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This study exposed adult Sydney rock oysters, of either sex or both, to the synthetic estrogen 17α-ethinylestradiol (EE2) at 50 ng/L for 21 days, followed by an examination of developmental endpoints and transcriptomic responses in unexposed larvae. Reduced survival was observed at 1 day post-fertilisation (dpf) in larvae from bi-parental exposure (F T M T ). Motile larvae at 2 dpf were fewer from maternal (F T M C ), paternal (F C M T ), and F T M T exposures. Additionally, shell length at 7 dpf decreased in larvae from F T M C and F T M T parents. RNA sequencing (RNA-seq) revealed 1064 differentially expressed genes (DEGs) in 1-dpf larvae from F T M T parents, while fewer DEGs were detected in larvae from F T M C and F C M T parents, with 258 and 7, respectively. GO and KEGG analyses showed significant enrichment of DEGs in diverse terms and pathways, with limited overlap among treatment groups. IPA results indicated potential inhibition of pathways regulating energy production, larval development, transcription, and detoxification of reactive oxygen species in F T M T larvae. qRT-PCR validation confirmed significant downregulation of selected DEGs involved in these pathways and relevant biological processes, as identified in the RNA-seq dataset. Overall, our results suggest that the intergenerational toxicity of EE2 is primarily maternally transmitted, with bi-parental exposure amplifying these effects., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: G R MacFarlane reports financial support was provided by Australian Research Council. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: Zinner Syndrome (ZS), a rare congenital malformation of the mesonephric duct, combines seminal vesicle cyst (SVC) with ipsilateral upper urinary tract abnormalities. Typically asymptomatic in childhood, ZS manifests between 2nd to 4th decades with bladder symptoms, perineal pain and infertility. Diagnostic confirmation with additional imaging is needed when either renal or seminal abnormalities are identified., Materials and Methods: A retrospective study spanning 22 years identified 20 pediatric ZS cases through clinical analytics. Demographic, clinical, and radiological data were analyzed, including presenting complaints, imaging modalities (ultrasound, CT, MRI), and surgical findings. The study was HIPAA-compliant and IRB-approved., Results: Among 20 cases (mean age: 7.3 years), clinical presentations included asymptomatic cases, urinary symptoms, and abdominal pain. Imaging revealed renal anomalies (agenesis, multicystic dysplastic kidney) and seminal vesicle abnormalities. Surgical interventions (n = 12) addressed symptomatic cases, often involving robotic or laparoscopic procedures., Discussion: ZS, though rare, presents with varied clinical features, necessitating a multidisciplinary approach. Early diagnosis is facilitated by prenatal identification of renal abnormalities. Surgical intervention is reserved for symptomatic cases, with techniques such as vesiculectomy and resection of remnant structures employed., Conclusion: This study highlights ZS's diverse clinical and radiological spectrum, emphasizing the need for vigilance in detecting overlapping entities. Timely identification, utilizing advanced imaging techniques, is crucial for accurate diagnosis and appropriate management of Zinner Syndrome in the pediatric population., Competing Interests: Conflict of interest None., (Copyright © 2024 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Background: Reports find that magnetic resonance elastography (MRE) and shear wave elastography (SWE) can classify intracranial tumors according to stiffness. However, systematic syntheses of these articles are lacking. In this report, a systematic review and meta-analysis was performed to evaluate whether SWE and MRE can predict meningioma and glioma grades., Methods: PubMed and Scopus were searched between February 10, 2022. and March 2, 2022. using manual search criteria. Eight out of 106 non-duplicate records were included, encompassing 84 patients with low-grade tumors (age 42 ± 13 years, 71% female) and 92 patients with high-grade tumors (age 50 ± 13 years, 42% female). Standardized mean difference in stiffness between high-grade and low-grade tumors were measured using a forest plot. The I 2 , χ 2 , and t tests were performed, and bubble plots were constructed to measure heterogeneity. An adapted QUADAS-2 scale evaluated study quality. Additionally, a funnel plot was constructed, and an Egger's intercept test determined study bias., Results: Low-grade tumors were stiffer than high-grade tumors (Cohen's D = -1.25; 95% CI -1.88, -0.62). Moderate heterogeneity was observed (I 2  = 67%; P = 0.006) but controlling for publication year (I 2  = 0.2%) and age (I 2  = 0.0%-17%) reduced heterogeneity. Included studies revealed unclear or high bias for the reference standard and flow and timing (>50%)., Conclusions: Elastography techniques have potential to grade tumors intraoperatively and postoperatively. More studies are needed to evaluate the clinical utility of these technologies., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Fertility preservation (FP) is an important aspect of the care of transgender patients in whom Gender Affirming Medical Treatment (GAT) may begin before puberty is completed. While there are overall few studies that can be used to guide conversations about long-term effects of GAT, there are concerns that GAT could negatively impact fertility. Prior studies have shown low utilization of FP in this population, with avoidance of delay in starting GAT cited as one of the most common reasons for foregoing FP. It is possible that strategies to mitigate delay in commencement of GAT can facilitate higher FP utilization, maintaining options for future family building., Objective: To describe our institution's experience with Testicular Sperm Extraction (TESE) for FP and Histrelin Acetate (Supprelin) Subcutaneous Implantation for GAT commencement., Study Design: A retrospective review of transfeminine adolescents at our institution from 2010 to 2022 who underwent TESE for FP at the time of Supprelin placement for GAT (FP/SP). Outcomes of interest included successful sperm retrieval, age at first visit to our institution's Transgender Multispecialty Service Health clinic (GeMS), age at time of FP/SP, testicular volume, and Tanner stage at time of FP/SP, and age when GnRH agonist (GnRHa) therapy was prescribed. Testosterone, LH, FSH, and Inhibin B values prior to combination FP/SP were also obtained., Results: Ten patients from 2017 to 2022 underwent FP/SP after prescription of GnRHa based on Endocrine Society Guidelines. Successful sperm retrieval and storage was achieved in all patients. Median age at FP/SP was fourteen years 5.5 months (range 12y5m-16y8m). Median time from GnRHa prescription to FP/SP was two months (range 2-5 m). Mean testicular volume at time of FP/SP was 13.2 cc (SD 3.38 cc, range 8-17 cc), and median Tanner Stage was IV (range III-V). Average testosterone level was 301.60 (SD 173.04), LH 3.00 (SD 1.25), FSH 3.33 (SD 1.71), Inhibin B 208.50 (SD 87.44)., Conclusions: Performing TESE for FP is feasible for transgender youth undergoing Histrelin implant placement, leading to short delays in starting GAT. Testicular volume and endocrine markers can provide preoperative insight into likelihood of successful sperm retrieval during TESE, are needed to identify which patients will have successful sperm retrieval to ensure optimal counseling and informed decision making for providers, patients and families., (Copyright © 2023. Published by Elsevier Ltd.)

This study assessed the ability of phosphorus (P) fertilizer to remediate the rhizosphere of three wild plant species (Banksia seminuda, a tree; Chloris truncata, a grass; and Hakea prostrata, a shrub) growing in a soil contaminated with total (aliphatic) petroleum hydrocarbon (TPH). Plant growth, photosynthesis (via chlorophyll fluorescence), soil microbial activity, alkane hydroxylase AlkB (aliphatic hydrocarbon-degrading) gene abundance, and TPH removal were evaluated 120 days after planting. Overall, although TPH served as an additional carbon source for soil microorganisms, the presence of TPH in soil resulted in decreased plant growth and photosynthesis. However, growth, photosynthesis, microbial activities, and AlkB gene abundance were enhanced by the application of P fertilizer, thereby increasing TPH removal rates, although the extent and optimum P dosage varied among the plant species. The highest TPH removal (64.66%) was observed in soil planted with the Poaceae species, C. truncata, and amended with 100 mg P kg -1 soil, while H. prostrata showed higher TPH removal compared to the plant belonging to the same Proteaceae family, B. seminuda. The presence of plants resulted in higher AlkB gene abundance and TPH removal relative to the unplanted control. The removal of TPH was associated directly with AlkB gene abundance (R 2  > 0.9, p < 0.001), which was affected by plant identity and P levels. The results indicated that an integrated approach involving wild plant species and optimum P amendment, which was determined through experimentation using different plant species, was an efficient way to remediate soil contaminated with TPH., (Crown Copyright © 2021. Published by Elsevier Inc. All rights reserved.)

This study examined the accumulation of As species, Se, Cu, Zn, Cd and Pb in the halophyte Juncus acutus, collected from three anthropogenically impacted estuaries in NSW, Australia. As concentration ranged from 4 to 22 μg/g at Georges River, 2-16 μg/g at Lake Macquarie and 6 μg/g at Hunter Estuary. Inorganic As was accumulated mainly in roots with low translocation to culm with a greater abundance of AsV. However, AsIII (TF = 0.32) showed greater mobility from the roots to shoots than AsV (TF = 0.04), indicating a higher quantity of AsIII specific transporter assemblages in the plasmalemma of the endodermis or cytoplasmic reduction of AsV to AsIII in culms. Metal(loid)s, including As (90%), were predominantly in root tissues and very limited translocation to culm, indicating the species is a useful phytostabiliser. As and all other metal(loid)s in roots were correlated with sediment loads (p < 0.05, R 2  = 0.10-0.52), indicating the species would be an accumulative bioindicator., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

An impact assessment of oceanic effluent releases from Belmont wastewater treatment works (WWTW) in Newcastle, Australia, was undertaken. Benthic infaunal assemblages in sandy sediments of ~25 m water depth were examined, at sites adjacent to the release point, and at increasing distances up to 2 km in both a NE and SW direction over five consecutive years (2016-2020). Localised impacts were evident for infaunal assemblages, with sites within 20 m of the outfall ("Impact" site types) exhibiting lower taxa richness and Shannon diversity, higher abundances of polychaetes and/or nematodes, higher polychaete ratios, and shifts in assemblage composition in comparison to sites at greater distances during some years. Taxa with increased localised abundances at the outfall were identified as indicators for monitoring impacts, including deposit-feeding polychaetes (Families Polygordiidae, Paraonidae and Dorvilleidae) and Phylum Nematoda. Future infaunal monitoring could include molecular tools and paired sediment analyses., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

We examined the patterns of uptake and partitioning of metal(loid)s in Suaeda australis from three highly urbanised estuaries (Sydney Olympic Park, Hunter Wetlands and Lake Macquarie) in NSW, Australia. Of these, Sydney Olympic Park was found to be the most contaminated estuary in terms of combined sediment metal(loid) load, followed by Hunter Wetlands and lowest in Lake Macquarie (via PERMANOVA). Uptake in roots was greater for the essential metals Cu and Zn along with the non-essential metal Cd and the metalloid Se (root BCFs >1) and lower for Pb and As (root BCFs <1). Substantial barriers for translocation from roots to stems were identified for all metal(loid)s (stem TFs; 0.07-0.68). Conversely, unrestricted flow from stems to leaves was observed for all metal(loid)s at unity or higher (leaf TFs ≥ 1). Strong linear relationships between sediment and root for Zn and Pb were observed, indicating roots as a useful bioindicator., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

The current study represents the first attempt to analyse quantitatively, within a phylogenetic framework, uptake and partitioning patterns of copper (Cu), zinc (Zn), cadmium (Cd) and lead (Pb) in extant saltmarsh taxa globally, and to assess associations of these patterns with various plant traits indicative of their halophytic adaptations. Despite saltmarsh being diverse taxonomically, most saltmarsh taxa accumulate metals to roots at, or above, unity (> 1). Further, there is significant translocation from roots to shoot for Cu, Zn and Cd (≤ 1), however, Pb is less mobile (TF = 0.65). Patterns of accumulation were similar among families, except greater Cd accumulation to roots in members of Juncaceae. Patterns of uptake to roots and translocation to leaves were broadly similar among plant type, plant form, habitat and photosynthetic mode. Zinc is lower in the leaves of salt-secreting species for some closely related taxa, suggesting some species co-excrete sodium (Na + ) and Zn 2+ through glands in leaf tissue. Salinity tolerance has no relationship to metal uptake and translocation. Translocation of Zn is greater at lower Zn sediment exposures, reflecting its active uptake and essentiality, but such bias does not affect outcomes of analyses when included as a covariate., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Remnant endangered saltmarsh communities in Australia often occur in urbanised estuaries where industrial processes have contaminated sediments with metal(loid)s. Despite this issue, virtually nothing is known on local plant species exposure to metal contaminants, nor their ability to uptake and translocate metal(loid)s from contaminated estuarine sediment. In the current study, we assessed the accumulation and partitioning of the metal(loid)s Zn, Cu, Pb, Cd and Se in the dominant saltmarsh primary producer, Sporobolus virginicus, across three urbanised estuaries in NSW Australia. Lake Macquarie was the most contaminated estuary, while Sydney Olympic Park, Port Jackson exhibited intermediate metal(loid) loadings and Hunter Wetlands exhibited the lowest loadings among estuaries. Essential metals (Zn and Cu) were more mobile, with sediment:root bioconcentration factors (BCFs) greater than unity and translocation among plant organs greater than, or equal to, unity. Other metal(loid)s were less mobile, with BCFs equal to unity and translocation factors among organs much reduced. Despite these barriers to translocation, all metal(loid)s were accumulated to roots with dose, and further accumulative relationships between metal(loid)s in roots and culms, and culms and leaves, were evidenced (with the exception of Cu). Along with sediment metal(loid)s, increases in sediment pH predicted Cu uptake in roots and increases in soil organic matter predicted Se uptake in roots. Although significant positive linear relationships were observed between sediment metal(loid)s and plant organ metal(loid)s(withholding Cu), the variance explained was low to intermediate for most metal(loid)s suggesting employing S. virginicus as an accumulative bioindicator would be impractical., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

The metal-binding protein metallothionein (MT) is widely used as a biomarker of metal contamination. In this study, we cloned a MT gene (sgMT) from the Sydney rock oyster Saccostrea glomerata. The gene encodes a MT-I protein with a classical αβ domain structure and is expressed as two transcripts resulting from alternative polyadenylation. The gene promoter contains two putative metal-responsive elements (MREs) which are known to be required for metal-inducible transcription. A specific and efficient qPCR assay was developed to quantify sgMT mRNA expression. Further, we assessed whether prior metal exposure history influences sgMT mRNA expression upon subsequent metal exposure. Oysters with varying prior metal exposure histories (contaminated and reference) were exposed to Cu, Cd and Zn. Expression of sgMT generally increased with metal dose, and oysters with an elevated past metal exposure history exhibited higher sgMT expression under Cd and Zn stress, representing a potential acclimatory response to prior metal exposure., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Introduction: Urethral meatotomy as treatment for meatal stenosis is a common pediatric urology procedure; however, little is known about the patient experience following this procedure., Objective: We aim to evaluate clinical factors associated with patient-reported symptom improvement after urethral meatotomy., Study Design: The families of boys undergoing urethral meatotomy between 2/2013 and 8/2016 received a survey by mail 6 weeks after surgery. Families were queried on changes in symptoms using a Likert-type scale (5 = much improved, 4 = somewhat improved, 3 = no change, 2 = somewhat worse, and 1 = much worse). Patient and procedure characteristics of the respondents were obtained via chart review. These included surgical indication(s) (abnormal stream, dysuria, or storage symptoms), postoperative complications, reoperation, and unplanned postoperative communications. Patients who had procedures other than simple urethral meatotomy were excluded. Descriptive statistics were compiled, and generalized estimating equations used to determine the associations of patient and procedure characteristics with symptom improvement., Results: We sent 629 surveys and received 194 responses (30.4%). Twelve respondents were excluded for complex procedures or miscoding. The majority of respondents were privately insured (74%) and were between 5 and 12 years old (45%) or 1 and 4 years old (42%). The most frequent surgical indication was abnormal stream (72%) followed by pain (21%) and storage symptoms (15.5%). Nine respondents had minor complications (4.9%). Four patients had restenosis requiring repeat urethral meatotomy. After surgery, a majority (79%) were "much improved," 16% were "somewhat improved," 3% had "no change," and 1% were "somewhat worse." No family reported "much worse." Those patients who had "abnormal stream" as a surgical indication were significantly more likely to report "much improved" (OR 1.83, p = 0.014) than those without. Patient-reported improvement was not associated with suture use, patient age, insurance, surgeon, or location of the procedure (Table)., Discussion: Little has been written about patient-reported outcomes following urethral meatotomy. Our study affirms that the majority of boys improve following this procedure. However, improvement is significantly more likely if the child has a preoperative indication of an abnormal stream, such as deflection or spraying. Boys with symptoms of dysuria, frequency, or incontinence may be experiencing sequelae of meatal stenosis that simply take longer to improve. Alternatively, the meatal stenosis may be incidental to the primary symptoms., Conclusions: A majority of families report substantial symptomatic improvement after urethral meatotomy. However, boys undergoing urethral meatotomy for reasons other than a urinary stream abnormality are less likely to experience improvement., (Copyright © 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Study Objective: To examine whether a robotic surgical platform can complement the fine motor skills of the nondominant hand, compensating for the innate difference in dexterity between surgeon's hands, thereby conferring virtual ambidexterity., Design: Crossover intervention study (Canadian Task Force classification II-1)., Setting: Centers for medical simulation in 2 tertiary care hospitals of Harvard Medical School., Participants: Three groups of subjects were included: (1) surgical novices (medical graduates with no robotic/laparoscopic experience); (2) surgeons in training (postgraduate year 3-4 residents and fellows with intermediate robotic and laparoscopic experience); and (3) advanced surgeons (attending surgeons with extensive robotic and laparoscopic experience)., Interventions: Each study group completed 3 dry laboratory exercises based on exercises included in the Fundamentals of Laparoscopic Surgery (FLS) curriculum. Each exercise was completed 4 times: using the dominant and nondominant hands, on a standard laparoscopic FLS box trainer, and in a robotic dry laboratory setup. Participants were randomized to the handedness and setting order in which they tackled the tasks., Measurements and Main Results: Performance was primarily measured as time to completion, with adjustments based on errors. Means of performance for the dominant versus nondominant hand for each task were calculated and compared using repeated-measures analysis of variance. A total of 36 subjects were enrolled (12 per group). In the laparoscopic setting, the mean overall time to completion of all 3 tasks with the dominant hand differed significantly from that with the nondominant hand (439.4 seconds vs 568.4 seconds; p = .0008). The between-hand performance difference was nullified with the robotic system (374.4 seconds vs 399.7 seconds; p = .48). The evaluation of performance for each individual task also revealed a statistically significant disparate performance between hands for all 3 tasks when the laparoscopic approach was used (p = .003, .02, and .01, respectively); however, no between-hand difference was observed when the tasks were performed robotically. On analysis across the 3 surgeon experience groups, the performance advantage of robotic technology remained significant for the surgical novice and intermediate-level experience groups., Conclusion: Robot-assisted laparoscopy may eliminate the operative handedness observed in conventional laparoscopy, allowing for virtual ambidexterity. This ergonomic advantage is particularly evident in surgical trainees. Virtual ambidexterity may represent an additional aspect of surgical robotics that facilitates mastery of minimally invasive skills., (Copyright © 2017 American Association of Gynecologic Laparoscopists. Published by Elsevier Inc. All rights reserved.)

Introduction: Ceritinib, 750 mg fasted, is approved for treatment of patients with ALK receptor tyrosine kinase gene (ALK)-rearranged (ALK-positive) NSCLC previously treated with crizotinib. Part 1 of the ASCEND-8 study determined whether administering ceritinib, 450 mg or 600 mg, with a low-fat meal may enhance gastrointestinal (GI) tolerability versus 750 mg fasted in patients with ALK-positive NSCLC while maintaining similar exposure., Methods: ASCEND-8 is a multicenter, randomized, open-label, phase 1 study. Part 1 investigated the steady-state pharmacokinetics (PK) and safety of ceritinib, 450 mg or 600 mg, taken with a low-fat meal versus 750 mg fasted in patients with advanced ALK-positive NSCLC who were either treatment naive or pretreated with chemotherapy and/or crizotinib. Part 2 will assess efficacy and safety of ceritinib in treatment-naive patients., Results: As of June 16, 2016, 137 patients were randomized (450 mg fed [n = 44], 600 mg fed [n = 47], and 750 mg fasted [n = 46]); 135 patients received ceritinib. Median follow-up duration was 4.14 months. At steady state, relative to 750 mg fasted, 450 mg with food demonstrated comparable PK as assessed by maximum (peak) concentration of drug in plasma and area under the plasma concentration-time curve from time zero to 24 hours, whereas 600 mg with food demonstrated approximately 25% higher PK. Relative to 750 mg fasted, 450 mg with food was associated with a lower proportion of patients with GI toxicities, mostly grade 1 (diarrhea [43.2%], nausea [29.5%], and vomiting [18.2%]); there were no grade 3 or 4 events, study drug discontinuations, or serious AEs due to GI toxicities., Conclusion: Ceritinib, 450 mg with food, had similar exposure and a more favorable GI safety profile than ceritinib, 750 mg in fasted patients with ALK-positive NSCLC., (Copyright © 2017 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.)

We aimed to determine if offspring of oysters from contaminated locations were more tolerant to metals, and whether this tolerance could be attributed to acclimation. Oysters from 10 estuaries were sampled, representing a gradient in metal contamination. Tolerance to metals of the F 1 offspring from adults residing in these estuaries was assessed. Then, adults from these estuaries were translocated to a single estuary and their offspring tolerance reassessed. No linear relationship was found between the Cu concentrations of adults and their offspring's tolerance to Cu. A positive linear relationship was found between the Zn concentration of adults and the Zn EC 50 's of their offspring. Zn tolerance was lost after translocation. Zn EC 50 values of offspring from transplanted adults bore no relation to the Zn EC 50 's of their location of origin. Thus the initial tolerance observed could be attributed to acclimation transferred to the F 1 generation., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Vitellogenin (Vtg) is a well-established biomarker of estrogenic exposure in aquatic animals. In vertebrates, Vtg gene transcription is controlled by the estrogen receptors (ERs). Although an ER ortholog is present in molluscs, its role as a transcriptional regulator remains elusive. Here, we tested the hypothesis that in the Sydney rock oyster, Saccostrea glomerata, the ER ortholog activates Vtg gene transcription through specific interaction with its promoter. Luciferase reporter assays indicated that sgER activated both a minimal promoter containing the consensus estrogen-responsive elements (EREs) and the sgVtg promoter in an estrogen-independent manner. The sgVtg promoter-luciferase activation was significantly reduced when any of three putative ERE half sites (½EREs) in the promoter were mutated. Electrophoretic mobility shift assay (EMSA) confirmed that sgER binds specifically to a 68-bp promoter sequence where these ½EREs reside. Overall, the results suggest that sgER is a constitutively active transcription factor that binds and activates the sgVtg promoter., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Introduction: We sought to compare complications and direct costs for open ureteral reimplantation (OUR) versus robot-assisted laparoscopic ureteral reimplantation (RALUR) in a sample of hospitals performing both procedures. Anecdotal reports suggest that use of RALUR is increasing, but little is known of the outcomes and costs nationwide., Objective: The aim was to determine the costs and 90-day complications (of any Clavien grade) in a nationwide cohort of pediatric patients undergoing OUR or RALUR., Methods: Using the Premier Hospital Database we identified pediatric patients (age < 21 years) who underwent ureteral reimplantation from 2003 to 2013. We compared 90-day complication rates and cost data for RALUR versus OUR using descriptive statistics and hierarchical models., Results: We identified 17 hospitals in which both RALUR and OURs were performed, resulting in a cohort of 1494 OUR and 108 RALUR cases. The median operative time was 232 min for RALUR vs. 180 min for OUR (p = 0.0041). Incidence of any 90-day complications was higher in the RALUR group: 13.0% of RALUR vs. 4.5% of OUR (OR = 3.17, 95% CI: 1.46-6.91, p = 0.0037). The difference remained significant in a multivariate model accounting for clustering among hospitals and surgeons (OR, 3.14; 95% CI, 1.46-6.75; p = 0.0033) (Figure). The median hospital cost for OUR was $7273 versus $9128 for RALUR (p = 0.0499), and the difference persisted in multivariate analysis (p = 0.0043). Fifty-one percent (55/108) of the RALUR cases occurred in 2012-2013., Discussion: We present the first nationwide sample comparing RALUR and OUR in the pediatric population. There is currently wide variation in the probability of complication reported in the literature. Some variability may be due to differential uptake and experience among centers as they integrate a new procedure into their practice, while some may be due to reporting bias. A strength of the current study is that cost and 90-day postoperative complication data are collected at participating hospitals irrespective of outcomes, providing some immunity from the reporting bias to which individual center surgical series' may be susceptible., Conclusions: Compared with OUR, RALUR was associated with a significantly higher rate of complications as well as higher direct costs even when adjusted for demographic and regional factors. These findings suggest that RALUR should be implemented with caution, particularly at sites with limited robotic experience, and that outcomes for these procedures should be carefully and systematically tracked., (Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Introduction: In pediatric urology, partial nephrectomy is used primarily to remove a non-functioning renal moiety in a duplicated system. There are few data on infants undergoing this procedure. As such, we present a robot-assisted laparoscopic lower pole partial nephrectomy in an infant., Methods: Our patient was an 11-month-old (10.7 kg) male with a history of prenatal hydronephrosis, who was diagnosed postnatally with a duplicated right collecting system and severe hydroureteronephrosis of the right lower collecting system. A DMSA scan demonstrated no radiotracer uptake in the right lower pole. A robot-assisted laparoscopic lower pole partial nephrectomy was performed., Results: A lower pole partial nephrectomy was accomplished. At 1 month postoperatively, an ultrasound demonstrated no hydronephrosis or perinephric fluid collection., Conclusions: Robotic partial nephrectomy is safe and feasible in pediatrics including both older children and infants. It is successful for both upper and lower pole partial nephrectomies., (Copyright © 2016. Published by Elsevier Ltd.)

Hypoxia alters sex hormone concentrations leading to reproductive impairment in fish; however the mechanisms underlying these effects remain largely unknown. Using zebrafish (Danio rerio), this study is the first to demonstrate that hypoxia causes endocrine disruption by simultaneously acting on multiple targets along the brain-pituitary-gonadal (BPG)-liver axis in fish. Alterations in the expression of key genes associated with reproductive endocrine pathways in the brain (sGnRH), pituitary (FSHβ and LHβ), gonads (FSH-R, LH-R, HMGR, StAR, CYP19A, CYP11A, CYP11β and 20β-HSD), and liver were correlated with significant reductions of estradiol in females and testosterone in males. Hypoxia also induced sex-specific and tissue-specific changes in the expression of estrogen, androgen, and membrane progestin receptors along the BPG axis, suggesting disruption of the feedback and synchronization of hormone signals. Furthermore, the hypoxia-induced upregulation of hepatic sex hormone-binding globulin suggests an increase in hormone transport and reduced bioavailability in blood, while upregulation of hepatic CYP3A65 and CYP1A in females suggests an increase in estrogen biotransformation and clearance. Given that the regulation of reproductive hormones and the BPG-liver axis are highly conserved, this study provides new insights into the hypoxia-induced endocrine disrupting mechanisms and reproductive impairment in other vertebrates., (Copyright © 2014 Elsevier Inc. All rights reserved.)

The lack of a specific marker differentiating early mycosis fungoides (eMF) from benign inflammatory dermatitis presents significant difficulties in the assessment and management of suspected MF patients, which often leads to delayed diagnosis and improper medical approaches. To address this, an investigation was carried out to characterize positive identification markers for eMF by comparing eMF lesions with healthy skin and benign inflammatory dermatitis, using high-throughput genomic transcription profiling. A total of 349 genes were differentially expressed in eMF lesions compared with normal skin. These genes belong to pathways associated with inflammation, immune activation, and apoptosis regulation. Most of them (N=330) also demonstrated significant upregulation in chronic dermatitis, making them nonideal markers for eMF. Among them, 19 genes with specific enrichment in eMF lesions were identified that showed no significant upregulation in chronic dermatitis. Two of them, TOX and PDCD1, showed high discrimination power between eMF lesions and biopsies from benign dermatitis by RNA expression. Furthermore, TOX demonstrated highly specific staining of MF cells in eMF skin biopsies in immunohistochemistry and immunofluorescence, including the early epidermotropic cells in Pautrier's microabscesses. This study demonstrates the potential of eMF-enriched genes, especially TOX, as molecular markers for histological diagnosis of eMF, which currently is a major diagnostic challenge.

Hypoxia triggers a broad range of gene responses that are primarily mediated by the transcription factor, hypoxia-inducible factor-1 (HIF-1) that complexes with the transcriptional coactivator CREB-binding protein/p300 (CBP/p300). In mammals, members of the CBP/p300-interacting transactivators with ED-rich tail (CITED) family, such as CITED2 and CITED4, bind CBP/p300 with high affinity and thereby negatively regulate HIF-1 transactivation. In fish, we have previously shown that two CITED3 homologues from the hypoxia-tolerant grass carp (Ctenopharyngodon idellus) are induced by hypoxia/HIF-1 and able to inhibit HIF-1 transactivation. Here we report the identification and functional characterization of the grass carp CITED1 (gcCITED1) protein as a new repressor of HIF-1-mediated transcriptional activity. Expression of gcCITED1 mRNA was increased in heart, kidney and liver in vivo after exposure to hypoxia. Luciferase reporter and ChIP assays, respectively, indicated the inducibility of the gcCITED1 promoter by gcHIF-1 and the in vivo binding of gcHIF-1 to the gcCITED1 promoter. Ectopic overexpression of gcCITED1 significantly attenuated HIF-1-dependent transactivation of a HRE-luciferase reporter gene. Furthermore, GST pull-down confirmed that gcCITED1 specifically binds via its CR2 domain to the CH1 region of the grass carp p300 coactivator. Overall, our findings suggest that the hypoxia/gcHIF-1-inducible gcCITED1 may function in a negative feedback loop to regulate gcHIF-1 activity in response to hypoxia stress., (Copyright (c) 2010 Elsevier Ltd. All rights reserved.)

Teleost choriogenins, precursors of the inner layer subunits of the egg envelope, are regarded as sensitive biomarkers for estrogenic pollutants. In this study, two full-length cDNAs, omChgH and omChgL, which encode the choriogenin H and L forms, respectively, were isolated from a brackish medaka, Oryzias melastigma. 17beta-Estradiol (E2; 10 microg/L)-dependent expression of omChgH and omChgL was observed starting at embryonic stage 34 and restricted exclusively to the liver. In hatchlings, E2 induction of omChgH was stronger than that of omChgL. Static exposure of adult fish to E2 (0, 1, 10, 100, and 500 ng/L), 17alpha-ethinylestradiol (EE2; 0, 1, 10, 100 and 500 ng/L), 4-nonylphenol (NP; 0, 1, 10, 100, and 200 microg/L), and bisphenol A (BPA; 0, 1, 10, 100, and 200 microg/L) in artificial seawater for 7 days resulted in dose-dependent induction of both genes in the liver. In the male livers, the sensitivity of omChgH to these estrogenic compounds was higher than that of omChgL; the lowest-observed-effect concentrations (LOECs) of E2, EE2, NP, and BPA on omChgH were 10 ng/L, 10 ng/L, 100 microg/L and 100 microg/L, respectively, and on omChgL were 100 ng/L, 100 ng/L, 100 microg/L, and 200 microg/L, respectively. All these suggest that omChgH can be used as a highly sensitive biomarker for monitoring estrogenic chemicals in the marine environment.

Polybrominated diphenyl ethers (PBDEs) are additive flame retardants that have been found in the environment as well as human tissues. Environmental concentrations of these compounds have been increasing in many parts of the world in recent years. Due to their structural similarity, PBDEs are believed to have similar toxicity to PCBs, but their toxicological properties are still being determined. In this study, the steroidogenic effects of hydroxylated, methoxylated and/or chlorinated derivatives of PBDEs were assessed at both the gene and enzyme/hormone levels in the H295R human adrenocortical carcinoma cell line. The expression levels of 10 steroidogenic genes were measured using quantitative real-time PCR (Q-RT-PCR). Aromatase activity in the cells and sex steroid (testosterone (T) and 17beta-estradiol (E2)) concentrations in the culture medium were also measured. CYP11B2, which regulates the synthesis of aldosterone, was the most sensitive gene and was induced by most of the compounds tested in this study. CYP19 gene expression, aromatase activity, and E2 production were also affected by several metabolites, but no consistent relationship was observed between these endpoints. Several PBDE metabolites showed some potential ability to interfere with steroidogenesis, including 5-Cl-6-OH-BDE-47, a biologically relevant BDE-47 metabolite, which significantly decreased aromatase activity and E2 production at a concentration of 10 microM. The results of this study indicate that PBDE metabolites affect steroidogenesis in vitro and that they may have the potential to affect steroidogenesis and reproduction in whole organisms.

The present studies were undertaken to evaluate the utility of the H295R system as an in vitro assay to assess the potential of chemicals to modulate steroidogenesis. The effects of four model chemicals on the expression of ten steroidogenic genes and on the production of three steroid hormones were examined. Exposures with individual model chemicals as well as binary mixtures were conducted. Although the responses reflect the known mode of action of the various compounds, the results show that designating a chemical as "specific inducer or inhibitor" is unwise. Not all changes in the mixture exposures could be predicted based on results from individual chemical exposures. Hormone production was not always directly related to gene expression. The H295R system integrates the effects of direct-acting hormone agonists and antagonists as well as chemicals affecting signal transduction pathways for steroid production and provides data on both gene expression and hormone secretion which makes this cell line a valuable tool to examine effects of chemicals on steroidogenesis.