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RESULTS In the ex vivo simulation, 20 mock stones mimicking varied fragmentation conditions were tested in the training model. The mean completion time of the basketing task without versus with digital stone measurement was 16.5 seconds (range 10.2-33.7) versus 38.9 seconds (range 27.2-60.0). Mean additional time required to measure stones was 22.3 seconds (range 8.4-42.7). In the in vivo workflow trial, 9 patients undergoing ureteroscopy were enrolled. A median of 5 fragments (range 3-10) were measured in each patient. Mean completion time for each measurement was 10.1 seconds (range 8.2-12.8). Mean total time required to perform digital measurement per procedure was 50.8 seconds (range 25.9-99.0). No technical failures or clinical complications were observed. CONCLUSIONS Integrating real-time digital stone measurement during ureteroscopy is safe and feasible. The findings support clinical trials of digital stone measurement to enhance intraoperative decision-making during ureteroscopy.The posterior pharyngeal flap is frequently the surgical intervention of choice for the correction of velopharyngeal insufficiency. Our patient initially presented for a superiorly based, posterior pharyngeal flap to correct for velopharyngeal insufficiency. However, the postoperative recovery was complicated by severe obstructive sleep apnea, which warranted division and subsequent takedown of the flap. Despite flap takedown, our patient's obstructive sleep apnea persisted. The patient's clinical course suggests that donor site closure, and not the actual pharyngeal flap, caused the persistent obstructive sleep apnea.Beetroot juice (BRJ) has become increasingly popular amongst athletes aiming to improve sport performances. BRJ contains high concentrations of nitrate, which can be converted into nitric oxide (NO) after consumption. NO has various functions in the human body, including a vasodilatory effect, which reduces blood pressure and increases oxygen- and nutrient delivery to various organs. These effects indicate that BRJ may have relevant applications in prevention and treatment of cardiovascular disease. Furthermore, the consumption of BRJ also has an impact on oxygen delivery to skeletal muscles, muscle efficiency, tolerance and endurance and may thus have a positive impact on sports performances. Aside from the beneficial aspects of BRJ consumption, there may also be potential health risks. Drinking BRJ may easily increase nitrate intake above the acceptable daily intake, which is known to stimulate the endogenous formation of N-nitroso compounds (NOC's), a class of compounds that is known to be carcinogenic and that may also induce several other adverse effects. Compared to studies on the beneficial effects, the amount of data and literature on the negative effects of BRJ is rather limited, and should be increased in order to perform a balanced risk assessment.Fermentation is an important way to process and preserve fish. It not only gives the product a unique flavor and texture, but it also contributes to increased nutritional value and better functional properties. The production of fermented fish relies on naturally occurring enzymes (in the muscle or the intestinal tract) as well as microbial metabolic activity. This review focuses on the role of microorganisms on texture change, flavor formation, and biogenic amines accumulation in fermented fish. In addition, the production conditions and the major biochemical changes in fermented fish products are also introduced to help understand the factors influencing the quality of fermented fish. Moreover, prospects for further research of fermented fish are discussed.OBJECTIVE To report the outcomes of percutaneous nephrolithotomy (PCNL) in horseshoe kidneys (HSK) in 12 institutions worldwide and evaluate the impact of patient position during surgery. METHODS We performed a retrospective analysis of PCNL procedures performed between 2008 and 2018 in patients with HSK. Pre-, peri-, and postoperative data were collected, and a subgroup analysis was performed according to patient position. Success was defined as an absence of &gt;4-mm fragments. ; p-values less then 0.05 were considered significant. RESULTS We analyzed 106 surgeries. The transfusion, complication, and immediate success rates were 3.8%, 17.5%, and 54.7%, respectively. The final success rate increased to 72.4% after a mean of 0.24 secondary procedures. Logistic regression showed that higher body mass index (BMI) and stone size were significantly associated with residual fragments ≥4 mm. Sixty-seven patients (63.2%) were treated in prone and 39 (36.8%) in supine. The prone group had a significantly higher BMI than the supine group (30.1 vs, 27.7, p=0.024). The transfusion, complication, and immediate success rates between the prone and supine groups were 4.5% vs. 2.6% (p=0.99), 16.9% vs. 18.4% (p=0.99), and 52.5% vs. 69.2% (p=0.151), respectively. Surgical time was significantly longer in the prone group (126.5 vs. 100 minutes, p=0.04). Upper pole was the preferred access in 80.3% of the prone group and 43.6% of the supine group (p less then 0.001). The prone group had significantly more Clavien 2 complications than the supine (p=0.013). The final success rate in the prone and supine groups increased to 66.1% and 82.1% after 0.26 and 0.21 secondary procedures, respectively. No complications higher than Clavien 3 occurred. CONCLUSION PCNL in HSK patients is safe and effective with a low complication rate. Higher BMI and stone size negatively impacted outcomes. Supine PCNL may be an option for treating kidney stones in patients with HSK.A Brönsted acid multicomponent reaction between pyruvate derivatives, amines, and aldehydes for the preparation of phosphorus and fluorine substituted γ-lactam derivatives is presented. Depending on the substitution in the resulting 1,5-dihydro-2H-pyrrol-2-one substrates, the reaction provides enol- or enamine-derived γ-lactams. Some enantioselective examples of this reaction are also reported using chiral phosphoric acids as organocatalysts. [https://www.selleckchem.com/products/simufilam.html see more] Moreover, several synthetic applications of γ-lactam derivatives are presented including some examples of highly diastereoselective transformations.