bluuebunny/crossref_metadata_2025_split huggingface dataset:
Congenital completely buried penis in boys: anatomical basis and surgical technique
Authors: Liu Xing , He Da‐wei , Hua Yi , Zhang De‐ying , Wei Guang‐hui 
Published: January 2013

What's known on the subject? and What does the study add?
Surgical correction of the congenital completely buried penis (CCBP) is a difficult challenge and there is no unanimous consensus about the surgical ‘gold standard’ and patient eligibility for surgery.
In the present study, dysgenetic fundiform ligaments were found to be attached to the distal or middle shaft of the penis. This abnormality can be successfully corrected by releasing the fundiform ligament and mobilising the scrotal skin to cover the length of the penile shaft. The study shows that the paucity and traction of the penile skin and an abnormal fundiform ligament are important anatomical defects in CCBP. Dorsal curve and severe shortage of penile skin in erectile conditions are the main indications for surgical correction.
Objective
To present our experience of anatomical findings for congenital completely buried penis (CCBP), which has no unanimous consensus regarding the ‘gold standard’ for surgical correction and patient eligibility, by providing our surgical technique and illustrations.
Patients and Methods
Between February 2006 and February 2011, 22 children with a median (range) age of 4.2 (2.5–5.8) years, with CCBP underwent surgical correction by one surgeon.
Toilet training and photographs of morning erections by parents were advised before surgery.
The abnormal anatomical structure of buried penis during the operation was observed. The technique consisted of the release of the fundiform ligament, fixation of the subcutaneous penile skin at the base of the degloved penis, penoscrotal Z‐plasty and mobilisation of the penile and scrotal skin to cover the penile shaft.
Results
In reflex erectile conditions, CCBP presents varying degrees of dorsal curve and shortage of penile skin.
Dysgenetic fundiform ligaments were found to be attached to the distal or middle shaft of the penis in all patients.
All wounds healed well and the cosmetic outcome was good at 6‐month follow‐up after the repair.
Conclusion
The appearance of the dorsal curve in CCBP mainly results from the traction of penile dorsal skin and the abnormal attachment of the fundiform ligament to the shaft. This abnormality can be successfully corrected by releasing the abnormal fundiform ligament and mobilising scrotal skin to cover the length of the penile shaft.
Extracorporeal shockwave lithotripsy to distal ureteric stones: the transgluteal approach significantly increases stone‐free rates
Authors: Phipps Simon , Stephenson Carolann , Tolley David 
Published: January 2013

What's known on the subject? and What does the study add?
Shockwave lithotripsy (SWL) can be used to treat stones at any position within the ureter, as long as the stone is radio‐opaque and there is a path for the shockwave to reach the stone. However the results of SWL to distal ureteric calculi, with the patient in a prone position, were inferior to those of treating stones within the upper ureter.
The transguteal approach allows the lithotripsy shockwave to reach the lower ureter via the greater selatle foramen. This study shows that this approach for SWL to distal ureteric calculi is more effective than the prone approach.
Objective
To compare the outcomes of extracorporeal shockwave lithotripsy (ESWL) for distal ureteric stones treated using the prone and transgluteal (supine) approaches in a tertiary referral stone unit using a fourth generation lithotriptor.
Patients and Methods
We selected consecutive patients undergoing ESWL to distal ureteric stones over 1 year, during which we changed our treatment protocol from a prone to transgluteal (supine) approach.
Patients were treated using the Sonolith Vision Lithotriptor (Technomed Medical Systems, Vaulx‐en‐Velin, France).
Outcome was assessed using plain abdominal film of kidney, ureter and bladder (KUB) X‐ray taken at 2 weeks then monthly as required.
Treatment success was defined as complete clearance of stone fragments and treatment failure was defined as persistence of stone fragments beyond 3 months or the need for ureteroscopy.
Results
A total of 38 patients were treated in the prone position and 72 patients using a transgluteal approach.
Patient and stone characteristics were identical in both groups. The mean (range) stone size was 7.8 (4–16) mm.
The proportions of patients who were stone‐free after one treatment session within the prone and transgluteal treatment groups were 40 and 78%, respectively (<0.001).
The overall success rates for treatment within the prone and transgluteal groups were 63 and 92%, respectively (<0.001).
Conclusions
Transgluteal ESWL to stones within the distal ureter leads to significantly higher stone‐free rates than treatment using the prone approach.
The majority of patients are rendered stone‐free after one session of treatment and the overall success rates are similar to those of ureteroscopic management.
Comparison of musculoskeletal anatomic relationships, determined by magnetic resonance imaging, in postpubertal female patients with and without classic bladder exstrophy
Authors: Anusionwu Ifeanyi , Tekes Aylin , Stec Andrew A. , Gearhart John P. , Wright E. James 
Published: January 2013

What's known on the subject? and What does the study add?
Several studies in the paediatric literature have characterized the pelvic musculoskeletal anatomy of infants and children with bladder exstrophy using MRI and three‐dimensional CT. The pelvic floor anatomy of female patients with bladder exstrophy who have undergone somatic growth and puberty is less well described.
This study uses MRI to characterize comprehensively the pelvic anatomy of postpubertal females with classic bladder exstrophy by measuring 15 pelvic floor variables previously described in younger children with bladder exstrophy.
Objective
To characterize pelvic musculoskeletal anatomy in postpubertal females with classic bladder exstrophy, and to compare this with females without bladder exstrophy.
Patients and Methods
The authors reviewed the medical records of all females in our institutional review board‐approved bladder exstrophy database of 1078 patients and identified those with classic bladder exstrophy who underwent pelvic magnetic resonance imaging (MRI) after the age of 12 years.
Indications for MRI included haematuria, adnexal lesion, perineal fistula, non‐pelvic cancer staging, abdominal wall hernia and vaginal stenosis.
Age‐ and race‐matched female patients without exstrophy who underwent MRI evaluation for similar indications were included for comparison.
The MRI protocol included axial, sagittal and coronal T1‐ and/or T2‐weighted imaging.
Results
The study included 30 patients with a median (range) age of 22.5 (12–55) years at time of MRI. Ten patients had bladder exstrophy while 20 control patients did not.
A smaller percentage of levator ani was located in the anterior compartment of the pelvis in patients with bladder exstrophy compared with controls.
The iliac wing angle, puborectalis angle, ileococcygeous angle, levator ani width, symphyseal diastasis, erectile body diastasis, posterior bladder neck distance and posterior anal distance was greater in patients with bladder exstrophy than in those without.
The ischial angle and obturator internus angle were narrower in patients with bladder exstrophy than in those without, and there was no significant difference between levator ani surface area, sacral anal angle, sacral bladder neck angle and bladder neck erectile body distance between the two patient groups.
Conclusions
In postpubertal females with bladder exstrophy, significant deviations from normal pelvimetry exist, including posterior location of the majority of the levator ani muscle, a wider ileococcygeous angle and a wider symphyseal diastasis.
These differences are similar to those described in previous comparisons of younger children with bladder exstrophy and control children.
Serum receptor activator of nuclear factor κB ligand (RANKL) levels predict biochemical recurrence in patients undergoing radical prostatectomy
Authors: Todenhöfer Tilman , Hennenlotter Jörg , Leidenberger Philipp , Wald Alexander , Hohneder Andrea , Kühs Ursula , Mischinger Johannes , Aufderklamm Stefan , Gakis Georgios , Blumenstock Gunnar , Stenzl Arnulf , Schwentner Christian 
Published: January 2013

What's known on the subject? and What does the study add?
There is increasing evidence that the receptor activator of nuclear factor κB ligand (RANKL) pathway not only contributes to the development of bone metastases, but also influences tumour biology in earlier stages of cancer.
The study shows that preoperative serum levels of RANKL and its inhibitor osteoprotegerin (OPG) have a prognostic impact in patients undergoing radical prostatectomy for clinically localized prostate cancer. Both high levels of RANKL and a higher RANKL/OPG ratio are independent predictors of early biochemical recurrence in these patients.
Objective
To assess the prognostic impact of proteins of the receptor activator of nuclear factor κB (RANKL) pathway in serum samples from patients undergoing radical prostatectomy.
Patients and Methods
We retrospectively determined soluble RANKL (sRANKL) and osteoprotegerin (OPG) by ELISA in serum samples of 178 patients undergoing radical prostatectomy between 2004 and 2006.
Clinical and patient follow‐up data were analysed using the Wilcoxon–Mann–Whitney test, the Kaplan–Maier method, and single variable or multifactorial Cox proportional hazards analysis.
Results
Higher serum sRANKL levels (P = 0.01), lower serum OPG levels (P = 0.01) and a higher sRANKL/OPG ratio (P = 0.004) were significant risk factors for biochemical recurrence (BCR).
In multifactorial analysis, adjusted for the common risk factors for BCR, sRANKL and sRANKL/OPG ratio were confirmed as independent prognostic factors.
Neither sRANKL nor OPG showed a clear association with histopathological factors such as pT stage, pN Gleason score or resection margin status, nor were they associated with prostate‐specific antigen level.
Conclusions
Greater activity of the RANKL pathway in the serum of patients with prostate cancer undergoing radical prostatectomy is a risk factor for BCR.
The RANKL pathway seems to contribute to the biological behaviour of prostate cancer even at the organ‐confined stage of the disease.
Bladder preservation in the treatment of muscle‐invasive bladder cancer (MIBC): a review of the literature and a practical approach to therapy
Authors: Smith Zachary L. , Christodouleas John P. , Keefe Stephen M. , Malkowicz S. Bruce , Guzzo Thomas J. 
Published: January 2013

What's known on the subject? and What does the study add?Bladder preservation therapies for muscle‐invasive bladder cancer (MIBC) have been developed to address the needs of two cohorts: patients with severe medical co‐morbidities for whom radical cystectomy is too high risk and patients with limited disease who wish to avoid aggressive surgery. There are multiple bladder preservation options, although the trimodal approach of maximal transurethral resection with chemoradiotherapy is the most strongly supported. While outcomes are worse for patients unfit for surgery than those otherwise fit for surgery, bladder preservation approaches still offer curative potential.We present a comprehensive review of the literature and outline a practical approach to bladder preservation therapy for MIBC. This review aims to help urologists easily navigate through the decision tree of therapeutic options.
Radical cystectomy (RC) is associated with considerable morbidity. Aside from the perioperative period, RC with urinary diversion poses great potential for long‐term complications and morbidity.
Bladder preservation therapies for muscle‐invasive bladder cancer (MIBC) have been developed to address the needs of two cohorts: patients with severe medical co‐morbidities for whom a radical surgery is too high risk and patients with limited disease who wish to avoid radical surgery.
The goal of achieving complete response to treatment while maintaining bladder form and function has led to the development of multimodal approaches to this disease.
There are multiple bladder preservation options, although the trimodal approach of maximal transurethral resection with chemoradiotherapy is the most strongly supported.
In medically operable patients (‘fit’ for surgery), there is abundant evidence to support trimodal therapy as an acceptable treatment option for highly selected patients with MIBC with favourable pathological parameters.
While outcomes are worse for medically inoperable patients (‘unfit’ for surgery), bladder preservation approaches still offer curative potential. However, prospective trials comparing the above regimens to RC are still needed to better define their role in the treatment of MIBC.
We present a comprehensive review of the literature and outline a practical approach to bladder preservation therapy for MIBC.
Quantifying Phosphorus Flow Pathways Through Socioeconomic Systems at the County Level in China
Authors: Bi Jun , Chen Qinqin , Zhang Ling , Yuan Zengwei 
Published: January 2013

SummaryPhosphorus (P) is a key factor in aquatic eutrophication, and P contamination has become a common issue worldwide. Many developing countries, including China, have made great efforts in the anti‐P contamination battle. In this article we mainly discuss the P flow in Wuwei, a typical county in China with insufficient wastewater treatment, using the method of static substance flow analysis. We show that characterizing P metabolic pathways and flows at the county level can provide useful information about P pollution. Through complex calculations, we found that Wuwei County released 3,552 metric tons (t) of P into the local aquatic environment in 2008 and that its P load (3.35 kilograms P per capita per year [kg P/cap/yr] or 19.43 kilograms P per hectare per year [kg‐P/ha/yr]) was greater than both the adjoining counties’ and Chaohu City's average levels combined. The agricultural subsystem discharged the largest quantity of P (2,572 t) and had a relatively low production conversion efficiency (32%) and P waste recycling rate (36%). The rural residential and small‐scale livestock breeding systems also accounted for substantial portions of P discharge. Anti‐P contamination efforts should consequently focus on those three subsystems. Based on the results of this case study, we also discuss the feasibility of potential efforts to reduce P contamination.
RAMESES publication standards: meta‐narrative reviews
Authors: Wong Geoff , Greenhalgh Trish , Westhorp Gill , Buckingham Jeanette , Pawson Ray 
Published: January 2013

AbstractBackgroundMeta‐narrative review is one of an emerging menu of new approaches to qualitative and mixed‐method systematic review. A meta‐narrative review seeks to illuminate a heterogeneous topic area by highlighting the contrasting and complementary ways researchers have studied the same or a similar topic. No previous publication standards exist for the reporting of meta‐narrative reviews. This publication standard was developed as part of the RAMESES (Realist And MEta‐narrative Evidence Syntheses: Evolving Standards) project. The project's aim is to produce preliminary publication standards for meta‐narrative reviews.DesignA mixed method study synthesising data between 2011 to 2012 from a literature review, online Delphi panel and feedback from training, workshops and email list.MethodsWe: (a) collated and summarized existing literature on the principles of good practice in meta‐narrative reviews; (b) considered the extent to which these principles had been followed by published reviews, thereby identifying how rigor may be lost and how existing methods could be improved; (c) used a three‐round online Delphi method with an interdisciplinary panel of national and international experts in evidence synthesis, meta‐narrative reviews, policy, and/or publishing to produce and iteratively refine a draft set of methodological steps, and publication standards; (d) provided real‐time support to ongoing meta‐narrative reviews and the open‐access RAMESES online discussion list so as to capture problems and questions as they arose; and (e) synthesized expert input, evidence review, and real‐time problem analysis into a definitive set of standards.ResultsWe identified nine published meta‐narrative reviews, provided real‐time support to four ongoing reviews, and captured questions raised in the RAMESES discussion list. Through analysis and discussion within the project team, we summarized the published literature, and common questions and challenges into briefing materials for the Delphi panel, comprising 33 members. Within three rounds this panel had reached consensus on 20 key publication standards, with an overall response rate of 90%.ConclusionsThis project used multiple sources to draw together evidence and expertise in meta‐narrative reviews. For each item we have included an explanation for why it is important and guidance on how it might be reported. Meta‐narrative review is a relatively new method for evidence synthesis and as experience and methodological developments occur, we anticipate that these standards will evolve to reflect further theoretical and methodological developments. We hope that these standards will act as a resource that will contribute to improving the reporting of meta‐narrative reviews.
RAMESES publication standards: realist syntheses
Authors: Wong Geoff , Greenhalgh Trish , Westhorp Gill , Buckingham Jeanette , Pawson Ray 
Published: January 2013

AbstractBackgroundThere is growing interest in realist synthesis as an alternative systematic review method. This approach offers the potential to expand the knowledge base in policy‐relevant areas – for example, by explaining the success, failure or mixed fortunes of complex interventions. No previous publication standards exist for reporting realist syntheses. This standard was developed as part of the RAMESES (Realist And MEta‐narrative Evidence Syntheses: Evolving Standards) project. The project's aim is to produce preliminary publication standards for realist systematic reviews.DesignA mixed method study synthesising data between 2011–2012 from a literature review, online Delphi panel and feedback from training, workshops and email list.MethodsWe: (a) collated and summarized existing literature on the principles of good practice in realist syntheses; (b) considered the extent to which these principles had been followed by published syntheses, thereby identifying how rigour may be lost and how existing methods could be improved; (c) used a three‐round online Delphi method with an interdisciplinary panel of national and international experts in evidence synthesis, realist research, policy and/or publishing to produce and iteratively refine a draft set of methodological steps and publication standards; (d) provided real‐time support to ongoing realist syntheses and the open‐access RAMESES online discussion list to capture problems and questions as they arose; and (e) synthesized expert input, evidence syntheses and real‐time problem analysis into a definitive set of standards.ResultsWe identified 35 published realist syntheses, provided real‐time support to 9 ongoing syntheses and captured questions raised in the RAMESES discussion list. Through analysis and discussion within the project team, we summarized the published literature and common questions and challenges into briefing materials for the Delphi panel, comprising 37 members. Within 3 rounds this panel had reached consensus on 19 key publication standards, with an overall response rate of 91%.ConclusionsThis project used multiple sources to develop and draw together evidence and expertise in realist synthesis. For each item we have included an explanation for why it is important and guidance on how it might be reported. Realist synthesis is a relatively new method for evidence synthesis and as experience and methodological developments occur, we anticipate that these standards will evolve to reflect further methodological developments. We hope that these standards will act as a resource that will contribute to improving the reporting of realist syntheses.
Water barriers and intra‐island isolation contribute to diversification in the insular Aethopyga sunbirds (Aves: Nectariniidae)
Authors: Hosner Peter A. , Nyári Árpád S. , Moyle Robert G. 
Published: January 2013

AbstractAimColonization and subsequent isolation across deep‐water barriers is thought to be the primary driver of diversification in insular birds. Shallow‐water barriers and intra‐island isolation are less well‐documented drivers of avian diversification. We examined the relative roles of different geographical barriers in the diversification of Aethopyga sunbirds, a widespread Southeast Asian genus that has its greatest diversity in the Philippine Archipelago.LocationPhilippines, Southeast Asia, Wallacea.MethodsWe reconstructed the phylogenetic relationships among Aethopyga sunbirds with mitochondrial and nuclear DNA sequences. Phylogeny was inferred using concatenated and coalescent frameworks, implemented in maximum likelihood and Bayesian analyses. We used maximum likelihood ancestral state reconstructions to examine the ancestral distribution and colonization history of Aethopyga. To determine whether the diversification at each node occurred within a continent, across a shallow‐water barrier, across a deep‐water barrier or within an island, we used a series of statements based on the phylogeny, current distribution of species and bathymetric reconstructions.ResultsAncestral state reconstructions inferred that the core Aethopyga ancestor was continental, and that the diversity of Aethopyga on oceanic islands is the result of three or four independent colonization events. Dispersal and subsequent isolation across deep‐water barriers was the most common mode of diversification in insular Aethopyga, although intra‐island isolation contributed to diversity, producing a small montane radiation within Mindanao. Analyses inferred only a single unequivocal event of diversification across a shallow‐water barrier. Deep molecular divergences between phenotypically distinct subspecies suggested that the taxonomy of Aethopyga is overly conservative and obscures biogeographical patterns. We recommend elevating five subspecies, all of which are endemic to the Philippines, to full species.Main conclusionsIn addition to corroborating the importance of isolation across deep‐water barriers, these data also underscore a potential role for additional isolating mechanisms in the generation of biodiversity on oceanic islands. A clade of four montane Aethopyga taxa evolved in situ within the Mindanao sky‐island system, an exception to the paradigm that birds do not diversify within the geographical confines of oceanic islands.