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A new algorithm to derive near-real-time (NRT) data products for the Aura Microwave Limb Sounder (MLS) is presented. The old approach was based on a simplified optimal estimation retrieval algorithm (OE-NRT) to reduce computational demands and latency. This paper describes the setup, training, and evaluation of a redesigned approach based on artificial neural networks (ANN-NRT), which is trained on >17 years of MLS radiance observations and composition profile retrievals. Comparisons of joint histograms and performance metrics derived between the two NRT results and the operational MLS products demonstrate a noticeable statistical improvement from ANN-NRT. This new approach results in higher correlation coefficients, in addition to lower root-mean-square deviations and biases at almost all retrieval levels compared to OE-NRT. The exceptions are pressure levels with concentrations close to 0 ppbv (parts per billion by volume), where the ANN models fail to establish a functional relationship and tend to predict 0. Depending on the application, this behavior might be advantageous. While the developed models can take advantage of the extended MLS data record, this study demonstrates that training ANN-NRT on just a single year of MLS observations is sufficient to improve upon OE-NRT. This confirms the potential of applying machine learning to the NRT efforts of other current and future mission concepts.

The mainstays of the management of clinically localized prostate cancer have historically rested upon active surveillance, radiation therapy, or radical prostatectomy. Although both radiation and surgical treatment of localized prostate cancer can achieve excellent oncologic outcomes, the subsequent potential adverse effects of urinary stress incontinence and erectile dysfunction are unappealing to patients. This has led to investigational studies centered upon focal treatment of the cancerous lesion, with the aim to improve quality-of-life outcomes. In this review, we describe numerous novel modalities, including nanoparticle ablation and irreversible electroporation, which are being utilized for the focal treatment of clinically localized prostate cancer.Although many of these novel therapies are in their investigational infancy, several have revealed very promising results both in their post-treatment pathologic outcomes as well as objective quality-of-life measures.Initial data regarding novel focal therapy for prostate cancer treatment show promising short-term outcomes in regards to oncologic and quality-of-life assessments. Further investigational studies are needed to determine inclusion criteria for the selection of optimal candidates.

A comprehensive investigation of the climatology of and interannual variability and trends in the Asian summer monsoon anticyclone (ASMA) is presented, based on a novel area and moments analysis. Moments include centroid location, aspect ratio, angle, and “excess kurtosis” (measuring how far the shape is from elliptical) for an equivalent ellipse with the same area as the ASMA. Key results are robust among the three modern reanalyses studied. The climatological ASMA is nearly elliptical, with its major axis aligned along its centroid latitude and a typical aspect ratio of ~5–8. The ASMA centroid shifts northward with height, northward and westward during development, and in the opposite direction as it weakens. New evidence finding no obvious climatological bimodality in the ASMA reinforces similar suggestions from previous studies using modern reanalyses. Most trends in ASMA moments are not statistically significant. ASMA area and duration, however, increased significantly during 1979–2018; the 1958–2018 record analyzed for one reanalysis suggests that these trends may have accelerated in recent decades. ASMA centroid latitude is significantly positively (negatively) correlated with subtropical jet-core latitude (altitude), and significantly negatively correlated with concurrent ENSO; these results are consistent with and extend previous work relating monsoon intensity, ENSO, and jet shifts. ASMA area is significantly positively correlated with the multivariate ENSO index 2 months previously. These results improve our understanding of the ASMA using consistently defined diagnostics of its size, geometry, interannual variability, and trends that have not previously been analyzed.

Following the 15 January 2022 Hunga Tonga-Hunga Ha'apai eruption, several trace gases measured by the Aura Microwave Limb Sounder (MLS) displayed anomalous stratospheric values. Trajectories and radiance simulations confirm that the H₂O, SO₂, and HCl enhancements were injected by the eruption. In comparison with those from previous eruptions, the SO₂ and HCl mass injections were unexceptional, although they reached higher altitudes. In contrast, the H₂O injection was unprecedented in both magnitude (far exceeding any previous values in the 17-year MLS record) and altitude (penetrating into the mesosphere). We estimate the mass of H₂O injected into the stratosphere to be 146 ± 5 Tg, or ∼10% of the stratospheric burden. It may take several years for the H₂O plume to dissipate. This eruption could impact climate not through surface cooling due to sulfate aerosols, but rather through surface warming due to the radiative forcing from the excess stratospheric H₂O.

Purpose: Although MRI/ultrasound fusion has been primarily used to assist in the diagnosis of prostate cancer, this technology can also be used to focally treat localized prostate cancer. We presen...

The Microwave Limb Sounder (MLS), launched on NASA's Aura spacecraft in 2004, measures vertical profiles of the abundances of key atmospheric species from the upper troposphere to the mesosphere with daily near-global coverage. We review the first 15 years of the record of H2O and N2O measurements from the MLS 190-GHz subsystem (along with other 190-GHz information), with a focus on their long-term stability, largely based on comparisons with measurements from other sensors. These comparisons generally show signs of an increasing drift in the MLS version 4 (v4) H2O record starting around 2010. Specifically, comparisons with v4.1 measurements from the Atmospheric Chemistry Experiment-Fourier Transform Spectrometer (ACE-FTS) indicate a ~2–3 %/decade drift over much of the stratosphere, increasing to as much as ~7 %/decade around 46 hPa. Larger drifts, of around 7–11 %/decade, are seen in comparisons to balloon-borne frost point hygrometer measurements in the lower stratosphere. In contrast, the MLS v4 N2O product is shown to be generally decreasing over the same period (when an increase in stratospheric N2O is expected, reflecting a secular growth in emissions), with a more pronounced drift in the lower stratosphere than that found for H2O. Detailed investigations of the behavior of the MLS 190-GHz subsystem reveal a drift in its sideband fraction (the relative sensitivity of the 190-GHz receiver to the two different parts of the microwave spectrum it observes). Our studies indicate that sideband fraction drift accounts for much of the observed changes in the MLS H2O product and some portion of the changes seen in N2O. The 190-GHz sideband fraction drift has been corrected in the new version 5 MLS algorithms, which have now been used to reprocess the entire MLS record. As a result of this correction, the MLS v5 H2O record shows no statistically significant drifts compared to ACE-FTS. However, statistically significant drifts remain between MLS v5 and frost point measurements, though they are reduced. Drifts in v5 N2O are about half the size of those in v4 but remain statistically significant. Scientists are advised to use MLS v5 data in all future studies. Quantification of inter-regional and seasonal-to-annual changes in MLS H2O and N2O will not be affected by the drift. However, caution is advised in studies using the MLS record to examine long-term (multi-year) variability and trends in either of these species, especially N2O; such studies should only be undertaken in consultation with the MLS team. Importantly, this drift does not affect any of the MLS observations made in other spectral regions such as O3, HCl, CO, ClO, or temperature.

An improved cloud detection algorithm for the Aura Microwave Limb Sounder (MLS) is presented. This new algorithm is based on a feedforward artificial neural network and uses as input, for each MLS limb scan, a vector consisting of 1,710 brightness temperatures provided by MLS observations from 15 different tangent altitudes and up to 13 spectral channels in each of 10 different MLS bands. The model has been trained on global cloud properties reported by Aqua’s Moderate Resolution Imaging Spectroradiometer (MODIS). In total, the colocated MLS-MODIS data set consists of 162,117 combined scenes sampled on 208 days over 2005–2020. We show that the algorithm can correctly classify > 96 % of cloudy and clear instances for previously unseen MLS scans. A comparison to the current MLS cloudiness flag used in “Level 2” processing reveals a huge improvement in classification performance. For all profiles in the colocated MLS-MODIS data set, the algorithm successfully detects 97.8 % of profiles affected by clouds, up from 15.8 % for the Level 2 flagging. Meanwhile, false positives reported for actually clear profiles are reduced to 1.7 %, down from 6.2 % in Level 2. The classification performance is not dependent on geolocation. The new cloudiness flag is applied to determine average global cloud cover between 2015 and 2019, successfully reproducing the spatial patterns of mid-level to high clouds reported in previous studies. It is also applied to four example cloud fields to illustrate the reliable performance for different cloud structures with varying degrees of complexity. Training a similar model on MODIS-retrieved cloud top pressure yields reliable predictions with correlation coefficients greater than 0.99. The combination of cloudiness flag and predicted cloud top pressure provides the means to identify MLS profiles in the presence of high-reaching convection.

Gravity waves play a significant role in driving the semiannual oscillation (SAO) of the zonal wind in the tropics. However, detailed knowledge of this forcing is missing, and direct estimates from global observations of gravity waves are sparse. For the period 2002–2018, we investigate the SAO in four different reanalyses: ERA-Interim, JRA-55, ERA-5, and MERRA-2. Comparison with the SPARC zonal wind climatology and quasi-geostrophic winds derived from Microwave Limb Sounder (MLS) and Sounding of the Atmosphere using Broadband Emission Radiometry (SABER) satellite observations show that the reanalyses reproduce some basic features of the SAO. However, there are also large differences, depending on the model setup. Particularly, MERRA-2 seems to benefit from dedicated tuning of the gravity wave drag parameterization and assimilation of MLS observations. To study the interaction of gravity waves with the background wind, absolute values of gravity wave momentum fluxes and a proxy for absolute gravity wave drag derived from SABER satellite observations are compared with different wind data sets: the SPARC wind climatology; data sets combining ERA-Interim at low altitudes and MLS or SABER quasi-geostrophic winds at high altitudes; and data sets that combine ERA-Interim, SABER quasi-geostrophic winds, and direct wind observations by the TIMED Doppler Interferometer (TIDI). In the lower and middle mesosphere the SABER absolute gravity wave drag proxy correlates well with positive vertical gradients of the background wind, indicating that gravity waves contribute mainly to the driving of the SAO eastward wind phases and their downward propagation with time. At altitudes 75–85 km, the SABER absolute gravity wave drag proxy correlates better with absolute values of the background wind, suggesting a more direct forcing of the SAO winds by gravity wave amplitude saturation. Above about 80 km SABER gravity wave drag is mainly governed by tides rather than by the SAO. The reanalyses reproduce some basic features of the SAO gravity wave driving: all reanalyses show stronger gravity wave driving of the SAO eastward phase in the stratopause region. For the higher-top models ERA-5 and MERRA-2, this is also the case in the lower mesosphere. However, all reanalyses are limited by model-inherent damping in the upper model levels, leading to unrealistic features near the model top. Our analysis of the SABER and reanalysis gravity wave drag suggests that the magnitude of SAO gravity wave forcing is often too weak in the free-running general circulation models; therefore, a more realistic representation is needed.

Introduction: Risk assessment for non-organ-confined prostate cancer (PCa) is important in the surgical planning for radical prostatectomy (RP). Perineural invasion (PNI) on prostate biopsy has been associated with adverse pathological outcomes at prostatectomy. Similarly, the identification of suspected extracapsular extension (ECE) on multiparametric magnetic resonance imaging (mpMRI) has been shown to predict non-organ-confined disease. However, no prior study has compared these factors in predicting adverse pathology at prostatectomy. We evaluated mpMRI ECE and prostate biopsy PNI on multivariable analysis to determine their ability to predict pathological stage at time of RP. Methods: We retrospectively investigated the prostatectomy database at our institution to identify men who underwent prostate biopsy with pre-biopsy mpMRI and subsequent RP from 2013–2017. Multivariable regression analysis was performed to compare the association of mpMRI ECE (mECE) and PNI on prostate biopsy on the likelihood of finding pT3 disease on pathology post-prostatectomy. Results: Of a total 454 RP between 2013 and 2017, 191 patients met our inclusion criteria. Stage pT2 and pT3+ were found in 120 (62.8%) and 71 (37.2%) patients, respectively. Patients with mECE had 4.84 cumulative odds of worse pathological stage on RP (p=0.045) compared to PNI on biopsy, which showed cumulative odds of 2.25 (p=0.048). When controlling only for those patients without PNI, mECE was still found to be a significant predictor of pT3 disease at RP (p=0.030). However, in patients without mECE, PNI was not significant (p=0.062). Conclusions: While mECE and biopsy PNI were both associated with worse pathological stage on RP, mECE had significantly higher cumulative odds compared to PNI. The significant predictive ability of mECE adds further clinical value to the use of mpMRI in PCa management. While validation in a larger cohort is required, these factors have important clinical implications with regards to early diagnosis of advanced disease and surgical planning.

Following the Australian New Year's pyrocumulonimbus complex between 29‐Dec‐2019 and 4‐Jan‐2020, the Aura Microwave Limb Sounder (MLS) observed a plume with unprecedented enhancements of H2O and biomass‐burning products (CO, HCN, CH3Cl, CH3CN, and CH3OH) in the lower/middle stratosphere, accompanied by depressions in stratospheric species (O3 and HNO3). The plume persisted for ⁓110 days, circling the globe twice while ascending to 5.62 hPa (⁓35 km). Air masses drawn off the main plume moved toward the developing Antarctic polar vortex but do not appear to have penetrated it. Comparison of species in the plume requires consideration of their measurements' spatial resolutions and background abundances. The apparent decay of some long‐lived plume constituents is largely attributable to their coarsening spatial resolution with height, which reduces observed peak values. Differing HCN/H2O signatures indicate that multiple early plumes originated from different stratospheric injection events.

Objective To provide real-time assessment and feedback on the competency of urology residents’ surgical skill via mobile applications and examine their feasibility and utility. Materials and methods Two mobile application-based systems (SIMPL and myTIPreport) were sequentially implemented for the case-by-case assessment of residents’ performance of surgical skills at a single institution. Data was collected regarding residents’ perception of their feedback pre- and post-implementation of the applications. Faculty were surveyed after their implementation to determine their feasibility and utility. Results 297 individual evaluations were completed with SIMPL and 822 with myTIPreport over four and eleven months respectively. Post-implementation, residents showed significantly improved perceptions regarding the quantity and personalization of surgical skill feedback (P = .043 and .005 respectively). A majority (75%) of the faculty found the mobile applications feasible to use, an improvement compared to prior methods of resident evaluation, and would recommend continued use. Conclusion This study represents the first documented use of real-time surgical competency assessment in urology. The use of mobile applications to evaluate urology residents’ surgical competency in clinical practice is both feasible and useful. Their use may allow for more individualized surgical skill teaching during training and for the verification of the surgical skills necessary to practice autonomously.

Convectively injected water vapor (H2O) in the North American (NA) summer lowermost stratosphere results in significant outliers in the 100‐hPa H2O measurements from the Aura Microwave Limb Sounder (MLS). MLS statistics from 15 years confirm that the NA region contains over 60% of global 100‐hPa H2O > 12 ppmv, despite having only ∼1.8% of all MLS observations. A profile sampled in August 2019 stands out, with H2O=26.3 ppmv, far exceeding the prior record and the median ∼4.5‐ppmv abundance in NA. This particular outlier is associated with a large overshooting convective event (OCE) that spanned multiple U.S. states and persisted for several hours. Colocation of the MLS data over NA with cloud observations from Aqua's Moderate Resolution Imaging Spectroradiometer (MODIS) reveals the unique character of this case, as only 2.3% of MLS profiles are as close to an OCE and only 0.024% of OCEs cover as large an area within a 500‐km perimeter of a profile., Key Points A profile with unprecedented stratospheric humidity is associated with large overshooting convectionLarge lower stratospheric humidity outliers are in close proximity to strong overshooting convectionMLS humidity indicates trend toward larger stratospheric outliers and strengthening of North American monsoon

We studied recurrence-free survival after partial vs radical nephrectomy for clinical stage T1 renal cell carcinoma in all patients and in those up staged to pathological stage T3a.We retrospectively reviewed the records of 1,250 patients who underwent partial or radical nephrectomy for clinically localized T1 renal cell carcinoma between 2006 and 2014. Recurrence-free survival was estimated using the Kaplan-Meier method and evaluated as a function of nephrectomy type with the log rank test and Cox models, adjusting for clinical, radiological and pathological characteristics.A total of 86 recurrences (7%) were observed during a median followup of 37 months. No difference in recurrence-free survival between partial and radical nephrectomy was found among all clinical stage T1 renal cell carcinomas. T3a up staging was noted in 140 patients (11%) and recurrent disease was observed in 44 (31.4%) during a median followup of 38 months. Among up staged T3a cases partial nephrectomy was associated with shorter recurrence-free survival compared to radical nephrectomy on univariable analysis (recurrence HR 2.04, 95% CI 1.12-3.68, p = 0.019) and multivariable analysis (recurrence HR 5.39, 95% CI 1.94-14.9, p = 0.001).In a subgroup of patients clinically staged T1 renal cell carcinoma will be pathologically up staged to T3a. Among these patients those who undergo partial nephrectomy appear to have inferior recurrence-free survival relative to those who undergo radical nephrectomy.

Many methods used to improve hospital and perioperative services productivity and quality of care have assumed that the hospital is essentially a factory, and therefore, that industrial engineering and manufacturing-derived redesign approaches such as Six Sigma and Lean can be applied to hospitals and perioperative services just as they have been applied in factories. However, a hospital is not merely a factory but also a complex adaptive system (CAS). The hospital CAS has many subsystems, with perioperative care being an important one for which concepts of factory redesign are frequently advocated. In this article, we argue that applying only factory approaches such as lean methodologies or process standardization to complex systems such as perioperative care could account for difficulties and/or failures in improving performance in care delivery. Within perioperative services, only noncomplex/low-variance surgical episodes are amenable to manufacturing-based redesign. On the other hand, complex surgery/high-variance cases and preoperative segmentation (the process of distinguishing between normal and complex cases) can be viewed as CAS-like. These systems tend to self-organize, often resist or react unpredictably to attempts at control, and therefore require application of CAS principles to modify system behavior. We describe 2 examples of perioperative redesign to illustrate the concepts outlined above. These examples present complementary and contrasting cases from 2 leading delivery systems. The Mayo Clinic example illustrates the application of manufacturing-based redesign principles to a factory-like (high-volume, low-risk, and mature practice) clinical program, while the Kaiser Permanente example illustrates the application of both manufacturing-based and self-organization-based approaches to programs and processes that are not factory-like but CAS-like. In this article, we describe how factory-like processes and CAS can coexist within a hospital and how self-organization-based approaches can be used to improve care delivery in many situations where manufacturing-based approaches may not be appropriate.

Intense deep convection associated with the Asian summer monsoon (ASM) lofts surface pollutants to the upper troposphere / lower stratosphere (UTLS), where strong winds and long chemical lifetimes allow intercontinental transport, affecting atmospheric composition around the globe. The Aura Microwave Limb Sounder (MLS), launched in 2004, makes simultaneous colocated measurements of trace gases and cloud ice water content (a proxy for deep convection) in the UTLS on a daily basis. Here we exploit the dense spatial and temporal coverage, long-term data record, extensive measurement suite, and insensitivity to aerosol and most clouds of Aura MLS to characterize the climatological (2005–2014) composition of the ASM anticyclone throughout its annual lifecycle. We use version 4 MLS data to quantify spatial and temporal variations in both tropospheric (H2O, CO, CH3Cl, CH3CN, CH3OH) and stratospheric (O3, HNO3, HCl) tracers on four potential temperature surfaces (350–410K). Inside the mature anticyclone, all species exhibit substantial changes, not only from their pre-monsoon distributions in the ASM region, but also from their summertime distributions in the rest of the hemisphere. Different tracers exhibit dissimilar seasonal evolution, and the exact location and timing of their extreme values vary. Although individual aspects of the anticyclone have been described previously, we present a uniquely comprehensive overview of the climatological seasonal evolution of the ASM and its impact on UTLS composition. This work provides valuable context for planned in situ measurements as well as a benchmark for model evaluation and future investigations of interannual variability and long-term changes in monsoon processes.

The state of pregnancy introduces additional hurdles in the diagnosis and management of renal and ureteral calculi. Although new imaging modalities have been developed in recent years in hopes of more accurate diagnosis, the reluctance of patients and physicians alike to experiment with unknown risks has prevented widespread usage of newer technology. Luckily, a large proportion of pregnant women with symptomatic nephrolithiasis can be treated conservatively. However, for patients who do require more invasive treatment, the options must be considered thoroughly as each has its own set of risks and benefits.

This work focuses on studying the presence and characteristics of solar 27-day signatures in middle atmospheric temperature observed by the Microwave Limb Sounder (MLS) on NASA’s Aura spacecraft. The 27-day signatures in temperature are extracted using the superposed epoch analysis (SEA) technique. We use time-lagged linear regression (sensitivity analysis) and a Monte-Carlo test method (significance test) to explore the dependence of the results on latitude and altitude, on solar activity and season, as well as on different parameters (e.g., smoothing filter, window width and epoch centers). Using different parameters does impact the results to a certain degree, but it does not affect the overall results. Analyzing the 13-year data set shows that highly significant solar 27-day signatures in middle atmospheric temperature are present at many altitudes and latitudes. A tendency to higher temperature sensitivity to solar forcing in the winter hemisphere is found. In addition, the sensitivity of temperature to solar 27-day forcing tends to be larger at high latitudes than at low latitudes. For solar 11-year minimum conditions no statistically significant identification of a solar 27-day signature is possible at most altitudes and latitudes. Several results we obtained suggest that processes other than solar variability drive atmospheric temperature variability at periods around 27-days. Comparisons of the obtained sensitivity values with earlier experimental and model studies show good overall agreement.

OBJECTIVE To create, distribute, and evaluate the efficacy of a portable, cost-effective 3D-printed laparoscopic trainer for surgical skills development. METHODS The UCI Trainer (UCiT) laparoscopic simulator was developed via computer-aided designs (CAD), which were used to 3D-print the UCiT. Once assembled, a tablet computer with a rear-facing camera was attached for video and optics. Four institutions were sent the UCiT CAD files with a 3D-printer and instructions for UCiT assembly. For a comparison of the UCiT to a standard trainer, peg transfer and intracorporeal knot tying skills were accessed. These tasks were scored, and participants were asked to rate their experience with the trainers. Lastly, a questionnaire was given to individuals who 3D-printed and assembled the UCiT. RESULTS We recruited 25 urologists; none had any 3D-printing experience. The cost of printing each trainer was $26.50 USD. Each institution used the Apple iPad for optics. Six of eight participants assembled the UCiT in < 45 minutes, and rated assembly as somewhat easy. On objective scoring, participants performed tasks equally well on the UCiT vs the conventional trainer. On subjective scoring, the conventional trainer provided a significantly better experience vs the UCiT; however, all reported that the UCiT was useful for surgical education. CONCLUSION The UCiT is a low cost, portable training tool that is easy to assemble and use. UCiT provided a platform whereby participants performed laparoscopic tasks equal to performing the same tasks on the more expensive, nonportable standard trainer.

To evaluate the oncologic outcomes among a large cohort of octogenarian patients placed on active surveillance for a localized renal mass. We retrospectively reviewed patients ≥80 years of age presenting for asymptomatic, incidentally detected clinically localized stage T1 renal mass between 2006 and 2013 who were followed by active surveillance (AS). The primary endpoint was development of metastatic renal cell carcinoma. Secondary outcomes included intervention-free survival, cancer-specific survival, and overall survival. Eighty-nine octogenarians (median age = 83.4 years) were placed on AS for a median 29.9 months. Median Charlson Comorbidity Index and Katz Index of Independence in Activities of Daily Living scores were 2 and 5, respectively. For all comers, median initial tumor size was 2.4 cm with median growth rate of 0.20 cm/year. Eight (9.0%) patients failed AS due to delayed intervention and three (1.1%) due to systemic progression after median follow-up of 27.8 and 39.9 months, respectively. Two (2.2%) patients in the delayed intervention cohort developed metastasis after treatment. Tumor growth rate was significantly higher among those undergoing intervention versus no intervention (0.60 vs. 0.15 cm/year, P = 0.05) and among patients with systemic progression versus no metastasis (1.28 vs. 0.18 cm/year, P = 0.001). Five-year intervention-free, metastasis-free, cancer-specific, and overall survivals were 90.6, 95.6, 95.6, and 85.7%, respectively. AS represents an effective management strategy in octogenarians given low overall risk of metastasis. Tumor growth kinetics may identify patients at risk of systemic progression in whom treatment should be considered.

During the Deep Convective Clouds and Chemistry (DC3) experiment in summer 2012, airborne measurements were performed in the anvil inflow/outflow of thunderstorms over the Central U.S. by three research aircraft. A general overview of Deutsches Zentrum fur Luft- und Raumfahrt (DLR)-Falcon in situ measurements (CO, O3, SO2, CH4, NO, NOx, and black carbon) is presented. In addition, a joint flight on 29 May 2012 in a convective line of isolated supercell storms over Oklahoma is described based on Falcon, National Science Foundation/National Center for Atmospheric Research Gulfstream-V (NSF/NCAR-GV), and NASA-DC8 trace species in situ and lidar measurements.

In situ and remote sensing observations of water vapor are analyzed to assess the evidence for direct convective hydration of the lower stratosphere. We have examined several hundred balloon-borne and airborne in situ measurements of lower stratospheric humidity in the tropics and northern midlatitudes. We find that the tropical lower stratospheric H2O enhancements above the background occur quite infrequently, and the height of the enhancements is within about 1 km of the cold-point tropopause. Following Schwartz et al. (2013, https://doi.org/10.1002/grl.50421), we examine the anomalously high (above 8 ppmv) water vapor mixing ratios retrieved by the Aura Microwave Limb Sounder (MLS) at 100- and 82-hPa pressure levels, and we determine their vertical location relative to the local tropopause based on both Global Forecast System (GFS) operational analysis and the ERA5 reanalysis temperature data. We find that essentially all of the >8-ppmv MLS water vapor measurements over the extratropical North American monsoon region are above the relatively low lapse-rate tropopause in the region, and most are above the local cold-point tropopause. Over the Asian monsoon region, most (80/90%) of the high H2O values occur below the relatively high-altitude local lapse-rate/cold-point tropopause. Anomalously high MLS water vapor retrievals at 100 and 82 hPa almost never occur in the deep tropics. We show that this result is consistent with the in situ observations given the broad vertical averaging kernel of the MLS measurement. The available evidence suggests that direct hydration of the lower stratosphere is important over North America during the monsoon season but likely has limited impact in the tropics.

We present a case study based on balloon-borne ozone measurements during SEACIONS (SouthEast American Consortium for Intensive Ozonesonde Network Study) in August-September 2013. Data from Socorro, NM (34oN, 107oW) show a layer of anomalously low ozone in the upper troposphere (UT) during 8-14 August. Back trajectories, UT jet analyses, and data from the Microwave Limb Sounder (MLS) on the Aura satellite indicate that this feature originated from the marine boundary layer in the eastern/central tropical Pacific, where several disturbances and one hurricane (Henriette) formed within an active region of the Intertropical Convergence Zone in early August 2013. The hurricane and nearby convection pumped boundary layer air with low ozone (20-30 ppbv) into the UT. This outflow was advected to North America 3-5 days later by a strong subtropical jet, forming a tongue of low ozone observed in MLS fields and a corresponding layer of low ozone in Socorro vertical profiles.

We describe the publicly available data from the Global OZone Chemistry And Related trace gas Data records for the Stratosphere (GOZCARDS) project and provide some results, with a focus on hydrogen chloride (HCl), water vapor (H2O), and ozone (O3). This data set is a global long-term stratospheric Earth system data record, consisting of monthly zonal mean time series starting as early as 1979. The data records are based on high-quality measurements from several NASA satellite instruments and the Atmospheric Chemistry Experiment Fourier Transform Spectrometer (ACE-FTS) on SCISAT. We examine consistency aspects between the various data sets. To merge ozone records, the time series are debiased relative to SAGE II (Stratospheric Aerosol and Gas Experiments) values by calculating average offsets versus SAGE II during measurement overlap periods, whereas for other species the merging derives from an averaging procedure during overlap periods. The GOZCARDS files contain mixing ratios on a common pressure–latitude grid, as well as standard errors and other diagnostics; we also present estimates of systematic uncertainties in the merged products. Monthly mean temperatures for GOZCARDS were also produced, based directly on data from the Modern-Era Retrospective analysis for Research and Applications. The GOZCARDS HCl merged product comes from the Halogen Occultation Experiment (HALOE), ACE-FTS and lower-stratospheric Aura Microwave Limb Sounder (MLS) data. After a rapid rise in upper-stratospheric HCl in the early 1990s, the rate of decrease in this region for 1997–2010 was between 0.4 and 0.7 % yr−1. On 6–8-year timescales, the rate of decrease peaked in 2004–2005 at about 1 % yr−1, and it has since levelled off, at ~ 0.5 % yr−1. With a delay of 6–7 years, these changes roughly follow total surface chlorine, whose behavior versus time arises from inhomogeneous changes in the source gases. Since the late 1990s, HCl decreases in the lower stratosphere have occurred with pronounced latitudinal variability at rates sometimes exceeding 1–2 % yr−1. Recent short-term tendencies of lower-stratospheric and column HCl vary substantially, with increases from 2005 to 2010 for northern midlatitudes and deep tropics, but decreases (increases) after 2011 at northern (southern) midlatitudes. For H2O, the GOZCARDS product covers both stratosphere and mesosphere, and the same instruments as for HCl are used, along with Upper Atmosphere Research Satellite (UARS) MLS stratospheric H2O data (1991–1993). We display seasonal to decadal-type variability in H2O from 22 years of data. In the upper mesosphere, the anticorrelation between H2O and solar flux is now clearly visible over two full solar cycles. Lower-stratospheric tropical H2O has exhibited two periods of increasing values, followed by fairly sharp drops (the well-documented 2000–2001 decrease and a recent drop in 2011–2013). Tropical decadal variability peaks just above the tropopause. Between 1991 and 2013, both in the tropics and on a near-global basis, H2O has decreased by ~ 5–10 % in the lower stratosphere, but about a 10 % increase is observed in the upper stratosphere and lower mesosphere. However, such tendencies may not represent longer-term trends. For ozone, we used SAGE I, SAGE II, HALOE, UARS and Aura MLS, and ACE-FTS data to produce a merged record from late 1979 onward, using SAGE II as the primary reference. Unlike the 2 to 3 % increase in near-global column ozone after the late 1990s reported by some, GOZCARDS stratospheric column O3 values do not show a recent upturn of more than 0.5 to 1 %; long-term interannual column ozone variations from GOZCARDS are generally in very good agreement with interannual changes in merged total column ozone (Version 8.6) data from SBUV instruments. A brief mention is also made of other currently available, commonly formatted GOZCARDS satellite data records for stratospheric composition, namely those for N2O and HNO3.

Stratospheric transport and polar processing during the 2014/2015 Arctic winter were strongly influenced by a minor sudden stratospheric warming (SSW) in early January. Disturbances to temperatures and trace gases in the middle and upper stratosphere were similar in character to those associated with major SSWs: The stratopause dropped, and vertical temperature gradients weakened, followed by renewed descent of mesospheric air. The lower stratospheric polar vortex was barely disrupted and remained unusually strong throughout the winter. The SSW did, however, cause lower stratospheric temperatures to rise well above chlorine activation thresholds; trace gas abundances from the Aura Microwave Limb Sounder (MLS) were consequently exceptional. The degree of chlorine activation in January was the smallest, and lower stratospheric ozone values in February were the highest, in the 11 year MLS record. The major role played by a minor SSW highlights the Arctic stratosphere's sensitivity to a spectrum of dynamical variability.

PurposeWe explored the diagnostic use of circulating tumor cells in patients with neoadjuvant bladder cancer using enumeration and next generation sequencing.Materials and methodsA total of 20 patients with bladder cancer who were eligible for cisplatin based neoadjuvant chemotherapy were enrolled in an institutional review board approved study. Subjects underwent blood draws at baseline and after 1 cycle of chemotherapy. A total of 11 patients with metastatic bladder cancer and 13 healthy donors were analyzed for comparison. Samples were enriched for circulating tumor cells using the novel IsoFlux™ System microfluidic collection device. Circulating tumor cell counts were analyzed for repeatability and compared with Food and Drug Administration cleared circulating tumor cells. Circulating tumor cells were also analyzed for mutational status using next generation sequencing.ResultsMedian circulating tumor cell counts were 13 at baseline and 5 at followup in the neoadjuvant group, 29 in the metastatic group and 2 in the healthy group. The concordance of circulating tumor cell levels, defined as low-fewer than 10, medium-11 to 30 and high-greater than 30, across replicate tubes was 100% in 15 preparations. In matched samples the IsoFlux test showed 10 or more circulating tumor cells in 4 of 9 samples (44%) while CellSearch® showed 0 of 9 (0%). At cystectomy 4 months after baseline all 3 patients (100%) with medium/high circulating tumor cell levels at baseline and followup had unfavorable pathological stage disease (T1-T4 or N+). Next generation sequencing analysis showed somatic variant detection in 4 of 8 patients using a targeted cancer panel. All 8 cases (100%) had a medium/high circulating tumor cell level with a circulating tumor cell fraction of greater than 5% purity.ConclusionsThis study demonstrates a potential role for circulating tumor cell assays in the management of bladder cancer. The IsoFlux method of circulating tumor cell detection shows increased sensitivity compared with CellSearch. A next generation sequencing assay is presented with sufficient sensitivity to detect genomic alterations in circulating tumor cells.

Upper tropospheric and lower stratospheric measurements from the Aura Microwave Limb Sounder (MLS), the Aura High Resolution Dynamics Limb Sounder (HIRDLS), and the Atmospheric Chemistry Experiment-Fourier transform spectrometer (ACE-FTS) are used to present the first global climatological comparison of extratropical, nonpolar trace gas distributions in double-tropopause (DT) and single-tropopause (ST) regions. Stratospheric tracers, O3, HNO3, and HCl, have lower mixing ratios ∼2–8 km above the primary (lowermost) tropopause in DT than in ST regions in all seasons, with maximum Northern Hemisphere (NH) differences near 50% in winter and 30% in summer. Southern Hemisphere winter differences are somewhat smaller, but summer differences are similar in the two hemispheres. H2O in DT regions of both hemispheres shows strong negative anomalies in November through February and positive anomalies in July through October, reflecting the strong seasonal cycle in H2O near the tropical tropopause. CO and other tropospheric tracers examined have higher DT than ST values 2–7 km above the primary tropopause, with the largest differences in winter. Large DT-ST differences extend to high NH latitudes in fall and winter, with longitudinal maxima in regions associated with enhanced wave activity and subtropical jet variations. Results for O3 and HNO3 agree closely between MLS and HIRDLS, and differences from ACE-FTS are consistent with its sparse and irregular midlatitude sampling. Consistent signatures in climatological trace gas fields provide strong evidence that transport from the tropical upper troposphere into the layer between double tropopauses is an important pathway for stratosphere-troposphere exchange.

The Southern Hemisphere Antarctic stratosphere experienced two noteworthy events in 2015: a significant injection of sulfur from the Calbuco volcanic eruption in Chile in April, and a record-large Antarctic ozone hole in October and November. Here, we quantify Calbuco's influence on stratospheric ozone depletion in austral spring 2015 using observations and an earth system model. We analyze ozonesondes, as well as data from the Microwave Limb Sounder. We employ the Community Earth System Model, version 1, with the Whole Atmosphere Community Climate Model (CESM1(WACCM)) in a specified dynamics setup, which includes calculations of volcanic effects. The Cloud Aerosol Lidar with Orthogonal Polarization data indicate enhanced volcanic liquid sulfate 532 nm backscatter values as far poleward as 68°S during October and November (in broad agreement with WACCM). Comparison of the location of the enhanced aerosols to ozone data supports the view that aerosols played a major role in increasing the ozone hole size, especially at pressure levels between 150 and 100 hPa. Ozonesonde vertical ozone profiles from the sites of Syowa, South Pole, and Neumayer, display the lowest individual October or November measurements at 150 hPa since the 1991 Mt. Pinatubo eruption period, with Davis showing similarly low values, but no available 1990s data. The analysis suggests that under the cold conditions ideal for ozone depletion, stratospheric volcanic aerosol particles from the moderate-magnitude eruption of Calbuco in 2015 greatly enhanced austral ozone depletion, particularly at 55–68°S, where liquid binary sulfate aerosols have a large influence on ozone concentrations.

The representation of upper tropospheric/lower stratospheric (UTLS) jet and tropopause characteristics is compared in five modern high-resolution reanalyses for 1980 through 2014. Climatologies of upper tropospheric jet, subvortex jet (the lowermost part of the stratospheric vortex), and multiple tropopause frequency distributions in MERRA (Modern Era Retrospective Analysis for Research and Applications), ERA-I (the ECMWF interim reanalysis), JRA-55 (the Japanese 55-year Reanalysis), and CFSR (the Climate Forecast System Reanalysis) are compared with those in MERRA-2. Differences between alternate products from individual reanalysis systems are assessed; in particular, a comparison of CFSR data on model and pressure levels highlights the importance of vertical grid spacing. Most of the differences in distributions of UTLS jets and multiple tropopauses are consistent with the differences in assimilation model grids and resolution: For example, ERA-I (with coarsest native horizontal resolution) typically shows a significant low bias in upper tropospheric jets with respect to MERRA-2, and JRA-55 a more modest one, while CFSR (with finest native horizontal resolution) shows a high bias with respect to MERRA-2 in both upper tropospheric jets and multiple tropopauses. Vertical temperature structure and grid spacing are especially important for multiple tropopause characterization. Substantial differences between MERRA and MERRA-2 are seen in mid- to high-latitude southern hemisphere winter upper tropospheric jets and multiple tropopauses, and in the upper tropospheric jets associated with tropical circulations during the solstice seasons; some of the largest differences from the other reanalyses are seen in the same times and places. Very good qualitative agreement among the reanalyses is seen between the large scale climatological features in UTLS jet and multiple tropopause distributions. Quantitative differences may, however, have important consequences for transport and variability studies. Our results highlight the importance of considering reanalyses differences in UTLS studies, especially in relation to resolution and model grids; this is particularly critical when using high-resolution reanalyses as an observational reference for evaluating global chemistry climate models.

A global climatology (1979–2012) from the Modern-Era Retrospective Analysis for Research and Applications (MERRA) shows distributions and seasonal evolution of upper tropospheric jets and their relationships to the stratospheric subvortex and multiple tropopauses. The overall climatological patterns of upper tropospheric jets confirm those seen in previous studies, indicating accurate representation of jet stream dynamics in MERRA. The analysis shows a Northern Hemisphere (NH) upper tropospheric jet stretching nearly zonally from the mid-Atlantic across Africa and Asia. In winter–spring, this jet splits over the eastern Pacific, merges again over eastern North America, and then shifts poleward over the North Atlantic. The jets associated with tropical circulations are also captured, with upper tropospheric westerlies demarking cyclonic flow downstream from the Australian and Asian monsoon anticyclones and associated easterly jets. Multiple tropopauses associated with the thermal tropopause “break” commonly extend poleward from the subtropical upper tropospheric jet. In Southern Hemisphere (SH) summer, the tropopause break, along with a poleward-stretching secondary tropopause, often occurs across the tropical westerly jet downstream of the Australian monsoon region. SH high-latitude multiple tropopauses, nearly ubiquitous in June–July, are associated with the unique polar winter thermal structure. High-latitude multiple tropopauses in NH fall–winter are, however, sometimes associated with poleward-shifted upper tropospheric jets. The SH subvortex jet extends down near the level of the subtropical jet core in winter and spring. Most SH subvortex jets merge with an upper tropospheric jet between May and December; although much less persistent than in the SH, merged NH subvortex jets are common between November and April.

The objective of this paper is to understand the response of upper tropospheric (UT) clouds and water vapour (H2O) to sea surface temperature (SST) changes over the Indian Ocean. UT ice water content (IWC) and H2O observed by Aura Microwave Limb Sounder (MLS) show dominant dipole mode variability over the Indian Ocean. This is characterized by the oscillating differences between the western and eastern Indian Ocean (WIO and EIO) with greater amplitude in September, October and November (SON) as compared with other seasons. We denote δX = X_WIO − X_EIO, with X being H2O and IWC at three UT levels (215, 147 and 100 hPa) or SST, following the documented definition for Indian Ocean Dipole (IOD). We find a strong positive correlation between δIWC at the three UT levels and δSST, and a relatively weak positive correlation between δIWC and Nino 3.4 SST, suggesting that the UT clouds over the Indian Ocean are largely controlled by the local thermally driven circulation, while teleconnection to El Nino and Southern Oscillation (ENSO) plays a secondary role. The change per degree of δSST for δIWC in SON is 5.5 mg m−3 C−1 at 215 hPa, 1.6 mg m−3 C−1 at 147 hPa and 0.13 mg m−3 C−1 at 100 hPa (i.e. 96% C−1, 87% C−1 and 46% C−1 increase at 215, 147 and 100 hPa, respectively). We find 36% C−1 increase in δH2O at 215 hPa with increasing δSST, associated with a sharp contrast in convective strength (indicated by δIWC) over the Indian Ocean region. On the other hand, δH2O at 100 hPa decreases with increasing δSST because cold temperature is observed above convective clouds and 100 hPa H2O is largely controlled by temperature. The Nino 3.4 SST has a relatively weak positive (negative) correlation with δH2O at 215 hPa (100 hPa).

Objective To present outcomes of a randomized, patient-blinded controlled trial on Pfannenstiel laparoendoscopic single-site (LESS) vs conventional multiport laparoscopic live donor nephrectomy. Patients and Methods Patients presenting as left kidney donors between January 2009 and November 2011 were randomized to LESS donor nephrectomy (LESS-DN: n = 15) or conventional laparoscopic donor nephrectomy (LDN: n = 14). Patients were blinded to the surgical approach preoperatively and attempts to continue patient blinding postoperatively were made by applying dressings consistent with multiple conventional laparoscopic incisions for all patients. De-identified data related to the operation, peri-operative course and postoperative follow-up were prospectively collected and compared between the two groups with an intention-to-treat analysis. Results There were no significant differences between the groups when comparing operating time, estimated blood loss (EBL), i.v. fluid administration, renal allograft warm ischaemia time (WIT), length of hospital stay (LOS) and total inpatient analgesic requirements. Quantitative pain assessment was not significantly different on postoperative day (POD) #0, however, it was significantly lower in the LESS-DN group, beginning on POD #1 (P < 0.05). The changes in haematocrit and serum creatinine in the two groups were not significantly different, and there were no blood transfusions in either group, nor was there a decline in estimated glomerular filtration rate to

[1] Anderson et al. (2012) (A2012) report in situ observations of convectively injected water vapor (H2O) in the North American (NA) summer lowermost stratosphere (LMS), occasionally exceeding 12ppmv. They contend that, in such cold/wet conditions, heterogeneous chemistry on binary water‒sulfate aerosols can activate chlorine, leading to catalytic ozone destruction. Aura Microwave Limb Sounder 100 hPa and 82.5 hPa H2O measurements show that, indeed, the NA LMS is unusually wet, both in mean values and in outliers reaching 18ppmv. Using A2012's threshold, 4% (0.03%) of 100 hPa (82.5 hPa) NA July–August observations are cold/wet enough for activation. Cold parcels, whether wet or dry, typically have much less HCl to activate and O3to destroy than A2012's initial conditions. Slightly lower concentrations of HCl and O3 in cold/wet parcels are attributable, at least in part, to dilution by tropospheric air. Alarming reductions in NA summer column O3suggested by A2012 are not seen in the current climate.

[1] The chemical discontinuity at the extratropical tropopause (ExTP) and stratosphere-troposphere exchange (STE) pathways are investigated using the long-lived chemical species carbon monoxide (CO) and ozone (O3) measured by the Aura Microwave Limb Sounder (MLS). A relative coordinate, tropopause latitude (TpLat), is developed based on potential vorticity (PV) from the Goddard Earth Observing System version 5 (GEOS-5) data assimilation system. TpLat is defined as the shortest geographic distance along an isentropic surface from the extratropical tropopause (ExTP) to an observation location. Our results show that this coordinate highlights the sharp chemical discontinuities at the ExTP more clearly than the widely-used equivalent latitude coordinate. Geographical distributions of STE pathways and barriers are investigated based on meridional gradients in O3 abundances in the new TpLat coordinate in conjunction with analysis of Rossby wave breaking between 330 K and 360 K. In northern hemispheric (NH) winter (Dec–Jan–Feb), NH STE pathways are seen mainly above the northeast Pacific. In NH summer (Jun–Jul–Aug), the NH pathway covers all longitudes at 330 K. However, it is mainly located above Asia at 340 K and above the Atlantic and the North Pacific at 350 K and 360 K. In the southern hemisphere (SH), there is a weaker STE region above the Eastern Indian Ocean and the southwestern Pacific, at and above 350 K in SH winter, and a stronger STE region over the Southeastern Pacific at these levels during SH summer. In addition, this study shows NH PV gradients are slightly stronger near the ExTP in summer than in winter even though the subtropical jet is weaker and Rossby wave breaking is stronger in summer than in winter.

The NASA ER-2 aircraft sampled the lower stratosphere over North America during the field mission for the NASA Studies of Emissions and Atmospheric Composition, Clouds and Climate Coupling by Regional Surveys (SEAC4RS). This study reports observations of convectively influenced air parcels with enhanced water vapor in the overworld stratosphere over the summertime continental United States and investigates three case studies in detail. Water vapor mixing ratios greater than 10 ppmv, which is much higher than the background 4 to 6 ppmv of the overworld stratosphere, were measured by the JPL Laser Hygrometer (JLH Mark2) at altitudes between 16.0 and 17.5 km (potential temperatures of approximately 380 to 410 K). Overshooting cloud tops (OTs) are identified from a SEAC4RS OT detection product based on satellite infrared window channel brightness temperature gradients. Through trajectory analysis, we make the connection between these in situ water measurements and OT. Back trajectory analysis ties enhanced water to OT 1 to 7 days prior to the intercept by the aircraft. The trajectory paths are dominated by the North American monsoon (NAM) anticyclonic circulation. This connection suggests that ice is convectively transported to the overworld stratosphere in OT events and subsequently sublimated; such events may irreversibly enhance stratospheric water vapor in the summer over Mexico and the United States. A regional context is provided by water observations from the Aura Microwave Limb Sounder (MLS).

Sudden stratospheric warmings (SSWs) are circulation anomalies in the polar region during winter. They mostly occur in the Northern Hemisphere and affect also surface weather and climate. Both planetary waves and gravity waves contribute to the onset and evolution of SSWs. While the role of planetary waves for SSW evolution has been recognized, the effect of gravity waves is still not fully understood, and has not been comprehensively analyzed based on global observations. In particular, information on the gravity wave driving of the background winds during SSWs is still missing. We investigate the boreal winters 2001/2002 until 2013/2014. Absolute gravity wave momentum fluxes and gravity wave dissipation (potential drag) are estimated from temperature observations of the satellite instruments HIRDLS and SABER. In agreement with previous work, we find that sometimes gravity wave activity is enhanced before the central date of major SSWs, particularly during vortex-split events. Often, SSWs are associated with polar-night jet oscillation (PJO) events. For these events, we find that gravity wave activity is strongly suppressed when winds reverse from eastward to westward (usually after the central date of a major SSW). In addition, gravity wave potential drag at the bottom of the newly forming eastward directed jet is remarkably weak, while considerable potential drag at the top of the jet likely contributes to the downward propagation of both the jet and the new elevated stratopause. During PJO events, we also find some indication for poleward propagation of gravity waves. Another striking finding is that obviously localized gravity wave sources, likely mountain waves and jet-generated gravity waves, play an important role during the evolution of SSWs and potentially contribute to the triggering of SSWs by preconditioning the shape of the polar vortex. The distribution of these hot spots is highly variable and strongly depends on the zonal and meridional shape of the background wind field, indicating that a pure zonal average view sometimes is a too strong simplification for the strongly perturbed conditions during the evolution of SSWs.

The clinical significance of a positive surgical margin after partial nephrectomy remains controversial. The association between positive margin and risk of disease recurrence in patients with clinically localized renal neoplasms undergoing partial nephrectomy was evaluated.A retrospective multi-institutional review of 1,240 patients undergoing partial nephrectomy for clinically localized renal cell carcinoma between 2006 and 2013 was performed. Recurrence-free survival was estimated using the Kaplan-Meier method and evaluated as a function of positive surgical margin with the log rank test and Cox models adjusting for tumor size, grade, histology, pathological stage, focality and laterality. The relationship between positive margin and risk of relapse was evaluated independently for pathological high risk (pT2-3a or Fuhrman grades III-IV) and low risk (pT1 and Fuhrman grades I-II) groups.A positive surgical margin was encountered in 97 (7.8%) patients. Recurrence developed in 69 (5.6%) patients during a median followup of 33 months, including 37 (10.3%) with high risk disease (eg pT2-pT3a or Fuhrman grade III-IV). A positive margin was associated with an increased risk of relapse on multivariable analysis (HR 2.08, 95% CI 1.09-3.97, p=0.03) but not with site of recurrence. In a stratified analysis based on pathological features, a positive surgical margin was significantly associated with a higher risk of recurrence in cases considered high risk (HR 7.48, 95% CI 2.75-20.34, p0.001) but not low risk (HR 0.62, 95% CI 0.08-4.75, p=0.647).Positive surgical margins after partial nephrectomy increase the risk of disease recurrence, primarily in patients with adverse pathological features.

What's known on the subject? and What does the study add? Off-clamp laparoscopic partial nephrectomy (LPN) is thought to preserve renal function by limiting warm ischaemia time (WIT) and consequently reperfusion injury. To date, studies using the off-clamp technique represent a heterogeneous group, with limited follow-up showing feasibility and safety in a restricted number of cases. We report the largest experience of off-clamp vs on-clamp LPN with perioperative outcomes and intermediate follow-up of renal functional outcomes with stratification by WIT. OBJECTIVE • To evaluate perioperative and 6-month renal functional outcomes of patients undergoing off-clamp vs complete hilar control laparoscopic partial nephrectomy (LPN). PATIENTS AND METHODS • A retrospective review of 489 patients undergoing LPN was completed. • Preoperative imaging assessed tumour characteristics. • Patient demographics, perioperative parameters, and postoperative outcomes were documented. • Multivariable regression analysis was used to assess factors contributing to changes in postoperative renal function between off-clamp and clamped LPN. RESULTS • In all, 289 LPNs were performed on-clamp and 150 were performed off-clamp. • Tumours in the on-clamp group were larger than those in the off-clamp group (mean [range] 3.3 [0.5–13.5] vs 2.7 [0.4–9] cm, P= 0.003). • Univariable analysis comparing off-clamp to on-clamp cohorts showed that estimated glomerular filtration rate (eGFR) was better preserved in the off-clamp cohort at 6 months (−5.8% vs –11.4%, P= 0.046). Multivariable analysis of the groups showed that estimate blood loss (P= 0.015) and warm ischaemia time (WIT, P< 0.001) were the only significant predictors of decreased eGFR in the postoperative period. • Difference in eGFR at 6 months was not significant when WIT was limited to 30 min. The complication rate was greater in the clamped cohort (10% vs 20%, P= 0.012). • There was no difference in transfusion rate or positive margin status. CONCLUSIONS • LPN without hilar clamping is feasible, safe and associated with less renal injury as assessed by postoperative GFR in select patients. • With experience, it can be applied to complex renal lesions.