Efficacy of the intracorporeal one-hand tie technique for renal pedicle control during hand-assisted retroperitoneoscopic nephroureterectomy

AbstractObjectiveThis study examined the efficacy of the intracorporeal one-hand tie technique for renal pedicle control during hand-assisted retroperitoneoscopic nephroureterectomy (HARN).MethodsThe intracorporeal one-hand tie technique was conducted in 32 consecutive patients with upper tract urothelial cancer that underwent HARN and open bladder cuff excision.ResultsAll suture ligatures were successful in securing the renal vessels, except one minor venous bleeding that occurred during vessel transection, which was then controlled by additional clips. The process of controlling the renal pedicle took an average of 12.4 minutes (range, 8–30 minutes). No pedicle control related morbidities were noted. By sparing the usage of endovascular clips and staplers, operative costs were reduced and associated malfunctions eliminated.ConclusionThe intracorporeal one-hand tie technique is an easy, reliable, and cost-effective method in controlling the renal pedicle during HARN. Its efficacy in pedicle control is beyond doubt

Acquisition of skills in digital rectal examination through supervised patient examination with real-time feedback in transrectal sonography room

AbstractObjectiveTo assess the acquisition digital rectal examination (DRE) skills by medical students through an alternative teaching method.Materials and methodsMedical students at the National Cheng-Kung University Hospital, Tainan, Taiwan in 2009 were assigned to receive training through supervised rectal examination (DRE) with real-time feedback in a transrectal sonography room during their standard urologic rotation. Students completed a questionnaire (before and after the training) regarding their experiences in performing DRE to assess their confidence levels. Direct observation of practical skills (DOPS) was used to assess the students' competence in performing DRE at the end of urologic rotation.ResultsA total of 75 students received the questionnaire, of which 72 (96%) responded. On average, every student had an experience of 6.6 supervised patient examinations with real-time feedback in a transrectal sonography room. Following the training, students were more confident in their ability to give an opinion based on their findings related to DRE. The overall rate of the students' ability to interpret the DRE findings after urologic rotation improved from 69% to 100% for identification of the prostate, from 14% to 60% for assessment of prostate size, from 32% to 95% to describe prostate consistency accurately, and from 9.8% to 64% to identify overt prostate cancer from benign prostate hyperplasia. All students met expectations or were above expectations according to the grading scale of performing DOPS.ConclusionStudents' skills and confidence with regard to performing DRE were improved significantly through supervised examination with real-time feedback in a transrectal sonography room

Garlic Accelerates Red Blood Cell Turnover and Splenic Erythropoietic Gene Expression in Mice: Evidence for Erythropoietin-Independent Erythropoiesis

Garlic (Allium sativum) has been valued in many cultures both for its health effects and as a culinary flavor enhancer. Garlic's chemical complexity is widely thought to be the source of its many health benefits, which include, but are not limited to, anti-platelet, procirculatory, anti-inflammatory, anti-apoptotic, neuro-protective, and anti-cancer effects. While a growing body of scientific evidence strongly upholds the herb's broad and potent capacity to influence health, the common mechanisms underlying these diverse effects remain disjointed and relatively poorly understood. We adopted a phenotype-driven approach to investigate the effects of garlic in a mouse model. We examined RBC indices and morphologies, spleen histochemistry, RBC half-lives and gene expression profiles, followed up by qPCR and immunoblot validation. The RBCs of garlic-fed mice register shorter half-lives than the control. But they have normal blood chemistry and RBC indices. Their spleens manifest increased heme oxygenase 1, higher levels of iron and bilirubin, and presumably higher CO, a pleiotropic gasotransmitter. Heat shock genes and those critical for erythropoiesis are elevated in spleens but not in bone marrow. The garlic-fed mice have lower plasma erythropoietin than the controls, however. Chronic exposure to CO of mice on garlic-free diet was sufficient to cause increased RBC indices but again with a lower plasma erythropoietin level than air-treated controls. Furthermore, dietary garlic supplementation and CO treatment showed additive effects on reducing plasma erythropoietin levels in mice. Thus, garlic consumption not only causes increased energy demand from the faster RBC turnover but also increases the production of CO, which in turn stimulates splenic erythropoiesis by an erythropoietin-independent mechanism, thus completing the sequence of feedback regulation for RBC metabolism. Being a pleiotropic gasotransmitter, CO may be a second messenger for garlic's other physiological effects

Association analyses of East Asian individuals and trans-ancestry analyses with European individuals reveal new loci associated with cholesterol and triglyceride levels

Large-scale meta-analyses of genome-wide association studies (GWAS) have identified >175 loci associated with fasting cholesterol levels, including total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG). With differences in linkage disequilibrium (LD) structure and allele frequencies between ancestry groups, studies in additional large samples may detect new associations. We conducted staged GWAS meta-analyses in up to 69,414 East Asian individuals from 24 studies with participants from Japan, the Philippines, Korea, China, Singapore, and Taiwan. These meta-analyses identified (P < 5 × 10-8) three novel loci associated with HDL-C near CD163-APOBEC1 (P = 7.4 × 10-9), NCOA2 (P = 1.6 × 10-8), and NID2-PTGDR (P = 4.2 × 10-8), and one novel locus associated with TG near WDR11-FGFR2 (P = 2.7 × 10-10). Conditional analyses identified a second signal near CD163-APOBEC1. We then combined results from the East Asian meta-analysis with association results from up to 187,365 European individuals from the Global Lipids Genetics Consortium in a trans-ancestry meta-analysis. This analysis identified (log10Bayes Factor ≥6.1) eight additional novel lipid loci. Among the twelve total loci identified, the index variants at eight loci have demonstrated at least nominal significance with other metabolic traits in prior studies, and two loci exhibited coincident eQTLs (P < 1 × 10-5) in subcutaneous adipose tissue for BPTF and PDGFC. Taken together, these analyses identified multiple novel lipid loci, providing new potential therapeutic targets

Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: A comparative risk assessment

Background: High blood pressure, blood glucose, serum cholesterol, and BMI are risk factors for cardiovascular diseases and some of these factors also increase the risk of chronic kidney disease and diabetes. We estimated mortality from cardiovascular diseases, chronic kidney disease, and diabetes that was attributable to these four cardiometabolic risk factors for all countries and regions from 1980 to 2010. Methods: We used data for exposure to risk factors by country, age group, and sex from pooled analyses of population-based health surveys. We obtained relative risks for the effects of risk factors on cause-specific mortality from meta-analyses of large prospective studies. We calculated the population attributable fractions for each risk factor alone, and for the combination of all risk factors, accounting for multicausality and for mediation of the effects of BMI by the other three risks. We calculated attributable deaths by multiplying the cause-specific population attributable fractions by the number of disease-specific deaths. We obtained cause-specific mortality from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We propagated the uncertainties of all the inputs to the final estimates. Findings: In 2010, high blood pressure was the leading risk factor for deaths due to cardiovascular diseases, chronic kidney disease, and diabetes in every region, causing more than 40% of worldwide deaths from these diseases; high BMI and glucose were each responsible for about 15% of deaths, and high cholesterol for more than 10%. After accounting for multicausality, 63% (10·8 million deaths, 95% CI 10·1-11·5) of deaths from these diseases in 2010 were attributable to the combined effect of these four metabolic risk factors, compared with 67% (7·1 million deaths, 6·6-7·6) in 1980. The mortality burden of high BMI and glucose nearly doubled from 1980 to 2010. At the country level, age-standardised death rates from these diseases attributable to the combined effects of these four risk factors surpassed 925 deaths per 100 000 for men in Belarus, Kazakhstan, and Mongolia, but were less than 130 deaths per 100 000 for women and less than 200 for men in some high-income countries including Australia, Canada, France, Japan, the Netherlands, Singapore, South Korea, and Spain. Interpretation: The salient features of the cardiometabolic disease and risk factor epidemic at the beginning of the 21st century are high blood pressure and an increasing effect of obesity and diabetes. The mortality burden of cardiometabolic risk factors has shifted from high-income to low-income and middle-income countries. Lowering cardiometabolic risks through dietary, behavioural, and pharmacological interventions should be a part of the global response to non-communicable diseases. Funding: UK Medical Research Council, US National Institutes of Health. © 2014 Elsevier Ltd

Efficient &lt;em&gt;k&lt;/em&gt;-Winner-Take-All Competitive Learning Hardware Architecture for On-Chip Learning

A novel &lt;em&gt;k&lt;/em&gt;-winners-take-all (&lt;em&gt;k&lt;/em&gt;-WTA) competitive learning (CL) hardware architecture is presented for on-chip learning in this paper. The architecture is based on an efficient pipeline allowing &lt;em&gt;k&lt;/em&gt;-WTA competition processes associated with different training vectors to be performed concurrently. The pipeline architecture employs a novel codeword swapping scheme so that neurons failing the competition for a training vector are immediately available for the competitions for the subsequent training vectors. The architecture is implemented by the field programmable gate array (FPGA). It is used as a hardware accelerator in a system on programmable chip (SOPC) for realtime on-chip learning. Experimental results show that the SOPC has significantly lower training time than that of other &lt;em&gt;k&lt;/em&gt;-WTA CL counterparts operating with or without hardware support