Iatrogenic ureteral injuries and strictures are relatively common complication of pelvic surgery and radiation treatment.Left untreated they are associated with severe shortand long-term complications such as urinoma,...Iatrogenic ureteral injuries and strictures are relatively common complication of pelvic surgery and radiation treatment.Left untreated they are associated with severe shortand long-term complications such as urinoma,septic state,renal failure,and loss of a renal unit.Treatment depends on timing of diagnosis,as well as extent of injury,and ranges from simple endoscopic management to complex surgical reconstruction under usage of pedicled grafts.While recent advances in ureteral tissue engineering are promising the topic is still underreported.Historically a domain of open surgery,laparoscopic and robotic-assisted approaches have proven their feasibility in small case series,and are increasingly being utilized as means of reconstructive surgery.This review aims to give an outline of incidence and treatment of ureteral injuries and strictures in light of the latest advances.展开更多
AIM To assess the incidence of hepatocellular carcinoma(HCC) in chronic liver disease due to hepatitis B virus(HBV) or hepatitis C virus(HCV) coinfected with human immunodeficiency virus(HIV).METHODS A retrospective c...AIM To assess the incidence of hepatocellular carcinoma(HCC) in chronic liver disease due to hepatitis B virus(HBV) or hepatitis C virus(HCV) coinfected with human immunodeficiency virus(HIV).METHODS A retrospective cohort study was performed, including patients with chronic liver disease due to HBV or HCV, with and without HIV coinfection. Patients were selected in the largest tertiary public hospital complex in southern Brazil between January 2007 and June 2014. We assessed demographic and clinical data, including lifestyle habits such as illicit drug use or alcohol abuse, in addition to frequency and reasons for hospital admissions via medical records review.RESULTS Of 804 patients were included(399 with HIV coinfection and 405 monoinfected with HBV or HCV). Coinfected patients were younger(36.7 ± 10 vs 46.3 ± 12.5, P < 0.001). Liver cirrhosis was observed in 31.3% of HIV-negative patients and in 16.5% of coinfected(P < 0.001). HCC was diagnosed in 36 patients(10 HIV coinfected and 26 monoinfected). The incidence density of HCC in coinfected and monoinfected patients was 0.25 and 0.72 cases per 100 patient-years(95%CI: 0.12-0.46 vs 0.47-1.05)(long-rank P = 0.002), respectively. The ratio for the HCC incidence rate was 2.98 for HIV-negative. However, when adjusting for age or when only cirrhotic are analyzed, the absence of HIV lost statistical significance for the development of HCC. CONCLUSION In this study, the presence of HIV coinfection in chronic liver disease due to HBV or HCV showed no relation to the increase of HCC incidence.展开更多
This study aimed to identify stable indicator contaminants of pharmaceuticals and personal care products(PPCPs)to trace the anthropogenic fingerprint of the Pearl River plume in the coastal waters of the northern Sout...This study aimed to identify stable indicator contaminants of pharmaceuticals and personal care products(PPCPs)to trace the anthropogenic fingerprint of the Pearl River plume in the coastal waters of the northern South China Sea.40 PPCPs were under investigation,of which 14 were detected along the Pearl River Estuary and 4 on the shelf of the northern South China Sea.Results show that caffeine,metoprolol,diclofenac,and carbamazepine can be utilized to detect the human impact.They are diluted along the Pearl River,as their concentrations decrease from low salinity towards high salinity.Sulfonamide antibiotics and trimethoprim are suitable to determine the veterinary and human impact.Their highest concentrations were detected along the river yet still in low saline water whereas,the origin of the organic UV-filter is diverse.Their source could not be precisely determined.Only caffeine,metoprolol,octocrylene,and PBSA were detected at the near-coastal stations in the South China Sea.They can be utilized as suitable indicators to detect an anthropogenic impact on the northern South China Sea.The detected concentrations are of low risk to organisms in the Pearl River and the northern South China Sea.展开更多
atients undergoing urologic surgery are at risk of acute kidney injury （AKI） and consequently long-term deterioration in renal function. AKI is further associated with signifcantly higher odds of perioperative compl...atients undergoing urologic surgery are at risk of acute kidney injury （AKI） and consequently long-term deterioration in renal function. AKI is further associated with signifcantly higher odds of perioperative complications, prolonged hospital stay, higher mortality and costs. Therefore, better awareness and detection of AKI, as well as identifcation of AKI determinants in the urological surgery setting is warranted to pre-empt and mitigate further deterioration of renal function in patients at special risk. New consensus criteria provide precise definitions of diagnosis and description of the severity of AKI. However, they rely on serum creatinine （SCr）, which is known to be an inaccurate marker of early changes in renal function. Therefore, several newurinary and serum biomarkers promise to address the gap associated with the use of SCr. Novel biomarkers may complement SCr measurement or most likely improve the diagnostic accuracy of AKI when used in combinations. However, novel biomarkers have to prove their clinical applicability, accuracy, and cost effectiveness prior to implementation into clinical practice. Most preferably, novel biomarkers should help to positively improve a patient’s long-term renal functional outcomes. The purpose of this review is to discuss currently available biomarkers and to review their clinical evidence within urologic surgery settings.展开更多
Protein-losing enteropathy(PLE) is characterized by loss of serum proteins into the gastrointestinal tract. It may lead to hypoproteinemia and clinically present as protein deficiency edema, ascites, pleural or perica...Protein-losing enteropathy(PLE) is characterized by loss of serum proteins into the gastrointestinal tract. It may lead to hypoproteinemia and clinically present as protein deficiency edema, ascites, pleural or pericardial effusion and/or malnutrition. In most cases the site of protein loss is the small intestine. Here we present an unusual case of severe PLE in a 55-year old female with a one-year history of recurrent diarrhea, crampy abdominal pain, and peripheral edema. Endoscopy and MRI showed a diffuse inflammatory thickening of the sigmoid colon and the rectum. Surgical resection of the involved colon was performed and the symptoms were significantly resolved. The final histologic evaluation confirmed a diagnosis of a pseudomembranous colitis with cap polyposis-like features. Such a cause of PLE has never been described before.展开更多
Objective: To compare pregnancy and implantation rates after ART when embryos for day 3 embryo transfer were selected based on soluble HLA-G (sHLA-G) expres sion in the culture media at 46 hours after fertilization by...Objective: To compare pregnancy and implantation rates after ART when embryos for day 3 embryo transfer were selected based on soluble HLA-G (sHLA-G) expres sion in the culture media at 46 hours after fertilization by intracytoplasmic sp erm injection (ICSI). Design: Prospective cohort study. Setting: Private practic e. Patient(s): One hundred seven patients undergoing ART aged < 39 years with no rmal ovarian reserve, a normal uterine cavity, and two or more embryos scoring < 70 by the graduated embryo scoring (GES) method, transferred on day 3. Interven tion(s): Patients were divided into two groups. In group A (n = 51) all embryos transferred expressed sHLA-G above the geometric mean (sHLA-G+), whereas in g roup B (n = 56) all embryos transferred were sHLA-G-ve. Main Outcome Measure(s ): Viable pregnancy rate (patients with fetal heart activity at 8 weeks of gesta tion per embryo transfer procedure), and implantation rate (viable gestational s acs per total embryos transferred). Result(s): When all embryos transferred were sHLA-G+ve the pregnancy and implantation rates were 75%(38/51) and 44%(51/1 16), respectively, compared to 23%(13/56) and 14%(20/143) when all embryos tra nsferred were sHLA-G-ve. Conclusion(s): Pregnancy and implantation rates after day 3 embryo transfer are improved when sHLA-G expression in phase I culture m edia at 46 hours after fertilization by ICSI is used prospectively as a criterio n for selecting optimal embryos for transfer.展开更多
Part of the sandization process in southwestern Rio Grande do Sul (Brazil) originates from daily torrential rains. However, it is believed that climate changes have been provoking more frequent and more intense rains ...Part of the sandization process in southwestern Rio Grande do Sul (Brazil) originates from daily torrential rains. However, it is believed that climate changes have been provoking more frequent and more intense rains in the region, a phenomenon which can change the dynamic of erosion/transport/sedimentation natural processes. The objective of this work is to identify the behavior of daily rainfall extreme events (in terms of their frequency, return time, tendency and genesis), relating them to both climatic change issue and enhancement of erosive processes. We have used daily rainfall data from meteorology stations of Brazilian National Water Agency (ANA) for the period between 1928 and 2017 and the percentile 99 was used to identify daily rainfall extreme value (71.5 mm). The upper values were categorized and their absolute and relative frequencies as well as their return time were identified. The temporal tendency of these events was evaluated by the Mann-Kendall test, considering the 90 years of the series. The results showed that there was a significant increase in heavy rainfall events in November and December in the last two decades and that the return time for these events decreased throughout the time. Synoptic analyses from GOES 13 satellite infrared imagery and from ECMWF/ERA/Interim reanalysis data allowed concluding that such intense rainfall events originated themselves from the transport of moisture from the Amazon by Low-Level Jets, which promoted the formation of Mesoscale Convective Complex, with large volumes of rain in the study region. Thus, the recurrence of these events in the southwest of Rio Grande do Sul may intensify these sandization processes, since they arise from the association between natural morphoscultural dynamics and agricultural practices, generating environmental problems for the region.展开更多
AIM: To evaluate safety and utility of coronary computed tomography angiography (CCTA) compared to invasive coronary angiography (ICA) in new cardiomyopathy. METHODS: Eighteen patients (mean age 56.5 years, 10 males) ...AIM: To evaluate safety and utility of coronary computed tomography angiography (CCTA) compared to invasive coronary angiography (ICA) in new cardiomyopathy. METHODS: Eighteen patients (mean age 56.5 years, 10 males) who presented for evaluation of new onset heart failure with evidence of systolic dysfunction (ejection fraction < 40%) on echocardiography and recent ICA were prospectively enrolled. Patients with known coronary artery disease, atrial fibrillation, creatinine > 1.5 g/dL, and contraindication to intravenous contrast administration were excluded. CCTA was performed using a dual source 64-slice scanner. Mean heart rate was 75 beats per minute. Stenosis was graded for each coronary segment as: none, mild (< 50%), moderate (50%-70%), severe (> 70%), or non-evaluable. Ischemic cardiomyopathy (ICM) was diagnosed if severe stenosis was present in the left main, proximal left anterior descending artery, or two or more major arteries. RESULTS: Two patients were diagnosed with ICM by ICA. CCTA correctly identified 2 patients with ICM and 16 patients as non-ICM. CCTA successfully evaluated 240/246 coronary segments with an accuracy of 97.5%, sensitivity 70%, specificity 98.7%, positive predictive value of 70%, and negative predictive value of 98.7% for identifying severe stenosis on a per-segment level. CONCLUSION: Dual source 64-slice multi-detector CCTA is a safe, accurate, and non-invasive technique for diagnosing ICM in patients presenting during the acute phase of newly diagnosed cardiomyopathy.展开更多
Allegations for a worldwide decline in semen par.ameter values have not withstood scientific scrutiny. Methodological flaws in an influential 1992 paper are summarized here, and studies that have been published since ...Allegations for a worldwide decline in semen par.ameter values have not withstood scientific scrutiny. Methodological flaws in an influential 1992 paper are summarized here, and studies that have been published since 1992 are reviewed. Of the 35 major studies of time trends in semen quality reviewed here, eight （a total of 18 109 men） suggest a decline in semen quality; 21 （112 386 men） show either no change or an increase in semen quality;, and six （26 007 men） show ambiguous or conflicting results. The cause （or causes） of the geographical and temporal variations in semen parameter values reported by these diverse studies deserve further investigation.展开更多
文摘Iatrogenic ureteral injuries and strictures are relatively common complication of pelvic surgery and radiation treatment.Left untreated they are associated with severe shortand long-term complications such as urinoma,septic state,renal failure,and loss of a renal unit.Treatment depends on timing of diagnosis,as well as extent of injury,and ranges from simple endoscopic management to complex surgical reconstruction under usage of pedicled grafts.While recent advances in ureteral tissue engineering are promising the topic is still underreported.Historically a domain of open surgery,laparoscopic and robotic-assisted approaches have proven their feasibility in small case series,and are increasingly being utilized as means of reconstructive surgery.This review aims to give an outline of incidence and treatment of ureteral injuries and strictures in light of the latest advances.
文摘AIM To assess the incidence of hepatocellular carcinoma(HCC) in chronic liver disease due to hepatitis B virus(HBV) or hepatitis C virus(HCV) coinfected with human immunodeficiency virus(HIV).METHODS A retrospective cohort study was performed, including patients with chronic liver disease due to HBV or HCV, with and without HIV coinfection. Patients were selected in the largest tertiary public hospital complex in southern Brazil between January 2007 and June 2014. We assessed demographic and clinical data, including lifestyle habits such as illicit drug use or alcohol abuse, in addition to frequency and reasons for hospital admissions via medical records review.RESULTS Of 804 patients were included(399 with HIV coinfection and 405 monoinfected with HBV or HCV). Coinfected patients were younger(36.7 ± 10 vs 46.3 ± 12.5, P < 0.001). Liver cirrhosis was observed in 31.3% of HIV-negative patients and in 16.5% of coinfected(P < 0.001). HCC was diagnosed in 36 patients(10 HIV coinfected and 26 monoinfected). The incidence density of HCC in coinfected and monoinfected patients was 0.25 and 0.72 cases per 100 patient-years(95%CI: 0.12-0.46 vs 0.47-1.05)(long-rank P = 0.002), respectively. The ratio for the HCC incidence rate was 2.98 for HIV-negative. However, when adjusting for age or when only cirrhotic are analyzed, the absence of HIV lost statistical significance for the development of HCC. CONCLUSION In this study, the presence of HIV coinfection in chronic liver disease due to HBV or HCV showed no relation to the increase of HCC incidence.
基金The research is part of the Sino-German MEGAPOL project,which is financed by State Ocean Administration(SOA)in China and the Federal Ministry of Education and Research(BMBF,03F0786A)in Germany.
文摘This study aimed to identify stable indicator contaminants of pharmaceuticals and personal care products(PPCPs)to trace the anthropogenic fingerprint of the Pearl River plume in the coastal waters of the northern South China Sea.40 PPCPs were under investigation,of which 14 were detected along the Pearl River Estuary and 4 on the shelf of the northern South China Sea.Results show that caffeine,metoprolol,diclofenac,and carbamazepine can be utilized to detect the human impact.They are diluted along the Pearl River,as their concentrations decrease from low salinity towards high salinity.Sulfonamide antibiotics and trimethoprim are suitable to determine the veterinary and human impact.Their highest concentrations were detected along the river yet still in low saline water whereas,the origin of the organic UV-filter is diverse.Their source could not be precisely determined.Only caffeine,metoprolol,octocrylene,and PBSA were detected at the near-coastal stations in the South China Sea.They can be utilized as suitable indicators to detect an anthropogenic impact on the northern South China Sea.The detected concentrations are of low risk to organisms in the Pearl River and the northern South China Sea.
基金supported by the Professor Walter Morris-Hale Distinguished Chair in Urologic Oncology at the Brigham and Women’s Hospital
文摘atients undergoing urologic surgery are at risk of acute kidney injury （AKI） and consequently long-term deterioration in renal function. AKI is further associated with signifcantly higher odds of perioperative complications, prolonged hospital stay, higher mortality and costs. Therefore, better awareness and detection of AKI, as well as identifcation of AKI determinants in the urological surgery setting is warranted to pre-empt and mitigate further deterioration of renal function in patients at special risk. New consensus criteria provide precise definitions of diagnosis and description of the severity of AKI. However, they rely on serum creatinine （SCr）, which is known to be an inaccurate marker of early changes in renal function. Therefore, several newurinary and serum biomarkers promise to address the gap associated with the use of SCr. Novel biomarkers may complement SCr measurement or most likely improve the diagnostic accuracy of AKI when used in combinations. However, novel biomarkers have to prove their clinical applicability, accuracy, and cost effectiveness prior to implementation into clinical practice. Most preferably, novel biomarkers should help to positively improve a patient’s long-term renal functional outcomes. The purpose of this review is to discuss currently available biomarkers and to review their clinical evidence within urologic surgery settings.
文摘Protein-losing enteropathy(PLE) is characterized by loss of serum proteins into the gastrointestinal tract. It may lead to hypoproteinemia and clinically present as protein deficiency edema, ascites, pleural or pericardial effusion and/or malnutrition. In most cases the site of protein loss is the small intestine. Here we present an unusual case of severe PLE in a 55-year old female with a one-year history of recurrent diarrhea, crampy abdominal pain, and peripheral edema. Endoscopy and MRI showed a diffuse inflammatory thickening of the sigmoid colon and the rectum. Surgical resection of the involved colon was performed and the symptoms were significantly resolved. The final histologic evaluation confirmed a diagnosis of a pseudomembranous colitis with cap polyposis-like features. Such a cause of PLE has never been described before.
文摘Objective: To compare pregnancy and implantation rates after ART when embryos for day 3 embryo transfer were selected based on soluble HLA-G (sHLA-G) expres sion in the culture media at 46 hours after fertilization by intracytoplasmic sp erm injection (ICSI). Design: Prospective cohort study. Setting: Private practic e. Patient(s): One hundred seven patients undergoing ART aged < 39 years with no rmal ovarian reserve, a normal uterine cavity, and two or more embryos scoring < 70 by the graduated embryo scoring (GES) method, transferred on day 3. Interven tion(s): Patients were divided into two groups. In group A (n = 51) all embryos transferred expressed sHLA-G above the geometric mean (sHLA-G+), whereas in g roup B (n = 56) all embryos transferred were sHLA-G-ve. Main Outcome Measure(s ): Viable pregnancy rate (patients with fetal heart activity at 8 weeks of gesta tion per embryo transfer procedure), and implantation rate (viable gestational s acs per total embryos transferred). Result(s): When all embryos transferred were sHLA-G+ve the pregnancy and implantation rates were 75%(38/51) and 44%(51/1 16), respectively, compared to 23%(13/56) and 14%(20/143) when all embryos tra nsferred were sHLA-G-ve. Conclusion(s): Pregnancy and implantation rates after day 3 embryo transfer are improved when sHLA-G expression in phase I culture m edia at 46 hours after fertilization by ICSI is used prospectively as a criterio n for selecting optimal embryos for transfer.
文摘Part of the sandization process in southwestern Rio Grande do Sul (Brazil) originates from daily torrential rains. However, it is believed that climate changes have been provoking more frequent and more intense rains in the region, a phenomenon which can change the dynamic of erosion/transport/sedimentation natural processes. The objective of this work is to identify the behavior of daily rainfall extreme events (in terms of their frequency, return time, tendency and genesis), relating them to both climatic change issue and enhancement of erosive processes. We have used daily rainfall data from meteorology stations of Brazilian National Water Agency (ANA) for the period between 1928 and 2017 and the percentile 99 was used to identify daily rainfall extreme value (71.5 mm). The upper values were categorized and their absolute and relative frequencies as well as their return time were identified. The temporal tendency of these events was evaluated by the Mann-Kendall test, considering the 90 years of the series. The results showed that there was a significant increase in heavy rainfall events in November and December in the last two decades and that the return time for these events decreased throughout the time. Synoptic analyses from GOES 13 satellite infrared imagery and from ECMWF/ERA/Interim reanalysis data allowed concluding that such intense rainfall events originated themselves from the transport of moisture from the Amazon by Low-Level Jets, which promoted the formation of Mesoscale Convective Complex, with large volumes of rain in the study region. Thus, the recurrence of these events in the southwest of Rio Grande do Sul may intensify these sandization processes, since they arise from the association between natural morphoscultural dynamics and agricultural practices, generating environmental problems for the region.
基金Supported by Grants from the NYU Department of Radiology and Society of Computed Body Tomography and Magnetic Resonance
文摘AIM: To evaluate safety and utility of coronary computed tomography angiography (CCTA) compared to invasive coronary angiography (ICA) in new cardiomyopathy. METHODS: Eighteen patients (mean age 56.5 years, 10 males) who presented for evaluation of new onset heart failure with evidence of systolic dysfunction (ejection fraction < 40%) on echocardiography and recent ICA were prospectively enrolled. Patients with known coronary artery disease, atrial fibrillation, creatinine > 1.5 g/dL, and contraindication to intravenous contrast administration were excluded. CCTA was performed using a dual source 64-slice scanner. Mean heart rate was 75 beats per minute. Stenosis was graded for each coronary segment as: none, mild (< 50%), moderate (50%-70%), severe (> 70%), or non-evaluable. Ischemic cardiomyopathy (ICM) was diagnosed if severe stenosis was present in the left main, proximal left anterior descending artery, or two or more major arteries. RESULTS: Two patients were diagnosed with ICM by ICA. CCTA correctly identified 2 patients with ICM and 16 patients as non-ICM. CCTA successfully evaluated 240/246 coronary segments with an accuracy of 97.5%, sensitivity 70%, specificity 98.7%, positive predictive value of 70%, and negative predictive value of 98.7% for identifying severe stenosis on a per-segment level. CONCLUSION: Dual source 64-slice multi-detector CCTA is a safe, accurate, and non-invasive technique for diagnosing ICM in patients presenting during the acute phase of newly diagnosed cardiomyopathy.
文摘Allegations for a worldwide decline in semen par.ameter values have not withstood scientific scrutiny. Methodological flaws in an influential 1992 paper are summarized here, and studies that have been published since 1992 are reviewed. Of the 35 major studies of time trends in semen quality reviewed here, eight （a total of 18 109 men） suggest a decline in semen quality; 21 （112 386 men） show either no change or an increase in semen quality;, and six （26 007 men） show ambiguous or conflicting results. The cause （or causes） of the geographical and temporal variations in semen parameter values reported by these diverse studies deserve further investigation.
