Effect of Stepwise Voltage Escalation on Treatment Outcomes following Extracorporeal Shock Wave Lithotripsy of Renal Calculi: A Prospective Randomized Study.

PURPOSE: In this study we assessed the effects of a ramping protocol in patients undergoing extracorporeal shock wave lithotripsy of renal stones. MATERIALS AND METHODS: In this prospective study patients with renal stones were randomized to receive shock wave lithotripsy delivered using a ramping protocol in group 1 (first 1,000 shocks at energy level 5 followed by 1,000 shocks at energy level 6 and 1,000 final shocks at energy level 7) and a fixed voltage protocol in group 2 (all 3,000 shocks at energy level 7). Treatment was administered using a Modulith® SLX-F2. The primary outcome was treatment success 12 weeks after a single shock wave lithotripsy session, defined as lack of a stone or a less than 4 mm stone fragment on computerized tomography. Other outcomes included the stone-free rate and the perinephric hematoma incidence. RESULTS: A total of 300 patients (150 per group) were recruited between February 2016 and June 2018. The 2 groups did not differ in baseline parameters. Group 1 received 14.8% lower energy than group 2, which was significant (p <0.001). The treatment success rate in groups 1 and 2 was 67.8% and 73.6%, respectively, which did not statistically differ (group 1 crude OR 0.753, 95% CI 0.456-1.244, p=0.268). The stone-free rate in groups 1 and 2 was 36.6% and 41.9%, respectively, which did not differ statistically between the groups. However, in groups 1 and 2 perinephric hematoma developed in 23.8% and 43.8% of patients, respectively, which was a statistically significant difference (p <0.001). CONCLUSIONS: The fixed voltage shock wave lithotripsy and ramping protocols provided similar treatment success rates for renal stones. However, the ramping protocol reduced the incidence of perinephric hematoma after shock wave lithotripsy.

Effect of Focal Zone Size on Treatment Outcomes and Renal Injury Following Extracorporeal Shockwave Lithotripsy of Renal Calculi: A Prospective Randomized Study.

Background: The narrower focal zone (FZ) size of modern lithotripter was considered as one of the factors that resulted in suboptimal treatment result of extracorporeal shockwave lithotripsy (SWL). Therefore, we investigate the efficacy and safety of standard narrow or extended (FZ) sizes in SWL for patients with renal stones. Materials and Methods: In this prospective study conducted between April 2018 and October 2022, patients with renal stones were randomized to receive SWL with either standard or extended FZ. Treatment was delivered using a Modulith SLX-F2 lithotripter with a maximum of 3000 shocks at 1.5 Hz. The primary outcome was treatment success 12 weeks after a single SWL session, defined as the absence of a stone or stone fragment <4 mm on computed tomography. Secondary outcomes included the incidence of perinephric hematoma, stone-free rate (SFR), and changes in the urinary levels of acute renal injury markers. Results: A total of 320 patients were recruited, and 276 patients were randomized into the two groups. The two groups had similar baseline parameters. The treatment success rate was significantly better for standard FZ (74.3%) than the extended FZ group (59.3%) (p = 0.009). Standard FZ also had a significantly better SFR (Grade-A, 36.8% vs 23.0%, p = 0.013) and less pain after treatment. Both groups had similar perinephric hematoma formation rates, unplanned hospital admission rates, and changes in urinary acute renal injury markers. Conclusions: The standard narrow FZ has better treatment efficacy and similar safety compared with the extended FZ during SWL for renal stones. This clinical trial has been registered in the public domain (CCRBCTR) under trial number CUHK_CCRB00510.

The extreme illusion of understanding.

Though speakers and listeners monitor communication success, they systematically overestimate it. We report an extreme illusion of understanding that exists even without shared language. Native Mandarin Chinese speakers overestimated how well native English-speaking Americans understood what they said in Chinese, even when they were informed that the listeners knew no Chinese. These listeners also believed they understood the intentions of the Chinese speakers much more than they actually did. This extreme illusion impacts theories of speech monitoring and may be consequential in real-life, where miscommunication is costly. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Oral antibiotics perturbation on gut microbiota after prostate biopsy.

Introduction: The use of antibiotics may induce the changes in gut microbiota. Previous studies have shown conflicting results on whether the changed gut microbiota by antibiotics can be recovered. Our study aims to investigate whether the gut microbiota could be recovered after a single dose of oral co-amoxiclav before transrectal ultrasound-guided transperineal prostate biopsy (TPPBx) in 5 weeks' time. Methods: Fifteen patients with elevated serum prostate-specific antigen (PSA) were recruited to provide pre-antibiotic and post-antibiotic fecal samples. The V4 region of 16S rRNA was sequenced. Analysis was performed by QIIME2. Alpha- and beta-diversities were analyzed, as well as the differential enrichment by Linear discriminant analysis Effect Size (LEfSe) analysis. Results: Both the alpha- and beta-diversities of the pre- and post-antibiotic fecal samples were significantly different. Genera that are associated with alleviation of inflammation were enriched in the pre-antibiotic fecal samples, while the inflammation-associated genera were more enriched in the post-antibiotic fecal samples. Conclusion: A single dose of oral co-amoxiclav before TPPBx could have led to a change of gut microbiota that cannot be recovered in 5 weeks' time. Microbiome studies on prostate cancer patients should be cautioned on the use of post-prostate biopsy fecal sampling. Further studies should be conducted for the impact on gut microbiome for TPPBx alone.

Effect of androgen deprivation therapy on cardiovascular function in Chinese patients with advanced prostate cancer: a prospective cohort study.

Androgen deprivation therapy (ADT) is the standard treatment for advanced prostate cancer, but its effect on cardiovascular and metabolic function in Asian patients is still inconclusive. We prospectively assess the effects of ADT on 36 patients with advanced prostate cancer, with reference to another 24 prostate cancer patients not requiring ADT, for 2 years. Patients' anthropometric, metabolic and vascular parameters were assessed every six-monthly. The baseline parameters of the two groups were comparable. There was a significant negative effect of the usage of ADT on the changes in BMI (p = 0.020), waist to hip ratio (p = 0.005), body fat percentage (p = 0.012), and high-density-lipoprotein (p = 0.012). ADT-patients were 4.9 times more likely to have metabolic syndrome at 24 months. (CI 0.889-27.193, p = 0.068). The Framingham risk score (p = 0.018) and pulse-wave-velocity (p = 0.024) for ADT-group were also significantly higher than controls, which signified increase in cardiovascular risk. Although there was no statistically significant difference in ischemic cardiovascular events between two groups, a trend for more events in ADT-group was observed. Therefore, Asian patients have increased cardiovascular and metabolic risks after being treated with ADT for two years. Appropriate counselling and monitoring of associated complications with ADT are essential.

On the reliability of the foreign language effect on risk-taking.

People consider choices that involve risk on a daily basis. In principle, willingness to take risks should be independent of the language used while considering the available options. However, research has shown that using a foreign language can increase willingness to take risks, presumably because a foreign language is less emotional. Here, we investigate the robustness of this effect of language on risk by varying participant language background and methodological design features. In addition, we investigate whether using a foreign language increases risk-seeking behaviour in general, or whether it promotes a more strategic approach to risk. Four experiments reveal mixed results regarding the effect that using a foreign language has on risk-taking. Experiment 1 clearly shows that using a foreign language increases strategic risk-taking compared with using a native tongue. In contrast, Experiments 2 and 3 find no effect of the native-ness of language on risk-taking. Experiment 4 supports the idea that using a foreign language promotes risk-taking in general compared with using a native language. We discuss these mixed results in the context of previous findings and suggest potential directions for future research to clarify the effect of language on risk-taking.

The influence of self-relevant materials on working memory in dysphoric undergraduates.

Difficulties in updating working memory (WM) may underlie problems with regulating emotions that contribute to depression. To examine the ability of updating affective materials in WM, 33 dysphoric and 34 non-dysphoric participants were asked to evaluate the self-descriptiveness of emotional adjectives and provide answers to self-relevant questions. Within 3-7 days, they completed a two-back task with a series of self-irrelevant or self-relevant emotional words (they had generated previously) and four conditions (match-set, break-set, perseveration-set, and no-set). After the WM task, an unexpected recall task was administered; controls recalled more positive self-relevant words and intrusions while dysphoric participants recalled more negative self-relevant words and intrusions. In break-set trials of the two-back task, dysphoric individuals showed slower response to self-relevant words regardless of valence. In the match-set and perseveration-set trials, dysphoric participants showed delayed response to self-related negative words. Moreover, longer reaction times for self-relevant negative words were correlated with higher rumination and worse depression. The results suggest that dysphoric undergraduates are interfered more by and have a better memory of self-relevant negative stimuli in WM, which is closely correlated with rumination. This study is among the first to confirm the potential mechanism that could underwrite the involvement of self-schema in effectively regulating negative affect.