Robotic distal ureterectomy for high-risk distal ureteral urothelial carcinoma: a retrospective multicenter comparative analysis (ROBUUST 2.0 collaborative group).

BACKGROUND: The role of kidney-sparing surgery in patients with high-risk upper urinary tract urothelial carcinoma is controversial. The present study aimed to assess oncological and functional outcomes of robot-assisted distal ureterectomy in patients with high-risk distal ureteral tumors. METHODS: The ROBUUST 2.0 multicenter international (2015-2022) dataset was used for this retrospective cohort analysis. High-risk patients with distal ureteral tumors were divided based on type of surgery: robot-assisted distal ureterectomy or robot-assisted nephroureterectomy. A survival analysis was performed for local recurrence-free survival, distant metastasis-free survival, and overall survival. After adjusting for clinical features of the high-risk prognostic group, Cox proportional hazard model was plotted to evaluate significant predictors of time-to-event outcomes. RESULTS: Overall, 477 patients were retrieved, of which 58 received robot-assisted distal ureterectomy and 419 robot-assisted nephroureterectomy, respectively, with a mean (±SD) follow-up of 29.6 months (±2.6). The two groups were comparable in terms of baseline features. At survival analysis, no significant difference was observed in terms of recurrence-free survival (P=0.6), metastasis-free survival (P=0.5) and overall survival (P=0.7) between robot-assisted distal ureterectomy and robot-assisted nephroureterectomy. At Cox regression analysis, type of surgery was never a significant predictor of worse oncological outcomes. At last follow-up patients undergoing robot-assisted distal ureterectomy had significantly better postoperative renal function. CONCLUSIONS: Comparable outcomes in terms of recurrence-free survival, metastasis-free survival, and overall survival between robot-assisted distal ureterectomy and robot-assisted nephroureterectomy patients, and better postoperative renal function preservation in the former group were observed. Kidney-sparing surgery should be considered as a potential option for selected patients with high-risk distal ureteral UTUC.

Decisional and prognostic impact of diagnostic ureteroscopy in high-risk upper tract urothelial carcinoma: A multi-institutional collaborative analysis (ROBUUST collaborative group).

BACKGROUND: Diagnostic ureteroscopy (URS) with or without biopsy remains a subject of contention in the management of upper tract urothelial carcinoma (UTUC), with varying recommendations across different guidelines. The study aims to analyse the decision-making and prognostic role of diagnostic ureteroscopy (URS) in high-risk UTUC patients undergoing curative surgery. MATERIALS AND METHODS: In this retrospective multi-institutional analysis of high-risk UTUC patients from the ROBUUST dataset, a comparison between patients who received or not preoperative URS and biopsy before curative surgery was carried out. Logistic regression analysis evaluated differences between patients receiving URS and its impact on treatment strategy. Survival analysis included 5-year recurrence-free survival (RFS), metastasis-free survival (MFS), cancer-specific survival (CSS) and overall survival (OS). After adjusting for high-risk prognostic group features, Cox proportional hazard model estimated significant predictors of time-to-event outcomes. RESULTS: Overall, 1,912 patients were included, 1,035 with preoperative URS and biopsy and 877 without. Median follow-up: 24 months. Robot-assisted radical nephroureterectomy was the most common procedure (55.1%), in both subgroups. The 5-year OS (P = 0.04) and CSS (P < 0.001) were significantly higher for patients undergoing URS. The 5-year RFS (P = 0.6), and MFS (P = 0.3) were comparable between the 2 groups. Preoperative URS and biopsy were neither a significant predictor of worse oncological outcomes nor of a specific treatment modality. CONCLUSIONS: The advantage in terms of OS and CSS in patients undergoing preoperative URS could derive from a better selection of candidates for curative treatment. The treatment strategy is likely more influenced by tumor features than by URS findings.

Evaluation of sodium butyrate and nutrient concentration for broiler chickens.

The relation between nutrition and intestinal health is a subject with an increasing interest in research, as nutritionists need knowledge about how formulation affects different parameters in the gastrointestinal tract (GIT). That is why 4 trials were conducted to evaluate the effect of nutrient concentration and a feed additive (sodium butyrate protected with sodium salts of palm fatty acid distillates (PSB, Gustor N'RGY produced by Norel S.A., Spain, dosed at 1 kg/t), on performance, diet digestibility, intestinal morphology, volatile fatty acid concentration (VFA) in the GIT and intestinal microbiota of broiler chickens, when fed diets with different energy and amino acids concentration. Control diets, C, with the recommended metabolizable energy (ME) and ideal amino acid (AA) composition; Reduction 1, R1, C - 60 kcal ME and - 2.3% AA and Reduction 2, R2, C - 120 kcal ME and - 4.6% AA) based on different feed ingredients (Corn Soy [CS] and Wheat Barley Soy (WBS) were formulated. All trials lasted 42 d. In trials 2 and 4, the nutrient dilution decreased performance of the animals. In all trials, PSB improved animal performance (growth or FCR), despite the different situations. In trials 1 and 4, animals receiving R1 diets and PSB showed similar performance to those receiving C diets without PSB. PSB improved Gross Energy metabolizability (69.94 vs. 72.55; P: 0.02). Nutrient concentration affected histology results in T2 (ileum) and T3 (jejunum); PSB showed effects in T2 (jejunum, ileum) and in T3 (jejunum). In T1, PSB affected VFA in duodenum, jejunum, and ileum, changing the profile depending on diet nutrient concentration. PSB altered microbiology in caecum of animals in T2. It can be concluded that the dilution of ME and AA concentration of the diet impairs animal performance, influences intestinal microbiota and affects intestinal histology. PSB improves animal performance, increases gross energy metabolizability, steers intestinal microbiota and alters VFA concentrations in the intestine. The addition of PSB may help the animal to counteract the negative effects of diluted diets.

High-dose chemotherapy with hematopoietic rescue in patients with stage III to IV ovarian cancer: long-term results.

PURPOSE: A series of 53 patients with poor-prognosis epithelial ovarian cancer treated with high-dose chemotherapy (HDC) followed by hematopoietic rescue was retrospectively studied from the day of diagnosis for toxicity and long-term survival analysis. PATIENTS AND METHODS: Patients were treated with surgery followed by cisplatin combination chemotherapy. After second-look operation (SLO), HDC was administered: 23 patients received melphalan (140 mg/m2 on day 1) and 30 patients received a combination of carboplatin (400 mg/m2 on days 1 to 4) and cyclophosphamide (1.6 g/m2 on days 1 to 4). After HDC, autologous stem-cell transplantation was performed for hematologic support. RESULTS: One patient died of cardiac failure after HDC, but the acute toxicity was acceptable for the other patients. With a median follow-up of 81.5 months, the 5-year overall survival rate for the 53 patients was 59.9% and the disease-free survival (DFS) rate at 5 years was 23.6%. Twenty-four patients (45.3%) were alive, 12 with no evidence of disease and 12 with recurrent disease. The best results were achieved in 19 patients with pathologic complete response at SLO (74.2% 5-year overall survival; 32.8% 5-year DFS). CONCLUSION: HDC followed by autologous stem-cell support is a well-tolerated therapeutic approach for patients with poor-prognosis ovarian carcinoma. In this report, the 59.9% survival of 53 patients at 5 years must be compared to the 20% to 30% 5-year survival observed after conventional therapy. These results should be confirmed by an ongoing prospective randomized trial.

Micronucleus formation in human keratinocytes is dependent on radiation quality and tissue architecture.

The cytokinesis-block micronucleus (MN) assay was used to assess the genotoxicity of low doses of different types of space radiation. Normal human primary keratinocytes and immortalized keratinocytes grown in 2D monolayers each were exposed to graded doses of 0.3 or 1.0 GeV/n silicon ions or similar energies of iron ions. The frequencies of induced MN were determined and compared to γ-ray data. RBE(max) values ranged from 1.6 to 3.9 for primary keratinocytes and from 2.4 to 6.3 for immortalized keratinocytes. At low radiation doses ≤ 0.4 Gy, 0.3 GeV/n iron ions were the most effective at inducing MN in normal keratinocytes. An "over-kill effect" was observed for 0.3 GeV/n iron ions at higher doses, wherein 1.0 GeV/n iron ions were most efficient in inducing MN. In immortalized keratinocytes, 0.3 GeV/n iron ions produced MN with greater frequency than 1.0 GeV/n iron ions, except at the highest dose tested. MN formation was higher in immortalized keratinocytes than in normal keratinocytes for all doses and radiation qualities investigated. MN induction was also assessed in human keratinocytes cultured in 3D to simulate the complex architecture of human skin. RBE values for MN formation in 3D were reduced for normal keratinocytes exposed to iron ions, but were elevated for immortalized keratinocytes. Overall, MN induction was significantly lower in keratinocytes cultured in 3D than in 2D. Together, the results suggest that tissue architecture and immortalization status modulate the genotoxic response to space radiation, perhaps via alterations in DNA repair fidelity.

Detection and quantitation of human cytomegalovirus DNA in faeces.

The development and performance of a robust and sensitive PCR assay are described for the detection and quantitation of human cytomegalovirus DNA in human faecal specimens. In this assay, CMV DNA was purified by an optimised DNA extraction protocol together with internal control DNA that monitored both DNA extraction efficiency and PCR efficiency. The lower detection limit of the assay was reached at about 100 CMV particles per ml of (25-50%) faecal suspension. CMV DNA could be quantitated in the range of about 300-100000 molecules per ml of faecal suspension. CMV DNA loads obtained in clinical faeces specimens suggest that the assay can be used to monitor the efficacy of antiviral treatment. Reconstruction experiments that monitored the efficiency of DNA extraction of a preliminary DNA extraction protocol, showed low DNA yields for 9% of the specimens (n = 78). In all cases, low DNA extraction efficiency seemed to be due to a component present in faeces that prevented DNA binding to silica particles, presumably by competitive binding. Choosing the right ratio of silica particles to faeces specimen solved this problem. Similarly, reconstruction experiments showed that the strong PCR inhibition that was observed in 8% of the specimens could effectively be relieved by the inclusion of alpha-casein in the PCR mixtures.

[Myocardial scintigraphy]. / La scintigraphie du myocarde.

Myocardial scintigraphy may be performed at rest or after stress testing using potassium-like cations, labeled metabolites or infarct-fixing tracers. It is an in vivo method of studying myocardial ischaemia and infarction and may provide diagnostic information when other techniques fail. The diagnostic possibilities of myocardial scintigraphy have been increased by the introduction of tomographic techniques and new radioisotopes with very short half lives.

Myocardial scintigraphy with technetium 99m pyrophosphate. / La scintigraphie du myocarde au pyrophosphate technetium 99m

The pyrophosphate of Tc99m attaches itself to ischaemic myocardial cells, and therefore makes it possible to obtain a scintigram of necrotic or necrosing myocardium. In a series of 65 cases the scintigram was positive in every case in which there had been a recent transmural infarct (17 cases). The results showed greater variation in the other ischaemic conditions involving the myocardium (limited infarcts or simple angina). The progress as a function of time was stuided in a series of fairly recent and older infarcts. The limitations and future prospects of this investigations are discussed.

[Assessment of the myocardial infarct size and kinetic study of the necrosis process by serial determinations of creatine kinase]. / Estimation de la masse de l'infarctus du myocarde et étude cinétique du processus de nécrose par les dosages en série de la créatine kinase.

Assessment of the size of a myocardial infarct is important from a prognostic point of view, given the opportunities for surgical and pharmacological limitation of the process of necrosis. Serial doses of creatine kinase and its isoenzyme MB given every 4 hours for the first 48 hours of the infarct have allowed us to estimate the size of the infarct and to study the kinetics of enzyme liberation during necrosis. Unknown factors limit the sensitivity of this means of assessing the size of an infarct. The kinetic study showed that the enzyme is liberated by differing mechanisms.

[Value and limitations of sequential technetium 99m angiocardiography in the detection, localization and quantification of left-right intracardiac shunts apropos of 110 cases]. / Valeurs et limites de l'angiocardiographie séquentielle au technétium 99 m pour la détection, la localisation et la quantification des shunts intra-cardiaques gauche-droite. A propos de 110 observations.

A comparative study of the diagnosis of intracardiac left-to-right shunts by isotope radiography on the one hand and oxymetry, abnormal catheter trajectory and angiocardiography on the other, was performed on a series of 110 patients, comprising 12 normals, 46 valvulopathies or cardiomyopathies without shunts, 23 ASDs, 22 VSDs, and 7 other shunts. Intravenous injection of Technetium 99 m with scintigraphic imagery and interpretation of time-activity curves detected even small left-to-right shunts and appeared to be more sensitive than oxumetry. The estimation of the size of the shunt correlated well with oxymetry for VSDs but not for ASDs. The localisation of the shunt was more difficult. The atrial level of the defect was detected in some but not the majority of cases. The isotopic technique appeared unreliable in the presence of severe haemodynamic disturbances. The isotopic method is a quick means of detecting left-to-right shunts without measurable risk, particularly useful in the investigation of children and young adults thought to have left-to-right shunts.

Piglet behavior as a measure of vitality and its influence on piglet survival and growth during lactation.

The aim of the study was to develop a vitality scoring method, based on piglet behavior and relate it to piglet growth and survival. From 21 sows (Sus scrofa), 287 piglets were used. After farrowing (d 0), piglets were weighed and tested for 4 behavioral parameters in a circular enclosure (55 cm diam.): movement capacity (M), udder stimulation (U), number of completed circles around the enclosure (NCC), and screaming (Sc). Piglets were weighed again on d 1, 2, 3, and 17. Piglet rectal temperature (RT) was recorded on d 0, 1, 2, and 3. Farrowing information of the sow was also recorded. Multiple regression analyses for survival and BW gain at weaning as dependent variables were performed. Piglet BW gain at weaning was influenced by BW at birth (P < 0.001), sow parity (P = 0.024), total number of piglets born alive per sow (P < 0.001), and sum of U and NCC parameters (UN; P = 0.023). Piglet survival during lactation was influenced by BW at birth (P = 0.015), UNCC parameter (P = 0.026), and RT on d 3 (P = 0.085). The sum of U and NCC parameters, in combination with BW at birth and information of the sow, might be useful to predict piglet growth survival during lactation, thus becoming a useful tool to improve piglet management during the first days of lactation. In conclusion, UNCC parameter seems to be an easy and useful way to assess piglet vitality for both scientific and commercial purposes.

Synthesis of biphenyl-based arsine ligands by Suzuki-Miyaura coupling and their application to Pd-catalyzed arsination.

A versatile and efficient approach for the synthesis of new biphenyl-based arsine ligands, by a Pd-catalyzed arsination to introduce the -AsPh(2) moiety, and then a Suzuki-Miyaura cross-coupling for biaryl construction is reported. By Pd-catalyzed arsination with n-Bu(3)SnAsPh(2) (1), (2-bromophenyl)diphenylarsine (2, 83%) was obtained. The Suzuki-Miyaura reaction between the bromoarsine 2 and aryl boronic acids bearing different substituents provided biarylarsine ligands (80-99%). The efficiency of catalysts derived from the new biarylarsine ligands was evaluated in the Pd-catalyzed arsination with perfluoroalkyl iodides (R(f)I). Outstanding activities of catalysts derived from Pd/methoxybiarylarsine ligands were found in this coupling reaction affording perfluoroalkyl arsines in very good yields (57-100%).

Uso de la regeneración ósea guiada (rog) con membranas biodegradables de co-polímeros en cirugía bucal para reparar defectos óseos: estudio clínico de 30 meses de seguimiento postquirúrgico

La regeneración ósea guiada (ROG) es frecuentemente usada para tratar defectos óseos pero muchas veces el tipo de membrana usada se degrada antes de que ocurra la adecuada cicatrización ósea y se introduce tejido blando en la zona a regenerar. El objetivo de éste estudio es evaluar la eficacia de usar el sistema de membranas y tachuelas biodegradables de co-polímeros en pacientes con defectos óseos o que necesiten levantamiento de membrana sinusal con un periódico control clínico y radiográfico. Este estudio fue realizado en 15 pacientes que tenían defectos óseos o necesitaban levantamiento de membrana sinusal, con un rango de edad entre 19 y 49 años con un promedio de 34 años de edad. 8 pacientes fueron femeninos y 7 masculinos. Se usó relleno óseo con las membranas y tachuelas biodegradables de co-polímeros en todos los casos, 7 de los casos fueron levantamiento de membrana sinusal y los otros 8 se trataron de defectos óseos. Se les realizó un seguimiento clínico y radiográfico cada 3 y 6 meses hasta 30 meses después del día de la cirugía entre los años 2005 y 2007, realizándose un análisis longitudinal. Se encontró que a 5 pacientes se les expuso la membrana, uno de ellos se mantuvo con enjuagues de clorhexidina hasta que cicatrizó por segunda intención, en 2 de los pacientes se les recortó y moldeó el borde expuesto y los otros 2 casos se tuvo que retirar la membrana y tachuelas por completo. Los 10 pacientes restantes cicatrizaron adecuadamente y no tuvieron ningún tipo de exposición, siendo el porcentaje de éxito al utilizar éste nuevo sistema de membranas y tachuelas biodegradables de co-polímeros del 66,7%. Se destaca que éste sistema de membranas y tachuelas biodegradables de co-polímeros no necesita ser retirado en una 2da cirugía. Debido al buen control postquirúrgico se pudo manejar de inmediato los casos donde hubo exposición de la membrana y sólo fracasaron 2 de 15. Se observó una adecuada cicatrización ósea tanto clínica ...

Guided bone regeneration (GBR) is frequently used to treat bone defects, however, most of the membranes degrade before bone healing has occurred permitting soft tissue invasion into the desired bone chamber. The aim of this clinical trail is to evaluate the efficacy of using a biodegradable co-polymers membrane and tacks system in patients with bone defects or need of maxillary sinus lift for implant placement with a long term clinical and radiographically follow up. All patients included in this study had the necessity of guided bone regeneration. 15 patients consisted of bone defects or the need of maxillary sinus lifting, with an age range of 19 to 49 years of age with an average of 34 years old. There were 8 females and 7 males. In all cases, we used biodegradable co-polymers membrane and tacks system that gets soft when applied but becomes rigid in-situ after approximately 15 minutes allowing the new bone cicatrization because it becomes a barrier for the bone grafting material, 7 patients underwent surgery for maxillary sinus lift and the other 8 for bone defects. Patients were followed clinical and radiographically during 3 to 6 months intervals up to 30 months between 2005 - 2007. A longitudinal study was performed by checking the patients clinical and radiographically during a continuously period of time up to 30 months postoperatively. 5 patients had partial membrane exposure, one of them was kept in clorhexidine mouth rinses and irrigation until secondary healing was accomplished. 2 patients were treated by cutting and trimming the membrane edges in order to get full mucosa coverage and it was obtained in 2 weeks after this procedure. In 2 cases the flap open totally and we had to remove the membrane. The rest 10 of the 15 patients healed uneventfully. The percentage of success using the biodegradable co-polymers membrane and tacks system was 66,7% . This biodegradable co-polymers membrane and tacks system does not require ...

Estimación del volumen orbitario mediante imágenes de TC y el principio de cavalieri / Estimation of the orbital volume with ct images and cavalieris principle

Determination of the orbital volume has significance in cases such as facial injuries and lens implants where it is necessary to restore the normal position of the structures, since providing the patient with a volume-deficient orbit may result in enophthalmos. The aim of this study is to assess the volume of the orbit by using the Cavalieri s principle supplemented with sequential analysis of CT images on the computer screen. We conducted a series of CT images with a thickness of 1mm on 10 human skulls. After selection, initially random and then sequential, images were analyzed on a computer screen with a mesh test chart to determine orbital area. Once having identifed both area and thickness, we measured the volume of segments, and the total volume of the orbit was extrapolated by using a mathematical formula based on the Cavalieri s principle. Results were compared with the actual volume obtained by the displacement of fuid from printouts of the orbits. The result of this comparison suggests that the method is statistically reliable when considering that we assessed seven images of a randomly chosen orbit and then in a known sequence with a straightforward technique for orbital volume estimation.

Conocer el volumen de la órbita es importante en traumatismos faciales o implantes oculares, donde es necesario restablecer la posición normal de las estructuras y devolver un volumen deficiente puede traducirse en enoftalmo. El objetivo del presente trabajo es realizar estimación del volumen orbitario utilizando el principio de Cavalieri complementado con análisis secuencial de imágenes de TC en la pantalla del computador. Se realizó imágenes de TC de 1mm de espesor a 10 cráneos humanos. Luego de la selección, inicialmente aleatoria y luego secuencial, las imágenes se analizaron sobre la pantalla del computador con un test de malla de puntos para determinar área orbitaria. Conociendo el área y el grosor, determinamos el volumen de los segmentos y se extrapola al volumen total de la órbita, utilizando fórmula matemática basada en el principio de Cavalieri. Los resultados fueron comparados con el volumen real obtenido por el desplazamiento de fluidos de impresiones de las órbitas. Esta comparación sugiere que el método es estadísticamente confable al evaluar 7 imágenes de una órbita escogida aleatoriamente y luego en una secuencia conocida, con una manera simple de estimación del volumen.

The complete nucleotide sequence of bovine polyomavirus.

The complete sequence of the genome of bovine polyomavirus (BPyV), formerly known as the CK isolate of the stump-tailed macaque virus, is presented. The genomic organization of BPyV is similar to that of the non-rodent polyomaviruses. With a genome size of 4697 bp, BPyV has the smallest polyomavirus genome known so far. When compared to simian virus 40 (SV40), the shortness of the BPyV genome is due mainly to differences in the coding capacity of the BPyV early region. The first exon of the proposed large T antigen encodes only 35 amino acids; also, a coding region corresponding to the C-terminal 64 amino acids of the SV40 large T antigen is absent in BPyV. It is proposed that the nucleotide sequence encompassing the small t antigen coding sequence contains an intron sequence of 71 nucleotides. Together the two exon sequences encode a 124 amino acid protein. We conclude that this may be the first example of a polyomavirus that has a small t antigen which is translated from two exon sequences. The enhancer region of BPyV does not show homology to the SV40 enhancer sequences. An agnogene is present with a coding capacity of 118 amino acid residues. The highest degree of homology to SV40 and PyV is present in the VP1 molecule.

Isolation of human immunodeficiency virus type 1 (HIV-1) RNA from feces by a simple method and difference between HIV-1 subpopulations in feces and serum.

A simple method for the isolation and subsequent detection of human immunodeficiency virus type 1 (HIV-1) RNA from feces is described. Viral RNA was isolated by the method developed by Boom et al. (R. Boom, C.J.A. Sol, M.M.M. Salimans, C.L. Jansen, P.M.E. Wertheim-van Dillen, and J. van der Noordaa, J. Clin. Microbiol. 28:495-503, 1990), which was adapted for feces. HIV-1 RNA was detected by reverse transcription (RT) followed by a nested PCR encompassing the V3 region. Reconstruction experiments revealed that the efficiencies of the extraction technique and the subsequent RT-PCR were not considerably affected by the varied composition of feces. The method was applied on fecal specimens from 18 HIV-1-infected individuals, among which were samples that had been stored for 9 years. It appeared that HIV-1 RNA was detectable in the feces of 12 persons (67%). Viral RNA was present in the feces of persons who fulfilled the criteria for CDC class II and CDC class III HIV infection as well as in patients who were diagnosed with AIDS (CDC class IV). Direct sequencing of amplimers obtained from paired fecal and serum specimens showed that differences in sequence heterogeneity existed. In one patient a remarkable difference in the HIV-1 sequences between isolates from feces and serum was observed. In conclusion, HIV-1 RNA is frequently present in the feces of HIV-1-infected individuals, and in some cases the HIV-1 subpopulation in feces differs from the HIV-1 subpopulation in serum.