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BACKGROUND There are two main techniques for arterial reconstruction in RT: TA using a stab longitudinal incision which creates an elliptical opening and AP which fashions a circular defect. We hypothesized that AP creates a natural anastomosis lumen, similar to the donor renal artery, which optimizes RT perfusion. METHODS A retrospective review of a single-institution database was performed between 2000 and 2018. Twenty patients who underwent AP arteriotomy were compared to 40 TA-matched controls. Data were collected on creatinine (preoperative, nadir, and time to nadir), and DUS RI and PSV at 1 week, 3 months, and 6-12 months post-RT. RESULTS ttNC was shorter in the AP group (5 ± 4 vs 12 ± 13 days; P = .03). PSV at 1 week was lower in the AP group (186 ± 65 cm/s vs 232 ± 89 cm/s; P = .04). There was no difference in nadir creatinine value (P = .26), preoperative creatinine (P = .66), and initial postoperative creatinine (P = .80). RI at week 1 were not different between groups (P = .37). Follow-up DUS showed the difference in PSV between groups became non-significant (1 month P = .50 and 6-12 months P = .53). CONCLUSIONS AP arteriotomy in RT improves early perfusion and function parameters (ttNC and initial PSV) as compared to TA. AP arteriotomy optimizes early allograft reperfusion, which may have important long-term implications and deserves further evaluation.

Introduction: Missed appointments are barriers to health care delivery that result in loss of revenue and disruption of physician-patient relationship. There is a paucity of data describing the rate and impact of missed appointments in Pediatric Ophthalmology. Methods: A retrospective review of 3,922 patient appointments for two pediatric ophthalmologists at an academic Canadian institution was conducted over one year. Demographic data included patient age, day and appointment month. Results: There were 720 missed appointments (18.4%), the equivalent of 26.7 full day clinics. New patients were significantly more likely to miss appointments (P < 0.001). There was no difference between patient age (P = 0.46) or day of week (P = 0.16). There was a significant difference between appointment month (P = 0.001), the highest rates were January (26.39%) and February (23.11%). Subset analysis of 1574 patients (one of the providers) revealed surgical strabismus patients were significantly more likely to attend appointments (P < 0.001). Patients were more likely to miss appointments if they previously missed appointment(s) (P < 0.001) or were referred by nurse practitioners (P = 0.027). There was no difference between sex (P = 0.111), distance to clinic (P = 0.073) or appointment time (P = 0.347). The average physician billing loss was estimated at $54,722.46 USD in 1 year. Conclusion/Relevance: This study identifies factors that can be targeted to improve missed appointments. New patients, non-surgical patients and patients referred by nurse practitioners have higher missed appointment rates. Missed appointments cause significant financial loss, physician time wasted, and increase in patient wait times. In the current COVID-19 environment, reduced clinic capacity makes it essential to reduce missed appointments and associated financial loss.

Background The natural history of renal angiomyolipoma (AML) is unknown. Treatment recommendations are based on smaller case series, with selection bias towards symptomatic patients. Objective To define the natural history of renal AML, including growth rates, size, and clinical presentation. Design, setting, and participants We used a unique radiology data-mining system (Montage; Montage Healthcare Systems, Philadelphia, PA, USA) to retrospectively review the radiology database in an academic health centre between 2002 and 2013 to identify all renal AMLs. Of 2741 patients identified, 447 with 582 AMLs had three or more imaging studies suitable for analysis. Intervention Angioembolisation, surgery, radiofrequency ablation, and mammalian target of rapamycin inhibitors. Outcome measurements and statistical analysis The primary end point was the growth rate of untreated AMLs. We used a linear mixed-effects model to determine change in growth rate over time. We evaluated the association among growth rate, size, and patient factors as well as interventions. Results and limitations The majority of untreated AMLs (>92%) had not grown at a median follow-up of 43 mo, with no difference in growth rates between AMLs ≤4 and >4cm. Most AMLs occurred in female participants (80%) and were asymptomatic (91%). Tuberous sclerosis complex (TSC) was confirmed in 3.8% ( n =17) and presented at an earlier age. Median size was 1cm but was significantly larger for TSC (5.5cm; p Conclusions This large, single-institution series on AMLs confirms that lesions >4cm do not require early intervention based on size alone. The vast majority are sporadic, asymptomatic, and initially harmless, with a negligible growth rate. Our findings support a policy of initial active surveillance for all asymptomatic AMLs. Patient summary We evaluated the natural history and growth rates of renal AMLs. We found no difference in growth rates between AMLs >4 and ≤4cm. Initial AS appears to be a safe management option.