Flow measurements: Can several “Wrongs” make a “Right”?

AIMS: Although measurement of maximum flow rate (Qmax) is a standard and straightforward test, it is often difficult to obtain reliable readings. We obtained multiple measurements using a simple home uroflow device which categorizes Qmax into ranges. We hypothesize that the average of a series of relatively coarse measurements of Qmax would be more repeatable and therefore more representative of an individual's voiding function than a single, albeit more precise measurement. METHODS: We studied 22 male volunteers with a wide range of Qmax. They were asked to record flow category (<10 ml/sec; 10-15 ml/sec; 15-20 ml/sec; >20 ml/sec) and voided volume twice daily for 12 days using the home flow device. In addition, a clinic-based flow recording using a spinning-disc uroflowmeter was obtained at both the start and the end of the 12-day period. RESULTS: Good agreement between mean home flow and mean clinic flow was seen with mean (SD) difference of 1.3 (5) ml/sec. The mean for consecutive halves of an individual's home flow data showed excellent agreement (-0.2 (1.3) ml/sec). The two clinic readings showed poorer agreement (2.3 (6.8) ml/sec) than the home readings, and poorer agreement even than between clinic and home flows. CONCLUSIONS: Although simple in design, the home flowmeter actually shows greater accuracy than might be expected when used repeatedly to study the flow rates of men. Simple flow devices such as this could be used in conjunction with voiding diaries to give a more representative picture of patients' day-to-day voiding function.     

Use of SARS‐CoV‐2‐infected deceased organ donors: Should we always “just say no?”

In the context of a rapidly evolving pandemic, multiple organizations have released guidelines stating that all organs from potential deceased donors with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection should be deferred, including from otherwise medically eligible donors found to have mild or asymptomatic SARS‐CoV‐2 discovered on routine donor screening. In this article, we critically examine the available data on the risk of transmission of SARS‐CoV‐2 through organ transplantation. The isolation of SARS‐CoV‐2 from nonlung clinical specimens, the detection of SARS‐CoV‐2 in autopsy specimens, previous experience with the related coronaviruses SARS‐CoV and MERS‐CoV, and the vast experience with other common RNA respiratory viruses are all addressed. Taken together, these data provide little evidence to suggest the presence of intact transmissible SARS‐CoV in organs that can potentially be transplanted, specifically liver and heart. Other considerations including ethical, financial, societal, and logistical concerns are also addressed. We conclude that, for selected patients with high waitlist mortality, transplant programs should consider accepting heart or liver transplants from deceased donors with SARS‐CoV‐2 infection.     

Does low-energy helium-neon laser irradiation alter “in vitro” replication of human fibroblasts?

Cultured human fibroblasts were treated in a controlled, randomized manner to assess the effect of low-energy (0.9 mW) helium-neon (HeNe) laser irradiation on cellular proliferation. Two trials were performed: one with fibroblasts in the third to fourth passage and the other with fibroblasts in the 13th to 14th passage. In each trial, separate plastic petri dishes were inoculated with the cells, maintained in a 5% CO2-95% air atmosphere, and nourished with HB 102 media. Treatment began 48 h after inoculation with daily 60-s irradiations of the "treated" cultures over a 5-d period. Control cultures underwent the same handling but were not irradiated. A significant stimulative, or inhibitive, effect on replication was not found in either trial.     

Intensive Hemodialysis: Normalizing the “Unphysiology” of Conventional Hemodialysis?

Interest in intensified hemodialysis (HD) regimens is increasing internationally, as there is growing evidence that they are associated with improved outcomes. Appreciation that conventional hemodialysis (CHD), delivered as 4-hour sessions three times a week, is not providing optimal physiological replacement of renal function has led to the development of intensified dialysis therapies. These include long intermittent hemodialysis typically lasting 6-8 hours and delivered three times a week, short daily hemodialysis, providing more frequent sessions 4-7 days a week lasting 2-3.5 hours, and nocturnal hemodialysis, performed 5-7 days a week for 6-8 hours. Studies evaluating outcomes from these programs have indicated superior results to those achieved with CHD, including favorable modifications of cardiovascular risk factors and improvements in a variety of clinical measures. The objective of this review is to present available evidence supporting the hypothesis that in an attempt to provide a "more normal physiology," intensified HD regimens achieve outcomes superior to those historically achieved with CHD.     

Does liberal use of bone wax increase the risk of mediastinitis?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether bone wax increases the risk of mediastinitis in patients undergoing cardiac surgery. Altogether 276 papers were found using the reported search, of which five presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these papers are tabulated. We conclude that animal studies indicate that there are strong reasons for concern over the liberal usage of bone wax.