Explore the vast range of titles available.

To investigate the feasibility of RAPN on T1b renal mass by assessment of Trifecta and Pentafecta rate between T1a and T1b renal mass. We retrospectively reviewed the medical records of 277 cases of RPN performed from 2006 to 2015. Sixty patients with clinically T1b renal masses (> 4 cm and ≤ 7 cm) were identified, and from 180 patients with clinically T1a renal mass, 60 patients were matched with T1b renal mass by propensity score. Tumor complexity was investigated according to R.E.N.A.L nephrometry score. \"Pentafecta\" was defined as achievement of Trifecta (negative surgical margin, no postoperative complications and warm ischemia time of ≤ 25 minutes) with addition of over 90% estimated GFR preservation and no chronic kidney disease stage upgrading at 1 year postoperative period. Propensity score matching was performed by OneToManyMTCH. Logistic regression models were used to identify the variables which predict the Trifecta, and Pentafecta ac. Preoperative variables (age, sex, body mass index, ASA score) were similar between T1a and T1b after propensity score matching. The median R.E.N.A.L. nephrometry score was 8 vs 9 for T1a and T1b respectively (p<0.001). The median warm ischemia time was 20.1 min vs 26.2 min (p<0.001). Positive surgical margin rate was 5% vs 6.6% (p = 0.729) and overall complication rate of 13.3%. vs 15% (p = 0.793). The rate of achievement of Trifecta rate were 65.3% vs 43.3% (p = 0.017) and Pentafecta rate were 38.3% vs 26.7% (p = 0.172). For achievement of Pentafecta, R.E.N.A.L nephrometry score (HR 0.80; 95% CI (0.67-0.97); p = 0.031) was significant predictor of achieving Pentafecta. Subanalyis to assess the component of R.E.N.A.L nephrometry score, L component (location relative to the polar lines, HR 0.63; 95% CI (0.38-1.03); P = 0.064) was relatively important component for Pentafecta achievement. The rate of Pentafecta after RAPN was comparable between T1a and T1b renal masses. RAPN is a feasible modality with excellent long term outcome for patients with larger renal mass (cT1b).

Background Flexible cystoscopy is widely used for the diagnosis and surveillance of various urological conditions and is commonly performed in an outpatient setting under local anaesthesia. Various adjuncts have been proposed to reduce patient discomfort, with the most notable being the manual bag squeeze method. This approach elevates irrigation fluid pressure, induces hydrodistension, and has received a strong recommendation from the European Association of Urology (EAU). However, the manual bag squeeze method is limited by inconsistencies in the pressure applied by individuals and the need for additional staff members to perform the procedure. This trial aims to assess the efficacy of standardised pressure bags in elevating irrigation fluid pressure during flexible cystoscopy and its impact on reducing mean pain scores, compared to conventional gravity drainage and the manual bag squeeze manoeuvre. Methods A randomised, controlled, double blinded, single-centre, parallel-group trial will be conducted. Participants scheduled to undergo flexible cystoscopy will be recruited, screened for eligibility and randomised to one of three study groups: (1) Intervention 1 – Pressure bag Group, (2) Intervention 2 – Manual bag squeeze group, and (3) Control – Gravity drainage group with a simulated bag squeeze. Randomisation will be stratified based on participants’ history of prior flexible cystoscopy. The primary outcome is the mean pains score reported by participants immediately after the procedure, assessed using a Numerical Rating Scale (NRS). Secondary outcomes include Patient Reported Outcome Measures (PROMIS) surveys at day 7 post flexible cystoscopy to evaluate for pain intensity (1a), Pain inference (short form 6a) and emotional distress-anxiety (Short form 4a), as well as the incidence of complications reported at day 30 post-procedure. Discussion This trial will evaluate the role of pressure bags to elevated fluid irrigation pressure and its effect on reducing patient discomfort during flexible cystoscopy using a rigorous methodology. If proven to be effective, pressure bag fluid irrigation has the potential to be implemented as one of the standards of practice for flexible cystoscopies. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR). Prospective Registration Number: ACTRN12623000799651. Date of Registration 26/07/2023.

Current National Comprehensive Cancer Network guidelines recommend postoperative radiation therapy based only on adverse pathologic findings (APFs), irrespective of preoperative risk group. We assessed whether a model incorporating both the preoperative risk group and APFs could predict long-term oncologic outcomes better than a model based on APFs alone. We retrospectively reviewed 4,404 men who underwent radical prostatectomy (RP) at our institution between 1992 and 2014. After excluding patients receiving neoadjuvant therapy or with incomplete pathological or follow-up data, 3,092 men were included in the final analysis. APFs were defined as extraprostatic extension (EPE), seminal vesicle invasion (SVI), or a positive surgical margin (PSM). The adequacy of model fit to the data was compared using the likelihood-ratio test between the models with and without risk groups, and model discrimination was compared with the concordance index (c-index) for predicting biochemical recurrence (BCR) and prostate cancer-specific mortality (PCSM). We performed multivariate Cox proportional hazard model and competing risk regression analyses to identify predictors of BCR and PCSM in the total patient group and each of the risk groups. Adding risk groups to the model containing only APFs significantly improved the fit to the data (likelihood-ratio test, p <0.001) and the c-index increased from 0.693 to 0.732 for BCR and from 0.707 to 0.747 for PCSM. A RP Gleason score (GS) ≥8 and a PSM were independently associated with BCR in the total patient group and also each risk group. However, only a GS ≥8 and SVI were associated with PCSM in the total patient group (GS ≥8: hazard ratio [HR] 5.39 and SVI: HR 3.36) and the high-risk group (GS ≥8: HR 6.31 and SVI: HR 4.05). The postoperative estimation of oncologic outcomes in men with APFs at RP was improved by considering preoperative risk group stratification. Although a PSM was an independent predictor for BCR, only a RP GS ≥8 and SVI were associated with PCSM in the total patient and high-risk groups.

This first part of a two-part review of pheochromocytoma and paragangliomas (PPGLs) addresses clinical presentation, diagnosis, management, treatment, and outcomes. In this first part, the epidemiology, prevalence, genetic etiology, clinical presentation, and biochemical and radiologic workup are discussed. In particular, recent advances in the genetics underlying PPGLs and the recommendation for genetic testing of all patients with PPGL are emphasized. Finally, the newer imaging methods for evaluating of PPGLs are discussed and highlighted.

This is the second part of a two-part review on pheochromocytoma and paragangliomas (PPGLs). In this part, perioperative management, including preoperative preparation, intraoperative, and postoperative interventions are reviewed. Current data on outcomes following resection are presented, including outcomes after cortical-sparing adrenalectomy for bilateral adrenal disease. In addition, pathological features of malignancy, surveillance considerations, and the management of advanced disease are also discussed.

Introduction Accurate grading at the time of diagnosis is fundamental to risk stratification and treatment decision making, particularly for men being considered for Active Surveillance (AS). With the introduction of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) there has been considerable improvement in sensitivity and specificity for the detection and staging of clinically significant prostate cancer. Our study aims to determine the role of PSMA PET/CT in men with newly diagnosed low or favourable intermediate risk prostate cancer to better select men for AS. Method This is a retrospective single centre study performed from January 2019 and October 2022. This study includes men identified from electronic medical record system who had undergone a PSMA PET/CT following newly diagnosed low or favourable-intermediate risk prostate cancer. Primary outcome was to assess the change in management for men being considered for AS following PSMA PET/CT results on the basis of PSMA PET characteristics. Results In total, there were 11 of 30 men (36.67%) who were assigned management by AS and 19 of 30 men (63.33%) who had definitive treatment. 15 of the 19 men that needed treatment had concerning features on PSMA PET/CT results. Of the 15 men with concerning features on PSMA PET, 9 (60%) men were found to have adverse pathological features on final prostatectomy features. Conclusion This retrospective study suggests that PSMA PET/CT has potential to influence the management of men with newly diagnosed prostate cancer that would otherwise be appropriate for active surveillance.

Aim The effects of the COVID-19 pandemic on healthcare in Australia have yet to be fully determined. There are well documented decreases in the rates of screening and diagnostic testing for many cancers in 2020, with commensurate stage migration of cancers when they are eventually detected. We aimed to determine whether there was a decrease in the rate of prostate cancer (PC) screening and testing in Australia in 2020. Method Data was extracted from the Department of Human Services (DHS) website for Medicare Benefits Schedule (MBS) item numbers for tests pertinent to detection of Prostate Cancer. This data is de-identified and publicly available. Data was analysed at both a national, and a state level. Results For 2020 nationwide the percentage change for prostate cancer testing was minor with 97% as many PSA tests, 99% as many prostate MRIs, and 105% as many prostate biopsies as the average for the preceding years. The differences were not significant (PSA tests p  = 0.059 and prostate biopsies p  = 0.109). The predicted values are fairly similar to both the average values for the preceding 5 years and the actual number of tests done in 2020. With exception of PSA tests in Victoria the actual number of tests performed was within the 95% Prediction Interval (performed: 167,426; predicted 171,194–196,699; p  = 0.015). Conclusion The current pandemic has had a widespread reach across Australia, with varying impact across each state and territory. Contrary to the trends across the world, our data suggest that during 2020 in Australia most areas remained unaffected in terms of prostate cancer testing excluding Victoria, which had statistically significant decrease in the number of PSA tests correlating with the extended lockdown that occurred in the state.

Primary adrenal lymphoma (PAL) is a rare form of lymphoma with fewer than 200 cases reported.1 The most common subtypes are diffuse large B-cell lymphoma and peripheral T-cell lymphoma, which account for approximately 78 per cent and 7 per cent of all PAL, respectively.1 To our knowledge, there are only four cases of primary adrenal Hodgkin lymphoma (HL) reported in the literature before the case presented here.2 HL accounts for 11 per cent of all lymphoma within the United States, with approximately 9000 new cases each year.3 HL most commonly involves regional LNs; however, it can involve extranodal sites, particularly the spleen, liver, bone marrow, and lungs.3 Rarely does HL involve the adrenal glands, either as a primary location of tumor manifestation or as a site of local invasion.1 We present a unique case of unilateral primary adrenal nodular sclerosis subtype classical HL (NSCHL) that was diagnosed by histopathology after adrenalectomy and nephrectomy of what was initially thought to be an adrenocortical carcinoma (ACC). Early-stage HL patients receiving combinedmodality treatment, typically with ABVD followed by radiation therapy, obtain good disease control with the potential for cure.3 Although the standard treatment of HL involves consolidative radiation after two cycles of ABVD chemotherapy, our patient's combined-modality therapy consisted of surgery followed by ABVD because of the initial suspicion of ACC. Because of the complete surgical resection, radiation was not deemed necessary. The patient we present here was initially treated as an ACC patient, for which the standard is complete tumor resection.4 When pathology confirmed the tumor as primary adrenal HL stage Ia, the treatment was altered to the early-stage HL standard of care by following surgical management with ABVD chemotherapy. [...]we present the case of a patient with a unique primary adrenal NSCHL that was managed with complete surgical resection and chemotherapy.

IntroductionPreclinical studies suggest a potential link between glucagon-like peptide 1 receptor agonists (GLP-1RA) and thyroid cancer (TC), yet it is unclear if this risk translates to humans.Research design and methodsWe estimated the comparative effect of incretin-based therapies (GLP-1RA and dipeptidyl-peptidase-4 inhibitors (DPP-4i)) versus sodium-glucose cotransporter-2 inhibitors (SGLT-2i) on TC incidence among US older adults with type 2 diabetes. We defined TC as a thyroidectomy followed by ≥2 separate diagnoses codes for malignant neoplasm of thyroid gland within 90 days. We estimated adjusted 3-year cumulative risk differences of TC (aRDs) with 95% CIs using weighted Kaplan-Meier survival functions, and adjusted HRs using weighted Cox models.ResultsWe included 73 388 new users in the GLP-1RA versus SGLT-2i cohort (mean age 72.4 years, men: 48.3%) and 106 274 in the DPP-4i versus SGLT-2i cohort (mean age 74.6 years, men: 44.9%). At 3 years and a median duration of treatment of 0.82–1.15 years, the aRD for GLP-1RA versus SGLT-2i for TC was −23 per 10 000 (95% CI: −51 to 4) and the aRD for DPP-4i versus SGLT-2i was −2 per 10 000 (95% CI: −17 to 13). Secondary and sensitivity analyses were consistent.ConclusionsOur study of US Medicare beneficiaries with type 2 diabetes suggests that the initiation of incretin-based therapies may not increase the 3-year risk of TC compared with initiation of SGLT-2i. This finding offers reassurance for short-term use but does not eliminate the possibility of increased long-term or subtype-specific risks.

Fitness technologies such as wearables and sit-stand desks are increasingly being used to fight sedentary lifestyles by encouraging physical activity. However, adherence to such technologies decreases over time because of apathy and increased dismissal of behavioral nudges. To address this problem, we introduced shared autonomy in the context of sit-stand desks, where user input is integrated with robot autonomy to control the desk and reduce sedentary behavior and investigated user reactions and preferences for levels of automation with a sit-stand desk. As demographics affect user acceptance of robotic technology, we also studied how perceptions of nonvolitional behavior change differ across cultures (United States and India), sex, familiarity, dispositional factors, and health priming messages. We conducted a web-based vignette study in the United States and India where a total of 279 participants watched video vignettes of a person interacting with sit-stand desks of various levels of automation and answered questions about their perceptions of the desks such as ranking of the different levels of automation. Participants generally preferred either manual or semiautonomous desks over the fully autonomous option (P<.001). However, participants in India were generally more amenable to the idea of nonvolitional interventions from the desk than participants in the United States (P<.001). Male participants had a stronger desire for having control over the desk than female participants (P=.01). Participants who were more familiar with sit-stand desks were more likely to adopt autonomous sit-stand desks (P=.001). No effects of health priming messages were observed. We estimated the projected health outcome by combining ranking data and hazard ratios from previous work and found that the semiautonomous desk led to the highest projected health outcome. These results suggest that the shared autonomy desk is the optimal level of automation in terms of both user preferences and estimated projected health outcomes. Demographics such as culture and sex had significant effects on how receptive users were to autonomous intervention. As familiarity improves the likelihood of adoption, we propose a gradual behavior change intervention to increase acceptance and adherence, especially for populations with a high desire for control.