Long-term outcome of urethral and genital reconstruction in hypospadias and exstrophy-epispadias complex.

PURPOSE OF REVIEW: Although immediate surgical outcomes of genitourinary reconstruction used to be the main focus in hypospadias and exstrophy-epispadias complex (EEC), recent research demonstrates rising concerns about long-term functional and psychosexual outcomes. Recent results about long-term outcomes of complex genitourinary reconstruction in those children transitioning into adulthood are summarized and discussed in this comprehensive review. RECENT FINDINGS: Long-term outcomes in hypospadias focus on psychosexual satisfaction and decisional regret. Interestingly, uncomplicated hypospadias repair results in equal satisfaction rates to those found in controls. Most adult patients are happy with their parents' decision to have them undergo surgery during childhood. No decisional regret was found in parents. Reinterventions were associated with a decline in satisfaction, as was a decrease in perceived penile length. Long-term, males with EEC are more dissatisfied with penile length than with continence problems. In cases of severe penile insufficiency, phalloplasty shows promising psychosexual outcomes at the price of a high complication rate. Female EEC patients show higher rates of pregnancy complications, portending a higher risk of miscarriage. SUMMARY: Psychosexual satisfaction of patients with repaired hypospadias transitioning into adulthood demonstrates equal satisfaction rates to those found in controls, without decisional regret associated with surgery during childhood. In EEC, more complications are seen when transitioning into a sexually active adult life.

Pediatric Challenges in Robot-Assisted Kidney Transplantation.

Kidney transplantation is universally recognized as the gold standard treatment in patients with End-stage Kidney Disease (ESKD, or according to the latest nomenclature, CKD stage 5). Robot-assisted kidney transplantation (RAKT) is gradually becoming preferred technique in adults, even if applied in very few centra, with potentially improved clinical outcomes compared with open kidney transplantation. To date, only very few RAKT procedures in children have been described. Kidney transplant recipient patients, being immunocompromised, might be at increased risk for perioperative surgical complications, which creates additional challenges in management. Applying techniques of minimally invasive surgery may contribute to the improvement of clinical outcomes for the pediatric transplant patients population and help mitigate the morbidity of KT. However, many challenges remain ahead. Minimally invasive surgery has been consistently shown to produce improved clinical outcomes as compared to open surgery equivalents. Robot-assisted laparoscopic surgery (RALS) has been able to overcome many restrictions of classical laparoscopy, particularly in complex and demanding surgical procedures. Despite the presence of these improvements, many challenges lie ahead in the surgical and technical-material realms, in addition to anesthetic and economic considerations. RALS in children poses additional challenges to both the surgical and anesthesiology team, due to specific characteristics such as a small abdominal cavity and a reduced circulating blood volume. Cost-effectiveness, esthetic and functional wound outcomes, minimal age and weight to undergo RALS and effect of RAKT on graft function are discussed. Although data on RAKT in children is scarce, it is a safe and feasible procedure and results in excellent graft function. It should only be performed by a RAKT team experienced in both RALS and transplantation surgery, fully supported by a pediatric nephrology and anesthesiology team. Further research is necessary to better determine the value of the robotic approach as compared to the laparoscopic and open approach. Cost-effectiveness will remain an important subject of debate and is in need of further evaluation as well.

Brain oxygen balance under various experimental pathophysiologycal conditions.

Normally, brain tissue copes with negative oxygen balance by increasing cerebral blood flow (CBF). We examined the effects of increasing oxygen demand, by inducing spreading depression (SD) under various oxygen balance states, on brain O2 balance. The Tissue Vitality Monitoring System was used, which enables real time simultaneous in vivo monitoring of CBF, mitochondrial NADH and tissue HbO2 from the same region of the cerebral cortex. SD was induced during normoxia, hypoxia, hyperoxia, ischemia, and in normal and ischemic brain after systemic epinephrine administration. Under normoxia, hyperoxia and ischemia & epinephrine, the compensation of energy demand induced by SD, was carried out by increasing CBF. The higher oxygen delivery under hyperoxia and epinephrine did not change the pattern of recovery from SD as compared to normoxia, whereas in the ischemic and hypoxic brain, the recovery from SD was prolonged, indicating a lake in oxygen delivery. Epinephrine infusion in the ischemic rat, decreased oxyhemoglobin utilization during SD, indicating that tissue oxygen balance improves even under higher oxygen demand induced by SD.

Examining maternal influence on OLETF rats' early overweight: insights from a cross-fostering study.

Obese female Otsuka Long Evans Tokushima Fatty (OLETF) rats display increased nursing time and frequency compared to lean LETO controls, suggesting a maternal contribution to pup preobesity. In previous studies, OLETF pups presented high adiposity, showed greater suckling efficiency, initiative and weight gain from nursing than controls throughout lactation. To further elucidate maternal-infant interactions contributing to pup preobesity, we cross-fostered pups a day after birth and examined maternal behavior. Nursing frequency decreased in OLETF dams raising LETO pups (OdLp) in the third postnatal week, while LETO dams raising OLETF pups showed no significant changes. Fat % was greater in the milk of OLETF versus LETO dams. OdLp pups showed long-term body weight (BW) increase, suggesting that maternal environment can induce BW increases even in the absence of a genetic tendency. Additionally, interaction between OLETF dams and pups produces high nursing frequency, exposing the pups to abundant high-fat milk, thus strengthening their preobese phenotype.

Exfoliated molybdenum di-sulfide (MoS2) electrode for hydrogen production in microbial electrolysis cell.

The most widely reported catalyst in microbial electrochemical cells (MEC) cathodes is platinum (Pt). The disadvantages of Pt include its high cost and sensitivity to various molecules. In this research an exfoliated molybdenum di-sulfide (MoS2-EF) catalyst was synthesized. The size of the obtained particles was 200 ±â€¯50 nm, 50-fold smaller than the pristine MoS2 catalyst. The MoS2-EF Raman spectrum displays the E12g and A1g peaks at 373 cm-1 and 399 cm-1. Electrochemical characterization by linear sweep voltammetry (LSV) of a rotating disc electrode RDE showed that the current density of Pt in 0.5 M H2SO4 was 3.3 times higher than MoS2-EF. However, in phosphate buffer (pH-7) electrolyte this ratio diminished to 1.9. The polarization curve of Pt, MoS2-EF and the pristine MoS2 electrodes, at -1.3 V in MEC configuration in abiotic conditions exhibit current densities of 17.46, 12.67 and 3.09 mA cm-2, respectively. Hydrogen evolution rates in the same MEC with a Geobacter sulfurreducens anode and Pt, MoS2-EF and the pristine MoS2 cathodes were 0.106, 0.133 and 0.083 m3 d-1 m-3, respectively. The results in this study show that MoS2-EF led to highly purified hydrogen and that this catalyst can serve as an electrochemical active and cost-effective alternative to Pt.

Blocking the postpartum mouse dam's CB1 receptors impairs maternal behavior as well as offspring development and their adult social-emotional behavior.

Maternal care is the newborns' first experience of social interaction, which affects their development and social competence throughout life. For the first time, we investigated the involvement of the endocannabinoid system (ECS) in mother-infant interaction in mice. We found that blocking the dam's CB1 receptors (CB1R) by the antagonist/inverse agonist rimonabant (SR141716) during postpartum days 1-8 affected maternal behavior as well as the social and emotional characteristics of the offspring as adults. Pups of rimonabant treated dams (RTD) had lower body weight during the first week of life and emitted fewer ultrasonic vocalizations (USVs) than vehicle treated dams (VTD). RTD crouched less over their pups and exhibited delayed pup retrieval. In Y-maze preference tests conducted at weaning age, females and males of both groups preferred their dam over milk. Males and females of RTD preferred dam over pup and pup over milk as opposed to the control group. At the age of 2.5 months, males of RTD displayed less motor activity. In the social behavior test, RTD male and female offspring were both more active, showing higher levels of active social interaction and rearing. These results indicate that the ECS is crucial for establishment of maternal behavior during the first postpartum week, with a long-term impact on the offspring's socio-emotional development.