Experimental and clinical applications and outcomes of using different forms of suction in retrograde intrarenal surgery. Results from a systematic review.

OBJECTIVE: To identify the latest advances in suction devices and evaluate their effect in Retrograde intrarenal surgery (RIRS) and ureteroscopy for stones. BASIC PROCEDURES: A systematic literature search was performed on 4th January 2023 using Scopus, PubMed, and EMBASE. Only English papers were included; both pediatric and adult studies were accepted. Duplicate studies, case reports, letters to the editor, and meeting abstracts were excluded. MAIN FINDINGS: Twenty-one papers were selected. Several methods have been proposed for suction use in RIRS, such as through the ureteral access sheath or directly to the scope. Artificial intelligence can also regulate this system, monitoring pressure and perfusion flow values. All the proposed techniques showed satisfactory perioperative results for operative time, stone-free rate (SFR), and residual fragments. Moreover, the reduction of intrarenal pressure (induced by aspiration) was also associated with a lower infection rate. Even the studies that considered kidney stones with a diameter of 20 mm or higher reported higher SFR and reduced postoperative complications. However, the lack of well-defined settings for suction pressure and fluid flow prevents the standardization of the procedure. CONCLUSION: Aspiration device in the surgical treatment of urinary stones favours a higher SFR, reducing infectious complications, as supported by the included studies. RIRS with a suction system provided to be a natural successor to the traditional technique, regulating intrarenal pressure and aspirating fine dust.

Does gender influence retrograde intrarenal surgery (RIRS) outcomes? Data from the Flexible Ureteroscopy Outcomes Registry (FLEXOR).

INTRODUCTION AND OBJECTIVES: As well established flexible ureteroscopy (RIRS). There is still no evidence if gender can have any influence on the outcomes and complication when performing. This study aims to evaluate the role that gender has in performing flexible ureteroscopy from a large series of patients. METHODS: This study retrospectively analyzed patients who underwent RIRS for renal stones from January 2018 to August 2021 within the multicentric FLEXOR registry. Demographics, stone characteristics, perioperative findings, results and complications were analyzed and compared between gender groups. RESULTS: A total of 6669 patients were included, 66.1% were male and 33.9% were female. Stone characteristics was comparable between groups. Female patients had significant higher fever and positive urine culture rates (12% vs. 8% and 37% vs. 34%). Also, females had a slight longer hospital stay (3.8 vs. 3.5 days; P < 0.001) and more residual fragments after the procedure (23.03% vs. 20.97 (P = 0.032). Overall complications were slightly significantly higher in women (15.74% vs. 14% (P = 0.042)) mainly at the expense of fever rates (6.9% vs. 5.7%) whereas the risk of sepsis was similar in both groups. A multivariate analysis showed that larger stone size, multiple and lower pole stones seem to have a negative impact in the incidence of residual stones and complications. CONCLUSION: Our real life global study reflects that female gender may have a correlation with a slightly increased residual fragment rate and overall low grade complications. However, women can safely be treated with RIRS with no increased the rate of sepsis with appropriate care.

Role of pre-operative ureteral stent on outcomes of retrograde intra-renal surgery (RIRS): systematic review and meta-analysis of 3831 patients and comparison of Asian and non-Asian cohorts.

PURPOSE: To evaluate the outcomes of pre-stented (PS) versus non-pre-stented (NPS) patients who have undergone retrograde intrarenal surgery (RIRS) for renal calculi with subgroup analysis of Asian and non-Asian cohorts. METHODS: Protocol is registered in PROSPERO, CRD42021261123. Eligible studies identified from four electronic databases. Meta-analysis was done to enumerate the outcomes of RIRS in between PS and NPS. Secondary sub-analysis was done to look for differences in outcomes in Asian and non-Asian cohorts. RESULTS: Fourteen studies involving 3831 patients (4 prospective, 10 retrospective studies) were included. PS patients experienced higher success rates of ureteral access sheath (UAS) insertion than NPS (RR 1.09, 95% CI 1.05-1.13, p < 0.00001). PS patients had lower risk of ureteral injuries from UAS placement (RR 0.69, 95% CI 0.50-0.96, p = 0.03). No significant differences in intra- and postoperative complications between two groups were found. Stone-free rate (SFR) outcomes for residual fragment (RF) cut-off of < 1 mm and < 4 mm favoured the PS patients (RR 1.10, 95% CI 1.04-1.17, p = 0.002 for < 4 mm, RR1.10, 95% CI 1.02-1.19, p = 0.02 for < 1 mm). In the subgroup analysis, PS Asian patients had similar SFR as NPS patients for SFR(< 4 mm) but non-Asian population showed better outcomes in the PS patients for SFR(< 4 mm) (RR 1.31, 95% CI 1.13-1.52, p = 0.0005). CONCLUSIONS: This meta-analysis suggests that pre-stenting results in a higher success for UAS placement, minimising intraoperative ureteric injury, with higher overall SFR for any RF cut-off in PS cohorts. In non-Asian cohort, significant differences occurred at SFR < 4 mm but not for SFR < 1 mm. No difference was seen in our Asian cohort for any SFR cut-off in both PS and NPS patients.

Coeficientes técnicos de produção da priprioca (Cyperus articulatus L. ) em sistema orgânico, na região de Belém (PA) / Technical coefficients of priprioca production (Cyperus articulatus L. ) in organic system at the region of Belém (PA)

Foram elaborados os coeficientes técnicos de produção de priprioca (Cyperus articulatus) em três áreas fornecedoras parceiras da Natura, situadas na região do entorno de Belém, Amazônia Oriental. Para elaboração dos coeficientes técnicos de produção de priprioca, os itens de custo e as atividades que compreendem o cultivo, a colheita e o beneficiamento foram levantados e classificados em: Insumos; Serviços; Equipamentos; e Outros. O detalhamento destas atividades e o valor dos itens foram obtidos e construídos in loco, juntamente com os agricultores. As informações utilizadas neste trabalho consideraram a produção de 1 tonelada de raiz de priprioca, cultivadas anualmente em sete canteiros de 60 m² (1,2 m largura x 50 m comprimento), espaçamento de 0,20 x 0,20 m, em sistema orgânico com rendimento médio de 2,5 kg m2 -1. Os resultados descrevem os materiais consumidos, o tempo de mão-de-obra para realização das operações e os custos, baseados na realidade local. Conclui-se com este trabalho que a elaboração do coeficiente técnico de produção auxilia o agricultor a estimar o custo de produção de uma determinada matéria prima e evidencia as atividades que podem contribuir no lucro como, por exemplo, as boas práticas de produção.

Were prepared the technical coefficients of priprioca (Cyperus articulatus) production in three areas suppliers partner of Natura, situated around Belem, Eastern Amazon. For preparation of technical coefficients of priprioca production, the cost items and activities that comprise the growing, harvesting and processing were collected and classified as: Inputs, Services, Equipment, and Others. The details of these activities and the value of the items were obtained and constructed in situ, together with the farmers. Information used in this study considered the production of one tonne of priprioca root cultivated annually in seven plots of 60 m² (1,2 m wide x 50 m length) 0,20 x 0,20 m, in an organic system average yield of 2,5 kg m2 -1. The results describe the materials consumed, the time of manpower to carry out the operations and costs, based on local realities. Were conclude with this work that the preparation of the technical coefficient production helps farmers to estimate the cost of production and highlights the activities that can contribute to profit, for example, good manufacturing practices.

A simplified method for anal ultrasonography: assessment of patient satisfaction and the simplicity of the procedure.

BACKGROUND: Anal endosonography reliably visualizes and identifies anal sphincter abnormalities. However, dedicated probes are quite expensive. We evaluated a simple and less-costly procedure for anal endosonography involving the insertion of the endoscope through a disposable anoscope filled with standard ultrasound gel in terms of patient satisfaction and the simplicity of the procedure in comparison with the standard technique in a unit that already had echoendoscopes available. METHODS: The two techniques were used in 35 subjects without anal abnormalities and data on the simplicity of the procedures, patient discomfort, the quality of images, and the time needed to perform the procedures were compared. RESULTS: All the variables under investigation scored significantly better with the modified technique compared to the standard one. No differences in thickness of either the internal or the external anal sphincter were found between the two methods. CONCLUSIONS: This simple and less-costly adaptation of anal ultrasonography allows good quality examinations to be performed with better patient comfort in units with echoendoscopes already available, avoiding the need for a more expensive dedicated probe.

Colon and gastric metastases from a primary signet-ring cell carcinoma of the urinary bladder.

Signet-ring cell carcinoma is a relatively rare neoplasm that rarely occurs in the urinary bladder. We report a case of a 60-year-old man who presented with gross haematuria. Cystoscopy revealed a white sessile tumour of the anterior bladder wall. The histological diagnosis showed a primary signet-ring cell carcinoma of the bladder (T3bN0M0). Eighteen months after radical cystectomy, the patient developed colon and stomach metastases. This case represents the first description of a primary signet-ring cell carcinoma of the urinary bladder with gastrointestinal metastases.

[Mandibular atrophy and a screw-retained implant-supported prosthesis]. / Atrophie mandibulaire et prothèse implantoportée, fixe, vissée. Etude préliminaire de 7 cas.

Prosthetic care for mandibular atrophy has raised many difficult problems, particularly in the most severe cases. The solution to most of these problems lies in the use of osteointegrated implants. Good results were obtained by using a small number of implants associated with adjustable overdenture prostheses or, alternatively, by using a larger number of implants (5 or 6) associated with a screw fixed prosthesis with posterior cantilever. Cantilever prostheses can provide support for the mental foramen zones and the posterior zones of the mandibular body where bone resorption is important after application of adjustable plates to the fibromucosa.

An alternative method for direct custom tray construction using a visible light-cured resin.

The use of a properly made tray is highly desirable for impression making. To avoid the extra time required for tray fabrication, the alternative techniques of the putty wash or "reline" technique and intraoral fabrication of a custom tray by relining a stock tray with self-curing resin are proposed. This article illustrates a new technique of direct custom tray fabrication used for impression making for fixed prosthodontics. The proposed technique allows the direct fabrication of custom trays with light-cured resin and is time-saving, efficient, and inexpensive.

In vivo plaque formation on cast ceramic (Dicor) and conventional ceramic.

This study compared plaque accumulation on glazed and nonglazed metal ceramic porcelain surfaces with shaded and nonshaded Dicor cast ceramic surfaces. Plaque accumulation on natural teeth was also measured at 4, 12, 24, and 48 hours. Bacterial cultures were prepared from each sample to establish the aerobic and anaerobic charge. Plaque accumulation between 12 and 24 hours was measured on different materials. No significant differences were discovered between the plaque-retaining capacities of metal ceramic porcelain and Dicor ceramic surfaces. There was less plaque accumulation on glazed surfaces than on nonglazed surfaces.

Thermal distortion of different materials in crown construction.

This study compared the thermal distortion of all-ceramic crowns with porcelain-fused-to-metal crowns. The materials exhibited different responses: metal ceramic crowns stabilized after an initial loss of marginal precision, and the all-ceramic crowns continued to distort with each firing cycle.

Resistance to fracture of metal ceramic and all-ceramic crowns.

This study evaluated the fracture resistance of three types of all-ceramic crowns and compared these to the fracture values of metal ceramics. Uniform metal ceramic specimens; veneered, cast glass-ceramic; and porcelain fused to two different dispersion-strengthened ceramic cores (Hi-Ceram and In-Ceram) were investigated. The metal ceramic specimens demonstrated a significantly higher resistance to fracture than did the Hi-Ceram or veneered glass-ceramic units but did not significantly differ from the In-Ceram specimens. The metal ceramic crowns showed cracks only in the ceramic layer, whereas the all-ceramic specimens underwent global fracture.

[Ethical, medico-legal and deontological aspects of dentistry in HIV infection]. / Aspetti etici, medico-legali e deontologici dell'odontoiatra nella infezione HIV.

Medical behaviour toward HIV infected patients is often complicated by fear, confusion and lack of knowledge. Since frequently pathological manifestations in the oral area are early signs warning of HIV infection, dentists must deepen their knowledge in this field in order to be able to help diagnose for early treatment as well to cope with connected ethical, medico-legal and deontological aspects.

Multidisciplinary team approach to the pediatric burn patient.

Burn trauma is the most devastating injury the body can sustain. Each year, 100,000 victims will sustain burn injuries serious enough to require hospitalization; 35% of these victims are children. The Shriners Hospitals for Crippled Children Burns Institute, Cincinnati Unit (SBI-Cincinnati), is a 30-bed hospital with all of the support systems of a major university medical center. SBI-Cincinnati uses a multidisciplinary team approach to family-centered care. The primary nurse and physician collaborate with the rest of the health care team to manage all aspects of care. This approach assures that coordination of care occurs and allows the family the opportunity to maintain a unique role as the primary caregiver.

Prostanoid concentrations in human CSF following acute ischaemic brain infarction.

Thromboxane A2 and prostacyclin are two compounds which have been implicated as important modulators of local cerebral blood flow. Concentrations of the stable metabolites of these two compounds, thromboxane B2 and 6-keto-PGF1 alpha, were measured in cerebrospinal fluid (CSF) from eight acute ischaemic stroke patients and 14 patients with no evidence of cerebrovascular disease. Concentrations of thromboxane B2 ranged from 0.15 to 4.0 pg/ml and were significantly higher (P = 0.025) in the ischaemic stroke group when compared with the control group (0.1-0.3 pg/ml). Simultaneously acquired concentrations of 6-keto-PGF1 alpha were not elevated in the stroke group when compared to normals. These clinical findings support evidence from animal studies that emphasizes the importance of cerebral prostaglandins in mediating the secondary vascular changes of cerebral infarction. In conclusion there is an aberration in CSF thromboxane B2 concentrations in patients who have had a stroke. This may be an acute or chronic phenomenon.