Does Ta Low Grade Urothelial Carcinoma of the Bladder with Focal High-Grade Features Carry Worse Prognosis? The Roswell Park Comprehensive Cancer Center Experience.

OBJECTIVES: To describe the management and outcomes of patients with Ta predominantly low-grade urothelial carcinoma with focal high-grade features (FHG) (<5%), compared to those with Ta low grade (LG) and Ta high grade (HG). METHODS: Retrospective review of all patients who underwent transurethral resection of bladder tumor (TURBT) between 2005 and 2023. Patients with Ta disease were identified and categorized into LG, FHG, and HG. Kaplan Meier method was used to depict high-grade recurrence, T-stage progression, and radical cystectomy-free survival. RESULTS: 449 patients with Ta disease were identified (LG 48%, FHG 12%, and HG 40%). Patients with FHG (32%) had a second-look TURBT more frequently compared to LG (7%) and HG (29%) (p<0.01). They received intravesical therapy more frequently compared to LG (36% vs 20%) but lower than HG (55%) (p<0.01). They received radical cystectomy less frequently (7% compared to 20% for HG and 11% for LG, p=0.01). HG recurrence-free survival at 1, 3, and 5 years was HG (68%, 52%, and 43%), FHG (74%, 53%, and 49%), and LG (87%, 79%, and 73%) (log-rank p<0.01). T progression-free survival at 1, 3, and 5 years was HG (84%, 77%, and 70%), FHG (92%, 82%, and 82%), and LG (94%, 89%, and 85%) (log-rank p=0.02). Cystectomy-free survival at 1, 3, and 5 years was HG (92%, 84%, and 80%), FHG (96%, 94%, and 94%), and LG (99%, 95%, and 92%) (log-rank p<0.01) CONCLUSION: Patients with Ta FHG seem to behave more like Ta HG disease in terms of high-grade recurrences, but they are less likely to experience T stage progression and convert to cystectomy.

Is Stent-Free Ureteroenteric Anastomosis Associated With Lower Ureteroenteric Strictures After Robot-Assisted Radical Cystectomy and Ileal Conduit?

INTRODUCTION: We aimed to investigate the differences in perioperative outcomes, especially ureteroenteric strictures, between patients who underwent a stented ureteroenteric anastomosis at the time of robot-assisted radical cystectomy (RARC) and ileal conduit vs those who did not. METHODS: A retrospective review of our RARC database was performed (2009-2023). Patients were divided into those who received stented ureteroenteric anastomosis vs those who did not. Propensity score matching was performed in the ratio of 3 (stented ureteroenteric anastomosis) to 1 (stent-free) in terms of age, gender, BMI, race, American Society of Anesthesiologists score, neoadjuvant chemotherapy, Charlson Comorbidity Index, prior radiation therapy, previous abdominal surgery history, clinical T3/clinical T4 stage, preoperative metastasis, and preoperative hydronephrosis. A cumulative incidence curve was used to depict ureteroenteric strictures and a Cox regression model was used to identify variables associated with ureteroenteric strictures. RESULTS: Four hundred eighty-eight patients underwent RARC, 366 individuals underwent a stented ureteroenteric anastomosis, and 122 patients underwent a stent-free approach. There was no significant difference in 90-day overall complications, high-grade complications, readmissions, UTIs, leakage, and ileus (P > .05). Ureteroenteric strictures occurred at a rate of 13% and 18% at 1 and 2 years, respectively in the stented group, vs 7% and 10% in the stent-free group (P = .05). Stent placement was significantly associated with ureteroenteric strictures. CONCLUSIONS: Stent-free ureteroenteric anastomosis was associated with fewer strictures following RARC and ileal conduit.

NCCN Guidelines® Insights: Bladder Cancer, Version 3.2024.

Bladder cancer, the sixth most common cancer in the United States, is most commonly of the urothelial carcinoma histologic subtype. The clinical spectrum of bladder cancer is divided into 3 categories that differ in prognosis, management, and therapeutic aims: (1) non-muscle-invasive bladder cancer (NMIBC); (2) muscle invasive, nonmetastatic disease; and (3) metastatic bladder cancer. These NCCN Guidelines Insights detail recent updates to the NCCN Guidelines for Bladder Cancer, including changes in the fifth edition of the WHO Classification of Tumours: Urinary and Male Genital Tumours and how the NCCN Guidelines aligned with these updates; new and emerging treatment options for bacillus Calmette-Guérin (BCG)-unresponsive NMIBC; and updates to systemic therapy recommendations for advanced or metastatic disease.

Evaluation of Retentive Strength of 50 Endodontically-Treated Single-Rooted Mandibular Second Premolars Restored with Cast Post Cores Using 5 Common Luting (Cement) Agents.

BACKGROUND A luting agent is a dental cement used to secure a dental restoration. This study aimed to evaluate retentive strength of 50 endodontically-treated single-rooted mandibular second premolars (extracted) restored using 5 common luting (cement) agents. MATERIAL AND METHODS Fifty single-rooted mandibular second premolars with adequate root length and uniform size/shape were decoronated. After completing endodontic biomechanical preparation and obturation, root canals of all specimens were prepared to receive a cast post core. Depending upon cementation type, CPC specimens were divided in 5 groups (10 each) (Gp): Zinc phosphate (Gp ZP), polycarboxylate (Gp PC), glass ionomer (Gp GI), resin-modified glass ionomer (Gp RGI), and resin cement (Gp RC). Retentive strength was determined using the adhesive failure pull-out test. Mean/standard deviations were calculated for tensile forces (in kilograms) and differences were determined using analysis of variance (ANOVA). Multiple comparison was performed using the t test. A P value of ≤0.05 indicated a statistically significant difference. RESULTS The order of mean tensile strength from higher to lower was Gp RC (21.46) >Gp RGI (18.17) >Gp GI (16.07) >Gp ZP (15.33) >Gp PC (13.63). Differences in retentive strengths between the cements were significant (P≤0.05). Multiple-group comparisons showed that except for Gp ZP and Gp GI, all groups differed significantly from each other. CONCLUSIONS All investigated cements provided optimal retentive strengths, with wide differences between them. Resin cements should be used when CPC removal is not anticipated, while polycarboxylate or zinc phosphate should be used if CPC removal is anticipated.

Prevalence and Variation of Medical Comorbidities in Oral Surgery Patients: A Retrospective Study at Jazan University.

BACKGROUND An aged population is susceptible to chronic diseases, which impacts oral surgery treatment procedures. This retrospective study aimed to evaluate the incidence of medical comorbidities in 640 oral surgery patients treated at the College of Dentistry, Jazan University. MATERIAL AND METHODS This single-center observational study investigated medical records of outpatients who visited Jazan University Dental College Hospital in a 1-year period (2018-2019). Patients’ clinical and radiographic archives were screened to obtain relevant data. Categorical and continuous variables were expressed in terms of frequency and mean values, respectively. Differences in variables were statistically analyzed using the chi-square goodness of fit and proportional test, with a probability value P≤0.05 considered significant. RESULTS Analysis of 640 patient records included records of 300 men and 340 women who underwent oral surgery, of whom 176 patients (27.5%), including 97 men and 79 women, had medical comorbidities. The most common comorbidities were endocrine disease (7.03%), cardiovascular disease (6.71%), respiratory disease (4.53%), and hematological disorders (3.43%). Individual diseases that showed higher prevalence were diabetes mellitus (4.68%), hypertension (3.43%), bronchial asthma (2.65%), and anemia (1.4%). Differences by sex were observed in many individual disorders. CONCLUSIONS Outpatients in oral surgery clinics presented a significant variance in the incidence of medical comorbidities, among which diabetes and hypertension were most common. A proper case history is the best preventive measure that helps a surgeon avert medical emergencies and post-surgical complications.

Evaluation of the Milled and Three-Dimensional Digital Manufacturing, 10-Degree and 20-Degree Preparation Taper, Groove and Box Auxiliary Retentive Features, and Conventional and Resin-Based Provisional Cement Type on the Adhesive Failure Stress of 3 mm Short Provisional Crowns.

BACKGROUND This study evaluated the effects of milling (CADCAM), 3D printing, preparation taper angles (10-degree and 20-degree), auxiliary retentive features (groove and box), and provisional cement types (conventional and resin-based) on the adhesive failure stress of 3-mm short provisional crowns (PC). The research was motivated by the need to understand how digital dentistry technologies impact the retention and durability of provisional crowns. MATERIAL AND METHODS A total of 160 working models (3D-printed) and PCs [80 milled (CopraTemp)/80 printed (Asiga)] were fabricated from two 10- and 20-degree typodont master models and two 20-degree 3D-printed master models (groove and box), simulating a 3 mm high all-ceramic short PC. After provisional cementation with conventional (Kerr TempBond) and resin-based (ProviTemp) cements, 16 subgroups (n=10 each) underwent thermocycling (10 000 cycles; 5-55°C) and pull-off tests on a universal testing machine. Statistical analysis was performed using one-way ANOVA and post hoc Tukey test. RESULTS Conventional cement failed at lower stress for milled (47.68 to 73.54) and printed (48.40 to 77.91) as compared to resin cement for milled (104.2 to 137.27) and printed (184.85 to 328.84), respectively, with significant differences. Increased taper and groove decreased failure load except for the printed PC/resin cement combination. Use of proximal box preparation increased retention significantly. Except for 20-degree taper cemented with conventional cement, the differences in auxiliary retentive features for milled and printed provisional crowns were statistically significant at P≤0.05. CONCLUSIONS 3D-printed PC, resin-based cement, 10-degree taper, and proximal box preparation were associated with higher retention than milled, conventional cements, 20-degree taper, and vertical groove.

Effect of betamethasone injection into the pterygomandibular space on the neurosensory disturbance after bilateral sagittal split ramus osteotomy: a pilot study.

AIM: The aim of this study was to evaluate the effect of local betamethasone injection into the pterygomandibular space on postoperative neurosensory deficits. MATERIALS AND METHODS: A prospective controlled clinical study was conducted on 16 patients (6 male, 10 female; mean age, 24.95 ± 9.22 years) who underwent bilateral sagittal ramus osteotomy for mandibular discrepancies. One side of each patient's mandible was randomly selected as the control side, and the opposite side as the experimental side. On the experimental side, a solution of betamethasone (6 mg/1 ml) was injected into the pterygomandibular space after the completion of wound closure. Neurosensory tests, including light touch, two-point discrimination, direction of movement, thermal sensitivity, and pin-prick discrimination, were performed. The follow-up period ranged between 6 and 12 months, according to the particular sensory test. The Fisher exact test was used to analyse the data. RESULTS: The light touch sensation was abnormal in 75% of the control side and 31% of the study side, with the difference being significant (p = 0.03). However, at 6 months, all the study cases regained touch sensation, compared to 69% of the control side. No significant difference in direction movement discrimination was seen; however, at 3 months, the study side showed significantly less direction sensation (19%) compared to the control side (56%) (p = 0.02). There was no significant difference in the two-point discrimination; however, at 3 months, the study side had a significantly less abnormal two-point sensation (13%) than the control side (56%) (p = 0.02). In addition, no significant difference was noted in thermal sensitivity or pin-prick sensation. CONCLUSION: Betamethasone injection into the pterygomandibular space reduces neurosensory disturbances after bilateral sagittal split ramus osteotomies nd leads to faster recovery of sensations.

Effect of Repeated Moist Heat Sterilization on Titanium Implant-Abutment Interface-An In Vitro Study.

OBJECTIVES: Sterilization eliminates microbial viability by decreasing the biological load, but likewise have the ability to deteriorate the mechanical properties of an implant material. This study intended to evaluate the effect of repeated moist heat sterilization on implant-abutment interface using two different implant systems. MATERIALS AND METHODS: Forty screw-retained titanium implant-abutment combinations (fixture 3.5 ×10 mm, abutment 2 mm diameter), twenty each from Genesis (Aktiv Implant Systems, United States) and Bredent (SKY, Germany), were divided into four different groups (n = 10) and placed in a computer-aided diagnostic model. The abutments from each group were exposed to first and second autoclave cycle (121°C for 30 minutes), connected back to the fixture and analyzed under scanning electron microscope for marginal gap and surface roughness. RESULTS: Genesis group showed higher marginal gaps on both sides (buccal/mesial [2.8 ± 0.47]; lingual/distal [2.8 ± 0.33]), while Bredent implant-abutment system (IAS) did not show any changes in marginal gaps after autoclaving. Differences within and between the group were found to be statistically significant. Surface roughness for Genesis (243.7 ± 70.30) and Bredent groups (528.9 ± 213.19) was highest at second autoclave, with Bredent implant-abutment showing higher values for surface roughness than Genesis IAS. CONCLUSION: Marginal vertical gap increased with autoclaving for Genesis IAS, while Bredent implant abutments were more stable. Surface roughness increases with autoclaving for both Genesis and Bredent group of IAS.

Does osteotomizing the lower border of the mandible affect the lingual split pattern in a sagittal split ramus osteotomy?

AIM: The purpose of this study was to evaluate the effect of adding a fourth osteotomy at the lower border of the mandible on the lingual cortical fracture pattern in bilateral sagittal split ramus osteotomies. PATIENTS AND METHODS: The sample of the study consisted of 20 patients (12 male and 8 female, with a mean age of 26.79 ± 7.12 years) with mandibular deformities who needed bilateral sagittal split ramus osteotomy. One side underwent a traditional sagittal split ramus osteotomy, and the procedure was modified on the other side by adding a 1 cm horizontal osteotomy at the lower border of the mandible, just distal to the caudal end of the vertical buccal osteotomy cut. A 3D CBCT was used to identify the split pattern. RESULTS: In the total sample, 40% of the lingual splits ran vertically toward the lower border of the mandible (LSS1), 20% of the splits passed horizontally to the posterior border of the mandible (LSS2), 32.5% of the splits took place along the inferior alveolar canal (LSS3), and 7.5% of the splits were unfavourable fractures (LSS4). On the inferior border osteotomy sides, the distribution of LSS1, LSS2, LSS3, and LSS4 was 10 (25%), 6 (15%), 4 (10%), and 0 (00), respectively. Their distribution on the sides without inferior border osteotomy was 6 (15%), 8 (20%), 13 (32.5%), and 3 (7.5%), respectively. Statistical analysis revealed a significant difference between the two groups (p < 0.05). CONCLUSION: Inferior border osteotomy tends to direct the lingual split fracture line toward the lower and posterior borders of the mandible and minimizes bad splits; however, further studies are needed to confirm our findings.

Ultraviolet disinfection (UV-D) robots: bridging the gaps in dentistry.

Maintaining a microbe-free environment in healthcare facilities has become increasingly crucial for minimizing virus transmission, especially in the wake of recent epidemics like COVID-19. To meet the urgent need for ongoing sterilization, autonomous ultraviolet disinfection (UV-D) robots have emerged as vital tools. These robots are gaining popularity due to their automated nature, cost advantages, and ability to instantly disinfect rooms and workspaces without relying on human labor. Integrating disinfection robots into medical facilities reduces infection risk, lowers conventional cleaning costs, and instills greater confidence in patient safety. However, UV-D robots should complement rather than replace routine manual cleaning. To optimize the functionality of UV-D robots in medical settings, additional hospital and device design modifications are necessary to address visibility challenges. Achieving seamless integration requires more technical advancements and clinical investigations across various institutions. This mini-review presents an overview of advanced applications that demand disinfection, highlighting their limitations and challenges. Despite their potential, little comprehensive research has been conducted on the sterilizing impact of disinfection robots in the dental industry. By serving as a starting point for future research, this review aims to bridge the gaps in knowledge and identify unresolved issues. Our objective is to provide an extensive guide to UV-D robots, encompassing design requirements, technological breakthroughs, and in-depth use in healthcare and dentistry facilities. Understanding the capabilities and limitations of UV-D robots will aid in harnessing their potential to revolutionize infection control practices in the medical and dental fields.

Does the urinary microbiome profile change after treatment of bladder cancer?

INTRODUCTION: We sought to investigate the change in the urinary microbiome profile after transurethral resection of bladder tumor (TURBT). METHODS: Urine specimens were collected from consecutive patients with bladder cancer. Patients were divided into those with bladder tumors ("Tumor group": de novo tumors or recurrent/progressed after TURBT ± intravesical therapy) versus those without evidence of recurrence after treatment "No Recurrent Tumor group". Samples were analyzed using 16S rRNA sequencing. Alteration in the urinary microbiome was described in terms of alpha (diversity within a sample measured by Observed, Chao, Shannon, and Simpson indices), beta diversities (diversity among different samples measured by Brady Curtis Diversity index), and differential abundance of bacteria at the genus level. Analyses were adjusted for gender, method of preservation (frozen vs preservative), and method of collection (mid-stream vs. catheter). RESULTS: Sixty-eight samples were analyzed (42 in "Tumor" vs 26 in "No Recurrent Tumor" groups). The median age was 70 years (IQR 64-74) and 85% were males. All patients in the "No Recurrent Tumor" group had non-muscle invasive bladder cancer and 85% received BCG compared to 69% and 43% for the "Tumor" group, respectively. There was no significant difference in alpha diversity (p > 0.05). Beta diversity was significantly different (p = 0.04). Veillonella and Bifidobacterium were more abundant in the "Tumor" group (> 2FC, p = 0.0002), while Escherichia-Shigella (> 2FC, p = 0.0002) and Helococcus (> 2FC, p = 0.0008) were more abundant in the "No Recurrent Tumor" group. CONCLUSION: Bladder cancer patients with no recurrence and/or progression exhibited a different urinary microbiome profile compared to those with tumors.

Does testosterone replacement therapy increase the risk of conversion to treatment in patients with prostate cancer on active surveillance?

PURPOSE: We aimed to evaluate the impact of testosterone replacement therapy (TRT) in patients with localized prostate cancer (CaP) who elected active surveillance (AS). METHODS: A retrospective review of our CaP database was performed. Patients who received TRT while on AS were identified and were matched to a cohort of patient on AS while not on TRT (1:3) using propensity score matching. Treatment-free survival (TFS) was computed using Kaplan Meier method. Multivariable Cox regression model was used to evaluate variables associated with treatment. RESULTS: Twenty-four patients in the TRT group were matched to 72 patients without TRT. Median follow-up was 5.82 years (IQR 3.27-9.30). There was no significant difference in conversion to treatment (24% vs. 21%, P = 1.00) There was no significant difference in TFS (log rank P = 0.87). Prostate specific antigen (PSA) density was the only variable associated TFS (HR 1.08, 95%CI 1.03-1.13, P = 0.001). CONCLUSION: TRT was not associated with conversion to treatment in this matched analysis among patients with localized prostate cancer on AS.

A Clinical Study of 50 Partially Edentulous Patients with Fixed Partial Denture Restorations to Compare Clinical Parameters and Changes in Gingival Sulcus Width After Displacement with 2 Different Gingival Retraction Cord Materials (Cotton and Polymer).

BACKGROUND The present study aimed to compare the clinical performance and gingival sulcus width changes in partially edentulous patients using cotton and polymer gingival retraction cords. MATERIAL AND METHODS Fifty partially edentulous patients were divided into 2 groups (Gp C and Gp P) and were subjected to single crown/fixed partial denture treatment. Clinical parameters, including plaque index scores, placement time, and hemorrhage control scores, were assessed. Gingival sulcus width changes before and after retraction were evaluated using individual type 4 dental stone dies observed under an optical microscope. Statistical analysis was performed using dependent/independent t tests. RESULTS The mean placement time, hemorrhage control time, and hemorrhagic scores were lower in Gp P than in Gp C, indicating better clinical performance of polymer-based retraction cord. Both groups showed an increase in sulcus width after retraction, but Gp P had a significantly higher sulcus width (690.03±45.37) compared to Gp C (471.38±28.13). The mean difference in sulcus width between baseline and after retraction was also significantly higher in Gp P (525.84 micrometers) than in Gp C (309.11 micrometers). CONCLUSIONS The present study shows that polymer-based cords produce more sulcus width and have better clinical performance compared to cotton-based gingival retraction cords. These results suggest that the use of polymer-based retraction cords can improve the quality of dental impressions in partially edentulous patients.

Robot-assisted Radical Cystectomy Versus Open Radical Cystectomy: A Systematic Review and Meta-analysis of Perioperative, Oncological, and Quality of Life Outcomes Using Randomized Controlled Trials.

CONTEXT: Differences in recovery, oncological, and quality of life (QoL) outcomes between open radical cystectomy (ORC) and robot-assisted radical cystectomy (RARC) for patients with bladder cancer are unclear. OBJECTIVE: This review aims to compare these outcomes within randomized trials of ORC and RARC in this context. The primary outcome was the rate of 90-d perioperative events. The secondary outcomes included operative, pathological, survival, and health-related QoL (HRQoL) measures. EVIDENCE ACQUISITION: Systematic literature searches of MEDLINE, Embase, Web of Science, and clinicaltrials.gov were performed up to May 31, 2022. EVIDENCE SYNTHESIS: Eight trials, reporting 1024 participants, were included. RARC was associated with a shorter hospital length of stay (LOS; mean difference [MD] 0.21, 95% confidence interval [CI] 0.03-0.39, p = 0.02) than and similar complication rates to ORC. ORC was associated with higher thromboembolic events (odds ratio [OR] 1.84, 95% CI 1.02-3.31, p = 0.04). ORC was associated with more blood loss (MD 322 ml, 95% CI 193-450, p < 0.001) and transfusions (OR 2.35, 95% CI 1.65-3.36, p < 0.001), but shorter operative time (MD 76 min, 95% CI 39-112, p < 0.001) than RARC. No differences in lymph node yield (MD 1.07, 95% CI -1.73 to 3.86, p = 0.5) or positive surgical margin rates (OR 0.95, 95% CI 0.54-1.67, p = 0.9) were present. RARC was associated with better physical functioning or well-being (standardized MD 0.47, 95% CI 0.29-0.65, p < 0.001) and role functioning (MD 8.8, 95% CI 2.4-15.1, p = 0.007), but no improvement in overall HRQoL. No differences in progression-free survival or overall survival were seen. Limitations may include a lack of generalization given trial patients. CONCLUSIONS: RARC offers various perioperative benefits over ORC. It may be more suitable in patients wishing to avoid blood transfusion, those wanting a shorter LOS, or those at a high risk of thromboembolic events. PATIENT SUMMARY: This study compares robot-assisted keyhole surgery with open surgery for bladder cancer. The robot-assisted approach offered less blood loss, shorter hospital stays, and fewer blood clots. No other differences were seen.

Impact of an NCCN-Compliant Multidisciplinary Conference on Treatment Decisions for Localized Prostate Cancer.

BACKGROUND: We sought to investigate the impact of an NCCN-compliant multidisciplinary conference on treatment decisions of patients with localized prostate cancer. METHODS: A retrospective review of our quality assurance localized prostate cancer database was performed. All patients with localized prostate cancer who sought a second opinion at Roswell Park Comprehensive Cancer Center between 2009 and 2019 were presented to the multidisciplinary Localized Prostate Cancer Conference (LPCC) that includes urologists, radiation oncologists, pathologists, and patient advocates. Multivariable regression models were fit to evaluate variables associated with concordance between community recommendations, LPCC recommendations, and treatment received by patients. RESULTS: A total of 1,164 patients were identified, of whom 26% had NCCN very low-/low-risk, 27% had favorable intermediate-risk, 25% had unfavorable intermediate-risk, and 22% had high-/very high-risk prostate cancer. Pathology changed in 11% of patients after genitourinary pathologist review, which caused disease reclassification in 9%. Concordance between community and LPCC recommendations occurred in 78%, with lowest concordance for androgen deprivation therapy (21%) and radiotherapy (53%). Concordance between community recommendations and treatment received occurred in 65%, with lowest concordance for androgen deprivation therapy and radiotherapy; among those who were recommended radiotherapy as the only option by their community urologist, only 26% received it. Concordance between LPCC recommendations and treatment received occurred in 92%. CONCLUSIONS: Community recommendations differed from the multidisciplinary NCCN-compliant recommendations in 22% of patients, primarily for radiotherapy. Multidisciplinary recommendations matched the treatment received in 92% of patients compared with 65% for community recommendations.

Outcomes after primary intramedullary nail fixation of open tibial and femoral fractures in low resource settings.

INTRODUCTION: Open fractures are unique in the urgency they impart to the injury and the therapeutic challenge they pose. Non-union and infection are among the major concerns. Open tibial and femoral shaft fractures are among the commonest orthopaedic urgencies. Primary intramedullary (IM) nailing requires a skillset and knowledge of the principles of open fracture management and also a well-equipped operating room with the necessary implants and instruments. In a low resource setting, one or more of these prerequisites may not be met, and the outcome may thus be affected similarly. The objective of this study was to study these outcomes. METHODS: We prospectively studied primary IM nailing of open 1, 2 and 3A tibial and femoral fractures done in our hospital, in a simple non-modular operating room without an image intensifier. RESULTS: There were 106 fractures in 104 patients: 93 tibial and 13 femoral. The mean time from injury to surgical debridement was 19.6 h. Mean duration of antibiotics therapy was 4.3 days, and the mean duration of hospital stay was 4.1 days. All patients were followed up to union. Mean time to radiographic union was 6.1 months for the tibia and 5.7 months for the femur. Non-union was seen in 4 tibial and 1 femoral fractures. There were 3 superficial infections but no deep infection. CONCLUSION: The outcomes were comparable to, and in some cases better than, those found in existing literature. We conclude that primary IM nailing in open long bone fractures can be performed in austere environments with good success, in expert hands if the principles are adhered to.

Transition from da Vinci to Versius robotic surgical system: initial experience and outcomes of over 100 consecutive procedures.

We sought to describe the development of the robotic urology program at Sindh Institute of Urology and Transplantation (SIUT) and the feasibility of transitioning from the da Vinci to Versius robotic systems. The SIUT robotics program began in 2017 utilizing the da Vinci Si robotic system, transitioning to the Versius system in 2021. Retrospective review of our quality assurance database was performed. All procedures performed utilizing the two systems were identified, analyzed, and compared. Data were described with descriptive statistics. Matched procedures (by type of procedure) performed by the same surgeons utilizing the da Vinci and Versius were compared. All tests were double-sided with statistical significance set at p < 0.05.106 cases were performed by the Versius robotic surgical system in 2021. Median age was 42 years (IQR 26-56), and 69 (65%) were males. Procedures included both benign (83%) and malignant disorders (17%), several upper tract (75%), and pelvic/lower tract (25%). No major intraoperative complications were observed. Conversion to open occurred in six procedures. Malfunction of the robotic arms occurred in two procedures: the erroneous bedside units (BSU) were replaced. Eight patients developed postoperative high-grade complications. Matched analysis of various procedures (pyeloplasty, stone surgery, radical, partial, and simple nephrectomy) showed no significant difference in perioperative outcomes. To our knowledge, this is the first and largest series of urologic procedures performed by the Versius robotic surgical system.

Analysis of Complications After Robot-Assisted Radical Cystectomy Between 2002-2021.

OBJECTIVE: To identify trends in complications following robot-assisted radical cystectomy (RARC) using a multi-institutional database, the International Robotic Cystectomy Consortium (IRCC). METHODS: A retrospective review of the IRCC database was performed (2976 patients, 26 institutions from 11 countries). Postoperative complications were categorized as overall or high grade (≥ Clavien Dindo III) and were further categorized based on type/organ site. Descriptive statistics was used to summarize the data. Multivariate analysis (MVA) was used to identify variables associated with overall and high-grade complications.  Cochran-Armitage trend test was used to describe the trend of complications over time. RESULTS: 1777 (60%) patients developed postoperative complications following RARC, 51% of complications occurred within 30 days of RARC, 19% between 30-90 days, and 30% after 90 days. 835 patients (28%) experienced high-grade complications. Infectious complications (25%) were the most prevalent, while bleeding (1%) was the least. The incidence of complications was stable between 2002-2021. Gastrointestinal and neurologic postoperative complications increased significantly (P < .01, for both) between 2005 and 2020 while thromboembolic (P = .03) and wound complications (P < .01) decreased. On MVA, BMI (OR 1.03, 95%CI 1.01-1.05, P < .01), prior abdominal surgery (OR 1.26, 95%CI 1.03-1.56, P = .03), receipt of neobladder (OR 1.52, 95%CI 1.17-1.99, P < .01), positive nodal disease (OR 1.33, 95%CI 1.05-1.70, P = .02), length of inpatient stay (OR 1.04, 95%CI 1.02-1.05, P < .01) and ICU admission (OR 1.67, 95%CI 1.36-2.06, P < .01) were associated with high-grade complications. CONCLUSION: Overall and high-grade complications after RARC remained stable between 2002-2021. GI and neurologic complications increased, while thromboembolic and wound complications decreased.

How to Define Fast and Slow Progressors in Any-Type Occlusion Acute Ischemic Stroke.

The variable rate of infarct progression in acute ischemic stroke as assessed by various thresholds excludes a substantial proportion of patients due to time or core constraints. We evaluated 106 patients with any-type occlusion to compare these thresholds and assessed performance of hypoperfusion index (HI) for fast and slow rate of infarct progression. Seven (12.5%) were classified fast progressors and 23 (46%), 25 (50%), 12 (24%), and 33 (66%) slow progressors using different core and time criteria. In comparison, HI categorized 100% (n = 106) of cohort with optimal cutoff 0.5 for any-type occlusion (slow progressors: HI ≤ 0.5), sensitivity/specificity 100%/91%, AUC 0.94, and indicative of eligibility for reperfusion and clinical outcomes (median 90-day modified Rankin Scale; 2 for HI ≤ 0.5 versus 5). Estimation of progressors by HI seems comprehensive but needs external validation.