Descemet Stripping Only: Long-Term Outcomes.

PURPOSE: Descemet stripping only (DSO) is a relatively novel treatment for Fuchs endothelial corneal dystrophy (FECD). In this procedure, a central area of Descemet membrane and endothelium is removed without the insertion of donor tissue. Evaluation of long-term outcomes (≥5 years) after DSO is imperative to establish the validity of this procedure and to determine its role in the management of Fuchs endothelial dystrophy. Published outcomes are limited but promising. This study evaluates the 5- and 6-year outcomes of patients who had DSO at a single institution. METHODS: This is a retrospective chart review of patients with FECD who underwent DSO in 2016 and 2017. RESULTS: Eleven patients and 13 eyes met the criteria. Twelve of 13 eyes achieved corneal clearance. Two eyes had corneal decompensation requiring subsequent endothelial keratoplasty (EK). Of the 10 eyes that maintained clear corneas, 9 had a best-corrected visual acuity (BCVA) of at least 20/30 (mean logarithm of the minimim angle of resolution [logMAR] visual acuity [VA] 0.18 ± 0.16) at 5 years post-operatively (POY5). At 6 years, 7 of 8 eyes had a VA better than 20/40 (mean logMAR VA 0.17 ± 0.04). One patient had decreased VA due to progression of macular degeneration. Patients who required EK achieved good vision and corneal clearance. CONCLUSIONS: This is the largest series of patients with long-term follow-up after DSO. Ten of the 13 eyes (77%) responded and maintained clear central corneas for at least 5 years. Patients with failed DSO can achieve corneal clearance and good vision with subsequent EK. These patient outcomes support the role of DSO in the management of patients with FECD.

Detailed Analysis of Urinary Tract Infections After Robot-Assisted Radical Cystectomy.

Objective: To describe urinary tract infections (UTIs) after robot-assisted radical cystectomy (RARC) and investigate the variables associated with it. Materials and Methods: A retrospective review of 616 patients who underwent RARC between 2005 and 2019 was performed. Patients were divided into those who developed UTI and those who did not. Patients who developed UTI were further subdivided into three subgroups according to the onset, number, and severity. The Kaplan-Meier method was used to depict time to UTI. Multivariate analysis was used to investigate variables associated with UTI. Result: Two hundred forty (39%) patients were diagnosed with UTI after RARC; 48% occurred within 30 days, 17% within 30-90 days, and 35% at 90 days after RARC. Twenty-three percent of the patients presented with urosepsis. The median (interquartile ratio) time to develop UTI was 1 (0.3-7) month. On multivariate analysis, patients who received neobladders (odds ratio [OR] 2.80; 95% confidence interval [CI] 1.50-5.20; p < 0.01), prolonged hospital stay (OR 1.06; 95% CI 1.03-1.08; p < 0.01), adjuvant chemotherapy (OR 2.20; 95% CI 1.40-3.60; p < 0.01), poor renal function postoperatively (OR 2.30; 95% CI 1.30-3.80; p < 0.01), postoperative hydronephrosis (OR 2.50; 95% CI 1.40-4.50; p < 0.01), ureteroileal anastomotic stricture (OR 2.90; 95% CI 1.50-5.70; p < 0.01), and stented ureteroileal anastomosis (OR 9.35; 95% CI 1.23-71.19; p = 0.03) were associated with UTI after RARC. Conclusion: UTI is common after RARC mainly within the first month after RARC. Enterococcus faecalis was the most common causative organism.

Herbivory improves the fitness of predatory beetles.

While many predatory arthropods consume non-prey foods from lower trophic levels, little is known about what drives the shift from predator to omnivore. Predatory lady beetles often consume non-prey foods like plant foliage and pollen. One species, Coccinella septempunctata, eats foliage to redress sterol deficits caused by eating sterol-deficient prey. Here we explore how omnivory benefits lady beetle fitness. We reared seven species of lady beetles-from five genera distributed across the tribe Coccinellini-on pea aphids in the presence or absence of fava bean foliage; pea aphids have very low sterol content. Foliage supplements lengthened the development times of four species and decreased survival to adulthood of two species; it had no effect on adult mass. We mated beetles in a 2 × 2 factorial design (males with or without foliage paired with females with or without foliage). For each species, we observed a profound paternal effect of foliage supplements on fitness. Females mated to foliage-supplemented males laid more eggs and more viable eggs compared to females mated to non-supplemented males. Foliage-supplemented males produced 2.9-4.6 times more sperm compared to non-supplemented males for the three species we examined. We analysed the sterol profile of four beetle species reared on pea aphids-with or without foliage-and compared their sterol profile to field-collected adults. For two laboratory-reared species, sterols were not detected in adult male beetles, and overall levels were generally low (total ng of sterol/beetle range: 3-33 ng); the exception being Propylea quatuordecimpunctata females (total ng of sterol/beetle range: 50-157 ng). Laboratory-reared lady beetle sterol content was not significantly affected by the presence of foliage. Field-collected beetles had higher levels of sterols compared to laboratory-reared beetles (2,452-145,348 ng per beetle); cholesterol and sitosterol were the dominant sterols in both field-collected and laboratory-reared beetles. Our findings indicate that herbivory benefits lady beetle fitness across the Coccinellini, and that this was entirely a paternal effect. Our data provide a rare example of a nutritional constraint impacting fitness in a sex-specific manner. It also shows, more broadly, how a nutritional constraint can drive predators towards omnivory.

The Effect of Complexity of the Surgical Field on Perioperative Outcomes of Robot-Assisted Radical Cystectomy.

OBJECTIVE: To report the outcomes of patients who underwent robot-assisted radical cystectomy (RARC) and have a history of previous pelvic surgery and/or radiation. METHODS: Retrospective review of our prospectively maintained database between 2005 and 2018. Patients were divided into 3 groups based on surgical complexity; Complexity grade 1 included patients who did not have any history of prior pelvic surgery or radiation (n = 323); Complexity grade 2 included those who had history of a single pelvic surgery or radiation (n = 186); and Complexity grade 3 included those who had history of 2 or more pelvic surgeries, or one or more pelvic surgery and radiation (n = 80). All groups were compared in terms of perioperative outcomes. Multivariate linear and logistic regression models were used to depict the predictors of operative time, ≥500 ml blood loss, 90-day complications, high grade complications, and readmissions. RESULTS: Complexity grades 2 and 3 exhibited higher 90-day complications compared to CG1 (CG3: 74%, CG1: 59%, CG2: 68%, P = .02), and high grade complications (CG3: 24%, CG1: 13%, CG2 18%, P = .03). On multivariate linear and logistic regression models, CG 3 was significantly associated with higher 90-day complications (OR 2.18, 95% CI 1.21-3.94, P <.01) but not significantly associated with higher rates of significant blood loss, longer operative time, 90-day high grade complications and readmissions. CONCLUSION: Patients with higher complexity of the surgical field exhibited more complications after robot-assisted radical cystectomy, but not readmissions.