Smartphone-based stent tracking application for prevention of forgotten ureteral double-J stents: a prospective study.

PURPOSE: Retained or forgotten ureteral stents (FUS) have a potential to cause significant morbidity as well as medico-legal issues and increased cost. We aimed to evaluate the efficacy and usefulness of smartphone-based Ureteral Stent Tracker (UST) application and compare the results with basic appointment card system to prevent FUS, prospectively. MATERIALS AND METHODS: A total of 90 patients who underwent ureteroscopic stone treatment procedure with indwelling DJ stents were equally distributed into two groups. In group-1, patients were followed using UST application. In group-2, only appointment cards were given to the patients. Two groups were compared in terms of stent overdue times and complete lost to follow up rates. RESULTS: Forty-four patients in group-1 and 43 patients in group-2 completed the study. Among patients, 22.7% in group-1 and 27.9% in group-2 did not return for the stent removal on the scheduled day. In group-1, these patients were identified using the UST and called for the stent removal on the same day. After 6 weeks of maximal waiting period, mean overdue times in group-1 and group-2 were 3.5 days and 20 days, respectively (p = 0.001) . In group-2, 3 patients (6.9%) were lost to follow up, while in group-1, it was none (p = 0.001). CONCLUSIONS: We found that the patients who were followed by the smartphone-based UST application has less overdue times and lost to follow up cases compared to the basic appointment card system. The UST application easily follows patients with indwelling ureteral stents and can identify patients when overdue.

Endoscopic, Single-Session Management of Encrusted, Forgotten Ureteral Stents.

Background and Objectives: Remained or forgotten ureteral double-J stents may cause serious complications. Removing of an encrusted, forgotten stent can be challenging. We present our experience with heavily encrusted ureteral stents and discuss the endourologic treatment options as well as their effectivity. Materials and Methods: Eleven men and six women (mean 48.58 ± 14.48 years of age) with 18 encrusted forgotten stents (mean 16.4 ± 13.25 months of indwelling) were treated at our clinic. All patients underwent the operation after negative urine cultures were obtained. Their medical records were retrospectively reviewed and analyzed in terms of number of interventions required to remove the stent, operation time, complications, hospital stay and stone-free rate. Results: According to the Forgotten-Encrusted-Calcified (FECal) classification, the most common form of stent encrustation was grade III (64.7%) and 17.6% of the stents were fragmented. Four of 17 patients were initially treated with extracorporeal shock-wave lithotripsy. The patients required a mean of two endoscopic interventions for removing the encrusted stent and all stents were removed endoscopically in a single session. The mean operating time was 63.3 ± 41.8 minutes. Cystolithotripsy followed by ureteroscopy was the most common intervention (41.1%). Of the 17 patients, peroperative and postoperative complications were Clavien grade I in two, grade II in two and grade IIIb in one. The mean hospital stay was 1.3 ± 0.99 days. All patients were stone-free after a month of stent removal. Conclusions: The endourological removal of the encrusted forgotten stents in a single session is feasible and effective with a minimal morbidity. The treatment strategy should be to minimize the number of interventions.

Preoperatively Assessable Clinical and Pathological Risk Factors for Parametrial Involvement in Surgically Treated FIGO Stage IB-IIA Cervical Cancer.

OBJECTIVE: Determining the risk factors associated with parametrial involvement (PMI) is of paramount importance to decrease the multimodality treatment in early-stage cervical cancer. We investigated the preoperatively assessable clinical and pathological risk factors associated with PMI in surgically treated stage IB1-IIA2 cervical cancer. METHODS: A retrospective cohort study of women underwent Querleu-Morrow type C hysterectomy for cervical cancer stage IB1-IIA2 from 2001 to 2015. All patients underwent clinical staging examination under anesthesia by the same gynecological oncologists during the study period. Evaluated variables were age, menopausal status, body mass index, smoking status, FIGO (International Federation of Obstetrics and Gynecology) stage, clinically measured maximal tumor diameter, clinical presentation (exophytic or endophytic tumor), histological type, tumor grade, lymphovascular space invasion, clinical and pathological vaginal invasion, and uterine body involvement. Endophytic clinical presentation was defined for ulcerative tumors and barrel-shaped morphology. Two-dimensional transvaginal ultrasonography was used to measure tumor dimensions. RESULTS: Of 127 eligible women, 37 (29.1%) had PMI. On univariate analysis, endophytic clinical presentation (P = 0.01), larger tumor size (P < 0.001), lymphovascular space invasion (P < 0.001), pathological vaginal invasion (P = 0.001), and uterine body involvement (P < 0.001) were significantly different among the groups with and without PMI. In multivariate analysis endophytic clinical presentation (odds ratio, 11.34; 95% confidence interval, 1.34-95.85; P = 0.02) and larger tumor size (odds ratio, 32.31; 95% confidence interval, 2.46-423.83; P = 0.008) were the independent risk factors for PMI. Threshold of 31 mm in tumor size predicted PMI with 71% sensitivity and 75% specificity. We identified 18 patients with tumor size of more than 30 mm and endophytic presentation; 14 (77.7%) of these had PMI. CONCLUSIONS: Endophytic clinical presentation and larger clinical tumor size (>3 cm) are independent risk factors for PMI in stage IB-IIA cervical cancer. Approximately 78% of the patients with a tumor size of more than 3 cm and endophytic presentation will require adjuvant chemoradiation for PMI following radical surgery. Considering clinical tumor presentation along with tumor size can enhance the physician's prediction of PMI in early-stage cervical cancer.

Impact of personalized three-dimensional -3D- printed pelvicalyceal system models on patient information in percutaneous nephrolithotripsy surgery: a pilot study.

OBJECTIVE: To investigate the impact of personalized three dimensional (3D) printed pelvicalyceal system models on patient information before percutaneous nephrolithotripsy surgery. MATERIAL AND METHODS: Patients with unilateral complex renal stones with indicatation of percutaneous nephrolithotripsy surgery were selected. Usable data of patients were obtained from CT scans as Digital Imaging and Communications in Medicine (DICOM) format. Mimics software version 16.0 (Materialise, Belgium) was used for segmentation and extraction of pelvicalyceal systems. DICOM format were converted to Stereolithography file format. Finally, fused deposition modeling was used to create plasticine 3D models of pelvicalyceal systems. A questionnaire was designed for patients to assess personalized 3D models effect on patient's understanding their conditions before percutaneous nephrolithotripsy surgery (PCNL). The day before surgery, each patient was seen by a urologist to deliver information about surgery. Questionnaire forms were asked to patients complete before and after presentation of 3D models and the results of the questions were compared. RESULTS: Five patient's anatomically accurate models of the human renal collecting system were successfully generated. After the 3D printed model presentation, patients demonstrated an improvement in their understanding of basic kidney anatomy by 60% (p=0.017), kidney stone position by 50% (p=0.02), the planned surgical procedure by 60% (p=0.017), and understanding the complications related to the surgery by 64% (p=0.015). In addition, overall satisfaction of conservation improvement was 50% (p=0.02). CONCLUSION: Generating kidney models of PCSs using 3D printing technology is feasible, and understandings of the disease and the surgical procedure from patients were well appreciated with this novel technology.

Should omentectomy be a part of surgical staging in patients with endometrioid adenocarcinoma of the uterine corpus?

BACKGROUND: The purpose of the study was to determine the prevalence of omental metastasis in endometrioid adenocarcinoma and to correlate risk variables with this spread. METHODS: A retrospective analysis of patients with endometrioid adenocarcinoma who underwent omentectomy in addition to staging laparotomy was performed. RESULTS: Omental metastases were noted in 11 of the 322 patients with endometrioid adenocarcinoma (3.4%). Multivariate analyses showed that there was a significant correlation between omental metastasis and positive peritoneal cytology, adnexal involvement, and grade 3 tumor (p = 0.028, p = 0.001, and p = 0.01, respectively). There was no statistical relationship between omental metastasis and lymphovascular space involvement, deep myometrial invasion, and lymph node metastasis (p = 0.087, p = 0.97, and p = 0.92, respectively). CONCLUSION: Grade 3 endometrioid adenocarcinomas, especially those that are complicated by deep myometrial invasion, have a pattern of intra-abdominal spread similar to more aggressive endometrial cancers, with frequent involvement of the omentum. Overall, we conclude that 37.5% (3/8) of patients who had a grade 3 tumor and omental metastasis stage IV disease would have been missed if a staging operation similar to that employed for ovarian cancer had not been performed.

Additional surgical risk factors and patient characteristics for mesh erosion after abdominal sacrocolpopexy.

AIM: The aim of this study is to determine the risk factors of mesh exposures following abdominal sacral colpopexy (ASC) in which polypropylene mesh is used. METHODS: This is a retrospective cohort study of patients who underwent ASC and were subsequently followed for development of mesh exposure for vaginal/vault prolapse between 2002 and 2012. Demographics and risk factors of the patients who did develop mesh exposure after ASC and the ones who did not were compared. RESULTS: In 42 months of survey, 19 of the 292 patients who underwent ASC developed mesh exposure. It was found that rates of patients with stage 3-4 prolapse were significantly greater in the mesh exposure group than in the control group (P = 0.04). Rates of mesh exposure were lower in patients with previous hysterectomy (P = 0.03). Also, it was found that concomitant hysterectomy or three or more additional procedures increased the risk of mesh exposure (P = 0.03 and P = 0.02). CONCLUSION: In abdominal sacrocolpopexy operations in which polypropylene meshes are used, stage 3 or 4 prolapse, concomitant hysterectomy and three or more additional procedures increase the risk of mesh exposure development.

Lymph node metastasis in patients with epithelial ovarian cancer macroscopically confined to the ovary: review of a single-institution experience.

BACKGROUND: To evaluate the patterns of lymphatic spread in epithelial ovarian cancer (EOC) macroscopically confined to the ovary and to determine risk factors for lymph node metastasis. MATERIALS AND METHODS: All patients with clinically apparent stage IA/B/C EOCs who underwent staging surgery between January 2003 and February 2013 were retrospectively identified. RESULTS: Two hundred and thirty-six (n = 236) consecutive patients were operated for primary epithelial ovarian carcinoma. Sixty-two of these patients (26.2 %) who underwent a comprehensive staging procedure including pelvic and paraaortic lymphadenectomy were diagnosed with tumors confined to one or two ovaries (stage IA/B/C). Of these 62 patients, 17 (27.4 %) had upstaged disease and 8 (12.9 %) had lymph node metastasis. Tumor histology was serous in 25 patients (40.3 %), mucinous in 23 patients (37 %), endometrioid in 9 patients (14.5 %), and clear cell in 5 patients (8 %). Positive lymph node status was found in 20 % (5/25) of those with serous histology while this rate was only 8.1 % (3/37) in those with non-serous disease. Although the presence of ascites was not associated with an increased risk of lymph node involvement (p = 0.24), positive peritoneal cytology (p = 0.001) and grade 3 disease (p = 0.001) were significant predictors of lymph node involvement. CONCLUSION: All patients diagnosed with EOC macroscopically confined to the ovary should be considered for comprehensive staging surgery including pelvic and paraaortic lymphadenectomy.

Determining the diagnostic value of endogenous carbon monoxide in chronic obstructive pulmonary disease exacerbations.

OBJECTIVE: To determine whether endogenous carbon monoxide levels in exacerbations of Chronic Obstructive Pulmonary Disease patients were higher compared to healthy individuals and to investigate alteration of carbon monoxide levels across the three different severity stages of Global Initiative for Chronic Obstructive Lung Disease criteria related to Chronic Obstructive Pulmonary Disease exacerbations. METHODS: The prospective study was conducted from January to March 2011 at two medical institutions in Ankara, Turkey, and comprised patients of acute Chronic Obstructive Pulmonary Disease exacerbations. The severity of the exacerbations was based on the Global Initiative for Chronic Obstructive Lung Disease criteria. Patients with active tobacco smoking, suspicious carbon monoxide poisoning and uncertain diagnosis were excluded. healthy control subjects who did not have any comorbid diseases and smoking habitus were also enrolled to compare the differences between carboxyhaemoglobin levels A two-tailed Mann-Whitney U test with Bonferroni correction was done following a Kruskal-Wallis test for statistical purposes. RESULTS: There were 90 patients and 81 controls in the study. Carboxyhaemoglobin levels were higher in the patients than the controls (p < 0.001). As for the three severity stages, Group 1 had a median carboxyhaemoglobin of 1.6 (0.95- 2.00). The corresponding levels in Group 2 (1.8 [1.38-2.20]) and Group 3 (1.9 [1.5-3.0]) were higher than the controls (p < 0.001 and p < 0.005 respectively). No statistically significant difference between Group 1 and the controls (1.30 [1.10-1.55]) was observed (p < 0.434). CONCLUSION: Carboxyhaemoglobin levels were significantly higher in exacerbations compared with the normal population. Also, in more serious exacerbations, carboxyhaemoglobin levels were significantly increased compared with healthy individuals and mild exacerbations.

Ovarian fibroma/fibrothecoma: retrospective cohort study shows limited value of risk of malignancy index score.

BACKGROUND: Ovarian fibromas/fibrothecomas are uncommon benign tumours of ovary. Due to their solid structure, these benign tumours are sometimes confused with malignant tumours during clinical evaluation. AIMS: To determine the clinico-pathological characteristics of ovarian fibroma/fibrothecoma and analyse the efficiency of risk of malignancy index (RMI) scoring system to distinguish malignancy among these tumours. METHODS: Between November 2001 and February 2012, women with a pathological diagnosis of ovarian fibroma/fibrothecoma were identified. Depending on the menopausal status, serum CA-125 level and ultrasonographic findings, RMI scores were calculated for each of the patients. RESULTS: During the study period, 43 ovarian fibroma/fibrothecoma (4.7%) were detected among 912 adnexal masses operated. The mean age of the women was 52.2 (range, 21-80 years). Upon calculating RMI scores, 33 women (76.7%) were classified as low risk and 10 women (23.3%) as high risk for malignancy. Sensitivity, specificity, positive predictive value and negative predictive value of the RMI scoring for identification of malignant lesions preoperatively were found as 0%, 76%, 0% and 97%, respectively. Final pathological diagnosis was ovarian fibroma in 13 (30%) women, fibrothecoma in 29 (67%) and fibrosarcoma in one woman (2%). CONCLUSION: There are no specific markers for accurate preoperative diagnosis of ovarian fibroma/fibrothecoma. Moreover, according to our results, RMI scoring system does not aid clinicians in this issue either, with a high false-positive rate and very low sensitivity. Further studies with higher number of cases are needed to state clearly the role of RMI scores in preoperative discrimination of malignancy.

The statuses of HER2 expression and mismatch repair in endometrial clear cell carcinoma.

High-grade endometrial carcinomas (HGEC) are difficult to classify. With the current use of HER2-based therapy in serous carcinoma, a diagnosis of clear cell carcinoma (CCC) has the potential to exclude patients from receiving therapy. Therefore, we examined HER2 expression in our CCC patients. The preparations of 8 patients with CCC who underwent hysterectomy, bilateral salpingo-oophorectomy, and lymph node dissection were re-evaluated. Patients did not have any prior treatment. Histopathologic parameters that were evaluated include cytoplasmic clearing, nuclear atypia, mitotic activity, hobnail architecture, hyalinized cores, hyaline globules, stratification of epithelial lining papillae, or glandular structures, and highly atypical cell layers. Immunohistochemically, HER2, ER, PR, HNF1ß, Napsin A, MLH1, MSH2, MSH6 and PMS2 were applied. HER2 staining pattern, ASCO/CAP protocol used for endometrial carcinom was used. HER2 was positive in 3 of our 8 CCC patients (37.5%). While all of our HER2 + cases were Napsin A and HNF1ß positive, MMR proteins were intact and ER and PR were negative. Two patients had wild type p53 and 1 patient had aberrant p53 staining. Considering that there is not always a consensus between SC and CCC, even among gynecopathologists, tumor heterogeneity and different tumor components may exist, and while patients may be diagnosed with CCC and benefit from HER2 therapy, there is also a possibility that they may not benefit from the treatment. The fact that 37.5% of our CCC cases were HER2 + is a finding with strong implications for the therapeutic approach. As a result of our study, in patients with CCC, if MMR is intact and ER-PR is negative, regardless of the p53 staining pattern, HER2 testing may be an objective screening method for patients who are likely to benefit from HER-targeted therapy. Consequently, patients with a diagnosis of CCC can be candidates for future clinical trials of HER2-targeted therapy.

Immediate colposcopic evaluation in postmenopausal women with low-grade squamous intraepithelial lesion cytology.

OBJECTIVE: To compare the final diagnosis among pre- and postmenopausal women with low-grade squamous intraepithelial lesion (LGSIL) cervical smear results. DESIGN: Retrospective, comparative study. SETTING: Departments of obstetrics and gynecology in two teaching and research hospitals. POPULATION: Data were evaluated on 712 women with LGSIL between April 2005 and April 2011. METHODS: Results from 129 postmenopausal women with LGSIL were compared with 583 premenopausal women with a similar LGSIL result with respect to sociodemographic data and histopathology. MAIN OUTCOME MEASURES: Final clinicopathological diagnosis. RESULTS: The mean age of the pre- and postmenopausal women was 37.2 and 52.5 years, respectively, and lesions of cervical intraepithelial neoplasia grade 2 or worse were detected by biopsy and/or endocervical curettage in 13.6 and 9.3%, respectively. There was no significant difference between the final diagnosis among pre- and postmenopausal women with LGSIL cytology (relative risk 1.43; 95% confidence interval 0.82-2.48; p= 0.19). Invasive cervical cancer was detected in three premenopausal (0.5%) and two postmenopausal women (1.6%). CONCLUSIONS: Cervical pre-invasive and invasive disease rates were similar in pre- and postmenopausal women with LGSIL cytology. For this reason, LGSIL in postmenopausal women should be considered more seriously, and colposcopic evaluation may be as acceptable an option in the management of LGSIL in this group of patients as it is with premenopausal women.

Malignant transformation arising from mature cystic teratoma of the ovary: a report of six cases.

AIM: Malignant transformation of mature cystic teratoma (MCT) is an uncommon complication. Preoperative diagnosis is difficult because of the lack of specific symptoms and signs indicating malignancy. Thus, we retrospectively analyzed the clinical characteristics of patients and the role of surgery in their management. MATERIAL AND METHODS: During a 9-year period (2002-2010), six patients with malignant transformation arising from ovarian MCT were treated at the Gynecologic Oncology Unit of Bakirkoy Woman and Children's Training and Research Hospital. A retrospective chart review and analysis of the patients' data were conducted. RESULTS: Malignant transformation arising from ovarian MCT accounted for 1.9% of all ovarian MCT (6/321). Three cases were stage IA and the other three were stage IC. Histologically, three of six cases had squamous cell carcinoma (50%), two had a carcinoid tumor (33%), and one had mucinous adenocarcinoma (17%). All patients underwent comprehensive surgical staging. Two patients received adjuvant chemotherapy and one received adjuvant chemoradiation. Five of six patients were observed for 16-104 months and no recurrence was detected. One patient with a carcinoid tumor in stage IC died of disease within 34 months following the surgery. CONCLUSION: Early detection of malignant transformation arising from MCT is mandatory for treating patients, but in most patients malignancy was detected intraoperatively. Surgical cytoreduction with a complete staging procedure and adjuvant treatment may be reasonable for stage IC. Additionally, prognosis is better when the tumor is completely excised and does not extend beyond the capsule.

Preoperative assessment of myometrial and cervical invasion in endometrial carcinoma by transvaginal ultrasound.

OBJECTIVE: To evaluate the diagnostic accuracy of transvaginal ultrasound (TVS) in preoperative assessment of the depth of myometrial infiltration and the presence of cervical invasion in endometrial carcinoma. METHODS: 298 consecutive patients with a diagnosis of endometrial cancer were evaluated by TVS within 3 days of surgical intervention. The depth of myometrial invasion was classified into two groups: no or <50% invasion and ≥50% invasion. Invasion of cervix was diagnosed when the neoplastic tissue distended the cervix and showed ill-defined borders with the cervical stroma. RESULTS: The sensitivity, specifity, positive predictive value (PPV), negative predictive value (NPV) and overall diagnostic accuracy of TVS in evaluation of the depth of myometrial infiltration were 68.4%, 82%, 65.1%, 84.1% and 77.5%, respectively. While the sensitivity and PPV were significantly higher among grade 3 tumors, the specifity, NPV and accuracy were significantly higher among grade 1 tumors. The sensitivity, specifity, PPV, NPV, and overall diagnostic accuracy of TVS in assessment of the presence or absence of neoplastic tissue in cervix were 76.5%, 99.3%, 86.7%, 98.2% and 98%, respectively. While the sensitivity and PPV were significantly higher among grade 1 tumors, the NPV and accuracy were significantly lower among grade 3 tumors. CONCLUSION: TVS can be considered as a feasible, economical and simple imaging modality with a high diagnostic accuracy for the prediction of cervical involvement. However, it is not a reliable method in estimating the depth of myometrial infiltration.

Cesarean techniques in cases with one previous cesarean delivery: comparison of modified Misgav-Ladach and Pfannenstiel-Kerr.

AIM: To compare the effectiveness of the Pfannenstiel-Kerr method (PKM) or modified Misgav-Ladach method (MMLM) in previous cesarean sections (C/Ss). METHODS: Hundred and fifteen gravidas were included with previous one C/S, using either a PKM or MMLM. Demographic characteristics, operative outcomes, surgical complications, and neonatal outcomes were compared in two groups. RESULTS: The mean operative time (18.0 ± 3.5 vs. 23.5 ± 5.7 min; p < 0.0001) and mean extraction time (90.1 ± 41.2 vs. 208.1 ± 79.1 s; p < 0.0001) were significantly shorter in the MMLM group than the PKM group. Postoperative recovery (mobilization, normalization of bowel function, need for analgesics, time to oral feeding, and intra-operative blood loss) was similar between the MMLM and PKM groups. CONCLUSION: The MMLM appears to be a faster alternative to PKM for previous C/Ss, with similar results as in previous studies with primary CSs.

Prenatal sonographic diagnosis of tuberous sclerosis complex.

We report the case of a male fetus with tuberous sclerosis complex (TSC), in whom multiple cardiac rhabdomyomas and renal angiomyolipomas were detected at 33 weeks by ultrasound with additional brain lesions detected on MRI, all confirmed after birth. DNA analysis of the TSC2 gene detected a de novo mutation in the TSC2 gene. Postnatal follow-up and neurological examination were normal, as were the results of Holter monitoring.

Vaginocutaneous fistula: A rare long-term complication of transobturator tape procedure for stress urinary incontinence.

INTRODUCTION: Synthetic mid-urethral slings are currently the most common performed surgical procedure for the treatment of female stress urinary incontinence. The transobturator mid-urethral sling technique has been widely accepted owing to its high success and low complication rates. Although complications are rarely seen, it may cause significant morbidity. CASE PRESENTATION: We report a case of vaginocutaneous fistula following transobturator mid-urethral sling procedure and a successful reconstruction with transvaginal sling excision and fistula closure. CONCLUSION: Vaginocutaneous fistula is a known but rarely seen long-term complication of transobturator tape. With an increased use of mesh, various delayed complications can be seen in the long-term follow-up. This case showed us the need for longer and detailed studies that evaluate the effectiveness and safety of the transobturator tape procedure.

Incidental adnexal masses at cesarean section and review of the literature.

AIM: To study the outcome of cases of incidental adnexal masses detected during cesarean section. METHODS: A total of 126 093 live births and 39 115 cesarean deliveries performed between 2002 and 2008 were retrospectively evaluated and cases with additional adnexal masses and surgical interventions were included in the study. Histopathologic assessment and related outcomes were examined. RESULTS: One hundred and nineteen patients had incidental adnexal masses at the time of cesarean delivery; the incidence of adnexal masses was 1/329. The most common histopathologic diagnoses were mature cystic teratoma (32%) and functional cysts (26%). Six cases (5%) were bilateral. The mean cyst size was 6.4 cm; two of the masses were malignant. CONCLUSION: Incidental masses detected at the time of cesarean section should be extirpated in order to exclude the possibility of malignancy and to avoid additional surgical procedures following cesarean section.

Angiokeratoma of the clitoris with evident vulvar varicosity.

Angiokeratomas of the vulva are uncommon, benign vascular lesions that are generally located on the labia. However, the clitoris is an extremely rare location, with only three published cases. We report a case of clitoral angiokeratoma in a 22-year-old nulligravida with a history of surgery to remove a clitoral mass at 6 years of age. The case described herein is distinguished from the other case reports by an accompanying varicose structure involving the vulva.

NLRP7 plays a functional role in regulating BMP4 signaling during differentiation of patient-derived trophoblasts.

Complete hydatidiform mole (HM) is a gestational trophoblastic disease resulting in hyperproliferation of trophoblast cells and absence of embryo development. Mutations in the maternal-effect gene NLRP7 are the major cause of familial recurrent complete HM. Here, we established an in vitro model of HM using patient-specific induced pluripotent stem cells (iPSCs) derived trophoblasts harboring NLRP7 mutations. Using whole transcriptome profiling during trophoblast differentiation, we showed that impaired NLRP7 expression results in precocious downregulation of pluripotency factors, activation of trophoblast lineage markers, and promotes maturation of differentiated extraembryonic cell types such as syncytiotrophoblasts. Interestingly, we found that these phenotypes are dependent on BMP4 signaling and BMP pathway inhibition corrected the excessive trophoblast differentiation of patient-derived iPSCs. Our human iPSC model of a genetic placental disease recapitulates aspects of trophoblast biology, highlights the broad utility of iPSC-derived trophoblasts for modeling human placental diseases and identifies NLRP7 as an essential modulator of key developmental cell fate regulators.

Visual clarity of irrigants used during flexible ureterorenoscopy: an in vitro comparison.

INTRODUCTION: Saline solution is the standard irrigant used during ureteroscopy. However, there is an opinion that water has better visual clarity. We aimed to compare the visual clarities of saline, water, and 5% mannitol as an irrigant during ureteroscopy. MATERIAL AND METHODS: An in vitro model consisting of an irrigant-filled container and a fiberoptic flexible ureteroscope was designed. A 1951 USAF Resolution Test Target and color checker within irrigants were used to evaluate the clarity of vision. The visual clarity was compared for 0.9% saline, distilled water and 5% mannitol solution with screen resolution and color contrast. The tests were repeated after adding human blood (2/400 ml) and contrast (20/400 ml) to the irrigants. RESULTS: There was no significant difference in resolution values of three plain irrigants at a distance of 10 mm. However, when blood was added to the irrigants, a better resolution of 29.3% for water and 20.6% for mannitol was achieved compared to saline. At 20 mm of distance, it was observed that the difference was more pronounced in irrigants with blood. Water and mannitol had 55.6% and 37.1% better resolution than saline, respectively. In the color reproduction test, there was no significant difference in the three plain irrigants, however, water had better color contrast compared to the others. CONCLUSIONS: Water and 5% mannitol did not provide a significant image clarity advantage compared to saline. However, when blood was added to the irrigants, water provided significantly better visual clarity compared to saline. The use of water during various clinical scenarios in flexible ureteroscopy should be further investigated.