bluuebunny/crossref_metadata_2025 huggingface dataset:
Digital Peer Support for People With Severe Mental Illness
Authors: Bento Mafalda da Silva , Carvalho Felipe Natan Alves Barbosa , Antunes Inês Beatriz , Olmo Giselle Carpi
Published: December 2021

The literature has recognized peer support as a fundamental part of the recovery process for people with severe mental illness (SMI). These populations frequently experience barriers related to (self)stigmatization, social relationship, poor friendship quality, ostracism, isolation, and fear of being rejected or embarrassed. Scientific research suggests those individuals are more willing to share personal and sensitive details through digital technologies, building friendships and using the internet to access health information rather than their peers who do not experience SMI. The purpose of this chapter is to explore the digital-based peer programs and to analyze scientific evidence behind the alternative paradigm, related concepts, intervention designs, and results.
Digital Technologies in Dementia Care
Authors: Coelho Tiago
Published: December 2021

Dementia is characterized by significant cognitive deterioration, behavioral and psychological symptoms, and expanding disability. The well-being of people with dementia is influenced by the support provided by caregivers and health professionals. Especially in the past two decades, advancements in digital technology have helped reshape the way care and treatment are delivered. The main goal of the chapter is to describe technological solutions aimed at supporting the independence and safe participation of people with dementia in meaningful activities, as well as promoting their involvement in engaging experiences that seek to delay cognitive decline and diminish behavioral and psychological symptoms. These technologies include distributed systems, robotics, wearable devices, application software, and virtual reality.
An Evidence-Based Protocol for Manual Prone Positioning of Patients With ARDS
Authors: Ryan Patrick , Fine Cynthia , DeForge Christine
Published: December 2021

Background

Manual prone positioning has been shown to reduce mortality among patients with moderate to severe acute respiratory distress syndrome, but it is associated with a high incidence of pressure injuries and unplanned extubations. This study investigated the feasibility of safely implementing a manual prone positioning protocol that uses a dedicated device.

Review of Evidence

A search of CINAHL and Medline identified multiple randomized controlled trials and meta-analyses that demonstrated both the reduction of mortality when prone positioning is used for more than 12 hours per day in patients with acute respiratory distress syndrome and the most common complications of this treatment.

Implementation

An existing safe patient-handling device was modified to enable staff to safely perform manual prone positioning with few complications for patients receiving mechanical ventilation. All staff received training on the protocol and use of the device before implementation.

Evaluation

This study included 36 consecutive patients who were admitted to the medical intensive care unit at a large academic medical center because of hypoxemic respiratory failure/acute respiratory distress syndrome and received mechanical ventilation and prone positioning. Data were collected on clinical presentation, interventions, and complications.

Sustainability

Using the robust protocol and the low-cost device, staff can safely perform a low-volume, high-risk maneuver. This method provides cost savings compared with other prone positioning methods.

Conclusions

Implementing a prone positioning protocol with a dedicated device is feasible, with fewer complications and lower costs than anticipated.
Susceptibility of iris (Iridaceae) to larval infestation by Neorthacheta dissimilis (Diptera: Scathophagidae)
Authors: Doyon Josée , Savage Jade , Bailleul Stéphane , Labelle Stéphane , Brodeur Jacques
Published: December 2021

Neorthacheta dissimilis Malloch (Diptera: Scathophagidae) is a poorly known scathophagid fly that feeds and develops on iris (Iridaceae). A survey of its occurrence was performed at the Montréal Botanical Garden (Montréal, Québec, Canada) in 2018, 2019, and 2020. Iris species and cultivars from two subgenera, Iris and Limniris, were evaluated for larval infestation. When pooled for subgenera and years, data from 18 Iris classes revealed high levels of infestation per flower stalk, ranging from 34% to 100%. When analysed per bud or flower, levels of infestation remained high, ranging from 19% to 100%, but generally was lower than for flower stalks as the unit of replication. The mean number of N. dissimilis larvae per infested flower or bud was higher for the subgenus Limniris (1.13) than for the subgenus Iris (1.03), with a maximum of four N. dissimilis larvae per flower being observed. These figures are worrying for horticulturalists because the insect is prevalent and causes either abortion or aesthetic damages to iris flowers.
Efficacy of transmuscular quadratus lumborum block in the multimodal regimen for postoperative analgesia after total laparoscopic hysterectomy
Authors: Jadon Ashok , Ahmad Asif , Sahoo Rajendra K , Sinha Neelam , Chakraborty Swastika , Bakshi Apoorva
Published: December 2021

Background and Aims:

Transmuscular Quadratus Lumborum Block (TQLB) is a novel regional anaesthesia technique, however, its analgesic efficacy as a component of multimodal analgesia (MMA) in Total Laparoscopic Hysterectomy (TLH) is not well studied. The aim of the study was to evaluate the analgesic efficacy of TQLB as a component of MMA for postoperative pain in TLH.

Methods:

A prospective double-blind randomised controlled study was done after approval from the ethical committee and informed patient consent. After randomisation, 37 patients in Group-Q received 20 ml 0.375% ropivacaine and in Group-C, 37 patients received saline in TQLB bilaterally after TLH surgery. All patients received intravenous patient controlled analgesia (IV-PCA) with fentanyl along with diclofenac 75 mg every 12 h. All the patients were assessed at 2, 4, 6, 8, 12, 18, and 24 hours. The primary outcome was the time to first analgesic request. The secondary outcome measures were total fentanyl consumption in 24 hrs, pain scores during rest and movement, postoperative nausea-vomiting, sedation and complications related to local anaesthetic and TQLB procedure.

Results:

The mean [standard deviation (SD)] time to first analgesic request was 7.8 (1.5) hours in Group-Q and 3.2 (1.0) hours in Group-C (P < 0.0001). The mean (SD) dose of fentanyl used in 24 hours was 167.3 (44) μg in Group-Q and 226.5 (41.9) μg in Group-C (P < 0.0001).

Conclusion:

The ultrasound-guided TQLB provides effective postoperative analgesia after TLH surgery in a multimodal analgesia approach. It reduces the fentanyl consumption and improves the visual analogue scale (VAS) score.
Comparison of erector spinae plane block and local anaesthetic infiltration of the incision site for postoperative analgesia in percutaneous nephrolithotomy – A randomised parallel-group study
Authors: Ramachandran Srinivasan , Ramaraj Krishna P , Velayudhan Savitri , Shanmugam Balasubramanian , Kuppusamy Sureshkumar , Lazarus Suneeth P
Published: December 2021

Background and Aims:

Erector spinae plane block (ESPB) has been found effective in providing postoperative analgesia following a myriad of surgeries. This study was designed to evaluate the effectiveness of ultrasonography (USG) guided erector spinae plane block to provide postoperative analgesia following percutaneous nephrolithotomy (PCNL).

Methods:

This was a prospective, double-blinded, randomised parallel-group study conducted in patients undergoing PCNL. Patients in Group C (n = 33) received subcutaneous infiltration of 20 mL of 0.25% bupivacaine at the incision site and Group B (n = 33) received USG guided ESPB with 20 mL of 0.25% bupivacaine postoperatively. Numeric rating scale (NRS) scores were assessed at intervals of 30 min, 60 min, then hourly for six h, followed by four-hourly up to 24 h. The primary objective of the study was to compare postoperative pain relief using the NRS score between the two groups. Secondary objectives were to compare the analgesic requirement and to assess the incidence of complications. Normally distributed data were expressed as mean and standard deviation and analysed using Student's t-test. Data following non-normal distribution were expressed as median and interquartile range and analysed using Mann- Whitney U-test. For categorical data, the Chi-square test was used.

Results:

NRS scores were lower in Group B than Group C. There was significant prolongation in time for first analgesia in Group B (12 h) compared to Group C (30 min). There was a significant reduction in total tramadol consumption at 24 h postoperatively in the ESPB group.

Conclusion:

Ultrasound-guided ESPB is an efficacious analgesic technique with an opioid-sparing effect following PCNL.
Real-time ultrasound-guided spinal anaesthesia vs pre– procedural ultrasound-guided spinal anaesthesia in obese patients
Authors: Ravi Parli Raghavan , Naik Sudarshan , Joshi Mukund C , Singh Seema
Published: December 2021

Background and Aims:

Spinal anaesthesia is conventionally performed using a landmark-guided midline approach. These surface landmarks may be absent, indistinct or distorted in the presence of obesity, previous spinal surgeries, deformities, or degenerative changes associated with ageing. In the present study, we compared the efficacy of real-time ultrasound (RUS)-guided paramedian approach, and pre-procedure ultrasound (PUS) landmark-guided paramedian approach in obese patients.

Methods:

Eighty patients with body mass index (BMI) >30 kg/m2 were included in the study. The participants were randomly assigned to two intervention groups, i.e., RUS and PUS approach. The primary end point was to attain a successful lumbar puncture. Variables like the number of attempts, the number of passes, the time taken for identifying landmark(s), and time for a successful lumbar puncture(s) were secondary end points and were recorded in both the groups.

Results:

The median number of attempts were 4 (IQR 2-4) and 2 (IQR 1-2), respectively, in the PUS and RUS group (P-value < 0.001). The median number of passes, the median time for identifying space, and the time for successful lumbar puncture was statistically significantly less in the RUS group, than the PUS group.

Conclusion:

The time taken for the identification of the space, the number of attempts, number of passes, and the time taken for successful lumbar puncture was more in the PUS group as compared to the RUS group.
Comparative Study of Extracorporeal Shock Wave Lithotripsy Versus Mini Percutaneous Nephrolithotomy for the Treatment of Nonlower Calyceal 10–20 mm Size Kidney Stone
Authors: Roy Pinaki , Sarkar Debansu , Jalan Vishal , Pal Dilip Kumar
Published: December 2021

Purpose:

Urolithiasis is a common medical condition and the treatment is mainly minimally invasive methods. There exists no specific guidelines for the treatment of radio-opaque solitary non lower calyceal kidney stones of 10–20 mm in literature and no head to head study comparing both the procedures. Hence, this study was performed to have a specific guide for the treatment of such stones.

Materials and Methods:

This study, included all patients aged >18 years, with solitary radiopaque calculi of 10–20 mm size in upper or middle calyx or pelvis of the kidney. A total of 105 patients were assigned to receive extracorporeal shock wave lithotripsy (ESWL) or mini-percutaneous nephrolithotomy (PCNL) for treatment of stone were enrolled in the study and the results were compared in terms of retreatment, stone-free rate (SFR), and complications.

Results:

The SFR was statistically higher in the mini PCNL group for all locations. The SFR for the ESWL group was low after 1st session; however, it increased with multiple sessions. We had a total of 9 complications in both groups, which was statistically insignificant.

Conclusion:

This study showed that the mini PCNL is a viable, safe option for the treatment of 10–20 mm non lower calyceal stones, having superior SFRs compared to ESWL with statistically insignificant complications. It can be offered as first-line option for the management of such stones.
Management of Right-Sided Polyorchidism with Torsion
Authors: Nepal Sat Prasad , Nakasato Takehiko , Naoe Michio , Shimoyama Hideaki , Ogawa Yoshio , Fuji Kohzo , Maeda Yoshiko , Morita Jun , Oshinomi Kazuhiko , Matsui Yuki , Unoki Tsutomu , Hiramatsu Aya
Published: December 2021

Polyorchidism is a rare congenital condition associated with various anomalies; triorchidism is the most common form of this condition. A 21-year-old patient visited our hospital with pain in the right testis. He was diagnosed with right-sided polyorchidism with torsion and underwent manual detorsion followed by orchidopexy. We preserved the extra testis but did not perform histology, as radiological examination revealed no malignant features.
Toward a Validated Diagnostic Test with Machine Learning Algorithm for Interstitial Cystitis
Authors: Chancellor Michael B. , Lamb Laura E.
Published: December 2021

Diagnosing interstitial cystitis/bladder pain syndrome (IC/BPS) is difficult as there is no definitive test for IC/BPS. Instead, the diagnosis is based on urinary symptoms and cystoscopy may be recommended. However, cystoscopic diagnosis is associated with potentially exacerbating painful side effects and is highly subjective among physicians. Furthermore, IC/PBS symptoms overlap with symptoms of bladder cancer, urinary tract infection, or overactive bladder. As a result, many patients may go years without a correct diagnosis and proper disease management. The goal of our current IC/BPS research is to develop a simple diagnostic test based on several urine proteins called the IC-risk score (IC-RS). A machine learning (ML) algorithm uses this information to determine if a person has IC/BPS or not; if they have IC/BPS, whether their IC/BPS is characterized by Hunner's lesions. We are currently in the middle of a grant to collect urine samples from 1000 patients with IC/BPS and 1,000 normal controls from across the United States. We are using social media such as Twitter and Facebook and working with patient advocacy organizations to collect urine samples from across the country. We hope to validate the IC-RS and apply for regulatory approval. Having a validated diagnostic test for IC/BPS would be a major advancement to help urology patients. In addition, drug companies developing new drugs and therapies for IC/BPS would have a better way to determine who to include in their clinical trials, and possibly another way to measure if their drug or therapy is effective. We will hereby review the steps that have led us in urine biomarker discovery research from urine protein assessment to use crowdsourcing stakeholders participation to ML algorithm IC-RS score development.
Suppression of Quercetin-Induced Autophagy Enhances Cytotoxicity through Elevating Apoptotic Cell Death in Human Bladder Cancer Cells
Authors: Tsai Te-Fu , Hwang Thomas I-Sheng , Lin Ji-Fan , Chen Hung-En , Yang Shan-Che , Lin Yi-Chia , Chou Kuang-Yu
Published: December 2021

Objective:

Quercetin, a natural dietary compound, has been demonstrated with antitumor activities against several types of cancers by disrupting cell cycle and inducing apoptotic cell death. However, human bladder cancer cells such as 5637 and T24 cells expressing mutant p53 are resistant to a 24 hrs quercetin treatment. In this study, the anticancer effect of quercetin was evaluated in these bladder cancer cells.

Materials and Methods:

The bladder cancer cells treated with quercetin were subjected to evaluated cell apoptosis by caspase activity, TUNEL assay and cell viability assay. The cell autophagy was assessed by detecting procession of LC3-II autophagic marker protein.

Results:

After 48 and 72 hrs of incubation, quercetin was found to be significantly effective in inhibiting proliferation of 5637 and T24 cells in a dose-dependent manner. Quercetin treatment increased the caspase 3/7 activities, percentage of subG0/G1 cells, and DNA fragmentation, indicating an induced apoptotic cell death. Pretreatment of a pan-caspase inhibitor, Z-VAD-FMK, attenuated the quercetin-decreased cell viability, suggesting that the cytotoxicity caused by quercetin mainly via apoptotic cell death. We also found that quercetin induced autophagy, as evidenced by the increased processing of LC3-II, a specific marker of autophagy. The disruption of autophagic flux by using bafilomycin A1, an autophagy inhibitor, caused significant accumulation of cellular p62 and LC3-II. In addition, the pretreatment of autophagy inhibitors, Baf A1 and chloroquine, strongly augmented apoptosis in 5637 and T24 cells, indicating the suppression of quercetin-induced autophagy enhanced apoptosis. Furthermore, the decreased cell viability and increased LC3-II processing were attenuated in quercetin-treated cells which pretreated with a reactive oxygen species (ROS) scavenger, N-acetyl cystine (NAC) suggested that quercetin-induced cytotoxicity and autophagy were initiated by the generation of ROS.

Conclusion:

This study proposes that combined treatment of autophagy inhibitor which sensitizes cells to quercetin treatment may be a better therapeutic approach to reduce bladder cancer cells proliferation.
Outcome Analysis of Pediatric Pyeloplasty in Varied Presentation in Developing Countries
Authors: Khemchandani Sajni I.
Published: December 2021

Objectives:

The objective was to study the various presentations of pelviureteric junction (PUJ) obstruction in developing countries and its outcomes.

Materials and Methods:

We retrospectively reviewed the medical records of 239 children (260 renal units) who underwent surgery for PUJ obstruction between January 1994 and December 2016. Data on the patients presenting with symptoms and preoperative imaging findings of ultrasonography, intravenous urography, or diuretic renography were analyzed.

Results:

In all cases, we preferred dismembered Anderson-Hynes pyeloplasty with or without JJ stenting. Complications of pyeloplasty included prolonged urine leakage in 13 patients, of whom 4 responded to conservative management, 5 required percutaneous nephrostomy (PCN), and 4 were treated with endoscopic JJ stenting. Six patients had persistent obstruction: two responded to endopyelotomy, and in four, redo pyeloplasty was successful. Five patients with renal function of <10% were initially treated with PCN and ultimately required nephrectomy.

Conclusions:

In patients born with PUJ obstruction and impaired renal function, pyeloplasty fails to significantly improve function, possibly because of cortical loss. However, in patients with antenatal PUJ obstruction managed expectantly, there is a small but significant risk of modest permanent loss of renal function.
Immunoglobulin G4-Related Bilateral Kidney Disease
Authors: Anukoolphaiboon Apiwich , Attawettayanon Worapat
Published: December 2021

Immunoglobulin G4-related disease (IgG4-RD) is uncommon and is characterized by dense tissue infiltration of IgG4-positive plasma cells or mass-like sclerosing lesions. In addition, it can involve any anatomic site, which has frequently elevated serum IgG4 concentrations. Japanese gastroenterologists are the ones who first discussed the concept of IgG4-RD; they first introduced the term IgG4-related kidney disease (IgG4-RKD), which refers to the involvement of the kidney and its surrounding tissues. Common urologic indicators of IgG4-RKD typically include subacute pain, on the detection of a tumor-like mass or enlargement, with or without tubulointerstitial nephritis. Conventional imaging computed tomography and magnetic resonance imaging are of limited usefulness in determining IgG4-RKD. The gold-standard for the diagnosis of IgG4-RD is the identification of typical histopathological features of dense lymphoplasmacytic infiltration, storiform fibrosis (an irregular cartwheel like fibrotic pattern), and obliterative phlebitis; these are the three hallmarks of IgG4-RD. The current report discusses a case of IgG4-RKD, who came into our hospital with chronic flank pain.
Genotyping and Molecular Characterization of Extended-Spectrum Beta-Lactamases-Producing Uropathogenic Escherichia Coli in and Around Coimbatore District, Tamil Nadu, India
Authors: Muraleetharan Mylsamy , Viswanathan Thirumoorthy
Published: December 2021

Background:

Escherichia coli, an extraintestinal flora, develops virulence traits through a persistent encounter with host and constant exposure to antibiotics, which makes it line up as the most common urinary pathogen. Thus, this study aimed to screen the presence of virulence traits among multidrug-resistant urinary pathogenic E. coli among the urine samples collected from inpatients and outpatients of the multispecialty hospitals.

Materials and Methods:

Standard microbiological laboratory protocols were followed, and about 210 samples were processed and screened.

Results:

Among those samples, 114 were reported positive for the presence of uropathogenic E. coli(UPEC). Gender-wise distribution was found to be more among female patients (56%) than male patients (51%). During screening for hemolytic activity, 37% of test isolates were α hemolytic, 48% were β hemolytic, and 15% were γ hemolytic. Screening virulence among test isolates, sfa gene (49%), afa (42%), hly (68%), CNF (43%), and aer, accounts for 65%. Further, the multidrug resistance of the isolates was done by using ten antibiotics. All the isolates exhibited the multiple antibiotic resistance (MAR), and the highest percentage of resistance was found against ceftazidime (100%), and the least percentage of resistance was observed against imipenem (2%) followed by amikacin (8%). MAR index values of all the isolates ranged from 0.4 to 1.

Conclusion:

The presence of various virulence genes and the high degree of resistance among the isolates against the antibiotics used in this study confirm the prevalence of extended-spectrum β-lactamase producers among the UPEC.
The Associations of Genital-Normalizing Surgery and Assigned Gender in Predicting Gender Outcomes
Authors: Veale Jaimie F.
Published: December 2021

Purpose:

The purpose was to systematically analyze the associations of childhood gender assignment and genital normalizing surgeries with adult gender in case reports of adults with differences of sex development (DSD). We did this using a pooled nested analysis of DSD adult cases reported in the academic literature.

Materials and Methods:

A search of academic databases uncovered 282 adult DSD cases reported in 58 academic articles that met the criteria for inclusion in the analysis. These were cases with 46, XX congenital adrenal hyperplasia, partial androgen insensitivity, mixed or partial gonadal dysgenesis, and micropenis where data about the assigned gender, childhood genital-normalizing surgery, and adult gender could be extracted. We conducted a generalized logistic mixed-model regression analysis, with multiple predictors of adult assigned gender incongruence.

Results:

Controlling for assigned gender, age, year of article publication, and DSD type, childhood genital surgery was not significantly associated with adult assigned gender incongruence. Cases assigned female had more than five times greater likelihood of assigned gender incongruence (95% confidence interval = 1.96–14.92).

Conclusion:

This study did not find evidence that childhood genital surgery is related to assigned gender incongruence; it also found that assigning a child as a female increased this possibility. These findings may inform decisions taken by clinicians and family members about the early management of DSD cases. The study was limited by publication bias in the types of cases that get published. Ethical considerations should always take precedence in decision-making regarding these surgeries.
Current and Future Aspect of Immunotherapy for Advanced Renal Cell Carcinoma
Authors: Hsueh Fu-Jen , Tsai Yu
Published: December 2021

Renal cell carcinoma (RCC) has been recognized as a cancer responsive to the activation of the immune system. In the 1980s, interferon-alpha and interleukin-2 were shown to prolong survival, but they were not widely used due to toxicities. Then, vascular endothelial growth factor receptor and mammalian target of rapamycin inhibitors demonstrated clinical benefits and became the principal treatment in the first- and second-line setting of metastatic RCC (mRCC). In recent years, the efficacy of immune checkpoint inhibitors (ICIs) is confirmed, either alone or in combination with ICI or antiangiogenic agents. ICI-based immunotherapies have now changed the landscape of treatment of mRCC. In this article, we will review the progress of immunotherapy in clear-cell mRCC.
Is Repeated Direct Vision Internal Urethrotomy Feasible in the Management of Recurrent Anterior Urethral Strictures?
Authors: Chung Cho-Hsing , Wu Wen Ling , Liu Yin-Ting , Tzou Kai-Yi , Hu Su-Wei , Chiang Yi-Te , Ho Chen-Hsun , Liu Chia-Hung , Wu Chia-Chang , Chen Kuan-Chou , Kao Wei-Tang
Published: December 2021

Purpose:

Direct vision internal urethrotomy (DVIU) is the most common surgical intervention for anterior urethral strictures. We evaluated the long-term outcome and success rate of optic urethrotomy in patients treated in our hospital who had recurrent anterior urethral strictures, according to different predisposing causes and stricture sites. The aim is to find the success rate of optic urethrotomy in patients treated who had recurrent anterior urethral strictures.

Materials and Methods:

This study is a retrospective chart review. From January 2000 to August 2017, 232 patients received internal optic urethrotomy for anterior urethral strictures in our hospital. A retrospective chart review of all patients involved in the study was performed. Median follow-up period after receiving the first urethrotomy procedure was 91 months (range: 8–204 months). The Kaplan–Meier method was used to analyze the success rate of the first, second, third, fourth, and fifth urethrotomy procedures.

Results:

Of the 232 patients who underwent at least two procedures of urethrotomy, 150 (64.65%) were included in the study. The success rate of the first urethrotomy procedure was 0%, with a mean time to recurrence of 20 months. For the second urethrotomy, the success rate was 53%, with a mean time to recurrence of 22.5 months. For the third urethrotomy, the success rate was 40%, with a mean time to recurrence of 16.1 months. For the fourth and fifth urethrotomy procedures, the success rate was 39% and 18%, with a mean time to recurrence of 17.9 and 10.2 months, respectively. Patients who had anterior urethral stricture related to previous surgery (surgery-related) had a better outcome (success rate, 87.3%) than patients with strictures stemming from other causes (P = 0.003). No association was found between preoperative infection, the age of the patient, and the site of the strictures and the success rate of the procedure.

Conclusion:

The patient population was older and had a longer-term follow-up, compared with previous studies, but even with repeated DVIU, the surgery-related stricture group had a higher success rate of urethrotomy than the groups with different etiology. In patients with pelvic fracture or infection, repeated urethrotomy may not be recommended as first-line treatment for recurrent anterior urethral stricture.
Initial Prostate Biopsy of Grade Group One
Authors: Hung Fan-Ching , Tseng Chi-Shin , Chen Chung-Hsin , Chang Hong-Chiang , Huang Chao-Yuan , Lu Yu-Chuan
Published: December 2021

Purpose:

The aim of our study was to analyze the outcomes and predictive factors in patients with an initial biopsy grade group 1 (GG1) prostate cancer (PCa) at risk of GG upgrading.

Materials and Methods:

We performed a retrospective review of patients who had GG1 PCa at biopsy and were managed with robotic-assisted laparoscopic radical prostatectomy (RaLRP) from January 2012 to December 2018 and collected their clinical characteristics and pathological data. The primary outcomes were GG upgrading at RaLRP and biochemical recurrence-free survival (BCRFS) in these patients. The secondary outcome was to analyze the risk factors of pathological upgrades.

Results:

Among the 159 patients with initial prostate biopsy of GG1, 122 patients (76.7%) had GG upgrading based on the final pathology at RaLRP. Multivariable analysis showed that transrectal ultrasound (TRUS)-measured prostate volume <30 mL (odds ratio [OR] 4.727, P = 0.011), prostate-specific antigen density [PSAD] ≥0.2 ng/mL2 (OR 3.201, P = 0.019), magnetic resonance imaging (MRI)-measured prostate volume <30 mL (OR 3.892, P = 0.007), and PSAD ≥ 0.2 ng/mL2 (OR 2.65, P = 0.019) were independent predictive factors of GG upgrading. During 5 years of follow-up, patients who upgraded to GG3-5 had a significantly shorter time to biochemical recurrence than those who remained as GG1 (P = 0.001) or upgraded to GG2 (P = 0.008).

Conclusion:

The final pathology grading was underestimated in 76.7% of initial biopsy GG1 and may influence the BCRFS after RaLRP. Prostate volume <30 mL and PSAD ≥0.2 ng/mL2, measured by either MRI or TRUS, were significant predictive factors of biopsy GG1 upgrading.
Recent Literature on the Minimally Invasive Management of Pediatric Urolithiasis
Authors: Kim Jin Kyu , Chua Michael Erlano , Yang Stephen Shei-Dei , Ming Jessica M. , Santos Joana Dos , Farhat Walid A.
Published: December 2021

Although the surgical management of pediatric urolithiasis does not differ significantly from that of adults, there are anatomical and physiological differences that necessitate special considerations. This review aims to summarize the existing high-level evidence (systematic review, meta-analysis, randomized controlled trials) for surgical management of pediatric urolithiasis, with a discussion on different technical tips to make these surgical approaches achievable. A PubMed web-based medical literature search was performed on May 26, 2020, using the search strategy (Pediatric or children) and (urolithiasis or stone) and Urology. The search was limited to meta-analysis, systematic reviews, and randomized controlled trials published in the past 10 years. Only studies that focused on surgical management of pediatric urolithiasis were included. Fifty-seven records were identified and 47 were excluded as these records were duplicates, did not assess surgical management, or were trials that were included in systematic reviews/meta-analyses that were included in this study. Ten studies were included in this review. Depending on the review/trial, the stone-free rate (SFR) had wide ranges for all of the surgical management options assessed (shock wave lithotripsy, retrograde intrarenal surgery, and percutaneous nephrolithotomy). There are many considerations in choosing the appropriate surgical management for a patient presenting with pediatric nephrolithiasis–SFRs, radiation exposure, and adverse events being some of these features. All three procedures assessed had different characteristics, with advantages and disadvantages unique to each procedure. As each surgical technique for pediatric urolithiasis provides its advantages and disadvantages, surgeons should discuss all options to provide the best-informed decision-making process to a patient or family who may require surgical management of pediatric nephrolithiasis.
STRATEGI PROMOSI DALAM MENINGKATKAN PENJUALAN PRODUK MARIA SNACK
Authors: Maria Sendi  , Vuspitasari Benedhikta Kikky
Published: December 2021

Di era modern ini, banyak masyarakat yang mencari Snack unik dan tentunya memiliki cita rasa yang berbeda dengan yang lainnya. Tujuan Penelitian Skripsi Dengan Judul Strategi Promosi Dalam Meningkatkan Penjualan Produk Maria Snack adalah untuk mengetahui strategi promosi yang tepat  digunakan oleh Maria Snack untuk meningkatkan penjualan produk dari Maria Snack. Penelitan ini menggunakan metode penelitian kualitatif, dengan teknik pengumpulan data yang dilakukan dengan wawancara, observasi, dan dokumentasi. Dalam mendeskripsikan hasil penelitian menggunakan analisis SWOT dengan menganalisis faktor internal dan eksternal dari strategi promosi yang dilakukan dengan memberikan gambaran umum mengenai kekuatan, kelemahan, peluang serta ancaman dari strategi promosi yang dilakukan oleh Maria Snack. Berdasarkan hasil penelitian dan pembahasan di atas, jadi dapat disimpulkan antara lain: 1. Analisis faktor internal dan eksternal strategi promosi yang diterapkan Oleh Maria Snack menggunakan matriks SWOT menjadi 9(sembilan)  alternatif strategi dilihat dari strategi SO, strategi WO, strategi ST, dan strategi WT yang dapat digunakan dalam mempromosikan produk Maria Snack untuk meningkatkan penjualan, adalah sebagai berikut: Iklan yang digunakan seperti media sosial facebook, instagram, dan  whatshapp yang dilakukan terus menerus dapat membuat  merek produk Maria Snack  lebih mudah diingat oleh masyarakat. Berhubungan baik dengan konsumen  agar lebih dekat, sehingga akan terjadi penjualan dalam  jangka panjang. Memanfaatkan teknologi dan media promosi agar mempermudahkan periklanan produk Maria Snack dan mengikuti event atau bazar yang diadakan. Meningkatkan hubungan dengan konsumen agar konsumen mepercayai produk Maria Snack
A CROSS-SECTIONAL SURVEY STUDY TO ASSESS THE PREVALENCE OF PALITYA IN YOUTH WSR TO PRAKRITI
Authors: Rashmi Temani , Surendra Kumar Sharma
Published: December 2021

Ayurveda is a science of vast knowledge of Ahar, Vihar and Prakriti. In this modern era due to stress, lifestyle changes, eating habits and many psychological and environmental factors are responsible for premature greying of hair. The present cross-sectional survey study was planned to know about etiological factors of Palitya in youth and the prevalence of Prakriti also. Total 500 patients of premature canities fulfilling the criteria of inclusion as per GSS1 were selected from O.P.D. of department Rog Nidana and Vikriti Vigyana, National Institute of Ayurved, Jaipur. A structured questionnaire will be administered to each subject of Nidanatmaka survey to collect data on Prakriti, Socio-demographic profile, Dietary patterns and other Ayurvedic variables. Results: Max. 37% have Akala bhojana,36.4% having Vishmagni,35 and 32% habituated to Katu and Lavan Rasa,42% consuming Amla Rasa, and max.36.4% were having Vata -Pitta Prakriti. Overall, it was observed that in youth diet, dietary habits were prone to vitiate Pitta dosha. especially in the Pitta Prakriti persons. The faulty dietary habits like Vishamashana, Adhyashana, Ajeernashana, Amla-Lavana Rasa Atisevana can accelerate the process of greying hair.
Keywords: Premature canities, Prakriti
A COMPARATIVE CLINICAL STUDY TO EVALUATE THE EFFICACY OF ABHA GUGGULU AND YOGARAJA GUGGULU IN JANU SANDHIGATA VATA
Authors: Jadav Archana B.H. , Shetty Susheel
Published: December 2021

Mobility is the basic character of life that depends on the structural as well as the functional character of the body. As age advances, while proper nutrition is not available, the body loses its qualitative capacity for structure and function. Janu Sandhigata Vata has been explained classically by Acharyas and its lakshanas are Vata Poorna- dhrithi Sparsha, Sandhi Shotha, Sandhi Shoola and the presence of Vedana during Prasarana and Aakunchana. The lakshanas of Janu Sandhigata Vata is found to be congruent with Osteoarthritis of the Knee. Research statis- tics have shown that in India, 22% of the population shows Osteoarthritis and females slightly dominate in the incidence. Abha Guggulu and Yogaraja Guggulu are two formulations that contain the drugs of Vatahara, Shothahara, Vedanasthapaka property which will help in the management of Janu Sandhigata Vata. Methods: It was a single-blind randomized comparative clinical trial. The study was conducted on 40 subjects for 30 days. Observations were analyzed and findings were evaluated by using statistical methods. Results: The severity of symptoms markedly reduced in both the groups which is statistically significant and on comparing the effect be- tween Abha Guggulu and Yogaraja Guggulu, there was no statistical difference obtained. Conclusion: The result suggests that both Abha Guggulu and Yogaraja Guggulu had a significant effect on Janu Sandhigata Vata There was no significant difference in the effect of Abha Guggulu and Yogaraja Guggulu.
Keywords: Janu Sandhigata Vata, Abha Guggulu, Yogaraja Guggulu
A CLINICAL STUDY TO EVALUATE THE EFFECT OF TOPICAL APPLICATION OF CERTAIN INDIGENOUS DRUGS IN THE MANAGEMENT OF KIKKISA
Authors: Purohit Dharitri , G Ramadevi , Jain Arpana
Published: December 2021

The woman is the most artistic creation of our creator. She carries pride in her appearance & gains confidence by maintaining her beauty also is equally esteemed about motherhood. For every woman, pregnancy is the most important & pleasurable phase of life, as this is the time she evolves as a mother. This comes with several inevitable changes in her appearance like weight gain, skin changes & whatnot. Kikkisa is one such physiological skin changes of pregnancy. Kikkisa is a skin manifestation in 3rd trimester of pregnancy seen in about 90 % of pregnancies. This is co-related with striae gravidarum presenting as stretch marks on abdomen, thighs and breasts associated with itching, burning sensation, dryness & discolouration. Though not a disease, it does seek a lot of attention for the symptoms are very disturbing to women. Hence, an efficient & easy method was selected in our study for treating kikkisa. Objectives: To assess the effect of the application of raktachandanadi churna with lakshadi taila over the abdomen in the management of kikkisa. Study design:30 pregnant women from 28 weeks of gestation diagnosed with kikkisa were selected & given to apply Raktachandanadi churna with Lakshadi taila over abdomen half an hour before bath for 2 months. Result: After trial, marks became less prominent but not reduced completely. We found an effective reduction in symptoms like itching (93.1%), dryness (95.45%), burning sensation (78.6%), & discolouration (57.6%), without causing any changes in the texture of the skin.
Keywords: Kikkisa, Striae gravidarum, Raktachandanadi churna, Lakshadi taila
EVALUATION OF ANTI-HISTAMINIC ACTIVITY OF KASANKUSHA RASA IN GUINEA PIGS
Authors: Shekar.B Divya , S Medikeri Surekha
Published: December 2021

Many formulations in Rasashastra textbooks are indicated for allergic conditions like Bronchial Asthma. Ra- saushadhis are more effective than herbal preparations owing to their infinite shelf life, lower dose, faster action and palatability1. Kasankusha rasa is a Kharaliya preparation indicated in various conditions of Shwasa and Kasa as per the reference of Rasa Yoga Sagara2 which is composed of Hingula, Maricha, Mustha, Vatsanabha and Tankana. It is chosen for the present study, focusing on its Anti-Histaminic effect. Instead of using Kajjali which is a tedious procedure to prepare as in other formulations, this yoga contains ShuddhaHingula thus easing the pro- cedure. Hence, an attempt is made to validate the classical indications of the formulation to the current bio- medicine scenario.
Keywords: Kasankusha rasa, Rasashastra, Shwasa ,Kasa, Anti-Histaminic activity
A CRITICAL STUDY OF “PESHI” AS DESCRIBED IN SUSHRUT SAMHITA
Authors: Priyanka Ashok Shinde
Published: December 2021

Ayurveda is a human science. It provides knowledge of the structural and functional constitution of the human body. Sushrut, “Father of Surgery” according to Ayurveda, describes the human body to be made up of 6 major parts – Shadanga – 4 Shakhas (extremities), Madhya (middle part/trunk) the fifth and Shira (head) the sixth. These parts are further subdivided into Pratyangas (sub-parts) like Sira (veins), Dhamani (arteries), Srotas (chan- nels), Asthi (bones), Sandhi (joints), Avayava (organs), Kala (membrane) etc. Peshi is one of the Pratyangas de- scribed by Sushrut. Peshi is developed from Pishit (Mamsa / muscle) and is present in close relation to Sira, Sna- yu (ligaments), Asthi and Sandhi enveloping and protecting them. The information available regarding the Peshi evokes the curiosity to determine the anatomical structural entity described in the classics. This study, therefore, analyses the information and tries to correlate it with the most suitable anatomical structure with logical interpre- tation.
Keywords: Peshi, Pishit (Mamsa / muscle), Sira, Snayu, Sandhi
Acknowledgement: edge deletion, singular values and ABC energy of graphs
Authors: Ghorbani Modjtaba , Hakimi-Nezhaad Mardjan , Feng Lihua
Published: December 2021

Following Estrada's method, as given in [1], Ghorbani et al. communicated in [2], and later also in [3], the following result on A-energy.
Pole-Mounted Electric Vehicle Charging: Preliminary Guidance for a Low-Cost and More Accessible Public Charging Solution for U.S. Cities
Authors: Werthmann Emmett , Kothari Vishant
Published: December 2021

This paper examines the use of existing utility poles and streetlights to meet the growing demand for public electric vehicle charging while enabling equitable access to this infrastructure. Building on insights collected from current U.S. pilots and interviews with over 30 stakeholders across city governments, electric utilities, charging equipment manufacturers, and ridesharing companies, this paper offers stepwise guidance for U.S. cities and utilities interested in pole-mounted chargers.
Beneficios de utilizar el Cuestionario para Evaluar las Disfuncionalidades de las Articulaciones Temporomandibulares en Artritis Reumatoide (CEDATAR)
Authors: Rhys Karen Vanesa , Gobbi Carla Andrea , Busamia Beatriz , Albiero Eduardo , Lagnarini Ana Laura , Alba Paula
Published: December 2021

Han aumentado las técnicas para la examinación clínica e imagenológica de las articulaciones temporomandibulares, sin embargo, no sucede lo mismo en la posibilidad de evaluación en la anamnesis cotidiana en la consulta de rutina. Existen muy pocos cuestionarios y la mayoría son antiguos.  Objetivo: Utilizar una herramienta útil y práctica para las interconsultas y derivaciones de pacientes entre el Servicio de Reumatología y el Servicio de Odontología. Material y métodos: Se implementó el Cuestionario para evaluar las disfuncionalidades de las articulaciones temporomandibulares en artritis reumatoide (CEDATAR) para evaluar si presentaba la capacidad de detectar alteraciones en las articulaciones que le sirvieran a los distintos profesionales en la decisión de derivar a un especialista al paciente. Resultados: Se evidenció que todos los pacientes que acusaron alteraciones en las respuestas del cuestionario, al corroborarse presentaron modificaciones importantes en el análisis imagenológico y/o clínico. Conclusiones: La artritis reumatoide es una enfermedad declarada de importancia en salud pública y políticas sanitarias, es de imponderable relevancia la utilización de CEDATAR en las consultas reumatológicas cotidianas para agilizar las terapéuticas limitando el avance de la enfermedad autoinmune a nivel de las articulaciones temporomandibulares suministrando un pronóstico más favorable y limitando lesiones y discapacidades.
Nomofobia: o telefone celular, o uso do tempo e o desengajamento ocupacional/Nomofobia: cell phone, time use and occupational disengagement
Authors: Cezar da Cruz Daniel Marinho , Bragatto Renata Lemes
Published: December 2021

Objetivo: O ensaio fotográfico propõe, a partir do conceito de Nomofobia, refletir sobre o aspecto negativo da tecnologia móvel nas ocupações humanas. Descrição da imagem: É contextualizado brevemente o desenvolvimento da tecnologia de modo geral e suas diferentes consequências para os sujeitos na sociedade. A partir de quatro imagens ilustra-se a des-conexão com o mundo real, a contradição do estar em grupo, mas solitariamente, a dependência e o uso do tempo com a tecnologia móvel. Por fim, aponta-se a necessidade de pesquisas e de intervenções na terapia ocupacional, referindo-se à tecnologia móvel dentro do conceito de engajamento e desengajamento ocupacional. Palavras-chave: Telefone Celular. Ocupações Relacionadas com Saúde. Tempo de Tela. Terapia Ocupacional. AbstractObjective: From a photographic perspective, this essay proposes reflections based on the concept of Nomophobia, considering the negative side of mobile technology in human doings. Picture descripition: The development of technology in general and its different consequences for man in the society is briefly contextualized. Four photos illustrate the dis-connection with the real world, the contradiction of being in a group, but alone, the dependence and use of time with cell phones. Finally, the need for research and interventions in occupational therapy is pointed out, referring to mobile technology within the concept of occupational engagement and disengagement.Keywords: Cell Phone. Allied Health Occupations. Screen Time. Occupational Therapy. ResumenObjetivo: Desde una perspectiva fotográfica, este ensayo propone, desde el concepto de Nomofobia, considerar el lado negativo de la tecnología móvil en las actividades humanas. Descripción de la imagen: El desarrollo de la tecnología en general y sus diferentes consecuencias para el hombre se contextualiza brevemente. Cuatro fotos ilustran la desconexión con el mundo real, la contradicción de estar en un grupo, pero solo, la dependencia y el uso del tiempo con los teléfonos celulares. Finalmente, se señala la necesidad de investigación e intervenciones en terapia ocupacional, refiriéndose a la tecnología móvil dentro del concepto de involucración y desinvolucración ocupacional.Palabras clave: Teléfono Celular. Empleos Relacionados con Salud. Tiempo de Pantalla. Terapia Ocupacional.