Comparison of cost-effectiveness and postoperative outcomes following integration of a stiff shaft glidewire into percutaneous nephrolithotripsy

Aims: To analyze the cost effectiveness of integrating a stiff shaft glidewire (SSGW) in percutaneous nephrolithotripsy (PCNL) relative to standard technique (ST). This is prudent because healthcare providers are experiencing increased pressure to improve procedure-related cost containment. Methods: ST for PCNL at our institution involves a hydrophilic glidewire during initial percutaneous access and then two new stiff shaft wires. The SSGW is a hydrophilic wire used for initial access and the remainder of the procedure. We collected operating room (OR) costs for all primary, unilateral PCNL cases over a 5-month period during which ST for PCNL was used at a single institution with a single surgeon and compared with a 6-month period during which a SSGW was used. Mean costs for each period were then compared along with stone-free rates and complications. Results: We included 17 total cases in the ST group and 22 in the SSGW group. The average operating room supply cost for the ST group was $1937.32 and$1559.39 in the SSGW group. The net difference of $377.93 represents a nearly 20% decrease in cost. This difference was statistically significant (p = 0.031). There was no difference in postoperative stone-free rates (82.4% versus 86.4%, p = 1.0, respectively) or complications (23.5% versus 13.6%, p = 0.677, respectively) between ST and SSGW groups. Conclusion: Transitioning to a SSGW has reduced OR supply cost by reducing the number of supplies required. The change in wire did not affect stone-free rates or complications

Brain-Wide Correspondence of Neuronal Epigenomics and Distant Projections

Single-cell analyses parse the brain’s billions of neurons into thousands of ‘cell-type’ clusters residing in different brain structures1. Many cell types mediate their functions through targeted long-distance projections allowing interactions between specific cell types. Here we used epi-retro-seq2 to link single-cell epigenomes and cell types to long-distance projections for 33,034 neurons dissected from 32 different regions projecting to 24 different targets (225 source-to-target combinations) across the whole mouse brain. We highlight uses of these data for interrogating principles relating projection types to transcriptomics and epigenomics, and for addressing hypotheses about cell types and connections related to genetics. We provide an overall synthesis with 926 statistical comparisons of discriminability of neurons projecting to each target for every source. We integrate this dataset into the larger BRAIN Initiative Cell Census Network atlas, composed of millions of neurons, to link projection cell types to consensus clusters. Integration with spatial transcriptomics further assigns projection-enriched clusters to smaller source regions than the original dissections. We exemplify this by presenting in-depth analyses of projection neurons from the hypothalamus, thalamus, hindbrain, amygdala and midbrain to provide insights into properties of those cell types, including differentially expressed genes, their associated cis-regulatory elements and transcription-factor-binding motifs, and neurotransmitter use

Identification of Protein Targets of Reactive Metabolites of Tienilic Acid in Human Hepatocytes

This document is the Accepted Manuscript version of a Published Work that appeared in final form in Chemical Research in Toxicology, copyright © American Chemical Society after peer review and technical editing by the publisher. To access the final edited and published work see http://pubs.acs.org/doi/abs/10.1021/tx300103jTienilic acid (TA) is a uricosuric diuretic that was withdrawn from the market only months after its introduction because of reports of serious incidents of drug-induced liver injury including some fatalities. Its hepatotoxicity is considered to be primarily immunoallergic in nature. Like other thiophene compounds, TA undergoes biotransformation to a S-oxide metabolite which then reacts covalently with cellular proteins. To identify protein targets of TA metabolites, we incubated [14C]-TA with human hepatocytes, separated cellular proteins by 2D gel electrophoresis, and analyzed proteins in 36 radioactive spots by tryptic digestion followed by LC-MS/MS. Thirty one spots contained at least one identifiable protein. Sixteen spots contained only one of 14 non-redundant proteins which were thus considered to be targets of TA metabolites. Six of the 14 were also found in other radioactive spots that contained from 1 to 3 additional proteins. Eight of the 14 had not been reported to be targets for any reactive metabolite other than TA. The other 15 spots each contained from 2–4 identifiable proteins, many of which are known targets of other chemically reactive metabolites, but since adducted peptides were not observed, the identity of the adducted protein(s) in these spots is ambiguous. Interestingly, all the radioactive spots corresponded to proteins of low abundance, while many highly abundant proteins in the mixture showed no radioactivity. Furthermore, of approximately 16 previously reported protein targets of TA in rat liver (Methogo, R., Dansette, P. and Klarskov, K. (2007) Int. J. Mass Spectrom., 268, 284–295), only one (fumarylacetoacetase) is among the 14 targets identified in this work. One reason for this difference may be statistical, given that each study identified a small number of targets from among thousands present in hepatocytes. Another may be the species difference (i.e. rat vs. human), and still another may be the method of detection of adducted proteins (i.e. Western blot vs. C-14). Knowledge of human target proteins is very limited. Of more than 350 known protein targets of reactive metabolites, only 42 are known from human and only 21 of these are known to be targets for more than one chemical. Nevertheless, the demonstration that human target proteins can be identified using isolated hepatocytes in vitro should enable the question of species differences to be addressed more fully in the future

Evolution de la populiculture période 1992-1995. Rapport national de la France (Commission Internationale du Peuplier : 20ème session Hongrie)

In spite of unfavorable economical conditions during the period 1992-1994, the surface of poplar stands has increased at the same rate as before 1991. The development of ecological opposition, evolution of pathological situation and scientific efforts on biotechnologies are main characteristics for this period. / Malgré une conjoncture économique plutôt défavorable, la peupleraie française est encore en extension sur la période 1992-1994. L'émergence d'opposition à la culture des peupliers, l'évolution du contexte pathologique et le développement des biotechnologies constituent les points forts de cette période

Demande d'homologation provisoire de populus deltoïdes Marsh : cv "Alcinde"

Selected by the SEITA and experimented in France by the Cemagref as early as 1972, the cultivar Populus deltoïdes "Alcinde" exhibits a correct level of resistance to the main leaf diseases. Its sensitivity to bacterial canker reduces its use to southern regions where its growth is optimum on rich stations with balanced texture. Its very good behavior during wood-peeling makes it a very interesting cultivar for noble uses. It is a cultivar that shows a good survival rate at vegetative propagation and at plantation and it also shows a very good resistance to wind. / Sélectionné par la SEITA et expérimenté en France par le Cemagref dès 1972, le cultivar de Populus deltoïdes "Alcinde" présente au niveau de résistance correct aux principaux pathogènes foliaires. Sa sensibilité au chancre bactérien limite son utilisation aux régions méridionales dans lesquelles il trouve son optimum de croissance sur des stations riches à texture équilibrée. Les excellentes caractéristiques de comportement au déroulage en font un cultivar très intéressant pour des emplois nobles. Il présente en outre une bonne reprise au bouturage et en plantation ainsi qu'une très bonne résistance au vent

Le marché des grumes de peuplier

Since 1985 France knows a strong increment of the national crop for poplar wood. Since 1990 this species has become the first deciduous for collected volumes, before oaks. Crop is now overpassing the annual increment. Thisgag can be explained by a diminution of diameter at cutting, connected with an evolution of pilling machines. Nevertheless there is no overexploitation of the potential as the surface of poplar stands is still increasing. But one can expect a reduction of the national crop of poplar wood in the next few years. The increment of the crop is explained by high prices offered for exportation. The main buyer is Italy. This country imports more and more from Eastern Europe. Consequently it is difficult to forecast the future of our exportation to Italy, even if the deficit of poplar wood is structural for this country. / La France connaît depuis 1985 une augmentation forte de la récolte des bois de peuplier. Depuis 1990, cette essence est devenue la première essence feuillue devant le chêne pour les volumes exploités. Les quantités récoltées sont supérieures à l'accroissement annuel. Cet écart s'explique par une réduction des diamètres d'exploitation, elle-même liée à une évolution des machines de déroulage. Il serait inexact de parler de surexploitation du potentiel dans la mesure où parallèlement les surfaces de peupleraies continuent à s'accroître. Par contre, il faut s'attendre à une réduction des récoltes dans les prochaines années. L'augmentation des récoltes actuelles s'explique par des cours soutenus par une forte demande à l'exportation. Le premier client de la France est l'Italie. Ce pays importe cependant de plus en plus de peupliers en provenance des pays de l'Europe de l'Est. Il est donc difficile de se prononcer sur la pérennité de nos exportations vers l'Italie, même si le déficit de ce pays est structurel

Comportement des cultivars de peupliers commercialisables dans l'Union européenne vis-à-vis de quelques parasites majeurs

The 130 poplar cultivars registered for commercial use in any country of the European Union (EU) can be marketed within the EU since 1966 but their circulation became free in 1993 with the opening of the single market. This paper aims to present most of the knowledge available about their behaviour towards major diseases such as the oozing canker (Xanthomonas populi), leaf brown spots (Marssonina brunnea), foliar rusts (Melampsora spp), leaf mosaic (poplar mosaic virus) and bark necrosis (Discosporium populeum). For three-quarters of the cultivars information is available which provides useful data to choose cultivars for wood production and for scientific purposes. Nevertheless, there are contradictions among authors, especially for leaf diseases, and this phenomenon is discussed. Information is scarce for some cultivars whose culture is generally limited and for some diseases (mainly M medusae, virus and Discosporium populeum). Disease resistance depends partly on the poplar species. Fair resistance is common to the oozing canker (P nigra), M brunnea (P deltoides, P nigra and P trichocarpa), rusts (P deltoides) and Discosporium populeum (P trichocarpa). Tendencies are less clear for interspecific hybrids, also due to active selection for resistance. It is therefore suggested to increase our knowledge through international cooperation including exchanges of methods and development of some early tests. A better appraisal of damages is necessary for foliar diseases. / Les 130 cultivars de peupliers inscrits aux catalogues des différents pays membres de l'Union Européenne sont commercialisables dans l'ensemble de ces Etats depuis 1966 mais leur libre circulation résulte de l'ouverture du marché unique en 1993. Cette note vise à récapituler les informations disponibles sur leur comportement envers les maladies les plus dommageables : le chancre bactérien (Xanthomonas populi), la brunissure des feuilles (Marssonina brunnea), les rouilles foliaires (Melampsora spp), la mosaïque virale et la nécrose d'écorce à Discosporium populeum. Le comportement envers les principales maladies a pu être renseigné pour les trois quarts des clones. Il en résulte des informations utiles pour raisonner le choix des cultivars tant pour la production que pour la définition de modèles. Il existe parfois des différences notables d'appréciation pour un cultivar donné selon les auteurs. Ce phénomène concerne surtout les maladies du feuillage, dont l'expression est particulièrement dépendante du climat. De plus, il existe des différences importantes de répartition géographique des trois espèces de Melampsora. D'autres raisons responsables de divergences entre auteurs sont discutées. Il apparaît que, pour certains clones (peu cultivés) et certaines maladies (Melampsora medusae, la mosaïque virale et Discosporium populeum), les informations disponibles sont insuffisantes. Selon les espèces auxquelles appartiennent les cultivars, il est possible d'identifier des sources de résistance au chancre bactérien (Populus nigra), au M. brunnea (P deltoides, P nigra et P trichocarpa), aux rouilles (P deltoides) et au Discosporium populeum (P trichocarpa). Les tendances sont moins nettes pour les hybrides interspécifiques dont l'échantillon est de plus biaisé par la sélection. Il est suggéré d'approfondir les connaissances en se basant sur une coopération internationale, un échange de méthodes de test et parfois la mise au point de tests précoces. Des informations complémentaires seraient utiles pour mieux cerner les seuils de nuisibilité, en particulier des parasites foliaires

Comportement des cultivars de peupliers commercialisables dans l'Union européenne vis-à-vis de quelques parasites majeurs

The 130 poplar cultivars registered for commercial use in any country of the European Union (EU) can be marketed within the EU since 1966 but their circulation became free in 1993 with the opening of the single market. This paper aims to present most of the knowledge available about their behaviour towards major diseases such as the oozing canker (Xanthomonas populi), leaf brown spots (Marssonina brunnea), foliar rusts (Melampsora spp), leaf mosaic (poplar mosaic virus) and bark necrosis (Discosporium populeum). For three-quarters of the cultivars information is available which provides useful data to choose cultivars for wood production and for scientific purposes. Nevertheless, there are contradictions among authors, especially for leaf diseases, and this phenomenon is discussed. Information is scarce for some cultivars whose culture is generally limited and for some diseases (mainly M medusae, virus and Discosporium populeum). Disease resistance depends partly on the poplar species. Fair resistance is common to the oozing canker (P nigra), M brunnea (P deltoides, P nigra and P trichocarpa), rusts (P deltoides) and Discosporium populeum (P trichocarpa). Tendencies are less clear for interspecific hybrids, also due to active selection for resistance. It is therefore suggested to increase our knowledge through international cooperation including exchanges of methods and development of some early tests. A better appraisal of damages is necessary for foliar diseases. / Les 130 cultivars de peupliers inscrits aux catalogues des différents pays membres de l'Union Européenne sont commercialisables dans l'ensemble de ces Etats depuis 1966 mais leur libre circulation résulte de l'ouverture du marché unique en 1993. Cette note vise à récapituler les informations disponibles sur leur comportement envers les maladies les plus dommageables : le chancre bactérien (Xanthomonas populi), la brunissure des feuilles (Marssonina brunnea), les rouilles foliaires (Melampsora spp), la mosaïque virale et la nécrose d'écorce à Discosporium populeum. Le comportement envers les principales maladies a pu être renseigné pour les trois quarts des clones. Il en résulte des informations utiles pour raisonner le choix des cultivars tant pour la production que pour la définition de modèles. Il existe parfois des différences notables d'appréciation pour un cultivar donné selon les auteurs. Ce phénomène concerne surtout les maladies du feuillage, dont l'expression est particulièrement dépendante du climat. De plus, il existe des différences importantes de répartition géographique des trois espèces de Melampsora. D'autres raisons responsables de divergences entre auteurs sont discutées. Il apparaît que, pour certains clones (peu cultivés) et certaines maladies (Melampsora medusae, la mosaïque virale et Discosporium populeum), les informations disponibles sont insuffisantes. Selon les espèces auxquelles appartiennent les cultivars, il est possible d'identifier des sources de résistance au chancre bactérien (Populus nigra), au M. brunnea (P deltoides, P nigra et P trichocarpa), aux rouilles (P deltoides) et au Discosporium populeum (P trichocarpa). Les tendances sont moins nettes pour les hybrides interspécifiques dont l'échantillon est de plus biaisé par la sélection. Il est suggéré d'approfondir les connaissances en se basant sur une coopération internationale, un échange de méthodes de test et parfois la mise au point de tests précoces. Des informations complémentaires seraient utiles pour mieux cerner les seuils de nuisibilité, en particulier des parasites foliaires