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Background Transrectal prostate biopsy (pbx) is the most frequent outpatient procedure in the urological field. Septic complications are a major health issue. Objective To evaluate complication rates with or without an antimicrobial lubricant. Design, setting, and participants A total of 1000 patients received pbx between 2013 and 2015. Information about complications was collected by a 3-wk questionnaire. Return rate was 73.2% (n = 732). Intervention Randomization for pbx with the instillation of an antimicrobial lubricant (intervention group, n = 385) or the standard lubricant (control group, n = 347) was performed. Outcome measurements and statistical analysis Multivariable analyses assessed the association between infectious complications at biopsy and use of an antimicrobial lubricant, International Prostate Symptom Score (IPSS), history of urogenitourinary infections, and several other confounders. Results and limitations The use of an antimicrobial lubricant did not reduce infection rate. Overall complication rate was very low. Of all patients, 69.3% described the procedure as pain free. Fever ≥38.5 °C was reported in overall 1.9% of patients. Urinary retention with catheterization occurred in 3.1%. Most common complications were hematospermia (47.4%), macrohematuria (23.8%), and rectal bleeding (7.4%). Readmission rate was 1% (n = 7). In multivariable analyses, IPSS and previous infectious complications were associated with a higher risk of infectious complications. Our results stem from a large German single center and therefore are limited to this patient group. Conclusions No significant reduction was shown in infectious complications in the intervention group with the antimicrobial agent. Low incidence of those complications may be the underlying cause. Severe morbidity at pbx is uncommon. Specifically, the rate of infection was very low. Patient summary Severe complications at prostate biopsy are rare. Among participants, 69.3% had no pain. Fever was rare (1.9% of patients). Voiding issues with catheterization occurred in 3.1%. Most common complications were blood in the semen (47.4%), urine (23.8%), or stool (7.4%). Men with voiding issues or previous infectious complications had a higher risk of infectious complications.

Polymer–ceramic composite electrolytes are major contenders for applications in commercial Li-metal solid-state batteries. However, the cycling performance and energy density of such batteries are ...

The industrial development of Li metal solid state batteries will be boosted not only by providing highly Li+ conductive electrolyte materials, but also by demonstrating their technical viability in the actual device. For the first time, the electrochemical performances of two different electrolytes, a pure Li7La3Zr2O12 ceramic and a polymer–ceramic composite, are compared in a solid state battery with a Li metal anode and a LiFePO4 cathode. No liquid or gel additive was added to improve the interfacial contacts. The technological viability of these two systems was assessed under realistic cycling conditions with a competitive cathode loading of 1 mA h cm−2. Here, we show promising performances for both electrolytes at 70 °C under slow cycling rates; however, the composite stands out under fast cycling rates due to enhanced interfacial contacts. The energy density of the two systems is compared to the electric vehicle industry targets providing clear specifications for future system development.

As the ionic conductivity of solid-state lithium ion conductors rises, knowledge of the detailed conductivity mechanisms is harder to obtain due to the limited frequency resolution of the traditional impedance spectrometers. Moreover, the data is easily affected by the local microstructure (i.e. pores, grain-boundaries) and the preparation conditions. The aim of this work is to demonstrate the feasibility of the coaxial reflection technique as a reliable tool to study fast ionic conductors (i.e. σ > 10−4 S cm−1). Especially the relative permittivity can be determined more accurately at room temperature. For the first time the electrical performance of LATP and LLZO manufactured via a scalable top-down glass-ceramic route is evaluated. The density turns out to be a key parameter influencing both relative permittivity and resulting conductivities. For a 100% dense LATP sample the coaxial reflection technique reveals a high grain-core conductivity of 6 × 10−3 S cm−1 similar to the conductivity of ideal single crystals.

For the first time, glass-ceramic particles (LATP and LLZO) have been processed with both a tumbling-mixer and a kneader on semi-industrial scale. Although sintered LATP and LLZO discs reveal a statistically negligible ionic interface resistance to PEO with LiTFSI, the total conductivity of dispersed particles within a PEO-LiTFSI matrix is only slightly enhanced at 80 °C. However, for a tumbling mixing process, SEM investigations prove insufficient contact of particles within the matrix as well as agglomerates, cracks and voids. With the shear intensive kneader, dense and homogeneous samples were obtained. Compared to nanometer-sized SiO2 particles, the LATP filler enable an increase of the ionic conductivity of the hybrid PEO system by a factor of about two. These finding help to overcome solvent-based mixing processes that may cause uncontrolled decomposition and surface reactions of filler particles thereby changing microscopic conduction mechanisms in the hybrid electrolytes.

Antibiotic resistance may lead to increasing infection rates at transrectal prostate biopsy. Local antimicrobial agents might help to reduce bacterial load. The aim of this study was to test the potency of antimicrobial lubricants to reduce local bacterial loads and specifically fluoroquinolone-resistant strains. Overall, 384 prostate biopsy (PBx) patients of a larger prospective randomized trial (n = 1000) were included. Patients were randomized for biopsy with pre-interventional instillation of an antimicrobial lubricant (intervention group n = 256) or with the standard lubricant (control group n = 128). Bacteria were recovered on pre- and post-biopsy rectal swab cultures from both patient groups. Bacterial colonization was semi-quantitatively recorded and analyzed for the presence of ciprofloxacin-resistant isolates. Within the intervention group, where antimicrobial lubricant was instilled for PBx, the post-biopsy bacterial count was statistically significantly lower compared to prior biopsy bacterial count (p

Objective To describe a feasible surgical technique for patients with renal cell carcinoma associated with a supradiaphragmatic tumor thrombus that avoids cardiopulmonary bypass procedure. Materials and Methods From 2004 to 2009, 4 patients with a right kidney tumor and tumor thrombus above the diaphragm (pT3c) underwent manual repositioning of the tumor thrombus out of the right atrium into the inferior vena cava on the beating heart. These patients were aged 65.8 years and had a body mass index of 25.5 kg/m 2 . Median tumor size was 10.8 cm, and 3 patients had synchronous metastasis. Results Manual repositioning of the tumor thrombus was safe and feasible in all patients. Mean operating time was 561 minutes (range, 302-613 minutes), and no perioperative death occurred. Auxiliary cardiopulmonary bypass procedure was applied in 1 patient to remove a preoperatively diagnosed pulmonary embolus. Three patients subsequently underwent systemic therapy for metastatic disease. Median survival was 16 months (range, 1.7-26 months). Conclusion Manual repositioning of a vena cava tumor thrombus without cardiopulmonary bypass is a safe and feasible approach. The risk of tumor thrombembolization seems to be low, and cardiopulmonary bypass can be avoided or at least reduced to a minimum time of intervention.

Growing evidence supports the use of multimedia presentations for informing patients. Therefore, we supported preoperative education by adding a multimedia tool and examined the effects in a randomized controlled trial. We randomized German-speaking patients scheduled for radical prostatectomy at our center to receive either a multimedia-supported (MME) or a standard education (SE). Outcomes were measured in a structured interview. Primary outcome was patient satisfaction. In addition, we applied validated instruments to determine anxiety and measures of decision-making. Results were given by mean and standard deviation. For comparison of groups we used t test and chi-square test. For an explorative analysis we applied multivariate logistic regression. We randomized 203 patients to receive MME (n = 102) or SE (n = 101). Complete satisfaction with preoperative education was more frequent in the MME group (69 vs 52 %, p = .016) and patients after MME reported more questions (5.7 vs 4.2, p = .018). There was no difference concerning the duration of talks and the number of recalled risks. However, perceived knowledge was higher after MME (1.3 vs 1.6, p = .037). Anxiety and measures of decision-making were comparable. Patients judged the multimedia tool very positive, and 74 % of the MME group thought that their preoperative education had been superior to SE. Multimedia support should be considered worthwhile for improving the informed consent process before surgery ( www.germanctr.de ; DRKS00000096).