Key Words: Pigs, Digestibility, Retention

Four barrows of approximately 40 kg initial body weight, fitted with post-valvular T-cecum cannulas, were used to study the effect of lecithin as an external emulsifier on apparent ileal and overall digestibility of crude fat, fatty acids, and other dietary nutrients (DM, N, GE, crude fiber [CF], P, Ca, and Mg), as well as the utilization of N, GE, Ca, P, and Mg. Two levels of lecithin (0 and .24%) and two levels of rendered fat (0 and 6%) in cereal-soybean meal-based diets were investigated according to a 4 x 4 Latin square design. No significant interactions were found between lecithin and rendered fat for apparent digestibility of crude fat as estimated at the end of the small intestine and the total digestive tract. Lecithin decreased the apparent ileal digestibility of C16:0 fatty acid (P [is less than] .1) and the apparent overall digestibility of C14:0 fatty acid (P [is less than] .05) and C18:2 fatty acid (P [is less than] .1). The apparent ileal and overall digestibility of crude fat (P [is less than] .001) and total fatty acids (P [is less than] .05) increased with the inclusion of rendered fat in diets. Furthermore, rendered fat increased the apparent ileal and overall digestibility of C14:0 (P [is less than] .01), C16:1 (ileal, P [is less than] .001; overall, P [is less than] .1), and C18:1 (P [is less than] .05) fatty acids and the apparent overall digestibility of C18:0 (P [is less than] .001) fatty acid. Lecithin had no impact on the apparent digestibility and retention (percentage of intake) of GE, N, total P, Ca, and Mg. Rendered fat increased the apparent digestibility of DM (ileal, P [is less than] .1; overall, P [is less than] .05), N (P [is less than] .05), and GE (P [is less than] .05) at the terminal ileum and total tract. Also, the apparent ileal digestibility of Ca (P [is less than] . 1) and the retention (percentage of intake) of N, ME, and [ME.sub.n] were improved (P [is less than] .05) by the addition of rendered fat. Dietary lecithin had no influence on the apparent ileal or overall digestibility of rendered fat as estimated in the small intestine and the whole digestive tract of pigs.

Lecithin was investigated in diets for growing-finishing pigs. Diets were based on corn and soybean meal and contained a constant ME:lysine level. The use of lecithin as an emulsifier on utilization of soy oil by the pig was investigated in Exp. 1. Diets were arranged in a 2 x 2 factorial structure with two levels of lecithin (0 and 2%) and two levels of soy oil (0 and 6%). There were no interactions between lecithin and soy oil for any measurements of growth performance. In general, the inclusion of lecithin or soy oil did not affect (P |is greater than~ .1) ADG but did improve (P |is less than~ .01) gain/feed during the finishing period and during the entire experiment. During the finishing period, gain/ME intake was improved (P |is less than~ .01) by both lecithin and soy oil. The use of lecithin as an energy source for pigs was investigated in Exp. 2. Dietary treatments were corn and soybean meal diets with 0, 1, 2, or 3% lecithin. There were no significant differences in performance of pigs as measured by ADG, ADFI, gain/feed, and gain/ME intake among the four lecithin levels. Lecithin did not improve utilization of soy oil by growing-finishing pigs. Furthermore, lecithin was not an efficacious source of supplemental dietary fat for growing-finishing pigs in this study.

One digestibility experiment (Exp. 1) and two growth experiments (Exp. 2 and 3) were conducted to evaluate the use of lecithin as an emulsifier of soy oil and(or) an energy source in a two-phase starter diet program. Phase 1 consisted of d 0 to 14 postweaning, and Phase 2 consisted of d 14 to 35 postweaning. Diets were based on corn, soybean meal, and 20% dried whey and contained a constant ME:lysine level. In Exp. 1 and 2, two levels of lecithin (0 and 2%) at two levels of soy oil (0 and 6%) were investigated. In both experiments, there was no interaction between lecithin and soy oil for any traits measured. In Exp. 1, the apparent digestibility of fat increased significantly with increased fat level in the diets. Addition of lecithin to diets improved (P |is less than~ .05) nitrogen retention, and the addition of soy oil significantly improved apparent digestibility of DM, GE, fat, and CP. In Exp. 2, there was no significant effect of lecithin or soy oil on ADG. In Phase 2 and overall, the inclusion of lecithin and soy oil to diets significantly increased gain/feed but did not significantly improve gain/ME intake. In Exp. 3, pigs were fed diets containing 0, 1, 2, or 3% lecithin. The addition of lecithin to diets did not affect ADG, ADFI, gain/feed, or gain/ME intake during Phases 1, 2, or overall. These results fail to demonstrate that the addition of lecithin to diets for young pigs improves utilization of soy oil or growth performance.

The aim of this investigation was to study the effect of K-diformate on the intraluminal pH, microbial composition in digesta and feces, organic acids along the digestive tract, and alterations of the gastric epithelium of pigs. Pigs (n = 36) weaned at 28 d of age were allotted to two groups and fed without (control diet) or with 1.8% supplemental K-diformate. Fecal samples were taken from the rectum on d 0, 1, 3, 5, 7, 14, 21, and 28 postweaning. Half of the animals from each group were killed on d 7 and the other half on d 29 postweaning. Growth performance was not different for both groups (P [is greater than or equal to] 0.73). The gastric epithelium was not negatively affected by K-diformate (P = 0.25). Potassium-diformate decreased (P [is less than or equal to] 0.04) or tended to decrease (P [is less than or equal to] 0.10) the counts of total anaerobic bacteria, lactic acid bacteria, and yeasts in feces and digesta samples from the stomach, distal small intestine, cecum, and middle segment of the colon. The pH along the gastrointestinal tract of piglets was not affected by K-diformate (P [is greater than or equal to] 0.30). On d 7, the concentration of lactic acid along the gastrointestinal tract was similar with both diets (P = 0.15). On d 29, the concentrations of lactic acid tended to be lower along the small intestine (P [is less than or equal to] 0.08) and the stomach (P = 0.11) of the pigs fed K-diformate. Formic acid in digesta was detected at significant levels only in the distal segment of the small intestine of the control pigs (from 4 to 11 mmol/kg of wet digesta), whereas considerable amounts were measured in the stomach (from 23 to 40 mmol/kg of wet digesta) and all segments of the small intestine (from 7 to 25 mmol/kg of wet digesta) in the K-diformate-fed pigs on both days. On d 7, pigs fed the K-diformate diet had a tendency (P [is less than or equal to] 0.08) to have higher concentrations of organic acids (acetic + propionic + butyric) in the digesta of the distal small intestine, cecum, and proximal colon. On d 29, both groups had similar concentrations of these acids, irrespective of the segment of the gastrointestinal tract (P = 0.95). Our study showed that the addition of K-diformate to a starter diet for piglets decreased total anaerobic bacteria, lactic acid bacteria, coliforms, and yeasts in feces and in digesta from various segments of the gastrointestinal tract, without affecting the gastric or intestinal pH. Key Words: Formates, Microbial Flora, pH, Pigs, Short Chain Fatty Acids

Three experiments were conducted to evaluate the effect of adding salts of formic acid to diets for growing-finishing pigs. In Exp. 1, 72 pigs (23.1 kg and 104.5 kg initial and final BW) were used to evaluate the effect of Ca/Na-formate and K-diformate on performance and carcass traits. Treatments were organized in a 2 x 3 factorial arrangement with two feeding regimens (limit and semi-ad libitum feeding) and three diets (control, .85% Ca/Na-formate, and .8% K-diformate). No significant feeding regime x diet interaction was found. The K-diformate diet increased overall ADG of pigs compared with the control and Ca/Na-formate diets, but had no effect on ADFI or gain/feed (G/F) ratio. Neither K-diformate nor Ca/Na-formate had any effect on carcass lean or fat content. In Exp. 2, 10 limit-fed pigs (24.3 kg and 85.1 kg initial and final BW) were used to study the effect of K-diformate on performance and sensory quality of pork. Adding .8% K-diformate to diets increased ADG (P [is less than] .13) and G/F (P [is less than] .04), but had no effect on sensory quality of the pork or content of formate in liver, kidney, or muscle tissue of pigs. In Exp. 3, 96 limit-fed pigs (27.1 kg and 105 kg initial and final BW) were used to determine the effect of adding K-diformate to diets on performance, carcass traits, and stomach keratinization and(or) lesions. Adding K-diformate (0, .6, or 1.2%) to diets increased ADG and ADFI (linear P [is less than] .01). The K-diformate reduced the percentage of carcass fat (linear P [is less than] .03) and fat area in the cutlet (linear P [is less than] .09) and increased percentage lean in the ham (linear P [is less than] .01), flank (linear P [is less than] .02), loin (linear P [is less than] .09), and neck and shoulder (linear P [is less than] .09). The K-diformate had no negative effect on stomach alterations. In Exp. 3, the concentration of coliform bacteria in the gastrointestinal tract was evaluated in eight control and eight 1.2% K-diformate-fed pigs. The K-diformate reduced the number of coliforms in the duodenum (P [is less than] .03), jejunum (P [is less than] .02), and rectum (P [is less than] .10) of pigs. In conclusion, K-diformate improved growth performance and carcass quality of growing-finishing pigs, whereas Ca/Na-formate had no effect. K-diformate had no adverse effect on sensory quality of pork or on stomach alteration scores. Key Words: Carcass Traits, Formate, Growth Performance, Pigs, Sensory Quality

Two growth experiments and one digestibility experiment were conducted to study the effect of trimethylamine oxide (TMAO) and betaine in swine diets. In Exp. 1, 36 limit-fed pigs averaging 19.1 kg in initial weight were used to study the effect of adding TMAO at 10 g/kg of feed or betaine at an equivalent level of methyl groups (10.5 g/kg feed) to a high-fat (11.3% ether extract) basal diet. Dietary addition of TMAO increased ADG by 61 g/d, reduced number of days to market by 8.3 d (P < .02), and tended (P < .09) to improve gain/feed (G/F) compared with the control diet. Betaine had no effect on growth performance of pigs. Adding TMAO or betaine to diets had no effect on percent carcass fat, percent carcass lean, or dressing percentage. Dietary supplementation of TMAO reduced (P < .05) plasma triacylglycerol level (TAG) compared with the control diet. There was no effect of dietary TMAO or betaine on sensory quality characteristics of pork. In Exp. 2, 48 ad libitum-fed pigs averaging 21.7 kg initial BW and 104.7 kg final BW were used to determine the effect of adding low and intermediate levels of TMAO (1, 2, or 5 g/kg) to diets. Adding I g of TMAO increased G/F (P < .01) compared with control pigs. When using orthogonal contrasts, adding 2 g of TMAO reduced (P < .05) P2 backfat thickness and tended to increase (P < .09) lean percentage compared with the control diet. Trimethylamine oxide gave a quadratic effect (P < .05) on plasma TAG levels. Adding 1 and 2 g of TMAO increased plasma TAG, but 5 g of TMAO decreased it compared with the control diet. In Exp. 3, 12 barrows of 42.3 kg average initial BW and 50.0 kg final BW were used to investigate the effect of supplementing diets with I g of TMAO and 1.27 g of betaine/kg of feed on apparent total tract nutrient digestibility. The addition of TMAO increased (P < 0.03) apparent total tract digestibility of fat (HCl-EE). Betaine had no such effect. Adding TMAO to diets influenced growth performance and carcass quality in a dose-dependent manner. Key Words: Pigs, Trimethylamine oxide, Betaine, Animal Fat, Sensory Evaluation

Forty-eight cross-bred [(Norwegian Landrace×Yorkshire)×(Norwegian Landrace×Duroc)] growing-finishing pigs (average 28.3 kg initial body weight and 104.7 kg final weight) were used to study the effect of adding food waste products (FWP) in diets. The treatments were comprised of six levels of FWP (0, 20, 40, 60, 80 and 100% of net energy), in combination with a barley-soybean diet. The FWP consisted of food leftovers, waste from food-processing plants, bakery waste, dairy waste and blood. The chemical composition of FWP averaged 214 g kg[sup -1] dry matter, 49 g kg[sup -1] crude protein, 33 g kg[sup -1] crude fat, 5 g kg[sup -1] crude fibre, 115 g kg[sup -1] N-free extracts and 12 g kg[sup -1] ash. Increasing dietary levels of FWP reduced (linear, P<0.001) average daily intake of feed on a dry matter basis (ADFI), and ADFI was significantly lower when pigs were fed the diets with 60% or more of net energy as FWP. Increasing dietary levels of FWP reduced (linear, P<0.01) the fat firmness and lightness (L* values) of both backfat and loin meat. The proportion of saturated fatty acid in backfat decreased (linear, P<0.001), while the proportion of polyunsaturated fatty acids increased (quadratic, P<0.05). The sensory quality of loin muscle was not affected by dietary treatment. To conclude, FWP could be used at moderate levels for growing-finishing pigs without negatively affecting growth performance, carcass characteristics or meat quality. [ABSTRACT FROM AUTHOR]

Introduction: Robot-assisted Laparoscopic Appendicovesicostomy (RALAPV) is increasingly performed as a minimally invasive alternative to the open appendicovesicostomy (OPAV), but questions remain regarding the efficacy of the RALAPV compared to OPAV., Objective: To assess and compare outcomes for non-augmented RALAPV to the open surgical approach., Materials and Methods: An IRB approved prospective registry was retrospectively examined to abstract all patients who underwent APV without augment between 2012 and 2023. Baseline demographics, intra and post-operative characteristics, and long-term outcomes were aggregated and compared. P-values were two sided and a p-value <0.05 was considered statistically significant., Results: 52 children were identified, 19 (36.5%) OAPV and 33 (63.5%) RALAPV. The median age at surgery was 8.5 years for OAPV and 9.3 years for RALAPV (p = 0.29). Longer operative time was noted in the RALPAV group (346 min vs 289 min, p = 0.04), with a lower estimated blood loss (5 cc vs 30 cc, p = 0.003), shorter median length of hospital stay (4 days vs 5 days, p = 0.07), and lower IV morphine administration (0.04 mg/kg/d vs 0.09 mg/kg/d, p = 0.01). Similar surgical reintervention rate was seen in both cohorts (42% OAPV vs 36% RALAPV, p = 0.77). At the end of follow-up, continence was achieved in 18 (95%) OAPV and 33 (100%) RALAPV patients (p = 0.37) CONCLUSIONS: RALAPV shows comparable success to patients who underwent OPAV procedures. The longer follow-up interval for OPAV highlights minimally invasive surgery as a recent adoption., Competing Interests: Conflict of interest The authors have no conflicts of interest to disclose., (Copyright © 2024 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Background: Although primary care is associated with population health benefits, the supply of primary care physicians continues to decline. Internal medicine (IM) primary care residency programs have produced graduates that pursue primary care; however, it is uncertain what characteristics and training factors most affect primary care career choice., Objective: To assess factors that influenced IM primary care residents to pursue a career in primary care versus a non-primary care career., Design: Multi-institutional cross-sectional study., Participants: IM primary care residency graduates from seven residency programs from 2014 to 2019., Main Measures: Descriptive analyses of respondent characteristics, residency training experiences, and graduate outcomes were performed. Bivariate logistic regression analyses were used to assess associations between primary care career choice with both graduate characteristics and training experiences., Key Results: There were 256/314 (82%) residents completing the survey. Sixty-six percent of respondents (n = 169) practiced primary care or primary care with a specialized focus such as geriatrics, HIV primary care, or women's health. Respondents who pursued a primary care career were more likely to report the following as positive influences on their career choice: resident continuity clinic experience, nature of the PCP-patient relationship, ability to care for a broad spectrum of patient pathology, breadth of knowledge and skills, relationship with primary care mentors during residency training, relationship with fellow primary care residents during training, and lifestyle/work hours (all p < 0.05). Respondents who did not pursue a primary care career were more likely to agree that the following factors detracted them from a primary care career: excessive administrative burden, demanding clinical work, and concern about burnout in a primary care career (all p < 0.05)., Conclusions: Efforts to optimize the outpatient continuity clinic experience for residents, cultivate a supportive learning community of primary care mentors and residents, and decrease administrative burden in primary care may promote primary care career choice., (© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.)

We have much to learn from other living organisms when it comes to engineering strategies to combat bacterial infections. This study describes the fabrication of cicada wing-inspired nanotopography on commercially pure (CP) nitrile sheets and nitrile gloves for medical use using the reactive ion etching (RIE) technique. Antibacterial activity against P. aeruginosa was tested using two different surface morphologies. It was observed that the etched nitrile surfaces effectively minimized bacterial colonization by inducing membrane damage. Our findings demonstrate a single-step dry etching method for creating mechanobactericidal topographies on nitrile-based surfaces. These findings have utility in designing next-generation personal protective gear in the clinical setting and for many other important applications in the age of antimicrobial resistance.

Ovotesticular syndrome is a rare disorder of sex development characterized by the presence of testicular and ovarian tissue. The histologic characteristics of human testicular tissue are well defined by the presence of seminiferous cords or tubules containing TSPY-positive germ cells and Sox9-positive Sertoli cells surrounded by interstitial tissue containing cytochrome P450-positive Leydig cells and smooth muscle α-actin-positive peritubular myoid cells. The histological characteristics of the ovary can be defined by germ cell nests and the development of follicles. In contrast to the testis, the ovary has a paucity of defined specific protein markers, with the granulosa cell marker FOXL2 being the most widely used. In practice, defining the ovarian component of the ovotestis can be quite difficult. We developed a model of human ovotesticular syndrome by combining fetal human testis and ovary in a xenograft model. Ovotesticular xenografts were grown under the renal capsules of gonadectomized athymic nude mice for 6-32 weeks along with age matched control grafts of fetal testis and ovary. Forty ovotesticular xenografts and their controls were analyzed by histology, immunohistochemistry, and fluorescent in situ hybridization to determine the protein expression and karyotype of the cells within the grafts. The ovotesticular xenografts exhibited recognizable testicular and ovarian tissue based on testis-specific and ovary-specific markers defined above. The xenografts simulated a bipolar ovotestis in which the testicular and ovarian elements retain their separate histological characteristics and are separated by a well-defined border. This contrasts with the compartmentalized ovotestis previously described in the literature where the testicular tissue is surrounded by ovarian tissue or a mixed histology where testicular and ovarian tissues are interspersed throughout the gonad. In conclusion, we have characterized a human model of ovotestis which will allow a deeper understanding of ovotestis development in humans and facilitate a more accurate diagnosis of the ovotesticular syndrome., (Copyright © 2021. Published by Elsevier B.V.)

A comprehensive immunohistochemical ontogeny of the developing human fetal testis has remained incomplete in the literature to date. We collected human fetal testes from 8 to 21 weeks of fetal age, as well as postnatal human testes at minipuberty, pre-pubertal, and pubertal stages. Immunohistochemistry was performed with a comprehensive panel of antigens targeting gonadocytes, Sertoli cells, fetal Leydig cells, peritubular myoid cells, and other hormonal and developmental targets. Testicular cords, precursor structures to seminiferous tubules, developed from 8 to 14 weeks of fetal age, separating the testis into the interstitial and intracordal compartments. Fetal gonadocytes were localized within the testicular cords and evaluated for Testis-Specific Protein Y, Octamer-binding transcription factor 4, Sal-like protein 4, and placental alkaline phosphatase expression. Fetal Sertoli cells were also localized in the testicular cords and evaluated for SRY-box Transcription Factor 9, inhibin, and anti-Mullerian hormone expression. Fetal Leydig cells were present in the interstitium and stained for cytochrome p450c17 and calretinin, while interstitial peritubular myoid cells were examined using smooth muscle α-actin staining. Androgen receptor expression was localized close to the testicular medulla at 8 weeks and then around the testicular cords in the interstitium as they matured in structure. Postnatal staining showed that Testis-Specific Protein Y remained positive of male gonadocytes throughout adulthood. Anti-Mullerian hormone, SRY-box Transcription Factor 9, and Steroidogenic factor 1 are expressed by the postnatal Sertoli cells at all ages examined. Leydig cell markers cytochrome p450c17 and calretinin are expressed during mini-puberty and puberty, but not expressed during the pre-pubertal period. Smooth muscle α-actin and androgen receptor were not expressed during mini-puberty or pre-puberty, but again expressed during the pubertal period. The ontogenic map of the human fetal and postnatal testicular structure and expression patterns described here will serve as a reference for future investigations into normal and abnormal testicular development., (Copyright © 2022 International Society of Differentiation. Published by Elsevier B.V. All rights reserved.)

Objective: To rank percentages of underrepresented residents in surgical subspecialties and understand the experience of mentees and mentors who participated in the inaugural University of California, San Francisco Urology UnderRepresented Trainees Entering Residency (UReTER) Mentorship Program for Black, Indigenous, and/or LatinX medical students applying into urology., Methods: Medical student mentees across the country were recruited via social media and email listservs. Demographic information and photos of mentors were presented on the UReTER website. Medical students could choose a mentor, and once matched, both parties were notified. A survey was emailed to all participants on Urology Match Day 2021., Result: The 2018 -2019 ACGME Databook showed underrepresented minority residents made up 7.6% of urology residents, lagging behind neurosurgery, vascular surgery, general surgery, and obstetrics and gynecology. 71 mentees and 101 mentors volunteered for the UReTER Mentorship Program (71 mentor-mentee couplets). Overall response rate was 51% [33 mentors and 32 mentees]. Of mentees who completed the survey, 16 (47%) participated in the 2021 Urology Match; 15 (94%) matched and 6 (38%) felt that UReTER helped them match., Conclusion: Feedback on this pilot program was very positive including a high match rate among those who participated. Future changes to the program include expanded student outreach, increased structure, broadened mentor network. The implementation of a low-cost program to increase underrepresented applicants into Urology has great potential to increase representation and improve the field. This program can and should be replicated in all subspecialties., (Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objectives: To investigate the feasibility and efficacy of live renal ultrasonography to guide Double-J ureteral stent placement at the bedside. Patients and Methods: Between April 12 and June 5, 2020, patients presenting with acute ureteral obstruction requiring decompression were prospectively selected for ultrasound-guided bedside ureteral stent placement. During stent placement, upper tract access confirmed using ultrasound with or without retrograde injection of ultrasound contrast before Double-J stent insertion. A postprocedural abdominal X-ray was obtained for stent position confirmation. Results: Eight patients (four men and four women) were offered bedside ultrasound-guided ureteral stent placement, and all eight consented to proceed. Stents were placed in seven of eight patients. One patient had an impacted ureterovesical junction stone and stricture requiring ureteroscopy and laser lithotripsy in the operating room. All patients tolerated procedures without immediate complications. Conclusion: Live renal ultrasonography can facilitate a high success rate for bedside ureteral stent placement outside the operating room. This approach is an attractive alternative to fluoroscopy-guided stent placement in the operating room and is of particular value in the COVID-19 era when judicious use of these resources is salient.

The Jost hypothesis states that androgens are necessary for normal development of the male external genitalia. In this review, we explore the complementary hypothesis that estrogens can elicit abnormal development of male external genitalia. Herein, we review available data in both humans and mice on the deleterious effects of estrogen on external genitalia development, especially during the "window of susceptibility" to exogenous estrogens. The male and female developing external genitalia in both the human and mouse express ESR1 and ESR2, along with the androgen receptor (AR). Human clinical data suggests that exogenous estrogens can adversely affect normal penile and urethral development, resulting in hypospadias. Experimental mouse data also strongly supports the idea that exogenous estrogens cause penile and urethral defects. Despite key differences, estrogen-induced hypospadias in the mouse displays certain morphogenetic homologies to human hypospadias, including disruption of urethral fusion and preputial abnormalities. Timing of estrogenic exposure, or the "window of susceptibility," is an important consideration when examining malformations of the external genitalia in both humans and mice. In addition to a review of normal human and mouse external genital development, this article aims to review the present data on the role of estrogens in normal and abnormal development of the mouse and human internal and external genitalia. Based on the current literature for both species, we conclude that estrogen-dependent processes may play a role in abnormal genital development., (Copyright © 2020 International Society of Differentiation. Published by Elsevier B.V. All rights reserved.)

To better understand how the human fetal penis and clitoris grows and remodels, we undertook an investigation to define active areas of cellular proliferation and programmed cell death spatially and temporally during development of human fetal external genitalia from the indifferent stage (8 weeks) to 18 weeks of gestation. Fifty normal human fetal penile and clitoral specimens were examined using macroscopic imaging, scanning electron microscopy and immunohistochemical localization for the cellular proliferation and apoptotic markers, Ki67 and Caspase-3, respectively. A number of hot spots of cellular proliferation characterized by Ki67 localization are present in the penis and clitoris especially early in development, most notably in the corporal body, glans, remodeling glanular urethra, the urethral plate, the roof of the urethral groove and the fully formed penile urethra. The 12-fold increase in penile length over 10 weeks of growth from 8 to 18 weeks of gestation based on Ki67 labelling appears to be driven by cellular proliferation in the corporal body and glans. Throughout all ages in both the developing penis and clitoris Ki67 labeling was consistently elevated in the ventral epidermis and ventral mesenchyme relative to the dorsal counterparts. This finding is consistent with the intense morphogenetic activity/remodeling in the ventral half of the genital tubercle in both sexes involving formation of the urethral/vestibular plates, canalization of the urethral/vestibular plates and fusion of the urethral folds to form the penile urethra. Areas of reduced or absent Ki67 staining include the urethral fold epithelium that fuses to form the penile tubular urethra. In contrast, the urethral fold mesenchyme is positive for Ki67. Apoptosis was rarely noted in the developing penis and clitoris; the only area of minimal Caspase-3 localization was in the epithelium of the ventral epithelial glanular channel remodeling., (Copyright © 2019. Published by Elsevier B.V.)

To better understand how the human fetal penis and clitoris grows and remodels, we undertook an investigation to define active areas of cellular proliferation and programmed cell death spatially and temporally during development of human fetal external genitalia from the indifferent stage (8 weeks) to 18 weeks of gestation. Fifty normal human fetal penile and clitoral specimens were examined using macroscopic imaging, scanning electron microscopy and immunohistochemical localization for the cellular proliferation and apoptotic markers, Ki67 and Caspase-3. A number of hot spots of cellular proliferation characterized by Ki67 localization are present in the penis and clitoris especially early in development, most notably in the corporal body, glans, remodeling glanular urethra, the urethral plate, the roof of the urethral groove and the fully formed penile urethra. The 12-fold increase in penile length over 10 weeks of growth from 8 to 18 weeks of gestation based on Ki67 labelling appears to be driven by cellular proliferation in the corporal body and glans. Throughout all ages in both the developing penis and clitoris Ki67 labeling was consistently elevated in the ventral epidermis and ventral mesenchyme relative to the dorsal counterparts. This finding is consistent with the intense morphogenetic activity/remodeling in the ventral half of the genital tubercle in both sexes involving formation of the urethral/vestibular plates, canalization of the urethral/vestibular plates and fusion of the urethral folds to form the penile urethra. Areas of reduced or absent Ki67 staining include the urethral fold epithelium that fuses to form the penile tubular urethra. In contrast, the urethral fold mesenchyme is positive for Ki67. Apoptosis was rarely noted in the developing penis and clitoris; the only area of minimal Caspase-3 localization was in the epithelium of the ventral epithelial glanular channel remodeling., (Copyright © 2019 International Society of Differentiation. Published by Elsevier B.V. All rights reserved.)