Prophylactic Mesh Placement With Ileal Conduit: A Cost-effectiveness Analysis.

OBJECTIVE: To determine the cost-effectiveness of mesh placement in patients undergoing ileal conduit urinary diversion for bladder cancer. Long-term studies have shown that parastomal hernias (PSH) occur in more than half of all stomas. Mesh prophylaxis has been shown to reduce PSH after end-colostomy and ileal conduits. However, no cost-effectiveness studies on mesh prophylaxis have been performed for this population. METHODS: We created a Markov model incorporating the costs and effectiveness of mesh prophylaxis for patients undergoing radical cystectomy and ileal conduit construction. Costs were obtained from the literature and adjusted to 2022 US dollars. Effectiveness was measured in quality-adjusted life years (QALY). 1- and 2-way sensitivity analyses were performed to test the robustness of our model. RESULTS: In stage I-IV bladder cancer, prophylactic mesh placement was costlier, but more effective in providing quality of life compared with no mesh placement at index surgery. Average incremental cost between the 2 strategies across all stages was an additional $897 when mesh was utilized. Incremental effectiveness averaged 0.49 additional QALY across all stages. This resulted in an incremental cost-effectiveness ratio of $2114.71/QALY. Sensitivity analyses indicated that benefit of mesh placement was sensitive to the probability of mesh infection. CONCLUSION: In patients undergoing ileal conduit urinary diversion for bladder cancer, mesh prophylaxis at the time of radical cystectomy is an overall cost-effective strategy in preventing PSH for patients presenting with all stages of bladder cancer.

General anesthesia, using remimazolam, for the patient with myelin oligodendrocyte glycoprotein antibody associated disease (MOGAD): A case report.

RATIONALE: Myelin oligodendrocyte glycoprotein antibody associated disease (MOGAD) is one of auto-immune demyelinating diseases of nervous system. Although both regional anesthesia and general anesthesia has been successfully performed in the patient with demyelinating diseases of nervous system, it has been controversial which one is better. PATIENT CONCERNS: Forty-four male patient was admitted for arthroscopic elbow surgery due to limitation of range of motion. The patient was diagnosed as MOGAD with anti-N-methyl-D-aspartate (NMDA) receptor encephalitis, and steroid was used to prevent and treat symptoms and signs. DIAGNOSIS: He was diagnosed as MOGAD with anti-NMDA receptor encephalitis, 1 year ago. The patient complaint of dizziness, diplopia, nausea, vomiting, seizure, general weakness and so on when he was confirmed as MOGAD with anti-NMDA receptor encephalitis. The diagnosis of MOGAD was confirmed with positive anti-myelin oligodendrocyte glycoprotein (MOG) Immunoglobulin (Ig)G and negative anti-aquaporin 4 (AQP4) IgG in the blood. INTERVENTIONS AND OUTCOMES: After steroid cover, total intravenous anesthesia (TIVA) with remimazolam and remifentanil was established for the patients. Rocuronium was administered under monitoring of neuromuscular blockade, using train of 4 (TOF). The operation was performed without any event under right lateral decubitus position. The patient was uneventfully recovered from anesthesia. LESSONS: The case report showed total intravenous anesthesia with remimazolam and remifentanil under proper monitoring was successfully performed in the patient with MOGAD.

Incidence of Preoperative Antibiotic Use and Its Association with Postoperative Infectious Complications after Radical Cystectomy.

OBJECTIVE: To determine exposure rates to antibiotics prior to radical cystectomy and determine if there is correlation with post-operative infections. METHODS AND MATERIALS: 2248 patients were identified in the 2016 SEER-Medicare linkage who underwent radical cystectomy between 2008 and 2014 with complete prescription information. An outpatient prescription for an antibiotic within 30 days prior to cystectomy was considered exposure. Antibiotic class and combinations were recorded. Postoperative infectious diagnoses and readmissions were tabulated within 30 days of cystectomy. RESULTS: Fifty one percent of patients (n = 1149) were prescribed an outpatient antibiotic prior to cystectomy. Patients receiving antibiotics were more likely to be female (31% vs 25%, P < .01) and had been diagnosed with an infection (17% vs 11%, P < .01). Antibiotic bowel prophylaxis was prescribed to 42% of patients receiving antibiotics. Postoperatively, the exposure group had higher rates of any infection, (56% vs 51% P < .01) and UTI (36% vs 31% P < .01). All-cause readmission within 30 days was higher in the exposure cohort (26% vs 22%, P = .02) Multivariable logistic regression showed outpatient preoperative antibiotics were an independent risk factor for any infection (HR 1.19, P < .05) and readmission (hazards ratio 1.24, P = .03) in the 30 days after radical cystectomy. CONCLUSION: Outpatient antibiotic use prior to radical cystectomy is common and may be associated with increased risk of postoperative infection and readmission. Antibiotic use prior to radical cystectomy should be examined as a modifiable factor to decrease post-operative morbidity.

The Preventive Effect of the Phenotype of Tumour-Associated Macrophages, Regulated by CD39, on Colon Cancer in Mice.

BACKGROUND: This study was designed to investigate the effect of cluster differentiation (CD)39 and CD73 inhibitors on the expresion of tumour-associated macrophages (TAMs), M1- versus M2-tumour phenotypes in mice with colon cancer. METHODS: An in vivo study of co-culture with colon cancer cells and immune cells from the bone marrow (BM) of mice was performed. After the confirmation of the effect of polyoxotungstate (POM-1) as an inhibitor of CD39 on TAMs, the mice were randomly divided into a control group without POM-1 and a study group with POM-1, respectively, after subcutaneous injection of CT26 cells. On day 14 after the injection, the mice were sacrificed, and TAMs were evaluated using fluorescence-activated cell sorting. RESULTS: In the in vivo study, the co-culture with POM-1 significantly increased the apoptosis of CT26 cells. The cell population from the co-culture with POM-1 showed significant increases in the expression of CD11b+ for myeloid cells, lymphocyte antigen 6 complex, locus C (Ly6C+) for monocytes, M1-tumour phenotypes from TAMs, and F4/80+ for macrophages. In the in vivo study, tumour growth in the study group with POM-1 was significantly limited, compared with the control group without POM-1. The expressions of Ly6C+ and major histocompatibility complex class II+ for M1-tumour phenotypes from TAMs on F4/80+ from the tumour tissue in the study group had significantly higher values compared with the control group. CONCLUSION: The inhibition of CD39 with POM-1 prevented the growth of colon cancer in mice, and it was associated with the increased expression of M1-tumour phenotypes from TAMs in the cancer tissue.

mu-Opioid Receptor Polymorphisms and Breast Cancer Recurrence in Adult Korean Women Undergoing Breast Cancer Surgery: A Retrospective Study.

Background: Genetic variations of mu-opioid receptors are well known to contribute to growth and progression of tumors. The most common single-nucleotide polymorphism (SNP) in the mu-opioid receptor 1 gene (OPRM1) is the A118G mutation. We examined the association between the recurrent breast cancer and genotypes of OPRM1 A118G SNP (AA vs. AG vs. GG) in Korean women population. Methods: We analysed medical records and genetic data of 200 patients aged more than 20 who underwent primary breast cancer surgery from June 2012 to June 2014 and diagnosed recurrent breast cancer from June 2012 to September 2019. Results: The incidence of recurrent breast cancer was 6.1%, 8.2%, and 4.8% in genotype AA, AG and GG, respectively (p=0.780). The incidence of recurrent breast cancer in volatile anaesthesia group was 7.0% and 7.1% in total intravenous anaesthesia (TIVA) group (RR = 0.984, 95% CI = 0.328 - 2.951; p = 0.978). Conclusion: OPRM1 A118G SNP had no influence on breast cancer recurrence in Korean women. Anaesthesia technique did not show significant effect on the incidence of recurrent breast cancer.

Combined Placement of Artificial Urinary Sphincter and Inflatable Penile Prosthesis Does Not Increase Risk of Perioperative Complications or Impact Long-term Device Survival.

OBJECTIVE: To determine the impact of concurrent inflatable penile prosthesis (IPP) and artificial urinary sphincter (AUS) implantation on perioperative complications and long-term device survival, among men with postprostatectomy erectile dysfunction and urinary incontinence. METHODS: We identified men older than 65 treated with radical prostatectomy in the Surveillance, Epidemiology, and End Results Medicare database between 2002 and 2016. IPP or AUS placement was determined by current procedural terminology (CPT) code, with dual implantation (DI) defined as IPP and AUS placement on the same date. Device survival was assessed using CPT codes for device removal, replacement, and/or repair. Complications were assessed within 90 days using ICD-9 codes. Statistical analysis was performed using SAS v9.3 (Cary, NC). RESULTS: A total of 37,599 men underwent radical prostatectomy, with AUS placed in 793 (2.1%), IPP placed in 644 (1.7%), and DI in 62 (0.2%). Relative to AUS placement alone, men undergoing DI were younger (68.8 vs 70.2 years, P = 0.03), but had equivalent Charlson comorbidity index, tumor grades, and rates of prior radiotherapy. Relative to IPP placement alone, men were more likely to undergo DI if treated with adjuvant or salvage radiotherapy. The incidence of complications within 30 and 90 days of prosthetic implantation did not differ between groups. Long-term device survival on Kaplan-Meier analysis was not impacted by DI relative to single device implantation with median follow-up of 61 months. CONCLUSION: Combined AUS and IPP placement does not adversely affect perioperative complications or device survival relative to placement of either device alone.

Facility-level analysis of robot utilization across disciplines in the National Cancer Database.

To evaluate trends in contemporary robotic surgery across multiple organ sites as they relate to robotic prostatectomy volume. We queried the National Cancer Database for patients who underwent surgery from 2010 to 2013 for prostate, kidney, bladder, corpus uteri, uterus, cervix, colon, sigmoid, rectum, lung and bronchus. The trend between volumes of robotic surgery for each organ site was analyzed using the Cochran-Armitage test. Multivariable models were then created to determine independent predictors of robotic surgery within each organ site by calculating the odds ratio with 95% CI. Among the 566,399 surgical cases analyzed, 35.1% were performed using robot assistance. Institutions whose robotic prostatectomy volume was in the top 75 percentile compared to the bottom 25 percentile performed a larger percentage of robotic surgery on the following sites: kidney 32.6 vs. 28.8%, bladder 23.6 vs. 18.6%, uterus 52.5 vs. 47.7%, cervix 43.5 vs. 39.2%, colon 3.2 vs. 2.9%, rectum 10.7 vs. 8.9%, and lung 7.3 vs. 6.8% (all p < 0.0001). It appears that increased trends toward robotic surgery in urology have lead to increased robotic utilization within other surgical fields. Future analysis in benign utilizations of robotic surgery as well as outcome data comparing robotic to open approaches are needed to better understand the ever-evolving nature of minimally invasive surgery within the United States.

Patterns and timing of artificial urinary sphincter failure.

PURPOSE: To assess population-based trends in artificial urinary sphincter (AUS) placement after prostatectomy and determine the effect of timing on device survival and complications. METHODS: We identified patients who underwent prostatectomy and AUS placement in SEER-Medicare from 2002 to 2011. We analyzed factors affecting the time of reoperation from AUS implantation and prostatectomy using multivariable Cox proportional hazard models. RESULTS: In total, 841 men underwent AUS placement at a median 23 months after prostatectomy. Patients who underwent reoperation (28.5%) had higher clinical stage, more likely underwent open prostatectomy, or had prior sling placement (p < 0.03). There were no differences in rates of diabetes, smoking status, prior radiation therapy, or Charlson Comorbidity Index between those requiring reoperation vs. not (all p > 0.15). Patients with AUS placement > 15 months after prostatectomy (75%) initially experienced less need for operative reinterventions. Patients with later AUS placement were significantly more likely to have received radiation therapy [22.9 vs. 3.8% (p < 0.01)]. Nonetheless, late implantation was confirmed to be protective on multivariate analysis during the first 5 years after AUS placement [HR 0.79 (95% CI 0.67-0.92); p < 0.01]. Factors independently associated with a shorter interval time until reoperation included history of radiation [HR 1.93 (95% CI 1.33-2.80); p < 0.01] and history of prior sling [HR 1.70 (95% CI 1.08-2.68); p = 0.02]. Even for patients who underwent radiation therapy, delayed AUS implantation reduced reoperative risk. CONCLUSIONS: Late AUS implantation in the Medicare population is associated with prolonged device survival initially, while radiation and prior sling surgery predict for earlier reoperation. Patients with delayed AUS implantation experience less immediate complications. Further work is required to identify patient-specific factors which may explain variability in timing for AUS.

Neoadjuvant and adjuvant chemotherapy use in upper tract urothelial carcinoma.

OBJECTIVE: To determine trends in neoadjuvant and adjuvant chemotherapy use for upper tract urothelial cancer and assess its effects on survival. MATERIALS AND METHODS: We identified all patients diagnosed with upper tract urothelial cancer who underwent surgical treatment in the SEER-Medicare database from 2002 to 2011. We collected and analyzed patient demographic, clinical, and pathologic characteristics. We strictly defined neoadjuvant and adjuvant chemotherapy and studied patients who met such criteria. Multivariable Cox proportional hazards models identified were used to identify independent predictors of overall and cancer-specific survival. RESULTS: A total of 3,432 patients met inclusion criteria, and their median age was 77 years. Overall, 86.4% of patients underwent surgery alone, 1.8% received neoadjuvant chemotherapy plus surgery, and 11.8% underwent surgery and adjuvant chemotherapy. Neoadjuvant chemotherapy use increased during the study period. Gemcitabine, carboplatin, cisplatin, and paclitaxel were the most commonly used agents. Cancer-specific survival at 5 years was 65.0% (95% CI: 63.2%-66.8%). Cox proportional hazards modeling controlling for sex, race, year of diagnosis, location, and pathologic stage revealed that higher pathologic nodal stage, tumor size>3cm, increased age, and carcinoma in situ predicted for worse survival. CONCLUSION: Age, nodal stage, and tumor size>3cm predict for worse cancer-specific survival. Neoajduvant chemotherapy is underused.

Wide Variation in Radiation Exposure During Computerized Tomography.

OBJECTIVE: To determine the variance in computeed tomography (CT) radiation measured via dose-length product (DLP) and effective dose (ED) during stone protocol CT scans. METHODS: We retrospectively examined consecutive records of patients receiving stone protocol diagnostic CT scans (n = 1793) in 2010 and 2014 in our health system. Patient age, body mass index (BMI), and gender were recorded, along with the hospital, machine model, year, DLP, and ED of each scan. Multivariate regression was performed to identify predictive factors for increased DLP. We also collected data on head (n = 837) CT scans to serve as a comparison. RESULTS: For stone CT scans, mean patient age was 55.1 ± 18.4 years with no significant difference in age (P=.2557) or BMI (P=.1794) between 2010 and 2014. Gender, BMI, and machine model were independent predictors of radiation dosage (P < .0001). Within each BMI class, there was an inexplicable 6-fold variation in the ED for the same imaging test when comparing the lowest and highest CT dose patients. There was no significant change in DLP over time for stone CT scans, but head scan patients in 2014 received lower radiation doses than those in 2010 (P < .0001). Low-dose scans for renal colic (defined as <4 mSv) were underutilized. Substantial variation exists for head scan radiation doses. CONCLUSION: Our data demonstrate large variations in diagnostic CT radiation dosage. Such differences within a single institution suggest similar trends elsewhere, warranting more stringent dosage guidelines and regulations for diagnostic CT scans within institutions.

Urolithiasis in pregnancy: a cost-effectiveness analysis of ureteroscopic management vs ureteral stenting.

OBJECTIVE: The purpose of this study was to determine the cost-effectiveness of serial stenting vs ureteroscopy for treatment of urolithiasis during pregnancy as a function of gestational age (GA) at diagnosis. STUDY DESIGN: We built decision analytic models for a hypothetical cohort of pregnant women who had received a diagnosis of symptomatic ureteral calculi and compared serial stenting to ureteroscopy. We assumed ureteral stent replacement every 4 weeks during pregnancy, intravenous sedation for stent placement, and spinal anesthetic for ureteroscopy. Outcomes were derived from the literature and included stent infection, migration, spontaneous kidney stone passage, ureteral injury, failed ureteroscopy, postoperative urinary tract infection, sepsis, and anesthetic complications. Four separate analyses were run based on the GA at diagnosis of urolithiasis. Using direct costs and quality-adjusted life years, we reported the incremental costs and effectiveness of each strategy based on GA at kidney stone diagnosis and calculated the net monetary benefit. We performed 1-way and Monte-Carlo sensitivity analyses to assess the strength of the model. RESULTS: Ureteroscopy was less costly and more effective for urolithiasis, irrespective of GA at diagnosis. The incremental cost of ureteroscopy increased from -$74,469 to -$7631, and the incremental effectiveness decreased from 0.49 to 0.05 quality-adjusted life years for a kidney stone diagnosed at 12 and 36 weeks of gestation, respectively. The net monetary benefit of ureteroscopy progressively decreased for kidney stones that were diagnosed later in pregnancy. The model was robust to all variables. CONCLUSION: Ureteroscopy is less costly and more effective relative to serial stenting for urolithiasis, regardless of the GA at diagnosis. Ureteroscopy is most beneficial for women who received the diagnosis early during pregnancy.

Design and preliminary study of custom laser scanning cystoscope for automated bladder surveillance.

BACKGROUND: The current gold standard of bladder cancer surveillance, endoscopic visualization, is manually manipulated and still has significant room for improvement in performance and controls. METHODS: This paper reports our developments toward automated bladder surveillance that employs a shape memory alloy-based machine-controlled scanning mechanism. In conjunction with the electro-mechanical advances, we use modified commercial post-processing computer vision software capable of converting cystoscopic video of the bladder into stitched panoramas. RESULTS: Experimental results conducted on a synthetic bladder demonstrate that this computer-aided scanning tool can help 82% of the entire bladder surface being scanned. Although the panoramic stitching algorithm increases the field of view and generates reasonable results in many cases, some image matching failures result in incompleteness in its full panoramic reconstruction. CONCLUSION: Our current study ensures that the automated steering mechanism can follow the desired trajectory to scan the surface of the bladder but must be improved. The current reconstruction algorithm needs further modification. Our methodology may constitute a first step in suggesting a new automated and computer-aided bladder surveillance system.

Development of an Automated Steering Mechanism for Bladder Urothelium Surveillance.

Given the advantages of cystoscopic exams compared with other procedures available for bladder surveillance, it would be beneficial to develop an improved automated cystoscope. We develop and propose an active programmable remote steering mechanism and an efficient motion sequence for bladder cancer detection and postoperative surveillance. The continuous and optimal path of the imaging probe can enable a medical practitioner to readily ensure that images are produced for the entire surface of the bladder in a controlled and uniform manner. Shape memory alloy (SMA) based segmented actuators disposed adjacent to the distal end of the imaging probe are selectively activated to bend the shaft to assist in positioning and orienting the imaging probe at a plurality of points selected to image all the interior of the distended bladder volume. The bending arc, insertion depth, and rotational position of the imaging probe are automatically controlled based on patient-specific data. The initial prototype is tested on a 3D plastic phantom bladder, which is used as a proof-of-concept in vitro model and an electromagnetic motion tracker. The 3D tracked tip trajectory results ensure that the motion sequencing program and the steering mechanism efficiently move the image probe to scan the entire inner tissue layer of the bladder. The compared experimental results shows 5.1% tip positioning error to the designed trajectory given by the simulation tool. The authors believe that further development of this concept will help guarantee that a tumor or other characteristic of the bladder surface is not overlooked during the automated cystoscopic procedure due to a failure to image it.

Differences in patterns of care: reablation and nephrectomy rates after needle ablative therapy for renal masses stratified by medical specialty.

OBJECTIVE: We aimed to study differences in reablation rates, modality utilization, and outcomes after renal tumor cryoablation (CA) and radiofrequency ablation (RFA), stratified by medical specialty. METHODS: A literature review was performed to identify papers reporting renal RFA and CA results. Patient demographics and clinical and pathological variables were collected, as were ablation success and salvage treatment rates. RESULTS: Interventional radiologists (IR) reported more experience with renal RFA than with CA (31.4% v 11.3% of all reported cases, p < 0.001). However, the majority of renal RFA and CA are performed by urologists. The percutaneous approach was used far more often with RFA than with CA, reflecting this preference by radiologists (80.9% v 23.4%, p < 0.01). The mean tumor size, cancer-specific survival rates, mean follow-up duration, and salvage nephrectomy rates were not statistically different between CA and RFA. Tumor reablation rates were significantly higher for RFA than for CA (7.4% v 0.9%, p = 0.009). RFA reablation rate correlated closely to surgeon specialty, such that 72% of reablations were reported by IR, while only 28% were performed primarily by urologists (p < 0.0001). This was despite IR being primary surgeons in only 31.4% of first tumor ablations. Salvage nephrectomy was performed more after CA than after renal RFA, probably because 89% of CA were done by urologists. There were no reablations in the laparoscopically approached cases. CONCLUSIONS: Cancer-specific outcomes after renal tumor CA and RFA are similar. However, RFA has required more reablations to achieve 95% cancer-specific survival rates. IR reported more experience with RFA, and urologists reported more experience with CA. Overall, RFA and CA reablation rates are significantly higher when a percutaneous approach is used and seemed to correlate with surgeon specialty.

Focal radiofrequency coagulation-assisted laparoscopic partial nephrectomy: a novel nonischemic technique.

OBJECTIVE: HABIB 4X is a laparoscopic focal radiofrequency-coagulation (FRFC) device utilized in liver and kidney resections to facilitate dissection while minimizing blood loss. We evaluated the ergonomics and safety of a laparoscopic FRFC device for a non-ischemic laparoscopic partial nephrectomy (LPN) in a survival porcine model. METHODS: Five female pigs (10 renal units) underwent 14 laparoscopic transperitoneal partial nephrectomies using the laparoscopic FRFC device without hilar clamping. In phase 1, either one or multiple segments of the lower, upper, or middle pole were resected following FRFC of the resection plane. Large entries into the collecting system were sutured, while very small rents were left open. Following 2-week survival, a laparoscopic FRFC-assisted heminephrectomy without hilar clamping was performed on the opposite renal unit (phase 2). Both kidneys were then harvested for histologic examination. Retrograde pyelography (RGP) was used to assess the collecting system integrity of the kidneys treated in phase 1. RESULTS: All 14 LPNs were performed successfully without hilar clamping or open conversion. On average, the resected segments comprised 12.3% of the kidney in phase 1 and 34.8 % in phase 2, with a mean estimated blood loss of 45 mL and 76.5 mL, respectively. At harvest, no hematomas or perinephric collections were observed. RGP revealed urinary extravasation in two renal units that were not repaired. Histologic examination of the resection margin revealed hemorrhage and inflammation with some hyalinization of the proximal and distal tubules, none extending deeper than 3 mm. CONCLUSION: The FRFC-assisted non-ischemic porcine LPN is feasible and safe and can be accomplished with minimal bleeding, even with large resections. The laparoscopic FRFC device holds promise in decreasing the inherent difficulty of LPN by obviating the need for laparoscopic suturing to control small parenchymal vessels, as well as in reducing the deleterious effects of warm renal ischemia. Clinical evaluation of this device is warranted.

A randomized comparison of conventional vs articulating laparoscopic needle-drivers for performing standardized suturing tasks by laparoscopy-naive subjects.

OBJECTIVES: To compare the efficacy of conventional and articulating laparoscopic needle-drivers for performing standardized laparoscopic tasks by medical students with no previous surgical experience. SUBJECTS AND METHODS: Twenty medical students with no surgical experience were randomly assigned to two equal groups, one using a conventional laparoscopic needle-holder (Karl Storz, Tuttlingen, Germany) and the other using a first-generation articulating laparoscopic needle-holder (Cambridge Endo, Framingham, MA, USA). Each student performed a series of four standardized laparoscopic tasks, during which speed and accuracy were assessed. The tasks tested needle passage through rings (1), an oblique running suture model (2), a urethrovesical anastomosis model (3) and a model simulating renal parenchymal reconstruction following partial nephrectomy (4). RESULTS: Tasks 1 and 3 were completed significantly more quickly by those using the conventional instruments (P < 0.05), but there was no statistically significant difference for task 2 and 4 (P > 0.05). Those using conventional instruments were significantly more accurate in all of the tasks than those using the articulated instruments (P < 0.05). CONCLUSIONS: The conventional laparoscopic needle-driver allowed laparoscopy-naive medical students to complete a series of standardized suturing tasks more rapidly and accurately than with the novel articulating needle-driver. Laparoscopic suturing with first-generation articulating needle-drivers might be more difficult to learn, secondary to the complexity of physical manoeuvres required for their use.

Intermediate-term prospective results of radiofrequency-assisted laparoscopic partial nephrectomy: a non-ischaemic coagulative technique.

OBJECTIVE To report the first intermediate-term oncological outcomes of laparoscopic radiofrequency coagulation followed by laparoscopic partial nephrectomy (RF-LPN) to treat small renal masses, as LPN is limited by the technical difficulty of efficient tumour resection and parenchymal repair during warm ischaemia of the kidney. PATIENTS AND METHODS A prospective database was searched to identify patients treated with RF-LPN; in each case the tumour was first RF coagulated with a margin of normal parenchyma, and then excised. Only fibrin glue was applied to the haemostatic resection site to prevent urinary leaks. In all, 32 tumours were treated with this approach, and a radiographic follow-up was completed yearly. RESULTS All PNs were accomplished with no hilar clamping, with a mean blood loss of 80 mL; 72% of masses were renal cell carcinoma. There was a positive margin in four masses (13%); 29 tumours (mean size 1.9 cm) were eligible for analysis of oncological outcomes, with a mean follow-up of 31 months. There were no tumour recurrences at the last follow-up, giving a cancer-specific survival rate of 100%. CONCLUSIONS RF-LPN with no hilar clamping simplifies the surgical technique and appears to have excellent cancer control in the intermediate term. In the few patients with a positive surgical margin, it is possible that coagulation beyond the tumour margin kills any residual microscopic tumour, minimizing or obviating the risk of tumour recurrence. Nevertheless, vigilance during tumour excision and margin identification is mandatory.

Efficacy of laser-activated gold nanoshells in ablating prostate cancer cells in vitro.

BACKGROUND AND PURPOSE: Nanoshells (NS) are nanoparticles consisting of a dielectric silica core covered by a thin gold shell. Nanoshells can be designed to absorb near-infrared (NIR) light strongly to generate heat and provide optically guided hyperthermic ablation. Laser-activated gold nanoshells (LAGN) may offer a minimally invasive targeted ablative treatment for prostate cancer. We studied the in-vitro effectiveness of LAGN ablation on human prostate cancer cells. MATERIALS AND METHODS: Two human prostate cancer (PCa) cell lines, PC-3 and C4-2, were grown to 80% confluency in T medium with 5% fetal bovine serum. In order to determine a threshold concentration of gold nanoshells (GNS) needed to achieve full cellular ablation, dose titration was performed. In subsequent experiments, GNS were added to PCa cells in phosphate-buffered saline at concentrations above the predetermined threshold. The cells were then exposed to NIR light (810 nm, 88 W/cm2) for 5 minutes and stained immediately for viability using the Calcein AM assay. For determining long-term cell survival, the crystal violet assay was employed. RESULTS: The GNS could be evenly distributed across the culture plates. A ratio of 5000 GNS per PCa cell was critical for achieving cell kill. Cells treated with GNS + NIR demonstrated a laser-specific zone of cell death. The crystal violet viability assay confirmed consistent cell death rather than induction of cell dormancy. Cells treated with GNS alone or with NIR light alone demonstrated no toxicity. CONCLUSION: Laser-activated gold nanoshells can ablate human PCa cells in vitro. This nanoparticle technology is an attractive therapeutic agent for selective tumor ablation.

Effect of dendritic cells treated with CpG ODN on atopic dermatitis of Nc/Nga mice.

Atopic dermatitis (AD) is a chronic inflammatory skin disease and the pathogenesis of AD is associated with the release of various cytokines/chemokines due to activated Th(2) immune responses. Synthetic oligodeoxynucleotides (ODNs) containing unmethylated CpG dinucleotide in the context of particular base sequence (CpG motifs) are known to have the immunostimulatory activities in mice and to convert from Th(2) to Th(1) immune responses in AD. We aimed to investigate that CpG ODN, especially phosphodiester form, can stimulate the protective immunity in NC/Nga mice with AD. We isolated BMDCs from NC/Nga mice and then, cultured with GM-CSF and IL-4 for 6 days, and treated for 2 days by either phosphorothioate ODN or phosphodiester ODN. CpG ODN-treated DCs resulted in more production of IL-12. When CpG ODN-treated DCs were intravenously injected into the NC/Nga mice, the NC/Nga mice with CpG ODN-treated DCs showed significant improvement of AD symptoms and decrease of IgE level. Histopathologically, the NC/Nga mice skin with CpG ODN-treated DCs showed the decreased IL-4 and TARC expression comparing with non-injected mice. These results may suggest that phosphodiester CpG ODN-treated DCs might function as a potent adjuvant for AD in a mouse model.