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Our objective is to assess the long-term results of phytotherapy, focusing on the interval between phytotherapy and pharmacological treatment and the predisposing risk factors to such switch on a 10-year follow-up.The data of patients taking phytotherapy for mild to moderate male lower urinary tract symptoms (LUTS) from January to December 2010 were retrospectively reviewed from a prospectively maintained database. Patients were followed for 10 years through medical visits and telephone consultations.102 patients underwent at least one cycle of phytotherapy for LUTS. Twenty (19.6%) patients resolved their symptoms after one phytotherapy cycle and stopped any treatment, 27 (26.4%) continued phytotherapy, and 52 (51%) switched to alpha-blockers and/or 5a-reductase inhibitors after a median interval of 24 months. The reasons for treatment switch were symptoms (n = 45) or clinical progression (increased residual volume n = 15; urinary retention, n = 5). Patients switching to synthetic drugs had median higher age (60 vs 49), prostate volume (40 vs 26 cc), prostate specific antigen (PSA) (1.9 vs 0.9 ng/ml), residual volume (40 vs 0 cc), and a lower maximum flow rate (Qmax) (12 vs 15 ml/s) at presentation.46% patients with mild to moderate LUTS undergoing phytotherapy will be either free of treatment or still on phytotherapy at 10 years from disease presentation. Older patients with larger prostates, increased residual volume and PSA, should be informed regarding their higher risk of symptomatic or clinical progression: the risk of a treatment switch to alpha-blockers or 5a-reductase inhibitors becomes an actual fact after an average span of 2 years.

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

To assess the feasibility and operative outcomes of RARP following colo-rectal surgery. A prospective database of patients undergoing RARP is maintained at our Institution since January 2015. We reviewed all patients undergoing RARP after previous colo-rectal surgery. Overall, 49 (7.4%) of 658 RARPs were performed after previous pelvic surgery, 14 (2.1%) of which following colo-rectal surgery after an interval of 5 years. (a) Colo-rectal surgery. Previous colo-rectal surgery included resection of the left colon (n = 6), and right colon (n = 4), and rectum (n = 4). Histopathology showed pT0-T2N0 in 5, pT3N0-1 in 3, and benign conditions in 4. Prostate-specific antigen (PSA) was elevated (4 ng/ml or greater) or slightly elevated (3.5-4 ng/ml) in 9 (65%) of 14 cases at the time of colo-rectal surgery. (b) Prostatectomy. Overall prostatectomy and adhesiolysis median operative times were 235 and 42 min, respectively. A robotic approach was accomplished in 11 cases with previous uncomplicated colo-rectal surgery; open conversion occurred in 3 cases. Risk factors for open conversion during RARP were: history of multiple or complicated abdominal surgery, previous open conversion, and hospital stay > 10 days. Postoperative complications included: anemization (n = 2), persistent drain output (n = 1), and urinary tract infection (n = 1). The robotic approach was successful in the case of previous uncomplicated colo-rectal surgery. The risk of intestinal injury during conversion might suggest a direct retropubic approach in case of previous multiple or complicated abdominal surgery. A planned elective colo-rectal surgery should include a thorough urologic evaluation, considering the risk of a subsequent prostate surgery.

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

Although viruses are common in the urinary tract in healthy people, viral infections can become a major concern in immunocompromised individuals. Patients undergoing hematopoietic stem cell or solid organ transplantation may be particularly susceptible to BK and other viruses, and experience a high risk of mortality. The most common presentation in this setting is hemorrhagic cystitis. The treatment is mostly supportive, including the reduction of immunosuppression; a variety of experimental agents has also been proposed. A different context is offered by chronic (HBV, HCV, HIV) or acute/subacute (Dengue, Hantavirus, etc.) infections, where the kidneys can be secondarily involved and suffer from several glomerular syndromes. Many protocols based on different oral direct-acting antivirals and combined antiretrovirals are available, according to the systemic infection. Viral infections can be classified according to the organ involved, i.e. lower (bladder) or upper urinary tract (kidneys, ureters), and to the mechanism of injury. A section is dedicated to the current breakout of SARS-CoV-2, which does not spare the urinary tract, sometimes with serious implications. Even if this topic is mostly the discipline of ultra-dedicated physicians, this overview has a practical approach and could be useful to a wider medical audience, especially in times of viral pandemics.

To assess the feasibility and operative outcomes of RARP following colo-rectal surgery. A prospective database of patients undergoing RARP is maintained at our Institution since January 2015. We reviewed all patients undergoing RARP after previous colo-rectal surgery. Overall, 49 (7.4%) of 658 RARPs were performed after previous pelvic surgery, 14 (2.1%) of which following colo-rectal surgery after an interval of 5 years. (a) Colo-rectal surgery. Previous colo-rectal surgery included resection of the left colon (n = 6), and right colon (n = 4), and rectum (n = 4). Histopathology showed pT0-T2N0 in 5, pT3N0-1 in 3, and benign conditions in 4. Prostate-specific antigen (PSA) was elevated (4 ng/ml or greater) or slightly elevated (3.5-4 ng/ml) in 9 (65%) of 14 cases at the time of colo-rectal surgery. (b) Prostatectomy. Overall prostatectomy and adhesiolysis median operative times were 235 and 42 min, respectively. A robotic approach was accomplished in 11 cases with previous uncomplicated colo-rectal surgery; open conversion occurred in 3 cases. Risk factors for open conversion during RARP were: history of multiple or complicated abdominal surgery, previous open conversion, and hospital stay 10 days. Postoperative complications included: anemization (n = 2), persistent drain output (n = 1), and urinary tract infection (n = 1). The robotic approach was successful in the case of previous uncomplicated colo-rectal surgery. The risk of intestinal injury during conversion might suggest a direct retropubic approach in case of previous multiple or complicated abdominal surgery. A planned elective colo-rectal surgery should include a thorough urologic evaluation, considering the risk of a subsequent prostate surgery.

PURPOSE OF REVIEW: To describe and critically discuss the most recent evidence regarding stone management during the coronavirus disease 2019 (COVID-19) and post-COVID-19 era. RECENT FINDINGS: There is a need to plan for resuming the normal elective stone surgery in the post-COVID era, keeping a clear record of all surgeries that are being deferred and identifying subgroups of surgical priorities, for the de-escalation phase. Telehealth is very useful because it contributes to reduce virus dissemination guaranteeing at the same time an adequate response to patients' care needs. Once the pandemic is over, teleurology will continue to be utilized to offer cost-effective care to urological patients and it will be totally integrated in our clinical practice. SUMMARY: This COVID-19 pandemic represents a real challenge for all national health providers: on the one hand, every effort should be made to assist COVID patients, while on the other hand we must remember that all other diseases have not disappeared in the meanwhile and they will urgently need to be treated as soon as the pandemic is more under control. A correct prioritization of cases when surgical activity will progressively return back to normality is of paramount importance.

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

Objective: A prospective longitudinal cohort study on the impact of anthropometric measures on the sexual function and continence recovery in patients treated with laparoscopic radical prostatectomy (LRP) is presented.Material and methods: Anthropometric measures, International Index of Erectile Function (IIEF-5) and International Prostatic Symptoms Score questionnaires, were collected before surgery and at the end of follow-up period. All patients were assigned into the following groups: A) non-obese; B) non-obese with central adiposity; C) obese without central adiposity; D) obese with central adiposity. Urinary and sexual functions were the outcome measures. Results: At the end of follow-up, in 29 patients with visceral adiposity (VA) the median IIEF-5 was 14 (IQR 7-18) while in 49 non-VA patients (62.8%) was 22 (IQR 17-24) (p < 0.001). Twenty-three patients (79.3%) with VA reported complete continence, while 6 (20.7%) used ≥ 2 pads per day. Forty-eight patients (97.9%) without VA reported complete continence. VA was confirmed as a strong independent predictor for worse continence (HR 3.67; 2.75-4.51 CI95% p = 0.003) and sexual function recovery (HR: 4.51; 3.09-5.63 CI95% p < 0.001). Conclusion: We truly believe obese with visceral adiposity patients with prostate cancer should receive detailed preoperative counseling before surgery, including higher risk of suboptimal functional outcomes.

Background: To evaluate the intermediate perioperative outcomes, rate of complications and functional data after XPS 180-W Greenlight photoselective laser vaporization (PVP) compared with transurethral resection of the prostate (TURP) in a prospective non-randomized single centre study. Methods: We analyzed a prospectively-maintained database collecting data on 100 patients undergoing surgical treatment of BPH (50 consecutive PVP and 50 consecutive TURP). All complications, recorded and graduated according to the Clavien Dindo system and the clinical, operative, perioperative variables were compared. The functional outcomes, International Prostate Symptom Score (IPSS), max flow rate (Qmax) and Prostate Specific Antigen (PSA), were recorded preoperatively and at 1 year of follow up. Results: Age, prostate volume, use of anticoagulants or antiplatelets, ASA score and operative time were comparable in the two groups. The reduction in the hemoglobin levels (0.46 vs 1.8 g/dL), the catheterization time (1.2 vs 3.2 days), the hospital stay (1.7 vs 3.8 days) and rate of transfused patients (0 vs 8%), were significantly lower for PVP. Transient re-catherization (6 vs 26%) was significantly lower for PVP. The IPSS and Qmax at 1 year showed no significant difference. The rate of repeat TURP/PVP was higher in the TURP group (0 vs 10%). Reduction of PSA, that reflects the major reduction of prostate volume, was statistically greater in PVP group respect TURP group (p = 0.001). Conclusions: PVP has advantages in terms of perioperative safety and major complications than TURP. Functional outcomes at 1 year of follow-up were comparable.

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

In this paper we will show the boosting performance of nonlinear machine learning techniques applied to a novel soil moisture sensing approach. A probe consisting in a transmitting and a receiving dipole antenna was set up to indirect assess the moisture content (%) of three different types of soils (silty clay loam, river sand and lightweight expanded clay aggregate, LECA). Gain and phase signals acquired in the 1.0 GHz – 2.7 GHz frequency range were used to built predictive models based on linear PLS regression and on nonlinear Kernel-based orthogonal projections to latent structures (K-OPLS) algorithms. K-OPLS algorithm slightly increased the accuracy of the models built on the gain response on specific kind of soils with respect to classical linear PLS. However, the predictability increases significantly in the case where the models are built starting from a matrix containing all the considered soil samples (silty clay loam + river sand + LECA) achieving R2 = 0.971 (RMSE = 1.4%) when using K-OPLS non-linear model with respect to R2 = 0.513 (RMSE = 6.1%) obtained using linear PLS. Therefore, K-OPLS algorithm appears to give a significant improvement to modelling data where nonlinear behaviours occur.

In this paper, we demonstrate the effectiveness of multivariate analysis to increase the performance and reliability of a novel method for a non-invasive sensing approach for measuring gravimetric soil moisture. Unlike time and frequency domain spectrometers, as well as impedance sensors, where probes should be inserted into the terrain, the proposed approach simply uses a waveguide faced to the soil surface. An open-ended waveguide spectrometer system was developed to acquire “gain” and “phase” spectra, related to received and transmitted signals, in the 1.5–2.7 GHz range from river sand, lightweight expanded clay aggregate (LECA) and silty clay loam soil samples. For each soil type, predictive models of the moisture (%) were obtained and discussed by using multivariate tools (Principal Component Analysis, Partial Least Square Regression and N-dimensional Partial Least Square Regression). The potentiality of the measurement technique was explored for both non-layered (homogeneous moisture) and layered (two layers with different, homogeneous moisture) soils. In validation tests, R 2 values up to 0.989 (RMSE = 0.8%, river sand gain) were observed for single layer test. For double layer test, R 2 values up to 0.977 (RMSE = 1.4%, LECA gain, top layer) and 0.962 (RMSE = 1.9%, LECA gain, bottom layer) were obtained. A better accuracy was achieved with N-PLS combining “gain” and “phase” spectra: R 2 values increase up to 0.991 (RMSE = 0.9%, LECA samples). The measurement results demonstrate that the non-invasive waveguide-based spectrometry together with the multivariate analysis is able to assess different moisture contents, with a high level of accuracy, both for non-layered and layered samples of soil with homogenous moisture.

Current research is focused on crack formation and propagation in cross laminated timber (CLT) panels and its impacts on the water vapour resistance and air permeability of panels. Crack formation was examined by means of climate tests with five layer CLT-panels with a thickness of 95 mm. Results of climate tests showed that decreasing the moisture content (MC) from 11 % to 7 % caused mean crack widths in panels of 0.27 mm and 0.38 mm, and an MC decreasing from 17 % to 7 % caused mean crack widths of 0.89 mm and 2.0 mm. From these test results it was concluded that in CLT panels which were produced and stored in a humid environment there was an approximate 200% increase in the mean maximum width of cracks compared to panels stored in a dry environment. The water vapour transmission increased by about 9 % with smaller cracks (that were imitated with 2 mm holes) and 30 % with larger cracks (6 mm holes). The air permeability of CLT at a maximum air pressure difference of 550 Pa was 2.25 l/(s*m2) with 2 mm holes and 5.56 l/(s*m2) with 6 mm holes. It can be concluded from the afore mentioned test results that cracks significantly influence the hygrothermal properties of CLT. Deeper investigation as to the reasons, formation and propagation procedures are needed to avoid inadvisable cracks in CLT.

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

One of the emerging research areas at the convergence of physical science, chemistry, engineering, and life science is the development of theranostic nanoagents that integrate therapy and diagnosis for cost-effective precision medicine. Among currently available imaging methodologies, photoacoustic imaging (PAI) is an exciting new modality that uses non-ionizing radiation for real-time imaging with high spatial resolution and penetration depth. Furthermore, PAI could be easily combined with poor invasive cancer therapies, such as Phototermal Ablation. The development of bio-inspired NIR responsive nanomaterials plays a key role in improving sensitivity and signal-to-noise ratio in PAI. To this purpose a promising approach relies on the green synthesis of nanoparticles starting from natural or endogenous materials as a source of contrast. To date, several melanin-based probes have been reported with specific properties for PAI, however, poor solubility in biological fluids as well as poor contrast of photoacoustic signal, if compared to other contrast agents must be addressed. By mimicking natural melanin we reported the first example of stable monodispersed hybrid nanoparticles (MelaSil-NPs) made up of eumelanin biopolymer intimately integrated into a silica matrix. One-pot in-situ templated synthesis strategy was carried out where all components, form together and influenced each other. In particular, metal chelating and reducing properties of melanins towards transition metal ions were exploited to obtain Ag ions reduction (MelaSil_Ag), while at the same time controlling the growth of in-situ generated silver-nanoclusters. Nanostructured SiO2 was employed as templating agent for DHICA polymerization to melanin and a core-shell architecture was obtained, with enhanced photoacoustic signal. Furthermore, hybrid nature of the material allowed a fine control of morphology and stability to aggregation, ensuring cellular uptake and ultimately leading to promising probes for multimodal imaging in cancer diagnosis and therapy.

L'utilizzo di polveri e miscele ibride (polvere-gas) infiammabili è molto diffuso nei processi dell'industria chimica. La progettazione di sistemi di prevenzione e/o protezione del rischio di esplosioni richiede la conoscenza dei parametri di infiammabilità ed esplosività per tali sistemi. Tra i parametri di infiammabilità, assume particolare rilevanza la temperatura massima alla quale può essere portata una polvere e/o una miscela ibrida oltre la quale sono possibili fenomeni combustione. Ad oggi, le temperature di riferimento sono due: la temperatura minima di ignizione (della nube) (MIT) e la temperatura minima di ignizione dello strato (LIT). Recentemente è stato dimostrato che, nel caso di polveri organiche, in aggiunta alla MIT (Minimum Ignition Temperature) e alla LIT (Layer Ignition Temperature), è necessario considerare il cosiddetto "Voltaile Point" (VP). L'introduzione del concetto di VP è legata al fatto che il fenomeno reattivo che coinvolge le polveri organiche avviene attraverso due fasi: l'iniziale produzione di volatili per pirolisi e la loro successiva combustione. I volatili generati nella pirolisi possono dar luogo alla formazione di miscele gassose infiammabili in aria, analogamente al caso di nubi infiammabili prodotte a seguito della parziale evaporazione di un liquido a partire da una temperatura critica definita Flash Point (FP). È possibile, quindi, definire il VP come la temperatura alla quale una particella di solido produce volatili in quantità sufficienti, tali da formare una miscela in aria infiammabile (concentrazione dei volatili pari all'LFL, lower flammable limit).

To measure the early impact of robot-assisted partial nephrectomy (RAPN) on renal function as assessed by renal scan (Tc 99m-DTPA), addressing the issue of risk factors for ischemic damage to the kidney. All patients undergoing RAPN for cT1 renal masses between June 2013 and May 2014 were included in this prospective study. Renal function as expressed by glomerular filtration rate (GFR) was assessed by Technetium 99m-diethylenetriaminepentaacetic acid (Tc 99m-DTPA) renal scan preoperatively and postoperatively at 1 month in every patient. A multivariable analysis was used for the determination of independent factors predictive of GFR decrease of the operated kidney. Overall, 32 patients underwent RAPN in the time interval. Median tumor size, blood loss, and ischemia time were 4 cm, 200 mL, and 24 min, respectively. Two grade III complications occurred (postoperative bleeding in the renal fossa, urinoma). The GFR of the operated kidney decreased significantly from 51.7 ± 15.1 mL/min per 1.73 m(2) preoperatively to 40, 12 ± 12.4 mL/min per 1.73 m(2) 1 month postoperatively (p = 0.001) with a decrease of 22.4 %. On multivariable analysis, only tumor size (p = 0.05) was a predictor of GFR decrease of the operated kidney. Robotic-assisted partial nephrectomy had a detectable impact on early renal function in a series of relatively large tumors and prevailing intermediate nephrometric risk. A mean decrease of 22 % of GFR as assessed by renal scan in the operated kidney was found at 1 month postoperatively. In multivariable analysis, tumor size only was a significant predictor of renal function loss.

The evolution of resistant pathogens is a worldwide health crisis and adherence to European Association of Urology (EAU) guidelines on antibiotic prophylaxis may be an important way to improve antibiotic stewardship and reduce patient harm and costs.To evaluate the prevalence of antibiotic-resistant bacterial strains and health care costs during a period of adherence to EAU guidelines in a tertiary referral urologic institution.A protocol for adherence to EAU guidelines for antibiotic prophylaxis for all urologic procedures was introduced in January 2011. Data for 3529 urologic procedures performed between January 2011 and December 2013 after protocol introduction were compared with data for 2619 procedures performed between January 2008 and December 2010 before protocol implementation. The prevalence of bacterial resistance and health care costs were compared between the two periods.The outcome measures were the proportion of resistant uropathogens and costs related to antibiotic consumption and symptomatic postoperative infection. We used χ2 and Fisher's exact tests to test the significance of differences.The proportion of patients with symptomatic postoperative infection did not differ (180/3529 [5.1%] vs. 117/2619 [4.5%]; p=0.27). A total of 342 isolates from all patients with symptomatic postoperative infections were analysed. The rate of resistance of Escherichia coli to piperacillin/tazobactam (9.1% vs. 5.4%; p=0.03), gentamicin (18.3% vs. 11.2%; p=0.02), and ciprofloxacin (32.3% vs. 19.1%; p=0.03) decreased significantly after protocol introduction. The defined daily dose (DDD) use of ciprofloxacin fell from 4.2 to 0.2 DDD per 100 patient-days after implementation (p0.001). Antibiotic drug costs (€76,980 vs. €36,700) and costs related to postoperative infections (€45,870 vs. €29,560) decreased following introduction of the protocol (p0.001).Adherence to EAU guidelines on antibiotic prophylaxis reduced antibiotic usage without increasing post-operative infection rate and lowered the prevalence of resistant uropathogens.We analysed the impact of adherence to European Association of Urology guidelines on antibiotic prophylaxis for all surgical urologic procedures on the prevalence of infections and resistant bacterial strains and on costs. We found that adherence to the guidelines reduced the rate of bacterial resistance, in particular against piperacillin/tazobactam, gentamicin, and ciprofloxacin, and reduced costs without increasing the risk of postoperative infection after urologic procedures. We recommend adherence to the guidelines as an important part of antibiotic stewardship programmes.

Percutaneous nephrolithotomy is the gold standard for large kidney stones. Supine approach has proved to be safe and effective. Herein we present an educational video about our stepwise technique of supine PCNL in a safe way.

Objectives: We evaluated the efficacy of sutureless laparoscopic partial nephrectomy (LPN), using a fibrin gel in order to minimize renal ischemia time and preserve kidney function. Materials and Methods: Nineteen patients (mean age 58.3 ± 7.1) undergoing sutureless LPN using a fbrin gel were compared with a control group consisting of 21 patients (mean age 57.9 ± 7.5) subjected to LPN with standard suturing. Intraand post-operative data for the two groups were compared. The following parameters were recorded: patient demographics, Charlson Comorbidity Index, tumor characteristics according to the RENAL score, warm ischemia and operative times, estimated blood loss, mean hospital stay, post-operative complications referring to the Clavien-Dindo classification, renal function parameters pathologic and follow-up data. The main outcome measure was renal ischemia time and maintenance of kidney function. Results: Median warm ischemia time was 13 minutes (range 11-19) in the group treated with fibrin gel and 19 (range 17- 29) in the control group, with a statistically significant difference (p < 0.001). The two groups were homogeneous in terms of the Charlson Comorbidity Index (4.6 vs 4.8) and RENAL score (9.6 vs 9.4). Median operative time differed significantly in the two groups, 183 minutes (range 145-218) in the group treated with fibrin gel and 201 (range 197-231) in the control group (p < 0.001). A negative surgical margin was reported in 18 patients (94.7%) in the group treated with fibrin gel and in 21 patients (100%) in the control group. No difference in renal function was found between the two groups. Conclusions: Sutureless LPN with fibrin gel can reduce warm ischemia and total operative time while preserving kidney function.

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

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

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

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

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

This study aimed at reporting our first experience with robotic laparoendoscopic single-site radical prostatectomy (R-LESS-RP) with single-site VesPa platform (Intuitive Surgical Inc.). A 68-year-old-man presenting with a cT1c adenocarcinoma Gleason Score 3 + 4 = 7 in 4/12 bilateral cores underwent a transperitoneal robotic LESS-RP with a single-site Vespa platform. Initial PSA, prostate weight, and body mass index (BMI) were 4.4 ng/ml, 45 g, and 25, respectively. Instruments and camera cross within the Single-Site port; the da Vinci System software detects and reassigns the user's hands with the instruments position. The single-site port is inserted through a 2-cm intraumbilical incision. The robotic 8.5 mm scope and two surgical curved instruments (fenestrated bipolar forceps and cautery hook) are introduced through the ports and used for most of the procedure, whereas a wristed needle driver on the right hand is used for the reconstructive steps. An additional 12 mm port (Air Seal, SurgiQuest) is placed in a midline between the umbilicus and the right iliac spine in order to facilitate table assistance during surgery and to place a drain at the end of the procedure. Operative time and blood loss were 300 min and 400 mL, respectively. The postoperative course was uneventful. The drain and the catheter were removed on days 1 and 6, respectively. The patient experienced a temporary mild stress incontinence (one pad at sixth month) and erectile dysfunction. Our first robotic laparoendoscopic single-site radical prostatectomy (R-LESS-RP) with the single-site VesPa platform was associated with acceptable operative times and perioperative outcome. This procedure is feasible without complications, provided that a proper patient selection has occurred. Limited movements together with the lack of the fourth robotic arm require a considerable expertise in robotic surgery. Some tricks can help overcome technical limitations. The Robotic LESS-RP reduces in some measure the limitations of conventional LESS RP, although further refinement of the robotic instruments is necessary.

Objective:In recent years, several biomarkers alternative to standard prostate specific antigen (PSA) for prostate cancer (PCa) diagnosis have become available. The aim of this systematic review is to assess the current knowledge about alternative serum and urinary biomarkers for the diagnosis of PCa.Material and Methods:A research was conducted in Medline, restricted to English language articles published between December 2014 and June 2018 with the aim to update previously published series on PCa biomarkers. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) criteria were used for selecting studies with the lowest risk of bias.Results:Emerging role and actual controversies on serum and urine alternative biomarkers to standard PSA for PCa diagnosis, staging and prognosis assessment, such as prostate health index (PHI), PCA3, ConfirmMDx, Aberrant PSA glycosylation, MiPS, miRNAs are critically presented in the current review.Conclusion:Although the use of several biomarkers has been recommended or questioned by different international guidelines, larger prospective randomized studies are still necessary to validate their efficacy in PCa detection, discrimination, prognosis and treatment effectiveness. To date, only PHI and 4Kscore have shown clinical relevance for discriminating more aggressive PCa. Furthermore, a new grading classification based on molecular features relevant for PCa risk-stratification and tailoring treatment is still needed.

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

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

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

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

The objective of this is to compare the surgical outcomes of partial nephrectomy (PN), performed via three different approaches: robot-assisted (RAPN), laparoscopic (LPN), and open (OPN), in a single non-academic regional center. The data of patients undergoing PN at our Department from 2005 to 2016 were prospectively collected. A logistic regression model adjusted for preoperative variables (age, tumor size, creatinine and hemoglobin, ASA and Padua scores) was performed to evaluate whether transfusion, conversion, and postoperative complication rate were influenced by the surgical approach. Overall 270 patients underwent PN: analysis included 253 cases (RAPN = 110, LPN = 70, OPN = 73). Preoperative variables did not differ significantly among the three groups. Shorter operative (130 vs 180 and 200′) and ischaemia (12 vs 23 and 22′) times and longer hospital stay (8 vs 7 and 6 days) were found in the OPN group as compared to LPN and RAPN, respectively. The RAPN group included a higher rate of pT1b (31.8 vs 14.2 and 15%) and malignant histotype (90 vs 82.9 and 68.5%) as compared to LPN and OPN, respectively. Clavien Grade III–IV complications were lower in the RAPN (7.2%) as compared to OPN (12.3%) and LPN (17.1%) groups. Multivariate analysis showed a lower risk for conversion, transfusion and overall complications in the RAPN group versus LPN and OPN. The surgical approach affects the perioperative outcomes in a regional setting. The advantages of RAPN over OPN (lower risk of conversion, transfusion, and overall complications) are extended over LPN as well, although OPN offered faster operative and ischemia times at the expense of greater blood loss and hospital stay.

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

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

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