Is conservative management safe in patients with acute ureterolithiasis and perirenal stranding?

In patients presenting with ureterolithiasis, perirenal stranding is frequently observed in non-contrast computed tomography. Because perirenal stranding may be caused by tears in the collecting system, previous studies have described an increased risk of infectious complications and suggested broad empiric antibiotic therapy and immediate decompressing of the upper urinary tract. We hypothesized that these patients can also be managed conservatively. Therefore, we retrospectively identified patients with ureterolithiasis and perirenal stranding and compared diagnostic and treatment characteristics as well as treatment outcomes between patients undergoing conservative versus interventional management by ureteral stenting, percutaneous drainage or primary ureteroscopic stone removal. We classified perirenal stranding as mild, moderate or severe based on its radiological extent. Of 211 patients, 98 were managed conservatively. Patients in the interventional group had larger ureteral stones, more proximal ureteral stone location, more severe perirenal stranding, higher systemic and urinary infectious parameters, higher creatinine levels, and received more frequent antibiotic therapy. The conservatively managed group experienced a spontaneous stone passage rate of 77%, while 23% required delayed intervention. In the interventional and conservative groups, 4% and 2% of patients, respectively, developed sepsis. None of the patients in either group developed a perirenal abscess. Comparison of perirenal stranding grade between mild, moderate and severe in the conservatively treated group showed no difference in the spontaneous stone passage and infectious complications. In conclusion, conservative management without prophylactic antibiotics for ureterolithiasis and perirenal stranding is a valid treatment option as long as no clinical or laboratory signs of renal failure or infections are observed

Current observations from a looking down vertical V-ADCP: interaction with winds and tide? The case of Giglio Island (Tyrrhenian Sea, Italy)

Summary In the context of the environmental monitoring of the Concordia wreck removal project, measurements of currents, winds and sea level height were made along the eastern coast of the Giglio Island, Tyrrhenian Sea (Italy), during 2012–2013. The aim of the study was to investigate the effect of atmospheric forcing and periodic sea-level changes on the coastal currents. Normalised Cross-Correlation Function analysis allowed us to correlate these observations. A marked inter-seasonal variability was found in both current and local wind velocity observations but a significant level of correlation between the data was only found during strong wind events. Current and wind directions appeared to be uncorrelated and current measurements showed a predominant NW–SE direction, presumably linked to the shape and orientation of Giglio Island itself. During strong winds from the SSE, current flow was towards the NNW but it suddenly switched from the NNW to the SE at the end of wind events. The results show that, at Giglio Island, currents are principally dominated by the general cyclonic Tyrrhenian circulation, and, secondly, by strong wind events. The sea level had no effects on the current regime

Exploitation of large archives of ERS and ENVISAT C-band SAR data to characterize ground deformations

In the last few years, several advances have been made in the use of radar images to detect, map and monitor ground deformations. DInSAR (Differential Synthetic Aperture Radar Interferometry) and A-DInSAR/PSI (Advanced DInSAR/Persistent Scatterers Interferometry) technologies have been successfully applied in the study of deformation phenomena induced by, for example, active tectonics, volcanic activity, ground water exploitation, mining, and landslides, both at local and regional scales. In this paper, the existing European Space Agency (ESA) archives (acquired as part of the FP7-DORIS project), which were collected by the ERS-1/2 and ENVISAT satellites operating in the microwave C-band, were analyzed and exploited to understand the dynamics of landslide and subsidence phenomena. In particular, this paper presents the results obtained as part of the FP7-DORIS project to demonstrate that the full exploitation of very long deformation time series (more than 15 years) can play a key role in understanding the dynamics of natural and human-induced hazards. © 2013 by the authors

Excellent survival in relapsed stage I testicular cancer

Abstract Background Two thirds of patients with germ-cell cancer (GCC) present as clinical stage I (CSI). Following orchiectomy, active surveillance (AS) has become their standard management. However, 15–50% of patients eventually relapse with metastatic disease after AS. Relapses need to be detected early in order to achieve cure and avoid overtreatment. Methods We retrospectively analyzed consecutive GCC patients treated at two Swiss academic centers between 2010 and 2020. Patients with stage IS and extragonadal primaries were excluded. We compared disease characteristics and survival outcomes of patients relapsed from initial CSI to patients with de novo metastatic disease. Primary endpoint was the IGCCCG category at the time of relapse. Main secondary endpoints were progression-free survival (PFS) and overall survival (OS). Results We identified 360 GCC patients with initial CSI and 245 de novo metastatic patients. After a median follow-up of 47 months, 81 of 360 (22.5%) CSI patients relapsed: 41 seminoma (Sem) and 40 non-seminoma (NSem) patients. All Sems relapsed in the IGCCCG good prognosis group. NSem relapsed with good 29/40 (72.5%) and intermediate 11/40 (27.5%) prognostic features; 95.1% of relapses occurred within five years post-orchiectomy. Only 3 relapsed NSem patients died from metastatic disease. Five-year OS for relapsed CSI patients was 100% for Sem and 87% (95% CI: 61–96%) for NSem patients; five-year PFS was 92% (95% CI: 77–97) and 78% (95% CI: 56–90) for Sem and NSem, respectively. When stratified by IGCCCG prognostic groups, good risk relapsed patients had a trend towards better OS and PFS as compared to de novo metastatic patients. Conclusions GCC patients who relapse after initial CSI can be detected early by active surveillance and have an excellent survival

Perioperative complications and oncological outcomes of post-chemotherapy retroperitoneal lymph node dissection in patients with germ cell cancer at two high-volume university centres in Switzerland – a retrospective chart review

BACKGROUND: Post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) is an integral part of the management of patients with metastatic non-seminoma and residual masses >1 cm after chemotherapy. AIMS: To assess perioperative complications and oncological outcomes at two major referral centres in Switzerland. METHODS: This was a retrospective chart review of 136 patients with non-seminoma who underwent PC-RPLND between 2010 and 2020 at the university hospitals of Bern and Zürich. Patient, treatment and tumour characteristics as well as the types and frequencies of intra- and postoperative complications were registered and compared using the chi-square test. Oncological outcomes consisted of the time and location of relapses as well as progression-free and overall survival, which were compared using the log-rank test. RESULTS: Overall, 70 patients from Bern and 66 patients from Zürich were included; 5 patients had a previous retroperitoneal lymph node dissection (RPLND) (2 Bern, 3 Zürich). Vascular injuries were the most frequent intraoperative complication, occurring in 27/136 (19.9%) patients. Postoperative complications were observed in 42/136 (30.9%) patients, ileus being the most common. Perioperative mortality was 2.2%. A retroperitoneal mass ≥50 mm was significantly associated with intraoperative complications (p = 0.004) and increased resource demands (p = 0.021). Postoperative morbidity was higher according to age at post-chemotherapy retroperitoneal lymph node dissection ≥40 years (p = 0.028) and retroperitoneal mass ≥20 mm (p = 0.005). The median follow-up time was 37 months (interquartile range [IQR] 18–64 months). The median progression-free survival at 5 years was 76% (95% confidence interval [CI]: 64–85%) in Bern and 69% (95% CI: 54–80%) in Zürich (p = 0.464). The median overall survival at 5 years was 88% (95% CI: 76–94%) in Bern and 77% (95% CI: 60–87%) in Zürich (p = 0.335). Patients with progressive disease or a tumour marker increase before retroperitoneal lymph node dissection had significantly inferior progression-free and overall survival compared to non-progressing patients. The presence of teratoma in resected specimens did not confer inferior survival probabilities compared to necrosis only, whereas the presence of vital undifferentiated tumour conferred inferior progression-free and overall survival. Patients with a previous retroperitoneal lymph node dissection and patients operated for late relapses >2 years after chemotherapy also had significantly inferior progression-free and overall survival. CONCLUSIONS: We found a relevant rate of severe perioperative complications at PC-RPLND at even experienced high-volume centres. The oncological outcomes at two major university urological centres in Switzerland were similar and determined by preoperative risk factors and intraoperative histology

Highly Stable and Red‐Emitting Nanovesicles Incorporating Lipophilic Diketopyrrolopyrroles for Cell Imaging

Diketopyrrolopyrroles (DPPs) have recently attracted much interest as very bright and photostable red‐emitting molecules. However, their tendency to form nonfluorescent aggregates in water through the aggregation‐caused quenching (ACQ) effect is a major issue that limits their application under the microscope. Herein, two DPP molecules have been incorporated into the membrane of highly stable and water‐soluble quatsomes (QS; nanovesicles composed of surfactants and sterols), which allow their nanostructuration in water and, at the same time, limits the ACQ effect. The obtained fluorescent organic nanoparticles showed superior structural homogeneity, along with long‐term colloidal and optical stability. A thorough one‐ (1P) and two‐photon (2P) fluorescence characterization revealed the promising photophysical features of these fluorescent nanovesicles, which showed a high 1P and 2P brightness. Finally, the fluorescent QSs were used for the in vitro bioimaging of Saos‐2 osteosarcoma cell lines; this demonstrates their potential as nanomaterials for bioimaging applications.This work was financially supported by the DGI, Spain (Grant MOTHER; MAT2016‐80826‐R); AGAUR, Generalitat de Catalunya (Grant 2017 SGR 918); and the Networking Research Center on Bioengineering, Biomaterials, and Nanomedicine (CIBER‐BBN). Part of the characterization work has been performed by the ICTS “NANBIOSIS”, at the Biomaterial Processing and Nanostructuring Unit #6 of the CIBER in Bioengineering, Biomaterials & Nanomedicine (CIBER‐BBN). D.B. and A.A. acknowledge the European Commission (EC) FP7‐PEOPLE‐2013‐Initial Training Networks (ITN) “NANO2FUN” project no. 607721 for their predoctoral contracts. This work was also supported by the Ministero dell'Istruzione, dell'Università e della Ricerca (MIUR; Progetto PRIN 2012 prot. 2012A4Z2RY and Project PON02_00563_3316357 (PON MAAT)). Financial support from the Fonds National Suisse de la Recherche Scientifique (no. 200020‐165890) and the University of Geneva is also acknowledged.Peer reviewe

SARS-CoV-2 infection in patients with inflammatory bowel disease: comparison between the first and second pandemic waves

Background: In Italy, the incidence of SARS-CoV-2 infection peaked in April and November 2020, defining two pandemic waves of coronavirus disease 2019 (COVID-19). This study compared the characteristics and outcomes of patients with inflammatory bowel disease (IBD) and SARS-CoV-2 infections between pandemic waves. Methods: Observational longitudinal study of IBD patients with SARS-CoV-2 infection. Patients with established diagnoses of IBD and of SARS-CoV-2 infection were consecutively enrolled in two periods: (i) first wave, from 1 March 2020 to 31 May 2020; and (ii) second wave, from 15 September to 15 December 2020. Results: We enrolled 937 IBD patients (219 in the first wave, 718 in the second wave). Patients of the first wave were older (mean ± SD: 46.3 ± 16.2 vs. 44.1 ± 15.4 years, p = 0.06), more likely to have ulcerative colitis (58.0% vs. 44.4%, p < 0.001) and comorbidities (48.9% vs. 38.9%; p < 0.01), and more frequently residing in Northern Italy (73.1% vs. 46.0%, p < 0.001) than patients of the second wave. There were no significant differences between pandemic waves in sex (male: 54.3% vs. 53.3%, p = 0.82) or frequency of active IBD (44.3% vs. 39.0%, p = 0.18). The rates of negative outcomes were significantly higher in the first than second wave: pneumonia (27.8% vs. 11.7%, p < 0.001), hospital admission (27.4% vs. 9.7%, p < 0.001), ventilatory support (11.9% vs. 5.4%, p < 0.003) and death (5.5% vs. 1.8%, p < 0.007). Conclusion: Between the first and second SARS-CoV-2 pandemic waves, demographic, clinical and geographical features of IBD patients were different as were the symptoms and outcomes of infection. These differences are likely due to the different epidemiological situations and diagnostic possibilities between the two waves

Continuous clinical remission with biologics in ulcerative colitis: the 'AURORA' comparison study

Comparative trials among biological drugs for the treatment of ulcerative colitis (UC) provided conflicting results. After patent expire of infliximab originator, adalimumab, infliximab biosimilar, golimumab and vedolizumab have been approved in Italy.We compared the efficacy of these four biologics in UC according to the concept of continuous clinical remission (CCR)