Resident training in urology: Bipolar transurethral resection of the prostate - a safe method in learning endoscopic surgical procedure

Introduction: Modern medicine uses increasingly innovative techniques that require more and more capabilities for acquisition. In the urological department is increasing the presence of patients with lower urinary tract symptoms (LUTS) and transurethral resection of the prostate (TURP) is the standard of care in their surgical treatment. We report our surgical experience and learning curve of using bipolar plasmakinetic devices in the training of urological residents to benign prostatic hyperplasia (BPH) treatment. Materials and Methods: 80 patients with benign prostatic enlargement due to BPH were enrolled in the study. TURP has been performed by three urological residents and by an expe- rienced urologist. Patients were evaluated before and 6 months after the endoscopic bipolar plasmakinetic resection using the International Prostate Symptom Score (IPSS), maximum uri- nary flow rate (Qmax), postvoid residual urine (PVR) and prostate specific antigen (PSA). Results: Overall 60 procedures were performed, 18 PlasmaKinetic (PK)-TURP procedures were completed by the three residents. In the other 42 cases the procedures were completed by the experienced urologist. In eight cases there was a capsular perforation and the experienced urol- ogist replaced the resident to complete the resection. No complications have been reported in the procedures completed by the senior urologist. All complications caused by the residents were man- aged intraoperatively without changing the course of the procedure. Statistical differences were observed regarding IPSS, quality of life (QoL), and PVR at 6-month follow-up when procedures completed by urological residents were compared to those completed by the senior urologist. Conclusion: Bipolar device represents appropriate tools to acquire endoscopic skills. It is safe and it can be used at the first experience of BPH treatment by a resident who has not previ- ously approached this endoscopic surgical procedure

timed flat infusion tfi 5 fluorouracil with irinotecan and oxaliplatin in pancreatic adenocarcinomas a single institution experience with fir fox regimen

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Versatile mid-infrared frequency-comb referenced sub-Doppler spectrometer

We present a mid-IR high-precision spectrometer capable of performing accurate Doppler-free measurements with absolute calibration of the optical axis and high signal-to-noise ratio. The system is based on a widely tunable mid-IR offset-free frequency comb and a Quantum-Cascade-Laser (QCL). The QCL emission frequency is offset locked to one of the comb teeth to provide absolute-frequency calibration, spectral-narrowing, and accurate fine frequency tuning. Both the comb repetition frequency and QCL-comb offset frequency can be modulated to provide, respectively, slow- and fast-frequency-calibrated scanning capabilities. The characterisation of the spectrometer is demonstrated by recording sub-Doppler saturated absorption features of the CHF3 molecule at around 8.6 μm with a maximum signal-to-noise ratio of ∼7 × 103 in 10 s integration time, frequency-resolution of 160 kHz, and accuracy of less than 10 kHz.We present a mid-IR high-precision spectrometer capable of performing accurate Doppler-free measurements with absolute calibration of the optical axis and high signal-to-noise ratio. The system is based on a widely tunable mid-IR offset-free frequency comb and a Quantum-Cascade-Laser (QCL). The QCL emission frequency is offset locked to one of the comb teeth to provide absolute-frequency calibration, spectral-narrowing, and accurate fine frequency tuning. Both the comb repetition frequency and QCL-comb offset frequency can be modulated to provide, respectively, slow- and fast-frequency-calibrated scanning capabilities. The characterisation of the spectrometer is demonstrated by recording sub-Doppler saturated absorption features of the CHF3 molecule at around 8.6 μm with a maximum signal-to-noise ratio of ∼7 × 103 in 10 s integration time, frequency-resolution of 160 kHz, and accuracy of less than 10 kHz

'He just gave up': an exploratory study into the perspectives of paid carers on supporting older people living in care homes with depression, self-harm, and suicide ideation and behaviours

This study explored the concept of ‘giving up’ from the perspective of care staff working in care homes, and their everyday communication and hidden knowledge concerning what they think about this taboo topic and the context it reflects. Moving to a care home is a major transition where cumulative losses can pose risks to mental health in later life. If not recognised, this vulnerability can lead to depression which extends to suicide ideation and behaviours in the form of self-harm and self-neglect. Care homes are a significant place of care until death, yet a discourse of silence means that self-harm and suicide is under-reported or not attended to with specialist expertise. The layperson’s concept of an older person ‘giving up’ on life is hardly discussed in the literature. This co-produced qualitative study used an inductive approach to explore this phenomenon through focus groups with 33 care staff across four care homes in South-East England. Findings paint a complex picture, highlighting tensions in providing the right support and creating spaces to respond to such challenging situations. ‘Giving up’ requires skilled detailed assessment to respond to risks alongside improved training and support for paid carers, to achieve a more holistic strategy which capitalises on significant relationships within a wider context

Quantificação dos teores de açúcares, oligossacarídeos e amido em genótipos/ cultivares de soja (Glycine Max (L) Merril) especiais utilizados para alimentação humana.

RESUMO: Na soja, vários componentes, tais como açúcares, aminoácidos, ácidos orgânicos, sais inorgânicos, isoflavonas e saponinas estão relacionados com o sabor. Os açúcares, a sacarose e o amido, podem melhorar o sabor e a textura da soja. O objetivo deste trabalho foi quantificar os teores desses compostos e dos oligossacarídeos, em sementes de 28 genótipos/cultivares do Banco Ativo de Germoplasma da Embrapa Soja, que apresentam características especiais para o melhoramento genético. Os açúcares e os oligossacarídeos foram quantificados pela técnica de cromatografia liquida de alto desempenho (CLAE) e o amido pela metodologia adaptada de Rickard e Behn (1987). Os genótipos PI 417.159 e F83-8119 apresentaram menores teores de oligossacarídeos totais (2,744 e 3,064 g.100 g de massa seca). As cultivares Tambaguro e Koji Amarela foram as que apresentaram teores de sacarose superiores a 6 g.100 g–1 de massa seca(6,327 e 6,162), enquanto que a única cultivar que apresentou um teor superior a 1 g.100g–1–1 de massa seca de amido foi a Tambaguro (1,191). As cultivares Koji Preta, Tamahomare, Tambaguro e BRS 267 foram estatisticamente superiores quando os 3 atributos (oligossacarídeos totais, sacarose e amido) foram avaliados conjuntamente, com o foco em sabor superior. As cultivares Koji Preta, Tamahomare, Tambaguro foram as melhores fontes genéticas indicadas para cruzamentos, pois não são tropicalizadas, enquanto a cultivar BRS 267 pode melhorar as qualidades sensoriais dos produtos processados a partir de soja. Por outro lado, a cultivar Late Giant, devido ao maior teor de oligossacarídeos, é uma fonte genética em potencial para produção de um alimento funcional à base de soja. ABSTRACT: In soybeans, many components such as sugars, amino acids, organic acids, inorganic salts, saponins and isoflavones are related to the flavour. The sugars, sucrose and starch can improve the soybean flavour and texture. The present study aimed to quantify the contents of these compounds and also the oligosaccharides in the seeds from 28 genotypes/cultivars obtained from the Embrapa Soybean Germplasm Bank, that present special characteristics for genetic improvement programmes. The sugars and oligosaccharides were quantified by high-performance liquid chromatography (HPLC) and the starch by methodology adapted from Rickard e Behn (1987). The genotypes PI 417.159 and F83-8119 showed the lowest contents of total oligosaccharides (2.744 and 3.064 g.100 g DW). The cultivars Tambaguro and Koji Amarela showed sucrose levels above 6 g.100 g–1 DW (6.327 and 6.162), and the only cultivar with a starch content above 1 g.100 g–1 DW was Tambaguro (1.191). The cultivars Koji Preta, Tamahomare, Tambaguro and BRS 267 were statistically better when the 3 attributes (total oligosaccharides, sucrose and starch) were analysed together with a focus on better flavour. The cultivars Koji Preta, Tamahomare, Tambaguro were the best genetic sources for breeding because they have not been tropicalized, whilst the cultivar BRS 267 could improve the sensory qualities of processed soybean-based foods. On the other hand, on account of its higher oligosaccharide content, the cultivar Late Giant is a potential genetic source for the production of functional soybean-based foods

Slow relaxation in weakly open vertex-splitting rational polygons

The problem of splitting effects by vertex angles is discussed for nonintegrable rational polygonal billiards. A statistical analysis of the decay dynamics in weakly open polygons is given through the orbit survival probability. Two distinct channels for the late-time relaxation of type 1/t^delta are established. The primary channel, associated with the universal relaxation of ''regular'' orbits, with delta = 1, is common for both the closed and open, chaotic and nonchaotic billiards. The secondary relaxation channel, with delta > 1, is originated from ''irregular'' orbits and is due to the rationality of vertices.Comment: Key words: Dynamics of systems of particles, control of chaos, channels of relaxation. 21 pages, 4 figure

Asymmetric Fluid Criticality I: Scaling with Pressure Mixing

The thermodynamic behavior of a fluid near a vapor-liquid and, hence, asymmetric critical point is discussed within a general ``complete'' scaling theory incorporating pressure mixing in the nonlinear scaling fields as well as corrections to scaling. This theory allows for a Yang-Yang anomaly in which \mu_{\sigma}^{\prime\prime}(T), the second temperature derivative of the chemical potential along the phase boundary, diverges like the specific heat when T\to T_{\scriptsize c}; it also generates a leading singular term, |t|^{2\beta}, in the coexistence curve diameter, where t\equiv (T-T_{\scriptsize c}) /T_{\scriptsize c}. The behavior of various special loci, such as the critical isochore, the critical isotherm, the k-inflection loci, on which \chi^{(k)}\equiv \chi(\rho,T)/\rho^{k} (with \chi = \rho^{2} k_{\scriptsize B}TK_{T}) and C_{V}^{(k)}\equiv C_{V}(\rho,T)/\rho^{k} are maximal at fixed T, is carefully elucidated. These results are useful for analyzing simulations and experiments, since particular, nonuniversal values of k specify loci that approach the critical density most rapidly and reflect the pressure-mixing coefficient. Concrete illustrations are presented for the hard-core square-well fluid and for the restricted primitive model electrolyte. For comparison, a discussion of the classical (or Landau) theory is presented briefly and various interesting loci are determined explicitly and illustrated quantitatively for a van der Waals fluid.Comment: 21 pages in two-column format including 8 figure

Mancha areolada de Thanatephorus da seringueira na Amazônia: identificação filogenética e variação genética em populações do patógeno.

A mancha areolada de Thanatephorus é uma das doenças mais importantes da seringueira (Hevea brasiliensis) na Amazônia. Apesar disso, questão importante sobre o real posicionamento filogenético deste patógeno ainda não foi respondida. Neste estudo, nós analisamos os padrões de variação genética em seqüências da região ITS-5.8S do rDNA de uma população de T. cucumeris (fase assexuada = Rhizoctonia solani AG 2-2) associado à mancha areolada da seringueira amostrada em Belém (Pará), Manaus (Amazonas) e Xapuri/Rio Branco (Acre) na Amazônia, e comparando-a filogeneticamente com membros do complexo AG 2 descritos mundialmente. Este estudo representa um passo importante para revelar a etiologia da fase assexuada de T.cucumeris da seringueira

Estimation of the incubation period and generation time of SARS-CoV-2 Alpha and Delta variants from contact tracing data

Quantitative information on epidemiological quantities such as the incubation period and generation time of SARS-CoV-2 variants is scarce. We analyzed a dataset collected during contact tracing activities in the province of Reggio Emilia, Italy, throughout 2021. We determined the distributions of the incubation period for the Alpha and Delta variants using information on negative PCR tests and the date of last exposure from 282 symptomatic cases. We estimated the distributions of the intrinsic generation time using a Bayesian inference approach applied to 9724 SARS-CoV-2 cases clustered in 3545 households where at least one secondary case was recorded. We estimated a mean incubation period of 4.9 days (95% credible intervals, CrI, 4.4-5.4) for Alpha and 4.5 days (95%CrI 4.0-5.0) for Delta. The intrinsic generation time was estimated to have a mean of 7.12 days (95% CrI 6.27-8.44) for Alpha and of 6.52 days (95%CrI 5.54-8.43) for Delta. The household serial interval was 2.43 days (95%CrI 2.29-2.58) for Alpha and 2.74 days (95%CrI 2.62-2.88) for Delta, and the estimated proportion of pre-symptomatic transmission was 48-51% for both variants. These results indicate limited differences in the incubation period and intrinsic generation time of SARS-CoV-2 variants Alpha and Delta compared to ancestral lineages

Transperineal versus transrectal prostate biopsy for predicting the final laterality of prostate cancer : are they reliable enough to select patients for focal therapy? Results from a multicenter international study

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