Endosonography endoscopic ultrasound (EUS)-guided fine needle aspiration and endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration is increasingly used for lung cancer staging and ...the assessment of sarcoidosis. Serious adverse events (SAE) have been reported in case reports, but the true incidence of complications is yet unknown.
To assess the rate of SAE related to endosonography and to investigate associated risk factors.
PubMed, EMBASE and Cochrane libraries were searched for eligible references up to April 2012 and these included studies reporting on linear EUS or EBUS for the analysis of mediastinal/hilar nodal or central intrapulmonary lesions. Case series describing complications were excluded. Reported complications were classified into SAE or minor adverse events (AE).
190 studies met the inclusion criteria. Information on follow-up was missing in half of the studies. In 16,181 patients, 23 SAE (0.14%) and 35 AE (0.22%) were reported. No mortality was observed. SAE were more frequent in patients investigated with EUS (0.30%) than in those investigated with EBUS (0.05%). Infectious SAE were most prevalent (0.07%) and predominantly occurred in patients with cystic lesions and sarcoidosis. In lung cancer patients, complications were rare.
Endosonography for intrathoracic nodal assessment seems safe for lung cancer patients and mortality has not been reported. For cystic lesions and sarcoidosis, there may be a small, but nonnegligible risk of infectious complications. The true incidence of SAE might be higher as accurate documentation of complications is missing in most studies.
Sedimentary facies analysis aided by quantitative 3D georeferenced field data is applied to constrain the sequence stratigraphy of a complex stratigraphic interval in the Late Triassic of the ...Dolomites. This multidisciplinary approach was the key to disentangle the timing of climatic change vs. sea-level fluctuation and their effects on shallow water carbonate depositional systems. The “Carnian Pluvial Event”, a global episode of climate change worldwide documented at low latitudes, involved increased rainfall and possibly global warming. This climatic event begins before a drop of sea-level and caused the demise of microbial-dominated high-relief carbonate platforms that dominated the Dolomites region, and was followed by a period of coexistence of small microbial carbonate mounds and arenaceous skeletal–oolitic grainstones. A subsequent sea-level fall brought to the definitive disappearance of microbialites and shallow water carbonates switched to ramps dominated by oolitic–bioclastic grainstones. The crisis of early Carnian shallow water carbonate systems of the Dolomites generated a geological surface similar to a drowning unconformity, although no transgression occurred. As the high-relief microbial carbonate systems characterized by steep slopes switched to gently inclined oolitic–skeletal–siliciclastic ramps, basins were rapidly filled. The change of carbonate depositional systems was associated with an increase in siliciclastic input, in turn triggered by the onset of a humid climatic event and only later to a sea-level drop. This evolution of carbonate systems cannot be interpreted in the light of sea-level changes only: climate change, and consequent ecological changes in the main carbonate producing biotas, induced significant modifications in depositional geometries. This case study may serve as a conceptual model for the sedimentary evolution of carbonate systems subject to ecological crisis that do not evolve in platform drowning because, despite a drop in shallow water carbonate production, a combination of low subsidence and/or sea level drop maintains the platform top at shallow depth.
•Facies analysis and analysis of quantitative 3D field data applied to constrain sequence stratigraphy•A multidisciplinary approach to disentangle climatic vs. sea-level change effects•The switch from microbial to cool-water factory results triggered by climate change•A carbonate system subject to ecological crisis that does not evolve in a drowning•Generation of a surface similar to a drowning unconformity without a transgression
Lightweight and high strength sheet metal such as aluminum alloy sheets are used in a variety of industrial applications. Due to the limited weldability of these materials, mechanical joining ...techniques such as clinching are of interest. The challenge in this regard is that conventional round clinch forming locally induces large plastic deformations which potentially cannot be accommodated by materials with limited ductility. Ductile damage models are used to predict the occurrence of bottom cracks during conventional round clinch forming of EN AW-6082 T6 sheet. It is shown that cracks in the bottom of a clinched joint and the final static strength of a single lap shear specimen can be numerically reproduced provided that the post-necking strain hardening behavior and damage behavior of the base material are properly identified. The observed bottom cracks did not have a detrimental effect on the static strength and fatigue life of single shear lap specimens. It is hypothesized that fatigue cracks in single shear lap tests initiate due to fretting.
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•Conventional clinch forming of materials with limited ductility is investigated.•The occurrence and location of process-induced defects in clinch forming can be simulated with the aid of relatively simple ductile damage criteria.•The observed bottom cracks in this study have no detrimental effect on the static strength and fatigue life of clinched single shear lap specimens.
This article describes the life challenges university students experienced in their first year of study during the transition into academia, how these impacted on their studies at the time, and how ...these have impacted on their life satisfaction and academic progress over the next year or two. Data were collected using a quantitative survey instrument from 463 second and third year students at the University of Johannesburg, South Africa. Results showed that prevalent and severe life challenges during the first year of study were the death of loved ones and poverty. Most of the life challenges impacted negatively on academic progress and well-being a year or two later, and in combination the pileup of vulnerability in first year has a sustained negative impact on student’s academic progress a year or two later. Universities need to engage with the whole student as human within their social environment, with both academic and personal development needs.
Purpose Open partial nephrectomy has emerged as the standard of care in the management of renal tumors smaller than 4 cm. While laparoscopic radical nephrectomy has been shown to be comparable to ...open radical nephrectomy with respect to long-term outcomes, important questions remain unanswered regarding the oncological efficacy of laparoscopic partial nephrectomy. We examined the practice patterns and pathological outcomes following laparoscopic partial nephrectomy. Materials and Methods A survey was sent to academic medical centers in the United States and in Europe performing laparoscopic partial nephrectomy. The total number of laparoscopic partial nephrectomies, positive margins, indications for intraoperative frozen biopsy as well as tumor size and position were queried. Results Surveys suitable for analysis were received from 17 centers with a total of 855 laparoscopic partial nephrectomy cases. Mean tumor size was 2.7 cm (±0.6). There were 21 cases with positive margins on final pathology, giving an overall positive margin rate of 2.4%. Intraoperative frozen sections were performed selectively at 10 centers based on clinical suspicion of positive margins on excised tumor. Random biopsies were routinely performed on the resection bed at 5 centers. Frozen sections were never performed at 2 centers. Of the 21 cases with positive margins 14 underwent immediate radical nephrectomy based on the frozen section and 7 were followed expectantly. Conclusions Early experience with laparoscopic partial nephrectomy in this multicenter study demonstrates oncological efficacy comparable to that of open partial nephrectomy with respect to the incidence of positive margins. The practice of intraoperative frozen sections varied among centers and is not definitive in guiding the optimal surgical treatment.
Purpose
The aim of the present study is to investigate the impact of the near-infrared (NIRF) technology with indocyanine green (ICG) in robotic urologic surgery by performing a systematic literature ...review and to provide evidence-based expert recommendations on best practices in this field.
Methods
All English language publications on NIRF/ICG-guided robotic urologic procedures were evaluated. We followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement to evaluate PubMed
®
, Scopus
®
and Web of Science™ databases (up to April 2019). Experts in the field provided detailed pictures and intraoperative video-clips of different NIRF/ICG-guided robotic surgeries with recommendations for each procedure. A unique QRcode was generated and linked to each underlying video-clip. This new exclusive feature makes the present the first “dynamic paper” that merges text and figure description with their own video providing readers an innovative, immersive, high-quality and user-friendly experience.
Results
Our electronic search identified a total of 576 papers. Of these, 36 studies included in the present systematic review reporting the use of NIRF/ICG in robotic partial nephrectomy (
n
= 13), robotic radical prostatectomy and lymphadenectomy (
n
= 7), robotic ureteral re-implantation and reconstruction (
n
= 5), robotic adrenalectomy (
n
= 4), robotic radical cystectomy (
n
= 3), penectomy and robotic inguinal lymphadenectomy (
n
= 2), robotic simple prostatectomy (
n
= 1), robotic kidney transplantation (
n
= 1) and robotic sacrocolpopexy (
n
= 1).
Conclusion
NIRF/ICG technology has now emerged as a safe, feasible and useful tool that may facilitate urologic robotic surgery. It has been shown to improve the identification of key anatomical landmarks and pathological structures for oncological and non-oncological procedures. Level of evidence is predominantly low. Larger series with longer follow-up are needed, especially in assessing the quality of the nodal dissection and the feasibility of the identification of sentinel nodes and the impact of these novel technologies on long-term oncological and functional outcomes.
Updates on intravesical therapy Pisano, Francesca; Vila Reyes, H; Breda, A ...
Current opinion in urology,
2019-November, 2019-11-00, 20191101, Volume:
29, Issue:
6
Journal Article
PURPOSE OF REVIEWTo review the current literature concerning the intravesical treatment of nonmuscle invasive bladder cancer.
RECENT FINDINGSBladder cancer is a high prevalent disease. Despite the ...recognized efficacy of traditional intravesical therapies, the best treatment strategy still needs to be found. Improvement in bladder cancer research lead to develop new intravesical agents and drug delivery systems for nonmuscle invasive bladder cancer tumours. Moreover, the emerging knowledge of bladder cancer immune profile strongly improves and provides new available treatment strategies.
SUMMARYThe future of nonmuscle invasive bladder cancer therapy will be influenced by the development of immunotherapy and new technologies for device-assisted treatment. Moreover, nanotechnology and delivery systems present promising results.
Purpose
Nodal recurrent prostate cancer (PCa) after primary radical treatment represents a heterogeneous entity with many treatment options. In some cases, surgical removal of metastatic nodes seems ...to improve cancer control and delay systemic treatments. The objectives of this study were to analyze the available literature on salvage lymphadenectomy for the treatment of nodal recurrent PCa and to elucidate the real oncological benefit deriving from this procedure.
Methods
A PubMed search was performed using the following terms: prostate cancer, metastatic, oligometastatic, salvage lymphadenectomy, salvage lymph node dissection, salvage lymph node excision, and cytoreductive surgery. We included in the study all papers on salvage lymphadenectomy in nodal recurrent PCa, with no temporal limits. In addition, several papers addressing cytoreductive surgery and the biology of oligometastatic disease, published in different medical and basic research journals, were included.
Results
Salvage lymphadenectomy is still characterized by a lack of standardization in patient selection and surgical template. Its primary objectives are to prolong progression-free survival and to delay the need for systemic therapy. The improvements in preoperative imaging techniques in conjunction with the wide use of minimally invasive surgery have generated growing interest in this procedure.
Conclusion
Salvage lymphadenectomy is a promising treatment approach; however, its real oncological benefit is still far from proven. Prospective randomized trials need to be designed to improve understanding of this issue.
The hydrochlorides of the 1:3 aluminum:norfloxacin and aluminum:ciprofloxacin complexes were characterized according to the Biopharmaceutics Classification System (BCS) premises in comparison with ...their parent compounds. The pH–solubility profiles of the complexes were experimentally determined at 25 and 37
°C in the range of pH 1–8 and compared to that of uncomplexed norfloxacin and ciprofloxacin. Both complexes are clearly more soluble than the antibiotics themselves, even at the lowest solubility pHs. The increase in solubility was ascribed to the species controlling solubility, which were analyzed in the solid phases at equilibrium at selected pHs. Additionally, permeability was set as low, based on data reported in the scientific literature regarding oral bioavailability, intestinal and cell cultures permeabilities and also considering the influence of stoichiometric amounts of aluminum. The complexes fulfill the BCS criterion to be classified as class 3 compounds (high solubility/low permeability). Instead, the active pharmaceutical ingredients (APIs) currently used in solid dosage forms, norfloxacin and ciprofloxacin hydrochloride, proved to be BCS class 4 (low solubility/low permeability). The solubility improvement turns the complexes as potential biowaiver candidates from the scientific point of view and may be a good way for developing more dose-efficient formulations. An immediate release tablet showing very rapid dissolution was obtained. Its dissolution profile was compared to that of the commercial ciprofloxacin hydrochloride tablets allowing to dissolution of the complete dose at a critical pH such as 6.8.
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