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Objectives: The aim of this study was to establish a tool to identify patients at risk for pharmaceutical and surgical interventions for benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTS) over a 10 year follow-up. Methods: The data of patients with mild to moderate male LUTS undergoing phytotherapy from January to December 2010 were reviewed. Patients were followed for 10 years through medical visits and telephone consultations. The outcomes were (1) treatment switch from phytotherapy or no therapy to alpha-blockers or 5α-reductase inhibitors (5-ARI), and (2) clinical progression (acute urinary retention or need for surgery). Two calibrated nomograms (one for each outcome) were constructed on significant predictors at multivariate analysis. Results: A total of 107 patients with a median age of 55 years at presentation were included; 47% stopped or continued phytotherapy, while 53% switched to alpha-blockers and/or 5-ARI after a median time of 24 months. One-third in the second group experienced clinical progression after a median time of 54 months. Age, symptom score, peak flow rate (Qmax), prostate-specific antigen (PSA), and post-void residual volume were significantly associated with the outcomes. According to our nomograms, patients switching therapy or progressing clinically had average scores of 75% and 40% in the dedicated nomograms, respectively, as compared to 25% and 75% and >40% for high risk and

Background: Hypertension (HTN) is a global public health issue. There are limited data regarding the effects of HTN in patients undergoing partial nephrectomy (PN) for renal tumors. To address this void, we tested the association between HTN and renal function after minimally invasive PN (MIPN). Methods: Using a multi-institutional database (2007–2017), we identified patients aged ≥ 18 years with a diagnosis of cT1 renal tumors treated with MIPN. Kaplan–Meier plots and Cox regression models addressed newly-onset CKD stage ≥ 3b or higher (sCKD). All analyses were repeated after 1:1 propensity score matching (PSM). Results: Overall, 2144 patients were identified. Of those, 35% (n = 759) were yes-HTN. Yes-HTN patients were older, more frequently male and more often presented with diabetes. Yes-HTN patients harbored higher RENAL nephrometry scores and higher cT stages than no-HTN patients. Conversely, yes-HTN patients exhibited lower preoperative eGFRs. In the overall cohort, five-year sCKD-free survival was 86% vs. 94% for yes-HTN vs. no-HTN, which translated into a multivariable HR of 1.67 (95% CI: 1.06–2.63, p = 0.026). After 1:1 PSM, virtually the same results were observed (HR 1.86, 95% CI: 1.07–3.23, p = 0.027). Conclusions: Yes-HTN patients exhibited worse renal function after MIPN when compared to their no-HTN counterparts. However, these observations need to be further tested in a prospective cohort study.

A posterior reconstruction (PR) might improve the fluidity and delicacy of the maneuvers related to the neovesico-urethral anastomosis during robotic-assisted radical cystectomy (RARC). Our objective is to describe in detail the surgical steps of PR and to assess its feasibility and functional outcomes. The data regarding patients undergoing a totally intracorporeal RARC with neobladder and PR for high-grade and/or muscle-invasive urothelial cancer of the bladder at Karolinska University Hospital between October 2015 and November 2016 by a single surgeon (PW) were reviewed. Prior to the anastomosis, a modified posterior Rocco’s repair involving the Denonvillier’s fascia, the rhabdosphincter, and the posterior side of the ileal neobladder neck was performed. The steps are shown in a video at https://doi.org/10.1089/vid.2019.0029 . The primary outcome was urinary continence; the secondary outcomes were urinary leakage, intermittent catheterization, and complications related to the reconstructive steps. Eleven male patients with a median age and BMI of 67 years and 24, respectively, underwent RARC with PR associated to the neovesico-urethral anastomosis. Overall and posterior reconstruction time were 300′ (195–320) and 6′ (4–7), respectively. The daytime and nighttime continence rates were 100% and 44% at 12 months, respectively; the median pad weight was 3.5 g and 108 g at daytime and nighttime, respectively. One urinary leakage from the urethrovesical anastomosis was treated conservatively. Two patients perform intermittent catheterization. The posterior reconstruction during RARC is safe and feasible, providing good continence rates. It supported a careful suturing of the anastomosis as well as an uncomplicated catheter placement.

To assess the implementation and outcomes of telemedicine in a Department of Urology in Northern Italy during the outbreak of the Covid-19 pandemic.All the outpatient clinical activities during the 4 weeks following the national lockdown (March 9-April 3, 2020) in the Department of Urology of the Trento Province, Italy, were reviewed and categorized. Expert staff members examined the electronic records, selecting whether the clinic appointments should be canceled or confirmed (via telephone consultation or face-to-face visit). The rate, indication, and modality of visits were investigated.Overall, 415 of 928 (45%) scheduled patients canceled their clinic appointment themselves or were canceled by staff members without rescheduling. The remaining 523 (55%) cases were screened undergoing telephone consultation in 295 (56%) and face-to-face visit in 228 (44%). The rate of face-to-face visit decreased from 63% to 9% during week 1 and 4, respectively. Seventy-four percent of face-to-face visits regarded suspected recurrent or new onset malignancy or potentially dangerous clinical conditions (severe urinary symptoms or complicated urinary stones or infection). The median age of patients in the face-to-face and telephone groups was 59 (range 20-69) and 65 years old (range 37-88), respectively.A pandemic is a dynamic scenario, requiring reorganization and flexibility of the healthcare delivery. Forty-five percent visits were canceled without rescheduling. Although a minimum portion of face-to-face visit (10% 1 month after the lockdown) was preserved mostly for suspected malignancy or potentially life-threatening conditions, telemedicine proved a pragmatic approach allowing efficient screening of cases and adequate protection for patients and clinicians.

Distributed measurements are important in many application fields, from environment to biomedicine. In both cases, the sensor nodes employed in the measurement network have to satisfy many requirements; among them, the most important ones are: i) low power consumption, ii) miniaturization, iii) adequate accuracy, and iv) capability of multi-parameter measurement. This paper presents a Vector Impedance Analyser (VIA) architecture that satisfies these main requirements. The architecture is specifically devised to be interfaced with an array of impedimetric sensors for environmental applications, such as distributed water monitoring, or for mobile-Health/wearable biomedical devices. The proposed architecture is based on delta-sigma digital-to-analogue (D/A) conversion for the generation of the low-noise excitation and on band-pass delta-sigma analogue-to-digital (A/D) conversion for the low-power and high-accuracy acquisition of the impedimetric sensor response. The proposed combination of delta-sigma D/A and A/D conversion allows to i) implement many measurement cores in a single silicon chip with reduced dimensions, ii) achieve a fair accuracy/power trade-off, and iii) tune the operative frequency in real time so as to span the target portion of the frequency domain. A prototype of the VIA is implemented in a 3 × 6-cm PCB board to investigate the potentialities of the architecture. The low-noise analogue circuits of the architecture are implemented in an Application Specific Integrated Circuit (ASIC), while part of the digital circuits are implemented on a commercial microcontroller for better testability purposes. The prototype embeds four independent cores to allow real-time multi-parameter measurement. To prove the performance of the proposed VIA, the prototype is characterized in terms of noise (input-referred noise between 20 mΩ and 70 mΩ in 10-Hz bandwidth, i.e. from 25 to 92 ppm of the full scale), accuracy (average uncertainty of 0.14% of the full scale for the magnitude and 0.72° for the argument, accounting for the limited accuracy of the reference instrument used for calibration), and power consumption (approximately 125 mW per-core including the power consumption of the microcontroller and the ancillary circuits used for power management and communication). The multi-parameter measurement capability is demonstrated by the realistic case-study of estimating the concentration of total dissolved solids in a potassium chloride (KCl) solution by means of direct concurrent measurements of conductivity and temperature.

Objectives To evaluate the importance of leukocyturia in detecting the transition from asymptomatic bacteriuria to symptomatic infection in women with recurrent urinary tract infections. Methods In this cross-sectional study, we evaluated all women with recurrent urinary tract infection and asymptomatic bacteriuria who had been enrolled in two previous studies. Data from urological visits, urine analyses and microbiological evaluations were collected. Patients were divided into two groups: patients with symptomatic recurrence (group A) and patients without recurrence (group B), with a mean follow-up period of 38.8 months. Data on leukocyturia and clinical data were compared. Logistic regression analyses were carried out and areas under the receiver operating characteristic curves were calculated. Results A total of 301 women with symptomatic urinary tract infection were included in group A, whereas 249 women without clinical infection were included in group B. Group A showed a higher level of leukocytes in the urinary analysis taken at the moment of recurrence when compared with the baseline value (mean leukocytes per high power field 54 ± 5 vs 19 ± 6 at baseline; P 150% from baseline was used for logistic regression, the area under the receiver operating characteristic of the model was 0.82 (95% CI 0.78-0.94; P = 0.01). An increase of leukocytes/mm3 of >150% from baseline had a sensitivity of 90.1% and a specificity of 91.2% for symptomatic urinary tract infection. Conclusions This study shows that an increase of leukocyturia of >150% from baseline has a predictive role for the transition from asymptomatic bacteriuria to symptomatic urinary tract infection in women with recurrent urinary tract infections.

Nowadays, even if the “machine learning” term has degenerated into a buzz-word, it encloses a large framework of techniques that has recently demonstrated a disruptive change of the performance in a large number of application, thanks to the increased amount of data and novel approaches to treat them. Some parts of these framework (such as multivariate analysis) have been known since a long time, however they have been rediscovered and improved thanks to this new application trend. In this paper we will show how the extraction of the information in sensing could be dramatically improved on the basis of multivariate analysis techniques. We demonstrate the capabilities in a novel compact implementation of a soil moisture sensor based on a contactless microwave impedance spectroscopy technique.

The effect of Fe and Mn content in mixed perovskites (La0.6Sr0.4Mn1-xFexO3-?) on the performance of solar thermochemical CO2 splitting is studied. Catalyst were tested by thermogravimetric analysis (TGA) and activity tests in a lab-scale reactor. On increasing the Fe content the temperature at which reduction is activated decreases. Conversely, the oxidation step is favored by high Mn content. Results show that for optimizing both reduction and oxidation step bi-functional systems with two active sites are needed. One site should enhance the self-reduction activity, the other should enhance the oxidation reaction.

Background To compare the surgical outcomes of radical prostatectomy (RP) performed via 3 different approaches: retropubic (RRP), laparoscopic-assisted (LRP), and robot-assisted (RARP), in a single non-academic regional center by a single surgeon. Materials and methods The data of patients undergoing RP from 2005 to 2014 were reviewed. The standard approach changed through the years: RRP (n = 380, years 2005 to 2008), LRP (n = 240, years 2009 to 2011), and RARP (n = 262, years 2012 to 2014). Our analysis included the last consecutive 100 RP for each surgical technique by a single surgeon. A logistic regression model adjusted for pre-and postoperative variables was done to evaluate whether transfusion, conversion, and post-operative complication rates were influenced by the approach. Results RARP was associated with significantly lower blood loss (400 vs. 600 and 600 ml, respectively), transfusion (6 vs. 21 and 21%, respectively), and shorter hospital stay (6 vs. 7 and 8 days, respectively), compared to LRP and RRP, and a lower conversion rate (1 vs. 12%) compared to LRP. Multivariate analysis adjusted for confounders confirmed that the risk of transfusion and conversion was significantly lower in the RARP group compared to the LRP and RRP groups. The RARP group was also associated with a significantly lower risk of complications compared to the RRP group and with a trend in favor of the RARP group compared to the LRP group. The 1-year continence rate was significantly higher in the RARP group compared to the RRP and LRP groups (80 vs. 72 and 68%, respectively). Conclusion The surgical approach affected the operative outcomes in a regional setting. The advantages of RARP over RRP (complications, transfusion, conversion, hospital stay, 1-year continence) were over LRP as well, with the only exception being complications.

Introduction The aim of this study was to evaluate the current literature on single-session bilateral endoscopic surgery for renal stones, analyzing their effectiveness and safety. Evidence acquisition A systematic literature review was performed to identify articles published between 1995 and July 2016 that reported data on bilateral single-session endoscopic surgery for renal stones. Articles were separated into the following categories: bilateral PCNL, bilateral FURS and bilateral PCNL with contralateral FURS. We used a narrative synthesis for the analyses of the studies. Evidence syntesis Five reports of bilateral FURS were identified in the literature search. These studies included a total of 218 patients that underwent bilateral FURS for renal stones. The primary SFR ranged from 64% to 92.8%. Postoperative complications were mostly described as minor complications; one major complication (0.5%) (grade V) was reported. Thirteen reports of bilateral PCNL were identified. These case studies included a total of 729 patients undergoing bilateral PCNL for renal stones. The primary SFR ranged from 24% to 100%. In all the studies a total of 29 (4%) major complications were described: 28 of them grade III while one was grade IV. One single study of bilateral PCNL with contralateral FURS for renal stones was identified. This report included 26 patients and the primary SFR was 92.3%. Two major complications (7.7%) (Grade III) were described. Conclusions Bilateral single-session endoscopic procedures for bilateral renal stones are effective and safe. It should be considered a viable treatment option in carefully selected patients, performed by experienced urologists in high-volume centers. Key to success is the proper selection of patients and extending surgery on the second side only when the first side has been uneventful.

Purpose: We aim to evaluate the efficacy of pollen extract in association with vitamins in patients affected by chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and to evaluate the level of the pro-inflammatory mediators interleukin (IL)-6, IL-8, and IL-10. Materials and Methods: Patients diagnosed with CP/CPPS between January and December 2015 were enrolled in this study. Participants were randomly assigned to receive oral capsules of pollen extract and vitamins (group A) or bromelain (group B) for 3 months. At the enrolment time and 3 months after enrolment, all patients completed questionnaires (the National Institutes of Health Chronic Prostatitis Symptom Index [NIH-CPSI] and the Short Form-36 and underwent urological examinations and microbiological evaluation. Levels of IL-6, IL-8, and IL-10 were evaluated in seminal plasma. Results: Sixty-five male patients (mean age of 32.7±4.7 years) were analysed (group A, n=32; group B, n=33). At the follow-up examination, 24 of the 32 patients in group A showed a significant reduction in the NIH-CPSI total score compared with 8 of the 33 patients in the bromelain group (p＜0.001). Moreover, the mean level of IL-8 was significantly lower in the pollen extract and vitamins group when compared with the bromelain group (298 pg/mL vs. 736 pg/mL, respectively; p＜ 0.001). In group A we found a statistically significant reduction in the levels of IL-8 between enrolment and the follow-up visit (878 pg/mL vs. 298 pg/mL, respectively; p＜0.001). Conclusions: Treatment with pollen extract and vitamins improved the quality of life in CP/CPPS patients by reducing the levels of pro-inflammatory IL-8.

Objective: In the last years there is a growing interest in nutraceutical substances that seems able to improve clinical symptoms in patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). In this paper, we evaluated both efficacy and safety of a combination of daidzein with isolase and zinc in patients with LUTS due to BPH. Materials and methods: In a phase I-II study clinical trial we enrolled patients with clinical and instrumental diagnosis of LUTS associated to BPH that received a six-month treatment with a combination of daidzein with isolase and zinc (1 tablet/day). Clinical, laboratory and instrumental analyses were carried out at the time of admission (T0) and 6 months after the ending of the treatment (T1). The Italian version of International Prostatic Symptom Score (IPSS), International Index of Erectile Function (IIEF-5) and Quality of Well-Being (QoL) questionnaires were used. The development of adverse drug reactions (ADRs) and drug interactions (DDIs) were recorded using the Naranjo scale and drug interaction probability scale. Student’s t test and Anova test were used for statistical analysis, and the threshold of statistical significance was set at P < 0.05. Results: We enrolled 71 patients, 62 (87.3%) completed the follow-up and we documented a significant differences between T0 and T1 in terms of IPSS [21.5 ± 1.2 vs 16.2 ± 1.5; (-4.8); p < 0.001], Cmax [9.7 ± 3.7 vs 15.3 ± 2.5; (+5.6); p < 0.001] and QoL [0.56 ± 0.15 vs 0.84 ± 0.19; (+0.28); p < 0.001]. In contrast, no significant difference were recorded in terms of IIEF-5 [p = 0.50] and PSA [p = 0.67]. Finally, we did not record any significant ADRs or DDIs during the study. Conclusions: In this study, we documented that a combination of daidzein with isolase and zinc, reduces the clinical symptoms of LUTS and improves the quality of life in patients with BPH, without the development of ADRs or DDIs.

Mixed perovskites, whose composition can be described by the formula La0.6Sr0.4Mn1-xFexO3 with x ranging from 0 to 1, were prepared and tested as potential catalysts for the solar thermochemical water splitting. The increase of the iron amount improves the reduction step giving higher oxygen production at lower temperature. On the other hand, the reactivity towards H2O seems to be favored by high Mn contents, while the H2 amount produced during splitting tests shows a behavior resembling that of O2 amount evolved during TGA. The results reported in this work indicates the route for the preparation of catalysts with larger intrinsic H2 productivity and lower reduction/oxidation temperature by the combination of two "phases", the first showing good self-reduction, the second with good reactivity towards water splitting.

Liposarcoma accounts for 20% of all sarcomas and is a rare occurrence in the paratesticular region. We present the case of a 66-year-old man with a massive liposarcoma of the right scrotum invading the lower limb and the abdominal wall skin. The case concerns an unusually large and aggressive liposarcoma (25 cm), presenting with multiple lung and nodal metastases. The patient had an unfavourable evolution with rapid progression of metastases, although there were no signs of local disease. In this case, a wide local excision was performed in order to obtain local control of the disease. Even though paratesticular sarcomas might have a more favourable evolution, the association with lung involvement carries an ominous prognosis. Diagnosis of paratesticular sarcoma should be kept in mind in case of irregular necrotic masses in the inguinal and scrotal region.

Recent studies of CO2 sorption on low-cost metal oxides strongly encourage their use as sorbents [Alfè, PROCI, 2015] in CO2 capture and storage (CCS) strategies. Magnetite (Fe3O4, FM) and CO2 interaction proceeds through acid-base interactions involving unsaturated metal and O sites exposed on FM surface. The FM sorption capacity is lowered by the tendency of magnetite particles to agglomerate causing a decrease of the exposed surface area. The dispersion of magnetic particles on carbon-based solid matrices has been proposed to face this limitation. Thanks to their low-cost, high surface area and porosity, carbonized biomasses are good candidates for supporting FM phase. Rice husk (RH) is an agricultural residue abundantly available in rice producing countries, obtained during the milling of paddy (22 wt. % of the weight of unmilled rice is received as husk). It presents a high ash content, which is 92 to 95% silica, highly porosity and a high surface area. RH is a green material that has a great potential for technological applications since it can be converted to different types of fuels and chemical feedstocks through a variety of thermochemical conversion processes. Following the same approach presented in our previous works on the CO2 capture performances of FM supported on a carbon-based reference material (carbon black) [Alfè, PROCI, 2015; Gargiulo, App. Surf. Sci. 2016], the synthesis and characterization of RH/FM composite materials were performed. A set of RH/FM composites were produced by varying the amount of carbonized RH from 20 to 80 wt.% in order to optimize the sorbent properties for CO2 adsorption applications. Preliminary data about the CO2 sorption capacity were also obtained.

One intriguing route for in vivo imaging, as well as drug delivery, is the use of core-shell type structures that effectively allow confinement or protection of both tracers and/or drugs in the inner core. Actually, a capsule-like configuration with different compartments to encapsulate both hydrophilic and hydrophobic agents is highly desirable, since it could allow smart combination of drugs (hydrophilic/hydrophobic) thus maximizing therapeutic efficacy, while reducing drug resistance as well as side effects [1]. Silica gel can act as a hydrophilic biocompatible compartment for hydrophilic drugs. Here, we propose a synthetic strategy to obtain oil core-multilayered shell nanocapsules (Fig. 1) [1]. In situ deposition of tunable silica shells was carried out directly around a mono-disperse oil in water nano-emulsion system [1,2] stabilized by polymer bilayers via layer-by-layer (LBL) approach. The lipophilic core – with a size ranging from 100 to 200 nm – shows the ability to confine high payloads of lipophilic tracers (CdSe quantum dots, Nile Red) or drugs (Paclitaxel). The polymeric inter-layers can be independently exploited if properly functionalized – as demonstrated by conjugating chitosan with fluorescein isothiocianate. Modified Stober method was optimised to obtain a continuous outer silica shell, with tuneable thickness as drawn from morphological analysis through TEM microscopy (Fig. 2). Furthermore, it was coated with polyethylenglycol (PEG), to confer antifouling properties. It can be loaded with hydrophilic drugs, as demonstrated by embedding sulforhodamine B. Finally, monitoring of free silicic acid by a colorimetric assay proved complete degradation of silica shell in a physiological medium (SBF) within three days. Such numerous features in a single nanocarrier system make it very intriguing as a multifunctional platform for smart diagnosis and therapy. Fig. 1. Schematic representation of the emulsion templated silica-biopolymer nanocapsules for theranostic and co-delivery. Each compartment can be exploited to add functionalities to the final nanocarrier

Wide-bandwidth lossless current sensors are critical in numerous applications, from current monitoring in DC-DC converters to non-invasive load monitoring. CMOS Hall sensor is a low-cost solution for current sensing and can be easily integrated as part of mixed-signal system-on-chips (SoCs). State-of-the-art CMOS Hall sensors offer only limited acquisition bandwidths of a few hundred kHz. This paper presents a 1 MHz Hall current sensor SoC integrating a broadband CMOS Hall sensor, two 2 MS/s ADCs and a multi-mode digital compressive sensing encoder for data rate reduction. The complete SoC is implemented in a STM 0.16 µm BCD technology, and occupies 16 mm2 while consuming less than 94 mW at 1.8 V.

To evaluate the effectiveness and safety of supine bilateral percutaneous nephrolithotomy (BPCNL) performed in the same session in patients affected with bilateral renal calculi.We retrospectively identified patients with bilateral renal stones with diameters2 cm for each side, who had been treated with supine BPCNL in the same session, from November 2006 to April 2014. We reviewed demographic and stone characteristics, intraoperative and perioperative outcomes, and complications related to the procedure adopted. The stone size was calculated by measuring the maximum stone diameter by computed tomography scan. Stone-free rate was defined as clinically insignificant when residual fragments of ≤2 mm were detected by computed tomography scan.Twenty-five patients were included in the study; the mean age was 51.9 ± 11.4 years; the mean maximum stone diameter per renal unit was 3.1 ± 0.8 cm. Statistical significant differences in creatinine serum levels were detected at day 1 postoperatively compared with the baseline (P .0001) values that became insignificant at 1 week and 1 month postoperatively (P.05). The primary stone-free rate was 80%; ancillary procedures were performed in 3 of 25 patients (12%). Grade I complications occurred in 3 patients (12%), grade II in 4 patients (16%), and grade IIIA in 1 patient (4%).Supine BPCNL performed in the same session is a safe and effective procedure in patients affected with bilateral renal calculi. On the other hand, it is still a very challenging operation, and consequently, it should be performed only by experienced surgeons in a tertiary center.

The therapeutic efficacy for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is currently unsatisfactory. The aim of the present study was to assess the safety and efficacy of pollen extract in association with vitamins (DEPROX 500®) in males with CP/CPPS. All patients with a diagnosis of CP/CPPS attending the same urologic centre between March and October 2012 were enrolled in this randomised controlled phase III study. Participants were randomised to receive oral capsules of DEPROX 500® (two capsules every 24 h) or ibuprofen (600 mg, one tablet three times a day) for four weeks. The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), International Prostate Symptom Score and Quality of Well-Being (QoL) questionnaires were used. In the intention-to-treat analysis, 87 males (25 class IIIa and 62 class IIIb) with a mean age of 33.6±5.9 years were randomly allocated to the DEPROX 500® (n=41) or ibuprofen (n=46) treatment groups. At the follow-up examination (following one month of treatment), in the DEPROX 500® group, 31/41 patients (75.6%) reported an improvement in quality of life, defined as a reduction of the NIH-CPSI total score by ≥25%, compared with 19/46 (41.3%) in the control group (P=0.002). The greater improvement in the DEPROX 500® group compared with the ibuprofen group was statistically significant (treatment difference in the NIH-CPSI pain domain, −2.14±0.51, P

We report a case of an uncommon site of metastasis of a renal cell carcinoma. The most common sites of renal cell carcinoma metastasis are the lung, lymph nodes, liver, bone and adrenal glands; skeletal muscle metastasis is a rare occurrence. We report the case of a 75-year-old female who underwent a laparoscopic left radical nephrectomy for a renal neoplasm in 2011. The histological examination revealed the presence of a renal cell carcinoma, Fuhrman grade 2, with extensive necrosis and phlogosis areas (TNM 2009 RCC pT2a). Ten months later, the patient noted an indolent swelling on the proximal third of the right thigh and underwent a ultrasonographic and CT evaluation, documenting the presence of a pathological, solid bulk in the front of the right iliac vessels and in the rectus femoris muscle. The fine needle biopsy revealed a metastasis of renal cell carcinoma. The patient underwent 4 cycles of sunitinib therapy, followed by 3 cycles of salvage therapy with sorafenib, which were well tolerated. This unpredictable behaviour of RCC suggests the need to perform a thorough follow-up of patients.

To evaluate the safety of laparoscopic radical nephrectomy (LRN) for renal cell carcinoma (RCC)7 cm, addressing the issue of modality and risk factors for complications and open conversion, and to assess the oncologic outcome.The data of 222 patients undergoing LRN for RCC7 cm prospectively enrolled from 2002 to 2010 at 5 urologic centers were reviewed. Transperitoneal LRN was performed by 5 experienced laparoscopic surgeons. The Clavien-Dindo classification was used to assess complications. Multivariable analysis of factors predictive of conversions was performed. Oncologic outcomes for survival were estimated using the Kaplan-Meier method.Median tumor size was 8.5 cm, operative time was 180 minutes, and blood loss was 280 mL. Forty-two patients (19%) received a blood transfusion. Six (2.7%) patients had grade III-IV complications: 2 with postoperative bleeding requiring abdominal re-exploration and 1 each with adrenal injury, splenic injury, wound diastasis, and respiratory insufficiency. Twelve patients (5.4%) were converted to open surgery. The diameter was 11.9 in converted groups and 8.5 cm in nonconverted groups (P = .001). Multivariable analysis revealed that pathologic stage was the only independent predictor of conversion (P = .002). The 5-year overall (OS), cancer-specific (CSS), and progression-free (PFS) survival was 74%, 78%, and 66%, respectively. The 5-year stage-adjusted CSS was 89% in pT2 and 40% in pT3 patients (P .0001). Limitations of this study were its retrospective nature and the relatively short follow-up period for oncologic outcome.LRN for large RCC is a safe operation. Stage pT3 is a risk factor for open conversion and is associated to significantly lower cancer-specific survival compared with pT2 stage.

This study aimed to evaluate whether the interleukin-6 (IL-6) and interleukin-10 (IL-10) ratio (IL-6/IL-10) can be used as a prognostic marker of recurrence following bacillus Calmette-Guerin (BCG) therapy in patients with high-risk non-muscle invasive bladder cancer (NMIBC). One hundred and twenty-one consecutive urological patients (72 affected by high-risk NMIBC and 49 controls) were selected for this prospective study. Urine samples for dipstick and interleukin analyses were collected from each subject before surgery. All patients underwent transurethral resection of bladder tumours (TUR-BT), followed by six weekly BCG instillations. IL-6 and IL-10 concentrations in urine were determined by solid phase ELISA Quantikine IL-6 and IL-10 Immunoassay. Patients with NMIBC were stratified in accordance with IL-6/IL-10: group A ≤0.09 and group B >0.10. The main outcome measures were time to first recurrence and recurrence rate following BCG therapy. At enrolment, IL-6/IL-10 was not statistically different between patients and controls (p=0.763, degrees of freedom (df)=1, F-test result (F)=0.092). Of the 72 patients with NMIBC, 38 (52.7%) had an IL-6/IL-10 of ≤0.09 (group A), while 34 (47.3%) had an IL-6/IL-10 of >0.10 (group B). A significant difference between IL-6/IL-10 and status at follow-up was found (p=0.016, df=1, χ2=5.800). The Kaplan-Meier curves demonstrated that group B patients had a significantly higher probability of being recurrence-free than group A patients [p=0.003; recurrence rate (RR)=3.1]. At multivariate analysis, IL-6/IL-10 (p

The insertion of proper coils to generate a magnetic field, with controlled gradient, in a standard thermogravimetric apparatus is shown to be a valid solution to measure on-line, upon heat treatment, the magnetic susceptibility in ribbon shaped samples of a metastable ferromagnetic material. The method is very useful to individuate the annealing conditions that optimise soft or hard magnetic properties without using separate apparatuses for heat treatment, control of the structural phase transition and characterization of magnetic susceptibility.

Aim: To evaluate the efficacy of a new sclerotization technique with pure ethanol in the treatment of symptomatic renal cysts. Patients and Methods: Fourteen patients having renal cysts with a meant diameter of 10 (range 5–15) cm were treated. Our technique includes: ultrasound-guided percutaneous puncture with an 18-gauge needle, positioning of a 5-Fr catheter, complete cyst fluid aspiration, injection of pure alcohol equal to 15% of the initial cyst volume, and alcohol aspiration after 90 min. The procedure was repeated eight times within 5 days. The patients were followed up by ultrasound and/or CT scan for 1 year. Results: All patients became symptom free. Follow-up showed a progressive reduction of the cyst diameter in all cases. Three cysts only (in 2 patients; cyst diameter Conclusions: In our experience, injections of pure ethanol in renal cysts, repeated after some days, were effective in eliminating recurrences and related symptoms. The procedure was not associated with significant complications. Our findings suggest that it be considered the first-choice procedure in the treatment of renal cysts, due to the good results and the low cost of ethanol.

A new metallic glass alloy characterized by high amplitude of magnetoelastic waves was synthesized. X-ray spectra evidenced the amorphous structure in the as-cast material, while differential thermal analysis confirmed the metastable initial phase and the occurrence of several crystallization peaks. The alloy shows a high difference between the grass transition and crystallization temperatures. Several heat treatments were performed and the structural relaxation effects were shown by means of the behavior of magnetization, Curie temperature and the resonant magneto-elastic wave amplitude. The strong increase of the last parameter, induced by the occurrence of the amorphous structure, is the most important result for application. Magnetic and magneto-elastic properties deteriorate if crystallization occurs, but in the optimal condition a partial nanocrystallisation may be present.

A retrospective study was conducted to determine incidence and predisposing factors of incisional hernia after an emergency midline laparotomy.The study population consisted in 197 patients of whom 138 were followed-up for 2 years after surgery.An incisional hernia developed in 25 (18.1%) patients at a mean follow-up of 11.2 months. Multivariate analysis showed the importance of age (60 years, p0.004), obesity (p0.008) and occurrence of post-operative wound infection (p0.00001) for the development of an incisional hernia. Univariate analysis showed that intestinal occlusion (p0.02), peritonitis (p0.006), upper abdominal access (p0.04) and post-operative wound infection (p0.003) in older patients and obesity (p0.003) and the presence of a neoplasm (p0.006) in younger patients, played a significant role. The comparison between young and old patients showed that upper abdominal access (p0.007), interrupted and layered wound closure (p0.02 and p0.01, respectively) and contamination of the operative field (p0.004) played a statistically significant role in older patients.The rate of incisional hernia after an emergency midline laparotomy is higher than after elective procedures. However, it could be reduced with proper attention to the suture technique, i.e. mass and continuous suture, better preparation of the operative field and scrupulous sterility throughout the procedure in order to decrease the incidence of post-operative wound infection.