A Single-Surgeon Retrospective and Preliminary Evaluation of the Safety and Effectiveness of the Penuma Silicone Sleeve Implant for Elective Cosmetic Correction of the Flaccid Penis.

BACKGROUND: Silicone blocks and sleeves are simple devices used in cosmetic surgery. They are generally viewed as safe and effective; however, there is little information on their use in the penis. AIM: This study evaluates a large single-surgeon series using a novel silicone sleeve penile implant (Penuma) to cosmetically correct the flaccid penis. METHODS: 526 patients underwent elective cosmetic penile surgery using a silicone sleeve penile implant between 2009 and 2014. Institutional Review Board approval was obtained for a retrospective analysis, and study consent was obtained from 400 patients. Penile circumference was measured before surgery, immediately after surgery, and 30-90 days after the implant surgery. Using the nonvalidated Augmentation Phalloplasty Patient Selection and Satisfaction Inventory (APPSSI), changes in self-confidence, self-esteem, and satisfaction scores were assayed 6-8 weeks postoperatively. Scores were again assayed 2-6 years postoperatively in 77% of patients. The questionnaires rated patient self-confidence, self-esteem, and satisfaction as very low, low, medium, high, or very high. MAIN OUTCOME MEASURE: Outcomes include changes in penile measurements; changes in APPSSI satisfaction, self-confidence, and self-esteem scores; and incidences of adverse events. RESULTS: In the 400 patients, the implantation of the Penuma silicone implant increased midshaft circumference from an average of 8.5 ± 1.2 cm to 13.4 ± 1.9 cm (56.7% increase; P < .001). A 2-category improvement in self-confidence and self-esteem was noted in 83% of patients 6-8 weeks postoperatively. On long-term follow-up (2-6 years; mean 4 years), 72% patients remained improved (2-category improvement in APPSSI scoring), and 81% of subjects reported "high" or "very high" levels of satisfaction. The most frequently reported postoperative complications were seroma (4.8%), scar formation (4.5%), and infection (3.3%). No patients reported any changes in sexual function, erections, or ejaculation. 3% experienced adverse events necessitating device removal. CLINICAL IMPLICATIONS: The Penuma silicone implant can help patients cosmetically correct the penis with increased flaccid penile girth and achieve enhanced self-confidence and self-esteem over the short- and long term. STRENGTHS AND LIMITATIONS: Strengths include the large number of subjects (400 men) and the long-term follow-up period (2-6 years). Limitations include the retrospective and single-surgeon (inventor) nature of the study; the presence of 126 non-consenting subjects, potentially impacting the complication rate; and the APPSSI's lack of validation. CONCLUSION: Retrospective analysis of 400 men electing to have penile cosmetic correction with the Penuma device demonstrates improvements in girth (56.7% increase) and high and sustained patient satisfaction, self-confidence, and self-esteem with minimal and manageable adverse events. Elist JJ, Valenzuela R, Hillelsohn J, et al. A Single-Surgeon, Retrospective, and Preliminary Evaluation of the Safety and Effectiveness of the Penuma Silicone Sleeve Implant for Elective Cosmetic Correction of the Flaccid Penis. J Sex Med 2018;15:1216-1223.

The impact of KIR-HLA genotype on hepatitis B virus clearance in Iranian infected individuals.

Killer cell immunoglobulin like receptors (KIRs) have a principal role in regulating the effector functions of NK cells, particularly in viral infections. The major ligands for KIRs are human leukocyte antigen (HLA) class I molecules. The aim of this study is to investigate the possible association of KIR genes, their known HLA ligands and compound KIR-HLA genotypes with hepatitis B virus (HBV) infection. Our study group consisted of 202 Iranian HBV-infected patients (52 spontaneously recovered, 50 asymptomatic carriers, 50 chronic sufferers and 50with liver cirrhosis) and 100 ethnic-matched healthy control subjects. KIR and HLA genotyping was performed by a polymerase chain reaction-sequence-specific primer (PCR-SSP). The frequencies of the KIR2DL5A, KIR2DS1, and KIR3DS1 genes were significantly elevated in recovered individuals when compared with both control and patient groups. Also, KIR2DL5, and KIR3DP1 full were escalated in recovered individuals in comparison with patient groups. In addition, HLA-Bw4 ligand and HLA-A Bw4 were highly frequent in recovered individuals compared with healthy controls. Furthermore, the KIR3DS1 + HLA-Bw4, KIR3DS1 + HLA-Bw4 Iso80 , and KIR3DS1 + HLA-A Bw4 genotypes were significantly more common in recovered individuals than both healthy control and patient groups. Interestingly, AA genotype had less frequency and Bx had higher frequency in recovered individuals compared with both healthy control and patient groups. Our findings suggest a potential impact of the NK cells' activating phenotype that leads to the HBV clearance in infected individuals.

Benign joint hypermobility syndrome in soldiers; what is the effect of military training courses on associated joint instabilities?

BACKGROUND: Hypermobile joints are joints with beyond normal range of motion and may be associated with joint derangements. This study aimed to evaluate the prevalence of benign joint hypermobility syndrome (BJHS) among soldiers and effect of training courses on related joint instabilities. MATERIALS AND METHODS: In a prospective cohort study on 721 soldiers of Iran Army in Isfahan in 2013 the prevalence of joint hypermobility was obtained by using Beighton criteria. Soldiers divided in two groups of healthy and suffered based on their scores. The prevalence of ankle sprain, shoulder and temporomandibular joint (TMJ) dislocations identified before beginning service by history-taking and reviewing paraclinical documents. After 3 months of military training, a recent occurrence of mentioned diseases was revaluated in two groups. The collected data were analyzed using SPSS-20 software using Independent-T and Chi-square tests. RESULTS: The frequency of BJHS before military training was 29.4%. After passing military training period, the incidence of ankle sprain was significantly higher in suffered group achieving the minimum Beighton score (BS) of 4 (4.3%, P = 0.03), 5 (5.5%, P = 0.005) and also 6 out of 9 (6.5%, P = 0.01). The incidence of TMJ dislocation was not significantly different based on a minimum score of 4, while it was higher in suffered group when considering the score of 5 (2.1%) and 6 (2.6%) for discrimination of two groups (P = 0.03). There was no significant difference between two groups in case of shoulder dislocation anyway. CONCLUSION: Military training can increase the incidence of ankle sprains and TMJ dislocations in hypermobility persons with higher BS in comparison with healthy people. Therefore, screening of joint hypermobility may be useful in identifying individuals at increased risk for joint instabilities.

Exploring the impact of competitive compounds and catalyst synthesis method in DBT oxidative desulfurization using MoO3-V2O5/Al2O3 catalyst.

This research endeavors to address the pressing challenge of reducing sulfur content in fuels, an environmental imperative. It does so by employing bimetallic catalysts to enhance the efficiency of oxidative desulfurization (ODS) processes. This involves utilizing successive impregnation and co-impregnation methods to prepare a MoO3-V2O5/Al2O3. The catalysts underwent characterization using various techniques including X-ray diffraction (XRD), N2 adsorption-desorption, UV-vis (DRS), temperature-programmed desorption (NH3-TPD), Raman, Fourier-transform infrared spectroscopy (FTIR), field emission scanning electron microscopy (FE-SEM), and energy dispersive spectrum (EDS). The catalyst was utilized for the evaluation of the ODS process of dibenzothiophene (DBT). The effects of oxidants, namely H2O2 and t-butyl hydroperoxide (TBHP), were studied in the ODS. The catalyst prepared using the co-impregnation method (5M-15V-co) demonstrated significant acidic sites and exhibited remarkable efficiency in oxidative desulfurization. Remarkably, this catalyst achieved 100% oxidation of sulfur components within 30 min (min). To assess the catalyst's performance further, competitive compounds including nitrogen-containing compounds (NCCs) and saturated and unsaturated hydrocarbon compounds (HCs) were employed in the ODS. Initially, the introduction of NCCs led to a decrease in the sulfur removal rate; however, the catalyst successfully oxidized DBT completely within 60 min. When cyclohexene was present as an olefinic hydrocarbon compound, the catalyst oxidized DBT by approximately 75%, whereas DBT oxidation reached 100% within 20 min when p-xylene was introduced to the catalytic reactor. Additionally, as the O/S ratio increased from 2/5 to 10, the sulfur removal rate improved from 30 to 90%, indicating that HCs and NCCs compete with sulfur in terms of oxidant consumption.

Evaluation of the effectiveness of curcumin and piperine co-supplementation on inflammatory factors, cardiac biomarkers, atrial fibrillation, and clinical outcomes after coronary artery bypass graft surgery.

BACKGROUND: Coronary artery bypass graft (CABG) is one of the preferred treatments for patients with heart problems, especially in individuals with other comorbidities and when multiple arteries are narrowed. This study aimed to assess the effects of administrating curcumin-piperine on patients who underwent CABG surgery. METHODS: This was a randomized, double-blind, placebo-controlled clinical trial, in which 80 eligible adults who underwent CABG surgery, were randomized into 4 groups. Patients received 3 tablets daily for 5 days after the surgery, which contained curcumin-piperine (each tablet contained 500 mg curcumin +5 mg piperine) or a placebo (each tablet contained 505 mg maltodextrin). Group A received 3 placebo tablets, group B received 2 placebos and one curcumin-piperine tablet, group C received 1 placebo and 2 curcumin-piperine tablets, and group D received 3 curcumin-piperine tablets. Before and after the intervention, C-reactive protein (CRP), total antioxidant capacity (TAC), cardiometabolic factors, clinical outcomes, and 28-day mortality were evaluated. RESULTS: Between-group analysis showed that CRP significantly decreased (P = 0.028), and TAC significantly increased (P = 0.033) after the intervention (Post hoc analysis showed that for CRP, the difference was between group B and D, and for TAC was between group C and D). Between-group analysis also showed that creatine kinase mono-phosphate (CK-MB) marginally reduced (P = 0.077); however, changes for troponin I (P = 0.692), lactate dehydrogenase (LDH) (P = 0.668), ejection fraction (P = 0.340), and arterial fibrillation (P = 0.99) were not significant. Blood urea nitrogen (P = 0.820) and serum creatinine (P = 0.244) did not show notable changes between groups. CONCLUSION: Supplementation with curcumin-piperine had a promising effect on serum CRP and TAC. It also had a favorable impact on CK-MB among patients who underwent CABG surgery. TRIAL REGISTRATION: IRCT20201129049534N4, available on https://en.irct.ir/trial/56930.

Floating knee injuries: Results of treatment and outcomes.

BACKGROUND: Floating knee, referred to as ipsilateral fractures of the femur and tibia, is usually associated with several complications and mortality. This study was designed to present our experience with treatment of this injury throughout; age, sex, mechanism of injury, associated injuries, method and results of treatment, and complications of floating knee are discussed. MATERIALS AND METHODS: This retrospective study was performed between January 2006 and December 2011. All patients with floating knee injuries who were admitted to the referral educational hospitals were included. The information about the 238 cases of floating knee injuries were gathered through the 254,620 trauma files and after excluding 18 patients who died within 6 months, the remaining files were studied and the target information was recorded. RESULTS: The most frequent age group was 20-29 years (44.5%). The floating knee injuries were more common in males (85.5%). Type (D) according to "the classification of Letts and Vincent" was observed in 38.9% cases. The most frequent mechanism of injury was car to motorcycles accidents (48.2%). The most common associated injury was pelvic fractures (86.8%). Open reduction and internal fixation was the common type of treatment (70%). The most common early and late complications were knee hemarthrosis in 31 cases (14%) and knee osteoarthritis in 30 cases (13.6%), respectively. Death during the 5 years follow up was due to circulatory disruption, followed by deep vein thrombosis (61%). There was a significant relation between the age and outcomes as it worsens with age (P-value < 0.05). CONCLUSION: This study revealed that the complication rate associated with floating knee injuries remained high, regardless of the used treatment regimen and surgeons should focus on reducing complications while treating it.

Report of a Case with Intraventricular Cardiac Hydatid Cyst with Coronary Artery Disease and Multiple Hepatic Hydatid Cysts.

Despite the prevalence of hydatid cyst in humans, its occurrence in the heart is rare. The clinical signs of the mentioned cyst in the heart are diverse, which makes its diagnosis challenging. In addition, the cardiac hydatidosis is diagnosed late as this disease progresses gradually. In this report, the cases discussed of a case with intraventricular cardiac hydatid cyst with coronary artery disease and multiple hepatic hydatid cysts. After diagnosis, the patient underwent coronary artery bypass graft surgery, and the cyst was successfully removed. Considering the probability of heart involvement in endemic regions, devoting due attention to the disease as well as performing faster diagnosis of the disease can play a significant role in reducing its complications.

Evaluation of Vasodilatory Effect of Nitroglycerin in Cardioplegia Solution on Patients Undergoing Coronary Artery Bypass Graft Surgery.

INTRODUCTION: This study aimed to evaluate the vasodilatory effect of nitroglycerin (NTG) in cardioplegia solution on changes in troponin I and creatine phosphokinase-MB (CPK-MB) levels during coronary artery bypass graft (CABG) surgery. METHOD: A randomized controlled double-blind clinical trial was performed on 44 patients who were candidates for CABG surgery. These patients were divided into two groups. In the first group (NTG group), 3 mg/kg NTG was added to the cardioplegia solution, while 10 cc placebo (distilled water) was added to the cardioplegia solution in the second group (control group). Troponin I and CPK-MB levels were then assessed before and after the surgery. RESULTS: In this study, 72.7% and 27.3% of patients in the NTG group and 68.2% and 31.8% of patients in the control group were male and female, respectively. In addition, 9.1% within the age range of 40-50 years, 27.3% within the age range of 50-60 years, and 63.6% within the age range of more than 60 years were present in the NTG group. Moreover, 18.2% within the age range of 40-50 years, 36.4% within the age range of 50-60 years, and 45.5% within the age range of more than 60 years were present in the control group. Although the mean cardiopulmonary bypass (CPB) and cross-clamp time was insignificantly higher in the NTG group compared to the control group. In addition, troponin I and CPK-MB levels after surgery in the NTG group with the mean of 2090.68 ± 1856.07 and 97.27 ± 38.17 were significantly lower than those of the control group with the mean of 2697.02 ± 5586.56 and 137.95 ± 227.99, respectively (P-value <0.05). CONCLUSION: According to the results of this study, although troponin I and CPK-MB levels increased significantly after CABG surgery, this increase was significantly lower in the intervention group compared to the control group following the administration of NTG.

Investigating various metal contacts for p-type delafossite α-CuGaO2 to fabricate ultraviolet photodetector.

Delafossite semiconductors have attracted substantial attention in the field of electro-optics owing to their unique properties and availability of p-type materials that are applicable for solar cells, photocatalysts, photodetectors (PDs) and p-type transparent conductive oxides (TCOs). The CuGaO2 (CGO), as one of the most promising p-type delafossite materials, has appealing electrical and optical properties. In this work, we are able to synthesize CGO with different phases by adopting solid-state reaction route using sputtering followed by heat treatment at different temperatures. By examining the structural properties of CGO thin films, we found that the pure delafossite phase appears at the annealing temperature of 900 °C. While at lower temperatures, delafossite phase can be observed, but along with spinel phase. Furthermore, their structural and physical characterizations indicate an improvement of material-quality at temperatures higher than 600 °C. Thereafter, we fabricated a CGO-based ultraviolet-PD (UV-PD) with a metal-semiconductor-metal (MSM) configuration which exhibits a remarkable performance compared to the other CGO-based UV-PDs and have also investigated the effect of metal contacts on the device performance. We demonstrate that UV-PD with the employment of Cu as the electrical contact shows a Schottky behavior with a responsivity of 29 mA/W with a short response time of 1.8 and 5.9 s for rise and decay times, respectively. In contrast, the UV-PD with Ag electrode has shown an improved responsivity of about 85 mA/W with a slower rise/decay time of 12.2/12.8 s. Our work sheds light on the development of p-type delafossite semiconductor for possible optoelectronics application of the future.

Evaluation of water quality of Chahnimeh as natural reservoirs from Sistan region in southwestern Iran: a Monte Carlo simulation and Sobol sensitivity assessment.

Maintaining the water quality is essential because of the limitation of drinking water bodies and their significant effects on life. Recently, much scientific interest has been attracted to the ecological condition assessment of water resources. Because of numerous health issues connected to water quality, the present work aimed to define the water quality status of Chahnimeh reservoirs, Sistan and Baluchistan province, Iran via the Iran Water Quality Index (IRWQISC), the National Sanitation Foundation Water Quality Index (NSFWQI), and human risk assessment. This cross-sectional descriptive work was accomplished in 4 seasons in 2020. The samples were gathered from 5 various points of Chahnimeh reservoirs. This study led to the results that the NSFWQI index was between 29.4 to 49.32, which showed "bad" quality, and the IRWQI index was between 19.27 and 39.23, which indicated "bad" and "relatively bad" quality. The best water quality based on both indexes was observed in the spring, and the worst was in the fall and summer. The highest value of HQ related to nitrate in drinking water was 1.60 in the group of children. However, according to the Monte Carlo simulation, HQ95% was estimated as 1.29. The Sobol sensitivity analysis of the first-order effect showed that daily water's daily ingestion rate (IR) was the most sensitive input. In addition, the value of the second-order effect indicated that the interaction effect of concentration-ingestion rate was the most sensitive input parameter for HQ. Therefore, regular monitoring is necessary to ensure water safety for human consumption.

Comparison of Postoperative Pain and Clinical Outcomes of Total Knee Arthroplasty Among Patients with Rheumatoid Arthritis and Osteoarthritis Referred to Clinic or Emergency Department.

Background: Total knee arthroplasty (TKA) is among the most frequent orthopedic procedures. TKA has been shown to provide significant benefits to patients with rheumatoid arthritis (RA) and osteoarthritis (OA). We hypothesized that patients undergoing primary TKA with diverse preoperative diseases would have varying expectations for both pain and function following TKA. Materials and Methods: Patients diagnosed with OA or RA participated in this prospective cohort investigation. We assessed variables including Knee society score (KSS), and patient's quality of life using 36-Item Short Form Survey Instrument (SF-36). Pain was also measured using the Visual Analogue Scale (VAS). Results: In this study, 606 patients including 412 females and 194 males with a mean age of 65.5 ± 8.7 years were included in the study. Among patients, 46 patients underwent TKA due to RA and 560 patients due to knee OA. There was no statistically significant difference in term of KSS clinical score before the operation (P = 0.101). The mean of KSS clinical score and functional score variables at 6 months and 12 months after the operation were higher in OA group in comparison to RA group. SF-36 was significantly improved in OA group in comparison to RA group. Also, VAS in the RA group is significantly higher than in the OA group after 12 months of follow-up. Conclusion: Our results demonstrate that patients with OA after TKA have better KSS clinical and functional results than patients with RA.

Evaluating the Effectiveness of Conventional Prostheses Against Dual-Mobility Prostheses in the Treatment of Femoral Neck Fractures in Two Separate Groups of Patients: A Clinical Trial Study.

Background: Femoral neck fracture is a common posttraumatic injury in the elderly. Currently, orthopedic surgeons conducting total hip arthroplasty (THA) for hip fractures have various prosthetic alternatives. Dual-mobility cup THA is recommended for hip fracture patients to reduce prosthesis dislocation. Therefore, the goal of this research is to evaluate the effectiveness of conventional prostheses against dual-mobility prostheses in treating femoral neck fractures in two groups of patients. Materials and Methods: The current clinical investigation involved patients with femoral neck fractures. Among approved 84 patients, 44 and 40 were undergoing conventional THA (group A) and dual-mobility THA (group B), respectively. Patients were observed regularly after surgeries, and the same measurements were performed. The data were assembled and entered into SPSS software (version 25, IBM Corporation, Armonk, NY, USA) and analyzed. In all analyses, a P value of less than 0.05 was considered significant. Results: Eighty-four cases with an average age of 63.97 years were evaluated. In postoperative follow-up, there were no statistically significant differences between the groups in terms of Harris hip score, SF-36, and infection (P > 0.05). However, patients who received conventional implants had more dislocation postoperatively (P = 0.045). Regarding the rehabilitation costs, there were no statistically significant differences between the groups, so the group using the conventional implants incurred a higher cost (P = 0.041). Conclusion: According to the results, both dual mobility and conventional implants had optimal functional outcomes in patients with femoral neck fractures.

HVHC-ESD-Induced Oxygen Vacancies: An Insight into the Phenomena of Interfacial Interactions of Nanostructure Oxygen Vacancy Sites with Oxygen Ion-Containing Organic Compounds.

The challenging environmental chemical and microbial pollution has always caused issues for human life. This article investigates the detailed mechanism of photodegradation and antimicrobial activity of oxide semiconductors and realizes the interface phenomena of nanostructures with toxins and bacteria. We demonstrate how oxygen vacancies in nanostructures affect photodegradation and antimicrobial behavior. Additionally, a novel method with a simple, tunable, and cost-effective synthesis of nanostructures for such applications is introduced to resolve environmental issues. The high-voltage, high-current electrical switching discharge (HVHC-ESD) system is a novel method that allows on-the-spot sub-second synthesis of nanostructures on top and in the water for wastewater decontamination. Experiments are done on rhodamine B as a common dye in wastewater to understand its photocatalytic degradation mechanism. Moreover, the antimicrobial mechanism of oxide semiconductors synthesized by the HVHC-ESD method with oxygen vacancies is realized on methicillin- and vancomycin-resistant Staphylococcus aureus strains. The results yield new insights into how oxygen ions in dyes and bacterial walls interact with the surface of ZnO with high oxygen vacancy, which results in breaking of the chemical structure of dyes and bacterial walls. This interaction leads to degradation of organic dyes and bacterial inactivation.

Developing Equations for Free Vibration Parameters of Bistable Composite Plates Using Multi-Objective Genetic Programming.

For the last three decades, bistable composite laminates have gained publicity because of their outstanding features, including having two stable shapes and the ability to change these states. A common challenge regarding the analysis of these structures is the high computational cost of existing analytical methods to estimate their natural frequencies. In the current paper, a new methodology combining the Finite Element Method (FEM) and Multi-Objective Genetic Programming (MOGP) is proposed for the analysis of bistable composite structures, leading to some analytical relations derived to obtain the modal parameters of the shells. To achieve this aim, the data extracted from FEM, consisting of the ratio of the length to width (a/b) and the thickness (t) of the laminate, is split into Train and Validation, and Test, subsets. The former is used in MOGP, and four formulas are proposed for the prediction of the free vibration parameters of bistable laminates. The formulas are checked against the Test subset, and the statistical indices are calculated. An excellent performance is observed for all GP formulas, which indicates the reliability and accuracy of the predictions of these models. Parametric studies and sensitivity analyses are conducted to interpret the trend of input parameters in the GP models and the level of sensitivity of each natural frequency formula to the input parameters. These explicit mathematical expressions can be extended to the other bistable laminates to obtain their natural frequencies on the basis of their geometrical dimensions. The results are validated against the experimental data and verified against FEM outcomes.

Role of the Bone Marrow Microenvironment in Drug Resistance of Hematological Malignances.

The unique features of the tumor microenvironment (TME) govern the biological properties of many cancers, including hematological malignancies. TME factors can trigger an invasion and protect against drug cytotoxicity by inhibiting apoptosis and activating specific signaling pathways (e.g. NF-ΚB). TME remodeling is facilitated due to the high self-renewal ability of the bone marrow. Progressing tumor cells can alter some extracellular matrix (ECM) components which act as a barrier to drug penetration in the TME. The initial progression of the cell cycle is controlled by the MAPK pathway (Raf/MEK/ERK) and Hippo pathway, while the final phase is regulated by the PI3K/Akt /mTOR and WNT pathways. This review summarizes the main signaling pathways involved in drug resistance (DR) and some mechanisms by which DR can occur in the bone marrow. The relationship between autophagy, endoplasmic reticulum stress, and cellular signaling pathways in DR and apoptosis is covered in the TME.

Compressed MRI reconstruction exploiting a rotation-invariant total variation discretization.

Inspired by the first-order method of Malitsky and Pock, we propose a new variational framework for compressed MR image reconstruction which introduces the application of a rotation-invariant discretization of total variation functional into MR imaging while exploiting BM3D frame as a sparsifying transform. In the first step, we provide theoretical and numerical analysis establishing the exceptional rotation-invariance property of this total variation functional and observe its superiority over other well-known variational regularization terms in both upright and rotated imaging setups. Thereupon, the proposed MRI reconstruction model is presented as a constrained optimization problem, however, we do not use conventional ADMM-type algorithms designed for constrained problems to obtain a solution, but rather we tailor the linesearch-equipped method of Malitsky and Pock to our model, which was originally proposed for unconstrained problems. As attested by numerical experiments, this framework significantly outperforms various state-of-the-art algorithms from variational methods to adaptive and learning approaches and in particular, it eliminates the stagnating behavior of a previous work on BM3D-MRI which compromised the solution beyond a certain iteration.

Effect of single-dose crystalloid cardioplegic agent compared to bloody cardioplegic agent in cardiac surgery in children with Tetralogy of Fallot.

BACKGROUND: Cardioplegia is one of the main post-operative cardiac protective factors widely used in recent decades in the form of crystalloid (St. Thomas) and bloody solutions [del Nido (DN)]. The purpose of this study was to compare the effect of a crystalloid cardioplegic agent (St. Thomas) with that of a bloody cardioplegic agent (DN) in pediatric cardiac surgery among children with Tetralogy of Fallot (TOF). METHODS: This study was performed on 60 children with TOF, who were candidates for heart repair surgery. The participants were randomly divided into two groups of crystalloid cardioplegic agent and bloody cardioplegic agent. Operative outcomes such as required time for onset of heart arrest, duration of returning to normal heart rhythm, and cardiopulmonary bypass (CPB) time, and operative complications were compared between the two groups. RESULTS: The duration of returning to normal heart rhythm (50.43 ± 10.93 seconds vs. 43.03 ± 16.35 seconds; P = 0.044) and duration of inotropy (80.40 ± 27.14 hours vs. 63.20 ± 26.91 hours; P = 0.017) were significantly higher in the DN group compared to the St. Thomas group. However, there were no significant differences between the two groups in terms of heart arrest time, cross-clamp time, CPB time, supplementary lasix time, duration of intubation, and intensive care unit (ICU) and hospital length of stay (LOS) (P > 0.050). CONCLUSION: The use of St. Thomas cardioplegic solution was more effective in reducing the duration of returning to normal heart rhythm and inotropy compared with DN cardioplegic agent, and a single dose of these two cardioplegic agents can keep the mean cardiac arrest duration within the range of 50-70 minutes. It seems that the use of St. Thomas cardioplegic solution can be suggested in pediatric heart surgery.

Correction of retractile penis with subcutaneous soft silicone penile implant.

We report a novel solution for patients suffering from adult acquired retractile penis. Three patients complained of retractile penis (when standing) and/or prepubic recession. Physical examination confirmed the shaft of the penis was buried with only the glans visible. All three patients reported lower levels of self-confidence, self-esteem, and sexual confidence prior to their procedure. The three patients received surgical treatment with the insertion of a subcutaneous soft silicone penile implant and two of the three also received removal of the suprapubic fat pad. Over one year post operatively, the penile shaft and glans was visible and appeared natural. All patients reported an increase in self-confidence and self-esteem. The insertion of a subcutaneous soft silicone penile implant may prove to be a viable solution to reverse retractile penis and to increase patient quality of life when compared to more invasive current surgical treatments.

Effect of hydroalcoholic Allium atroviolaceum L. on the pathology of testicular tissue in cyclophosphamide-treated mice.

BACKGROUND: The most important side effects of Cyclophosphamide, as an anticancer broad-spectrum drug, are the negative effects on the reproduction and fertility because of oxidative stress. Considering the antioxidant properties of medicinal plants, especially those of the Allium genus, this paper studied the effect of hydroalcoholic extract of Allium atroviolaceum L. on the pathology of testicular tissue in CP-treated mice. METHODS: Groups of this experimental study consisted of normal saline recipients; three groups receiving A. atroviolaceum extract at 50, 100, 200 mg/kg; three groups receiving A. atroviolaceum extract at 50, 100, and 200 mg/g and 6.6 mg/kg of Cyclophosphamide; and a group given Cyclophosphamide at 1.6 mg/kg. All injections were performed intra-peritoneally. After 30 days, the testicular histological profile as well as the number of spermatozoa, the number of primary and round spermatocytes, and the number of spermatogonia were investigated. RESULTS: Cyclophosphamide treatment significantly reduced the lumen diameter, the seminiferous tubule diameter, the epithelial thickness, as well as decreased the quantity of spermatozoa and round and primary spermatocytes compared to the control group. Cyclophosphamide groups treated with A. atroviolaceum extract at 50, 100 and 200 mg/kg in a significant manner improved these variables (P < 0.001). CONCLUSION: A. atroviolaceum extract can significantly improve Cyclophosphamide-induced toxicity and pathological process on testicular tissue. It seems that this plant, with high antioxidant capacity, can be considered a complementary therapy for Cyclophosphamide to prevent undesirable effects on the reproductive system.

Topical WIN55212-2 alleviates intraocular hypertension in rats through a CB1 receptor mediated mechanism of action.

INTRODUCTION: Systemically administered cannabinoids can reduce intraocular pressure (IOP), but produce undesirable cardiovascular and central nervous system effects. In a chronic model of ocular hypertension, we examined the efficacy of acute topical administration of WIN55212-2 (WIN) in a novel commercially available vehicle and in combination with timolol. METHODS: IOP was chronically elevated by the surgical ligature of vortex veins in Sprague Dawley rats. IOP was measured by using Goldmann applanation tonometry. IOP, blood pressure (BP), and heart rate (HR) were measured at baseline and 30, 60, 90, and 120 min after the topical administration of WIN 1.0%, 0.25%, 0.06%, or 0.015%, the commercially available vehicle, timolol 0.5%, or a combination of WIN and timolol. SR141716 (CB1 antagonist) or SR144528 (CB2 antagonist) was administered topically 30 min before WIN to determine receptor specificity. To determine ocular and systemic penetration, 3H WIN 55212-2 was administered topically and tissues were collected at 60 and 120 min. Ocular irritation was evaluated by slit-lamp examination (SLE) at baseline and 120 min. RESULTS: WIN significantly decreased IOP in the hypertensive eye, with no BP or HR effects. SR141716 pretreatment significantly inhibited the IOP effects of WIN 1.0% in a dose-dependent manner, while SR 144528 was not as effective. No significant additive effects were observed by combining WIN (0.5% or 1.0%) with timolol 0.5%. WIN was retained in ocular tissue with a t1/2 of 80-100 min. SLE at 120 min revealed no solvent or drug-related toxic effects. CONCLUSIONS: In a chronic ocular hypertensive rat model, topically applied WIN is an effective, nontoxic ocular hypotensive agent with no hemodynamic side-effects. This effect was predominantly CB1 receptor mediated, but some CB2 contribution could not be ruled out.