Therapeutic efficacy of 180-W GreenLight laser photoselective vaporization of the prostate for storage symptoms concomitant with benign prostatic obstruction and a search for outcome predictors.

PURPOSE: Benign prostatic obstruction (BPO) is the most common cause of lower urinary tract symptoms among men. GreenLight photoselective vaporization of the prostate (GL-PVP) using a 180-W Xcelerated performance system (XPS) laser is a well-established method for treating BPO-induced voiding symptoms. However, its therapeutic effects on storage symptoms remain unclear. This study aimed to analyze the storage outcomes in patients who underwent 180-W XPS GL-PVP for BPO and to identify outcome predictors. MATERIALS AND METHODS: Patients who underwent 180-W XPS GL-PVP for BPO between May 2018 and May 2021 were retrospectively reviewed. Data on clinical characteristics, prostate volume, preoperative and postoperative International Prostate Symptom Scores (IPSS), and preoperative urodynamic parameters were collected. A favorable storage outcome was defined as ≥50% reduction in the IPSS storage subscore. RESULTS: Ninety-nine male patients were included, with a mean age of 69.4 ± 9.6 years and a baseline prostatic volume of 75.9 ± 33.1 mL. The IPSS total, storage, and voiding subscores significantly decreased after GL-PVP (all p < 0.001). Seventy-two patients achieved favorable storage outcome at 6 months. Multivariate analysis revealed that detrusor underactivity was predictive of unfavorable storage outcomes (p = 0.022), while IPSS voiding-to-storage subscore ratio >1.25 and the presence of detrusor overactivity were predictive of favorable storage outcomes (p = 0.008 and 0.033, respectively). CONCLUSION: 180-W XPS GL-PVP provided excellent outcomes in both voiding and storage lower urinary tract symptoms concomitant with BPO. Preoperative IPSS and multichannel urodynamic parameters including detrusor overactivity and underactivity are valuable predictors of postoperative storage outcomes.

Intravesical Injection of Botulinum Toxin Type A in Patients with Refractory Overactive Bladder-Results between Young and Elderly Populations, and Factors Associated with Unfavorable Outcomes.

Intravesical botulinum toxin type A (BoNT-A) injection has been recognized as the standard treatment for refractory overactive bladder (OAB). However, its therapeutic efficacy and safety have not been thoroughly reviewed in elderly patients. This study aims to provide treatment outcomes for patients aged ≥75 years, and to identify factors associated with unfavorable outcomes. Patients receiving intradetrusor injections of 100 U onabotulinumtoxinA for refractory OAB between 2011 and 2021 were retrospectively reviewed. Urodynamic parameters, underlying comorbidities, subjective success, and unfavorable outcomes were assessed. A total of 192 patients were included, and 65 of them were classified into the elderly group. For the elderly group, 60.0% experienced subjective dryness, and 84.6% remained subjective success at 6 months after the injections. The prevalence rates of common unfavorable outcomes, including urinary tract infections, large post-void residual urine volume, and urinary retention, were 9.2%, 27.7%, and 12.3%, respectively. Multivariate analysis revealed that female, baseline urodynamic parameters, and diabetes mellitus were associated with unfavorable outcomes in the elderly group. Intravesical BoNT-A injections provide comparable therapeutic efficacy and safety concerns in elderly patients with refractory OAB. A thorough consultation for treatment benefits and possible adverse events is mandatory before the procedure.

Applying the Balanced Scorecard to Build Service Performance Measurements of Medical Institutions: An AHP-DEMATEL Approach.

The main purpose of this study is to explore the application of the balanced scorecard (BSC) to service performance measurements of medical institutions using the analytic hierarchy process (AHP) and decision making and trial evaluation laboratory (DEMATEL). According to the concept of BSC, a total of four evaluation dimensions and twenty-two indicators of medical service performance measurements were developed. To collect data, this study delivered expert questionnaires to medical-related professional supervisors, deans, and heads of medical institutions in Taiwan. By combining the AHP and DEMATEL, the priority and causality of service performance standards in medical institutions were obtained. The results of this study show that the customer dimension is the most important service performance measurement dimension for medical institutions. The seven key service performance measurement indicators that are most important for medical institutions, in order, are "complete and comfortable equipment", "competitiveness of the medical profession", "continuity of patient-to-hospital treatment", "classification of medical profession according to customers (VIP system)", "complete medical service", "complete salary, remuneration, and policy", and "medical incomes of institutions". In terms of causality, provided the complete services of medical institutions are improved, the continuity of patient-to-hospital treatment, the competitiveness of the medical profession, and the medical incomes of institutions would be influenced.

Antecedents and Consequences of Green Mindfulness: A Conceptual Model.

While many companies take the environmental environment as a fundamental part of their business strategies, managers are facing the challenges to explore the integration of environmental concepts and business operations. Although there are an amount of studies about environmental management in the literature, only a few of them applied the concept of mindfulness to environmental management. Mindfulness is regarded as a way of operation marked by the willingness to consider alternative perspectives, focus on the present, attention to operational detail, and interest in exploring and understanding failures. This study suggests that companies require keeping mindfulness in environmental management implementation. Therefore, this paper aims to explore the application of mindfulness theory to environmental management, and propose a conceptual model of antecedents and consequences of green mindfulness. The proposed multilevel model describes the influences of organizational and individual antecedents on green mindfulness, and the organizational and individual consequences of green mindfulness.

[The prevalence and signs of Dysphagia among stroke patients in rehabilitation units].

BACKGROUND: Dysphagia, a very common post-stroke symptom, has been linked to aspiration pneumonia, malnutrition, and increased length of hospitalization. While patients are typically monitored for dysphagia continuously following their transfer to a rehabilitation unit, little is known about the results of dysphagia reassessments. PURPOSE: This study investigates the prevalence and signs of dysphagia among stroke patients in rehabilitation units. METHODS: We analyzed patients with stroke admitted to a rehabilitation unit of a medical center in southern Taiwan. The procedure included chart review, the repetitive saliva swallowing test (RSST), and the modified water swallowing test (MWST). Dysphagia was defined as either RSST or MWST abnormal. JMP 9.0 was used to perform descriptive statistics, t-test, chi-square test and logistic regression analysis. RESULTS: At clinical examination, 53.61% of the study subjects demonstrated dysphagia. Chi-square analysis showed that five abnormal signs (could not close mouth with water, without mastication, food stuck in the throat, obvious sputum sound, and choking after swallowing) are all associated with dysphagia. Multiple logistic regression analysis revealed choking is a significant predictor variable of dysphagia. CONCLUSIONS: Over half of the rehabilitation unit stroke patients in this study had dysphagia. Nurses are the primary care providers for dysphagia patients. Therefore, there is a need for ward nurses to have skills to assess, recognize, and manage dysphagia and to enhance patient safety.

The operations of quantum logic gates with pure and mixed initial states.

The implementations of quantum logic gates realized by the rovibrational states of a C(12)O(16) molecule in the X((1)Σ(+)) electronic ground state are investigated. Optimal laser fields are obtained by using the modified multitarget optimal theory (MTOCT) which combines the maxima of the cost functional and the fidelity for state and quantum process. The projection operator technique together with modified MTOCT is used to get optimal laser fields. If initial states of the quantum gate are pure states, states at target time approach well to ideal target states. However, if the initial states are mixed states, the target states do not approach well to ideal ones. The process fidelity is introduced to investigate the reliability of the quantum gate operation driven by the optimal laser field. We found that the quantum gates operate reliably whether the initial states are pure or mixed.

On-line stacking and sweeping capillary electrophoresis for detecting heroin metabolites in human urine.

Heroin metabolites including morphine, codeine, and 6-acetylmorphine were determined by cation-selective exhaustive injection and sweeping micellar electrokinetic chromatography (CSEI-sweep-MEKC). Liquid-liquid extraction was used for urine pretreatment. An uncoated fused silica capillary (Ld=30 cm, 50 microm ID) was filled with phosphate buffer (50 mM, pH 2.5) containing 30% methanol, then high conductivity buffer (100 mM phosphate, 41.3 kPa for 18 s) was followed. Samples were injected electrokinetically (20 kV, 300 s). The sweeping and separation were performed at -25 kV using phosphate buffer (20 mM, pH 2.5) and 80 mM sodium dodecyl sulfate. The baseline separation was done within 10 min. During method validation, the calibration curves were linear over a range of 50-500 ng/mL (r > or = 0.994). The RSD and RE values in intra-day and inter-day assays were all below 20%, which showed good precision and accuracy. Their detection limits were 10 ng/mL (S/N=3). The optimized method was applied to determine real urine samples from addicts. These samples were confirmed by liquid chromatography/mass spectrometry.