Does prior PCNL affect RIRS? A retrospective analysis of a single center data.

PURPOSE: The aim of this study is to investigate the results and safety of retrograde intrarenal surgery (RIRS) in patients who have previously undergone percutaneous nephrolithotomy (PCNL). METHODS: A retrospective analysis included patients who underwent RIRS for kidney stones between August 2018 and April 2023. Group 1 comprised 396 patients who underwent primary RIRS, while Group 2 included 231 individuals who had RIRS after previous PCNL. Evaluation parameters included preoperative characteristics, stone attributes, operative details, treatment outcomes, stone-free status, and complications. Statistical analysis utilized Student's t test, Mann-Whitney U test, and Pearson Chi-square test (p < 0.05). RESULTS: The mean age, body mass index, stone number, mean stone burden, and SFS were not statistically different between the groups. Lower pole stones were identified in 144 patients in Group 1 and 88 patients in Group 2 (p = 0.315). In Group 1 and Group 2, the mean operation time and fluoroscopy time were 65.23 ± 18.1 min, 81.32 ± 14.3 min, 26.34 ± 8.31 s, 46.61 ± 7.6 s, respectively, showing statistically significant differences between the groups (p = 0.013, p < 0.001, respectively). Infundibulum stenosis was identified and treated with a laser in 12% of Group 2 cases. Complications occurred in 12 patients in Group 1 and 14 patients in Group 2 (p = 0.136). CONCLUSION: A history of PCNL may contribute to extended operation times and increased fluoroscopy exposure in subsequent RIRS without significantly affecting postoperative SFS or complication rates.

Surgical Delay Increases the Perioperative Blood Transfusion Rate In Percutaneous Nephrolithotomy.

Objectives: We aimed to investigate the effect of prolonged time from diagnosis to treatment (TDT) on surgical outcomes in patients undergoing percutaneous nephrolithotomy (PNL). Methods: This study included a total of 544 patients who underwent PNL in our clinic between November 2017 and November 2021. Clinicodemographical, radiological, and perioperative data of the patients were recorded. The stone-free rate as assessed by abdominal computed tomography at 3 months was estimated. The possible relation of the stone-free rate and perioperative complications with TDT was examined. Results: The median age was 48 (range, 38-58) years, the median stone size was 405 (range, 250-700) mm2, and the median stone density was 1,000 (range, 730-1,221) Hounsfield units. The median TDT was 75 (range, 42-133) days. Twenty-seven patients (5.0%) required perioperative blood transfusion (PBT). There was a statistically significant correlation between TDT and the need for PBT (p=0.022). However, there was no significant correlation between TDT and stone-free rate (p>0.05). Using a cutoff value of 90.5 days, TDT could predict the need for PBT with 59.3% sensitivity and 60% specificity. Conclusion: Our study results suggest that the need for PBT increases in patients undergoing PNL longer than 90.5 days after the diagnosis. However, further large-scale, prospective studies are warranted to elucidate the effect of prolonged TDT on surgical outcomes in this patient population.

Peritumoral Adipose Tissue Density Predicts the Malignancy in cT1 Renal Masses.

OBJECTIVE: Not only the frequency of surgery for small renal masses has increased secondary to the improvements and frequent use of imaging techniques but also the frequency of detection of benign lesions in nephrectomy specimens has increased as well. We aimed to assess the predictive value of computed tomography density of perirenal adipose tissue and peritumoral adipose tissue in distinguishing between benign and malignant renal masses. MATERIALS AND METHODS: The current study included 116 patients who underwent nephrectomy for renal masses between January 2015 and December 2020. Clinicodemographic and preoperative computed tomography features and final pathological findings of the patients were recorded. According to the final pathological results, the patients were divided into 2 groups benign (n = 32) and malignant (n = 84). Groups were compared statistically in terms of perirenal adipose tissue and peritumoral adipose tissue density. RESULTS: The median tumor size was 5.00 cm. The rate of benign tumors was higher in female patients (P = .005). The median peritumoral adipose tissue density among cT1 and cT1a tumors was higher in the malignant group (P < .001, for each). At a cutoff value of 97.50 Hounsfield Units, the peritumoral adipose tissue density had a sensitivity of 83.0% and a specificity of 79.2% for predicting the presence of malignant tumors in ≤7 cm renal masses. Using a cutoff value of -97.50 Hounsfield Units, the peritumoral adipose tissue density had a sensitivity of 88.9% and a specificity of 83.3% for predicting the presence of malignant tumors in ≤4 cm renal masses. CONCLUSION: The peritumoral adipose tissue density in the preoperative computed tomography images predicts the malignancy in cT1 renal masses.

Comparative Study of Prone Position Variations for Percutaneous Nephrolithotomy.

Objective: In this comparative study, we evaluated the results of flat prone and prone hip flexed percutaneous nephrolithotomy in terms of efficacy and safety to contribute to the optimal prone percutaneous nephrolithotomy position. Materials and Methods: Data of the patients who underwent percutaneous nephrolithotomy operations in a flat-prone or prone hip flexed positions due to renal pelvis and/or ≥2 Calix filling stones between January 2016 and January 2022 were collected retrospectively. Demographic data of the patient groups in different prone positions as well as clinical findings, stone characteristics and operative data were analyzed. The groups were also compared in terms of post-operative findings and complications. Results: The average age and CROES scores of patients included in the study were 47.15±15.6 years and 221.76±62.49, respectively. There was no statistically significant difference between the two groups in terms of patient demographic data, stone-free status and complication rates. Operation Room Time (ORT) (min) in flat prone PCNL group was shorter in average (100.57±32.74 min vs 92.32±28.75 min, p = 0.041) and duration with nephrostomy (days) and hospitalization (days) parameters were statistically significantly shorter in prone hip flexed PCNL (respectively, p < 0.001; p = 0.005). Conclusion: Flat-prone PCNL provides significantly shorter ORT. However, the time with nephrostomy and hospitalization with the prone hip flexed PCNL were shorter than flat-prone position. The findings will guide the optimal prone PCNL position.

Quality and content analysis of female urethroplasty videos on YouTube.

OBJECTIVES: In this study, we aimed to analyze scientific quality and content of female urethroplasty videos on YouTube. METHODS: We searched YouTube using the "female urethroplasty", "female urethral stricture", and "urethroplasty" keywords on February 22, 2022. The quality and content of videos were analyzed using the Global Quality Score (GQS) and Female Urethroplasty-Specific Checklist Score (FUSCS) which was developed by our clinic. Video analysis was performed by two independent urologists. The relationship between the video characteristics and GQS and FUSCS was examined. RESULTS: A total of 38 videos were analyzed. Fourteen (36.8%) videos were uploaded by academic sources such as urology societies and universities/hospitals, while 24 (63.2%) videos were uploaded by urologists. The median GQS was 3 (range, 2-4) and the median FUSCS was 8 (range, 5-9) for all videos. The Cohen's kappa was 0.834 for GQS and 0.899 for FUSCS, indicating a high level of agreement between the observers. The median GQS was 4 (range, 4-5) and the median FUSCS was 9 (range, 8-10) for academic videos, indicating a statistically significantly higher scores than the urologists videos (p = .002 and p < .001, respectively). CONCLUSION: Academic videos on female urethroplasty on YouTube have adequate scientific quality and content for both patients and healthcare professionals. The number of videos by academic sources on female urethroplasty should be increased and individuals should be encouraged to search such videos on search engines.

Quality and utility of YouTube videos about mPCNL.

This study assessed the reliability, efficacy, and quality of YouTube videos on miniaturized PCNL procedures using a scoring system. Video searches were conducted using the keywords miniaturized percutaneous nephrolithotomy (mPCNL), ultra-mini-PCNL (UMP), and super-mini-PCNL (SMP) via https://www.youtube.com . All videos > 2 min in English containing the procedure of mPCNL were ordered and listed according to relevance and popularity. Global quality scores (GQS) and reliability scales were used for quality and content analysis of the videos. The confirmed video power index (VPI) was used to assess video popularity, and the mPCNL score, developed by three endourologists, was used to measure the informational and educational value of the videos. While specialists (61.9%) were the main source for uploading 63 videos included in the study, the largest target group was patients (61.9%). Operational procedures (68.3%) were the main content, and the highest upload region was Asian continent (66.7%). The majority of videos were in English (60.3%), focused on standard mPCNL rather than miniaturization subtypes (77.8%). The mean VPI, GQS, reliability, and mPCNL scores were 4.61, 2.86, 2.61, 9.58, respectively. These parameters, which were positively correlated, were found to be statistically significantly higher for videos of 'academic' origin, 'Physicians' target audience and 'English audio' language format (p < 0.05). Because mPCNL videos, which are popular and have high informational and educational value, are aimed at medical professionals rather than patients, they are not functional in treatment selection and explaining the procedure. By raising its standards, video portals can make the treatment process practical as a functional bridge between patients and health care professionals.

Drivers of technology adoption during the COVID-19 pandemic: The motivational role of psychological needs and emotions for pre-service teachers.

The vital role of motivation becomes even more evident when considering the digital transformation of learning and teaching environments, especially with the effect of the pandemic. Basic psychological needs and emotions, which have not been comprehensively examined together despite their important roles in motivating, draw attention. Accordingly, this study aims to reveal the psychological, emotional, and individual variables that influence the pre-service teachers' intention to use technology, and to evaluate and validate the predictive power of a proposed model. The technology acceptance model formed the basis of the proposed model, and the model was extended with the self-determination theory (competence, autonomy, relatedness) and a framework of emotions (enjoyment, playfulness, anxiety, frustration). Data were collected online from 591 pre-service teachers studying in 10 different departments of a state university. In data analysis PLS-SEM, PLSpredict and multi-group analysis were performed. The results revealed that the model explains 79.8% of the intention and that the predictive power of the model is high. The relationship between competence and perceived ease of use represents the strongest relationship in the model, and the most influential construct on intention is enjoyment. These findings suggest that both intrinsic and extrinsic motivation play a major role in technology acceptance, especially during the pandemic. In addition, innovativeness, which is related to technology use and motivation, had various moderator effects on the relationships. Findings indicate that the model, which offers a motivational approach based on basic psychological needs and emotions, provides rare information and has high relevance for the field.

Emotional outcomes of e-learning adoption during compulsory online education.

Information on the emotional outcomes of e-learning system use and emotional aspects of user experience in higher education is quite limited. Accordingly, the aim of the study is to identify the factors that influence university students' intention to continue using e-learning systems and to examine the emotional outcomes of the continuance intention. The core constructs of the Technology Acceptance Model formed the basis of the proposed model, and the model was extended with a framework of emotions (challenge, achievement, deterrence, loss) and external variables. Data were collected online from 19,530 university students of a state university. For the analysis, Partial Least Squares-Structural Equation Modeling was employed. The proposed model explained 73.5% of continuance intention, 50.3% of achievement, and 52.2% of challenge emotions. In addition, 23 of the 25 tested hypotheses were supported. The findings indicate that perceived usefulness is a decisive factor in creating user experiences that generate emotions such as enjoyment, playfulness and satisfaction. In addition, the results showed that personal innovativeness strongly influenced the core constructs of technology acceptance model and the positive aspects of emotions (achievement and challenge). Accordingly, it can be stated that these findings lead us to the fact that students' value perceptions regarding e-learning systems have a critical role in terms of emotional outcomes. In addition, the findings suggest that both intrinsic-extrinsic motivators, innovativeness characteristics and emotional outcomes should be taken into account in design and development process in order to improve the quality of the user experience. In this direction, implications for research and practice are discussed.

Effects of Smoking on Very-Long Term Mortality after First ST Elevation Myocardial Infarction. / Efeitos do Ato de Fumar na Mortalidade de Longo Prazo após Infarto do Miocárdio por Elevação de ST.

BACKGROUND: The smoking paradox has been a matter of debate for acute myocardial infarction patients for more than two decades. Although there is huge evidence claiming that is no real paradox, publications supporting better outcomes in post-MI smokers are still being released. OBJECTIVE: To explore the effect of smoking on very long-term mortality after ST Elevation myocardial infarction (STEMI). METHODS: This study included STEMI patients who were diagnosed between the years of 2004-2006 at three tertiary centers. Patients were categorized according to tobacco exposure (Group 1: non-smokers; Group 2: <20 package*years users, Group 3: 20-40 package*years users, Group 4: >40 package*years users). A Cox regression model was used to estimate the relative risks for very long-term mortality. P value <0.05 was considered as statistically significant. RESULTS: There were 313 patients (201 smokers, 112 non-smokers) who were followed-up for a median period of 174 months. Smokers were younger (54±9 vs. 62±11, p: <0.001), and the presence of cardiometabolic risk factors were more prevalent in non-smokers. A univariate analysis of the impact of the smoking habit on mortality revealed a better survival curve in Group 2 than in Group 1. However, after adjustment for confounders, it was observed that smokers had a significantly increased risk of death. The relative risk became higher with increased exposure (Group 2 vs. Group 1; HR: 1.141; 95% CI: 0.599 to 2.171, Group 3 vs Group 1; HR: 2.130; 95% CI: 1.236 to 3.670, Group 4 vs Group 1; HR: 2.602; 95% CI: 1.461 to 4.634). CONCLUSION: Smoking gradually increases the risk of all-cause mortality after STEMI.

FUNDAMENTO: O paradoxo do fumante tem sido motivo de debate para pacientes com infarto agudo do miocárdio (IM) há mais de duas décadas. Embora haja muitas evidências demonstrando que não existe tal paradoxo, publicações defendendo desfechos melhores em fumantes pós-IM ainda são lançadas. OBJETIVO: Explorar o efeito do fumo na mortalidade de longo prazo após infarto do miocárdio por elevação de ST (STEMI). MÉTODOS: Este estudo incluiu pacientes com STEMI que foram diagnosticados entre 2004 e 2006 em três centros terciários. Os pacientes foram categorizados de acordo com a exposição ao tabaco (Grupo 1: não-fumantes; Grupo 2: <20 pacotes*anos; Grupo 3: 2-040 pacotes*anos; Grupo 4: >40 pacotes*anos). Um modelo de regressão de Cox foi utilizado para estimar os riscos relativos para mortalidade de longo prazo. O valor de p <0,05 foi considerado como estatisticamente significativo. RESULTADOS: Trezentos e treze pacientes (201 fumantes e 112 não-fumantes) foram acompanhados por um período médio de 174 meses. Os fumantes eram mais novos (54±9 vs. 62±11, p: <0,001), e a presença de fatores de risco cardiometabólicos foi mais prevalente entre os não-fumantes. Uma análise univariada do impacto do hábito de fumar na mortalidade revelou uma curva de sobrevivência melhor no Grupo 2 do que no Grupo 1. Porém, após ajustes para fatores de confusão, observou-se que os fumantes tinham um risco de morte significativamente maior. O risco relativo tornou-se maior de acordo com a maior exposição (Grupo 2 vs. Grupo 1: RR: 1,141; IC95%: 0,599 a 2.171; Grupo 3 vs. Grupo 1: RR: 2,130; IC95%: 1,236 a 3,670; Grupo 4 vs. Grupo 1: RR: 2,602; IC95%: 1,461 a 4,634). CONCLUSÃO: O hábito de fumar gradualmente aumenta o risco de mortalidade por todas as causas após STEMI.

High visceral adiposity index is associated with female orgasmic disorder in premenopausal women: a cross-sectional study.

This study aimed to evaluate the association between the visceral adiposity index (VAI) and female sexual dysfunction (FSD). This cross-sectional study included 165 premenopausal, sexually active women admitted to the gynaecology outpatient clinic between January 2021 and April 2021. Female Sexual Function Index (FSFI) was used to assess the sexual function of the women. After measuring body mass index (BMI) and waist circumference (WC), biochemical serum analysis was performed. The VAI was calculated for all participants. The relationship between VAI and total FSFI and subdomain scores was investigated. Of the participants, FSD was detected in 65.5%. There was no relationship between the total FSFI scores and age, BMI, WC and VAI (p = .126, p = .675, p = .790, p = .220, respectively). Increased VAI levels were associated with dysfunction in orgasm (p = .008). Although VAI seems not to be directly related to FSD, it may predict the orgasmic disorder in women.Impact StatementWhat is already known on this subject? Obesity and female sexual dysfunction (FSD) are common health problems which adversely affect the biopsychosocial well-being. Although the relationship between FSD and obesity, body mass index (BMI) and waist circumference (WC) has been widely discussed in the literature to date, there is not enough evidence for the link between FSD and visceral adiposity index (VAI) which is a reliable indicator of visceral fat dysfunction.What do the results of this study add?The results of this study showed that none of the factors indicating obesity such as BMI, WC and VAI were correlated with the total FSFI scores. However, a significant positive correlation was found between the VAI and female orgasmic disorder (FOD).What are the implications of these findings for clinical practice and/or further research? The VAI may be a useful tool for detecting FOD patients. Diagnosis and treatment of orgasmic disorder would significantly improve the patient's quality of life and general well-being. Further large-scale and high-evidence studies are needed to clarify the impact of obesity on FSD and the relationship between VAI and FOD.

Should haematological inflammatory markers be included as an adjuvant in the differential diagnosis of acute scrotal pathologies?

The aim of this study was to determine discriminative role of haematological inflammatories between acute scrotal pathologies and malignancies. In addition, it was aimed to search for a predictive marker of testicular survival in the TT group. Medical data of 141 patients with acute scrotal pathology and 63 TTm patients who presented to our clinic between January 2015 and July 2019 were retrospectively reviewed and compared in terms of haematological values and demographic parameters following the inclusion of 92 healthy controls. In the TTm group, NLR was the discriminative parameter with a median of 2.42 (0.25-8.42), whereas discriminative median values of MCV for TT and CRP for EO were 83.65 (56.9-98.16) and 59.5 (2.9-337) respectively. NLR, PLR, MER and RDW values were statistically lower in the control group compared to the patients groups. In TT subgroup analysis, monocyte count, MER and CRP were found to be statistically higher in the orchiectomy group, while multivariate logistic regression analysis performed for testicular viability revealed monocyte count to be the only significant variable (Odds Ratio [95% Confidence Interval] = 0.046 (0.006-0.366), p<0.004). While our study demonstrated both diagnostic and discriminative values of haematological parameters, it also showed that monocyte count could predict testicular salvage in TT patients. However, further prospective studies are required.

Efeitos do Ato de Fumar na Mortalidade de Longo Prazo após Infarto do Miocárdio por Elevação de ST / Effects of Smoking on Very-Long Term Mortality after First ST Elevation Myocardial Infarction

Resumo Fundamento O paradoxo do fumante tem sido motivo de debate para pacientes com infarto agudo do miocárdio (IM) há mais de duas décadas. Embora haja muitas evidências demonstrando que não existe tal paradoxo, publicações defendendo desfechos melhores em fumantes pós-IM ainda são lançadas. Objetivo Explorar o efeito do fumo na mortalidade de longo prazo após infarto do miocárdio por elevação de ST (STEMI). Métodos Este estudo incluiu pacientes com STEMI que foram diagnosticados entre 2004 e 2006 em três centros terciários. Os pacientes foram categorizados de acordo com a exposição ao tabaco (Grupo 1: não-fumantes; Grupo 2: <20 pacotes*anos; Grupo 3: 2-040 pacotes*anos; Grupo 4: >40 pacotes*anos). Um modelo de regressão de Cox foi utilizado para estimar os riscos relativos para mortalidade de longo prazo. O valor de p <0,05 foi considerado como estatisticamente significativo. Resultados Trezentos e treze pacientes (201 fumantes e 112 não-fumantes) foram acompanhados por um período médio de 174 meses. Os fumantes eram mais novos (54±9 vs. 62±11, p: <0,001), e a presença de fatores de risco cardiometabólicos foi mais prevalente entre os não-fumantes. Uma análise univariada do impacto do hábito de fumar na mortalidade revelou uma curva de sobrevivência melhor no Grupo 2 do que no Grupo 1. Porém, após ajustes para fatores de confusão, observou-se que os fumantes tinham um risco de morte significativamente maior. O risco relativo tornou-se maior de acordo com a maior exposição (Grupo 2 vs. Grupo 1: RR: 1,141; IC95%: 0,599 a 2.171; Grupo 3 vs. Grupo 1: RR: 2,130; IC95%: 1,236 a 3,670; Grupo 4 vs. Grupo 1: RR: 2,602; IC95%: 1,461 a 4,634). Conclusão O hábito de fumar gradualmente aumenta o risco de mortalidade por todas as causas após STEMI.

Abstract Background The smoking paradox has been a matter of debate for acute myocardial infarction patients for more than two decades. Although there is huge evidence claiming that is no real paradox, publications supporting better outcomes in post-MI smokers are still being released. Objective To explore the effect of smoking on very long-term mortality after ST Elevation myocardial infarction (STEMI). Methods This study included STEMI patients who were diagnosed between the years of 2004-2006 at three tertiary centers. Patients were categorized according to tobacco exposure (Group 1: non-smokers; Group 2: <20 package*years users, Group 3: 20-40 package*years users, Group 4: >40 package*years users). A Cox regression model was used to estimate the relative risks for very long-term mortality. P value <0.05 was considered as statistically significant. Results There were 313 patients (201 smokers, 112 non-smokers) who were followed-up for a median period of 174 months. Smokers were younger (54±9 vs. 62±11, p: <0.001), and the presence of cardiometabolic risk factors were more prevalent in non-smokers. A univariate analysis of the impact of the smoking habit on mortality revealed a better survival curve in Group 2 than in Group 1. However, after adjustment for confounders, it was observed that smokers had a significantly increased risk of death. The relative risk became higher with increased exposure (Group 2 vs. Group 1; HR: 1.141; 95% CI: 0.599 to 2.171, Group 3 vs Group 1; HR: 2.130; 95% CI: 1.236 to 3.670, Group 4 vs Group 1; HR: 2.602; 95% CI: 1.461 to 4.634). Conclusion Smoking gradually increases the risk of all-cause mortality after STEMI.

Idiopathic bilateral massive perirenal subcapsular effusion: The first case in the literature.

INTRODUCTION: Bilateral perirenal subcapsular effusion is a rare clinical condition and is associated with several underlying etiologies. We present a 33 years old male patient with idiopathic bilateral massive subcapsular effusion. CASE PRESENTATION: A 33-year-old male patient presented to our outpatient clinic with bilateral flank pain and fever for 2 weeks. Bilateral perirenal subcapsular effusion was detected in intravenous contrast-enhanced CT and dynamic MRI. TREATMENT: Bilateral ultrasound-guided percutaneous drainage was performed by an expert uroradiologist to reduce the parenchymal pressure, Control CT imaging after 6 weeks demonstrate that bilateral normal kidneys. DISCUSSION: It has been reported that subcapsular and perirenal effusion is a rare clinical condition that may develop secondary to causes such as Nephrotic syndrome, Eisenmenger Syndrome, Lymphangiomatosis, and Page Kidney Disease. In our case, the clinical symptoms of the patient regressed after the whole effusion fluid was drained. No underlying pathology was found in further examinations. Therefore, we present the first case of Idiopathic Bilateral Massive Perirenal Subcapsular Effusion in the literature.

Relationship between a Prolonged Corrected QT Interval and Mortality in Patients Presenting with Syncope at the Emergency Department.

BACKGROUND: Syncope is a common symptom in emergency department patients. Among various etiological factors, cardiac causes have the highest risk of mortality. The corrected QT interval is considered an independent predictor of mortality for many diseases. OBJECTIVES: Analyze QT interval analysis of patients presenting to the emergency department with syncope. METHODS: In this prospective observational study, patients who presented to the emergency department with syncope between January 1, 2018, and January 1, 2019 were included. RESULTS: The median age was 64 (49-78) years, and 58.8% of patients were male. The corrected QT interval (QTc) in patients with coronary artery disease and chronic obstructive pulmonary disease was longer than those without. There was no statistically significant association between hypertension, diabetes, stroke, thyroid disease, and prolonged QTc. Patients who did not survive had significantly prolonged QT intervals. According to ROC analysis, sensitivity of >440.5 ms QTc values in predicting mortality was 86% and specificity was 71% (AUC = 0.815; 95%CI = 0.71 - 0.91; p < 0.001). CONCLUSIONS: Patients admitted to emergency department with syncope and a prolonged QTc are associated with a higher mortality rate and thus can provide us with an important guide for the management of these patients.

Evaluation of the Sexual Functioning of Individuals Living in Turkey During the COVID-19 Pandemic: An Internet-Based Nationwide Survey Study.

INTRODUCTION: Although many countries in the world prioritize self-isolation measures during the corona virus disease 2019 (COVID-19) pandemic period, the effects of this process on sexual functioning are not yet known. AIM: To evaluate the effects of the COVID-19 pandemic on the sexual functioning of individuals who declared no medical history of the COVID-19 disease. METHODS: A total of 1,356 participants filled out an Internet-based survey between June 1 and June 20, 2020. The data from these participants were analyzed to determine sexual functioning in terms of sexual intercourse frequency and sexual desire during the COVID-19 pandemic. Subgroups analyses were also performed, wherein the subgroups were developed according to the population density of the cities in which the participants lived to examine whether population density has any effect on the sexual functions of the participants during the COVID-19 pandemic. MAIN OUTCOME MEASURE: The study outcomes were obtained using a study-specific questionnaire to assess the changes in people's sexual functioning. RESULTS: The mean age of the participants was 33.16 ± 8.31 years. There was a statistically significant difference between the participants according to the decrease in the number of weekly sexual intercourses when they were compared in terms of smoking status, alcohol consumption, marital and parental status, being a health-care worker, having a regular sexual partner, and the working status during the COVID-19 pandemic (P < .05, for each). In the subgroup analyses, it was observed that there was a statistically significant difference between the groups for change in the number of sexual intercourses, the number of masturbations, and sexual desire during the COVID-19 pandemic (P < .05, for each). CONCLUSION: A decline in sexual functioning was observed during the COVID-19 pandemic period. Living in a metropolitan area was associated with a decline in both sexual intercourse frequency and sexual desire during the COVID-19 pandemic. Karsiyakali N, Sahin Y, Ates HA, et al. Evaluation of the Sexual Functioning of Individuals Living in Turkey During the COVID-19 Pandemic: An Internet-Based Nationwide Survey Study. Sex Med 2021;9:100279.

De Ritis ratio: how effectively can we use in bladder cancer management?

Background: This study aims to determine the relationship between the pre-operative De Ritis ratio (DRR) and bladder cancer (BCa) pathological subtypes. Results & methodology: A total of 248 patients with primary BCa were included. Univariate and multivariate analyses were performed to identify whether DRR can be a risk factor for the presence of carcinoma in situ (CIS). There was a statistically significant difference between the nonmuscle invasive BCa risk groups and the muscle-invasive BCa group according to the median DRR levels (p < 0.001). DRR was an independent risk factor for the presence of CIS in multivariate analysis (OR: 1.909; 95% CI: 0.030-0.196; p = 0.008). Discussion & conclusion: DRR can be considered as an independent risk factor for the presence of CIS in patients with primary BCa.

Musical mirror-symmetrical movement tasks: comparison of rhythm versus melody-playing.

Bimanual mirror-symmetrical movement (MSM) is relatively easy to control movement. Different MSM tasks may have different activations and interhemispheric interactions. The purpose of this study is to compare anatomo-physiological features such as hemispheric activations and dominance of two different MSMs, namely melody-playing and rhythm. We examined functional MRI (fMRI) recordings in a group of fifteen right-handed pianists performing two separate tasks: bimanual rhythm and bimanual melody-playing on two different keyboards with standard key order for right hand and reversed for left hand, which allows homolog fingers' movements. Activations and laterality indices on fMRI were examined. The results show that significant cerebellar activations (especially in anterior cerebellum) in both groups. Significant primary sensorimotor cortical activations are observed in the melody-playing group. While there are also bilaterally symmetric activations, and laterality indices suggest overall lateralization towards the left hemisphere in both groups. Activations in the left fronto-parietal cortex, left putamen and left thalamus in conjunction with right cerebellar activations suggest that the left cortico-thalamo-cerebellar loop may be a dominant loop. Dynamic causal modeling (DCM) indicates the presence of causal influences from the left to the right cerebral cortex. In conclusion, melody-playing with bimanual MSM is a complex in-phase task and may help activate the bilateral cortical areas, and left hemisphere is dominant according to laterality indices and DCM results. On the other hand, bimanual rhythm is a simpler in-phase task and may help activate subcortical areas, which might be independent of the voluntary cortical task.

Comparison of semi-automatic and deep learning-based automatic methods for liver segmentation in living liver transplant donors.

PURPOSE: To compare the accuracy and repeatability of emerging machine learning based (i.e. deep) automatic segmentation algorithms with those of well-established semi-automatic (interactive) methods for determining liver volume in living liver transplant donors at computerized tomography (CT) imaging. METHODS: A total of 12 (6 semi-, 6 full-automatic) methods are evaluated. The semi-automatic segmentation algorithms are based on both traditional iterative models including watershed, fast marching, region growing, active contours and modern techniques including robust statistical segmenter and super-pixels. These methods entail some sort of interaction mechanism such as placing initialization seeds on images or determining a parameter range. The automatic methods are based on deep learning and they include three framework templates (DeepMedic, NiftyNet and U-Net) the first two of which are applied with default parameter sets and the last two involve adapted novel model designs. For 20 living donors (6 training and 12 test datasets), a group of imaging scientists and radiologists created ground truths by performing manual segmentations on contrast material-enhanced CT images. Each segmentation is evaluated using five metrics (i.e. volume overlap and relative volume errors, average/RMS/maximum symmetrical surface distances). The results are mapped to a scoring system and a final grade is calculated by taking their average. Accuracy and repeatability were evaluated using slice by slice comparisons and volumetric analysis. Diversity and complementarity are observed through heatmaps. Majority voting and Simultaneous Truth and Performance Level Estimation (STAPLE) algorithms are utilized to obtain the fusion of the individual results. RESULTS: The top four methods are determined to be automatic deep models having 79.63, 79.46 and 77.15 and 74.50 scores. Intra-user score is determined as 95.14. Overall, deep automatic segmentation outperformed interactive techniques on all metrics. The mean volume of liver of ground truth is found to be 1409.93 mL ± 271.28 mL, while it is calculated as 1342.21 mL ± 231.24 mL using automatic and 1201.26 mL ± 258.13 mL using interactive methods, showing higher accuracy and less variation on behalf of automatic methods. The qualitative analysis of segmentation results showed significant diversity and complementarity enabling the idea of using ensembles to obtain superior results. The fusion of automatic methods reached 83.87 with majority voting and 86.20 using STAPLE that are only slightly less than fusion of all methods that achieved 86.70 (majority voting) and 88.74 (STAPLE). CONCLUSION: Use of the new deep learning based automatic segmentation algorithms substantially increases the accuracy and repeatability for segmentation and volumetric measurements of liver. Fusion of automatic methods based on ensemble approaches exhibits best results almost without any additional time cost due to potential parallel execution of multiple models.

Improving the diagnosis of high grade and stage bladder cancer by detecting increased urinary calprotectin expression in tumor tissue and tumor-associated inflammatory response.

Purpose: To investigate whether measurement of urinary calprotectin can serve as a biomarker in the diagnosis of primary bladder cancer and to confirm its diagnostic role in determining high grade and stage disease. Materials and Methods: Urinary calprotectin was measured in spot urine samples from patients with primary bladder cancer and control subjects. To confirm levels in urine, tissue samples were also obtained from bladder tumor and healthy trigone of bladder by transurethral resection in both groups. Finally, calprotectin levels in tissue and urine of the patients and control subjects were compared and their diagnostic potential was investigated in high grade and stage bladder cancers. Results: Of 82 participants, 52 were patients with bladder cancer and 30 were control subjects. The two groups were comparable in terms of age, smoking status, and comorbidities. Tissue and urinary calprotectin levels were significantly higher in the bladder cancer group. In subgroup analyses, urinary calprotectin levels were significantly higher in patients with high-grade, muscle-invasive tumors. After receiver operating characteristic analyses, the sensitivity and specificity of urinary calprotectin was 100% and 96.7%, respectively, in the diagnosis of primary bladder cancer. High grade and stage bladder cancers were detected with sensitivity and specificity of 70% and 74.2%, and 80% and 84.8%, respectively. Conclusions: Urinary calprotectin may be a valuable parameter in the diagnosis of primary bladder cancer with high sensitivity and specificity. Furthermore, it may be useful in the prediction of high grade and stage disease. However, more investigations are needed.