Switching from Endoscopic Extraperitoneal Radical Prostatectomy to Robot-Assisted Laparoscopic Prostatectomy: Comparing Outcomes and Complications

OBJECTIVE Endoscopic extraperitoneal radical prostatectomy (EERPE) and robot-assisted laparoscopic prostatectomy (RALP) are minimally invasive surgical techniques to treat localized prostate cancer. We report the outcome and complications of these two techniques conducted by one individual surgeon. PATIENTS AND METHODS 86 patients underwent EERPE between January 2008 and June 2011, and 100 patients underwent RALP between August 2011 and October 2012. All surgeries were performed by one single surgeon. RESULTS The patients of the EERPE and RALP groups had similar clinical characteristics in PSA, prostate volume and D'Amico classification, and were significantly different in their age and BMI as well as in the number of prior surgeries. RALP surgeries were significantly slower (183 vs. 157 min) but also involved lower blood loss (147 vs. 245 ml). Pathological stages and positive surgical margins were similar in both groups. Complications were assessed by the Clavien-Dindo classification. 6 patients in the EERPE group and 3 patients of the RALP group suffered major complications (IIIb-IV). CONCLUSION Altogether our results indicate that the learning curve for RALP was short after experience with EERPE. We hypothesize that this is more a result of the surgical experience of the surgeon with the EERPE than on the robotic technique

Romanian complex data center for dense seismic network

In 2002, the National Institute for Earth Physics started the development of its own real-time digital seismic network. This now consists of 86 seismic stations, of which 32 are broad-band sensors, 52 stations are equipped with short-period sensors, and two seismic arrays, all of which transmit data in real time to the National Data Center (NDC) and the Eforie Nord (EFOR) seismic observatory. EFOR is the back-up for the NDC, and it is also a monitoring center for Black Sea tsunamis. The seismic stations are equipped with Quanterra Q330 and K2 digitizers, broad-band seismometers (STS2, CMG40T, CMG 3ESP, CMG3T) and Episensor Kinemetrics acceleration sensors (±2g). SeedLink is a part of Seiscomp2.5 and Antelope, which are the software packages used for data acquisition in real time and data exchange. Communication from the digital seismic stations to the NDC in Bucharest and EFOR is assured by five providers (GPRS, VPN, satellite, radio and internet). AntelopeTM 4.11 is used for acquisition and data processing at these two data centers for the reception and processing of the data, which runs on two workstations: one for real-time processing and the other for off-line processing. A Seiscomp 3 server works as the back-up for the Antelope 4.11. This acquisition and analysis systems for the seismic data produce information about the local and global parameters of earthquakes. In addition, Antelope is used for manual processing (e.g. association events, creation of a database, sending seismic bulletins, and calculation of magnitude and peak ground acceleration and velocity), generation of ShakeMap products, and interactions with global data centers. The NDC has developed tools to make all of this information easily available across the internet, and also to lay the grounds for a more modular and flexible development environment. This will enable centralizing of the data from software such as Antelope, which is using a dedicated database system (Datascope; a database system based on text files), to the more general-purpose database, MySQL. This acts like a hub between the different acquisition and analysis systems used at the NDC, while also providing better connectivity at no expense to security. Mirroring certain data to MySQL also allows the NDC to easily share information with the public, via the new application that is being developed, and also to mix in data collected from the public (e.g. information about the damage after an earthquake, which can be used to produce macroseismic intensity indices that are then stored in the database and also made available via the web application). For internal use, there is also a web application that uses the data stored in the database to display earthquake information, like location, magnitude and depth, in semi real time, thus aiding the personnel on duty. Another use for the data collected is to create and maintain contact lists to which the datacenter sends notifications (SMS and email), based on the parameters of an earthquake. For the future development, one of the NDC plans is to develop the means to cross-check the data generated between the different acquisition and analysis systems (e.g. comparing data generated by Antelope with data generated by Seiscomp)

Exploring Clinical and Biological Features of Premature Births among Pregnant Women with SARS-CoV-2 Infection during the Pregnancy Period

Studies observed that women infected with SARS-CoV-2 during pregnancy had a higher risk of preterm birth. Although it is likely that COVID-19 during the late trimester of pregnancy can trigger premature birth, prematurity remains a concern, and it is vital to study additional clinical and biological patient factors that are highly associated with this negative pregnancy outcome and allow for better management based on the existing predictors. In order to achieve this goal, the current study retrospectively recruited 428 pregnant patients that were separated into three study groups using a 1:2:4 matching ratio and a nearest-neighbor matching method. Sixty-one pregnant patients had a history of COVID-19 during pregnancy and gave birth prematurely; 124 pregnant patient controls had COVID-19 and gave birth full-term, while the second control group of 243 pregnant patients had a premature birth but no history of COVID-19. It was observed that a symptomatic SARS-CoV-2 infection during the third trimester was significantly more likely to be associated with premature birth. Even though the rate of ICU admission was higher in these cases, the mortality rate did not change significantly in the COVID-19 groups. However, SARS-CoV-2 infection alone did not show statistical significance in determining a premature birth (β = 1.09, CI = 0.94–1.15, p-value = 0.067). Maternal anemia was the strongest predictor for prematurity in association with SARS-CoV-2 infection (β = 3.65, CI = 1.46–5.39, p-value < 0.001), followed by elevated CRP (β = 2.11, CI = 1.20–3.06, p-value < 0.001), and respectively IL-6 (β = 1.92, CI = 1.20–2.47, p-value = 0.001. SARS-CoV-2 infection is associated with an increased risk of preterm birth, as shown by our data. If SARS-CoV-2 infection arises during the third trimester, it is recommended that these patients be hospitalized for surveillance of clinical evolution and biological parameters, such as anemia and high inflammatory markers, which have a multiplicative influence on the pregnancy result

Microcoil embolisation for ablation of septal hypertrophy in hypertrophic obstructive cardiomyopathy

Background and aim: Percutaneous transcatheter occlusion with ethanol injection of septal arteries is an efficient treatment procedure of hypertrophic obstructive cardiomyopathy (HOCM). The aim of our study was to evaluate the feasibility and efficiency of septal artery embolisation with microcoils.Methods: Microcoils were delivered through the guide-wire lumen of a 2mm-diameter coaxial balloon positioned inside the target vessel as distally as possible. One or more 0.018"-straight microcoils (Hilal straight coils, Cook, USA) were used for each target vessel until complete flow obstruction was achieved. The intraventricular pressure gradient was measured before, during and after the procedure. Septal branch occlusion was finally documented by coronary angiography.Results: We treated 7 patients (5 males; mean age: 48±10 years). All patients were symptomatic (NYHA class III or IV). The target vessels were successfully occluded in all patients without complications. Moderate pain was recorded during and after the procedure and the CK level increased five- to ten-fold. The pressure gradient diminished during the procedure from 72±21 mmHg to 30±15 mmHg. The number of coils delivered ranged from 3 to 7 per patient. The embolised septal branches included 1 vessel in 5 patients, 2 vessels in 1 patient and 3 vessels in 1 case. After the procedure, the pressure gradient, evaluated by transthoracic echocardiography, was 34±16 mmHg and 42±12 mmH at 3 month-follow-up. Clinical improvement was recorded in all patients after the procedure (NYHA class I or II). Temporary pacing was necessary in 3 patients during and immediately after the procedure but no patient needed permanent pacing.Conclusions: Microcoil embolisation is an efficient and safe approach for transcatheter ablation of septal hypertrophy in HOCM. This technique induced myocardial necrosis without the toxic effects of alcohol, reducing the risk of complications such as permanent pacemaker implantation or ethanol flow to other myocardial regions