[The 1-cm lower calyx calculus: SWT, URS or Mini-PCNL? Guidelines vs. reality.] / Der 1 cm UKG-Stein: ESWL, URS oder Mini-PCNL? Leitlinien versus Realität.

Urinary stones of the upper urinary tract can be considered a widespread public health concern due to their high incidence and prevalence and their health policy-related and financial implications. A significant proportion of newly diagnosed kidney stones are lower-pole stones, i.e., stones affecting the lower calyx group of the renal pelvicalyceal system. These are often diagnosed by chance, i.e., as incidental findings during ultrasound or CT scans performed for other reasons, or as "secondary stones" detected during the diagnostic work-up of symptomatic urinary stones in other locations. Residual disintegrates after extracorporeal shock-wave lithotripsy (ESWL) or endoscopic stone therapy constitute a further, quantitatively significant group. These incidentally discovered lower-pole stones are often characterised by their small size and lack of symptoms. It stands to reason that some of these small, asymptomatic lower-pole stones do not always remain small and asymptomatic, and that treatment tends to become more complex with increasing size. There has been an astonishing lack of published studies with a high level of evidence over the last 20 years to provide a conclusive and reproducible answer to the question posed in this review. Small, asymptomatic stones can be monitored. Symptomatic and rapidly growing stones should be treated. There is a lack of valid risk factors allowing an identification of subgroups that should be treated prophylactically at the asymptomatic stage. In active therapy, a 10-to-20-year-old principle still holds true today: a high stone-free rate in one therapy session is offset by an increased complication rate, with increasing miniaturisation in endourology (retrograde and percutaneous) and increasingly effective laser disintegration shifting this basic principle more and more in favour of flexible URS and (mini, micro) PCNL. The range of indications for ESWL is undoubtedly becoming smaller, and this also applies to lower-pole stones. The results of an ongoing prospective randomised study comparing the different treatment modalities, albeit with recruitment difficulties, are still pending.

[CpG-ODN instillation boosts ICAM-1 expression in an orthotopic murine UCC model: immunohistochemical evaluation of the local response to immunostimulatory DNA]. / ICAM-1-Induktion durch CpG-ODN im murinen, orthotopen UCC-Modell ­ Immunhistochemische Analyse der lokalen Immunantwort auf immunstimulatorische DNA-Sequenzen.

BACKGROUND: Immunostimulatory CpG oligodeoxynucleotides (CpG-ODN) have been verified as an effective antineoplastic agent for intravesical application in a murine orthotopic C57-BL6 /MB-49 urothelial cell carcinoma (UCC). To date, many details in the mode of action have remained unclear. Preceding studies pointed towards a Th1-weighted response. The aim of this work was to identify the local lymphocyte subsets in murine tumour-bearing bladders and to examine effects on the expression of Intercellular Adhesion Molecule 1 (ICAM-1) after treatment with CpG-ODN. MATERIAL AND METHODS: Different instillation schedules were applied in an established orthotopic C57-BL6 /MB49 UCC model. After 13 days, fresh frozen sections of the harvested bladders were immunohistochemically examined for the infiltration density of lymphocytes expressing CD 3, CD4, CD8 and CD19. In a second series of the same animal model, healthy and tumour-bearing bladders were exposed to CpG-ODN or PBS and later stained for the expression of ICAM-1. RESULTS: CpG-ODN instillation led to augmented T-cell infiltration (represented by CD3). Further T-cell subdifferentiation between T-helper cells (CD4) and cytotoxic T cells (CD 8a) did not show a perceptible variety between groups. The B-cell population (CD19) was found to decrease over the course of treatment. In the second series, treatment provoked a strong expression of ICAM-1 by infiltrating leukocytes, endothelial cells and particularly by the cancer cells themselves. DISCUSSION: The previously observed augmented lymphocyte density was classified as T-cell infiltration. The decline of the B-cell concentration over the course of treatment suggests a Th2 suppression in favour of a Th-1 polarisation. These findings support the assumption that a cell-mediated immune response is the mode of action underlying the antineoplastic CpG-ODN capacities. The marked upregulation of ICAM-1 expression, especially on tumour cells, suggests a crucial role of this membrane protein for the initiation and maintenance of anticancer immune response. CONCLUSION: CpG-ODN might be a prospective alternative to established instillation therapies. With a view to the current BCG shortage and the well-known toxicities, an amplification of the topic therapy armamentarium could be achievable. The now described capability of ICAM-1 induction on carcinoma cells and, by association, the reversal of escape strategies to cancer immunity may also make the agent interesting as an adjuvant for modern checkpoint inhibition.

Child-Robot Relationship Formation: A Narrative Review of Empirical Research.

This narrative review aimed to elucidate which robot-related characteristics predict relationship formation between typically-developing children and social robots in terms of closeness and trust. Moreover, we wanted to know to what extent relationship formation can be explained by children's experiential and cognitive states during interaction with a robot. We reviewed 86 journal articles and conference proceedings published between 2000 and 2017. In terms of predictors, robots' responsiveness and role, as well as strategic and emotional interaction between robot and child, increased closeness between the child and the robot. Findings about whether robot features predict children's trust in robots were inconsistent. In terms of children's experiential and cognitive states during interaction with a robot, robot characteristics and interaction styles were associated with two experiential states: engagement and enjoyment/liking. The literature hardly addressed the impact of experiential and cognitive states on closeness and trust. Comparisons of children's interactions with robots, adults, and objects showed that robots are perceived as neither animate nor inanimate, and that they are entities with whom children will likely form social relationships. Younger children experienced more enjoyment, were less sensitive to a robot's interaction style, and were more prone to anthropomorphic tendencies and effects than older children. Tailoring a robot's sex to that of a child mainly appealed to boys.

Norms of online expressions of emotion: Comparing Facebook, Twitter, Instagram, and WhatsApp.

The main aim of this study was to examine the norms of expressing emotions on social media. Specifically, the perceived appropriateness (i.e. injunctive norms) of expressing six discrete emotions (i.e. sadness, anger, disappointment, worry, joy, and pride) was investigated across four different social media platforms. Drawing on data collected in March 2016 among 1201 young Dutch users (15-25 years), we found that positive expressions were generally perceived as more appropriate than negative expressions across all platforms. In line with the objective of the study, some platform differences were found. The expression of negative emotions was rated as most appropriate for WhatsApp, followed by Facebook, Twitter, and Instagram. For positive emotion expression, perceived appropriateness was highest for WhatsApp, followed by Instagram, Facebook, and Twitter. Additionally, some gender differences were found, while age showed little variations. Overall, the results contribute to a more informed understanding of emotion expression online.

[Recommendations for the Use of Indirect and Direct Anticoagulants for Long-Term Prophylaxis after Venous Thromboembolism]. / Empfehlungen zur Anwendung der indirekten und direkten Antikoagulanzien zur langfristigen Sekundärprophylaxe nach venösen Thromboembolien.

In routine clinical work, the dosage of direct oral anticoagulants for long-term maintenance therapy after acute deep vein thrombosis and pulmonary embolism is often made on an individual basis. As two doses are available for the preparations apixaban and rivaroxaban and no separate indication spectra have been specified. The working group of practising vascular physicians and surgeons in Germany has therefore developed this position paper. Patients with a clearly identified and temporary trigger factor for venous thromboembolism (e.g. trauma, operation, acute internal disease, oral contraception or pregnancy or isolated thrombosis of veins in the lower leg have a lower risk of recurrence and are generally not given permanent anticoagulation. If there is a high risk of recurrence with unchanged trigger factor (e.g. active malignancy, unambiguous antiphospholipid syndrome or deficiency of a clotting factor, such as Protein C, Protein S or antithrombin with a positive family history of venous thromboembolism, first occurrence of a pulmonary embolism, multiple recurrence of VTE) prolonged maintenance therapy is indicated, unless this is contraindicated by a very high risk of bleeding. For all patients with former VTE and whose anticoagulation phase has in principle been completed, prolonged prophylaxis can be continued, as these patients too are at increased risk of VTE.

The Importance of Adolescents' Sexually Outgoing Self-Concept: Differential Roles of Self- and Other-Generated Sexy Self-Presentations in Social Media.

The present study investigated the relationships between (exposure to) sexy self-presentations on social network sites (SNSs) and adolescents' sexual self-concept over time. Results from a three-wave panel study among 1,288 Dutch adolescents (aged 13-17 years) showed that more frequent engagement in sexy self-presentation, rather than exposure to sexy self-presentations of others, on SNSs positively predicted the importance of being sexually outgoing (e.g., sexy, seductive, and wild) in adolescents' self-concept 6 months later.

Adolescents and Pornography: A Review of 20 Years of Research.

The goal of this review was to systematize empirical research that was published in peer-reviewed English-language journals between 1995 and 2015 on the prevalence, predictors, and implications of adolescents' use of pornography. This research showed that adolescents use pornography, but prevalence rates varied greatly. Adolescents who used pornography more frequently were male, at a more advanced pubertal stage, sensation seekers, and had weak or troubled family relations. Pornography use was associated with more permissive sexual attitudes and tended to be linked with stronger gender-stereotypical sexual beliefs. It also seemed to be related to the occurrence of sexual intercourse, greater experience with casual sex behavior, and more sexual aggression, both in terms of perpetration and victimization. The findings of this review need to be seen against the background of various methodological and theoretical shortcomings, as well as several biases in the literature, which currently precludes internally valid causal conclusions about effects of pornography on adolescents.

Adolescents' Social Network Site Use, Peer Appearance-Related Feedback, and Body Dissatisfaction: Testing a Mediation Model.

Previous correlational research indicates that adolescent girls who use social network sites more frequently are more dissatisfied with their bodies. However, we know little about the causal direction of this relationship, the mechanisms underlying this relationship, and whether this relationship also occurs among boys to the same extent. The present two-wave panel study (18 month time lag) among 604 Dutch adolescents (aged 11-18; 50.7% female; 97.7% native Dutch) aimed to fill these gaps in knowledge. Structural equation modeling showed that social network site use predicted increased body dissatisfaction and increased peer influence on body image in the form of receiving peer appearance-related feedback. Peer appearance-related feedback did not predict body dissatisfaction and thus did not mediate the effect of social network site use on body dissatisfaction. Gender did not moderate the findings. Hence, social network sites can play an adverse role in the body image of both adolescent boys and girls.

Media Effects: Theory and Research.

This review analyzes trends and commonalities among prominent theories of media effects. On the basis of exemplary meta-analyses of media effects and bibliometric studies of well-cited theories, we identify and discuss five features of media effects theories as well as their empirical support. Each of these features specifies the conditions under which media may produce effects on certain types of individuals. Our review ends with a discussion of media effects in newer media environments. This includes theories of computer-mediated communication, the development of which appears to share a similar pattern of reformulation from unidirectional, receiver-oriented views, to theories that recognize the transactional nature of communication. We conclude by outlining challenges and promising avenues for future research.

Message Variability and Heterogeneity: A Core Challenge for Communication Research.

Messages are central to human social experience, and pose key conceptual and methodological challenges in the study of communication. In response to these challenges, we outline a systematic approach to conceptualizing, operationalizing, and analyzing messages. At the conceptual level, we distinguish between two core aspects of messages: message variability (the defined and operationalized features of messages) and message heterogeneity (the undefined and unmeasured features of messages), and suggest preferred approaches to defining message variables. At the operational level, we identify message sampling, selection, and research design strategies responsive to issues of message variability and heterogeneity in experimental and survey research. At the analytical level, we highlight effective techniques to deal with message variability and heterogeneity. We conclude with seven recommendations to increase rigor in the study of communication through appropriately addressing the challenges presented by messages.

The Relationship Between Sexual Content on Mass Media and Social Media: A Longitudinal Study.

The goal of this study was to investigate whether exposure to sexual reality television content and Internet pornography (IP) is related to sexual self-presentation on social media. Based on a two-wave panel survey among 1,765 adolescents aged 13-17 years, we found that watching sexual reality television content stimulated adolescents to produce and distribute sexual images of themselves on social media. In turn, sexual self-presentation on social media led adolescents to watch sexual reality television content more frequently. These relationships were similar among boys and girls. No reciprocal relationship between exposure to IP and boys' and girls' sexual self-presentation on social media was found. The results suggest that sexual content in mainstream mass media may predict adolescents' sexually oriented behavior on social media and vice versa. Moreover, adolescents seem to differentiate between types of sexual content (i.e., mainstream versus more explicit sexual content) when incorporating sexual media content in their sexual behavior online.

Exploring associations between exposure to sexy online self-presentations and adolescents' sexual attitudes and behavior.

Previous research suggests that adolescents' social network site use is related to their sexual development. However, the associations between adolescents' exposure to sexy self-presentations of others on social network sites and their sexual attitudes and experience have not yet been empirically supported. This study investigated reciprocal longitudinal relationships between adolescents' exposure to others' sexy self-presentations on social network sites and their sexual attitudes (i.e., sexual objectification of girls and instrumental attitudes towards sex) and sexual experience. We further tested whether these associations depended on adolescents' age and gender. Results from a representative two-wave panel study among 1,636 Dutch adolescents (aged 13-17, 51.5 % female) showed that exposure to sexy online self-presentations of others predicted changes in adolescents' experience with oral sex and intercourse 6 months later, but did not influence their sexual attitudes. Adolescents' instrumental attitudes towards sex, in turn, did predict their exposure to others' sexy online self-presentations. Sexual objectification increased such exposure for younger adolescents, but decreased exposure for older adolescents. In addition, adolescents' experience with genital touching as well as oral sex (only for adolescents aged 13-15) predicted their exposure to sexy self-presentations of others. These findings tentatively suggest that the influence on adolescents' sexual attitudes previously found for sexual media content may not hold for sexy self-presentations on social network sites. However, exposure to sexy self-presentations on social network sites is motivated by adolescents' sexual attitudes and behavior, especially among young adolescents.

Gender (In)equality in Internet Pornography: A Content Analysis of Popular Pornographic Internet Videos.

Although Internet pornography is widely consumed and researchers have started to investigate its effects, we still know little about its content. This has resulted in contrasting claims about whether Internet pornography depicts gender (in)equality and whether this depiction differs between amateur and professional pornography. We conducted a content analysis of three main dimensions of gender (in)equality (i.e., objectification, power, and violence) in 400 popular pornographic Internet videos from the most visited pornographic Web sites. Objectification was depicted more often for women through instrumentality, but men were more frequently objectified through dehumanization. Regarding power, men and women did not differ in social or professional status, but men were more often shown as dominant and women as submissive during sexual activities. Except for spanking and gagging, violence occurred rather infrequently. Nonconsensual sex was also relatively rare. Overall, amateur pornography contained more gender inequality at the expense of women than professional pornography did.

Women's critical responses to sexually explicit material: the role of hyperfemininity and processing style.

Previous research on women's responses to male-targeted sexually explicit material (SEM) suggests that women may be critical toward such content. However, women's critical responses to SEM have not been explained empirically. The present study had two goals: (1) to investigate whether women's critical responses to male-targeted SEM depend on individual differences in gender role orientation (i.e., hyperfemininity) and (2) to explain the effect of hyperfemininity on critical responses to SEM by looking at the way sexual material is processed. In an online experiment among women aged 18 to 30 (N = 195), both the type of SEM (a male- versus female-targeted erotic story) and processing style (stimulus- versus response-focused) were manipulated. In addition, participants were divided into three groups based on low, moderate, or high hyperfemininity. When using stimulus-focused processing (i.e., attending to the characters and situational context of the story), women were more critical toward male-targeted SEM (relative to female-targeted material), but only when they had low and moderate degrees of hyperfemininity.

A cross-cultural content-analytic comparison of the hookup culture in U.S. and Dutch teen girl magazines.

This quantitative content analysis investigated the hookup culture in U.S. and Dutch teen girl magazines. Using Hofstede's cultural dimension of masculinity/femininity, the hookup culture (i.e., the relational context of sex, emotional context of sex, specific sexual activities, and contraceptives) was examined in 2,496 stories from all 2006 through 2008 issues of the three most popular U.S. (i.e., Seventeen, CosmoGirl! U.S. edition, and Teen) and Dutch teen girl magazines (i.e., Fancy, CosmoGirl! Netherlands edition, and Girlz!). Regarding the relational context of sex, stories about casual sex occurred more often in U.S. magazines, and Dutch magazines focused more on committed sex. Dutch magazines also emphasized sex within the emotional context of love more often than did U.S. magazines. In terms of sexual activities, coital sex was mentioned more often in U.S. coverage, while petting was mentioned more frequently in Dutch coverage. Condoms were covered more positively in U.S. magazines than in Dutch magazines. Overall, the hookup culture seems to be more visible in U.S. magazines for the occurrence of casual sex and lack of love stories, whereas it does not emerge in Dutch magazines due to the presence of committed sex and love-related articles.

Identifying teens at risk: developmental pathways of online and offline sexual risk behavior.

OBJECTIVES: The aims of this study were (1) to investigate the prevalence and development of both online (OnSRB) and offline sexual risk behavior (OffSRB) in adolescence, (2) to establish whether OnSRBs and OffSRBs are related, and (3) to identify risk factors that determine problematic pathways of OnSRB and OffSRB. METHODS: A 4-wave longitudinal study with 1762 Dutch adolescents aged 12 to 18 was conducted (mean age, T1 = 14.52, 49% girls). By using group-based modeling, developmental pathways for OnSRB and OffSRB were identified and the relationship between both behaviors over time was examined. RESULTS: Substantial intraindividual differences in the development of OnSRB and OffSRB were found. The analysis revealed 3 developmental pathways of OnSRB: no risk (70.2%), moderate risk (23.7%), and high risk (6.1%). For OffSRB, we identified a no risk (90.6%) and an increasing pathway (9.4%). OnSRBs and OffSRBs were related and had common predictors (ie, sensation seeking, low educational level, gender). CONCLUSIONS: Only a minority of adolescents shows sustained high OnSRB. This group is likely to consist of low-educated, high-sensation-seeking adolescents who spend more time communicating on the Internet and come from less cohesive families. These same adolescents are also more likely to engage in OffSRB. Preventions should focus on these adolescents.

Attentional bias and disinhibition toward gaming cues are related to problem gaming in male adolescents.

PURPOSE: The aim of this study was to examine whether behavioral tendencies commonly related to addictive behaviors are also related to problematic computer and video game playing in adolescents. The study of attentional bias and response inhibition, characteristic for addictive disorders, is relevant to the ongoing discussion on whether problematic gaming should be classified as an addictive disorder. METHODS: We tested the relation between self-reported levels of problem gaming and two behavioral domains: attentional bias and response inhibition. Ninety-two male adolescents performed two attentional bias tasks (addiction-Stroop, dot-probe) and a behavioral inhibition task (go/no-go). Self-reported problem gaming was measured by the game addiction scale, based on the Diagnostic and Statistical Manual of Mental Disorders-fourth edition criteria for pathological gambling and time spent on computer and/or video games. RESULTS: Male adolescents with higher levels of self-reported problem gaming displayed signs of error-related attentional bias to game cues. Higher levels of problem gaming were also related to more errors on response inhibition, but only when game cues were presented. CONCLUSIONS: These findings are in line with the findings of attentional bias reported in clinically recognized addictive disorders, such as substance dependence and pathological gambling, and contribute to the discussion on the proposed concept of "Addiction and Related Disorders" (which may include non-substance-related addictive behaviors) in the Diagnostic and Statistical Manual of Mental Disorders-fourth edition.

Developmental trajectories of peer victimization: off-line and online experiences during adolescence.

PURPOSE: This study investigated the development and consequences of off-line and online victimization during adolescence. We examined the number and shapes of off-line and online victimization trajectories, the relationship between trajectories of off-line and online victimization, and their effect on life satisfaction. METHODS: A four-wave panel study with 6-month time intervals was conducted among a representative sample of Dutch adolescents aged 12-17 years (N = 1,762). We used group-based modeling to investigate the victimization trajectories. RESULTS: Three off-line victimization trajectories could be distinguished. One group followed a trajectory of low to no victimization experiences across adolescence. A second group followed a pathway of moderate and decreasing victimization. A third group followed a pathway of high and decreasing victimization. Two groups in online victimization could be distinguished. One group followed a trajectory of low to no victimization experiences. A second group followed a pathway of moderate victimization that peaked at age 14. Dual-trajectory analyses revealed a substantial overlap between off-line and online victimization trajectories. Finally, victimization and life satisfaction were longitudinally related; moderate and high victimization trajectories resulted in lower levels of life satisfaction during wave 4. CONCLUSIONS: The overlap between the off-line and online victimization trajectories and their negative consequences on life satisfaction suggests that prevention of victimization should focus on both types of victimization. The results suggest that peer victimization should not be studied without considering adolescent peer relationships on the Internet.