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single-institution experience. Furthermore, post-operative functional studies were not available for all patients, limiting the ability to draw conclusions on the change in DRF after surgery.

In a large cohort, preoperative DRF was not predictive of pyeloplasty success rate. DRF ≤10% was not associated with higher incidence of complications or failure rate. The DRF alone should not dictate the management options available for patients with UPJO.

In a large cohort, preoperative DRF was not predictive of pyeloplasty success rate. DRF ≤10% was not associated with higher incidence of complications or failure rate. The DRF alone should not dictate the management options available for patients with UPJO.

Although the learning curve in various surgical procedures is increasingly discussed, there have been only a few reports about the learning curve especially in proximal hypospadias repair.

To evaluate the learning curve in one-stage hypospadias repair for proximal hypospadias.

We retrospectively reviewed 73 cases of primary hypospadias repair by a single pediatric urologist using one-stage urethroplasty with a preputial skin graft between 2007 and 2018. The overall complication rate included fistula, glans dehiscence, and meatal stenosis. To analyze the impact of the surgeon's experience on the complication rate, we compared the complication rates among different groups of 20 consecutive cases each. In addition, we graphed the actual data of the operative time and cumulative complication rate to evaluate the learning curve. The cumulative complication rate was defined as the surgeon's complication rate (the number of complications accumulated at a time/number of cases at that time).

The median age at arning curve in proximal hypospadias repair stabilized after about 50 cases although the supervision of experienced surgeons is required during the early phase of learning curve.Computed tomography angiography not only detects atherosclerotic coronary artery disease but also helps delineate the anomalous coronary arterial anatomy that may be more than just an incidental finding and could contribute to patients' symptomatology. Additionally, identification of coronary artery anomalies is clinically significant for preoperative planning and optimizing the approach for coronary catheterizations or surgical treatments. In this work, we review rare origination anomalies of coronary arteries and illustrate their characteristics through computed tomography images.

Consistent with certification best practices, update the board-certified ambulatory care pharmacist (BCACP) certification content outline and examination blueprint.

Qualitative (i.e., focus group) and quantitative (i.e., survey) methods were used to assess, shape, and empirically validate the knowledge, skills, and abilities characterized by the practice performance domain of the BCACP certification content outline and its associated examination blueprint.

Survey responses were collected from 434 BCACPs and then reviewed by a representative panel of subject matter experts in ambulatory care pharmacy in addition to psychometric analyses. Using statistical summaries of rating scale data, the panelists recommended revisions to the certification content outline and examination blueprint. find more Descriptions of how the survey results were used to develop test specifications are also provided.

This analysis provides validity evidence for the content scope for the BCACP certification and the specifications (i.e., domain weight percentages) of the high-stakes examination. In particular, the study reaffirmed the BCACP examination as a clinically relevant, patient-focused credential, consistent with the BPS mission.

This analysis provides validity evidence for the content scope for the BCACP certification and the specifications (i.e., domain weight percentages) of the high-stakes examination. In particular, the study reaffirmed the BCACP examination as a clinically relevant, patient-focused credential, consistent with the BPS mission.It is well appreciated that a loss of body water (dehydration) can impair endurance performance and that the effect is magnified by environmental heat stress. A majority of professional sports medicine and nutrition organizations recommend drinking during exercise to replace sweat losses and prevent dehydration, while also avoiding frank over-hydration. Knowledge of sweating rate, which is highest in the heat for any given metabolic rate, is therefore considered key to developing a sound drinking strategy. Exercise duration and the provision of liquid fuel interacts with required drink volumes in important ways that are infrequently discussed but are of utmost practical concern. This review details some challenges related to the optimized coupling of fluid and fuel needs during prolonged exercise in the heat and the need for personalization.

Right-sided infective endocarditis (IE) carries favourable prognosis compared to left-sided IE. However, theprognostic significance of vegetation size in right-sided IE is less well defined. This study reports the clinical, microbiological, and echocardiographic findings associated with right-sided IE and examines the predictors of adverse outcomes.

Consecutive adults admitted with isolated right-sided IE at an Australian tertiary referral centre between June 1999 and May 2017 were retrospectively reviewed. Patients were stratified according to intravenous drug user (IVDU) status. Culprit organisms, sepsis severity, treatment regimens, inpatient complications, and vegetation size were recorded. Hospital survivors were followed mean 6.9±4.8 years for late mortality and IE recurrence.

Of 318 consecutive cases of IE, 60 (19%) were isolated right-sided IE and included in this study. Forty-three (43) (72%) patients were current IVDUs, who were younger and more likely to have hepatitis. The majority (90%) of d small vegetations do well with medical management and this should continue to be the preferred strategy. However, those with large vegetations have poorer late outcomes and may require more aggressive treatment and closer follow-up.

Capsular contracture is a common complication after breast augmentation. However, no objective methods are available to assess capsular contracture at present. The goal of the present study was to evaluate the correlation between capsular contracture and 3D images of the silicone implants by using magnetic resonance imaging (MRI) with sampling perfection with application optimized contrast using different flip angle evolutions (SPACE) sequence.

Twenty-one patients (42 breasts) underwent breast augmentation, had postoperative MRI examinations with SPACE sequence, and the evaluation of the Baker grade by two trained plastic surgeons. Capsular thickness was measured on the T2-weighted images. The software ITK-SNAP was used to reconstruct 3D images of the implants. The fold characteristics such as number, depth, direction, and distribution were compared with the Baker grade.

Of the 42 breasts, 14, 8, 12, and 8 breasts were classified as Baker grade I, II, III, and IV, respectively. The MRI images of breasts with Baker grade III or IV revealed a thicker capsule (mean of 2.29 mm) as compared to the capsule with the lower Baker grades (mean of 1.58 mm). The 3D images of implants showed no difference in the number of folds between the groups with different Baker grades. The fold direction and fold distribution differed between grade I to II and grade III to IV.

The 3D image of an implant with pathological folds is a potential and feasible diagnostic indication of capsular contracture.

IV.

IV.

The use of acellular dermal matrix (ADM) for breast reconstruction continues to change in both single- and two-stage reconstruction. Determining optimal outcomes clinically, aesthetically, financially as well as for the patient's quality of life has become a priority.

A retrospective review of implant-based reconstructions was performed at a single center from 2010 to 2016, with patients blindly matched 111 into three cohorts based on reconstruction type 1) single stage direct to implant with ADM, 2) two-stage tissue expander to implant (TE/I) without ADM, and 3) two-stage TE/I with ADM. Relative cost between groups, esthetic outcomes, and quality of life within each group was analyzed.

Group 1 was more likely to be older and use intraoperative angiography, but with fewer overall surgeries and postoperative visits (p<0.001). There was no statistically significant difference in reconstructive success among all three groups (p = 0.85). Cost was significantly higher for group 3 relative to groups 1 and functional and aesthetically pleasing outcomes in single- and two-stage breast reconstructions.

The thigh region is a well-known area for harvesting cutaneous flaps for microsurgery replacement, given the characteristics of the skin thin, flexible, and glabrous. We investigated the vascular pattern of 32 cadaveric anteroproximal thighs for the possibility of an extended harvesting area, which we call the proximal femoral artery perforator region.

We injected colored, radio opaque latex in the external iliac artery and investigated the perforator branches from the superficial circumflex iliac, femoral common, superficial, and deep femoral (profunda femoris) arteries to the skin of the proximal femoral artery perforator region. This region was divided into 3 equal subregions (superior, medial, and lateral), and their perforators were counted and measured.

There was no significant difference in the number of arterial pedicles across the three subregions 30 superior, 35 inferolateral, and 27 inferomedial. The perforators had a cutaneous path in 81% of the cases, while 6% were musculocutaneous and 5% septocutaneous, without a significant difference in their proportion in the three subregions. The mean length and diameter of the pedicles were 5.39 ± 2.1 cm and 1.07 ± 0.4 mm, respectively, without significant differences in the three subregions.

The proximal femoral artery perforator region is a suitable area to generate flaps of various sizes and shapes, as needed by the surgeon. All perforators were constant and possessed a sufficient diameter and length for a successful anastomosis during the surgical procedure. The donor site retains all technical advantages to successfully replace areas of glabrous skin.

The proximal femoral artery perforator region is a suitable area to generate flaps of various sizes and shapes, as needed by the surgeon. All perforators were constant and possessed a sufficient diameter and length for a successful anastomosis during the surgical procedure. The donor site retains all technical advantages to successfully replace areas of glabrous skin.

Despite the increasing use of preimplantation genetic testing (PGT) for aneuploidy and monogenic diseases, for children conceived using PGT there is limited follow-up beyond 2 years of age. This study examined the health, well-being and development of school-aged children (5-8 years old) conceived following PGT.

Retrospective cohort study of children conceived after IVF with PGT (exposed cohort) and children conceived after IVF without PGT (unexposed cohort) at two IVF clinics in Melbourne, born between 2000 and 2008, recruited with a 12 ratio. Mothers of the children completed a questionnaire asking child-specific questions regarding health and well-being, mental health, development, educational achievement and family-specific questions regarding family functioning and parent-child attachment.

A total of 155 participants were recruited to the PGT cohort and 303 participants to the IVF-only cohort. There were no differences between the two cohorts with regards to maternal characteristics, birth defect frequency and pregnancy characteristics, apart from delivery by Caesarean section, which was more frequent in PGT singletons (55%) compared with IVF-only singletons (36%).