Online surgical education adopted among urology residency programs in response to COVID-19: A pilot study.

OBJECTIVE: To understand the residents' perceptions of the, COVID-19 driven, newly implemented online learning systems adopted among accredited urology residency programs nationwide, and their sustainability following the pandemic era. MATERIALS AND METHODS: A survey was designed and dispersed to urology program coordinators and directors to distribute to their residents. In the survey, Online education models was the all-encompassing term to describe any form of resident education that occurred online. Anonymous surveys were exported from Survey Monkey and data was analyzed for statistical significance. RESULTS: Over 70% of urology residents agreed or were neutral to the statement that Online education models were equivalent to in-person learning. Only 13% of residents stated that online learning should not be continued following the pandemic. Several different parameters were assessed, and only 5 of them showed statistical significance. Stress, personal engagement, interpersonal communication efficiency and non-verbal cues were all lower with online education models. The only attribute that was scored higher by residents was network connectivity issues. CONCLUSIONS: An overwhelming majority of urology residents in the United States believe Online education models should continue to be adopted once the pandemic is over.

[Online surgical education adopted among urology residency programs in response to COVID-19: A pilot study]. / La educación quirúrgica en línea implementada en los programas de residencia urológica como respuesta a la COVID-19: estudio piloto.

Objective: To understand the residents' perceptions of the, COVID-19 driven, newly implemented online learning systems adopted among accredited urology residency programs nationwide, and their sustainability following the pandemic era. Materials and methods: A survey was designed and dispersed to urology program coordinators and directors to distribute to their residents.In the survey, online education models was the all-encompassing term to describe any form of resident education that occurred online. Anonymous surveys were exported from Survey Monkey and data was analyzed for statistical significance. Results: Over 70% of urology residents agreed or were neutral to the statement that online education models were equivalent to in-person learning. Only 13% of residents stated that online learning should not be continued following the pandemic. Several different parameters were assessed, and only 5 of them showed statistical significance. Stress, personal engagement, interpersonal communication efficiency and non-verbal cues were all lower with online education models. The only attribute that was scored higher by residents was network connectivity issues. Conclusions: An overwhelming majority of urology residents in the United States believe online education models should continue to be adopted once the pandemic is over.

Renal carcinoma CD105-/CD44- cells display stem-like properties in vitro and form aggressive tumors in vivo.

Clear cell renal cell carcinoma (ccRCC) is the most common kidney cancer. Prognosis for ccRCC is generally poor since it is largely resistant to chemo- and radiotherapy. Many studies suggested that cancer stem cells/tumor initiating cells (CSCs/TICs) are responsible for development of tumor, disease progression, aggressiveness, metastasis and drug resistance. However, tumorigenic potential of CSCs/TICs isolated from established RCC cell lines - basic ccRCC research model - has never been investigated in vivo. CD105+, CD105-, CD44+ and CD44- as well as CD44-/CD105- CD44+/CD105+ and CD44-/CD105+ cells were isolated from Caki-1 RCC cell line, confirming coexistence of multiple subpopulations of stem-related phenotype in stable cell line. Sorted cells were injected subcutaneously into NOD SCID mice and tumor growth was monitored with MRI and PET/CT. Tumor growth was observed after implantation of CD105+, CD44+, CD44-, CD44-/CD105+ and CD44-/CD105- but not CD105- or CD44+/CD105+. Implantation of CD44-/CD105- cells induced tumors that were characterized by longer T1 and distinct metabolic pattern than other tumors. All the tumors were characterized by low uptake of [18F]FDG. CD105+ and CD44- tumors expresses Nanog and Oct-4, while CD44- tumors additionally expressed endothelial cell marker - CD31.

Detecting chemical markers to uncover counterfeit rebated excise duty diesel oil.

In this study, differences in the chemical compositions of rebated excise duty diesel oil samples that were caused by fuel laundering were investigated. Two possible laundering pathways were simulated using either reduction or adsorption agents in model samples that were spiked with Solvent Yellow 124 and Solvent Red 19. The samples were characterized by their chromatographic fingerprints, which were recorded using gas chromatography coupled with a nitrogen chemiluminescence detector. The collections of fingerprints were further analyzed by discriminant partial least squares and the models with the optimal complexities presented the correct discrimination rates in the range of 69.1%-99.6%, respectively. The most informative fingerprint sections that were associated with the investigated differences were identified using the variable importance in projection, selectivity ratio and uninformative variable elimination methods. The reduced multivariate discriminant models presented a relatively high performance with the correct classification rates in the range of 74.9%-99.8%, respectively. O-toluidine and 2,5-diaminotoluene were identified as potential markers of diesel oil counterfeiting by laundering through a reduction agent.

Simultaneous determination of Solvent Yellow 124 and Solvent Red 19 in diesel oil using fluorescence spectroscopy and chemometrics.

Differences in tax levels for diesel oil stimulate the illegal removal of characteristic diazo compounds purposely added to designate its possible usage. In order to reduce the losses in the national income, there is a strong need to develop a sensitive and cost-effective analytical procedure for the detection of this illegal action. In this study, we describe a novel analytical approach for a qualitative and quantitative determination of two diazo compounds (Solvent Yellow 124 and Solvent Red 19) that are usually added to diesel oil. The methodology proposed combines the use of excitation-emission matrix fluorescence spectroscopy as an analytical technique and partial least squares regression as a multiple modeling tool. With this new methodology, relatively low root mean square errors of prediction (for independent set of test samples) that are equal to 0.223 for Solvent Red 19 and 0.263 for Solvent Yellow 124, were obtained and the results were stable, which were indicated by an analysis performed after 48 and 96 h. The methodology is also nondestructive and allows for (i) simultaneous detection of diesel oil additives, (ii) determination of satisfactory limits of detection (0.048 and 0.042 mg L(-1) for Solvent Red 19 and Solvent Yellow 124, respectively), and (iii) obtaining of considerably low relative standard deviations of 2.33% for Solvent Yellow 124 and of 3.23% for Solvent Red 19 in comparison with the existing norm level.

Misleading appearances of the bladder on pediatric genitourinary imaging.

The authors reviewed images of the bladder on 100 consecutive Tc-99m DTPA pediatric renograms for any abnormal distribution of radionuclide or asymmetry suggestive of anatomic bladder abnormality. The results were correlated with radiographic contrast voiding cystourethrograms and ultrasound examination. Of 81 patients with adequate bladder imaging, 50 (62%) had symmetric and uniform distribution of radioactivity within the bladder. Thirty-one patients (38%) had a sufficiently abnormal bladder appearance to suggest anatomic abnormality. Of these 31 patients, 27 had contrast cystograms and ultrasound evaluation; only one (4%) had a proven bladder abnormality which correlated with the abnormal scintigraphic appearance. The appearance of the bladder on pediatric genitourinary imaging is a nonspecific and unreliable indicator of anatomic bladder abnormality.

Superselective embolization for renal hemorrhage with a new coaxial catheter and steerable guidewire.

We utilized a new commercially available 2.2 French coaxial catheter and steerable guidewire to superselectively catheterize and embolize a small renal artery branch to abolish hemorrhage which was a complication of percutaneous nephrostomy. Because of the superselective technique and small caliber of the vessel occluded, there was no demonstrable loss of global renal function or evidence of significant cortical infarction by laboratory and radionuclide scintigraphic studies.

Lymphoma of the skeleton: scintigraphic evaluation.

We retrospectively reviewed the 99mTc-diphosphonate scans of 980 patients with Hodgkin or non-Hodgkin lymphoma to define the typical appearance and distribution of skeletal lesions. The results were compared with the presence of skeletal symptoms and the findings on 67Ga-citrate scintigraphy, when available. Forty (4%) of the 980 patients had 77 scintigrams showing osseous involvement; there was an average of 3.5 lesions per study. Compared with patients with non-Hodgkin lymphoma, patients with Hodgkin disease had significantly fewer axial lesions (44% vs 82%, p less than .000001, two-tailed test) and more frequent involvement of the extremities. Subtle lesions were common. Of the lesions detected by scintigraphy, significantly more were detected by 99mTc-diphosphonate imaging (95%) than were detected by 67Ga-citrate (44%) (p less than .00001, two-tailed test), and most of these were far less apparent on the 67Ga-citrate study. Skeletal pain was an insensitive but specific indicator of skeletal disease. These results show that skeletal scintigraphy in patients with lymphoma typically reveals multiple subtle and asymptomatic lesions with frequent extremity involvement. Diffusely increased calvarial activity is commonly seen and often persists in proved remission. Increased juxtaarticular activity is specific for malignant skeletal involvement.

Prevention of motion artifacts on dual isotope subtraction parathyroid scintigraphy.

A simple, effective technique is described to identify and eliminate motion artifacts which might potentially invalidate dual isotope subtraction parathyroid scintigraphy. Cobalt-57 markers, appropriately placed on the patient, allow detection of movement and permit realignment if movement occurs between imaging sequences. This technique should assure the accuracy of dual isotope parathyroid subtraction scintigraphy.

Gastroesophageal reflux demonstrated by hepatobiliary imaging in scleroderma.

Radionuclide hepatobiliary imaging was performed on a patient with a longstanding history of scleroderma who presented with abdominal pain suggestive of biliary disease. Cystic duct patency was documented after 10 min with tracer accumulation in the second portion of the duodenum which failed to progress consistent with the duodenal hypomotility of scleroderma. The patient was given intravenous Kinevac resulting in gastroesophageal reflux of radionuclide.

Parotid gland biopsy and 67Ga imaging correlation in systemic sarcoidosis.

We correlated the results of parotid gland biopsy, chest roentgenograms, and gallium citrate scintigraphy in 24 patients evaluated for possible systemic sarcoidosis. Of 19 patients ultimately proven to have sarcoidosis, 11 (57.9 percent) had positive parotid gland biopsy. The yield of parotid gland biopsy in patients with abnormal gallium parotid activity was only marginally higher (64.7 percent). Abnormal parotid gland uptake of gallium citrate was seen in 17 of these 19 patients (89.5 percent) and was always associated with abnormal lung or perihilar activity. The parotid gland biopsy is a useful technique for obtaining the tissue diagnosis of sarcoidosis; however, gallium scintigraphy should not be performed to select patients as this will only marginally increase the biopsy yield.

Radioiodine therapy of hyperthyroidism precludes thallium-201 myocardial scintigraphy.

The authors attempted to perform Tl-201 myocardial perfusion scintigraphy in a 42-year-old man 23 and 35 days after he received 9.8 mCi of oral I-131 for documented Graves' disease. Interference from primary and scattered photons from residual thyroid I-131 made Tl-201 myocardial scintigraphy technically impossible. A series of phantom and patient studies using I-131 and Tl-201 were performed, yielding guidelines for planning Tl-201 myocardial scintigraphy following radioiodine therapy.

Intraosseous rheumatoid nodule.

The authors present a case of an intraosseous rheumatoid nodule in the rib of a 9-year-old boy.

Scintigraphic documentation of hemorrhage from coronary artery bypass graft.

Tc-99m labeled RBC imaging was used to conclusively demonstrate continuing intrathoracic hemorrhage from the anastomotic site of a coronary artery bypass graft. Demonstration of continuing hemorrhage and localization of the most likely site of bleeding resulted in timely and appropriate surgical intervention, which resulted in hemostasis and eventual patient recovery. Tc-99m RBC imaging may be an ideal noninvasive technique to investigate the site and activity of intrathoracic hemorrhage after coronary bypass surgery and other thoracic procedures.

Evaluation of traumatic mesenteric hemorrhage in a hemophiliac with Tc-99m labeled red blood cell scintigraphy.

A hemophiliac with a self-inflicted abdominal stab wound was evaluated with computerized tomography, ultrasound, and technetium-99m labeled red blood cell (Tc-99m RBC) imaging. A large intra-abdominal hematoma was best defined by CT and ultrasound; however, continued bleeding, indicating the need for emergency surgery, could only be demonstrated by radiolabeled red blood cell scintigraphy.

Superior vena cava syndrome and bilateral subclavian vein thrombosis. CT and radionuclide venography correlation.

Radionuclide venography (RNV) and CT with contrast infusion were performed in a patient with superior vena cava (SVC) syndrome and upper extremity swelling due to SVC and bilateral subclavian vein thrombosis resulting from infection of a Le Veen peritoneovenous shunt. Although CT was suggestive of thrombosis and excluded extrinsic compression by a mass, obstruction of the SVC and deliniation of collateral venous channels were best demonstrated by RNV.

Severe systemic reaction to diphosphonate bone imaging agents: skin testing to predict allergic response and a safe alternative agent.

We describe a severe systemic reaction which occurred in a patient on two occasions after i.v. injection of chemically related diphosphonate bone imaging agents. Skin testing showed reactivity to multiple commercially available diphosphonate compounds but no significant response to pyrophosphates. A subsequent pyrophosphate bone scan resulted in no adverse reaction. Severe systemic reactions to diphosphonates can occur, skin testing may prove useful in evaluating allergic reactions, and pyrophosphates appear to be a safe alternative agent in patients proven or suspected allergic to diphosphonates.