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Objective: To present the surgical technique and outcomes of robotic ureteral reimplantation in ileal conduit (IC) and neobladder (NB) in patients with prior minimally-invasive radical cystectomy and intracorporeal urinary diversion, who developed benign uretero-ileal anastomotic strictures. Patients and surgical procedure: We report on a multiinstitutional cohort of 10 patients (7 IC, 3 NB) who had 12 uretero-ileal strictures (8 unilateral, 2 bilateral) causing hydronephrosis and renal function deterioration, who underwent robotic uretero-ileal reimplantation in referral centers for robotic surgery between 2016 and 2022. Median age was 67.5 years (Interquartile range [IQR]: 66–69). The stricture was diagnosed at a median of 6 months (IQR 5–10) from the initial surgery. All unilateral strictures were on the left side. Two patients received unsuccessful endoscopic dilatation before the reconstructive surgery. All patients underwent nephrostomy placement prior to the reconstructive procedure. Robotic uretero-ileal reanastomosis started with adhesiolysis, followed by the identification of the ureters and urinary diversion, facilitated by the use of intracavitary saline or ICG. When dissecting the ureters, a „no touch” technique was used, in order to minimize devascularization and ischemia. Localization of the ureteral stricture was critical. The excision of the entire ischemic segment was performed until signs indicative of adequate tissue trophism were found. At the same time, consideration was given to spare sufficient length of the ureteral stumps to allow for a tension-free anastomosis. Direct anastomosis using monofilament resorbable suture, with insertion of mono J or double J stent was performed with both ileal conduit and neobladder. Bricker technique was used in case of unilateral stricture. Results: The median operative time for robotic uretero-ileal reanastomosis was 152 min (IQR 120–180) and the median blood loss was 50 ml (IQR 40–70). No intraoperative complications occurred according to the ICARUS criteria. Median length of hospital stay was 4.5 days (IQR 3–6). Two Clavien-DIndo II (20 %) postoperative complications were registered (urinary tract infection and acute kidney injury). No patients required readmission or reoperation. The mean length of ureteral catheterization for reimplantation in IC was 20.7 days (± 4.29). For patients with NB, the mean ureteral and urethral catheterization times were 54.3 days (± 22.8) and 19.3 days (± 11.08), respectively. The ureteral stents were removed in all patients. At a median of 16 months follow-up (range 6–36 months), 2 patients (one IC and one NB, respectively) had persistent hydronephrosis. Conclusion: In patients requiring surgery for benign ureteral strictures following cystectomy, robotic surgery allows for safe and efficient ureteral reimplantation in urinary diversion.

miRNAs constitute fine-tuners of gene expression and are implicated in a variety of diseases spanning from inflammation to cancer. miRNA expression is deregulated in rheumatoid arthritis (RA); however, their specific role in key arthritogenic cells such as the synovial fibroblast (SF) remains elusive. Previous studies have shown that Mir221/222 expression is upregulated in RA SFs. Here, we demonstrate that TNF and IL-1β but not IFN-γ activated Mir221/222 gene expression in murine SFs. SF-specific overexpression of Mir221/222 in huTNFtg mice led to further expansion of SFs and disease exacerbation, while its total ablation led to reduced SF expansion and attenuated disease. Mir221/222 overexpression altered the SF transcriptional profile igniting pathways involved in cell cycle and ECM (extracellular matrix) regulation. Validation of targets of Mir221/222 revealed cell cycle inhibitors Cdkn1b and Cdkn1c, as well as the epigenetic regulator Smarca1. Single-cell ATAC-seq data analysis revealed increased Mir221/222 gene activity in pathogenic SF subclusters and transcriptional regulation by Rela, Relb, Junb, Bach1, and Nfe2l2. Our results establish an SF-specific pathogenic role of Mir221/222 in arthritis and suggest that its therapeutic targeting in specific subpopulations could lead to novel fibroblast-targeted therapies.

This paper invokes cognitive developmental theory as a means for preparing citizens to deal with and resolve conflicts within or across nations. We take the centuries-old Greek-Turkish dispute as an example. We first outline a theory of intellectual development postulating that mental changes emerge in response to changing developmental priorities in successive life periods, namely, interaction control in infancy, attention control and representational awareness in preschool, inferential control and cognitive management in primary school, and advanced forms of reasoning and self-evaluation in adolescence. Based on this model, we outline a control theory of wisdom postulating that different aspects of wisdom emerge during development as different levels of control of relations with others: trust and care for others in infancy, taking the other's perspective, reflectivity, and empathy in preschool, rationality and understanding the rules underlying individual and group interactions in primary school, and understanding the general principles of societal operation explaining the differences in approach and interest between groups in adolescence and early adulthood. We also outline the educational implications of this theory for the education of citizens by capitalizing on intellectual strengths at successive developmental periods to comprehensively understand the world and to act prudently when dealing with interpersonal and social or national conflict. Finally, the paper discusses the political constraints and implications of this theory. This is the first attempt to derive wisdom from the development of cognitive and personality processes from infancy through early adulthood and to connect it to serious world problems.

ABSTRACT Purpose: Salvage robotic-assisted radical prostatectomy (S-RARP) has gained prominence in recent years for treating patients with cancer recurrence following non-surgical treatments of Prostate Cancer. We conducted a systematic literature review to evaluate the role and outcomes of S-RARP over the past decade. Materials and Methods: A systematic review was conducted, encompassing articles published between January 1st, 2013, and June 1st, 2023, on S-RARP outcomes. Articles were screened according to PRISMA guidelines, resulting in 33 selected studies. Data were extracted, including patient demographics, operative times, complications, functional outcomes, and oncological outcomes. Results: Among 1,630 patients from 33 studies, radiotherapy was the most common primary treatment (42%). Operative times ranged from 110 to 303 minutes, with estimated blood loss between 50 to 745 mL. Intraoperative complications occurred in 0 to 9% of cases, while postoperative complications ranged from 0 to 90% (Clavien 1-5). Continence rates varied (from 0 to 100%), and potency rates ranged from 0 to 66.7%. Positive surgical margins were reported up to 65.6%, and biochemical recurrence ranged from 0 to 57%. Conclusion: Salvage robotic-assisted radical prostatectomy in patients with cancer recurrence after previous prostate cancer treatment is safe and feasible. The literature is based on retrospective studies with inherent limitations describing low rates of intraoperative complications and small blood loss. However, potency and continence rates are largely reduced compared to the primary RARP series, despite the type of the primary treatment. Better-designed studies to assess the long-term outcomes and individually specify each primary therapy impact on the salvage treatment are still needed. Future articles should be more specific and provide more details regarding the previous therapies and S-RARP surgical techniques.

Mucormycosis, an invasive fungal infection caused by members of the order Mucorales, often progresses fulminantly if not recognized in a timely manner. This comprehensive review discusses the latest developments in diagnostic approaches for mucormycosis, from traditional histopathology and culture-based methods to advanced and emerging techniques such as molecular assays, imaging, serology, and metabolomics. We discuss challenges in the diagnosis of mucormycosis and emphasize the importance of rapid and accurate identification of this life-threatening infection.

Extreme floods occurred from 4 to 6 August 2023 in Slovenia causing three casualties and causing total direct and indirect damage, including post-disaster needs according to the Post-Disaster Needs Assessment (PDNA), close to EUR 10 billion. The atypical summer weather conditions combined with the high air and sea temperatures in the Mediterranean and the high soil moisture led to the most extreme flood event in Slovenia in recent decades. The return periods of both daily and sub-daily precipitation extremes and peak discharges reached 250–500 years, and the runoff coefficient of a typical torrential and mostly forested mesoscale catchment was around 0.5. In addition, flooding, soil erosion, mass movements and river sediment transport processes caused major damage to buildings (more than 12 000 houses) and diverse infrastructure.

Abstract As a network of researchers we release an open-access database (EUSEDcollab) of water discharge and suspended sediment yield time series records collected in small to medium sized catchments in Europe. EUSEDcollab is compiled to overcome the scarcity of open-access data at relevant spatial scales for studies on runoff, soil loss by water erosion and sediment delivery. Multi-source measurement data from numerous researchers and institutions were harmonised into a common time series and metadata structure. Data reuse is facilitated through accompanying metadata descriptors providing background technical information for each monitoring station setup. Across ten European countries, EUSEDcollab covers over 1600 catchment years of data from 245 catchments at event (11 catchments), daily (22 catchments) and monthly (212 catchments) temporal resolution, and is unique in its focus on small to medium catchment drainage areas (median = 43 km2, min = 0.04 km2, max = 817 km2) with applicability for soil erosion research. We release this database with the aim of uniting people, knowledge and data through the European Union Soil Observatory (EUSO).

We investigate how an inquiry-oriented, dynamic, open-source calculus textbook shaped one college instructor's planning. We rely on Dietiker et al.'s [(2018). Research commentary: Curricular noticing: A framework to describe teachers' interactions with curriculum materials. "Journal for Research in Mathematics Education," 49(5), 521-532. https://doi.org/10.5951/jresematheduc.49.5.0521] curriculum noticing framework to situate the instructor's actions during lesson planning using data from surveys, logs and interviews. The instructor's planning practices are characterized by intense use of the textbook, including creating additional curricular material related to its content. Our observations suggest that the textbook supported and influenced the instructor in implementing his inquiry-oriented visions and goals while planning his lessons. We conclude by suggesting further investigation of how textbooks shape undergraduate mathematics education and the textbooks' role in shaping undergraduate mathematics planning practices.

Here, we present and release the Global Rainfall Erosivity Database (GloREDa), a multi-source platform containing rainfall erosivity values for almost 4000 stations globally. The database was compiled through a global collaboration between a network of researchers, meteorological services and environmental organisations from 65 countries. GloREDa is the first open access database of rainfall erosivity (R-factor) based on hourly and sub-hourly rainfall records at a global scale. This database is now stored and accessible for download in the long-term European Soil Data Centre (ESDAC) repository of the European Commission's Joint Research Centre. This will ensure the further development of the database with insertions of new records, maintenance of the data and provision of a helpdesk.In addition to the annual erosivity data, this release also includes the mean monthly erosivity data for 94% of the GloREDa stations. Based on these mean monthly R-factor values, we predict the global monthly erosivity datasets at 1 km resolution using the ensemble machine learning approach (ML) as implemented in the mlr package for R. The produced monthly raster data (GeoTIFF format) may be useful for soil erosion prediction modelling, sediment distribution analysis, climate change predictions, flood, and natural disaster assessments and can be valuable inputs for Land and Earth Systems modelling.

The goal of this study is to identify the multiple ways in which instructors take advantage of a feature designed into university textbooks that seeks to invite students to get acquainted with the content prior to attending the class in which such content will be discussed. We present an analysis of teacher instrumentation of this feature, which we call questioning devices, using data from 15 instructors who taught calculus, linear algebra, or abstract algebra over one semester. The instructors taught at 14 different universities in the United States. We identified four utilization schemes of the questioning devices in which instructors: completed questioning devices for pre-planning, required students to complete the questioning devices for the purpose of lesson planning, used the questioning devices for the purpose of instruction, and required students complete the questioning devices for the purpose of assessment. These schemes are supported by various operational invariants related to self-perception as competent instructors and implicit theories of teaching and learning. The identified utilization schemes inform textbook developers and author-designers, making them aware of whether these features fulfill their design purposes, and possibly think about changes that might be needed to support instructors in achieving their instructional goals and improve learning. We suggest some further areas of inquiry.

Background: Since the introduction of minimally invasive surgery, the number of simulation models available for teaching new surgeons has continued to increase. Objective: To evaluate and validate use of a model for teaching robot-assisted pyeloplasty. Design, setting, and participants: Twenty simulated robot-assisted pyeloplasty procedures were performed by experienced (n = 4) and novice (n = 16) surgeons using a chicken crop model at two different training centers using third- and fourth-generation robotic systems. Outcome measurements and statistical analysis: We evaluated the time needed to perform the procedure, and the sufficiency and patency of the anastomosis. Participants rated the efficiency, face validity, and possible acceptance of the model as part of a structured curriculum on a scale from 0 to10. Statistical significance for comparison of results was set at p

Objectives The aim of this study was to assess whether age ≥75 years impairs surgical, functional, and oncological outcomes after robot-assisted radical prostatectomy (RARP). Materials and methods Patients with prostate cancer (PCa) were stratified in ≥75(n = 669) vs.

Objective The aim of this study was to evaluate the prognostic impact of concomitant prostate cancer (PCa) of the cancer-specific mortality (CSM) in the aging patient’s papulation with bladder cancer (BCa) treated with radical cystoprostatectomy (RCP). Materials and Methods Within the SEER database (2004–2015), 1468 patients were treated with RCP for BCa harboring histopathological PCa findings. To account for other cause mortality (OCM), multivariable competing risk regression (CRR) tested for potential BCa-CSM differences according to PCa characteristics risk factors predicting CSM Results CRR analysis revealed that only following BCa characteristics, as high pathological tumor stages(Ta/Tis/T1 [REF.] vs. T2; HR 2.03, 95% CI: 1.16-3.57, p = 0.014 vs. T3; HR 4.32, 95% CI: 2.45-7.61, p

Background: Robot-assisted partial nephrectomy (RAPN) is a challenging procedure that is influenced by a multitude of factors. Objective: To assess the impact of prior surgical experience on perioperative outcomes in RAPN. Design, setting, and participants: In this retrospective multicenter study, results for 2548 RAPNs performed by 25 surgeons at eight robotic referral centers were analyzed. Perioperative data for all consecutive RAPNs from the start of each individual surgeon’s experience were collected, as well as the number of prior open or laparoscopic kidney surgeries, pelvic surgeries (open, laparoscopic, robotic), and other robotic interventions. Intervention: Transperitoneal or retroperitoneal RAPN. Outcome measurements and statistical analysis: The impact of prior surgical experience on operative time, warm ischemia time (WIT), major complications, and margin, ischemia, complication (MIC) score (negative surgical margins, WIT ≤20 min, no major complications) was assessed via univariate and multivariable regression analyses accounting for age, gender, body mass index (BMI), American Society of Anesthesiologists score, PADUA score, and RAPN experience. Results and limitations: BMI, PADUA score, and surgical experience in RAPN had a strong impact on perioperative outcomes. A plateau effect for the learning curve was not observed. Prior laparoscopic kidney surgery significantly reduced the operative time (p

Abstract Cryptococcuria is a rare manifestation of localized cryptococcal disease. We present a case of Cryptococcus neoformans urinary tract infection in an immunocompromised host missed by routine laboratory workup. The patient had negative blood cultures, a negative serum cryptococcal antigen (CrAg), and “non-Candida yeast” growing in urine culture that was initially dismissed as non-pathogenic. The diagnosis was ultimately made by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) from a repeat urine culture after transfer to a tertiary care center. Cryptococcus should be considered in the differential of refractory urinary tract infections growing non-Candida yeast.

Objective:. To compare binary metrics and Global Evaluative Assessment of Robotic Skills (GEARS) evaluations of training outcome assessments for reliability, sensitivity, and specificity. Background:. GEARS–Likert-scale skills assessment are a widely accepted tool for robotic surgical training outcome evaluations. Proficiency-based progression (PBP) training is another methodology but uses binary performance metrics for evaluations. Methods:. In a prospective, randomized, and blinded study, we compared conventional with PBP training for a robotic suturing, knot-tying anastomosis task. Thirty-six surgical residents from 16 Belgium residency programs were randomized. In the skills laboratory, the PBP group trained until they demonstrated a quantitatively defined proficiency benchmark. The conventional group were yoked to the same training time but without the proficiency requirement. The final trial was video recorded and assessed with binary metrics and GEARS by robotic surgeons blinded to individual, group, and residency program. Sensitivity and specificity of the two assessment methods were evaluated with area under the curve (AUC) and receiver operating characteristics (ROC) curves. Results:. The PBP group made 42% fewer objectively assessed performance errors than the conventional group (P < 0.001) and scored 15% better on the GEARS assessment (P = 0.033). The mean interrater reliability for binary metrics and GEARS was 0.87 and 0.38, respectively. Binary total error metrics AUC was 97% and for GEARS 85%. With a sensitivity threshold of 0.8, false positives rates were 3% and 25% for, respectively, the binary and GEARS assessments. Conclusions:. Binary metrics for scoring a robotic VUA task demonstrated better psychometric properties than the GEARS assessment.

We present the results of a fourth planetary defense exercise, focused this time on the small near-Earth asteroid (NEA) 2023 DZ2 and conducted during its close approach to the Earth in 2023 March. The International Asteroid Warning Network (IAWN), with support from NASA's Planetary Defense Coordination Office (PDCO), has been coordinating planetary defense observational campaigns since 2017 to test the operational readiness of the global planetary defense capabilities. The last campaign focused on the NEA Apophis, and an outcome of that exercise was the need for a short burst campaign to replicate a real-life near-Earth object impact hazard scenario. The goal of the 2023 DZ2 campaign was to characterize the small NEA as a potential impactor and exercise the planetary defense system including observations, hypothetical risk assessment and risk prediction, and hazard communication with a short notice of just 24 hr. The entire campaign lasted about 10 days. The campaign team was divided into several working groups based on the characterization method: photometry, spectroscopy, thermal IR photometry and optical polarimetry, radar, and risk assessment. Science results from the campaign show that 2023 DZ2 has a rotation period of 6.2745 ± 0.0030 minutes; visible wavelength color photometry/spectroscopy/polarimetry and near-IR spectroscopy all point to an E-type taxonomic classification with surface composition analogous to aubrite meteorites; and radar observations show that the object has a diameter of 30 ± 10 m, consistent with the high albedo (0.49) derived from polarimetric and thermal IR observations.

Introduction. Multisystem inflammatory syndrome in adults (MIS-A) is a rare but potentially life-threatening sequel of SARS-CoV-2 infection, requiring early recognition and treatment. Nevertheless, it is often hard to distinguish MIS-A from other COVID-19-related hyperinflammatory complications. Case presentation. A 74-year-old male presented to the emergency department with persistent fever, diarrhea, altered consciousness, polymorphous rash with oral lesions and erythema of the palms and soles, with progressive exfoliation. The patient had been hospitalized for COVID-19 four weeks before and was suffering from chronic lymphocytic leukemia, diabetes and hypertension. During his recent hospital stay he received multiple courses of antibiotics and was discharged home with instructions to add sitagliptin and re-initiate therapy with ibrutinib. Upon re-admission, polymerase chain reaction test for SARS-CoV-2 was still positive and inflammatory markers were markedly elevated. Although MIS-A could not be excluded, a presumptive diagnosis of Stevens-Johnson Syndrome (SJS) was made, and the patient was treated empirically with intravenous immunoglobulin and high-dose methylprednisolone. SJS is usually considered an adverse drug reaction that affects the skin and mucous membranes. In this patient, MIS-A was also initially included in the differential diagnosis due to previous COVID-19, despite the patient’s advanced age and lack of cardiac involvement or conjunctivitis. The patient only partially fulfilled current diagnostic criteria for MIS-A. Conclusions. SJS results from a dysregulated immune response and can have a similar presentation to MIS-A. A better characterization of both conditions is required particularly in older adults with comorbidities, to facilitate timely diagnosis and management and to reduce mortality.

Abstract Background Synovial fibroblasts (SFs) are specialized cells of the synovium that provide nutrients and lubricants for the proper function of diarthrodial joints. Recent evidence appreciates the contribution of SF heterogeneity in arthritic pathologies. However, the normal SF profiles and the molecular networks that govern the transition from homeostatic to arthritic SF heterogeneity remain poorly defined. Methods We applied a combined analysis of single-cell (sc) transcriptomes and epigenomes (scRNA-seq and scATAC-seq) to SFs derived from naïve and hTNFtg mice (mice that overexpress human TNF, a murine model for rheumatoid arthritis), by employing the Seurat and ArchR packages. To identify the cellular differentiation lineages, we conducted velocity and trajectory analysis by combining state-of-the-art algorithms including scVelo, Slingshot, and PAGA. We integrated the transcriptomic and epigenomic data to infer gene regulatory networks using ArchR and custom-implemented algorithms. We performed a canonical correlation analysis-based integration of murine data with publicly available datasets from SFs of rheumatoid arthritis patients and sought to identify conserved gene regulatory networks by utilizing the SCENIC algorithm in the human arthritic scRNA-seq atlas. Results By comparing SFs from healthy and hTNFtg mice, we revealed seven homeostatic and two disease-specific subsets of SFs. In healthy synovium, SFs function towards chondro- and osteogenesis, tissue repair, and immune surveillance. The development of arthritis leads to shrinkage of homeostatic SFs and favors the emergence of SF profiles marked by Dkk3 and Lrrc15 expression, functioning towards enhanced inflammatory responses and matrix catabolic processes. Lineage inference analysis indicated that specific Thy1+ SFs at the root of trajectories lead to the intermediate Thy1+/Dkk3+/Lrrc15+ SF states and culminate in a destructive and inflammatory Thy1− SF identity. We further uncovered epigenetically primed gene programs driving the expansion of these arthritic SFs, regulated by NFkB and new candidates, such as Runx1. Cross-species analysis of human/mouse arthritic SF data determined conserved regulatory and transcriptional networks. Conclusions We revealed a dynamic SF landscape from health to arthritis providing a functional genomic blueprint to understand the joint pathophysiology and highlight the fibroblast-oriented therapeutic targets for combating chronic inflammatory and destructive arthritic disease.