Functional Gains Using Radial and Combined Shockwave Therapy in the Management of Achilles Tendinopathy.

Achilles tendinopathy is a common condition and many patients have functional limitations after initial conservative treatment. Shockwave therapy has been shown to improve function within patients; however, comparative outcomes for different forms of shockwave are poorly described. In this retrospective cohort study, we describe findings from a quality improvement initiative evaluating safety and functional outcomes after treatment with radial shockwave therapy (n = 58) or combined radial and focused shockwave therapy (n = 29) for patients with Achilles tendinopathy refractory to exercise therapy. All patients were prescribed an eccentric exercise program. We hypothesized both groups would see improvements in function quantified using the Victorian Institute of Sports Assessment-Achilles with similar safety outcomes. Overall, the minimal clinically important difference (defined at 7 for insertional and 12 for noninsertional Achilles tendinopathy) was met in a greater proportion of patients treated with combined shockwave compared to radial shockwave (26 [89.7%] vs 37 [63.8%], p = .022). The change in Victorian Institute of Sports Assessment-Achilles from baseline to final treatment was not different between combined and radial-only groups (23.3 ± 12.6 vs 19.9 ± 18.7, p = .2). Within group differences from baseline to final follow-up measures (mean duration 17.9 ± 14.8 weeks) demonstrated overall functional improvement for both groups (both p < .0001). No serious adverse effects were observed. Our findings suggest combined radial and focused shockwave therapy may provide more predictable functional gains for treatment of Achilles tendinopathy compared to radial shockwave therapy.

The effect of informative video before the procedure on anxiety levels in patients who will have ureteral stent removal under local anesthesia.

OBJECTIVE: Our objective was to assess the impact of video-animated information on the anxiety levels of patients undergoing ureteral stent removal under local anesthesia. METHOD: The study was designed as a randomized prospective trial. The one group received only verbal and written information before the surgery, while the other group received video-animated information in addition to the written and verbal instructions. The patients' anxiety levels were assessed using the STAI-S and STAI-T questionnaires, while their pain scores were evaluated using VAS scores. Tolerability and satisfaction scores were also evaluated on a 5-point Likert scale. RESULTS: The video-group (Group 1) consisted of 74 patients, while the non-video group (Group 2) consisted of 82 patients. The mean pre-information STAI-T score was 34.4 ±â€¯3.7 in Group 1 and 35.2 ±â€¯3 in the Group 2 (p = 0.113). In the video group, pre-information STAI-S scores was 34.8 ±â€¯3.3 and post-information STAI-S scores was 33.8 ±â€¯3 (p < 0.001). In the non-video group, pre-information STAI-S score was 35.6 ±â€¯2.6 and post-information STAI-S score was 35.5 ±â€¯2.7 (p = 0.260). The mean VAS score of Group 1 is 5.7 ±â€¯1.2 and Group 2 is 5.7 ±â€¯1.4 (p = 0.608). The mean tolerability scores of Group 1 and Group 2 were 3.7 ±â€¯0.9 and 2.7 ±â€¯1, respectively. The mean satisfaction scores of Group 1 and Group 2 were 4.1 ±â€¯0.9 and 2.6 ±â€¯1, respectively. Both tolerability score and satisfaction score improved statistically significantly after video information (p < 0.001). CONCLUSION: Providing video-animated information in addition to written and verbal information before removing the ureteral stent reduces patients' preoperative anxiety. Furthermore, patient tolerance and satisfaction are higher when informative videos are included.

Ultrafast hot-carrier dynamics in ultrathin monocrystalline gold.

Applications in photodetection, photochemistry, and active metamaterials and metasurfaces require fundamental understanding of ultrafast nonthermal and thermal electron processes in metallic nanosystems. Significant progress has been recently achieved in synthesis and investigation of low-loss monocrystalline gold, opening up opportunities for its use in ultrathin nanophotonic architectures. Here, we reveal fundamental differences in hot-electron thermalisation dynamics between monocrystalline and polycrystalline ultrathin (down to 10 nm thickness) gold films. Comparison of weak and strong excitation regimes showcases a counterintuitive unique interplay between thermalised and non-thermalised electron dynamics in mesoscopic gold with the important influence of the X-point interband transitions on the intraband electron relaxation. We also experimentally demonstrate the effect of hot-electron transfer into a substrate and the substrate thermal properties on electron-electron and electron-phonon scattering in ultrathin films. The hot-electron injection efficiency from monocrystalline gold into TiO2, approaching 9% is measured, close to the theoretical limit. These experimental and modelling results reveal the important role of crystallinity and interfaces on the microscopic electronic processes important in numerous applications.

Retrospective evaluation of the efficacy of daily paroxetine/tadalafil combination in patients with premature ejaculation and erectile dysfunction.

OBJECTIVE: Premature ejaculation (PE) and erectile dysfunction (ED) are sexual dysfunction diseases affecting males. The phosphodiesterase type 5 (PDE5) inhibitors such as tadalafil are used to treat ED whereas selective serotonin reuptake inhibitors (SSRIs) are preferred for PE. Most of the patients with ED also suffer from PE simultaneously. The combined drug therapies are commonly preferred as they favor elevated intra-vaginal ejaculation latency time (IELT) scores and improved sexual function. The study aimed to evaluate the efficacy and safety of daily paroxetine and tadalafil combination therapy in patients with PE and ED. PATIENTS AND METHODS: A total of 81 PE patients with ED were enrolled in the study. Patients were treated with daily paroxetine 20 mg and tadalafil 5 mg for 4 weeks. Pre- and post-treatment IELT, premature ejaculation profile (PEP), and International Index of Erectile Function-Erectile Function (IIEF-EF) scores of the patients were analyzed. RESULTS: The mean IELT and PEP index scores, and mean IIEF-EF values improved after combination therapy (p<0.001 for each). When lifelong and acquired PE+ED patients were compared, significant improvements were observed in IELT, PEP, and IIEF-EF scores in both groups (p<0.001). CONCLUSIONS: Even though the treatment methods are different, combined therapies to treat simultaneous PE and ED presence are effective compared to monotherapies. However, there is still no definitive treatment that can cure all subtypes of PE or ED.

Transport and Interfacial Injection of d-Band Hot Holes Control Plasmonic Chemistry.

Harnessing nonequilibrium hot carriers from plasmonic metal nanostructures constitutes a vibrant research field with the potential to control photochemical reactions, particularly for solar fuel generation. However, a comprehensive understanding of the interplay of plasmonic hot-carrier-driven processes in metal/semiconducting heterostructures has remained elusive. In this work, we reveal the complex interdependence among plasmon excitation, hot-carrier generation, transport, and interfacial collection in plasmonic photocatalytic devices, uniquely determining the charge injection efficiency at the solid/liquid interface. Measuring the internal quantum efficiency of ultrathin (14-33 nm) single-crystalline plasmonic gold (Au) nanoantenna arrays on titanium dioxide substrates, we find that the performance of the device is limited by hot hole collection at the metal/electrolyte interface. Our solid- and liquid-state experimental approach, combined with ab initio simulations, demonstrates more efficient collection of high-energy d-band holes traveling in the [111] orientation, enhancing oxidation reactions on {111} surfaces. These findings establish new guidelines for optimizing plasmonic photocatalytic systems and optoelectronic devices.

Identification of post-transplant lymphocele using lymphatic mapping with isosulphane blue.

Lymphocele development after renal transplantation is a well-recognized complication that occurs with the incidence of 0.6-18%. Although the majority of patients are asymptomatic, post-renal transplant lymphocele continues to be a major cause of morbidity if it is left untreated. The standard approach for the treatment of symptomatic lymphoceles is accepted to be laparoscopic or open marsupialization in many centers if simple drainage and conservative measures fail. However, marsupialization is almost impossible under certain circumstances, such as in the case of excessive abdominal adhesions. Hence, direct visualization of the lymphatic leak and suture ligation may become inevitable, which is usually a challenging procedure for the surgeon. Herein we report a case of post-renal transplant lymphocele treated by the direct identification and suture ligation of injured lymphatic vessel using a new method similar to sentinel lymph node detection using the dye isosulphane blue.

Synthesis & Anticancer Evaluation of New Substituted 2-(3,4- Dimethoxyphenyl)benzazoles.

BACKGROUND: The benzazole nucleus is found in many promising small molecules such as anticancer and antibacterial agents. Bendamustine (Alkylating agent), Nocodazole (Mitotic inhibitor), Veliparib (PARP inhibitor), and Glasdegib (SMO inhibitor) are being clinically used as anticancer therapeutic which bear benzimidazole moiety. Based on the principle of bioisosterism, in the present work, 23 compounds belonging to 2-(3,4-dimethoxyphenyl)benzazoles and imidazopyridine series were synthesized and evaluated for their anticancer and antimicrobial activities. OBJECTIVE: A series of new 2-(3,4-dimethoxyphenyl)-1H-benz(or pyrido)azoles were synthesized and evaluated for their anticancer and antimicrobial activities. METHOD: N-(5-chloro-2-hdroxyphenyl)-3,4-dimethoxybenzamide 1, was obtained by the amidation of 2-hydroxy-5-chloroaniline with 3,4-dimethoxybenzoic acid by using 1,1'-carbonyldiimidazole. Cyclization of 1 to benzoxazole derivative 2, was achieved by p-toluenesulfonic acid. Other 1H-benz(or pyrido)azoles were prepared by the reaction between 2-aminothiophenol, ophenylenediamine, o-pyridinediamine with sodium metabisulfite adduct of 3,4-dimethoxybenzaldehyde. The NMR assignments of the dimethoxy groups were established by the NOESY spectra. RESULTS: Compound 12, bearing two chlorine atoms at the 5(4) and 7(6) positions of the benzene moiety of benzimidazole was found the most potent analogue against A549 cells with the GI50 value of 1.5 µg/mL. Moreover, 24 showed remarkable cell growth inhibition against MCF-7 and HeLa cells with the GI50 values of 7 and 5.5 µg/mL, respectively. The synthesized compounds have no important antibacterial and antifungal activities. CONCLUSION: It could be concluded that the introduction of di-chloro atoms at the phenyl ring of 2-(3,4-dimethoxyphenyl)-1H-benzimidazoles increases significant cytotoxicity to selected human tumor cell lines in comparison to other all benzazoles synthesized. Unsubstituted 2-(3,4- dimethoxyphenyl)-imidazopyridines also gave good inhibitory profile against A549 and HeLa cells.

Treatment of the textile wastewater by combined electrocoagulation.

Electrocoagulation (EC) due to some advantages over chemical coagulation is becoming a popular process to be used for wastewater treatment. The aim of this paper is to investigate the effect of initial addition of a chemical coagulant such as polyaluminum chloride (PAC) or alum on the COD removal efficiency of EC treatment of textile wastewaters. The two salts exhibited the same performance in chemical coagulation, but in the combined electrocoagulation (CEC), PAC was found to significantly enhance the COD removal rate and efficiency, depending on the amount of the total aluminum supplied, by initial addition and electrochemical generation. A comparative operating cost analysis was also given and it was found that with the same operating cost per mass of COD removed, CEC performance was 80%, in contrast to 23% with EC, in 5 min of operation.

Treatment of levafix orange textile dye solution by electrocoagulation.

The decolorization of the levafix orange textile dye in aqueous solution by electrocoagulation using aluminum sacrificial anode has been investigated. The process performance is analyzed in terms of decolorization efficiency and the important cost-related parameters such as electrode and energy consumptions, as a function of initial pH, conductivity, current density, initial dye concentration and electrolysis time. The present study proves the effectiveness of electrochemical treatment for the textile dye solution. 95% decolorization efficiency may be obtained at suitable operating conditions such as; current density 100 A/m(2), operating time 12 min and initial pH 6.4. The corresponding electrode and energy consumptions during the electrolysis were found to be 1.8 kg Al/kg dye and 35 k Wh/kg dye.

The administration sequence of propofol and remifentanil does not affect the ED50 and ED95 of rocuronium in rapid sequence induction of anesthesia: a double-blind randomized controlled trial.

OBJECTIVE: The topic of drug administration sequence in rapid sequence induction (RSI) is still an object of interest in terms of rocuronium effectiveness. The aim of this prospective, randomized trial was to evaluate the effect of administration sequence of propofol and remifentanil on ED50 and ED95 of rocuronium in a RSI model. PATIENTS AND METHODS: Eighty-four patients were randomized into Group Remifentanil (Group R, n = 43), where induction of general anesthesia started with remifentanil (2 µg/kg) and followed by propofol (2 mg/kg) and rocuronium administrations; and Group Propofol (Group P, n = 41), where induction of general anesthesia started with propofol and followed by remifentanil and rocuronium. First patients in each group were paralyzed by 0.8 mg/kg rocuronium. In case of acceptable intubation as evaluated according to the criteria described by Viby-Mogensen et al, rocuronium dose was decreased by 0.1 mg/kg for the next patient; otherwise, rocuronium dose was increased by 0.1 mg/kg. After three crossover points, increments or decrements in rocuronium dosage were set to 0.05 mg/kg. The process was repeated until a total of ten crossover points were obtained. RESULTS: The ED50 and ED95 doses of rocuronium were similar in Group R (0.182 mg/kg, and 0.244 mg/kg, respectively) and Group P (0.121 mg/kg, and 0.243 mg/kg, respectively) according to 95% CI of the estimates. There was no statistically significant difference in terms of clinically acceptable intubation conditions between the two groups (56.1% in Group R vs. 59% in Group P, p = 0.795). CONCLUSIONS: The choice of administration sequence of propofol and remifentanil does not have an impact on estimated ED50 and ED95 of rocuronium in providing acceptable intubation conditions in the RSI technique.

Tacrolimus-Induced Diabetic Ketoacidosis and Effect of Switching to Everolimus: A Case Report.

BACKGROUND: New-onset diabetes after transplantation (NODAT) is a common metabolic complication. Most conventional immunosuppressive medications, especially steroids and tacrolimus, are responsible for its development. NODAT may rarely be associated with severe, life-threating complications in kidney transplantation recipients. CASE REPORT: A 44-year-old man was admitted to our polyclinic for a routine post kidney transplantation visit. He reported polyuria, polydipsia, and general weakness. The patient had undergone preemptive, living-related kidney transplantation 5 weeks previously. Immunosuppressive treatment comprised tacrolimus, prednisolone, and mycophenolate mofetil. Physical examination revealed no abnormalities except signs of mild dehydration. Although he had no history of diabetes before kidney transplantation and his serum fasting glucose levels were within the reference range at the follow-up visits, his laboratory tests revealed high serum glucose and creatinine levels, ketosis, and metabolic acidosis. Our diagnosis was NODAT with diabetic ketoacidosis and prerenal azotemia. Initial treatment comprised intravenous saline and insulin infusion and subsequently involved intensive subcutaneous insulin administration. Despite the intensive insulin therapy and reduction of the tacrolimus dose, sufficient glucose regulation was not achieved. Tacrolimus was switched to everolimus on day 6 of hospitalization. The patient's insulin requirement gradually decreased to one-half of the primary dose over the following several days, and he was discharged on day 10 with successful serum glucose regulation. Although the diabetogenic potential of sirolimus is similar to that of tacrolimus, the impact of everolimus on glucose metabolism remains unclear. CONCLUSIONS: We have reported a life-threating metabolic complication associated with tacrolimus and successful treatment of NODAT by switching from tacrolimus to everolimus.

Successful Ultrasound-Guided Percutaneous Drainage of Multiple Splenic Abscesses in a Kidney Transplant Patient With Encapsulated Sclerosing Peritonitis: A Case Report.

Differential diagnosis of post-transplant infections should include rare/uncommon foci and pathogens. We present a rare case of life-threatening infection, a splenic abscess in a 53-year-old woman who was transplanted with a cadaveric kidney 5 months previously. The patient was admitted to our clinic with chills, shivering, and fever. She required a kidney transplant because of end-stage renal disease secondary to systemic lupus erythematosus, which had previously been treated by means of peritoneal dialysis for 7 years, until encapsulated sclerosing peritonitis developed, at which time therapy was changed to hemodialysis for 1 year. On physical examination, the patient was slightly lethargic and had tenderness in the left upper quadrant of the abdomen. Laboratory evaluation revealed leukocytosis and high acute phase reactant. Abdominal ultrasonography (US) revealed multiple abscesses in the spleen, but splenectomy was not recommended because of her history of sclerosing peritonitis. Percutaneous drainage catheters were placed under US guidance. Culture of blood and fluid drained from the abscess revealed imipenem-sensitive Escherichia coli and Klebsiella spp. Imipenem (500 mg IV q6hr) was initiated, and the drainage volume was 40 to 50 mL/day in the first week and gradually decreased through the third week. The abscess was completely drained over a period of 6 weeks, as confirmed by computed tomography; percutaneous catheters were then removed. Although splenic abscesses are life-threatening, especially for immunocompromised patients, this case suggests that percutaneous drainage guided by US or computed tomography is an efficient treatment alternative to splenectomy.

Factors Affecting the Selection of Patients on Waiting List: A Single Center Study.

INTRODUCTION: There is an increasing gap between organ supply and demand for cadaveric transplantation in our country. Our aim was to evaluate factors affecting selection of patients on waiting list at our hospital. METHOD: Patients who have been waiting on list and who were transplanted were compared in order to find factors, which affected the selection of patients. Non-parametric Mann-Whitney U test was used for comparison and cox regression analysis was used to find the risk factors that decrease the probability of transplantation in this retrospective case-control study. RESULTS: Patients in the transplanted group were significantly younger, had relatively lower body mass index than the awaiting group. Cardiovascular diseases were more in the awaiting group than the transplanted group. There was no patient with diabetes in transplanted group, despite fifteen diabetic patients were in the awaiting group. Selected patients had lower immunologic risk with regard to peak panel reactive antibody levels. No significant difference was found for gender, hypertension, hyperlipidemia, viral serology, time spent on dialysis and on waiting list between two groups. With cox regression analysis female gender, older age, diabetes mellitus, high body mass index, positive hepatitis B serology and high levels of peak class 1-2 peak panel reactive antibody positivity were found as risk factors that decrease the probability of transplantation. CONCLUSION: A tendency for selection of low risk patients was found with this study. Time and energy consuming complications and short allograft survival after transplantation in high risk patients and the scarcity of cadaveric pool in our country may contribute to this tendency.

Analgesic and antispasmodic activities of 2-(2-nitro-phenyl)-1H-benzimidazole 5-carboxylic acid: evidence for the importance of the 2-(o-substituted phenyl) group.

Benzimidazole 5-carboxylic acid derivatives were investigated for analgesic activity in this study. Of the benzimidazole compounds tested, 2-(2-nitro-phenyl)-1H-benzimidazole 5-carboxylic acid showed remarkable naloxone sensitive analgesic activity in the tail clamp but not in the tail immersion analgesia tests. This centrally active compound showed antispasmodic activity only on KCl induced contractions of isolated rat ileum and not on acetylcholine induced contractions. Acute toxicity of the compounds were >100 mg/kg i.p. mice. It was concluded that substitution of the 2(o-phenyl) by nitro- but not by chloro- or methoxy groups is important for naloxone sensititive analgesic activity of benzimidazole compounds and it was hypothetized that new imidazole compounds having a 2-(o-substituted phenyl) moiety needs to be investigated.

Pure laparoscopic versus open live donor nephrectomy: evaluation of health survey and graft functions.

BACKGROUND: Laparoscopic donor nephrectomy (LDN) has become the gold standard in many kidney transplantation centers seeking to increase the number of potential live donors. This study was designed to compare the health surveys and graft functions between LDN and open donor nephrectomy (ODN). METHODS: We retrospectively analyzed all patients who underwent donor nephrectomy between December 2005 and September 2009 who had at least 1 year of follow-up. We reviewed demographic data, operative time, warm ischemia period, graft function, and quality of life. RESULTS: Among the 132 cases, 98 were pure LDN and 34 were ODN. Demographic data were similar in both groups. Operative times were significantly longer in the ODN group but warm ischemia times significantly longer in the LDN group. However, graft functions were similar in both groups. There was 1 graft loss due to arterial thrombosis of the transplanted kidney among the LDN group. Short-Form 36 health survey scores were similar except for the role-physical subscale. CONCLUSION: Although we failed to observe a significant difference between ODN and LDN as far as the quality of life and graft functions were concerned, the previously documented advantages of laparoscopy with similar operative results suggest? LDN to be the gold standard for this procedure in our institution.

Living-donor hepatectomy.

BACKGROUND: Organ transplantation from deceased donors is still far below the need. Because of this deficiency, liver transplantations are performed mostly from live donors in many transplant centers in our country. Living-donor liver transplantation (LDLT) has evolved dramatically over the past decade. The aim of this study was to present our clinical experience with living-donor hepatectomy. METHODS: We retrospectively analyzed all patients who underwent donor hepatectomy between March 2000 and September 2010. We reviewed demographic data, operation type, operation and cold ischemia times, duration of hospital stay, and postoperative complications. RESULTS: During the study period, 140 living donors underwent operations for liver transplantation. We performed 108 right hepatectomies, 17 left hepatectomies, and 15 left lateral hepatectomies. The mean age of the donors was 30.8 years. There was no operative or postoperative mortality. Overall morbidity rate was 13.57% (n = 19). Nine patients had biliary leakages, 4 biliomas; 2 urinary tract infections, and 1 each inferior vena caval injury, pneumonia, portal vein thrombosis, and acute tubular necrosis. Reoperation was not required in any of these patients. CONCLUSIONS: Living-donor liver transplantation is a valuable alternative for patients awaiting a cadaver organ. Live-donor hepatectomy can be performed with low morbidity. The greatest disadvantage of this procedure is the risk of the surgical operation for the individual who will experience no medical benefit from this procedure.

Single stapler technique in laparoscopic donor nephrectomy.

BACKGROUND: Laparoscopic donor nephrectomy (LDN) is usually performed with at least 2 separate vascular staplers for division of the renal artery and vein. However, we used a single stapler regardless of the number of renal arteries and veins. Furthermore, the graft was quickly retrieved by hand without using an extraction bag using our technique. Herein we have presented our experience with LDN of grafts with single or multiple renal arteries and/or veins using a single stapler and hand removal. METHODS: We reviewed demographic data, operative and warm ischemia times, postoperative complications, and graft function. RESULTS: Between December 2005 and September 2009, we performed 85 cases with 1 renal artery (group LDN-1), 8 cases with two renal arteries (group LDN-2), and 5 cases with 3 or more renal arteries (group LDN-3). The demographic data among the groups were similar. The mean operative time was significantly longer among groups LDN-2 (100.3 ± 9.5 minutes) and LDN-3 (120.6 ± 10.3 minutes) compared with LDN-1 (76.1 ± 9.3 minutes; P < .001). Similar results were observed with respect to warm ischemia times. There were no significant differences related to graft function and outcomes among these groups. CONCLUSION: The single stapler and hand removal technique was safe, technically feasible, and cost effective regardless of the number of renal arteries and veins. This technique removes the necessity of additional staplers and extraction bags, lowers the operative and warm ischemia times, and thus decreases the cost.

The effect of process conditions on the treatment of benzoquinone solution by electrocoagulation.

The present study provides an electrocoagulation (EC) process for the removal of p-benzoquinone (BQ) from aqueous solution using aluminium as anode and stainless steel as cathode materials. Experiments carried out to investigate the effects of solution pH and conductivity, current density, time, BQ concentration on the removal efficiency of the process and the adsorption capacity of aluminium hydroxide electrocoagulant flocs. The results show that pH 7.5 seems to be optimum for high removal of BQ near 90% at typical operating conditions such as 20 A/m(2) current density and 20 min operating time. The competing reduction of BQ to hydroquinone (HQ) accompanying the H(+) reduction at the cathode and low removal extent of HQ by electrocoagulant flocs decreases the performance of the EC process.