Surgical Complications in the Management of Benign Prostatic Hyperplasia Treatment.

PURPOSE OF REVIEW: There are a variety of treatment options for men with symptomatic benign prostatic hyperplasia (BPH); transurethral resection of the prostate (TURP) remains the gold standard surgical treatment. The field continues to evolve with the introduction of new energy and laser technologies, increasing adoption of enucleation techniques, in addition to the advent of minimally invasive surgical technologies (MIST) that enable office-based treatments. The choice in surgical management has become very nuanced depending on a variety of patient and anatomic factors. There continues to be high success rates for surgical treatment of BPH; however, the risk profiles vary across the various surgical treatments. We sought to evaluate contemporary series and summarize the experience of complications associated with BPH treatment and management of these complications. RECENT FINDINGS: A comprehensive literature review was performed, and identified 79 manuscripts, published between 2005 and 2021 characterizing the diagnosis and management of complications following BPH surgery. Commonly cited issues included bleeding, ureteral orifice injury, bladder neck injury, rectal injury, TURP syndrome, bladder neck contractures, urethral stricture disease, refractory OAB symptoms, and complications unique to new modalities of treatment. The practicing urologist has multiple surgical options to choose from in treating patients with symptomatic BPH. The surgical management of BPH is generally well tolerated with high objective success rates that allow for significant improvement in urinary quality of life. It is critical to understand the potential complications associated with these various treatment options, which will enable trainees and practicing urologists to better counsel patients and manage these potential complications.

Feasibility of a play-based intervention set for toddlers with autism.

The Meta-play Method is a play-based, naturalistic set of interventions designed to decrease the symptoms associated with autism in toddlers. The purpose of the present study was to explore the feasibility of using this intervention set with a small group of toddlers and their parents. We selected seven toddlers diagnosed with autism and tested these children for autism severity and severity of repetitive behaviors. Parents were trained on the basic concepts of DBTA and the Meta-play activities. Researchers reviewed the integrity of interventions at once- or twice-monthly home visits for a six-month period, and recorded progress as rated by the parent. Activities were adapted at each visit to the interests and progress of the participating toddler. At the end of six months, autism symptoms and repetitive behavior decreased and parents reported high levels of social validity. Additional aspects of data collection and outcome measures, and suitability of interventions and procedures are discussed. While some outcomes were encouraging, a number of changes are recommended for future research.

Integrated recovery management model for ex-offenders with co-occurring mental health and substance use disorders and high rates of HIV risk behaviors.

This paper provides outcomes from an evaluation of a federally funded program combining HIV prevention services with an integrated mental health and substance abuse treatment program to a population of primarily African American ex-offenders living with, or at high risk for contracting HIV in Memphis, Tennessee. During the 5-year evaluation, data were collected from 426 individuals during baseline and 6-month follow-up interviews. A subset of participants (n = 341) completed both interviews. Results suggest that the program was successful in reducing substance use and mental health symptoms but had mixed effects on HIV risk behaviors. These findings are important for refining efforts to use an integrated services approach to decrease (a) the effects of substance use and mental health disorders, (b) the disproportionate impact of criminal justice system involvement, and (c) the HIV infection rate in African American ex-offenders in treatment.

Chitin-glucan fiber effects on oxidized low-density lipoprotein: a randomized controlled trial.

BACKGROUND/OBJECTIVES: Elevated oxidized low-density lipoprotein (OxLDL) may promote inflammation, and is associated with increased risk of atherosclerotic coronary heart disease and worsening complications of diabetes mellitus. The primary objective of this study was to evaluate the efficacy of chitin-glucan (CG), alone and in combination with a potentially anti-inflammatory olive oil (OO) extract, for reducing OxLDL in subjects with borderline to high LDL cholesterol (LDL-C) levels. SUBJECTS/METHODS: This 6-week, randomized, double-blind, placebo-controlled study of a novel, insoluble fiber derived from the Aspergillus niger mycelium, CG, evaluated 130 subjects free of diabetes mellitus with fasting LDL-C 3.37-4.92 mmol/l and glucose ≤ 6.94 mmol/l. Participants were randomly assigned to receive CG (4.5 g/day; n=33), CG (1.5 g/day; n=32), CG (1.5 g/day) plus OO extract (135 mg/day; n=30), or matching placebo (n=35). RESULTS: Administration of 4.5 g/day CG for 6 weeks significantly reduced OxLDL compared with placebo (P=0.035). At the end of study, CG was associated with lower LDL-C levels relative to placebo, although this difference was statistically significant only for the CG 1.5 g/day group (P=0.019). CG did not significantly affect high-density lipoprotein cholesterol, triglycerides, glucose, insulin or F2-isoprostane levels. Adverse events did not substantively differ between treatments and placebo. CONCLUSIONS: In this 6-week study, CG (4.5 g/day) reduced OxLDL, an effect that might affect the risk for atherosclerosis.

Immune response and blood chemistry of pigs fed conjugated linoleic acid.

Immune function (response to concanavalin A, cytokine production, and lymphocyte profiles) and blood chemistry variables were measured in growing-finishing pigs (Yorkshire/Landrace/Duroc dam × Hampshire sire) fed varying percentages of CLA (0, 0.12, 0.25, 0.50, and 1.0%). Blood was collected at 0, 14, 28, 42, and 56 d on feed (DOF). Total white blood cell (WBC) count increased (P < 0.01) linearly to 42 DOF. No differences (P = 0.53) were observed for WBC across CLA treatment. Nitric oxide was greater (P < 0.01) for the 1.0% CLA treatment compared with all other treatments. Flow cytometry using fluorescent labeled monoclonal antibodies to the CD4, CD8, double-positive CD4/CD8, and CD2 surface markers was used to determine lymphocyte subpopulations. Supplementation of CLA had no effect (P = 0.61) on lymphocyte subpopulation cell distribution. Most blood chemistry variables were within the normal metabolic range for pigs. A decrease was observed over DOF for P (P < 0.01) and K (P < 0.05). Additionally, Na and Cl concentrations increased (P < 0.05) from 14 to 28 DOF and decreased over the remainder of the trial. Electrolyte balance was not different (P = 0.38) across CLA treatments and was likely explained by no differences in feed intake among the CLA treatment groups. Blood lipid variables indicated that total cholesterol (P < 0.001), triglycerides (P < 0.001), high-density lipoproteins (P < 0.001), and low-density lipoproteins (P < 0.01) increased as the amount of CLA in the diet increased, but none of the results from these treatments exceeded the normal range of acceptability. These results suggested that CLA was safe when fed to growing-finishing pigs and had little effect on their immune function and blood chemistry variables.

The influence of inclusions of vitamin E and corn oil on semen traits of Japanese quail (Coturnix coturnix japonica).

Reported was an investigation of the effect of vitamin E (Vit.E) and corn oil on semen traits of male Japanese quail (Coturnix coturnix japonica). From 8 to 20 wk of age, birds were raised on corn-based diets supplemented with corn oil (0 and 3%) and Vit.E (National Research Council (NRC) recommended 25mg/kg/day/dry matter and 150 mg/kg/day/dry matter) in a 2×2 factorial manner. The diet was supplemented with corn oil and Vit.E (E2C2) which provided additional n-6 polyunsaturated fatty acids in the form of 20:4n-6 and 22:4n-6 in spermatozoa phospholipid. The left testes weights were increased (P<0.01) in groups that received Vit.E in the diet (3.95 and 4.12 g, respectively) (P=0.03) and combined testes weight was the greatest in E2C2 group (7.57g) (P=0.02). Semen volume increased throughout the experiment in the E2C2 group. E2C1 and E2C2 birds had the greatest (90.05% and 92.1%, respectively) live sperm percent by comparison with other groups. The susceptibility of semen to lipid peroxidation in vitro was increased in quail fed E1C1 and E1C2, but was reduced when 150 mg Vit.E kg/day/dry matter feed was provided in the diet. The amount of Vit.E in the seminal plasma of E1C1 and E1C2 groups was (P<0.01) less than that in the other two groups (E2C1 and E2C2). From this study, it may be concluded that increasing diet n-6/n-3 ratio can be beneficial for semen traits, however, this application increased sperm peroxidation sensitivity but it can be controlled by inclusion of antioxidant such as Vit.E (150 mg/kg/day/dry matter) to diet.

The effects of orally administered crude alcohol and aqueous extracts of African potato (Hypoxis hemerocallidea) corm on the morphometry of viscera of suckling rats.

The litter from six Sprague-Dawley rats was used to study the short-term effects of African potato (AP) corm extracts in suckling rats. Ten days after birth, the pups in each litter were assigned to treatment groups and received alcohol (AL) or aqueous (AQ) extracts of AP (50 mg kg(-1) b.w. in 0.9% saline, 10 ml kg(-1) b.w., and a high dose 200 mg kg(-1) b.w. in 0.9% saline, 10 ml kg(-1) b.w.) via a stomach tube, for 5 consecutive days. A fifth group (control) received 0.9% saline (10 ml kg(-1) b.w.). Between gavage, the pups were kept with their dams. The pups were then killed and the viscera removed for gross and microscopic morphometric measurements. The low dose of AQ and AL extracts of AP significantly increased (P<0.01, ANOVA) the mean weight gain. The high dose of AQ significantly increased (P<0.05, ANOVA) the weight of the caeca whilst the low dose of the AL extract reduced pancreas weight compared to the control and low dose AQ groups. All other morphometric parameters of the viscera measured did not differ significantly between the groups. The small intestinal villi and crypts did not reveal any signs of pathology.

Hyperzincaemia in a pet African giant rat (Cricetomys gambianus Waterhouse, 1840).

Presented is an African giant rat (Cricetomys gambianus) following zinc ingestion. The sick rat was lethargic, withdrawn, had soft, mucus-impregnated faeces and diahorrea, foot twitching and icterus. Comparative age, sex and body weight (b.wt.)-matched analyses were made with a healthy giant rat. Twelve-hourly Urine volume (UV), Haematocrit (Hct), urinary glucose, plasma zinc and Alkaline Phosphatase (ALP) were performed over an 8-week period. Full blood counts were performed and differential WBC counts and microscopic observations were made on blood smears obtained from both healthy and sick rats. Consecutive blood samples were drawn at the end of each week (Weeks <2-6 treatment; Weeks 7-8 post-treatment). Treatment involved oral vitamin B12 supplement at 4 microg/day and 2 ml diethylenetriaminepentaacetic acid (DTPA) intramuscular injections at 1 ml/450g b.wt./5 wks (Week 2 - 6). Day 1 showed neutropaenia, Heinz bodies on RBCs (reticulocytes and immature forms). Zinc (Day 1 - end Week 7), glucose (Day 1 - end Week 4), ALP (Day 1 -Week 4) and UV were elevated (Day 1 - end Week 6). Indications of moderate zinc toxicosis following ingestion and stress-associated glucosuria were concluded.

Effects of carnitine supplementation on muscle metabolism by the use of magnetic resonance spectroscopy and near-infrared spectroscopy in end-stage renal disease.

BACKGROUND/AIM: A defect in skeletal muscle mitochondrial metabolism develops in patients with chronic renal failure on haemodialysis. Treatment with carnitine, a compound essential for normal mitochondrial function, has been suggested to have significant benefits in such patients, so we carried out a study to see if carnitine acts by improving muscle bioenergetics and function. METHODS: In a phase II randomised double-blind trial, patients with end-stage renal disease received placebo or intravenous L-carnitine (20 mg/kg dry body weight three times weekly after haemodialysis) for 16 weeks (n = 13 in each group). 31P magnetic resonance spectroscopy, 1H magnetic resonance imaging and near-infrared spectroscopy were used to measure muscle bioenergetics and function at baseline and at 16 weeks. RESULTS: There were no significant differences between groups at baseline. Mean plasma carnitine rose 10-fold in the carnitine group but was unchanged in the placebo group. L-carnitine had no statistically significant effect on any of the parameters measured. The rate of proton efflux from muscle, as a measure of tissue perfusion, was low in both groups and was not affected by treatment. CONCLUSIONS: The study failed to show any significant effect of 16 weeks' L-carnitine supplementation on these objective measures of muscle metabolism and function. Slow proton efflux from muscle provides evidence supporting low blood flow and, therefore, decreased oxygen availability, as an underlying mechanism for muscle mitochondrial dysfunction in this disorder.

The efficacy of honey in inhibiting strains of Pseudomonas aeruginosa from infected burns.

Because there is no ideal therapy for burns infected with Pseudomonas aeruginosa, there is sufficient need to investigate the efficacy of alternative antipseudomonal interventions. Honey is an ancient wound remedy for which there is modern evidence of efficacy in the treatment of burn wounds, but limited evidence for the effectiveness of its antibacterial activity against Pseudomonas. We tested the sensitivity of 17 strains of P. aeruginosa isolated from infected burns to two honeys with different types of antibacterial activity, a pasture honey and a manuka honey, both with median levels of activity. All strains showed similar sensitivity to honey with minimum inhibitory concentrations below 10% (vol/vol); both honeys maintained bactericidal activity when diluted more than 10-fold. Honey with proven antibacterial activity has the potential to be an effective treatment option for burns infected or at risk of infection with P. aeruginosa.

CordyMax Cs-4 improves steady-state bioenergy status in mouse liver.

OBJECTIVE: To evaluate effects of CordyMax Cs-4, a mycelial fermentation product of Cordyceps sinensis, on energy metabolism. DESIGN: An in vivo pharmacology study using 31P nuclear magnetic resonance (NMR) spectroscopy. SUBJECTS AND STUDY INTERVENTIONS: Adult male C57-BL/6 mice were given an aqueous extract of CordyMax, 200 or 400 mg/kg per day or placebo for 7 days. OUTCOME MEASUREMENTS: Using 31P-NMR spectroscopy to measure cellular triphosphates and inorganic phosphate, expressed as a ratio to a reference peak, and calculate tissue pH. RESULTS: Steady-state beta adenosine triphosphate (ATP) increased in the liver of mice that received CordyMax (200 or 400 mg/kg per day) for 7 days, by 12.3% +/- 0.8% and 18.4% +/- 0.9%, respectively, compared to placebo controls (both p < 0.001), suggesting a higher hepatic bioenergy status in CordyMax-treated animals. Hepatic inorganic phosphate (Pi) decreased by 24.5% +/- 0.9% and 17.6% +/- 1.7% in the two treatment groups, respectively, compared to placebo controls (p < 0.001). The ratio of beta-ATP:Pi increased by 47.7% +/- 1.6% and 41.4% +/- 2.4%, respectively, in the treatment groups (both p < 0.001 compared to placebo). After discontinuation of CordyMax for 7 days, beta-ATP and Pi returned towards baseline. CONCLUSION: CordyMax is effective in improving bioenergy status in the murine liver, suggesting a mechanism underlying the known clinical effectiveness of CordyMax in alleviating fatigue and improving physical endurance, especially in elderly subjects.

Conjugated linoleic acid changes swine performance and carcass composition.

Conjugated linoleic acid (CLA) is a collective term for positional and geometric isomers of linoleic acid. Dietary CLA has been shown to improve feed efficiency, decrease body fat, and increase lean tissue in laboratory animals. We hypothesized that CLA would improve performance and carcass composition and would be deposited in pork tissues. Diets of 40 crossbred pigs were supplemented with CLA to determine its effects on performance and carcass composition. Eight replications of five littermate barrows with an initial average weight of 26.3 kg were allotted at random to individual pens. Within replication dietary treatments containing 0, 0.12, 0.25, 0.5, or 1.0% CLA were assigned at random. Pigs were weighed and feed disappearance was determined at 14-d intervals. Average daily gain increased linearly as the level of CLA increased in the diet (P < 0.05). Average daily feed intake was not affected by the concentration of CLA in the diet. Therefore, a linear increase in gain:feed ratio (P < 0.05) was observed. Carcasses from animals fed control diets had greater 10th rib backfat than carcasses from animals fed CLA (P < 0.05). Ultrasound measurement and carcass measurements showed less fat depth over the loin eye at the 10th rib of pigs fed doses of CLA (P < 0.05) than that observed for control pigs. Belly hardness (firmness) increased linearly as the concentration of CLA in the diet increased when bellies were measured for firmness either lean side up (P < 0.001) or lean side down (P < 0.05). Loin dissection data demonstrated that CLA produced a quadratic treatment effect both for less intermuscular fat (P < 0.001) and less subcutaneous fat (P < 0.05) and a linear increase for bone (P < 0.05), although finished loin weight only tended to increase (P = 0.08). The CLA concentration increased in a linear relationship in both subcutaneous fat (P < 0.001) and lean tissue (P < 0.001). Dietary CLA was incorporated into pig tissues and had positive effects on performance and body composition.

Influence of two dietary fats on the composition of emu oil and meat.

Male and female emus were fed a diet rich in saturated fat (beef tallow) or a diet rich in unsaturated fat (soybean oil) until they weighed about 35 kg. Samples of subcutaneous and retroperitoneal adipose tissues and samples of six major meat cuts were taken for determination of composition. Emus fed the two different diets grew at similar rates, but the male emus had a higher percentage of carcass fat. The adipose tissue cells from males were larger than those from females. All six meat cuts averaged 2.2% fat, with the regular filet having the most and the inside and outside drums the least. Cholesterol concentration of all sizes of meat cuts averaged 32.2 mg/100 g meat. Diet did not influence cholesterol content of the rendered oil. Fan filets had the greatest concentration of cholesterol, and the inside and outside drums had the least. Source of dietary fat had no effect on fat and cholesterol content of the meats. Meat from emus fed beef tallow was more tender and juicy. Fan filets were the most tender meat, had the least intense flavor, and were the most flavorful. Untrained panelists were able to discriminate between emu meat and beef. Source of dietary fat did not influence the fatty acid compositions of the meats. As expected, the soybean oil-fed emus produced oil that was more polyunsaturated than did the tallow-fed emus.

Distribution and functional consequences of nucleotide polymorphisms in the 3'-untranslated region of the human Sep15 gene.

Selenium has been shown to prevent cancer in a variety of animal model systems. Both epidemiological studies and supplementation trials have supported its efficacy in humans. However, the mechanism by which selenium suppresses tumor development remains unknown. Selenium is present in known human selenoproteins as the amino acid selenocysteine (Sec). Sec is inserted cotranslationally in response to UGA codons within selenoprotein mRNAs in a process requiring a sequence within the 3'-untranslated region (UTR), referred to as a Sec insertion sequence (SECIS) element. Recently, a human Mr 15,000 selenoprotein (Sep15) was identified that contains an in-frame UGA codon and a SECIS element in the 3'-UTR. Examination of the available cDNA sequences for this protein revealed two polymorphisms located at position 811 (C/T) and at position 1125 (G/A) located within the 3'-UTR. Here, we demonstrate significant differences in Sep15 allele frequencies by ethnicity and that the identity of the nucleotides at the polymorphic sites influences SECIS function in a selenium-dependent manner. This, together with genetic data indicating loss of heterozygosity at the Sep15 locus in certain human tumor types, suggests that Sep15 may be involved in cancer development, risk, or both.

Health care workforce for the twenty-first century: the impact of nonphysician clinicians.

For many years, nonphysician clinicians (NPCs) have participated in the care of patients. However, their numbers were small and their licensed prerogatives were narrow. Over the past decade, these characteristics have changed in three important ways. First, training in many of the NPC disciplines has increased substantially, and the growth of these disciplines is accelerating. Second, state laws and regulations have expanded both the practice prerogatives of NPCs and their autonomy from physician supervision. Third, payers have increased their access to reimbursement. As a consequence, NPCs are undertaking many elements of care that previously were provided by physicians. Their participation is generally cost-effective and is met with a high degree of patient satisfaction. This presents both opportunities and challenges to physicians as they forge new relationships with NPCs and as their own spectrum of responsibilities evolves.

Constituents of red yeast rice, a traditional Chinese food and medicine.

Detailed analyses were undertaken of the natural constituents of red yeast rice, a traditional Chinese medicine and food known for centuries to improve blood circulation. Preparation of red yeast rice following ancient methods by fermenting the fungal strain Monascus purpureus Went on moist and sterile rice indicated the presence of a group of metabolites belonging to the monacolin family of polyketides, together with fatty acids, and trace elements. The presence of these compounds may explain in part the cholesterol-lowering ability associated with this traditional Chinese food.

Novel antihyperglycemic terpenoid-quinones from Pycnanthus angolensis.

Two new compounds, pycnanthuquinone A (1) and pycnanthuquinone B (2), were isolated from leaves and stems of the African plant, Pycnanthus angolensis (Welw.) Warb (Myristicaceae), by bioassay-guided fractionation of an ethanolic extract using a diabetic mouse model. Pycnanthuquinones A and B are the first representatives of a novel terpenoid-type quinone skeleton, and both compounds possess significant antihyperglycemic activity.

The effect of atrazine on puberty in male wistar rats: an evaluation in the protocol for the assessment of pubertal development and thyroid function.

Since atrazine (ATR), a chlorotriazine herbicide, has been shown previously to alter the secretion of luteinizing hormone (LH) and prolactin (PRL) through a direct effect on the central nervous system (CNS), we hypothesized that exposure to ATR in the EDSTAC male pubertal protocol (juvenile to peripubertal) would alter the development of the male rat reproductive system. We dosed intact male Wistar rats from postnatal day (PND) 23 to 53 and examined several reproductive endpoints. ATR (0, 12.5, 25, 50, 100, 150, or 200 mg/kg) was administered by gavage and an additional pair-fed group was added to compare the effects of any decreased food consumption in the high dose group. Preputial separation (PPS) was significantly delayed in the 12.5, 50, 100, 150, and 200 mg/kg ATR dose groups. PPS was also delayed in the pair-fed group, although significantly less than in the high dose-ATR group. The males were killed on PND 53 or 54, and pituitary, thyroid, testes, epididymides, seminal vesicles, and ventral and lateral prostates were removed. ATR (50 to 200 mg/kg) treatment resulted in a significant reduction in ventral prostate weights, as did the reduced food consumption of the pair-fed group. Testes weights were unaffected by atrazine treatment. Seminal vesicle and epididymal weights were decreased in the high dose-ATR group and the control pair-fed group. However, the difference in epididymal weights was no longer significantly different when body weight was entered as a covariable. Intratesticular testosterone was significantly decreased in the high dose-ATR group on PND 45, but apparent decreases in serum testosterone were not statistically significantly on PND 53. There was a trend for a decrease in luteinizing hormone (LH) as the dose of ATR increased; however, dose group mean LH was not different from controls. Due to the variability of serum prolactin concentrations on PND 53, no significant difference was identified. Although prolactin is involved in the maintenance of LH receptors prior to puberty, we observed no difference in LH receptor number at PND 45 or 53. Serum estrone and estradiol showed dose-related increases that were significant only in the 200 mg/kg-ATR group. No differences were observed in thyroid stimulating hormone (TSH) and thyroxine (T4) between the ATR groups and the control; however triiodothyronine (T3) was elevated in the high dose-ATR group. No differences in hormone levels were observed in the pair-fed animals. These results indicate that ATR delays puberty in the male rat and its mode of action appears to be altering the secretion of steroids and having subsequent effects on the development of the reproductive tract, which appear to be due to ATR's effects on the CNS. Thus, ATR tested positive in the pubertal male screen that the Endocrine-Disrupter Screening and Testing Advisory Committee (EDSTAC) is considering as an optional screen for endocrine disrupters.