Comparison of outcomes in patients with and without neurologic diseases undergoing holmium laser enucleation of the prostate.

INTRODUCTION: We aimed to compare holmium laser enucleation of the prostate (HoLEP) outcomes in patients with and without neurologic diseases (ND). METHODS: A prospectively maintained database of patients undergoing HoLEP from January 2021 to April 2022 was reviewed. The following NDs were included: diabetes-related neuropathy/neurogenic bladder, Parkinson's disease, dementia, cerebrovascular accident, multiple sclerosis, traumatic brain injury, transient ischemic attack, brain/spinal tumors, myasthenia gravis, spinal cord injury, and other. Statistical analysis was performed using t-tests, Chi-squared, and binomial tests (p<0.05). RESULTS: A total of 118 ND patients were identified with 135 different neurologic diseases. ND patients were more likely to have indwelling catheters (57% vs. 39%, p=0.012) and urinary tract infections (UTIs) preoperatively (32% vs. 19%, p=0.002). Postoperatively, ND patients were more likely to fail initial trial of void (20% vs. 8.1%, p<0.001) and experience an episode of acute urinary retention (16% vs. 8.5%, p=0.024). Within 90 days postoperative, the overall complication rate was higher in the ND group (26% vs. 13%, p=0.001). Within the ND group, 30/118 (25%) had ≥1 UTI within 90 days preoperative, which decreased to 10/118 (8.7%) 90 days postoperative (p<0.001). At last followup (mean 6.7 months [ND] vs. 5.4 months [non-ND], p=0.03), four patients (4.4%) in the ND group required persistent catheter/clean intermittent catheterization compared to none in the non-ND group (p=0.002). CONCLUSIONS: Patients with ND undergoing HoLEP are more likely to experience postoperative retention and higher complication rates compared to non-ND patients. While UTI rates are higher in this population, HoLEP significantly reduced three-month UTI and catheterization rates.

Engineering a Hierarchy of Disorder: A New Route to Synthesize High-Performance 3D Nanoporous All-Carbon Materials*.

We report a new nanoporous amorphous carbon (NAC) structure that achieves both ultrahigh strength and high electrical conductivity, which are usually incompatible in porous materials. By using modified spark plasma sintering, we create three amorphous carbon phases with different atomic bonding configurations. The composite consists of an amorphous sp2-carbon matrix mixed with amorphous sp3-carbon and amorphous graphitic motif. NAC structure has isotropic electrical conductivity of up to 12,000 S/m, a Young's modulus of up to ∼5 GPa, and Vickers hardness of over 900 MPa. These properties are superior to those of existing conductive nanoporous materials. Direct investigation of the multiscale structure of this material through transmission electron microscopy (TEM), electron energy loss spectroscopy (EELS), and machine learning-based electron tomography revealed that the origin of the remarkable material properties is the well-organized sp2/sp3 amorphous carbon phases with a core-shell-like architecture, where the sp3-rich carbon forms a resilient core surrounded by a conductive sp2-rich layer. Our research not only introduces novel material with exceptional properties, but also opens new opportunities for exploring amorphous structures and designing high-performance materials. This article is protected by copyright. All rights reserved.

A systematic scoping review of communication skills training in medical schools between 2000 and 2020.

BACKGROUND: Communication skills training (CST) remains poorly represented and prioritised in medical schools despite its importance. A systematic scoping review (SSR) of CST is proposed to better appreciate current variability in their structure, content, and assessment. This is to guide their future design in medical school curricula. METHODS: The Systematic Evidence-Based Approach (SEBA) was used to guide concurrent SSRs of teaching and assessment in CST. After independent database searches, concurrent thematic and content analysis of included articles were conducted separately. Resultant themes/categories were combined via the jigsaw perspective to provide a more holistic view of the data. These were then compared to tabulated summaries of the included articles to create funnelled domains. RESULTS: 52,300 papers were identified, 150 full-text articles included, and four funnelled domains were identified: Indications, Design, Assessment, and Barriers and Enablers of CST. CSTs confer numerous benefits to physicians and patients. It saw increased confidence, improved diagnostic capabilities and better clinical management, as well as greater patient satisfaction and treatment compliance. Skills may be divided into core, prerequisite competencies, and advanced skills pertinent to more challenging and nuanced scenarios - such as population or setting-specific situations. CST teaching and assessment modalities were found to align with Miller's Pyramid, with didactic teaching gradually infused with experiential approaches to enhance their understanding and integration. A plethora of CST frameworks, teaching and assessment methods were identified and are presented together. CONCLUSION: While variable in approach, content and assessment, CST in medical schools often employ stage-based curricula to instil competency-based topics of increasing complexity throughout medical school education. This process builds on the application of prior knowledge and skills, influencing practice and, potentially, the students' professional identity formation. In addition, the institution plays a critical role in overseeing training, ensuring longitudinal guidance and holistic assessments of the students' progress.

A Surgeon's Guide to Understanding Artificial Intelligence and Machine Learning Studies in Orthopaedic Surgery.

PURPOSE OF REVIEW: In recent years, machine learning techniques have been increasingly utilized across medicine, impacting the practice and delivery of healthcare. The data-driven nature of orthopaedic surgery presents many targets for improvement through the use of artificial intelligence, which is reflected in the increasing number of publications in the medical literature. However, the unique methodologies utilized in AI studies can present a barrier to its widespread acceptance and use in orthopaedics. The purpose of our review is to provide a tool that can be used by practitioners to better understand and ultimately leverage AI studies. RECENT FINDINGS: The increasing interest in machine learning across medicine is reflected in a greater utilization of AI in recent medical literature. The process of designing machine learning studies includes study design, model choice, data collection/handling, model development, training, testing, and interpretation. Recent studies leveraging ML in orthopaedics provide useful examples for future research endeavors. This manuscript intends to create a guide discussing the use of machine learning and artificial intelligence in orthopaedic surgery research. Our review outlines the process of creating a machine learning algorithm and discusses the different model types, utilizing examples from recent orthopaedic literature to illustrate the techniques involved.

The safety and efficacy of autologous adipose-derived stromal vascular fraction for nonscarring alopecia: A systematic review.

IMPORTANCE: Nonscarring alopecia, including androgenetic alopecia and alopecia areata, are common and can negatively impact quality of life. Recent clinical studies have investigated autologous, adipose-derived stromal vascular fraction (SVF) as a potentially beneficial treatment option. OBJECTIVE: To assess the available evidence on the utility and safety of SVF for nonscarring alopecia. EVIDENCE REVIEW: A systematic review of the literature was performed using MEDLINE (PubMed), Embase, and CENTRAL from inception to November 2020. Included articles were prospective, observational or interventional studies of SVF for nonscarring alopecia in humans. FINDINGS: Six studies of 188 patients were identified, including three randomized controlled trials. There were no reported severe adverse events. All studies found improved hair density with SVF compared to control or pre-treatment baseline. One study reported that improvement in hair density varied based on time for follow-up, severity of hair loss, and concentration of adipose-derived stem cells (ADSCs) within the SVF. Two studies reported an increase in hair diameter from baseline, and two studies reported an improvement in hair pull test outcomes. CONCLUSIONS AND RELEVANCE: SVF may be safe and effective for nonscarring alopecia in the appropriate patients. Hair loss severity, method of SVF preparation and frequency of treatment, and adjunctive therapies may be important considerations for treatment success. Additional studies evaluating appropriate patient selection and treatment methods are needed.

Observations on the brain vasculature in multiple sclerosis: A historical perspective.

OBJECTIVES: To review the literature on vascular aspects of multiple sclerosis (MS) specifically pathological observations of the perivenular distribution of MS lesions and venous pathology in MS. METHODS: Comprehensive literature search from 2012 back to 1839. RESULTS: One hundred and thirty two papers from 1839 to 2012 were included in this study. Multiple authors observed central venules in MS lesions as a feature of MS with the first specific mention by Rindfleisch in 1863. Recent high field strength MRI has reintroduced the perivenular distribution of MS lesions to a new generation, and has suggested that there is disease specificity to this distribution. In addition Putnam and others in the 1930s hypothesized that venous disease was causative for MS. Treatments based on these observations have included anticoagulation, hyperbaric oxygen therapy, and recently endovascular venous procedures. The significance of these findings in terms of MS pathogenesis has been debated over the same period of time. CONCLUSIONS: While the controversy over venous disease in MS is new, the observation of perivenular MS plaques and venous theories about MS pathogenesis are as old as the history of MS research.