Minimal invasive treatment of urethral strictures: An experimental study of the effect of Paclitaxel coated balloons in the wall of strictured rabbit’s urethra

Purpose: The aim of this study is the evaluation of the distribution of Paclitaxel (PTX) released by a coated balloon in the layers of rabbit’s urethra. Methods: 18 rabbits were included. A Laser Device was used for the stricture formation. After two weeks, dilation of the strictured urethra was performed by using Advance 35LP PTA balloons and Advance 18 PTX PTA balloons. The experimental models were divided into 3 groups. The group Α included two rabbits without any intervention except for the stenosis procedure. Group B compromised six rabbits that underwent dilation with Advance 35LP PTA balloons. Group C consisted of 10 rabbits to which dilation with both Advance 35LP PTA balloons and Advance 18 PTX PTA balloons was applied. Histological evaluation and Immunohistochemistry were performed on all specimens. Results: Inflammation, fibrosis and ruptures were detected in the specimens of the study. In specimens of Group C the decrease of inflammation and fibrosis rate was greater. Anti-PTX antibody was detected in the epithelium, lamina propria and smooth muscle layer of all specimens of urethras that have been harvested immediately and 1 day after the dilation with Advance 18 PTX PTA balloon and it was not observed in any layer of the urethral wall of the rest of the examined specimens of Group C. Conclusions: PTX’s enrichment was detected in the smooth muscle layer of all specimens that have been harvested immediately and 24h after the dilation with Advance 18 PTX PTA balloons. PTX may play an inhibitive role in the recurrence of the stenosis

Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action

Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or “golden rules,” for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Comparison between 18Fr nephroscope (22Fr access), 7,5Fr nephroscope (12Fr access) and 26Fr nephroscope (30Fr access) regarding renal parenchyma trauma during percutaneous nephrolithotomy

This study has a clinical and an experimental part. The purpose of the experimental part was to evaluate whether reducing tract dilation diameter in PCNL procedures results in minimizing of renal trauma of the percutaneous tract. To achieve that, a percutaneous renal access tract was established bilaterally to eleven pigs. Two pigs were euthanized immediately after the experiment, while nine pigs were sacrificed one month later. The percutaneous accesses were dilated up to 30Fr, 22Fr or 12Fr. The animals underwent a contrast-enhanced computer tomography immediately after the procedure and 30 days later. DMSA-scintigraphy with SPECT-CT was also performed. The kidneys of all animals were harvested for histological evaluation. The volume of scar tissue and the percentage of renal volume replaced by scar tissue were calculated. Results from the immediate post-procedural CT-scans revealed a significant difference in defect diameter among the three modalities. However, the scar volume calculated on CT-images and histopathology showed a significant difference only when 30Fr dilation was compared to 12Fr dilation. The percentage of scar volume was negligible in all cases, but there was still a statistical difference between 30Fr and 12Fr dilation. Dilation up to 22Fr revealed no statistical differences compared to the other two modalities. DMSA-scintigraphy showed no scar tissue in any case. In conclusion, dilation up to 30Fr may cause a significantly larger scar tissue on renal parenchyma compared to 12Fr dilation as it was shown on CT-images and microscopic evaluation, but based on the DMSA/SPECT-CT this difference seems to be insignificant to the renal function. The scar tissue caused by 22Fr dilation seemed to have no significant difference from the other modalities. The purpose of the clinical part was to compare the safety and efficacy among standard, mini and ultra-mini PCNL (s-PCNL, m-PCNL, um-PCNL). To achieve that, we performed a prospective, non-randomized trial between January 2018 and July 2020. Patients with stones classified as Guy’s stone score grade I were included. The set-up for s-PCNL and m-PCNL included a 30Fr and 22Fr percutaneous tract, respectively. In both set-ups, an ultrasonic/ballistic lithotripter was utilized. In the case of um-PCNL, a 12Fr percutaneous tract was established. A high-power laser was used for lithotripsy. Hemoglobin drop, complication rate, length of hospital stay(LOS), stone-free rate(SFR) and operation time were evaluated. A total of 84 patients, 28 patients per method, were evaluated. Hemoglobin drop was higher in the s-PCNL group when compared to m-PCNL(p=0.008) and um-PCNL groups(p<0.001), while um-PCNL group had the slightest hemoglobin drop. LOS was similar between s-PCNL group and m-PCNL group, but um-PCNL group required shorter hospital stay than the other two modalities(p<0.001). The complication and transfusion rates as well as SFR did not differ between groups. Operation time in the um-PCNL set-up was longer compared to s-PCNL(p<0.001) and m-PCNL(p=0.011), whereas s-PCNL and m-PCNL did not differ significantly. To conclude, m-PCNL showed less hemoglobin drop, but similar operation time and SFR when compared to s-PCNL. um-PCNL showed even less hemoglobin drop, but the operation time was longer compared to the two other modalities.Η παρούσα μελέτη έχει ένα κλινικό και ένα πειραματικό μέρος. Ο σκοπός του πειραματικού μέρους ήταν να αξιολογηθεί εάν η μείωση της διαμέτρου της διαστολής στις επεμβάσεις PCNL οδηγεί σε μικρότερο νεφρικό τραύμα. Για να επιτευχθεί αυτό, πραγματοποιήσαμε διαδερμική νεφρική πρόσβαση σε έντεκα χοίρους. Δύο χοίροι θανατώθηκαν αμέσως μετά το πείραμα, ενώ εννέα χοίροι θανατώθηκαν ένα μήνα αργότερα. Οι διαδερμικές προσβάσεις είχαν διαστολή 30Fr, 22Fr ή 12Fr. Τα ζώα υποβλήθηκαν σε τομογραφία υπολογιστή με σκιαγραφικό αμέσως μετά τη διαδικασία και 30 ημέρες αργότερα. Πραγματοποιήθηκε επίσης σπινθηρογράφημα DMSA με SPECT-CT. Οι νεφροί όλων των ζώων συλλέχθηκαν για ιστολογική αξιολόγηση. Υπολογίστηκε ο όγκος του ουλώδους ιστού και το ποσοστό του νεφρικού όγκου που αντικαταστάθηκε από ουλώδη ιστό. Τα αποτελέσματα από τις άμεσες μετεγχειρητικές αξονικές τομογραφίες αποκάλυψαν σημαντική διαφορά στη διάμετρο του ελαττώματος μεταξύ των τριών μεθόδων. Ωστόσο, ο όγκος της ουλής που υπολογίστηκε στις εικόνες CT και στην ιστοπαθολογία έδειξε σημαντική διαφορά μόνο όταν η διαστολή 30Fr συγκρίθηκε με τη διαστολή 12Fr. Το ποσοστό του όγκου της ουλής ήταν αμελητέο σε όλες τις περιπτώσεις, αλλά υπήρχε πάλι στατιστική διαφορά μεταξύ της διαστολής 30Fr και 12Fr. Η διαστολή 22 Fr δεν είχε στατιστικές διαφορές σε σύγκριση με τις άλλες δύο μεθόδους. Το σπινθηρογράφημα DMSA δεν έδειξε σε καμία περίπτωση ουλώδη ιστό. Συμπερασματικά, η διαστολή 30Fr μπορεί να προκαλέσει σημαντικά μεγαλύτερο ουλώδη ιστό στο νεφρικό παρέγχυμα σε σύγκριση με τη διαστολή 12Fr όπως φάνηκε στη CT και τη μικροσκοπική εξέταση, αλλά με βάση το DMSA/SPECT-CT αυτή η διαφορά φαίνεται να είναι ασήμαντη για νεφρική λειτουργία. Ο ουλώδης ιστός που προκλήθηκε από τη διαστολή 22Fr φάνηκε να μην έχει σημαντική διαφορά από τις δύο άλλες προσβάσεις. Ο σκοπός του κλινικού μέρους ήταν η σύγκριση της ασφάλειας και της αποτελεσματικότητας μεταξύ standard, mini και ultra-mini PCNL (s-PCNL, m-PCNL, um-PCNL). Για να το επιτύχουμε αυτό, πραγματοποιήσαμε μια προοπτική, μη τυχαιοποιημένη μελέτη μεταξύ Ιανουαρίου 2018 και Ιουλίου 2020. Συμπεριλήφθηκαν ασθενείς με πέτρες που ταξινομήθηκαν με το σύστημα Guy's ως βαθμός Ι. Οι s-PCNL και m-PCNL είχαν διαστολή 30Fr και 22Fr, αντίστοιχα. Και στις δύο, χρησιμοποιήθηκε υπερηχητικός/βαλλιστικός λιθοτριπτής. Στην περίπτωση της um-PCNL, η διαστολή ήταν 12Fr. Για τη λιθοτριψία χρησιμοποιήθηκε λέιζερ υψηλής ισχύος. Η πτώση της αιμοσφαιρίνης, το ποσοστό επιπλοκών, η διάρκεια παραμονής στο νοσοκομείο (LOS), το stone-free rate (SFR) και ο χρόνος χειρουργείου αξιολογήθηκαν. Συνολικά συμμετείχαν 84 ασθενείς, 28 ασθενείς ανά ομάδα. Η πτώση της αιμοσφαιρίνης ήταν υψηλότερη στην ομάδα s-PCNL σε σύγκριση με τις ομάδες m-PCNL(p=0,008) και um-PCNL (p<0,001), ενώ η ομάδα um-PCNL είχε τη μικρότερη πτώση. Η LOS ήταν παρόμοια μεταξύ s-PCNL και m-PCNL, ενώ η um-PCNL είχε τη μικρότερη παραμονή στο νοσοκομείο (p<0,001). Τα ποσοστά επιπλοκών και μετάγγισης καθώς και το SFR δεν διέφεραν μεταξύ των ομάδων. Ο χρόνος χειρουργείου στην um-PCNL ήταν μεγαλύτερος σε σύγκριση με τις s-PCNL(p<0,001) και m-PCNL(p=0,011), ενώ οι s-PCNL και m-PCNL δεν διέφεραν σημαντικά. Συμπερασματικά, η m-PCNL έδειξε λιγότερη πτώση αιμοσφαιρίνης, αλλά παρόμοιο χρόνο λειτουργίας και SFR σε σύγκριση με το s-PCNL. Η um-PCNL έδειξε ακόμη λιγότερη πτώση αιμοσφαιρίνης, αλλά ο χρόνος επέμβασης ήταν μεγαλύτερος σε σύγκριση με τις δύο άλλες μεθόδους

Bio-hydrometallurgy dynamics of copper sulfide-minerals probed by micro-FTIR mapping and Raman microspectroscopy

We report the μm-FTIR mapping and Raman microspectroscopic detection of bornite [Cu5FeS4]-, chalcocite [Cu2S]-, and covelitte [CuS]- bacterial interactions by a consortium of microorganisms consisted of Acidithiobacillus ferrooxidans, Acidithiobacillus thiooxidans, Acidithiobacillus caldus, Leptospirillum ferriphilum, Leptospirillum ferroodiazotrophum and Sulfobacillus thermosulfidooxidans. The absorption signals of amide I, K+-jarosite [KFe3(SO4)2(OH)6] and of the produced extracellular polymeric substances (EPS) from the mixed culture as a function of position on the surfaces of the bioleached bornite, chalcocite and covellite demonstrated their heterogeneity within the surface of the minerals. This reveals the high level of biofilm, EPS, and jarosite biosynthesis on the surface of the minerals and might explain why they associate. To our knowledge this is the first combined application of μm-FTIR mapping and Raman microspectroscopy for the bioleaching behaviour of bornite, chalcocite and covellite and the comparison with other bioleached systems such as chalcopyrite [CuFeS2] provides valuable information on the whole bio-hydrometallurgy Cu/Fe/S system. Both techniques provide spectrally rich, label-free, nondestructive visualizations of the bio-hydrometallurgy dynamics of copper sulfide minerals for processing and storage of large spectral data sets which are valuable for evaluation of copper containing minerals

Probing the whole ore chalcopyrite–bacteria interactions and jarosite biosynthesis by Raman and FTIR microspectroscopies

The whole ore chalcopyrite–bacteria interaction and the formation of the extracellular polymeric substances (EPS) during the bioleaching process by microorganisms found in the mine of Hellenic Copper Mines in Cyprus were investigated. Raman and FTIR microspectroscopies have been applied towards establishing a direct method for monitoring the formation of secondary minerals and the newly found vibrational marker bands were used to monitor the time evolution of the formation of covellite, and the K+ and NH4+-jarosites from the chalcopyrite surfaces. The Raman data indicate that the formation of K+-jarosite is followed by the formation of NH4+-jarosite. The variation in color in the FTIR imaging data and the observation of the amide I vibration at 1637 cm−1 indicate that the microorganisms are attached on the mineral surface and the changes in the frequency/intensity of the biofilm marker bands in the 900–1140 cm−1 frequency range with time demonstrate the existence of biofilm conformations

Bacterial colonization on the surface of copper sulfide minerals probed by fourier transform infrared micro-spectroscopy

Biofilm formation is a molecular assembly process occurring at interfaces, such as in bioleaching processes. The real time monitoring of the marker bands of amide I/amide II by FTIR microspectroscopy during Acidithiobacillus ferrooxidans colonization on chalcopyrite surfaces revealed the central role of lipids, proteins and nucleic acids in bacterial cell attachment to copper sulfide surfaces. The Raman and FTIR spectra of the interactions of Acidithiobacillus ferrooxidans with bornite are also reported

The use of S-curved coaxial dilator for urethral dilatation: Experience of a tertiary department

Objective: Urethral strictures can be treated by urethral dilation, optical internal urethrotomy, or open surgical reconstruction (urethroplasty). Urethral dilation is done with filiforms and followers, balloons, or coaxial dilators inserted over a guidewire. The S-curved coaxial dilator (SCCD) was designed to facilitate the passage of the dilator through the stricture and the urethra because it imitates the curved anatomy of the male urethra. This study presents our experience with SCCD. Materials and Methods: We used this kind of dilation in 310 patients. The technique included the insertion of a hydrophilic floppy-tipped guidewire through the urethra directly into the bladder under fluoroscopic control. The SCCDs were then inserted over the guidewire. Dilators of gradually increased size from 8F to 20F were used. The follow-up of the patients includes uroflowmetry and measurement of postvoid residual at 4 weeks, 6 months, or in the case of a recurrence of symptoms. Results: The age of the patients were 69.08 ± 15.77 years. The causes of urethral stricture were iatrogenic (n = 114), traumatic (n = 35), infectious (n = 22), and of unknown origin (n = 139). The stricture length was 1.62 ± 0.85 cm. The mean number of dilations needed per case was 2 (range: 1–15), and the time between the dilations was 212.19 ± 253.9 days. We had seven failures. Conclusion: We propose the S-curved coaxial dilators for urethral dilation as a safe and effective technique because of their similarity to the shape of the male urethra and because of their hydrophilic coating

Systematic review and meta-analysis comparing percutaneous nephrolithotomy, retrograde intrarenal surgery and shock wave lithotripsy for lower pole renal stones less than 2 cm in maximum diameter

Purpose: The aim of the current systematic review and meta-analysis is to provide an answer on which is the most appropriate approach for the management of the lower pole stones with a maximal dimension of 2 cm or less. Materials and Methods: A systematic review was conducted on PubMed (R), SCOPUS (R), Cochrane and EMBASE (R). The PRISMA guidelines and the recommendations of the EAU Guidelines office were followed. Retrograde intrarenal surgery, shock wave lithotripsy and percutaneous nephrolithotomy were considered for comparison. The primary end point was the stone-free rate. Results: A total of 15 randomized controlled trials were eligible. Percutaneous nephrolithotripsy and retrograde intrarenal surgery have higher stone-free rates in comparison to shock wave lithotripsy and require fewer re-treatment sessions. Operative time and complications seem to favor shock wave lithotripsy in comparison to percutaneous nephrolithotripsy, but this takes place at the expense of multiple shock wave lithotripsy sessions. Retrograde intrarenal surgery seems to be the most efficient approach for the management of stones up to 1 cm in the lower pole. Conclusions: The pooled analysis of the eligible studies showed that the management of lower pole stones should probably be percutaneous nephrolithotripsy or retrograde intrarenal surgery to achieve stone-free status over a short period and minimal number of sessions. For stones smaller than 10 mm, retrograde intrarenal surgery is more efficient in comparison to shock wave lithotripsy. The decision between the 2 approaches (percutaneous nephrolithotripsy or retrograde intrarenal surgery) should be individual, based on the anatomical parameters, the comorbidity and the preferences of each patient

Non-papillary percutaneous nephrolithotomy for treatment of staghorn stones

BACKGROUND: To evaluate the non-papillary puncture for Percutaneous Nephrolithotomy (PCNL) for the treatment of staghorn stones in terms of safety and efficacy.METHODS: Data of 53 patients undergoing PCNL for staghorn stones were retrospectively collected from January 2015 to December 2019. A non-papillary puncture was performed with a two- step track dilation technique up to 30Fr. A 26 Fr semirigid nephroscope and an ultrasonic lithotripter with integrated suction (Swiss Lithoclast master, EMS S.A, Switzerland) were used for the treatment. Demographics and perioperative data were retrospectively gathered from an institutional board approved database.RESULTS: The average stone size was 60.1±16.1 mm. Mean operative time was 54.57±14.83 minutes, while mean time using fluoroscopy was 2.67±1.02 minutes. Mean number of accesses was 1.2 (a total of 64 accesses). Flexible nephroscope was never used. Primary stone-free rate after PCNL was 81.1% (43 patients). Mean hemoglobin drop was 1.6±1.86 gr/dl. Overall patient stay was 3.94±0.82 days, while overall complication rate was 20.7% (11 patients), with only one patient requiring blood transfusion due to pseudoaneurysm.CONCLUSIONS: The use of non-papillary access for PCNL in the treatment of staghorn stones resulted in promising results in terms of stone-free rate, operating time, complication rate, hemoglobin drop and reduced the number of percutaneous tracts. These parameters of the current investigation were directly comparable to current literature. The safety and efficacy of a non-papillary approach for the treatment of staghorn stones could be advocated