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Most stars in our Galaxy form in stellar aggregates, which can become long-lived structures called open clusters (OCs). Along their dynamical evolution, their gradual depletion leave some imprints on their structure. In this work, we employed astrometric, photometric and spectroscopic data from the \textit{Gaia} DR3 catalogue to uniformly characterize a sample of 60 OCs. Structural parameters (tidal, core and half-light radii, respectively, $r_t$, $r_c$ and $r_h$), age, mass ($M_{\textrm{clu}}$), distance, reddening, besides Jacobi radius ($R_J$) and half-light relaxation time ($t_{rh}$), are derived from radial density profiles and astrometrically decontaminated colour-magnitude diagrams. Ages and Galactocentric distances ($R_G$) range from 7.2$\,\lesssim\,$log($t.$yr$^{-1}$)$\,\lesssim\,$9.8 and 6$\,\lesssim\,R_G$(kpc)$\,\lesssim\,$12. Analytical expressions derived from $N$-body simulations, taken from the literature, are also employed to estimate the OC initial mass ($M_{\textrm{ini}}$) and mass loss due to exclusively dynamical effects. Both $r_c$ and the tidal filling ratio, $r_h/R_J$, tend to decrease with the dynamical age (=$t/t_{rh}$), indicating the shrinking of the OCs' internal structure as consequence of internal dynamical relaxation. This dependence seems differentially affected by the external tidal field, since OCs at smaller $R_G$ tend to be dynamically older and have smaller $M_{\textrm{clu}}/M_{\textrm{ini}}$ ratios. In this sense, for $R_G\lesssim8\,$kpc, the $r_h/R_J$ ratio presents a slight positive correlation with $R_G$. Beyond this limit, there is a dichotomy in which more massive OCs tend to be more compact and therefore less subject to tidal stripping in comparison to those less massive and looser OCs at similar $R_G$. Besides, the $r_t/R_J$ ratio also tends to correlate positively with $R_G$., Comment: 21 pages, 15 figures. Accepted for publication in MNRAS

Lines contribute to the visual experience of drawings. People show a higher preference for curved than sharp angled lines. We studied preference for curvature using drawings of commonly-used objects drawn by design students. We also investigated the relationship of that preference with drawing preference. Experiments 1 and 2 revealed preference for the curved drawings in the laboratory and web-based contexts, respectively. Experiment 3 showed that the curved drawings were also preferred to draw than the sharp-angled ones. However, this effect only appeared when the drawings were made by hand, but not when they were made by computer. We found a moderate positive correlation between liking and drawing preference. This relationship was mainly explained by the hand-made drawings. Sex, art experience and openness to experience did not influence preference for curvature. Altogether, our findings support the curvature effect and the hypothesis that people prefer to draw what they like to see.

A number of stellar open cluster (OC) pairs in the Milky Way occupy similar positions in the phase space (coordinates, parallax and proper motions) and therefore may constitute physically interacting systems. The characterization of such objects based on observational data is a fundamental step towards a proper understanding of their physical status and to investigate cluster pair formation in the Galaxy. In this work, we employed Gaia EDR3 data to investigate a set of 16 OCs distributed as seven stellar aggregates. We determined structural parameters and applied a decontamination technique that allowed to obtain unambiguous lists of member stars. The studied OCs span Galactocentric distances and ages in the ranges ~7 < $R_G$ (kpc) < ~11 and 7.3, Accepted for publication in MNRAS

We present the results of a chemical analysis of fast and anomalous rotator giants members of the young open cluster NGC 6124. For this purpose, we carried out abundances of the mixing sensitive species such as Li, C, N, Na, and 12C/13C isotopic ratio, as well as other chemical species for a sample of four giants among the seven observed ones. This study is based on standard spectral analysis technique using high-resolution spectroscopic data. We also performed an investigation of the rotational velocity ($v\, \sin \, i$) once this sample exhibits abnormal values – giant stars commonly present rotational velocities of few km s−1. In parallel, we have performed a membership study, making use of the third data release from ESA Gaia mission. Based on these data, we estimated a distance of d = 630 pc and an age of 178 Myr through isochrone fitting. After that procedure, we matched all the information raised and investigated the evolutionary stages and thermohaline mixing model through of spectroscopic Teff and $\log \, g$ and mixing tracers, such as 12C/13C and Na, of the studied stars. We derived a low mean metallicity of [Fe/H] = −0.13 ± 0.05 and a modest enhancement of the elements created by the s-process, such as Y, Zr, La, Ce, and Nd, which is in agreement with what has already been reported in the literature for young clusters. The giants analysed have homogeneous abundances, except for lithium abundance [$\log \, \epsilon$(Li)NLTE = 1.08 ± 0.42] and this may be associated with a combination of mechanisms that act increasing or decreasing lithium abundances in stellar atmospheres.

PURPOSE: We aimed to report the morbidity profile of salvage radical prostatectomy (SRP) after radiotherapy failure and assess the impact of minimally invasive surgery (MIS) on postoperative complications and functional outcomes. MATERIALS AND METHODS: Between 1985 and 2019, a total of 293 patients underwent SRP; 232 underwent open SRP and 61 underwent laparoscopic SRP with or without robotic assistance. Complications were recorded and classified into standardized categories per the Clavien-Dindo classification. RESULTS: Twenty-nine patients (10%) experienced grade 3 complications within 30 days, 22 (9.5%) after open and 7 (11%) after MIS (p=0.6). Between 30 to 90 days after surgery, 7.3% of patients in the open group and 10% in the MIS group had grade 3 complications (p = 0.5). The most common complication was bladder neck contracture (BNC), representing 40% of the 30–90 day complications. Within one year of SRP, 81 patients (31%, 95% C.I. 25%, 37%) developed BNC; we saw non-significant lower rates in MIS (25% vs 32%; p=0.4). Functional outcomes were poor after SRP, and showed no difference between open and MIS groups for urinary continence (16% vs 18%, p=0.7) and erectile function (7% vs 13%, p=0.4). Five year cancer-specific survival and overall survival was 95% and 88% for the entire cohort, respectively. CONCLUSIONS: Our outcomes suggest poor functional recovery after SRP, regardless of the operative approach. Currently there is no evidence favoring the use of open or MIS approach. Further studies are required to ensure comparable outcomes between these approaches.

In this study, we characterized 16 objects previously classified as faint or low-contrast Galactic open clusters (OCs). We employed parameters associated with the dynamical evolution of the OCs: the core (rc), tidal (rt) and half-mass (rhm) radii, age and crossing time (tcr). Relations among these parameters were exploited to draw some evolutionary connections. We also included 11 OCs with previous characterizations to provide wider coverage of the parameter space. The investigated sample spans a considerable range in age, log (t yr−1) ∼7.0–9.7, and Galactocentric distance, RG ∼ 6–11 kpc). Most of these OCs present solar metallicity. We employed Gaia Data Release 2 astrometry and photometry, and we selected member stars through a decontamination algorithm that explores the three-dimensional astrometric space (μα, μδ, ϖ) to assign membership likelihoods. Previous studies of most of these objects were based mostly on photometric information. All investigated OCs were proved to be real stellar concentrations. The relations among their parameters indicate a general disruption scenario in which OCs tend to be more concentrated as they evolve. Internal interactions sucessively drive OCs to develop more dynamically relaxed structures and make them less subject to mass loss due to tidal effects. Tidal radius tends to increase with RG in accordance with the strength of the Galactic tidal field. Besides, the correlation between rc and the dynamical ratio τdyn = age/tcr suggests two distinct evolutionary sequences, which may be a consequence of different initial formation conditions.

OBJECTIVE To examine a set of proposed eligibility factors for hemi-ablative focal therapy in prostate cancer and to determine the likelihood of residual extensive disease. METHODS We retrospectively analyzed data from 98 patients with unilateral prostate cancer on biopsy with detailed tumor maps from whole-mount slides and preoperative magnetic resonance imaging data. These patients met the focal therapy consensus meeting inclusion criteria (prostate-specific antigen

The "super-active surveillance" concept denotes any active surveillance optimization that allows longer surveillance periods, with the main intention of avoiding overtreatment, by safely eliminating or postponing radical treatment. Super-active surveillance might add to the oncological control with minimal functional impact and similar quality of life compared to active surveillance, which has proved to be safe in well-selected patients. Vascular targeted photodynamic therapy has pioneering shown to significantly reduce the upgrade on subsequent biopsies, resulting in fewer cases converted to radical therapy, and any energy source can be applied to the super-active surveillance concept allowing more men to consider a tissue-preserving therapy for prostate cancer.

OBJECTIVE To investigate the effectiveness of combination treatment of vascular targeted photodynamic therapy and anti-cytotoxic T-lymphocyte-associated antigen 4 immunotherapy in a mouse model of urothelial carcinoma. METHODS We used C57BL/6 mice injected with murine bladder 49 cell line. Mice were randomly allocated into four treatment groups: vascular targeted photodynamic therapy only, anti-cytotoxic T-lymphocyte-associated antigen 4 only, combination therapy and control. We carried out three separate experiments that used distinct cohorts of mice: tumor growth and development of lung metastases monitored with bioluminescent imaging (n = 91); survival evaluated with Kaplan-Meier curves (n = 111); and tumor cell population studied with flow cytometry (n = 20). In a fourth experiment, we re-challenged tumors in previously treated mice and compared tumor growth with that of naive mice. RESULTS Combination therapy provided significant benefits over the other three treatment groups: prolonged survival (P

We report the discovery of 34 new open clusters and candidates as a result of a systematic search carried out in 200 adjacent fields of 1x1 square degrees area projected towards the Galactic bulge, using Gaia DR2 data. The objects were identified and characterized by a joint analysis of their photometric, kinematic and spatial distribution, which has been consistently used and proved to be effective in our previous works. The discoveries were validated by cross-referencing the objects position and astrometric parameters with the available literature. Besides their coordinates and astrometric parameters, we also provide sizes, ages, distances and reddening for the discovered objects. In particular, 32 clusters are closer than 2 kpc from the Sun, which represents an increment of nearly 39% of objects with astrophysical parameters determined in the nearby inner disk. Although these objects fill an important gap in the open clusters distribution along the Sagittarius arm, this arm, traced by known clusters, appears to be interrupted, which may be an artifact due to the incompleteness of the cluster census., Comment: 5 pages, 4 figures, Accepted in MNRAS Jan-2021

Serum testosterone concentrations decrease as men age. The age-related decline in testosterone levels, confirmed in several studies, results from defects in both testicular and hypothalamic-pituitary function. In some cases, it is unclear whether coexisting nonspecific signs and symptoms, such as decreases in energy and muscle mass, are a consequence of the age-related decline in endogenous testosterone or whether they are a result of other factors, such as coexisting conditions, concomitant medications, or perhaps aging itself. There is a widespread belief that undesirable changes in body composition and sexual dysfunction in men with hypogonadism are due to androgen deficiency. However, studies have shown that the amount of testosterone required to maintain lean mass, fat mass, strength, and sexual function varies widely in men. Therefore, benefits of raising testosterone levels in older men have not been established. In addition, metabolic and cardiovascular benefits or risks from testosterone therapy are still being debated.

In this work, we investigate the dynamical properties of 38 Galactic open clusters: 34 of them are located at low Galactic latitudes (|b| < 10$^{\circ}$) and are projected against dense stellar fields; the other 4 comparison objects present clearer contrasts with the field population. We determine structural and time-related parameters that are associated with the clusters' dynamical evolution: core ($r_c$), tidal ($r_t$) and half-mass ($r_{hm}$) radii, ages ($t$) and crossing times ($t_{cr}$). We have also incorporated results for 27 previously studied clusters, creating a sample of 65, spanning the age and Galactocentric distance ($R_G$) ranges: 7.0 < log ($t$) < 9.7 and 6 < $R_G$ (kpc) < 13. We employ a uniform analysis method which incorporates photometric and astrometric data from the Gaia DR2 catalogue. Member stars are identified by employing a decontamination algorithm which operates on the 3D astrometric space of parallax and proper motion and attributes membership likelihoods for stars in the cluster region. Our results show that the internal relaxation causes $r_c$ to correlate negatively with the dynamical ratio $��_{dyn}$ = $t/t_{cr}$. This implies that dynamically older systems tend to be more centrally concentrated. The more concentrated ones tend to present smaller $r_{hm}/r_t$ ratios, which means that they are less subject to tidal disruption. The analysis of coeval groups at compatible $R_G$ suggests that the inner structure of clusters is reasonably insensitive to variations in the external tidal field. Additionally, our results confirm, on average, an increase in $r_t$ for regions with less intense Galactic gravitational field., 18 pages, 12 figures. Accepted for publication in MNRAS

We report the discovery of 25 new open clusters resulting from a search in dense low galactic latitude fields. We also provide, for the first time, structural and astrophysical parameters for the new findings and 34 other recently discovered open clusters using Gaia DR2 data. The candidates were confirmed by jointly inspecting the vector point diagrams and spatial distribution. The discoveries were validated by matching near known objects and comparing their mean astrometric parameters with the available literature. A decontamination algorithm was applied to the three-dimensional astrometric space to derive membership likelihoods for clusters stars. By rejecting stars with low membership likelihoods, we built decontaminated colour-magnitude diagrams and derived the clusters astrophysical parameters by isochrone fitting. The structural parameters were also derived by King-profile fittings over the stellar distributions. The investigated clusters are mainly located within 3 kpc from the Sun, with ages ranging from 30 Myr to 3.2 Gyr and reddening limited to E(B-V)=2.5. On average, our cluster sample presents less concentrated structures than Gaia DR2 confirmed clusters, since the derived core radii are larger while the tidal radii are not significantly different. Most of them are located in the IV quadrant of the Galactic disc at low latitudes, therefore they are immersed in dense fields characteristic of the inner Milky Way., Comment: 18 pages, 15 figures, Accepted in MNRAS jun-2020

To evaluate the effect of pharyngeal surgery on swallowing pattern in patients with obstructive sleep apnea syndrome (OSAS), and to compare two surgical techniques: uvulopalatopharyngoplasty (UPPP) and expansion pharyngoplasty (EP), through videofluoroscopy. Longitudinal prospective cohort, in a tertiary referral center. 17 adult patients were enrolled this study, divided into two groups: patients who underwent UPPP (n = 10) or EP (n = 7). Swallowing videofluoroscopy (for both liquid and pasty consistences) was assessed at three different periods: before surgery, and at 14 and 28 days following surgery. Comparisons were performed between pre- and post-operative (PO) swallowing conditions in the same patient, and between surgical techniques. Asymptomatic OSAS patients already presented altered swallowing pattern before surgery. Both surgical procedures led to an increased hyoid movement time and an increased frequency of laryngeal penetration in early PO during liquid ingestion. For pasty consistency, both techniques reduced velum movement time and increased pharyngeal transit time and the rate of stasis in hypopharynx. All these parameters reached or tended to reach the pre-operative indices at day PO 28. OSAS patients show sub-clinical changes in swallowing pattern before surgery. Both surgical techniques are related to transitory changes in swallowing biomechanics. Complete or partial reversal to pre-operative swallowing parameters occurs 1 month after both surgery techniques.

International audience; OBJECTIVE:To evaluate a recently published volume-based renal function prediction calculator intended to be used in small renal mass surgical counseling.METHODS:Retrospective data collection included three-dimensional calculation of renal mass and parenchyma of patients who have undergone extirpative therapy. The predicted glomerular filtration rate (GFR) was calculated using the online calculator. The predicted GFR was compared with the actual 6-month GFR. The Pearson correlation coefficient, paired t test and root-mean-square error (RMSE) are utilized for statistical analysis.RESULTS:After institutional review board approval, three institutions provided data for analysis. After patients with renal mass size >300 cc, renal size >400 cc or preoperative CKD ≥stage 3 had been excluded, we retrospectively analyzed data from 136 patients. The median mass volume was 22.2 cc (IQR 7-49). In multiple linear regression analysis, the most significant variables predicting postoperative GFR were partial versus radical nephrectomy and preoperative GFR with an overall R2 of .68 (F = 26.13, P < .001). The predicted GFR was 75.4 mL/min/1.73 m2 compared to an actual GFR of 70.7 mL/min/1.73 m2 (P < .001, paired t test). The predicted GFR was highly correlated with the actual postoperative GFR at 6 months (Pearson correlation, r = .65, P < .001). RMSE of the validation cohort was 16.87.CONCLUSIONS:The predictive tool to determine renal function benefit of nephron sparing surgery compared to radical nephrectomy online calculator effectively predicts GFR and could potentially be used to help urologists and patients discuss renal function prior to extirpative renal surgery.

A significant number of patients with minimal lymph node disease at radical prostatectomy (RP) and pelvic lymph node dissection (PLND) have better than expected long-term outcomes. We explored whether stratification by number of positive nodes enhances our institutional prediction model for biochemical recurrence after RP. A total of 7789 patients underwent RP and pelvic lymph node dissection from 1995 to 2012 at a tertiary referral center. We compared two recurrence prediction models: one incorporated lymph node invasion and the other tracked the number of positive nodes. Existing and updated models' discrimination was assessed using Harrell's c-index and calibration. The 10-fold cross-validation was performed to correct for model overfitting. Of the 491 patients (6.3%) harboring nodal disease, 387 (5.0%) had 1-2 positive nodes and 104 (1.3%) had ⩾3 positive nodes. Data on number of positive nodes did not improve the c-index for the cohort as a whole. When we assessed discrimination for node-positive patients only, c-index for the model with number of positive nodes was 0.01 (95% confidence interval 0.001-0.024) higher than the model with lymph node invasion. Illustrative examples were provided by reclassification tables using number of positive lymph nodes. For instance, 40 of 7789 patients would be reclassified with a cutoff point of 50% for biochemical recurrence at 1 year, and 36 of 7789 patients would be reclassified with a cutoff point of 40% for biochemical recurrence at 10 years. Stratification by number of positive lymph nodes provided additional discriminative ability for evaluating risk in node-positive patients. Pending external validation, this model could be used for patient counseling and clinical trial stratification in this subpopulation.Prostate Cancer and Prostatic Diseases advance online publication, 13 December 2016; doi:10.1038/pcan.2016.60.

Renato B Corradi,1,2 Thiago C Travassos,1,2 Leonardo O Reis1,21UroScience, Pontifical Catholic University of Campinas, Campinas, SP, Brazil; 2University of Campinas, Campinas, SP, BrazilAbstract: The “super-active surveillance” concept denotes any active surveillance optimization that allows longer surveillance periods, with the main intention of avoiding overtreatment, by safely eliminating or postponing radical treatment. Super-active surveillance might add to the oncological control with minimal functional impact and similar quality of life compared to active surveillance, which has proved to be safe in well-selected patients. Vascular targeted photodynamic therapy has pioneering shown to significantly reduce the upgrade on subsequent biopsies, resulting in fewer cases converted to radical therapy, and any energy source can be applied to the super-active surveillance concept allowing more men to consider a tissue-preserving therapy for prostate cancer.Keywords: Super-active surveillance, ablation, minimally invasive

Background Indications for partial nephrectomy (PN) have expanded to include larger tumors. Compared with radical nephrectomy (RN), PN reduces the risk of chronic kidney disease but is associated with higher morbidity. Objective To explore whether the benefit of PN (preservation of estimated glomerular filtration rate [eGFR] ≥60 ml/min/1.73 m2 1 yr postoperatively) over RN is offset by higher morbidity for cT2-cT3a tumors. Design, setting, and participants A total of 1921 patients with renal cortical tumors who underwent nephrectomy between 2000 and 2012 were analyzed, with 297 having clinical stage T2 or higher disease. Outcome measurements and statistical analysis Multivariable logistic regression models adjusted for age, tumor size, and comorbidities were used to calculate the risk of complications within 90 d and the risk of low eGFR across a range of tumor sizes. Models were created separately for RN and PN, and the difference between risk estimates was calculated. Results and limitations For tumors with diameters between 7 and 12 cm, the risk of eGFR downgrade associated with RN was higher than the risk of complications associated with PN. The magnitude of the risk of eGFR downgrade was similar to the magnitude of complications risk across all tumor sizes. Our analysis was performed at a single institution, and used only tumor size to compare the risk and benefits of surgery. Conclusions Our study suggests that PN is associated with higher eGFR preservation than RN for cT2 or greater renal tumors. The magnitude of this advantage offsets the higher morbidity observed with PN. Patient summary When treating a large kidney tumor, it is difficult to decide whether it is better to remove the whole kidney or remove just the tumor. The second option improves postoperative renal function but is more complex. We tried to find whether there is a tumor size at which one technique should be used over the other.

The stellar content of Galactic open clusters is gradually depleted during their evolution as a result of internal relaxation and external interactions. The final residues of the evolution of open clusters are called open cluster remnants, barely distinguishable from the field. We aimed to characterise and compare the dynamical states of a set of 16 such objects. The sample also includes 7 objects that are catalogued as dynamically evolved open clusters. We used photometric data from the 2MASS, astrometric data from the GAIA DR2 and a decontamination algorithm that was applied to the three-dimensional astrometric space of proper motions and parallaxes for stars in the objects' areas. The luminosity and mass functions and total masses for most open cluster remnants are derived here for the first time. Our analysis used predictions of N-body simulations to estimate the initial number of stars of the remnants from their dissolution timescales. The investigated open cluster remnants present masses and velocity dispersions within well-defined ranges: M between ~10-40M_Sun and sigma_v between ~1-7km/s. Some objects in the remnant sample have a limiting radius R_lim, Comment: Accepted for publication in A&A

The “super-active surveillance” concept denotes any active surveillance optimization that allows longer surveillance periods, with the main intention of avoiding overtreatment, by safely eliminating or postponing radical treatment. Super-active surveillance might add to the oncological control with minimal functional impact and similar quality of life compared to active surveillance, which has proved to be safe in well-selected patients. Vascular targeted photodynamic therapy has pioneering shown to significantly reduce the upgrade on subsequent biopsies, resulting in fewer cases converted to radical therapy, and any energy source can be applied to the super-active surveillance concept allowing more men to consider a tissue-preserving therapy for prostate cancer.

Purpose: Surgical management of upper tract urothelial carcinoma requires kidney and ureter removal, compromising renal function. Nonsurgical alternatives have potentially prohibitive safety concerns. We examined the feasibility and safety of ablation of the ureter and renal pelvis using endoluminal vascular targeted photodynamic therapy in a porcine model. We also report the efficacy of WST11 vascular targeted photodynamic therapy in a murine model.Materials and Methods: After receiving approval we performed a total of 28 endoluminal ablations in the ureters and renal pelvis of 18 swine. Intravenous infusion of WST11 (4 mg/kg) followed by 10-minute laser illumination was done via percutaneous access or a retrograde ureteroscopic approach. Animals were followed clinically with laboratory testing, imaging and histology, which were evaluated at several postablation time points. A murine xenograft was created with the 5637 human urothelial cell carcinoma line to determine sensitivity to this therapy.Results:...

Introduction and Objective Radical cystectomy (RC) with pelvic lymph node dissection is the standard treatment for muscle invasive bladder cancer and the oncologic outcomes following it are directly related to disease pathology and surgical technique. Therefore, we sought to analyze these features in a cohort from a Brazilian tertiary oncologic center and try to identify those who could negatively impact on the disease control. Patients and Methods We identified 128 patients submitted to radical cystectomy, for bladder cancer treatment, from January 2009 to July 2012 in one oncology tertiary referral public center (Mario Penna Institute, Belo Horizonte, Brazil). We retrospectively analyzed the findings obtained from their pathologic report and assessed the complications within 30 days of surgery. Results We showed similar pathologic and surgical findings compared to other large series from the literature, however our patients presented with a slightly higher rate of pT4 disease. Positive surgical margins were found in 2/128 patients (1.5%). The medium number of lymph nodes dissected were 15. Major complications (Clavien 3 to 5) within 30 days of cystectomy occurred in 33/128 (25.7%) patients. Conclusions In the management of invasive bladder cancer, efforts should focus on proper disease diagnosis and staging, and, thereafter, correct treatment based on pathologic findings. Furthermore, extended LND should be performed in all patients with RC indication. A critical analysis of our complications in a future study will help us to identify and modify some of the factors associated with surgical morbidity.

PURPOSE: To assess the association between obstructive sleep apnea (OSA) and Fuhrman grade in patients with clear cell renal cell carcinoma (ccRCC). As secondary endpoints, we studied its association with tumor size, metastasis-free survival (MFS) and cancer-specific survival (CSS). METHODS: We reviewed the databases of two tertiary care centers, identifying 2579 patients who underwent partial or radical nephrectomy for ccRCC between 1991 and 2014. Descriptive statistics were used to compare pathologic variables between patients with and without OSA. Linear and logistic regression models were used to assess the association of OSA with Fuhrman grade and tumor size. A Cox proportional hazards model was used to determine OSA association with MFS and CSS. A pathway analysis was performed on a cohort with available gene expression data. RESULTS: In total, 172 patients (7 %) had self-reported OSA at diagnosis. More patients with OSA had high Fuhrman grade compared to those without OSA [51 vs. 38 %; 13 % risk difference; 95 % confidence interval (CI), 5-20 %; p = 0.003]. On multivariable analysis, the association remained significant (OR 1.41; 95 % CI 1.00-1.99; p = 0.048). OSA was not associated with tumor size (p > 0.5), MFS (p = 0.5) or CSS (p = 0.4). A trend toward vascular endothelial growth factor pathway enrichment was seen in OSA patients (p = 0.08). CONCLUSIONS: OSA is associated with high Fuhrman grade in patients undergoing surgery for ccRCC. Pending validation of this novel finding in further prospective studies, it could help shape future research to better understand etiological mechanisms associated.

Obstructive Sleep Apnoea Syndrome (OSAS) is believed to be associated with craniofacial and neuromuscular changes, although the interplay among these variables still is poorly recognised. The objective of this study was to identify hyoid, muscular and swallowing changes associated with OSAS, and to correlate these alterations with OSAS severity. Cross-sectional study, in a tertiary referral centre. Seventy-two adult individuals participated in this study: 12 controls (without apnoea) and 60 patients with apnoea (mild, moderate and severe OSAS-20 individuals in each group). All participants were initially evaluated by otorhinolaryngologist and neurologist and underwent polysomnography for OSAS stratification. Cephalometric data, clinical myofunctional status and swallow videofluoroscopy exam were assessed. A hybrid effect model was used to analyse swallowing parameters; dependent variables were age, body mass index (BMI) and cephalometric measures. Individuals with OSAS presented lower hyoid position and narrower posterior airway distance when compared to controls. These parameters correlated to OSAS severity. Additionally, OSAS patients exhibited significantly lower myofunctional scores. Both velum and hyoid contraction times were significantly lower in the OSAS group at videofluoroscopy, regardless of its severity. Premature leakage into pharynx was more common in OSAS groups. Laryngeal penetration phenomenon occurred only in two patients (both from OSAS group). Our results suggest that hyoid bone position is associated with OSAS severity. Muscular pattern and swallowing are impaired in OSAS patients, irrespective of OSAS severity and facial profile. These findings indicate a higher predisposition of OSAS patients to present an inferior hyoid positioning, accompanied by myofunctional and swallowing disorders.

PURPOSE: We tested the latest update in the prostate cancer staging system by assessing the prognostic association of pT2 subclassification with the probability of survival related outcomes in patients who underwent radical prostatectomy. MATERIALS AND METHODS: We retrospectively analyzed the records of a total of 15,305 patients who underwent radical prostatectomy at 2 referral centers between 1985 and 2016, and had pT2 disease at the final pathological evaluation. Descriptive statistics were used to compare baseline data stratified by pT2 substages (pT2a/b vs pT2c). Cox regression models were adjusted for institution analyzed differences in the rate of biochemical recurrence, metastasis, cancer specific death and overall mortality. Multivariable Cox regression models were used to evaluate the predictive value of pT2 subclassification for survival, including the linear predictor from the Stephenson nomogram. RESULTS: Prostate specific antigen levels and Gleason score differed significantly between the pT2 substages (each p

We report the serendipitous discovery of three new open clusters, named UFMG 1, UFMG 2 and UFMG 3 in the field of the intermediate-age cluster NGC 5999, by using Gaia DR2 data. A colour-magnitude filter tailored for a proper selection of main-sequence stars and red clump giants turned evident the presence of NGC 5999 and these three new stellar groups in proper motion space. Their structural parameters were derived from King-profile fittings over their projected stellar distributions and isochrone fits were performed on the clusters cleaned colour-magnitude diagrams built with Gaia bands to derive their astrophysical parameters. The clusters projected sky motion were calculated for each target using our members selection. Distances to the clusters were inferred from stellar parallaxes through a bayesian model, showing that they are marginally consistent with their isochronal distances, considering the random and systematic uncertainties involved. The new clusters are located in the nearby Sagittarius arm (d ~ 1.5 kpc) with NGC 5999 at the background (d ~ 1.8 kpc). They contain at least a few hundred stars of nearly solar metallicity and have ages between 100 and 1400 Myr., Comment: 10 pages, 12 figures, Accepted in MNRAS dec-2018

BACKGROUND A growing number of men undergo repeat biopsies prior to radical prostatectomy for prostate cancer. However, the long-term impact of repeat biopsies on functional outcomes in this patient population remains unelucidated. Thus, we compared functional outcomes between patients who underwent single biopsy versus repeat biopsies before radical prostatectomy. METHODS From 1996 to 2015, 1015 consecutive patients underwent radical prostatectomy, and subsequently had urinary continence and erectile function assessed for >2 years follow-up. One-fourth of patients (275; 27%) had ≥2 biopsies before prostatectomy. Logistic regression models tested whether repeat biopsy before prostatectomy predicted continence or erectile function recovery. RESULTS For the overall cohort, continence rates were 84%, 92%, 96%, and 98% at 3, 6, 12, and 24 months, respectively. Repeat biopsy before prostatectomy was associated with lower continence rate at 3 months compared to single biopsy (P = 0.03); however, no significant differences were observed at 6, 12, or 24 months. In multivariable analyses adjusting for age, body mass index and diabetes/cardiovascular disease/smoking, the association between repeat biopsy and lower likelihood of continence at 3 months remained (odds ratio 0.67, 95% confidence interval 0.47-0.97; P = 0.03). Overall erectile function recovery rates were 16%, 33%, 51%, and 55% at 3, 6, 12, and 24 months, respectively. No difference in erectile function recovery rates was seen at any time point for single biopsy versus repeat biopsy. In multivariable analyses, repeat biopsy was not predictive of erectile function recovery at any time point. CONCLUSIONS Repeat biopsy before radical prostatectomy impairs early continence after surgery. However, erectile function recovery and mid-term to long-term continence are not affected. These data support the current trend towards active surveillance and delayed local treatment in patients with low- to intermediate-risk prostate cancer.

Objectives: Based on imaging features, nephrometry scoring systems have been conceived to create a standardized and reproducible way to characterize renal tumor anatomy. However, less is known about which of these individual measures are important with regard to clinically relevant perioperative outcomes such as ischemia time (IT), estimated blood loss (EBL), length of hospital stay (LOS), and change in estimated glomerular filtration rate (eGFR) after robotic partial nephrectomy (PN). We aimed to assess the utility of the RENAL and PADUA scores, their subscales, and C-index for predicting these outcomes. Materials and Methods: We analyzed imaging studies from 283 patients who underwent robotic PN between 2008 and 2014 to assign nephrometry scores (NS): PADUA, RENAL and C-index. Univariate linear regression was used to assess whether the NS or any of their subscales were associated with EBL or IT. Multivariable linear regression and linear regression models were created to assess LOS and eGFR. Results: The three NS were significantly associated with EBL, IT, LOS, and eGFR at 12 months after surgery. All subscales with the exception of anterior/posterior were significantly associated with EBL and IT. Collecting system, renal rim location, renal sinus, exophytic/endophytic, and nearness to collecting system were significant predictors for LOS. Only renal rim location, renal sinus invasion and polar location were significantly associated with eGFR at 12 months. Conclusions: Tumor size and depth are important characteristics for predicting robotic PN outcomes and thus could be used individually as a simplified way to report tumors features for research and patient counseling purposes.

To report survival outcomes of patients treated surgically for sarcomatoid-variant renal cell carcinomas (sRCC) and to assess whether the underlying histologic subtype is an independent predictor of outcome. One hundred and fifty-one patients underwent surgery at a referral center between 1991 and 2014 and had sRCC in final pathology. Kaplan–Meier curves for metastasis-free survival and cancer-specific survival (CSS) were calculated, and the log-rank test assessed differences between clear cell sRCC and nonclear cell sRCC. Cox regression models were generated to test the prognostic value of histologic subtype. Of 151 patients, 120 (79 %) had clear cell sRCC and 31 (21 %) had nonclear cell sRCC. Ninety-eight (65 %) patients had M0/Mx disease at presentation. Among those M0/Mx patients, metastasis-free survival probabilities were 49 % at 2 years [95 % confidence interval (CI) 38–60] and 39 % at 5 years (95 % CI 28–50), while CSS probabilities were 50 % at 2 years (95 % CI 41–58) and 32 % at 5 years (95 % CI 24–41). There was no significant difference in metastasis-free survival between clear cell and nonclear cell sRCC (p = 0.8). However, patients with nonclear cell sRCC had significantly lower CSS than patients with clear cell sRCC (p = 0.035). In multivariable analyses, nonclear cell sRCC conferred a higher risk of cancer-specific death compared with clear cell sRCC (HR 2.30, 95 % CI 1.38–3.82, p = 0.001). In a cohort of patients treated surgically, the underlying histologic subtype of sRCC had an impact on CSS. These results present valuable information for individual counseling and patient selection in clinical trials.

Purpose: PD-1/PD-L1 pathway inhibition is effective against advanced renal cell carcinoma, although results are variable and may depend on host factors, including the tumor microenvironment. Vascular-targeted photodynamic (VTP) therapy with the photosensitizer WST11 induces a defined local immune response, and we sought to determine whether this could potentiate the local and systemic antitumor response to PD-1 pathway inhibition.Experimental Design: Using an orthotopic Renca murine model of renal cell carcinoma that develops lung metastases, we treated primary renal tumors with either VTP alone, PD-1/PD-L1 antagonistic antibodies alone, or a combination of VTP and antibodies and then examined treatment responses, including immune infiltration in primary and metastatic sites. Modulation of PD-L1 expression by VTP in human xenograft tumors was also assessed.Results: Treatment of renal tumors with VTP in combination with systemic PD-1/PD-L1 pathway inhibition, but neither treatment alone, resulted in regression of primary tumors, prevented growth of lung metastases, and prolonged survival in a preclinical mouse model. Analysis of tumor-infiltrating lymphocytes revealed that treatment effect was associated with increased CD8+:regulatory T cell (Treg) and CD4+FoxP3-:Treg ratios in primary renal tumors and increased T-cell infiltration in sites of lung metastasis. Furthermore, PD-L1 expression is induced following VTP treatment of human renal cell carcinoma xenografts.Conclusions: Our results demonstrate a role for local immune modulation with VTP in combination with PD-1/PD-L1 pathway inhibition for generation of potent local and systemic antitumor responses. This combined modality strategy may be an effective therapy in cancers resistant to PD-1/PD-L1 pathway inhibition alone. Clin Cancer Res; 24(3); 592–9. ©2017 AACR.

Background Tunneled central venous catheters (tCVCs) are considered inferior to arteriovenous fistulas (AVFs) and grafts in all nephrology guidelines. However, they are being increasingly used as hemodialysis vascular access. The purpose of this study was to document the natural history of tCVCs and determine the rate and type of catheter replacement. Methods This was a prospective study of 141 patients who underwent hemodialysis with tCVCs between January 2008 and December 2012. The patients used 154 tCVCs. Standard protocols about management of tCVCs, according to European Renal Best Practice, were well established. All catheters were inserted in the internal jugular vein. Criteria for catheter removal were persistent bloodstream infection, detection of an outbreak of catheter-related bloodstream (CRBS) infections, or catheter dysfunction. Event rates were calculated per 1,000 catheter days; tCVC cumulative survival was estimated by Kaplan-Meier analysis. Results Catheter replacement occurred in 15 patients (0.29 per 1,000 days); catheter dysfunction was the main cause of replacement (0.18 per 1,000 days), typically within 12 months of surgical insertion. A total of 53 CRBS events in 36 patients were identified (0.82 per 1,000 days); 17 organisms, most commonly Gram-positive pathogens, were isolated; 87% of CVC infections were treated by systemic antibiotics associated with lock therapy. tCVC cumulative survival was 91% at 1 year, 88% at 2 years and 85% at 4 years. Conclusions Our data show a high survival rate of tCVCs in hemodialysis patients, with low incidence of catheter dysfunction and CRBS events. These data justify tCVC use for hemodialysis vascular access, also as first choice, especially in patients with exhausted peripheral access and limited life expectancy.

The term ambivalence-meaning the coexistence of love and hate toward a person or object-is commonly used both in the vernacular and in psychiatry. However, how ambivalence contributes to understanding and treating some important psychiatric disorders has not been well defined. This article reviews Bleuler's original use of the concept, as well as contributions by Freud and other theorists, as background. The author proposes that mastery of ambivalence-depolarization of the primary drive expressions of love and hate so that a degree of ambivalence toward a loved object can be tolerated-is a fundamental developmental task. The significant role that ambivalence plays in some major psychiatric disorders-schizophrenia, borderline personality, and depression-is illustrated with case material and discussed.

Testosterone synthesis and male fertility are the results of the perfect coordination of the hypothalamic-pituitary-gonadal axis. A negative feedback finely controls the secretion of hormones at the 3 levels. Congenital or acquired disturbance at any level leads to an impairment of reproductive function and the clinical syndrome of hypogonadism. In some cases, this condition is reversible. Once the diagnosis is made, testosterone replacement therapy is the standard therapy; however, novel therapies may improve spermatogenesis while elevating testosterone levels.

Galactic open clusters (OCs) that survive the early gas-expulsion phase are gradually destroyed over time by the action of disruptive dynamical processes. Their final evolutionary stages are characterized by a poorly populated concentration of stars called open cluster remnant (OCR). This study is devoted to assess the real physical nature of the OCR candidate NGC 7193. GMOS/Gemini spectroscopy of 53 stars in the inner target region were obtained to derive radial velocities and atmospheric parameters. We also employed photometric and proper motion data. The analysis method consists of the following steps: (i) analysis of the statistical resemblance between the cluster and a set of field samples with respect to the sequences defined in colour-magnitude diagrams (CMDs); (ii) a 5-dimensional iteractive exclusion routine was employed to identify outliers from kinematical and positional data; (iii) isochrone fitting to the $K_{s}\times(J-K_{s})$ CMD of the remaining stars and the dispersion of spectral types along empirical sequences in the $(J-H)\times(H-K_{s})$ diagram was checked. A group of stars was identified for which the mean heliocentric distance is compatible with that obtained via isochrone fitting and whose metallicities are compatible with each other. Fifteen member stars observed spectroscopically were identified together with other 19 probable members. Our results indicate that NGC 7193 is a genuine OCR, of an once very populous OC, for which the following parameters were derived: $d=501\,\pm\,46\,$pc, $t=2.5\,\pm\,1.2\,$Gyr, $\langle\,[Fe/H]\,\rangle=-0.17\,\pm\,0.23$ and $E(B-V)=0.05\,\pm\,0.05$. Its luminosity and mass functions show depletion of low mass stars, confirming the OCR dynamically evolved state., Comment: 32 pages, 20 figures, 3 tables, accepted for publication in Research in Astronomy and Astrophysics (RAA)

The patient with schizophrenia often appears to be living in an alien world, one of strange voices, bizarre beliefs, and disorganized speech and behavior. It is difficult to empathize with someone suffering from symptoms so remote from one's ordinary experience. However, examination of the disorder reveals not only symptoms of the psychosis itself but also an intensely human struggle against the disintegration of personality it can produce. Furthermore, examination of the individual's attempts to cope with a devastating psychotic process reveals familiar psychodynamic processes and defense mechanisms, however unsuccessful they may be. Knowing that behind the seemingly alien diagnostic features of schizophrenia is a person attempting to preserve his or her self-identity puts a human face on the illness. This article utilizes clinical material to describe some of the psychodynamic processes of schizophrenia. Its purpose is to facilitate understanding of an illness that requires comprehensive biopsychosocial treatment in which a therapeutic doctor-patient relationship is as necessary as antipsychotic medication.

Open clusters belonging to star-forming complexes are the leftovers from the initial stellar generations. The study of these young systems provides constraints to models of star formation and evolution as well as to the properties of the Galactic disc. We aimed at investigating NGC1981, a young open cluster in the Orion Nebula Region, using near-IR and BV (RI)C photometric data.We devised a method that accounts for the field contamination and allows to derive photometric membership for the cluster stars. A new cluster centre was determined by Gaussian fittings to the 2-D stellar distribution on the sky, and has been used used to obtain the radial stellar density profile and the structural parameters. Mass functions were computed for stars inside the cluster limiting radius and total mass estimated from them. Although more easily distinguished by its grouping of 6 relatively bright stars, an underlying population of faint pre-main sequence stars is evident in the cluster area. We showed that this population is related to the cluster itself rather than to the nearby Orion Nebula cluster. Additionally a fraction of the cluster low mass stars may have been evaporated from the region in its early evolution leading to the present sparse, loose structure. The estimated parameters of NGC1981 are core radius Rc = 0.09 +/- 0.04 pc, limiting radius Rlim = 1.21+/-0.11 pc, age t = 5+/-1 Myr, distance modulus (m-M)0 = 7.9+/-0.1 (380 +/- 17 pc), reddening E(B - V)= 0.07 +/- 0.03 and total mass m = 137 +/- 14 M\cdot.

The repetition compulsion-the propensity to repeat formative early life experiences, for good or ill-is one of psychoanalysis's most important contributions to the understanding of human nature. However, its broader applications to psychodynamic psychiatry and psychotherapy have received little attention. In fact, it is a concept widely applicable to the understanding and treatment of psychiatric disorders, since maladaptive or self-defeating repetitions are the stuff of psychopathology. This article will discuss the repetition compulsion as a core concept of psychodynamic psychiatry. Principles of the compulsion to repeat will be applied to the dynamics of personality disorders, and will be illustrated by discussion of its usefulness in understanding and treating several common and representative psychiatric conditions: reactive depression, punitive superego function, and traumatic neurosis. These conditions illustrate the reparative, retributive, and restorative functions of the compulsion to repeat.

The open clusters fundamental physical parameters are important tools to understand the formation and evolution of the Galactic disk and as grounding tests for star formation and evolution models. However only a small fraction of the known open clusters in the Milky Way has precise determination of distance, reddening, age, metallicity, radial velocity and proper motion. One of the major problems in determining these parameters lies on the difficulty to separate cluster members from field stars and to assign membership. We propose a decontamination method by employing 2MASS data in the encircling region of the clusters NGC1981, NGC2516, NGC6494 and M11. We present a decontaminated CMD of these objects showing the membership probabilities and structural parameters as derived from King profile fitting., 4-page paper from IAU Symposium 266. Contain 13 figures and the document class 'iau.cls'

Turning passive into active is an ego function that plays an important role in managing anxiety associated with passive feelings of helplessness and powerlessness. Its use in childhood aids the ego in constructing a basic sense of mastery, a secure sense of being in control, both of oneself and of one's circumstances. Functioning first as a building block of ego, it subsequently becomes a versatile mechanism of defense with utility throughout the life cycle. This article discusses both the developmental and defensive uses of the passive into active mechanism of defense and illustrates them with clinical examples. Often regarded only as a byproduct of defense, its importance in mastering core developmental anxieties and their adult revivals warrants its inclusion in the glossary of discrete defenses.

The concept of borderline personality disorder (BPD) remains problematic despite psychiatrists' general familiarity with its DSM diagnostic criteria. The diagnosis of BPD is frequently based simply on the DSM checklist of traits and symptoms without knowledge of their origins or significance. Misdiagnosis is common, as is lack of recognition of the full complexity of this severe personality disorder and the nature of the vulnerabilities that underlie its myriad forms of pathology. The stresses of ordinary life are often too much for people with BPD. Knowledge of the nature and origins of their stress points, such as their great fear of loss or rejection, is necessary for adequate diagnosis and treatment. The author addresses how signature features of the disorder relate to psychosocial development, how they correlate with failed developmental milestones, and how they can be understood psychodynamically. This is essential knowledge for psychotherapists because the pathological interpersonal relationships of the borderline patient will be repeated and acted out in the transference, whatever the modality or intensity of treatment.

Tumor characteristics affect surgical complexity and outcomes of partial nephrectomy (PN).To develop an Arterial Based Complexity (ABC) scoring system to predict morbidity of PN.Four readers independently scored contrast-enhanced computed tomography images of 179 patients who underwent PN.Renal cortical masses were categorized by the order of vessels needed to be transected/dissected during PN. Scores of 1, 2, 3S, or 3H were assigned to tumors requiring transection of interlobular and arcuate arteries, interlobar arteries, segmental arteries, or in close proximity of the renal hilum, respectively during PN.Interobserver variability was assessed with kappa values and percentage of exact matches between each pairwise combination of readers. Linear regression was used to evaluate the association between reference scores and ischemia time, estimated blood loss, and estimated glomerular filtration rates at 6 wk and 6 mo after surgery adjusted for baseline estimated glomerular filtration rate. Fisher's exact test was used to test for differences in risk of urinary fistula formation by reference category assignment.Pairwise comparisons of readers' score assignments were significantly correlated (all p0.0001); average kappa = 0.545 across all reader pairs. The average proportion of exact matches was 69%. Linear regression between the complexity score system and surgical outcomes showed significant associations between reference category assignments and ischemia time (p0.0001) and estimated blood loss (p=0.049). Fisher's exact test showed a significant difference in risk of urinary fistula formation with higher reference category assignments (p=0.028). Limitations include use of a single institutional cohort to evaluate our system.The ABC scoring system for PN is intuitive, easy to use, and demonstrated good correlation with perioperative morbidity.The ABC scoring system is a novel anatomy-reproducible tool developed to help patients and doctors understand the complexity of renal masses and predict the outcomes of kidney surgery.