Is ‘Omega Sign’ anatomical endoscopic enucleation of the prostate technique reproducible?

We aimed to evaluate the learning curve of the surgically standardised ‘Omega Sign’ anatomical endoscopic enucleation (AEEP) of the prostate surgery technique for junior surgeons. This study is a retrospective comparison of cases that underwent AEEP by a mentor surgeon and three junior surgeons who have completed their learning curve. A video-based laser enucleation of the prostate assessment tool (LEAT) composed of 8 steps of the technique was used to assess a senior surgeon and junior surgeons’ surgical compatibility and consistency. The surgeon who defined Omega Sign technique was determined as group 1, and cases by three junior surgeons were identified as group 2. The end points were to assess the reproducibility and repeatability and operative post-operative outcomes of the technique. 55 patients’ videos were rated by five experienced endourologists. There was no significant difference in LEAT scores between the groups among all steps. The most symmetry was found in the 1st and 3rd steps. Inter-rater consistency was also high for each step, with no statistically significant difference between the evaluators. The standardised anatomical ‘Omega Sign’ technique is reproducible for the junior surgeons. The operative steps can be performed with high consistency, and the functional and perioperative outcomes are comparable with the senior surgeon.     

Predictors and the optimal duration of sustained remission in rheumatoid arthritis

Clinical Rheumatology - To determine predictors and optimal duration of sustained remission (SR) in patients with rheumatoid arthritis (RA). A total of 428 consecutive patients with RA visiting our...     

Are infectious diseases and microbiology new fields for thermal therapy research?

Antimicrobial chemotherapy and surgery are classical methods for treating infectious diseases. However, there is a need for alternative methods to cure infections caused by antibiotic-resistant pathogens, recurrent or chronic infections, and unreachable local infections in which the use of drugs or surgery is anatomically and physically restricted. Several micro-organisms are known to be sensitive to mild hyperthermia, and this sensitivity is one of the potential benefits proposed for the host during an episode of fever. Additionally, some immunological or biophysical changes occur during hyperthermia. These changes may be useful for eliminating thermo-susceptible microbial pathogens using local heat therapy. There are several experimental studies proposing the use of hyperthermia to treat local infections. The infected organs or tissues may be heated up to a temperature that can inhibit invading microorganisms. Here, it is hypothesised that local heat therapy may become an alternative or adjuvant method for curing local infections. Here, we highlight the potential for local hyperthermia in the treatment of bacterial infections caused by thermo-susceptible pathogens in a systematic plan. If the proposed thermal-microbiology concepts and local thermal therapies can be adapted to clinical microbiology and infectiology, new medical fields, such as thermo-microbiology and thermo-infectiology, may be created in the future.     

Factors affecting patient satisfaction with outpatient rheumatology phone visits during the COVID-19 pandemic

Clinical Rheumatology - The aim was to evaluate patient satisfaction with virtual care, and identify factors associated with level of satisfaction. Surveys were mailed to all patients who had a...     

High 3He/4He in central Panama reveals a distal connection to the Galápagos plume

It is well established that mantle plumes are the main conduits for upwelling geochemically enriched material from Earth''s deep interior. The fashion and extent to which lateral flow processes at shallow depths may disperse enriched mantle material far (>1,000 km) from vertical plume conduits, however, remain poorly constrained. Here, we report He and C isotope data from 65 hydrothermal fluids from the southern Central America Margin (CAM) which reveal strikingly high ³He/⁴He (up to 8.9R_A) in low-temperature (≤50 °C) geothermal springs of central Panama that are not associated with active volcanism. Following radiogenic correction, these data imply a mantle source ³He/⁴He >10.3R_A (and potentially up to 26R_A, similar to Galápagos hotspot lavas) markedly greater than the upper mantle range (8 ± 1R_A). Lava geochemistry (Pb isotopes, Nb/U, and Ce/Pb) and geophysical constraints show that high ³He/⁴He values in central Panama are likely derived from the infiltration of a Galápagos plume–like mantle through a slab window that opened ∼8 Mya. Two potential transport mechanisms can explain the connection between the Galápagos plume and the slab window: 1) sublithospheric transport of Galápagos plume material channeled by lithosphere thinning along the Panama Fracture Zone or 2) active upwelling of Galápagos plume material blown by a “mantle wind” toward the CAM. We present a model of global mantle flow that supports the second mechanism, whereby most of the eastward transport of Galápagos plume material occurs in the shallow asthenosphere. These findings underscore the potential for lateral mantle flow to transport mantle geochemical heterogeneities thousands of kilometers away from plume conduits.

The geochemical composition of the upper mantle is highly heterogeneous, even on a subkilometer scale (e.g., refs. 1 and 2). Plate tectonics controls the global chemical cycling between mantle and crustal reservoirs, with subduction being considered as the main driver for the reintroduction of incompatible element-rich components into the mantle (3, 4), especially into the source region of mantle plumes (5). Importantly, enriched magma sources are widespread in the upper mantle and sporadically observed both on- and off-axis at midocean ridges (see ref. 6 and the references therein). Although their origin was originally attributed to plume–ridge interactions (7) or small plumes randomly dispersed as small-scale heterogeneities in the mantle source of midocean ridge basalts (MORBs) (8), more recent studies, for instance, suggest fractionation during melting or metasomatic events (see refs. 3 and 6 and the references therein). More globally, “plume-like” geochemical signatures—also referred to as “geochemically enriched signatures” with respect to both trace elements and isotopic compositions—are observed in a wide range of geological settings including isolated seamounts (e.g., ref. 9), subduction zones (e.g., ref. 10), and intraplate continental regions (e.g., ref. 11).The extent and distribution of certain mantle geochemical heterogeneities are complicated by a large number of competing processes taking place throughout Earth history. However, coherent mantle geochemical anomalies have been related to patterns of mantle flow (7), thereby providing insights into mantle geodynamics. The buoyancy-driven lateral transport of plume material by local pressure gradients at sublithospheric depths has previously been described (12–14). While this process may explain local transport of plume material, its lateral extent is too limited to account for the large-scale dispersal of plume material across the upper mantle. Additional studies have suggested the potential for “distal plume–ridge interactions” and far-field influence of plumes beyond the classically considered length scale of a plume’s lateral spreading radius (15, 16). Because buoyant plumes tend to flow toward regions where the lithosphere is thinner, variations in lithospheric thickness along rifting and seafloor spreading axes could potentially channelize the lateral flow of mantle plume material and act as a conduit for its lateral transport over long distances (i.e., >1,000 km) (12, 17). However, the global frequency and extent of lateral plume material movement at sublithospheric depths remain poorly understood because of inherent difficulties associated with the observation and quantification of the underlying processes.In the southern segment of the Central America Margin (CAM), geographically restricted lavas with plume-like geochemical signatures formed over the last ∼5 My (10). Their origin remains actively debated, potentially reflecting magma source heterogeneities associated with the recycling of subducted Galápagos hotspot track material (SI Appendix, Fig. S1), direct contribution from a mantle plume source, or a combination of both (10, 18–21). The absence of a Wadati–Benioff zone associated with subduction from southeastern Costa Rica through Panama has been interpreted to reflect the presence of a slab window (22), potentially allowing the influx of hot asthenosphere beneath Central America (10, 18). Although the absence of a subducting slab as a fluid reservoir is a reasonable explanation for the lack of active arc volcanism in the region (23), the potential connection between the absence of deep seismicity and the emergence of plume geochemical signatures in the arc remains enigmatic. To identify the sources of volcanism in the southern CAM, helium and carbon isotopes were measured in deeply sourced hydrothermal fluid (n = 43) and gas (n = 22) samples collected in Costa Rica and Panama between 2005 and 2018. These results are combined with lava geochemistry systematics in the CAM, for which we present 1) ²⁰⁶Pb/²⁰⁴Pb, Ce/Pb, and Nb/U data for lavas collected at La Providencia in the back-arc region of the CAM and 2) an updated compilation of literature data for the entire CAM. Taken together with independent constraints from geophysics and a global mantle flow model (24), these geochemical data support lateral transport of enriched plume material at sublithospheric depths from the Galápagos plume to the CAM.     

Passiflora incarnata Linneaus as an anxiolytic before spinal anesthesia

Purpose  

Patients who undergo regional anesthesia experience anxiety in the preoperative period. Passiflora incarnata Linneaus is a plant that has traditionally been used as an anxiolytic and sedative. We aimed to investigate the effect of preoperative oral administration of Passiflora incarnata Linneaus on anxiety, psychomotor functions, sedation, and hemodynamics in patients undergoing spinal anesthesia.