Solving clinical challenges in prostate cancer using the single-port robot system

Objective: Patients who desire or require surgical management for prostate cancer, but are poor candidates for multi-port robotic surgery, can present a clinical challenge. Use of single port (SP) robotic technology may help overcome these challenges. We present our initial experience with robotic-assisted radical prostatectomy (RARP) using the da Vinci SP robot for prostate cancer in patients who would otherwise not be good surgical candidates for conventional multi-port transabdominal robotic surgery. Patients and surgical procedure: Fourteen of 41 patients who underwent SP-RARP from November 2020 to February 2022 for biopsy confirmed, organ-confined prostate adenocarcinoma at a single tertiary care institution qualified for inclusion in our study due to specific considerations posing challenges for conventional multiport transperitoneal RARP. Perioperative metrics, pathologic findings and functional outcomes were collected prospectively. The accompanying video shows two cases demonstrating our transvesical and extraperitoneal approaches to SP-RARP. Results: All patients underwent successful procedures without need to convert to multi-port robotic or open approach. Most patients had prior abdominal surgery (13/14, 93%) including aborted multi-port RARP (2), hernia repairs (5), bowel diversions (3), and peritoneal dialysis catheters (2) among others. Most underwent extraperitoneal (9/14, 64%) followed by transvesical (5/14, 36%) approach. There were no intraoperative complications and one Clavien III post-operative complication. Positive margin rate was 29%, most of which were microscopic (≤3 mm, 3/4, 75%). Eighty-five percent of patients had undetectable nadir PSA. Conclusions: Our initial experience using the SP robot suggests that this technology can facilitate surgery for prostate cancer patients who might otherwise not be considered surgical candidates. Operative outcomes are not compromised despite a smaller incision and working space. We have found the SP system to be a valuable tool for carefully selected patients

Gender Gap in Industry Payments to Urologists

Background: The Open Payments Program (OPP) was established in 2013 under the Sunshine Act, which mandated that medical device and pharmaceutical manufacturers submit public records of any financial incentive given to physicians. The study aim is to characterize the gap in general and research payments between male and female urologists over the past 7 years. Methods: The study sample included all urologists in the US who received at least one general (GP) or research payment from 2015 to 2021. In order to identify urologists’ genders, the OPP was matched with the National Provider Index dataset. Payments to male versus female urologists were analyzed by geography, year, payment type, subspecialty, and industry payer with nominal payments adjusted to the base year’s US dollar using the Bureau of Labor Statistics’ Consumer Price Index – Urban (CPI-U). Results: 1,351,533 payments to 13,678 urologists were analyzed. Of them, 11,926 urologists were male, and 1,752 were female with an average general payment of $17,683.18 to male urologists compared to$5,825.09 to female urologists. Women not only received fewer consultant, royalty/license, speaker, and equity payments, but also received less per transaction in these categories. Conclusions: This study is the first to characterize differences in both research and general payments between male and female urologists. Further studies are needed to understand and interpret the unequal relationships between male and female urologists with industry. Industry should actively work to equitably engage female urologists in consultancies, speaking engagements, and research

A novel class of miniature inverted repeat transposable elements (MITEs) that contain hitchhiking (GTCY)n microsatellites

The movement of miniature inverted repeat transposable elements (MITEs) modifies genome structure and function. We describe the microsatellite-associated interspersed nuclear element 2 (MINE-2), that integrates at consensus WTTTT target sites, creates dinucleotide TT target site duplications (TSDs), and forms predicted MITE-like secondary structures; a 5\u27 subterminal inverted repeat (SIR; AGGGTTCCGTAG) that is partially complementary to a 5\u27 inverted repeat (IR; ACGAAGCCCT) and 3\u27-SIRs (TTACGGAACCCT). A (GTCY)(n) microsatellite is hitchhiking downstream of conserved 5\u27MINE-2 secondary structures, causing flanking sequence similarity amongst mobile microsatellite loci. Transfection of insect cell lines indicates that MITE-like secondary structures are sufficient to mediate genome integration, and provides insight into the transposition mechanism used by MINE-2s

Enabling and Enhancing Science Exploration Across the Solar System: Aerocapture Technology for SmallSat to Flagship Missions

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Sexual Cannibalism: High Incidence in a Natural Population with Benefits to Females

10 pages, 3 figures.[Background] Sexual cannibalism may be a form of extreme sexual conflict in which females benefit more from feeding on males than mating with them, and males avoid aggressive, cannibalistic females in order to increase net fitness. A thorough understanding of the adaptive significance of sexual cannibalism is hindered by our ignorance of its prevalence in nature. Furthermore, there are serious doubts about the food value of males, probably because most studies that attempt to document benefits of sexual cannibalism to the female have been conducted in the laboratory with non-natural alternative prey. Thus, to understand more fully the ecology and evolution of sexual cannibalism, field experiments are needed to document the prevalence of sexual cannibalism and its benefits to females.[Methodology/Principal Findings] We conducted field experiments with the Mediterranean tarantula (Lycosa tarantula), a burrowing wolf spider, to address these issues. At natural rates of encounter with males, approximately a third of L. tarantula females cannibalized the male. The rate of sexual cannibalism increased with male availability, and females were more likely to kill and consume an approaching male if they had previously mated with another male. We show that females benefit from feeding on a male by breeding earlier, producing 30% more offspring per egg sac, and producing progeny of higher body condition. Offspring of sexually cannibalistic females dispersed earlier and were larger later in the season than spiderlings of non-cannibalistic females.[Conclusions/Significance] In nature a substantial fraction of female L. tarantula kill and consume approaching males instead of mating with them. This behaviour is more likely to occur if the female has mated previously. Cannibalistic females have higher rates of reproduction, and produce higher-quality offspring, than non-cannibalistic females. Our findings further suggest that female L. tarantula are nutrient-limited in nature and that males are high-quality prey. The results of these field experiments support the hypothesis that sexual cannibalism is adaptive to females.This paper has been written under a Ramón y Cajal research contract from the Spanish Ministry of Science and Technology (MCYT) to JML and an I3P-BPD2004-CSIC scholarship to RRB. This work has been funded by MEC grants CGL2004-03153 and CGL2007-60520 to JML, MARG, RRB, CFM and DHW.Peer reviewe

Cellular and molecular biology of Neisseria meningitidis colonization and invasive disease

The human species is the only natural host of Neisseria meningitidis, an important cause of bacterial meningitis globally, and, despite its association with devastating diseases, N. meningitidis is a commensal organism found frequently in the respiratory tract of healthy individuals. To date, antibiotic resistance is relatively uncommon in N. meningitidis isolates but, due to the rapid onset of disease in susceptible hosts, the mortality rate remains approx. 10%. Additionally, patients who survive meningococcal disease often endure numerous debilitating sequelae. N. meningitidis strains are classified primarily into serogroups based on the type of polysaccharide capsule expressed. In total, 13 serogroups have been described; however, the majority of disease is caused by strains belonging to one of only five serogroups. Although vaccines have been developed against some of these, a universal meningococcal vaccine remains a challenge due to successful immune evasion strategies of the organism, including mimicry of host structures as well as frequent antigenic variation. N. meningitidis express a range of virulence factors including capsular polysaccharide, lipopolysaccharide and a number of surface-expressed adhesive proteins. Variation of these surface structures is necessary for meningococci to evade killing by host defence mechanisms. Nonetheless, adhesion to host cells and tissues needs to be maintained to enable colonization and ensure bacterial survival in the niche. The aims of the present review are to provide a brief outline of meningococcal carriage, disease and burden to society. With this background, we discuss several bacterial strategies that may enable its survival in the human respiratory tract during colonization and in the blood during infection. We also examine several known meningococcal adhesion mechanisms and conclude with a section on the potential processes that may operate in vivo as meningococci progress from the respiratory niche through the blood to reach the central nervous system

Aquatic therapy for children with Duchenne muscular dystrophy: a pilot feasibility randomised controlled trial and mixed-methods process evaluation.

BACKGROUND: Duchenne muscular dystrophy (DMD) is a rare disease that causes the progressive loss of motor abilities such as walking. Standard treatment includes physiotherapy. No trial has evaluated whether or not adding aquatic therapy (AT) to land-based therapy (LBT) exercises helps to keep muscles strong and children independent. OBJECTIVES: To assess the feasibility of recruiting boys with DMD to a randomised trial evaluating AT (primary objective) and to collect data from them; to assess how, and how well, the intervention and trial procedures work. DESIGN: Parallel-group, single-blind, randomised pilot trial with nested qualitative research. SETTING: Six paediatric neuromuscular units. PARTICIPANTS: Children with DMD aged 7-16 years, established on corticosteroids, with a North Star Ambulatory Assessment (NSAA) score of 8-34 and able to complete a 10-m walk without aids/assistance. Exclusions: > 20% variation between baseline screens 4 weeks apart and contraindications. INTERVENTIONS: Participants were allocated on a 1 : 1 ratio to (1) optimised, manualised LBT (prescribed by specialist neuromuscular physiotherapists) or (2) the same plus manualised AT (30 minutes, twice weekly for 6 months: active assisted and/or passive stretching regime; simulated or real functional activities; submaximal exercise). Semistructured interviews with participants, parents (n = 8) and professionals (n = 8) were analysed using Framework analysis. An independent rater reviewed patient records to determine the extent to which treatment was optimised. A cost-impact analysis was performed. Quantitative and qualitative data were mixed using a triangulation exercise. MAIN OUTCOME MEASURES: Feasibility of recruiting 40 participants in 6 months, participant and therapist views on the acceptability of the intervention and research protocols, clinical outcomes including NSAA, independent assessment of treatment optimisation and intervention costs. RESULTS: Over 6 months, 348 children were screened - most lived too far from centres or were enrolled in other trials. Twelve (30% of target) were randomised to AT (n = 8) or control (n = 4). People in the AT (n = 8) and control (n = 2: attrition because of parental report) arms contributed outcome data. The mean change in NSAA score at 6 months was -5.5 [standard deviation (SD) 7.8] for LBT and -2.8 (SD 4.1) in the AT arm. One boy suffered pain and fatigue after AT, which resolved the same day. Physiotherapists and parents valued AT and believed that it should be delivered in community settings. The independent rater considered AT optimised for three out of eight children, with other children given programmes that were too extensive and insufficiently focused. The estimated NHS costs of 6-month service were between £1970 and £2734 per patient. LIMITATIONS: The focus on delivery in hospitals limits generalisability. CONCLUSIONS: Neither a full-scale frequentist randomised controlled trial (RCT) recruiting in the UK alone nor a twice-weekly open-ended AT course delivered at tertiary centres is feasible. Further intervention development research is needed to identify how community-based pools can be accessed, and how families can link with each other and community physiotherapists to access tailored AT programmes guided by highly specialised physiotherapists. Bayesian RCTs may be feasible; otherwise, time series designs are recommended. TRIAL REGISTRATION: Current Controlled Trials ISRCTN41002956. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 27. See the NIHR Journals Library website for further project information