bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnostic and Therapeutic Approach in Patients with Urinary Calculi
Authors: Croppi Emanuele , Cupisti Adamasco , Lombardi Marco , Marangella Martino , Sanseverino Roberto , Carrano Francesco , D'Addessi Alessandro , Drudi Francesco Maria , Gambaro Giovanni , Micali Salvatore , Simeoni Pier Giorgio , Tasca Andrea , Terribile Maurizio , Zattoni Filiberto , Baggio Bruno , Bianchi Giampaolo , Caudarella Renata , Cicerello Elisa , Cosciani-Cunico Sergio , D'angelo Anna Rita , Mossetti Giuseppe , Muto Giovanni , Novenne Antonio , Prampolini Maurizio , Strazzullo Pasquale , Trinchieri Alberto , Vezzoli Giuseppe
Published: June 2018

The natural history of urolithiasis includes the risk of recurrence and of the development of chronic kidney and/or bone disease, which is why a thorough clinical and metabolic evaluation of these patients is of the utmost importance at disease onset. This paper is aimed at identifying the type of urolithiasis, the related risk factors, and the corresponding treatment options. The diagnostic and therapeutic approach described here includes 1) accurate history taking to detect secondary nephrolithiasis and screen for the main risk factors for kidney and bone disease; 2) metabolic evaluation graded according to different complexity levels based on the severity of the disease and the presence of risk factors; 3) carrying out appropriate imaging procedures. The resulting information allows to plan treatment based either on general rules of lifestyle and diet, or on selected medical intervention, if necessary. This report, which is based on current guidelines, was produced by the Gruppo Italiano di Studio Multidisciplinare per la Calcolosi Renale. It is addressed to all professionals involved in the management of patients suffering from nephrolithiasis, first of all general practitioners, who often become involved immediately at the onset of the disease.
Article
Authors: Yildirim Ibrahim , Irkilata Hasan Cem , Aydur Emiri , Zor Murai , Basal Seref , Goktas Serdar
Published: June 2018

Pelvic kidney is the most common type of renal ectopia. These abnormally positioned kidneys are often clinically asymptomatic. However, they are prone to urinary infection, stone formation and trauma. Admitted patients often complain of lower abdominal pain and urinary infection. Pelvic kidneys may also lead to misdiagnosis when it is associated with hydronephrosis or large cystic structures. Thus, it is rather difficult to pinpoint the origin of the problem. We reported here different clinical presentations of our two patients with pelvic kidneys.
Morris Syndrome: Description of a case Characterized by Partial Androgen Insensitivity
Authors: Massimiliano Creta , Salvatore Smelzo , Concetta Di Vito , Giacomo De Stefano , Francesco Forchia , Francesco Chiancone , Imbimbo Ciro
Published: June 2018

The Morris syndrome is a X-linked recessive condition due to a complete or partial insensitivity to androgens, resulting in a failure of normal masculinization of the external genitalia in chromosomally male individuals. This failure of virilization can be either complete or partial depending on the amount of residual androgen receptor function. The phenotype of individuals with partial androgen insensitivity syndrome may range from mildly virilized female external genitalia to mildly undervirilized male external genitalia. We describe a case of Partial Androgen Insensitivity Syndrome in a 21–year-old patient with a 46, XY karyotype, bilateral inguinal masses, clitoral enlargement and partial posterior labial fusion. Surgical care consisted of bilateral orchiectomy and plastic surgery of external genitalia. The patient underwent estrogen replacement therapy.
La Malattia di Fournier. Caso Clinico
Authors: Pedalino M. , Di Primio O.G. , Velia R. , Vercesi E. , Marino G.
Published: June 2018

Fournier's disease is a necrotizing fasciitis that prefers the male and which is located in the perineal area. In view of possible complications related to sepsis, systemic organ impairment and high mortality, is now considered a urological emergency. The main causes are infections of urethral and anal-rectal tract, immunodepression syndromes, diabetes mellitus and trauma. Infections are mixed with aerobic and anaerobic germs responsible of necrosis of tissue disorders due to the phenomena of necrotizing immunovasculitis disease. We present a case of Fournier's disease in perineal area, with gangrenosum necrotic evolution treated with antibiotic therapy, curettage of the necrotic tissue and local disinfection with saline and antiseptics solution. A total parenteral nutrition to ensure maximum perineal decontamination has been made. The extensive loss of substance scrotal was rebuilt in 25–day while the anal wound has healed spontaneously after complete surgical curettage.
Three Cases of Renal Cell Carcinoma with Sarcomatoid Differentiation
Authors: Diprimio O.G. , Martini C. , Velia R. , Pedalino M. , Piras D. , Vercesi E. , Marino G.
Published: June 2018

Renal cell carcinoma with sarcomatoid differentiation has an incidence of 4–6%. It occurs more frequently with clinical advanced presentation in relation to the greater biological aggressiveness. This variant was also found both in transplanted kidneys and in patients with von Hippel-Lindau syndrome. The authors present three cases of cancer all clinically evolving to rapidly progressive conditions. The pathologic staging was, respectively: Case 1 pT4 NO MO G4 case, Case 2 P G4 T3a N2 MO, Case 3 pT3a N0 M1 G4. The clinical responses related to protocols with VEGF drugs that seem to have better clinical response compared to immunotherapy are still being studied. From the pathologic point of view it is necessary, for all renal cell cancers, to search and identify the sarcomatoid components that, although poorly represented, give a negative prognosis.
Laparoscopic Removal of Voluminous Right Seminal Vesicle Neoplasm
Authors: Parma Paolo , Dall'oglio Bruno , Samuelli Alessandro , Bondavalli Candido , Bellomi Alberto
Published: June 2018

Introduction

We present the case of a male adnexal tumor of probable Wolffian origin occurred to the right seminal vesicle of a 47–year-old man.

Materials and Methods

The patient presented with a 2–month history of hematospermia. The diagnosis was achieved by transrectal ultrasound, CT of the abdomen and pelvis, and biopsy of both prostate and seminal vesicle. The patient was counseled for laparoscopic excision of the right seminal vesicle.

Results

The right seminal vesicle, along with the tumor and the right vas deferens, were excised and clear margins were ensured by frozen section. Total operative time was 180 with 200 mL blood loss. The patient's recovery was uncomplicated and he was discharged on the fourth post-operative day. The histologic examination demonstrated a male adnexal tumor of probable Wolffian origin, which is a rare low-grade malignant neoplasm that has been previously described in the broad ligament, ovaries and retroperitoneum of females. The patient is free of relapse at a 20–month follow-up.

Conclusions

This is the second report of this entity in a male. The laparoscopic approach for the excision of seminal vesicle neoplasms is a good treatment for its obvious benefits of minimal blood loss, short hospital stay and quick return to normal activity. The magnifications of the anatomical details of the pelvic floor help the surgeon in the dissection of the seminal vesicle from the other structures.
Neuroendocrine Small-Cell Bladder Cancer: Our Experience
Authors: Ruoppolo M. , Pezzica E. , Milesi R. , Corti D. , Mercurio P. , Fragapane G.
Published: June 2018

Introduction

Neuroendocrine bladder cancer is extremely rare, with an estimated incidence of 0.35–0.70% of all bladder tumors. The small-cell carcinoma represents the most frequent histologic variant described. Small-cell carcinoma is an epithelial tumor associated with a more aggressive behavior and poorer prognosis than transitional cell bladder carcinoma. The overall survival rate at 5 years does not exceed 8%. At the time of presentation 59% of patients have clinical stage >T2 and 56% show metastatic disease. In 50% of the patients, fatal progression occurrs within 6 months. Local recurrence after radical surgery occurred in 50–70% of cases.

Patients and Methods

We report three cases of pure neuroendocrine small-cell bladder cancer. Hematuria was the most common presenting symptom. Local advanced disease was present in all the cases with stage >T2, metastatic disease in 1 case, lymph node involvement and ureteral bilateral obstruction in 2. Two patients were treated by radical cystectomy, bilateral pelvic limph node resections and urinary derivation. Platinum-based adjuvant chemotherapy was proposed but only two patients received the treatment. One patient with liver metastasis was managed only by extensive TUR and support regimen.

Results

In 2 patients residual or relapsed cancer reappered within 2 months after surgery. All of the three patients died of metastatic disease at 5, 7, and 13 months. Median overall survival was 7 months. The most common site of relapse and spread of disease was the peritoneum and intestinal tract, and the reason of death was uncontrolled acute hemorrhage from gastro-intestinal district.

Conclusions

In the absence of a prospective study, and because of the rarity of the disease, the best treatment for small-cell bladder cancer remains uncertain. Neoadjuvant chemoterapy with platinum regimen plus aggressive surgical approach will be the treatment of choice. The association of chemotherapy and radiotherapy should also be considered.
Urologia funzionale: Nuove acquisizioni scientifiche al servizio della clinica
Authors: Porena Massimo
Published: June 2018

Questo seminar monografico di Urologia, dedicato all'urologia funzionale del basso tratto urinario, ospita quattro articoli che aprono a nuove prospettive sulla comprensione della fisiopatologia dei LUTS e del loro trattamento, alla luce delle recenti acquisizioni neurofisiologiche, di imaging e di biologia molecolari. Il progressivo allungarsi della vita media registratosi nell'ultima metà del secolo è destinato a diventare un fenomeno caratteristico della nostra epoca, portando all'attenzione dell'urologo nuovi contesti precedentemente considerati di scarso rilievo. L'intera comunità scientifica, e la comunità urologica nello specifico, appare oggi unanime nel considerare necessario incrementare i propri sforzi verso un costante supporto verso la qualità di vita. Questa volontà è particolarmente evidente per quelle patologie, come i disturbi del baso tratto urinario, che non minacciano direttamente la quantità di vista del singolo soggetto, ma minano profondamente la sua realizzazione individuale e sociale determinando profonde alterazioni qualitative. Succede così che dopo aver saputo opporsi con efficacia e prontezza inaspettate all'attacco di patologie infettive e neoplastiche, l'urologo si confronta oggi con altre sfide. I quattro lavori presentati in questo volume testimoniano l'impegno e il contributo dell'urologia funzionale italiana che con instancabile dedizione alla causa della salute dei propri pazienti, verso le patologie funzionali del basso tratto urinario. La comprensione che l'urotelio, in passato considerato alla stregua di una semplice barriera fisica, che separava le urine dal corpo, partecipi alla regolazione neurologica periferica del riflesso minzionale, che cellule epiteliali assumano la capacità di svolgere un ruolo sensorio afferenziale e che da questo ne derivi una nuova prospettiva terapeutica, rappresentano i principali avanzamenti nella gestione del paziente con vescica neurologica. Se in passato la correzione anatomia del difetto/descensus degli organi pelvici costituiva la prima ed unica soluzione, oggi siamo consapevoli che la correzione anatomica è un momento chirurgico che deve guardare ed ottenere un miglioramento dei sintomi. I quattro lavori, scritti da autori il cui valore è riconosciuto a livello nazionale ed internazionale, ci fanno comprendere come l'aumento dei valori relativi agli anni di vita media nei paesi più industrializzati sia un bene incompleto se non è accompagnato da un miglioramento della qualità di vita stessa delle persone.

Come urologi, abbiamo motivi di ritenere — certo ognuno potrà considerare dentro di sé quanto tutto ciò sia reale — che la tutela della qualità di vita rappresenti il problema di primaria ed imprescindibile importanza in ogni nostro reparto ed è per questo che siamo orgogliosi di ospitare su Urologia un contributo clinico-scientifico in tal senso.
Unusual metastatic localization to the kidney of basaloid squamous cell carcinoma of the oropharynx
Authors: Ricci Costantino , Rossi Martina S , De Stefano Roberta , Fiorentino Michelangelo , Vasuri Francesco
Published: June 2018

Case presentation:

A 55-year-old man with a history of basaloid squamous cell carcinoma of the oropharynx with laterocervical lymph node metastases 6 years before (and treated with chemoradiation) presented with flank pain and hematuria. Computed tomography scan found a renal lesion, with radiological features more suspicious for primitive renal neoplasia. Histopathological and immunohistochemical examination after surgical excision revealed a basaloid squamous cell carcinoma involving renal parenchyma.

Conclusion:

Basaloid squamous cell carcinoma is a rare tumor but with a high percentage of distant metastasis, and it is mandatory, also for a general pathologist, to know this disease. Moreover, in a patient with renal metastases, any type of cancer should be taken into account, and this case is emblematic of why the previous medical history is crucial for differential diagnosis.
Is there any relationship between serum levels of total bilirubin and the severity of erectile dysfunction?
Authors: Keskin Ercüment , Karabakan Mehmet , Bozkurt Aliseydi , Hirik Erkan , Karabulut İbrahim , Gunay Murat , Çakan Murat
Published: June 2018

Objective:

Recent studies have shown that atherosclerosis is associated with erectile dysfunction and the serum bilirubin level. In this study, the serum total bilirubin levels of patients with erectile dysfunction were measured to investigate the relationship between the levels of erectile dysfunction and total bilirubin.

Methods:

A total of 94 patients with erectile dysfunction were divided into three groups; severe erectile dysfunction (33 patients), moderate erectile dysfunction (31 patients), and mild erectile dysfunction (30 patients). In addition, a control group was formed with 31 healthy men. The International Index of Erectile Function-5 Questionnaire was used to measure the quality of erection in all the groups. The body mass index was calculated for all the participants. The serum glucose, low-density lipoprotein and high-density lipoprotein, cholesterol, triglyceride, total bilirubin, and total testosterone levels were also determined.

Results:

No statistically significant difference was observed between the groups in terms of the mean age, hypertension, smoking status, alcohol use, cardiovascular diseases, hepatobiliary disease, diabetes mellitus, and levels of total testosterone, low-density lipoprotein–cholesterol, and triglyceride. However, high-density lipoprotein, body mass index, and total bilirubin were significantly lower compared to the control group (p < 0.001). The serum total bilirubin level was found to be 0.41 ± 0.21 ng/dL in the severe erectile dysfunction, 0.43 ± 0.19 ng/dL in the moderate erectile dysfunction, and 0.48 ± 0.11 ng/dL in the mild erectile dysfunction groups (p < 0.001).

Conclusion:

Considering the significant differences between the erectile dysfunction and control groups in terms of serum total bilirubin levels, a low level of bilirubin may have a role in the etiology of erectile dysfunction.
Comparative results of cryoablation and laparoscopic radical prostatectomy in the treatment of localized prostate cancer
Authors: Chinenov Denis Vladimirovich , Rapoport Leonid Mikhailovich , Shpot Evgeniy Valerievich , Enikeev Dmitry Victorovich , Chernov Yaroslav Nikolaevich , Taratkin Mark Sergeevich , Korolev Dmitry Olegovich
Published: June 2018

Aim:

To evaluate early prostate cancer cryoablation functional and oncological results in comparison with results of extraperitoneoscopic radical prostatectomy.

Materials and methods:

We analyzed early results of surgical treatment of 285 patients with prostate cancer: 42 of them had undergone total cryoablation (Group 1) while the rest of them had been treated by radical laparo- and extraperitoneoscopic prostatectomy. For comparative assessment of prostate cryoablation results, 42 patients from Group 2 randomized in accordance with their age, stage of disease, Gleason, prostate-specific antigen, and prostate volume were selected. In compliance with the results of pre-surgical examination, all the patients had low oncological risk and were not concerned in sexual function. Volume of prostate was from 22 to 65 cm3, prostate-specific antigen level was from 4.1 to 10 ng/mL, and level of neoplastic process differentiation using Gleason grading system was from 6 to 7a (3 + 4) scores.

Results:

Patients after prostate cryoablation in early post-surgical period felt lower intensity of postoperative pain compared with those who had undergone prostatectomy. Follow-up period up to 12 months manifested significant true reduction of prostate-specific antigen level in both groups of patients. Frequency of stress-induced enuresis in Group 1 was not observed.

Conclusion:

Radical prostatectomy is still the traditional treatment of choice in the case of localized prostate cancer. But we can draw the conclusion that cryoablation is an effective low-invasive method for treatment of low oncological risk patients, which gives the opportunity both to achieve good oncological results and to preserve high life quality.
Postoperative complications and 90-day mortality in radical cystectomy in high-risk patients: A monocentric retrospective observational study
Authors: Pavone Carlo , Candela Luigi , Fontana Dario , Simonato Alchiede
Published: June 2018

Aim:

Assessing the incidence of immediate postoperative complications and 90-day mortality in high-risk patients who have undergone radical cystectomy; evaluating the correlation between preoperative conditions and surgery outcomes.

Materials and methods:

This is a monocentric retrospective observational study in which data of 65 patients have been analyzed.

High-risk criteria:

(a) Age ≥75 years, (b) obesity, (c) age-adjusted Charlson Comorbidity Index ≥8, (d) anemic status, and (e) pT ≥3. More than 50% of patients had two or more “high-risk” indicators. Postoperative complications were assessed through Clavien–Dindo classification.

Results:

Average age of patients was 70.4 years, average age-adjusted Charlson Comorbidity Index was 5.8, and average body mass index was 27.5. In 28% of patients, no complications arose, while in 46% grades I–II complications according to Clavien–Dindo occurred, in 23% grades III–IV complications occurred, and in 3% of the patients, death arose in the immediate postoperative period (grade V). Overall, 90-day mortality rate after surgery was 12.3%. The age ≥75 years and an age-adjusted Charlson Comorbidity Index score ≥8 have shown to be risk factors for the onset of severe complications (odds ratio = 3.54, p = 0.028 and odds ratio = 4.7, p = 0.026), while preoperative anemic status was a risk factor for complications in general (odds ratio = 4.1, p = 0.015). No analyzed parameter was a predictor of 90-day mortality ( p > 0.05).

Conclusion:

Immediate postoperative complications and 90-day mortality in radical cystectomy in high-risk patients remain significant, but still in line with the data in the literature on comparable populations. Some of the preoperative parameters were able to predict the outcomes of the intervention with regard to the onset of complications but not to the 90-day mortality.
Evaluation of the success rate and complications of conventional varicocelectomy: Do we need microscopic surgery really?
Authors: Ameli Mojtaba , Ahmadzadeh Milad , Khajavi Abdoljavad , Nabizadeh Mostafa
Published: June 2018

Objective:

Varicocele is the most commonly curable cause of infertility in men. Varicocele is found in 15% of the total male population, 35% of men with primary infertility, and 75%–81% of men with secondary infertility. Generally, patients seek microscopic surgery via surfing the Internet, which is not an available option in all medical centers. The purpose of this study was to determine the success rate and complications of conventional varicocelectomy and to compare it with that of the microscopic method.

Methods:

In this descriptive cross-sectional study, 88 patients with varicocele who underwent non-microscopic varicocele surgery in the 15th Khordad Hospital during 2013–2015 were evaluated by the census method.

Results:

The mean age of patients with varicocele was 27.30 years; 52 patients underwent bilateral varicocelectomy and 36 left varicocelectomy. Surgical complications of non-microscopic varicocelectomy in the studied patients included bleeding and hydrocele formation both in 0.7% and recurrence in 2.8%. Testicular atrophy was not observed in any case.

Conclusion:

The incidence of recurrence, hydrocele formation, atrophy, and bleeding in non-microscopic varicocelectomy, if done in accordance with its principles, is not more than the microscopic approach and therefore it could be recommended as a safe surgical treatment in centers where microscopic surgery is not available.
Entero-neovesical fistula after radical cystectomy and orthotopic ileal neobladder: A report of two cases requiring surgical management
Authors: Palumbo Vito , Giannarini Gianluca , Subba Enrica , Inferrera Antonino , Ficarra Vincenzo
Published: June 2018

Introduction:

Entero-neovesical fistula is a rare complication after radical cystectomy and orthotopic ileal bladder substitution. Typical presenting symptoms are faecaluria, pneumaturia, recurrent urinary tract infections and abdominal pain. Risk factors include history of pelvic radiation, chemotherapy and abdominal surgery, as well as diverticular colonic disease, inflammatory bowel disease and traumatic pelvic injury. The paucity of cases reported in the literature makes the management of this threatening complication very challenging. Conservative treatment has only anecdotally been reported.

Case description:

We describe two cases of entero-neovesical fistula with different presentation, which both required an immediate surgical treatment. The former patient was admitted to the emergency room with faecaluria, complete urinary incontinence and fever 2 years after radical cystectomy, and a fistula between the Y-shaped neobladder and the bowel anastomosis was detected. He had previously undergone chemotherapy because of tumour progression. Undiversion into an ileal conduit was required. The latter patient presented with faecaluria 20 days after an uneventful radical cystectomy, and a fistula between the Vescica Ileale Padovana neobladder and the sigmoid was documented. Treatment included resection of the sigmoid with several small diverticula, temporary ileostomy and closure of the neobladder fistula.

Conclusion:

Conservative treatment of entero-neovesical fistula can be attempted only in patients with small openings in the small bowel and no systemic symptoms. In all other cases, surgical treatment with bowel resection and either closure of the neobladder opening or undiversion should be the preferred option.
Onabotulinumtoxin-A improves health status and urinary symptoms in subjects with refractory overactive bladder: Real-life experience
Authors: Tamburro Fabiola R , Castellan Pietro , Neri Fabio , Berardinelli Francesco , Bada Maida , Sountoulides Petros , Giuliani Nicola , Finazzi Agrò Enrico , Schips Luigi , Cindolo Luca
Published: June 2018

Objective:

Onabotulinumtoxin-A has been approved for wet overactive bladder refractory to anticholinergics in randomised controlled trials; however, data from real-life practice are scarce. This study was designed to assess the efficacy of intravesical onabotulinumtoxin-A injections, focusing on health status, urinary symptoms and subjective satisfaction.

Methods:

Data from consecutive patients with overactive bladder-refractory to anticholinergics treated with onabotulinumtoxin-A were prospectively collected and analysed. Standard doses (100–150 U) were used, followed by repeat sessions when clinical benefits diminished. Efficacy and safety of repeat onabotulinumtoxin-A administrations were assessed at 12-week post-injection. Clinical parameters evaluated were: change in the magnitude and frequency of incontinence, urgency and nocturia episodes, change in the number of pads used and procedural complications. Quality of life was evaluated using the 36-Item Short-Form Health Survey, Overactive Bladder Screener and Treatment Benefit Scale questionnaires.

Results:

Consecutive overactive bladder-refractory to anticholinergics patients ( n = 22) (median duration of oral therapy: 10 months) were enrolled. No intraoperative complications occurred, but two urinary retention cases were recorded. Forty-five percent of patients (10/22) were re-treated (median duration of perceived benefits: 18 months, range: 8–55 months). The number of urinary incontinence, frequency and nocturia episodes, and pads used went from 3.6, 11.3, 2.7 and 2.4 preoperatively to 1.0, 5.8, 0.7 and 0.7 postoperatively ( p < 0.005). Quality of life (36-Item Short-Form Health Survey) was significantly improved and symptom scores (Overactive Bladder Screener) were reduced, from 34.5 to 17.1 at week 12 ( p < 0.05). Eighty-seven percent of patients indicated improvement/great improvement in their condition (Treatment Benefit Scale).

Conclusion:

Intradetrusor injections of onabotulinumtoxin-A in patients with overactive bladder-refractory to anticholinergics significantly improved health status and urinary symptoms, with high subjective satisfaction.
Ischemia of the glans 24 hours after circumcision: A case report and therapeutic solution
Authors: Mittino Irene , Sangalli Mattia , Fabbri Fabio , Sozzi Francesco , Ghezzi Massimo , Zanni Giuseppe , Cestari Andrea
Published: June 2018

Introduction:

Circumcision is a common surgical procedure, typically performed under local anesthesia and somehow also as outpatient clinic. Although complications are rare and most frequently related to the procedure itself, ischemia of the glans may occur as a major complication and can be related to local ischemia following dorsal penile nerve block.

Case description:

We describe the case of a 33-year-old patient who underwent circumcision at our institution and, 24 h after the procedure, developed an acute ischemia of the glans; a re-intervention was performed in emergency setting to ensure a large, not-tightened circular suture under the glans, and low-molecular-weight heparin and antiplatelet therapy was introduced to achieve anti-coagulative/antiaggregant effects. After 48 h, the skin returned to its normal color and in 7 days the penile glans achieved complete remission of the ischemic aspect. A 6-month follow-up confirmed regular outcomes with normal erectile functions.

Conclusion:

The treatment we proposed to treat acute post-circumcision ischemia of the glans is a simple and effective one, with a perfect aesthetic and functional outcome observed within 4 weeks and confirmed at 6-month follow-up.
15 years’ survey of safety and efficacy of Serenoa repens extract in benign prostatic hyperplasia patients with risk of progression
Authors: Vinarov Andrey Zinovievich , Spivak Leonid Grigorievich , Platonova Darina Vladimirovna , Rapoport Leonid Mikhailovich , Korolev Dmitry Olegovich
Published: June 2018

Aim:

The aim of this study is to investigate the efficacy and safety of long-term therapy with Serenoa repens extract with regard to halting benign prostatic hyperplasia progression.

Material and methods:

An open non-comparative observational study of the continuous use of S. repens plant extract at a dosage of 320 mg once a day for 15 years was performed in 30 patients at risk for benign prostatic hyperplasia progression. Changes in IPSS (International Prostatic Symptoms Scale) and QoL (Quality of life) scores and changes in Qmax, voided volume, residual urine volume, and prostate volume were evaluated during the study.

Results:

The study showed an absence of progression based on both subjective (the sum of scores on the IPSS and QoL scales) and objective (prostate volume, urination rate, residual urine volume) criteria. Furthermore, the patients had no adverse events related to the study drug, including prostate cancer.

Conclusions:

The 15 years’ study results suggest that taking S. repens plant extract continuously at a daily dose of 320 mg is an effective and safe way to prevent the progression of benign prostatic hyperplasia.
Challenges and Contradictions in the ‘Normalising’ of Precarious Work
Authors: Rubery Jill , Grimshaw Damian , Keizer Arjan , Johnson Mathew
Published: June 2018

Precarious work is increasingly considered the new ‘norm’ to which employment and social protection systems must adjust. This article explores the contradictions and tensions that arise from different processes of normalisation driven by social policies that simultaneously decommodify and recommodify labour. An expanded framework of decommodification is presented that identifies how the standard employment relationship (SER) may be extended and flexibilised to include those in precarious work, drawing examples from a recent study of precarious work across six European countries. These decommodification processes are found to be both partial and, in some cases, coexisting with activation policies that position precarious work as an alternative to unemployment, thereby recommodifying labour. Despite these challenges and contradictions, the article argues that a new vision of SER reform promises greater inclusion than alternative policy scenarios that give up on the regulation of employers and rely on state subsidies to mitigate against precariousness.
Resource Mobilisation and Precarious Workers’ Organisations: An Analysis of the Chilean Subcontracted Mineworkers’ Unions
Authors: Manky Omar
Published: June 2018

Despite the poor working conditions, between 2003 and 2007 Chilean miners organised the longest and largest strikes in the country since the 1980s, obtaining one of the most important recent victories of the Latin American labour movement. This article uses this experience to illustrate the importance of the links between precarious workers and political activists. Drawing on 18 months of extensive fieldwork conducted at several mining sites in Chile, the article contends that the analysis of precarious workers’ organisations needs to consider workers’ access to different organisational resources, and the role that political parties’ militants play in such access, particularly in the Global South.
Lost in Administration: (Re)Producing Precarious Citizenship for Young University-Educated Intra-EU Migrants in Brussels
Authors: Simola Anna
Published: June 2018

The mounting backlash against intra-EU migration in various EU countries has triggered national policies seeking to restrict EU citizens’ social rights and freedom of movement. Building on and expanding Noora Lori’s work around this concept, the article examines intra-EU migrants’ increasingly unsettled legal statuses as potentially precarious citizenship. Focusing on the experiences of young university-educated intra-EU migrants in Brussels, the article claims that, in the absence of straightforward EU legislation and explicit government policies, administrative actors use their discretion to draw indeterminate boundaries enforcing conditionality and temporariness of status for EU citizens in precarious work arrangements, therefore often increasing the pressure on them to take further precarious jobs. The article argues that, under the conditions of precarious employment, not even migrants with privileged access to citizenship rights are protected from processes of boundary enforcement that institutionalise the ambiguity of statuses and produce precarious citizenship.
Tackling Precarious Work in Public Supply Chains: A Comparison of Local Government Procurement Policies in Denmark, Germany and the UK
Authors: Jaehrling Karen , Johnson Mathew , Larsen Trine P , Refslund Bjarke , Grimshaw Damian
Published: June 2018

Through a cross-national comparative study of local government ‘best practice cases’ of socially responsible procurement in Denmark, Germany and the UK, this article critically examines the role of labour clauses in addressing issues of low wages and precarious work in public supply chains. It provides new insights on the negotiations and outcomes of labour clauses across different stages of the policy process, including implementation and monitoring. The analysis demonstrates the importance of pragmatic alliances of progressive local politicians, unions and employers in ensuring that socially responsible procurement moves beyond rhetoric, along with supportive national and sectoral employment regimes. Labour clauses can compensate for weak systems of labour market regulation by setting higher standards for outsourced workers, while they play a complementary role in more regulated labour markets by levelling up wages and working conditions to prevailing collectively agreed standards.
Physico-thermal properties of kenaf fiber/high-density polyethylene/maleic anhydride compatibilized composites
Authors: Salleh Fauzani Md , Hassan Aziz , Yahya Rosiyah , Mohd Isa Muhammad Rafiq , Lafia-Araga Ruth A
Published: June 2018

Kenaf fiber/high-density polyethylene/maleic anhydride (MA)-compatibilized composites were melt mixed in a twin-screw extruder and molded using injection molding machine. Physicothermal properties of the composites were studied at different percentages of compatibilizer contents using various techniques. The addition of 8% compatibilizer into 8.5 and 17.5 wt% fiber content improved the adhesion and tensile strength by 14.5% and 13.6%, respectively. Compatibilized samples exhibited higher peak load and fracture energy on impact testing compared to the samples without maleic anhydride compatibilizer. The effect of the addition of maleic anhydride compatibilizer on peak load and fracture energy was observed to be at its highest at 8%. Differential scanning calorimetric measurements revealed that the melting enthalpy and degree of crystallinity of composites increased with increasing compatibilizer content up to 8% and then decreased at 12% compatibilizer content. Dynamic mechanical analysis showed that the storage modulus of composites was increased, but the loss modulus and tangent delta were decreased after the addition of compatibilizer. This indicates that compatibilized composites produced have improved toughness and reduced stiffness.
Experimental kinematic identification and position control of a 3-DOF decoupled parallel robot
Authors: Heydarzadeh Mohsen , Karbasizadeh Nima , Tale Masouleh Mehdi , Kalhor Ahmad
Published: June 2018

This paper aims at using a kinematic identification procedure in order to enhance the control of a 3-DOF fully decoupled parallel robot, the so-called “Tripteron.” From a practical standpoint, manufacture errors lead to some kinematic uncertainties in the robot which cause real kinematic equations of the robot to be different from the theoretical ones. In this paper, using a white box identification procedure, the independence of degrees-of-freedom in the robot is studied. Considering the fact that the kinematic identification of a robotic manipulator requires the position of its end-effector to be known, in this paper “Kinect” sensor, which is a vision-infra red sensor, is utilized to obtain the spatial coordinates of the end-effector. In order to calibrate the Kinect, a novel approach which is based on a neuro-fuzzy algorithm, the so-called “LoLiMoT” algorithm, is used. Moreover, the results of experimentally performing the identification and calibrating approach are used to the end of implementing a closed-loop classic controller for path tracking purposes. Furthermore, the theoretical unidentified model was implemented in a sliding mode robust controller in order to compare the results with classic controller. The comparison reveals that classic controller which uses identified model leads to a better performance in terms of accuracy and control effort with respect to robust controller which is purely based on theoretical model.
Architectural exploration of multilayer perceptron models for on-chip and real-time road sign classification
Authors: Faiedh Hassene , Hamdi Sabrine , Bouguezzi Safa , Farhat Wajdi , Souani Chokri
Published: June 2018

Road sign recognition is part of the automatic driver assistance systems implemented on the dashboard of vehicles. The recognition task is often carried out based on a classification procedure manipulating the detected signs. Classification tasks can be resolved by the use of multilayer artificial neural network systems. This article proposes an optimized real-time on-chip hardware implementation of multilayer perceptron system used for road sign classification. Four architectural approaches were described: on the one hand, the classic and the serial optimized architectures that offer a very significant reduction in hardware resources, and, on the other hand, the parallel and the optimized architectures, which offer a much reduced, time execution. In order to benefit from the advantages of the allocated hardware resources and the classification of the runtime process, these four architectures have been implemented on field programmable gate array Virtex-6 devices and their performances were quantified and evaluated according to a cost criterion. The energy dissipated by each of these architectures was measured; the achieved results have allowed us to conclude that the serial optimized architecture is the optimal solution, since it creates a tradeoff between the low cost, and the energy efficiency, and still real-time for the considered application.
Better to be in The Placebo Arm for Trials of Neurological Therapies?
Authors: Kimmelman Jonathan
Published: June 2018

Patients with progressive neurodegenerative diseases often pursue trial entry seeking to access cutting edge therapies. However, cutting edge therapies for neurodegenerative diseases tend to have higher adverse event rates and underperform placebo. This essay argues that patients seeking trial entry are probably better off, medically, by being assigned to the placebo arm. Because trials involve extra clinic visits and research procedures, patients may be still better off medically by skipping trial participation altogether. I close by arguing that the Neurology research community might better honor the contributions of research subjects by pressing sponsors to promptly publish the results of non-positive trials, minimizing the use of uneven randomization ratios that favor assignment to the investigational treatment, and by fostering systematic collection of data on the risk/benefit balance of trial participation.
A Model for Out-of-School Educator Professional Learning
Authors: Wever Frerichs Saundra , Pearman Fenton Melissa Sue , Wingert Kerri
Published: June 2018

Quality out-of-school time (OST) programs for youth are limited by a lack of professional learning opportunities for staff and volunteers that are based upon solid learning theory, affordable, and scalable for a diverse field. The Click2Science project is an innovative model for professional learning experiences that support staff and volunteers in providing high-quality science, technology, engineering, and math (STEM) learning opportunities for youth. This model of professional learning emphasizes the importance of visual, social, and experiential learning experiences with reflection and application to practice. The model leverages technology and in-person support in a cycle of professional development experiences. The experiences included in the professional development model allow staff and volunteers in OST programs to develop their instructional skills in ways that are embedded in the actual practices of their program. In this article, each part of the professional development cycle is analyzed using constructivist learning theories to encourage adult educators to replicate this model in other fields. A brief review of promising research about the effectiveness of the model concludes the description of this approach to professional development.
An internal resonance based frequency up-converting energy harvester
Authors: Wu Yipeng , Ji Hongli , Qiu Jinhao , Liu Weiqun , Zhao Jinling
Published: June 2018

Frequency up-converting vibration energy harvester can bridge the gap between high-frequency response and low-frequency input, greatly increasing the efficiency of energy conversion. This article proposed a novel frequency up-converting energy harvester based on 1:3 internal resonance in 2 degree-of-freedom cubic nonlinear systems. The harvester consists of two asymmetric cantilevers corresponding to two vibration degrees-of-freedom. The ratio of cantilevers’ first-order resonances is (or close to) 1:3. When excited frequency matches the resonant frequency of the first assisting cantilever, 1:3 internal resonance of the harvester system occurs, leading to drastic vibration of the second generating cantilever at its resonance. The generated voltage frequency is then three times increased. Finally, simulated and experimental results clearly proved this frequency up-converting principle. In addition, the resonant frequency tuning and wideband behaviors of the harvester were also investigated, which increased the viability of the proposed harvester under the practical environment vibrations.
Fatigue properties by “self-heating” method: Application to orthodontic Ni-Ti wires after hydrogen charging
Authors: Rokbani Maha , Saint-Sulpice Luc , Arbab Chirani Shabnam , Bouraoui Tarak
Published: June 2018

Ni-Ti superelastic alloys have been successfully used in orthodontic clinics thanks to their good biomechanical and biochemical behavior. However, during treatment, some orthodontic wires may break in the oral cavity. The susceptibility of these alloys to cyclic loadings and to hydrogen embrittlement is supposed to be main causes of these unexpected failures. This study presents a contribution to studying the effect of hydrogen, obtained after cathodically charging in 0.9% NaCl solution, on the fatigue behavior of Ni-Ti commercial orthodontic wires subjected to high-cycle fatigue. Fatigue tests were analyzed using self-heating method based on observing thermal effects under mechanical cyclic loading. The results obtained with self-heating approach imply that the increase in hydrogen charging time is connected with an increase in the mean stabilized temperature and a decrease in the fatigue life. Self-heating method allows a rapid prediction of the endurance limit with a good reproducibility of fatigue tests at high number of cycles. Furthermore, cyclic stress–induced transformations and conventional fatigue tests under strain control are considered in this work to investigate the effect of hydrogen on cyclic loading type and to acquire for a better understanding of the interaction between hydrogen and thermo-mechanical mechanisms in Ni-Ti alloys.
Comparison Between Two Types of Educational Computer Games
Authors: Dedeaux Timothy , Hartsell Taralynn
Published: June 2018

Background. Educational computer games can enhance learner engagement and content knowledge gain. Video games based on Malone’s theory of game design that involve challenge, fantasy, and curiosity can help improve learning.

Aim. The purpose of the study is to compare differences between two drill-and-skill games to learn French phrases. Variables examined were student engagement, content knowledge gain, and demographical implications (e.g., gender, minority status, and socio-economic status). One of the games in the study meets Malone’s theory of game design.

Method. This quasi-experimental study divides participants into two groups, each playing a different type of drill-and-skill game. Instruments to collect data include a pre- and post-test on French phrases and a digital game engagement questionnaire. Participants receive a short instructional session, game play time, and instruments to complete.

Results. No significant results have been found in content knowledge gain and engagement between participants in the pre- and post-tests. A slight difference in relation to minority status has been discovered. Feedback from the participants show a positive response toward the games, except that some distraction and technicality have interfered with their learning.

Conclusion. Although results are inconclusive, drill-and-skill computer games can be a tool to enhance learning and provide student engagement.
Frequency and Impact of Adverse Events in Patients Undergoing Surgery for End-Stage Ankle Arthritis
Authors: Norvell Daniel C. , Shofer Jane B. , Hansen Sigvard T. , Davitt James , Anderson John G. , Bohay Donald , Coetzee J. Chris , Maskill John , Brage Michael , Houghton Michael , Ledoux William R. , Sangeorzan Bruce J.
Published: June 2018

Background:

This study summarized the frequency and functional impact of adverse events (AEs) that occur after surgery for end-stage ankle arthritis (ESAA) to inform decision making.

Methods:

This was a multisite prospective cohort study to compare ankle arthroplasty to ankle arthrodesis in the treatment of ESAA among 6 participating sites. We compared the risk and impact of nonankle AEs and ankle-specific AEs versus no AEs controlling for potential confounding factors, including operative procedure using multinomial logistic regression. We estimated differences in postoperative functional outcomes by AE occurrence using linear mixed effects regression. Among 517 patients who had surgery for ankle arthritis and completed the full baseline assessment, follow-up scores were available in 494 (95%) patients.

Results:

There were a total of 628 reported AEs (477 in the arthroplasty group and 151 in the arthrodesis group). These occurred in 261 (63%) arthroplasty patients and 67 (65%) arthrodesis patients. There were 50 (8%) ankle-specific AEs. The risk of an ankle-specific AE was slightly higher in the arthrodesis group versus the arthroplasty group, odds ratio (OR) 1.84, 95% confidence interval (CI, 0.85, 3.98). The OR for the risk of non–ankle-specific AE versus no AE was 0.96, 95% CI (0.57, 1.61) for those receiving arthrodesis compared to arthroplasty. Compared to patients with no AEs, those experiencing ankle-specific AEs had significantly less improvement in Foot and Ankle Ability Measure Sports and activities of daily living (ADL) subscores and worst pain outcomes; however, both groups improved significantly in all measures except mental health.

Conclusions:

Ankle-specific AEs were infrequent and only weakly associated with operative procedure. Although patients improved in all functional outcomes except mental health, regardless of AE occurrence, ankle-specific AEs negatively impacted patient improvement compared to those with no AEs or a nonankle AE. The logistical effort and cost of tracking nonankle AEs does not seem to be justified.

Level of Evidence:

Level II, prospective comparative study.