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55, 95% confidence interval (CI) 0.45-0.67, P less then .001). The rates of local adverse events were lower inMMC, with a statistical significance for dysuria (RR 0.55, 95% CI 0.36-0.84, P ¼ .006), urinary frequency (RR 0.60, 95% CI 0.43- 0.84, P¼ .003), cystitis (RR 0.22, 95% CI 0.06-0.81, P¼ .02), and incontinence (RR 0.48, 95% CI 0.24-0.96, P¼ .04). In terms of complete response, TURBT is superior to chemoresection withMMC. Currently, chemoresection withMMC should be restricted to patients unfit for surgery and in clinical trials. Future randomized controlled trials are recommended to confirm or refute the use ofMMC in treating recurrent NMIBC.The introduction of endoscopic anatomical enucleation of the prostate created a new educational field. We investigated the current literature for simulators, phantoms, and other training models that could be used as a tool for teaching urologists alone or within the boundaries of a course or a curriculum. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement and the European Association of Urology Guidelines office's recommendations for conducting systematic reviews. Seven out of 51 studies met our inclusion criteria and are presented in the current review. The VirtaMed UroSim HoLEP (Holmium Laser Enucleation of the Prostate) Simulator achieved excellent scores for face, content, and construct validity, and participants agreed that it could be used for training. In addition, this simulator offers the opportunity for morcellation training. The Kansai University model for HoLEP does not support morcellation simulation and has only demonstrated face and content validity. The CyberSim (Quanta System, Solbiate Olona, VA, Italy) has not been yet evaluated, but it seems that it can be used for training without tutoring. Only one training curriculum was revealed from the search. The Holmium User Group-Mentorship Program has been proposed since 2005 for training urologists for HoLEP. Simulators and courses or curricula based on a simulator could be valuable learning and training tools. The existent models seem efficient but have not been widely evaluated and accepted yet. It seems that the training field for transurethral enucleation of the prostate will be rapidly developed soon.Large granular lymphocytic leukemia (LGLL) is a rare clonal lymphoproliferative disorder from T or NK origin.

to report on the diagnostic and therapeutic management of LGLL investigated in the university hospital at Nancy, France.

retrospective (7 years) collection of clinical and biological data and patients' cohort analysis.

Eight out of fifteen patients presented with neutropenia, including five profound neutropenia (neutrophils <500 ×10

/L). Four patients had an infection. Two patients have rheumatoid arthritis and an associated Felty's syndrome, one a Sweet syndrome. Two also suffered from chronic Lymphocytic Leukemia, and one from a diffuse large B-cell lymphoma. Twelve patients had LGLL-T and 3 had a chronic LGLL-NK. Eleven out of twelve patients had a clonal LGLL-T when polymerase chain reaction assessed. No KIR clonality was sought among the 3 LGL-NK patients. Five patients out of fifteen received immunosuppressive treatment.

Although using simple and robust investigations, our series demonstrates a high heterogeneity in LGLL detection and assessment.

Although using simple and robust investigations, our series demonstrates a high heterogeneity in LGLL detection and assessment.

Various musculoskeletal and autoimmune manifestations have been described in patients with coronavirus disease 2019 (COVID-19).ObjectivesThis study aims to investigate the prevalence and etiology of arthritis in post-COVID Egyptian patients.MethodsWe included 100 post-COVID Egyptian patients who recovered 6 months ago and assessed several inflammatory and autoimmune markers.ResultsThe prevalence of post-COVID arthritis was 37%. Ankle, knee, and wrist were the most commonly affected joints. Old age (P = 0.010), smoking (P = 0.001), and arthralgia (P = 0.049) were all linked with post-COVID arthritis. click here Levels of pretreatment (baseline) interleukin (IL)-6 (46.41±3.67 vs. 24.03±2.46; P = 0.001), as well as 6-month post-COVID C-reactive protein (CRP; 98.49±67.55 vs. 54.32±65.73; P = 0.002), and erythrocyte sedimentation rate (ESR; 109.08±174.91 vs. 58.35±37.87; P = 0.029) were significantly higher in patients with arthritis compared to those without. On the other hand, complement C3 (P = 0.558) and C4 (P = 0.192) of post-COVID-19 arthritis is primarily due to the hyperinflammatory process associated with COVID-19 infection, and not the result of an autoimmune reaction. IL-6 levels before therapy can predict post-COVID arthritis allowing for early management.Inflammatory bowel disease (IBD), including Crohn disease and ulcerative colitis, with multifactorial etiologies has led to a global health-associated burden in many countries. Substantial efforts are devoted to understand the pathogenesis, behavioral and environmental triggers, which may be specifically valuable for the treatment of IBD. The specific pathogenesis underlying IBD is as yet incompletely understood. The use of anti-cytokine therapy and small molecule agents targeting the immune system is thought to restore the body's intestinal barrier function and relieve inflammation with manageable adverse effects. In this review, we report recent advances in anti-cytokine therapy and treatment with small molecule agents for the management of IBD.The abnormal accumulation of visceral adipose tissue in obesity is associated with metabolic changes that include altered glucose tolerance, insulin resistance, hyperlipidemia, and metabolic syndrome. Obesity also coincides with increased incidence of autoimmune diseases. Accumulating evidence suggest that prolonged metabolic overload related to overnutrition, influenced by genetic and epigenetic factors, might affect immunologic self-tolerance through changes in the energy metabolism of immune cells, particularly regulatory T (Treg) cells. A strong activation of nutrient-energy signaling pathways blocks the induction of the transcription factor forkhead P3 (FOXP3), a master regulator of Treg cells, consequently inhibiting their generation and proliferation, thereby promoting proinflammatory response. Expanding our knowledge on the topic, particularly on metabolic T cell flexibility in vivo will provide new insights that can be used to develop therapeutic strategies for various inflammatory diseases, including obesity and autoimmune diseases. Targeting specific metabolic pathways is emerging as an important approach to control immune response and maintain immunological homeostasis.

To examine the current medical and psychosocial status of patients with epilepsy, aiming to facilitate appropriate application of the Intractable/Rare Diseases Act of Japan.

By analysing the cross-sectional data of patients registered in the tertiary hospital-based Epilepsy Syndrome Registry of Japan, we investigated the proportion of patients who met the severity criteria as defined by the Act (seizure frequency of at least once a month, or presence of intellectual/neurological/psychiatric symptoms, or both) and whether there are candidate syndrome/diseases to be added to the existing list in the Act.

In total, 2,209 patients were registered. After excluding self-limited/idiopathic epilepsies, 1,851 of 2,110 patients (87.7%) met the severity criteria. The patients were classified into eight main epilepsy syndromes (594 patients), 20 groups based on aetiology (1,078 patients), and three groups without known aetiology (427 patients). Most of the groups classified by syndrome or aetiology had high proportnd the list of designated syndromes/diseases should be complemented by further amendments, as suggested by future research.An 88-year-old man is sent to hospital because of a rapid worthening of his general state. A myelogram is obtained following the discovery of hypercalcemia associated with a diminished glomerular filtration rate and the discovery of osteolytic lesions, showing a massive proliferation of plasma cells. The lack of plasma and urine detection of both monoclonal antibodies and immunoglobulin light chains, as well as an immature plasma cell phenotype, suggest the diagnosis of non-secretory multiple myeloma. This article aims to describe the atypical clinical presentation of a rare case of multiple myeloma.The polymyxin and lipopeptide classes of antibiotics are membrane-targeting drugs of last resort used to treat infections caused by multi-drug-resistant pathogens. Despite similar structures, these two antibiotic classes have distinct modes of action and clinical uses. The polymyxins target lipopolysaccharide in the membranes of most Gram-negative species and are often used to treat infections caused by carbapenem-resistant species such as Escherichia coli, Acinetobacter baumannii and Pseudomonas aeruginosa. By contrast, the lipopeptide daptomycin requires membrane phosphatidylglycerol for activity and is only used to treat infections caused by drug-resistant Gram-positive bacteria such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. However, despite having distinct targets, both antibiotic classes cause membrane disruption, are potently bactericidal in vitro and share similarities in resistance mechanisms. Furthermore, there are concerns about the efficacy of these antibiotics, and there is increasing interest in using both polymyxins and daptomycin in combination therapies to improve patient outcomes. In this review article, we will explore what is known about these distinct but structurally similar classes of antibiotics, discuss recent advances in the field and highlight remaining gaps in our knowledge.

Depression prevalence among young people is increasing, with growing pressures on specialist mental health services. Manualised behavioural activation therapy may be effective for young people, and can be delivered by a range of mental health professionals (MHPs). This study explored clinician perspectives of barriers and facilitators to implementing behavioural activation with young people in routine practice.

We conducted a qualitative study with individual semi-structured interviews with MHPs, as part of a wider feasibility study.

Participants were mental health professionals (therapists and supervisors) from two UK NHS sites delivering manualised behavioural activation for young people. Data were analysed with an inductive followed by deductive approach, applying the Theoretical Domains Framework (TDF) to understand key influences on practice change. Identified domains were mapped onto possible behaviour change techniques (BCTs) to support implementation, using the Theory and Techniques Tool (TTT).

ed behavioural activation with young people. Interventions using BCTs to address identified barriers could help the implementation of new therapies into routine practice, working to bridge the research-practice gap in clinical psychology.Tricuspid valvulopathy has gained a lot of attention in recent years, especially due to the advances in percutaneous management. CHD can present with primary or secondary malfunction of the tricuspid valve, often not addressed due to high surgical risk after several interventions. We present two cases of adults with complex congenital heart malformations and borderline clinical situations who successfully underwent percutaneous tricuspid replacement.