Percutaneous Nephrolithotomy in a Patient with Mainz Pouch II Urinary Diversion: A Case Report

Abstract: Mainz pouch II is a reliable and viable technique of continent urinary diversion. Patients are at increased risk of long-term complications including urolithiasis of the upper urinary tract and reservoir. We report the case of a 67-year-old male with prior Mainz pouch II due to invasive bladder cancer treated for a large renal calculus. Percutaneous nephrolithotomy (PCNL) was successfully performed. Stone management in these type of patients is of increased interest due to existed "anatomical challenges" concerning the access and safety during the procedure. To our knowledge this is the first case of PCNL in a patient with Mainz pouch II that has been reported in the literature

Evaluation of platelet-rich plasma therapy in erectile dysfunction

Background: Animal studies postulate that platelet-rich plasma (PRP) injections improve key elements of the pathophysiologic mechanisms leading to erectile dysfunction (ED). Aim: To conduct the first double-blind, randomized, placebo-controlled trial assessing the efficacy and safety of PRP injections in patients with mild and moderate ED. Methods: Sixty sexually active patients with mild and moderate ED were randomly assigned to two sessions, with a one-month difference, of 10 mL PRP (n = 30) or placebo (n = 30) intracavernosal injections. An FDA-approved separation system was used. Patients were evaluated at 1, 3 and 6 months after completion of the treatment protocol. A per-protocol analysis was applied. All participants withheld any ED treatment during the trial. Outcomes: The achievement of minimal clinically important difference (MCID) in the International Index of Erectile Function -Erectile Domain (IIEF-EF) from baseline to 6 months after final treatment. Erectile function at all time points, as well as safety of PRP injections, were also evaluated. Results: At 6 months, a MCID was achieved by 20/29 (69%) patients in the PRP group compared to 7/26 (27%) in the placebo group. The risk difference between the two groups was 42% (95%CI: 18-66), P < 0.001 and the baseline-adjusted mean between-group-difference in the IIEF-EF score was 3.9 points (95%CI: 1.8-5.9). Similarly, a statistically significant difference of both the number of participants attaining a MCID and the IIEF-EF score was also observed at the 1- and 3-month evaluation between the two groups. Accordingly, patients receiving PRP were more satisfied with the treatment. No adverse events were observed during the study period. Clinical implications: Intracavernosal PRP injection therapy used as outlined in this trial appears to be a safe and effective short-term treatment for the management of mild to moderate ED. Strengths & Limitations: We conducted the first clinical trial exploring the role of PRP in the management of ED. Conversely, our findings lack external validity due to single-center design. Furthermore, our results cannot be extrapolated to other PRP separation systems. Conclusions: PRP intracavernosal injections may be a promising addition to the urologist’s armamentarium for the management of ED. Still, further high-quality studies are warranted to corroborate our findings.Υπόβαθρο: Μελέτες σε ζώα υποστηρίζουν ότι οι ενέσεις πλάσματος πλούσιου σε αιμοπετάλια (PRP) βελτιώνουν βασικά στοιχεία των παθοφυσιολογικών μηχανισμών που οδηγούν σε στυτική δυσλειτουργία (ΣΔ). Σκοπός: Η διεξαγωγή της πρώτης διπλής-τυφλής, τυχαιοποιημένης, ελεγχόμενης με εικονικό φάρμακο μελέτης για την αξιολόγηση της αποτελεσματικότητας και της ασφάλειας των ενέσεων PRP σε ασθενείς με ήπια και μέτρια ΣΔ. Μέθοδοι: Εξήντα σεξουαλικά ενεργοί ασθενείς με ήπια και μέτρια ΣΔ κατανεμήθηκαν τυχαία σε δύο συνεδρίες, με διαφορά ενός μήνα, 10 mL PRP (n = 30) ή εικονικού φαρμάκου (n = 30) ενδοσηραγγωδών ενέσεων. Χρησιμοποιήθηκε ένα εγκεκριμένο από τον FDA σύστημα διαχωρισμού. Οι ασθενείς αξιολογήθηκαν στους 1, 3 και 6 μήνες μετά την ολοκλήρωση του πρωτοκόλλου θεραπείας. Όλοι οι συμμετέχοντες σταμάτησαν οποιαδήποτε θεραπεία για ΣΔ κατά τη διάρκεια της μελέτης. Αποτελέσματα: Η επίτευξη ελάχιστης κλινικά σημαντικής διαφοράς (MCID) στον Διεθνή Δείκτη Στυτικής Λειτουργίας -Τομέας Στύσης (IIEF-EF) από την έναρξη έως τους 6 μήνες μετά την τελική θεραπεία. Αξιολογήθηκε επίσης η στυτική λειτουργία σε όλα τα χρονικά σημεία, καθώς και η ασφάλεια των ενέσεων PRP. Αποτελέσματα: Στους 6 μήνες, επιτεύχθηκε MCID από 20/29 (69%) ασθενείς στην ομάδα PRP σε σύγκριση με 7/26 (27%) στην ομάδα του εικονικού φαρμάκου. Η διαφορά κινδύνου μεταξύ των δύο ομάδων ήταν 42% (95%CI: 18-66), P < 0,001 και η προσαρμοσμένη στην αρχική τιμή μέση διαφορά μεταξύ των ομάδων στη βαθμολογία IIEF-EF ήταν 3,9 μονάδες (95%CI: 1,8- 5.9). Ομοίως, μια στατιστικά σημαντική διαφορά τόσο του αριθμού των συμμετεχόντων που πέτυχαν MCID όσο και του IIEF-EF, παρατηρήθηκε επίσης στην αξιολόγηση 1 και 3 μηνών μεταξύ των δύο ομάδων. Αντίστοιχα, οι ασθενείς που έλαβαν PRP ήταν πιο ικανοποιημένοι με τη θεραπεία. Δεν παρατηρήθηκαν ανεπιθύμητες ενέργειες κατά την περίοδο της μελέτης. Κλινικές εφαρμογές: Η θεραπεία με ενδοσηραγγώδη ένεση PRP που χρησιμοποιείται όπως περιγράφεται σε αυτή τη μελέτη φαίνεται να είναι μια ασφαλής και αποτελεσματική βραχυπρόθεσμη θεραπεία για τη διαχείριση της ήπιας έως μέτριας στυτικής δυσλειτουργίας. Πλεονεκτήματα & Περιορισμοί: Πραγματοποιήσαμε την πρώτη κλινική δοκιμή που διερευνά τον ρόλο του PRP στη διαχείριση της ΣΔ. Αντίθετα, τα ευρήματά μας στερούνται εξωτερικής εγκυρότητας λόγω του ότι έγινε σε ένα κέντρο. Επιπλέον, τα αποτελέσματά μας δεν μπορούν να επεκταθούν σε άλλα συστήματα διαχωρισμού PRP. Συμπεράσματα: Οι ενδοσηραγγώδεις ενέσεις PRP μπορεί να είναι μια πολλά υποσχόμενη προσθήκη στο οπλοστάσιο του ουρολόγου για τη διαχείριση της ΣΔ. Ωστόσο, απαιτούνται περαιτέρω μελέτες υψηλής ποιότητας για να επιβεβαιώσουν τα ευρήματά μας

Study of the Hypergeometric Equation via Data Driven Koopman-EDMD Theory

We consider a data-driven method, which combines Koopman operator theory with Extended Dynamic Mode Decomposition. We apply this method to the hypergeometric equation which is the Fuchsian equation with three regular singular points. The space of solutions at any of its singular points is a two-dimensional linear vector space on the field of reals when the independent variable is restricted to take values in the real axis and the unknown function is restricted to be a real-valued function of a real variable. A basis of the linear vector space of solutions is spanned by the hypergeometric function and its products with appropriate powers of the independent variable or the logarithmic function depending on the roots of the indicial equation of the hypergeometric equation. With our work, we obtain a new representation of the fundamental solutions of the hypergeometric equation and relate them to the spectral analysis of the finite approximation of the Koopman operator associated with the hypergeometric equation. We expect that the usefulness of our results will come more to the fore when we extend our study into the complex domain

Percutaneous Nephrolithotomy in a Patient with Mainz Pouch II Urinary Diversion: A Case Report

Mainz pouch II is a reliable and viable technique of continent urinary diversion. Patients are at increased risk of long-term complications including urolithiasis of the upper urinary tract and reservoir. We report the case of a 67-year-old male with prior Mainz pouch II due to invasive bladder cancer treated for a large renal calculus. Percutaneous nephrolithotomy (PCNL) was successfully performed. Stone management in these type of patients is of increased interest due to existed “anatomical challenges” concerning the access and safety during the procedure. To our knowledge this is the first case of PCNL in a patient with Mainz pouch II that has been reported in the literature

Drivers’ Reaction Time and Mental Workload: A Driving Simulation Study

Drivers play a significant role in causing serious accidents, which underscores the need for further investigating the human element in order to improve road safety. Given the predominance of the information processing approach in driver’s behavior research field, an important psychological construct, Mental Workload (MWL), has been introduced to study the behavior of drivers. The objective of this paper is to investigate the impact of increased MWL on driver behavior and specifically the changes in driver’s Reaction Time (RT) under increased MWL. The experiment conducted in the driving simulator of the Hellenic Institute of Transport which is part of the Centre for Research and Technology Hellas, with the participation of 56 subjects from all age groups. For the simulation of the increased MWL conditions during driving, a secondary task was employed. To this end, the MIT AgeLab Delayed Digit Recall Task in the 1-back version was adapted for the needs of the present research. The driving scenario included 4 unexpected events, which further increase driver’s MWL. Driving performance was observed and relative parameters were measured as RT on the unexpected events, accidents occurred, and maneuvers performed. Appropriate statistical analysis was performed to examine the difference in the drivers’ RT in the unexpected events. Results demonstrated that higher MWL increased drivers’ RT in the majority of the participants. Furthermore, results also indicated a number of participants that probably employed adaptive control behaviors to counterbalance the increased MWL. Overall, variance on MWL proved to play an important role on driver performance, and thus further research on its consequences on driving performance, and the factors that influence its variance during driving, is imperative

Supplementary Figure 3 from Phase II window study of olaparib alone or with cisplatin or durvalumab in operable Head and Neck Cancer

Supplementary Figure 3. A. No significant differences in stromal TILs were found between pre- and post-treatment samples in all arms. In Arm D TILs were increased post-treatment in most of the samples (5 out of 7). Figures B and C show representative images of TILs in pre- and post-treatment samples respectively from one patient in Arm D, measured by QuPath v0.3.0. Figures show tissues before (left) and after (right) QuPath annotations. Color legend; red, tumor cells; purple, lymphocytes; green, fibroblasts; yellow, other; Cisplatin-Olaparib, C-O; Olaparib, O; Durvalumab-Olaparib, D-O</p

Supplementary Figure 4 from Phase II window study of olaparib alone or with cisplatin or durvalumab in operable Head and Neck Cancer

Supplementary Figure 4. Relative fold change (2-ΔΔCq) of PD-L1 in respect to Β2Μ (reference gene) in the CTC fraction for individual samples of HNSCC patients before (blue) and after (orange) therapy.</p

Supplementary Figure 6 from Phase II window study of olaparib alone or with cisplatin or durvalumab in operable Head and Neck Cancer

Supplementary Figure 6. Posttreatment CD163 (by QIF) increase in three patients with concurrent increase in the CD163 transcripts. Representative images from a patient’s tumor tissue sample showing pre and post treatment (Durvalumab-Olaparib Arm) CD163 expression. Nuclei (blue), Cytokeratin (green), CD163 (yellow) and CSF1R (red).</p

Supplementary Table 4 from Phase II window study of olaparib alone or with cisplatin or durvalumab in operable Head and Neck Cancer

Table 4a. Fold-change values for each signature between Response and No Response based on physical examination, pathology or imaging Table 4b. Fold-change values for significantly differentially expressed genes between Response and No Response based on physical examination, pathology or imaging</p

Supplementary Materials and Methods from Phase II window study of olaparib alone or with cisplatin or durvalumab in operable Head and Neck Cancer

The details for the assays and image analysis are summarized in the Supplementary Materials and Methods.</p