The feasibility of one-stage flexible ureteroscopy lithotripsy in solitary kidney patients with 1–3 cm renal stones and risk factors of renal function changes

PurposeTo compare perioperative outcomes and long-term renal function changes between prior stenting (PS) and not prior stenting (NPS) before flexible ureteroscopy lithotripsy (f-URS) for solitary kidney patients.MethodsSolitary kidney patients with 10–30 mm renal stones were enrolled in this historical control study. Perioperative parameters and complications were compared. Stone-free was defined as the absence of any residual stones on a CT scan. Renal function changes were evaluated by estimated glomerular filtration rate (eGFR) and adjusted for body surface area. A decrease in the eGFR over 20% was identified as ‘deterioration’ in renal function. The follow-up period was at least 6 months. Logistic regression was used to identify risk factors of renal function deterioration.ResultsOf the 76 patients included, 40 cases experienced prior stenting before f-URS. The average stone diameter was 16.8 ± 4.7 mm, ranging from 10.0 to 28.4 mm. Initial SFR was 85.0 and 83.3% in the PS and NPS groups, respectively (p = 0.842), while SFR after the second procedure was 97.5 and 94.4% (p = 0.926). Seven PS and 5 NPS patients developed complications (p = 0.666). At the postoperative 6 months, seven patients showed a deteriorated renal function. Surgical time in minutes was identified as a risk factor for renal function deterioration after the operation (OR = 1.061, 95% CI: 1.015–1.109, p = 0.009, per minute).ConclusionIt appears that one-stage f-URS without PS could be feasible for 10–30 mm renal stones in solitary kidney patients, and less surgical time might be beneficial to protect renal function.     

腹腔镜联合输尿管镜碎石术对56例肝胆结石患者疗效及并发症的影响

目的：探讨腹腔镜联合输尿管镜碎石术对肝胆结石患者疗效及并发症的影响。方法：选取肝胆管结石患者112例随机分为联合组和开腹组各56例，开腹组患者给予开腹碎石术治疗，联合组患者给予腹腔镜联合输尿管镜碎石术治疗，统计分析所有患者住院时间、T管拔出时间、术中出血量、肠功能恢复时间、术后结石取净和并发症发生情况以及术前（T0）、插管时（T1）、开切口或穿刺时（T2）、取石时（T3）、术毕时（T4）的心率变化。结果：联合组患者住院和肠功能恢复时间、术中出血量、并发症发生率和再手术率及在T2、T3、T4时刻心率变化明显少于或低于开腹组、T管拔出时间和结石取净率则明显长于或高于开腹组（P＜0.05）。结论：腹腔镜联合输尿管镜碎石术可有效减少取石过程中对患者的创伤和刺激，减轻患者的应激反应，有利于促进患者身体恢复及减少并发症的发生，进而提高临床疗效和改善预后。     

Implementing Smart Working in Public Administration: a follow up study

Background:Starting from February 2020, in Italy most organizations have had a forced transition to flexible working practice - called “smart working in emergency” – due to the Covid-19 epidemic outbreak. This allowed to continue work activities and services and contributed to contain the risk of infection in different sectors, particularly in the public administration.Objectives:This follow up study focussed on a panel of 187 workers from the Italian Workers’ Compensation Authority taking part to a pilot project “Smart Working in INAIL” from January 2019 to December 2019. The aim was to investigate the effects of work organization on work attitudes, work-life balance and health outcomes before and after the introduction of the smart working.Methods:The data were collected at two time points through a web-based questionnaire. The first wave aimed to collect information up to one month before the implementation of the smart working. The second wave aimed to collect information about potential changes occurred after one year of smart working.Results:This study showed that high demands, low control and low social support might lead to reduced well-being and less satisfaction with work, and have an effect on work engagement and work-life balance. Particularly, improving social support can moderate the negative impact of high strain on well-being, preventing work-life imbalance and risk of isolation.Discussion:Findings and future perspectives are discussed to support stakeholders in defining policies and practices concerning health and wellbeing at work while preserving productivity, for a successful implementation of smart working in the public administration.     

Awake tracheal intubation in a patient with a supraglottic mass with the Bonfils fibrescope after failed attempts with a flexible fibrescope

Awake intubation with a flexible fibrescope is usually done electively in patients with a known difficult airway. Herein, we describe the case of an elective awake tracheal intubation that was performed on a patient with a large, obstructive supraglottic mass. The intubation was successfully performed using the Bonfils fibrescope after several failed attempts with a flexible fibrescope. This case highlights the usefulness of the Bonfils fibrescope and the limitations of the flexible fibrescope in certain clinical situations.     

Development of advanced endoscopes for Natural Orifice Transluminal Endoscopic Surgery (NOTES)

Natural orifice transluminal endoscopic surgery (NOTES) is a hybrid procedure which uses flexible endoscopic technology to perform laparoscopic surgical procedures within the abdominal cavity. Initial reports of animal studies describe the use of standard endoluminal endoscopes to accomplish intra‐abdominal surgeries. Current flexible scopes suffer from several deficiencies which make them unlikely to be able to be used for large scale human NOTES experiences. This review analyzes the deficiencies of current endoscopes, discuses the requirements of the ideal NOTES endoscope and reviews some of the possible “endoscopes of the future” that are being developed for the next generation of surgery. Discussion focuses on the “R” scope (Olympus, Tokyo, Japan) and the Transport and Cobra scopes (USGI Medical, San Capistrano, CA).     

A novel prosthodontic alternative for patients who are edentulous and have microstomia: a case report

Excision of squamous cell carcinoma from the lower lip of a patient can result in limited mouth opening (microstomia). For any patients who have this condition, routine or general dentistry and prosthetic treatment is challenging. Traditional denture techniques tend to be unsatisfactory, due to the patients’ reduced ability to open their mouth. The use of sectional and modified dentures and those with a small degree of flexibility has been reported to be useful for patients needing complete dentures. This case report presents a flexible denture base material that can be manipulated on insertion into a smaller shape that is half the original size and is completely flexible for insertion into a mouth that has limited opening. Once seated on the maxillary and mandibular residual ridges, the denture regains its original form and becomes firm and strong to allow the patient to function. This procedure offers a prosthodontic treatment option for a patient with microstomia.     

输尿管镜术中进退镜困难的原因分析与对策

目的分析在输尿管镜手术中发生进退镜困难的原因及其相应处理方法。方法分析2006年5月～2012年7月收治的450例次输尿管镜手术患者的临床资料。结果65例进镜困难，通过技巧性旋转、钬激光内切开、控制液压灌注泵压力、改变患者体位、输尿管扩张等方法处理，53例手术成功。6例退镜困难，通过增加肌松、镇痛药，反复耐心旋转镜体等，均成功退镜。结论输尿管镜手术进退镜困难的原因复杂多样，克服输尿管进退镜困难的关键是掌握操作技巧，综合运用各种技巧能提高手术成功率。