Operating room noise hazards during laser lithotripsy: a comparison between the thulium fiber and holmium laser platforms.

PURPOSE: To evaluate and assess the impact of noise hazard during laser lithotripsy using the gold standard holmium:YAG laser and the novel thulium fiber laser (TFL). METHODS: Intraoperative noise measurements were obtained during ureteroscopy and laser lithotripsy from cases using both TFL and holmium laser. Readings were obtained from three key times: prior to laser activation, with the laser on but idle, and during laser activation. Questionnaires were circulated postoperatively to operating room staff regarding the effort required to perform tasks, concentrate, and communicate during the surgery. RESULTS: Noise levels were compared from 16 TFL and 15 holmium laser lithotripsy cases from 11/2020 to 5/2021. Significantly higher noise levels were recorded during holmium lithotripsy, with a mean of 3.1 dB and 4.3 dB higher noise with the device idle and device active, respectively. When compared to baseline noise with the device off, the holmium laser had a significant rise in recorded dB where the TFL had no statistically significant rise in noise over baseline once the laser was turned on. Operating room team members rated the noise level lower and the level of effort required for concentration, communication, and task completion lower with the TFL. CONCLUSIONS: The TFL produces 3.1 to 4.3 dB less noise than the standard holmium laser, which, because of the logarithmic nature of the dB scale, translates into less than one half the overall noise energy. There was also less effort required by operating room staff to complete critical tasks during the quieter TFL cases.

Population genomics and epigenomics of Spirodela polyrhiza provide insights into the evolution of facultative asexuality.

Many plants are facultatively asexual, balancing short-term benefits with long-term costs of asexuality. During range expansion, natural selection likely influences the genetic controls of asexuality in these organisms. However, evidence of natural selection driving asexuality is limited, and the evolutionary consequences of asexuality on the genomic and epigenomic diversity remain controversial. We analyzed population genomes and epigenomes of Spirodela polyrhiza, (L.) Schleid., a facultatively asexual plant that flowers rarely, revealing remarkably low genomic diversity and DNA methylation levels. Within species, demographic history and the frequency of asexual reproduction jointly determined intra-specific variations of genomic diversity and DNA methylation levels. Genome-wide scans revealed that genes associated with stress adaptations, flowering and embryogenesis were under positive selection. These data are consistent with the hypothesize that natural selection can shape the evolution of asexuality during habitat expansions, which alters genomic and epigenomic diversity levels.

Can the ROX index predict high-flow nasal cannula failure in children under 2 with lower respiratory tract infection?

OBJECTIVE: This study evaluates the ROX index's accuracy in predicting the success or failure of high-flow nasal cannula (HFNC) therapy in children under 2 years with acute respiratory failure (ARF) from lower respiratory tract infections. METHODS: From January 2018 to 2021 we conducted this multicenter retrospective cohort study, which included patients aged 2-24 months. We aimed to assess HFNC therapy outcomes as either success or failure. The analysis covered patient demographics, diagnoses, vital signs, and ROX index values at intervals from 0 to 48 h after initiating HFNC. We used bivariate analysis, repeated measures ANOVA, multivariate logistic regression, and the area under the receiver operating characteristic (AUC-ROC) curve for statistical analysis. RESULTS: The study involved 529 patients from six centers, with 198 females (37%) and a median age of 9 months (IQR: 3-15 months). HFNC therapy failed in 38% of cases. We observed significant variability in failure rates across different centers and physicians (p < .001). The ROX index was significantly associated with HFNC outcomes at all time points, showing an increasing trend in success cases over time (p < .001), but not in HFNC failure cases. Its predictive ability is limited, with AUC-ROC values ranging from 0.56 at the start to 0.67 at 48 h. CONCLUSION: While the ROX index is associated with HFNC outcomes in children under 2 years, its predictive ability is modest, impacted by significant variability among patients, physicians, and centers. These findings emphasize the need for more reliable predictive tools for HFNC therapy in this patient population.

Neuromuscular Paralysis is not a Barrier to Same Day Catheter Removal After HoLEP.

OBJECTIVE: To determine if same day catheter removal is feasible in a population of holmium laser enucleation of the prostate patients who received paralysis and if bladder pressure monitoring could predict successful catheter removal. METHODS: From February 2021 to February 2022, we evaluated same day catheter removal for patients undergoing holmium laser enucleation of the prostate. Criteria for proceeding with same day catheter removal included: an uncomplicated procedure, continuous bladder irrigation weaned within 120 minutes of arrival to PACU, minimal postoperative hematuria and a bladder pressure over 30 cmH20 as measured using the VP Test device (SRS Medical). RESULTS: One hundred and eight patients were enrolled, with a median age of 68 years (IQR: 62.0-73.0) and prostate volume 80.8cc (IQR: 64.8-112.3). Criteria for catheter removal was met by 83/108 (76.9%) patients. Of those that attempted a trial of void, 69/83 passed for an effective pass rate of 83.1%. Median maximum detrusor pressure for those that passed and failed were 51.0 cmH20 (IQR: 40.5 -68.0) and 48.0 cmH20 (IQR: 38.8-61.8) [P = .53], respectively. Intraoperative Lasix administration was associated with a higher rate of trial of void (TOV) success and preoperative PVR was associated with lower TOV success, with OR (95%CI) of 5.8 (1.4, 29.5) [P = .02] and 0.6 (0.4, 0.9) [P = .01], respectively. CONCLUSION: Same day catheter removal is feasible in those who receive neuromuscular paralysis, with a success rate >80%. Bladder pressure monitoring did not assist with differentiating which patients will pass or fail a trial of void. Intraoperative Lasix administration may be helpful in increasing success for same day catheter removal while elevated preoperative PVR was associated with TOV failure.

Repeatability and reproducibility of the color contrast technique for fingermark age estimation applications.

This research complements previous studies in which color contrast between ridges and furrows of latent fingermarks was investigated as a potential aging parameter. In this case, the robustness of the technique has been tested by including five female and five male donors who deposited sebaceous-rich latent fingermarks onto ceramic tile and polystyrene plastic as well as flat and rolled inked fingerprints on commercially available ten-print cards. Fresh latent fingermarks were visualized with either carbon black or titanium dioxide powder (TiO2 ) and inked fingerprints were imprinted in succession without re-charging ink. The mean intensity (MI) and intensity amplitude (IA) metrics of the color histogram were collected from each image for statistical analyses. The goals were to detect any differences within and between the analysts' own interpretation of the protocol as well as examine how color contrast may be influenced by donor, substrate, biological sex, powder type, and the quantity of ink deposited. Results show that the color contrast metrics (MI and IA) are repeatable and reproducible and not affected significantly by donor, sex, deposition pressure, or distortion. However, the metrics were sufficiently sensitive to distinguish substrate and powder types and to detect different quantities of ink. The statistical analyses confirm and expand upon previous observations regarding the reliability of MI and IA as metrics that could eventually be used to estimate the age of a latent fingermark. At the same time, it was revealed that the technique needs further improvement and standardization by including a universal "white color standard" to conduct image comparisons.

Past and Recent Effects of Livestock Activity on the Genetic Diversity and Population Structure of Native Guanaco Populations of Arid Patagonia.

Extensive livestock production and urbanization entail modifications of natural landscapes, including installation of fences, development of agriculture, urbanization of natural areas, and construction of roads and infrastructure that, together, impact native fauna. Here, we evaluate the diversity and genetic structure of endemic guanacos (Lama guanicoe) of the Monte and Patagonian Steppe of central Argentina, which have been reduced and displaced by sheep ranching and other impacts of human activities. Analyses of genetic variation of microsatellite loci and d-loop revealed high levels of genetic variation and latitudinal segregation of mitochondrial haplotypes. There were indications of at least two historical populations in the Monte and the Patagonian Steppe based on shared haplotypes and shared demographic history among localities. Currently, guanacos are structured into three groups that were probably reconnected relatively recently, possibly facilitated by a reduction of sheep and livestock in recent decades and a recovery of the guanaco populations. These results provide evidence of the genetic effects of livestock activity and urbanization on wild herbivore populations, which were possibly exacerbated by an arid environment with limited productive areas. The results highlight the importance of enacting conservation management plans to ensure the persistence of ancestral and ecologically functional populations of guanacos.

Genetic Variation in Coat Colour Genes MC1R and ASIP Provides Insights Into Domestication and Management of South American Camelids.

The domestication of wild vicuña and guanaco by early pre-Inca cultures is an iconic example of wildlife management and domestication in the Americas. Although domestic llamas and alpacas were clearly selected for key, yet distinct, phenotypic traits, the relative patterns and direction of selection and domestication have not been confirmed using genetic approaches. However, the detailed archaeological records from the region suggest that domestication was a process carried out under significant control and planning, which would have facilitated coordinated and thus extremely effective selective pressure to achieve and maintain desired phenotypic traits. Here we link patterns of sequence variation in two well-characterised genes coding for colour variation in vertebrates and interpret the results in the context of domestication in guanacos and vicuñas. We hypothesise that colour variation in wild populations of guanacos and vicunas were strongly selected against. In contrast, variation in coat colour variation in alpaca was strongly selected for and became rapidly fixed in alpacas. In contrast, coat colour variants in llamas were of less economic value, and thus were under less selective pressure. We report for the first time the full sequence of MC1R and 3 exons of ASIP in 171 wild specimens from throughout their distribution and which represented a range of commonly observed colour patterns. We found a significant difference in the number of non-synonymous substitutions, but not synonymous substitutions among wild and domestics species. The genetic variation in MC1R and ASIP did not differentiate alpaca from llama due to the high degree of reciprocal introgression, but the combination of 11 substitutions are sufficient to distinguish domestic from wild animals. Although there is gene flow among domestic and wild species, most of the non-synonymous variation in MC1R and ASIP was not observed in wild species, presumably because these substitutions and the associated colour phenotypes are not effectively transmitted back into wild populations. Therefore, this set of substitutions unequivocally differentiates wild from domestic animals, which will have important practical application in forensic cases involving the poaching of wild vicuñas and guanacos. These markers will also assist in identifying and studying archaeological remains pre- and post-domestication.

Panel experiencia clinica e investigación científica / Panel of clinic experience and scientific research

La práctica clínica diaria nos enfrenta a un gran número de pacientes, de casos y de datos. Sin embargo si nos comparamos con otros paises nos damos cuenta que no estamos generando investigación, las posibles causas son: 1) Falta de educación y de incentivos desde el pregrado. 2) Desconocimiento del proceso investigativo. 3) Carga asistencial grande. 4) Desconocimiento de que hacer con los resultados de la investigación. La verdadera utilidad de los estudios radica en que se obtengan conclusiones válidas o que se acerquen a la verdad, esto se fundamenta primero en que los eventos de la población de estudio se acerquen a la verdad (validez interna) para en segunda instancia poder generalizarlos a la población blanco (validez externa). Las claves para desarrollar una investigación científica son: 1) Que sea factible. 2) Interesante. 3) Novedosa. 4) Etica. 5) Relevante. En su formulación debe ser clara y concisa, antes de iniciar el proceso debemos preguntarnos con respecto a la factibilidad del estudio, desde tres puntos de vista: económico, logístico y temporal.

Comparacion de la satisfaccion del paciente con la utilizacion de dos tecnicas analgesicas para cirugia de Manguito Rotador / Comparison of the patient satisfaction with the use of two analgesic techniques in rotator cuff surgery

Comparación de la satisfacción del paciente con la utilización de dos técnicas analgésicas para cirugía de manguito rotador. Comparar la satisfacción global del paciente con dos técnicas analgésicas diferentes en el postoperatorio de cirugía del manguito rotador Análisis interino de un estudio experimental, se aleatorizan 25 pacientes a dos tratamientos analgésicos: Administración de anestésicos locales por catéter interescalénico (IE) o por catéter subacromial (SA) colocado por visión directa más infusión continua de los mismos durante 12 horas. Se mide secuencialmente: intensidad del dolor en el postoperatorio inmediato del paciente, a las 4 horas y a las 12 horas, bloqueo sensitivo, satisfacción global del paciente y del cirujano. Se realiza un análisis inferencial de los datos. La satisfacción global de los pacientes con las dos técnicas fue del 66.7 por ciento, la satisfacción del cirujano fue del 55 por ciento. De forma diferencial la satisfacción para los pacientes con catéter interescalénico fue del 50 por ciento comparado con el 80 por ciento del catéter subacromial. La satisfacción del cirujano con el manejo IE fue del 37.5 por ciento y con el SA del 70 por ciento. La intensidad del dolor fue mayor en el grupo subacromial en el postoperatorio inmediato y las 4 horas. La relación se invierte en la evaluación alas 12 horas. La presentación de bloqueo sensitivo es mas frecuente con catéter interescalénico. Se realiza un análisis interino para evaluar la efectividad de la técnica. A pesar de las cifras mas elevadas de presentación de dolor severo con el uso del catéter subacromial fue este grupo el que refirió mayor satisfacción global, resultado influenciado por diferentes factores que impiden la rehabilitación temprana en el postoperatorio. Se plantea la utilización del catéter subacromial como alternativa analgésica en la cirugía de manguito rotador cuando existe imposibilidad o contraindicación para la utilización del bloqueo interescalénico

Infusión Peridural Continua vs PCA en trabajo de parto

El objeto del presente estudio prospectivo y randomizado está dirigido a delimitar el menor consumo de anestésicos locales en dosis efectivas para el control del dolor en el trabajo de parto en 46 pacientes jóvenes ASA I o II, primigestantes o secundigestantes, con feto único en presentación cefálica, con embarazo sin complicaciones maternas o fetales mayores de 36 semanas, sin antecedentes de cesárea; para la cual se estudió un universo de 150 pacientes a quienes se les aplicó anestesia peridural en dilatación cervical de 4-5 centimetros con dosis basal fija de bupivacaína al 0.375 por ciento y 7 cc. y fentanyl 2 cc. Se hizo punción peridural en espacios LII-LIII y LIV-LV, colocando en todas catéter peridural con instalación al azar de Infusión Peridural Continua (IPC) dosis fija de 10 mlts/hora en concentración de bupivacaína al 0.125 por ciento con fentanyl 1 mcgr/ml, o Dosis a Demanda por Paciente (PCA) 3 mls, por infusión con un máximo permitido efectivo de seis disparos a la hora en intervalos de 10 minutos, a iguales concentraciones. En ambos grupos se dio inicio a la infusión peridural continua o la dosis a demanda luego de 60 minutos de la dosis basal. Distintos pediatras evaluaron el estado del RN por test de Apgar y Amiel.Tison. Del grupo se excluyeron 104 pacientes por completar la dilatación a la hora siguiente de la aplicación de la dosis basal, requerir mas de dos refuerzos anestésicos o por haber decidido intervención cesárea en cualquier momento de la infusión peridural, procedimiento que en nuestra institución promedia un 47 por ciento del total de nacimientos. La analgesia evaluada por escala visual análoga fue similar en los grupos con una moderada reducción en el consumo total de anestésico en las pacientes asignadas al grupo IPC=40.826 mgs mas 14.0216 mgs; PCA 44.500 mgs mas 24.1694 mgs. La dosis de fentanyl en el grupo IPC= 120.2174 mcgrs mas menos 10.63 mcgrs PCA 11.0870 mcgrs mas menos 40.79 mcgrs (truncado 2.500 caracteres)