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The FMCG industry is an impactful industry in many regions, especially when it is running during the COVID-19 pandemic, and they still make progress. However, as good as its blessings are, the FMCG industry has its struggles with innovation, and each region has shown some differences until now; thus, the data speaks for itself. India, which has a Hindu majority, and their vegetarianism show some differences in how they explored the wisdom of the FMCG industry. It makes the industry unique on its own to have an eco-friendly movement through a cultural push of their vegetarian beliefs. The method was Krippendorf content analysis on Twitter, we’ll get closer to looking at the unique data. Findings have shown that changing consumer preferences have also impacted the FMCG industry in India. Consumers are becoming more health-conscious and opting for products that are natural, organic, and free from harmful chemicals.

This policy brief outlines some suggestions in establishing an effective health communication strategy for Philippine local government units (LGUs) in response to Covid-19. Responsive, coordinated, and collaborative communication is crucial because it has the capacity to harness human and organizational efforts to combat the pandemic, establish trust, and minimize the pandemic’s negative consequences.

Este artículo analiza y critica las principales propuestas de reforma institucional ejecutadas en los últimos tiempos en el país, a través de las cuales se busca abordar el problema de la extrema debilidad de los partidos políticos y la ausencia de un sistema de partidos propiamente dicho —problema que se generó a partir de la crisis y el colapso del sistema de partidos ocurrido a fines de los años ochenta y principios de los noventa—. Se conoce que estos problemas también constituyen una seria amenaza para la subsistencia misma de nuestro régimen político democrático–representativo.

Objectives: Analyze the oncologic and functional outcomes in patients affected by low risk prostate cancer underwent prostate cryotherapy. Materiasl and methods: It’s a prospective tricentric study of 434 patients treated with prostate cryoablation for low risk prostate cancer. By low risk we refer to the D'Amico’s risk classification. Two cycles of freezing/thawing are run for each patient following the technique described by Onik. Results: For the 434 patients, the median age was 66 years with a standard deviation of ± 6.68, the average PSA was 6.17 ng/d/L, the median 5.55 with a standard deviation of ± 2.13, the mean prostate volume was 35.59 cc, the median 34.00 cc, with a standard deviation of ± 7.89. Biochemical failure occurred in 67 patients (15.4%). Pre-operative erectile function in men was distributed as follows: severe in 95 patients (19.2%), moderate in 95 (19.2%), medium-moderate in 180 (36.4%), mild in 92 (18.6%), with no dysfunction in 32 (6.5%) patients. Post-operative erectile function, measured 1 month after cryotherapy, was distributed as follows: severe in 321 (65%) patients, moderate in 69 (14%), medium-moderate in 79 (16%), mild in 23 (4.7%), and no dysfunction in only 2 patients (0.4%). Post-operative erectile function after 3 months was distributed as follows: severe in 233 (47.2%) patients, moderate in 66 (13.4%), medium-moderate in 122 (24.7%), mild in 65 (13.2%), and no dysfunction in 8 patients (1.6%). Urinary incontinence was present in 21 patients (4.8%) after 3 months while it dropped to 13 patients (2.9%) after 6 months. Conclusions: Cryotherapy in the treatment of prostate cancer remains a viable alternative. The availability of new cryoprobes and the use of new diagnostic means such as fusion magnetic resonance will make this more precise and more effective method.

Objective To evaluate our experience in patients undergoing hybrid transvaginal natural orifices transluminal endoscopic surgery (NOTES) nephrectomy and evaluate the sexual functions in the postoperative period. Materials and Methods Prospective data of 71 patients with renal tumors who underwent hybrid NOTES radical nephrectomy in three different centers were collected from March 2010 to October 2015. Patient and surgical characteristics were recorded. Sexual function was evaluated using the Female Sexual Function Index questionnaire the day prior to the operation and 3 months after. Results The mean age, tumor size, and operation duration were 66.16 ± 11.21, 8.51 ± 3.31 cm, and 119.94 ± 21.38 minutes, respectively. Five patients were immediately reoperated due to bleeding from uterine veins. The complication risk increases significantly with increasing tumor size. Among the whole cohort, even the Female Sexual Function Index score differences are small; there is a statistically significant decrease in the postoperative period in all domains except sexual satisfaction. In fact, the patients reported unaltered sexual function after surgery and satisfaction with the result when asked directly. In subgroup analyses, in nulliparous patients (n = 60), arousal, sexual desire, orgasm, and satisfaction domains have no significant differences in pre- and postoperative periods. Conclusions Hybrid NOTES nephrectomy is a feasible, safe operation that can be performed for large renal tumors. Due to incisions in the vaginal wall for specimen retrieval, sexual function can be altered in the postoperative period. So patient selection, preoperative evaluation, and close follow-up are mandatory. With this in mind, we strongly support the use of hybrid transvaginal NOTES nephrectomy for large renal tumors especially in nulliparous patients.

Desde que, en el año 2014, Uber dio inicio a sus actividades en nuestro país, y puso a disposición de todos los peruanos con acceso a un smartphone su aplicativo móvil de servicio de taxi (inspirado en un sistema de economía colaborativa “sharing economy”), caracterizado por conectar al cliente (usuario) directamente con el prestador de servicios, múltiples cambios se han advertido tanto a nivel empresarial (inexistencia de una figura empresarial física) como a nivel de relaciones de naturaleza laboral (huida del derecho del trabajo). Siendo materia del presente trabajo de investigación lo último señalado, pues en este nuevo escenario surge un sujeto denominado “intermediador” que está dotado de todas las facultades de un empleador (organización, fiscalización y subordinación) en relación a los prestadores de servicios (socios colaboradores – conductores de taxi); sin embargo, no ser considerado uno. Es en mérito a ello, que se genera un resquebrajamiento de la estructura tradicional laboral, y de la forma de cómo deben ser entendidos los elementos típicos de toda relación laboral (prestación personal de servicios, remuneración, subordinación). En virtud a ello es que entre los objetivos pretendidos en la presente investigación están la determinación de la relación existente entre los prestadores de servicios (conductores) y Uber; así como el hecho de establecer si los prestadores de Servicios (conductores) tienen la condición de socios (como estas empresas los denominan), o si por el contrario su naturaleza es la de trabajadores subordinados (relación laboral). Sin perjuicio de lo antes señalado, consideramos que, el sistema planteado por Uber, es uno de naturaleza laboral pues además de cumplir con los tres elementos de toda relación laboral, la labor que realizan los conductores de Uber es por cuenta ajena y de manera personalísima, sobre todo porque la mencionada (Uber) no les permite a los conductores ceder su cuenta de la aplicación para que otra persona preste servicios de taxi en lugar de ellos (prestación personal de servicios). Cumple con el elemento remuneración, pues Uber no solo remunera a los conductores por el servicio prestado, sino que les ofrece beneficios cuando cumplen con determinadas condiciones que previamente les impone, remunerándoles con mejores porcentajes de pago a aquellos quienes tengan una mayor tasa de aceptación, lo cual incentiva a los conductores a estar activos, y finalmente cumple con el elemento subordinación porque el control ejercido por Uber se acerca a las reglas y modelos de atención durante la prestación del servicio de taxi, por medio de las evaluaciones en forma de notas y de las quejas hechas por los usuarios. Tesis

Toothed whales possess a sophisticated biosonar system by which ultrasonic clicks are projected in a highly directional transmission beam. Beam directivity is an important biosonar characteristic that reduces acoustic clutter and increases the acoustic detection range. This study measured click characteristics and the transmission beam pattern from a small odontocete, the spinner dolphin (Stenella longirostis). A formerly stranded individual was rehabilitated and trained to station underwater in front of a 16-element hydrophone array. On-axis clicks showed a mean duration of 20.1 μs, with mean peak and centroid frequencies of 58 and 64 kHz [standard deviation (s.d.) ±30 and ±12 kHz], respectively. Clicks were projected in an oval, vertically compressed beam, with mean vertical and horizontal beamwidths of 14.5° (s.d. ± 3.9) and 16.3° (s.d. ± 4.6), respectively. Directivity indices ranged from 14.9 to 27.4 dB, with a mean of 21.7 dB, although this likely represents a broader beam than what is normally produced by wild individuals. A click subset with characteristics more similar to those described for wild individuals exhibited a mean directivity index of 23.3 dB. Although one of the broadest transmission beams described for a dolphin, it is similar to other small bodied odontocetes.

Bacterial blight (BB) caused by Xanthomonas oryzae pv. oryzae (Xoo) is a costly disease in rice that threatens global rice production. Gene expression analysis by quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) allows the study of the underlying mechanisms of both BB pathogenesis and resistance. In relative quantification, reference genes are often used to normalize the results to remove technical variations allowing the determination of true biological changes in a pilot experiment. However, variations in the expression of these reference genes can lead to erroneous and unreliable results. Thus, choosing the most stable reference genes for any specific experimental condition is of utmost importance in qRT-PCR experiments. Here, we used geNorm, NormFinder, Bestkeeper, Delta-Ct and RefFinder programs and/or methods to analyze the stability of the expression of eleven candidate reference genes namely: 18S ribosomal RNA (18S rRNA), Actin-1 (ACT1), ADP-Ribosylation Factor (ARF), Endothelial differentiation factor (Edf), eukaryotic Elongation Factor-1α (eEF-1α), eukaryotic Initiation Factor-4a (eIF-4a), Profilin 2 (Prof2), Nucleic Acid Binding Protein (NABP), Triosephosphate Isomerase (TI), Ubiquitin 5 (UBQ5) and Ubiquitin 10 (UBQ10) in cDNA samples from BB-susceptible and Xa21-mediated resistant rice cultivars collected at various times after Xoo inoculation. Under our experimental conditions, Edf and TI were the most stable reference genes while the common housekeeping genes 18S rRNA, and UBQ5 were among the least stable genes. Though using either Edf or TI as internal control is adequate for gene expression analysis, we suggest using both genes to normalize the data of qRT-PCR assays for rice subjected to Xoo inoculation.

La tesis denominada: “LA CULTURA TRIBUTARIA COMO HERRAMIENTA EFICAZ PARA REDUCIR LA EVASIÓN FISCAL EN LOS CONTRIBUYENTES DEL IMPUESTO A LA RENTA DE TERCERA CATEGORÍA DE LIMA METROPOLITANA”; cuyo problema se ha identificado en la evasión fiscal del impuesto a la renta de tercera categoría de los contribuyentes de Lima Metropolitana. La evasión fiscal o defraudación tributaria es un delito configurado en la Ley Penal Tributaria, cuya incidencia en el Perú es alta especialmente en el Impuesto a la renta de tercera categoría. Esta problemática se expresa en la siguiente pregunta: ¿De qué manera la cultura tributaria como herramienta eficaz podrá facilitar la reducción de la evasión fiscal en los contribuyentes del impuesto a la renta de tercera categoría de Lima Metropolitana? Ante la problemática se propone la solución a través de la formulación de la hipótesis: La cultura tributaria como herramienta eficaz facilita la reducción de la evasión fiscal en los contribuyentes del impuesto a la renta de tercera categoría de Lima Metropolitana. Este trabajo se ha orientado al siguiente objetivo: Determinar la manera como la cultura tributaria como herramienta eficaz podrá facilitar la reducción de la evasión fiscal en los contribuyentes del impuesto a la renta de tercera categoría de Lima Metropolitana. La investigación es de tipo básica o pura; del nivel descriptivo-explicativo; se utilizó los métodos descriptivo e inductivo. El diseño es el no experimental. La población estuvo compuesta por 100 personas y la muestra estuvo compuesta por 80 personas. El tipo de muestreo aplicado fue el muestreo probabilístico. Las técnicas utilizadas para la recopilación de datos fueron las encuestas. El instrumento utilizado fue el cuestionario. Se aplicaron técnicas de análisis de información; también técnicas de procesamiento de datos. El resultado más importante es que el 85 por ciento de los encuestados acepta que la cultura tributaria como herramienta eficaz facilita la reducción de la evasión fiscal en los contribuyentes del impuesto a la renta de tercera categoría de Lima Metropolitana

Cadmium (Cd) causes male infertility. There is the need to identify safe treatments counteracting this toxicity. Flavocoxid is a flavonoid that induces a balanced inhibition of cyclooxygenase (COX)-1 and COX-2 peroxidase moieties and of 5-lipoxygenase (LOX) and has efficacy in the male genitourinary system. We investigated flavocoxid effects on Cd-induced testicular toxicity in mice. Swiss mice were divided into 4 groups: 2 control groups received 0.9% NaCl (vehicle; 1 ml/kg/day) or flavocoxid (20 mg/kg/day ip); 2 groups were challenged with cadmium chloride (CdCl2; 2 mg/kg/day ip) and administered with vehicle or flavocoxid. The treatment lasted for 1 or 2 weeks. The testes were processed for biochemical and morphological studies. CdCl2 increased phosphorylated extracellular signal-regulated kinase (p-ERK) 1/2, tumor necrosis factor (TNF)-α, COX-2, 5-LOX, malondialdehyde (MDA), B-cell-lymphoma (Bcl)-2-associated X protein (Bax), follicle-stimulating hormone (FSH), luteinizing hormone (LH), transforming growth factor (TGF) -β3, decreased Bcl-2, testosterone, inhibin-B, occludin, N-Cadherin, induced structural damages in the testis and disrupted the blood-testis barrier. Many TUNEL-positive germ cells and changes in claudin-11, occludin, and N-cadherin localization were present. Flavocoxid administration reduced, in a time-dependent way, p-ERK 1/2, TNF-α, COX-2, 5-LOX, MDA, Bax, FSH, LH, TGF-β3, augmented Bcl-2, testosterone, inhibin B, occludin, N-Cadherin, and improved the structural organization of the testis and the blood-testis barrier. Few TUNEL-positive germ cells were present and a morphological retrieval of the intercellular junctions was observed. In conclusion, flavocoxid has a protective anti-inflammatory, antioxidant, and antiapoptotic function against Cd-induced toxicity in mice testis. We suggest that flavocoxid may play a relevant positive role against environmental levels of Cd, otherwise deleterious to gametogenesis and tubular integrity.

To assess the performance of prostate health index (PHI) and prostate cancer antigen 3 (PCA3) when added to the PRIAS or Epstein criteria in predicting the presence of pathologically insignificant prostate cancer (IPCa) in patients who underwent radical prostatectomy (RP) but eligible for active surveillance (AS). An observational retrospective study was performed in 188 PCa patients treated with laparoscopic or robot-assisted RP but eligible for AS according to Epstein or PRIAS criteria. Blood and urinary specimens were collected before initial prostate biopsy for PHI and PCA3 measurements. Multivariate logistic regression analyses and decision curve analysis were carried out to identify predictors of IPCa using the updated ERSPC definition. At the multivariate analyses, the inclusion of both PCA3 and PHI significantly increased the accuracy of the Epstein multivariate model in predicting IPCa with an increase of 17 % (AUC = 0.77) and of 32 % (AUC = 0.92), respectively. The inclusion of both PCA3 and PHI also increased the predictive accuracy of the PRIAS multivariate model with an increase of 29 % (AUC = 0.87) and of 39 % (AUC = 0.97), respectively. DCA revealed that the multivariable models with the addition of PHI or PCA3 showed a greater net benefit and performed better than the reference models. In a direct comparison, PHI outperformed PCA3 performance resulting in higher net benefit. In a same cohort of patients eligible for AS, the addition of PHI and PCA3 to Epstein or PRIAS models improved their prognostic performance. PHI resulted in greater net benefit in predicting IPCa compared to PCA3.

Objectives To explore whether serum and urinary advanced glycation end-products (AGEs) are related to urinary symptoms and bladder dysfunctions in diabetic patients. Methods Forty-seven patients with type 2 Diabetes mellitus (T2DM) and lower urinary tract symptoms (LUTS) were enrolled. LUTS evaluation was performed by IPSS (International Prostatic Symptoms Score), QoL (quality of life), OAB (overactive bladder). ICI-SF (International Consultation on Incontinence – short form) quaestionneires; ultrasound examination, evaluation of postvoid residual (PVR), uroflowmetry, cystometry with pressure-flow study (PFS) were performed to detect bladder dysfunctions. Serum and urinary AGEs were quantified by ELISA method. Results Patients were divided into four subgroups: (i) normal-detrusor-contractility + normal- detrusor-activity (1 ♂ [4.8%] and 4 ♀ [21%]), (ii) impaired-detrusor-contractility + normal-detrusor- activity (4 ♂ [19.1%] and 0 ♀), (iii) normal-detrusor-contractility + detrusor-overactivity (1 ♂ [4.8%] and 6 ♀ [31.6%]), (iv) impaired-detrusor-contractility + detrusor-overactivity (15 ♂ [71.4%] and 9 ♀ [47.4%]). Serum AGEs were 12.2 ± 5.5 in men and 10.4 ± 5.6 in women; urinary AGEs were 1.5 ± 1.1 in men and 2.5 ± 1.6 in women. Serum AGEs exhibited a positive correlation with IPSS (P

Resumen Objetivo Evaluar la calidad de vida (QoL) y supervivencia global tras cistectomia radical con ureterostomias cutaneas por cancer localmente avanzado de vejiga en pacientes ancianos con alto riesgo quirurgico. Metodos Cincuenta y ocho pacientes, mayores de 74 anos (edad media 80,6 ± 4,3) con cancer de vejiga localmente avanzado (grupo A), fueron sometidos a una cistectomia radical y derivacion ureterocutanea. Los pacientes completaron el cuestionario EORTC QLQC30 antes y 6 meses despues de la cirugia para valoracion de resultados funcionales, clinicos y de QoL. La misma evaluacion fue realizada en un grupo control (grupo B) de 29 pacientes (edad media 82,3 ± 3,8 anos), que habian rechazado la cistectomia. Los cuestionarios tambien fueron remitidos a pacientes de ambos grupos que sobrevivieron a los 20 meses y a los 5 anos. Resultados Todos los pacientes presentaron un ASA ≥ 3. La estancia hospitalaria media fue de 15,1 dias (± 4,8) en el grupo A y de 23,5 dias (± 4,1) en el grupo B. No hubo complicaciones intraoperatorias en el grupo A. La supervivencia global postoperatoria evaluada a los 6 meses en el grupo A fue del 97 vs 79% en el grupo B (p La relacion de calidad de vida e items de funcion y sintomas entre los 2 grupos a los 6 meses mostro una mejoria significativa de todos los parametros en el grupo A (p La supervivencia a corto plazo y a los 20 meses fue significativamente mayor en el grupo A (p Conclusion La cistectomia radical con ureterostomia cutanea representa una alternativa valida en pacientes ancianos con cancer de vejiga invasivo y alto riesgo quirurgico. La comparacion entre los grupos mostro una diferencia significativa en casi todos los parametros relacionados con la QoL y con respecto a la supervivencia a corto y medio plazo.

Renewed calls for identifying other variables and validating previous models that account for the complex interplay of mechanisms that are activated in the writing process have been made. In response to this call, the study investigates whether text production processes (idea generation, idea encoding, idea/text revision, and idea transcription) mediate the effect of topic knowledge, linguistic knowledge, writing approach, and writing experience on writing performance. Writer’s performance was measured by timed essays, while the psycholinguistic and linguistic variables were measured by scales and tests. Results yielded by Structural Equations Modeling indicate that topic knowledge and linguistic knowledge have direct effects on writing performance and indirect effects on writing performance through text production process. Writing approach and writing experience do not directly affect writing performance, but they indirectly affect writing performance through text production processes. Keywords: writing proficiency; cognitive process; ESL writing; L2 writing performance

Objectives: Locally advanced prostate cancer may cause several complications such as haematuria, bladder outlet obstruction, and renal failure due to the ureteral obstruction. Various treatments have been suggested, including radiotherapy, antifibrinolytics, bladder irrigation with alum solution, transurethral surgery and angioembolization, none of which have proven effectiveness. In the last years cryoablation has become a valid therapeutic option for prostate cancer. In our experience we used this ‘new’ technique as haemostatic therapy. Methods: We selected four patients with gross haematuria affected by locally advanced hormone refractory prostate cancer, who had already been treated with primary radiotherapy. We used third-generation cryotherapy: under ultrasonographic guidance, we inserted six cryoprobes, two in each of the vascular pedicles reaching at least −60°C, and three thermometers. We then induced two freeze–thaw cycles. Results: After the operation the haematuria stopped in all patients and at 9-month follow up we observed a mean of four red cells (range three to five) in the urinary sediment with no evidence of bacteriuria. Prostate volume, prostate-specific antigen and postmicturition residue were significantly reduced. Qmax improved significantly too. Conclusion: Our experience has given us good results with minimal intra- and postoperative complications. We think that haemostatic cryotherapy as a palliative approach for locally advanced prostate cancer could represent a valid treatment option and more consideration could be given to its use.

Transrectal Ultrasound (TRUS) guided prostate biopsy is regarded as the gold standard for prostate cancer diagnosis. The majority of patients perceive TRUS-guided prostate biopsy as a physically and psychologically traumatic experience. We aimed to compare in this paper the efficacy of three different anesthesia techniques to control the pain during the procedure. Materials and methods: 150 patients who underwent transrectal ultrasound (TRUS) guided prostate biopsy were randomly divided into three groups. Group A included 50 patients who received one hour before the procedure a mixture of 2.5% lidocaine and 2.5% prilocaine, Group B: 50 patients who received intrarectal local anesthetic administration (lidocaine 5 ml 10%) and lidocaine local spray 15 % and Group C included 50 patients who received periprostatic block anesthesia (lidocaine 10 ml 10%). Visual analogue scale (VAS) of patients in different groups was evaluated at the end of the biopsy and 30 minutes after the procedure. Results: The VAS of patients in Group A was 1.32 ± 0.65 (VAS I) and 2.47 ± 0.80 (VAS II). In group B the VAS of patients was 1.09 ± 0.47 (VAS I) and 1.65 ± 0.61 (VAS II). In group C the VAS of patients was 2.63 ± 0.78 (VAS I) and 1.70 ± 0.85 (VAS II). There was no statistically significant difference in term of VAS I between group A and B. A statistically significant difference was determined in terms of VAS II between group A and B. There was no statistically significant difference in term of VAS between group B and C. Conclusions: The most effective of the three methods for pain control we used was intrarectal local anesthetic administration and lidocaine local spray 15% that enables an ideal patient comfort.

Introduction: To evaluate the intermediate-term outcomes of thulium vapoenucleation of the prostate (ThuVEP) and thulium vaporesection of the prostate (ThuVaRP) in patients with benign prostate obstruction (BPO). Materials and Methods: A bicentric retrospective matched-paired comparison of patients treated by ThuVEP (n = 80) or ThuVaRP (n = 80) was performed. The patients were preoperatively assessed with International Prostate Symptom Score (IPSS), quality of life (QoL), post-void residual urine (PVR), maximum urinary flow rate (Qmax), prostatespecific antigen (PSA) and re-evaluated at 12- and 24-month follow-up. Results: Median prostate volume was 65 mL and not different between the groups. The immediate re-operation rate was significantly different between ThuVEP and ThuVaRP (5 vs. 0%, p ≤ 0.0434). IPSS, QoL, Qmax and PVR had improved significantly compared to preoperative assessment in both groups at 12- and 24-month follow-up (p ≤ 0.001). Median Qmax (18.2 vs. 21.0 mL/s) and PVR (29.4 vs. 0 mL) were significantly different between ThuVEP and ThuVaRP at 24-month follow-up (p ≤ 0.001), while IPSS and QoL showed no differences between the groups. However, the PSA reduction was significantly higher after ThuVEP compared to ThuVaRP (78.93 vs. 23.39%, p ≤ 0.006) at 24-month follow-up. Conclusions: ThuVEP and ThuVaRP are safe and efficacious procedures for patients with BPO. Although the peri-operative re-intervention rates were lower after ThuVaRP, the low PSA reduction rate after ThuVaRP at 24-month follow-up favours the ThuVEP procedure.

Este trabajo de investigación se enmarca como un proyecto de desarrollo estratégico para la mejora de la gestión pública respecto del sistema administrativo denominado “Sistema Electoral”, conformado por tres organismos constitucionalmente autónomos: la Oficina Nacional de Procesos Electorales (ONPE), el Jurado Nacional de Elecciones (JNE) y el Registro Nacional de Identificación y Estado Civil (Reniec). El propósito es obtener un diagnóstico lo más completo y objetivo posible de los problemas en la gestión electoral y en la prestación de servicios generados a partir de la forma inadecuada en que el ordenamiento jurídico ha distribuido las competencias entre los organismos electorales, y, a partir de ello, esbozar una propuesta de reforma o rediseño organizacional del referido sistema administrativo que tenga por objetivo corregir los problemas identificados, lo que comprende, por un lado, la redistribución de las competencias constitucionales y legales entre las tres instituciones conformantes del sistema electoral, a través del respectivo proyecto de reforma constitucional; y, por otro lado, la propuesta de adecuación organizativa de los órganos de línea al interior de cada uno de los tres organismos, que sea acorde con la redefinición de las competencias constitucionales y legales. Trabajo de investigación

Introduction The advancements in telemedicine provide the possibility to send photos of hematuria cases to professionals for further evaluation. We aimed to evaluate the inter-rater reliability of WhatsApp use in the evaluation of hematuria. Materials and methods Between December 2014 and April 2016, 212 patients were evaluated prospectively for hematuria by 2 groups of urologists; Group A: in direct contact with patients for evaluation; Group B: “blind” urologist who had no access to the patients’ data but received pictures via WhatsApp. Two photos of voided urine in a sterile container were taken and sent using WhatsApp. The opinions of Group A and B about the grade of hematuria were evaluated. Shapiro-Wilk test and Fleiss’ kappa statistics were used for statistical analyses. Results The median age of patients was 71 (min 22, max 96). The Group A urologists were in accordance in 96.22% of cases. Group B urologists had common opinions in 99.5% (n = 203) and there was almost perfect agreement between 2 groups (λ = 0.992). The number of common opinions among “blind” urologists is more than the number of common opinions among the consultants. When further classification is performed as serious and non-serious hematuria, the rate of misdiagnosing serious cases is approximately 6.5–7%. However, using WhatsApp, the urologists can differentiate normal urine and any form of hematuria with 100% accuracy. Conclusion It is possible to evaluate hematuria remotely and also reduce unnecessary costs of services for hematuria of mild clinical significance by using telemedicine. WhatsApp can provide valuable aid to tertiary hospitals where the urologist is not always present as well as in rural areas.

Interstitial cystitis/painful bladder syndrome (IC/PBS) is a chronic pain syndrome and a chronic inflammatory condition prevalent in women that leads to urgency, sleep disruption, nocturia and pain in the pelvic area, to the detriment of the sufferer’s quality of life. The aim of this review is to highlight the newest diagnostic strategies and potential therapeutic techniques. A comprehensive literature review was performed on MEDLINE, PubMed, and Cochrane databases gathering all literature about “Interstitial cystitis” and “Painful Bladder Syndrome”. Visual analogue scales, epidemiological strategies, pain questionnaires and similar techniques were not included in this literature survey. The etiology, exact diagnosis and epidemiology of IC/PBS are still not clearly understood. To date, its prevalence is estimated to be in the range of 45 per 100,000 women and 8 per 100,000 men, whereas joint prevalence in both sexes is 10.6 cases per 100,000. There are no “gold standards” in the diagnosis or detection of IC/PBS, therefore, several etiological theories were investigated, such as permeability, glycosaminoglycans, mast cell, infection and neuroendocrine theory to find new diagnostic strategies and potential biomarkers. Due to the fact that this disease is of an intricate nature, and that many of its symptoms overlap with other concomitant diseases, it could be suggested to classify the patients with emphasis on the phenotype, as well as their symptom clusters, to tailor the diagnostic and management choices according to the observed biomarkers.

Purpose Thulium vaporesection of the prostate (ThuVARP) is a new and safe approach for patients receiving anticoagulant therapy in whom transurethral resection of the prostate (TURP) may possess a high bleeding risk. We aimed to demonstrate the efficacy and safety of ThuVARP in patients receiving oral antiplatelet/anticoagulant (OAP/OAC) therapy. Materials and methods A total of 103 patients who underwent ThuVARP between 2011 and 2013 were enrolled in the study. Patients were divided into 2 groups. Group A consisted of 47 patients who underwent low molecular weight heparin (LMWH) bridging and group B consisted of 56 patients who were operated on while receiving OAP/OAC therapy. Results The drop in hemoglobin levels in the pre- and postoperative periods was significantly higher in group A than in group B. When subgroups were analyzed, the mean drop in hemoglobin was significantly lower in the warfarin and ticlopidine subgroups of group B than in group A. International Prostate Symptom Scores were significantly lower 3, 12, 18, and 24 months after surgery in group A than in group B. Quality of life scores, maximal flow rate values, and postmicturition residual urine volumes (mL) were similar between the 2 groups. A total of 38 and 41 patients in groups A and B, respectively, had no complications. Conclusions Our study showed the safety profile of continuing different OAP/OAC therapies in terms of bleeding problems in patients undergoing ThuVARP. We strongly recommend abandoning LMWH bridging and maintaining the OAP/OAC regimen patients are already receiving.

To evaluate the precision of the centrality index (CI) measurement on three-dimensional (3D) volume rendering technique (VRT) images in patients with renal masses, compared to its standard measurement on axial images.Sixty-five patients with renal lesions underwent contrast-enhanced multidetector (MD) computed tomography (CT) for preoperative imaging. Two readers calculated the CI on two-dimensional axial images and on VRT images, measuring it in the plane that the tumour and centre of the kidney were lying in. Correlation and agreement of interobserver measurements and inter-method results were calculated using intraclass correlation (ICC) coefficients and the Bland-Altman method. Time saving was also calculated.The correlation coefficients were r=0.99 (p0.05) and r=0.99 (p0.05) for both the CI on axial and VRT images, with an ICC of 0.99, and 0.99, respectively. Correlation between the two methods of measuring the CI on VRT and axial CT images was r=0.99 (p0.05). The two methods showed a mean difference of -0.03 (SD 0.13). Mean time saving per each examination with VRT was 45.5%.The present study showed that VRT and axial images produce almost identical values of CI, with the advantages of greater ease of execution and a time saving of almost 50% for 3D VRT images. In addition, VRT provides an integrated perspective that can better assist surgeons in clinical decision making and in operative planning, suggesting this technique as a possible standard method for CI measurement.

The sarcoglycan complex is a trans-membrane system playing a key role in mechano-signaling the connection from the cytoskeleton to the extracellular matrix. While β-, δ-, and e-sarcoglycans are widely distributed, γ- and α-sarcoglycans are expressed exclusively in skeletal and cardiac muscle. Insufficient data are available on the distribution of sarcoglycans in nonmuscular tissue. In the present study, we used immunohistochemical and RT-PCR techniques to study the sarcoglycans also in normal human glandular tissue, a type of tissue never studied in relation to the sarcoglycan complex, with the aim of verifying the real wider distribution of this complex. To understand the role of sarcoglycans, we tested specimens collected from patients affected by benign prostatic hyperplasia and adenocarcinoma. For the first time, our results showed that all sarcoglycans are detectable in normal samples both in epithelial and in myoepithelial cells; in pathological prostate, sarcoglycans appeared severely reduced in number or were absent. These data demonstrated that all sarcoglycans have a wider distribution suggesting a new unknown role for these proteins. The decreased number of sarcoglycans, containing cadherin domain homologs in samples of prostate affected by hyperplasia, and the absence of proteins in prostate biopsies, in cases affected by adenocarcinoma, could be responsible for the loss of adhesion between epithelial cells, which in turn facilitates the progression of benign tumors and the invasive potential of malignant tumors. Anat Rec, 297:327–336, 2014. © 2013 Wiley Periodicals, Inc.

Recent evidence has shown that positive results may be observed for fluorodeoxyglucose-positron emission tomography (FDG-PET) in undifferentiated, biologically aggressive and metastatic tumors. The present study describes a case series of six patients with normal prostate-specific antigen (PSA) serum levels who underwent FDG-PET due to other causes. Positive PET results were observed at the prostate and the patients were subsequently diagnosed with high-risk prostate cancer. Clinical, anamnestic, laboratory and instrumental data were collected from six asymptomatic patients with total serum PSA levels of

Blast fishing is an illegal and unsustainable practice that is often reported in Southeast Asia and Africa. Its impact on fish and reef-building corals is well documented, yet there is limited information on the effects on other larger species and near-shore predators. In recent years, several marine mammal strandings in the Philippines have coincided with underwater explosions associated with blast fishing. The goal of this study was to measure the hearing of stranded dolphins, including two spinner dolphins (Stenella longirostris) and two rough-toothed dolphins (Steno bredanensis), that were rehabilitated in Subic Bay at Ocean Adventure in cooperation with the Philippines Marine Mammal Stranding Network and Wildlife in Need. Hearing measurements were conducted using noninvasive auditory brain stem responses (ABRs). Test stimuli consisted of tone pips ranging from 8 to 128 kHz. The results indicated elevated thresholds and limited hearing range, including three individuals with no hearing response beyond...

Dapoxetine (DPX) has a pharmacokinetic profile suggesting a low rate of class-related adverse events (AEs).To assess the incidence of treatment emergent AEs (TEAEs) of special interest (known associations with selective serotonin reuptake inhibitors and/or potential clinically relevant AEs), and the related discontinuation rate in patients with premature ejaculation (PE) treated with DPX or alternate oral treatment (AOT), in routine clinical practice.In a prospective, 12-week, open-label, postmarketing observational, multinational study (PAUSE), 7545 patients were enrolled and divided into 2 groups: DPX 30-60 mg and AOT.The incidence rate of predefined TEAEs of special interest (mood and related, neurocognitive related, cardiovascular, urogenital and sexual function, accidental injury, and abnormal bleeding) in the DPX and the AOT groups, and the rate of AEs leading to study discontinuation.The safety analysis was performed on 6128 patients treated with DPX and 1417 with AOT. The incidence of TEAEs of special interest in each AE category was greater for patients treated with AOT than with DPX. The higher differences were observed in the neurocognitive-related category (DPX 1.9% vs. AOT 4.7%; P.001), in the mood and related category (DPX 0.4% vs. AOT 1.1%; P.001), and in the urogenital system/sexual function (DPX 0.4% vs. AOT 0.8%; P = .04). Cardiovascular TEAEs were the only AEs numerically greater in the DPX group (1.3 vs. 1.6%, P = .34). The overall discontinuation rate was 10.9% in the DPX group and 6.9% in the AOT group).DPX has a favorable safety profile in terms of class-related TEAEs and clinically relevant AEs of special interest. In particular, it shows a significantly better safety profile in mood and related AEs, neurocognitive-related AEs, urogenital system, and sexual function, compared to the AOT group in the study population.