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Background The role of prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) imaging in the initial staging of men with prostate cancer (PCa) has yet to be evaluated adequately. Objective To investigate the concordance of PSMA PET/CT with conventional imaging (CI) with cross-sectional abdominopelvic and/or radionuclide bone imaging in the initial staging of patients with treatment-naive PCa. Design, setting, and participants We performed a post hoc retrospective cohort study of patients enrolled in a prospective single-arm trial ( NCT03368547 ). We included patients with intermediate-risk (IR) and high-risk (HR) PCa who underwent PSMA PET/CT within 6 mo of CI. Patients with any treatment prior to PSMA PET/CT were excluded. Patient- and tumor-specific data, and imaging findings were obtained. Outcome measurements and statistical analysis Our primary outcome measurement was the concordance rate of PSMA PET/CT with CI for the identification of N, M1a, M1b, and M1c disease. Descriptive statistics were used. Results and limitations A total of 168 patients with treatment-naive IR and HR PCa met the inclusion criteria. HR disease accounted for 124/168 (73.8%) patients. The median prostate-specific antigen was 11.4 (6.8–24.6) ng/ml. The rates of nonconcordance between PSMA PET/CT and CI were 34/162 (21.0%), 5/70 (7.1%), 8/92 (8.7%), and 1/71 (1.4%) for N, M1a, M1b, and M1c disease, respectively. PSMA PET/CT assigned a higher stage in 37/168 (22.0%) patients and a lower stage in 12/170 (7.1%) patients. In a subset of 50 patients treated with radical prostatectomy and pelvic lymph node dissection, the prevalence of PSMA PET/CT–positive and that of CI-positive nodal disease were 14% and 4%, and the false negative rates were 30% and 32%, respectively. The principal limitations of this study include the heterogeneity in CI modalities and the 6-mo time frame between CI and PSMA PET. Conclusions PSMA PET/CT imaging may serve as a valuable tool in the initial staging of treatment-naive IR and HR PCa. Patient summary We evaluated how prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) compared with standard imaging (such as computed tomography, bone scan, and prostate magnetic resonance imaging) for initial staging of patients with prostate cancer. Our findings suggest that PSMA PET/CT may detect and rule out more metastatic lesions, which could prove valuable in guiding treatment.

We reviewed the literature surrounding the role of opioids and their receptors in urological malignancy. Recent studies have suggested clinically significant effects of agonism or antagonism of opioid receptors on cancer related outcomes and tumorigenesis. The focus of these efforts has centered on nonurological malignancies. However, a compelling body of evidence is growing in the fields of prostate, bladder and kidney cancer.A systematic review of English language articles published through 2020 was conducted with key phrases related to kidney, bladder or prostate cancer, and opioids or narcotics. A total of 837 unique records were identified, of which 49 were selected for full text review and 33 were included in the qualitative analysis. Eight records were identified via citation review and 1 study was recently presented at a national meeting.Retrospective reviews suggest poorer disease specific and recurrence-free survival with increased perioperative opioid administration in patients undergoing prostate or bladder cancer surgery. However, the data are controversial. Kappa opioid receptors are implicated in both proliferation and inhibition of prostate cancer cell growth across in vitro studies, with a proposed interaction with the androgen cascade. Similarly opioid growth factor receptor is highly expressed in prostate cancer cells and repressed by androgens. Prostate cancer tissue stains more intensely for the mu opioid receptor, and patients with higher expression have poorer oncologic outcomes. Opioid agonism in vitro induces urothelial cell carcinoma proliferation, migration and invasion, with possible additional influence from interactions with the bradykinin b2 receptor. Agonism of the mu, kappa and delta opioid receptors induces renal cell carcinoma tumorigenesis, possibly via upregulation of survivin. Meanwhile, opioid growth factor receptor agonism has the opposite effect in renal cell carcinoma.Evidence surrounding the role of opioids and their receptors in urological malignancy is provocative and should serve as an impetus for further investigation.

Background Upper tract urothelial carcinoma (UTUC) is a heterogeneous disease that presents a clinical management challenge for the urologic surgeon. We assessed treatment patterns, costs, and survival outcomes among patients with nonmetastatic UTUC. Methods We identified 4114 patients diagnosed with nonmetastatic UTUC from 2004 to 2013 in the Survival Epidemiology, and End Results–Medicare population-based database. Patients were stratified into low- or high-risk disease groups. Median total costs from 30 days prior to diagnosis through 365 days after diagnosis were compared between groups. Overall and cancer-specific survival were evaluated using Cox proportional hazards regression. All statistical tests were 2-sided. Results After risk stratification, 1027 (24.9%) and 3087 (75.0%) patients were classified into low- vs high-risk UTUC groups. Most patients underwent at least 1 surgical intervention (95.1%); 68.4% underwent at least 1 endoscopic intervention. Patients diagnosed with high- vs low-risk UTUC were more likely to undergo nephroureterectomy (83.6% vs 72.0%; P Conclusions UTUC continues to be managed primarily with nephroureterectomy, regardless of risk stratification, and patients with high-risk UTUC have worse overall and cancer-specific survival. Substantial costs are associated with management of low- and high-risk UTUC, with the latter being more costly up to 1 year from diagnosis.

Introduction/Background* Vulvar cancer is a rare neoplasm of the female genital organs. In 2020, less than 1% of women in Poland was diagnosed with this disease. Nevertheless, it remains an important clinical problem due to its localization and therapeutic difficulties. The aim of the study was to investigate risk factors, treatment protocols, treatment outcomes, the prevalence of histopathological types and the quality of life of patients with vulvar lesions. Methodology The case-control retrospective study involved 138 patients hospitalized in 2010-2020 at the Department of Surgery and Gynecological Oncology, Medical University in Lodz, Poland. The prospective part of the study constituted follow-up that was carried out in the form of a telephone survey. The patients were divided into two groups: with benign lesions (Gr.B) and malignant (Gr.M). The data was statistically processed using the Statistica13.1 program. Result(s)* Malignant lesions were found in 43 patients (31.16%). Patients with benign lesions were significantly younger (57.79vs.69.67;p=0.003), had fewer pregnancies (1.76vs.268;p=0.0009) and gave birth less frequently (1,35vs.2.35;p=0.0002). There was no significant difference between the groups in BMI (p=0.7141), number of miscarriages (p=0.4469), time of menopause (p=0.1544) and smoking (p=0.5533)). In group M 86.05% of women had squamous cell carcinoma, 4.65% basal cell carcinoma, 2.33% vulvar melanoma and 2.33% extra-mammary Paget’s disease. There was a high positive correlation between tumor diameter and length of hospitalization (R=0.5523;p=0.0010) and a weak positive correlation between age and length of hospitalization (R=0.2835;p=0.0010). Five-year survival was found in 77.78% of women in total. In group B, improvement in the quality of life was noted in 42.86% of women who started treatment after hospitalization and 36.84% of women who did not start treatment. The changes in the quality of life between the groups were not statistically significant (p=0.9115). Conclusion* The anticipated facts were proven in the studied group: incidence of vulvar cancer was significantly higher in the postmenopausal women, the most common malignant neoplasm was keratinizing squamous cell carcinoma. The time of hospitalization increased with the increase in tumor diameter and the age of the woman. Treatment of women with benign lesions did not significantly improve the quality of life.

INTRODUCTION AND OBJECTIVE:Even though non-muscle invasive bladder cancer (NMIBC) has high costs care, the patient-level impact of this cost (“financial toxicity”) has been understudied. We describ...

INTRODUCTION AND OBJECTIVE:Historically, prognostic studies of intermediate-risk non-muscle invasive bladder cancer (IR-NMIBC) have focused on the risk of initial recurrence, yet little is known ab...

INTRODUCTION AND OBJECTIVE:The transurethral resection of bladder tumor (TURBT) is a common urologic procedure with a reported complication rate of about 5% according to administrative data. Howeve...

INTRODUCTION AND OBJECTIVE:Cost-effectiveness analysis (CEA) defines value in healthcare by quantifying the benefit of an intervention for a given dollar expense. Cost-utility analysis (CUA) is a t...

OBJECTIVE To describe the incidence, clinical and demographic factors, and treatment patterns associated with discordant elevated alpha-fetoprotein (AFP) findings in patients with pure seminomatous histology. METHODS We queried the National Cancer Database to identify patients with testicular germ cell tumors (GCT) diagnosed in 2011-2015. Patients were grouped based on histologic diagnosis and pre-operative serum AFP level. RESULTS Of 18,616 patients diagnosed with testicular GCT, 53% (N = 9,849) had pure seminomatous histology, of whom 8.3% (N = 821) had an elevated serum AFP pre-operatively. Non-white patients with seminoma were more likely to have a pre-op elevated AFP (OR 1.42; 95% CI: 1.10-1.83); patients treated at higher volume centers were less likely to have a pre-op elevated AFP (0.66, 95% CI: 0.53-0.83). Patients with seminoma with elevated AFP received adjuvant radiation more frequently than those with NSGCT (Stage I: 15% vs 0.2%, P

Background Monitoring surgical recovery has traditionally been confined to metrics measurable within the hospital and clinic setting. However, commercially available mobile sensors are now capable of extending measurements into a patient’s home. As these sensors were developed for nonmedical applications, their clinical role has yet to be established. The aim of this systematic review is to evaluate the relationship between data generated by mobile sensors and postoperative outcomes. Objective The objective of this study is to describe the current use of mobile sensors in the perioperative setting and the correlation between their data and clinical outcomes. Methods A systematic search of EMBASE, MEDLINE, and Cochrane Library from inception until April 2019 was performed to identify studies of surgical patients monitored with mobile sensors. Sensors were considered if they collected patient metrics such as step count, temperature, or heart rate. Studies were included if patients underwent major surgery (≥1 inpatient postoperative day), patients were monitored using mobile sensors in the perioperative period, and the study reported postoperative outcomes (ie, complications and hospital readmission). For studies including step count, a pooled analysis of the step count per postoperative day was calculated for the complication and noncomplication cohorts using mean and a random-effects linear model. The Grading of Recommendations, Assessment, Development, and Evaluation tool was used to assess study quality. Results From 2209 abstracts, we identified 11 studies for review. Reviewed studies consisted of either prospective observational cohorts (n=10) or randomized controlled trials (n=1). Activity monitors were the most widely used sensors (n=10), with an additional study measuring temperature, respiratory rate, and heart rate (n=1). Low step count was associated with worse postoperative outcomes. A median step count of around 1000 steps per postoperative day was associated with adverse surgical outcomes. Within the studies, there was heterogeneity between the type of surgery and type of reported postoperative outcome. Conclusions Despite significant heterogeneity in the type of surgery and sensors, low step count was associated with worse postoperative outcomes across surgical specialties. Further studies and standardization are needed to assess the role of mobile sensors in postoperative care, but a threshold of approximately 1000 steps per postoperative day warrants further investigation.

Postoperative ileus (POI) and constipation are common secondary effects of opioids and carry significant clinical and economic impacts. μ-Opioid receptors mediate opioid analgesia in the central nervous system (CNS) and gastrointestinal-related effects in the periphery. Peripherally acting μ-opioid receptor antagonists (PAMORAs) block the peripheral effects of opioids in the gastrointestinal tract, while maintaining opioid analgesia in the CNS. While most are not approved for POI or postoperative opioid-induced constipation (OIC), PAMORAs have a potential role in these settings via their selective effects on the μ-opioid receptor. This review will discuss recent clinical trials evaluating the safety and efficacy of PAMORAs, with a focus on alvimopan (Entereg®) and methylnaltrexone (Relistor®) in patients with POI or postoperative OIC. We will characterize potential factors that may have impacted the efficacy observed in phase 3 trials and discuss future directions for the management and treatment of POI.

To investigate treatment patterns of partial cystectomy (PC), neoadjuvant chemotherapy (NAC), lymph node dissection (LND), and treatment delays, and the associations with overall survival (OS) among patients with muscle-invasive bladder cancer.We identified patients with cT2-4cN0cM0 urothelial carcinoma of the bladder in the National Cancer Database who underwent PC from 2007 through 2015. We performed descriptive statistics and assessed temporal trends using the Cochrane-Armitage test. Our outcomes of interest were NAC, LND, and treatment delay defined as ≥8 or ≥12 weeks for patients who underwent NAC or upfront surgery, respectively. We used logistic regression and multivariable Cox proportional hazards models to evaluate predictors and associations with OS, respectively.A total of 9,199 patients met inclusion criteria. Over the study period, PC utilization decreased from 9% to 7% (P = 0.06). Compared with patients who underwent radical cystectomy, patients treated with PC less frequently received NAC (7% vs. 17%, P0.01) and LND (57% vs. 91%, P0.01), but were less likely to experience treatment delays (25% vs. 31%, P0.01). Only 4.1% (27/655) of patients treated with PC received the combination of NAC, LND, and no treatment delay. In a Cox model, adequacy of LND was associated with improved OS (10 nodes: HR 0.62, 95% CI 0.48-0.81 and ≥10 nodes: HR 0.48, 95% Cl 0.32-0.72).PC is uncommon and associated with poorer utilization of NAC and LND, but fewer treatment delays. The adequacy of LND was associated with improved OS while NAC and treatment delay were not.

Renal mass biopsy (RMB) may not be indicated when the results are unlikely to impact management, such as in young and/or healthy patients and in elderly and/or frail patients. We analyzed the utility of RMB in three patient cohorts stratified by age-adjusted Charlson comorbidity index score (ACCI).We identified patients with cT1a renal tumors in the National Cancer Database from 2004-2014. We combined age and Charlson-Deyo scores to identify young and/or healthy patients ('healthy-ACCI'), elderly and/or frail patients ('frail-ACCI'), and a reference cohort. We performed multivariable logistic regression to identify predictors of RMB and treatment. We evaluated the impact of RMB on management by analyzing the proportion of high-grade disease on final pathology as a surrogate for risk stratification.We identified 36,720 healthy-ACCI, 2,516 frail-ACCI, and 18,989 reference-ACCI patients. Healthy-ACCI patients were less likely to undergo RMB (7.5% versus 10.8%; p0.001) while frail-ACCI patients underwent RMB at similar rates (11.8% versus 10.8%; p = 0.14) compared with reference-ACCI patients. On multivariable logistic regression, in both healthy-ACCI and frail-ACCI patients, RMB was associated with decreased odds of surgical treatment, and increased odds of ablation and surveillance (all p0.01). In the frail-ACCI patients, higher grade disease at surgery was identified in the RMB cohort (32.9% versus 23.5%, p = 0.05).RMB is performed less frequently in healthy-ACCI patients compared with the reference cohort. RMB is associated with decreased odds of surgical treatment and increased odds of surveillance and ablation in all cohorts. In frail-ACCI patients who underwent surgery, RMB may provide additional risk stratification as these patients had lower rates of low-grade disease.

Background High-risk ureteral tumors represent an understudied subset of upper tract urothelial carcinoma, whose surgical management can range from a radical nephroureterectomy (NU) to segmental ureterectomy (SU). Objectives To evaluate contemporary trends in the management of high-risk ureteral tumors, the utilization of lymphadenectomy and peri-operative chemotherapy, and their impact on overall survival (OS). Design, setting, and participants We performed a retrospective cohort study of patients in the National Cancer Database from years 2006 to 2013 with clinically localized high-risk ureteral tumors treated with NU or SU. Outcome measurements and statistical analysis Chi-squared tests were utilized to assess differences in clinicodemographic features and peri-operative treatment delivery between SU and NU cohorts. Cochran-Armitage tests and linear regressions were performed to evaluate temporal trends in treatment utilization. Multivariable logistic regression models were employed to assess predictors of treatment delivery. Multivariable Cox proportional hazards models evaluated associations with OS. Results Of the 1,962 patients included, NU was more commonly performed than SU (72.4%, 1,421/1,962 vs. 27.6%, 541/1,962). Only 22.7% (446/1,962) of the population underwent lymphadenectomy, and 24.8% (271/1,092) of those with advanced pathology (≥pT2 or pN+) received adjuvant chemotherapy. Lymphadenectomy was associated with improved OS in NU patients when more than 3 nodes were removed (hazard ratio [HR] 0.58, 95% confidence interval [CI] 0.39–0.89). Receipt of adjuvant chemotherapy for advanced pathology had no impact OS in both the NU (HR 1.10, 95% CI 0.84–1.44) and SU (HR 0.94, 95% CI 0.61–1.46) cohorts. Performance of SU was not associated with poorer OS on multivariable analysis (HR 1.02, 95% CI 0.89–1.21, P = 0.83). Conclusion Our study suggests that SU may be an appropriate alternative to NU for the management of high-risk ureteral tumors. Further, lymphadenectomy may play an important role at the time of NU, and adjuvant chemotherapy is infrequently utilized in patients with advanced pathology.

INTRODUCTION AND OBJECTIVE:As novel treatments improve survival for patients with advanced kidney, bladder, and prostate cancer, the burden of these diseases shifts from mortality to morbidity. Pal...

To assess the impact of N-methylnaltrexone, a peripherally acting mu-opioid receptor antagonist, on the post-operative recovery of patients undergoing robotic-assisted radical cystectomy for bladder cancer. We retrospectively reviewed patients undergoing robotic-assisted radical cystectomy by a single surgeon (KC) prior to (control group) and after (treatment group) the routine use of N-methylnaltrexone. Kaplan–Meier curves and the log-rank test were used to quantify time to flatus, bowel movement, and discharge. Daily mean opioid use, daily pain assessment rating, and episodes of severe pain (7–10/10) were compared. Gastrointestinal-related complications, including ileus, emesis, and/or need for post-op nasogastric tube placement, and 30-day readmissions were also compared between groups. Charge capture data were compared between groups to analyze cost impact. 29 patients each in the control and treatment group met inclusion criteria. Patients receiving N-methylnaltrexone had reduced length of stay compared with no N-methylnaltrexone (median 4 vs. 7 days, p

Background Palliative care has an established role in improving the quality of life in patients with advanced cancer, but little is known regarding its delivery among patients with urologic malignancies. Objective To determine trends in the utilization of palliative interventions among patients with advanced bladder, prostate, and kidney cancer. Design, Setting, and Participants We performed a retrospective cohort study of patients from years 2004 to 2013 in the National Cancer Database diagnosed with stage IV bladder (n = 17,997), prostate (n = 23,322), and kidney (n = 34,697) cancer, after excluding those with missing disease stage, treatment, and outcomes data. Outcome Measurements and Statistical Analysis Descriptive statistics and logistic regression were performed to evaluate utilization of palliative care intervention. Utilization was analyzed by cancer type and by overall survival strata ( 24 months). Kaplan-Meier and Cox proportional hazards models analyzed overall survival. Results and Limitations Palliative interventions were utilized in 12.5% (2,257/17,997), 14.7% (3,442/23,322), and 19.9% (6,935/34,697) of advanced bladder, prostate, and kidney cancer patients, respectively. Older age and longer survival were associated with lower odds of palliative intervention utilization in each malignancy, as was minority race in kidney and bladder cancer patients. Palliative radiation was used most commonly, and utilization of any palliative intervention was associated with poorer overall survival. Limitations largely stem from imperfect data abstraction, and the analysis of interventions’ incomplete reflection of palliative care. Conclusions Palliative interventions were seldom used among patients with advanced urologic malignancies. Palliative interventions were less frequently used in older patients and minority races. Further study is warranted to define the role of palliative interventions in advanced urologic malignancies and guide their utilization.

Radical cystectomy (RC) is the standard of care for refractory high-risk non-muscle invasive bladder cancer (NMIBC). We aim to identify predictors of adequate lymph node dissection (LND) in a cohort of NMIBC patients undergoing RC, as well as its impact on clinical outcomes.The National Cancer Database was queried for patients who underwent RC for urothelial cell carcinoma for clinical stage Tis/a/1 N0M0 disease between 2004 and 2013. Patients were stratified by LND: none, inadequate (10) or adequate (≥10 nodes). Factors associated with LND were analyzed. Inverse-probability weighted propensity score matching was used to assess the impact of adequate LND on overall survival.The final cohort of 3,226 patients had a median follow-up of 39.0 months, had a mean age of 65.3 years, was 70% male, and was 81% Caucasian. Overall, 16.6% received no LND, 28.5% inadequate LND, and 55.0% adequate LND. Treatment at an academic facility, Charlson-Deyo Comorbidity score of 1, and later year of treatment were significantly associated with adequate LND. Overall survival was significantly higher with adequate LND compared to a matched-cohort of inadequate LND patients (68.7% vs. 60.6% at 5 years, P0.01).Nearly half of NMIBC patients undergoing RC do not receive an adequate LND, despite an association with increased overall survival. Treatment at an academic facility was associated with increased likelihood of adequate LND. Initiatives to improve adequate LND in this population may be warranted.

Background Rates of persistent urine leak after partial nephrectomy are reported in the range of 2-13%, of which many are technically preventable by intra-operative identification and repair of collective system injuries. We describe our technique and institutional experience utilizing intravenous sodium fluorescein, a xanthene die with rapid urinary excretion, at the time of tumor resection during partial nephrectomy for identification of collecting system injury. Methods Here, we present a video illustrating the utilization of sodium fluorescein for the intra-operative identification of collecting system injury. We retrospectively reviewed all patients who underwent robot-assisted partial nephrectomy with sodium fluorescein between 10/2017 and 5/2019 by a single surgeon (KC), and report clinicodemographic and tumor characteristics, as well as rates of post-operative urine leak. Results Over the study period, 48 patients underwent robot-assisted partial nephrectomy with intraoperative sodium fluorescein, of which 44 had follow-up data. Patients were 66.7% male, had a median age of 65 (IQR 54–72) years and median body mass index of 27.5 (IQR 24.4– 35.5) kg/m2. Mean tumor nephrometry score was 7.8 (±1.45), with a mean distance of 3.3mm (±4.0) from the collecting system. In cases performed with arterial clamping, 5mL of sodium fluorescein (100mg/mL) was injected intravenously by anesthesia as the clamp was removed following tumor resection. In cases performed off-clamp, sodium fluorescein was delivered after tumor resection. The video demonstrates three cases where sodium fluorescein aided in the identification and repair of a collecting system leak. There were no recorded urine leaks at time of final follow-up (median 198.6, IQR 20–289 days). Conclusions Sodium fluorescein is a simple technique for identification of collecting system injuries at time of partial nephrectomy. With the aid of sodium fluorescein, intra-operative collecting system leaks can be identified and repaired, potentially mitigating post-operative urine leaks and urinomas.

A radial basis function (RBF) neural network is examined for modeling of acoustical properties of colloidal TiO/sub 2/ slurry. The colloidal slurry is a very complex multiphase medium. The RBF network with a set of local Gaussian functions is trained using the data from a previously developed physical model of TiO/sub 2/ slurry. The TiO/sub 2/ neural model is used for a prediction of the TiO/sub 2/ particle size distribution. The resulting prediction accuracies of the RBF network is 99.8% of the data used in the training process and 88% for the data not used in the training. Compared to other available techniques neural networks can offer an effective and time efficient approach for the modeling of complex materials. >

A prototype model of an Acoustic Engine Oil Quality (AEOQ) sensor is presented. The AEOQ sensor utilizes changes in oil viscosity as an indicator of the oil quality. The supporting electronic circuitry employs a novel VCO based measurement set-up. The output signal from the VCO set-up is a DC voltage, which simplifies the accompanying circuitry, and is compatible with existing automotive electronics. Experimental results showed that the AEOQ sensor is capable of differentiating between engine oils of different grades and monitoring the degradation processes of oils due to their use in automotive engines and due to artificial contamination by dilution with water, ethylene glycol, and gasoline.

One of the important tasks in sensor design is the development of a model for a sensing phenomena. Artificial neural networks are ideal for such a task because of their capability for representation of the mapping functions describing the processes and phenomena which are mathematically difficult or even intractable. We examined a radial basis function (RBF) neural network for modeling of acoustical properties of colloidal TiO2 slurry. The colloidal slurry is a very complex multiphase medium. The RBF network with a set of local Gaussian functions was trained using the data from the earlier developed physical model of TiO2 slurry. Next the TiO2 neural model was used for a prediction of the TiO2 particle size distribution. The resulting prediction accuracies of the RBF network were 99.8% for the data used in the training process and 88% for the data not used in the training. Compared to other available techniques neural networks can offer an effective and time efficient approach for the modeling of complex materials.© (1993) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

This final analysis of hadronic and leptonic cross-sections and of leptonic forward-backward asymmetries in e+e- collisions with the OPAL detector makes use of the full LEP1 data sample comprising 161 pb^-1 of integrated luminosity and 4.5 x 10^6 selected Z decays. An interpretation of the data in terms of contributions from pure Z exchange and from Z-gamma interference allows the parameters of the Z resonance to be determined in a model-independent way. Our results are in good agreement with lepton universality and consistent with the vector and axial-vector couplings predicted in the Standard Model. A fit to the complete dataset yields the fundamental Z resonance parameters: mZ = 91.1852 +- 0.0030 GeV, GZ = 2.4948 +- 0.0041 GeV, s0h = 41.501 +- 0.055 nb, Rl = 20.823 +- 0.044, and Afb0l = 0.0145 +- 0.0017. Transforming these parameters gives a measurement of the ratio between the decay width into invisible particles and the width to a single species of charged lepton, Ginv/Gl = 5.942 +- 0.027. Attributing the entire invisible width to neutrino decays and assuming the Standard Model couplings for neutrinos, this translates into a measurement of the effective number of light neutrino species, N_nu = 2.984 +- 0.013. Interpreting the data within the context of the Standard Model allows the mass of the top quark, mt = 162 +29-16 GeV, to be determined through its influence on radiative corrections. Alternatively, utilising the direct external measurement of mt as an additional constraint leads to a measurement of the strong coupling constant and the mass of the Higgs boson: alfa_s(mZ) = 0.127 +- 0.005 and mH = 390 +750-280 GeV., 119 pages, 26 figures, submitted to Eur. Phys. J. C