Conversion to Radical Nephrectomy From Robotic Partial Nephrectomy Is Most Commonly Due to Anatomic and Oncologic Complexity.

PURPOSE: Partial nephrectomy is standard-of-care treatment for small renal masses. As utilization of partial nephrectomy increases and includes larger and complex tumors, the risk of conversion to radical nephrectomy likely increases. We evaluated incidence and reason for conversion to radical nephrectomy in patients scheduled for partial nephrectomy by surgeons participating in MUSIC (the Michigan Urologic Surgery Improvement Collaborative). MATERIALS AND METHODS: All patients in whom robotic partial nephrectomy was planned were stratified by completed procedure (robotic partial nephrectomy vs radical nephrectomy). Preoperative and intraoperative records were reviewed for preoperative assessment of difficulty and reason for conversion. Patient, tumor, pathologic, and practice variables were compared between cohorts. RESULTS: Of 650 patients scheduled for robotic partial nephrectomy, conversion to radical nephrectomy occurred in 27 (4.2%) patients. No conversions to open were reported. Preoperative documentation indicated a plan for possible conversion in 18 (67%) patients including partial with possible radical (n = 8), partial vs radical (n = 6), or likely radical nephrectomy (n = 4). Intraoperative documentation indicated that only 5 (19%) conversions were secondary to bleeding, with the remaining conversions due to tumor complexity and/or oncologic concerns. Patients undergoing conversion had larger (4.7 vs 2.8 cm, P < .001) and higher-complexity tumors (64% vs 6%, P < .001) with R.E.N.A.L. (for radius, exophytic/endophytic, nearness of tumor to collecting system, anterior/posterior, location relative to polar line) nephrometry score ≥ 10. The converted cases had a higher rate of ≥ pT3 (27% vs 8.4%, P = .008). CONCLUSIONS: There was a low rate of conversion from robotic partial to radical nephrectomy in the MUSIC-KIDNEY (Kidney mass: Identifying and Defining Necessary Evaluation and therapY) collaborative, and an even lower risk of conversion due to uncontrolled bleeding. Targeted review of each conversion identified appropriate decision-making based on oncologic risk in most cases.

Transparent Porous Conductive Substrates for Gas-Phase Photoelectrochemical Hydrogen Production.

Gas diffusion electrodes are essential components of common fuel and electrolysis cells but are typically made from graphitic carbon or metallic materials, which do not allow light transmittance and thus limit the development of gas-phase based photoelectrochemical devices. Herein, the simple and scalable preparation of F-doped SnO2 (FTO) coated SiO2 interconnected fiber felt substrates is reported. Using 2-5 µm diameter fibers at a loading of 4 mg cm-2 , the resulting substrates have porosity of 90%, roughness factor of 15.8, and Young's Modulus of 0.2 GPa. A 100 nm conformal coating of FTO via atmospheric chemical vapor deposition gives sheet resistivity of 20 ± 3 Ω sq-1 and loss of incident light of 41% at illumination wavelength of 550 nm. The coating of various semiconductors on the substrates is established including Fe2 O3 (chemical bath deposition), CuSCN and Cu2 O (electrodeposition), and conjugated polymers (dip coating), and liquid-phase photoelectrochemical performance commensurate with flat FTO substrates is confirmed. Finally, gas phase H2 production is demonstrated with a polymer semiconductor photocathode membrane assembly at 1-Sun photocurrent density on the order of 1 mA cm-2 and Faradaic efficiency of 40%.

Factors Affecting Robotic Partial Nephrectomy Conversion to Radical Nephrectomy: A Retrospective Multi-Institutional Analysis in the Michigan Urologic Surgery Improvement Collaborative (MUSIC).

OBJECTIVE: To identify factors related to the conversion of robot-assisted partial nephrectomy (RPN) to robot-assisted radical nephrectomy (RRN) based on data collected by a statewide database in Michigan. METHODS: Using the Michigan Urological Surgery Improvement Collaborative-Kidney mass: Identifying and Defining Necessary Evaluation and therapY (MUSIC-KIDNEY) database we identified 574 patients for whom RPN was planned. Patient and tumor characteristics were obtained including body mass index (BMI), Charlson comorbidity index (CCI), RENAL nephrometry score, tumor size, and pathologic staging. Treating centers were subdivided by annualized case volume and academic status. Bivariate and multivariate analyses were performed to assess the impact of these factors on the risk of conversion to RRN from RPN. RESULTS: The conversion rate of RPN to RN was 5.75% (33/574). The difference in RENAL nephrometry score, tumor stage, and size reached statistical significance on bivariate analysis (p<0.001). The tumor stage also reached statistical significance on multivariate analysis [odds ratio (OR); 95%CI (8.97; 3.93-20.48) p<0.001]. The conversion rate was lower among high-volume versus low-volume practices; however, statistical significance was not reached [5.2% (27/520) vs.11% (6/54); p=0.11]. CONCLUSIONS:  Patient factors such as tumor size and renal nephrometry score are likely related to the conversion of RPN to RRN decisions. The data shows that Michigan urologists appear to appropriately assess intra-operative findings and convert to RRN in cases of more advanced kidney tumors. Lower volume centers appear to trend towards a higher conversion rate. Continued quality improvement tracking analysis may further clarify this relationship.

Comparison of Three Groups of Patients Having Low Dose Rate Prostate Brachytherapy: Prostate-Specific Antigen Failure and Overall Survival.

Purpose To examine dosimetric and clinical outcomes for Cs-131 radioactive seed implant compared to Pd-103 and I-125.  Background/Significance Cs-131 is a novel isotope with relatively short half-life (9.7 days) that may have clinical advantages in seed implant treatments of prostate cancers. There may be a shorter duration of symptoms and increased PSA control rates. Methods We performed a retrospective study in which clinical and dosimetric outcomes were compared for 186 prostate implants performed over a ten-year time period at three different Ascension hospitals. Isotopes that were used included Cs-131 (n=66; half-life 9.7 days), I-125 (n=60; half-life 60 days), and Pd-103 (n=60; half-life 17 days) Results The implants used standard radiation dosages. These were 145 Gy for I-125 alone or 109 Gy when combined with external beam radiation. In the case of Cs-131 used alone, the dose was 115 Gy or 85 Gy when combined with an external beam. For Pd-103, 125 Gy was used for monotherapy and 90 Gy when combined with an external beam. The Cs-131 dosimetry was found to be similar to I-125 and Pd-103 on a quantitative basis. However, there was better homogeneity, and the delivered activity per seed and the number of seeds employed were greater compared to other isotopes. We compared the corrected total source strengths (i.e. normalized to sample mean values) and were able to demonstrate similar distributions for the three isotopes. Dosimetric analysis also suggested there was superior homogeneity with Cs-131. The median PSA value at 60 months was 0.11 ng/ml. There were only a few PSA failures in the three groups of cases, nonetheless, the Cs-131 had the fewest.  Conclusions One attractive option for men with early-stage prostate cancer is interstitial brachytherapy. The use of the shorter-acting Cs-131 isotope may be expected to have dose-related side effects that resolve more rapidly. This series suggests a trend for improved PSA control outcomes for Cs-131 patients compared with I-125 and Pd-103.

Efficacy of Probiotics as Prophylaxis for Urinary Tract Infections in Premenopausal Women: A Systematic Review and Meta-Analysis.

INTRODUCTION: Although antibiotic therapy has been the mainstay of prophylaxis and treatment of urinary tract infections (UTIs), antibacterial resistance has led to increased incidence of infections and healthcare spending in both community-acquired and nosocomial UTIs. This has led to an active exploration of alternative remedies for both the prophylaxis and treatment of UTIs, especially in women with recurrent urinary tract infections. Probiotic supplementation is one novel intervention that has been studied as a prophylactic measure in patients with UTIs. The current systematic review and meta-analysis was conducted to evaluate the efficacy of probiotics for prophylaxis in UTIs in premenopausal women. METHODS: Detailed search strategies for each electronic database were developed for PubMed, EMBASE, and Scopus to identify relevant literature published between 2001-2021. RevMan 5.3 statistical software was used to analyze data in studies. The random-effects model was used for pooling the data. The risk of bias and study quality were assessed using Cochrane Collaboration's tool for assessing risk of bias in included studies. The scope of focus for this review was premenopausal adult women with a history of one or more UTI. The intervention consisted of a probiotic regimen for which the goal was to enhance the defensive microflora of the urogenital tract. Studies comparing a probiotic regimen to a placebo regimen were included. These studies' primary outcome was the proportion of women with at least one symptomatic bacterial UTI in each group (i.e., UTI recurrence rate) in the 12-month period following probiotic intervention. This study extends the work of researchers who systematically investigated the scientific literature on probiotics in the prevention of urinary tract infections with a particular focus on premenopausal women. RESULTS: After screening, three parallel-group randomized-controlled trials (RCTs) were included. We estimated the overall pooled data of these three studies with a total of 284 participants to have met the predefined inclusion criteria and were therefore included in this review. The results demonstrated that probiotics did not have a significant effect in the prophylaxis of UTIs. (Risk Ratio (RR): 0.59 confidence interval (CI): 0.26, 1.33), Heterogeneity: Chi² = 6.63, df = 2 (p = 0.04); I² =70%, Test for overall effect: Z = 1.27 (p = 0.20).  Conclusions: Probiotics did not demonstrate a significant benefit in reducing UTI recurrence compared to placebo in premenopausal women. However, more conclusive data is needed to determine the effect that probiotics have on strengthening the urogenital microbial barrier against pathogenic bacteria and protecting against UTI recurrence.

Management of Prostate Cancer During COVID-19 Pandemic: Perspective From Urologists and Radiation Oncologists in COVID Dense Metro Detroit.

Objective To survey Urologists and Radiation Oncologists in Metropolitan Detroit regarding practice patterns in managing non-metastatic prostate cancer during the pandemic.  Methods An online survey was created to capture the perspective of the impact the COVID-19 restrictions have on the management of prostate cancer by Urologists and Radiation Oncologists in the Detroit Metropolitan area.  Results While most physicians felt that their facilities had adequate quantities of personal protective equipment (PPE), one in four offices reported that they did not have sufficient access to PPE. Urologists surveyed indicated that most of the low risk prostate cancer surgeries were cancelled and 56.2% had half or more of intermediate and high risk disease prostatectomies cancelled as well. Treatment options were then shifted towards either temporary surveillance or hormone therapy. Radiation Oncologists indicated that prostate cancer patients ready to start treatment were mostly delayed with temporary surveillance or hormone therapy depending on risk category (60% indicated they delayed low risk and favorable intermediate risk cases, 56% unfavorable intermediate risk cases, and 44% high risk cases). More than 80% of patients already undergoing treatment continued radiation.  Conclusion In the setting of this pandemic, the management of prostate cancer has shifted to a much more conservative approach. While the response to the crisis has not been uniform, the majority of the practitioners followed newly established guidelines. The long-term outcomes of delays and deviations from standard treatment approaches will remain to be seen.

Previous preterm cesarean delivery: identification of a new risk factor for uterine rupture in VBAC candidates.

OBJECTIVE: A major risk of trials of labor in patients with prior cesarean delivery is uterine rupture. We evaluated the question of whether a previous cesarean delivery at an early gestational age predisposes the patient to subsequent uterine rupture. METHODS: This was a retrospective chart review of patients delivering at North Shore University Hospital with a trial of labor after previous cesarean delivery to ascertain all cases of uterine rupture. Patients who had had a previous cesarean delivery at our institution who did not suffer uterine rupture during a trial of labor served as controls. RESULTS: Twenty-five patients suffered a uterine rupture. The incidence of prior preterm cesarean delivery (PPCD) in this group was 40%, compared to 10.9% of 691 laboring vaginal birth after cesarean (VBAC) patients without rupture (p < 0.001). Patients in the rupture group with a PPCD were less likely to have experienced labor in the index pregnancy and more likely to have had an interdelivery interval of less than two years. CONCLUSIONS: An undeveloped lower segment in the preterm uterus represents a risk for later rupture, even if the incision is transverse.

The successful treatment of severe aplastic anemia with autologous cord blood transplantation.

Cord blood transplantation has been used extensively in the allogeneic setting for acquired and genetic disorders of hematopoiesis. There is less experience in the utility of autologous cord blood transplantation, and there is great controversy about the role of autologous cord blood collection and storage. We report on the successful use of autologous cord blood transplantation for the treatment of severe aplastic anemia following fulminant hepatic failure and living related liver transplantation.

Hallazgos radiológicos en pacientes con rinitis alérgica perenne / Radiological findings in patients with perennial allergic rhinitis

Antecedentes: la rinitis se define clínicamente por congestión, estornudos, prurito y rinorrea. Material y método: estudio prospectivo y longitudinal efectuado en 69 pacientes consecutivos del servicio de inmunología clínica y alergia del Hospital de Especialidades del CMN Siglo XXI. Resultados: del total de pacientes 53 eran mujeres y 16 hombres, con límites de edad entre 15 y 55 años, con diagnóstico de rinitis alérgica perenne. Todos los sujetos de estudio tuvieron antecedentes de atopia; 50.7 por ciento asma con enfermedad agregada, 47.8 por ciento poliposis nasal, 27.5 por ciento sinusitis, 59.9 por ciento en el maxilar, 36.2 por ciento etmoidal y frontal en 7.2 por ciento. Con desviación septal se encontró al 33.3 por ciento de los pacientes, 7.2 por ciento con desviación septal más espolen, obstrucción del complejo osteomeatal 4.3 por ciento, hipertrofia de cornetes 53.5 por ciento, pólipos 27.5 por ciento y concha bulosa 7.2 por ciento. El diagnóstico se realizó con tomografía axial de senos paranasales. La chi al cuadrado determinó la asociación entre las alteraciones estructurales y la sinusitis con una p = 0.001, con estrecha relación entre rinitis alérgica y sinusitis. Conclusiones: se demostró la importancia del diagnóstico y tratamiento oportuno de esta afección.