Strict Selection Criteria Research Articles

Cerebral venous thrombosis: continental disparities.

Cerebral venous thrombosis (CVT) usually accounts for <1% of all strokes. Global disparity and diversity in their demographics, etiology, clinical features, radiological presentation, and mortality have not been previously explored. A systematic search was performed for publications in PubMed using key words "cerebral venous thrombosis," "Cerebral vein thrombosis," and "Cortical vein Thrombosis." A total of 600 relevant studies were abstracted with strict selection criteria, and a total of 7048 patient's data were used for the final analysis. The frequency and relative frequency statistics were used to describe the data. Cases reported were Europe-3152, Asia-2722, North America-852, Africa-122, Australia-121, and South America-79. Overall male to female ratio was 1:2.2; among clinical characteristics, headache was the most common symptom and hematological factors were the most common etiology. Location of the thrombosis was described mostly in the transverse sinus. Intercontinental differences in relation to demographics, etiology, clinical features, radiological presentation, and mortality were identified. CVT can have significant disparity in their demographics, etiology, clinical features, radiological presentation, and mortality when compared from one continent to other. It is important for the worldwide physicians to recognize these differences and to follow the most recent guidelines, diagnostic methods, and treatment to insure the best outcome and prognosis.

Non-intubated single-incision video-assisted thoracic surgery: a two-center cohort of 188 patients.

Non-intubated single-incision procedures are slowly expanding because of high experience and skill required, and stricter selection criteria. The aim of this study is to present the first retrospective two-center series in Taiwan and Spain. We performed a retrospective analysis of 188 patients undergoing non-intubated single-incision video-assisted thoracic surgery (NI-SI-VATS) procedures between July 2013 to November 2015 in two centers in Taiwan (170 patients) and Spain (18 patients) with two different anesthetic methods. Demographic data, clinicopathological features, preoperative tests, and final outcomes were analyzed to compare the outcomes with the two different techniques. Of the 188 patients, 147 (78%) were women, with a mean body mass index (BMI) of 22.7. Of the 196 specimens, 145 (74%) were malignancies with a mean size of 9.7 mm. Wedge resection was performed in 172 patients (91.4%), anatomical segmentectomy with lymphadenectomy in 8 (4.7%), and lobectomy with lymphadenectomy in 5 (2.6%). Three patients (1.6%) required conversion to orotracheal intubation, while 5 patients (2.7%) required additional ports. Complications appeared in 16 patients (8.5%) with air leak as the most frequent in 7 cases (3.7%). Median chest drainage was 1 day, and median postoperative stay was 3 days. There was neither perioperative death nor postoperative readmission. Non-intubated single-incision procedures can be feasible and safe in expert hands and experienced teams, even for anatomical resections. Strict selection criteria, skill and experience are mandatory. Comparative cohorts and randomized trials are needed.

How to design a randomized clinical trial: tips and tricks for conduct a successful study in thoracic disease domain.

Randomized controlled trials (RCTs) are considered one of the highest level of evidence in clinical practice, due to their strong confidence and robustness in producing data. The "randomization" (e.g., allocating patients randomly in each group of the study) allows eliminating many pre-analytical differences that might bias the entire study. Nevertheless, RCTs aren't free of internal pitfalls that might make them not easy to be developed or utilized. Our objective is to explain RCT management difficulties and suggest certain tips useful for the design of a RCT in thoracic disease domain. In particular have a realistic timeline, define a clear objective and precise endpoints, balance the study with a correct randomization and focus on the right equilibrium between strict selection criteria and more heterogeneous parameters are key elements that help researchers assuring a strong scientific validity.

Effect of Preoperative Urodynamic Detrusor Underactivity onTransurethral Surgery for Benign Prostatic Hyperplasia: ASystematic Review and Meta-Analysis.

We investigated the effect of preoperative urodynamic detrusor underactivity on the transurethral surgery outcomes of benign prostatic hyperplasia. We systematically searched the online PubMed®, Embase® and Cochrane Library databases for articles published between January 1989 and June 2017. A total of 10 articles met the eligibility criteria for this systematic review. The eligible studies included a total of 1,113 patients with a median of 73 per study (range 40 to 382). Five of the 10 studies involved conventional transurethral prostatectomy and 5 described laser surgery. In patients with detrusor underactivity the pooled mean difference was significant for the poorer I-PSS (International Prostate Symptom Score) (pooled mean difference -3.73, 95% CI -5.65--1.80 for 9 studies and 936 participants) and maximal flow rate improvement (pooled mean difference -3.92, 95% CI -4.85--3.00 for 8 studies and 951 participants) but not for quality of life score (pooled mean difference -0.15, 95% CI -0.56-0.25 for 7 studies and 858 participants) or post-void residual volume (pooled mean difference -5.57, 95% CI -20.65-9.50 for 9 studies and 971 participants). Some comparisons showed interstudy heterogeneity despite strict selection criteria for the included studies. However, there was no clear evidence of publication bias in this meta-analysis. Our meta-analysis results showed that preoperative detrusor underactivity correlated with poorer I-PSS and maximal flow rate improvement. Preoperative urodynamic detrusor underactivity is a valuable finding for excluding patients who are inappropriate candidates for transurethral surgery.

Working Environment of a Military Pilot

The author of the article characterizes the working environment of a military pilot in terms of the external environment, where is performed flight and psycho-physical requirements. The article presents the conditions for the functioning of a military pilot on the modern battlefield. It indicates the need for human cooperation with the advanced technologies used in military aviation and to apply strict criteria for selection of candidates for service as a military pilot.

Abstract 544: Hypoxia response signaling is linked to TACE resistance in hepatocellular carcinoma (HCC) patients

Abstract Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide, and outcome is dismal, due to tumor heterogeneity and lack of effective treatment options for patients with later stage disease. Transcatheter arterial chemoembolization (TACE) is the gold standard of therapy for patients with intermediate to locally advanced tumors. TACE delivers a high dose of chemotherapy directly to the tumor via the hepatic artery, followed by an embolizing agent to restrict tumor blood supply. However, tumor hypoxia is linked to alterations in metabolism, such as increased glycolysis (the Warburg effect), and can lead to enhanced cell survival. Several randomized control trials (RCTs) showed a survival benefit with TACE, but only with strict patient selection criteria. In Asia, TACE is also commonly used as adjuvant therapy after surgical resection, yet RCTs evaluating adjuvant TACE have shown conflicting results, likely due to patient selection and stratification. We hypothesize that tumor gene expression is predictive of response following TACE, and that differential cellular metabolism resembling a hypoxic phenotype prior to treatment is responsible for TACE resistance. We retrospectively analyzed gene expression data in treatment-naive tumor tissue from a cohort of Chinese patients who received TACE. Using hierarchical clustering, followed by class comparison and survival risk prediction, we identified a 14-gene signature that is predictive of response vs. non-response to TACE, as measured by overall survival, independent of other clinical variables. We found that hypoxia- and glycolysis-related genes are enriched among differentially expressed genes in TACE Responders vs. Non-Responders, and that hypoxia master regulator HIF-1α and hypoxia target gene VEGF are significantly up-regulated in Non-Responders. We determined that a key glycolysis gene is up-regulated in Non-Responders, and conversely, two rate-limiting genes involved in gluconeogenesis, the pathway opposing glycolysis, are up-regulated in Responders. We also examined metabolomic data from the TACE cohort, and found an enrichment of glycolysis-related metabolites in Non-Responders, and gluconeogenesis-related metabolites in Responders. Further investigation will be required to connect altered glucose metabolism to TACE resistance and to determine driver genes linking hypoxia and metabolism, which, together with our 14-gene signature, may serve as a stratification tool to guide personalized treatment modalities for HCC patients. Citation Format: Valerie Fako, Joyce Lee, Tan-To Cheung, Irene O. Ng, Xin W. Wang. Hypoxia response signaling is linked to TACE resistance in hepatocellular carcinoma (HCC) patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 544. doi:10.1158/1538-7445.AM2017-544

The SAMI Galaxy Survey: energy sources of the turbulent velocity dispersion in spatially resolved local star-forming galaxies

We investigate the energy sources of random turbulent motions of ionised gas from H$\alpha$ emission in eight local star-forming galaxies from the Sydney-AAO Multi-object Integral field spectrograph (SAMI) Galaxy Survey. These galaxies satisfy strict pure star-forming selection criteria to avoid contamination from active galactic nuclei (AGN) or strong shocks/outflows. Using the relatively high spatial and spectral resolution of SAMI, we find that -- on sub-kpc scales our galaxies display a flat distribution of ionised gas velocity dispersion as a function of star formation rate (SFR) surface density. A major fraction of our SAMI galaxies shows higher velocity dispersion than predictions by feedback-driven models, especially at the low SFR surface density end. Our results suggest that additional sources beyond star formation feedback contribute to driving random motions of the interstellar medium (ISM) in star-forming galaxies. We speculate that gravity, galactic shear, and/or magnetorotational instability (MRI) may be additional driving sources of turbulence in these galaxies.

Report From the American Society of Transplantation Conference on Donor Heart Selection in Adult Cardiac Transplantation in the United States.

Cardiac transplantation remains the only definitive treatment for end-stage heart failure. Transplantation rates are limited by a shortage of donor hearts. This shortage is magnified because many hearts are discarded because of strict selection criteria and concern for regulatory reprimand for less-than-optimal posttransplant outcomes. There is no standardized approach to donor selection despite proposals to liberalize acceptance criteria. A donor heart selection conference was organized to facilitate discussion and generate ideas for future research. The event was attended by 66 participants from 41 centers with considerable experience in cardiac donor selection. There were state-of-the-art presentations on donor selection, with subsequent breakout sessions on standardizing the process and increasing utilization of donor hearts. Participants debated misconceptions and established agreement on donor and recipient risk factors for donor selection and identified the components necessary for a future donor risk score. Ideas for future initiatives include modification of regulatory practices to consider extended criteria donors when evaluating outcomes and prospective studies aimed at identifying the factors leading to nonacceptance of available donor hearts. With agreement on the most important donor and recipient risk factors, it is anticipated that a consistent approach to donor selection will improve rates of heart transplantation.

Absolute geomagnetic intensity record from pre-Columbian pottery dates elite Tlailotlacan Woman in ancient Teotihuacan

A detailed rock-magnetic and archaeomagnetic investigation were carried out on seven pottery fragments (49 specimens) found within the burial of an individual with the most body/dental modifications and prestige elements found so far in the ancient Teotihuacan city. The skull of this 35 to 40years old woman (at the time of death) shows an intentional cephalic modification with frontal-occipital compression. This is very uncommon within the Teotihuacan population and indicating the southern provenance (Oaxaca or Maya area). The age estimations, based on relative datings, placed the archaeological context between 350 and 400CE. The magnetic mineralogy experiments were characterized by a single remanence component, occasionally accompanied by a soft overprint, probably of viscous origin and Curie temperatures between 540°C and 565°C. Only twelve specimens, belonging to two distinct pottery fragments, yielded reliable determinations meeting very strict selection criteria. The values retrieved from both fragments are statistically undistinguishable. The absolute age estimation of the Tlailotlacan Woman archaeological context obtained in this study contradicts the early estimations and indicates a late time interval between 650 and 800CE corresponding to the decline of Teotihuacan, where the social differences of their inhabitants became much more evident.

High intensity focused ultrasound for the treatment of adenomyosis: selection criteria, efficacy, safety and fertility.

Adenomyosis is a disorder of uterus in which endometrial glands and stroma are present within the uterine musculature. The main clinical manifestations are dysmenorrhea and menorrhagia. Adenomyosis has a great impact on both the quality of life and fertility of women. The treatment of adenomyosis remains an immense challenge. Relevant articles were searched through MEDLINE and PubMed between 2000 and March 2017. The search terms of adenomyosis, magnetic resonance imaging (MRI) features of adenomyosis, high intensity focused ultrasound (HIFU), ultrasound-guided HIFU and MRgFUS were used. There were no language restrictions. HIFU is a non-invasive local thermal ablation technique which has been used in the treatment of both focal and diffuse adenomyosis. Several case studies have demonstrated that HIFU presents low rate of minor and/or major complications and, at the same time, a long symptom-relief period. Multiple factors such as the enhancement type of the adenomyotic lesion, volume of the adenomyotic lesions, number of hyperintense foci on T2WI, location of the uterus, location of adenomyotic lesions, thickness of the abdominal wall and distance from the skin to the adenomyotic lesions contribute to the efficacy of HIFU. Consequently, based on these contributing factors, specific and strict selection criteria have been used to achieve higher efficacy. Thus, patients with pelvic endometriosis, adhesions between the bowel and the uterus, or an abdominal surgical scar wider than 10mm, are not suitable for HIFU treatment. Moreover, HIFU-treated patients with adenomyosis, who wished to conceive, showed high conception and live birth rates. HIFU is a new and promising treatment option for patients with adenomyosis, but its efficacy, safety, cost-effectiveness and fertility outcome must be evaluated by randomized controlled trials.

Could careful patient selection for renal denervation warrant a positive effect on arterial stiffness and left ventricular mass reduction?

After the sequence of Symplicity HTN trials, the impact of the procedure on lowering blood pressure (BP) and cardiovascular risk is still debatable. We present initial results of the multimodal pilot study that aimed at carefully selecting proper patients and investigating the effects of RASD on cardiac morphology and central haemodynamic parameters in 15 patients with resistant arterial hypertension prior and 6 months after RASD. The multimodal (applanation tonometry, echocardiography and cardiac magnetic resonance (CMR)) study findings have shown a significant BP decrease (190/112 ± 23/12 to 153/91 ± 18/11 mm Hg, P < 0.002), a decrease of the arterial markers (carotid-femoral pulse wave velocity decreased from 11.46 ± 2.92 m/s to 9.17 ± 2.28 m/s and the augmentation index decreased from 25.47 ± 10.55 to 21 ± 12.19, P < 0.006), a significant left ventricular mass index decrease by 10% both by echocardiography (140.83 ± 38.46 to 115.26 ± 25.37 g/m2, n = 14, P < 0.001) and CMR (108.32 ± 39.02 to 97.25 ± 30.06 g/m2, n = 15, P = 0.003). A significant decrease of CMR retrograde flow volume in the ascending aorta non-dependent on BP was also found. Our study is characterised by strict and extensive patient selection criteria for renal artery sympathetic denervation (RASD), which seem to warrant a positive effect of the procedure on BP, arterial stiffness and left ventricular mass 6 months after RASD, although it should be confirmed in larger controlled trials.

On the Origin of Sub-subgiant Stars. I. Demographics

Abstract Sub-subgiants are stars that are observed to be redder than normal main-sequence stars and fainter than normal subgiant (and giant) stars in an optical color–magnitude diagram (CMD). The red straggler stars, which lie redward of the red giant branch, may be related and are often grouped together with the sub-subgiants in the literature. These stars defy our standard theory of single-star evolution and are important tests for binary evolution and stellar collision models. In total, we identify 65 sub-subgiants (SSG) and red stragglers (RS) in 16 open and globular star clusters from the literature; 50 of these, including 43 sub-subgiants, pass our strict membership selection criteria (though the remaining sources may also be cluster members). In addition to their unique location on the CMD, we find that at least 58% (25/43) of sub-subgiants in this sample are X-ray sources with typical 0.5–2.5 keV luminosities of order 1030–1031 erg s−1. Their X-ray luminosities and optical–to–X-ray flux ratios are similar to those of RS CVn active binaries. At least 65% (28/43) of the sub-subgiants in our sample are variables, 21 of which are known to be radial-velocity binaries. Typical variability periods are ≲15 days. At least 33% (14/43) of the sub-subgiants are Hα emitters. These observational demographics provide strong evidence that binarity is important for sub-subgiant formation. Finally, we find that the number of sub-subgiants per unit mass increases toward lower-mass clusters, such that the open clusters in our sample have the highest specific frequencies of sub-subgiants.

Is vaginal breech delivery associated with higher risk for perinatal death and cerebral palsy compared with vaginal cephalic birth? Registry-based cohort study in Norway

ObjectiveThis paper aims to study if vaginal breech delivery is associated with increased risk for neonatal mortality (NNM) or cerebral palsy (CP) in Norway where vaginal delivery accounts for 1/3...

Implementing the INTERGROWTH-21st fetal growth standards in France: a 'flash study' of the College Français d'Echographie Foetale (CFEF).

To assess potential differences in fetal size between the French population and the international population from the INTERGROWTH-21st (IG-21st ) Project and to measure the impact of switching to the IG-21st reference standards for fetal size. This was a nationwide cross-sectional study of fetal ultrasound biometry. Low-risk singleton pregnancies were recruited prospectively within the network of the national French College of Fetal Ultrasound, CFEF, over a 6-week period. Further selection was performed based on the criteria of the IG-21st Project in order to obtain a comparable population. Head circumference (HC) was used as the main fat-free skeletal measure of growth for comparison of French fetal size with that of the IG-21st population. The impact of switching to the IG-21st fetal growth standards was quantified by comparing Z-scores calculated using the IG-21st standards with those calculated using locally derived reference ranges for HC, abdominal circumference (AC) and femur length (FL). Following selection, 4858 cases were analyzed. The distribution of HC demonstrated clear similarity between our French population and the IG-21st population: our observed centile curves closely matched those of IG-21st and the Z-scores were close to 0 across gestational age. The IG-21st standards performed as well as did locally derived charts in terms of screening for small-for-gestational age by AC, while they identified significantly fewer small FL values than were expected and than did the locally derived charts. Under strict selection criteria, fetal size in France is similar to that of the international population used in the IG-21st Project. The discrepancies in FL are unlikely to impact on prenatal management. Therefore, switching from locally derived reference ranges to the IG-21st standards appears to be a safe option. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

MP06-01 EVALUATION OF THE RELATIONSHIP BETWEEN THE DONOR AND RECIPIENT DURING KIDNEY TRANSPLANT

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery I1 Apr 2017MP06-01 EVALUATION OF THE RELATIONSHIP BETWEEN THE DONOR AND RECIPIENT DURING KIDNEY TRANSPLANT Christopher Dru, D. Joseph Thum, Devin Patel, Justin Houman, and Gerhard Fuchs Christopher DruChristopher Dru More articles by this author , D. Joseph ThumD. Joseph Thum More articles by this author , Devin PatelDevin Patel More articles by this author , Justin HoumanJustin Houman More articles by this author , and Gerhard FuchsGerhard Fuchs More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.246AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In 2014, approximately 6,100 people in the United States underwent living donor nephrectomy. Unlike other types of organ donation, this patient population has a longer-than-average life expectancy due to strict selection criteria. Greater than 99% of patients that donated a kidney at Cedars-Sinai Medical Center donated to an immediate family member, relative, or close friend. Our study seeks to qualify and quantify functional changes in the relationship between the donor and the recipient before and after surgery as well as to identify perioperative complications and stress to determine if patients are content with their decision to donate. METHODS From 2002-2012, 532 patients underwent donor nephrectomy for kidney transplant at Cedars-Sinai Medical Center. After IRB approval, a randomized subset of these patients were administered a standardized questionnaire regarding his or her experience. We assessed if each patient would undergo the donation process again, now having more intimate knowledge and appreciation of the pre- and post-operative surgical and medical course. RESULTS Of the fifty patients who participated in our survey, 92% stated that their relationship with the recipient improved after surgery. Of the 8% that noted a deterioration in the relationship, there was a distribution of dissatisfaction with relation to the sexual relationship (n=1), recipient personality changes (n=1), or divorce (n=2). Approximately 10% of patients experienced a complication related to surgery, all of which were clavian grade I-II. Examples of these included incisional hernia (n=3, upper midline incision, BMI>30 kg/m2) and urinary tract infection (n=2). Overall, 98% of patients were extremely satisfied with the donation process and would not hesitate to participate again. Only one patient stated that he would not donate again, as he developed an unanticipated glomerulonephropathy not related to surgery that required hemodialysis. CONCLUSIONS Our research demonstrates that the act of donating a kidney overwhelmingly enhances the bond between the donor and recipient. Even donors who noted a decline in their relationship with the recipient all stated that they would still donate if faced with the same decision again. This suggests that the relationship with the recipient is of highest importance and a crucial component of pre-operative counseling that should be emphasized. Our urology group has started to incorporate this practice in our management with great success. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e72 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Christopher Dru More articles by this author D. Joseph Thum More articles by this author Devin Patel More articles by this author Justin Houman More articles by this author Gerhard Fuchs More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Management of Breech Presentation: Green-top Guideline No. 20b.

Management of Breech Presentation: Green-top Guideline No. 20b.

Minimally Invasive Video-Assisted Thyroidectomy (MIVAT) in the Era of Minimal Access Thyroid Surgery

Background: In the era of minimal access thyroid surgery, the terms minimal access and minimally invasive are often used interchangeably and in most instances this is far from being accurate. The aim of this article is to examine the characteristics and potential of one of the first minimal access thyroid procedures described; minimally invasive video-assisted thyroidectomy (MIVAT). Methods: The purpose of this article was obtained by almost two decades of experiences with the procedure at the authors’ center, and a systemic literature review was undertaken of all available medical literature to evaluate available literature by conducting a PubMed search limited to articles originally written in English language between the years 1997 and 2016. The search was limited by using the terms: minimally invasive thyroid surgery, video-assisted, endoscopic, and robotic thyroidectomy. The procedure’s design, radicality and safety, learning curve, cost, advantages and disadvantages were addressed. MIVAT’s potential as a surgical tool for thyroid pathology was also addressed by evaluating its indications, contraindications, and limitations. Results: MIVAT is a gasless hybrid procedure that is comparable to conventional thyroidectomy (CT) in terms of radicality and safety, with the added advantage of reduced early postoperative voice and swallowing symptoms. MIVAT has a relatively rapid learning curve with an additional advantage over other minimal access procedures; the ability of being adopted by the low-volume surgeon at a cost and time comparable to CT, but with improved patient satisfaction. Furthermore, it is non-inferior to procedures free of a neck scar in terms of patient satisfaction. MIVAT’s main drawback is that it is limited by its strict selection criteria. It is a viable treatment option for all types of thyroid pathologies. However, its role in therapeutic neck dissection remains to be validated. Conclusions: MIVAT is a safe and effective procedure which is obviously described in its name “minimally invasive”. It seems that in the era of innovative technologies and scarless-in-the neck thyroid surgery, MIVAT is here to stay.

How fisher‐influenced marine closed areas contribute to ecosystem‐based management: A review and performance indicator scorecard

AbstractA rapid review of the literature on closed areas that recognize key ecosystem‐based management (EBM) principles of fisheries and biodiversity conservation and had fisher involvement was employed to review closed areas worldwide from a fisheries perspective and to develop a scorecard that can assess their efficacy. The review provided 523 abstracts of which 19 areas from various regions worldwide had peer‐reviewed studies that met strict selection criteria. Criteria included fisher involvement, biodiversity conservation and fisheries management objectives. A repeat search without “fisher” and synonyms found, 62,622 papers indicating that most closed area studies had no mention of any fisher involvement. The general success of the areas selected suggests that fisher involvement benefits both biological conservation and fisheries management. Fisheries and biodiversity conservation outcomes were not exclusive to any one type of management closure (e.g. MPA, Fishery Closure). Twenty‐four indicators were selected, designed to provide measurable targets. High scoring indicators included management, planning and socio‐economic indicators such as local support (100%), habitat protection (100%), conservation and fisheries objectives (100%), monitoring (91.7%) and fishers concerns (91.7%). Bio‐ecological‐based indicators scored lower in most cases for all types of areas. Fisheries closures rated as highly as the MPAs with respect to both fisheries and bio‐ecological indicators. The scorecard provided a reasonable means to evaluate management success in the light of often qualitative or missing data. Addressing the interests and utilizing knowledge of those affected by closures and familiar with the area, most often local fishers, is key to achieving management objectives.

Diagnostic value of urodynamic bladder outlet obstruction to select patients for transurethral surgery of the prostate: Systematic review and meta-analysis.

PurposeTo investigate the diagnostic value of urodynamic bladder outlet obstruction (BOO) in the selection of patients for transurethral surgery of the prostate.Materials and methodsWe systematically searched online PubMed, Embase, and Cochrane Library databases from January 1989 to June 2014.ResultsA total of 19 articles met the eligibility criteria for this systematic review. The eligible studies included a total of 2321 patients with a median number of 92 patients per study (range: 12–437). Of the 19 studies, 15 conducted conventional transurethral prostatectomy (TURP), and 7 used other or multiple modalities. In urodynamic bladder outlet obstruction (BOO) positive patients, the pooled mean difference (MD) was significant for better improvement of the International Prostate Symptom Score (IPSS) (pooled MD, 3.48; 95% confidence interval [CI], 1.72–5.24; p < 0.01; studies, 16; participants, 1726), quality of life score (QoL) (pooled MD, 0.56; 95% CI, 0.14–1.02; p = 0.010; studies, 9; participants, 1052), maximal flow rate (Qmax) (pooled MD, 3.86; 95% CI, 2.17–5.54; p < 0.01; studies, 17; participants, 1852), and post-void residual volume (PVR) (pooled MD, 32.46; 95% CI, 23.34–41.58; p < 0.01; studies, 10; participants, 1219) compared with that in non-BOO patients. Some comparisons showed between-study heterogeneity despite the strict selection criteria of the included studies. However, there was no clear evidence of publication bias in this meta-analysis.ConclusionsOur meta-analysis results showed a significant association between urodynamic BOO and better improvements in all treatment outcome parameters. Preoperative UDS may add insight into postoperative outcomes after surgical treatment of benign prostatic hyperplasia.

BLOOD BAG;

Transfusion of blood products is one of the key aspects of hospital care. Amongthe risk of blood transfusions, bacterial contamination of the blood bags is not so uncommon.Sources of bacteria can be several. Majority of the times the source of bacteria is the arm of thedonor. Second important cause of bacterial contamination of blood transfusion, is bacteria inthe blood stream of the donor. Donor is usually selected with strict selection criteria. Detailedhistory is usually taken. Diversion is another method used to reduce the bacterial contaminationof blood bags. Temperature is also important parameter for the growth of bacteria. RBCs arestored at 4 ˚C and platelets are stored at 22˚C. For the ideal bacterial detection techniques,it is important that they can detect the bacteria as early and as low as possible. At the time ofcollection of sample for viral screening, number of bacteria might be too low to be detected.