bluuebunny/crossref_metadata_2025 huggingface dataset:
Inhibiting SHP2 reduces glycolysis, promotes microglial M1 polarization, and alleviates secondary inflammation following spinal cord injury in a mouse model
Authors: Ding Xintian , Chen Chun , Zhao Heng , Dai Bin , Ye Lei , Song Tao , Huang Shuai , Wang Jia , You Tao
Published: May 2024

JOURNAL/nrgr/04.03/01300535-202503000-00030/figure1/v/2024-06-17T092413Z/r/image-tiff

Reducing the secondary inflammatory response, which is partly mediated by microglia, is a key focus in the treatment of spinal cord injury. Src homology 2-containing protein tyrosine phosphatase 2 (SHP2), encoded by PTPN11, is widely expressed in the human body and plays a role in inflammation through various mechanisms. Therefore, SHP2 is considered a potential target for the treatment of inflammation-related diseases. However, its role in secondary inflammation after spinal cord injury remains unclear. In this study, SHP2 was found to be abundantly expressed in microglia at the site of spinal cord injury. Inhibition of SHP2 expression using siRNA and SHP2 inhibitors attenuated the microglial inflammatory response in anin vitrolipopolysaccharide-induced model of inflammation. Notably, after treatment with SHP2 inhibitors, mice with spinal cord injury exhibited significantly improved hind limb locomotor function and reduced residual urine volume in the bladder. Subsequentin vitroexperiments showed that, in microglia stimulated with lipopolysaccharide, inhibiting SHP2 expression promoted M2 polarization and inhibited M1 polarization. Finally, a co-culture experiment was conducted to assess the effect of microglia treated with SHP2 inhibitors on neuronal cells. The results demonstrated that inflammatory factors produced by microglia promoted neuronal apoptosis, while inhibiting SHP2 expression mitigated these effects. Collectively, our findings suggest that SHP2 enhances secondary inflammation and neuronal damage subsequent to spinal cord injury by modulating microglial phenotype. Therefore, inhibiting SHP2 alleviates the inflammatory response in mice with spinal cord injury and promotes functional recovery postinjury.
Reconstruction of Hand and Wrist Soft-Tissue Defects using Radial Artery Perforator Flap
Authors: FEBOPRAS Alper Ural , Bilgen Fatma , Bekerecioğlu Mehmet
Published: May 2024

Aim:

Soft-tissue defects in the hand and wrist are frequently encountered injuries that may occur due to trauma, burns, or other causes. We aimed to report our experiences in reconstruction of these defects using a radial artery perforator flap (RAPF).

Materials and Methods:

Eight patients who underwent surgery for reconstruction of the hand and wrist soft-tissue defects at our institution between December 2017 and December 2019 were included in the study. The patients were evaluated in terms of age, sex, etiology, flap size, defect region, and postoperative complications.

Results:

All defects were reconstructed by utilizing RAPF. The most common etiology of the defects was work-related accidents. The mean age of the patients was 40.4 (10–69) years. The mean flap size was 63.5 ± 14.76 cm2. Six patients healed uneventfully, while we observed partial necrosis of the RAPF flap in one of the cases and a marginal epidermolysis in another. The donor sites were skin grafted in each patient. The patient where partial necrosis observed was re-operated for debridement and skin grafting subsequentially. The duration of follow-up of the patients was 6 months.

Conclusions:

Radial forearm perforator flap is a reliable and effective reconstructive option to reconstruct small to moderately sized defects of the hand and wrist.
Determination of Facial Reanimation Patients Who can be Transferred Muscle after Crossfacial Nerve Graft
Authors: Majidov Nijat , Akdag Osman , Sutcu Mustafa , Tosun Zekeriya
Published: May 2024

Aims:

The aim of facial reanimation isto restore facial symmetry in spontaneous, mimic, and emotional movements. One of the important reconstructive treatment options in patients with long-term facial paralysis is free muscle transfers. The first stage in two-stage muscle transfers is the cross facial nerve graft (CFNG). In this study, our aim is to investigate the importance of Tinel's sign and EMG in the selection of patients who have had CFNG due to long-term facial paralysis and who can undergo muscle transfer repair and investigate the effectiveness of these methods.

Patients and Methods:

Ten patients who underwent crossfacial nerve grafting for long-term facial nerve paralysis between 2012 and 2018 were prospectively included in the study.

Results:

No complications were observed during the operation and follow-up of the patients. The reliability of EMG is lower than the Tinel's sign when making a muscle transfer decision in patients who undergo CFNG.

Conclusions:

In conclusion, the etiology of facial paralysis (severity of injury in traumatic paralysis), age of patients, comorbid conditions, surgical experience, postoperative physical therapy process and patient compliance play an active role in providing reinnervation.
Clinical and Radiological Features of Some Rare Forms of Craniosynostosis in Clinical Practice
Authors: Hicdonmez Tufan , Filinte Gaye
Published: May 2024

There are rare forms of craniosynostosis with single or multiple suture involvement. These are sphenofrontal plagiocephaly; posterior plagiocephaly with unilateral lambdoid synostosis; combined sagittal and metopic synostosis; combined sagittal and unilateral coronal synostosis; and bilateral lambdoid and sagittal synostosis with Mercedes–Benz pattern. In our study, we aimed to present both clinical and three-dimensional computed tomographic characteristics of these rare forms of craniosynostosis.
Utility of Short-Scar Incisions Mimicking Breast Augmentation Incisions Through Periareolar or Submammary Approach for a Better Aesthetic Outcome and Patient Satisfaction
Authors: Okumus Ayhan
Published: May 2024

Purpose:

The purpose of the study is to evaluate the long-term aesthetic outcome of single-session nipple-sparing mastectomy (NSM) and immediate breast reconstruction operations performed using short-scar incisions mimicking breast augmentation incisions through periareolar or submammary approach.

Materials and Methods:

A total of 23 breast cancer patients (mean age: 32 years, range 21–44 years) who underwent single-session NSM and immediate breast reconstruction operations (bilateral in 9) performed through periareolar or submammary approach were included. Data on patient age, breast cancer characteristics, side of mastectomy and reconstruction, postoperative complications were retrieved from hospital records. Aesthetic outcome (by both patients and plastic surgeon), patient satisfaction (visual analog scale [VAS] scores), and psychological outcome (via body image scale) were evaluated after a median 4-year (range, 9 months–11 years) follow-up.

Results:

Majority of the patients identified that size of the breast (95.7%), shape of breast (95.7%), breast symmetry (95.7%), scars on the breast (100.0%), nipple-areola complex (100%), and overall aesthetic results (95.7%) fulfilled expectations very much. Physician evaluation also revealed that aesthetic outcome was excellent for majority of patients in terms of breast symmetry (80.7%), breast volume (95.7%), position of submammary fold (95.7%), and overall aesthetic result (95.7%) and all patients in terms of scar appearance on the breast (100.0%). Mean (standard deviation) VAS scores for patient satisfaction were 9.4 (0.8). Total body image scale indicated very good body image in terms of affective (e.g. feeling self-conscious), behavioral (e.g. difficulty in looking at the naked body), and cognitive (e.g. satisfaction with appearance) aspects in all patients.

Conclusion:

Our findings indicate the utility of short-scar (~4 cm) incisions mimicking breast augmentation incisions in a single-session NSM and immediate breast reconstruction as associated with a low-postoperative complication rate, an excellent aesthetic outcome and a very high patient satisfaction.
Spontaneous Massive Vulvar Edema in the Postnatal Period
Authors: Ersahin Simay , Günes Deniz , Oksuz Sinan
Published: May 2024

Spontaneous and isolated massive vulvar edema is seen as a rare condition in pregnancy in the postpartum period. Underlying causes have to be well understood, and treatment plans has to be well organized because of its association with high maternal mortality rate. We report a case of postpartum massive vulvar edema in a 19-year-old-primigravida patient presented with vulvar pain and difficulty in mobilization in the postpartum 4th day. The vulvar edema resolved progressively with surgical incisions on the labia minoras. The aim of this report is to inform clinicians that surgical intervention can be a successful treatment modality.
Retrospective review of patients with testicular torsion in a University Hospital in Bahrain
Authors: Alkooheji Ishaq M , Alabbasi Mohamed , Khashaba Shehab , Rafie Mohamed A M Ebrahim , Corbally Martin
Published: May 2024

Introduction:

Testicular torsion is a surgical emergency that, with delayed treatment, may be associated with loss of the testis. It commonly presents with sudden onset testicular pain, vague lower abdominal pain, nausea, and vomiting. Management often requires emergent surgical scrotal exploration, detorsion, and fixation or removal of the affected testis.

Materials and Methods:

Retrospective review of all the patients in a hospital covering the Muharraq district in Bahrain presenting with testicular pain.

Results:

During the six-year period from 2015 to 2021, 48 patients with testicular torsion were managed, with a mean age of 18.4 (± 9.2) years. Most patients (54.7%) presented within 6 hours of the onset of symptoms. All 48 patients underwent a doppler ultrasound, which confirmed the presence of testicular torsion in 87.5% of patients, with a sensitivity of 87% and specificity of 98.5%. Fourteen patients had non-viable testis on surgical exploration, with an average age of 16.6 (± 6.8) years and took an average of 13 to 24 hours to present to the emergency department after the start of pain. Most patients underwent scrotal ultrasound 60 minutes from the presentation to the emergency department and surgical exploration within 120 to 179 minutes. The rate of testicular torsion in patients who underwent diagnostic ultrasound at 60 minutes or more from presentation was 40%, compared to an overall rate of 29%. All detected cases of testicular torsion, except for one case, underwent bilateral fixation of the testes. Of those patients who underwent contralateral fixation, none presented with contralateral torsion, supporting the recommendation of contralateral fixation.

Conclusion:

Patients underwent comprehensive assessment of their complaint and emergent surgical intervention, including an ultrasound that did not delay the surgical intervention. We agree that clinical judgment is the primary tool for assessment of patients with acute scrotum and an adjunct emergent ultrasound does not significantly cause delays. We concur with the current recommendations for contralateral fixation and prompt surgical management as the anatomical anomaly is present bilaterally.
Extraction of foreign body from the urinary bladder using nephroscope: A case report of endoscopy treatment
Authors: Aljarbou Abdulhkam , Abdo Ahmed Jamal , Almosa Mohammed Ali , Hariri Albara
Published: May 2024

Transurethral foreign bodies (FBs) in the urinary tract are rare findings in a clinical setting. The most common cases are reported for FBs in the urinary bladder. The present report similarly aimed to examine a whole pen as a FB with a discussion about symptoms and complexities. Here, we significantly reported the management of pen extraction from the bladder of a female patient using nephroscope and proposed success with possible recommendations for treatment in future operations.
Dilute povidone-iodine irrigation during percutaneous nephrolithotomy to reduce postoperative infective complications – Is there any benefit?
Authors: Kone Kalyanaram , Mallikarjun Naveen Thimiri , Philipraj Joseph
Published: May 2024

Background and Objective:

Infectious complications following stone lithotripsy is a significant source of patient morbidity and mortality. Post percutaneous nephrolithotomy fever is reported in 37% of patients undergoing PCNL and sepsis is the most common cause of mortality following PCNL. Thus, there is an urgent need to tackle lithotripsy-associated bacteremia occurring intraoperatively, keeping in mind the threat of emerging global antibiotic resistance. The aim of our study was to study the efficacy of using intermittent 0.35% dilute Povidone-Iodine (PI) irrigation during PCNL in reducing postoperative infection rate.

Materials and Methods:

This is a prospective observational study done in 24 patients diagnosed with Staghorn and matrix calculi requiring PCNL. All patients were taken up for the procedure with sterile urine culture or after treating them with culture-specific antibiotic with initial positive urine culture. Intraoperative pelvic urine was sent for culture and sensitivity. 0.35% dilute PI irrigation was used intermittently during the procedure. Patients were monitored and assessed for signs of post-PCNL infection and PI-related side effects. The results were compared with similar group of patients with similar stone characteristics who underwent PCNL before adopting the dilute PI irrigation protocol (non-PI irrigation group).

Results:

Among 24 patients, 18 patients had partial or complete Staghorn and 6 had matrix calculi. Five patients with Staghorn and three patients with matrix calculi had positive renal pelvic urine culture. In the non-PI irrigation group, 19 patients had Staghorn stones and 5 had matrix calculi. Three patients with Staghorn and two patients with matrix calculi had positive renal pelvic urine culture. Three patients (12.5%) had postoperative fever in the dilute PI irrigation group, compared to 11 patients (45.8%) in the non-PI irrigation group. No patient had PI-related complications.

Conclusion:

Our prospective study highlights that the use of 0.35% dilute PI irrigation intermittently during PCNL reduces the postoperative infection rate significantly.
The prevalence and risk factors of upgrading of Gleason grade group between transrectal ultrasound prostate biopsy and prostatectomy specimens
Authors: Promsen Worapong , Siriboonrid Satit , Binsri Nattapong , Kanjanatarayon Sarayut , Wiriyabanditkul Weerayut , Jiraanankul Vittaya
Published: May 2024

Background:

The risk stratification of prostate cancer using Gleason grade group (GG), serum prostate-specific antigen (PSA), and T staging has an important role for appropriate treatment. In fact, the GG of biopsy was not the same as the prostatectomy specimen. The upgrading of GG has a significant risk of delay treatment. The study aims to evaluate the concordance of GG between biopsy and prostatectomy specimens and the factors of upgrading GG.

Materials and Methods:

Retrospectively reviewed data from January 2010 to December 2019, 137 patients underwent prostate biopsy and followed by prostatectomy. Patients’ data include pathological reports, imaging reports, serum PSA, PSA density (PSAD), and free PSA were analyzed by univariate and multivariate analysis.

Results:

The concordance between the pathology was found in 54 specimens (39.4%) with the upgrading of GG in the prostatectomy was 57 specimens (41.6%). Furthermore, the downgrading was 26 specimens (18.9%). Serum PSA >10 ng/ml (P 0.003), PSAD >0.2 ng/ml/cm3 (P 0.002), free/total PSA ratio (P 0.003), margin positive for malignancy (P 0.033), and extraprostatic involvement (P 0.039) were significantly related with upgrading at the univariate analysis. Only a PSAD >0.2 (P 0.014) was found to be an independent factor that is predictive of upstaging in multivariate analysis.

Conclusions:

The prevalence of upgrading of GG from prostate biopsy to radical prostatectomy is as high as the other study. The factor that related to upstaging of GG was PSAD. Therefore, additional tools for biopsy were required to enhance the accurate diagnosis and staging of prostate cancer.
Incidental finding of bilateral ovarian and renal veins thromboses post cesarean hysterectomy complicated by ureteric injury
Authors: Al Awwad Ahmed , Alshubaili Hussam , Mohamed Abdelrahman Yahya , Abuanz Sami
Published: May 2024

This is a case report of a 36-year-old female patient who developed right flank pain on day 4 postcesarean hysterectomy due to placenta accreta and massive bleeding. Ultrasonography of the abdomen and pelvis showed moderate right hydronephrosis. A nephrostomy tube was urgently inserted followed by computed tomography urography which revealed a large pelvic urinoma secondary to right ureter injury and bilateral ovarian and renal veins thrombi. An abdominal drain was inserted and the hematology team was consulted. The patient was treated with enoxaparin with no subsequent complications. Ureteric injury was managed by reimplantation. We reported this case as the probable first presentation of bilateral ovarian and renal vein thromboses postcesarean hysterectomy.
Influence of tumor size in the progression of venous tumor thrombus in renal cell carcinoma
Authors: Thangarasu Mathisekaran , Prakash J. Sanjay , Bafna Sandeep , Aarthy P. , Govindaswamy Thirumalai Ganesan , Venugopal Balaji , Sivaraman Ananthakrishnan , Jain Nitesh , Balakrishnan Arunkumar , Raghavan Deepak , Venkatraman Murali , Chandranathan M. , Paul Rajesh , Selvaraj Nivash , Ramakrishnan Balasubramaniam , Ragavan Narasimhan
Published: May 2024

Objective:

The objective of the study is to describe the perioperative outcomes, disease-specific, and overall survival status in patients diagnosed with renal cell carcinoma with inferior vena cava (IVC) tumor thrombus.

Patients and Methods:

We did a retrospective analysis of all patients who underwent radical nephrectomy along with IVC thrombectomy from the year 2013 to 2020. Mayo’s classification was used to stratify the level of IVC thrombus. Demographic, perioperative, histopathology data, complications, and survival status were analyzed.

Results:

Total number of patients included in the study was 39, (Male: Female = 84.6%: 15.4%). Median age of patients was 58 (interquartile range [IQR] 50–63) years. Median size of renal tumor (in cms) was 9.5 (IQR 7.5–12), 8 (IQR 7–11.5), 8.5 (IQR 7–11.75), and 11 (IQR 9.5–11) (P = 0.998) in level 1,2,3, and 4 tumors, respectively. Clear cell variant was seen in 32 patients (82%) with R0 resection in 17 patients. Twelve patients (30.7%) had systemic metastasis on presentation. The overall mean survival time was 66.4 months with 95% confidence interval (CI) (52.4–80.5 months). Mean recurrence-free survival is 76 months with (63–90) CI of 95%. Mean survival in patients who presented with metastasis is 47 months with 95% CI (52.4–80.5). Perioperative mortality rate was 5.12% in this study.

Conclusion:

The tumor size does not have an influence on the progression of tumor thrombus into IVC. Significant difference in survival was observed between different levels of thrombus with high mortality in level four tumors.
Xanthogranulomatous pyelonephritis: Case series – Clinical, radiologic, therapeutic, and histological aspects
Authors: Pais João Sakuray , Rocha Mirelle Barbosa , Muglia Valdair Francisco , Chahud Fernando , Molina Carlos Augusto Fernandes , Ruellas Heitor Ramos , Tucci Silvio Junior
Published: May 2024

Purpose:

Xanthogranulomatous pyelonephritis (XGP) is a chronic and severe infection of the kidney. We aimed to review the main clinical, imaging, and histological findings and to assess predictors of surgical complications or hospitalization >10 days (no deaths reported).

Materials and Methods:

We retrospectively searched all patients with XGP treated at our institution from 2005 to 2019, with 57 patients enrolled. Clinical data were retrieved by a single reader, computed tomographic (CT) examinations by two radiologists, and histopathological specimens by an experienced pathologist.

Results:

The patients’ mean age was 44.3 ± 16.2 years and 41 (71.9%) were female. The most common symptoms were flank/lumbar pain (89.5%), fever (43.9%), and recurrent urinary tract infection (43.9%). The mean time until the presumptive diagnosis was 365.1 days and the median hospitalization period was 11 days. Blood tests showed anemia (78.9%), leukocytosis (43.6%) with left shift (21.6%). Urinalysis showed hematuria (75.6%), bacteriuria (40.9%), and leukocytes (93.2%). Urine cultures showed Escherichia coli in 14.8%, Proteus mirabilis in 7.4%, while 59.3% were negative. Of 40 patients with CT examinations, 38 (95%) presented with hydronephrosis and perinephric inflammatory changes (PIC) and 22 (55%) with Bear Paw sign. PIC was the only independent predictor at multivariate analysis for surgical complications. For prolonged hospitalization, fever and PIC were independent predictors at univariate, but only fever at multivariate analysis.

Conclusions:

XGP is a worrisome condition, with unclear pathophysiological mechanisms. Fever and PIC at CT examinations were predictors of poor outcomes.
Factors related to upstaging of clinical stage T2 organ-confined bladder cancer following radical cystectomy
Authors: El-Adawy Mahmoud Shoukry , Ibrahim Hisham , Zanaty Fouad , Kotb Sameh
Published: May 2024

Aims:

This study aimed to detect possible risk factors related to upstaging of clinical stage T2 organ-confined (OC) to non-OC (nOC) bladder cancer (BC) following radical cystectomy (RC).

Settings and Design:

This was a prospective multicenter study.

Subjects and Methods:

This is a multicenter prospective study including 196 Egyptian BC patients undergoing RC from January 2017 to February 2019 at Cairo University, Fayoum University, and Menoufia University. Only patients with muscle invasive BC (T2) were included in the study. Patients’ characteristics, preoperative clinical data (including Hydronephrosis), cystoscopy data, and biopsy pathological data were recorded. Preoperative clinical staging is compared to postoperative pathological staging, to determine upstaged cases. The occurrence of upstaging in correspondence to each preoperative factor is recorded and statistically analyzed.

Results:

Among 196 BC patients of our study, upstaging from OC T2 to nOC occurred in 88 (44.9%) patients. Statistical analysis showed that the factors related to upstaging are older age (P ≤ 0.001), large tumor size (P = 0.048), lymphovascular invasion (LVI) (P ≤ 0.001), and multifocal tumor (P ≤ 0.001). On the other hand, the following factors were not related to upstaging: gender (P = 0.159), smoking (P = 0.286), preoperative hydronephrosis (P = 0.242), and presence of carcinoma in situ (P = 0.349).

Conclusions:

The difference between clinical and pathological staging of BC patients following RC is a frequent problem with no clear guidelines to overcome it. Several factors including age of the patient, large tumor size, LVI, and multifocal tumor are predictors of upstaging in OC BC. A good concern must be taken in these patients to achieve an optimum treatment plan for them.
Surgical management of stricture urethra in patients with chronic renal failure: Ten years’ experience at a tertiary center
Authors: Pathak Himadri , Purkait Bimalesh , Hameed Shahid , Das Anjan Kumar , Sarkar Kaushik , Ghoshal Prithwiraj
Published: May 2024

Introduction:

Patients suffering from stricture urethra and deranged renal function have poor quality of life. The incidence of urethral stricture co-existing with renal failure is comparatively small and cause may be multifactorial. There is paucity of literature on management of urethral stricture associated with deranged renal function. We present our experience of managing stricture urethra associated with chronic renal failure.

Materials and Methods:

This was a retrospective study conducted from 2010 to 2019. Patients with stricture urethra and deranged renal function (serum creatinine >1.5 mg/dl) who underwent urethroplasty or perineal urethrostomy were included in our study. A total of 47 patients met the inclusion criteria and were included in this study. Patients were followed every 3 months in their 1st year of surgery and 6 monthly thereafter. Statistical analysis was done using SPSS version 16.

Results:

There was a significant increase in the mean postopérative maximum and average urinary flow rates when compared to the preoperative values. The overall success rate was 76.59%. Out of 47 patients, 10 had wound infection and delayed wound healing, 2 patients developed ventricular arrhythmias, 6 patients developed fluid and electrolyte imbalance, 2 patients developed seizures, and 1 patient developed septicemia in the postoperative period.

Conclusion:

Prevalence of patients with chronic renal failure associated with stricture urethra was 4.58% and features suggestive of deranged renal function at presentation were present in 1.81% patients. In the present study, complications related with chronic renal failure occurred in 17 (36.17%) patients. Multidisciplinary care of the patient along with appropriate surgical management is a viable option in this sub-group of patients.
Robotic-assisted reconstruction of a ureteral herniation into the psoas major fascia: A unique obstructive etiology and a surgical approach to management
Authors: Wiggins Adam , Moynihan Matthew , Canes David
Published: May 2024

Ureteral herniation has been described in urologic literature. Documented sites of herniation include the femoral and inguinal canals, obturator and sciatic foramen, and the thoracic cavity. Herein, we report what we believe to be the first described case of symptomatic obstruction from ureteral herniation through a defect in the psoas major muscle fascia and detail our approach to definitive robotic-assisted surgical management of this unique entity.
Migrating foreign body into the urinary bladder of children postperineal trauma
Authors: Alzubier Mosab A. A. , AlAsmi Raed , Taha Sami Mahjoub , Osman Yassin M.
Published: May 2024

Foreign body (FB) in the urinary bladder (UB) is uncommon and rarely reported in pediatric patients. FB migration into the UB is an extremely rare and unpredictable condition that needs a high index of suspicion with meticulous history taking and clinical reasoning, so diagnosis may be challenging. In this study, we report two cases of male pediatric patients from Sudan with FB in the UB, with a history of penetrating perineal trauma, both were presented with irritative lower urinary tract symptoms, history of penetrating perineal trauma, and unremarkable clinical examination. Both were diagnosed by abdominal Ultrasound study (USS) and confirmed by cystoscopy. One child was treated by endoscopic extraction, while the other was treated by open surgical extraction. The outcome of treatment of both the cases was satisfactory.
Comparative study of tamsulosin versus tadalafil in benign prostatic hyperplasia patients with lower urinary tract symptoms. A prospective randomized study
Authors: Ahmad Malik Suhail , Dar Yaser Ahmad , Khawaja Abdul Rauf , Para Sajad Ahamd , Malik Sajad Ahamad , Wani Mohammad Saleem , Bhat Arif Hamid , Wani Prince Muzaffar
Published: May 2024

Introduction:

Benign prostatic hyperplasia (BPH) is one of the common causes of lower urinary tract symptoms (LUTS) in aging men. Men with LUTS have a higher incidence of erectile dysfunction (ED), and LUTS themselves represent an independent risk factor for ED, triggering a significant negative impact on quality of life.

Materials and Methods:

A total of 92 patients were randomly assigned to two groups. Groups I and II had 45 and 47 patients, two patients from Group I and three patients from Group II did not follow and were excluded from the study. Patients in Group I received 0.4 mg of tamsulosin and Group II patients received 5 mg tadalafil. Patients were assessed at baseline, 3 months, and at 6 months after receiving treatment. Treatment efficacy was measured by a change in Qmax, post void residual urine (PVR), International Prostate Symptom Score (IPSS), and Sexual Health Inventory for Men (SHIM) score at 3 months and 6 months.

Results:

Baseline parameters between the two groups were similar. Mean Qmax improved by 7 ml/s at 3 months to 9.44 ml/s at 6 months in Group I versus 4.73 ml/s at 3 months to 6.46 ml/s at 6 months in Group II (P = 0.739). Mean PVRU decreased by 35.53 ml at 3 months to 47.23 ml at 6 months in Group I versus 44.98 at 3 months to 58.28 ml at 6 months in Group II (P = 0.102). IPSS score improved by 4.24 points at 3 months to 7.22 points at 6 months in Group I versus 4 points at 3 months to 5.02 points at 6 months in Group II (P = 0.336). SHIM score improved by 0.7 points 16.2 at 3 months to 0.8 points at 6 months in Group I versus 6.12 points at 3 months to 6.3 points at 6 months (P < 0.001).

Conclusion:

When both groups were compared, tadalafil showed statistically similar improvements in Qmax, PVRU, and IPSS score, but statistically significant improvement was observed with tadalafil in SHIM score compared with tamsulosin in treating LUTS secondary to BPH. Our study provides evidence that once daily tadalafil 5 mg is well tolerated and can be considered for the treatment of LUTS secondary to BPH especially in patient with ED.
Patient-reported outcomes after robot-assisted radical prostatectomy and institutional learning curve for functional outcomes
Authors: Hashine Katsuyoshi , Tada Koki , Minato Ryoei , Sawada Yuichiro , Matsumura Masafumi
Published: May 2024

Purpose:

The study was performed to examine patient-reported outcomes (PROs) in the 1st year after surgery and the institutional learning curve after the introduction of robot-assisted radical prostatectomy (RARP).

Materials and Methods:

The subjects were 320 consecutive patients who underwent RARP from 2014 to 2018. These cases were divided into three groups treated in the early, middle, and late periods, with about 100 cases in each. PROs were recorded using the Expanded Prostate Cancer Index Composite (EPIC).

Results:

There were no significant differences among the early, middle, and late periods based on EPIC scores. Urinary function and bother decreased in the 1st month after surgery, and gradually recovered thereafter. However, urinary function was significantly worse in the 1st year after surgery than at baseline. Urinary function and bother were better in patients treated with nerve-sparing surgery, and in nerve-sparing cases, urinary function and bother were best in the early period and worst in the late period. These cases also had the best score for sexual function in the early period, but sexual bother was worst in the early period. In contrast, in cases treated without nerve-sparing surgery, urinary function and bother were best in the late period and worst in the early period, although without significant differences.

Conclusion:

The functional results of this study based on PROs are useful for providing information for patients. Interestingly, the institutional learning curves for RARP differed in cases that did and did not undergo a nerve-sparing procedure.
Primary obstructive megaureter in children; 10 years’ experience from a tertiary care center
Authors: Hamid Raashid , Bhat Nisar A. , Baba Ajaz A. , Mufti Gowhar Nazir , Sheikh Khursheed A. , Bashir Mohd Idrees
Published: May 2024

Introduction:

Primary obstructive megaureter (POM) is a congenital dilatation of the ureter due to an adynamic segment of vesicoureteric junction obstruction. Surgical intervention is needed if nuclear scan shows obstructive curve. We analyzed our data and outcome of conservative and surgical treatment in such cases at our tertiary care hospital.

Materials and Methods:

We evaluated all cases of POMs during the study period. Investigations included ultrasonography (USG), voiding cystourethrogram, diethylene pentacetic acid (DTPA) scan, and dimercaptosuccinyle acid scan. In antenatal cases, any pelvic dilatation ≥12 mm after 6 weeks were subjected to reonography. Patients with anterior-posterior pelvic diameter (APPD) ≥12 mm had to undergo DTPA scan to look for DRF and drainage. Follow-up USG was done in all cases of mild-to-moderate hydroureteronephrosis, with APPD <12 at 3 months interval.

Results:

A total of 270 megaureters were registered and treated during the study period (2008–2019). The total number of patients included was 50 (64 ureters). The mean age of presentation in these 30 children was 21.78 ± 18.1 months (range 1–72 months) and the mean weeks of gestation in antenatal cases at presentation as megaureter was 24 ± 7 weeks (range 13–37 weeks). The mean weight of babies was 2.72 ± 0.7 g. The duration of follow-up ranged from 16 to 1W12 months. The mean APPD on the affected side was 19.99 ± 10.3 mm (range 11–43 mm). The mean ureteric diameter was 1.67 ± 0.33 mm (range 0.78–2.66 cm). The mean split function of patients with POM was 34.88% ± 11.5% on the affected side. Twenty patients (40%) had spontaneous resolution over a mean time period of 24.1 ± 11.1 months. Thirty patients underwent surgical procedures. In three children, HTN was observed over a mean follow-up period of 3 years.

Conclusion:

The babies with POM need a close follow-up. Surgery is indicated in prolonged t½/Tmax on renal scan, function <40% at the initial scan, or >5% split function deterioration in the subsequent renal scan.
The changing composition of urinary calculi in Southern Thailand over the past 14 years
Authors: Tanthanuch Monthira , Jakjaroenrit Nattawit , Boonchai Sarayuth , Bejrananda Tanan
Published: May 2024

Objective:

A worldwide increased incidence of urolithiasis has been observed over the past few decades. Insight into the composition of these stones can lead to enhanced medical treatment and outcomes. The objective of this study was to examine the distribution and chemical composition of urinary calculi in Southern Thailand over the past decade.

Materials and Methods:

An analysis was conducted on 2611 urinary calculi submitted to the Stone Analysis Laboratory, Songklanagarind Hospital, a single stone analysis laboratory in Southern Thailand. The analysis was performed from 2007 to 2020 using Fourier-transform infrared spectroscopy. The demographic results were described using descriptive statistical analyses, and the Chi-square test for trends was performed to identify changes in urinary calculi composition.

Results:

The patients’ demographic data revealed a male-to-female ratio of 2.2:1; the most common age group of affected men was 50–69 years, whereas the most common age group of affected women was 40–59 years. The most common components found in the calculi were uric acid (30.6%), mixed calcium oxalate with calcium phosphate (29.2%), and calcium oxalate (26.7%). We noted a trend of increasing uric acid calculi for 14 years (P = 0.00493), whereas the trend for the other major components was decreasing.

Conclusion:

The most common component of urinary calculi analyzed in Southern Thailand was uric acid, with a significant rising trend in proportion in the past decade; the trend of other major components, such as mixed calcium oxalate-calcium phosphate and calcium oxalate, decreased.
Management of early oesophageal cancer: An overview
Authors: Calpin Gavin G , Davey Matthew G , Donlon Noel E
Published: May 2024

The incidence of esophageal cancer, namely the adenocarcinoma subtype, continues to increase exponentially on an annual basis. The indolent nature of the disease renders a significant proportion inoperable at first presentation, however, with the increased utilisation of endoscopy, many early lesions are now being identified which are suitable for endotherapeutic approaches. This article details the options available for dealing with early esophageal cancer by endoscopic mean obviating the need for surgery thereby avoiding the potential morbidity and mortality of such intervention.
Effects of oral probiotics on inflammation and intestinal function in adult patients after appendectomy: Randomized controlled trial
Authors: Lan Ke , Zeng Ke-Rui , Zhong Fu-Rui , Tu Sheng-Jin , Luo Jin-Long , Shu Shi-Long , Peng Xue-Feng , Yang Hua , Lu Kai
Published: May 2024

BACKGROUND

Appendectomy is an acute abdominal surgery that is often accompanied by severe abdominal inflammation. Oral probiotics are one of the postoperative treatments for rapid rehabilitation. However, there is a lack of prospective studies on this topic after appendectomy.

AIM

To investigate whether the postoperative probiotics can modulate the inflammatory response and restore intestinal function in patients following appendectomy.

METHODS

This was a prospective, randomized trial. A total of 60 emergency patients were randomly divided into a control group (n = 30) and a probiotic group (n = 30). Patients in the control group started to drink some water the first day after surgery, and those in the probiotic group were given water supplemented with Bacillus licheniformis capsules for 5 consecutive days postsurgery. The indices of inflammation and postoperative conditions were recorded, and the data were analyzed with RStudio 4.3.2 software.

RESULTS

A total of 60 participants were included. Compared with those in the control group, the C-reactive protein (CRP), interleukin 6 and procalcitonin (PCT) levels were significantly lower in the probiotic group at 2 d after surgery (P = 2.224e-05, P = 0.037, and P = 0.002, respectively, all P < 0.05). This trend persisted at day 5 post-surgery, with CRP and PCT levels remaining significantly lower in the probiotic group (P = 0.001 and P = 0.043, both P < 0.05). Furthermore, probiotics resulted in a shorter time to first flatus and a greater percentage of gram-negative bacilli in the feces (P = 0.035, P = 0.028, both P < 0.05).

CONCLUSION

Postoperative oral administration of probiotics may modulate the gut microbiota, benefit the recovery of the early inflammatory response, and subsequently enhance recovery after appendectomy.
Mesenchymal stem cells’ “garbage bags” at work: Treating radial nerve injury with mesenchymal stem cell-derived exosomes
Authors: Mushtaq Mazhar , Zineldeen Doaa Hussein , Mateen Muhammad Abdul , Haider Khawaja Husnain
Published: May 2024

Unlike central nervous system injuries, peripheral nerve injuries (PNIs) are often characterized by more or less successful axonal regeneration. However, structural and functional recovery is a senile process involving multifaceted cellular and molecular processes. The contemporary treatment options are limited, with surgical intervention as the gold-standard method; however, each treatment option has its associated limitations, especially when the injury is severe with a large gap. Recent advancements in cell-based therapy and cell-free therapy approaches using stem cell-derived soluble and insoluble components of the cell secretome are fast-emerging therapeutic approaches to treating acute and chronic PNI. The recent pilot study is a leap forward in the field, which is expected to pave the way for more enormous, systematic, and well-designed clinical trials to assess the therapeutic efficacy of mesenchymal stem cell-derived exosomes as a bio-drug either alone or as part of a combinatorial approach, in an attempt synergize the best of novel treatment approaches to address the complexity of the neural repair and regeneration.
Therapeutic potential of urine-derived stem cells in renal regeneration following acute kidney injury: A comparative analysis with mesenchymal stem cells
Authors: Li Fang , Zhao Bin , Zhang Lei , Chen Guo-Qing , Zhu Li , Feng Xiao-Ling , Gong Meng-Jia , Hu Cheng-Chen , Zhang Yuan-Yuan , Li Ming , Liu Yong-Qiang
Published: May 2024

BACKGROUND

Acute kidney injury (AKI) is a common clinical syndrome with high morbidity and mortality rates. The use of pluripotent stem cells holds great promise for the treatment of AKI. Urine-derived stem cells (USCs) are a novel and versatile cell source in cell-based therapy and regenerative medicine that provide advantages of a noninvasive, simple, and low-cost approach and are induced with high multidifferentiation potential. Whether these cells could serve as a potential stem cell source for the treatment of AKI has not been determined.

AIM

To investigate whether USCs can serve as a potential stem cell source to improve renal function and histological structure after experimental AKI.

METHODS

Stem cell markers with multidifferentiation potential were isolated from human amniotic fluid. AKI severe combined immune deficiency (SCID) mice models were induced by means of an intramuscular injection with glycerol. USCs isolated from human-voided urine were administered via tail veins. The functional changes in the kidney were assessed by the levels of blood urea nitrogen and serum creatinine. The histologic changes were evaluated by hematoxylin and eosin staining and transferase dUTP nick-end labeling staining. Meanwhile, we compared the regenerative potential of USCs with bone marrow-derived mesenchymal stem cells (MSCs).

RESULTS

Treatment with USCs significantly alleviated histological destruction and functional decline. The renal function was rapidly restored after intravenous injection of 5 × 105 human USCs into SCID mice with glycerol-induced AKI compared with injection of saline. Results from secretion assays conducted in vitro demonstrated that both stem cell varieties released a wide array of cytokines and growth factors. This suggests that a mixture of various mediators closely interacts with their biochemical functions. Two types of stem cells showed enhanced tubular cell proliferation and decreased tubular cell apoptosis, although USC treatment was not more effective than MSC treatment. We found that USC therapy significantly improved renal function and histological damage, inhibited inflammation and apoptosis processes in the kidney, and promoted tubular epithelial proliferation.

CONCLUSION

Our study demonstrated the potential of USCs for the treatment of AKI, representing a new clinical therapeutic strategy.
Metabolic dysfunction-associated steatotic liver disease heterogeneity: Need of subtyping
Authors: Habib Shahid
Published: May 2024

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a widespread global disease with significant health burden. Unhealthy lifestyle, obesity, diabetes mellitus (DM), insulin resistance, and genetics have been implicated in the pathogenesis of MASLD. A significant degree of heterogeneity exists among each of above-mentioned risk factors. Heterogeneity of these risk factors translates into the heterogeneity of MASLD. On the other hand, MASLD can itself lead to insulin resistance and DM. Such heterogeneity makes it difficult to assess the natural course of an individual with MASLD in clinical practice. At present MASLD is considered as one disease despite the variability of etiopathogenic processes, and we lack the consensus definitions of unique subtypes of MASLD. In this review, pathogenic processes of MASLD are discussed and a need of subtyping is recommended.
Darkness: Joseph Conrad and Harriet Beecher Stowe
Authors: Meisel Martin
Published: May 2024

The article focusses on a multi-aspect comparative analysis of J. Conrad’s Heart of Darkness and H. B. Stowe’s Uncle Tom’s Cabin. Taking into account the obvious differences between the works, the author analyses the hell of slavery and exploitation of Africa by the colonial states that built systems that created criminals such as Kurtz and Legree. The author presents the genealogy of Conrad’s image of tortured Africa, the prefiguration of which is found in Polish romantic messianism. The article also presents a similar reception of both works. First, they gained recognition, then in the postwar period, they were criticized for the forms of racism hidden in them, and finally, in recent decades, they have been rehabilitated by new readings. The perspective presented here shows how women’s popular prose covertly influenced Conrad’s intertextual tendency, both his poetics and the worldview of his prose.
Philosophical Sources of Joseph Conrad’s Ethical Outlook: Jean Marie Guyau, Emil Boutroux
Authors: Samsel Karol
Published: May 2024

The aim of this paper is a thorough analysis of two philosophical sources of Joseph Conrad’s ethical outlook: the philosophies of Jean Marie Guyau and of Émile Boutroux. The first one, according to Maria Dąbrowska, had a strong influence on numerous aspects of Conrad’s ethics. However, the analysis of A Sketch of Morality Independent of Obligation or Sanction proves that, after all, Guyau – among other things, with his biological-vitalistic understanding of the doctrine of duty defined as a “mild obsession” – has created a philosophical-ethical system that is in stark contrast with Conrad’s views. Boutroux is a different case entirely. In his comprehension of modern life sciences and philosophy of nature, the most important issue is (this view is formed by Boutroux after Auguste Comte) to perpetuate “the laws of arbitrariness and free activity in nature.” Conrad’s references to his lectures on Natural Law in Science and Modern Philosophy might then be revealed directly: within such sea novels as Typhoon and The Shadow-Line, as well as indirectly, through portraying – in Boutroux’s language – an aspect of chance within the human “social nature” in such novels as Nostromo.
“Poor Stevie”
Authors: Rice Laura Beth
Published: May 2024

The article presents an interpretation of ‘The Secret Agent” in which the autistic Stevie is the most important character in the whole novel. The analysis of the statements and behaviours of individual characters allows us to show how confusing their attitude toward Stevie was. The article functionalises knowledge about the ways of defining physically and mentally ill people at the turn of the twentieth and twentieth centuries, and proves that an autistic man was not distinguished from cases of the most severe psychiatric diseases, as evidenced by many scenes in the novel. The article incorporates the perspective of disability studies into Conrad’s studies.
National History and Nostalgia in Joseph Conrad’s “Notes on Life and Letters”
Authors: Wojciechowska Sylwia Janina
Published: May 2024

The article investigates the interface between the national history of Poland and nostalgia as featured in Joseph Conrad’s collection Notes on Life and Letters. It is suggested that Conrad’s perception of history stands at odds with contemporary postmodern criticism. Initially Conrad’s stance on Poland’s national history is investigated in his political essays, “Autocracy and War” (1905), “A Note on the Polish Problem” (1916), and “The Crime of Partition” (1919), which, in my view, feature the ”definitive history” as discussed by Jenkins and Evans. Further, the lines of intersection between history, nostalgia, and politics are delineated. It is claimed that in Conrad’s works history is still assigned the classical role of a teacher, i.e., the Ciceronian historia magistra vitae, which, as I argue, corresponds with his view on literature as part of the historical record. Next, two autobiographical essays in the collection “Poland Revisited” (1915) and “First News” (1918) are examined in order to claim a heightened mode of nostalgia, on the one hand, with a simultaneous withdrawal of the attention from state affairs, which involves a re-positioning of the focus to Conrad’s personal experiences, on the other hand. Boym’s concepts of restorative and reflective nostalgia are juxtaposed and their deployment in the collection explored. I suggest that nostalgia underpins the internal integrity and interrelatedness of the essays included in Part II: “Life” of Notes on Life and Letters as regards their thematic scope and generic affiliation, the genre preconditioning the extent and intensity of the modal application of nostalgia. Finally, I contend that the mode of nostalgia largely explains the factual inconsistencies in Conrad’s autobiographical essays.