Association of Polypharmacy With 1-Year Trajectories of Cognitive and Physical Function in Nursing Home Residents: Results From a Multicenter European Study

Objectives

To test the association between polypharmacy and 1-year change in physical and cognitive function among nursing home (NH) residents.

Determination of the recipient vessels in the head and neck using multislice spiral computed tomography angiography before free flap surgery: a preliminary study

Preoperative assessment of the recipient vessels in free flap surgery directly affects the success rate of the operation by determining the flap type, pedicle length, orientation to the recipient site, and need for a vein graft. For this purpose, conventional angiographic methods are still being used with some disadvantages. The aims of this study were to evaluate the potential success of multislice computed tomography angiography in assessment of the recipient vessels before free flap surgery and to reveal if this may be an alternative to conventional angiography. The study was bilaterally carried out in 33 outpatients using a 16-detector spiral computed tomography scanner. In images of multiplanar reconstructions, maximum intensity projections, and three-dimensional volume renderings, the external carotid artery and its main branches were evaluated in terms of availability; patency, stenosis, or occlusion; maximal and minimal external diameters through their traces; variations involving ramification from another main vessel; and abnormal course. The superior thyroid artery was absent bilaterally in two patients (6.06%). The external carotid artery was stenotic on one side in two patients (6.06%) and on each side in one (3.03%). All the remaining vessels appeared without stenosis, occlusion, or variation. We think that multislice computed tomography angiography can provide detailed information about vascular structures and the remaining anatomic structures and their relationships with the recipient vessels. Therefore, multislice computed tomography angiography, as a less invasive vascular imaging method, can be a useful tool before planning free flap surgery.     

Relationship between left ventricle geometric patterns and lymphocyte DNA damage in patients with untreated essential hypertension

OBJECTIVE: To investigate the association between different the left ventricle (LV) geometric patterns and lymphocyte DNA damage in patients with hypertension (HT). METHODS: We studied 84 patients (50.0+/-6.1, years) with HT and 24 healthy control subjects (48.6+/-3.3, years). Four different geometric patterns were identified in patients according to LV mass index and relative wall thickness. Peripheral lymphocyte DNA damages and plasma levels of total antioxidant status (TAS) were determined in all subjects. RESULTS: DNA damage was increased in hypertensive patients compared with control group (p=0.001). The major increase in DNA damage was observed in concentric hypertrophic geometric pattern compared with all other geometric patterns (p<0.001, for all). In multiple linear regression analysis, lymphocyte DNA damage was independently correlated with only TAS (beta=-0.444, p<0.001), but not LV geometry (p>0.05). CONCLUSION: The major increase in lymphocyte DNA damage was observed in concentric hypertrophic geometric pattern. This result may be related to increased oxidative stress.     

Prognostic value of immunological profile based on CD8+ and FoxP3+ T lymphocytes in the peritumoral and intratumoral subsites for renal cell carcinoma

International Urology and Nephrology - We aimed to assess an “Immunological Profile (IP)” including CD8+ and FoxP3+ T lymphocytes for renal cell carcinoma (RCC) to evaluate its effects...     

Comparison of the safety and efficacy of the on-demand use of sertraline,dapoxetine, and daily use of sertraline in the treatment of patients with lifelong premature ejaculation: A prospective randomised study

This study compared the safety and efficacy of the on-demand (OD) use of sertraline (50 mg), sertraline (100 mg) and dapoxetine (30 mg), and the daily use of sertraline (50 mg) in the treatment of patients with premature ejaculation (PE). This prospective randomised study involved 120 lifelong PE patients (intravaginal ejaculatory latency time [IELT]: <1 min; Arabic Index of Premature Ejaculation [AIPE] score: < 30) without secondary causes of PE, identified between March 2018 and May 2020. Patients were divided into 4 groups (30 patients per group) and treated for 8 weeks. Assessments were conducted using the AIPE form as a diagnostic tool. Sertraline (50 mg, daily; 196.7 ± 115.5 s) and sertraline (100 mg, OD; 173.3 ± 97.0 s) had similar IELT and AIPE scores. The latter groups had better results in comparison with sertraline (50 mg, OD; 100.5 ± 54.4 s) and dapoxetine (93.7 ± 53.5 s; p < 0.01). Sertraline (100 mg, OD) had a similar efficacy to that of sertraline (50 mg, daily) and was more effective than sertraline (50 mg, OD) and dapoxetine (30 mg, OD). Sertraline (100 mg, OD) can be considered in the treatment of lifelong PE treatment, having tolerable side effects.     

Mid-term result of ceramic bearings in total hip arthroplasty

Purpose

The purpose of this study was to evaluate our clinical experience with ceramic-on-ceramic cementless total hip arthroplasty (THA) and complications after an average follow-up of more than eight years.

Methods

From January 2001 to December 2008, 540 THA with ceramic-on-ceramic bearings were performed in 448 patients (92 bilateral, 54 of which were operated simultaneously) with a mean age 49.9 years (range 18–84) by a senior surgeon. Pre-operative aetiological reasons were developmental dysplasia of the hip (DDH) in 205 hips, degenerative arthritis in 157 hips, avascular necrosis in 51 hips, rheumatoid diseases in 40 hips, posttraumatic arthritis in 40 hips, other reasons in 25 hips and revision surgery in 22 hips. Patients were evaluated with Harris hip score (HSS), and radiological findings of acetabular and femoral component loosening or osteolysis with ceramic bearing related complications like squeaking, liner and head fractures were recorded.

Result

The average duration of follow-up time was 8.2 years (range, five to 13.2). The main Harris hip score increased from 42.4 points preoperatively to 94.9 points at the time of last follow-up. We had one fracture of the ceramic head, 11 clicking and four squeaking; one of them was revised because of terrible squeaking due to acetabular liner fracture, the other three were seldom audible from the outside and followed conservatively. We did not observed loosening or osteolysis due to ceramic bearings at the time of the final follow-up.

Conclusion

Our study has demonstrated that ceramic-on-ceramic bearings can be used safely in different etiological problems. Incidences of noisy hips are becoming less frequent.     

Current Perspectives in the Use of Molecular Imaging To Target Surgical Treatments for Genitourinary Cancers

Context

Molecular imaging (MI) entails the visualisation, characterisation, and measurement of biologic processes at the molecular and cellular levels in humans and other living systems. Translating this technology to interventions in real-time enables interventional MI/image-guided surgery, for example, by providing better detection of tumours and their dimensions.

Objective

To summarise and critically analyse the available evidence on image-guided surgery for genitourinary (GU) oncologic diseases.

Evidence acquisition

A comprehensive literature review was performed using PubMed and the Thomson Reuters Web of Science. In the free-text protocol, the following terms were applied: molecular imaging, genitourinary oncologic surgery, surgical navigation, image-guided surgery, and augmented reality. Review articles, editorials, commentaries, and letters to the editor were included if deemed to contain relevant information. We selected 79 articles according to the search strategy based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis criteria and the IDEAL method.

Evidence synthesis

MI techniques included optical imaging and fluorescent techniques, the augmented reality (AR) navigation system, magnetic resonance imaging spectroscopy, positron emission tomography, and single-photon emission computed tomography. Experimental studies on the AR navigation system were restricted to the detection and therapy of adrenal and renal malignancies and in the relatively infrequent cases of prostate cancer, whereas fluorescence techniques and optical imaging presented a wide application of intraoperative GU oncologic surgery. In most cases, image-guided surgery was shown to improve the surgical resectability of tumours.

Conclusions

Based on the evidence to date, image-guided surgery has promise in the near future for multiple GU malignancies. Further optimisation of targeted imaging agents, along with the integration of imaging modalities, is necessary to further enhance intraoperative GU oncologic surgery.     

The Effect of Strut Allograft and Its Position on Vancouver Type B1 Periprosthetic Femoral Fractures: A Biomechanical Study

The aim of this study is to assess the biomechanical advantage of adding strut allograft and the effect of its position on the construct in Vancouver type B1 fractures. Fifteen forth-generation synthetic femurs were used and created a fracture model at the tip of prosthesis, and subsequently fixated with a lateral plate only, lateral plate and medial strut, lateral plate and anterior strut. Rotational and axial tests were performed. In all loading tests, the plate with medial strut group was stiffer than the other constructs and had higher failure load values and had less displacement in the fracture site. A combination of a plate with a medial strut allograft provides more mechanical stability on periprosthetic femoral fractures near the tip of a total hip arthroplasty.     

Laparoscopic Decortication of Hilar Renal Cysts Using LigaSure

Background and Objectives:

In this study, we evaluated the safety and efficacy of using the LigaSure sealing system (Valleylab, Boulder, Colorado) for laparoscopic decortication of symptomatic hilar renal cysts.

Methods:

Seventeen patients underwent laparoscopic decortication of hilar renal cysts with the LigaSure system. Our study included only symptomatic, Bosniak type 1, simple and symptomatic renal cysts. The operative route, transperitoneal or retroperitoneal, was planned according to the location confirmed by computed tomography. The patients'' symptoms were preoperatively and postoperatively evaluated by the Wong-Baker visual pain scale. Operative measures and radiologic outcomes were prospectively evaluated.

Results:

The mean age of the patients was 56.4 years, and the mean follow-up period was 12.5 months. Preoperative computed tomography showed only a single cyst in 15 patients (88.2%) and showed two separate cysts in 2 cases (11.8%). The cysts were located in the perihilar region close to the vascular structure in all patients. A transperitoneal approach was used in 9 patients, and a retroperitoneal approach was used in 8 patients. The mean operative time and hospitalization time were 56.4 minutes and 1.2 days, respectively. Minor complications were observed in 3 patients. Symptomatic and radiologic success rates of 94.2% and 100%, respectively, were achieved.

Conclusion:

Laparoscopic decortication of symptomatic hilar renal cysts—first reported in the literature in this study—using the LigaSure sealing system is feasible, effective, and safe, even if the cyst is located in the perihilar area.