Positive surgical margins in nephron-sparing surgery; the great unknown

There is a currently a general trend towards organ-preserving surgery, and urology is no exception. Specifically, nephron-sparing surgery (NSS) has gained general acceptance for T1a renal cell carcinoma (guidelines recommendations). Moreover T1b, T2 and even T3 stage tumors have been included on the nephron sparing list at some centers. An unresolved issue is that of positive surgical margins (PSM), not only their detection but also the implications for follow up and treatment. This paper highlights data available on risk factors for PSM, their clinical relevance, and possible therapeutic consequences. From the surgeon’s viewpoint, NSS is a daring and risky surgical procedure. Urological guidelines stress the importance of NSS, and thus the trend is moving in that direction. Unresolved, however, is the problem of PSM. Trifecta, MIC, and pentafecta are applicable concepts which attempt to define the optimal endpoint of NSS, but further elaboration is necessary. Specifically, research needs to focus less on the concept of definitive margins and more on their identification and avoidance. Although some studies suggest that PSMs do not influence overall survival rate, the basic idea of preserving tissue that is not cancerous leads to further medical, social, and psychological considerations

I ragazzi “trasparenti”: minori rom nei percorsi penali a Milano

Il capitolo analizza il punto di vista dei testimoni privilegiati, che lavorano all'interno del sistema penale minorile nella provincia di Milano, rispetto ai punti di forza e di criticità del sistema penale minorile in relazione con i minori rom e le loro particolari condizioni socioeconomiche in Italia, caratterizzati da precarietà abitativa, famiglie transnazionale, lavoro informale e difficile inserimento scolastica. I testimoni propongono anche dei possibili interventi che, dal loro punto di vista, potrebbero migliorare la presa in carico dei minori rom

Pelvic floor disorders in gynecological malignancies. An overlooked problem?

Cervical, endometrial, ovarian, vulvar, and vaginal cancers affect women of a broad age spectrum. Many of these women are still sexually active when their cancer is diagnosed. Treatment options for gynecological malignancies, such as gynecological surgery, radiation, and chemotherapy, are proven risk factors for pelvic floor dysfunction. The prevalence of urinary incontinence, fecal incontinence, and sexual dysfunction before cancer treatment is still unclear. Hypotheses have been raised in the literature that these manifestations could represent early symptoms of pelvic cancers, but most remain overlooked even in cancer surviving patients. The primary focus of therapy is always cancer eradication, but as oncological and surgical treatment options become more successful, the number of cancer survivors increases. The quality of life of patients with gynecological cancers often remains an underrated subject. Pelvic floor disorders are not consistently reported by patients and are frequently overlooked by many clinicians. In this brief review we discuss the importance of pelvic floor dysfunction in patients with gynecological malignant tumors

In Flight miRNA Isolation and Recovery on the ISS

Due to advancements in RNA research, mi (micro) RNAs and other small nucleotide RNAs have become a major research field in biology including spaceflight research. The regulation of RNA transcription and processing by miRNAs makes miRNAs an appealing topic for genetics and molecular research. It has been estimated that over 60% of human gene transcripts are targets of miRNA regulation. In fact, this is true for all organisms, including plants and insects. Small nucleotide RNAs can also play a role in regulating gene expression, meaning that gene expression alone is not a complete picture of the potential genetic changes that occur in an organism during spaceflight. The goal of the WetLab-2 project is to isolate and recover miRNAs from various tissue sources on the International Space Station (ISS). No system currently exists that can isolate and recover small nucleotide RNA in space. However, the WetLab-2 system that was validated on the ISS in 2016 can be adapted to fit this purpose. We are currently testing the new modified protocols by running plant and mouse blood experiments in parallel, allowing us to demonstrate the effectiveness of the procedure on different sample types. We expect to be able to optimize and implement the modified miRNA protocols for use on future ISS flights

In Flight MiRNA Isolation and Recovery on the ISS Using the Wetlab-2 System

Due to advancements in RNA research, mi (micro) RNAs and other small nucleotide RNAs have become a major research field in biology including spaceflight research. The regulation of RNA transcription and processing by miRNAs makes miRNAs an appealing topic for genetics and molecular research. It has been estimated that over 60% of human gene transcripts are targets of miRNA regulation. In fact, this is true for all organisms, including plants and insects. Small nucleotide RNAs can also play a role in regulating gene expression, meaning that gene expression alone is not a complete picture of the potential genetic changes that occur in an organism during spaceflight. The goal of the WetLab-2 project is to isolate and recover miRNAs from various tissue sources on the International Space Station (ISS). No system currently exists that can isolate and recover small nucleotide RNA in space. However, the WetLab-2 system that was validated on the ISS in 2016 can be adapted to fit this purpose. We are currently testing the new modified protocols by running plant and mouse blood experiments in parallel, allowing us to demonstrate the effectiveness of the procedure on different sample types. We expect to be able to optimize and implement the modified miRNA protocols for use on future ISS flights

A Miniaturized Video System for Monitoring Drosophila Behavior

Long-term spaceflight may induce a variety of harmful effects in astronauts, resulting in altered motor and cognitive behavior. The stresses experienced by humans in space - most significantly weightlessness (microgravity) and cosmic radiation - are difficult to accurately simulate on Earth. In fact, prolonged and concomitant exposure to microgravity and cosmic radiation can only be studied in space. Behavioral studies in space have focused on model organisms, including Drosophila melanogaster. Drosophila is often used due to its short life span and generational cycle, small size, and ease of maintenance. Additionally, the well-characterized genetics of Drosophila behavior on Earth can be applied to the analysis of results from spaceflights, provided that the behavior in space is accurately recorded. In 2001, the BioExplorer project introduced a low-cost option for researchers: the small satellite. While this approach enabled multiple inexpensive launches of biological experiments, it also imposed stringent restrictions on the monitoring systems in terms of size, mass, data bandwidth, and power consumption. Suggested parameters for size are on the order of 100 mm3 and 1 kg mass for the entire payload. For Drosophila behavioral studies, these engineering requirements are not met by commercially available systems. One system that does meet many requirements for behavioral studies in space is the actimeter. Actimeters use infrared light gates to track the number of times a fly crosses a boundary within a small container (3x3x40 mm). Unfortunately, the apparatus needed to monitor several flies at once would be larger than the capacity of the small satellite. A system is presented, which expands on the actimeter approach to achieve a highly compact, low-power, ultra-low bandwidth solution for simultaneous monitoring of the behavior of multiple flies in space. This also provides a simple, inexpensive alternative to the current systems for monitoring Drosophila populations in terrestrial experiments, and could be especially useful in field experiments in remote locations. Two practical limitations of the system should be noted: first, only walking flies can be observed - not flying - and second, although it enables population studies, tracking individual flies within the population is not currently possible. The system used video recording and an analog circuit to extract the average light changes as a function of time. Flies were held in a 5-cm diameter Petri dish and illuminated from below by a uniform light source. A miniature, monochrome CMOS (complementary metal-oxide semiconductor) video camera imaged the flies. This camera had automatic gain control, and this did not affect system performance. The camera was positioned 5-7 cm above the Petri dish such that the imaging area was 2.25 sq cm. With this basic setup, still images and continuous video of 15 flies at one time were obtained. To reduce the required data bandwidth by several orders of magnitude, a band-pass filter (0.3-10 Hz) circuit compressed the video signal and extracted changes in image luminance over time. The raw activity signal output of this circuit was recorded on a computer and digitally processed to extract the fly movement "events" from the waveform. These events corresponded to flies entering and leaving the image and were used for extracting activity parameters such as inter-event duration. The efficacy of the system in quantifying locomotor activity was evaluated by varying environmental temperature, then measuring the activity level of the flies

Positive surgical margins in nephron-sparing surgery; the great unknown

There is a currently a general trend towards organ-preserving surgery, and urology is no exception. Specifically, nephron-sparing surgery (NSS) has gained general acceptance for T1a renal cell carcinoma (guidelines recommendations). Moreover T1b, T2 and even T3 stage tumors have been included on the nephron sparing list at some centers. An unresolved issue is that of positive surgical margins (PSM), not only their detection but also the implications for follow up and treatment. This paper highlights data available on risk factors for PSM, their clinical relevance, and possible therapeutic consequences. From the surgeon’s viewpoint, NSS is a daring and risky surgical procedure. Urological guidelines stress the importance of NSS, and thus the trend is moving in that direction. Unresolved, however, is the problem of PSM. Trifecta, MIC, and pentafecta are applicable concepts which attempt to define the optimal endpoint of NSS, but further elaboration is necessary. Specifically, research needs to focus less on the concept of definitive margins and more on their identification and avoidance. Although some studies suggest that PSMs do not influence overall survival rate, the basic idea of preserving tissue that is not cancerous leads to further medical, social, and psychological considerations

New oral anticoagulants and their reversal agents

Atrial fibrillation is a commonly encountered pathology in medical practice, and its prevalence has shown a continuous rise over the past years. Atrial fibrillation has a significant impact on patients\u27 quality of life, not only due to the standard anticoagulant treatment with vitamin K antagonists that require close monitoring and dose adjustment, but also due to the fragile equilibrium between hemorrhagic and thrombotic risks. The introduction of new oral anticoagulants (NOACs) in the treatment guidelines for atrial fibrillation has improved the quality of life, as NOACs do not require close monitoring or dose adjustments. However, even if the safety profile of the NOACs regarding the hemorrhagic risk is superior to vitamin K antagonists, the problem raised by an unexpected hemorrhage (e.g. severe hemorrhage after an accident) and the need for efficient hemostasis in a chronic anticoagulated patient has remained unsolved. To find a solution for this problem, reversal agents for NOACs have been developed and tested, and two of them, idarucizumab and andexanet-alpha, have already been approved by the FDA, thus making NOACs increasingly appealing as a choice of anticoagulation treatment