Management of erectile dysfunction post-radical prostatectomy

© 2015 Saleh et al.Radical prostatectomy is a commonly performed procedure for the treatment of localized prostate cancer. One of the long-term complications is erectile dysfunction. There is little consensus on the optimal management; however, it is agreed that treatment must be prompt to prevent fibrosis and increase oxygenation of penile tissue. It is vital that patient expectations are discussed, a realistic time frame of treatment provided, and treatment started as close to the prostatectomy as possible. Current treatment regimens rely on phosphodiesterase 5 inhibitors as a first-line therapy, with vacuum erection devices and intraurethral suppositories of alprostadil as possible treatment combination options. With nonresponders to these therapies, intracavernosal injections are resorted to. As a final measure, patients undergo the highly invasive penile prosthesis implantation. There is no uniform, objective treatment program for erectile dysfunction post-radical prostatectomy. Management plans are based on poorly conducted and often underpowered studies in combination with physician and patient preferences. They involve the aforementioned drugs and treatment methods in different sequences and doses. Prospective treatments include dietary supplements and gene therapy, which have shown promise with there proposed mechanisms of improving erectile function but are yet to be applied successfully in human patients

High Performance Photocatalytic Activity of Mg2+ Doped Hexagonal ZnO Nanoparticles in the Methylene Blue Degradation under UV Irradiation.

Mg2+ doped hexagonal ZnO nanoparticles with different Mg2+contents (0%, 1%, 2%, 3%,4%, 5%, 10%, 15%, 20% and 25%) were prepared from oxalate precursors synthesized by direct reaction in the solid state between oxalic acid dihydrate (H2C2O4.2H2O), nitrate salts of zinc (Zn(NO3)2.6H2O) and magnesium (Mg(NO3)2.6H2O) at 150 °C. The resulting precursors were subsequently calcined at 500 °C to produce the corresponding oxides. In addition, the oxalates of the single metals were also prepared by heating at 180 °C to dehydrate the complexes, before using TGA thermal gravimetric analysis to determine the temperature range of the decomposition. The obtained oxides were characterized using X-ray Diffraction (XRD), Brunauer–Emmett–Teller technique (BET), transmission electron microscopy (TEM) and  tested as photocatalysts in the degradation of methylene blue (MB) under UV irradiation. The results show a segregation of phases starting at an Mg2+ content of 10%. The crystallites’ sizes, calculated using Scherer formula from the XRD data, are in the nanoscale for all the samples (19.8 to 29.8 nm), in good agreement with the particle size observed in TEM (20 to 50 nm). However, larger particles sizes were obtained from BET, ranging from 70 to 123 nm, due the agglomerated state of the powder. On the other hand, the highest efficiency as a photocatalyst in the photodegradtion of MB was observed for samples 7 and 8 corresponding to 10% and 15% in Mg2+ content respectively. The reaction rates were found to be 0.57min-1 for undoped ZnO and 1.17 min-1 for samples 7 and 8. In this range, the substituted compounds are twice more efficient than the undoped ZnO

A Prospective Evaluation of Opioid Utilization After Upper-Extremity Surgical Procedures: Identifying Consumption Patterns and Determining Prescribing Guidelines.

BACKGROUND: Although adequate management of postoperative pain with oral analgesics is an important aspect of surgical procedures, inadvertent overprescribing can lead to excess availability of opioids in the community for potential diversion. The purpose of our study was to prospectively evaluate opioid consumption following outpatient upper-extremity surgical procedures to determine opioid utilization patterns and to develop prescribing guidelines. METHODS: All patients undergoing outpatient upper-extremity surgical procedures over a consecutive 6-month period had the following prospective data collected: patient demographic characteristics, surgical details, anesthesia type, and opioid prescription and consumption patterns. Analysis of variance and post hoc comparisons were performed using t tests, with the p value for multiple pairwise tests adjusted by the Bonferroni correction. RESULTS: A total of 1,416 patients with a mean age of 56 years (range, 18 to 93 years) were included in the study. Surgeons prescribed a mean total of 24 pills, and patients reported consuming a mean total of 8.1 pills, resulting in a utilization rate of 34%. Patients undergoing soft-tissue procedures reported requiring fewer opioids (5.1 pills for 2.2 days) compared with fracture surgical procedures (13.0 pills for 4.5 days) or joint procedures (14.5 pills for 5.0 days) (p \u3c 0.001). Patients who underwent wrist surgical procedures required a mean number of 7.5 pills for 3.1 days and those who underwent hand surgical procedures required a mean number of 7.7 pills for 2.9 days, compared with patients who underwent forearm or elbow surgical procedures (11.1 pills) and those who underwent upper arm or shoulder surgical procedures (22.0 pills) (p \u3c 0.01). Procedure type, anatomic location, anesthesia type, age, and type of insurance were also all significantly associated with reported opioid consumption (p \u3c 0.001). CONCLUSIONS: In this large, prospective evaluation of postoperative opioid consumption, we found that patients are being prescribed approximately 3 times greater opioid medications than needed following upper-extremity surgical procedures. We have provided general prescribing guidelines, and we recommend that surgeons carefully examine their patients\u27 opioid utilization and consider customizing their opioid prescriptions on the basis of anatomic location and procedure type to prescribe the optimal amount of opioids while avoiding dissemination of excess opioids

Erratum: Effect of MoZrN Coating on a Steel XC100 [Metallofiz. Noveishie Tekhnol., 38, No. 7: 903–909 (2016), DOI: 10.15407/mfint.38.07.0903]

The zirconium nitride ZrN coatings are deposited on substrates of XC100 steel using physical vapour deposition (PVD) technique. Coatings based on nitrides of transition metals (Nb, Zr, Ti, V, ...) developed by PVD are known to increase the life of cutting tools, and so they naturally have seen a rapid industrial growth. It is possible to produce ZrN-coatings with variations of nitrogen partial pressure, the residual stresses, the thickness of the thin film, and the friction coefficient depending on the nitrogen content. Usage of nitrogen is a good way to enhance wear resistance and effectiveness in tribological applications.Покриття з нітриду цирконію ZrN наносилися на підложжя зі сталі XC100 з використанням технології вакуумного напорошення (PVD). Покриття на основі нітридів перехідних металів (Nb, Zr, Ti, V, ...), створені з використанням PVD-методи, як відомо, збільшують термін придатности різального інструменту; тому спостерігається швидкий ріст їх промислового виробництва. Наявна можливість виготовлення ZrN-покриттів зі змінними парціальним тиском азоту, залишковими напруженнями, товщиною тонкої плівки та коефіцієнтом тертя залежно від вмісту азоту. Використання азоту є перспективним шляхом підвищення зносостійкости та ефективности в трибології.Покрытия из нитрида циркония ZrN наносились на подложки из стали XC100 с использованием метода вакуумного напыления (PVD). Покрытия на основе нитридов переходных металлов (Nb, Zr, Ti, V, ...), созданные с использованием PVD-технологии, как известно, увеличивают срок службы режущего инструмента; поэтому наблюдается быстрый рост их промышленного производства. Имеется возможность изготавливать ZrN-покрытия с изменяемыми парциальным давлением азота, остаточными напряжениями, толщиной тонкой плёнки и коэффициентом трения в зависимости от содержания азота. Использование азота является перспективным путём повышения износостойкости и эффективности в трибологии

Non-stationary dynamic analysis of a wind turbine power drivetrain: Offshore considerations

This paper presents a multi-body model for studying the non-stationary dynamic behaviour of a wind turbine power drivetrain. The model includes some offshore considerations, such as the extra degrees of freedom and boundary conditions that installation on an offshore floating platform can add. The studied problem is an offshore implementation, with seafloor depths of the order of a hundred metres, making it necessary to use a floating platform. Special attention is paid to the characteristics of the combined offshore buoy support and detailed model of the power train, in order to assess the impacts of buoy movement on forces on gears and bearings. A multi-body analysis code was used to develop the model, and a conventional wind turbine set-up was implemented as an example. Gearbox dynamic behaviour was simulated for common manoeuvres such as a start-up and an emergency stop, and the results are presented and discussed.The authors like to thanks the company Apia XXI for supporting part of the research presented by the Project DINAER. Moreover, some parts of the developments presented have been made in the framework of Project DPI2006-14348 funded by the Spanish Ministry of Science and Technology

High-dose etoposide with granulocyte colony-stimulating factor for mobilization of peripheral blood progenitor cells: efficacy and toxicity at three dose levels.

High-dose etoposide (2.0-2.4 g m(-2)) with granulocyte colony-stimulating factor (G-CSF) is an effective strategy to mobilize peripheral blood progenitor cells (PBPCs), although in some patients this is associated with significant toxicity. Sixty-three patients with malignancy were enrolled into this non-randomized sequential study. The majority (55/63, 87%) had received at least two prior regimens of chemotherapy, and seven patients had previously failed to mobilize following high-dose cyclophosphamide with G-CSF. Consecutive patient groups received etoposide at three dose levels [2.0 g m(-2) (n = 22), 1.8 g m(-2) (n = 20) and 1.6 g m(-2) (n = 21)] followed by daily G-CSF. Subsequent leukaphereses were assayed for CD34+ cell content, with a target total collection of 2.0 x 10(6) CD34+ cells kg(-1). Toxicity was assessed by the development of significant mucositis, the requirement for parenteral antibiotics or blood component support and rehospitalization incidence. Ten patients (16%) had less than the minimum target yield collected. Median collections in the three groups were 4.7 (2 g m(-2)), 5.7 (1.8 g m(-2)) and 6.5 (1.6 g m(-2)) x 10(6) CD34+ cells kg(-1). Five of the seven patients who had previously failed cyclophosphamide mobilization achieved more than the target yield. Rehospitalization incidence was significantly lower in patients receiving 1.6 g m(-2) etoposide than in those receiving 2.0 g m(-2) (P = 0.03). These data suggest that high-dose etoposide with G-CSF is an efficient mobilization regimen in the majority of heavily pretreated patients, including those who have previously failed on high-dose cyclophosphamide with G-CSF. An etoposide dose of 1.6 g m(-2) appears to be as effective as higher doses but less toxic

Cell cyclins: triggering elements of cancer or not?

Cyclins are indispensable elements of the cell cycle and derangement of their function can lead to cancer formation. Recent studies have also revealed more mechanisms through which cyclins can express their oncogenic potential. This review focuses on the aberrant expression of G1/S cyclins and especially cyclin D and cyclin E; the pathways through which they lead to tumour formation and their involvement in different types of cancer. These elements indicate the mechanisms that could act as targets for cancer therapy

Combined effects of gamma irradiation and blanching process on acrylamide content in fried potato strips

Potato tubers were irradiated in 60Co gamma station at different doses in order to investigate the effect of gamma irradiation on acrylamide formation in fried potato strips. Acrylamide content due to the irradiation treatment was reduced by 20–54% compared to a control after frying the irradiated tubers. While apply a blanching process, using warm tap water, to potato strips before frying has decreased acrylamide by 61%. A combination of gamma irradiation and a blanching process, which was applied in this work, showed a maximum decrease in acrylamide formation to reach 78% in fried potatoes

Factors associated with spontaneous stone passage in a contemporary cohort of patients presenting with acute ureteric colic. Results from the MIMIC Study (A Multi-centre cohort study evaluating the role of Inflammatory Markers in patients presenting with acute ureteric Colic)

Objectives There is conflicting data on the role of white blood cell count (WBC) and other inflammatory markers in spontaneous stone passage in patients with acute ureteric colic. The aim of the study was to assess the relationship of WBC and other routinely collected inflammatory and clinical markers including stone size, stone position and Medically Expulsive Therapy use (MET) with spontaneous stone passage (SSP) in a large contemporary cohort of patients with acute ureteric colic. Subjects and Methods Multi‐centre retrospective cohort study coordinated by the British Urology Researchers in Surgical Training (BURST) Research Collaborative at 71 secondary care hospitals across 4 countries (United Kingdom, Republic of Ireland, Australia and New Zealand). 4170 patients presented with acute ureteric colic and a computer tomography confirmed single ureteric stone. Our primary outcome measure was SSP as defined by the absence of need for intervention to assist stone passage. Multivariable mixed effects logistic regression was used to explore the relationship between key patient factors and SSP. Results 2518 patients were discharged with conservative management and had further follow up with a SSP rate of 74% (n = 1874/2518). Sepsis after discharge with conservative management was reported in 0.6% (n = 16/2518). On multivariable analysis neither WBC, Neutrophils or CRP were seen to predict SSP, with an adjusted OR of 0.97 [95% CI 0.91 to 1.04, p = 0.38], 1.06 [95% CI 0.99 to 1.13, p = 0.1] and 1.00 [95% CI 0.99 to 1.00, p = 0.17], respectively. Medical expulsive therapy (MET) also did not predict SSP [adjusted OR 1.11 [95% CI 0.76 to 1.61]). However, stone size and stone position were significant predictors. SSP for stones 7mm. For stones in the upper ureter the SSP rate was 52% [95% CI 48 to 56], middle ureter was 70% [95% CI 64 to 76], and lower ureter was 83% [95% CI 81 to 85]. Conclusion In contrast to the previously published literature, we found that in patients with acute ureteric colic who are discharged with initial conservative management, neither WBC, Neutrophil count or CRP help determine the likelihood of spontaneous stone passage. We also found no overall benefit from the use of MET. Stone size and position are important predictors and our findings represent the most comprehensive stone passage rates for each mm increase in stone size from a large contemporary cohort adjusting for key potential confounders. We anticipate that these data will aid clinicians managing patients with acute ureteric colic and help guide management decisions and the need for intervention