Post Prostatectomy Vesicourethral Stenosis or Bladder Neck Contracture with Concomitant Urinary Incontinence: Our Experience and Recommendations.

OBJECTIVES: To present our experience in the management of bladder neck contracture with concomitant post prostatectomy incontinence and to provide our recommendations based on the updated literature. MATERIALS AND METHODS: Between Jan 2010 and June 2015, 37 patients from our cohort of 341 patients with post prostatectomy incontinence were evaluated. Patient data were retrospectively collected. Patients with bladder neck contracture confirmed on flexible cystoscopy underwent subsequent rigid cystoscopy and deep endoscopic bladder neck incision (BNI). A follow up flexible cystoscopy would be performed 3 months later. If there was no recurrence of the bladder neck contracture, an artificial urethral sphincter (AUS) or a male sling was recommended. RESULTS: The mean age of patients was 68 years (range 59-77) and the mean BMI was 31 (range 21-41) kg/m2. Twenty-five (67.7%) patients had open prostatectomy and 12 (32.4%) patients had laparoscopic prostatectomy. Fourteen patients (37.8%) underwent adjuvant radiotherapy. Twenty-four (64.8%) patients had one BNI procedure, 8 (21.6%) patients had two procedures and 5 (13.5%) patients had more than 2 procedures. Twenty-one (91.3%) patients had AUS implantation and 2 (8.7%) patients had male sling placement. Besides, 85.7% of AUS and 50% of male sling patients managed to achieve successful outcomes with a mean follow up period of 13.1 months (range 2-33 months). CONCLUSION: Initial management with aggressive BNI followed by implantation of an AUS or male sling when bladder neck is stable is essential to achieve a satisfactory urinary continence outcome.

Digital redesign of observer-based weighting switch controller for cascaded analog systems with state saturation and external loads.

This paper presents an observer-based weighting switch controller for dealing with the problem of cascaded systems with state saturation and external loads. This method improves the generally poor transition response and output deviation caused by state saturation and external loads. In order to maintain the state-saturation limits, we adopt the evolutionary programming optimal search technique to find the optimal switching parameters for the weighted switch controller. Also, a digital redesign method is utilized to replace a designed high-gain analog controller with a low-gain digital controller. It is shown that the digitally redesigned outputs closely track the analogously controlled outputs. The digital redesign technique is then extended to find the digital version of the continuous-time observer. An illustrative example is demonstrated to show the effectiveness of the proposed procedure.

High-resolution proton nuclear magnetic resonance studies of urine from asphyxiated newborn infants.

High-resolution proton nuclear magnetic resonance spectroscopy was used to study human urine obtained from 10 normal babies and twenty babies with various degrees of neonatal asphyxia, respiratory distress syndrome (RDS), and meconium aspiration syndrome (MAS). All sick babies showed different degrees of oxygen deficiency, indicated by an obvious increase of the lactate signal level in the urine spectra. Changes in the concentration of other urinary metabolites produced from the citric acid cycle were also observed. In extremely serious cases, the signals of some of the major components, including citrate, alpha-ketoglutarate, and succinate, simply disappeared. The spectra of urine, serum, and CSF of an infant suffering from SIDS showed common characteristics of the metabolites.

Digital redesign of anti-wind-up controller for cascaded analog system.

The cascaded conventional anti-wind-up (CAW) design method for integral controller is discussed. Then, the prediction-based digital redesign methodology is utilized to find the new pulse amplitude modulated (PAM) digital controller for effective digital control of the analog plant with input saturation constraint. The desired digital controller is determined from existing or pre-designed CAW analog controller. The proposed method provides a novel methodology for indirect digital design of a continuous-time unity output-feedback system with a cascaded analog controller as in the case of PID controllers for industrial control processes with the presence of actuator saturations. It enables us to implement an existing or pre-designed cascaded CAW analog controller via a digital controller effectively.

Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016

OBJECTIVE: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". DESIGN: A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy wasdeveloped at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroupsand among the entire committee served as an integral part of the development. METHODS: The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable. RESULTS: The Surviving Sepsis Guideline panel provided 93 statements on early management and resuscitation of patients with sepsis or septic shock. Overall, 32 were strong recommendations, 39 were weak recommendations, and 18 were best-practice statements. No recommendation was provided for four questions. CONCLUSIONS: Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.(AU)

Increased production and excretion of urea in the kuruma shrimp (Marsupenaeus japonicus) exposed to combined environments of increased ammonia and nitrite.

Marsupenaeus japonicus (6.37 +/- 1.29 g) individually exposed to 9 different combined solutions of ambient ammonia (C) and nitrite (C') ammonia at 0.003 [control], 0.39, and 1.49 mmol/L combined with nitrite at 0.001 [control], 0.38, and 1.49 mmol/L in 30 ppt were examined for nitrogenous excretion accumulations of ammonia, nitrite, urea, and uric acid in tissues after 48 hours. M. japonicus exposed to 0.39 mmol/L ammonia-0.38 mmol/L nitrite displayed higher levels of urea-nitrogen (UNE) and organic-N (ONE) excretion by a factor of 2.2 and 5.7, respectively, compared with shrimp exposed only to 0.39 mmol/L ammonia. Exposure to 0.39 mmol/L ammonia-0.38 mmol/L nitrite resulted in lower levels of hemolymph uric acid (HUA), gill ammonia (GAM), gill urea (GUE), gill uric acid (GUA), hepatopancreas ammonia (HPAM), hepatopancreas urea (HPUE), and hepatopancreas uric acid (APUA), respectively, compared with shrimp exposed only to 0.39 mmol/L ammonia. We concluded that M. japonicus exposed to combined environments of ammonia and nitrite display increased nitrogen metabolism and production of urea-N and other organic-N.

Erosion of a new family of biodegradable polyanhydrides.

Studies investigating the erosion mechanism of the newly developed poly (fatty acid dimer: sebacic acid) polyanhydride (p:[FAD:SA]) are described. The overall erosion of different monomer compositions of p(FAD:SA) copolymers was examined to determine whether and to what extent copolymer properties affected polymer erosion. Increasing the hydrophobic monomer (FAD) content up to 50 wt% in the copolymer resulted in longer erosion, whereas further increases up to 70 wt% decreased the erosion period. Polymer crystallinity depended on copolymer FAD content. Copolymer degradation was studied by examining anhydride bond hydrolysis using infrared spectroscopy. Much faster hydrolysis was found in p(FAD:SA) 70:30 compared with more crystalline copolymers of higher SA content. Light microscopy indicates the presence of an erosion zone, a distinct area where mass loss occurs. This erosion zone moves from the outside toward the interior of the polymer matrix. It plays an important role in erosion because any water or monomer must diffuse through this eroded layer.