[The role of the microbiome in urology]. / Die Rolle des Mikrobioms in der Urologie.

With the advent of novel high throughput-sequencing technologies we gained greater insights into the complex and diverse interactions of the microbiome for health and disease in the human body. The concept of urinary sterility has long been dismissed and now we strive for deciphering various microbial signatures associated with a disease. A dysbalance of the microbiome appears to have a substantial impact on the pathogenesis of both malignant and benign conditions. Novel preventive and therapeutic approaches and biomarker systems have been proposed for prostate cancer, renal cell carcinoma and bladder cancer based on microbiome analyses. The exclusion of a microbial origin was always part of the diagnosis of benign disorders such as interstitial cystitis, urinary urge incontinence or chronic prostatitis/chronic pelvic pain syndrome. Now we are certain that an imbalanced microbial profile plays an essential role for the pathogenesis and disease management of these challenging conditions.

[CEUS-Use in testicular pathologies]. / CEUS ­ Anwendung am Hoden.

BACKGROUND: The work-up of scrotal diseases forms an essential part of daily work in urology. Sonography plays an important role in the diagnostic process, due to its wide availability and feasibility. OBJECTIVES: Advantages of modern contrast-enhanced ultrasound (CEUS) are illustrated using examples of common testicular pathologies. MATERIALS AND METHODS: Relevant studies regarding the application of CEUS on testicular pathologies are evaluated. PubMed and Medline were screened for reviews and clinical trials. RESULTS: In the differentiation of benign and malignant testicular lesions, contrast medium uptake, e. g. can exclude a hemorrhagic testicular cyst. A differentiation between benign and malignant testicular lesions due to pure enhancement is currently not possible. Evaluation of testicular abscesses, infarctions and infections depends on the assessment of vascularization. Following a scrotal trauma, evaluation of enhancement can distinguish between vital and non-vital areas. A complete absence of perfusion may support the diagnosis of testicular torsion. CONCLUSION: CEUS is a feasible instrument in the diagnostic work-up of testicular pathologies. Results from previous studies are promising. Regarding the application in cases of scrotal trauma, the method could play an essential role in the future. With regard to a classification of unclear testicular lesions, further studies with a larger number of patients are needed in order to confirm previously described perfusion patterns.

[Urinary tract infections : What has been confirmed in therapy?] / Harnwegsinfektionen : Was ist gesichert in der Therapie?

Urinary tract infections (UTIs) affect approximately 150 million people worldwide per year, causing annual health costs of over three billion dollars just in the USA. Every second woman experiences at least one UTI in her lifetime, with every one in four experiencing recurrence. Uncomplicated infections like single or recurrent cystitis and pyelonephritis can be distinguished from complicated disease. UTIs in men can spread to the male glands, causing prostatitis and epididymitis. Antibiotic therapy is the standard procedure for UTIs. However, the extensive and sometimes irrational use of antibiotics for the treatment of infections has led to an increase in the incidence of multiresistant pathogens in recent years. Therefore, preventive nonantibiotic approaches are of great interest. This article provides an overview of the current management of urological infections as well as an outline of nonantibiotic preventive treatment modalities.

Ecophysiological interactions and water-related physicochemical parameters among freshwater stingrays

Abstract The objective of this study was to compare and correlate the ecology of neonates and young individuals of Potamotrygon wallacei, Potamotrygon motoro and Paratrygon aiereba with regard to their hematological profile and the physicochemical parameters of the water that they inhabit. Principal component analysis (PCA) on the complete blood count revealed total variation of 72.92%, thus demonstrating a differentiation system for oxygen demand. On the other hand, P. motoro was considered to be an intermediate species, given that its complete blood count characteristics interacted with both P. wallacei and with P. aiereba. The interaction among the biochemical variables was shown to total 64.67% of the factors. This allowed differentiation of P. wallacei from P. aiereba, while P. motoro maintained an intermediate position. These characteristics of differentiation within the preferred environment corroborate the PCA of the present study and confirm that these species can be differentiated through considering the complete blood count and biochemical parameters. The PCA on water properties showed 68.57% differentiation, mainly comprising the x axis (49.44%). It can be affirmed that P. motoro has the capacity to inhabit the preferential areas of P. wallacei and P. aiereba, as well as occupying localities in which other stingrays are not found. In conclusion, P. wallacei presents patterns differentiating it from P. aiereba, while P. motoro is a species that presents intermediate characteristics. The latter can be considered to be a more broadly distributed species regarding its ecophysiological characteristics.

Resumo Este trabalho tem por objetivo investigar o perfil hematológico e os parâmetros físico-químicos da água, comparando e correlacionando ecologicamente entre neonatos e jovens de Potamotrygon wallacei (arraia cururu), Potamotrygon motoro e Paratrygon aiereba. A análise de componentes principais (PCA) do hemograma revelou um total 72,92% de variação, constituindo-se em um sistema de diferenciação na demanda por oxigênio. P. wallacei apresenta diferenciação no eixo X quando comparada a P. aiereba, por outro lado P. motoro constitui-se como uma espécie intermediária que apresenta as características do hemograma interagindo tanto com P. wallacei quanto com P. aiereba. A interação entre as variáveis bioquímica demonstram um total de 64,67% dos fatores, no qual foi possível diferenciar, a arraia P. wallacei de P. aiereba, tendo P. motoro uma aspecto de espécie intermediária entre as demais. Esses aspectos de diferenciação de ambiente de preferência corroboraram a PCA obtida no presente estudo e confirmam que essas espécies podem ser diferenciadas quando se considerar as variáveis referentes ao hemograma e a bioquímica. Nos íons, no trombograma e no leucograma, não foi possível diferenciar as espécies. O PCA das propriedades da água foi constituído por 68,57% de diferenciação que se constituiu principalmente no eixo x (49,44%). É possível confirmar que P. motoro tem a capacidade de habitar as áreas preferências de P. wallacei e P. aiereba, além do mais esta possui uma localidade que as demais arraias não são encontradas. Conclui-se que P. wallacei, apresenta padrões diferenciados de P. aiereba, além do mais P. motoro é uma espécie que apresenta características intermediárias entre as descritas, o qual pode ser considerado uma espécie com distribuição mais ampla em seus aspectos ecofisiológicos.

Ecophysiological interactions and water-related physicochemical parameters among freshwater stingrays / Interações ecofisiológicas e dos parâmetros físico-químico da água em arraias de água doce

Abstract The objective of this study was to compare and correlate the ecology of neonates and young individuals of Potamotrygon wallacei, Potamotrygon motoro and Paratrygon aiereba with regard to their hematological profile and the physicochemical parameters of the water that they inhabit. Principal component analysis (PCA) on the complete blood count revealed total variation of 72.92%, thus demonstrating a differentiation system for oxygen demand. On the other hand, P. motoro was considered to be an intermediate species, given that its complete blood count characteristics interacted with both P. wallacei and with P. aiereba. The interaction among the biochemical variables was shown to total 64.67% of the factors. This allowed differentiation of P. wallacei from P. aiereba, while P. motoro maintained an intermediate position. These characteristics of differentiation within the preferred environment corroborate the PCA of the present study and confirm that these species can be differentiated through considering the complete blood count and biochemical parameters. The PCA on water properties showed 68.57% differentiation, mainly comprising the x axis (49.44%). It can be affirmed that P. motoro has the capacity to inhabit the preferential areas of P. wallacei and P. aiereba, as well as occupying localities in which other stingrays are not found. In conclusion, P. wallacei presents patterns differentiating it from P. aiereba, while P. motoro is a species that presents intermediate characteristics. The latter can be considered to be a more broadly distributed species regarding its ecophysiological characteristics.

Resumo Este trabalho tem por objetivo investigar o perfil hematológico e os parâmetros físico-químicos da água, comparando e correlacionando ecologicamente entre neonatos e jovens de Potamotrygon wallacei (arraia cururu), Potamotrygon motoro e Paratrygon aiereba. A análise de componentes principais (PCA) do hemograma revelou um total 72,92% de variação, constituindo-se em um sistema de diferenciação na demanda por oxigênio. P. wallacei apresenta diferenciação no eixo X quando comparada a P. aiereba, por outro lado P. motoro constitui-se como uma espécie intermediária que apresenta as características do hemograma interagindo tanto com P. wallacei quanto com P. aiereba. A interação entre as variáveis bioquímica demonstram um total de 64,67% dos fatores, no qual foi possível diferenciar, a arraia P. wallacei de P. aiereba, tendo P. motoro uma aspecto de espécie intermediária entre as demais. Esses aspectos de diferenciação de ambiente de preferência corroboraram a PCA obtida no presente estudo e confirmam que essas espécies podem ser diferenciadas quando se considerar as variáveis referentes ao hemograma e a bioquímica. Nos íons, no trombograma e no leucograma, não foi possível diferenciar as espécies. O PCA das propriedades da água foi constituído por 68,57% de diferenciação que se constituiu principalmente no eixo x (49,44%). É possível confirmar que P. motoro tem a capacidade de habitar as áreas preferências de P. wallacei e P. aiereba, além do mais esta possui uma localidade que as demais arraias não são encontradas. Conclui-se que P. wallacei, apresenta padrões diferenciados de P. aiereba, além do mais P. motoro é uma espécie que apresenta características intermediárias entre as descritas, o qual pode ser considerado uma espécie com distribuição mais ampla em seus aspectos ecofisiológicos.

Cyrilia sp. (Apicomplexa: Haemogregarinidae) in the Amazonian freshwater stingray Potamotrygon wallacei (cururu stingray) in different hydrological phases of the Rio Negro / Cyrilia sp. (Apicomplexa: Haemogregarinidae) na arraia de água doce Amazônica Potamotrygon wallacei (arraia cururu) em diferentes fases do ciclo hidrológico do Rio Negro

Abstract Intraerythrocytic parasites are frequently found in fish, including elasmobranchs. The Amazonian rivers present well defined annual hydrological cycles that results in drastic modifications of the environmental conditions with deep implications in the life cycle of the whole associated biota in those fluvial systems. The freshwater stingray Potamotrygon wallacei (stingray cururu) is a new species restricted to the Middle Rio Negro basin and it is subject to strong alterations in their natural habitats (igapós) a result of the constant variations in the water level of Rio Negro. This work demonstrates the occurrence of intraerythrocytic parasite Cyrilia sp. in this stingray species. Additionally, the prevalence and quantification of hemoparasites in different phases of Rio Negro were also established. Field sampling was carried in the Archipelago of Mariuá, Middle Rio Negro, involving different stages of the water cycle. The intraerythrocytic parasites were quantified by direct counting in blood smears using a total counting of 2000 erythrocytes in each blood smear. The presence of parasites intraerythrocytic generates changes in the morphology of blood cell. The largest amount of the hemoparasites was recorded in the drought period. We observed a decreasing tendency in the number of parasites in the blood between the drought periods and inundation. We concluded that the level of Negro River influences the incidence of intraerythrocytic parasites in the cururu stingray and the drought represents the period of larger susceptibility to the infestation.

Resumo Parasitas intraeritrocitários são frequentemente encontrados em peixes, incluindo elasmobrânquios. Os rios Amazônicos possuem ciclos hidrológicos anuais que resultam em modificações drásticas nas condições ambientais, com implicação profunda no ciclo de vida associada a biota dos sistemas fluviais. A arraia de água doce Potamotrygon wallacei (arraia cururu) é uma nova espécie restrita a bacia do médio Rio Negro e sujeita a fortes alterações em seus habitats naturais (igapós) resultantes das constantes variações do nível de água do Rio Negro. Este trabalho demonstra a ocorrência de parasita intraeritrocitário Cyrilia sp. em espécimes de arraias de água doce. Além disso, a prevalência e quantificação de hemoparasitas em diferentes fases do Rio Negro foi estabelecida. Coletas de campo foram realizadas no Arquipélago de Mariuá, médio Rio Negro, envolvendo diferentes fases do ciclo hidrológico. Os parasitas intraeritrocitários foram quantificados por contagem direta em esfregaços de sangue usando a contagem total de 2000 eritrócitos em cada esfregaço sanguíneo. A presença de parasitas intraeritrocitários gera alterações na morfologia da célula sanguínea. A maior quantidade dos hemoparasitas foi registrado no período de seca. Observou-se a tendência de diminuição no número de parasitas no sangue entre o período de seca e de cheia. Concluiu-se que o nível de Rio Negro influencia a incidência de parasitas intraeritrocitários na arraia cururu, e a seca representa o período de maior susceptibilidade à infestação.

[Pathogenesis of urinary tract infections : An update]. / Pathogenese der Harnwegsinfektion : Ein Update.

Urinary tract infections are among the most common bacterial infections worldwide. The management has become a public health concern of socioeconomic importance. Every second woman will experience at least one episode in her lifetime. Due to the emergence of multiresistant pathogens and the developmental void, treatment has become more challenging over the years. Deciphering the complex molecular interaction between host and pathogen is necessary to identify potent treatment targets for future approaches. The objective of this review is to present novel aspects on the pathogenesis of urinary tract infections and its relevance for clinical practice.

Cyrilia sp. (Apicomplexa: Haemogregarinidae) in the Amazonian freshwater stingray Potamotrygon wallacei (cururu stingray) in different hydrological phases of the Rio Negro.

Intraerythrocytic parasites are frequently found in fish, including elasmobranchs. The Amazonian rivers present well defined annual hydrological cycles that results in drastic modifications of the environmental conditions with deep implications in the life cycle of the whole associated biota in those fluvial systems. The freshwater stingray Potamotrygon wallacei (stingray cururu) is a new species restricted to the Middle Rio Negro basin and it is subject to strong alterations in their natural habitats (igapós) a result of the constant variations in the water level of Rio Negro. This work demonstrates the occurrence of intraerythrocytic parasite Cyrilia sp. in this stingray species. Additionally, the prevalence and quantification of hemoparasites in different phases of Rio Negro were also established. Field sampling was carried in the Archipelago of Mariuá, Middle Rio Negro, involving different stages of the water cycle. The intraerythrocytic parasites were quantified by direct counting in blood smears using a total counting of 2000 erythrocytes in each blood smear. The presence of parasites intraerythrocytic generates changes in the morphology of blood cell. The largest amount of the hemoparasites was recorded in the drought period. We observed a decreasing tendency in the number of parasites in the blood between the drought periods and inundation. We concluded that the level of Negro River influences the incidence of intraerythrocytic parasites in the cururu stingray and the drought represents the period of larger susceptibility to the infestation.

Ecophysiological interactions and water-related physicochemical parameters among freshwater stingrays.

The objective of this study was to compare and correlate the ecology of neonates and young individuals of Potamotrygon wallacei, Potamotrygon motoro and Paratrygon aiereba with regard to their hematological profile and the physicochemical parameters of the water that they inhabit. Principal component analysis (PCA) on the complete blood count revealed total variation of 72.92%, thus demonstrating a differentiation system for oxygen demand. On the other hand, P. motoro was considered to be an intermediate species, given that its complete blood count characteristics interacted with both P. wallacei and with P. aiereba. The interaction among the biochemical variables was shown to total 64.67% of the factors. This allowed differentiation of P. wallacei from P. aiereba, while P. motoro maintained an intermediate position. These characteristics of differentiation within the preferred environment corroborate the PCA of the present study and confirm that these species can be differentiated through considering the complete blood count and biochemical parameters. The PCA on water properties showed 68.57% differentiation, mainly comprising the x axis (49.44%). It can be affirmed that P. motoro has the capacity to inhabit the preferential areas of P. wallacei and P. aiereba, as well as occupying localities in which other stingrays are not found. In conclusion, P. wallacei presents patterns differentiating it from P. aiereba, while P. motoro is a species that presents intermediate characteristics. The latter can be considered to be a more broadly distributed species regarding its ecophysiological characteristics.

Shear wave elastography of the testes in a healthy study collective - Differences in standard values between ARFI and VTIQ techniques.

INTRODUCTION: Shear wave elastography (SWE) is a recent technique in the assessment of tissue elasticity. Different elastography techniques have been described over the years.Acoustic Radiation Force Impulse Imaging (ARFI) uses mechanical excitation of tissue to create detectable shear waves, a higher shear wave velocity being associated with an increased tissue stiffness.The Virtual Touch Tissue Imaging Quantification (VTIQ) method uses a mechanical push pulse as well, additionally creating a colour-coded map, in which tissue stiffness can be measured within a stored map on the ultrasound device after measurement.ARFI has been used in determining standard values in testes of a healthy study collective, VTIQ has already been used in the evaluation of unclear scrotal masses.Both techniques allow an operator-independent examination without application of mechanical pressure. The aim of this study was to determine whether there is a statistically significant difference between shear wave velocity values of both techniques in a healthy collective. MATERIAL AND METHODS: Twenty patients without known testicular pathology underwent standard B-mode sonography and additional shear wave elastography in the ARFI mode as well as the VTIQ technique of both testes using the Siemens Acuson S2000™ and S3000™ ultrasound devices (Siemens HealthCare, Erlangen, Germany).Measurements of shear wave velocity were performed in the upper pole, the central portion and the lower pole separately for each testis. Values were described in m/s.Statistical evaluation was performed using paired t-test analysis. RESULTS: We measured a mean shear wave velocity of 0.81 m/s using ARFI and 1.07 m/s with VTIQ.Shear wave velocities determined by VTIQ were all significantly higher than values gained in the ARFI mode. (p < 0.001 to p = 0.007). Values were between 0.22 and 0.29 m/s higher, when the examination was performed using VTIQ. CONCLUSION: ARFI and VTIQ elastography modes both proved to be feasible techniques in the assessment of testicular tissue elasticity. Consideration of higher values for VTIQ is important, when different elastography measurement results are compared, especially for the application of devices in a clinical setting, e.g. in the work-up of scrotal masses.A calculable factor for a comparison between both devices is desirable, but to be further assessed in largerstudies.

Three-dimensional vs. two-dimensional shear-wave elastography of the testes - preliminary study on a healthy collective.

INTRODUCTION: Shear wave elastography (SWE) and its derivative Supersonic Shear Imaging (SSI) are newer techniques for the determination of tissue elasticity by measuring the velocity of generated shear waves (SWV), which correlates positively with tissue stiffness.The techniques are integrated into many modern ultrasound systems and have been examined in the evaluation of viscoelastic properties of different organ systems. Two-dimensional shear wave elastography (2D SWE) of the testes has been found to be a useful tool in recent studies which included the determination of standard values in healthy volunteers. Three-dimensional shear wave elastography (3D SWE) is the latest development in elastography and is made possible by generation of a multiplanar three-dimensional map via volumetric acquisition with a special ultrasound transducer. This technique allows the assessment of tissue elasticity in a three-dimensional, fully accessible organ map.The aim of this preliminary study was to both evaluate the feasibility of 3D SWE and to compare 2D and 3D SWE standard values in the testes of healthy subjects. MATERIAL AND METHODS: We examined the testes of healthy male volunteers (n = 32) with a mean age of 51.06±17.75 years (range 25-77 years) by B-mode ultrasound, 2D and 3D SWE techniques in September of 2016. Volunteers with a history of testicular pathologies were excluded. For all imaging procedures the SL15-4 linear transducer (bandwidth 4-15 MHz) as well as the SLV16-4 volumetric probe (bandwidth 4-16 MHz) of the Aixplorer® ultrasound device (SuperSonic Imagine, Aix-en-Provence, France) were used. Seven regions of interest (ROI, Q-Box®) within the testes were evaluated for SWV using both procedures. SWV values were described in m/s. Results were statistically evaluated using univariateanalysis. RESULTS: Mean SWV values were 1.05 m/s for the 2D SWE and 1.12 m/s for the 3D SWE.Comparisons of local areas delivered no statistically significant differences (p = 0.11 to p = 0.66), except for the region in the central portion in the superior part of the coronal plane (p = 0.03). Testicular volume was significanty higher by a mean of 1.72 ml when measured with 3D SWE (p = 0.001). CONCLUSION: 3D SWE proved to be a feasible diagnostic tool in the assessment of testicular tissue, providing the examiner with a fully accessible three-dimensional map in a multiplanar or multislice view. With this technique a more precise testicular imaging - especially if combined with the display of tissue stiffness in SWE - is available and therefore could improve the diagnostic work-up of scrotal masses or the routine investigation of infertile men. Further studies for a better understanding in the context of various testicular pathologies will be required.

MRI and contrast enhanced ultrasound (CEUS) image fusion of renal lesions.

Ultrasound is a common and established imaging method for the initial characterization of renal lesions. The widespread used Bosniak classification (I-IV) classifies renal lesions in five individual groups using contrast-enhanced computer tomography (CE-CT), magnetic resonance imaging (MRI) and/or contrast-enhanced ultrasound (CEUS) imaging criteria. For complex pathologies, CEUS/MRI image fusion is a novel imaging technique for the differentiation of benign and malignant renal lesions. Compared to CE-CT and MRI alone, ultrasound image fusion offers the additional possibility of being a real-time imaging technique that can be used together with other cross-sectional imaging techniques.This article describes the newest possibilities of image fusion with CEUS and MRI in detection and characterization of unclear renal lesions.

Differences of standard values of Supersonic shear imaging and ARFI technique - in vivo study of testicular tissue.

PURPOSE: To investigate the difference of standard values of Supersonic shear imaging (SSI) and Acoustic Radiation Force Impulse (ARFI) technique in the evaluation of testicular tissue stiffness in vivo. MATERIALS AND METHODS: 58 healthy male testes were examined using B-mode sonography and ARFI and SSI. B-mode sonography was performed in order to scan the testis for pathologies followed by performance of real-time elastography in three predefined areas (upper pole, central portion and lower pole) using the SuperSonic® Aixplorer ultrasound device (SuperSonic Imagine, Aix-en-Provence, France). Afterwards a second assessment of the same testicular regions by elastography followed using the ARFI technique of the Siemens Acuson 2000™ ultrasound device (Siemens Health Care, Germany). Values of shear wave velocity were described in m/s. Parameters of elastography techniques were compared using paired sample t-test. RESULTS: The values of SSI were all significantly higher in all measured areas compared to ARFI (p < 0.001 to p = 0.015). Quantitatively there was a higher mean SSI wave velocity value of 1,1 compared to 0.8 m/s measured by ARFI. CONCLUSION: SSI values are significantly higher than ARFI values when measuring the stiffness of testicular tissue and should only be compared with caution.

Comparison of magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS) in the evaluation of unclear solid renal lesions.

PURPOSE: To compare the sensitivity and specificity of contrast-enhanced ultrasound (CEUS) and magnetic resonance imaging (MRI) in the evaluation of unclear renal lesions to the histopathological outcome. MATERIALS AND METHODS: A total of 36 patients with a single unclear solid renal lesion with initial imaging studies between 2005 and 2015 were included. CEUS and MRI were used for determining malignancy or benignancy and initial findings were correlated with the histopathological outcome. Out of the 36 renal masses a total of 28 lesions were malignant (77.8%) and 8 were found to be benign (22.2%). Diagnostic accuracy was testes by using the histopathological diagnosis as the gold standard. RESULTS: CEUS showed a sensitivity of 96.4%, a specificity of 100.0%, a positive predictive value (PPV) of 100.0% and a negative predictive value (NPV) of 88,9%. MRI showed a sensitivity of 96.4%, a specificity of 75.0%, a PPV of 93.1% and a NPV of 85.7%. Out of the 28 malignant lesions a total of 18 clear cell renal carcinomas, 6 papillary renal cell carcinomas and 4 other malignant lesions, e.g. metastases, were diagnosed. Out of the 8 benign lesions a total 3 angiomyolipomas, 2 oncocytomas, 1 benign renal cyst and 2 other benign lesions, e.g. renal adenomas were diagnosed. Using CEUS, 1 lesion was falsely identified as benign. Using MRI, 2 lesions were falsely identified as benign and 1 lesion was falsely identified as malignant. CONCLUSION: CEUS is an useful method which can be additionally used to clinically differentiate between malignant and benign renal lesions. CEUS shows a comparable sensitivity, specificity, PPV and NPV to MRI. In daily clinical routine, patients with contraindications for other imaging modalities can particularly benefit using this method.

[Current Aspects on the Pathogenesis of Urinary Tract Infections]. / Aktuelle Aspekte zur Pathogenese der Harnwegsinfektion.

Urinary tract infections are among the most common bacterial infectious diseases worldwide. Every second woman will experience at least one urinary tract infection in her lifetime. The administration of antibiotics has been a safe and efficient treatment modality so far. However, due to the emergence of multi-resistant pathogens and the developmental void of new antimicrobial drugs, the therapy of infections mighty become more challenging in the near future. So, knowledge of the complex host-pathogen interaction is of great importance. Common phenotypes observed in clinical practice suggest basic principles, which are relevant for the development of novel antimicrobial strategies. With invading pathogens forming intracellular bacterial communities they evade host response and provide a nidus for recurrent infection. A plethora of virulence factors allow uropathogenic bacteria to colonize and to establish infections in the urinary tract. In response, host responses seem to address specific virulence mechanisms that are essential to pathogenicity. Deciphering the molecular mechanisms underlying the complex host-pathogen interaction is critical to devise novel treatment options.

Shear-wave elastography of the testis in the healthy man - determination of standard values.

PURPOSE: Real-time shear-wave elastography (SWE) is a newly developed technique for the sonographic quantification of tissue elasticity, which already is used in the assessment of breast and thyroid lesions. Due to limited overlying tissue, the testes are ideally suited for assessment using shear wave elastography. To our knowledge, no published data exist on real-time SWE of the testes. MATERIALS AND METHODS: Sixty six male volunteers (mean age 51.86±18.82, range 20-86) with no known testicular pathology underwent normal B-mode sonography and multi-frame shear-wave elastography of both testes using the Aixplorer ® ultrasound system (SuperSonic Imagine, Aix en Provence, France). Three measurements were performed for each testis; one in the upper pole, in the middle portion and in the lower pole respectively. The results were statistically evaluated using multivariate analysis. RESULTS: Mean shear-wave velocity values were similar in the inferior and superior part of the testicle (1.15 m/s) and were significantly lower in the centre (0.90 m/s). These values were age-independent. Testicular stiffness was significantly lower in the upper pole than in the rest of the testis with increasing volume (p = 0.007). CONCLUSION: Real-time shear-wave elastography proved to be feasible in the assessment of testicular stiffness. It is important to consider the measurement region as standard values differ between the centre and the testicular periphery. Further studies with more subjects may be required to define the normal range of values for each age group. Useful clinical applications could include the diagnostic work-up of patients with scrotal masses or male infertility.

[Conservative therapy of erectile dysfunction]. / Konservative Therapie der erektilen Dysfunktion.

The erectile dysfunction (ED) with a prevalence of 19.2% and a steep age-related increase up to 53.4% in men over 70 years is a common sexual disorder. Especially after market launch of the phosphodiesterase 5 inhibitors the possibility of an easy-to-use and well-tolerated therapy is available. In case of nonresponse, vasoactive substances can be applied in different forms. In case of an additional hypogonadism, testosterone substitution is indicated. Simultaneously the causes of ED should always be treated, including a change of lifestyle with elimination of exogenous noxa. The use of mechanic tools as single or combination therapy can lead to improved erection. This article provides a critical overview of the latest conservative therapy options, it explains previous unsuccessful therapeutic trials and gives an outlook into potential ED therapy concepts of the future.

The role of VTIQ as a new tissue strain analytics measurement technique in testicular lesions.

PURPOSE: Virtual touch tissue imaging quantification (VTIQ) is a newly developed technique for the sonographic quantification of tissue elasticity. It has been used in the assessment of breast lesions. The purpose of this study was to determine the diagnostic performance of VTIQ in indeterminate testicular lesions. METHODS: Twenty patients with known testicular pathology underwent conventional B-mode sonography with additional VTIQ of the testicular lesions using a Siemens Acuson S2000™ and S3000™ (Siemens Medical Solutions, Mountain View, CA, USA) system. Tissue mechanical properties were analysed in the VTIQ examination. The pathologic diagnosis was established after surgery or in the follow-up examination for suspected benign lesions. RESULTS: Over 36 months, 22 focal testicular lesions (median lesion size, 18 mm; range, 4-36 mm in 20 patients (median age, 43 years; range, 22-81 years) were examined. Lesions were hyperechoic (n = 1), hypoechoic (n = 14), isoechoic (n = 1), of mixed echogenicity (n = 3) or anechoic (n = 3). Histological examination showed one benign lesion (6.25%) with a mean size of 7 mm and 15 malignant lesions (93.75%) with a mean size of 20 mm. Mean shear wave velocity for normal testicular tissue was 1.17 m/s. No shear wave velocity could be measured in cystic lesions. The rest of the benign lesions showed a mean shear wave velocity of 2.37 m/s. The value of the shear wave velocity in germ cell tumours showed a mean shear wave velocity of 1.94 m/s and for seminoma it showed a mean shear wave velocity of 2.42 m/s. CONCLUSIONS: VTIQ is a reliable new method for measuring qualitative and quantitative stiffness of testicular lesions and tissue. The qualitative shear-wave elastography features were highly reproducible and showed good diagnostic performance in unclear testicular lesions. The VTIQ technique is also useful in assessing small testicular nodules and pseudolesions.

THE CONSUMPTION OF RED PUPUNHA (BACTRIS GASIPAES KUNTH) INCREASES HDL CHOLESTEROL AND REDUCES WEIGHT GAIN OF LACTATING AND POST-LACTATING WISTAR RATS.

INTRODUCTION: The lactating and post-lactating periods are marked by large metabolic change. Production of milk is 60% lipid dependent. We reported in a recent scientific meeting that Red pupunha palm tree fruit increases HDL cholesterol in lactating rats. This study evaluated if consumption of Red Pupunha by adult female rats has a beneficial impact on the lipid metabolism of lacting and post-lacting adult rats. OBJECTIVE: Evaluate if consumption of red pupunha has a beneficial effect in the lipid metabolism of lacting and post-lacting adult Wistar rats. RESEARCH METHODS: Four groups including two for control; (1) control adult lactating rats, (2) control adults post-lactating rats; and two experimental groups; (3) pupunha adults lactating rats and (4) pupunha adult post-lactating rats were evaluated and compared regarding: weight gain, food consumption, plasma total protein, glucose, total lipid, triglycerides, total cholesterol and HDL-cholesterol levels. The mean difference and its 95% confidence intervals were used for group comparisons. Group comparisons were evaluated by using analysis of variance (one-way ANOVA). The statistical significance of the pairwise differences among groups was assessed by using the two-sided Tukey test. RESULTS: There were no important differences in food consumption, plasma glucose, total lipids and triglycerides among groups. The red pupunha lactating group gain less weight showing lower body mass index (BMI) than controls (p < 0.05). Total cholesterol was lower in red pupunha lactating than in controls but not in the red pupunha post-lactating group as compared to controls. Triglycerides were lower in the post-lactating red pupunha group as compared to the control group (p = 0.039) but not for the lactating groups. Red pupunha lactating and post-lactating groups had higher HDL-cholesterol than their corresponding control groups (p ≤ 0.01). CONCLUSION: Original findings include the beneficial effect of red pupunha in post-lactating rats increasing the HDL-cholesterol and lowering the BMI. Red pupunha was confirmed to increase HDL-cholesterol in lactating rats. These results suggest that red pupunha is a healthy fruit to be consumed during lactating and post-lactating periods as it is related to better lipid profile and less body weight gain.