Native nephrectomy in the management of hypertension in children with kidney disease: a tool to improve blood pressure control.

AIM: Hypertension in children with abnormal kidneys often requires multiple antihypertensive agents (complex), or could present with complications (e.g. hypertensive encephalopathy). Our objective in this report is to evaluate blood pressure control following unilateral or bilateral laparoscopic native nephrectomy in children with renal hypertension. MATERIALS AND METHODS: Single-centre retrospective review of all children who underwent nephrectomy for management of hypertension over a recent study period (2008-2017) with post-operative follow-up of at least 3 years. We describe the association of age, primary kidney disease and blood pressure and its management including time to resolution following unilateral or bilateral nephrectomy. RESULTS: During the 9-year study period, 21 of 215 (9.8%) children underwent nephrectomy for management of hypertension. We included 19 children [6 with unilateral native nephrectomy (UNN) and 13 with bilateral native nephrectomy (BNN)] in this study as they continued with their follow-up at our centre. Out of the 19 children, 15 had laparoscopic retroperitoneoscopic nephrectomies and 4 had laparoscopic transperitoneal nephrectomies. Six children had unilateral nephrectomy and 13 children had bilateral nephrectomies [7 were pre-transplant (haemodialysis-6, peritoneal dialysis-1) and 6 were post-kidney transplant]. Fifteen of 19 children (79%) had complete resolution [5 UNN and 10 BNN] and 3 (16%) partial resolution [1 UNN and 2 BNN]. One patient with BNN was observed to have no change in blood pressure control. CONCLUSION: Our data demonstrate improved management of hypertension in 95% of the children. Nephrectomy could offer a reasonable treatment option for selected group of complex and complicated renal hypertension.

An intelligent predictive and optimized wastewater treatment plant.

The intelligent predictive and optimized wastewater treatment plant method represents a ground-breaking shift in how we manage wastewater. By capitalizing on data-driven predictive modeling, automation, and optimization strategies, it introduces a comprehensive framework designed to enhance the efficiency and sustainability of wastewater treatment operations. This methodology encompasses various essential phases, including data gathering and training, the integration of innovative computational models such as Chimp-based GoogLeNet (CbG), data processing, and performance prediction, all while fine-tuning operational parameters. The designed model is a hybrid of the Chimp optimization algorithm and GoogLeNet. The GoogLeNet is a type of deep convolutional architecture, and the Chimp optimization is one of the bio-inspired optimization models based on chimpanzee behavior. It optimizes the operational parameters, such as pH, dosage rate, effluent quality, and energy consumption, of the wastewater treatment plant, by fixing the optimal settings in the GoogLeNet. The designed model includes the process such as pre-processing and feature analysis for the effective prediction of the operation parameters and its optimization. Notably, this innovative approach provides several key advantages, including cost reduction in operations, improved environmental outcomes, and more effective resource management. Through continuous adaptation and refinement, this methodology not only optimizes wastewater treatment plant performance but also effectively tackles evolving environmental challenges while conserving resources. It represents a significant step forward in the quest for efficient and sustainable wastewater treatment practices. The RMSE, MAE, MAPE, and R2 scores for the suggested technique are 1.103, 0.233, 0.012, and 0.002. Also, the model has shown that power usage decreased to about 1.4%, while greenhouse gas emissions have significantly decreased to 0.12% than the existing techniques.

Pediatric Nephrectomy: Comparison of Perioperative Outcomes of Three Different Minimally Invasive and Open Approaches.

Background: Minimally invasive surgery (MIS) is now the gold standard for nephrectomy in pediatric patients. Retroperitoneoscopic (using either one or two instruments) and transperitoneal (TP) approaches are described. We compared the perioperative outcomes of different techniques [single-instrument retroperitoneoscopic (SIRP), two-instrument retroperitoneoscopic (TIRP), TP, and open approach]. Patients and Methods: Retrospective review of patients who underwent nephrectomy surgery in the period from January 2009 to January 2020 at a single center was carried out. We excluded patients who underwent other procedures under the same anesthetic, underwent heminephrectomy, and those with incomplete records. The primary outcome measures were operative time, intraoperative complications, postoperative complications, and length of hospital stay. One-way analysis of variance (ANOVA) test was used to analyze continuous variables. Chi square test was used to compare categorical variables. Results: A total of 213 nephrectomies were analyzed; SIRP (n = 35), TIRP (n = 50), TP (n = 74), and open (n = 54). Median age (months) was 71 for SIRP, 113 for TIRP, 67 for TP, and 21 for open. No statistical difference was identified for mean operative time (P = .067) or mean hospital stay (P = .69). Intraoperative complications were significantly more in the open group (P = .03). Postoperative complications were rare and only noted in the open group. There was no conversion to open surgery in the SIRP and TIRP groups. Conversion rate was 5.4% (4/74) in the TP group. Conclusion: MIS nephrectomy is safe, and no difference among techniques (SIRP, TIRP and TP) has been demonstrated. They are comparable to open surgery in terms of operative time and hospital stay, but are associated with significantly less complications.

High-dose-rate brachytherapy boost for carcinoma of external auditory canal.

PURPOSE: To report dosimetry and outcome in a case of early stage carcinoma of external ear (T1N0M0) treated with radical radiotherapy alone using a combination of external beam radiotherapy (EBRT) and intracavitary irradiation with a high-dose-rate (HDR) (192)Ir remote afterloading system. METHODS AND METHODS: A 64-year-old gentleman who was diagnosed as T1N0M0 carcinoma of external ear was treated with combination of external beam radiation therapy followed by brachytherapy (BRT). A total dose of 40Gy was delivered by EBRT, following which a 6-Fr catheter for the HDR (192)Ir remote afterloader, fixed by a customized acrylic mold, was inserted into the external auditory canal (EAC) and a total intracavitary radiation dose of 22.5Gy (4.5Gy/F) was given. RESULTS: Evaluation at the completion of treatment and at the end of 4-year followup revealed no evidence of the disease. CONCLUSIONS: In the radical treatment of early stage EAC carcinoma, combination of external beam radiation therapy and BRT may be a modality of choice for its efficacy, less severe side effects, and better cosmetic results.

Foreskin reconstruction at the time of single-stage hypospadias repair: is it a safe procedure?

INTRODUCTION: Foreskin reconstruction (FR) is a recognised, yet debated, option for patients undergoing single-stage hypospadias repair (HR). METHODS: We evaluated the incidence of complications after single-stage HR in our institution. This is a retrospective review of all single-stage HR. Patients were classified into group 1 (circumcision) and group 2 foreskin reconstruction (FR). Urethroplasty and foreskin complications were recorded. Statistics used are as follows: Mann-Whitney test to compare age at operation and length of follow-up (FU); Chi-Square test to analyse the incidence of urethral complications and need for reoperation; Log rank test to compare the survival curves; p statistically significant < 0.05. Data are presented as median (range). RESULTS: 304 patients were identified, operated between January 2010 and December 2016, and 20 were excluded: 6 already circumcised at the time of the surgery, 3 with megameatus intact prepuce, 11 lost at FU. 284 patients were included: 161 circumcised and 123 FR. Median age at the operation was 17 months (8-179) (group 1) and 17 months (8-148) (group 2) (p = 0.71). Length of FU was 19 months (8-91) (group 1) and 17 months (4-87) (group 2) (p = 0.45). The survival curve was homogeneous (p = 0.28). Urethroplasty complications occurred in 32/161 (20%) (group 1) and in 21/123 (17%) (group 2) (p = 0.55). Foreskin complications occurred in 18/123 (15%). A second operation was required in 33 boys in each group, (20% group 1 and 27% group 2) (p = 0.21). CONCLUSION: FR does not increase the complication rate or the need for a reoperation after single-stage HR. Parents should be offered the option between the two procedures according to their personal preference.

Estimation of dose enhancement to soft tissue due to backscatter radiation near metal interfaces during head and neck radiothearpy - A phantom dosimetric study with radiochromic film.

The objective of this study was to investigate the dose enhancement to soft tissue due to backscatter radiation near metal interfaces during head and neck radiotherapy. The influence of titanium-mandibular plate with the screws on radiation dose was tested on four real bones from mandible with the metal and screws fixed. Radiochromic films were used for dosimetry. The bone and metal were inserted through the film at the center symmetrically. This was then placed in a small jig (7 cm × 7 cm × 10 cm) to hold the film vertically straight. The polymer granules (tissue-equivalent) were placed around the film for homogeneous scatter medium. The film was irradiated with 6 MV X-rays for 200 monitor units in Trilogy linear accelerator for 10 cm × 10 cm field size with source to axis distance of 100 cm at 5 cm. A single film was also irradiated without any bone and metal interface for reference data. The absolute dose and the vertical dose profile were measured from the film. There was 10% dose enhancement due to the backscatter radiation just adjacent to the metal-bone interface for all the materials. The extent of the backscatter effect was up to 4 mm. There is significant higher dose enhancement in the soft tissue/skin due to the backscatter radiation from the metallic components in the treatment region.

Hepatoprotective Activity of Cucumis trigonus Roxb. Fruitagainst CCl4 Inducesd Hepatic Damage in Rats.

In India, a number of medicinal plants and their formulations are used to cure hepatic disorders in traditional systems of medicine. No systemic study has been done on protective effect of Cucumis trigonus Roxb. (Cucurbitaceae) to treat hepatic diseases. Protective action of C. trigonus fruit extracts was evaluated in this study in animal model of hepatotoxicity, which was induced by carbon tetrachloride. Forty two healthy female albino Wistar rats weighing between 180 and 200 g were divided in to seven groups of 6. Group 1 was normal control group; Group 2, the hepatotoxic group was given CCl4; Group 3 was administered standard drug (Liv-52); Groups 4-7 received pet. ether, chloroform, alcohol and aqueous fruit extract (300 mg/kg) with CCl4. The parameters studied were alanine transaminase, aspartate transaminase, alkaline phosphatase and serum bilirubin activities. The hepatoprotective activity was also supported by histopathological studies of liver tissue. Results of the biochemical studies of blood samples of CCl4 treated animals showed significant increase in the levels of serum enzyme activities, reflecting the liver injury caused by CCl4. Whereas blood samples from the animals treated with chloroform and aqueous fruit extracts showed significant and alcohol extract showed highly significant decrease in the levels of serum markers, indicating the protection of hepatic cells. The results revealed that alcoholic fruit extract of Cucumis trigonus could afford highly significant protection against CCl4 induced hepatocellular injury.

Effect of Baliospermum montanum Root Extract on Phagocytosis by Human Neutrophils.

Aqueous extract of roots of Baliospermum montanum was evaluated on preliminary basis for immunomodulatory activity by studying neutrophil phagocytic function. The different concentration of (25, 50, 100 mug/ml) of aqueous extract of roots of Baliospermum montanum was subjected to study its effect on different in vitro methods of phagocytosis such as neutrophil locomotion, chemotaxis, immunostimulant activity of phagocytosis of killed Candida albicans and qualitative nitroblue tetrazolium test by using human neutrophils. This preliminary study revealed that Baliospermum montanum extract has stimulated chemotactic, phagocytic and intracellular killing potency of human neutrophils at the different concentration. From the results obtained it can be observed that the aqueous extract of Baliospermum montanum stimulate cell-mediated immune system by increasing neutrophil function.

Phantom dosimetric study of nondivergent aluminum tissue compensator using ion chamber, TLD, and gafchromic film.

Anatomic contour irregularity and tissue inhomogeneity in head-and-neck radiotherapy can lead to significant dose inhomogeneity due to the presence of hot and cold spots across the treatment volumes. Missing tissue compensators (TCs) can overcome this dose inhomogeneity. The current study examines the capacity of 2-dimensional (2D) custom aluminum TCs fabricated at our hospital to improve the dose homogeneity across the treatment volume. The dosimetry of the 2D custom TCs was carried out in a specially designed head-and-neck phantom for anterior-posterior (AP) and posterior-anterior (PA) fields with an ion chamber, thermoluminscence dosimeters (TLDs), and film. The results were compared for compensated and uncompensated plans generated from the Eclipse treatment planning system. On average, open-field plans contained peak doses of 117%, optimally wedged-plans contained peak doses of 113%, and custom-compensated plans contained peak doses of 105%. The dose variation between prescribed and measured dose at midplane of the phantom was observed as high as 17%, which was reduced to 3.2% for the customized TC during ionometric measurements. It was further confirmed with TLDs, in a sagittal plane, that the high-dose region of 13.3% was reduced to 2.3%. The measurements carried out with the ion chamber, TLDs, and film were found in good agreement with each other and with Eclipse. Thus, a custom-made 2D TC is capable of reducing hot spots to improve overall dose homogeneity across the treatment volume.