Development and construction of an open-platform, open-source low-cost portable uroflowmeter: The OpenFlow device.

BACKGROUND: Uroflowmetry is useful to screen for and manage many voiding disorders. Home-based uroflowmetry might better represent the patient's true voiding pattern and be more widely adopted if an accurate low-cost portable device was available. OBJECTIVE: Development and initial evaluation of an open-platform, open-source low-cost portable uroflowmeter. MATERIALS AND METHODS: We designed and built an uroflowmeter comprising of a load cell and digital memory card unit connected to a programmable microcontroller board mounted upon a 3D printed frame. It generated date-stamped tables which were processed and plotted. Twenty urologists were recruited to assess the device. Each participant received the equipment that was returned, along with a bladder diary, after at least 24 consecutive hours of homemade uroflowmetry recording. Additionally, were assessed with the International Prostatic Symptom Score (I-PSS) and Peeling diagram, whereas the device's ease of use, robustness, and portability were evaluated with a Likert-type questionnaire. Two experienced urodynamicists independently evaluated the tracings' quality rated with a 3° ordinal scale: (1) Interpretable without artifacts; (2) Interpretable with artifacts; (3) Uninterpretable. RESULTS: Participants' median age was 36.6 years old, none having an I-PSS > 5 or Peeling > 2. Overall 138 voidings were recorded (77 daytime, 61 nightly episodes). The device's ease of use, robustness, and portability obtained maximum score in 80% of evaluations. Most (98%) of the tracings were considered interpretable. Limitations included its small study population and short monitoring times. CONCLUSION: The construction of a cheap (<50 USD), accurate user-friendly portable uroflowmeter proved feasible, which could facilitate access to portable uroflowmetry.

Testicular Torsion Patients Should Be Manually Detorsed at Diagnosis: A Propensity Score Matched Analysis of the Influence of Interhospital Transfer and Surgical Wait Times on Surgical Organ Salvage.

OBJECTIVE: The aim of the study was to assess organ salvage in testicular torsion patients submitted to manual detorsion according to interhospital transfer and surgical wait times. METHODS: Retrospective analysis of consecutive surgically treated testicular torsion patients between 2012 and 2018. We compared testicular surgical salvage in testicular torsion patients submitted to manual detorsion either at clinical diagnosis (immediate detorsion) or after interhospital transfer from lower level-of-care facilities (delayed detorsion) and estimated the influence of interhospital transfer and surgical wait times on outcomes. Analysis included Bayesian logistic regression after propensity score matching. We excluded patients first examined at off-state and private facilities, with prediagnostic time of more than 24 hours, not initially diagnosed with testicular torsion or not submitted to manual detorsion at any time. RESULTS: One hundred sixty-two patients (median age, 15.8 years) fulfilled inclusion criteria. The median prediagnostic, transfer, and surgical wait times were respectively 4.9, 2.4, and 4.3 hours, with 58 patients undergoing immediate and 104 delayed detorsion. Propensity score matching for prediagnostic and surgical wait times paired 58 immediate with 40 delayed detorsion patients, with corresponding surgical salvage rates of 54/58 (93%) and 33/40 (82%). Forty-seven patients (29%) still had torsion at surgery. Transfer time was inversely associated with testicular salvage, with median 13% greater probability of an unfavorable outcome for each hour of transfer time. Similarly, each hour of surgical wait time decreased surgical salvage by 6%. CONCLUSIONS: Immediate detorsion led to improved surgical outcomes in testicular torsion patients. Because of residual torsion, surgery for detorsed patients should not be postponed.

Donor Age Amplifies the Detrimental Effects of Cold Ischemia Time on Long-Term Kidney Allograft Survival Independently of the Occurrence of Delayed Graft Function or Early Acute Rejection.

OBJECTIVES: We investigated the influence of the interaction between donor age and cold ischemia time on allograft survival in the absence of delayed graft function, early acute rejection, or the combination of both. MATERIALS AND METHODS: We conducted a retrospective analysis of a cohort of patients first transplanted with living-related and deceased-donor allografts between 2001 and 2016. Predictors included cold ischemia time, donor and recipient age and sex, body mass index, renal replacement therapy duration, cause of end-stage renal disease, HLA class I and II mismatches, panel of reactive antibodies score, donor creatinine concentration, development of delayed graft function, and biopsy-proven acute rejection. The response variable was time until return to renal replacement therapy. Patients who died with functioning allografts were censored at the time of death. Analyses included multivariate Cox proportional hazards regression. RESULTS: The study included 498 patients followed for median of 4.1 years with median cold ischemia time of 17.0 hours. On multivariate analysis, allograft survival was negatively affected by the cold ischemia time-donor age interaction (P = .026), acute rejection (P = .043), delayed graft function (P = .001), and acute rejection combined with delayed graft function (P = .002). Restricted mean allograft survival times in patients who developed neither delayed graft function nor acute rejection decreased from 13.6 to 8.6 years when cold ischemia time increased from 12 to 36 hours and donor age increased from 30 to 60 years. CONCLUSIONS: Allograft survival was negatively affected by donor age-cold ischemia time interaction independently of the development of delayed graft function, acute rejection, or their combination.

Immediate and delayed effects of atmospheric temperature in the incidence of testicular torsion.

INTRODUCTION: Ongoing controversy surrounds the role of atmospheric temperature in the incidence of intravaginal testicular torsion (iTT). This debate may be attributed to inadequate research methodology. As environmental risk factors have been successfully investigated with distributed lag non-linear model regression (DLNM), we applied this methodology to investigate the association between daily mean atmospheric temperatures (Tmean) and daily incidences of intravaginal testicular torsion (iTT) in our region. STUDY DESIGN: We analyzed time series consisting of the daily incidences of surgically confirmed iTT according to Tmean, in a circumscribed region in central Brazil from 2012 to 2015, with non-parametric tests, unadjusted and seasonally and long-term trend adjusted time series regression, as well as with DLNM. RESULTS: We recovered 218 cases of iTT in 1125 days of study. Most patients were teenagers (median 15.8 years, interquartile range 14.1-18.5 years). Within the 188 days with events, a single event was recorded on 161 days, two events were recorded on 24 days, and three events were recorded on 3 days. Tmean was lower in days with iTT compared with days without iTT (median 21.4 °C vs. 20.9 °C, p = 0.0002). We found decreasing magnitude and uncertainty of the direction of the effect of Tmean as a risk factor for iTT as the time series regression model was adjusted for seasonal and long-term trends. DLNM indicated a more complex exposure-response relation, with a proportional increase in risk when Tmean fell below 19.4 °C at the day of exposure (for 18.0 °C, RR 4.35) and a protective effect, for similar temperatures, after 1-2 and 7-12 days of exposure (RR 0.44 and 0.78, respectively). DISCUSSION: The association between lower Tmean and higher incidences of iTT at first observed with conventional non-parametric tests and unadjusted time series regression disappeared with adjusted time series regression models, reproducing the conflicting results of the literature. In contrast, DLNM revealed both a proportional effect of Tmean with decreasing temperatures and a delayed decrease in risk, suggesting a harvesting effect, seen when the pool of susceptible patients is depleted at exposure leading to a subsequent decrease in the incidence of the disease. CONCLUSION: According to DLMN, exposures to lower Tmean were associated with immediate greater risk and delayed reduction in risk for iTT. This pattern, indicating a harvesting effect, strongly argues that low temperatures do constitute a risk factor for iTT.