Bladder Research Articles

Endoparasites of peritoneal organs and skeletal muscles of the European wildcat (Felis silvestris) in Germany

Abstract Background For several decades, the European wildcat (Felis silvestris) has gradually been returning to the forests of Germany, mainly in the central and southwestern regions. To increase the knowledge about this threatened species, the endoparasite status of dead found specimens from Germany was surveyed. Methods A total of 118 wildcats were examined for endoparasites in peritoneal organs and skeletal muscles. Owing to decomposition or incomplete carcasses, 104 gastrointestinal tracts (stomachs and intestines), 101 livers with gallbladders, 99 urinary bladders, as well as kidneys of 95 and skeletal muscles of 112 specimens were available for examination. All detected parasites were identified morphologically to genus or species level, followed by molecular examinations of one to ten specimens of each parasite species. Results Overall endoparasite prevalence in peritoneal organs was 99.0% (103/104). Among the 99.0% (103/104) infected gastrointestinal tracts, the most frequent species were Toxocara cati (95.2% [99/104]), Hydatigera kamiyai (84.6% [88/104]), Mesocestoides litteratus (69.2% [72/104]), Strongyloides spp. (58.7% [61/104]), Cylicospirura petrowi (37.5% [39/104]), Ancylostoma tubaeforme (31.7% [33/104]), Capillaria putorii (24.0% [25/104]), and Echinococcus multilocularis (18.3% [19/104]). In 77.8% (77/99) of the urinary bladders, Capillaria plica and/or Capillaria feliscati were detected. Moreover, the liver fluke Metorchis bilis occurred in 2.0% (2/101) of the livers, and roundworm larvae (presumably Toxocara spp.) were detected in 33.0% (37/112) of the muscle samples. Conclusions These results show a broad spectrum of endoparasite species infecting European wildcats in Germany. It might be assumed that some of the endoparasites could pose a risk to domestic cats (Felis catus) and humans through spillover events, or may be transmitted from domestic cats to the free-ranging population, posing a potential risk to wildcats. Graphical Abstract

Urine microbiota and bladder cancer

Urine analysis data obtained using modern microbiological methods and 16S rRNA gene sequencing technology indicate that the urinary system has its own microbial ecosystem. Individual microbiota members can play a key role in the development of cancer. Certain bacterial taxa have been revealed in bladder urothelial carcinoma cells that can affect carcinogenesis, treatment response, and the development of relapses through various mechanisms. The studies are conducted to use not only vaccine strains, but also probiotic strains and oncolytic bacteria for the treatment and prevention of relapses.

Model-informed drug development for antimicrobials: translational pharmacokinetic-pharmacodynamic modelling of apramycin to facilitate prediction of efficacious dose in complicated urinary tract infections.

The use of mouse models of complicated urinary tract infection (cUTI) has usually been limited to a single timepoint assessment of bacterial burden. Based on longitudinal in vitro and in vivo data, we developed a pharmacokinetic-pharmacodynamic (PKPD) model to assess the efficacy of apramycin, a broad-spectrum aminoglycoside antibiotic, in mouse models of cUTI. Two Escherichia coli strains were studied (EN591 and ATCC 700336). Apramycin exposure-effect relationships were established with in vitro time-kill data at pH 6 and pH 7.4 and in mice with cUTI. Immunocompetent mice were treated with apramycin (1.5-30 mg/kg) starting 24 h post-infection. Kidney and bladder tissue were collected 6-96 h post-infection for cfu determination. A PKPD model integrating all data was developed and simulations were performed to predict bacterial burden in humans. Treatment with apramycin reduced the bacterial load in kidneys and bladder tissue up to 4.3-log compared with vehicle control. In vitro and in vivo tissue time-course efficacy data were integrated into the PKPD model, showing 76%-98% reduction of bacterial net growth and 3- to 145-fold increase in apramycin potency in vivo compared with in vitro. Simulations suggested that an 11 mg/kg daily dose would be sufficient to achieve bacterial stasis in kidneys and bladder in humans. PKPD modelling with in vitro and in vivo PK and PD data enabled simultaneous evaluation of the different components that influence drug effect, an approach that had not yet been evaluated for antibiotics in the cUTI model and that has potential to enhance model-informed drug development of antibiotics.

Pitfalls of frozen section diagnosis in ureter margin evaluation of plasmacytoid urothelial carcinoma of urinary bladder.

Plasmacytoid urothelial carcinoma (PUC) is a rare and aggressive subtype that often presents at advanced stages with poor prognosis. This study investigated tumor invasion to better understand tumor behavior and potentially to improve management strategies by comparing the clinicopathologic characteristics of PUC with positive ureter resection margin (+ URM) with PUC with negative URMs (-URM). This retrospective analysis used pathology reports from 2017 to 2023 for cases diagnosed with PUC during radical cystectomy (RC). All applicable H&E slides of RC specimens were reviewed. Cases with a plasmacytoid component greater than 25% in the RC specimens were analyzed. Frozen section analyses (FSAs) and permanent section analyses (PSAs) of ureter resection margins were performed. Fifteen patients with a plasmacytoid component greater than 25% in their RC specimens were identified. Compared with -URM PUC cases, +URM PUC cases were located more frequently at the trigone or bladder neck, and all + URM cases exhibited ureter orifice involvement. Among 6 PSA-positive cases, three (50%) cases showed discrepancies with FSA. Three + URM cases exhibited PUC tumor cells along the submucosa and muscularis propria layer, and the 3 remaining cases showed PUC tumor cells along the adventitia. We observed a consistent adventitia invasion in all the discordant cases, with sectioning errors and misinterpretation identified as the primary causal factors. To the best of our knowledge, this is the first study to demonstrate two separate patterns of tumor infiltration along the ureter and to discuss the significance of comparing FSA with PSA in PUC. The significance of comprehensive management strategies for PUC patients, including a thorough evaluation of ureteral margins and accurate interpretation of periureteral fat tissue, is highlighted. Large, well-designed studies are needed to strengthen the evidence and to establish optimal management strategies for patients with PUC.

Regulation of Apoptosis, Autophagy, and Metastasis by Luteolin in Human Bladder Cancer EJ138 Cells: An Experimental Study

Background: Chemotherapy remains a primary approach to cancer treatment, widely applied in bladder cancer (BC). However, the various side effects and resistance associated with chemotherapeutic drugs pose significant challenges in BC therapy, prompting interest in natural compounds like luteolin. Studies focus on its effects on key biological processes involved in BC, including metastasis, apoptosis, and autophagy. Objectives: This study investigated the regulation of mRNA expression of genes associated with apoptosis (BCL2, P53), autophagy (ULK1, ATG12), and metastasis (MMP2, MMP9) in malignant BC cells treated with luteolin. Methods: This was an in vitro experimental study. EJ138 BC cells were treated with various concentrations of luteolin, and its impact on cell viability, proliferation, and gene expression was assessed. The cytotoxic effect of luteolin on EJ138 BC cells was evaluated using the MTT assay after 24- and 48-hour treatments with different luteolin concentrations. Flow cytometry was performed to examine luteolin’s anti-proliferative effect, and RT-PCR was used to analyze mRNA expression of BCL2, P53, ULK1, ATG12, MMP2, and MMP9 genes. Results: MTT assay results confirmed that luteolin reduced the proliferation rate of BC cells. Flow cytometry indicated increased cell death in EJ138 BC cells following luteolin treatment. RT-PCR findings demonstrated that luteolin upregulated P53, ULK1, and ATG12 expression while downregulating BCL2 mRNA expression. However, luteolin treatment in EJ138 cells did not significantly alter MMP2 and MMP9 expression levels. Conclusions: These findings indicate that luteolin exerts cytotoxic effects on EJ138 BC cells by dysregulating mRNA expression of genes involved in apoptosis and autophagy. Therefore, luteolin shows potential as an effective anti-cancer agent for BC therapy.

From central to peripheral: A new perspective on bladder dysfunction in Parkinson disease

As opposed to classical overactive (OAB) symptoms, Parkinson disease (PD) patients often exhibit detrusor hyperreflexia and impaired contractility or underactive bladder. OAB would be more related to central nervous system dysfunction, but nerve damage in peripheral ganglia (eg, pelvic ganglia in the bladder wall) may play a mechanism of dysfunction manifesting as underactive bladder in PD. We propose a novel hypothesis regarding neurogenic urologic dysfunction in PD, suggesting a potential involvement of peripheral nervous system dysfunction in addition to central nervous system dysfunction. This hypothesis emphasizes the significance of investigating peripheral neuron damage in the urinary bladder. We hereby review the relevant neurogenic bladder dysfunction associated with PD, compare and contrast OAB and underactive bladder manifestations and dysfunction, and discuss novel considerations toward this disease with great unmet needs.

A Novel UBM/SIS Composite Biological Scaffold for 2-Year Abdominal Defect Repairing and Strength Recovery in Canine Model.

Biological scaffolds are widely utilized in hernia treatment due to their exceptional pro-regenerative properties, which mitigate scar formation. However, serious complications occurred, caused by inflammatory response, premature degradation, and mechanical failure. Consequently, improvements of the biological scaffold are necessary to mitigate these risks. In this study, a novel biological scaffold integrating basement membrane-containing urinary bladder matrix (UBM) and small intestinal submucosa (SIS) is developed, and its safety and effectiveness are assessed in comparison to a commercial SIS (c-SIS) scaffold. The introduction of UBM as top surface layers significantly promotes cell adhesion, facilitating rapid formation of isolated regeneration zone. Proteomic analysis has demonstrated a more efficientdecellularization of the UBM/SIS scaffold, which subsequently mitigates inflammation in murine models, and promotes the polarization of macrophages toward the pro-healing M2 phenotype in a rat model of abdominal wall muscle defect. Furthermore, a two-year repair trial is conducted on a full-thickness abdominal wall muscle defect in canine model and confirmed that the UBM/SIS scaffold exhibits reduced seroma occurrences and enhanced tissue repair performances. Overall, the efficacyof this novel biological scaffold suggests its potential to minimize hernia recurrence in clinical practice and mitigatepatient suffering from severe inflammatory responses.

Mechanosensitive release of ATP in the urinary bladder mucosa.

The urinary bladder mucosa (urothelium and suburothelium/lamina propria) functions as a barrier between the content of the urine and the underlying bladder tissue. The bladder mucosa is also a mechanosensitive tissue that releases signaling molecules that affect functions of cells in the bladder wall interconnecting the mucosa with the detrusor muscle and the CNS. Adenosine 5'-triphosphate (ATP) is a primary mechanotransduction signal that is released from cells in the bladder mucosa in response to bladder wall distention and activates cell membrane-localized P2X and P2Y purine receptors on urothelial cells, sensory and efferent neurons, interstitial cells, and detrusor smooth muscle cells. The amounts of ATP at active receptor sites depend significantly on the amounts of extracellularly released ATP. Spontaneous and distention-induced release of ATP appear to be under differential control. This review is focused on mechanisms underlying urothelial release of ATP in response to mechanical stimulation. First, we present a brief overview of studies that report mechanosensitive ATP release in bladder cells or tissues. Then, we discuss experimental evidence for mechanosensitive release of urothelial ATP by vesicular and non-vesicular mechanisms and roles of the stretch-activated channels PIEZO channels, transient receptor potential vanilloid type 4, and pannexin 1. This is followed by brief discussion of possible involvement of calcium homeostasis modulator 1, acid-sensing channels, and connexins in the release of urothelial ATP. We conclude with brief discussion of limitations of current research and of needs for further studies to increase our understanding of mechanotransduction in the bladder wall and of purinergic regulation of bladder function.

Abstract PR006: The potential of multi-cancer early detection screening for reducing cancer mortality

Abstract Background: Currently, routine screening is recommended for only four cancer types (i.e., breast, cervical, colorectal, and lung) by the United States Preventive Services Task Force (USPSTF), and two-thirds of incident cancers have no screening guidelines. Emerging liquid biopsy multi-cancer early detection (MCED) tests have the potential to revolutionize early cancer detection. Their impact on cancer mortality remains uncertain. Computer models are needed to forecast long-term outcomes. Methods: We developed Simulation Model for MCED (SiMCED), a continuous-time, discrete-event microsimulation model of 14 solid tumor cancers: breast, cervical, colorectal, endometrial, esophageal, gastric, head and neck, kidney, liver, lung, ovarian, pancreatic, prostate, and urinary bladder. Cancer type- and stage-specific dwell times informed the transitions between cancer stages I-IV. Cancer type- and stage-specific MCED test sensitivities were derived from a large, multi-center, prospective, case-control study: Ascertaining Serial Cancer patients to Enable New Diagnostic 2 (ASCEND-2). The model was calibrated to reproduce annual incidence rates of cancer diagnosis as captured in the Surveillance, Epidemiology, and End Results (SEER) database, while accounting for the unobserved cancer burden. Using a 10-year time horizon, we simulated the life course of 5 million US adults aged 50-84 years, representative of the US population age distribution. Cancer diagnosis could arise from usual care or annual MCED screening. The MCED test was administered at the beginning of each year to individuals aged 50-84 years. After a cancer diagnosis, individuals followed SEER survival curves to determine the time and cause of death (cancer- or non-cancer-related). Results: Over the 10-year time horizon, the supplemental use of MCED screening reduced stage IV incidence by 876 (42%) per 100,000, relative to usual care. The 10-year reduction in cancer mortality was 439 (17%) per 100,000, which translates to 505,600 cancer-related deaths averted among US adults aged 50-84 years. Lung cancer had the highest absolute 10-year cancer mortality reduction at 126 (13%) per 100,000. Among the cancer types for which there is no routine screening, the 10-year cancer mortality reduction was 175 (15%) per 100,000, equating to 201,500 cancer-related deaths averted among US adults aged 50-84 years. Within the 10-year time window, earlier diagnosis by MCED led to an aggregated life-year gain of 1,165 per 100,000, which translates to a gain of 1,340,000 life-years among US adults aged 50-84 years. Conclusion: Our study suggests that MCED screening could be effective for reducing both stage IV incidence and cancer mortality. The real-world impact of MCED tests and their cost-effectiveness require further investigation. Citation Format: Jagpreet Chhatwal, Jade Xiao, Andrew ElHabr, Christopher Tyson, Xiting Cao, Sana Raoof, A. Mark Fendrick, A. Burak Ozbay, Paul Limburg, Tomasz M. Beer, Ashish Deshmukh, Andrew Briggs. The potential of multi-cancer early detection screening for reducing cancer mortality [abstract]. In: Proceedings of the AACR Special Conference: Liquid Biopsy: From Discovery to Clinical Implementation; 2024 Nov 13-16; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(21_Suppl):Abstract nr PR006.

TC-Sniffer: A Transformer-CNN Bibranch Framework Leveraging Auxiliary VOCs for Few-Shot UBC Diagnosis via Electronic Noses.

Utilizing electronic noses (e-noses) with pattern recognition algorithms offers a promising noninvasive method for the early detection of urinary bladder cancer (UBC). However, limited clinical samples often hinder existing artificial intelligence (AI)-assisted diagnosis. This paper proposes TC-Sniffer, a novel bibranch framework for few-shot UBC diagnosis, leveraging easily obtainable UBC-related volatile organic components (VOCs) as auxiliary classification categories. These VOCs are biomarkers of UBC, helping the model learn more UBC-specific features, reducing overfitting in small sample scenarios, and reflecting the imbalanced distribution of clinical samples. TC-Sniffer employs intensity-based augmentation to address small sample size issues and focal loss to alleviate model bias due to the class imbalance caused by auxiliary VOCs. The architecture combines transformers and temporal convolutional neural networks to capture long- and short-range dependencies, achieving comprehensive representation learning. Additionally, feature-level constraints further enhance the learning of distinctive features for each class. Experimental results using e-nose data collected from a custom-designed sensor array show that TC-Sniffer significantly surpasses existing approaches, achieving a mean accuracy of 92.95% with only five UBC training samples. Moreover, the fine-grained classification results show that the model can distinguish between nonmuscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC), both of which are subtypes of UBC. The superior performance of TC-Sniffer highlights its potential for timely and accurate cancer diagnosis in challenging clinical settings.

Intestinal Incarceration and Strangulation by the Median Ligament of the Urinary Bladder in a Dog

A 4.5-year-old female spayed, mixed-breed (Beagle X Cavalier King Charles Spaniel) presented with acute onset of vomiting and abdominal pain. The dog had undergone an exploratory celiotomy for comparable symptoms 9 months earlier, with no aetiology identified. Computed tomography (CT) was highly suggestive of mechanical obstruction of the small intestine. An exploratory celiotomy was performed and identified strangulation of the jejunum by a rent within the median ligament of the urinary bladder. It was hypothesised the rent formed secondary to previous surgical trauma. Complete excision of the median ligament resulted in resolution of clinical signs. This report emphasises the importance of minimising the formation of mesenteric rents when performing abdominal surgery.

Using large administrative data for mining patients' trajectories for risk stratification: An example from urological diseases.

To identify latent clusters among urological patients by examining hospitalisation rate trajectories and their association with risk factors and outcome quality indicators. Victorian Admitted Episodes Dataset, containing information on all hospital admissions in Victoria from 2009 to 2019. The top twenty ICD-10 primary diagnosis codes in urology were used to select patients (n = 98,782) who were included in the study. Latent class trajectory modelling (LCTM) was used to cluster urological patient hospitalisation trajectories. Logistic regression was used to find baseline factors that influence cluster membership, the variables tested included comorbidities, baseline diagnosis codes, and socio-demographic factors. The analysis was further stratified into non-surgical procedures and surgical procedures. Five clusters of hospitalisation trajectories were identified based on clustering hospitalisation rates over time. Higher hospitalisation clusters were strongly associated with longer length of stay, higher readmission rates and higher complication rates. Higher-risk groups were strongly associated with comorbidities such as renal disease and diabetes. For surgical procedures, urological cancers (kidney, prostate and bladder cancer) and irradiation cystitis were associated with higher-risk groups. For non-surgical procedures, calculus of the bladder, urethral stricture and bladder neck obstruction were associated with higher-risk groups. For patients with two or more admissions, liver cardiovascular disease and being diagnosed with benign prostatic hyperplasia were also associated with higher risk groups. A novel statistical approach to cluster hospitalisation trajectories for urological patients was used to explore potential clusters of patient risks and their associations with outcome quality indicators. This study supports the observation that baseline comorbidities and diagnosis can be predictive of higher hospitalisation rates and, therefore, poorer health outcomes. This demonstrates that it is possible to identify patients at risk of developing complications, higher length of stay and readmissions by using baseline comorbidities and diagnosis from administrative data.

Evaluation of Standard Wire Loop Method in Determination of Significant Bacteriuria among Pregnant Women in Ekpoma

Standard wire loop method is a time-tested method for UTI diagnosis. The term "bacteriuria" means the presence of bacteria in urine. It may result from contamination during or after collection of urine or it may indicate the presence of bacteria in the bladder urine. There are several cultural quantitative techniques for determining bacteriuria but standard wire loop method is the most popular method though relatively simple and cheap. This study was carried out to evaluate the standard wire loop method for determination of significant bacteriuria among pregnant women in Ekpoma. A total of one hundred (100) early morning mid-stream urine samples from pregnant women attending antenatal clinics in Ekpoma and environs were collected aseptically using sterile, wide-mouthed, leak-proof universal bottles. Microscopic examination was carried out to detect the presence of pus cells, epithelial cells, red blood cells, yeast cells, crystals, parasites, bacteria and casts. Undiluted urine, 1:10and 1:1000 diluted urine samples were aseptically inoculated into blood agar and MacConkey agar using the Standard Loop method and compared with Miles and Mirsa method, it was incubated at 370C aerobically for 24 hours. After incubation colonies were counted and isolates identified by standard biochemical methods. Colony count of ≥105 CFU per ml were considered as significant growth. In vitro antibiotics susceptibility of bacterial isolates was determined using disc diffusion technique. The data generated was analyzed statistically using the chi-squared statistics to ascertain the significance of the results. Out of 100 urine samples collected 39(39%) samples yielded significant bacterial growth, while 61(61%) of the samples had no significant bacterial growth or no growth with higher prevalence in age group <25 years which is a sexually active group than in other age group ≤35 years which had incidence rate of 12 (25%). Standard loop method gave false positive rates of 4/35 (11.4%) and false negative rates of 4/36 (11.1%). The standard loop was found to have a sensitivity of 100%, specificity of 88.9% and identical results in 76.3% of the samples. To reduce bacteriuria and consequently prevent UTIs, it is necessary to take the precautions by doing regular routine check-ups and appropriate treatment. For large scale urine surveys the method chosen should be reasonably accurate, fast and simple to use. The materials required should be minimal, stable and easily transported. It is recommended that the method of choice for most laboratories is the standard loop method.

Use of the Martius Flap for Tethered Vagina Syndrome After a Single-Incision Mini-Sling Procedure.

Tethered vagina syndrome is an iatrogenic, but poorly defined condition that usually develops after surgical procedures performed on the anterior vaginal wall. Loss of elasticity as a result of scarring in the bladder neck-urethra is blamed for its pathogenesis. Patients often present with typical, massive uncontrollable urine loss and have specific examination findings. Having awareness about the diagnosis is important for its management. Surgical restoration and maintenance of bladder neck elasticity are essential for treatment. In our case, we presented the surgical approach we applied to tethered vagina syndrome that developed after the single-incision mini-sling operation. We demonstrated the surgical technique of Martius flap transposition and showed that this flap can be used to maintain the elasticity of the bladder neck area of the vagina.

A Study Of Association Of Intra-Abdominal Pressure With Severity And Outcome In Patients Of Emergency Laparotomy

Introduction: The present study is done to study the association of intra-abdominal pressure with intra-operative findings and postoperative surgical complications in patients of emergency laparotomies so that timely and appropriate interventions can be planned and administered. Methods: The study was done on 84 patients. The intra-abdominal pressure was measured indirectly by measuring the pressure within the urinary bladder via Foley's catheter. Results: There was positive association between the higher grades of IAP and intra-abdominal contamination and gangrenous bowel, the mean value of IAP being 20.4 mmHg. A statistically positive association was also observed between preoperative IAP and post-operative complications, the mean IAP ≥19mmHg. Conclusion: There is a significant positive association of raised pre-operative intra-abdominal pressure with intra-operative finding of gangrenous and edematous bowel and postoperative surgical complications.

DEVELOPMENT OF THE PERINEUM STRUCTURES IN THE EMBRYONIC AND PREFETAL PERIODS

Traditionally, it is believed that the division of the cloaca into the ventral genitourinary pert and the dorsal - ureteric part occurs at the expense of the urorectal septum during the fourth week of intrauterine development. The separation of the cloaca finally ends during the sixth week of fetal development, with the fusion of the urorectal septum with the cloaca membrane. During the seventh week, both departments become separate entities. However, a significant cohort of authors question the traditional view of the mechanisms of cloacal separation.Purpose to establish and visualize the mechanism of cloaca division; to resolve the controversy regarding the role of the urorectal septum in the separation of the cloaca; to reveal the beginnings of future organ complexes of the male perineum.Material and method. Series of sections of 15 embryo preparations (4-7 weeks of gestational age; 4.5-13.5 mm. PCL) and 15 preparations of pre-fetus (7-9 weeks of gestational age; 14.0-35.0 mm. PCL) were studied by the methods of morphological research: microscopy, morphometry. In order to more accurately visualize and understand the processes of formation of the structures of the male perineum, the method of three-dimensional visualization was used.The results of own research. We found a significant number of mitotic divisions in the dorsal and lateral parts of the mesodermal tissue around the cranial part of the cloaca, but the absence of mitotic divisions was observed in the cells of the mesodermal tissue of the urogenital septum. The urorectal septum becomes visible after the cloacal folds separate the cloaca from the hindgut, distal to the junction between the mesonephric ducts and the cloaca. We established that from the 36th day of intrauterine development, an abdominal cavity is formed, which is located inside the urorectal septum and extends in the caudal direction distally from the point of entry of the mesonephric ducts to the middle of the distance between the entrance of the mesonephric ducts and the caudal top of the urorectal septum. On the 41st day of intrauterine development, parts of the mesonephric ducts, which are located between the cloaca and the ureteric buds, gradually disappear. Thus, both ureters and mesonephric ducts have a common entrance to the genitourinary sinus. Taking into account our observations, it should be noted that the division of the cloaca is a direct consequence of the growth and increase in the volume of the mesenchymal tissue that surrounds the cloaca and, especially in the later stages, its ventral part - the genitourinary sinus. During the 6-9th week of intrauterine development, the genitourinary sinus and urinary bladder are formed along with the demarcation of the mesonephric ducts and ureters.Conclusions. We identified three main structures that indirectly affect the division of the cloaca: after the formation of the urorectal septum, a decrease in the frequency of mitotic divisions of the latter is noted, which indicates its temporary and initial role in the division of the cloaca. Disproportionate growth and increase in the volume of mesenchymal tissue of the ventral part and dorsal part of the cloaca significantly affects the change in its shape and its division. The urorectal septum is not a single, separate structure and extends laterally. Finally, role of the abdominal cavity in the distribution of the cloaca is uncertain.

Pediatric Reconstruction of Full-Thickness Dog Bite Scalp Avulsion with a Combination of Acellular and Matrix Products: A Case Report

The reconstruction of large full-thickness scalp injuries represents a great challenge in pediatric plastic surgery. Epidermal–dermal substitutes come to the rescue when traditional surgical strategies are not suitable. Recently, the new Integra MicroMatrix UBM particulate has arisen on the market. This is an extracellular matrix derived from the porcine urinary bladder matrix (UBM) in which the particulate structure provides close contact to the wound bed. We present the concomitant application of Integra DRT and MicroMatrix for the reconstruction of a full-thickness subtotal scalp defect in a child mauled by a dog.

Validation of Radiosynthesis and First in-Human Dosimetry of 68Ga-NOTA-UBI-29-41: A Proof of Concept Study.

Background: Antimicrobial peptides (AMPs) such as UBI-29-41 offer a distinctive approach for precise detection due to their unique interactions with bacteria and makes them promising candidates for specific and selective imaging. The study was aimed to corroborate the in-house manual synthesis of 68Ga-NOTA-UBI-29-41, evaluate its uptake in patients with suspected infection, and estimate of patient-specific dosimetry to ensure optimal clinical application. Materials and Methods: 68Ga-NOTA-UBI-29-41 was synthesized by using a variable amount of UBI-29-41 (60-90 μg) to 555 MBq of Ga-68 in 0.05 M Hydrochloric acid (HCl) and heating the reaction sample for 12 min at 90°C at pH: 3.5-4 to obtain the radiopeptide with high yield and high radiochemical purity (RCP). 68Ga-NOTA-UBI-29-41 positron emission tomography/Computed tomography (CT) scans at variable timepoints were done to evaluate its biodistribution and maximum uptake time. Furthermore, patient-specific dosimetric estimation was done using the HERMES software. Results: A total of 5 μg/37 MBq (5 μg/mCi) of NOTA-UBI-29-41 for 12 min at 90°C were the optimal parameters to obtain 88%-90% of yield and 98%-99 % of RCP. 68Ga-NOTA-UBI-29-41 showed expeditious blood clearance and high renal excretion. The optimal time for imaging of infection with 68Ga-NOTA-UBI-29-41 was found to be at 60 min postinjection (n = 8). The critical organ was the urinary bladder, receiving an average dose of 138.02 ± 45.92 µSv/MBq, followed by 53.81 ± 13.72 µSv/MBq for kidneys with a mean effective dose of 1.52 ± 0.64 mSv. Conclusion: The protocol for in-house manual labeling of 68Ga-NOTA-UBI-29-41 was reproducible, providing high yield and RCP. 68Ga-NOTA-UBI-29-41 administration was found to be safe and nontoxic. The favorable biodistribution and the first-in-human patient-specific dosimetry ensure optimal clinical application.

Outcomes of nephrostomy and double J stent in malignant ureteral obstruction in the Palestinian practice

BackgroundMalignant ureteral obstruction (MUO) is a serious health condition in which a malignant tumor compresses the ureter. The optimal decompressive intervention in MUO remains unclear. This study was conducted to assess and compare renal function, the occurrence of ureterohydronephrosis (UHN), intraoperative, and postoperative complications among patients with MUO who underwent double J stenting (DJS) and percutaneous nephrostomy (PCN) in the Palestinian practice.MethodsThis study was conducted in retrospective design in one of the main tertiary care hospitals in the West Bank of Palestine. The data were collected from the electronic health information system of the hospital for the patients with MUO who received either DJS or PCN as a decompressive intervention from January 2018 to January 2024.ResultsIn this retrospective analysis, 62 patients who had stage 2 to stage 4 cancer and suffered MUO were included. The mean age of the patients was 60.8 ± 13.6 years. Of the patients, 40 (64.5%) were male and 22 (35.5%) were female. Of the patients, 26 (41.9%) had urinary bladder cancer. Of the patients, 23 (37.1%) had flank pain and 16 (25.8%) had lower urinary tract symptoms. Of the patients, 34 (54.8%) experienced bilateral UHN and 28 (45.2%) experienced unilateral UHN. In this study, 43 patients (69.4%) received PCN, and 19 (30.6%) received DJS as a decompressive intervention. Of the patients, 36 (58.1%) suffered postoperative complications. Stent migration/slip, UTIs, and urosepsis were the most commonly reported postoperative complications. There were no statistically significant differences in the occurrence of intraoperative complications, postoperative complications, time elapsed from receiving the decompression intervention to the diagnosis of complications, ICU admission, prognosis of UHN, serum creatinine, and serum BUN between both decompressive interventions.ConclusionDespite improvements in renal functions, creatinine and BUN levels remained abnormal even after receiving a decompressive intervention. Postoperative complications were frequently reported among patients who received DJS or PCN as decompressive interventions. Larger prospective studies are still needed to determine the optimal interventions to improve outcomes, quality of life, and survival rates of patients with DJS or PCN.

Ureteroinguinal hernia: an added advantage for laparoscopy in the management of inguinal hernia—a case report

Different abdominal organs can herniate into the inguinal canal, including the small bowel, colon, appendix, ovaries, and, less commonly, the urinary bladder and fallopian tubes. Herniation of the ureter within an inguinal hernia is a very rare occurrence. To the best of our knowledge, less than 150 cases have been reported in the literature, including only 15 pediatric cases. A 3-month-old boy presented to our clinic with a left inguinal swelling. Ultrasound of the abdomen and pelvis showed grade 4 left hydronephrosis with a dilated tortuous ureter passing through the left inguinal canal. Further investigation revealed that the patient had a left primary obstructing megaureter with a ureteroinguinal hernia. The case was managed with laparoscopic repair of the inguinal hernia and urethrostomy. The current case proves an additional advantage for laparoscopy as it allows proper visualization of the anatomy and identification of atypical hernias, such as ureteroinguinal hernia.