Creation and validation of a novel low-cost dry lab for early resident training and assessment of robotic prostatectomy technical proficiency.

Purpose: To evaluate the preliminary validity and acceptability of a low-cost low-fidelity robotic surgery dry lab for training and assessing residents' technical proficiency with key robotic radical prostatectomy steps. Materials and methods: Three standardized inanimate tasks were created to simulate the radical prostatectomy steps of posterior dissection, neurovascular bundle release, and urethrovesical anastomosis. Urology trainees and faculty at a single institution completed and evaluated each dry lab task. Construct validity was evaluated by comparing task completion times and Global Evaluative Assessment of Robotic Skills scores across four participant cohorts: medical students (n = 5), junior residents (n = 5), senior residents (n = 5), and attending surgeons (n = 7). Content validity, face validity, and acceptability were evaluated through a posttask survey using a 5-point Likert scale. Results: There was a significant difference in the individual and composite task completion times and Global Evaluative Assessment of Robotic Skills scores across all participant cohorts (all p < 0.01). The model was rated favorably in terms of its content validity and acceptability for use in residency training. However, model realism, compared with human tissue, was poorly rated. The dry lab production cost was less than US $25. Conclusions: This low-cost procedure-specific dry lab demonstrated evidence of content validity, construct validity, and acceptability for simulating key robotic prostatectomy technical steps and can be used to augment robot-assisted laparoscopic prostatectomy surgical training.

Immunogenic Treatment of Metastatic Breast Cancer Using Targeted Carbon Nanotube Mediated Photothermal Therapy in Combination with Anti-Programmed Cell Death Protein-1.

The high prevalence of breast cancer is a global health concern, compounded by the lack of safe or effective treatments for its advanced stages. These facts urge the development of novel treatment strategies. Annexin A5 (ANXA5) is a natural human protein that binds with high specificity to phosphatidylserine, a phospholipid tightly maintained in the inner leaflet of the cell membrane on most healthy cells but externalized in tumor cells and the tumor vasculature. Here, we have developed a targeted photosensitizer for photothermal therapy (PTT) of solid tumors through the functionalization of single-walled carbon nanotubes (SWCNTs) to ANXA5-the SWCNT-ANXA5 conjugate. The ablation of tumors through the SWCNT-ANXA5-mediated PTT synergizes with checkpoint inhibition, creating a systemic anticancer immune response. In vitro ablation of cells incubated with the conjugate promoted cell death in a dose-dependent and targeted manner. This treatment strategy was tested in vivo with the orthotopic EMT6 breast tumor model in female balb/cJ mice. Enhanced therapeutic effects were achieved by using intratumoral injection of the conjugate and treating tumors at a lower PTT temperature (45°C). Intratumoral injection prevented the accumulation of the SWCNTs in major clearance organs. When combined with checkpoint inhibition of anti-programmed cell death protein-1, SWCNT-ANXA5-mediated PTT increased survival and 80% of the mice survived for 100 days. Evidence of immune system activation by flow cytometry of splenic cells strengthens the hypothesis of an abscopal effect as a mechanism of prolonged survival. SIGNIFICANCE STATEMENT: This study demonstrated a relatively high survival rate (80% at 100 days) of mice with aggressive breast cancer when treated with photothermal therapy using the SWCNT-ANXA5 conjugate injected intratumorally and combined with immune stimulation using the anti-programmed cell death protein-1 checkpoint inhibitor. Photothermal therapy was accomplished by maintaining the tumor temperature at a relatively low level of 45°C and avoiding accumulation of the nanotubes in the clearance organs by using intratumoral administration.

Bibliometric analysis of academic journal recommendations and requirements for surgical and anesthesiologic adverse events reporting.

BACKGROUND: Standards for reporting surgical adverse events (AEs) vary widely within the scientific literature. Failure to adequately capture AEs hinders efforts to measure the safety of healthcare delivery and improve the quality of care. The aim of the present study is to assess the prevalence and typology of perioperative AE reporting guidelines among surgery and anesthesiology journals. MATERIALS AND METHODS: In November 2021, three independent reviewers queried journal lists from the SCImago Journal & Country Rank (SJR) portal (www.scimagojr.com), a bibliometric indicator database for surgery and anesthesiology academic journals. Journal characteristics were summarized using SCImago, a bibliometric indicator database extracted from Scopus journal data. Quartile 1 (Q1) was considered the top quartile and Q4 bottom quartile based on the journal impact factor. Journal author guidelines were collected to determine whether AE reporting recommendations were included and, if so, the preferred reporting procedures. RESULTS: Of 1409 journals queried, 655 (46.5%) recommended surgical AE reporting. Journals most likely to recommend AE reporting were: by category surgery (59.1%), urology (53.3%), and anesthesia (52.3%); in top SJR quartiles (i.e. more influential); by region, based in Western Europe (49.8%), North America (49.3%), and the Middle East (48.3%). CONCLUSIONS: Surgery and anesthesiology journals do not consistently require or provide recommendations on perioperative AE reporting. Journal guidelines regarding AE reporting should be standardized and are needed to improve the quality of surgical AE reporting with the ultimate goal of improving patient morbidity and mortality.

Strategies for Improving the Standardization of Perioperative Adverse Events in Surgery and Anesthesiology: "The Long Road from Assessment to Collection, Grading and Reporting".

The assessment, collection, and reporting of all aspects of surgical procedures are crucial for optimizing patient safety and improving surgical/procedural quality [...].

Targeted Prostate Biopsy: Umbra, Penumbra, and Value of Perilesional Sampling.

BACKGROUND: Systematic prostate biopsies add to the cancer detection rate of targeted biopsies, but the explanation for that increased sensitivity is not yet clear. OBJECTIVE: To determine and quantify the utility of perilesional biopsies in the detection of clinically significant prostate cancer (csPCa). DESIGN, SETTING, AND PARTICIPANTS: Participants were 2048 men with magnetic resonance imaging (MRI) lesions (grades 3-5) who underwent targeted and systematic prostate biopsy via MRI/ultrasound fusion at University of California Los Angeles and Cornell between 2011 and 2019. The study is a retrospective examination of prospectively acquired data. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: All biopsy cores (30191), locations of which had been stored digitally in the image-fusion device, were analyzed for tissue pathology and relationship with MRI lesions. A validated Matlab script was used to determine the distance between MRI lesions and cores containing csPCa (3552 cores from 927 men). Significance of distance measurements was determined by multilevel, multivariable logistic regression to account for within patient-biopsy correlation and control for patient characteristics. RESULTS AND LIMITATIONS: Overall, 90% (95% confidence interval [CI] = 89-91) of csPCa cores (3206/3552) were located within a radius of 10 mm from the nearest lesion: 65% (95% CI = 63-67) within the region of interest (ROI) and 26% (95% CI = 24-27) outside the ROI but within the 10-mm "penumbra." The width of the penumbra or concentric band, which enclosed 90% of csPCa, was primarily related to MRI grade of lesion: grade 5, 5 mm; grade 4, 12 mm; grade 3, 16 mm. In 18% (95% CI = 15-20) of patients (166/927), csPCa was diagnosed only by sampling outside the MRI lesion, the yield decreasing with increasing distance. Limitations of MRI interpretation and fusion biopsy performance could affect the utility of these data in individual patients. CONCLUSIONS: Perilesional biopsies, that is, samples taken from a band of 10-mm radius outside MRI lesions (the penumbra), contain most cores of csPCa that are not present within the lesion. These data may help increase the performance characteristics of targeted prostate biopsy. PATIENT SUMMARY: We studied the locations of cancer within the prostate in men undergoing magnetic resonance imaging (MRI)-guided biopsy. We found that not all cancers are located within the MRI lesion, but 90% (95% confidence interval = 89-91) of the cancers arewithin 1 cm of the lesions. Biopsies taken from both within and around MRI lesions provide greater sensitivity for cancer detection than samples taken from the lesion only.

Kidney Stone Surgery: Assessing Public Interest and Evaluating Social Media Content.

An increasing number of patients are utilizing the internet to answer their medical questions. Given the lack of verified stone treatment resources on the web, we sought to evaluate online interest in kidney stone surgical interventions and assess the quality of the most popular resources on social media. Google Trends was used to evaluate public interest in different kidney stone interventions between March 2016 and February 2021 and reported as search volume index (SVI). Next, the social media analysis tool, BuzzSumo, was used to identify stone surgery content online on the social media platforms, YouTube, Instagram, Pinterest, Reddit, and Twitter. To evaluate the quality of health information presented in the online resources, the DISCERN instrument was employed by three individual raters. Ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), and extracorporeal shockwave lithotripsy (SWL) were identified as the top search terms on Google Trends with mean SVIs of 47.75, 42.98, and 45.74, respectively (p = 0.012). On YouTube, URS, PCNL, and SWL had 12,549, 116,222, and 20,717 views, respectively. Nine articles and fifteen videos were chosen for analysis using the DISCERN tool with a mean score of 2.82 and 2.27, respectively, among three independent evaluators. The result of our study suggests that online users are interested in URS but engaged more often with PCNL content on social media platforms. We found that the quality of online resources related to stone surgery highlights the need for involvement of urologists in creation of engaging high-quality content and sharing of accurate information in a social media-driven society.

Improving Shared Decision Making in Latino Men With Prostate Cancer: A Thematic Analysis.

Background. Multiple studies have shown that digitally mediated decision aids help prepare patients for medical decision making with their providers. However, few studies have investigated whether decision-support preferences differ between non-English-speaking and English-speaking Latino men with limited literacy. Objective. To identify and compare health information seeking patterns, preferences for information presentation, and interest in digital decision aids in a sample of Southern Californian underserved Latino men with newly diagnosed prostate cancer at a county hospital. Methods. We conducted semistructured, in-depth telephone interviews with 12 Spanish-speaking and 8 English-speaking Latino men using a purposive sampling technique. Following transcription of taped interviews, Spanish interviews were translated. Using a coding protocol developed by the team, two bilingual members jointly analyzed the transcripts for emerging themes. Coder agreement exceeded 80%. Differences were resolved through discussion. Results. Thematic differences between groups with different preferred languages emerged. Most respondents engaged in online health information seeking using cellphones, perceived a paternalistic patient-provider relationship, and expressed willingness to use hypothetical digital decision aids if recommended by their provider. English speakers reported higher digital technology proficiency for health-related searches. They also more frequently indicated family involvement in digital search related to their condition and preferred self-guided, web-based decision aids. In comparison, Spanish speakers reported lower digital technology proficiency and preferred family-involved, coach-guided, paper and visual decision aids. English speakers reported substantially higher levels of formal education. Conclusion. Preferences regarding the use of digital technology to inform prostate cancer treatment decision making among underserved Latino men varied depending on preferred primary language. Effective preparation of underserved Latino men for shared decision making requires consideration of alternative approaches depending on level of education attainment and preferred primary language.

Differential expression of circulating micro-RNAs in patients with active and latent tuberculosis. / Expresión diferencial de micro-ARN circulantes en pacientes con tuberculosis activa y latente.

OBJECTIVES: To analyze the differential expression of miR-21, miR-29a, miR-99b and miR-155 in serum samples from patients with latent tuberculosis (TB) and active TB compared to healthy controls. MATE RIALS AND METHODS: We used 28 serum samples (9 with active TB, 10 with latent TB and 9 healthy con trols) for the analysis of gene expression by RT-qPCR with Primers and TaqMan probes. The differential expression was calculated by the Livak method using a normalizing gene (RNU-48). RESULTS: Overex pression of miR-155 was found in people with latent tuberculosis, compared to healthy controls (0.63 vs. 0.01; p value = 0.032). CONCLUSION: The miR-155 could be considered a biomarker to differentiate latent TB from active disease. Studies with larger sample sizes are required to corroborate the findings.

OBJETIVO: El objetivo del estudio fue analizar la expresión diferencial de miR-21, miR-29a, miR-99b y miR-155 en muestras de suero de pacientes con tuberculosis (TB) latente y TB activa respecto a contro les sanos. MATERIALES Y MÉTODOS: Se utilizaron 28 muestras de suero (nueve con TB activa, diez con TB latente y nueve controles sanos) para el análisis de expresión génica mediante RT-qPCR con Primers y sondas TaqMan. Se calculó la expresión diferencial por el método de Livak utilizando un gen norma lizador (RNU-48). RESULTADOS: Se halló una sobreexpresión de miR-155 en personas con tuberculosis latente, respecto a los controles sanos (0,63 vs. 0,01; valor de p=0,032). CONCLUSIÓN: El miR-155 podría ser considerado un biomarcador para diferenciar TB latente de enfermedad activa. Se requieren estudios con mayores tamaños muestrales para corroborar nuestros hallazgos.

Expresión diferencial de micro-ARN circulantes en pacientes con tuberculosis activa y latente / Differential expression of circulating micro-RNAs in patients with active and latent tuberculosis

RESUMEN Objetivo: El objetivo del estudio fue analizar la expresión diferencial de miR-21, miR-29a, miR-99b y miR-155 en muestras de suero de pacientes con tuberculosis (TB) latente y TB activa respecto a contro les sanos. Materiales y métodos: Se utilizaron 28 muestras de suero (nueve con TB activa, diez con TB latente y nueve controles sanos) para el análisis de expresión génica mediante RT-qPCR con Primers y sondas TaqMan. Se calculó la expresión diferencial por el método de Livak utilizando un gen norma lizador (RNU-48). Resultados: Se halló una sobreexpresión de miR-155 en personas con tuberculosis latente, respecto a los controles sanos (0,63 vs. 0,01; valor de p=0,032). Conclusión: El miR-155 podría ser considerado un biomarcador para diferenciar TB latente de enfermedad activa. Se requieren estudios con mayores tamaños muestrales para corroborar nuestros hallazgos.

ABSTRACT Objectives: To analyze the differential expression of miR-21, miR-29a, miR-99b and miR-155 in serum samples from patients with latent tuberculosis (TB) and active TB compared to healthy controls. Mate rials and Methods: We used 28 serum samples (9 with active TB, 10 with latent TB and 9 healthy con trols) for the analysis of gene expression by RT-qPCR with Primers and TaqMan probes. The differential expression was calculated by the Livak method using a normalizing gene (RNU-48). Results: Overex pression of miR-155 was found in people with latent tuberculosis, compared to healthy controls (0.63 vs. 0.01; p value = 0.032). Conclusion: The miR-155 could be considered a biomarker to differentiate latent TB from active disease. Studies with larger sample sizes are required to corroborate the findings.

Using spatial tracking with magnetic resonance imaging/ultrasound-guided biopsy to identify unilateral prostate cancer.

OBJECTIVES: To create reliable predictive metrics of unilateral disease using spatial tracking from a fusion device, thereby improving patient selection for hemi-gland ablation of prostate cancer. PATIENTS AND METHODS: We identified patients who received magnetic resonance imaging (MRI)/ultrasound-guided biopsy and radical prostatectomy at a single institution between 2011 and 2018. In addition to standard clinical features, we extracted quantitative features related to biopsy core and MRI target locations predictive of tumour unilaterality. Classification and Regression Tree (CART) analysis was used to create a decision tree (DT) for identifying cancer laterality. We evaluated concordance of model-determined laterality with final surgical pathology. RESULTS: A total of 173 patients were identified with biopsy coordinates and surgical pathology available. Based on CART analysis, in addition to biopsy- and MRI-confirmed disease unilaterality, patients should be further screened for cancer detected within 7 mm of midline in a 40 mL prostate, which equates to the central third of any-sized prostate by radius. The area under the curve for this DT was 0.82. Standard diagnostics and the DT correctly identified disease laterality in 73% and 80% of patients, respectively (P = 0.13). Of the patients identified as unilateral by standard diagnostics, 47% had undetected contralateral disease or were otherwise incorrectly identified. This error rate was reduced to 17% (P = 0.01) with the DT. CONCLUSION: Using spatial tracking from fusion devices, a DT was more reliable for identifying laterality of prostate cancer compared to standard diagnostics. Patients with cancer detected within the central third of the prostate by radius are poor hemi-gland ablation candidates due to the risk of midline extension of tumour.