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Introduction: Percutaneous nephrolithotomy (PCNL) is widely performed as the preferred treatment for kidney stones larger than 20 mm in pediatric patients, with current research focusing on comparing outcomes between prone and supine positions to determine optimal procedural positioning. Therefore, the aim of this study is to compare the efficacy of prone versus supine positioning in pediatric PCNL, providing clarity on this critical aspect of the procedure to guide clinical decision-making., Methods: We conducted a systematic review in PubMed, Embase, Scopus, Cochrane, Web of Science and Google Scholar. We included studies that compared PCNL in prone vs supine positions for pediatric patients. Our primary outcome was stone-free rate (SFR). Secondary outcomes included operative time, length of hospital stay and overall complications rate. The statistical analysis was performed using Review Manager 5.4., Results: We retrieved 8 articles, with 269 patients in the prone group and 223 patients in the supine group. The mean age of all patients was 7.92 years old. Our findings presented no statistically significant difference in SFR between the two positions (OR 0.67; CI95 0.38, 1.18; p = 0.17; I 2  = 0%). Additionally, we noted a significant reduction in operative time in the supine position group (MD 13.75; CI95 4.35, 23.15; p = 0.004; I 2  = 84%). At the same time, the length of hospital stay after the procedure was lower in supine group (MD 0.61; CI95 0.34, 0.88; p < 0.0001; I 2  = 21%). No difference was observed regarding the total complication rate (OR 1.47; CI95 0.88, 2.47; p = 0.15; I 2  = 0%)., Conclusion: Our meta-analysis suggests that PCNL performed in the prone position is equivalent to supine PCNL in terms of SFR. However, mainly in the RCT studies, we could observe benefits of the supine position in comparison of prone position in terms of lower operative time, as well as a reduced postoperative hospital stay., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable since this work is a systematic review and a meta-analysis. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Introduction: The use of pneumoperitoneum is an essential step for performing laparoscopic and robotic surgery. Pneumoperitoneum insufflation can cause complications such as pneumothorax, subcutaneous emphysema, and pneumomediastinum. The purpose of this meta-analysis is to compare the safety of using the conventional insufflation system versus a Valveless insufflation system as devices for manufacturing pneumoperitoneum in robotic-assisted nephrectomy., Methods: A comprehensive literature search was conducted on PUBMED, EMBASE, SCOPUS, and Cochrane, from inception until January 2024. Randomized and nonrandomized prospective studies were included in the meta-analysis, performed by the R+ Rstudio., Results: Three publications encompassing 478 patients were included. We observed no difference in SCE (OR 0.60, CI 95% 0.27;1.34, p = 0.134, I 2  = 0), PNM (OR 0.82, CI 95% 0.24;2.78, p = 0.558, I 2  = 0), When comparing groups conventional insufflation system (CIS) versus AirSealTM insufflation system (AIS) with pneumoperitoneum pressure of 15 mmHg or 12 mmHg., Conclusion: The presented data showed no difference between the AIS when compared with CIS in Pneumoperitoneum insufflation-related complications., (© 2024. The Author(s).)

Introduction: Ureteroscopy (URS) and retrograde intrarenal surgery (RIRS) are minimally invasive urologic procedures that are commonly used to treat kidney stones. However, they often result in significant postoperative pain. Historically, patients undergoing these surgeries have predominantly been managed with opioids, which has contributed to the escalating global complications associated with these drugs, including abuse and addiction. As a result, over the recent years, many healthcare centers have made efforts to minimize opioid use, opting instead for safer alternative medications. In this study, we aim to compare the efficacy of both opioid and opioid-free pain management regimens following URS or RIRS procedures., Evidence Acquisition: A systematic search was conducted in MEDLINE, Embase, Scopus, Cochrane, LILACS, and Google Scholar. We included studies that compared opioid-based and opioid-free postoperative care for managing pain in patients who underwent URS or RIRS for lithotripsy. Our primary outcome of interest was the frequency of postoperative emergency department (ED) visits. Secondary outcomes included pain-related phone calls, postoperative unexpected encounters, need for opioids at discharge, and patients with opioid refills., Evidence Synthesis: We retrieved 10 articles, encompassing 6786 patients in the opioid group and 5276 patients in the opioid-free group. Overall, our findings lean towards favoring the opioid-free regimen, revealing notable differences between the groups. Opioid-free regimen was associated with less ED visits (OR=0.67; 95% CI: 0.58, 0.77; P=0.00001; I 2 =0%) and required less opioids at discharge (OR=0.11; 95% CI 0.02, 0.64; P=0.01; I 2 =89%)., Conclusions: Through statistically superior results, our meta-analysis suggests that an opioid-free regimen outperforms the use of opioids after URS or RIRS, particularly in terms of pain management.

Introduction: The optimal temperature of irrigation solution in patients undergoing PCNL is still unclear. Accordingly, this study aims to investigate the effects of different irrigation solution temperatures (cold/room temperature irrigation fluid versus warm/body temperature fluid). Our primary endpoint was hypothermia rate. Secondary outcomes were shivering rate, mean temperature decrease, mean patient final temperature, blood loss, and operative time., Evidence Acquisition: This systematic review was conducted in accordance with PRISMA guidelines. Multiple databases were searched in November 2023. Among 299 studies screened, eight were selected for full-text review, resulting in four randomized clinical trials that fit inclusion criteria and desired outcomes. Studies selection and data extraction were performed by multiple reviewers and a random-effects model was used for pooling of data., Evidence Synthesis: The primary outcome, hypothermia rate, showed a significant statistical difference between groups, occurring less frequently in the experimental group (35-37 ºC) than in the cold/room temperature irrigation group (RR 0.64;95%CI 0.46, 0.89; P<0.008; I 2 =33%). Secondary outcomes such as shivering rate (RR 0.46; 95%CI 0.31, 0.67; P<0.0001; I 2 =0%) and mean final temperatures (MD 0.43; 95%CI 0.12, 0.75; I 2 =82%) also showed statistically significant differences between groups, favoring the irrigation with heated fluid., Conclusions: There was a decreased rate of hypothermia and shivering among patients undergoing PCNL with warm irrigation fluid. Mean final temperatures were also higher in the experimental group. As to blood loss, mean hemoglobin decrease showed no statistically significant difference between groups, prompting further investigation of the influence of Irrigation solution temperature on blood loss volume.

Background: Lymph node status is vital for gastric cancer (GC) prognosis, but the conventional pN stage may be limited by variations in lymphadenectomy and stage migration. The N-Ratio, which assesses the ratio of metastatic to resected lymph nodes, emerges as a promising prognostic tool., Aims: To assess N-Ratios prognostic value in GC, particularly in patients with <25 resected lymph nodes., Methods: Patients who underwent gastrectomy with curative intent for GC were retrospectively evaluated. The N-Ratio categories were determined using the ROC curve method, and the area under the curve (AUC) was used as a measure of performance in predicting recurrence/death., Results: A total of 561 GC patients were included in the study, 57% had pN+ status, and 17.5% had <25 resected lymph nodes. N-Ratio, with a mean of 0.12, predicted survival with 74% accuracy (AUC=0.74; 95%CI 0.70-0.78, p<0.001). N-Ratio categories included: N-Ratio 0 (43%); N-Ratio 1 (12.3%); N-Ratio 2 (31.6%); and N-Ratio 3 (13.2%). Disease-free survival (DFS) varied among all N-Ratio groups, with N-Ratio 3 showing worse survival than pN3 cases (DFS=21.8 vs. 11 months, p=0.022, p<0.05). In cases with <25 resected lymph nodes, DFS was not significantly worse in N-Ratio 0 (68.8 vs. 81.9%, p=0.061, p>0.05) and N-Ratio 1 (66.2 vs. 50%, p=0.504, p>0.05) groups. The DFS of N-Ratio-0 cases with <25 lymph nodes was similar to N-Ratio 1 cases., Conclusions: N-Ratio influenced survival in GC patients, especially in advanced lymph node disease (N-Ratio 3). Considering that N-Ratio does not impact pN0 cases, individualized prognosis assessment is essential for patients with <25 resected lymph nodes.

Purpose: The purpose of this study is to assess whether the Dunning-Kruger effect occurs in surgical residents when performing laparoscopic cholecystectomy in a porcine model., Methods: Prospective blinded study, which counted with forty PGY-1 general surgery residents who agreed to participate in the study were blindly recruited to perform a laparoscopic cholecystectomy in a porcine model. At the end of the procedure, the participants assigned a score of 0-10 for their own performance and the video of the operation was independently assessed by 2 experienced laparoscopic surgeons using a validated tool., Results: Participants were divided into groups of 10 individuals according to objective performance and compared. The group with the worst objective result was inferior to the group with the best objective result (3.77 ± 0.44 vs. 8.1 ± 0.44, p < 0.001), but they were similar in self-perception of performance (5.11 ± 1.69 vs. 6.1 ± 1.79, p = 0.999)., Conclusions: In the studied sample, it was possible to demonstrate the presence of the Dunning-Kruger effect.

Purpose: To conduct a systematic literature review with meta-analysis to identify whether antibiotic prophylaxis after removal of the indwelling urinary catheter reduces posterior infections., Methods: A systematic literature review was conducted in the databases PubMed, Embase, Cochrane, Google Scholar, and Latin American and Caribbean Health Sciences Literature, using the keywords "antibiotics" AND "prostatectomy" AND "urinary catheter.", Results: Three articles were identified having the scope of our review, with 1,040 patients, which were subjected to our meta-analysis revealing a marginally significant decrease in the risk of urinary infection after indwelling urinary catheter removal (odds ratio-OR = 0.51; 95% confidence interval-95%CI 0.27-0.98; p = 0.04; I2 = 0%). No difference was found regarding the presence of bacteriuria (OR = 0.39; 95%CI 0.12-1.24; p = 0.11; I2 = 73%)., Conclusions: In our meta-analysis, there was a significant decrease in urinary tract infection with antibiotic prophylaxis after indwelling urinary catheter removal following radical prostatectomy.

Introduction: Percutaneous nephrolithotomy (PCNL) is considered the gold standard treatment for kidney stones greater than 20 mm. However, retrograde intrarenal surgery (RIRS) may achieve the same stone-free rate with repeated procedures, and potentially fewer complications. This study aimed to compare the efficacy and safety of PCNL and two-staged RIRS., Evidence Acquisition: We conducted a systematic search in PubMed, Embase, Scopus, Cochrane, and Web of Science for studies comparing PCNL and RIRS for kidney stones greater than 20mm. The primary outcome is stone-free rate (SFR) of PCNL and RIRS (repeated once if needed). Secondary outcomes were SFR of PCNL versus RIRS (single procedure), operative time, hospital stay, need for auxiliary procedures, and complications. We performed a subgroup analysis for randomized trials, non-randomized trials, and patients with solitary kidney. We performed a trial sequential analysis for the main outcome., Evidence Synthesis: We included 31 articles, with 1987 patients in the PCNL and 1724 patients in RIRS. We confirmed the traditional result that after a single procedure PCNL has a higher SFR. We also found that comparing the SFR of PCNL and RIRS, repeated up to two times if needed, no difference in SFR was observed. Surprisingly, only 26% (CI95 23%-28%) of the patients required a second RIRS. In the trial sequential analysis, the last point of the z-curve was within futility borders. We observed that PCNL has a higher incidence of complications (RR=1.51; CI95 1.24, 1.83; P<0.0001; I 2 =28%), specifically CD2 (RR=1.82; CI95 1.30, 2.54; P=0.0004; I 2 =26%) and longer hospital stay (MD 2.57; 2.18, 2.96; P<0.00001; I 2 -98%). No difference was observed regarding operative time., Conclusions: RIRS repeated up to two times is equivalent to PCNL in terms of the SFR and may have the same safety.

Introduction: Robot-assisted laparoscopic surgery (RALS) and conventional laparoscopic surgery (LS) are the main options for ileal ureteral replacement (IUR). It is not clear which option is superior. The purpose of this study is to compare RALS and LS for IUR., Material and Methods: We searched MEDLINE, Embase, Web of Science, Scopus, Cochrane Central, and Google Scholar for studies comparing RALS and LS for IUR. The outcomes of interest are operative time, blood loss, postoperative stay, and Clavien-Dindo complications. Meta-analysis was performed with Rev Man version 5.4., Results: We included 36 patients from 3 studies. The mean age was 44 years, with 53% male patients. Blood loss (MD -89.13 cc, CI -129.03 to -49.22, I 2 = 0%) was significantly lower in patients undergoing RALS when comparing with LS. No differences were observed when comparing operative time (MD -10.99 minutes, CI -85.66 to 63.59, p = 0.77, I 2 = 64%), postoperative stay (MD -2.56 days, CI -8.24 to 3.13, p = 0.38, I 2 = 30%), and postoperative complications (OR 1.63, CI 0.27 to 10.02, p = 0.60, I 2 = 0%)., Conclusions: Overall, we conclude that the robot-assisted technique showed less bleeding compared to the laparoscopic technique., Competing Interests: The authors declare no conflicts of interest., (Copyright by Polish Urological Association.)

Purpose: In Brazil, healthcare services traditionally follow a fee-for-service (FFS) payment system, in which each medical procedure incurs a separate charge. An alternative reimbursement with the aim of reducing costs is diagnosis related group (DRG) remuneration, in which all patient care is covered by a fixed amount. This work aimed to perform a systematic review followed by meta-analysis to assess the effectiveness of the Budled Payment for Care Improvement (BPCI) versus FFS., Methods: Our work was performed following the items of the PRISMA report. We included only observational trials, and the primary outcome assessed was the effectiveness of FFS and DRG in appendectomy considering complications. We also assessed the costs and length of hospital stay. Meta-analysis was performed with Rev Man version 5.4., Results: Out of 735 initially identified articles, six met the eligibility criteria. We demonstrated a shorter hospital stay associated with the DRG model (mean difference = 0.39; 95% confidence interval - 95%CI - 0.38-0.40; p < 0.00001; I2 = 0%), however the hospital readmission rate was higher in this model (odds ratio = 1.57; 95%CI 1.02-2.44, p = 0.04; I2 = 90%)., Conclusions: This study reveals a potential decrease in the length of stay for appendectomy patients using the DRG approach. However, no significant differences were observed in other outcomes analysis between the two approaches.

Purpose: Kidney stones are one of the most common urological diseases worldwide. The size and location of the stone are the most important factors in determining the most suitable treatment options. The aim of this review was to evaluate the displacement of lower pole stones., Methods: Three studies assessing the efficacy of translocating kidney stones from the lower pole of the kidney to other locations during retrograde intrarenal surgery published in the last 20 years were included. A systematic search was conducted in the PubMed, Embase, Latin American and Caribbean Health Sciences Literature (LILACS), and Web of Science databases using the following search terms: "Lower pole," "Lithotripsy." Meta-analysis was performed using Review Manager version 5.4., Results: Stone-free rates were improved through displacement (odds ratio - OR = -0.15; 95% confidence interval-95%CI -0.24--0.05; p = 0.002; I2 = 21%), but at the cost of increased surgical duration (mean difference = -12.50; 95%CI -24.06--0.95; p = 0.03; I2 = 94%). Although this represents a potentially negative outcome, the improvement in clearance rates justifies the additional investment of time and effort., Conclusions: Displacement of lower pole kidney stones for subsequent lithotripsy brings significant benefits in terms of stone-free rate, with no difference in laser energy usage. However, it results in increased surgical time. Despite these factors, the benefits to patients undergoing the procedure are substantial.

Dynamic high pressure (DHP) has been applied in the physical modification of biopolymers as polysaccharides, proteins and gums. It is known that DHP is able to promote degradation of polysaccharides (e.g. molecular weight reduction). However, few studies have assessed the effect of DHP on the emulsifying and encapsulating properties of polysaccharides. Thus, this study aimed to investigate the effect of DHP on the emulsifying (average droplet size and particle size distribution, optical and confocal scanning laser microscopy, rheology, zeta potential and electric conductivity, creaming index, and turbidity) and encapsulating (scanning electronic microscopy, flavor retention, average droplet size, and particle size distribution) properties of cashew tree gum (CG). The application of DHP process improved the emulsifying capacity of cashew tree gum (CG) by reducing the medium droplet size (D3,2 and D4,3), increasing the turbidity and improving the emulsion stability. However, no effect of DHP was observed on the encapsulating capacity of CG., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

This study was conducted to investigate the occurrence of oxidative stress in the heart tissue of rats infected with Trypanosoma evansi. Rats were divided into 2 groups (A and B) with 12 animals each, and further subdivided into 4 subgroups (A1 and A2, 6 animals/each; and B1 and B2, 6 animals/each). Animals in the groups B1 and B2 were subcutaneously inoculated with T. evansi. Thiobarbituric acid reactive substances (TBARS), superoxide dismutase activity (SOD), glutathione S-transferase activity (GST), reduced glutathione activity (GSH), and non-protein thiols (NPSH) in the heart tissue were evaluated. At day 5 and 15 post-infection (PI), an increase in the TBARS levels and a decrease in the SOD activity (P<0.05) were observed. GSH and GST activities were decreased in infected animals at day 15 PI (P<0.05). Considering the proper functioning of the heart, it is possible that the changes in the activity of these enzymes involved in the oxidative stress may be related, at least in part, in the pathophysiology of rats infected with T. evansi.

Dynamic high pressure (DHP) appears to be an alternative approach to physical modification of polysaccharides aimed improving their technological properties. Therefore, its effect on the functional properties of polysaccharides (i.e., oil absorption capacity, emulsifier, and rheology) needs to be investigated. Cashew tree gum (CG) is a biological macromolecule that has been proposed to be used as an emulsifier in beverage emulsions. To the best of our knowledge, none of the articles in the literature investigates the effect of DHP on the CG properties. This work presents a study on the evaluation of the effects of DHP on functional characteristics of CG, including rheological properties, molecular weight, glycosyl-linkage analysis, solubility, swelling and oil absorption capacity (OAC). The results suggest that DHP is able to modify the technological properties of cashew tree gum (increasing solubility and decreasing apparent viscosity)., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

This study aims to evaluate soil contamination by Toxocara spp. eggs in public parks in Presidente Prudente, São Paulo, Brazil. Soil samples (500 g) were collected every month over a 12-month period, from 25 parks in different parts of the city (northern, southern, eastern, western and central areas). Two 10-g aliquots of the material collected from each park were subjected to the centrifuge-flotation method to recover Toxocara spp. eggs. Twenty-four out of the 25 squares studied (96.0%) were contaminated and the number of eggs recovered ranged from 1 to 398 per sample. Eggs were recovered all over the year. Despite the number being greater in autumn (p < 0.001), there was no correlation between number egg number and average monthly temperature (r = -0.492; p = 0.148) or between egg number and monthly rainfall (r = -0.299; p = 0.402). Park localization does not influence egg presence (p = 0.7116). Because of the high level of contamination of the parks by Toxocara spp. eggs, prevention of contamination of public areas by larva migrans agents is indicated.