Middle meningeal artery embolization (MMAE) has been studied as an adjunct to surgical evacuation for chronic subdural hematoma (cSDH). Previous meta-analyses comparing MMAE with conventional treatment for cSDH included both observational and randomized studies. To provide a more robust assessment, we performed a meta-analysis of randomized controlled trials to evaluate the outcomes of adjunct MMAE compared to surgical treatment alone. We searched PubMed, EMBASE, and Cochrane CENTRAL databases for studies comparing adjunct middle meningeal artery embolization to surgical treatment alone until December 2024. The outcomes assessed were treatment failure, reoperation, complications, mortality, functional outcome, and length of hospital stay. Statistical analysis was performed via R software (version 4.3.2). Heterogeneity was assessed with I2 statistics. The risk of bias was assessed using the Cochrane Risk of Bias Tool for Randomized Trials. We included 6 studies with 1,422 patients, of whom 700 (49.2 %) received adjunct middle meningeal artery embolization. The mean age ranged from 64.2 to 77.4 years in the embolization group and from 70 to 74.4 years in the surgery-only group. Among the patients, 435 (54.5 %) had previous known head trauma, and 315 (22.1 %) were on antiplatelets or anticoagulants. The follow-up ranged from 90 to 180 days. Adjunct middle meningeal artery embolization reduced the occurrence of treatment failure compared to surgical treatment alone (RR 0.482; 95 % CI 0.328 to 0.708; p < 0.001; I2 = 0 %) and reoperation (RR 0.333; 95 % CI 0.212 to 0.521; p < 0.001; I2 = 0 %), however, didńt reduce the occurrence of any cause mortality (RR 0.970; 95 % CI 0.400 to 2.353; p = 0.946; I2 = 39.6 %), functional dependence at the last follow-up (RR 1.000; 95 % CI 0.726 to 1.377; p = 0.705; I2 = 0 %), or the length of stay (MD 0.576; 95 % CI -0.085 to 1.238; p = 0.088; I2 = 0 %). Furthermore, no differences were found regarding complications secondary to the surgical procedure (RR 0.902; 95 % CI 0.688 to 1.182; p = 0.455; I2 = 0 %), and the occurrence of embolization-related complication was low (RR 0.013; 95 % CI 0.006 to 0.027; I2 = 0 %). Trial sequential analysis judged the sample size sufficient for treatment failure and reoperation but suggested that further trials are needed to prove differences in surgical-related complications. Our results confirm that middle meningeal artery embolization significantly reduces recurrence and reoperation rates compared to surgery alone, with low adverse event rates. However, the impact on functional outcomes and mortality remains uncertain, warranting further studies to clarify its long-term benefits.
G protein-coupled receptor 55 (GPR55) has been thought to be a putative cannabinoid receptor. However, little is known about its functional role in cannabinoid action and substance use disorders. Here we report that GPR55 is predominantly found in glutamate neurons in the brain, and its activation reduces self-administration of cocaine and nicotine in rats and mice. Using RNAscope in situ hybridization, GPR55 mRNA was identified in cortical vesicular glutamate transporter 1 (VgluT1)-positive and subcortical VgluT2-positive glutamate neurons, with no detection in midbrain dopamine (DA) neurons. Immunohistochemistry detected a GPR55-like signal in both wildtype and GPR55-knockout mice, suggesting non-specific staining. However, analysis using a fluorescent CB1/GPR55 ligand (T1117) in CB1-knockout mice confirmed GPR55 binding in glutamate neurons, not in midbrain DA neurons. Systemic administration of the GPR55 agonist O-1602 didnt impact ∆9-THC-induced analgesia, hypothermia and catalepsy, but significantly mitigated cocaine-enhanced brain-stimulation reward caused by optogenetic activation of midbrain DA neurons. O-1602 alone failed to alter extracellar DA, but elevated extracellular glutamate, in the nucleus accumbens. In addition, O-1602 also demonstrated inhibitory effects on cocaine or nicotine self-administration under low fixed-ratio and/or progressive-ratio reinforcement schedules in rats and wildtype mice, with no such effects observed in GPR55-knockout mice. Together, these findings suggest that GPR55 activation may functionally modulate drug-taking and drug-seeking behavior possibly via a glutamate-dependent mechanism, and therefore, GPR55 deserves further study as a new therapeutic target for treating substance use disorders.
Performing the surgical procedure in a high-volume center has been seen to be important for some surgical procedures. However, this issue has not been studied for patients with an anal fistula (AF). A retrospective multicentric study was performed including the patients who underwent AF surgery in 2019 in 56 Spanish hospitals. A univariate and multivariate analysis was performed to analyse the relationship between hospital volume and AF cure and fecal incontinence (FI). 1809 patients were include. Surgery was performed in a low, middle, and high-volume hospitals in 127 (7.0%), 571 (31.6%) y 1111 (61.4%) patients respectively. After a mean follow-up of 18.9 months 72.3% (1303) patients were cured and 132 (7.6%) developed FI. The percentage of patients cured was 74.8%, 75.8% and 70.3% (p = 0.045) for low, middle, and high-volume hospitals. Regarding FI, no statistically significant differences were observed depending on the hospital volume (4.8%, 8.0% and 7.7% respectively, p = 0.473). Multivariate analysis didńt observe a relationship between AF cure and FI. Cure and FI in patients who underwent AF surgery were independent from hospital volume.
The first cases of the COVID-19 disease were identified in late 2019 in China, but it didnt take long for it to become pandemic. At first, it was believed that it was restricted to respiratory symptoms only, until extrapulmonary manifestations were reported worldwide. Acute pancreatitis concomitant with the diagnosis of SARS-CoV-2 infection has been observed in some patients, in the absence of the most common etiologies described in the literature. It is postulated that the presence of the ECA-2 viral receptor in the pancreas is responsible for the direct cellular damage and that the hyperinflammatory state of COVID-19 favors the development of pancreatitis through an immune-mediated mechanism. This study aimed to analyze the correlation between acute pancreatitis and COVID-19 disease as a probable causality factor. An integrative literature review was carried out, including studies published between January 2020 and December 2022 that brought data on patients diagnosed with acute pancreatitis according to the revised Atlanta Classification with a confirmed diagnosis of COVID-19 in the same period. A total of thirty studies were reviewed. Demographic, clinical, laboratory and imaging aspects were analyzed and discussed. It is believed that SARS-CoV-2 was responsible for the development of acute pancreatitis in these patients, due to the absence of other precipitating risk factors, as well as the close temporal relationship between both. Attention should be given to gastrointestinal manifestations in patients affected by COVID-19. Os primeiros casos da doença COVID-19 foram identificados no final de 2019 na China, mas não foi necessário muito tempo para que se tornasse pandêmica. Acreditava-se, a princípio, que ela fosse restrita apenas a sintomas respiratórios, até que manifestações extrapulmonares fossem mundialmente relatadas. Quadros de pancreatite aguda concomitantes ao diagnóstico de infecção por SARS-CoV-2 vêm sendo observados em alguns pacientes, na ausência das etiologias mais comuns descritas na literatura. Postula-se que a presença do receptor viral ECA-2 no pâncreas seja responsável pelo dano celular direto e que o estado hiperinflamatório da COVID-19 favoreça o desenvolvimento da pancreatite por mecanismo imunomediado. Este estudo teve como objetivo analisar a correlação entre pancreatite aguda e a doença COVID-19 como um provável fator de causalidade. Realizou-se uma revisão integrativa da literatura, foram incluídos estudos publicados entre janeiro de 2020 e dezembro de 2022 que trouxessem dados acerca de pacientes diagnosticados com pancreatite aguda conforme a Classificação de Atlanta revisada com diagnóstico confirmado de COVID-19 no mesmo período. Um total de trinta estudos foram revisados. Aspectos demográficos, clínicos, laboratoriais e de imagem foram analisados e discutidos. Acredita-se que o SARS-CoV-2 foi o responsável pelo desenvolvimento de pancreatite aguda nestes pacientes, devido à ausência de demais fatores de risco precipitantes, bem como à estreita relação temporal entre ambos. Uma atenção deve ser dada às manifestações gastrointestinais em pacientes acometidos pela COVID-19.
Fontan-palliated patients are at risk for the development of Fontan-associated liver disease (FALD). Currently, there is no consensus on how to stage FALD. Transient elastography (TE) is a rapid, non-invasive method to assess FALD and liver fibrosis. To assess the availability and conditions of using TE to monitor liver disease in Fontan patients in german centers for pediatric cardiology and to propose the introduction of a standardized national protocol for the monitoring of liver disease, we developed a questionnaire. In total, 95 valid questionnaires were collected. Only 20% of the centers offer the TE investigation directly. Most of the centers transfer the patients to another department or center (40%) or didńt offer TE (40%). In only 2.6% of the centers TE is performed directly by the cardiologist. Most of the centers transfer the patients to a other department. In 29.2% TE is performed only at a certain age of the patients and in 27.7% it is performed if the patients present symptoms of failing Fontan. In only 13.9% of the centers TE is proposed in all the Fontan patients on a routine basis. Most often TE is performed only from the beginning of the adolescence. In the majority of answers it was not known if the patients are fasting for the examination (68%) or not and if the TE examination had to be performed in a specific breathing phase during TE (Inspiration/Expiration, 90%). In the majority, TE is not offered routinely (46.9%). To date in Germany, TE is only used in a few numbers of centers specialized in Fontan follow-up. A standardized protocol to use TE is currently not existing. With regard to the feasibility of the examination, it is evident that TE is a quick, cheap and easy method to distinguish between cases with and without progressive FALD. This makes TE a useful and prognostic tool for screening of liver disease and to failing Fontan circulation. We propose a systematic TE evaluation of possible liver congestion and fibrosis, as a part of the routine follow-up of Fontan patients.
The aim of this study was to investigate the association between inflammatory plasma protein concentrations and long-term mortality in patients with ST-elevation myocardial infarction (STEMI). For 343 STEMI patients recorded between 2009 and 2013 by the population-based Myocardial Infarction Registry Augsburg, 92 inflammatory plasma proteins were measured at the index event using the OLINK inflammation panel. In multivariable-adjusted Cox regression models, the association between each plasma protein and all-cause long-term mortality was investigated. Median follow-up time was 7.6 (IQR: 2.4) years. For plasma protein that showed a strong association with long-term mortality, a 5-year survival ROC analysis was performed. One plasma protein, namely Fibroblast Growth Factor 23 (FGF-23), was particularly well associated with long-term mortality in the multivariable-adjusted Cox model with an FDR-adjusted p-value of <0.001 and a Hazard Ratio (HR) of 1.57 [95% CI: 1.29-1.91]. In the 5-years ROC analysis, an AUC of 0.6903 [95% CI: 0.594-0.781] was estimated for FGF-23. All other plasma protein didńt show strong associations, each marker with FDR-adjusted p-values >0.05 in the multivariable-adjusted Cox models. FGF-23 is independently associated with long-term mortality after STEMI and might play an important role in the response to myocardial injury. The results suggest FGF-23 to be a useful marker in the long-term treatment of STEMI patients and a potential target for drug development.
At the Fish Collection of the Museo de la Escuela Politecnica Nacional (MEPN), Quito, the specimens of the genus Pseudohemiodon were revised and three species were identified. The three species inhabit the Amazon versant of Ecuador. Chronologically the species are: P. lamina (Gnther 1868) originally described from Xeberos (Jeberos), Peru; P. apithanos Isbrcker Nijssen 1978, originally described from the Conejo River, Putumayo River system, Ecuador, and a new species described herein. The new species was caught in the Aguarico River, Napo River system, and is represented by two small sized specimens. It is distinguished from all congeners by the combination of the following characters: abdomen totally covered with small to medium-sized, irregularly shaped plates; absence of small plates, anterior to gill openings; eyes relatively small, and six to seven dark transverse bands, posterior to the dorsal-fin. Isbrcker Nijssen (1978) indicate the presence of P. laticeps (Regan 1904) in Ecuador; however we didnt find any specimen of this species. The specimens that could potentially be identified as P. laticeps are large sized specimens of P. apithanos. Some external morphological characters, morphometric and meristic data of analyzed specimens of P. apithanos and P. lamina are provided.
According to domestic and foreign publications, benign prostatic hyperplasia (BPH) is one of the most common urological diseases among older men, which prevalence reaches 50% by the age of 60. To analyze the efficiency of the use of the alpha1-blocker silodosin at a dose of 8 mg a day in comorbid patients with lower urinary tract symptoms (LUTS), associated with BPH. A total of 197 comorbid patients with LUTS/BPH were included in the study. All men underwent a standard examination. They were divided into 2 groups without differences in baseline parameters. In the main group (n=100) patients received silodosin at a dose of 8 mg, while in the control group 97 men did not receive any drug therapy for LUTS. There were significant differences between groups in the total IPSS score, postvoid residual (ml), maximum urine flow rate (ml/s), patient satisfaction with treatment efficacy based on the TS-VAS visual analogue scale (total score). However, we didnt find significant differences in rate of cardiovascular side effects between the groups. Treatment of comorbid patients with LUTS/BPH with silodosin at a dose of 8 mg results in significant improvement and is not associated with cardiovascular adverse events.
Antibiotics represent the main drugs for the treatment and prevention of recurrent lower urinary tract infections (UTIs). At the same time, there is no consensus regarding the duration of therapy and the interval between courses. A total of 50 women aged 18 to 65 years (mean age 44.6+/-13.2 years) with recurrent lower UTIs in the acute stage were treated. All patients were prescribed fosfomycin trometamol (Fosfomycin Esparma, Esparma GmbH, Germany) at a dose of 3 g once every 10 days for 3 months. The changes of clinical and laboratory parameters were evaluated on the 3rd day after the first administration of fosfomycin, and then after 1, 3 and 6 months from the start of treatment. A decrease in the severity of clinical manifestations of cystitis was seen on the next day after first administration of fosfomycin. By the 3rd day, the ACSS score decreased from the initial 9.2+/-2.1 to 1.4+/-1.0 (p<0.001), while the average urinary frequency changed from 12.3+/-2.3 to 7.5+/-1.4 (p<0.05). After 3 months of therapy, the clinical results virtually did not differ from results on the 3rd day. The therapy was well tolerated; adverse events were noted in 10 patients, but they didnt result in discontinuation of the drug. During follow-up for 3 months after the completion of therapy, 47 (94%) women didnt have recurrence of lower UTI. the results of the study suggest a high efficiency and good tolerability of fosfomycin when it is prescribed according to specific scheme for the treatment and prevention of recurrent lower UTIs in women.
To assess the influence of diabetes mellitus and obesity on contrast-induced acute kidney injury risk in patients with chronic coronary artery disease requiring percutaneous coronary intervention. 1023 patients with chronic coronary artery disease were enrolled in a prospective, open, cohort study (ClinicalTrials.gov ID NCT04014153). Contrast-induced acute kidney injury was defined as an increase of 25% or more, or an absolute increase of 0.5 mg/dl or more in serum creatinine from baseline value, assessed at 48 hours following the administration of the contrast. The majority of the patients were overweight male ones with BMI 29.25.5 kg/m2. The primary endpoint of the study was the development of contrast-induced acute kidney injury according to KDIGO criteria. The prevalence of contrast-induced acute kidney injury was 12.9% (132 patients). 21.2% suffered from diabetes mellitus, 43% were obese and 12.9% had both diabetes mellitus and obesity. Diabetes wasnt a statistically significant independent risk factor of the contrast-induced acute kidney injury, as well as the combination of diabetes and obesity. In the group of obese patients the prevalence of contrast-induced acute kidney injury was higher (13.4%vs12.5%), but didnt meet statistical significance (p=0.7, OR 0.924, 95% CI 0.641.325). According to the multiple logistic regression model, female gender, age, BMI, weight, arterial hypertension, baseline creatinine were the risk factors of the contrast-induced acute kidney injury development (AUC 0.742,p0.0001). Diabetes mellitus was not associated with higher incidence of contrast-induced acute kidney injury. The prevalence of contrast-induced kidney injury was higher in the group of patients with BMI30 kg/m2, but didnt meet statistical significance and needs further evaluation in larger studies. Цель.Оценить влияние сахарного диабета и ожирения на риск развития контраст-индуцированного острого повреждения почек (КИ-ОПП) у пациентов с хронической ишемической болезнью сердца, имеющих показания к проведению чрескожных коронарных вмешательств. Материалы и методы.В проспективное открытое когортное исследование (ClinicalTrials.gov ID NCT04014153) включены 1023 пациента с хронической ишемической болезнью сердца. КИ-ОПП определялось как повышение на 25% и больше от исходного уровня креатинина либо на 0,5 мг/дл и более от исходного, оцениваемое через 48 ч после введения контрастного вещества. Большинство пациентов мужчины с индексом массы тела (ИМТ) 29,25,5 кг/м2. Первичной конечной точкой являлось развитие КИ-ОПП в соответствии с критериями KDIGO (Kidney Disease: Improving Global Outcomes). Результаты.Частота КИ-ОПП составила 12,9% (132 случая): 21,2% страдали сахарным диабетом, 43% ожирением и 12,9% имели и сахарный диабет, и ожирение. Сахарный диабет не являлся статистически значимым независимым фактором риска развития КИ-ОПП, как и его сочетание с ожирением. В группе пациентов, страдавших ожирением, частота КИ-ОПП отмечена выше (13,4 и 12,5% соответственно), но не достигала статистической значимости (p=0,7, отношение шансов 0,924, 95% доверительный интервал 0,641,325). Построена многофакторная логистическая регрессионная модель, включившая в себя следующие факторы риска: женский пол, возраст, ИМТ, массу тела, наличие артериальной гипертензии, исходный уровень сывороточного креатинина (AUC 0,742,p0,0001). Заключение.Сахарный диабет не ассоциирован с увеличением частоты КИ-ОПП. Частота КИ-ОПП отмечена выше в группе больных с ИМТ30 кг/м2, но не достигала статистической значимости и требует дальнейшего изучения в более крупных исследованиях.
We had provided secondary analysis of our randomized controlled study comparing vaginal mesh with sacrospinous fixation for vaginal prolapse. We correlated data from subjective and objective assessment. Secondly we had provided correlations results of subjective and objective assessment between patient with anatomical failure and those without. The aim of this analysis was to provide correlation between objective and subjective outcome measures. Subanalysis of randomized controlled study. Obstetric Gynecology Department, First Faculty of Medicine of Charles University and General University Hospital in Prague. This is secondary analysis of single center randomized controlled study comparing two standard procedures for vaginal prolapse after hysterectomy in patients with levator avulsion injury. We had analyzed pre- and postoperative subjective POPDI score (Pelvic Organ Prolapse Distress Inventory) and correlated this score with most prolapsed portion of vaginal wall. We had compared all vaginal compartments using POPQ (Pelvic Organ Prolapse Quantification): anterior wall with point Ba, apical with point C, and posterior with point Bp. Subsequently we compared subjective POPDI score in group of patients with anatomical failure and those without. We had included in randomized study 70 women. Mean preoperative POPDI score was 65.25 (3.57-200). We didnt found any correlation between subjective score and objective assessment in preoperative data: POPDI vs. Ba (p = 0.75) POPDI vs. C (p = 0.57) a POPDI vs. Bp (p = 0.22) and no correlation in postoperative assessment. Postoperative POPDI score decreased to 26.1, but there was no difference in POPDI score in woman with anatomical failure and no failure - 17.4 vs. 23.3 (p = 0.64)CONCLUSION: Secondary analysis of randomized controlled study had shown that objective and subjective assessment have poor correlation. We didnt found any correlation between degree of prolapse and intensity of complains. The large inter-individual variability in symptoms and low sensitivity of subjective assessment to detect difference makes subjective assessment as an inappropriate tool as a primary outcome measure of pelvic floor surgery.
In our study we compared effect of cardiac resynchronization therapy (CRT) in chronic heart failure (CHF) patients with permanent atrial fibrillation (AF) and patients with sinus rhythm. Special feature of our work was that patients with permanent atrial fibrillation didnt have obligatory ablation of atrio-ventricular node but underwent aggressive rate control to achieve more than 90% of biventricular (BV) complexes. We used 24 hours Holter monitoring because there are data that this method is more accurate than CRT counters. We included 30 patients: 21 patients with sinus rhythm and 9 patients with permanent AF with ejection fraction <35%, II-IV NYHA class and wide QRS (>120 ms). We examined patients before implantation of CRT and after 6 months. mean NYHA class decreased from III to II. Distance at 6-min walk test increased by 107 m in AF group and by 105 in sinus rhythm group. EF increased by 7% in AF group and by 6% in sinus rhythm group. Mean time of further observation was 2 years (from 10 months to 5 years). There was 1 death (11.1%) in AF group and 3 deaths (15%) in sinus rhythm group (p>0,05). CRT is effective in CHF patients with permanent AF and pharmacological rate control if percent of BV pacing is more than 90% on Holter monitoring.
Benign prostatic hyperplasia (BPH) and chronic prostatitis (CP) are common disorders that are typical for age-related health changes in men. The combination of BPH with CP raises many questions when treatment tactics is chosen. Currently, new drugs have been developed and widely used, namely entomological drugs, which are biologically active substances with anti-inflammatory and antioxidant properties. The aim of our study was to study the efficiency of the entomological drug Adenoprosin in the complex therapy of patients with BPH and CP. A total of 60 patients with BPH and P were included in the study. Patients were randomized into two groups of 30 people. In the control group, alpha-blockers and fluoroquinolones were prescribed. In the main group, patients received the same therapy with alpha-blockers and fluoroquinolones, but additionally took Adenoprosin once a day for three months. The results were evaluated at baseline (Visit 1), after four weeks (Visit 2) and three months (Visit 3) of therapy. The frequency of urination, the number of night urinations, the average score on the IPSS, QOL, NIH-CPSI scales, the maximum urine flow rate (Qmax), prostate volume and residual urine volume, as well as microscopic study and culture of expressed prostatic secretion were evaluated. At baseline, there were no differences between group in all studied values (p>0.05). By the second visit, despite the absence of significant differences (p>0.05), a more pronounced positive changes in the most parameters were showed in the main group. According to evaluation at visit 3, in the control group all values didnt change significantly compared to those at visit 2. In the main group, there was a significant decrease in the number of day and night urinations, an increase in the Qmax and the average score on the NICH-CPSI, IPSS and QOL scales, and a decrease in the prostate volume and residual urine volume. There was significant difference between results in the main and control group (p<0.05). Considering anti-inflammatory, antioxidant activity and antiproliferative effect, entomological drug Adenoprosin may become a novel drug for the complex therapy of patients with BPH and CP. However, to validate the results and to study the mode of action of this group of drugs in details, there is a need to carry out large-scale placebo-controlled clinical trials.
On 17th Dec 2019 gastroenteritis outbreak occurred in two Pragues neighbouring institutions. Investigation aimed to describe outbreak, identify etiological agent, vehicle and propose control measures. Routine outbreak investigation and retrospective cohort study was done. Data collected via online questionnaire were analysed using descriptive, univariate and stratified analysis. Of 960 employees, 276 responded (29%). We identified 39 (14%) cases, one tested norovirus positive. Canteen staff didnt report illness. No food item or environmental sample was tested. Sichuan pork served for lunch on 17th Dec was the most likely vehicle of outbreak (odds ratio (OR) 5.02, 95% confidence interval (CI) 1.98-12.64). Eating Sichuan pork and Chinese soup showed OR 31.5, 95% CI 5.0-320.7. Twenty-two (56%) cases can be explained by consumption of these food items. Epidemiological analytical method provided evidence of likely vehicle. We did not find the source. Control measures were early ensured and outbreak ceased. We emphasise full outbreak investigation using analytical epidemiology, environmental screening and microbiological testing of cases and possibly all kitchen staff.
Percutaneous nephrolithotomy (PCNL) is the method of choice for large and staghorn renal stones, including those in patients with solitary kidney. The aim of the literature review was to analyze the results of PCNL in patients with large stones in the solitary kidney. The literature search was conducted in databases Embase, Medline, Google Scholar, Scopus for the period from 2010 to 2019. A total 94 articles were selected, of which 16 papers were included in the review after analyzing the abstracts. Data was pooled and analyzed using SPSS Statistics 22.0. The primary stone-free rate for PCNL in these patients was 68.3+/-14.2%, and the final stone-free rate increased by 86.5+/-4.9%. The average duration of the operation was 86+/-25 (43.7-138.3) min, the length of stay was 5 (2-6) days. The baseline creatinine level was 137 (110-200) mmol/L, compared to 142 (122-183) mmol/L postoperatively. The mean difference between the baseline and postoperative Hb level was 7.8 (1.3-17.5) g/l. The estimated glomerular filtration rate (GFR) before PCNL was 62.3+/-7.5 ml/min/1.73 m2, and it did not exceed 62.5+/-9.3 ml/min/1.73 m2 postoperatively. The overall complication rate ranged from 10.6 to 68.8%, averaging 29.9%. In most cases, there were grade I and II complications, according to Clavien-Dindo classification, which didnt require additional interventions. PCNL is a highly effective treatment method for patients with large stones in solitary kidney. Complications rate is relatively low, which is achieved by an individual approach, with a consideration of the condition and all risk factors.
The authors deal with a case of suicidal attempt resulting in a fatal head injury. A young man shot himself with a serially produced mechanical sports crossbow. The young man with a critical intracranial injury, a penetration, was nevertheless capable of basic locomotive activity, as well as of coherent communication with another people present at the scene. The critically injured patient was transported from the scene directly to medical centre where he subsequently underwent a neurologic surgery. On the eight day after the incident he died in the hospital as a result of sustained wounds. During the autopsy, a penetrating arrow-shot wound head injury was certified, occurring in the right and left temple area. Signs of a complex decompressive craniectomy were established too. The shooting channel was generally horizontally oriented, extending from the right to the left side, from behind in a 10 up to 15 degrees angle to the frontal plane, penetrating the brain from the right temple lobe and the frontal lobe, thereby pervading also frontal horns of lateral ventricles, and from the left afflicting the frontal lobe on the left side of the brain. In the course of the shooting channel, brain contusion occurred, accompanied by intraventricular haemorrhage. In addition, a heavy cerebral oedema, multiple secondary malacias, Durett haemorrhages and extensive thrombosis of cerebral sinuses were stated. In the course of police investigation, based mainly on the information given by the wounded man right after he had been found at the scene, it was revealed that another person might have been involved. The forensic autopsy, the investigation of the Police and the subsequent criminalist-ballistics expert investigation, supported by a series of experimental substitutive target shots, didnt, however, decidedly prove that any other culprit had been involved.
MTM1 gene is essential for superoxide dismutase 2 activity and normal mitochondrial functions. MTM1 deletion results in decreased superoxide dismutase 2 activity, impaired mitochondrial functions and growth defect on nonfermentable carbon source. To promote understanding of MTM1 gene, we started a genetic screen for transposon insertions which are able to rescue the growth defect resulting from MTM1 deletion. Routine screening strategy didnt work because of the irreversible damage caused by MTM1 deletion. So we adopted the following screening strategy: we transformed a plasmid overexpressing MTM1 into wild type before deleting MTM1 in chromosome and got the resulting strain, designated YES2MTM1. Then we transformed mTn-lacZ/LEU2 transposon library into the YES2MTM1 strain. Transformants lost the plasmid overexpressing MTM1 after 5-Fluoroorotic acid treatment. We picked up the yeast strains able to grow on nonfermentable carbon source with MTM1 deletion and some transposon insertion and identified the insertion sites. We found transposon insertions in two genes were able to rescue the growth defect resulting from MTM1 deletion on nonfermentable carbon source. Our study will provide reference for thorough understanding of MTM1 gene function.
to compare the prostate cancer (PCa) detection rate, accuracy and safety of prostate image-guided fusion biopsy methods (cognitive fusion, software-fusion and HistoScanning-guided biopsy) on the basis of published studies in patients from 48 to 75 years with suspected prostate cancer during primary or repeat biopsy. To identify the limitations of these methods and improve the efficiency of fusion biopsy of the prostate in a further clinical trial. search was carried out in the PubMed, Medline, Web of Science and eLibrary databases using following requests: (prostate cancer OR prostate adenocarcinoma) AND (MRI or magnetic resonance) AND (targeted biopsy); (prostate cancer OR prostate adenocarcinoma) AND (PHS OR Histoscanning) AND (targeted biopsy) and (prostate cancer OR prostate adenocarcinoma) AND (MRI or magnetic resonance) AND (targeted biopsy) AND (cognitive registration), targeted prostate biopsy, prostate histoscanning, histoscanning, cognitive prostate biopsy. a total of 672 publications were found, of which 25 original scientific papers were included in the analysis (n=4634). According to the results, PCa detection rate in patients with an average age of 62.5 years. (48-75) and an average PSA of 6.3 ng/ml (4.1-10.8), who underwent cognitive fusion biopsy under MRI control (MR-fusion) was 32.5%, compared to 30% and 35% for histoscanning in combination with a systematic biopsy and combination of methods (MR-fusion biopsy and histoscanning-guided biopsy), respectively. The accuracy of cognitive MR-fusion biopsy was 49.8% (20.8%-82%), the accuracy of the software MR-fusion biopsy was 52.5% (26.5%-69.7%), the accuracy of histoscanning-guided targeted biopsy was 46.8% (26%-75.8%). The highest values were observed in the patients undergoing primary biopsy (75.8%). Currently, imaging methods allow us to change the approach to the diagnosis of PCa by improving the efficiency of prostate biopsy, the only formal method for verifying PCa. A common method for PCa diagnosis in 2018 is a systematic prostate biopsy. However, due to the its drawbacks, fusion biopsy under control of MRI or ultrasound has being introduced into clinical practice with superior results. So far, there is a lack of sufficient scientific data to select a specific technique of the fusion biopsy of the prostate. According to the analysis, it was concluded that the incidence of complications didnt increase when performing targeted biopsy in addition to the systematic protocol. The efficiency of cognitive MR-fusion biopsy is comparable to software MR-fusion biopsy. Histoscanning-guided biopsy has lower diagnostic value than MR-guided target biopsy using software. The lack of solid conclusions in favor of a particular prostate fusion biopsy technique stresses on the relevance of further research on this topic.
To establish the processing method of fructus evodiae and its standard for quality control, toxicity aspects and pharmacodynamics were carried out at the same time. In the studies of processing techniques, the optimized technical parameters were determined by the contents of evodiamine and evodine. And the acute toxicity and pharmacodynamics were studied by rats. The process was that the liquorice-processed fructus evodiae was wetted by liquorice decoction by sixth of raw fructus evodiae (V/W) and fried below 230 degrees C. The method of detecting the contents of evodiamine and evodine was that Alltima ODS C18 (4.6 mm x 250 mm, 5 microm); mobile phase acetonitrile-water-tetrahydrofuran-phosphoric acid (51:48: 1: 0.05); column temperature 25 degrees C; mobile rate 0.8 mL x min(-1); wave length 225 nm. The toxicity experimentation show that rats didnt show any notable changes after affused the raw material and the processed fructus evodiae's decotion 40 g x kg(-1) b. w. at one time seven days constantly. The analgesic effect was observed after 0.6 g (material) x kg(-1) (weight) b. w. The toxicity of the raw material and the processed one were low and the liquorice-processed fructus evodia analgesic effect was good.
Overactive bladder syndrome (OAB) is very common. It has been shown that urge incontinence is more difficult for women than for men, sinse they have higher levels of stress, depression, and more pronounced sexual dysfunction. The study included 47 patients aged 54.6+/-3.5 years with symptoms of OAB. The Overactive Bladder Symptom Score (OABSS) was used to assess the symptoms, while the sexual function of the patients was evaluated using the Female Sexual Dysfunction Index (FSFI). In addition, Mini Mental State Examination (MMSE) scale was used for assessing the cognitive function. In comparison group there were 22 women who were comparable in socio-demographic characteristics, but didnt have symptoms of OAB. The comparison between two groups was carried out using FSFI scale. Patients in the OAB group were prescribed trospium chloride (Spazmex) 15 mg b.i.d. for three months, after which the patients completed the OABSS, FSFI, and MMSE questionnaires again. All patients with OAB reported sexual dysfunction, which was significantly more profound than in the control group. The FSFI scores were, respectively, 15.23+/-6.12 versus 22.46+/-5.47. The average assessment of the cognitive abilities of patients with OAB was 27.9+/-1.4, which indicates that their cognitive functions were completely intact. The mean score on the OABSS scale was 11.8+/-2.7, and 11 women (23.4%) had a mild OAB, and 36 (76.6%) had moderate severity of symptoms. After three months of therapy, the mean score on the OABSS scale decreased by half, to an average of 5.4+/-1.2 points; the overall score of the FSFI approached the level of healthy women (20.64 and 22.46, respectively). The repeated assessment of the mental status did not reveal any changes, since the mean score of MMSE was 27.8+/-1.3. No significant adverse events were noted in any case. None of the patients required dose adjustment of the drugs that they received for concomitant diseases. All women with OAB syndrome had decreased sexual function compared to healthy women of the same age and social status. A three-month course of trospium chloride (Spazmex), 30 mg daily, significantly improved both the parameters of urination and the sexual function, without having any adverse effect on their cognitive abilities. Moreover, there was no need to adjust the doses of drugs taken for concomitant diseases.