Bipolar saline TURP for large prostate glands

The objective of this study was to evaluate the feasibility of bipolar transurethral resection of the prostate (TURP) in patients with very large prostate glands and significant comorbidities

Bipolar Saline TURP for Large Prostate Glands

The objective of this study was to evaluate the feasibility of bipolar transurethral resection of the prostate (TURP) in patients with very large prostate glands and significant comorbidities. Four patients with prostate glands >160 cc on preoperative volume measurement and ASA class three or higher underwent bipolar TURP with the Gyrus PlasmaKinetic system. Preoperative, operative, and postoperative parameters were studied. The results showed an average ASA class 3.25 (range: 3–4). The average preoperative prostate volume was 207.4 cc (range: 163–268). The average preoperative International Prostate Symptom Score (IPSS) and bother score was 31 and 6, respectively. Mean resection time was 163 min (range: 129–215). The weight of resected tissue and percentage of vaporized tissue was 80.8 g (range: 62–115) and 10.0% (range: 3.8–15.1), respectively. An average of 61L of saline was used (range: 48–78). The mean change in hemoglobin and serum sodium was 2.1 g/dl (range: 1.4–2.7) and 3.3 meq/l (range: 2–4), respectively. Postoperative catheter time averaged 76 h (range: 40–104). Mean length of hospital stay was 12 h (range: 4–24). The mean postoperative IPSS and bother score was 2.75 and 0.25, respectively. Bipolar TURP is a feasible alternative to simple open prostatectomy in high-risk patients with massive prostate adenomas. Prostate volume is reduced by approximately 10% due to vaporization

Molecular architecture of the kinetochore-microtubule attachment site is conserved between point and regional centromeres

Point and regional centromeres specify a unique site on each chromosome for kinetochore assembly. The point centromere in budding yeast is a unique 150-bp DNA sequence, which supports a kinetochore with only one microtubule attachment. In contrast, regional centromeres are complex in architecture, can be up to 5 Mb in length, and typically support many kinetochore-microtubule attachments. We used quantitative fluorescence microscopy to count the number of core structural kinetochore protein complexes at the regional centromeres in fission yeast and Candida albicans. We find that the number of CENP-A nucleosomes at these centromeres reflects the number of kinetochore-microtubule attachments instead of their length. The numbers of kinetochore protein complexes per microtubule attachment are nearly identical to the numbers in a budding yeast kinetochore. These findings reveal that kinetochores with multiple microtubule attachments are mainly built by repeating a conserved structural subunit that is equivalent to a single microtubule attachment site

Robot-assisted laparoscopic transperitoneal pelvic lymphadenectomy and metastasectomy for melanoma: initial report of two cases

Robotic pelvic lymphadenectomy is a well established procedure in the urologic and gynecologic literature. To our knowledge robotic pelvic lymphadectomy for metastatic melanoma has yet to be described. Herein we present the first report of robot-assisted pelvic lymphadenectomy in malignant melanoma. After placement of six laparoscopic ports (12 mm camera, three 8-mm robotic ports, 12-mm and 5-mm assistant ports) the DaVinci S robot (Intuitive Surgical, CA, USA) was docked in standard fashion with the patient in low lithotomy. In both cases the patients had enlarged pelvic lymph nodes on computed tomography and complete excision of these masses was accomplished along with complete lymphadenectomy extending from Cooper’s ligament to just below the hypogastric artery in case 1 and to level of the bifurcation of aorta in case 2. A PK Maryland Dissector and monopolar scissors were used for dissection. Both patients were discharged on postoperative day #1. Robotic pelvic lymphadenectomy can be safely used for management of patients with metastatic melanoma involving the pelvic lymph nodes. Compared with the standard open procedure, pelvic lymphadenectomy with robotic assistance is associated with excellent vision and minimum morbidity

Optical Spectroscopy of Supernova 1993J During Its First 2500 Days

We present 42 low-resolution spectra of Supernova (SN) 1993J, our complete collection from the Lick and Keck Observatories, from day 3 after explosion to day 2454, as well as one Keck high-dispersion spectrum from day 383. SN 1993J began as an apparent SN II, albeit an unusual one. After a few weeks, a dramatic transition took place, as prominent helium lines emerged in the spectrum. SN 1993J had metamorphosed from a SN II to a SN IIb. Nebular spectra of SN 1993J closely resemble those of SNe Ib and Ic, but with a persistent H_alpha line. At very late times, the H_alpha emission line dominated the spectrum, but with an unusual, box-like profile. This is interpreted as an indication of circumstellar interaction.Comment: 19 pages plus 13 figures, AASTeX V5.0. One external table in AASTeX V4.0, in landscape format. Accepted for publication in A

Approaches for advancing scientific understanding of macrosystems

The emergence of macrosystems ecology (MSE), which focuses on regional- to continental-scale ecological patterns and processes, builds upon a history of long-term and broad-scale studies in ecology. Scientists face the difficulty of integrating the many elements that make up macrosystems, which consist of hierarchical processes at interacting spatial and temporal scales. Researchers must also identify the most relevant scales and variables to be considered, the required data resources, and the appropriate study design to provide the proper inferences. The large volumes of multi-thematic data often associated with macrosystem studies typically require validation, standardization, and assimilation. Finally, analytical approaches need to describe how cross-scale and hierarchical dynamics and interactions relate to macroscale phenomena. Here, we elaborate on some key methodological challenges of MSE research and discuss existing and novel approaches to meet them

Ubiquitin Chains Are Remodeled at the Proteasome by Opposing Ubiquitin Ligase and Deubiquitinating Activities

SummaryThe ubiquitin ligase Hul5 was recently identified as a component of the proteasome, a multisubunit protease that degrades ubiquitin-protein conjugates. We report here a proteasome-dependent conjugating activity of Hul5 that endows proteasomes with the capacity to extend ubiquitin chains. hul5 mutants show reduced degradation of multiple proteasome substrates in vivo, suggesting that the polyubiquitin signal that targets substrates to the proteasome can be productively amplified at the proteasome. However, the products of Hul5 conjugation are subject to disassembly by a proteasome-bound deubiquitinating enzyme, Ubp6. A hul5 null mutation suppresses a ubp6 null mutation, suggesting that a balance of chain-extending and chain-trimming activities is required for proper proteasome function. As the association of Hul5 with proteasomes was found to be strongly stabilized by Ubp6, these enzymes may be situated in proximity to one another. We propose that through dynamic remodeling of ubiquitin chains, proteasomes actively regulate substrate commitment to degradation