Long term experience of robotic retroperitoneal partial nephrectomy as the default approach in the management of renal masses: should the paradigm shift?

Although retroperitoneal surgery has demonstrated a better quality of recovery compared to transperitoneal routes, Retroperitoneal Robot Assisted Partial Nephrectomy (RRAPN) remains proportionally infrequent. As the boundaries of what is achievable robotically continue to be pushed, we present our experience at a high-volume tertiary referral centre that specialises in retroperitoneal surgery, exploring its feasibility as standard of care in the management of small renal masses. A prospective database of 784 RAPNs (2009-2020) was reviewed and 721 RRAPNs (92%) were performed at our centre. In our practice, we utilise a four-port approach to RRAPN. Patient, tumour and operative characteristics were assessed and both oncological outcomes and trifecta and pentafecta achievements were determined. Pentafecta was defined as achieving trifecta (negative surgical margin, no post-operative complications and WIT of < 25 min) plus over 90% estimated GFR preservation and no CKD stage upgrading at 1 year. Multivariate analysis was conducted to predict peri-operative factors which may prevent achieving a trifecta/pentafecta outcome. From 784 cases, 112 RAPNs were performed for imperative reasons, whilst the remainder were elective. Mean BMI ± s.d amongst our cohort was 28.6 ± 5.7. Mean tumour size was 3.1 cm (range 0.8-10.5 cm) and 47% of cases were stratified as intermediate/high risk using R.E.N.A.L nephrometry scoring. Forty-six patients had lesions in a hilar location, and 31% were anterior. Median blood loss was 30mls, with an open conversion rate of 1% and transfusion rate of 1.6%. Median warm ischaemic time (WIT) was 21 min, positive surgical margins were found in 4% and our post-operative Clavien 3/ > complication rate was 2.6%. We had a 1-day median length of stay with a 30 day readmission rate of 2%. Of 631 patients (80%) with a definitive histological diagnosis of cancer, 23% had T1b/ > disease. Over a mean 15 month follow-up period (range 1-125 months), 2% of patients developed recurrences and our cohort demonstrated a 99% 5 year cancer specific survival. Trifecta was achieved in 67% of cases and pentafecta in 47%. Age (p = 0.05), operative time (p = 0.008), pT1b tumours (p = 0.03), R.E.N.A.L score and blood loss (p = 0.001) were found to statistically significantly influence achievement of trifecta. Pentafecta achievement was influenced by R.E.N.A.L score (p = 0.008), operative time (p = 0.001) and blood loss (p = 0.001). We demonstrate the retroperitoneal approach in RAPN is feasible and safe irrespective of lesion location and complexity. In the hands of high-volume centres that are skilled in the retroperitoneal approach the benefits of retroperitoneal surgery can be extended even to challenging cohorts of patients without compromising their oncological or functional outcomes.

Distribution of Zelus longipes (Hemiptera: Reduviidae) in south Florida corn fields and its functional response to corn-infesting picture-winged flies (Diptera: Ulidiidae).

The milkweed assassin bug, Zelus longipes (L.) (Hemiptera: Reduviidae), is a generalist predator and a potential biological control agent of picture-winged flies (Diptera: Ulidiidae), which cause considerable economic damage to sweet corn yields in Florida. We studied the potential of Z. longipes as a biocontrol agent of four ulidiid pests in corn fields: Euxesta stigmatias Loew, Euxesta eluta Loew, Euxesta annonae F., and Chaetopsis massyla Walker. Within-plant and within-field distributions of Z. longipes and ulidiids and functional responses of Z. longipes to ulidiid prey were determined. Highest numbers of Z. longipes and ulidiids in the R1, R2, and R3 corn stages were generally in the basal or middle leaves at 09:00 h EST, ears at 13:00 h EST, and top and tassel at 17:00 h EST. Hence, there seemed to be a coordinated migration of Z. longipes and ulidiids from the lowest to the highest parts of the corn plant during the day. Within the corn field, aggregated (clumped) distributions were most common for Z. longipes and ulidiids especially in the later R2 and R3 stages based on Taylor's power law, Iwao's patchiness regression, index of dispersion, and Lloyd's patchiness indices of dispersion. However, predator and prey populations were lower in the R1 stage, and there were inconsistent results for dispersion indices among times of day and between predators and prey. Ulidiid distributions in R1 were mostly regular (uniform) at 13:00 h EST, but aggregated at 09:00 h and 17:00 h. However, Z. longipes R1 distributions were mostly aggregated at 13:00 h, but random or regular at 09:00 h and 17:00 h EST. Handling times for male and female Z. longipes were 1.0-1.39 h and 0.67-0.97 h, respectively, and each had a type II functional response to E. stigmatias, E. eluta, and E. annonae and consumed about five flies per day. Although the population abundance of Z. longipes can vary between seasons, it appears to be a promising biocontrol agent of ulidiid flies in corn.

Changes in the static accommodation response with age.

A transverse study of the monocular, steady-state accommodation response/stimulus curves for 49 normal subjects with ages between 17 and 49 years shows that the slope of the curve reduces only slowly with age up to about 40 years and then declines rapidly as complete presbyopia is approached. Such behaviour appears to result from the accommodation system changing its characteristics with age to make optimal use of the available objective amplitude of accommodation and the depth-of-focus of the eye.

Production of manganese peroxidase and organic acids and mineralization of 14C-labelled lignin (14C-DHP) during solid-state fermentation of wheat straw with the white rot fungus nematoloma frowardii

The basidiomycetous fungus Nematoloma frowardii produced manganese peroxidase (MnP) as the predominant ligninolytic enzyme during solid-state fermentation (SSF) of wheat straw. The purified enzyme had a molecular mass of 50 kDa and an isoelectric point of 3.2. In addition to MnP, low levels of laccase and lignin peroxidase were detected. Synthetic 14C-ring-labelled lignin (14C-DHP) was efficiently degraded during SSF. Approximately 75% of the initial radioactivity was released as 14CO2, while only 6% was associated with the residual straw material, including the well-developed fungal biomass. On the basis of this finding we concluded that at least partial extracellular mineralization of lignin may have occurred. This conclusion was supported by the fact that we detected high levels of organic acids in the fermented straw (the maximum concentrations in the water phases of the straw cultures were 45 mM malate, 3.5 mM fumarate, and 10 mM oxalate), which rendered MnP effective and therefore made partial direct mineralization of lignin possible. Experiments performed in a cell-free system, which simulated the conditions in the straw cultures, revealed that MnP in fact converted part of the 14C-DHP to 14CO2 (which accounted for up to 8% of the initial radioactivity added) and 14C-labelled water-soluble products (which accounted for 43% of the initial radioactivity) in the presence of natural levels of organic acids (30 mM malate, 5 mM fumarate).

Lignin Peroxidases, Manganese Peroxidases, and Other Ligninolytic Enzymes Produced by Phlebia radiata during Solid-State Fermentation of Wheat Straw.

The white rot fungus Phlebia radiata 79 (ATCC 64658) produces lignin peroxidase (LiP), manganese peroxidase (MnP), glyoxal oxidase (GLOX), and laccase in the commonly used glucose low-nitrogen liquid medium. However, the enzymes which this fungus utilizes for selective removal of lignin during degradation of different lignocellulosic substrates have not been studied before. Multiple forms of LiP, MnP, GLOX, and laccase were purified from P. radiata culture extracts obtained after solid-state fermentation of wheat straw. However, the patterns of extracellular lignin-modifying enzymes studied were different from those of the enzymes usually found in liquid cultures of P. radiata. Three LiP isoforms were purified. The major LiP isoform from solid-state cultivation was LiP2. LiP3, which has usually been described as the major isoenzyme in liquid cultures, was not expressed during straw fermentation. New MnP isoforms have been detected in addition to the previously reported MnPs. GLOX was secreted in rather high amounts simultaneously with LiP during the first 2 weeks of growth. GLOX purified from P. radiata showed multiple forms, with pIs ranging from 4.0 to 4.6 and with a molecular mass of ca. 68 kDa.