Optimizarea metodelor de hemostază şi adrenării vezicii urinare în adenomectomia transvezicală. Aspect economic

Summary Due to the appearance of a space for drainage between Foley’s catheter, tubs and urethra the proposed method of adenomectomy operation permits a better and adequate drainage of the bladder adenoma’s site. By this the post-surgical hospital treatment decreased considerably. Introducere. Hemostaza intraoperatorie şi drenarea căilor urinare este un moment principial, cu posibile consecinţe în perioada postoperatorie imediată şi în cea tardivă: hemoragii întra- şi postoperatorii, apariţia stricturilor uretrale, volumul medicaţiei aplicate şi durata aflării pacientului în staţionar. Material şi metodă. Metoda pentru hemostază, drenarea vezicii urinare (VU) şi a lojei adenomului de prostată (AP), a fost propusă pe 23.01.2001 de medicul B. Ipatii (inovaţia Nr. 695/15). Studiul de evaluare a metodei a fost realizat pe un lot de 200 pacienţi cu adenom de prostată, trataţi în Clinica Urologie IMSP SCM „Sfânta Treime”, Chişinău. Din numărul total de pacienţi, 100 au fost operaţi prin metoda clasică, iar 100 prin procedeul propus de noi. Metoda constă în următoarele: după enucleerea bim anuală a adenom ului şi hem ostază corespunzătoare, se perfectează revizia lojei pentru înlăturarea ţesutului restant. Porţiunile ambundent sângerânde se suturează cu catgut. Dacă loja este de dimensiuni mari, se suturează cu catgut mucoasă-mucoasă pentru a fi micşorată şi a permite cateterului Foley (CF) asigurarea hemostazei mecanice. Paralel cu CF, se instalează suplimentar un tub de perfuzie ce este fixat cu suturi de capron scoase prin VU la abdomen. VU se suturează ermetic. Astfel se formează un spaţiu între CF, tub şi mucoasa uretrei, ceea ce permite o drenare mai adecvată a lojei adenomului, a VU şi a uretrei, fapt ce permite ameliorarea evacuării cheagurilor de sânge, a ţesuturilor necrotizate, detritului. Catereul Foley şi tubul se menţine în uretră 7-9 zile, ceea ce permite instituirea unui lavaj, în caz de hemoragie. Rezultate şi concluzii. In urma aplicării metodei propuse nu au fost semnalate hemoragii majore cu tamponada vezicii urinare, stări febrile sau frisoane; nu au fost necesare hemotransfuzii. Vindecarea plăgii s-a realizat „per primam”, fără formarea de fistule urinare. La extragerea drenajului uretral micţiile au fost libere. Studiul efectuat retrospectiv referitor la durata de spitalizare postoperatorie a pacienţilor a demonstrat o eficacitate superioară a metodei propuse, în comparaţie cu metoda clasică. Astfel, în lotul I, durata medie de aflare a pacienţilor în spital a costituit 20,5 zile. In lotul II (perioada 2000-2004), pentru bolnavii operaţi prin metoda noastră, durata tratamentului în staţionar a constituit 11,3 zile. In concluzie, putem afirma că aspectul economic al metodei propuse este evident şi necesită studii suplimentare

Статистическая оценка сопутствующих патологических процессов при аденоме простаты

Department of morphopathology, Department of urology and surgical nephrology, Nicolae Tesmitsanu State University of Medicine and FarmacyThis study aims to assess the statistical figures of morphopathological aspects of prostatic adenoma using the methods of statistical processing and analyzing to determine the informative indices of variability and the trend of the development of the pathological processes concurrent to the Benign Prostate Hiperplasia (BPH). It has been found that in 30 patients aged 45-68 along with BPH the pathological processes with a predominance of the inflammatory, dystrophic and discirculatory ones, involving all the structural elements of the adenoma and its bordering zones, have been identified. The level of activity of the processes, including the inflammatory processes in the peripheral area has been found out. The inflammatory processes of moderate and emphasized activity (the IInd and IIId degrees) have made up a maximum frequency and accounted for 77% of the cases, being followed by circulatory disorders of the IInd and IIId degrees of activity, what has corresponded to 76% of cases. В данном исследовании отражена статистическая оценка морфопатологических аспектов, выявленных при аденоме простаты, использованы методы статистической обработки и анализа для выявления информативных параметров вариабельности, а также тенденции развития патологических процессов, которые сопутствуют доброкачественной гиперплазии простаты (ДГП). Установлено, что у 30 пациентов в возрасте 45-68 лет, одновременно с ДГП присутствуют патологические процессы, преимущественно воспалительные, дисциркуляторные и дистрофические, включающие все структурные элементы аденомы и ее пограничной зоны. Выявлена степень активности процессов, в том числе на периферии, что соответствовало зоне энуклеации аденомы. Воспалительные процессы умеренной и выраженной степени активности (II-III степень) соответствовали максимальной частоте и составили 77% случаев, за ними следовали дисциркуляторные нарушения II-III степени, которые составили 76%

Changes of free radical oxidation and of antioxidant defense system in peripheral blood and fluid discharged from prostate draining lodge in large transbladder adenomectomy

Department of Urology, Holy Trinity Municipal Hospital, Chisinau, the Republic of Moldova, Laboratory of Biochemistry, Department of Urology and Surgical Nephrology, Department of Pathomorphology, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaBackground: This study is dedicated to determination of the peculiarities of the lipid peroxidation and antioxidant system processes in the patients with prostate adenoma (PA), and the correlation between blood serum and fluid draining from lodge after adenomectomy with the aim of highlighting the risk factors of this pathology. Material and methods: There were studied 79 men aged 50-75 years, divided into two specific groups: group 1 – 49 men with PA treated surgically by transvezical method, modified by us and group 2 – 30 healthy men. Results: The results showed that in PA the processes of lipid oxidation with production of reactive oxygen species increased, confirmed by marked increasing of hydroperoxides of lipids, keto-diene conjugates and carbonyl compounds. There had been an impressive increase of the malondialdehyde level in both blood serum at pre- and postoperative stages and in the drained fluids from the lodge in patients of group 1. A deficiency of antioxidants was demonstrated by total antioxidant reduced activity and decreased functionality of the main antioxidant enzymes – superoxide dismutase, glutathione peroxidase, catalase in pre- and post-operative periods, as well as in fluids from the drained lodge in group 2. Conclusions: It was found that oxygen species manifested an imbalance between reactive oxygen species generation and antioxidant protective system and they are an important pathogenic cause in self-maintenance and exacerbation of inflammatory response that can influence the pre- and postoperative evolution of PA, a predictive factor in developing treatment strategies, postoperative management

Biochemical profile of the proteolytic processes in blood serum and in the prostatic lodge fluid at the patients with transvesical adenomectomy with the usage of endourethral drainage

IP USMF "Nicolae Testemiţanu", IMSP Spitalul Clinic Municipal "Sf. Treime", Secţia Urologie, Al VI-lea Congres de Urologie, Dializă şi Transplant Renal din Republica Moldova cu participare internaţională (21-23 octombrie 2015)Studiului constă în evaluarea proceselor proteolitice în serul sanguin în perioada pre - şi postoperatorie la pacienţii cu AP şi în eliminările din loja după adenomectomie întru determinarea rolului lorpredictiv în evoluţia proceselor lezionare concomitente şi monitorizării hemostazeiîn loja prostatică utilizând drenarea endouretrală a lo je i. Cercetările actualului studiu sunt de tip prospectiv fiind bazate pe un eşantion de 65 bărbaţi, conlocuitori ai R. Moldova, cu vârsta între 50-75 ani. Eşantionul general de studiu a fost divizat în două loturi specifice Lf - lotul de cercetare cu AP (n=45)şi LM - lotul m artor(n=20). în lotul de cercetare, sa inclus pacienţi cu AP rezolvat chirurgical prin metoda transvezicală în modificarea elaborată şi propusă de noi, [3] (fig.1). Sa constatat că în cadrul evoluţiei AP are loc creşterea pronunţată a funcţionalităţii majorităţii enzimelor proteolitice atât în serul sanguin cât şi în eliminările din lojă. Sa stabilit unii parametrii aşa ca SN şi MMM în serul sanguin şi la nivel de lojă, servind drept marcheri ale prezenţei intoxicaţiei endogene şi toxicităţii din serul sanguin ca rezultat a proceselor proteolitice derulate în cadrul AP şi postoperatoriu. Este relevantă importanţa rezultatelor obţinute privind sensibilitatea diferită a proteazelor acide în AP, fapt ce confirmă că utilizarea drenării lojei deschide noi posibilităţi a unei tactici medico-chirurgicale şi terapeutice alternative în optimizarea unei hemostaze la nivel de lojă.Summary The aim of study is to appreciate proteolytic processes both in blood serum and the lodge drainage fluid in the pre-and post-operative period in patients with BPH after adenomectomy in order to identify their predictive role in the development of concomitant injurious processes and monitoring of the hemostasis in the prostatic lodge using endourethral drainage. Current research is a prospective study based on a sample of 65 men from the Republic of Moldova, aged 50-75 years. General study sample was divided into two specific lots: Rg - research group with PA, (n = 45) and Cg - control group (n = 20). The research group included patients with PA surgically solved by the changed transvesical method developed and proposed by us. It was found that in the evolution of PA most proteolytic enzymes functionality is increasing both in the blood serum and in the fluid drained from the lodge. Were determined some parameters such as SN and MMM in blood serum and in the lodge, serving as markers of endogenous intoxication presence and toxicity of blood serum as a result of proteolytic processes developed within BPH and postoperatively. The results revealed the importance of the different sensitivity of the acidic proteases in BPH, which confirms that the use of lodge drainage opens new possibilities of alternative surgical and therapeutic tactics to optimize the hemostasis in the prostatic lodge

Особенности активности лизосомальных энзимов в сыворотке крови при аденоме простаты и их уровень в ложе после черезпузырной аденомэктомии при трансуретральном дренировании ложе

USMF Nicolae Testemiţanu, IMSP SCM Sfânta Treime, Conferinţa consacrată aniversării celor 40 de ani de la fondarea SCM Sfânta Treime 17 iunie 2016 Chișinău, Republica MoldovaThe mechanisms by which lysosomal disorders affecting prostate functions in prostate adenoma News. The mechanisms by which lysosomal disorders affecting prostate functions in prostate adenoma bulky (APV), including the Lodge of adenomectomy are poorly understood, and the effectiveness of current therapeutic measures are limited and uncertain. The research is based on two study groups: Lb – patients with a mean age of 68.6±1.05 and bulky AP definite diagnosis (≥ 80 cm3) repair surgery using drainage endouretralnye and Lm – 20 men of the same age, basically healthy. Lysosomal enzyme activity determination (Cat G rnd CatD; FA; NAG; β -gal, β-gul, and β-glucuronidase, arylsulfatase A and B, total protein was performed by standard techniques, adapted for application to multi-modal hybrid rider microplate Synergy H1 (Reader Hydride). As a result it was determined that AP ≥ 80 m3 bulky significantly induce the growth of all lysosomal enzymes studied, reaching values of 2-3 times higher compared with controls, with the prevalence of high values of 4-6 times, β –gal, ß-gluc and CatG fact catgut as coexistent inflammatory process caused by the presence of biological membranes and destabilization celulare. Sa direct interdependencies found the presence of liposomal enzymes in their blood serum and deletions to the lodge postoperative which can serve as a biomarker of evolution postoperative period, with predictive role in assessing the effectiveness of the treatment strategy and local general medical and surgical, monitoring and optimization of rehabilitation of patients with AP and adenomectomy.Механизмы расстройств лизосомальных энзимов, влияющие на функции простаты при аденоме предстательной железы (АПЖ), в том числе в ложе после аденомэктомии недостаточно изучены, а эффективность лечебных мероприятий ограничены и неопределенны. Исследование проводилось в двух группах: основная группа – 49 пациентов возрастом в среднем 68,6±1,05, оперированные по поводу АП с дренированием ложе [3], и контрольная – 20 мужчин того же возраста, в основном здоровые. Определение активности лизосомальных энзим (Cat G rnd CatD; FA; NAG; β -gal, β-gul, и β-glucuronidase, arylsulfatase A и B), общего белка проводили с помощью стандартных методов используя микропланшеты Synergy H1 (гидрид Reader). В результате было установлено, что при АПЖ происходит значительный рост всех лизосомальных энзимов, включенных в исследование, достигая цифры в 2-3 раза выше по сравнению с контрольной группой и в 4-6 раз значений β-галактозидазы (β-gal), бетаглюкозидазы (β-glu) и катепсина (Cat) G, обусловленные воспалительными существующими процессами приводящие к дестабилизации биологических клеточных мембран. Установлено наличие прямой зависимости между активностью лизосомных энзимов в сыворотке и послеоперационной ложе, что может служить биомаркером эволюции послеоперационного периода, с предсказательной ролью в оценке эффективности медицинской и хирургической тактики лечения, общего и локального мониторинга и оптимизации реабилитации больных с АПЖ до и после аденомэктомии

Prolonged light exposure induces widespread phase shifting in the circadian clock and visual pigment gene expression of the Arvicanthis ansorgei retina.

PURPOSE: Prolonged periods of constant lighting are known to perturb circadian clock function at the molecular, physiological, and behavioral levels. However, the effects of ambient lighting regimes on clock gene expression and clock outputs in retinal photoreceptors--rods, cones and intrinsically photosensitive retinal ganglion cells--are only poorly understood. METHODS: Cone-rich diurnal rodents (Muridae: Arvicanthis ansorgei) were maintained under and entrained to a 12 h:12 h light-dark cycle (LD; light: ~300 lux). Three groups were then examined: control (continued maintenance on LD); animals exposed to a 36 h dark period before sampling over an additional 24 h period of darkness (DD); and animals exposed to a 36 h light period before sampling over an additional 24 h period of light (~300 lux, LL). Animals were killed every 3 or 4 h over 24 h, their retinas dissected, and RNA extracted. Oligonucleotide primers were designed for the Arvicanthis clock genes Per1, Per2, Cry1, Cry2, and Bmal1, and for transcripts specific for rods (rhodopsin), cones (short- and mid-wavelength sensitive cone opsin, cone arrestin, arylalkylamine N-acetyltransferase) and intrinsically photosensitive retinal ganglion cells (melanopsin). Gene expression was analyzed by real-time PCR. RESULTS: In LD, expression of all genes except cone arrestin was rhythmic and coordinated, with acrophases of most genes at or shortly following the time of lights on (defined as zeitgeber time 0). Arylalkylamine N-acetyltransferase showed maximal expression at zeitgeber time 20. In DD conditions the respective profiles showed similar phase profiles, but were mostly attenuated in amplitude, or in the case of melanopsin, did not retain rhythmic expression. In LL, however, the expression profiles of all clock genes and most putative output genes were greatly altered, with either abolition of daily variation (mid-wavelength cone opsin) or peak expression shifted by 4-10 h. CONCLUSIONS: These data are the first to provide detailed measures of retinal clock gene and putative clock output gene expression in a diurnal mammal, and show the highly disruptive effects of inappropriate (nocturnal) lighting on circadian and photoreceptor gene regulationjournal articleresearch support, non-u.s. gov't20132013 05 21importe

The estimation of the peculiarities and the activity degree of the consisting inflammatory processes in the benign prostatic hyperplasia

Secţia Urologie, IMSP Spitalul Clinic Municipal “ Sf. Treime”, Catedra Morfopatologie, USMF „N. Testemiţanu”, Secţia Ştiinţifică Morfopatologie, IMSP Institutul de Cercetări Ştiinţifice în Domeniul Ocrotirii Sănătăţii Mamei şi Copilului, Catedra Urologie şi Nefrologie Chirurgicală, USMF „N. Testemiţanu”, Al V-lea Congres de Urologie, Dializă şi Transplant Renal din Republica Moldova cu participare internaţională (1-13 iunie 2011)Summary. The conducted study has the aim to estimate the histopathological peculiarities of the inflammatory processes, evaluated in prostatic nodular hyperplasia, the character and the activity of these processes in the area of nodular hyperplasia structures, and the border limit in the adenectomy. The results of the morphopathological study allowed detailed diagnosis of the prostatic hyperplasia. Severe modifications of inflammatory origin and considerable implications of the structural-architectonical components indicate concomitant persisting or coexisting of chronic or acute prostatitis. The establishment of the lesion character, activity degree of the inflammatory process, saving border limit in the surgical management regarding the residual cavity of cleavage and postoperative prognosis was the second aim of the study. It facilitates the choice of the best therapeutic and surgical approach. The character of the inflammatory processes coexisting with prostatic benign hyperplasia was evaluated. A clinical-morphological concept of inflammatory associations in prostate benign hyperplasia was formulated

Review of the techniques used in motor‐cognitive human‐robot skill transfer

Abstract A conventional robot programming method extensively limits the reusability of skills in the developmental aspect. Engineers programme a robot in a targeted manner for the realisation of predefined skills. The low reusability of general‐purpose robot skills is mainly reflected in inability in novel and complex scenarios. Skill transfer aims to transfer human skills to general‐purpose manipulators or mobile robots to replicate human‐like behaviours. Skill transfer methods that are commonly used at present, such as learning from demonstrated (LfD) or imitation learning, endow the robot with the expert's low‐level motor and high‐level decision‐making ability, so that skills can be reproduced and generalised according to perceived context. The improvement of robot cognition usually relates to an improvement in the autonomous high‐level decision‐making ability. Based on the idea of establishing a generic or specialised robot skill library, robots are expected to autonomously reason about the needs for using skills and plan compound movements according to sensory input. In recent years, in this area, many successful studies have demonstrated their effectiveness. Herein, a detailed review is provided on the transferring techniques of skills, applications, advancements, and limitations, especially in the LfD. Future research directions are also suggested