The association of stone opacity in plain radiography with percutaneous nephrolithotomy outcomes and complications

Purpose: To investigate the influence of stone opacity in plain radiography on stone free rate and complications of percutaneous nephrolithotomy (PCNL). Materials and Methods: A number of 101 patients who underwent PCNL between July-September 2015 were prospectively included. Stone opacity was judged on preoperative plain Kidney-Ureter-Bladder X-ray. Stone free rate was evaluated two weeks after the operation by ultrasonography and KUB. Results: There were 61 patients with opaque stones and 40 patients with non-opaque stones. The age, body mass index, preoperative creatinine, history of stone surgery, and stone size was not statistically different between patients with opaque and non-opaque stones. Neither operation duration nor access numbers were statistically significant between opaque and non-opaque stones. The frequency of stone free patients in opaque stones and nonopaque stones were 55/61 (90) and 30/40 (75) respectively (P = .04) The magnitude of hemoglobin drop in opaque stones and non-opaque stones were 1.9 ± 1.2 mg/dL versus 2.9 ± 1.7 mg/dL (P = .005). Conclusion: The stone free rate is lower and the magnitude of bleeding is higher in PCNL of non-opaque stones when compared to opaque stones if rigid instruments are used for nephroscopy

Management of ureteropelvic junction obstruction in horseshoe kidneys by an assortment of laparoscopic options

Introduction: We report our experience with laparoscopic management of ureteropelvic junction obstruction in horseshoe kidneys. Methods: Between February 2004 and March 2014, 15 patients with horseshoe kidneys and symptomatic ureteropelvic junction obstruction underwent laparoscopic management at our national referral centre. Depending on the anatomy and presence of obtrusive vessels or isthmus, we performed either dismembered, Scardino or Foley YV pyeloplasty, or Hellstrom vessel transposition. Patients were initially evaluated by ultrasonography, then diuretic scintiscan at 4 to 6 months, and followed by yearly clinical and sonographic exams. Results: This study included 11 male and 4 female patients between the ages of 4 to 51 year (average 17.7). The left kidney was involved in 12 patients (80). Operation time was 129 minutes (range: 90-186), and patients were discharged within 2.8 days (range: 1-6). Although 8 (53.3) patients had crossing vessels, of which 6 required transposing, the Hellstrom technique was solely used in 3 cases, of which notably 1 case failed to resolve and required laparoscopic Hynes within the next year. Eight cases underwent dismembered pyeloplasty, 2 Foley YV, 1 Scardino flap and 1 required isthmectomy and vessel suspension. At the mean follow-up of 60 (range: 18-120) months, the overall success rate was 93.3. Conclusions: To our knowledge, this represents the largest report on laparoscopic pyeloplasty for horseshoe kidneys, providing the longest follow-up. Our findings confirm prior reports supporting laparoscopy and furthermore show that despite the prevalence of crossing vessels, transposition alone is seldom sufficient. © 2015 Canadian Urological Association

Estimation of Fracture path in the Structures and the Influences of Non-singular term on crack propagation

In the present research, a fully Automatic crack propagation as one of the most complicated issues in fracture mechanics is studied whether there is an inclusion or no inclusion in the structures. In this study The Extended Finite Element Method (XFEM) is utilized because of several drawbacks in standard finite element method in crack propagation modeling. Estimated Crack paths are obtained by using Level Set Method (LSM) in coupling with XFEM for 2D mixed mode crack propagation problems. Also, stress intensity factors for mixed mode crack problems are numerically calculated by using interaction integral method completely based on familiar path independent J-integral approach. However, the influence of the first non-singular term (T-stress) of Williams’ stress distribution series in a cracked body is considered. Different crack growth paths are calculated for different domains with predefined notches such as edge and center cracks. In addition, predefined cracks and inclusions are implicitly defined using enrichment procedure in the XFEM framework and the effects of soft or hard inclusions are studied on crack propagation schemes. Finally, estimated crack paths under assumed conditions by using XFEM, are compared with the experimental results

The comparison between two methods of basic life support instruction: Video self-instruction versus traditional method

Introduction: Medical education is changing and evolving. Teachers need to re-evaluate their medical teaching practice to enhance student learning. The data about the ideal training method of Basic Life Support (BLS) is lacking. The goal of this study was to analyse the use and performance of video self-instruction (VSI) method in BLS, in order to develop an efficient BLS training method. Methods: Eighty-one undergraduate medical interns were enrolled in a prospective clinical study in 2011. They were divided into VSI group and traditional group. We provided the first group with a DVD containing a 20-minute training video while the second group took part in a 4-hour training class of BLS. Subjects participated in a pre-test and post-test based on 2010 American Heart Association Resuscitation guideline. Results: The average scores of VSI group and the traditional group before training were 8.85±2.42 and 8.57±2.22 respectively (p=0.592). After training, the average scores of the VSI and the traditional group were 20.24±0.83 and 18.05±1.86 respectively. VSI group achieved slightly better scores compared with the traditional group (p<0.001). Conclusions: Training through VSI achieves more satisfying results than the traditional lecture method. VSI method can be considered a useful technique in undergraduate educational programs. Developing VSI can increase significantly the access to the BLS training. © 2015, Medcom Limited. All rights reserved

The relationship between the findings of transvaginal dynamic sonography with patient�s signs and symptoms after mid-urethral sling surgery using TVT tape

Introduction: Stress urinary incontinence is a major problem affecting economic - social aspects and private lives of many women. Different surgical techniques such as TVT are used to treat the problem. This study was performed with aim to investigate the relationship between the findings of transvaginal dynamic sonography with patient�s signs and symptoms after Mid-urethral sling surgery using TVT tape. Methods: In this study, all women aged between 17 to 88 years who underwent TVT surgery for treatment of urinary incontinence at Tehran Hasheminejad Hospital during the past 2 years (2011-2013) and at least three months had passed of their surgery were entered to the study. A questionnaire for evaluation of age, body mass index, parity, irritative and obstructive symptoms was completed by the urologist. Then, a radiologists performed transvaginal ultrasound for the patients to determine the distance of tape from the urethra and bladder neck. Data was analyzed using SPSS statistical software (version 16) and non-parametric tests. PResults: Among 190 patients, 22 cases (10) had irritative symptoms, 14 (?) obstructive symptoms, and 17 (8.9) with symptoms of incontinence urgency. The sonography showed that mean distance of tape (c shape) from urethra was 3 ± 0.3 mm and mean distance of tape (c shape) from bladder neck was 11.3 ± 0.3 mm; there was no significant relationship between the prevalence of irritative symptoms and variables (P=0.14). Conclusion: There is no significant relationship between the findings of dynamic trans-vaginal ultrasound with patient�s signs and symptoms after Mid-urethral sling surgery using TVT tape to treat urinary incontinence in women. © 2015, Mashhad University of Medical Sciences. All rights reserved

The effects of thermomechanical history on the microstructure of a nickel-base superalloy during forging

The effect of thermo-mechanical history on hot compression behaviour and resulting microstructures of a nickel base superalloy is presented. Hot compression tests were carried out on HAYNES® 282® specimens to varying strains from 0.1 to 0.8. Both single pass and multi-pass tests were completed. 60 minute inter-pass times were utilized to accurately replicate industrial forging practices. The effect of dynamic, metadynamic and static recrystallization during inter-pass times on flow stress was investigated. The study showed the presence of yield peaks in the flow stress data which have been identified in previous studies and thought to be due to solute atoms pinning dislocations, but in this work are shown to be due to friction. The resulting microstructures were analysed using scanning electron, optical microscopy and EBSD to relate grain size and homogeneity with flow stress data. The study showed a negligible difference between multi-pass and single pass tests for strain increments above 0.2. Therefore, when modelling similar low strain and strain rate forging processes inHAYNES® 282®, previous forging steps can be ignored

Comparing the Efficacy of Tolterodine and Gabapentin Versus Placebo in Catheter Related Bladder Discomfort after Percutaneous Nephrolithotomy: A Randomized Clinical Trial

Purpose: The purpose of this study was to compare the efficacy of tolterodine and gabapentin vs placebo in catheter related bladder discomfort (CRBD) following percutaneous nephrolithotomy (PCNL). Materials and Methods: This study was a double-blind parallel group randomized clinical trial. Patients who were candidates of PCNL were enrolled. Patients were randomized to treatment groups of tolterodine 2 mg orally (PO) (group T, n = 50), gabapentin 600 mg PO (group G, n = 50), and placebo (group P, n = 70) 1 hour before operation using balanced block randomization. The primary endpoint of interest was visual analog pain scale in 1, 3, 12, and 24 hours after the operation. Secondary endpoints included rescue analgesic use (opioid and nonopioid). Results: The frequency of severe CRBD in 1,12, and 24 hours after the operation was 4, 4, and 6 in group T vs 4, 0, and 2 in group G vs 47, 14, and 6 in the P group (p < 0.001). The number of paracetamol injections for CRBD in the T and G groups was significantly lower than the placebo group (1.8 ± 0.8 vs 1.8 ± 0.7 vs 3.6 ± 0.7, p < 0.001). Likewise the number of pethidine injections in the T and G groups was significantly lower than the placebo group (0.42 ± 0.54 vs 0.68 ± 0.62 vs 2.4 ± 0.64, p < 0.001). In patients with history of Double-J insertion, the severity of CRBD was lower in all treatment groups. Conclusions: Preoperative administration of oral tolterodine or gabapentin reduces postoperative CRBD and the need for rescue analgesics as much as 24 hours after surgery. Patients with history of Double-J insertion experience less CRBD. © Copyright 2018, Mary Ann Liebert, Inc

Comparing the Efficacy of Tolterodine and Gabapentin Versus Placebo in Catheter Related Bladder Discomfort after Percutaneous Nephrolithotomy: A Randomized Clinical Trial

Purpose: The purpose of this study was to compare the efficacy of tolterodine and gabapentin vs placebo in catheter related bladder discomfort (CRBD) following percutaneous nephrolithotomy (PCNL). Materials and Methods: This study was a double-blind parallel group randomized clinical trial. Patients who were candidates of PCNL were enrolled. Patients were randomized to treatment groups of tolterodine 2 mg orally (PO) (group T, n = 50), gabapentin 600 mg PO (group G, n = 50), and placebo (group P, n = 70) 1 hour before operation using balanced block randomization. The primary endpoint of interest was visual analog pain scale in 1, 3, 12, and 24 hours after the operation. Secondary endpoints included rescue analgesic use (opioid and nonopioid). Results: The frequency of severe CRBD in 1,12, and 24 hours after the operation was 4, 4, and 6 in group T vs 4, 0, and 2 in group G vs 47, 14, and 6 in the P group (p < 0.001). The number of paracetamol injections for CRBD in the T and G groups was significantly lower than the placebo group (1.8 ± 0.8 vs 1.8 ± 0.7 vs 3.6 ± 0.7, p < 0.001). Likewise the number of pethidine injections in the T and G groups was significantly lower than the placebo group (0.42 ± 0.54 vs 0.68 ± 0.62 vs 2.4 ± 0.64, p < 0.001). In patients with history of Double-J insertion, the severity of CRBD was lower in all treatment groups. Conclusions: Preoperative administration of oral tolterodine or gabapentin reduces postoperative CRBD and the need for rescue analgesics as much as 24 hours after surgery. Patients with history of Double-J insertion experience less CRBD. © Copyright 2018, Mary Ann Liebert, Inc

Strategies for improving the communication of satellite-derived InSAR data for geohazards through the analysis of Twitter and online data portals

Satellite-based earth observation sensors are increasingly able to monitor geophysical signals related to natural hazards, and many groups are working on rapid data acquisition, processing, and dissemination to data users with a wide range of expertise and goals. A particular challenge in the meaningful dissemination of Interferometric Synthetic Aperture Radar (InSAR) data to non-expert users is its unique differential data structure and sometimes low signal-to-noise ratio. In this study, we evaluate the online dissemination of ground deformation measurements from InSAR through Twitter, alongside the provision of open-access InSAR data from the Centre for Observation and Modelling of Earthquakes, Volcanoes and Tectonics (COMET) Looking Into Continents from Space with Synthetic Aperture Radar (LiCSAR) processing system. Our aim is to evaluate (1) who interacts with disseminated InSAR data, (2) how the data are used, and (3) to discuss strategies for meaningful communication and dissemination of open InSAR data. We found that the InSAR Twitter community was primarily composed of non-scientists (62 %), although this grouping included earth observation experts in applications such as commercial industries. Twitter activity was primarily associated with natural hazard response, specifically following earthquakes and volcanic activity, where users disseminated InSAR measurements of ground deformation, often using wrapped and unwrapped interferograms. For earthquake events, Sentinel-1 data were acquired, processed, and tweeted within 4.7±2.8 d (the shortest was 1 d). Open-access Sentinel-1 data dominated the InSAR tweets and were applied to volcanic and earthquake events in the most engaged-with (retweeted) content. Open-access InSAR data provided by LiCSAR were widely accessed, including automatically processed and tweeted interferograms and interactive event pages revealing ground deformation following earthquake events. The further work required to integrate dissemination of InSAR data into longer-term disaster risk-reduction strategies is highly specific, to both hazard type and international community of practice, as well as to local political setting and civil protection mandates. Notably, communication of uncertainties and processing methodologies are still lacking. We conclude by outlining the future direction of COMET LiCSAR products to maximize their useability.</p