Safety and Outcomes of using ureteric access sheath (UAS) for treatment of Pediatric renal stones: Outcomes from 2 tertiary endourology centers.

OBJECTIVE: To look at the safety and outcomes of using ureteral access sheath (UAS) for pediatric renal stones. The use of UAS is variable in urological practice with very little clinical work on their use in pediatric kidney stone disease. PATIENTS AND METHODS: Data was retrospectively collected from 2 large European tertiary endourology centers for all pediatric patients (≤16 years) with renal stones who underwent flexible ureteroscopy and lasertripsy (FURSL) via UAS. Data was collected on patient details, stone demographics and clinical outcomes of the FURSL procedure. RESULTS: Forty-eight patients with a mean age of 10.7 years were treated with FURSL for a mean single and cumulative stone size of 10.4 mm and 15 mm respectively, with two-third having multiple stones and stones in the lower pole. The initial and final stone free rate (SFR) was 66.7% and 100% respectively with 1.3 procedures/patient. One patient each had intra-operative grade 1 ureteric injury and post-operative UTI, with no other injuries or complications noted. Over a mean follow-up of 17 months, no other complications were noted. CONCLUSION: Ureteral access sheath is safe for treatment of pediatric renal stones with excellent outcomes and are especially useful for larger or multiple stones. While there does not seem to be any medium-term sequalae, to avoid risk of ureteral injury, we would suggest using the smallest size sheath possible. We would argue these procedures are best done in specialist high-volume endourology units for optimal results.

Crioablación total o hemiglandular para el cáncer de próstata primario localizado: resultados oncológicos y funcionales a corto y medio plazo / Whole and hemi-gland cryoablation for primary localized prostate cancer: Short and medium-term oncological and functional outcomes

INTRODUCCIÓN: Comparar los resultados oncológicos, funcionales y postoperatorios de la crioablación hemiglandular (CH) vs. crioablación de toda la glándula (CT) como terapia primaria del cáncer de próstata localizado. MATERIAL Y MÉTODO: Se incluyeron 66 pacientes consecutivos tratados entre 2010 y 2018 con crioablación total (CT = 40) o crioablación hemiglandular (CH = 26) en un centro de referencia terciario. Todos los pacientes tenían cáncer de próstata de riesgo bajo-intermedio según criterios D'Amico. Se propuso crioablación hemiglandular en caso de cáncer de próstata unilateral comprobado por biopsia y RM. La variable principal de evaluación fue el fracaso de la crioterapia, para el que se consideraron y compararon tres definiciones: 1) fallo bioquímico (> PSA nadir + ≥ 2 ng/mL), 2) rebiopsia positiva de próstata Gleason ≥ 7, y 3) inicio de un tratamiento adicional para el cáncer de próstata. RESULTADOS: La edad media de los pacientes durante el tratamiento fue 74 [42-81] vs.76 [71-80] años en el grupo de CT vs. CH, respectivamente (p = 0,08). Los grupos de riesgo bajo e intermedio (D'Amico) fueron 15% y 85% frente a 23% y 77% (p = 0,75), respectivamente. El tiempo medio de seguimiento fue de 41 [1,5-99,0] vs.27 [0,9-93] meses (p = 0,03). La supervivencia libre de fracaso de la crioterapia a cuatro años en CT vs. CH fue de 69% vs.53% con la definición 1 (p = 0,24), 82% vs.80% con la definición 2 (p = 0,95), y 83% vs.77% con la definición 3 (p = 0,73). La continencia urinaria postoperatoria y al año fue de 60% y 83% en CT frente a 72% y 83% en CH (p = 0,26). La impotencia de novo tras la crioterapia fue del 75% frente al 46% (p = 0,33) en CT y CH, respectivamente. CONCLUSIONES: En nuestra cohorte de pacientes altamente seleccionados con CP unilateral de riesgo bajo-intermedio, la crioterapia hemiglandular puede proporcionar resultados oncológicos similares y menos complicaciones tempranas en comparación con la crioablación de toda la glándula

INTRODUCTION: To compare oncological, functional and post-operative outcomes of hemi (HC) vs. whole gland (WGC) cryoablation as first line treatment of localized prostate cancer. MATERIAL AND METHOD: Sixty-six consecutive patients undertaking whole-gland cryoablation (WGC = 40) or hemi-cryoablation (HC = 26) in a tertiary referral centre between 2010 and 2018 were included. All patients had a low-intermediate risk prostate cancer according to D'Amico risk classification. Hemi-ablation was proposed in case of biopsy and prostate MRI proven unilateral prostate cancer. Primary endpoint was Cryotherapy Failure for which 3 definitions were considered and compared: 1) biochemical failure (> PSA nadir+ ≥ 2 ng/mL), 2) positive prostate re-biopsy with Gleason score ≥ 7, 3) initiation of further prostate cancer treatment. RESULTS: Median patients age at treatment was 74 [42-81] vs.76 [71-80] years in WGC vs. HC group, respectively (p=.08). Low and intermediate D'Amico risk group were 15% and 85% vs.23% and 77% (p=.75), respectively. Median follow- up time was 41 [1.5-99.0] vs.27 [0.9-93] months (p=.03). Four-years cryotherapy failure free survival in WGC vs. HC were 69% vs.53% with definition 1 (p=.24), 82% vs.80% with definition 2 (p=.95), 83% vs.77% with definition 3 (p=.73). Early and 1-year urinary continence were 60% and 83% in WGC vs.72% and 83% in HC (p=.26). De novo impotency after cryotherapy was 75% vs.46% (p=.33) in WGC vs. HC. CONCLUSIONS: In our cohort of highly selected patients with unilateral low/intermediate risk PCa, hemi-cryoablation may provide similar oncological outcomes and less early complications compared to whole-gland cryoablation

Whole and hemi-gland cryoablation for primary localized prostate cancer: Short and medium-term oncological and functional outcomes. / Crioablación total o hemiglandular para el cáncer de próstata primario localizado: resultados oncológicos y funcionales a corto y medio plazo.

INTRODUCTION: To compare oncological, functional and post-operative outcomes of hemi (HC) vs. whole gland (WGC) cryoablation as first line treatment of localized prostate cancer. MATERIAL AND METHOD: Sixty-six consecutive patients undertaking whole-gland cryoablation (WGC=40) or hemi-cryoablation (HC=26) in a tertiary referral centre between 2010 and 2018 were included. All patients had a low-intermediate risk prostate cancer according to D'Amico risk classification. Hemi-ablation was proposed in case of biopsy and prostate MRI proven unilateral prostate cancer. Primary endpoint was Cryotherapy Failure for which 3 definitions were considered and compared: 1) biochemical failure (> PSA nadir+≥ 2 ng/mL), 2) positive prostate re-biopsy with Gleason score ≥ 7, 3) initiation of further prostate cancer treatment. RESULTS: Median patients age at treatment was 74 [42-81] vs. 76 [71-80] years in WGC vs. HC group, respectively (p=.08). Low and intermediate D'Amico risk group were 15% and 85% vs. 23% and 77% (p=.75), respectively. Median follow- up time was 41 [1.5-99.0] vs. 27 [0.9-93] months (p=.03). Four-years cryotherapy failure free survival in WGC vs. HC were 69% vs. 53% with definition 1 (p=.24), 82% vs. 80% with definition 2 (p=.95), 83% vs. 77% with definition 3 (p=.73). Early and 1-year urinary continence were 60% and 83% in WGC vs. 72% and 83% in HC (p=.26). De novo impotency after cryotherapy was 75% vs. 46% (p=.33) in WGC vs. HC. CONCLUSIONS: In our cohort of highly selected patients with unilateral low/intermediate risk PCa, hemi-cryoablation may provide similar oncological outcomes and less early complications compared to whole-gland cryoablation.

Leucoencefalopatía megaencefálica con quistes subcorticales y la importancia de la resonancia magnética. A propósito de dos casos / Megalencephalic leukoencephalopathy with Subcortical Cysts. Importance of Magnetic Resonance Imaging. Report of two cases

La leucoencefalopatía megaencefálica con quistes subcorticales (MLC) o enfermedad de Van der Knaap es un trastorno genético infrecuente. La mutación en el gen MLC1 se ha demostrado como la responsable de esta alteración. La disminución en la expresión de la proteína codificada causa vacuolización en los astrocitos y alteración de la homeostasis del agua y los electrolitos. Los casos presentados permiten ilustrar los hallazgos imaginológicos característicos de esta entidad, debido a que el diagnóstico se fundamenta en las imágenes en resonancia magnética (RM).

Megalencephalic leukoencephalopathy with subcortical cysts (MLC) or Van der Knaap disease is a rare genetic disease. The MLC1 mutation genes participate in the pathogenesis. The decreased expression of the encoded protein in astrocytes causes vacuolation, impaired water, and electrolyte homeostasis. We report two cases and illustrate the typical imaging features. The diagnosis of this disease is based on magnetic resonance imaging findings (MRI).

Comparison of the reliability and validity of four contemporary risk stratification schemes to predict thromboembolism in non-anticoagulated patients with atrial fibrillation.

BACKGROUND: The risk of thromboembolic (TE) complications in atrial fibrillation (AF) patients is not homogeneous. Risk schemes can help target anticoagulant therapy for patients at highest risk of TE complications. OBJECTIVES: To test the predictive ability of 4 risk schemes: The Framingham, the 8th ACCP, the ACC/AHA/ESC 2006, and the CHA2DS2-VASc. METHODS: 186 patients with non-valvular AF and off anticoagulant therapy were included. All subjects who experienced a stroke, transient ischemic attack, or peripheral embolism were identified. Each schema was divided into low, intermediate, and high-risk categories. Discrimination was assessed via the c-statistic. RESULTS: We identified 10 TE events that occurred during 668 person-years off anticoagulation therapy. All risk schemes had fair discriminating ability (c-statistic ranged from 0.59 [for CHA2DS2-VASc] to 0.73 [for Framingham]). The proportion of patients assigned to individual risk categories varied widely across schemes. CHA2DS2-VASc categorized the fewest patients into low and intermediate-risk categories, whereas the Framingham schema assigned the highest patients into low-risk strata. There were no TE events in the low and intermediate-risk categories using CHA2DS2-VASc, whereas the most schemes assigned patients into intermediate-risk category had a event rate ranging from 2.5 (ACC/AHA/ESC and 8th ACCP schemes) to 6% (Framingham). The negative predictive value of TE events was of 100% for the no high-risk patients using CHA2DS2-VASc. CONCLUSIONS: Compared to ACC/AHA/ESC, 8th ACCP, and Framingham, CHA2DS2-VASc risk stratification schema may be better in discriminating between patients at a low and intermediate risk of TE complications.

Actinomicosis del sistema nervioso central: presentación de caso / Actinomycosis of the Central Nervous System: Case Report

La actinomicosis es una infección bacteriana indolente, producida por bacilos Gram positivos y que puede afectar cualquier parte del organismo. El compromiso del sistema nervioso central es raro, de baja sospecha clínica y fácilmente confundible con una neoplasia. Los hallazgos clínicos y radiológicos son inespecíficos, por lo cual la confirmación histológica es necesaria. Se deben descartar focos de diseminación distantes o por contigüidad al neuroeje. El tratamiento debe ser antibioticoterapia por largo plazo y drenaje quirúrgico.

Actinomycosis is a bacterial infection caused by Gram-positive bacilli which can affect any part of the body. It is uncommon that the central nervous system is compromised, it has low clinical suspicion and could easily be mistaken for neoplasm. The clinical and radiologic findings are nonspecific. For this reason, histopathologic confirmation for diagnosis is necessary. It is important to rule out contiguous and distant dissemination to the neuroaxis. The treatment for this disease must consist of a prolonged antibiotics regimen and surgical drainage.

In-fiber Fabry-Perot refractometer assisted by a long-period grating.

We present an optical fiber refractometer based on a Fabry-Perot interferometer defined by two fiber Bragg gratings and an intracavity long-period grating that makes the light confined in the resonator interact with the surrounding medium. The external refractive index is monitored by the resonant frequencies of the Fabry-Perot interferometer, which can be measured either in transmission or in reflection. In this first experiment, wavelength shifts measured with a resolution of 0.1 pm have allowed one to establish a refractive index detection limit of 2.1x10(-5).

Paraganglioma of the bile duct.

We report the case of a 28-year-old woman with a 3-month history of right upper quadrant abdominal pain. Medical history and physical examination were unremarkable. Abdominal ultrasonography showed a dilated gallbladder, suggestive of gallstones, without bile duct dilatation. Serum chemistry values were normal. Laparoscopic cholecystectomy was planned, and a mass encircling the common bile duct was found. The procedure was converted to an open operation, and cholecystectomy, mass excision, and hepaticojejunostomy were done. The specimen was interpreted as paraganglioma of the bile duct. There were no manifestations of catecholamine hypersecretion or signs of biliary obstruction. Six years later, the patient is asymptomatic without signs of recurrence. This is the third report of paraganglioma of the hepatic ducts. We describe the clinical and pathologic findings and therapeutic approach in this unusual case and review the literature.

DEADSouth is a germ plasm specific DEAD-box RNA helicase in Xenopus related to eIF4A.

DEADSouth was selected in a screen for localized RNAs in Xenopus oocytes. In situ hybridization analysis shows that DEADSouth localizes to the vegetal cortex via the mitochondrial cloud early in oogenesis and segregates with germ plasm during early embryogenesis. These results lend further support for the general concept that the role of the early RNA localization pathway in Xenopus is to localize germ cell components (reviewed in King, M.L., Zhou, Y., Bubunenko, M. , 1999. BioEssays 21, 546-557). Further analysis shows that DEADSouth is a germline specific RNA, found exclusively within the germ plasm of oocytes and PGCs, as well as in male germ cells. Sequence comparisons with DEADSouth show it to be a member of a small sub-family of the DEAD-box RNA-dependent helicases related to eIF4A.

Early pregnancy nausea and vomiting in a high-altitude Andean population.

OBJECTIVES: We examined the prevalence, risk factors, and maternal-neonatal consequences of early pregnancy nausea and vomiting (NVP) in a high altitude Ecuadorian Andean population. METHODS: Subjects were 1000 low-income urban primigravidas who delivered full-term pregnancies. RESULTS: NVP prevalence was 67%. Decreased NVP risk was associated with higher altitude and increased risk with less education, common law marriage, and white collar/professional occupation. Lifestyle changes associated with NVP included decreased likelihood of drinking and outside employment but increased probability of prenatal care, supportive living arrangements, and dietary disturbances. NVP had no apparent long-term effect on maternal nutritional status but was associated with increased fetal subcutaneous fat reserves. CONCLUSIONS: NVP prevalence and timing was similar to developed populations although some of the identified risk factors were unique to the group. NVP did not appear to have a significant impact on prenatal nutrition at term but was linked with increased fetal fat accumulation.

Laparoscopic vasectomy.

A case is presented in which a laparoscopic vasectomy was performed concomitantly with laparoscopic hernia repair. A laparoscopic vasectomy should not replace an office procedure done under local anesthesia and minimal complications. Reanastomosis after laparoscopic vasectomy is a more complicated procedure. The additional benefit of laparoscopic surgery to those men who desire infertility while having elective pelvic laparoscopic procedures is presented.

A mRNA localized to the vegetal cortex of Xenopus oocytes encodes a protein with a nanos-like zinc finger domain.

mRNAs concentrated in specific regions of the oocyte have been found to encode determinants that specify cell fate. We show that an intermediate filament fraction isolated from Xenopus stage VI oocytes specifically contains, in addition to Vg1 RNA, a new localized mRNA, Xcat-2. Like Vg1, Xcat-2 is found in the vegetal cortical region, is inherited by the vegetal blasomeres during development, and is degraded very early in development. Sequence analysis suggests that Xcat-2 encodes a protein that belongs to the CCHC RNA-binding family of zinc finger proteins. Interestingly, the closest known relative to Xcat-2 in this family is nanos, an RNA localized to the posterior pole of the Drosophila oocyte whose protein product suppresses the translation of the transcription factor hunchback. The localized and maternally restricted expression of Xcat-2 RNA suggests a role for its protein in setting up regional differences in gene expression that occur early in development.

DNA sequence and transcript mapping of a soybean gene encoding a small heat shock protein.

The DNA sequence of a gene (Gmhsp17.5-E) encoding a small heat shock protein of soybean, Glycine max, has been determined. Nuclease S1 mapping of the 5' terminus of the corresponding RNA indicates that the start site for transcription is located 82 bases upstream from the coding region and 24 bases downstream from a "TATA"-like region (-T-T-T-A-A-A-T-A-). The 5' flanking region of Gmhsp17.5-E contains two imperfect dyads that closely resemble regulatory elements present in the promoters of heat-inducible genes of Drosophila. One, positioned 18 bases upstream from the TATA-like region, shows 90% homology to the Drosophila heat shock consensus sequence. The other overlaps an upstream TATA sequence and is located at position -213. Analysis of the derived amino acid sequence indicates that the protein encoded by Gmhsp17.5-E is related structurally to the four small heat shock proteins of Drosophila. This relationship is most evident by comparison of hydropathy profiles; they show conservation of several major hydrophilic and hydrophobic regions, which suggests that these proteins have common structural features.