Method Of Choice Research Articles

“The ones at the bottom of the food chain”: structural drivers of unintended pregnancy and unsafe abortion amongst adolescent girls in Zambia

BackgroundAccess to safe abortion care is highly unequal and fundamentally rooted in socioeconomic inequalities which are amplified by restrictive social norms and legal systems. We analyse these inequalities along the reproductive health continuum amongst adolescent girls in Zambia.MethodologyThis paper draws from 20 focus group discussions conducted in 2021 with community members (young/adult) in five urban, peri urban, and rural sites in Zambia. Data was analysed using thematic analysis.ResultsAdolescent pregnancy in the community was reported to be very common across the communities with girls from poorer families being disproportionately affected. Parents were reported to be complicit in facilitating their daughter’s sexual-economic exchanges which emerged as a key driver of pregnancies. Young age and unmarried status meant adolescent girls could face triple stigma: stigma around accessing contraception to prevent a pregnancy, stigma in experiencing an unintended pregnancy and stigma around terminating an unintended pregnancy. There were clear socioeconomic differences in adolescent girl’s exposure to community and health provider censure and/or acceptance of their pregnancy, and in their ability to conceal an abortion. Having the means to pay for health care allows some adolescents to seek terminations earlier and to access private health facilities while poorer adolescent girls face greater exposure to community censure through their embeddedness within the community. Abortions in this group attracts greater visibility through complications arising from their constrained choice for safe abortion methods. Stigmatising attitudes of community members also undermined adolescents’ reproductive agency and mental health. For adolescents who choose to keep an unintended pregnancy, reintegration into school was highly challenging despite a national policy in place, with marriage being viewed as the only future option for poorer teenage mothers.ConclusionThe embeddedness of adolescent pregnancies within community structures of economic insecurity and gendered and age-related power relations highlight the importance of introducing community level approaches to tackle unintended pregnancies and unsafe abortion. Understanding teenage pregnancy as a community issue creates opportunities for community level support to young girls especially when they return to school.

MicroRNA profile of endometrial cancer from Indian patients-identification of potential biomarkers for prognosis

Endometrial cancer is one of the major cancers in women throughout the world. If diagnosed early, these cancers are treatable and the prognosis is usually good. However, one major problem in treating endometrial cancer is accurate diagnosis and staging. Till date, the choice method for diagnosis and staging is histopathology. Although there are few molecular markers identified, they are not always sufficient in making accurate diagnosis and deciding on therapeutic strategy. As a result, very often patients are under treated or over treated. In this study, our group has profiled microRNAs from Indian patients using NGS-based approach. We have identified 212 differentially expressed microRNAs in endometrial cancer. Among these, there are 17 novel miRNAs. Since this data represents only Indian cohort and also lacks survival data, validation across other populations is necessary before being considered as biomarkers. As one approach towards this, these microRNAs have also been compared to data from TCGA, which represent other populations and also correlated to relevance in overall survival. Using in-silico approaches, mRNA targets of the miRNAs have been predicted. After comparing with TCGA, we have identified 16 miRNA-mRNA pairs which could be potential prognostic biomarkers for endometrial cancer. This is the first miRNA profiling report from Indian cohort and one of the very few studies which have identified potential biomarkers of prognosis in endometrial cancer.

Mixed effects models but not t-tests or linear regression detect progression of apathy in Parkinson’s disease over seven years in a cohort: a comparative analysis

IntroductionWhile there is an interest in defining longitudinal change in people with chronic illness like Parkinson’s disease (PD), statistical analysis of longitudinal data is not straightforward for clinical researchers. Here, we aim to demonstrate how the choice of statistical method may influence research outcomes, (e.g., progression in apathy), specifically the size of longitudinal effect estimates, in a cohort.MethodsIn this retrospective longitudinal analysis of 802 people with typical Parkinson’s disease in the Luxembourg Parkinson's study, we compared the mean apathy scores at visit 1 and visit 8 by means of the paired two-sided t-test. Additionally, we analysed the relationship between the visit numbers and the apathy score using linear regression and longitudinal two-level mixed effects models.ResultsMixed effects models were the only method able to detect progression of apathy over time. While the effects estimated for the group comparison and the linear regression were smaller with high p-values (+ 1.016/ 7 years, p = 0.107, -0.056/ 7 years, p = 0.897, respectively), effect estimates for the mixed effects models were positive with a very small p-value, indicating a significant increase in apathy symptoms by + 2.345/ 7 years (p < 0.001).ConclusionThe inappropriate use of paired t-tests and linear regression to analyse longitudinal data can lead to underpowered analyses and an underestimation of longitudinal change. While mixed effects models are not without limitations and need to be altered to model the time sequence between the exposure and the outcome, they are worth considering for longitudinal data analyses. In case this is not possible, limitations of the analytical approach need to be discussed and taken into account in the interpretation.

Modern features of diagnosis and surgical treatment of occlusive hydrocephalus in infants

The article reviews national and international studies that address current issues in the diagnosis and surgical management of occlusive hydrocephalus in infants. Currently, there is a considerable amount of work describing the clinical manifestations and pathogenesis of occlusive hydrocephalus, particularly in infants. However, there is a lack of evidence regarding the early diagnosis and choice of surgical treatment of occlusive hydrocephalus in infants. In recent years, with the introduction of diagnostic techniques such as ultrasound, CT and MRI, significant progress has been made in understanding the clinical features and course of occlusive hydrocephalus. However, a universal algorithm of diagnostic approaches for young children has not yet been developed. The method of choice for surgical treatment of occlusive hydrocephalus in infants is still controversial. The complexity lies in the variety of clinical courses and combinations of causes leading to this pathology. Therefore, the creation of a systematic approach in terms of diagnosis and surgical treatment allows to choose the right method of surgical treatment depending on the aetiology of this pathology.

Modification of proximal row carpectomy (PRC) technique for adaptive wrist collapse (pilot study)

Introduction Proximal carpal row resection has been used for many decades as a “salvage procedure” for progressive wrist collapse. Improving the technique of its implementation, as well as introducing various modifications of the technique into practice are an important area for achieving better results of surgical treatment.The purpose of this work was to demonstrate aspects of the modified proximal row carpectomy (PRC) technique and the immediate results of its use.Materials and methods Eight patients aged from 24 to 57 years (seven men and one woman) were treated with the modified PRC technique. Treatment results were assessed using an adapted QuickDASH questionnaire, a visual analogue scale (VAS), based on patient satisfaction and radiographic results.Results The average duration of surgical intervention was (149.0 ± 35.5) minutes. In the postoperative period, six patients (75 %) underwent fixation with an Ilizarov apparatus, the rest with a plaster splint. The average range of motion of flexion and extension was (67.5 ± 18.3)°, range: 40–95°. The patients had an average of (35.6 ± 16.13)° extension, range: 10–65° and (31.87 ± 10.9)° flexion, range: 10–45°. Patients reported decreased grip strength after surgery. Pain syndrome according to VAS at rest was equal to 0–1 points and 3–4 points when the affected limb was loaded. Six patients completed the QuickDASH survey, with a mean score of (14.83 ± 4.25) points. All patients are satisfied with the result of treatment and the absence of pain at rest. Patients returned to their usual work.Discussion Unlike the conventional dorsal approach through the III–IV tendon canals, the use of two mini-approaches provides a better cosmetic effect and makes it easier to restore the integrity of the tendon canals, which are important for the prevention of desmogenic contractures. The use of the Ilizarov apparatus has proven to be the method of choice, providing absolute stability and reduction of pain in the postoperative period. For patients under 45 years of age with increased functional demands, a balanced approach is required when choosing PRC or intercarpal arthrodesis, depending on which functional parameters are more important to the patient.Conclusion The analysis of short-term results of using the modified PRC technique shows that it reduces the invasiveness of the operation, improves its esthetic result, provides pain relief and a satisfactory range of motion and grip strength.

Comparative Evaluation of UV-Vis Spectroscopy-Based Approaches for Hemoglobin Quantification: Method Selection and Practical Insights.

The growing demand for effective alternatives to red blood cells (RBCs) has spurred significant research into hemoglobin (Hb)-based oxygen carriers (HBOCs). Accurate characterization of HBOCs-including Hb content, encapsulation efficiency, and yield-is crucial for ensuring effective oxygen delivery, economic viability, and the prevention of adverse effects caused by free Hb. However, the choice of quantification methods for HBOCs is often driven more by tradition than by a thorough assessment of available options. This study meticulously compares various UV-vis spectroscopy-based methods for Hb quantification, focusing on their efficacy in measuring Hb extracted from bovine RBCs across different concentration levels. The findings identify the sodium lauryl sulfate Hb method as the preferred choice due to its specificity, ease of use, cost-effectiveness, and safety, particularly when compared to cyanmethemoglobin-based methods. Additionally, the study discusses the suitability of these methods for HBOC characterization, emphasizing the importance of considering carrier components and potential interferences by analyzing the absorbance spectrum before selecting a method. Overall, this study provides valuable insights into the selection of accurate and reliable Hb quantification methods, which are essential for rigorous HBOC characterization and advancements in medical research.

Remote sensing of artisanal and small-scale mining: A review of scalable mapping approaches

Artisanal and small-scale mining (ASM) significantly influences the socio-economic development of many low-to-middle-income countries, albeit sometimes at the expense of environmental and human health. Characterized by its labor-intensive extraction from confined (<5 ha) or peripheral mineral reserves, congregated ASM practices can rival the spatial footprint of industrial mines. The unregulated and informal nature of many ASM activities presents monitoring challenges that remote sensing (RS) methods aim to address. While local-scale ASM mapping has seen success, scaling these methods to regional or global levels remains unclear. We review literature on mapping ASM to determine: (1) if studies represent the global distribution and diversity of ASM activities, (2) how ASM's unique characteristics influence the choice of RS methods, and (3) which RS approaches are the most accurate and cost-effective. We found current studies disproportionately focused on ASM regions in Africa, which highlights the need to extend the research to other regions with unique ASM characteristics, such as coal and sand mining in India and China. The selection of RS approaches is heavily influenced by local ASM contexts, the scale of analysis, and resource constraints such as funding for high-resolution imagery and validation data availability. We argue that accurate regional-scale ASM mapping (>100,000 km2) requires innovative combinations of data and methods to overcome data management and storage challenges. Local community participation, including miners, is vital for on-ground mapping and monitoring capacity. We outline a research agenda needed to develop a range of approaches for mapping and monitoring ASM in under-studied regions. By synthesizing effective methods, we provide a foundation for generating accurate and comprehensive spatial data, addressing the issues of inaccurate and incomplete data that global ASM platforms aim to resolve. This spatial data can guide policymakers, NGOs, and businesses in making informed decisions and targeted interventions to improve ASM sector safety, sustainability, and efficiency. Leveraging cloud-based geoprocessing platforms, with regularly updated global satellite image archives, combined with crowd-sourced on-ground information offers a potential solution for sustained regional-scale monitoring.

Diagnostic management of acute pulmonary embolism

Straightforward, accurate diagnostic management in patients presenting with clinically suspected pulmonary embolism (PE) is essential, since starting anticoagulant treatment may give important adverse effects of bleeding, while false exclusion of the disease may lead to recurrent VTE, with associated morbidity and mortality. In the past three decades, considerable improvement in the diagnostic management of PE has been made. Computed tomography pulmonary angiography (CTPA) has largely replaced conventional pulmonary angiography and ventilation-perfusion lung scanning as the imaging methods of choice. Several diagnostic algorithms, all able to minimize the need for radiological imaging have been developed and validated. Lastly, within the diagnostic algorithms, varying d-dimer cut-off levels have successfully been introduced to further downsize the need for radiological imaging.

Super-efficient exact Hamiltonian Monte Carlo for the von Mises distribution

Markov Chain Monte Carlo algorithms, the method of choice to sample from generic high-dimensional distributions, are rarely used for continuous one-dimensional distributions, for which more effective approaches are usually available (e.g. rejection sampling). In this work we present a counter-example to this conventional wisdom for the von Mises distribution, a maximum-entropy distribution over the circle. We show that Hamiltonian Monte Carlo with Laplacian momentum has exactly solvable equations of motion and, with an appropriate travel time, the Markov chain has negative autocorrelation at odd lags for odd observables and yields a relative effective sample size bigger than one.

Data analysis and review of the research landscape in performance-enhancing thermal management strategies of photovoltaic technology

New researchers in Performance-Enhancing Thermal Management Strategies (PETS) for photovoltaic (PV) technology struggle with scattered data, hindering their efforts. This research gap is addressed by extracting key information from 1,474 documents in the Web of Science and Scopus databases and conducting a thorough data analysis. The findings reveal three phases of the trend inception, gradual growth period, tech-advanced period, and rapid progress. The bibliometric results show a 24.98% growth rate, 25.01 citations per document, 2,577 researchers involved, and 275 production sources. China, India, and other Asian countries are the main collaborators in this field, emphasizing the impact of hot climate regions in Asia on the choice of PETS methods. The main researchers collaborating with PETS are Sopian. K, Jie Ji, and Pie Gang. Furthermore, a review of keywords suggests that most experimental and numerical studies have prioritized temporal and performance outcomes, often neglecting long-term practical viability considerations. Future research should prioritize the 4E (Energy, Exergy, Economic and Environmental) analysis approach to address this gap effectively. Advancements in evaporative cooling and PVT technology have evolved in offshore solar plants, PV with heat pumps, and building-integrated PV (BIPV). This analysis sets the stage for future PV advancements in PETS technology.

Specific back pain - effective diagnosis and treatment from the radiologist's point of view.

The diagnosis and treatment of specific back pain is important in radiology. Due to the high number of patients suffering from back pain, it is important to provide excellent diagnostic and therapeutic support.Based on a recent literature search and considering the relevant guidelines as well as expert opinions, the aspects of specific back pain important for radiologists in terms of pathogenesis, diagnosis, and treatment are presented.Clinical examination in combination with the medical history provides a valid suspected diagnosis. This should subsequently be verified radiologically. MRI is the most effective cross-sectional diagnostic method for investigating specific back pain. A conventional X-ray on two planes in a standing position can be a useful addition if postural causes are suspected. If the clinical symptoms match the morphological findings, radiological treatment can be carried out for nerve root involvement as well as for inflammatory changes of the facet joints. The improvement in symptoms after radiological therapy is considered good overall; at least a short-term improvement in symptoms can generally be achieved, but no reliable data is available regarding the long-term outcome. Using preparations containing triamcinolone, low dosages should be selected in accordance with the guidelines. Embedding in a multimodal pain therapy treatment concept should be considered.Radiology provides essential diagnostic findings regarding specific back pain. Interventional pain therapy is an effective and safe method of treating proven specific back pain. · First examine clinically, then confirm the suspected diagnosis radiologically.. · MRI is usually the method of choice.. · Interventional pain therapy should show success after a maximum of 2 interventions.. · The anti-inflammatory drug dose should be kept as low as possible.. · The individual course determines the number of interventions.. · Stueckle CA, Haage P. Specific back pain - effective diagnosis and treatment from the radiologist's point of view. Fortschr Röntgenstr 2024; DOI 10.1055/a-2371-1752.

Development of mental regulation of students' psychological states during the learning process

The article presents the results of a study of the development of mental regulation of students’ psychological states during their studies at a university. This work is based on authors’ conceptual model of the structural and functional organization of psychological states’ mental regulation. The study was carried out at the initial and final stages of students’ education in everyday and stressful situations of academic activity covering the period from 2019 to 2023. Methods and effectiveness of psychological state self-regulation were studied using well-known valid methods and specially designed questionnaires. Mental structures such as reflection, life meaning orientation, and self-system, as well as individual regulatory properties studied outside educational situations in first (2018) and fourth years (2022) of study were investigated. As a result of the study, it was established, that, regardless of the situation of educational activity, psychological states acquire greater stability (equilibrium) by the senior year of study, which is associated with the effectiveness of states’ self-regulation. Changes in mental structures from the initial course to the final of study are revealed in an increase in the intensity of their manifestations in all main indicators. It has been established that in both situations, during the learning process, students experience an increase in the involvement of mental structures (primarily reflexive) and regulatory properties in the regulation of psychological states. In each situation of educational activity and at each stage of training, there were identified the leading structures of consciousness, determining the choice of self-regulation methods, which, in turn, are associated with the substructures of psychological states. It has been also stablished that from the initial stage of study to the final one, there is an increase in the number of methods used for states’ self-regulation, as well as their relationships with mental structures and regulatory properties of the personality, which indicates the development of a system of mental regulation of students’ psychological states.

The role of the “history effect” in the formation of the expected result in the problem-solving process

The article presents the results of a study of the development of mental regulation of students’ psychological states during their studies at a university. This work is based on authors’ conceptual model of the structural and functional organization of psychological states’ mental regulation. The study was carried out at the initial and final stages of students’ education in everyday and stressful situations of academic activity covering the period from 2019 to 2023. Methods and effectiveness of psychological state self-regulation were studied using well-known valid methods and specially designed questionnaires. Mental structures such as reflection, life meaning orientation, and self-system, as well as individual regulatory properties studied outside educational situations in first (2018) and fourth years (2022) of study were investigated. As a result of the study, it was established, that, regardless of the situation of educational activity, psychological states acquire greater stability (equilibrium) by the senior year of study, which is associated with the effectiveness of states’ self-regulation. Changes in mental structures from the initial course to the final of study are revealed in an increase in the intensity of their manifestations in all main indicators. It has been established that in both situations, during the learning process, students experience an increase in the involvement of mental structures (primarily reflexive) and regulatory properties in the regulation of psychological states. In each situation of educational activity and at each stage of training, there were identified the leading structures of consciousness, determining the choice of self-regulation methods, which, in turn, are associated with the substructures of psychological states. It has been also stablished that from the initial stage of study to the final one, there is an increase in the number of methods used for states’ self-regulation, as well as their relationships with mental structures and regulatory properties of the personality, which indicates the development of a system of mental regulation of students’ psychological states.

A statistical simulation model to guide the choices of analytical methods in arrayed CRISPR screen experiments.

An arrayed CRISPR screen is a high-throughput functional genomic screening method, which typically uses 384 well plates and has different gene knockouts in different wells. Despite various computational workflows, there is currently no systematic way to find what is a good workflow for arrayed CRISPR screening data analysis. To guide this choice, we developed a statistical simulation model that mimics the data generating process of arrayed CRISPR screening experiments. Our model is flexible and can simulate effects on phenotypic readouts of various experimental factors, such as the effect size of gene editing, as well as biological and technical variations. With two examples, we showed that the simulation model can assist making principled choice of normalization and hit calling method for the arrayed CRISPR data analysis. This simulation model is implemented in an R package and can be downloaded from Github.

KEY PRINCIPLES OF FUNDAMENTALIZATION ASSESSMENT OF THE QUALITY OF KNOWLEDGE OF FUTURE PHYSICS TEACHERS

The article defines and characterizes a number of key principles of fundamentalization of the assessment of the quality of knowledge of future physics teachers: effective monitoring, generalization of knowledge, complexity, phasing, technological innovations, strategic planning, active use of scientific and pedagogical knowledge. Thus, the principle of effective monitoring involves taking into account three main aspects of monitoring, which are important in the context of improving the quality of student training in the university environment (organizational-management, procedural-didactic, intra-personal) and implements a number of management functions of monitoring the quality of knowledge of future physics teachers through planning and forecasting, organizational leadership, administrative activities, motivational measures, control and diagnostic measures, information analysis. The principle of generalization of knowledge as a key principle of foundationalization of the assessment of the quality of knowledge of future physics teachers is aimed at determining the necessary minimum knowledge that will allow the specialist to successfully solve the professional tasks facing him in modern society. The principle of complexity provides orientation to the evaluation of the quality of the educational process by components (target, motivational, content, operational-activity, control-regulatory, evaluation-resultative) and compliance with a number of requirements when evaluating the quality of knowledge of future physics teachers (planning, systematicity and systematicity, objectivity, openness and transparency, economy, subject matter, taking into account the individual capabilities of students, unity of requirements). The principle of phasing as a principle of foundationalization of the quality of knowledge assessment of future physics teachers implies that this process should be considered as the creation of a holistic system of evaluation of the professional activity of future physics teachers, which meets the standard of higher education, which includes the professionalization stage, the foundationalization stage and the stage of practical readiness. The principle of technological innovation involves the selection of new methods, means and forms of organization for assessing the quality of knowledge of future physics teachers, thereby designing an innovative system for assessing the fundamental knowledge of physics students. The principle of strategic planning provides: the orientation of the process of professional training of physics teachers on the development of the personality of the future specialist through the creation of an objective evaluation system in the context of academic integrity; development of a strategic evaluation plan; compliance of the didactic process with modern trends in the development of science, technology and educational and scientific trends; optimal combination of various forms and methods of assessing the quality of knowledge of future physics teachers; rational application of digital tools for assessing the quality of knowledge at various stages of training at the university; compliance of the training results of future physics teachers with the requirements set forth by the field of their professional activity, ensuring their competitiveness in the market of educational services. The principle of active use of scientific and pedagogical knowledge provides that the creation of a system for assessing the quality of knowledge of future physics teachers should reflect the current state of pedagogical science in the context of monitoring the quality of education, predict future directions and prospects for development, as well as consider cause-and-effect relationships, interrelationships and the influence of the content of professional training on program results at the level of theoretical generalizations. It was found that the process of assessing the quality of knowledge of future physics teachers is planned as follows: conduct an analysis of the course (each educational component) to develop an assessment that will meet the goals and methods of the course; drawing up a calendar plan for control, which covers different stages of training: before the start, during training and at the end of the course; the choice of control methods that correspond to the goals and phases of control; selection of assessment tools, such as tests, surveys, problem-solving, in particular, tools based on the use of digital technologies; determining the weight of the current control in the final result.

Strategies for the Sustainable Management of Solid Waste from Sinfra's Urban Hotel Establishments

Located in the Marahoué region in the central-west of Côte d'Ivoire, the town of Sinfra is a victim of inappropriate hotel waste management. This poor management of solid waste from hotel establishments has repercussions on the environment of this urban area, which is exposed to an abundance of rainfall. The aim of this study is to propose actions and strategies to mitigate the impact of poor hotel waste management. The methodology used is based on documentary research and field surveys supported by semi-directive interviews, questionnaires and direct observation.Systematic random sampling was used, which made it possible to include half of the city's hotel establishments. The reasoned choice method was used to target the hotels to be surveyed on the basis of certain criteria. The results showed that in the town of Sinfra, 45% of hotels dispose of their waste in unauthorised dumps and collection sites, 33% of hotels entrust their waste to pre-collectors and 22% of hotels have their waste collected by municipal services. This situation has given rise to environmental problems affecting people's quality of life. In response, solutions have been proposed for the sustainable management of hotel waste. These include supporting hotel managers in changing their practices, setting up and encouraging waste recovery channels and creating appropriate solid waste management infrastructures.

How consumers process online hotel ratings

Online travel agencies commonly utilize 5-point and 10-point scales to display hotel ratings. When processing and comparing hotel ratings on different numerical scales (e.g., 4.1/5 vs. 8.4/10), what method(s) do consumers use? Through nine studies, this research shows that consumers tend to employ absolute differences (e.g., 5–4.1 vs. 10–8.4) or relative differences (e.g., 4.1 ÷ 5 vs. 8.4 ÷ 10) when making comparative judgments. Notably, the choice of method can lead to preference reversals. We further reveal that higher numeracy leads to greater reliance on relative differences. However, such an impact is attenuated under a utilitarian motive. Additionally, a greater promotion focus leads to greater reliance on absolute differences. The findings contribute to a more nuanced understanding of how consumers process hotel ratings.

METHODS OF ORAL HYGIENE FOR CRITICAL PATIENTS IN INTENSIVE CARE UNIT. A REVIEW

Background: currently, the problem of the effectiveness and quality of oral hygiene is very relevant, however, for patients in the intensive care unit (ICU) this is extremely important issue. Purpose: to study, according to the literature sources, the state of oral hygiene for patients in the ICU, with the use of various antiseptics and methods. Methods: a literature search was conducted in the Scopus, Pubmed, Web of science, Elibrary, Google Scholar databases to study the issue of literature data on oral care methods for critical patients. Inclusion criteria: original peer-reviewed studies with a focus on evaluating the clinical effectiveness of oral care, published in the period 2000-2023. Results: most studies have found that oral hygiene in patients in the intensive resuscitation unit reduces the incidence of ventilator-associated pneumonia (VAP) but does not affect the duration of stay on artificial lung ventilation and mortality. The literature re-view included studies on the effectiveness of hydrogen peroxide n=2(10%), chlorhexidine n=10(50%), povidone iodine n=2(10%), phytopreparations n=4(20%). Conclusion: there is no universal and effective protocol for conducting the oral hygiene in the ICU patients, as well as recommendations on the choice of antiseptic, concentration and method of application. Further study of this issue is required.

Perineal prostate biopsy

The prostate biopsy is an essential tool for diagnosing prostate cancer (PCa). While transrectal biopsy (TR-Bx) continues to be considered the gold standard in Germany, the European Association of Urology (EAU) guidelines increasingly recommend transperineal biopsy (TP-Bx) due to lower infection rates and higher tumor detection rates. This article provides an overview of the history and development of the perineal biopsy, compares TR-Bx and TP-Bx and discusses the need for antibiotic prophylaxis before TP-Bx. Current studies have shown that TP-Bx can be performed without antibiotic prophylaxis and new techniques such as robotic-assisted and vector biopsy show very precise results. The establishment of TP-Bx is being promoted by extrabudgetary funding and technological advancements, with the choice of biopsy method remaining an individual decision jointly made in dialogue with the patient.

Severity-adjusted evaluation of initial dialysis on short-term health outcomes in urea cycle disorders

ObjectiveIn individuals with urea cycle disorders (UCDs) and neonatal disease onset, extracorporeal detoxification by continuous kidney replacement therapy is considered the therapeutic method of choice in addition to metabolic emergency treatment to resolve hyperammonemic decompensation. However, the indications for the initiation of dialysis are heterogeneously implemented transnationally, thereby hampering our understanding of (optimal) short-term health outcomes. MethodsWe performed a retrospective comparative analysis evaluating the therapeutic effects of initial dialysis on survival as well as neurocognitive outcome parameters in individuals with UCDs in comparison to a severity-adjusted non-dialyzed control cohort. Overall, 108 individuals with a severe phenotype of male ornithine transcarbamylase deficiency (mOTC-D), citrullinemia type 1 (CTLN1) and argininosuccinic aciduria (ASA) were investigated by stratification based on a recently established and validated genotype-specific disease prediction model. ResultsMortality is associated with the height of initial peak plasma ammonium concentration, but appears to be independent from treatment with initial dialysis in mOTC-D. However, improved survival after initial dialysis was observed in CTLN1, while there was a trend towards improved survival in ASA. In survivors, annual frequency of (subsequent) metabolic decompensations did not differ between the dialyzed and non-dialyzed cohorts. Moreover, treatment with initial dialysis was not associated with improved neurocognitive outcomes. InterpretationThe present severity-adjusted comparative analysis reveals that general practice of initial dialysis is neither associated with improved survival in individuals with mOTC-D nor does it differ with regard to the neurocognitive outcome for the investigated UCD subtypes. However, initial dialysis might potentially prove beneficial for survival in CTLN1 and ASA.Clinical trial registration: The UCDC database is recorded at the US National Library of Medicine (https://clinicaltrials.gov).