Predicting stone free rate after retrograde intrarenal surgery using RIRS scoring system versus Resorlu Unsal stone score (RUSS).

Background: To evaluate the predictive ability of the RIRS scoring system and the RUSS in predicting stone-free rate (SFR) after retrograde intrarenal surgery (RIRS). Methods: This prospective study was conducted on patients who underwent RIRS for kidney stones. Two scoring systems were used to determine the degree of procedure difficulty: the RIRS scoring system and the RUSS. We assessed the predictive ability of the two scoring systems utilizing receiver operating characteristic (ROC) analysis and calculated the sensitivity and specificity of each system. Additionally, we analyzed the association between the scoring systems and the stone-free outcome using a multivariate logistic regression model. Results: One hundred seventy-one patients were incorporated into this study with a mean age of 43 years, and 65.5% were male. The results showed a significant AUC of 0.868 for the RIRS score (P < 0.001, 95% CI = 0.813-0.924). The sensitivity and specificity were 72% and 93.7%, respectively. In contrast, the RUSS score revealed a non-significant unsatisfactory AUC of 0.480 (P = 0.660), with a 95% confidence interval ranging from 0.384-0.576. Conclusion: The RIRS scoring system showed a better predictive ability for SFR after RIRS than the RUSS. Additionally, RIRS was a significant predictor of SFR, controlling for age, gender, body mass index, and previous renal surgery.

The Association Between Preoperative Insulin-Like Growth Factor 1 Levels and the Total Body Weight Loss in Women Post Laparoscopic Sleeve Gastrectomy.

BACKGROUND: Despite the well-described optimal initial clinical response of sleeve gastrectomy (SG) in the treatment of obesity, some patients do not achieve optimal initial clinical response. Insulin-like growth factor-1 (IGF-1) has currently shown an association with post-bariatric surgery weight loss. This study aimed to assess the IGF-1 levels in female patients with obesity, the change after surgery, and their association with the metabolic profile and weight loss after surgery. PATIENTS AND METHODS: This was a prospective study that was conducted on adult female patients who were recruited for SG. The patients underwent clinical and laboratory investigations that included the IGF-1 measurement. At the 1-year follow-up, the same clinical and laboratory measures were repeated. RESULTS: This study included 100 female patients. At the 1-year follow-up, there was a statistically significant reduction in body mass index (BMI) (p < 0.001), fasting HbA1C levels (p < 0.001), and triglycerides (p < 0.001), as well as a statistically significant increase in HDL (p < 0.001) and IGF-1 (p < 0.001). Multiple regression analysis revealed that, among the patients baseline characteristics, the significant predictors for the percentage of total weight loss (%TWL) were the patients' BMI (p < 0.001) and IGF-1 levels (p < 0.001). The ROC curve showed that an IGF1 cutoff value of ≤ 23 ng/ml detected suboptimal initial clinical response, with a sensitivity of 95.35% and a specificity of 100%. CONCLUSION: This study underscores the significant impact of SG on weight loss and metabolic improvements in female patients. Baseline IGF-1 levels emerged as a crucial predictor of optimal initial clinical response.

Assessment of depth of penetration and antibiofilm properties of Boswellia sacra compared with calcium hydroxide intracanal medicament (in vitro study).

Successful endodontic treatment requires advanced materials to eliminate biofilm This study aims to assess the penetration depth and the effectiveness of Boswellia sacra as a novel intracanal medicament compared with calcium hydroxide against Enterococcus faecalis biofilm. 60 single-rooted teeth were decoronated, prepared and sterilised. Fifty teeth were contaminated with a culture of E. faecalis (ATCC 19433) for 21 days. Two teeth were used to confirm the biofilm using scanning electron microscope. For colony-forming unit (CFU), 40 samples were divided into one control group (calcium hydroxide) and the other experimental group (B. sacra). Each group was divided into two subgroups to be tested at 3 and 7 days. The minimum inhibitory concentration (MIC) of B. sacra was determined, and the B. sacra's ethanolic extract medicament was prepared. Eight discs divided into groups similar to CFU were used to evaluate live/dead bacteria using confocal laser scanning microscopy (CLSM). Ten teeth were selected for penetration depth using CLSM. The intracanal medicaments were mixed with 0.1% rhodamine B. were inserted into the root canals 0.2 slices were dissected and viewed under CLSM. The MIC of B. sacra was 1.25 mg/ml. The CFU evaluation proved that B. sacra are more effective than calcium hydroxide in the 3 days groups. However, it was statistically insignificant compared with calcium hydroxide after 7 days. The depth of penetration of B. sacra exceeds that of calcium hydroxide. B. sacra is an effective intracanal medicament.

Acute abdomen caused by rupture of a torted intra-abdominal testicular mass: Case report.

INTRODUCTION: Cryptorchidism is defined as the absence of one or both testicles from the scrotum, which is considered one of the most common birth defects of male genitalia. Mostly the undescended testes are in the inguinal region, while the intra-abdominal location accounts for only 10 % of the cases. The potential risk of malignant transformation in an undescended testis is approximately 2.5-8 times higher than in scrotal position. Torsion of the cryptorchid testis is a very rare cause of acute abdominal pain with few cases published in literature. CASE PRESENTATION: A 44-year-old male patient presented to the emergency room with acute abdominal pain. General examination revealed relevant tachycardia. Upon abdominal examination there was tenderness and rebound tenderness all over the abdomen, more evident in the lower abdomen. Interestingly, routine examination of the inguino-scrotal region revealed empty right hemi-scrotum despite the patient not being aware. Routine blood tests showed marked anemia Hb: 7.4 g/dl. Urgent pelvi-abdominal U/S showed moderate free intra-abdominal collection in addition to a pelvic mass. CT of the abdomen showed a well-defined heterogenous hypodense mass measuring about 8.5 × 5.5 cm in the pelvis. Urgent exploratory laparotomy was done, and a mass was found to be torted and ruptured. Excision was done and histo-pathological examination revealed testicular mixed germ cell tumor. CONCLUSION: Undescended testis is associated with an increased risk of infertility, testicular cancer and torsion. In any male with undescended testis and intra-abdominal mass; the risk of intra-abdominal testicular tumor should be considered.

Exposure to ZnO nanoparticles alters neuronal and vascular development in zebrafish: Acute and transgenerational effects mitigated with dissolved organic matter.

Exposure to ZnO-nanoparticles (NPs) in embryonic zebrafish reduces hatching rates which can be mitigated with dissolved organic material (DOM). Although hatching rate can be a reliable indicator of toxicity and DOM mitigation potential, a fish that has been exposed to ZnO-NPs or any other toxicant may also exhibit other abnormal phenotypes not readily detected by the unaided eye. In this study, we moved beyond hatching rate analysis to investigate the consequences of ZnO-NPs exposure on the nervous and vascular systems in developing zebrafish. Zebrafish exposed to ZnO-NPs (1-100 ppm) exhibited an array of cellular phenotypes including: abnormal secondary motoneuron (SMN) axonal projections, abnormal dorsal root ganglion development and abnormal blood vessel development. Dissolved Zn (<10 kDa) exposure also caused abnormal SMN axonal projections, but to a lesser extent than ZnO-NPs. The ZnO-NPs-induced abnormal phenotypes were reversed in embryos concurrently exposed with various types of DOM. In these acute mitigation exposure experiments, humic acid and carbohydrate, along with natural organic matter obtained from the Suwannee River in Georgia and Milwaukee River in Wisconsin, were the best mitigators of ZnO-NPs-induced motoneuron toxicity at 96 h post fertilization. Further experiments were performed to determine if the ZnO-NPs-induced, abnormal axonal phenotypes and the DOM mitigated axonal phenotypes could persist across generations. Abnormal SMN axon phenotypes caused by ZnO-NPs-exposure were detected in F1 and F2 generations. These are fish that have not been directly exposed to ZnO-NPs. Fish mitigated with DOM during the acute exposure (F0 generation) had a reduction in abnormal motoneuron axon errors in larvae of subsequent generations. Therefore, ZnO-NPs exposure results in neurotoxicity in developing zebrafish which can persist from one generation to the next. Mitigation with DOM can reverse the abnormal phenotypes in an acute embryonic exposure context, as well as across generations, resulting in healthy fish.

Zinc oxide nanoparticle toxicity in embryonic zebrafish: Mitigation with different natural organic matter.

Exposure experiments were conducted to evaluate the influence of dissolved organic matter (DOM) on the toxicity of ZnO-NPs (10-30 nm) and dissolved Zn at sub-lethal doses (50 and 5 ppm, respectively) to zebrafish (Danio rerio). Humic acid, alginic acid, bovine serum albumin and various natural DOM isolated from rivers as the Milwaukee River-WI (NOMW), Yukon River-AK (NOMA) and Suwannee River-GA DOM (NOMS) were used to represent humic substances (HA), carbohydrates (CHO), proteins (PTN), and natural organic matter (NOM), respectively. Initial experiments were carried out to confirm the toxic effect of ZnO-NPs at 50 ppm, followed by mitigation experiments with different types and concentrations of DOM (0.4-40 mg-C/L). Compared to 0% hatch of 50 ppm ZnO-NPs exposed embryos at 72 h post fertilization (hpf), NOMS, NOMW and HA had the best mitigative effects on hatching (53-65%), followed by NOMA, CHO and PTN (19-35%); demonstrating that the mitigation effects on ZnO-NPs toxicity were related to DOM's quantity and composition. At 96 hpf, 20% of embryos exposed to 50 ppm ZnO-NPs hatched, 100% of embryos reared in embryo medium hatched, and close to 100% of the embryos hatched upon mitigation, except for those mitigated with PTN which had less effect. Dissolved Zn (5 ppm) also exhibited the same toxicity on embryos as ZnO-NPs (50 ppm). However, in the presence of HA, NOM and CHO, the hatching rates at 72 and 96 hpf increased significantly compared to 5% hatch without DOM. The overall mitigation effects produced by DOM followed the order of HA ≥ NOMS > NOM (A&W) > CHO >> PTN, although specific mitigation effects varied with DOM concentration and functionalities. Our results also indicate that the toxicity of ZnO-NPs to embryos was mostly derived from NPs although dissolved Zn released from ZnO-NPs also interacted with embryos, affecting hatching, but to a less extent.

Evaluation of Root and Canal Morphology of Maxillary Permanent Molars in an Egyptian Population by Cone-beam Computed Tomography.

INTRODUCTION: The purpose of this study was to evaluate the number of roots and canal morphology of maxillary permanent molars in an Egyptian population. METHODS: Six hundred fifty-seven cases were included in this study. Digitized images from cone-beam computed tomographic scanning were assessed by 2 endodontists. The number of roots and canal configuration according to Vertucci were tabulated. Age, sex, and bilateral distribution differences were calculated. RESULTS: All maxillary first molars showed 3-root configuration, whereas maxillary second molars showed 3-, 2-, and single-root configurations. For maxillary first molars, the most common Vertucci classifications for the mesiobuccal root were type II (2-1, 45.6%), type IV (2-2, 27.27%), and type I (1, 25.45%). For maxillary second molars, the most common Vertucci classifications for the mesiobuccal root were type II (2-1, 47.1%), type I (1, 42.06%), and type IV (2-2, 8.03%). The prevalence of a second mesiobuccal canal is statistically not affected by either sex, tooth position (right or left side), or age. CONCLUSIONS: Under the conditions of this study, the root canal configurations of an Egyptian population showed that the most common Vertucci classifications for the mesiobuccal root for maxillary first molars were type II (2-1), type IV (2-2), and type I (1). For maxillary second molars, the most common types were type II (2-1), type I (1), and type IV (2-2). Pre-evaluation of the endodontic case using cone-beam computed tomographic digital imaging provides better information of root canal morphology, which might improve the management and prognosis of the case.