Notes

High-efficiency degradation involving phthalic acidity esters (PAEs) by Pseudarthrobacter defluvii E5: Efficiency, degradative path, and crucial family genes.
Radical nephroureterectomy (RNU) represents the standard of care for high grade upper tract urothelial carcinoma (UTUC). Open and laparoscopic approaches are well-established treatments, but evidence regarding robotic RANU is growing. The introduction of the Xi® system facilitates the implementation of this multi-quadrant procedure. The aim of this video-article is to describe the surgical steps and the outcomes of Xi® robotic RNU.

Single stage Xi® robotic RNU without patients repositioning and robot re-docking were done between 2015 and 2019 and collected in a large worldwide multi-institutional study, the ROBotic surgery for Upper tract Urothelial cancer STudy (ROBUUST). Institutional review board approval and data share agreement were obtained at each center. Surgical technique is described in detail in the accompanying video. Descriptive statistics of baseline characteristics and surgical, pathological, and oncological outcomes were analyzed. RESULTSː Overall, 148 patients were included in the analysieatment of UTUC. Additional potential advantages of the robot might be a wider implementation of LND with a minimally invasive approach.
Non-adherence (NA) to immunosuppressive drugs is to date considered a crucial issue in kidney transplanted patients (KTRs), leading to de novo donor-specific anti-HLA antibodies (dnDSA) development, acute and chronic rejection, and at least graft loss. Rhapontigenin However, NA assessment is challenging, often leading to underestimation in real-life settings.

NA evaluation in all KTRs referred to our post-transplantation clinic in the period between 01/01-15/07/2018 with self-report questionnaire combined to intra-patient variability (IPV) of the pivotal immunosuppressive drug (based on trough levels of tacrolimus/mTOR inhibitor).

Based on both questionnaire and IPV, 86 out of the 504 tested KTRs (17%) were classified as NA. Male gender (OR, 2.0; 95% confidence interval [CI], 1.2 to 3.4), high educational level (OR for KTRs with a degree, 1.8 [95% CI, 1.0 to 3.1]), employment (OR, 2.0 [95% CI, 1.2 to 3.3]), young age at transplantation (p=0.017), longer time on the waiting list and after transplantation (p= 0.027 and 0.049 respectively) were all associated with NA. High IPV was mostly documented in KTRs treated with the twice-daily formulation of the immunosuppressive drug (OR, 1.5 [95% CI, 1.0 to 2.1]) and better associated with dnDSA appearance (OR, 2.1 [95% CI, 1.1 to 3.9]).

NA is a significant problem, difficult to assess, and can lead to dnDSA development also in our population. Identifying risk factors for NA might be an underestimated tool to improve graft and patient outcome in KTRs.
NA is a significant problem, difficult to assess, and can lead to dnDSA development also in our population. Identifying risk factors for NA might be an underestimated tool to improve graft and patient outcome in KTRs.
A systematic review and meta-analysis was conducted to explore the safety and efficacy of single-tract and multiple-tract percutaneous nephrolithotomy (PCNL) in complex renal calculi treatment.

PubMed, Web of Science, Embase, EBSCO, and Cochrane library databases (updated November 2020) were searched for studies assessing the effect of different numbers of tracts on cases that underwent PCNL. The search strategy and study selection process were managed according to the PRISMA statement.

Five comparative studies were included in the meta-analysis. The multiple-tract PCNL group had a significantly increased total complications rate than the single-tract group (OR = 2.35, 95% CI = 1.71, 3.25; P < 0.00001) with insignificant heterogeneity (I2 = 0%, P = 0.52). Subgroup analysis showed there were different incidence of complications, mainly because the multiple-tract PCNL group was significantly associated with a higher rate of blood transfusion (OR = 2.99, 95% CI = 1.95, 4.57; P < 0.00001) with insignificant heterogeneity (I2 = 9%, P = 0.35). There were no differences in operation time (MD = 12.04, 95% CI = 6.36, 17.72; P < 0.0001) or hospitalization (MD = 0.54, 95% CI = 0.14, 0.95, p = 0.008). However, the singletract group had a higher stone-free rate (OR = 0.37, 95% CI = 0.19, 0.74; P = 0.005) with heterogeneity (I2 = 51%, P = 0.08), as stones in the single-tract group were smaller than those in the multiple-tract group.

The current research did not find that the multiple-tract group had a higher stone-free rate. Additionally, multiple-tract PCNL was associated with a higher incidence of blood transfusion and negative impact on renal function.
The current research did not find that the multiple-tract group had a higher stone-free rate. Additionally, multiple-tract PCNL was associated with a higher incidence of blood transfusion and negative impact on renal function.
Active surveillance (AS) and minimally invasive ablative therapies such as percutaneous cryoablation (PCA) are emerging as alternative treatment modalities in the management of small renal masses (SRMs).

Fifty-nine patients underwent PCA since 2011 and 75 underwent AS since 2010 at two different institutions. Only patients with follow-up ≥ 6 months were included. All patients were followed with a standardized protocol. Treatment failure was defined by dimensional progression for AS and renal recurrence for PCA, in addition to stage and/or metastatic progression for both groups.

Treatment failure was observed in 14 cases (18,7%) during AS (mainly due to dimensional progression) and 12 patients (16%) underwent delayed intervention with a mean follow-up of 36,83 months. Seven patients (11,9%) in the PCA group experienced treatment failure with a mean follow-up of 33,39 months and 3 of them underwent re-ablation successfully. Cancer-specific-survival at 2 and 5 years was 100% and 95,8% in AS-group vs. 98,2% and 98,2% in PCA-group (p=0,831). One patient in both groups died from metastatic disease. Overall-survival at 2 and 5 years was 91,7% and 82,4% in the AS-group vs. 96,5% and 96,5% in the PCA-group (p=0,113). Failure-free survival at 2 and 5 years was 90,9% and 70,1% in the AS-group vs. 93,1% and 70,9% in the PCA-group (p=0,645).

AS and PCA provide similar survival outcomes and are safe and valid treatment options for elderly and comorbid patients with SRMs.
AS and PCA provide similar survival outcomes and are safe and valid treatment options for elderly and comorbid patients with SRMs.
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