The SPARE score reliably predicts the conversion from open partial to radical nephrectomy

Aim To assess the power of nephrometry scores to predict the intraoperative conversion from partial nephrectomy (PN) to radical nephrectomy (RN). Methods We identified all the patients at our institution who were scheduled for PN between April 2012 and December 2017. Patients who underwent robotic or laparoscopic surgery were excluded. A total of 149 patients (94 men) who underwent open surgery and had complete data were included. The power of the R.E.N.A.L., PADUA, SPARE, and DAP scores to predict the conversion to RN, and the threshold values were assessed. In the multivariate analysis, the predictive power of the nephrometry scores was tested by separately including them in different models. Results The median age was 57 (48-67) years, while the median follow-up was 15 (7-29.5) months. The overall conversion rate was 10.7%. The optimal cut-off values for the R.E.N.A.L., PADUA, SPARE, and DAP scores were 7.5, 9.5, 5.5 and 7.5, respectively. The SPARE score had the highest area under the curve (AUC=0.807, P<0.001). In the multivariate analysis, the SPARE score had the highest odds ratio (OR 12.561; confidence interval 3.456-45.534, P<0.001]. Conclusion A high SPARE score was significantly associated with the conversion to RN in patients who underwent open PN

Risk Factors for Testicular Cancer: Environment, Genes and Infections-Is It All?

: The incidence of testicular cancer is steadily increasing over the past several decades in different developed countries. If on one side better diagnosis and treatment have shone a light on this disease, on the other side, differently from other malignant diseases, few risk factors have been identified. The reasons for the increase in testicular cancer are however unknown while risk factors are still poorly understood. Several studies have suggested that exposure to various factors in adolescence as well as in adulthood could be linked to the development of testicular cancer. Nevertheless, the role of environment, infections, and occupational exposure are undoubtedly associated with an increase or a decrease in this risk. The aim of this narrative review is to summarize the most recent evidence regarding the risk factors associated with testicular cancer, starting from the most commonly evaluated (cryptorchidism, family history, infections) to the newer identified and hypothesized risk factors

Primary osteosarcoma of the urinary bladder following cyclophosphamide therapy for systemic lupus erythematosus: a case report

<p>Abstract</p> <p>Introduction</p> <p>The association of systemic lupus erythematosus with malignancies is an uncommon occurrence. We present the case of an osteosarcoma of the urinary bladder developing in a patient with a prolonged history of active systemic lupus erythematosus. This is a previously unreported association. Primary osteosarcoma is an extremely rare disease in the urinary bladder.</p> <p>Case presentation</p> <p>A 24-year-old Caucasian woman with a 13-year history of systemic lupus erythematosus, who had been treated with high dose immunosuppressive agents, presented with pain and hematuria. A deeply invasive high-grade tumor was detected in the urinary bladder and the patient underwent radical surgery. A diagnosis of osteosarcoma was made based on the characteristic histology.</p> <p>Conclusion</p> <p>Predisposing factors for primary sarcomas in the urinary bladder are mostly unknown; however, in our case, long-term administration of immunosuppressive agents, as well as long standing systemic lupus erythematosus, may both be of significance.</p

Minimal Invasive Management of Small Renal Masses: State of Art and New Trends

With the widespread use of abdominal imaging modalities such as ultrasound (US), computerized tomography (CT) and magnetic resonance imaging (MRI), there has been a pronounced increase in the incidence of renal tumors especially clinically localized, small < 2 cm ones. Moreover the final pathology of these lesions is benign up to 30%. The development of ablation techniques (radiofrequency ablation, cryoablation, high-intensity focused ultrasound and microwave ablation) with continuous innovations such as refinement of probes and real-time imaging capabilities has pioneered the great interest in these techniques, especially for the treatment of T1 renal malignancies. RFA and CA have similar cancer specific survival, disease-free survival, recurrence free survival and overall survival rates compared to nephrectomy. MWA and HIFU remain still experimental due to low patient volume and insufficient clinical experience. Minimal invasive techniques can be a feasible treatment alternative for patients who have high surgical and anesthetic risk with multiple comorbidities, have multiple tumors due to a systemic disease like VHL or do not want to undergo extirpative surgery. Especially elderly patients can be good candidates for these procedures with their relatively short life expectance and impaired performance status

Does solitary- and organ-confined metastasectomy really improve survival in advanced urologic malignancies?

The role of metastasectomy on survival in advanced/urologic malignancies still remains unclear. Renal cell carcinoma (RCC) is the most common solid tumor within the kidney. 25-30 % of patients have metastases at manifestation. Urothelial carcinoma (UC) consists of bladder carcinoma, upper urinary tract urothelial cell carcinoma and urethral carcinoma. Bladder cancer is the ninth most common cancer worldwide. Half of patients with muscle invasive bladder cancer have lymph node or distant metastases. In metastatic disease first-line treatment is multi-agent platinum-based systemic chemotherapy. Testicular cancer is the most common cancer in men between the age of 15 and 35. Testicular tumors represent excellent oncologic outcomes. Prostate cancer is the most common solid tumor in Europe. Surgical resection of metastases can be considered as a treatment choice in advanced/metastatic urologic malignancies to improve survival rates, particularly in RCC and UC. Metastasectomy can be suggested in conjunction with effective chemotherapy if complete resection is possible. Solitary metastasectomy can represent better survival rates compared to multiple metastasectomy even if multiple metastases confined to single organ. Site of metastases is one of the main determinants of successful metastasectomy such as lung metastasectomy in urothelial cell carcinoma and liver metastasectomy in RCC may lead to better oncologic outcomes. Due to the lack of the relevant data it is not possible to make an evidence-based recommendation on the role of metastasectomy for solitary-/organ-confined metastases of prostate cancer, testicular cancer and penile cancer

Enrichment of W2B5 from WO3 and B2O3 by Double SHS Method

A second self-propagating high-temperature synthesis (SHS) was carried out to enrich the W2B5 content in the SHS product containing a mixture of various tungsten boride compounds. In the experiment, the process called Double-SHS (D-SHS) was conducted in two steps. In the first SHS reaction, an initial molar composition ratio of WO3:B2O3:Mg mixture was selected as 1:3:8. The product was then hot-leached with hydrochloric acid to eliminate MgO and Mg3B2O6 phases. The leached product, consisting of 72.6 wt.% W2B5, 16.1 wt.% WB, 8.4 wt.% W2B, and 2.9 wt.% W, was again reacted with the Mg and B2O3 mixture by second SHS. After another acid leaching step, W2B5 content in the D-SHS product was found to be 98.2 wt.%. The study showed that D-SHS is an effective method for boron enrichment in the tungsten compounds.DOI: http://dx.doi.org/10.5755/j01.ms.24.1.17834</p

Using Edible Insects in the Production of Cookies, Biscuits, and Crackers: A Review

The world&rsquo;s population is ever-increasing and thus food security is becoming a big problem. To meet protein demand, edible insects could be a sustainable, eco-friendly, economical, and alternative source. However, consumers have some concerns about the sensorial properties of edible insect-based foods. To make them invisible and more familiar to consumers, powder of edible insects could be used together with flours in most commonly consumed bakery products, particularly bread, followed by biscuits, cookies, and crackers. Moreover, the rearing and processing conditions should be enhanced, a marketing strategy should be developed, and education about the health and environmental benefits should be given