ABSTRACT Introduction: Robotic Radical Prostatectomy using the Da-Vinci Single-Port (SP) robot can provide comparable functional and oncological outcomes with potential advantages pertaining to peri-operative morbidity, especially in patients with an extensive history of prior abdominal surgeries (1, 2). Materials and Methods: Our case is a 74-year-old male with a history of diabetes, cardiac bypass, hypertension, and hyperlipidemia, presenting with a PSA of 7.2. His MRI showed a PIRADS-5 lesion in the left apex and mid-gland peripheral zone, and he was diagnosed with unfavorable intermediate-risk prostate cancer after MRI guided fusion biopsy. His BMI was 31, and past surgical history was pertinent for two exploratory laparotomies due to gunshot wounds and a colostomy creation followed by reversal. The standardized steps of robotic radical prostatectomy were carried out using SP robotic platform performed by author SH (3, 4). Results: Total operative time and estimated blood loss were 210 minutes and 150mL respectively. The patient was discharged on postoperative day one and final pathology showed adenocarcinoma of the prostate Gleason score 4+3=7, pT2NxR0 and negative surgical margins. The patient was continent four weeks after surgery and the PSA continues to be undetectable after three months. Conclusion: Transvesical Radical prostatectomy using the single port platform provides acceptable oncological and functional outcomes and quicker recovery given decreased risk of ileus and peritoneal irritation. Given that the abdominal cavity is not violated, the risk of bowel or vascular injury is mitigated, especially in patients with a hostile abdomen. Introduction DaVinci Da Vinci SinglePort Single Port (SP perioperative peri morbidity 1, 1 (1 2. 2 . 2) Methods 74yearold yearold 74 year old diabetes bypass hypertension hyperlipidemia 72 7 7.2 PIRADS5 PIRADS 5 PIRADS- midgland mid gland zone intermediaterisk intermediate biopsy 31 reversal 3, 3 (3 4. 4 4) Results 21 mL respectively 437 4+3=7 pTNxR pT NxR pT2NxR margins months Conclusion irritation violated mitigated abdomen ( 7. 43 4+3= 4+3 4+

ABSTRACT Introduction: The introduction of Single-Port (SP) platform opened the field to new surgical options, allowing to perform major urological robot-assisted procedures extraperitoneally and with a supine patient positioning (1–3). Nevertheless, a comprehensive description of different supine access options is still lacking (4–6). In this light, we provided a step-by-step guide of SP extraperitoneal supine access options also exploring preliminary surgical outcomes. Materials and methods: Transvesical access was performed by a transversal incision 3cm above the pubic bone, after the anterior abdominal sheet incision, the bladder was insufflated with a flexible cystoscope and the detrusor muscle was incised at the level of the bladder dome. Similarly, the extraperitoneal access was carried out with a 4cm incision above the pubic bone, once visualized the preperitoneal space the prevesical fat was gently spread. The Low Anterior Access was performed with a 3cm incision at the McBurney point, the abdominal muscles were then spread. A gentle dissection was used laterally to develop the retroperitoneal space. Results: Overall, sixteen different procedures were performed with supine extraperitoneal access on 623 consecutive patients. No intraoperative conversions occurred. The median access time was 16 (IQR 12-21), 11 (IQR 7-14) and 14 (IQR 10-18) minutes in case of transvesical, extraperitoneal and low anterior access, respectively. Notably, 81.5 % of patients were discharged on the same day with a postoperative opioid free rate of 73%. Conclusion: The Atlas provides a comprehensive step-by-step guide to successfully perform all major urological SP procedures extraperitoneally and with supine patient positioning. Introduction SinglePort Single Port (SP robotassisted robot assisted 1–3. 13 1–3 . 1 3 (1–3) Nevertheless 4–6. 46 4–6 4 6 (4–6) light stepbystep step outcomes methods cm bone dome Similarly spread point Results Overall 62 occurred IQR 1221, 1221 12 21 , 12-21) 714 7 7-14 1018 10 18 10-18 transvesical respectively Notably 815 81 5 81. 73 73% Conclusion 1– (1–3 4– (4–6 122 2 12-21 71 7-1 101 10-1 8 (1– (4– 12-2 7- 10- (1 (4 12- (

SUMMARY: Drinking alcohol while pregnant can cause several diseases, belonging to an umbrella of disorders known as Fetal Alcohol spectrum disorders. Alcohol exposure during pregnancy is linked to reduced birth weights, shorter bones, delayed bone growth, decreased bone resilience, and delayed ossification of the bones. However, the specific effects on the craniofacial bones, particularly the mandible, remain less explored. This study aims to fill this gap by examining the impact of gestational alcohol consumption on mandibular structure. Time-mated pregnant Sprague Dawley dams were divided into an ethanol group (n=6) and a saline control group (n=6). The ethanol group was given 0.015ml/g of 25.2% ethanol, while the control group received 0.9% saline for the first 19 days of gestation. The presence of a vaginal plug indicated the first day of gestation. After birth, the pups were euthanized at three weeks of age, and their mandibles were harvested and analyzed using a 3D-mCT scanner to assess bone ratio, trabecular thickness, number, and spacing. Osteometric measurements for mandibular length and height were also taken. The study found no significant differences in trabecular morphometric parameters between the groups. However, one parameter for mandibular length (Cd-Bi) and two parameters for mandibular height (Cd-Ag and Cr-Ag) were significantly smaller in the ethanol group than in the controls. The study reveals that gestational alcohol consumption can significantly affect the development of the mandible, with potential implications for understanding the mechanisms behind alcohol-induced teratogenicity. The findings highlight the need for further research to explore the intricate interactions between embryological, biological, genetic, and epigenetic factors that contribute to the varied effects of alcohol exposure during pregnancy on different skeletal systems.

RESUMEN: Beber alcohol durante el embarazo puede causar varias enfermedades, pertenecientes a un conjunto de trastornos conocidos como trastornos del espectro alcohólico fetal. La exposición al alcohol durante el embarazo está relacionada con un peso reducido al nacer, huesos más cortos, retraso en el crecimiento óseo, disminución de la resistencia ósea y retraso en la osificación de los huesos. Sin embargo, los efectos específicos sobre los huesos craneofaciales, particularmente la mandíbula, siguen siendo menos analizados. Este estudio tiene como objetivo llenar este vacío examinando el impacto del consumo de alcohol gestacional en la estructura mandibular. Las madres preñadas Sprague Dawley apareadas en el tiempo, se dividieron en un grupo de etanol (n=6) y un grupo control de solución salina (n=6). El grupo de etanol recibió 0,015 ml/g de etanol al 25,2 %, mientras que el grupo control recibió solución salina al 0,9 % durante los primeros 19 días de gestación. La presencia de un tapón vaginal indicó el primer día de gestación. Después del nacimiento, las crías fueron sacrificadas a las tres semanas de edad, y sus mandíbulas fueron extraídas y analizadas utilizando un escáner 3D-mCT para evaluar la proporción ósea, el grosor trabecular, el número y el espaciado. También se tomaron medidas osteométricas de longitud y altura mandibular. El estudio no encontró diferencias significativas en los parámetros morfométricos trabeculares entre los grupos. Sin embargo, un parámetro para la longitud mandibular (Cd-Bi) y dos parámetros para la altura mandibular (Cd-Ag y Cr-Ag) fueron significativamente menores en el grupo de etanol que en los controles. El estudio revela que el consumo de alcohol gestacional puede afectar significativamente el desarrollo de la mandíbula, con implicaciones potenciales para comprender los mecanismos detrás de la teratogenicidad inducida por el alcohol. Los hallazgos resaltan la necesidad de realizar más investigaciones para explorar las intrincadas interacciones entre factores embriológicos, biológicos, genéticos y epigenéticos que contribuyen a los diversos efectos de la exposición al alcohol durante el embarazo en diferentes sistemas esqueléticos.

SUMMARY: Studies have shown an association between homocysteine (Hcy) and several pathological conditions, including cardiovascular disease. However, the relationship between Hcy and testicular disorders is still unclear. The present study investigated the effects of Hcy on testicular structure. Thirteen adult Wistar albino rats were divided into two groups. The control group and the methionine group received an oral solution of L-methionine 200 mg /kg per day for six months. Blood samples and testes were collected for subsequent experiments. Serum levels of Hcy and testosterone were analyzed. We examined the histopathological and immunohistochemical localization of GATA-4, vimentin (VIM), connexin-43 (Cx-43), occludin (OCLN), androgen receptor (AR), estrogen receptor 1 (ESR1), estrogen receptor 2 (ESR2) in the rat testis. Results showed that rats receiving methionine showed a reduction in body and testicular weights. Histological and immunohistochemical examination of the testicular tissues of methionine group showed altered structure of seminiferous tubules with decreased immunoexpression of Cx-43, GATA-4, OCLN, VIM, AR, ESR1 and ESR2 compared to control. The results suggest that Hcy has a negative effect on the testes with a probable disruption of spermatogenesis.

RESUMEN: Estudios han demostrado una asociación entre la homocisteína (Hcy) y varias afecciones patológicas, incluidas las enfermedades cardiovasculares. Sin embargo, la relación entre Hcy y los trastornos testiculares aún no está clara. El presente estudio investigó los efectos de la Hcy sobre la estructura testicular. En este trabajo se dividieron trece ratas albinas Wistar adultas en dos grupos. El grupo de control y el grupo de metionina recibieron una solución oral de L-metionina 200 mg/kg por día durante seis meses. Se recogieron muestras de sangre y testículos para experimentos posteriores. Se analizaron los niveles séricos de Hcy y testosterona. Examinamos la localización histopatológica e inmunohistoquímica de GATA-4, vimentina (VIM), conexina-43 (Cx-43), ocludina (OCLN), receptor de andrógenos (AR), receptor de estrógeno 1 (ESR1) y receptor de estrógeno 2 (ESR2) en el testículo de la rata. Los resultados mostraron que las ratas que recibieron metionina presentaron una reducción en el peso corporal y testicular. El examen histológico e inmunohistoquímico de los tejidos testiculares del grupo de metionina mostró una estructura alterada de los túbulos seminíferos con una inmunoexpresión disminuida de Cx-43, GATA-4, OCLN, VIM, AR, ESR1 y ESR2 en comparación con el control. Los resultados sugieren que la Hcy tiene un efecto negativo sobre los testículos con una probable alteración de la espermatogénesis.

SUMMARY: Simple hepatic cysts of the liver (SHCL) are incidentally detected in the liver, and may be solitary or multiple. There is sufficient evidence supporting the role of laparoscopic surgery in the treatment of these lesions. The aim of this study was to report the outcomes of laparoscopic treatment in patients with BSHCs in terms of postoperative complications (POC). Case series.All patients who underwent laparoscopic surgery for BSLC at RedSalud Mayor Clinic between January 2013 and December 2023 were included. Preoperative assessment consisted of general examinations, determination of ELISA-IgE and IgG for hydatidosis, abdominal ultrasound or computed tomography. The outcome variable was the development of postoperative complications (POCs). Descriptive statistics were used. During the study period, 22 patients with BSLC were operated, resecting them a total of 34 cysts. The median age of the series was 59 years, and 81.8 % of patients were female. The median sonographic diameter of the lesions was 9 cm. Subtotal pericystectomy was performed in all of them, without using drainage. In 45.4 % of cases simultaneously cholecystectomy for coexistent cholelithiasis was performed. The median operative time was 52 minutes. No patients needed to be converted. The series does not register POC or mortality. The median hospital stay was 1 day. The histopathological study confirmed "biliary type cyst" in all cases. With a minimum follow-up of 6 months, no late postoperative complications or recurrence of the resected lesions have been observed. The treatment applied to this series of cases was associated with a short hospital stay and good short- and medium-term outcomes.

RESUMEN: Los quistes hepáticos benignos simples del hígado (QHBSH) se detectan de forma incidental, pudiendo ser únicos o múltiples. Existe suficiente evidencia que avala el rol de la cirugía laparoscópica en el tratamiento de estas lesiones. El objetivo de este estudio fue informar los resultados del tratamiento laparoscópico en pacientes con QHBSH en términos de complicaciones postoperatorias (CPO). Serie de casos. Se incluyeron todos los pacientes intervenidos quirúrgicamente vía laparoscópica por QHBSH en la Clínica RedSalud Mayor entre enero de 2013 y diciembre de 2023. El estudio preoperatorio consistió en exámenes generales, determinación de ELISA-IgE e IgG para hidatidosis, ecotomografía abdominal o tomografía computarizada. La variable resultado fue desarrollo de CPO. Se utilizó estadística descriptiva. En el período estudiado, se intervinieron 22 pacientes con QHBSH, resecándose en ellos, un total de 34 quistes. El 81,8 % de los casos eran de sexo femenino; y la mediana de edad de la serie fue de 59 años. La mediana del diámetro ecográfico de las lesiones fue de 9 cm. Se realizó periquistectomía subtotal en todos ellos, sin utilización de drenaje. En el 45,4 % de los casos se ejecutó de forma simultánea una colecistectomía por colelitiasis coexistente. La mediana del tiempo quirúrgico fue de 52 minutos. No fue necesario convertir a ningún paciente. La serie no registra CPO ni mortalidad. La mediana de estancia hospitalaria fue de 1 día. El estudio histopatológico confirmó “quiste de tipo biliar” en la totalidad de los casos. Con un seguimiento mínimo de 6 meses, no se ha evidenciado CPO tardía ni reaparición de las lesiones resecadas. El tratamiento aplicado a esta serie de casos se asoció a escasa estancia hospitalaria y buena evolución a corto y mediano plazo.

Abstract In this article, we recover and expand our lenses on the research experience in dialogue with a part of María Bertely's production. To do this, and about the academic spaces that we shared with María, we return to some nodal analyses and reflections around the lines of research that we have developed for several decades regarding indigenous schooling in urban and migration contexts in Mexico. Every day, this field of study becomes more important in the face of the growing migration of the indigenous population to the various cities of the national territory. Among its multiple causes and consequences, both structural and cyclical, we analyze its links and implications with the schooling context, mainly in this text referring to elementary education considering national and international public policies. Bertely was a pioneer in studies that addressed the relationship between school and indigenous migration in urban contexts. In the fabric of these debates, the authors developed a series of investigations that make visible the right to education with cultural and linguistic recognition, mainly of indigenous populations in schools of the general system of the national territory. The text, more than reflecting a state of knowledge on the subject, documents certain journeys that refer to epistemic and methodological transformations that occurred in educational anthropological research. Likewise, it seeks to contribute to public policies in the education, diversity, and interculturalism field, an approach that currently guides the entire educational system in Mexico.

Resumen En este artículo recuperamos y ampliamos nuestras lentes sobre la experiencia de investigación en diálogo con una parte de la producción de María Bertely. Para ello, y en referencia a los espacios académicos que compartimos con María, retomamos algunos análisis y reflexiones nodales en torno a las líneas de investigación que hemos desarrollado desde hace varias décadas referente a escolarización indígena en contextos urbanos y de migración en México. Este campo de estudio cobra cada día mayor importancia ante la creciente migración de población indígena a las diversas urbes del territorio nacional. Entre sus múltiples causas y consecuencias, tanto estructurales como coyunturales, analizamos sus vínculos e implicaciones con el contexto escolarizado, principalmente en este texto referido a la educación básica, a la luz de las políticas públicas nacionales e internacionales. Bertely fue pionera en los estudios que abordaron la relación entre escuela y migración indígena en contextos urbanos. En el tejido de estos debates, las autoras desarrollamos una serie de investigaciones que visibilizan el derecho a la educación con reconocimiento cultural y lingüístico, y en particular de poblaciones indígenas en escuelas del sistema general del territorio nacional. El trabajo, más que reflejar un estado del conocimiento sobre el tema, documenta ciertos recorridos que refieren a transformaciones epistémicas y metodológicas ocurridas en la investigación antropológica educativa. Asimismo, busca contribuir a las políticas públicas en el campo de la educación y la diversidad e intercultural, enfoque que en la actualidad orienta a todo el sistema educativo en México.

Abstract Introduction Unplanned hospital returns are frequent and may be preventable. Objective To comprehend the reasons for unplanned hospital readmission and return to the Outpatient Department (OPD) and Emergency Department (ED) within 60 days after discharge following head and neck surgery (HNS) at a tertiary care center in Saudi Arabia. Methods In the present retrospective study, the medical records of all patients who underwent HNS for benign and malignant conditions between January 2015 and June 2022 were reviewed in terms of demographic data, comorbidities, and reasons for hospital return. Results Out of 1,030 cases, 119 (11.55%) returned to the hospital within 60 days after discharge, 19 of which (1.84%) were readmitted. In total, 90 (8.74%) patients returned to the OPD, and 29 (2.82%), to the ED. The common reasons for readmission included infections (26.32%) and neurological symptoms (21.05%). For OPD visits, the common causes were hematoma (20%) and neurological symptoms (14.44%). For ED returns, the frequent causes were neurological symptoms (20.69%) and equipment issues (17.24%). Compared with nonreadmitted patients, readmitted patients had a higher preoperative baseline health burden when examined using the American Society of Anesthesiologists (ASA) score (p = 0.004) and the Cumulative Illness Rating Scale (CIRS; p = 0.002). Conclusion The 60-day rates of unplanned hospital return to the OPD and ED were of 8.74% and 2.82% respectively, and 1.84% of the patients were readmitted. Hematoma, infections, and neurological symptoms were common causes. Addressing the common reasons may be beneficial to decrease postoperative hospital visits. preventable (OPD (ED 6 (HNS Arabia study 201 202 data comorbidities 1030 1 030 1,03 cases 11 11.55% 1155 55 (11.55% 184 84 (1.84% total 9 874 8 74 (8.74% 2 2.82%, 282 , 82 (2.82%) 26.32% 2632 26 32 (26.32% 21.05%. 2105 21.05% . 21 05 (21.05%) visits 20% 20 (20% 14.44%. 1444 14.44% 14 44 (14.44%) 20.69% 2069 69 (20.69% 17.24%. 1724 17.24% 17 24 (17.24%) ASA (ASA 0.004 0004 0 004 CIRS (CIRS 0.002. 0002 0.002 002 0.002) 60day day 8.74 2.82 respectively 1.84 Hematoma 103 03 1,0 11.55 115 5 (11.55 18 (1.84 87 7 (8.74 28 (2.82% 26.32 263 3 (26.32 210 21.05 (21.05% (20 144 14.44 4 (14.44% 20.69 206 (20.69 172 17.24 (17.24% 0.00 000 00 8.7 2.8 1.8 10 1, 11.5 (11.5 (1.8 (8.7 (2.82 26.3 (26.3 21.0 (21.05 (2 14.4 (14.44 20.6 (20.6 17.2 (17.24 0.0 8. 2. 1. 11. (11. (1. (8. (2.8 26. (26. 21. (21.0 ( 14. (14.4 20. (20. 17. (17.2 0. (11 (1 (8 (2. (26 (21. (14. (17. (21 (14 (17

Abstract Introduction Eagle syndrome is a rare and an often misdiagnosed entity in otorhinolaryngology. Objective To determine the efficacy of the surgical treatment for Eagle syndrome. Methods The present prospective study included 25 patients who presented with complaints of pain in the throat, ear, and neck, as well as difficulty and/or pain while swallowing; they were assessed for Eagle syndrome. As per patient profile, we performed a clinical assessments along with orthopantomograms (OPGs), three-dimensional computed tomography (3D CT) scans, and cone beam computed tomography (CBCT). Pain was assessed pre- and postoperatively through the Numerical Rating Scale-11 (NRS-11), whose score ranges from 0 to 10. Microscopic tonsillo-styloidectomy was performed in cases in which the conservative treatment failed to relieve pain. Results The mean age of the entire study population was of 36.08 ± 7.19 years, and the male-to-female ratio was of 1.08:1. Referred otalgia was the commonest (44%) complaint. Radiologically, out of 25 patients, 20 patients presented elongated styloid processes. The longest symptomatic styloid process measured radiographically was of 64.7 mm while the shortest was of 28.2 mm. Out of 20 patients, 12 underwent surgery. The postoperative pain assessment through the NRS-11 was performed on day 0 (3.83 ± 0.83), day 7 (1.5 ± 0.52), week 4 (0.5 ± 0.52), and week 12 (0.41 ± 0.51). By 12 weeks, 7 patients were symptom-free, while 5 patients still reported mild pain. Conclusion Eagle syndrome associated with an elongated styloid process is not a rarity, but it often goes undiagnosed. Microscopic tonsillo-styloidectomy shows excellent results in the management of patients with Eagle syndrome. otorhinolaryngology 2 throat ear neck andor or swallowing profile OPGs, OPGs , (OPGs) threedimensional three dimensional 3D D CT scans CBCT. CBCT . (CBCT) pre Scale11 Scale 11 Scale-1 NRS11, NRS11 NRS (NRS-11) 10 tonsillostyloidectomy tonsillo styloidectomy 3608 36 08 36.0 719 19 7.1 years maletofemale male female 1.081. 1081 1.08 1. 1 1.08:1 44% 44 (44% complaint Radiologically processes 647 64 64. 282 28 28. surgery NRS-1 3.83 383 3 83 (3.8 0.83, 083 0.83 0.83) 1.5 15 (1. 0.52, 052 0.52 52 0.52) 0.5 05 (0. 0.41 041 41 (0.4 0.51. 051 0.51 51 0.51) weeks symptomfree, symptomfree symptom free, free symptom-free rarity undiagnosed (OPGs (CBCT Scale1 Scale- NRS1 (NRS-11 360 36. 71 7. 081 1.081 108 1.0 1.08: (44 6 NRS- 3.8 38 8 (3. 0.8 (1 0. (0 0.4 04 (NRS-1 (4 3. (3 ( (NRS- (NRS

Abstract Introduction Tonsillectomy is one of the most common operations performed by otorhinolaryngology surgeons worldwide; however, the insufficient quality of the postoperative pain management and effective posttonsillectomy pain relief remain a clinical dilemma. Objective To evaluate the efficacy of applying bismuth iodine paraffin paste (BIPP) to the dissected fossa as an adjuvant therapy for a better outcome in terms of posttonsillectomy pain management and due to its wound healing properties. Methods The present is a prospective randomized control pilot study with 44 patients aged > 7 years who underwent tonsillectomy. The patients were divided into two groups: the control group and the group that had BIPP applied to the dissected tonsillar fossa. The visual analogue scale score and the post-onsillectomy percentage of tonsillar fossa epithelization were recorded and evaluated. Results Both subjectively and objectively, there a was statistically significant pain-relieving effect in the BIPP group within the first 5 postoperative days (p < 0.05). From postoperative day 3 onward, the dissected area of the tonsillar fossa healed significantly faster in the BIPP group compared with the control group, and it became stable on day 14. Conclusion The topical application of BIPP showed a better pain-relieving effect, it was safe, and hastened wound healing after tonsillectomy. worldwide however dilemma (BIPP properties 4 tonsillectomy groups postonsillectomy post onsillectomy evaluated objectively painrelieving relieving p 0.05. 005 0.05 . 0 05 0.05) onward 14 safe 00 0.0 1 0.

Abstract Introduction Despite the evidence against drain placement after thyroidectomy, there is a lack of consensus on drain use in patients with substernal goiter. Objective To assess the factors that increase the likelihood of drain placement and its impact on postoperative hematoma and other 30-day complications among adult patients undergoing thyroidectomy for substernal goiter. Methods A retrospective cohort study that used data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Adult patients (aged ≥ 18 years) who underwent elective thyroidectomy for substernal goiter from 2016 to 2020 were included. Cases with closed suction neck drains placed upon completion of surgery were included in the drain group, and the remaining cases formed the nondrain group. Results A total of 1,229 patients were included (46.5% with drain placement). The factors that increased the likelihood of drain placement included body mass index (BMI) ≥ 30 kg/m2, score between 3 and 5 on the American Society of Anesthesiologists (ASA) physical status classification, sternal split/transthoracic surgical approach, operative time ≥ 90 minutes, and surgery conducted by otolaryngologists. Patients with clean-contaminated or contaminated wound classifications were less likely to be submitted to drain placement. In addition, drain use had no impact on postoperative hematoma formation but was found to independently increase the risk of prolonged length of hospital stay. Conclusion Thyroidectomy without drain placement might be safe for substernal goiter. However, this decision should be individualized for each patient. Level Of Evidence: 3 30day day ACSNSQIP. ACSNSQIP ACS NSQIP . (ACS-NSQIP) aged 1 years 201 202 group 1229 229 1,22 46.5% 465 46 (46.5 placement) BMI (BMI kgm2 kgm kg m2 m kg/m2 ASA (ASA classification splittransthoracic split transthoracic approach 9 minutes otolaryngologists cleancontaminated clean addition stay However patient Evidence (ACS-NSQIP 20 122 22 1,2 46.5 4 (46. kg/m 2 12 1, 46. (46 (4 (

RESUMEN: El consumo de alcohol entre menores de edad se ha convertido en una importante preocupación pública que tiene un impacto negativo en el crecimiento y desarrollo del esqueleto. La masa ósea máxima se alcanza durante la adolescencia, por lo que el objetivo del estudio fue investigar el efecto del consumo excesivo de alcohol en forma aguda sobre la morfometría trabecular y la resistencia a la tracción de la mandíbula en ratas adolescente Sprague Dawley (SD). El estudio estuvo compuesto por 24 ratas, de 7 semanas de edad, colocadas en el grupo control expuesto al alcohol [n=12 (6 machos y 6 hembras)] y alimentado en parejas [n=12 (6 machos y 6 hembras)]. El tratamiento de los grupos fue el siguiente; al grupo expuesto al alcohol y al control alimentado en parejas se les administró una dosis única diaria de 3 g/kg de alcohol al 20 % 3 días a la semana (días alternos) durante 7 días y una dosis equivalente calórica de maltosa dextrina mediante sonda oral, respectivamente. Los animales fueron sacrificados el día 7 mediante inyección de pentobarbital. Las mandíbulas se recolectaron y se escanearon utilizando un escáner 3D-microCT Nikon XTH 255L (Nikon Metrology, Lovaina, Bélgica), y las pruebas biomecánicas se realizaron utilizando una máquina de prueba de resistencia a la tracción universal Shimadzu (China). Después del escaneo y la reconstrucción, la morfometría trabecular se evaluó utilizando el software Volume Graphics Studio®. Se utilizó una prueba de flexión de 3 puntos para evaluar la resistencia a la tracción del hueso. Los hallazgos de nuestro estudio mostraron cambios en algunos parámetros trabeculares en el grupo de hembras expuestas al alcohol, mientras que los grupos de machos no se vieron afectados. No se observaron cambios en la resistencia a la tracción al comparar los grupos control de machos alimentados en parejas y los grupos expuestos al alcohol y al comparar los grupos control de las hembras alimentadas en parejas y los grupos expuestos al alcohol. Se observaron diferencias trabeculares y de resistencia a la tracción entre los sexos al comparar los grupos control de los machos alimentados en parejas y expuestos al alcohol con los grupos de control de hembras alimentadas en parejas y expuestas al alcohol. Estos hallazgos sugieren que el consumo excesivo de alcohol tiene efectos perjudiciales sobre la microarquitectura ósea en ratas hembras expuestas al alcohol y que se observan diferencias entre los sexos.

SUMMARY: Underage drinking has become a major public concern having a negative impact on the growth and development of the skeleton. Peak bone mass is attained during adolescence hence the aim of the study was to investigate the effect of acute binge alcohol consumption on trabecular morphometry and tensile strength of the adolescent mandible in the Sprague Dawley (SD) rat. The study comprised of 24 SD rats, aged 7 weeks, placed into either the alcohol-exposed [n=12 (6 males and 6 female)] or pair-fed control group [n=12 (6 male and 6 female)]. The treatment of the groups was as follows; the alcohol exposed group and the pair-fed control were administered a single daily dose of 3 g/kg of 20 % alcohol 3 days a week (alternate days) for 7 days and a caloric equivalent dose of maltose dextrin via oral gavage, respectively. The animals were terminated on day 7 via pentobarbital injection. The mandibles were harvested and scanned using a Nikon XTH 255L 3D-microCT scanner (Nikon Metrology, Leuven, Belgium), and biomechanical tests were done using a Shimadzu universal tensile strength testing machine (China). Following scanning and reconstruction, the trabecular morphometry was assessed using Volume Graphics Studio® software. A 3-point bending test was used to evaluate the tensile strength of the bone. Findings from our study showed changes in some trabecular parameters in the female alcohol-exposed group, while the male groups remained unaffected. No changes in tensile strength were seen when comparing male pair-fed control and alcohol-exposed groups and when comparing female pair-fed control and alcohol-exposed groups. Trabecular and tensile strength differences were observed between the sexes when comparing male pair-fed control and alcohol-exposed groups to female pair-fed control and alcohol-exposed groups. These findings do suggest that acute binge alcohol consumption has detrimental effects on the bone micro-architecture in female alcohol-exposed rats and that differences are seen between the sexes.

RESUMEN: Se realizó un estudio sobre la relación entre el valor de la Unidad Hounsfield (HU) de corte único del húmero proximal chino y la densidad mineral ósea (DMO) mediante TC de tórax de rutina y absorciometría de rayos X de energía dual (DEXA). Se recopilaron datos de 240 personas que se sometieron a DEXA y tomografías computarizadas de rutina de tórax (incluidas imágenes completas del húmero proximal) el mismo día en 967 hospitales entre enero de 2019 y diciembre de 2021. El método para medir los valores de HU de un solo corte del húmero proximal en las tomografías computarizadas de tórax mostraron alta confiabilidad y repetibilidad (coeficiente de correlación intraclase > 0,961, P < 0,001). Se observó una fuerte correlación positiva entre los valores de HU de un solo corte del húmero proximal y los resultados de DEXA, demostrando el valor de HU de 20 mm la correlación más alta. En diferentes grupos de IMC, el área bajo la curva (AUC) para el valor HU de 20 mm fue consistentemente el más grande (AUC = 0,701-0,813, P <0,05). Por lo tanto, el valor de HU de 20 mm puede considerarse una referencia fiable para el cribado oportunista de DMO baja, con valores de referencia de -4 HU para personas con bajo peso, -13 HU para personas con peso normal, -7 HU para personas con sobrepeso y -16 HU para personas obesas. Los valores por debajo de estos umbrales indican un riesgo de DMO baja. Este estudio es un aporte para los datos chinos sobre la DMO y ofrece un enfoque rápido y eficaz para detectar de forma oportunista la DMO baja.

SUMMARY: A Study on Relationship between Single-Slice Hounsfield Unit(HU) value of the Chinese proximal humerus and Bone Mineral Density(BMD) Using Routine Chest CT and Dual-energy X-ray Absorptiometry(DEXA) was performed. Data were collected from 240 individuals who underwent DEXA and routine chest CT scans (including full images of the proximal humerus) on the same day at 967 Hospitals between January 2019 and December 2021. The method of measuring single-slice HU values of the proximal humerus on routine chest CT scans exhibited high reliability and repeatability (intraclass correlation coefficient > 0.961, P < 0.001). A strong positive correlation was observed between single-slice HU values of the proximal humerus and DEXA results, with the 20-mm HU value demonstrating the highest correlation. Across different BMI groups, the Area Under Curve (AUC) for the 20-mm HU value was consistently the largest (AUC=0.701- 0.813, P< 0.05). Therefore, the 20-mm HU value can be considered a reliable reference for the opportunistic screening of low BMD, with reference values of -4HU for underweight individuals, -13HU for normal weight individuals, -7HU for overweight individuals, and -16HU for obese individuals. Values below these thresholds indicate a risk of low BMD. This study enriches the Chinese BMD data and offers a swift and effective approach for opportunistically screening low BMD.

The decomposition of a body, and the associated gaseous and liquid discharges emanating from it, attract gravid female blow flies which lay their eggs in or on the body. After the eggs have hatched, the emerging larvae start feeding on the body. As decomposition progresses, the blow fly larvae often migrate away, typically in a random manner in search of favourable conditions for pupation. In this paper, we report on a rarely described phenomenon of unidirectional mass migration of blow fly larvae and postulate on the factors which may drive this process. A decomposition trial utilising a 60-kg pig carcass, deployed in the summer months in Table Mountain National Park, Cape Town, South Africa, was conducted in 2022. On the fifth day of the trial, simultaneous unidirectional mass dispersal of blow fly larvae was observed. The larvae moved downhill in a southeasterly direction, following the flow of decomposition fluids oozing out from the pig carcass. The 'larval migration stream' had a length of approximately 1.5 m with a width of 40 cm, tapering to 17 cm at the terminal point. The larval migration stream consisted of the larvae of Chrysomya albiceps and Chrysomya chloropyga. This study demonstrates the importance of understanding the timing and pattern of dispersal of post-feeding blow fly larvae in each geographical region. This is crucial as the minimum post-mortem interval can be miscalculated if older immature insects dispersing from the corpse are not considered and collected during crime scene investigations. SIGNIFICANCE: • Understanding the timing and pattern of dispersal of blow fly larvae from decomposing vertebrate remains in each geographical region is important in time-since-death estimations when using entomological evidence. • In the summer season of the Western Cape Province, Chrysomya albiceps and Chrysomya chloropyga are among the blow fly species of forensic importance as they deposit their eggs on vertebrate remains. • When a decomposing body is found within the Table Mountain region, we suggest that crime scene investigators should examine the downhill area of the scene for larval/pupal entomological evidence that can assist in time and season of death estimations.

ABSTRACT Introduction Ureteral stricture is often a consequence of urolithiasis or previous endourological procedures (1-3). Precisely delineating the stricture zone intraoperatively is crucial to minimize ureter shortening and target only the affected tissue (4, 5). Flexible ureteroscopy offers a significant advantage in this regard. Objective This video aims to demonstrate the step-by-step technique of flexible ureteroscopic guided laparoscopic ureteroplasty for treating ureteral stricture caused by urolithiasis and prior endourological interventions. Patient and Methods We present a case of a 36-year-old male with a history of urolithiasis and unsuccessful endourological treatments, including endoureterotomy and balloon dilation, diagnosed with re-stenosis of the proximal ureter of 1 cm through ureteroscopy and pyelography. He underwent a successful laparoscopic ureteroplasty. While the lead surgeon performed the laparoscopy, an assistant conducted the flexible ureteroscopy. Intraoperatively, using transillumination facilitated by the flexible ureteroscope, we can precisely identify the narrowed area, allowing for resection of only the damaged segment. Subsequently, we perform the end-to-end ureteroplasty, confirming its patency through the seamless passage of the ureteroscope. Upon completion, we employ a fat patch to safeguard the anastomosis. Results The patient was discharged on the third postoperative day. Double J stent was removed six weeks after surgery. Symptoms resolved. Renal function improved: eGFR 49 to 67 ml/min. Furthermore, improvement was observed in the DTPA scan, and a decrease in hydronephrosis was noted on the follow-up tomography. Conclusion Flexible ureteroscopy effectively identifies the stricture zone in laparoscopic ureteroplasty, enhancing surgical precision and outcomes. This approach is safe, effective, and reproducible, offering a valuable technique in the surgical treatment of ureteral strictures. 13. 13 3 . (1-3) 4, 4 (4 5. 5 5) regard stepbystep step interventions 36yearold yearold 36 year old treatments dilation restenosis re stenosis pyelography laparoscopy Intraoperatively ureteroscope area segment Subsequently endtoend end completion anastomosis day surgery resolved improved 6 mlmin ml min ml/min Furthermore scan followup follow up tomography outcomes safe effective reproducible strictures (1-3 ( (1- (1

ABSTRACT Introduction Vesicovaginal fistula (VVF) is the most common urogenital fistula due to iatrogenic cause, primarily associated with gynecologic surgery (1). Although both conservative and surgical management may be considered, the optimal treatment is still uncertain and several studies were published using different techniques (open, laparoscopic or robotic) and approaches (extravesical, transvesical or transvaginal) (2–5). In this context, we aim to report our initial experience repairing VVF with Single-Port (SP) Transvesical (TV) access. Materials and Methods Four patients with a diagnosis of VVF underwent SP-TV VVF repair between May 2022 and December 2023. Diagnosis was confirmed by cystoscopy, cystogram and in two cases by CT Urogram. Under general anesthesia, before robotic time, patients were placed in lithotomy position and a preliminary cystoscopy was performed. Fistula was noted and a 5fr stent was placed through the fistulous tract. Two ureteral stents were placed. Then, with patient supine, a transverse suprapubic 3cm incision and 2cm cystotomy were made for SP access. First step was to mark and remove fistula tract to the vagina. The edges of the vagina and bladder were dissected in order to have a closure free of tension and to create three different layers to close: vagina, muscularis layer of the bladder and mucosal layer of the bladder. A bladder catheter was placed, and the two ureteral stents were removed at the end of procedure. Results Mean age was 53 years old and three out of 4 patients developed VVF after gynecologic surgery. Two patients underwent VVF repair 6 and 8 months after total hysterectomy. One patient developed VVF after total hysterectomy and oophorectomy followed by radiation therapy. Last patient developed VVF after previous urological procedure. Fistula diameter was between 11 and 15mm. Operative time was 211 min, including preliminary cystoscopy, stents placement and SP-access. All patients were discharged on the same day with a bladder catheter, successfully removed between post-operative day 14-18 after negative cystogram. Only in one case a ureteral stent was left because the fistula was closed to the ureteral orifice and we reported one case of UTI twelve days after surgery, treated with outpatient antibiotics. Mean follow-up was 8 months, patients were scheduled for regular follow-up visits and no recurrence was reported. All patients have at least 3 months of post-operative follow-up. Conclusions Our experience suggests that SP Transvesical VVF repair may be considered as a safe and feasible minimally invasive treatment for small/medium fistulae (10-15mm). (VVF cause 1. 1 . (1) open, open (open extravesical, extravesical (extravesical transvaginal 2–5. 25 2–5 2 5 (2–5) context SinglePort Single Port (SP TV (TV access SPTV 202 2023 Urogram anesthesia performed fr Then supine cm close procedure therapy 15mm mm 21 min SPaccess. SPaccess SP-access postoperative post operative 1418 14 18 14-1 antibiotics followup follow up followup. up. smallmedium small medium 1015mm. 1015mm 10 (10-15mm) (1 2– (2–5 20 141 14- (10-15mm ( (2– (2