Vesicoureteral reflux (VUR) is defined as the urine backflow from the urinary bladder to the pyelo-caliceal system. In contrast, intrarenal reflux (IRR) is the backflow of urine from the renal calyces into the tubulointerstitial space. VURs, particularly those associated with IRR can result in reflux nephropathy when accompanied by urinary tract infection (UTI). The prevalence of IRR in patients with diagnosed VUR is 1–11% when using voiding cystourethrography (VCUG), while 11.9–61% when applying the contrast-enhanced voiding urosonography (ceVUS). The presence of IRR diagnosed by VCUG often correlates with parenchymal scars, when diagnosed by a 99mTc dimercaptosuccinic acid scan (DMSA scan), mostly in kidneys with high-grade VURs, and when diagnosed by ceVUS, it correlates with the wide spectrum of parenchymal changes on DMSA scan. The study performed by both ceVUS and DMSA scans showed IRRs associated with non-dilated VURs in 21% of all detected VURs. A significant difference regarding the existence of parenchymal damage was disclosed between the IRR-associated and IRR-non-associated VURs. A higher portion of parenchymal changes existed in the IRR-associated VURs, regardless of the VUR grade. That means that kidneys with IRR-associated VURs represent the high-risk group of VURs, which must be considered in the future classification of VURs. When using ceVUS, 62% of places where IRR was found were still unaffected by parenchymal changes. That was the basis for our recommendation of preventive use of long-term antibiotic prophylaxis until the IRR disappearance, regardless of the VUR grade. We propose a new classification of VURs using the ceVUS method, in which each VUR grade is subdivided based on the presence of an IRR.

Introduction Technical advances and the increasing role of interdisciplinary decision-making may warrant formal definitions of expertise in surgical neuro-oncology. Research question The EANS Neuro-oncology Section felt that a survey detailing the European neurosurgical perspective on the concept of expertise in surgical neuro-oncology might be helpful. Material and methods The EANS Neuro-oncology Section panel developed an online survey asking questions regarding criteria for expertise in neuro-oncological surgery and sent it to all individual EANS members. Results Our questionnaire was completed by 251 respondents (consultants: 80.1%) from 42 countries. 67.7% would accept a lifetime caseload of >200 cases and 86.7% an annual caseload of >50 as evidence of neuro-oncological surgical expertise. A majority felt that surgeons who do not treat children (56.2%), do not have experience with spinal fusion (78.1%) or peripheral nerve tumors (71.7%) may still be considered experts. Majorities believed that expertise requires the use of skull-base approaches (85.8%), intraoperative monitoring (83.4%), awake craniotomies (77.3%), and neuro-endoscopy (75.5%) as well as continuing education of at least 1/year (100.0%), a research background (80.0%) and teaching activities (78.7%), and formal interdisciplinary collaborations (e.g., tumor board: 93.0%). Academic vs. non-academic affiliation, career position, years of neurosurgical experience, country of practice, and primary clinical interest had a minor influence on the respondents’ opinions. Discussion and conclusion Opinions among neurosurgeons regarding the characteristics and features of expertise in neuro-oncology vary surprisingly little. Large majorities favoring certain thresholds and qualitative criteria suggest a consensus definition might be possible.

Objective: High blood pressure and proteinuria play major roles in chronic kidney disease (CKD), a high-mortality condition that affects millions of people. Reactive oxygen species (ROS) produced by NADPH oxidases are implicated in many pathophysiological processes including hypertension and CKD. Apocynin (APO) shows the anti-oxidative activity by inhibiting the assembly of NADPH oxidase and overproduction of ROS. The aim of this study was to investigate the effects of apocynin on oxidative stress, blood pressure and kidney function in normotensive rats with CKD induced by 5/6 nephrectomy through ligation of renal poles (Nx-L). Design and method: Male Wistar rats were divided into three groups. One group was control (sham surgery) and two other groups underwent two-step surgical procedure of 5/6 nephrectomy induced by ligation of renal poles. Unlike conventional Nx which leads to high mortality due to hemorrhage in or after surgery, here we induced Nx by ligation of the upper and lower poles (leads to necrosis of these poles) of left kidney after removal the right kidney one week later. After 4 weeks from this procedure, control and model group (Nx-L) received vehicle, while Nx-L+APO received apocynin 20 mg/kg/day (i.p.) for 4-week-period. Mean blood pressure (MAP), proteinuria, and oxidative stress marker (thiobarbituric acid reactive species-TBARS) in plasma and urine were measured. Results: In model group we observed significantly increased MAP (121,13±2,01vs.94,88±4,13mmHg, p<0.001), plasma creatinine (55,4±1,3vs. 41,3±2,3μmol/l, p<0.001), and proteinuria (0,036±0,006vs.0,017±0,001mg/min/kg, p<0.01) levels compared to those in control. Furthermore, significant increase of plasma TBARS level (5,47±0,77vs.2,75±0,52nmol/ml, p<0.01) and urine TBARS excretion (1,10±0,06vs.0,86±0,04nmol/min/kg, p<0.01) were detected in model compared to control. Interestingly, APO treatment significantly reduced blood pressure to the level of control (83,88±5,14vs.94,88±4,13mmHg). APO significantly reduced urine protein loss (0,024±0,002vs.0,036±0,006mg/min/kg, p<0.05) and plasma creatinine level (49,9±1,5vs.55,4±1,3μmol/l, p<0.05) as well as reduced plasma lipid peroxidation (2,19±0,26vs.5,47±0,77nmol/ml, p<0.001) in comparison to model group. Conclusions: Our results show that APO treatment prevents blood pressure rising and ameliorates kidney function in rats with 5/6 nephrectomy trough improvement of systemic oxidative status. Therefore, NADPH oxidase presents a potential therapeutic target in this form of kidney disease.

This paper investigates the role of slip boundary conditions in computational fluid dynamics modeling of material extrusion and layer deposition during 3D concrete printing. The mortar flow governed by the Navier-Stokes equations was simulated for two different slip boundary conditions at the extrusion nozzle wall: no-slip and free-slip. The simulations were conducted with two constitutive models: a generalized Newtonian fluid model and an elasto-viscoplastic fluid model. The cross-sectional shapes of up to three printed layers were compared to the experimental results from literature for different geometrical-and speed-ratios. The results reveal that employing free-slip boundary conditions at the extrusion nozzle wall improves layer-mimicking quality for both constitutive models, indicating the presence and importance of a lubricating layer of fine particles at the concrete-solid wall interface. This enhanced performance is primarily due to the observed decrease in extrusion pressure that minimizes layer height-and width-deviations compared to the experimental prints. Furthermore, the free-slip boundary conditions play an important role in predicting the multilayer prints, its deformation and groove shapes.

BACKGROUND Cryptorchidism and testicular torsion (TT) are relatively common conditions in clinical practice; however, sparse information about cryptorchid TT is available in the current literature. METHODS We retrospectively reviewed the clinical characteristics, treatment modalities, and long-term outcomes of pediatric patients treated for acute cryptorchid TT. RESULTS We found eight patients with unilateral acute cryptorchid TT with a prevalence of 8.9% (8/90) among all TT cases. The left testis was affected in six patients. The median age of patients at the time of the surgery was 65 months (interquartile range (IQR) 4-136 months). The median duration of symptoms was 16 h (IQR 9-25 h), while the median time to treatment was 60 min (IQR 59-63 min). The most common symptoms were pain (abdominal and inguinal) and inguinal mass with no palpable testis in the ipsilateral hemiscrotum. Preoperative color Doppler ultrasonography revealed absent or decreased testicular blood flow in the affected testes in 7/8 of patients. Various degrees of testicular torsion (median 540°, min 360°, max 1260°) were found during surgery. A necrotic testis that led to orchidectomy was found in 4/8 of patients. The median follow-up period was 42.6 months (IQR 12.5-71.2 months), revealing only one patient with testicular atrophy. The final testicular salvage rate was 35%. CONCLUSIONS Greater awareness among caregivers and primary care physicians about acute cryptorchid TT is required to improve their timely diagnosis and treatment. A physical examination of the external genitalia and inguinal regions should be mandatory to attain a proper diagnosis and treatment without delay.

The exact incidence of failed hypospadias repair (FHR) in adult patients remain unknown, but the number is rapidly increasing. The study aims to evaluate the most common issues in adult patients requiring additional surgical treatment due to FHR in childhood. From January 2015 to January 2023 patients with previous hypospadias repair in childhood, who underwent additional surgery in adulthood, were evaluated. The most common complications, total number of surgical procedures and time span between childhood and adulthood surgery were recorded. Postoperative follow-up included 1-, 3-, and 6-months evaluation and annually afterward. Fifty-five patients were treated with a mean age of 26 years. One stage repair was performed in 47 (85.5%) and staged repairs in 8 (14.5%) patients. The most common reasons for surgical repair were: urethral stricture in 8 (14.5%) patients, failed urethroplasty with abnormal meatal position in 10 (18.2%) patients, residual curvature or deformity in 10 (18.2%) patients and combination of several complications in 27 (49.1%) patients. Urethral repair was performed using buccal mucosa graft (BMG), penile skin flap, or combination of BMG and skin flap. Penile curvature and deformities were corrected by plication procedures. Mean time interval between the last surgical procedure in childhood and the definitive correction in adulthood was 16 years. Twenty-four (43.6%) of 55 patients underwent one surgical and 31 (56.4%) patients underwent two or more surgical procedures in childhood. Mean number of procedures was 4. The mean postoperative follow-up period was 18 months. The overall successful outcome was achieved in 50 (90.9%) patients while 5 (9.1%) patients were considered failures, as additional procedures were necessary. Surgical treatment of failed hypospadias repair is challenging due to poor quality of available tissue and excessive scar formation. Regular and long-term follow-up after primary repair is necessary and these patients should be referred to a center of excellence. The authors declare no conflict of interest.

Pediatric urethral strictures (US) are not a common problem and published series usually include small number of patients with short follow-up. Pediatric urethral reconstruction represents a great challenge due to anatomical characteristics of the pediatric urethra and small number of cases. The aim of this study is to present the surgical approaches for pediatric US. From January 2007 until January 2023, 18 boys with US aged between 2 and 18 years were treated. Nine patients had US due to trauma, 7 patients underwent harmful iatrogenic procedures and 2 patients had a stricture of unknown cause. Patients with US due to complications of hypospadias repair were excluded. Stricture was presented on the anterior urethra in 14 and on the posterior urethra in 4 patients. Patients were treated with endoscopic intervention (2), augmentation using buccal mucosa graft (9) or urethrorrhaphy (7). Very short strictures of bulbar urethra were treated endoscopically (internal urethrotomy). More extensive bulbar strictures and obliterative posterior urethral disruption were treated by excision and primary anastomosis. The treatment method of the anterior US was urethral augmentation with buccal mucosa graft. The patients were followed for 12 to 160 months (mean 42 months). Quality of urinary stream, the presence of urinary tract infections or dysuria were recorded. If any disturbances were reported further exams were performed, uroflowmetry, urethrography and urethroscopy. Sixteen patients (89%) had good outcome, while two patients (11%) underwent redo procedure, one with endoscopic incision, and another with buccal mucosa graft augmentation. Complications as penile curvature, urethral fistula or diverticulum were not reported. Pediatric US can be successfully treated by open surgery. Repeated dilatation and endoscopic treatment should not be preferred treatment method due to low success rate, possibility for additional injuries and non-compliance of the pediatric patients. For successful outcome of the US surgery individualized approach is required. The authors declare no coflict of interest.

Objective: The 2023 ESH guidelines strongly emphasize the lack of data on women, both in randomized clinical trials and in real-world data. It is not known whether the considerable efforts to equalize the treatment of women and men have led to changes in routine practice, which was the main aim of our study. Design and method: The DISCOVERY study is a large real-world prospective observational study investigating the treatment of patients with hypertension and/or hypercholesterolemia in primary or secondary care in 10 countries in 2021 and 2022. Patients of both sexes over 18 years were included. Investigators (301 GPs, 127 internists, 271 cardiologists) treated the patients according to their usual routine. They collected data on admission and up to 12 weeks after admission so that treatment characteristics could be analyzed. The physicians were not informed about the aim (comparison of women vs. men) of the study to avoid information bias. Results: The study included 11,287 patients, 93.6% of whom had hypertension at baseline that was either newly diagnosed (N=2247) or previously treated (N=8280; 86.6% inadequately treated). Patients were recruited in consecutive order. Slightly more women (53.2%, mean age 62.2±11.3 years, 94% with hypertension) than men (46.8%, mean age 58.6±12.3 years, 93.2% with hypertension) were included. There were no significant differences in mean blood pressure (women 156/92mmHg, men 157/93mmHg) and in antihypertensive treatment (mainly monotherapy). There were several gender-specific differences such as age, body mass index, physical activity, smoking status and comorbidities that did not affect the results. At the second observation, blood pressure had decreased significantly (p<0.001) and consistently. Mean pressure in women was 130/80mmHg and in men 131/81mmHg. The blood pressure target < 140/90mmHg was achieved by 73.2% of women and 72.1% of men. The prescribed antihypertensive medications did not differ between women and men, being mainly single-pill combinations (71.6% for women, 71.5% for men). Conclusions: The study showed no differences in the treatment of hypertension between women and men under real-world conditions. The effectiveness was quite good, mainly achieved by single-pill combinations, although the treatment can still be improved.

This article focuses on the parameter estimation problem in wireless sensor networks (WSNs) under adversarial attacks, considering the complexities of sensing and communication in challenging environments. In order to mitigate the impact of these attacks on the network, we propose a novel AP-DLMS algorithm with adaptive threshold attack detection and malicious punishment mechanism. The adaptive threshold is constructed using the observation matrix and network topology to detect the location of malicious attacks, while the standard reference estimation is designed to obtain the estimated deviation of each node. To mitigate the impact of data tampering on network performance, we introduce the honesty factor and punishment factor to combine the weights of normal nodes and malicious nodes respectively. Additionally, we propose a new probabilistic random attack model. Simulations are conducted to investigate the influence of key parameters in the adaptive threshold on the performance of the proposed AP-DLMS algorithm, and the mean square performance of the algorithm is analyzed under various attack models. The results demonstrate that the proposed algorithm exhibits strong robustness in adversarial networks, and the proposed attack model effectively demonstrates the impact of attacks.