Assessing textbook outcomes following major liver surgery in association with obesity at a referral academic center.

INTRODUCTION: Outcomes of major surgeries in tertiary educational hospitals have been complicated by the referral of high-risk patients and the participation of trainees in surgical procedures. We analyzed outcomes of major hepatectomies in a tertiary academic setting emphasizing the role of training and obesity on textbook outcomes (TO). MATERIALS AND METHODS: 971 adult patients who underwent open major hepatectomy (Mesohepatectomy [n = 111], hemihepatectomy [n = 610], and extended hepatectomy [n = 250]) were evaluated. A TO was defined as: a negative resection margin, no grade B/C bile leak, no major complications, no in-hospital mortality, and no 30-day readmission. TOs were compared following operations performed by senior surgeons and those performed by junior surgeons under the supervision of senior surgeons and between patients with and without obesity. RESULTS: TO was achieved in 70.1% of patients overall (78.4% in mesohepatectomy, 73.1% in hemihepatectomy, and 59.2% in extended hepatectomy). The rate of TO was similar following operations performed by and supervised by a senior surgeon (69.3% vs 71.0%, p = 0.570). The rate of TO was significantly lower in patients with obesity (41.5% vs 74.6%, p < 0.001). Factors including increased age (odds ratio [OR] for 10-year increase = 0.83, 95% confidence interval [CI]: 0.73-0.96, p = 0.009), obesity (OR = 0.25, 95%CI: 0.16-0.37, p < 0.001), biliodigestive anastomosis (OR = 0.27, 95%CI: 0.19-0.40, p < 0.001), and portal vein resection (OR = 0.49, 95%CI: 0.28-0.87, p = 0.014) lower the rate of TO. CONCLUSION: Promising outcomes are possible after major hepatectomy in an academic setting. Obese patients and those undergoing more complex surgeries had a higher risk of poor postoperative outcomes.

ESG investing and the financial performance: a panel data analysis of developed REIT markets.

This study investigates the empirical link between the social and financial performance of the Real Estate Investment Trusts (REITs) by utilizing the PVAR-Granger causality model and a fixed-effects panel data model with a rich dataset comprising 234 ESG-rated REITs across five developed economies from 2003 to 2019. The results suggest that investors pay attention to individual E/S/G metrics and price each component of ESG investing differently, with E-investing and S-investing practices being the significant financial performance factors of REITs. This study is the first attempt to test the social impact and risk mitigation hypotheses of the stakeholder theory of the corporation and the neoclassic trade-off argument to explore the association between corporate social responsibility and the market valuation of REITs. The full sample results strongly support the trade-off hypothesis, indicating that REITs' environmental policies involve high financial costs that may drain off capital and lead to decreasing market returns. On the contrary, investors have attached a higher value to S-investing performance, especially in the post-GFC period from 2011 to 2019. A positive premium for S-investing supports the stakeholder theory as the social impact could be monetarized into a higher return and a lower systematic risk and give rise to a competitive advantage.

Bladder calculi concomitant with benign prostatic enlargement: is prostate surgery mandatory in patients who have never received medical therapy?

The historical dogma that bladder calculi comprise the main indication for prostatic surgery has recently been questioned. In this study, we aimed to predict which patients should undergo simultaneous prostate and bladder calculi surgery or only bladder calculi removal by evaluating preoperative risk factors. One hundred and seventeen men with bladder stones and concomitant benign prostate enlargement (BPE) who had not received medical treatment before were included in the study. In the first step, only the bladder calculi of patients were removed and medical treatment was given for BPE. The patients who benefited from medical treatment during the follow-up were defined as Group 1 and the patients who required prostate surgery for any indication comprised Group 2. Risk factors for prostate surgery requirements were determined by comparing preoperative characteristics between the two groups with a cox regression model. In the follow-up of 117 patients with bladder stones removed and medical treatment initiated, 49 (41.9%) patients had prostate surgery indications. The indication for 33 (67.3%) of 49 patients was medical treatment failure. The presence of intravesical prostatic protrusion (IPP; hazard ratio: 2.071, 95% confidence interval [CI]: 1.05-4.05, P = 0.034), and high postvoiding residual urine volume (hazard ratio: 1.013, 95% CI: 1.007-1.019, P < 0.001) were found to be preoperative risk factors for needing future prostate surgery. In patients who have not received medical treatment for BPE before, bladder calculi developing secondary to BPE do not always constitute an indication for prostate surgery.

What is the best approach for pediatric kidney stones of moderate-sized between shock wave lithotripsy, ultramini percutaneous nephrolithotomy and retrograde intrarenal surgery?

PURPOSE: This study aimed to compare the results of ultramini percutaneous nephrolithotomy (UMP), shock wave lithotripsy (SWL) and retrograde intrarenal surgery (RIRS) in pediatric patients with kidney stones 10-20 mm size. METHODS: The files of 159 pediatric patients (36 RIRS, 39 SWL, 84 UMP) with kidney stones were reviewed retrospectively. Preoperative age, sex, stone size and location were evaluated. The three methods were compared in terms of operation and fluoroscopy duration, complications with the modified Clavien grading system, and stone-free rate (SFR) in the postoperative first month. RESULTS: The stone burdens of the groups were similar (P = 0.102). At the end of the first month, SFR was higher in the RIRS and UMP groups compared to the SWL group (88.9%, 92.9% and 69.2%, respectively, P = 0.002). UMP had higher SFR for lower pole stones than the other two methods (P = 0.042). There was no difference in complications between the three methods (P = 0.758). CONCLUSION: SFR was similar for all three methods in all localizations, apart from lower pole stones. UMP had higher SFR for lower pole stones than the other two methods. There was no difference in terms of complications between the three methods.

Better outcomes with desmopressin melt than enuretic alarm therapy in children with nocturnal enuresis during coronavirus disease 2019 (COVID-19).

Objectives: This study aimed to investigate the effect of the coronavirus disease 2019 (COVID-19) pandemic on the treatment of children with primary monosymptomatic nocturnal enuresis (MNE) with desmopressin melt versus an enuresis alarm. Materials and methods: This study included 56 children with primary MNE who were taking desmopressin melt or using an alarm. Their anxiety levels were evaluated using the Social Anxiety Scale for Children-Revised. For both treatment methods, data from a 3-month bedwetting diary between the third and sixth months of the pre-pandemic treatment were compared with those assessed during the same period during the pandemic. Results: Prior to the COVID-19 pandemic, the median 3-month mean frequency of MNE was 1 (0-7.67) in children using desmopressin melt versus 1.33 (0-6) in those using alarm treatment (p = 0.095). During the COVID-19 pandemic period, the median monthly mean frequency of MNE was 1.33 (0-7.33) in children using desmopressin melt versus 6 (1.33-13) in those using alarm treatment (p < 0.001). Conclusions: The COVID-19 pandemic and its accompanying psychological effects did not affect the treatment efficacy of desmopressin melt in children with primary MNE but did adversely affect that of enuresis alarms.

Safety and Efficacy of Flexible Ureterorenoscopy Surgery: Results of Our Large Patient Series.

INTRODUCTION: The aim of our study is to evaluate the success rates of our retrograde intrarenal surgery operations and the complications we encountered and to determine in which kidney segment the operations were more successful with flexible ureterorenoscopy. METHODS: The records of retrograde intrarenal surgery operations performed between March 2013 and January 2021 in Health Sciences University, Adana City Training and Research Hospital, urology clinic were analyzed retrospectively. Patients' age, body mass index, operation side, stone size, stone density, duration of operation, first-day and first-month operation success status, presence of preoperative and postoperative ureteral stent, preoperative and postoperative first-day and first-month creatinine levels, and preoperative and postoperative first-day and first-month hematocrit levels were recorded. RESULTS: Our study consisted of a total of 1128 patients, 618 males (54.7%) and 510 (45.2%) females, with an average age of 42.3±14.4. Kidney stones were most commonly found in the renal pelvis (54.2%). The postoperative first-day success rate was highest in the pelvis stone group (P=0.009). The first month's success rates were highest in those with pelvic stones (93.1%), and the lowest in patients with multiple stones (85.7%). Patients' operation time, postoperative hematocrit and creatinine levels, and complications did not differ statistically between the groups (P>0.05). CONCLUSION: Retrograde intrarenal surgery is an acceptable minimally invasive and effective surgery with low complication rates. There is a high success rate, especially in pelvis stones.

Volume should be used instead of diameter for kidney stones between 10 and 20 mm to determine the type of surgery and increase success.

Aim of this study is to categorize stones between 10 and 20 mm according to stone diameter or volume and compare mini percutaneous nephrolithotomy (mPNL) and retrograde intrarenal surgery (RIRS) outcomes. Files of 515 patients who underwent surgery for kidney stones with sizes 10-20 mm were reviewed. Patients were divided into RIRS or mPNL groups. An attempt was made to find the diameter and volume threshold values above which the success of the operation, complication rates and the number of auxiliary treatments deteriorated. Subgroup analysis was performed below and above the threshold value to reveal the optimal treatment methods. RIRS complications increased with volumes above 1064 mm3, number of auxiliary interventions increased with volumes above 1256 mm3, and success of the operation decreased with volumes above 1416 mm3. A subgroup analysis under and over 1064 mm3 was performed in RIRS group. Complication and auxiliary treatment rates were higher, operative success was lower in patients with a stone volume greater than 1064 mm3. In patients who underwent RIRS, for every 1000 mm3 increase in stone volume success of the operation decreased by 2.1 times, while the probability of auxiliary treatment increased by 2.8 times. In patients with kidney stones between 10 and 20 mm, it is more meaningful to use volume instead of diameter to determine the success rate. When mPNL is used instead of RIRS for volumes greater than 1064 mm3, the success rate will be higher, complication rate will be similar, and the need for auxiliary treatment will be lower.

Comparison of Laparoscopic and Open Surgery in the Treatment of Renal Hydatid Cysts.

Background: To compare the efficacy, safety, and long-term results of laparoscopic and open approaches in patients undergoing surgery for renal hydatid cyst. Materials and Methods: The files of 36 patients who were surgically treated in our clinic and with diagnosis of renal cyst hydatid confirmed pathologically were reviewed. According to the surgical technique applied, the patients were divided into two groups as open (group 1) or laparoscopic (group 2) partial pericystectomy. Oral albendazole was given 10 mg/kg/day (in two divided doses) for 4 weeks preoperatively and for three cycles of 4 weeks at 1-week intervals after surgery in all patients. Demographic characteristics, laboratory and imaging findings, operation times, hospitalization times, complications, intraoperative bleeding amounts, and recurrence rates were statistically compared in both groups. Results: Open partial pericystectomy was performed in 21 patients in group 1, and laparoscopic transperitoneal partial pericystectomy was performed in 15 patients in group 2. Operation time and intraoperative bleeding amount in group 1 and group 2 were 119.6 ± 17.1/116.1 ± 17.6 minutes and 125.7 ± 27.8/113.9 ± 19.2 mL, respectively. There was no statistically significant difference between these values (P = .557, P = .167, respectively). Hospitalization duration of both groups was 5.9 ± 1.4/3.6 ± 0.7 days, respectively. Hospitalization duration in group 2 was statistically significantly shorter (P < .001). No recurrence occurred during postoperative follow-up in either group. Conclusions: In the treatment of renal hydatid cysts, laparoscopy, which is a minimally invasive approach, can be technically applied with the same principles as open surgery and has a similar efficacy and safety profile for short- and long-term results.

Predictive Factors Affecting the Success of Nephrectomy for the Treatment of Nephrogenic Hypertension: Multicenter Study.

INTRODUCTION: The aim of our study is to evaluate the predictive factors affecting the success of treatment with nephrectomy in patients with poorly functioning kidney and nephrogenic hypertension. METHODS: Data for patients who underwent nephrectomy with a diagnosis of nephrogenic hypertension in 3 centers between May 2010 and January 2020 were analyzed. In the postoperative period, if the blood pressure (BP) was below 140/90 mm Hg without medical treatment, it was accepted as complete response; if the arterial BP was below 140/90 mm Hg with medical treatment or less medication, it was accepted as partial response; and if BP did not decrease to normal values, it was accepted as unresponsive. Demographic characteristics, duration of hypertension, preoperative and postoperative BP values, and presence of metabolic syndrome were statistically evaluated. RESULTS: Our study consisted of 91 patients with a mean preoperative hypertension duration of 23.3 ± 12.1 months. Among patients, 42 (46.2%) had complete response, 18 (19.8%) had partial response, and 31 (34.0%) had no response. Preoperative systolic and diastolic BP values were not effective on treatment success (p = 0.071, p = 0.973, respectively), but the increase in age and hypertension duration (p = 0.030 and p < 0.001, respectively) and the presence of metabolic syndrome (p = 0.002) significantly decreased the complete response rates. CONCLUSIONS: Preoperative hypertension duration, advanced age, and presence of metabolic syndrome are predictive factors affecting the response to treatment in patients who undergo nephrectomy due to nephrogenic hypertension.

Systematic review and meta-analysis of the efficacy of prophylactic abdominal drainage in major liver resections.

Prophylactic drainage after major liver resection remains controversial. This systematic review and meta-analysis evaluate the value of prophylactic drainage after major liver resection. PubMed, Web of Science, and Cochrane Central were searched. Postoperative bile leak, bleeding, interventional drainage, wound infection, total complications, and length of hospital stay were the outcomes of interest. Dichotomous outcomes were presented as odds ratios (OR) and for continuous outcomes, weighted mean differences (MDs) were computed by the inverse variance method. Summary effect measures are presented together with their corresponding 95% confidence intervals (CI). The certainty of evidence was evaluated using the Grades of Research, Assessment, Development and Evaluation (GRADE) approach, which was mostly moderate for evaluated outcomes. Three randomized controlled trials and five non-randomized trials including 5,050 patients were included. Bile leakage rate was higher in the drain group (OR: 2.32; 95% CI 1.18-4.55; p = 0.01) and interventional drains were inserted more frequently in this group (OR: 1.53; 95% CI 1.11-2.10; p = 0.009). Total complications were higher (OR: 1.71; 95% CI 1.45-2.03; p < 0.001) and length of hospital stay was longer (MD: 1.01 days; 95% CI 0.47-1.56 days; p < 0.001) in the drain group. The use of prophylactic drainage showed no beneficial effects after major liver resection; however, the definitions and classifications used to report on postoperative complications and surgical complexity are heterogeneous among the published studies. Further well-designed RCTs with large sample sizes are required to conclusively determine the effects of drainage after major liver resection.

A Different and Novel Alternative (ADANA) Renal Access Technique when CT or USG Guidance Is Inadequate in Case of Retro-Renal Colon.

INTRODUCTION: Computed tomography (CT) or ultrasonography (USG)-guided renal access for percutaneous nephrolithotomy (PNL) is not suitable in all cases with retro-renal colon (RRC) due to anatomical and technical restrictions. We would like to describe our novel technique that permits standard subcostal renal access with a small incision for these patients. METHODS: This method was performed on adult patients with severe RRC and complex renal stones who were not suitable for renal access with CT or USG guidance. Time from skin incision to puncture needle insertion, incision length, stone-free rate (SFR), and complications were evaluated. SURGICAL TECHNIQUE: The appropriate renal calyx for renal access was identified with retrograde pyelography. The skin closest to the identified calyx was incised and retroperitoneum visualized. The RRC was swept laterally by blunt dissection to obtain a safe puncture line. The retractors were placed to keep the colon away from the incision. Then, the puncture needle was placed over Gerota's fascia. After this, the puncture needle was inserted into the targeted calyx under fluoroscopic guidance. The insertion of guidewire and the rest of the procedure such as dilatation and insertion of Amplatz sheath were performed under same maneuver. RESULTS: A total of 1,348 patients were treated with PNL between January 2016 and November 2019. Our group consisted of 16 adult patients with a median age of 44.8 years (7 females and 9 males) who underwent PNL with our new access technique. SFR and clinically insignificant residual fragment (CIRF) rate were 72.5 and 14.2%, respectively. The median access time was 22.2 min (range: 15-30 min). The median skin incision length was 3.7 (range: 3.0-4.5) cm. The average skin incision length was 3.7 cm. The SFR and CIRF rate were 72.5 and 14.2%, respectively. We did not observe any complication related to our access technique. CONCLUSION: Our novel access technique created a safe anatomical route for standard subcostal renal access with acceptable incision length and very low complication rate.

Long-term follow-up results and complications in cancer patients with persistent nephrostomy due to malignant ureteral obstruction.

PURPOSE: We aimed to evaluate the long-term complications and predisposing factors for these complications in patients with malignant ureteral obstruction (MUO) treated with percutaneous nephrostomy (PN). METHODS: The records of patients with MUO treated with PN between January 2015 and 2018 were retrospectively reviewed for PN dislodgement, PN obstruction, PN replacement, pyelonephritis, hospitalizations due to PN complications, and other complications due to PN such as macroscopic hematuria, skin infections, or renal/perirenal abscess. RESULTS: Data for a total of 147 patients (229 renal units [RU], 107 males, 40 females) were evaluated. In 174 (76%) RU, PN was replaced due to PN dislodgement. The predisposing factors for PN dislodgement were follow-up time, body mass index (BMI), chemotherapy, diabetes mellitus (DM), low educational level (LEL), pyelonephritis, and catheter-related skin infections (CSRI). The PN was replaced in 40 RU due to obstruction. The predisposing factors for obstruction were follow-up time and BMI. Pyelonephritis developed at least once in 61 (41.5%) patients. Follow-up time, BMI, previous surgery, DM, and LEL were the predisposing factors for pyelonephritis. CSRI developed in 16 RU. Follow-up time, BMI, DM, and LEL were the predisposing factors for CSRI. Macroscopic hematuria developed in 11 patients. Follow-up time, previous surgery, DM, chemotherapy, and LEL were predisposing factors for macroscopic hematuria. CONCLUSION: The most common complication in patients with MUO treated with PN was PN dislodgement. However, life-threatening complications such as macroscopic hematuria and severe infections can also occur. Patients with DM, LEL, and chemotherapy are at high risk of PN-related complications.

Live surgical demonstrations for minimally invasive colorectal training.

PURPOSE: Live surgical demonstrations are considered an effective educational tool providing a chance for trainees to observe a real-time decision-making process of expert surgeons. No data exists evaluating the impact of live surgical demonstrations on the outcomes of minimally invasive colorectal surgery. This study evaluates perioperative and short-term postoperative outcomes in patients undergoing minimally invasive colorectal surgery in the setting of live surgical demonstrations. METHODS: Patients undergoing minimally invasive colorectal surgery which was performed as live surgical demonstrations (the study group) performed between 2006 and 2018 were reviewed. These patients were case-matched with those undergoing operations in routine practice (the control group). The study and control group were compared for intraoperative and short-term postoperative outcomes. RESULTS: Thirty-nine live surgery cases in the study group were case-matched with its thirty-nine counterparts as the control group. Operating time was longer (200 vs 165 min; p = 0.002) and estimated intraoperative blood loss was higher in the study group (100 vs 55 ml; p = 0.008). Patients in the study group stayed longer in the hospital (6 vs 5 days; p = 0.001). While conversion (n = 4 vs n = 1, p = 0.358) and intraoperative complications (n = 6 vs n = 2, p = 0.2) were more frequent in the study group, these outcomes did not reach statistical significance. Overall complications were higher in the study group (n = 22 vs n = 9, p = 0.003). One patient underwent a reoperation due to postoperative bleeding, and one mortality occurred in the live surgery group. CONCLUSIONS: Live surgical demonstrations in minimally invasive colorectal surgery seem to be associated with increased risk of operative morbidity.

Recurrent Pilonidal Sinus Cyst on Penis.

Pilonidal sinus, including one or more sinus canals and hairs, is a disease with a chronic course showing acute attacks which is often encountered in the general population, usually affecting young adults, at a rate in males twice that of females. Pilonidal sinus on the penis is so rare that very few cases have been reported in literature. A 20-year-old male presented to the urology outpatient clinic with the complaint of a suppurative lesion with discharge on the skin of the penis which had been ongoing for approximately three months. Clinical examination revealed an indurated, erythematous, ulcerative lesion, 3 cm x 2 cm in size, in the middle of the ventral aspect of the penile shaft. We present the first case in literature of recurrent pilonidal sinus related to Actinomyces israelii, located on the penis.

Conservative/surgical treatment predictors of maternal hydronephrosis: results of a single-center retrospective non-randomized non-controlled observational study.

PURPOSE: To determine the parameters that may help the clinicians decide the best suitable treatment method for the pregnant women with symptomatic hydronephrosis which will be based on the easily accessible laboratory tests, monitoring methods and clinical symptoms. METHODS: Digital data and documents of 246 pregnant women with symptomatic hydronephrosis who were hospitalized in our clinic between the dates of January 2011 and January 2016 were retrospectively evaluated. All patients were statistically evaluated in terms of age, symptomatic maximal anterior-posterior diameter of the renal pelvis (MADP), parity, C-reactive protein (CRP) level, white blood cell count (WBC), presence of pyuria, growth of urine culture, fever, serum urine and creatinine levels, visual analog scale (VAS) score of pre- and post-therapy and threatened preterm labor. RESULTS: The study includes a total of 211 pregnant women with symptomatic hydronephrosis. In the second and third trimester groups, the surgical treatment group statistically provided higher levels of CRP, WBC and VAS. Mean MADP in the second trimester of the conservative and surgical groups where symptomatic hydronephrosis was on the right side was 16.67 ± 4.67 and 28.68 ± 7.70 mm, respectively. Mean MADP in the third trimester group of the conservative and surgical groups where symptomatic hydronephrosis was on the right side was 16.96 ± 5.96 and 28.85 ± 7.64 mm, respectively. CONCLUSIONS: In patients with symptomatic pregnancy hydronephrosis, the likelihood of surgical treatment for CRP levels, WBC counts and VAS is high.

Safety and Efficacy of Pneumatic Lithotripters Versus Holmium Laser on Multiple Ureteral Calculi.

BACKGROUND: Different energy sources can be used for ureteroscopic stone fragmentation, such as pneumatic, ultrasonic, laser or electrohydraulic. The aim of this study was to compare the efficacy and safety of pneumatic lithotripters versus Ho: YAG laser in the treatment of multiple stones in the distal ureter. METHODS: A retrospective evaluation was done using the data of patients to whom ureteroscopic lithotripsy (URL) was applied for ureter stones in our clinic. From these patients, those with multiple unilateral distal ureter stones were identified, then these patients were separated into 2 groups according to the type of lithotriptor used in stone fragmentation as laser lithotripsy (Group 1) and pneumatic lithotripsy (Group 2). RESULTS: Statistically, the two groups were similar in respect of the number of stones, stone burden and the number of double J stents applied intra-operatively. The mean operating time was similar in the 2 groups as 53.47 (±17.3) minutes in Group 1 and 50.59 (±15.3) minutes in Group 2. On postoperative day 1 after the URL, the stone free rate (SFR) of Group 1 (78.7%) was found to be significantly high compared to the SFR of Group 2 (63.6%), while at postoperative month 1, the SFR of both groups was found to be similar. Binary logistic regression was applied to determine the effect of related independent variables on the 1st month SFR. In this model, age and stone burden were affecting variables. CONCLUSION: Compared to the pneumatic lithotripter, the Ho: YAG laser seems to have advantages of a higher SFR in the early postoperative period, eventhough there are statistically similar success rates and complication rates.

Treatment of Moderate Sized Renal Pelvis Calculi: Stone Clearance Time Comparison of Extracorporeal Shock Wave Lithotripsy and Retrograde Intrarenal Surgery.

PURPOSE: To compare the stone clearance times in patients undergoing extracorporeal shock wave lithotripsy (SWL) or retrograde intrarenal surgery (RIRS) for single radiopaque renal pelvis stones 10-20 mm in size. The results of this study may guide urologists and patients and aid in selecting the optimal preoperative treatment. MATERIALS AND METHODS: Between January 2013 and February 2015, we conducted a retrospective study and collected data from 333 patients treated with SWL (n = 172) or RIRS (n = 161). We included successfully treated patients with a single radiopaque renal pelvis stone 10-20 mm in size to calculate stone clearance times. RESULTS: The average stone size for the SWL group was 14.62 ± 2.58 mm and 14.91 ± 2.92 mm for the RIRS group. The mean Hounsfield unit (HU) of the patients was 585.40 ± 158.39 HU in the SWL group and 567.74 ± 186.85 HU in the RIRS group. Following full fragmentation, the mean stone clearance time was 26.55 ± 9.71 days in the SWL group and 11.59 ± 7.01 days in the RIRS group (P < .001). CONCLUSION: One of the most overlooked parameters in urinary stone treatments is stone clearance. We believe this study will shed light for those who aim to conduct larger randomized prospective studies. .

Epidemiology and risk factors for venous thromboembolism in lung cancer.

PURPOSE OF REVIEW: Cancer is a strong risk factor for venous thromboembolism (VTE). In patients with lung cancer VTE is a significant cause for morbidity and mortality. The purpose of the review is to summarize the epidemiology of thrombotic events, risk factors for VTE and the clinical impact of VTE in patients with lung cancer. RECENT FINDINGS: The rates of VTE in lung cancer patients vary according to different types of investigations, and reach 7 to 13%, including a significant number of unsuspected pulmonary emboli. Risk factors for VTE in patients with lung cancer can be basically divided into three categories: patient, tumor, and treatment related. In addition, a number of biomarkers have been described to be associated with VTE risk (e.g., D-dimer). SUMMARY: Knowledge about the epidemiology, risk factors, and prognostic value of VTE in lung cancer could help to prevent thrombotic complications and improve management of patients with lung cancer.

Monotherapy for hepatitis B infection: a review of treatment options.

Chronic hepatitis B (CHB) is a global health problem, causing liver failure, cirrhosis and hepatocellular carcinoma. CHB treatment aims to prevent liver-related complication. The treatment of CHB infection includes monotherapy with either interferons (IFNs) or nucleos(t)ide (NUC) analogs. IFNs have moderate antiviral effects, and their use is limited by side effects. With the availability of NUCs, IFN-intolerant and decompensated cirrhotic patients began to be treated. Lamivudine and telbivudine, nucleoside analogs, have low genetic barrier to resistance. Adefovir, a nucleotide analog, has moderate potency and potential nephrotoxicity. Entecavir and tenofovir, with their high potency, high genetic barrier to resistance and favorable safety profile are the standard of care in CHB treatment. Long-term use of NUCs with maintained viral suppression results in a decrease in liver-related complications.

A Rare Foreign Material in the Bladder: Piece of Pencil.

Cases with foreign bodies in the bladder are rarely seen. According to literature, it has been reported that foreign bodies were removed from the bladder. The etiology of these cases are iatrogenic causes, migration from adjacent organs, tissues and self-insertion. In this case report, we presented a 22-year-old female who was admitted to the emergency room with vaginal bleeding, and groin pain. The foreign body was removed from the urinary bladder.