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The acoustic emission (AE) technique is one of the most widely used in the field of structural monitoring. Its popularity mainly stems from the fact that it belongs to the category of non-destructive techniques (NDT) and allows the passive monitoring of structures. The technique employs piezoelectric sensors to measure the elastic ultrasonic wave that propagates in the material as a result of the crack formation's abrupt release of energy. The recorded signal can be investigated to obtain information about the source crack, its position, and its typology (Mode I, Mode II). Over the years, many techniques have been developed for the localization, characterization, and quantification of damage from the study of acoustic emission. The onset time of the signal is an essential information item to be derived from waveform analysis. This information combined with the use of the triangulation technique allows for the identification of the crack location. In the literature, it is possible to find many methods to identify, with increasing accuracy, the onset time of the P-wave. Indeed, the precision of the onset time detection affects the accuracy of identifying the location of the crack. In this paper, two techniques for the definition of the onset time of acoustic emission signals are presented. The first method is based on the Akaike Information Criterion (AIC) while the second one relies on the use of artificial intelligence (AI). A recurrent convolutional neural network (R-CNN) designed for sound event detection (SED) is trained on three different datasets composed of seismic signals and acoustic emission signals to be tested on a real-world acoustic emission dataset. The new method allows taking advantage of the similarities between acoustic emissions, seismic signals, and sound signals, enhancing the accuracy in determining the onset time.
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Acústica , Inteligencia Artificial , Sonido , Redes Neurales de la Computación , UltrasonidoRESUMEN
INTRODUCTION: To assess the outcome of same-session bilateral tubeless percutaneous nephrolithotomy (BPCNL) in supine and prone positions and to compare them to unilateral tubeless PCNL (UPCNL). MATERIALS AND METHODS: Consecutive PCNL patients treated at two institutions between 2006-2016 were analyzed. Tubeless BPCNL was performed when indicated. RESULTS: Fifty-eight patients underwent BPCNLs [30 supine (SBPCNL) and 28 prone (PBPCNL)], while 1395 patients underwent UPCNLs. Demographics and baseline data were similar for all groups (p > 0.05). SBPCNL had a longer operating time (124 +/- 38 minutes versus 105 +/- 36 minutes; p = 0.49) and a significantly longer hospital stay (3.6 +/- 1.9 versus 2.4 +/- 1.3 days, respectively; p = 0.019) in comparison to PBPCNL. Seven planned BPCNLs were converted to UPCNL, resulting in a BPCNL success rate of 58/65 (89%). When compared to UPCNL, BPCNL patients had a significantly increased postoperative creatinine level (0.74 +/- 0.3 versus -0.04 +/- 0.8 g/dL; p = 0.07E-7), a decreased postoperative hemoglobin level (2 +/- 1.1 versus 1.4 +/- 1.7 mg/dL; p = 0.026), a higher blood transfusion rate (9% versus 2%; p = 0.023), and a longer hospital stay (3 +/- 1.7 versus 1.6 +/- 1.7 days; p = 0.001E-4). Stone-free and overall complication rates were similar for both groups. CONCLUSION: BPCNL can be routinely offered to patients with a bilateral indication. BPCNL is associated with higher blood transfusion rates and longer hospital stays, but it may spare patients from repeat anesthesia and hospitalization. SBPCNL takes longer to perform than PBCNL, but without clinical ramifications.
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Cálculos Renales/cirugía , Nefrolitotomía Percutánea/métodos , Posicionamiento del Paciente , Adulto , Anciano , Transfusión Sanguínea , Creatinina/sangre , Femenino , Hemoglobinas/metabolismo , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Nefrolitotomía Percutánea/efectos adversos , Tempo Operativo , Complicaciones Posoperatorias/etiología , Periodo Posoperatorio , Posición Prona , Posición SupinaRESUMEN
To evaluate the influence of posterior musculofascial plate reconstruction (PR) on early return of continence after radical prostatectomy (RP); an updated systematic review of the literature. A systematic review of the literature was performed in June 2015, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and searching Medline, Embase, Scopus and Web of Science databases. We searched the terms posterior reconstruction prostatectomy, double layer anastomosis prostatectomy across the 'Title' and 'Abstract' fields of the records, with the following limits: humans, gender (male), and language (English). The authors reviewed the records to identify studies comparing cohorts of patients who underwent RP with or without restoration of the posterior aspect of the rhabdosphincter. A meta-analysis of the risk ratios estimated using data from the selected studies was performed. In all, 21 studies were identified, including three randomised controlled trials. The overall analysis of comparative studies showed that PR improved early continence recovery at 3-7, 30, and 90 days after catheter removal, while the continence rate at 180 days was statistically but not clinically affected. Statistically significantly lower anastomotic leakage rates were described after PR. There were no significant differences for positive surgical margins rates or for complications such as acute urinary retention and bladder neck stricture. The analysis confirms the benefits at 30 days after catheter removal already discussed in the review published in 2012, but also shows a significant advantage in terms of urinary continence recovery in the first 90 days. A multicentre prospective randomised controlled trial is currently being conducted in several institutions around the world to better assess the effectiveness of PR in facilitating an earlier recovery of postoperative urinary continence.
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Complicaciones Posoperatorias/prevención & control , Prostatectomía/efectos adversos , Prostatectomía/métodos , Incontinencia Urinaria/prevención & control , Humanos , Masculino , Músculo Estriado/cirugía , Procedimientos Quirúrgicos Urológicos Masculinos/métodosRESUMEN
INTRODUCTION: The ability to return to work after a cancer diagnosis is a key aspect of cancer survivorship and quality of life. Studies have reported a significant risk of income loss for cancer survivors; however, there is limited evidence of the Italian context. METHODS: The Work Histories Italian Panel (WHIP)-Salute database was used to select a cohort of incident cases of colorectal cancer (CRC) among workers in the private sector, based on hospital discharges. A propensity score matching was used to find a balanced control group for several confounders. Ordinary least square and logistic regressions were used to estimate the effect of a CRC diagnosis on annual income and the probability of switching from a full-time contract to a part-time one considering 3 years after the diagnosis. RESULTS: Overall, we identified 925 CRC incident cases from 2006 until 2012. Our results confirm a statistically significant reduction in survivors' income compared with controls. This reduction was greater in the first year and then tend to decrease, with an average income loss over 3 years of about 12 000. Stratified analyses by sex and position confirmed the overall trend while indicating a strong effect modification. Regarding the switching from full-time to part-time employment, the results were never significant. CONCLUSION: Income loss does not seem to be related to an increase in part-time contracts, but rather to survivors' reduced work capacity following the invasive treatments. Further research is needed to investigate the complex dynamics behind this association.
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Supervivientes de Cáncer , Neoplasias Colorrectales , Humanos , Calidad de Vida , Renta , Sobrevivientes , Neoplasias Colorrectales/epidemiologíaRESUMEN
The invention of the flexible ureteroscope (fURS) and its subsequent spread have revolutionized the surgical management of urolithiasis and upper tract urothelial carcinoma (UTUC). During the last few years, single-use flexible ureteroscopes (su-fURSs) have been developed to improve the limitations of reusable fURSs, namely their cost, durability and risk of device contamination. Since the introduction of the first fully disposable digital fURS, several su-fURSs have been developed by various manufacturers. In this pictorial review, we combined the different physical and technical features of su-fURSs currently available on the market with Food and Drug Administration (FDA) and European Conformity (CE) approval, in order to help surgeons choose the appropriate device according to each case requirement and personal preferences. To the best of our knowledge, 17 su-fURSs with CE and FDA approval have been developed to date.
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This article discusses the experience of adapting and applying the Outline for a Cultural Formulation in DSM-IV to the Swedish context. Findings from a research project on the Cultural Formulation highlight the value of combining psychiatric nosological categorization with an understanding of patients' cultural life context in order to increase the validity of categorization and to formulate individualized treatment plans. In clinical care practitioners need models and tools that help them take into account patients' cultural backgrounds, needs, and resources in psychiatric diagnostic practice. We present a summary of a Swedish manual for conducting a Cultural Formulation interview. The need for further development of the Cultural Formulation is also discussed.
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Competencia Cultural , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Entrevista Psicológica , Acontecimientos que Cambian la Vida , Trastornos Mentales/diagnóstico , Trastornos Mentales/etnología , Aculturación , Adulto , Femenino , Humanos , Irak/etnología , Islamismo/psicología , Trastornos Mentales/clasificación , Guías de Práctica Clínica como Asunto , Refugiados/psicología , Trastornos Somatomorfos/clasificación , Trastornos Somatomorfos/diagnóstico , Trastornos Somatomorfos/etnología , Trastornos por Estrés Postraumático/clasificación , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/etnología , Suecia , TraducciónRESUMEN
The aim of this study was to investigate barriers to diagnosis and adequate treatment of patients with early-onset dysthymia by studying how understandings of illness by patients and providers have evolved and how treatments have been negotiated over time. A theory-testing and explorative multiple-case study design was used with developmental cognitive theory as framework. Data pertaining 10 non-remission dysthymic patients were analyzed using five sources: 1) case records, 2) interviews, 3) self-report questionnaires, 4) observations, and 5) life-charting, eliciting life events, course and treatments. The analysis comprised qualitative content analysis and a coding scheme of knowledge structures. Barriers could be explained by misunderstandings as patients mainly expressed illness in concrete, perceptually bound knowledge structures and providers focused on one aspect, instead of on the complexity of concurrent aspects. Another barrier, associated to comorbid personality disorder, was a core pattern of concealing due to fear of rejection and mistrust. Other barriers were connected to providers' attitudes and contextual factors such as access problems and lack of follow-up. A theoretical model that involves patients' understanding of illness in preoperational thinking and providers' cognitive errors can explain communication barriers. Means of shared understanding and treatment planning are suggested. Future treatment research could elucidate the impact of the core belief of rejection with associated strategy of concealing by assessing these variables as predictors and as targets for change.
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Barreras de Comunicación , Trastorno Distímico/epidemiología , Trastorno Distímico/terapia , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Adulto , Edad de Inicio , Actitud Frente a la Salud , Trastorno Distímico/psicología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Trastornos de la Personalidad/epidemiología , Trastornos de la Personalidad/psicología , Relaciones Profesional-Paciente , Suecia/epidemiologíaRESUMEN
INTRODUCTION: The purpose of this survey was to explore the dissemination of flexible ureteroscopy (fURS), shockwave lithotripsy (SWL) and percutaneous nephrolithotomy (PCNL) in the Italian urological community and to know the real availability of the complex endourological armamentarium all over the country. MATERIALS AND METHODS: An online questionnaire characterizing the case volume/year of upper urinary tract stone treatment and the availability of flexible ureteroscopes (FUs) armamentarium was sent to all urological Italian centers. RESULTS: The survey was sent to 294 urological centers and 146 responded (49.7%). The case volume/year of fURS was the following: <20 cases in 20 centers (13.7%); 20-50 cases in 40 centers (27.4%), >50- <100 cases in 55 centers (37.8%) and >100 cases in 28 centers (19.2%). The case volume/year of SWL was the following: <50 cases in 18 centers (12.3%); >50- <200 cases in 56 centers (36.4%) and >200 cases in 35 centers (24%). In 37 centers (25.3%) SWL was not utilized at all. The case volume/year of PCNL was the following: <10 cases in 20 centers (14%); >10 - <30 cases in 55 centers (30%), >30- < 50 cases in 33 centers(23%), >50- <100 cases in 13 centers (9%) and >100 procedures in 2 centers (1%). However, 24 centers (16%) did not perform any PCNL procedure.Four centers (3%) did not have any FU at the moment of the survey. The availability of FUs was as follows: 1 FU in 21 (14%) centers, 2 FUs in 61 (42%) centers, 3 FUs in 29 (20%) centers, 4 FUs in 13 (9%) centers and ≥5 FUs in 16 (9%) centers. Only 82 (56%) centers had all of their FUs in working condition. CONCLUSIONS: This survey succeeded in providing a complete overview on the Italian endourological panorama.
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OBJECTIVE: To assess the "body mass index" (BMI) (weight and length) of 12 flexible ureteroscopes (digital and fiber optic) along with the light cables and camera heads, to make the best use of our instruments. MATERIALS AND METHODS: Twelve different brand-new flexible ureteroscopes from four different manufacturers, along with eight camera heads and three light cables were evaluated. Each ureteroscope, camera head, and light cable was weighted; the total length of each ureteroscope, shaft, handle, flexible end-tip, and cable were all measured. RESULTS: According to our measurements (in grams [g]), the lightest ureteroscope was the LithoVue (277.5 g), while the heaviest was the URF-V2 (942.5 g). The lightest fiber optic endoscope was the Viper (309 g), while the heaviest was the Cobra (351.5 g). Taking into account the entirety of the endoscopes, the lightest ureteroscope was the Lithovue and the heaviest was the Wolf Cobra with the Wolf camera "3 CHIP HD KAMERA KOPF ENDOCAM LOGIC HD" (1474 g). The longest ureteroscope was the URF-P6 (101.6 cm) and the shortest was the LithoVue (95.5 cm); whereas the Viper and Cobra had the longest shaft (69 cm) and URF-V had the shortest shaft (67.2 cm). The URF-V2 had the longest flexible end-tip (7.6 cm), while the LithoVue had the shortest end-tip (5.7 cm) in both directions (up/down), while the URF-V had the shortest upward deflection (3.7 cm). CONCLUSIONS: Newer more versatile digital endoscopes were lighter than their traditional fiber optic counterparts in their entirety, with disposable endoscope having a clear advantage over other reusable ureteroscopes. Knowing the "BMI" of our flexible ureteroscopes is an important information that every endourologist should always take into consideration.
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Diseño de Equipo/normas , Ureteroscopios/normas , Ureteroscopía/instrumentación , Tecnología de Fibra Óptica , HumanosRESUMEN
INTRODUCTION: The aim of this study was to evaluate the current literature on single-session bilateral endoscopic surgery for renal stones, analyzing their effectiveness and safety. EVIDENCE ACQUISITION: A systematic literature review was performed to identify articles published between 1995 and July 2016 that reported data on bilateral single-session endoscopic surgery for renal stones. Articles were separated into the following categories: bilateral PCNL, bilateral FURS and bilateral PCNL with contralateral FURS. We used a narrative synthesis for the analyses of the studies. EVIDENCE SYNTESIS: Five reports of bilateral FURS were identified in the literature search. These studies included a total of 218 patients that underwent bilateral FURS for renal stones. The primary SFR ranged from 64% to 92.8%. Postoperative complications were mostly described as minor complications; one major complication (0.5%) (grade V) was reported. Thirteen reports of bilateral PCNL were identified. These case studies included a total of 729 patients undergoing bilateral PCNL for renal stones. The primary SFR ranged from 24% to 100%. In all the studies a total of 29 (4%) major complications were described: 28 of them grade III while one was grade IV. One single study of bilateral PCNL with contralateral FURS for renal stones was identified. This report included 26 patients and the primary SFR was 92.3%. Two major complications (7.7%) (Grade III) were described. CONCLUSIONS: Bilateral single-session endoscopic procedures for bilateral renal stones are effective and safe. It should be considered a viable treatment option in carefully selected patients, performed by experienced urologists in high-volume centers. Key to success is the proper selection of patients and extending surgery on the second side only when the first side has been uneventful.
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Endoscopía/métodos , Cálculos Renales/cirugía , Procedimientos Quirúrgicos Urológicos/métodos , Femenino , Humanos , Masculino , Nefrolitotomía Percutánea/métodos , Nefrostomía Percutánea , Ureteroscopía/métodosRESUMEN
BACKGROUND: Thanks to advancements in the endoscopic armamentarium, flexible ureteroscopy (fURS) has become a viable and attractive option for the treatment of renal stones because of its high stone-free rates (SFRs) and low morbidity. OBJECTIVE: To describe our surgical technique for fURS, step-by-step, for the treatment of renal stones and to assess its effectiveness and safety. DESIGN, SETTING, AND PARTICIPANTS: A retrospective analysis of 316 consecutive patients who underwent fURS for renal stones at our institution between March 2014 and September 2015 was performed. SURGICAL PROCEDURE: Ureteroscopy and laser lithotripsy using a standardized technique with last-generation flexible ureteroscopes. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Clinical data were collected in a dedicated database. Intraoperative and postoperative outcomes were assessed. A descriptive statistical analysis was performed. RESULTS AND LIMITATIONS: The mean overall stone size was 16.5 ± 7.9mm. Ureteral access sheath placement was possible in 287 patients (90.8%). At 1-mo follow-up, the overall primary SFR was 79.1%; the secondary and tertiary SFRs were 89.5% and 91.5%, respectively. The mean operative time was 72.6 ± 27.5min. The mean number of procedures was 1.27. Complications were reported in 92 patients (29.1%) overall, with Clavien grade 1 in 55 patients (17.4%), grade 2 in 30 patients (9.5%), grade 3 in 6 patients (1.9%), grade 4 in 1 patient (0.3%), and grade 5 in none. The main limitation of the study was the retrospective nature. CONCLUSIONS: The fURS procedure is safe and effective for the treatment of renal stones. A staged procedure is necessary to achieve stone-free status with large calculi. PATIENT SUMMARY: Flexible ureteroscopy is an effective treatment with low complication rates for the majority of renal stones. Both the modern highly technological armamentarium and surgical know-how should be available.
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Cálculos Renales/cirugía , Ureteroscopía/métodos , Adulto , Femenino , Humanos , Litotripsia por Láser/efectos adversos , Masculino , Persona de Mediana Edad , Tempo Operativo , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Ureteroscopía/efectos adversos , Ureteroscopía/normasRESUMEN
OBJECTIVE: To report the first performance of simultaneous bilateral percutaneous nephrolithotomy and flexible ureteroscopy carried out in tandem by 2 different surgeons in a patient with bilateral medium-sized renal calculi, describing step-by-step details of the surgical technique. MATERIALS AND METHODS: A 46-year-old man, affected with hyperparathyroidism, was diagnosed with asymptomatic bilateral medium-sized renal stones. An abdominal noncontrast computed tomography scan revealed a left single kidney stone with a maximum diameter of 16 mm and 2 right renal stones located in the pelvis and in the lower calyx, of 21 and 19 mm in maximum diameter, respectively. A bilateral simultaneous percutaneous nephrolithotomy on the right side and flexible ureteroscopy on the left side were therefore carried out. RESULTS: The total operative time was 80 minutes. No intra- or postoperative complications were experienced. On postoperative day 1, the creatinine serum level was stable (0.7 mg/dL); he was discharged home 48 hours later. Ureteral stents were removed 7 days after the procedure. At 2 weeks follow-up, an abdominal noncontrast computed tomography scan showed a stone-free status and no changes in renal function were detected. CONCLUSION: A simultaneous bilateral endoscopic manipulation is feasible and safe and it can be offered in the presence of medium-sized bilateral renal stones in high-volume centers by experienced surgeons.
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Cálculos Renales/cirugía , Nefrostomía Percutánea/métodos , Ureteroscopía , Humanos , Cálculos Renales/patología , Masculino , Persona de Mediana EdadRESUMEN
This study evaluated the use of the Outline for Cultural Formulation (OCF) from the DSM-IV in the diagnosis of immigrants and refugee patients at an outpatient psychiatric clinic in Sweden. Using the OCF in conjunction with standard diagnostic procedures led to major revisions of diagnoses for 56.5% of patients. Anxiety disorders, especially PTSD, constitute the disorder group in which the most changes were made. In order to understand how information from the OCF interview led clinicians to revise diagnoses, data from clinical discussions were analysed through qualitative content analysis. This revealed four major themes related to the reevaluation, and at times confirmation, of given clinical psychiatric diagnoses: new information; expression of distress in emotional language; expression of distress in relation to life experiences; and improved understanding of the patient's suffering. The findings suggest that the OCF may be useful for: (a) formulating culture in relation to illness experiences, (b) contextualising diagnostic categorisation, and (c) improving overall understanding of the patient that may facilitate individualised planning of treatment and therapy.
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Competencia Cultural , Emigrantes e Inmigrantes/psicología , Entrevista Psicológica/métodos , Trastornos Mentales/diagnóstico , Trastornos Mentales/etnología , Refugiados/psicología , Adulto , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Etnopsicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Suecia/etnologíaRESUMEN
In urology, the main use for the robotic technique has been in radical prostatectomy for prostate cancer. Robotic surgery for other organs, such as the kidneys and bladder, has been less explored. However, partial nephrectomy or radical nephroureterectomy can be difficult for inexperienced laparoscopic surgeons. The advent of the da Vinci robot, with multijointed endowristed instruments and stereoscopic vision, decreases the technical difficulty of intracorporeal suturing and improves the reconstructive steps. The objective of this article is to offer an overview of all robotic procedures recently developed in the field of urology. We evaluate the feasibility of these procedures and their potential advantages and disadvantages. We also describe perioperative, postoperative, and oncologic outcomes of robot-assisted surgery as well as perform a comparison with open and laparoscopic techniques. Comparative data and an adequate follow-up are needed to demonstrate equivalent oncologic outcomes in comparison with traditional open or laparoscopic procedures.
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A review of the literature was performed to summarize current evidence regarding the efficacy of topical immunotherapy and chemotherapy for upper urinary tract urothelial cell carcinoma (UUT-UCC) in terms of post-treatment recurrence rates. A Medline database literature search was performed in March 2012 using the terms upper urinary tract, urothelial cancer, bacillus Calmette-Guérin (BCG), and mitomycin C. A total of 22 full-text articles were assessed for eligibility, and 19 studies reporting the outcomes of patients who underwent immunotherapy or chemotherapy with curative or adjuvant intent for UUT-UCC were chosen for quantitative analysis. Overall, the role of immunotherapy and chemotherapy for UUT-UCC is not firmly established. The most established practice is the treatment of carcinoma in situ (CIS) with BCG, even if a significant advantage has not yet been proven. The use of BCG as adjuvant therapy after complete resection of papillary UUT-UCC has been studied less extensively, even if recurrence rates are not significantly different than after the treatment of CIS. Only a few reports describe the use of mitomycin C, making it difficult to obtain significant evidence.
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A systematic review of the literature was performed to assess the relationship between the presence of perineural invasion (PNI) at prostate biopsy and extraprostatic extension (EPE) of prostate cancer. In August 2012, Medline, Embase, Scopus and Web of Science databases were searched. A "free-text" protocol using the terms "perineural invasion prostate cancer" was applied. Studies published only as abstracts and reports from meetings were not included in this review. In total, 341 records were retrieved from Medline, 507 from Embase, 374 from Scopus and 65 from the Web of Science database. The records were reviewed to identify studies correlating the presence of PNI with that of EPE. A cumulative analysis was conducted using Review Manager software v. 5.1 (Cochrane Collaboration, Oxford, UK). In univariate analysis, PNI showed a statistically significant association with pT3 tumours (p < 0.00001), which could be observed for both pT3a (p < 0.0001) and pT3b (p < 0.0001). In conclusion, the cumulative analysis shows a statistically significant higher incidence of EPE in patients who had PNI at needle biopsy. The main limitation of the analysis was that it was not possible to perform a multivariate analysis. Further attempts to build a nomogram for the prediction of EPE could include the presence of PNI at needle biopsy.
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Nervios Periféricos/patología , Próstata/patología , Neoplasias de la Próstata/patología , Biopsia , Humanos , Masculino , Invasividad Neoplásica/patología , Estadificación de NeoplasiasRESUMEN
This paper explores the contributions of the Cultural Formulation (CF) interview to an overall understanding of patients, and focuses on the narratives of 23 newly referred patients with migrant backgrounds seeking help at a psychiatric outpatient clinic in Stockholm. Through text content analysis methods we identified five themes: displacement in space and time; mental illness as a physical disability; life events as etiological factors; concealing as a coping strategy; and being lost in a fragmented health care system. Findings indicate the need to contextualize symptoms for an in-depth comprehension of patients' phenomenology. Both clinical and policy implications are discussed. The findings suggest that a section on migration and acculturation should be added to the cultural formulation in the next edition of DSM.