Supine percutaneous nephrolithotomy in horseshoe kidney.

Introduction: Historically, percutaneous nephrolithotomy (PCNL) in horseshoe kidney (HSK) patients has been performed in the prone position. Nevertheless, thanks to the spread of the supine PCNL technique for patients with urinary stones and normal renal anatomy, some retrospective studies have already reported on supine PCNL and HSK, showing the effectiveness and safety of the procedure. Herein we report our experience with supine PCNL in a subset of patients with urolithiasis. Material and methods: Prospective data were collected for all HSK patients who underwent supine PCNL at our institution from June 2016 to June 2023. Stone volume was reported as the volume of a single stone or the sum of the volumes of multiple stones on computed tomography (CT) images. Patients were reported to be stone-free if there were no stones on postoperative non-contrast CT (NCCT) exam. Peri-/postoperative complications were reported according to the Clavien-Dindo classification system. The primary endpoint of the study was stone-free rate (SFR) and the secondary endpoints were Clavien-Dindo complications Grade I or higher. Results: A total of 35 patients met the inclusion criteria and were enrolled in the study. Forty-eight procedures were analyzed. SFR was 72.9% at 1-month follow-up. In 11 out of 48 procedures (22.9%) Clavien-Dindo Grade I-II complications were recorded. In one case Clavien-Dindo Grade IIIa complication was observed. Conclusions: In this prospective study of 35 HSK patients who underwent 48 procedures, supine PCNL was safe and effective, with minimal morbidity.

Flexible Ureteroscopic Lithotripsy with the Pulsed Thulium:Yttrium Aluminum Garnet Laser Thulio: Preliminary Results from a Prospective Study.

Background and objective: Recently, the new pulsed thulium:yttrium aluminum garnet (p-Tm:YAG) laser technology has been introduced in endourology for lithotripsy. The aim of this study was to assess and validate the clinical laser performance and safety profile of p-Tm:YAG laser in a series of patients with renal and ureteral stones who underwent flexible ureteroscopy (fURS). Methods: Prospective data were collected for patients who underwent fURS with the p-Tm:YAG laser Thulio (Dornier MedTech Systems GmbH, Wessling, Germany) at our institution by using two different laser fiber core diameters (270 and 200 µm). The primary endpoint of the study was stone-free rate (SFR), and the secondary endpoints were Clavien-Dindo complications grade ≥1 and the comparison between laser fibers of different diameters in all the parameters analyzed. Descriptive statistics relied on medians and interquartile ranges for continuous covariates, and on frequencies and percentages for categorical covariates. After stratification according to fiber types, differences between groups were tested with Wilcoxon and chi-square tests as appropriate. All the analyses and graphics were performed using R software (version 4.2.2). Key findings and limitations: The SFR was 82% at 1-mo follow-up. In six out of 50 procedures (12%), Clavien-Dindo grade I-II complications were recorded. There were no differences regarding all the laser parameters considered between patients who were treated with 270 or 200 µm laser fibers (p > 0.05). Limitations of the study include small sample size in a single center and the lack of comparative groups. Conclusions and clinical implications: In this prospective study of 50 patients who underwent fURS for ureteral and renal stones, the p-Tm:YAG laser Thulio was both effective and safe in a short-term follow-up. More prospective randomized studies in larger populations using different laser sources are required to confirm the clinical laser performance and safety of p-Tm:YAG laser for urinary stones treatment. Patient summary: In this report, we looked at the outcomes for the pulsed thulium:yttrium aluminum garnet laser Dornier Thulio in patients who underwent flexible ureteroscopy for ureteral and renal stones. We found that this new laser technology is effective and safe, representing a good alternative to the other laser machines available for stone lithotripsy. We need more studies with larger populations to establish the superiority of this laser technology over the others.

Clot stones in transplant kidneys.

We describe two cases of stones with unusual radiological characteristics in transplanted kidneys that originated from a blood clot as the nidus for lithogenesis. Both patients presented years after renal transplant, with gross haematuria. CT of the urinary tract showed a stone with a peripheral hyperdense shell (Hounsfield unit, HU >500) and a radiolucent centre (HU <100). Both patients underwent percutaneous nephrolithotomy successfully.Stone analysis showed that the outer shell was calcium oxalate monohydrate and further examination of the stone in the second case confirmed an inner layer of organised clot material. Although the management of these clot stones is similar to that of other types of stones, clinicians should be aware of such a phenomenon and investigate the patients for the possibility of stone formation after haematuria, especially in allograft kidneys.

Promotion of ABCG2 gene expression by neolignans from Piper longum L.

We focused on Piper longum L., a herbal drug produced in Myanmar, which has a renoprotective effect. Thus, we attempted to isolate and identify compounds that enhance the expression of the ABCG2 gene from the aerial parts of the plant except for the fruit. Among the various P. longum extracts, we isolated and identified the components. Using Caco-2 cells, the hABCG2 mRNA expression-enhancing effects of the isolated compounds were compared with the positive reference compound (3-methylcholanthrene [3MC]) using real-time polymerase chain reaction. Six compounds were isolated and identified from the methanol extract of P. longum. Among the isolated compounds, licarin A and neopomatene had lower toxicity and higher hABCG2 mRNA expression-enhancing effects in Caco-2 cells. Suppression of hAhR expression by siRNA reduced the activity of licarin A and neopomatene, as well as the hAhR agonist 3MC, suggesting that these 2 compounds may act as hAhR agonists to promote hABCG2 expression.

Taxonomic study of Palumbina Rondani (Lepidoptera, Gelechiidae, Thiotrichinae) in Japan: biology, immature stages, and a new species.

The genus Palumbina Rondani, 1876 belongs to the family Gelechiidae, which was until recently believed to comprise 26 species worldwide and mainly occurring in the Oriental region. Previously, only P.pylartis (Meyrick, 1908) had been recorded from this genus in Japan. In this study, five other species were identified. Four species were recorded for the first time in Japan, and another was newly described: P.acerosa Lee & Li, 2018; P.grandiunca Lee & Li, 2018; P.macrodelta (Meyrick, 1918), P.operaria (Meyrick, 1918) and P.muraseae Kyaw & Yagi, sp. nov. The host plant and larval feeding habits of P.pylartis, P.acerosa, P.grandiunca, and P.muraseae Kyaw & Yagi, sp. nov. were revealed. The immature stages of P.grandiunca, P.pylartis, and P.muraseae Kyaw & Yagi, sp. nov., including larval and pupal morphology, were first documented for the genus in which the larval chaetotaxy of P.pylartis and P.grandiunca is well observed. In their larval chaetotaxy, the details of their interspecific variation in the relative position and length of some setae are described. The pupal morphology of the species examined in this study is almost identical to the genus Thiotricha except for different traits on the abdominal segments A7 and A10. The traits of larval chaetotaxy and pupal morphology are also discussed for the subfamily. Photographs of the adult, male and female genitalia, and information on their biology and immature stages are provided.

Efficacy of 0.05% cetylpyridinium chloride mouthwash as an adjunct to toothbrushing compared with 0.12% chlorhexidine gluconate mouthwash in reducing dental plaque and gingival inflammation: A randomized control trial.

OBJECTIVES: This study determined the efficacy of alcohol-free 0.05% cetylpyridinium chloride (CPC) mouthwash as an adjunct to twice-daily toothbrushing in comparison with 0.12% chlorhexidine gluconate (CHX) mouthwash and a placebo in reducing plaque accumulation and gingival inflammation. The side effects of the mouthwashes were also determined. MATERIALS AND METHODS: A double-blind, parallel, randomized control trial was conducted with 219 university students who were divided into three trial groups using block randomization: CPC, CHX and placebo groups. Clinical oral examinations to assess dental plaque accumulation (modified Quigley-Hein Plaque Index), gingival health (Löe and Silness Gingival Index) and tooth staining (modified Lobene Stain Index) were performed at baseline and at 6 weeks. RESULTS: Plaque and gingivitis scores were not significantly different among participants at baseline. After 6 weeks, plaque and gingivitis scores between the CPC and placebo groups and between the CHX and placebo groups were found to be significantly different. However, there was no significant difference between the CPC and CHX groups. The staining scores of participants in the CPC group were lower than those in the CHX group, but the difference was not significant. Taste alteration and numbness were more common among participants in the CHX group than in the CPC group. No significant difference in the perception of a burning sensation was observed. CONCLUSIONS: The 0.05% CPC mouthwash was as efficient as 0.12% CHX mouthwash in reducing dental plaque accumulation and gingival inflammation with fewer side effects, supporting its use as an adjunct to toothbrushing.

Physical Performance Tests in Adult Neck Pain Patients with and without Clinical Myelopathic Signs: A Matched Case-Control Study.

Patients with neck pain may experience cervical myelopathy, this may be detected by clinical myelopathic signs, although they did not have any symptom of myelopathy, except having neck pain. Decreasing physical performance is one symptom of cervical myelopathy that can lead to reduced quality of life in the elderly, however, in adult neck pain with clinical myelopathic signs have not been evaluated. Therefore, this research aimed to compare physical performance in two groups of adult patients with neck pain: those with and without clinical myelopathic signs. A total of 52 participants, gender, age, and body mass index (BMI) matched were allocated into 2 groups of 26 subjects with neck pain, those with, and without, clinical myelopathic signs. The grip and release test, nine-hole peg test, ten second step test and foot-tapping test were evaluated. The group of neck pain participants with clinical myelopathic signs exhibited greater impairment in all the tests than the group without clinical myelopathic signs (p < 0.001). Effect sizes (Cohen's d) were grip and release test: 2.031, nine-hole peg test: 1.143, ten second step test: 1.329, and foot-tapping test: 0.798. Neck pain participants with clinical myelopathic signs demonstrated reduced physical performance. Physical performance tests may need to assessed in adult patients with neck pain who had clinical myelopathic signs.

School and community driven dengue vector control and monitoring in Myanmar: Study protocol for a cluster randomized controlled trial.

Background: Dengue is the most common and widespread mosquito-borne arboviral disease globally estimated to cause >390 million infections and >20,000 deaths annually. There are no effective preventive drugs and the newly introduced vaccines are not yet available. Control of dengue transmission still relies primarily on mosquito vector control. Although most vector control methods currently used by national dengue control programs may temporarily reduce mosquito populations, there is little evidence that they affect transmission. There is an urgent need for innovative, participatory, effective, and locally adapted approaches for sustainable vector control and monitoring in which students can be particularly relevant contributors and to demonstrate a clear link between vector reduction and dengue transmission reduction, using tools that are inexpensive and easy to use by local communities in a sustainable manner. Methods: Here we describe a cluster randomized controlled trial to be conducted in 46 school catchment areas in two townships in Yangon, Myanmar. The outcome measures are dengue cases confirmed by rapid diagnostic test in the townships, dengue incidence in schools, entomological indices, knowledge, attitudes and practice, behavior, and engagement. Conclusions: The trial involves middle school students that positions them to become actors in dengue knowledge transfer to their communities and take a leadership role in the delivery of vector control interventions and monitoring methods. Following this rationale, we believe that students can become change agents of decentralized vector surveillance and sustainable disease control in line with recent new paradigms in integrated and participatory vector surveillance and control. This provides an opportunity to operationalize transdisciplinary research towards sustainable health development. Due to the COVID-19 pandemic and political instability in Myanmar the project has been terminated by the donor, but the protocol will be helpful for potential future implementation of the project in Myanmar and/or elsewhere.Registration: This trial was registered in the ISRCTN Registry on 31 May 2022 ( https://doi.org/10.1186/ISRCTN78254298).

Dengue is a mosquito-borne disease, causing millions of infections and thousands of deaths annually. Current control efforts focus on reducing mosquito numbers, but there's little evidence of their impact on disease transmission. New innovative and locally adapted approaches are needed to sustain vector control. We describe a trial protocol for Yangon, Myanmar, involving 46 schools, for reducing the number of dengue cases and mosquitoes in schools and communities though various interventions. Middle school students will play a central role, becoming agents in transferring dengue knowledge to their communities, leading vector control efforts. The idea is that students can drive decentralized vector surveillance, aligning with modern disease control approaches. This initiative offers a chance to integrate diverse research disciplines for sustainable health development. Unfortunately, due to the COVID-19 pandemic and political instability in Myanmar, the project could not be realized. Despite this setback, the outlined protocol remains valuable for potential future implementation in Myanmar or elsewhere, emphasizing the importance of student involvement in community-based disease control efforts.

Anti-hepatitis B activities of Myanmar medicinal plants: a narrative review of current evidence.

Hepatitis B is one of the major burdens for health services and is the leading cause of morbidity and mortality from cirrhosis of liver and hepatocellular carcinoma. Current treatment strategies using nucleos(t)ide analogue reverse-transcriptase inhibitors or interferons are targeted for the long-term suppression of hepatitis B DNA. However, functional cure of hepatitis B infection (HBsAg clearance) was difficult to attain with such treatments. Therefore, new treatment strategies or innovative treatments are urgently needed. The new treatments should focus on the potential therapeutic targets such as covalently closed circular DNA which may be important for the HBsAg clearance. Plant based medicines have been used in different traditional medicine practices and these natural products/compounds serve as a good source of information or clues for use in drug discovery and design. Many natural products were found to be effective against hepatitis B virus and some even have better therapeutic activities than currently used compounds. This review summarizes the current evidence of Myanmar medicinal plants in basic and clinical research which shows promising potential for the development of novel therapeutic agents for the treatment of hepatitis B.

A Taxonomic study of two species of Thiotricha Meyrick (Lepidoptera: Gelechiidae), from southwestern Japan, with notes on the biology of their immature stages.

The taxonomy and biology of the immature stages of two gelechiid species of Thiotricha Meyrick, 1886, found in the southeastern part of the Sino-Japanese region is presented. Thiotricha lumnitzeriella Kyaw, Ueda Hirowatari sp. nov., from islands in southwestern Japan is described. The larva of this species feeds as a portable case maker on Lumnitzera racemosa Willd. (Combretaceae). Thiotricha gemmulans Meyrick, 1931 originally described from India is newly recorded from Japan, mainland China, and Thailand. This species feeds as a portable case maker on Glochidion zeylanicum var. lanceolatum (Hayata) and G. zeylanicum var. zeylanicum (Gaertn.) A. Juss (Phyllanthaceae). Thiotricha acrophantis Meyrick, 1936 is newly synonymized with T. gemmulans. Images of the adults of Thiotricha lumnitzeriella sp. nov. and T. gemmulans including genitalia, and images and illustrations of the larval chaetotaxy and pupa for both species are provided. Larval feeding habits are described in detail.