Investigating the impact of milk protein, inulin, and honey on quality attributes of goat milk yoghurt.

In this present study, a three-factor Box-Behnken, response surface methodology (RSM) design was employed to optimize the skimmed milk powder (SMP)/whey protein concentrate (WPC) ratio (0.25-0.75%w/v) as a source of milk protein, inulin (1-2%w/v), and honey (4-6%w/v) for production of high-quality goat milk yoghurt (GMY). The resulting ANOVA and response surface equations revealed the significant effect (p < 0.05) of these variables on the various attributes such as total solid (%), pH, titratable acidity [(LA) % by weight], syneresis (%), DPPH (% inhibition), viscosity (m.Pa⋅s), whiteness index (WI), and overall acceptability (OA). The coefficient of determination (R2) for all response variables ranged from 0.88 to 0.99. Lack-of-fit tests resulted in non-significant F-values. The optimal conditions were determined as SMP/WPC at 0.36%w/v, inulin at 1.00%w/v, and honey at 6.00%w/v. The optimum values for total solid, pH, titratable acidity, syneresis, DPPH, viscosity, WI, and OA were 22.03, 4.46, 0.77, 6.34, 25.20, 182.30, 76.29 and 8.37, respectively with desirability value of 0.95.

Polyethylene glycol-based hydrogel rectal spacers for prostate brachytherapy: a systematic review with a focus on technique.

INTRODUCTION: Radiation dose to the rectum in prostate brachytherapy (PBT) can be reduced by the use of polyethylene glycol (PEG) hydrogel spacers. This reduces the rate of rectal toxicity and allows dose escalation to the prostate. Our objectives were to provide an overview of technique for injection of a PEG hydrogel spacer, reduction in rectal dosimetry, gastrointestinal toxicity and potential complications. METHODS: We systematically reviewed the role of PEG hydrogel spacers in PBT using the Cochrane and PRISMA methodology for all English-language articles from January 2013 to December 2019. Data was extracted for type of radiotherapy, number of patients, type of PEG-hydrogel used, mean prostate-rectum separation, rectal dosimetry, acute and late GI toxicity, procedure-related complications and the technique used for hydrogel insertion. RESULTS: Nine studies (671 patients and 537 controls) met our inclusion criteria. Of these 4 used DuraSeal® and 5 used SpaceOAR®. The rectal spacing achieved varied between 7.7-16 mm. Failure of hydrogel insertion was seen only in 12 patients, mostly related to failure of hydrodissection in patients undergoing salvage PBT. Where reported, the rectal D2 cc was reduced by between 21.6 and 52.6% and the median rectal V75% cc was reduced by between 91.8-100%. Acute GI complications were mostly limited to grade 1 or 2 toxicity (n = 153, 33.7%) with low levels of grade 3 or 4 toxicity (n = 1, 0.22%). Procedure-related complications were limited to tenesmus (0.14%), rectal discomfort (1.19%), and bacterial prostatitis (0.44%). CONCLUSIONS: PEG hydrogel spacers are safe to insert. Gel insertion is easy, fast and has a low rate of failure. These studies convincingly demonstrate a significant reduction in rectal dosimetry. Although the results of spacers in reducing rectal toxicity is promising, these need to be confirmed in prospective randomised trial.

Clinical and imaging findings in cervical cancer and their impact on FIGO and TNM staging - An analysis from the EMBRACE study.

OBJECTIVE: To investigate differences in local tumour staging between clinical examination and MRI and differences between FIGO 2009, FIGO 2018 and TNM in patients with primary cervical cancer undergoing definitive radio-chemotherapy. METHODS: Patients from the prospective observational multi-centre study "EMBRACE" were considered for analysis. All patients had gynaecological examination and pelvic MRI before treatment. Nodal status was assessed by MRI, CT, PET-CT or lymphadenectomy. For this analysis, patients were restaged according to the FIGO 2009, FIGO 2018 and TNM staging system. The local tumour stage was evaluated for MRI and clinical examination separately. Descriptive statistics were used to compare local tumour stages and different staging systems. RESULTS: Data was available from 1338 patients. For local tumour staging, differences between MRI and clinical examination were found in 364 patients (27.2%). Affected lymph nodes were detected in 52%. The two most frequent stages with FIGO 2009 are IIB (54%) and IIIB (16%), with FIGO 2018 IIIC1 (43%) and IIB (27%) and with TNM T2b N0 M0 (27%) and T2b N1 M0 (23%) in this cohort. CONCLUSIONS: MRI and clinical examination resulted in a different local tumour staging in approximately one quarter of patients. Comprehensive knowledge of the differential value of clinical examination and MRI is necessary to define one final local stage, especially when a decision about treatment options is to be taken. The use of FIGO 2009, FIGO 2018 and TNM staging system leads to differences in stage distributions complicating comparability of treatment results. TNM provides the most differentiated stage allocation.

A linear viscoelastic model to understand skin mechanical behaviour and for cosmetic formulation design.

OBJECTIVES: Skin is arguably one of the most important organs that plays an active role in our everyday biological functions after brain. Owing to the wide range of applications in medicine, cosmetics industry and more recently robotics, skin research has gained tremendous attention with respect to its mechanical behaviour. Various macro modelling approaches are available for modelling skin's mechanical behaviour. The objective of this paper is to study skin's mechanical property change with age and demonstrate anti-ageing effects of cosmetic formulations from skin mechanical property change perspective. METHODS: In this study, skin's mechanical behaviour was modelled using a 1D linear viscoelastic phenomenological model and the model was validated using two sets of experimentally observed skin data (strain, stress relaxation and cyclical loading). The model was further modified to study the effect of the presence of a thin layer of cosmetic polymer and to demonstrate anti-ageing effects of the cosmetic polymer from the perspective of change in the mechanical behaviour of skin with cosmetic layer. RESULTS: The estimated values of skin mechanical properties from the model agree with those in literature. The extracted model features show good correlation with skin age (viscosity and time constant). The results from our model indicate that the cosmetic polymers enhance the mechanical properties of skin significantly. CONCLUSIONS: This work will find its applications in designing and testing anti-ageing formulations. This model can be used to filter various combinations of cosmetic formulations by knowing the mechanical response of polymer on skin, thereby accelerating the product development.

OBJECTIFS: La peau est sans doute l'un des organes les plus importants qui jouent un rôle actif dans nos fonctions biologiques quotidiennes après le cerveau. En raison du large éventail d'applications en médecine, dans l'industrie cosmétique et plus récemment en robotique, la recherche sur la peau a suscité une attention considérable en ce qui concerne son comportement mécanique. Diverses approches de modélisation macro sont disponibles pour modéliser le comportement mécanique de la peau. L'objectif de cet article est d'étudier les changements de propriétés mécaniques de la peau avec l'âge et de démontrer les effets antiâge des formulations cosmétiques du point de vue des changements de propriétés mécaniques de la peau. LES MÉTHODES: Dans cette étude, le comportement mécanique de la peau a été modélisé à l'aide d'un modèle phénoménologique viscoélastique linéaire 1D et le modèle a été validé à l'aide de deux ensembles de données cutanées observées de manière expérimentale (contrainte, relaxation de contrainte et charge cyclique). Le modèle a ensuite été modifié pour étudier l'effet de la présence d'une couche mince de polymère cosmétique et pour démontrer les effets anti-vieillissement du polymère cosmétique du point de vue de la modification du comportement mécanique de la peau avec une couche cosmétique. RÉSULTATS: Les valeurs estimées des propriétés mécaniques de la peau à partir du modèle concordent avec celles de la littérature. Les caractéristiques du modèle extraites montrent une bonne corrélation avec l'âge de la peau (viscosité et constante de temps). Les résultats de notre modèle indiquent que les polymères cosmétiques améliorent considérablement les propriétés mécaniques de la peau. CONCLUSIONS: Ce travail trouvera ses applications dans la conception et le test de formulations anti-âge. Ce modèle peut être utilisé pour filtrer diverses combinaisons de formulations cosmétiques en connaissant la réponse mécanique du polymère sur la peau, accélérant ainsi le développement du produit.

Oral hygiene, prevalence of gingivitis, and associated risk factors among pregnant women in Sarlahi District, Nepal.

BACKGROUND: The oral health status of pregnant women in low-resource communities such as Nepal has not been well characterized. This sub-population is also of specific interest given associations between poor oral health and adverse pregnancy outcomes previously documented in other settings. We explored relationships between gingivitis and risk factors among pregnant women in rural Nepal. METHODS: The design was a community-based, cross-sectional study in a sub-area of Sarlahi District, Nepal. Pregnant women < 26 weeks gestation underwent clinical periodontal exams conducted by community-based oral health workers. Exams included a full mouth assessment measuring bleeding on probing (BOP), probing depth (PD) (six sites per tooth), and gingival recession, the distance from the cemento-enamel junction to the free gingival margin (two direct sites per tooth). Data on participant risk factors were collected through household surveys, including demographic characteristics, oral health behaviors, care seeking, and health attitudes. Multivariable logistic regression modeling was used to assess relationships between gingivitis and risk factors. RESULTS: We enrolled 1452 participants, of which 40% (n = 582) had signs of clinical gingivitis and 60% (n = 870) clinical health. Average participant age was 23. Most participants (88%) had never received oral health care. Participants averaged 10% of sites with BOP with most (79%) having ≥1 site with BOP. Nine percent of participants had ≥1 site with PD ≥4 mm, although very few participants (0.7%) had sites with PD ≥5 mm. Few participants (13%) had any recession (≥1 mm). In the final adjusted model, odds of gingivitis increased by 3% for each year of age (aOR 1.03, 95% CI 1.00, 1.06) and were higher for women of short maternal stature (< 150 cm) (aOR 1.43, 95% CI: 1.14, 1.79) and among women reporting cost to be a barrier to seeking dental care (aOR 2.13, 95% CI: 1.09, 4.15). CONCLUSIONS: Gingivitis was common and associated with age, maternal stature, self-reported high cost of dental care, and other risk factors among pregnant women in rural Nepal. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01177111 (Nepal Oil Massage Study) and NCT02788786 (Pilot Trial).

Biodegradation of wastewater in alternating aerobic-anoxic lab scale pilot plant by Alcaligenes sp. S3 isolated from agricultural field.

The isolated microbial Alcaligenes sp. S3 from the agricultural field was used for the biodegradation of synthetic wastewater containing atrazine. This study was conducted in an alternating aerobic-anoxic lab scale pilot plant. The performance of continuously operated pilot plant was evaluated in three different phases with varying atrazine concentration. The best performance of plant was observed in phase-II. The atrazine (200 mg/L) having COD value 1356 mg/L was used with varying flow rate and 90.56% COD removal was obtained at a flow rate of 300 mL/h on 122th day of operation. The effect of process parameter like pH and DO on the performance of the reactor was studied. The GC-MS analysis was investigated, and urea was found the intermediate/metabolites of atrazine biodegradation. The kinetic parameters such as half saturation rate constant (Ks) 106.80 mg/L; maximum specific growth rate (µmax) 0.208 per day and inhibition constant (Ki) 374.91 mg/L were evaluated by Andrew-Haldane model.

Silk-PVA Hybrid Nanofibrous Scaffolds for Enhanced Primary Human Meniscal Cell Proliferation.

In this study, silk fibroin nanofibrous scaffolds were developed to investigate the attachment and proliferation of primary human meniscal cells. Silk fibroin (SF)-polyvinyl alcohol (PVA) blended electrospun nanofibrous scaffolds with different blend ratios (2:1, 3:1, and 4:1) were prepared. Morphology of the scaffolds was characterized using atomic force microscopy (AFM). The hybrid nanofibrous mats were crosslinked using 25 % (v/v) glutaraldehyde vapor. In degradation study, the crosslinked nanofiber showed slow degradation of 20 % on weight after 35 days of incubation in simulated body fluid (SBF). The scaffolds were characterized with suitable techniques for its functional groups, porosity, and swelling ratio. Among the nanofibers, 3:1 SF:PVA blend showed uniform morphology and fiber diameter. The blended scaffolds had fluid uptake and swelling ratio of 80 % and 458 ± 21 %, respectively. Primary meniscal cells isolated from surgical debris after meniscectomy were subcultured and seeded onto these hybrid nanofibrous scaffolds. Meniscal cell attachment studies confirmed that 3:1 SF:PVA nanofibrous scaffolds supported better cell attachment and growth. The DNA and collagen content increased significantly with 3:1 SF:PVA. These results clearly indicate that a blend of SF:PVA at 3:1 ratio is suitable for meniscus cell proliferation when compared to pure SF-PVA nanofibers.

Socio-economic deprivation and outcomes following radical nephroureterectomy for clinically localized upper tract transitional cell carcinoma.

BACKGROUND: Little is known about the effects of socio-economic deprivation on the oncological outcomes of surgically treated upper tract transitional cell carcinoma. METHODS: From January 1998 to December 2012, 161 patients underwent nephroureterectomy for upper urinary tract cancer at our tertiary medical centre. We included 124 patients where complete data were available for further analysis. This study also analysed the impact of the reported risk factors such as grade, stage, multifocality in addition to socio-economic deprivation on the long-term oncological outcomes after nephroureterectomy. RESULTS: One hundred and twenty-four (77 %) patients with complete data for socio-economic status were analysed in this study. The median age of the cohort was 73 years (interquartile range 45-86). There were 20, 18, 17, 40 and 29 patients in different socio-economic categories ranging from 1 to 5, respectively. The median duration of follow-up was 68 months (9-174). A statistically higher grade (p value 0.005) and higher stage (p value 0.0005) disease was seen in patients from less deprived categories on both univariate and multivariate analyses. The cancer-specific mortality and follow-up recurrences, however, did not significantly differ between the different socio-economic categories on multivariate analysis (p value 0.13; 0.6) and on univariate and multivariate analyses. A higher number of patients with multifocal disease and concomitant carcinoma in situ (CIS) had disease recurrences which were statistically significant (p values 0.026 and 0.014, respectively) on multivariate analysis. CONCLUSIONS: A lower recurrence-free survival was observed in patients with multifocal disease and those with concomitant CIS following nephroureterectomy for clinically localized disease. Long-term follow-up did not show any significant differences in cancer-specific survival between different deprivation categories.

Synthesis and magnetic properties of hard-soft SRFe10Al2O19/NiZnFe2O4 ferrite nanocomposites.

Pure phase exchange-coupled nanocomposites of hard-soft magnetic oxides, (hard) SrFe10Al2O19(-) (soft) Ni0.75Zn0.25Fe2O4 were prepared via autocombution method. Magnetic properties of the nanocomposites were assessed as a function of soft-phase content in the nanocomposite. A 40% increase in M(s) value was observed for nanocomposite with 30 Wt.% of the soft phase. A linear increase in M(r)/M(s) with soft-phase content indicates the presence of enhanced exchange-coupling between hard and soft phases of the nanocomposite. The highest M(r)/M(s) ratio of 0.68 was obtained for nanocomposite containing 30 Wt.% of the soft-phase. The observed reduction in coercieve field values of the nanocomposite with increase in soft-phase content is explained on the basis of competition between exchange and dipolar interaction between hard-soft and soft-soft phases of the nanocomposite.

Association of Maternal Serum Homocysteine level with Maternal Birth Weight.

A baby's weight at birth is an important predictor of infant growth and survival. Low birth weight leads to an impaired growth of the infant and its attendant risks of a higher mortality and morbidity. Various studies found higher maternal plasma homocysteine level was associated with lower offspring birth weight. Therefore, this study was carried out to find out association between maternal serum homocysteine and birth weight. A cross sectional study was conducted in the Department of Obstetrics and Gynaecology, BSMMU from September 2018 to August 2019. Pregnant women at their third trimester between 37-40 weeks admitted to in patient Department of Obstetrics and Gynaecology, BSMMU were included in this study. Ethical committee clearance was obtained from the institution. After matching eligibility criteria informed written consent were taken from the patients. Data was collected from the patients using the structured design by interview, observation, clinical examination and haematological investigations. The serum homocysteine level of these patients and birth weight of their babies was measured immediately after delivery. Negative correlation was found between maternal serum homocysteine level and neonatal birth weight, (r = -0.419, p<0.05). During regression analysis maternal homocysteine and gestational age was found significant when adjusted with maternal age, parity, maternal BMI and sex of the baby. So, increased maternal serum homocysteine is negatively associated with low birth weight babies.

Diagnosis of bladder cancer by immunocytochemical detection of minichromosome maintenance protein-2 in cells retrieved from urine.

BACKGROUND: We tested the accuracy of immunocytochemistry (ICC) for minichromosome maintenance protein-2 (MCM-2) in diagnosing bladder cancer, using cells retrieved from urine. METHODS: Adequate samples were obtained from 497 patients, the majority presenting with gross haematuria (GH) or undergoing cystoscopic surveillance (CS) following previous bladder cancer. We performed an initial study of 313 patients, followed by a validation study of 184 patients. In all cases, presence/absence of bladder cancer was established by cystoscopy/biopsy. RESULTS: In the initial study, receiver operator characteristic analysis showed an area under the curve of 0.820 (P<0.0005) for the GH group and 0.821 (P<0.01) for the CS group. Optimal sensitivity/specificity were provided by threshold values of 50+ MCM-2-positive cells in GH samples and 200+ cells in CS samples, based on a minimum total cell number of 5000. Applying these thresholds to the validation data set gave 81.3% sensitivity, 76.0% specificity and 92.7% negative predictive value (NPV) in GH and 63.2% sensitivity, 89.9% specificity and 89.9% NPV in CS. Minichromosome maintenance protein-2 ICC provided clinically relevant improvements over urine cytology, with greater sensitivity in GH and greater specificity in CS (P=0.05). CONCLUSIONS: Minichromosome maintenance protein-2 ICC is a reproducible and accurate test that is suitable for both GH and CS patient groups.

Mammalian Sulf1 RNA alternative splicing and its significance to tumour growth regulation.

SULF1/SULF2 enzymes regulate the activities of several growth factors by selective hydrolysis of 6-O-sulphates of heparan sulphate proteoglycan co-receptors, the sulfation of which is essential for signal transduction of some ligand/receptor interactions but not others. This study demonstrates the existence of SULF1 variants with a wide spectrum of splicing patterns in mammalian tumours. The levels and relative proportions of SULF1/SULF2 splice variants markedly vary in different tumours with a potential to regulate cell growth differentially. Although mammalian Sulf1 compared with Sulf2 gene generates a much larger number of splice variants, both enzymes follow generally similar distribution and signalling association trends in hepatocellular carcinomas.

Parental perception of neonatal retro-transfers from level 3 to level 2 neonatal intensive care units.

OBJECTIVE: The primary objective of this study was to determine the overall parental satisfaction with retro-transfers from a level 3 to a level 2 Neonatal Intensive Care Unit (NICU). The secondary objectives were to explore factors that caused parental satisfaction associated with retro-transfer and investigate the factors that could be modified to improve the retro-transfer process. METHODS: This is a retrospective cross-sectional study. Questionnaires were mailed to all parents of infants transferred from level 3 to level 2 NICUs from 2016 to 2017. Independent samples t-tests, Spearman's rank correlations, and multiple logistic regression analyses were conducted to identify factors associated with parental retro-transfer satisfaction. RESULTS: Our response rate was 39.1% (n = 140). Of all parents, 64.29% parents were extremely satisfied with the overall retro-transfer process. In our bivariate analyses, multiple factors were found to be strongly associated with parental retro-transfer satisfaction, including parental level of education, the amount of notice and rationale given for the retro-transfer and the level of parental communication and engagement with their infant's healthcare team before and after transfer. Multiple logistic regression analyses revealed that when questions regarding the retro-transfer were answered and the level 2 NICU team demonstrated a concrete understanding of the infant's medical issues and history, parental satisfaction increased. CONCLUSION: Majority of parents were satisfied with the retro-transfer process. However, close collaboration and ongoing and open lines of communication between parents and the level 3 NICU healthcare teams will increase parental retro-transfer satisfaction rates.

Effect of mixing intensity on biodegradation of phenol in a moving bed biofilm reactor: Process optimization and external mass transfer study.

In this work, an effort has been made to design the process variables and to analyse the impact of mixing intensity on mass transfer diffusion in a moving bed biofilm reactor (MBBR). A lab-scale MBBR, filled with Bacillus cereus GS2 IIT (BHU) immobilized-polyethylene biocarriers, was employed to optimize the process variables, including mixing intensity (60-140 rpm), phenol concentration (50-200 mg/L), and hydraulic retention time (HRT) (4-24 h) using response surface methodology. The optimum phenol removal of 87.64 % was found at 100 rpm of mixing intensity, 200 mg/L of phenol concentration, and 24 h of HRT. The higher mixing intensity improved the substrate diffusion between the liquid phase and the surface of the biofilm. The external mass transfer coefficients were found in the range of 1.431 × 10-5-1.845 × 10-5 m/s. Moreover, the detection of catechol and 2-hydroxymuconic semialdehyde revealed that the Bacillus sp. followed the meta-cleavage pathway during the biodegradation of phenol.

Sulf2 gene is alternatively spliced in mammalian developing and tumour tissues with functional implications.

SULF2 enzyme regulates the activities of a number of signalling pathways that in many tissues are up-regulated during development and disease. As we recently showed for avian Sulf1, the present study demonstrates that mammalian Sulf2 gene can also generate functionally distinct splice variants that would regulate normal development and tumour growth differentially. It is thus important to distinguish SULF1/SULF2 isoforms in mammalian tissues to understand their functional and clinical relevance to disease. This study demonstrates that unlike normal adult lung with little or no SULF2 expression, this enzyme is expressed at high levels in most lung tumours showing differential cellular distribution of full length and shorter SULF2 variants in such tumours. Furthermore, we show that the short SULF2 splice variants are associated with those signalling pathways that are inhibited by full length SULF1/SULF2 variants and therefore could promote growth in such lung tumours.

Prospective observational study evaluating acute and delayed treatment related toxicities of prophylactic extended field volumetric modulated arc therapy with concurrent cisplatin in cervical cancer patients with pelvic lymph node metastasis.

PURPOSE: To evaluate the treatment related acute and delayed toxicities of extended field Volumetric modulated arc therapy (VMAT) with concurrent chemotherapy in patients of locally advanced cervical cancer with pelvic lymph nodes. MATERIAL AND METHODS: From 2014 to 2016, 15 patients of locally advanced cervical cancer with Fluoro-deoxyglucose positron emission tomography (FDG-PET) positive pelvic lymph nodes were treated with extended field Simultaneous integrated boost (SIB)-VMAT 45 Gy/55 Gy/25#/5weeks and concurrent cisplatin. Acute toxicities were documented according to common terminology criteria for adverse events version 4 (CTCAE v.4). Dose volume parameters and patient characteristics were analyzed for association with toxicities. RESULTS: Median age of patients at diagnosis was 48 years. 40% (6 patients) were stage IIB & 60% (9 patients) were stage IIIB. Median number of involved pelvic lymph nodes was 2 (range, 1-4), commonest location was external iliac lymph node region (86%). Median number of concurrent chemotherapy cycles received was five. Treatment was well tolerated and there were no grade ≥ 3 acute toxicities. Commonest acute toxicities observed were vomiting (≥grade2 -13.3%) followed by & nausea (grade ≥ 2 in 6%) and were associated with volume of bowel bag receiving 45 Gy. Constitutional symptoms (≥grade 2) were observed in 6% patients and had no dosimetric associations. At a median follow up of 43 months, delayed ≥ grade1, 2, 3 toxicity were observed in 80%, 0%, and 0% respectively with diarrhea being the commonest. CONCLUSION: Prophylactic para aortic extended field VMAT with concurrent chemotherapy for locally advanced cervical cancer is well tolerated with acceptable acute toxicity profile. Significant grade 3 acute/delayed toxicities were not observed in this cohort of patients.

Accuracy of ultrasound vs computed tomography scan for upper urinary tract malignancies and development of a risk-based diagnostic algorithm for haematuria in a UK tertiary centre.

PURPOSE: There is no consensus across guidelines on a diagnostic algorithm for upper urinary tract (UUT) evaluation following presentation with haematuria. Our aim is to compare the diagnostic accuracy of ultrasound (USS) compared to CT-scan for UUT malignancies and also determine the considerations important for a risk-based diagnostic protocol for haematuria. METHODS: We reviewed our 'haematuria clinic' database to identify patients who had both USS and CT-scan for UUT evaluation between September 2015 and August 2017, and calculated the diagnostic accuracy of these imaging modalities for histologically confirmed UUT cancers. Furthermore, we identified risk factors in our diagnostic algorithm for haematuria and conducted regression analysis to determine their ability to predict UUT malignancies. RESULTS: Overall, 575 patient records were studied. Age range was 21-92 years, M:F was 1.4:1, majority (81.2%) had visible haematuria, and 12 (2.1%) UUT cancers were diagnosed [renal cell carcinoma-1.4%; upper tract urothelial cancer-0.7%]. USS and CT-scan had diagnostic accuracy for UUT cancers of 95.8 and 99.1%, respectively (p < 0.001). Haematuria type was a significant consideration only on univariate analysis, while multivariate binary logistic regression showed that male gender, smoking, occupational exposure, and positive urologic history were the main risk factors associated with UUT malignancies. CONCLUSION: USS and CT-scan have comparably high diagnostic accuracy for detecting UUT malignancies. USS may, therefore, be considered as the first-line UUT imaging modality when utilized in a risk-based diagnostic algorithm. Larger, multicentred studies are needed to validate our findings and influence guideline development.

Low yield but high levels of multidrug resistance in urinary tract infections in a tertiary hospital, Nepal.

SETTING: There are concerns about the occurrence of multidrug resistance (MDR) in patients with urine tract infections (UTI) in Nepal. OBJECTIVE: To determine culture positivity, trends in MDR among Escherichia coli and Klebsiella pneumoniae infections and seasonal changes in culture-positive UTI specimens isolated from 2014 to 2018 at the B P Koirala Institute of Health Sciences, Dharan, Eastern Nepal. DESIGN: This was a cross-sectional study using secondary laboratory data. RESULTS: Among 116,417 urine samples tested, 19,671 (16.9%) were culture-positive, with an increasing trend in the number of samples tested and culture positivity. E. coli was the most common bacteria (54.3%), followed by K. pneumoniae (8.8%). Among E. coli and K. pneumoniae isolates, MDR was found in respectively 42.5% and 36.0%. MDR was higher in males and people aged >55 years, but showed a decreasing trend over the years. The numbers of isolates increased over the years, with a peak always observed from July to August. CONCLUSION: Low culture positivity is worrying and requires further work into improving diagnostic protocols. Decreasing trends in MDR are a welcome sign. Information on seasonal changes that peak in July-August can help laboratories better prepare for this time with adequate buffer stocks to ensure culture and antibiotic susceptibility testing.

CONTEXTE: La résistance à plusieurs médicaments (MDR) chez les patients atteints d'infections urinaires (UTI) au Népal est un sujet de préoccupations. OBJECTIF: Déterminer le taux de positivité des cultures, les tendances de MDR parmi les infections à Escherichia coli et Klebsiella pneumoniae et les variations saisonnières dans les échantillons d'UTI positifs par culture de 2014 à 2018 au BP Koirala Institute of Health Sciences, Dharan, Népal oriental. MÉTHODE: Il s'agissait d'une étude transversale réalisée en utilisant des données de laboratoire secondaires. RÉSULTATS: Parmi les 116 417 échantillons urinaires testés, 19 671 (16,9%) étaient positifs par culture, avec une tendance à la hausse du nombre d'échantillons testés et du taux de positivité par culture. E. coli était la bactérie la plus fréquente (54,3%), suivie de K. pneumoniae (8,8%). Une MDR a été observée chez respectivement 42,5% et 36,0% des isolats de E. coli et de K. pneumoniae. La MDR était plus élevée chez les hommes et les personnes âgées >55 ans, mais une tendance à la baisse a été observée au fil des ans. Le nombre d'isolats a augmenté au fil des ans, avec un pic toujours observé de juillet à août. CONCLUSION: Le faible taux de positivité par culture est préoccupant et d'autres études sont nécessaires pour améliorer les protocoles diagnostiques. Les tendances à la baisse en matière de MDR sont un signe encourageant. Les informations relatives aux variations saisonnières avec un pic en juillet-août peuvent aider les laboratoires à mieux se préparer en prévision de cette période, en renouvelant les stocks de solutions tampons afin de pouvoir réaliser les cultures et les tests de sensibilité aux médicaments.

[Retroauricular robotic thyroidectomy: a preliminary report of 5 cases].

Objective: To explore the feasibility of retroauricular robotic thyroidectomy and introduce the experience and lessons. Methods: From May 2018 to December 2018, 5 consecutive cases underwent gasless retroauricular robotic thyroidectomy by using Davinci Si system at Beijing United Family Hospital, including 1 male and 4 females, aged from 18 to 37 years old. And they were retrospectively reviewed and analyzed. Among them, one case was a recurrence of cervical lympy nodes after total thyroidectomy for thyroid cancer. Results: Among 5 patients (mean age 32.4 years, mean tumor size 1.3 cm), one patient underwent unilateral thyroid lobectomies, 3 patients did total thyroidectomy and 4 patients did neck dissection. All patients had papillary thyroid carcinomas (PTC). The average time for unilateral retroauricular robotic thyroidectomy was 375 min. Intraoperative conversion to open surgery happened in one patient. Postoperative vocal cord paralysis and hypocalcemia developed in one of the patients. Conclusion: Retroauricular robotic thyroidectomy is feasible for selected patients and would be a potential alternative approach in remote-access approaches for thyroid surgery.