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In chirurgischen Fachdisziplinen zeichnet sich im Hinblick auf die Pra- und Rehabilitation des Patienten in den letzten Dekaden ein Paradigmenwechsel ab. Insbesondere kann nach aktueller Studienlage bei komplikationstrachtigen Operationen wie der radikalen Zystektomie durch enge interdisziplinare Zusammenarbeit die perioperative Betreuung des Patienten im Sinne einer Fast-track-Genesung optimiert werden. Konzeption standardisierter Behandlungsablaufe und Erstellung eines konkreten Masnahmenkatalogs nach radikaler Zystektomie orientierend an den Leitlinien der ERAS®-Society. Das prasentierte Programm beginnt bei der praoperativen Schulung des Patienten zur optimalen korperlichen und geistigen Vorbereitung auf die Operation. Wesentliche peri- und postoperative Aspekte sind eine schonende Operationstechnik, suffiziente Schmerztherapie, fruhzeitige Mobilisierung und Kostzufuhr, zugige Entfernung von Fremdmaterial und die fruhestmogliche Ruckkehr in den Alltag. Prospektive Datenanalysen bezuglich der Wirksamkeit der etablierten Masnahmen insbesondere in Bezug auf postoperative Komplikationen und mediane Hospitalisationsdauer sind die nachste Zielsetzung.

Radical cystectomy (RC) has a high morbidity and leads to a significant socio-economic burden. We aimed to investigate pre-, intra-, and post-operative variables to create a novel score predicting both post-operative clinical (complications) and economic (length of hospital stay) outcome after RC. We retrospectively evaluated clinical and histopathological data of 317 patients after RC. We performed univariate and multivariate logistic regression analyses to identify variables associated with post-operative clinical (30-day morbidity according to Clavien–Dindo complications) and economic (length of hospital stay) outcome. In multivariate analysis, a high number of intraoperative transfusions (T) of packed red blood cells predicted major complications (odds ratio [OR] 1.68, 95% confidence interval [CI] 1.10–2.58, p = 0.017), preoperative potassium (P) level predicted three or more complications (OR for high preoperative potassium 0.71, 95% CI 0.52–0.98, p = 0.037), and high drain (D) loss on post-operative day 1 predicted a longer hospital stay ≥ 22 days (OR 1.57, 95% CI 1.04–2.35, p = 0.003). The PT2D-Score was able to predict three or more complications (area under the curve: 0.70, 95% CI 0.61–0.78, p

Zusammenfassung Holzbalkendecken sind über Jahrhunderte eine typische und vielfältig verbaute hölzerne Deckenkonstruktion. Um sowohl neue gesellschaftliche Nutzungsanforderungen als auch den Erhalt der historischen Substanz zu gewährleisten, wurde 2017 am Lehrstuhl für Tragwerksplanung der TU Dresden, eine denkmalgerechte Methodik zur Ertüchtigung weit gespannter Holzbalkendecken mittels additiver Querschnittsergänzung unter Anwendung einer konstruktiven Klebung als zeitgemäße Holzverbindungstechnik erforscht. Im Ergebnis dieser Untersuchungen erhält das Kulturdenkmal Schloss Steinort in Sztynort, Republik Polen (ehem. Ostpreußen), seine bedeutenden und umfänglich polychrom bemalten Holzbalkendecken zurück, die dann zudem geeignet sind, größere Lasten aus den zukünftigen Nutzungsanforderungen zu tragen. Die untersuchte Sicherung und Ertüchtigung der Holzbalkendecken von Schloss Steinort ist eine innovative Kombination von neuen ingenieurwissenschaftlichen, konstruktiven Denkansätzen und hohen gesellschaftlichen Anforderungen moderner Denkmalpflege zu Gunsten des Fortbestandes des Kulturdenkmals.

In this paper we investigate the interaction of fluid flow with a thin porous elastic layer. We consider two fluid-filled bulk domains which are separated by a thin periodically perforated layer consisting of a fluid and an elastic solid part. Thickness and periodicity of the layer are of order $\epsilon$, where $\epsilon$ is small compared to the size of the bulk domains. The fluid flow is described by an instationary Stokes equation and the solid via linear elasticity. The main contribution of this paper is the rigorous homogenization of the porous structure in the layer and the reduction of the layer to an interface $\Sigma$ in the limit $\epsilon \to 0$ using two-scale convergence. The effective model consists of the Stokes equation coupled to a time dependent plate equation on the interface $\Sigma$ including homogenized elasticity coefficients carrying information about the micro structure of the layer. In the zeroth order approximation we obtain continuity of the velocities at the interface, where only a vertical movement occurs and the tangential components vanish. The tangential movement in the solid is of order $\epsilon$ and given as a Kirchhoff-Love displacement. Additionally, we derive higher order correctors for the fluid in the thin layer.

Ceftaroline fosamil, a fifth-generation cephalosporin antibiotic with activity against methicillin-resistant Staphylococcus aureus (MRSA), is currently approved for the treatment of pneumonia and complicated skin and soft tissue infections. However, pharmacokinetics data on free lung tissue concentrations in critical patient populations are lacking. The aim of this study was to evaluate the pharmacokinetics of the high-dose regimen of ceftaroline in plasma and lung tissue in cardiac surgery patients during intermittent and continuous administration. Nine patients undergoing elective cardiac surgery on cardiopulmonary bypass were included in this study and randomly assigned to intermittent or continuous administration. Eighteen hundred milligrams of ceftaroline fosamil was administered intravenously as either 600 mg over 2 h every 8 h (q8h) (intermittent group) or 600 mg over 2 h (loading dose) plus 1,200 mg over 22 h (continuous group). Interstitial lung tissue concentrations were measured by in vivo microdialysis. Relevant pharmacokinetics parameters were calculated for each group. Plasma exposure levels during intermittent and continuous administration were comparable to those of previously published studies and did not differ significantly between the two groups. In vivo microdialysis demonstrated reliable and adequate penetration of ceftaroline into lung tissue during intermittent and continuous administration. The steady-state area under the concentration-time curve from 0 to 8 h (AUC(ss 0–8)) and the ratio of AUC(SS 0-8) in lung tissue and AUC in plasma (AUC(lung/plasma)) were descriptively higher in the continuous group. Continuous administration of ceftaroline fosamil achieved a significantly higher proportion of time for which the free drug concentration remained above 4 times the minimal inhibitory concentration (MIC) during the dosing interval (% fT(>4xMIC)) than intermittent administration for pathogens with a MIC of 1 mg/liter. Ceftaroline showed adequate penetration into interstitial lung tissue of critically ill patients undergoing major cardiothoracic surgery, supporting its use for pneumonia caused by susceptible pathogens.

OBJECTIVES: To investigate the safety of robotic surgery during COVID-19 pandemic concerning new-acquired COVID-19 infections for patients and healthcare workers. PATIENTS: We performed a retrospective single-centre cohort study of patients undergoing robotic surgery in initial period of COVID-19 pandemic. Patients and Healthcare workers COVID-19 infection status was assessed by structured telephone follow-up and/or repeated nasopharyngeal swabs. RESULTS: After 61 robotic surgeries (93,5% cancer surgery), 1 patient (1.6%) had COVID-19 infection. 60 healthcare workers cumulatively exposed to 1,187 hours of robotic surgery had no infection. One patient with postoperative proof of SARS-CoV-2 had complete recovery. After this potentially contagious robotic surgery, 8 healthcare workers had no COVID-19 infection after follow-up with each 3 nasopharyngeal swabs. CONCLUSIONS: Early clinical experience of robotic surgery during COVID-19 pandemic shows that robotic surgery can be safely performed for patients and healthcare workers. Despite our results we recommend elective surgery only for verified COVID-19 negative patients. This article is protected by copyright. All rights reserved.

Bei onkologischen Patienten liegen einer Vorstellung in der Klinik haufig urologische Notfalle zugrunde. Diese konnen durch Neoplasien des Urogenitaltrakts oder anderer Organe des Retroperitoneums bzw. Beckens bedingt sein und stellen sich als Blutbeimengung zum Urin, Harnretention oder stauungsbedingte Infektionen des Harntrakts dar. Ein schnelles diagnostisches und therapeutisches Handeln ist zur Erzielung eines gunstigen klinischen Verlaufs entscheidend. Bei Blutungen beinhalten die Masnahmen eine exakte Lokalisation und anschliesende interventionelle Versorgung der Blutungsquelle, bei Harnretention und stauungsbedingten Infektionen eine Drainage des gestauten Urins.

Introduction After radical cystectomy, orthotopic neobladder is one surgical strategy for urinary diversion. To assess the usefulness of an operation, long-term data are essential. We examined long-term complications and continence rates of orthotopic ileocecal (MAINZ pouch) bladder substitution. Material and methods Between 1986 and 2011, 193 patients underwent orthotopic MAINZ pouch bladder substitution. Until July 2000, ureter implantation was performed into the ascending colon through a submucosal tunnel technique (Goodwin-Hohenfellner). After July 2000, ureters were implanted into the terminal Ileum using the ileocecal valve to prevent reflux: the left spatulated ureter by an end-to-end (Wallace) and the right ureter by an end-to side technique (Nesbit). Surgical and medical follow-up reports were evaluated and a recent follow-up was obtained by a questionnaire. Results Median follow-up in 183 patients was 72 months (1-336). A total of 74 patients (38%) died during the follow-up. A surgical intervention was required in 26 out of 193 patients with early complications while 45 out of 183 patients had late and 17 patients had both, early and late complications. Ureteral stenosis was found in 13% of submucosal implanted ureters, 13% with the Wallace technique, and 3.6% with the Nesbit technique. In total, 66 patients responded to the questions concerning long-term continence (minimal follow-up >2 years). Overall, 84.8% were completely continent, 1.6%, reported grade I and 9.8% grade II stress incontinence. Conclusions The long-term continence and complication rates are comparable to those of other types of orthotopic bladder substitution. Orthotopic MAINZ pouch procedure can be considered as one of the options for orthoptic diversion, which stands the test of time.

Background In testicular cancer determination of clinical stage and recommendation of therapeutic strategy after inguinal orchiectomy are based on primary imaging by CT-scan of the chest and CT- or MRI- abdomen. It has not been investigated so far, whether the imaging should be performed before or after primary testicular surgery. Staging before surgery means exposing all patients to CT radiation irrespective of ensured histologic malignancy while postoperative staging could pose a risk in biased clinical decision making by increased presence of unspecific lymph node enlargement caused by postsurgical effects. Therefore, we aimed to investigate the association between the timing of initial staging and occurrence of unspecific lymph node enlargement and adjuvant therapies after inguinal orchiectomy. Methods We retrospectively evaluated clinical and radiological data from 236 patients who had undergone inguinal orchiectomy for testicular cancer at our department. Statistical analysis was performed to determine whether the occurrence of unspecific lymph node enlargement or the rate of adjuvant therapies were influenced by timing of initial staging (preoperative vs. postoperative). Results The postoperative imaging cohort showed significant more inguinal, pelvic and retroperitoneal unspecific lymph node enlargement than the preoperative imaging cohort. Simultaneous occurrence of inguinal or pelvic lymph node enlargement together with retroperitoneal enlargements could only be found in the postoperative imaging cohort. No difference regarding adjuvant therapies could be found. Conclusions Timing of imaging affects the detection rate of unspecific lymph node enlargements but does not show a significant effect on the rate of adjuvant therapies.

Purpose Open simple prostatectomy (OSP) is a standard surgical technique for patients with benign prostatic hyperplasia with prostate size larger than 80 ml. As a minimally invasive approach, robot-assisted simple prostatectomy (RASP) emerged as a feasible surgical alternative. Currently, there are no definite recommendations for the standard use of RASP. Therefore, we aimed at investigating various clinical outcomes comparing RASP with OSP. Methods In this retrospective single-center study, we evaluated clinical data from 103 RASP and 31 OSP patients. Both cohorts were compared regarding different clinical characteristics with and without propensity score matching. To detect independent predictive factors for clinical outcomes, multivariate logistic regression analysis was performed. Results Robot-assisted simple prostatectomy patients demonstrated a lower estimated blood loss and need for postoperative blood transfusions as well as less postoperative complications. OSP had a shorter operative time (125 min vs. 182 min) longer hospital stay (11 days vs. 9 days) and longer time to catheter removal (8 days vs. 6 days). In the multivariate analysis, RASP was identified as an independent predictor for longer operative time, lower estimated blood loss, shorter length of hospital stay, shorter time to catheter removal, less postoperative complications and blood transfusions. Conclusion Robot-assisted simple prostatectomy is a safe alternative to OSP with less perioperative and postoperative morbidity. Whether OSP (shorter operative time) or RASP (shorter length of hospital stay) has a more favorable economic impact depends on the particular conditions of different health care systems. Further prospective comparative research is warranted to define the value of RASP in the current surgical management of benign prostatic hyperplasia.

In surgical fields there has been a perceivable paradigm shift during the last decade concerning patient pre- and rehabilitation. Current literature suggests close interdisciplinary collaboration after complex procedures such as radical cystectomy in order to optimize perioperative patient care for the benefit of "fast-track" surgery.To compose a catalogue of standardized measures after radical cystectomy based on guidelines set by the ERAS®-Society.The protocol commences with preoperative education in order to improve the physical and psychological condition of the patient. Crucial aspects in peri- and postoperative patient care are gentle surgical technique, adequate pain management, early mobilization and oral food intake, early removal of drains and foreign material and a seamless return to normal, daily life.Prospective data analysis will be the next step in order to establish the effectiveness of the protocol especially regarding postoperative complications and median duration of hospital stay.HINTERGRUND: In chirurgischen Fachdisziplinen zeichnet sich im Hinblick auf die Prä- und Rehabilitation des Patienten in den letzten Dekaden ein Paradigmenwechsel ab. Insbesondere kann nach aktueller Studienlage bei komplikationsträchtigen Operationen wie der radikalen Zystektomie durch enge interdisziplinäre Zusammenarbeit die perioperative Betreuung des Patienten im Sinne einer Fast-track-Genesung optimiert werden.Konzeption standardisierter Behandlungsabläufe und Erstellung eines konkreten Maßnahmenkatalogs nach radikaler Zystektomie orientierend an den Leitlinien der ERAS®-Society.Das präsentierte Programm beginnt bei der präoperativen Schulung des Patienten zur optimalen körperlichen und geistigen Vorbereitung auf die Operation. Wesentliche peri- und postoperative Aspekte sind eine schonende Operationstechnik, suffiziente Schmerztherapie, frühzeitige Mobilisierung und Kostzufuhr, zügige Entfernung von Fremdmaterial und die frühestmögliche Rückkehr in den Alltag.Prospektive Datenanalysen bezüglich der Wirksamkeit der etablierten Maßnahmen insbesondere in Bezug auf postoperative Komplikationen und mediane Hospitalisationsdauer sind die nächste Zielsetzung.

Background The SARS-CoV-2 pandemic presents an unprecedented challenge to health care systems worldwide. Data on SARS-CoV-2 transmission in a hospital is rare and outbreaks among health care professionals are complex to control. Material and Methods Over the course of 6 consecutive weeks we recorded data on an exponential outbreak of SARS-CoV-2 within our department. We reconstructed the assumed route of the spread of infection, and the employees’ acute and late symptoms. Increasing preventive measures (mandatory face masks, intense training in hygiene, physical distancing whenever possible, and termination of visits from outside the hospital) were implemented. Results Within 6 weeks, 13 employees were tested positive for SARS-CoV-2. All individuals had a moderate course, not resulting in hospitalization. The majority of infections was discovered after testing contacts of known cases, prior to their onset of symptoms and was predominantly related to removal of face masks during breaks. Increasing preventive measures resulted in a decline and finally containment of transmission rates amongst the staff, confirmed by mass testing at week 6, with no further SARS-CoV-2 infection. Three individuals, all in their late 40s or older, have lasting or newly onset neurological symptoms 8 months after their infection. Conclusions Outbreaks of SARS-CoV-2 are particularly difficult to contain in a medical setting, where employees work in close physical proximity. Adherence to preventive measures, particularly face masks, seem to be effective.

Introduction & Objectives: In this study, we investigated the safety of robotic surgery during the pandemic period concerning new-acquired COVID-19 infections for both patients, assessed by follow-up telephone interview, and healthcare workers, assessed by swab tests on SARS-CoV-2. Materials & Methods: We performed a retrospective single-centre cohort study of patients undergoing robotic surgery in the initial 2-months period of COVID-19 focusing on safety. Patients’ COVID-19 infection status was assessed by telephone follow-up at a minimum of 14 days (median: 48) after robotic surgery. All healthcare workers involved in robotic surgery including console surgeons, bedside surgeons, anesthetists, scrub nurses and anesthesia nurses were investigated for presence of SARS-CoV-2 in nasopharyngeal swabs at three different time points during the study period from 12 March to 11 May 2020. Results: After 61 robotic surgeries, 1 patient (1.6%) had a COVID-19 infection. 60 healthcare workers (4 console surgeons, 8 bedside surgeons, 21 anesthetists, 13 scrub nurses and 14 anesthesia nurses) that were cumulatively exposed to 1,187 hours of robotic surgery had no COVID-19 infection. One patient with proof of SARS-CoV-2 on postoperative day two after radical prostatectomy had complete recovery without need for ventilation. After this potentially contagious robotic surgery, 8 healthcare workers with direct patient contact had no COVID-19 infection after 2 weeks and follow-up with each 3 nasopharyngeal swabs. Conclusions: Early clinical experience of robotic surgery during COVID-19 pandemic on 61 patients shows that robotic surgery can be safely performed for both patients and healthcare workers. In particular, there was no COVID-19 infection among 8 healthcare workers with direct contact during potentially contagious robotic surgery on a patient for whom COVID-19 infection was proven two days after surgery.

Objectives While the coronavirus disease 2019 (COVID-19) pandemic captures healthcare resources worldwide, data on the impact of prioritization strategies in urology during pandemic are absent. We aimed to quantitatively assess the global change in surgical and oncological clinical practice in the early COVID-19 pandemic. Methods In this cross-sectional observational study, we designed a 12-item online survey on the global effects of the COVID-19 pandemic on clinical practice in urology. Demographic survey data, change of clinical practice, current performance of procedures, and current commencement of treatment for 5 conditions in medical urological oncology were evaluated. Results 235 urologists from 44 countries responded. Out of them, 93% indicated a change of clinical practice due to COVID-19. In a 4-tiered surgery down-escalation scheme, 44% reported to make first cancellations, 23% secondary cancellations, 20% last cancellations and 13% emergency cases only. Oncological surgeries had low cancellation rates (%): transurethral resection of bladder tumor (27%), radical cystectomy (21–24%), nephroureterectomy (21%), radical nephrectomy (18%), and radical orchiectomy (8%). (Neo)adjuvant/palliative treatment is currently not started by more than half of the urologists. COVID-19 high-risk-countries had higher total cancellation rates for non-oncological procedures (78% vs. 68%, p = 0.01) and were performing oncological treatment for metastatic diseases at a lower rate (35% vs. 48%, p = 0.02). Conclusion The COVID-19 pandemic has affected clinical practice of 93% of urologists worldwide. The impact of implementing surgical prioritization protocols with moderate cancellation rates for oncological surgeries and delay or reduction in (neo)adjuvant/palliative treatment will have to be evaluated after the pandemic.

The purpose of the study was to define clinical factors for successful treatment response and re-exposure to docetaxel in metastatic castration-resistant prostate cancer (mCRPC). An mCRPC database of patients receiving first-line docetaxel and rechallenge courses was established. Several clinical factors were evaluated for prediction of treatment response. Multivariate cox-regression analysis was used to define pre-treatment and treatment factors for survival. Between 2005 and 2013, 94 patients with mCRPC were treated with docetaxel. Full data set and follow-up were available for 62 patients. Median follow-up was 84 m [interquartile range (IQR) 64–104 m]. Median biochemical progression-free survival (bPFS) and overall survival under docetaxel were 9 m (IQR 5–16 m) and 20 m (IQR 16–26 m), respectively. Partial PSA-response at first docetaxel-sequence (n = 62), rechallenge (n = 32), and third-sequence (n = 22) docetaxel was 48.4%, 31.6%, and 34.8%, respectively. Time from start of primary androgen deprivation to CRPC > 47 m was the only independent pre-treatment parameter to predict improved overall survival (Hazard Ratio 0.48, p = 0.015). Interestingly, there was a strong trend for improved overall survival in patients with high Gleason Score (Hazard Ratio 0.58; p = 0.08). Partial PSA-response at docetaxel-rechallenge (Hazard Ratio 0.31; p = 0.008) and treatment-free interval > 3 m (Hazard Ratio 3.49; p = 0.014) were the only independent predictive factors under taxane treatment for overall survival. Despite novel hormonal drugs, docetaxel still plays an important role in the treatment of mCRPC. Patients with partial-PSA-response at rechallenge or a treatment-free interval > 3 m benefit most from docetaxel re-exposure.

In den letzten Jahren entwickelten sich eine Vielzahl neuer Therapieoptionen fur die Behandlung kleiner Nierentumoren (mit einem Durchmesser

Introduction We investigated the incidence, clinical course and risk factors for symptomatic lymphoceles after radical retropubic prostatectomy with pelvic lymph node dissection. Moreover, we explored parameters for the failure of percutaneous lymphocele drainage. Methods The incidence of symptomatic lymphoceles in patients with prostate cancer who underwent radical retropubic prostatectomy with pelvic lymph node dissection in our department between 2008 and 2013 was investigated retrospectively. The occurrence of lymphoceles was correlated with several clinical and histopathological parameters. In addition, logistic regression analysis was performed to assess the value of independent variables with regard to the development of symptomatic lymphoceles and failure of percutaneous drainage. Results A total of 599 consecutive patients treated with radical retropubic prostatectomy with pelvic lymph node dissection were included in the study, of whom symptomatic lymphocele had developed in 5%. Median time to diagnosis of symptomatic lymphocele was 22.5 days. Median time of percutaneous drainage was 16 days. Overall 43% of patients required surgical unroofing. On multivariate analysis age greater than 67 years (OR 3.27, p=0.005) and removal of more than 10 lymph nodes (OR 2.57, p=0.018) were independent predictors for the development of symptomatic lymphoceles. A significantly increased risk of percutaneous drainage failure was observed in patients who had a body mass index greater than 27 kg/m2 (OR 7.0, p=0.03), followed by a trend for those with a drainage volume of more than 375 ml 24 hours after puncture (OR 3.89, p=0.12). Conclusions Symptomatic lymphocele will develop in 1 of 20 patients after radical retropubic prostatectomy with pelvic lymph node dissection. The number of lymph nodes removed constitutes an independent risk factor. Percutaneous drainage failure is associated with high body mass index and high drainage volume within the first 24 hours after puncture.

Radical cystectomy (RC) has a high morbidity and leads to a significant socio-economic burden. We aimed to investigate pre-, intra-, and post-operative variables to create a novel score predicting both post-operative clinical (complications) and economic (length of hospital stay) outcome after RC.We retrospectively evaluated clinical and histopathological data of 317 patients after RC. We performed univariate and multivariate logistic regression analyses to identify variables associated with post-operative clinical (30-day morbidity according to Clavien-Dindo complications) and economic (length of hospital stay) outcome.In multivariate analysis, a high number of intraoperative transfusions (T) of packed red blood cells predicted major complications (odds ratio [OR] 1.68, 95% confidence interval [CI] 1.10-2.58, p = 0.017), preoperative potassium (P) level predicted three or more complications (OR for high preoperative potassium 0.71, 95% CI 0.52-0.98, p = 0.037), and high drain (D) loss on post-operative day 1 predicted a longer hospital stay ≥ 22 days (OR 1.57, 95% CI 1.04-2.35, p = 0.003). The PTThe novel PT

To compare toxicity and response of docetaxel chemotherapy between metastatic hormone-sensitive prostate cancer (mHSPC) and castration-resistant metastatic prostate cancer (mCRPC) patients of the same therapeutic era for assessing of upfront docetaxel against the benchmark of docetaxel in the castrate resistant stage in the setting outside of clinical trials.A prospectively collected database of real-world prostate cancer patients receiving docetaxel was divided in mHSPC and mCRPC cases and retrospectively analyzed. Principal objectives were toxicity measured by the common criteria of adverse events terminology and response characterized by Prostate specific antigen decline and radiographic progression-free disease at restaging. The prognostic value of suspected variables for grade 3 to 5 toxicity and response was investigated by logistic regression analysis.Of 72 patients 34 (47%) were treated for mHSPC and 38 (53%) for mCRPC. Patients with mCRPC were older and had worse performance status (P0.01). In mHSPC total number of grade 3 to 5 adverse events (24, median 0, interquartile range 0-1) was significantly less than in mCRPC (46, median 1, interquartile range 1-2) (P = 0.01). Multivariable analysis revealed age as independent predictive variable for grade 3 to 5 toxicity (P = 0.03) but not disease stage, Prostate specific antigen predocetaxel, volume of disease, and Eastern Cooperative Oncology Group performance status (P0.05). Objective response was significantly higher in mHSPC compared to mCRPC patients (P0.01). Multivariable analysis confirmed mHSPC stage as independent prognostic factor for radiographic progression free disease at restaging (P0.01).The association of age with toxicity and of mHSPC stage with response resulted in significantly fewer grade 3 to 5 adverse events but higher response rates for upfront docetaxel in mHSPC compared with docetaxel in the later mCRPC stage.

Background Urolithiasis is a widespread disease. Diagnostic imaging plays an important role in the evaluation and management of patients with suspected urolithiasis. Furthermore, modern imaging methods may provide information on stone location, size, fragility and composition aiding the urologist to determine the appropriate treatment modality. Purpose Based on the current literature and guidelines, this review reports on the various new and established diagnostic imaging modalities. Results Ultrasound should always be the initial imaging modality. Following ultrasound, noncontrast CT-principally using a low-dose protocol-is the imaging modality of choice in the evaluation of patients with acute flank pain and suspected urolithiasis. New imaging modalities like dual energy CT, Uro Dyna CT and digital tomosynthesis are currently under investigation but not yet part of daily clinical practice. Magnetic resonance imaging can be used to detect obstruction caused by urinary stones but is not a first-line imaging modality.

Superconductor (SC)/ferromagnet (FM) Nb/Co multilayers have been produced by magnetron-sputtering with a 100 nm thickness of Nb and 5, 10, and 20 nm of Co. The superconducting properties have been investigated by electric transport measurements. It was found that the thicker Co layers decrease the superconducting transition temperature (Tc) less than the thinner ones. In order to understand this unexpected behavior, the microstructure of the layers has been investigated by means of Atomic Force Microscopy (AFM), Transmission Electron Microscopy (TEM) and by energy-dispersive X-ray spectroscopy line scan analyses in scanning TEM (STEM) mode. It was found that the decisive parameter which determines the effect of magnetic layers on Tc of the superconducting layers is not only the roughness (R), but the ratio of the roughness to thickness (dCo) of the magnetic Co layer, δ = R / d Co . For δ > 1 the magnetic stray field of the magnetic layers is the main reason for the Tc reduction.

Several new treatment strategies have emerged in the treatment of small renal masses (4 cm in diameter). Active surveillance and ablative techniques have been introduced but it remains unclear which patients will benefit the most from these new treatment options. A surgical approach remains standard of care. In recent decades, radical nephrectomy has been replaced by nephron-sparing surgery for the management of small renal masses.In addition to the open partial nephrectomy, which is considered the standard approach, the number of surgeries performed using minimally invasive techniques is increasing. Recent data show that there might be some benefits such as less blood loss. The disadvantages shown by laparoscopic partial nephrectomy such as prolonged warm ischemia, longer operation times, and postoperative renal impairment might be negligible for the robotic approach. Therefore, current guidelines allow these approaches in addition to open partial nephrectomy if sufficient surgical expertise is given.

A novel inversion method is presented, which derives the two-variable number distribution for black carbon aerosol, using a coupled centrifugal particle mass analyzer (CPMA) and single particle soot photometer (SP2). The CPMA classifies all particles by their mass-to-charge ratio, and the SP2 detects the mass of refractive black carbon (rBC) in each individual particle. The results of the inversion are the simultaneous number distributions of both rBC mass and total particle mass. Using the distribution, the coating distribution on a population of rBC particles can be identified visually. Furthermore, the distribution can be integrated to find one-variable mass and number concentration distributions as a function of total or rBC particle mass. These capabilities were demonstrated via smog chamber experiments, where an organic (non-rBC) coating was grown onto uncoated rBC aerosol over several hours via photo-oxidation of p-xylene. The particle distributions were constructed using the inversion over a range of 1–60 fg of total particle mass. As the non-rBC coating thickness increased over time, a shift in the number distribution toward higher total mass was observed. At the end of the experiment, uncoated rBC was injected into the chamber, and the distribution was clearly resolved using the inversion. The CPMA-SP2 method offers several advantages over “SP-2 only” methods, namely, (i) coating mass information can be obtained over a wider range of total particle mass, (ii) total particle mass is measured directly, and (iii) it does not make core–shell morphology assumptions. Copyright © 2018 American Association for Aerosol Research

In bladder cancer (BCa) patients undergoing radical cystoprostatectomy (RCPx), concomitant prostate cancer (PCa) is a common finding. Up to now there is no clear evidence to suggest that concomitant PCa is a predictor of outcome in these patients. Aim of this study was to assess incidence and clinicopathologic characteristics of concomitant PCa in RCPx specimen and correlate it to survival parameters from a single-centre material over two decades. All men who had undergone RCPx for BCa at our institution between 1994 and 2013 were included in this study. Clinicopathologic parameters for BCa and PCa were evaluated and correlated with outcome parameters. Survival analysis was performed for the subgroup of nonmetastatic organ-confined BCa to evaluate the role of concomitant Gleason Score (GS) ≥7 PCa. Of 945 men who had undergone RCPx for BCa, concomitant PCa was present in 237 patients (25.1 %). There was a significant increase in PCa incidence from 18.9 to 32.3 % between 1994 and 2013 (p = 0.009). Concomitant PCa represented a more aggressive phenotype at the end of the study (p = 0.037). In nonmetastatic organ-confined BCa, concomitant GS ≥7 PCa (HR 3.09; p = 0.0001) and age > 68 (HR 1.80; p = 0.0004) were independent negative predictors for overall survival. Concomitant PCa in RCPx specimen of BCa patients is a common finding. The incidence of concomitant PCa has significantly increased within 2 decades, presenting a more aggressive phenotype. Age and in particular concomitant GS ≥7 PCa are independent prognosticators for poor survival in patients with nonmetastatic organ-confined BCa.

Intermittent hyperammonemic encephalopathy after ureterosigmoidostomy is a rare, but if unrecognized, potentially lethal condition. Ureterosigmoidostomy was performed in a male patient with bladder extrophy. After 35 years, he developed hyperammonemic encephalopathy. Diagnostic procedures did not reveal hepatic nor metabolic disorders. Despite administration of preventive medical treatment, several episodes recurred. A durable prevention was finally achieved by conversion into an ileal conduit. Intermittent hyperammonemic encephalopathy can occur decades after ureterosigmoidostomy. In the case of absence of metabolic disorders and resistance to medical treatment, conversion into a urinary diversion using an ileal segment constitutes an effective ultima ratio.

Orthotopic mouse models of urothelial cancer are essential for testing novel therapies and molecular manipulations of cell lines in vivo. These models are either established by orthotopic inoculation of human (xenograft models) or murine tumor cells (syngeneic models) in immunocompromised or immune competent mice. Current techniques rely on inoculation by intravesical instillation or direct injection into the bladder wall. Alternative models include the induction of murine bladder tumors by chemical carcinogens (BBN) or genetic engineering (GEM).

Zusammenfassung Hintergrund: Der Nd:YAG-Laser wird als eine nebenwirkungsarme und effektive Alternative zur systemischen Therapie der Onychomykose beschrieben. In dieser Studie werden ein langund ein kurzgepulster Nd:YAG-Laser im Seitenvergleich ohne vorheriges Abtragen des onychomykotischen Materials klinisch evaluiert. Patienten und Methodik: Die Groszehennagel von zehn Patienten wurden einfach verblindet im Seitenvergleich in zwei Sitzungen mit einem kurzgepulsten und einem langgepulsten Nd:YAG-Laser behandelt. Zu Beginn und nach neun Monaten erfolgte eine histologische und kulturelle Diagnostik. Alle drei Monate erfolgte die Klassifikation mittels „Onychomycosis Severity Index (OSI)“ durch zwei unabhangige Untersucher und eine Fotodokumentation. Ergebnisse: Die Gesamtheit aller OSI-Punktwerte (n = 20) ging innerhalb von drei, sechs und neun Monaten um 3,8 (15 %; p = 0,006), 4,8 (19 %; p = 0,0002) und 2,9 (12 %; p = 0,04) zuruck. Die Gesamtzahl positiver Pilzkulturen war nach neun Monaten mit 35 % signifikant geringer (p = 0,0003). Der klinische Schweregrad der Onychomykose konnte dagegen nicht signifikant gebessert werden. Ein signifikanter Unterschied zwischen den beiden Lasertypen war nicht feststellbar. Schlussfolgerungen: Es konnte gezeigt werden, dass durch zwei Anwendungen des Nd:YAG-Lasers ohne vorheriges Abtragen des onychomykotischen Nagelmaterials eine vorubergehende klinische Besserung sowie eine signifikante Reduzierung der positiven Pilzkulturen erreichbar ist. Als Monotherapie der Onychomykose muss dieser Therapieaufbau jedoch optimiert und weiter evaluiert werden.

Urolithiasis is a widespread disease. Diagnostic imaging plays an important role in the evaluation and management of patients with suspected urolithiasis. Furthermore, modern imaging methods may provide information on stone location, size, fragility and composition aiding the urologist to determine the appropriate treatment modality.Based on the current literature and guidelines, this review reports on the various new and established diagnostic imaging modalities.Ultrasound should always be the initial imaging modality. Following ultrasound, noncontrast CT-principally using a low-dose protocol-is the imaging modality of choice in the evaluation of patients with acute flank pain and suspected urolithiasis. New imaging modalities like dual energy CT, Uro Dyna CT and digital tomosynthesis are currently under investigation but not yet part of daily clinical practice. Magnetic resonance imaging can be used to detect obstruction caused by urinary stones but is not a first-line imaging modality.

ABCB1 and ABCG2 work together at the blood-brain barrier (BBB) to limit brain distribution of dual ABCB1/ABCG2 substrates. In this pilot study we used positron emission tomography (PET) to assess brain distribution of two model ABCB1/ABCG2 substrates ([(11) C]elacridar and [(11) C]tariquidar) in healthy subjects without (c.421CC) or with (c.421CA) the ABCG2 single-nucleotide polymorphism (SNP) c.421CA. Subjects underwent PET scans under conditions when ABCB1 and ABCG2 were functional and during ABCB1 inhibition with high-dose tariquidar. In contrast to the ABCB1-selective substrate (R)-[(11) C]verapamil, [(11) C]elacridar and [(11) C]tariquidar showed only moderate increases in brain distribution during ABCB1 inhibition. This provides evidence for a functional interplay between ABCB1 and ABCG2 at the human BBB and suggests that both ABCB1 and ABCG2 need to be inhibited to achieve substantial increases in brain distribution of dual ABCB1/ABCG2 substrates. During ABCB1 inhibition c.421CA subjects had significantly higher increases in [(11) C]tariquidar brain distribution than c.421CC subjects, pointing to impaired cerebral ABCG2 function.

Objectives To analyze the oncologic outcome and overall survival (OS) for patients with renal cell carcinoma (RCC) >4 cm undergoing radical nephrectomy (RN) or elective nephron-sparing surgery (NSS) in a matched-pair cohort. Methods From 1988 to 2007, we identified 829 patients in our clinic treated with either RN (n = 641) or open NSS (n = 188) for renal masses >4 cm. After matching the cohort for age, time of surgery, grade, TNM stage, tumor size, and sex and excluding patients with metastases, benign lesions with an imperative indication, and those with missing records, 173 remained for oncologic analysis. OS, cancer-specific survival, and progression-free survival were estimated using the Kaplan-Meier method. The association with death was evaluated with Cox proportional hazards regression analysis. Results At the last follow-up visit, 39 patients had died of any cause and 134 were alive at a median of 7.0 years. RN and elective NSS had been performed in 100 and 73 patients, respectively. The OS ( P = .357), progression-free survival ( P = .558), and cancer-specific survival ( P = .239) were not significantly different between the elective NSS and RN groups using the Kaplan-Meier method. On univariate and multivariate Cox regression analysis, the type of surgery did not have an effect on OS (hazard ratio 1.35, 95% confidence interval 0.71-2.54, P = .359). Conclusions Our results suggest that it is oncologically safe to perform NSS for renal tumors >4 cm, for which the surgical feasibility according to the tumor location, rather than the tumor size, seemed to be the limiting factor.