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Soil moisture (SM) is an important driver for forest ecosystems, creating a need for globally extensive SM information that can only be achieved with satellite-based sensors and/or process-based model. However, the reliability of remotely sensed or modeled SM data in forests is poorly understood due to a lack of suitable validation sites and interference with remote sensing caused by vegetation water content. Here, we examine three multiyear SM products: remotely sensed surface (0–5 cm) SM from combined soil moisture active passive (SMAP) and Sentinel-1 observations (SMAP/Sentinel); the SMAP Level-4 surface (0–5 cm) and root-zone (0–1 m) SM data assimilation product (SMAP-L4); and simulated surface (0–10 cm) and root-zone (0–1 m) SM from the North American land data assimilation system (NLDAS). These estimates were compared with in situ measurements from 39 National Ecological Observatory Network sites throughout the U.S. At 21 unforested sites, the performance of the three products was similar for surface SM, and all three were able to track temporal changes in surface SM. The performance of the three products declined at 18 forested sites; however, while the performance declined modestly for SMAP-L4 and NLDAS, SMAP/Sentinel performance declined so much that it was largely unable to track changes in surface SM. The SMAP-L4 and NLDAS products also reliably captured temporal changes in root-zone SM at both forested and unforested sites. Our findings indicate that both SMAP-L4 and NLDAS can be used to track surface and root-zone SM changes in forests (unbiased root-mean-square deviation: 0.03–0.06 m3 m−3).

Aluminium (Al) toxicity in acid soils is a major abiotic stress that can limit plant production worldwide. Al toxicity directly inhibits root development and exacerbates oxidative stress in the plant. Sugarcane is mostly cultivated in tropical regions and is often exposed to phytotoxic concentrations of soil Al. In this study, our objectives were to evaluate nine sugarcane cultivars on their tolerance to Al in a hydroponic system, investigating the effects of 143µM {Al3+} on root growth and on activity of the antioxidant enzymes ascorbate peroxidase (APX), catalase (CAT) and superoxide dismutase (SOD). The screening method proposed was suitable for a rapid, reliable and reproducible procedure of the sugarcane cultivars. Exposure to Al for three days altered root growth and activity of enzymes of the nine sugarcane cultivars. However, the magnitude of the alterations varied significantly among cultivars. The cultivar RB928064 was classified as Al-tolerant and the cultivar RB835486 as Al-sensitive. Increases in enzyme activity after Al exposure varied from 4 to 46%, with average increases of 19% in APX, 20% in CAT, and 8% in SOD. The variations induced by Al in enzyme activity, however, did not correlate significantly with those variations induced by Al in the root growth.

Serious knee pain and related disability have an annual prevalence of approximately 25% on those over the age of 55 years. As curative treatments for the common knee problems are not available to date, knee pathologies typically progress and often lead to osteoarthritis (OA). While the roles that the meniscus plays in knee biomechanics are well characterized, biological mechanisms underlying meniscus pathophysiology and roles in knee pain and OA progression are not fully clear. Experimental treatments for knee disorders that are successful in animal models often produce unsatisfactory results in humans due to species differences or the inability to fully replicate disease progression in experimental animals. The use of animals with spontaneous knee pathologies, such as dogs, can significantly help addressing this issue. As microscopic and macroscopic anatomy of the canine and human menisci are similar, spontaneous meniscal pathologies in canine patients are thought to be highly relevant for translational medicine. However, it is not clear whether the biomolecular mechanisms of pain, degradation of extracellular matrix, and inflammatory responses are species dependent. The aims of this review are (1) to provide an overview of the anatomy, physiology, and pathology of the human and canine meniscus, (2) to compare the known signaling pathways involved in spontaneous meniscus pathology between both species, and (3) to assess the relevance of dogs with spontaneous meniscal pathology as a translational model. Understanding these mechanisms in human and canine meniscus can help to advance diagnostic and therapeutic strategies for painful knee disorders and improve clinical decision making.

Objectives: To identify a treatment-responsive population for botulinum toxin type A (BoNTA) and to evaluate the safety and efficacy of 3 different doses of BoNTA as prophylactic treatment of chronic daily headache (CDH).Patients and Methods: A randomized, double-blind, placebo-controlled study of BoNTA in patients with CDH was conducted from July 6, 2001, through November 7, 2003, at 28 North American study centers. Eligible patients were injected with BoNTA at 225 U, 150 U, 75 U, or placebo and returned for additional masked treatments at day 90 and day 180. Patients were assessed every 30 days for 9 months. The primary efficacy end point was the mean change from baseline in the frequency of headache-free days at day 180 for the placebo nonresponder group.Results: For this study, 702 patients were enrolled and randomized. The primary efficacy end point was not met. Mean improvements from baseline at day 180 of 6.0, 7.9, 7.9, and 8.0 headache-free days per month were observed in the placebo nonresponder group treated with BoNTA at 225 U, 150 U, 75 U, or placebo, respectively (P=.44). An a priori-defined analysis of headache frequency revealed that BoNTA at 225 U or 150 U had significantly greater least squares mean changes from baseline than placebo at day 240 (-8.4, -8.6, and -6.4, respectively; P=.03 analysis of covariance). Only 27 of 702 patients (3.8%) withdrew from the study because of adverse events, which generally were transient and mild to moderate.Conclusions: Although the primary efficacy end point was not met, all groups responded to treatment. The 225 U and 150 U groups experienced a greater decrease in headache frequency than the placebo group at day 240. The placebo response was higher than expected. BoNTA was safe and well tolerated. Further study of BoNTA prophylactic treatment of CDH appears warranted. [ABSTRACT FROM AUTHOR]

Purpose: The profession of physical therapy has historically relied on manual facilitation to improve motor control strategies and performance in persons rehabilitating from a stroke, yet there is insufficient evidence to support its use during functional task training. The purpose of this study was to determine the effects of integrated cueing (verbal and manual) and verbal cueing approaches during sit-to-stand training on midline alignment & muscle activation in chronic stroke survivors., Methods: Twenty-one chronic right-brained stroke survivors with hemiplegia were randomly assigned to the Integrated Cueing or Verbal Only group and outcome measures were recorded using an 18-Camera Motion Capture System, force plates, and surface electromyography (EMG)., Results: Both groups demonstrated a significant improvement in symmetry toward the midline after thirty training repetitions. Significant improvements in muscle activation were found in two muscle groups on the affected side of the body in the Integrated Cueing group, gastrocnemius and rectus femoris., Conclusion: Both the Verbal Only and Integrated Cueing groups made significant progress toward more symmetrical movement, yet more significant changes in the activation of hemiparetic extensor muscles were seen in the Integrated Cueing group. These findings support the use of manual cueing in movement activation and performance during the training of functional tasks.IMPLICATIONS FOR REHABPhysical therapists commonly use manual tactile cues to facilitate movement performance but there is currently insufficient evidence to support this use with stroke survivors.In a relatively small sample size, both verbal cues and integrated cues (verbal plus manual) improved symmetry during sit to stand in chronic right brain stroke survivors.Integrated cueing enhanced motor activation and performance during sit to stand better than verbal cues alone.Manual tactile cueing should be considered during functional task retraining.

Northern red oak (Quercus rubra L.) is an ecologically and economically important forest tree native to North America. We present a chromosome-scale genome of Q. rubra generated by the combination of PacBio sequences and chromatin conformation capture (Hi-C) scaffolding. This is the first reference genome from the red oak clade (section Lobatae). The Q. rubra assembly spans 739 Mb with 95.27% of the genome in 12 chromosomes and 33,333 protein-coding genes. Comparisons to the genomes of Quercus lobata and Quercus mongolica revealed high collinearity, with intrachromosomal structural variants present. Orthologous gene family analysis with other tree species revealed that gene families associated with defense response were expanding and contracting simultaneously across the Q. rubra genome. Quercus rubra had the most CC-NBS-LRR and TIR-NBS-LRR resistance genes out of the 9 species analyzed. Terpene synthase gene family comparisons further reveal tandem gene duplications in TPS-b subfamily, similar to Quercus robur. Phylogenetic analysis also identified 4 subfamilies of the IGT/LAZY gene family in Q. rubra important for plant structure. Single major QTL regions were identified for vegetative bud break and marcescence, which contain candidate genes for further research, including a putative ortholog of the circadian clock constituent cryptochrome (CRY2) and 8 tandemly duplicated genes for serine protease inhibitors, respectively. Genome-environment associations across natural populations identified candidate abiotic stress tolerance genes and predicted performance in a common garden. This high-quality red oak genome represents an essential resource to the oak genomic community, which will expedite comparative genomics and biological studies in Quercus species., Competing Interests: Conflicts of interest The authors declare no conflict of interest., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Genetics Society of America.)

Valproic acid (VPA) is a widely prescribed medication that has traditionally been used to treat epilepsy, yet embryonic exposure to VPA increases the risk of the fetus developing neural tube defects (NTDs). While the mechanism by which VPA causes NTDs is unknown, we hypothesize that VPA causes dysmorphogenesis through the disruption of redox-sensitive signaling pathways that are critical for proper embryonic development, and that protection from the redox disruption may decrease the prevalence of NTDs. Time-bred CD-1 mice were treated with 3H-1,2-dithiole-3-thione (D3T), an inducer of nuclear factor erythroid 2-related factor 2 (NRF2)-a transcription factor that activates the intracellular antioxidant response to prevent redox disruptions. Embryos were then collected for whole embryo culture and subsequently treated with VPA in vitro. The glutathione (GSH)/glutathione disulfide (GSSG) redox potential (E h ), a measure of the intracellular redox environment, was measured in the developing mouse embryos. Embryos treated with VPA exhibited a transiently oxidizing GSH/GSSG E h , while those that received D3T pretreatment prior to VPA exposure showed no differences compared to controls. Moving to an in utero mouse model, time-bred C57BL/6 J dams were pretreated with or without D3T and then exposed to VPA, after which all embryos were collected for morphological analyses. The prevalence of open neural tubes in embryos treated with VPA significantly decreased with D3T pretreatment, as did the severity of the observed defects evaluated by a morphological assessment. These data show that NRF2 induction via D3T pretreatment protects against VPA-induced redox dysregulation and decreases the prevalence of NTDs in developing mouse embryos., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Purpose: There is scarce literature regarding genitourinary symptoms in COVID-19, especially post-acute disease otherwise known as Long COVID. We identified recovered COVID-19 patients presenting with new or worsening overactive bladder symptoms, known as COVID-19-associated cystitis (CAC)., Methods: We used the American Urological Association Urology Care Foundation Overactive Bladder (OAB) Assessment Tool to screen COVID-19 recovered patients presenting with urological complaints at our urban-located institution from 5/22/2020 to 12/31/2020. Patients 10-14 weeks post-discharge responded to 5 symptom and 4 quality-of-life (QoL) questions. We reported median symptom scores, as well as QoL scores, based on new or worsening urinary symptoms, and by sex., Results: We identified 350 patients with de novo or worsening OAB symptoms 10-14 weeks after hospitalization with COVID-19. The median total OAB symptom score in both men and women was 18. The median total QoL score for both men and women was 19. Patients with worsening OAB symptoms had a median pre-COVID-19 symptom score of 8 (4-10) compared to post-COVID-19 median symptom score of 19 (17-21). Median age was 64.5 (range 47-82). Median hospital length-of-stay was 10 days (range 5-30)., Conclusion: We report survey-based results of patients suffering from new or worsening OAB symptoms months after their hospitalization from COVID-19. Future studies with larger sample sizes and more extensive testing will hopefully elucidate the specific pathophysiology of OAB symptoms in the context of long COVID so urologists can timely and appropriately treat their patients., (© 2021. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.)

Valproic acid (VPA) is an antiepileptic, bipolar, and migraine medication, which is associated with embryonic dysmorphology, more specifically neural tube defects (NTDs), if taken while pregnant. One mechanism by which VPA may cause NTDs is through oxidative stress that cause disruption of cell signaling. However, mechanisms of VPA-induced oxidative stress are not fully understood. Since VPA is a deacetylase inhibitor, we propose that VPA promotes mitochondrial superoxide dismutase-2 (SOD2) acetylation, decreasing SOD2 activity and increasing oxidant levels. Using the pluripotent embryonal carcinoma cell line, P19, VPA effects were evaluated in undifferentiated and neurodifferentiated cells. VPA treatments increased oxidant levels, oxidized the glutathione (GSH)/glutathione disulfide (GSSG) redox couple, and decreased total SOD and SOD2 activity in undifferentiated P19 cells but not in differentiated P19 cells. VPA caused a specific increase in mitochondrial oxidants in undifferentiated P19 cells, VPA did not alter respirometry measurements. Immunoblot analyses demonstrated that VPA increased acetylation of SOD2 at lysine 68 (AcK68 SOD2) in undifferentiated P19 cells but not in differentiated P19 cells. Pretreatments with the Nrf2 inducer, dithiol-3-thione (D3T), in undifferentiated P19 cells prevented increased oxidant levels, GSH/GSSG redox oxidation and restored total SOD and SOD2 activity, correlating with a decrease in AcK68 SOD2 levels. In embryos, VPA decreased total SOD and SOD2 activity and increased levels of AcK68 SOD2, and D3T pretreatments prevented VPA effects, increasing total SOD and SOD2 activity and lowering levels of AcK68 SOD2. These data demonstrate a potential, contributing oxidizing mechanism by which VPA incites teratogenesis in developing systems. Moreover, these data also suggest that Nrf2 interventions may serve as a means to protect developmental signaling and inhibit VPA-induced malformations.

The family Theraphosidae is the most speciose in the infraorder Mygalomorphae Pocock, 1892 with over one thousand described species (World Spider Catalog 2021). The taxonomy of the group has been subjected to considerable attention in modern times, with a focus on delineation based predominantly on genital organ and stridulatory organ morphology which has shown promise, both alongside molecular methods (where possible) and as a stand-alone line of evidence, in stabilising the group (e.g. Hamilton et al. 2016; Fabiano-da-Silva et al. 2020; see also Sherwood 2020). The predominant reference to the family is as Theraphosidae Thorell, 1870 with almost as many references to Theraphosidae Thorell, 1869. This non-congruence of dates is because Tord Tamerlan Teodor Thorell (1830-1901) had his important work On European Spiders published in two parts during its publication by the Royal Society of Upsala in its journal Nova Acta Regiae Societatis Scientiarum Upsaliensis. The first half (pages 1-108 and the supplement I-XIII) was published in 1869 whereas pages 109-242 (despite being dated on the cover page as 1869) were published in 1870 (see Roewer 1942; Bonnet 1945; World Spider Catalog 2021). In the second part, the secretary of the society notes: "L'auteur avait proposé comme titre du présent mémoire: Remarks on Synonyms of European Spiders, preceded by some observations on Zoological Nomenclature and a Review of the European Genera of Spiders; mais, la partie, insérée dans le Tome VII, étant seule présentée à la Société des Sciences le 13 Fevr. 1869, il a été nécessaii'e d'y conformer le titre." [= The author proposed as the title of this memoir: Remarks on Synonyms of European Spiders, preceded by some observations on Zoological Nomenclature and a Review of the European Genera of Spiders; but, the part, inserted in Volume VII, being the only one presented to the Société des Sciences on 13 Feb. 1869, it was necessary to conform the title to it.].

Cyrtopholis Simon 1892 is a spider genus from the Caribbean islands characterized by the presence of stridulatory setae on trochanter of palps and legs I. Franganillo Balboa described eight species of Cyrtopholis Simon 1892 from Cuba between 1926-1936. The type-material is deposited in the Instituto de Ecología y Sistematica do Ministerio de Ciencias, Tecnologia e Meio Ambiente, La Habana, Cuba. Four species are redescribed here: Cyrtopholis plumosa Franganillo, 1931, Cyrtopholis major Franganillo, 1926, Cyrtopholis unispina Franganillo, 1926 and Cyrtopholis gibbosa Franganillo, 1936. Cyrtopholis ischnoculoformis Franganillo, 1926 is based on a juvenile specimen without stridulatory setae, and it is therefore considered here as species inquirenda. The type-material of two other species were not located: Cyrtopholis anacanta Franganillo, 1935 and Cyrtopholis obsoleta (Franganillo, 1935), and are considered to be lost. These two species are here considered as species inquirenda, since the original descriptions do not permit identification. Cyrtopholis respina Franganillo 1935 is considered a nomen dubium, due to the lack of a formal description and a doubtful citation.

Objective: To report on the establishment of a unified, electronic patient-reported outcome (PRO) infrastructure and pilot results from the first 5 practices enrolled in the web-based collection system developed by the Michigan Urological Surgery Improvement Collaborative., Materials and Methods: Eligible patients were those undergoing radical prostatectomy of 5 academic and community practices. PRO was obtained using a validated 21-item web-based questionnaire, regarding urinary function, erection function, and sexual interest and satisfaction. Data were collected preoperatively, at 3 months, and 6 months postoperatively. Patients were provided a link via email to complete the surveys. Perioperative and PRO data were analyzed as reports for individual patients and summary performance reports for individual surgeons., Results: Among 773 eligible patients, 688 (89%) were enrolled preoperatively. Survey completion rate was 88%, 84%, and 90% preoperatively, at 3 months, and 6 months. Electronic completion rates preoperatively, at 3 months, and 6 months were 70%, 70%, and 68%, respectively. Mean urinary function scores were 18.3, 14.3, and 16.6 (good function ≥ 17), whereas mean erection scores were 18.7, 7.3, and 9.1 (good erection score ≥ 22) before surgery, at 3 months, and 6 months. Variation was noted for erectile function among the practices., Conclusion: Collection of electronic PRO via this unified, web-based format was successful and provided results that reflect expected recovery and identify opportunities for improvement. This will be extended to more practices statewide to improve outcomes after radical prostatectomy., (Copyright © 2017 Elsevier Inc. All rights reserved.)

A new diagnosis for the genus Stenoterommata Holmberg, 1881 is presented and six new species are described from Santa Catarina state, southern Brazil: S. pavesii sp. nov. and S. leticiae sp. nov. from Blumenau and Balneário Camboriú; S. sevegnaniae sp. nov. from Blumenau; S. gugai sp. nov., S. peri sp. nov. and S. pescador sp. nov. from Santa Catarina Island, Florianópolis. New records of S. palmar Goloboff, 1995 from southern Brazil are provided. Information on the natural history and habitat are included for all the species. In addition, Hermacha iricolor Mello-Leitão, 1923, described from Blumenau, is transferred to Rachias Simon, 1892.

Purpose: Urinary continence is a driver of quality of life after radical prostatectomy. In this study we evaluated the impact of a biological bladder neck sling on the return of urinary continence after robot-assisted radical prostatectomy., Materials and Methods: This study compared early continence in patients undergoing robot-assisted radical prostatectomy with a sling and without a sling in a 2-group, 1:1, parallel, randomized controlled trial. Patients were blinded to group assignment. The primary outcome was defined as urinary continence (0 to 1 pad per day) at 1 month postoperatively. Inclusion criteria were organ confined prostate cancer and a prostate specific antigen less than 15 ng/ml. Exclusion criteria were any prior surgery on the prostate, a history of neurogenic bladder and history of pelvic radiation. A chi-squared test was used for the primary outcome., Results: A total of 147 patients were randomized (control 74, sling 73) and 92% were available for primary end point analysis at 1 month. There were no significant differences in baseline or perioperative data except that operating room time was 20.1 minutes longer for the sling group (p=0.04). The continence rate was similar between the control and sling groups at 1 month (47.1% vs 55.2%, p=0.34) and 12 months (86.7% vs 94.5%, p=0.15), respectively. Adverse events were similar between the control and sling groups (10.8% vs 13.7%, p=0.59)., Conclusions: The application of an absorbable urethral sling at robot-assisted radical prostatectomy was well tolerated with no increase in obstructive symptoms in this randomized trial. However, the sling failed to show a significant improvement in continence., (Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

The article provides a historical report on venomous spider identification, venom obtainment methods and serum production at the Butantan Institute, São Paulo, Brazil. It is based on literature and personnal experience during the last 50 years. This result is the discovery that the real species causing potential severe human accidents were the spiders of the genus Loxosceles and Phoneutria.

Aims: To determine the levels of functional health literacy (FHL) among insulin-taking African Americans with diabetes from an urban medical practice and to determine if associations exist between FHL levels and glycemic control., Methods: Seventy insulin-taking African Americans seen for diabetes management comprised the analysis cohort. Patients were 18 years or older, African American, had diabetes, and currently using insulin via syringe, pen, or insulin pump. All participants completed a one-time assessment of FHL levels, using the Newest Vital Sign (NVS). Scores ranged from 0 to 6 (0-1 = high likelihood of limited FHL; 2-3 = possibility of limited FHL; 4-6 = adequate FHL). A combination of t tests, Pearson's chi-square tests, and multivariate logistic regression models were used to determine associations between glycemic control and FHL., Results: Average age was 58.7, 59.1% were female, 90.8% with type 2 diabetes, and 15.1% using an insulin pump. Glycemic control was: A1C < 7%: 22.9%, A1C < 8%: 47.1%. Of participants, 47.1% had adequate FHL, 31.4% had possible limited FHL, and 21.4% had a high likelihood of limited FHL. Also, 67.7% of participants with A1C ≥ 8% had a high likelihood of limited FHL. After adjusting for age and gender, participants with a high likelihood of limited FHL were 6.2 times (95% confidence interval [CI], 1.4-28.3) more likely to have A1C ≥ 8%., Conclusions: Insulin-taking African Americans with a high likelihood of limited FHL are approximately 6 times more likely to have an A1C ≥ 8% compared to patients with a possibility of limited FHL, or adequate FHL, demonstrating the need for focused interventions tailored to FHL needs.

Partial nephrectomy (PN) is a technically challenging procedure, making selection of appropriate patients paramount to a successful operation. To identify patients at increased risk of an adverse outcome after PN, there are a number of scoring systems available. The nephrometry score was initially described in a series of laparoscopic and open partial and radical nephrectomies. We compare the association of the nephrometry score with perioperative outcomes in a population of robot-assisted partial nephrectomies. A total of 119 patients were retrospectively reviewed. Correlation and regressional analysis was performed. We identified the separate variables R, E, N, and L to have limited correlation and no predictive value to patient outcomes. Nephrometry score and grade were found to have stronger correlation and predictive value than the individual components of the R.E.N.A.L. nephrometry score. Size of tumor measured on a continuous scale was found to have the strongest correlation and predictive value to outcomes. Outcomes predicted included operative time, length of stay, warm ischemia time, and entry into the collecting system.

Objective: The presence of hydronephrosis (HN) has been implicated as a predictor of poor outcomes for patients diagnosed with bladder cancer. Small, single institution preliminary reports suggest a similar negative relationship may exist for upper-tract urothelial carcinoma (UTUC). Herein, we attempt to validate the prognostic value of preoperative HN in a large, multi-institutional cohort of UTUC patients., Materials and Methods: Data on 469 patients with localized UTUC from 5 tertiary referral centers who underwent a radical nephroureterectomy (91%) or distal ureterectomy (9%) without neoadjuvant chemotherapy were integrated into a relational database. Preoperative HN data, including presence vs. absence and high vs. low grade, were available in 408 patients. The association of HN with pathologic features was evaluated., Results: A total of 254 men and 154 women with a median age of 69 years (IQR 15) were analyzed. Overall, 192 patients (47%) had ≥pT2 disease, 145 (36%) had non-organ-confined (NOC) cancers (≥pT3 and/or positive lymph nodes), and 298 (73%) had high grade UTUC on final pathology. Forty-six percent of patients had tumors in the renal pelvis, 27% in the ureter, and 27% in both locations. Preoperatively, 223 patients (55%) were noted to have ipsilateral HN (39% low grade and 61% high grade). Hydronephrosis was associated with ≥pT2 stage (P < 0.001), NOC disease (P < 0.001), and high grade cancers (P = 0.04). On multivariate analysis adjusting for gender, age, and tumor location, HN was an independent predictor of muscle invasive (HR 7.4, P < 0.001), NOC (HR 5.5, P < 0.001), and high pathologic grade (HR 1.6, P = 0.03) UTUC disease., Conclusion: The presence of preoperative HN was associated with advanced stage UTUC. This readily available imaging modality may improve preoperative risk stratification for UTUC patients thereby guiding use of endoscopic versus extirpative surgery as well as the need for neoadjuvant chemotherapy regimens., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Stigma against mental illness is a complex construct with affective, cognitive, and behavioral components. Beyond its symbolic value, federal law can only directly address one component of stigma: discrimination. This article reviews three landmark antidiscrimination laws that expanded protections over time for individuals with mental illness. Despite these legislative advances, protections are still not uniform for all subpopulations with mental illness. Furthermore, multiple components of stigma (e.g., prejudice) are beyond the reach of legislation, as demonstrated by the phenomenon of label avoidance; individuals may not seek protection from discrimination because of fear of the stigma that may ensue after disclosing their mental illness. To yield the greatest improvements, antidiscrimination laws must be coupled with antistigma programs that directly address other components of stigma.

Purpose: Open partial nephrectomy (OPN) and robotic partial nephrectomy (RPN) are widely utilized techniques for small renal masses. The lack of tactile feedback and limitations of laparoscopy may result in differences in the surgical specimen that may impact oncologic outcome. We present postoperative pathological outcomes data in a cohort of patients matched for nephrometry score, tumor size, gender and age., Materials and Methods: We reviewed 81 patients who underwent partial nephrectomy between January 2003 and March 2010. Twenty-seven underwent RPN and 54 received OPN. Two OPN cases were matched for nephrometry score, tumor size, gender and age for each RPN. Postoperative pathological specimens were reviewed by a urologic pathologist regarding margin status, pathologic stage, histology, renal capsule violation, among other variables., Results: Sixty-two (76.5 %) patients were found to have renal cell carcinoma on final pathology. Frozen sectioning with tumor bed sampling was intra-operatively employed in 70 cases (86.4 %). The overall positive margin occurrence was 1 of 81 patients, which occurred during an RPN for a hilar tumor and converted to radical nephrectomy to achieve negative clinical margins. Additionally, 14.8 % of OPN patients had renal capsule violation as compared to 3.7 % of RPN cases (p = 0.34). Importantly, the mean distance to the proximal margin edge for RPN specimens (2.77 mm) was equivalent to OPN (3.01 mm), p = 0.46., Conclusion: When matched for nephrometry score, tumor size, gender and age, RPN produces similar pathological outcomes to OPN.

Purpose: We studied the role of the R.E.N.A.L. nephrometry score (NS) in predicting surgical outcomes in a series of robot-assisted partial nephrectomy (RAPN)., Patients and Methods: Of 99 cases of minimally invasive partial nephrectomy performed by a single surgeon from 2003 to 2011, 83 were performed with robotic assistance. A trained physician investigator applied the NS to these 83 cases using the preoperative CT scans. Forty-two of these were reviewed by a urology resident to eliminate interobserver variation. Tumors were categorized into noncomplex (NS 4-6) or complex (NS 7-12) tumors, and perioperative outcomes were compared. Outcomes were also compared by each component of the NS. Perioperative outcomes were analyzed using chi-square tests and Mann-Whitney/Kruskal-Wallis tests. Univariate regression was used to analyze trends between nephrometry and outcomes., Results: Strong correlation was found between the two sets of NS (Spearman correlational coefficient 0.814, P<0.001). Comparing between noncomplex and complex tumors, statistical differences were found in operative time (181 min vs 215 min, P=0.028) and ischemia time (21 min vs 24 min, P=0.006). Complication rates, blood loss, conversion rate, and decrease in glomerular filtration rate were similar in both groups. On univariate regression analysis, only warm ischemia time showed a significant trend with the overall NS (P=0.007) and the location score (P=0.031)., Conclusions: A high NS was not associated with clinically worse outcomes during RAPN. Such renal tumors can still be excised safely with robotic assistance without adverse long-term effects.

Nitrosomonas sp. Is79 is a chemolithoautotrophic ammonia-oxidizing bacterium that belongs to the family Nitrosomonadaceae within the phylum Proteobacteria. Ammonia oxidation is the first step of nitrification, an important process in the global nitrogen cycle ultimately resulting in the production of nitrate. Nitrosomonas sp. Is79 is an ammonia oxidizer of high interest because it is adapted to low ammonium and can be found in freshwater environments around the world. The 3,783,444-bp chromosome with a total of 3,553 protein coding genes and 44 RNA genes was sequenced by the DOE-Joint Genome Institute Program CSP 2006.

Purpose: While laparoscopic donor nephrectomy has encouraged living kidney donation, debate exists about the safest laparoscopic technique. We compared purely laparoscopic and hand assisted laparoscopic donor nephrectomies in terms of donor outcome, early graft function and long-term graft outcome., Materials and Methods: We reviewed the records of consecutive laparoscopic and hand assisted laparoscopic donor nephrectomies performed by a single surgeon from 2002 to 2011. Donor operative time and perioperative morbidity were compared. Early graft function for kidneys procured by each technique was evaluated by rates of delayed graft function, need for dialysis and recipient discharge creatinine. Long-term outcomes were evaluated by graft function., Results: A total of 152 laparoscopic donor nephrectomies were compared with 116 hand assisted laparoscopic donor nephrectomies. Hand assisted procedures were more often done for the right kidney (41.1% vs 17.1%, p <0.001) and in older donors (age 41.4 vs 37.5 years, p = 0.011). Warm ischemia time was shorter for hand assisted than for purely laparoscopic nephrectomy (120 seconds, IQR 50 vs 145, IQR 64, p <0.001). Median operative time was slightly shorter for the hand assisted than for the purely laparoscopic procedure (155 vs 165 minutes, p = 0.038). In each group 2 intraoperative complications required intervention (open conversion in 1 case each). Postoperatively complications developed after 5 purely laparoscopic and 5 hand assisted operations (1 Clavien 3b in each). Median length of stay was 2 days for each surgery. Postoperatively recipient outcomes were also similar. Delayed function occurred after 0% hand assisted vs 0.9% purely laparoscopic nephrectomies, dialysis was required in 0.9% vs 1.7% and rejection episodes developed in 9.7% vs 18.4% (p >0.05). At last followup the organ was nonfunctioning in 6.1% of hand assisted and 7.7% of purely laparoscopic cases (p >0.05). The recipient glomerular filtration rate at discharge home was similar in the 2 groups., Conclusions: Hand assisted laparoscopic donor nephrectomy had shorter warm ischemia time but perioperative donor morbidity and graft outcome were comparable. The choice of technique should be based on patient and surgeon preference., (Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Agaricus bisporus is the model fungus for the adaptation, persistence, and growth in the humic-rich leaf-litter environment. Aside from its ecological role, A. bisporus has been an important component of the human diet for over 200 y and worldwide cultivation of the "button mushroom" forms a multibillion dollar industry. We present two A. bisporus genomes, their gene repertoires and transcript profiles on compost and during mushroom formation. The genomes encode a full repertoire of polysaccharide-degrading enzymes similar to that of wood-decayers. Comparative transcriptomics of mycelium grown on defined medium, casing-soil, and compost revealed genes encoding enzymes involved in xylan, cellulose, pectin, and protein degradation are more highly expressed in compost. The striking expansion of heme-thiolate peroxidases and β-etherases is distinctive from Agaricomycotina wood-decayers and suggests a broad attack on decaying lignin and related metabolites found in humic acid-rich environment. Similarly, up-regulation of these genes together with a lignolytic manganese peroxidase, multiple copper radical oxidases, and cytochrome P450s is consistent with challenges posed by complex humic-rich substrates. The gene repertoire and expression of hydrolytic enzymes in A. bisporus is substantially different from the taxonomically related ectomycorrhizal symbiont Laccaria bicolor. A common promoter motif was also identified in genes very highly expressed in humic-rich substrates. These observations reveal genetic and enzymatic mechanisms governing adaptation to the humic-rich ecological niche formed during plant degradation, further defining the critical role such fungi contribute to soil structure and carbon sequestration in terrestrial ecosystems. Genome sequence will expedite mushroom breeding for improved agronomic characteristics.

Introduction: Comparison of treatments for partial nephrectomy is limited by case selection. We compared robotic (RPN), laparoscopic (LPN), and open partial nephrectomy (OPN), controlling for tumor size, patient age, sex, and nephrometry score., Methods: RPN, LPN, and OPN procedures between March 2003 and March 2010 were reviewed. All RPN and LPN were included, and 2 OPN were matched for each RPN in tumor size (±0.5cm), patient age (±10 y), sex, and nephrometry score. Perioperative outcomes were compared., Results: Ninety-six partial nephrectomy procedures were reviewed: 27 RPN, 15 LPN, and 54 OPN. RPN, LPN, and OPN had similar median tumor size (2.4, 2.2, and 2.3cm, respectively), nephrometry score (6.0 each), and preoperative glomerular filtration rate (71.5, 84.6, and 77.0 mL/min/1.73m(2), respectively). Blood loss was higher for OPN (250 mL) than for RPN or LPN (100 mL), P < 0.001. Operative time was shorter in OPN (147 min) than in RPN (190 min) or LPN (195 min), P < .001. Median warm ischemia time was shorter for OPN (12.0 min) than for RPN (25.0 min) or LPN (29.5 min), P Kt; .05. Cold ischemia time for OPN was 25.0 min. A 10% glomerular filtration rate decline occurred in 10 RPN, 5 LPN, and 29 OPN cases (P < .252). Median hospital stay for LPN and RPN was 2.0 d versus 3.0 d for OPN (P < .001). Urine leak occurred in 1 RPN and 3 OPN cases. Postoperative complications occurred in 4 RPN (3 were Clavien grade 2 or less), 1 LPN (grade 1), and 7 OPN (6 were grade 2 or less) cases., Conclusion: Renal function preservation and complications are similar for each treatment modality. OPN offers faster operative and ischemia times at the expense of greater blood loss and hospital stay.

Objective: To assess the effect of aspirin on platelet reactivity in migraineurs., Background: Migraineurs, particularly women with aura and high monthly migraine frequency, are at risk for ischemic stroke and myocardial infarction (MI). High on-aspirin platelet reactivity (HAPR), or aspirin resistance, has been reported in females and patients with coronary artery disease, and is associated with adverse outcomes., Methods: Using a single group, pretest/posttest design, 50 migraineurs without prior history of stroke or MI were prospectively treated for 14 to 21 consecutive days with 325 mg generic enteric-coated aspirin, after undergoing a 14-day aspirin washout. Platelet reactivity was measured after aspirin washout and following aspirin treatment. Subjects were screened for HAPR using the VerifyNow™ Aspirin Assay (Accumetrics, San Diego, CA, USA). HAPR was defined as ≥ 460 Aspirin Reaction Units (ARU; primary endpoint)., Results: Fifty subjects, 44 (88%) female, aged (mean ± standard deviation) 43 ± 12 years were enrolled. Twelve (24%; 95% CI 12-36%) subjects, all female, had HAPR and were classified as aspirin resistant. Subjects with HAPR had lower baseline hemoglobin levels than those without HAPR (P = .03). Baseline hemoglobin was significantly correlated with final ARU (r = -0.39, P = .005)., Conclusions: Findings of this exploratory study suggest that migraineurs have a higher prevalence of HAPR than healthy volunteers or patients with coronary artery disease taking aspirin 325 mg. The clinical implications of HAPR in migraine warrant further exploration due to the risk of stroke and MI and the potential need for antiplatelet therapy in this population., (© 2012 American Headache Society.)

Unlabelled: background and purpose: Laparoendoscopic single-site (LESS) surgery offers potential improvements in cosmesis and recovery over standard laparoscopy (SL). We report the factors with which patients are most concerned in choosing surgery and how these affect preference for LESS. In addition, we rate the satisfaction of scars after laparoscopy., Patients and Methods: Patients followed after a laparoscopic procedure completed two surveys. First, patients rated, on a 5-point Likert scale, the importance of pain, recovery time, cost, treatment success, scars, and complications in choosing surgery. In addition, they were asked their preference for LESS. In the second survey, the impact of scars on body image and cosmesis was assessed., Results: Seventy-nine patients (median age 54.8 years, 65% male and 35% female) were treated for malignancy (53), donation (15), and benign indications (9). Treatment success (4.71 ± 0.81) and complications (4.22 ± 1.16) were most important, followed by pain (3.43 ± 1.21) and convalescence (3.65 ± 1.11), P<0.05. Cost was rated 2.68 ± 1.38, and cosmesis was 2.22 ± 1.13 (P<0.005). Cosmesis score increased in females (2.59 ± 1.08 vs 2.02 ± 1.12), patients <50 years (2.59 ± 1.09 vs 2.02 ± 1.12), and benign surgical indication (3.33 ± 1.12 vs 2.07 ± 1.06), P<0.05. LESS was preferred in 30.4%, SL in 39.2%. Concern for cosmesis was associated with LESS preference (48.5% vs 17.8%, P=0.004). Sex, age, and surgical indication also influenced this. On the body image scale, patients scored a mean 18.8 ± 1.5 of 20. Patients rated scar appearance 8.31 ± 1.80 of 10., Conclusion: Patients who were treated with laparoscopy were most concerned with success and complication. Preference for LESS was influenced by concerns for cosmesis, sex, age, and surgical indication.

Efficient lignin depolymerization is unique to the wood decay basidiomycetes, collectively referred to as white rot fungi. Phanerochaete chrysosporium simultaneously degrades lignin and cellulose, whereas the closely related species, Ceriporiopsis subvermispora, also depolymerizes lignin but may do so with relatively little cellulose degradation. To investigate the basis for selective ligninolysis, we conducted comparative genome analysis of C. subvermispora and P. chrysosporium. Genes encoding manganese peroxidase numbered 13 and five in C. subvermispora and P. chrysosporium, respectively. In addition, the C. subvermispora genome contains at least seven genes predicted to encode laccases, whereas the P. chrysosporium genome contains none. We also observed expansion of the number of C. subvermispora desaturase-encoding genes putatively involved in lipid metabolism. Microarray-based transcriptome analysis showed substantial up-regulation of several desaturase and MnP genes in wood-containing medium. MS identified MnP proteins in C. subvermispora culture filtrates, but none in P. chrysosporium cultures. These results support the importance of MnP and a lignin degradation mechanism whereby cleavage of the dominant nonphenolic structures is mediated by lipid peroxidation products. Two C. subvermispora genes were predicted to encode peroxidases structurally similar to P. chrysosporium lignin peroxidase and, following heterologous expression in Escherichia coli, the enzymes were shown to oxidize high redox potential substrates, but not Mn(2+). Apart from oxidative lignin degradation, we also examined cellulolytic and hemicellulolytic systems in both fungi. In summary, the C. subvermispora genetic inventory and expression patterns exhibit increased oxidoreductase potential and diminished cellulolytic capability relative to P. chrysosporium.

Objectives: To assess annual rates of robotic system malfunctions and compare the da Vinci S(®) system (dVS) and da Vinci(®) surgical system (dV). To assess the types of malfunctions and associated outcomes for robotic cases and determine the extent to which experience and technological improvements impact these., Patients and Methods: This study is a retrospective review of the US Food and Drug Administration (FDA) MAUDE (Manufacturer and User Facility Device Experience) database, a publicly available, voluntary reporting system (http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/search.cfm). The database was searched using the two phrases 'da Vinci' and 'Intuitive Surgical' from 2003 to 2009. Malfunctions of the instruments, console, patient-side cart, camera and cannula were recorded. Data on intraoperative injuries, case delays and conversions were also collected., Results: In all, 1914 reports were reviewed (991 dVS and 878 dV, 45 unclassified) with peak years for reports of 2008 for dVS (571) and 2007 for dV (211), P < 0.001. With respect to time, the proportion of console and patient-side cart malfunctions declined from 2007 onward compared with the proportions prior to 2007 (5.1% vs 9.4% and 6.6% vs 10.9%). Patient injury did not change with year of surgery (0.5-5.4% of malfunctions, P= 0.358), open conversions declined (21.3% of malfunctions before 2007 vs 9.9% from 2007 onward, P < 0.001) and patient deaths increased (0.0013% of cases before 2007 vs 0.0061% of cases from 2007 onward, P < 0.001). With regard to robotic system, console and patient-side cart malfunctions were more frequent with the dV than the dVS: 82/878 vs 39/991 and 100/878 vs 48/991, P < 0.001. Open conversion was more frequent with dV than dVS (19.3% vs 7.7% of reported malfunctions, P < 0.001), while patient injury was less with dV than dVS (3.5% vs 5.9%, P= 0.021)., Conclusions: The dVS decreased console and patient-side cart errors relative to total malfunctions, which were also influenced by surgical year. Open conversions were reduced by increased robotic experience and newer surgical system. Differences in patient injury may reflect changes in reporting or case complexity., (© 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.)

Background and Purpose: Accurate assessment of upper-tract urothelial carcinoma (UTUC) pathology may guide use of endoscopic vs extirpative therapy. We present a multi-institutional cohort of patients with UTUC who underwent surgical resection to characterize the association of ureteroscopic (URS) biopsy features with final pathology results., Patients and Methods: URS biopsy data were available in 238 patients who underwent surgical resection of UTUC. Biopsies were performed using a brush biopsy kit, mechanical biopsy device, or basket. Stage was classified as a positive brush, nonmuscle-invasive (

Purpose: We compared laparoscopic and robotic pyeloplasty to identify factors associated with procedural efficacy., Materials and Methods: We conducted a retrospective multicenter trial incorporating 865 cases from 15 centers. We collected perioperative data including anatomical and procedural factors. Failure was defined subjectively as pain that was unchanged or worse per medical records after surgery. Radiographic failure was defined as unchanged or worsening drainage on renal scans or worsening hydronephrosis on computerized tomography. Bivariate analyses were performed on all outcomes and multivariate analysis was used to assess factors associated with decreased freedom from secondary procedures., Results: Of the cases 759 (274 laparoscopic pyeloplasties with a mean followup of 15 months and 465 robotic pyeloplasties with a mean followup of 11 months, p <0.001) had sufficient data. Laparoscopic pyeloplasty, previous endopyelotomy and intraoperative crossing vessels were associated with decreased freedom from secondary procedures on bivariate analysis, with a 2-year freedom from secondary procedures of 87% for laparoscopic pyeloplasty vs 95% for robotic pyeloplasty, 81% vs 93% for patients with vs without previous endopyelotomy and 88% vs 95% for patients with vs without intraoperative crossing vessels, respectively. However, on multivariate analysis only previous endopyelotomy (HR 4.35) and intraoperative crossing vessels (HR 2.73) significantly impacted freedom from secondary procedures., Conclusions: Laparoscopic and robotic pyeloplasty are highly effective in treating ureteropelvic junction obstruction. There was no difference in their abilities to render the patient free from secondary procedures on multivariate analysis. Previous endopyelotomy and intraoperative crossing vessels reduced freedom from secondary procedures., (Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Introduction. Predicting the aggressiveness of prostate cancer at biopsy is invaluable in making treatment decisions. In this paper we review the differential expression of genes and microRNAs identified through microarray analysis as potentially useful markers for prostate cancer prognosis and discuss some of the challenges associated with their development. Methods. A review of the literature was conducted through Medline. Articles were identified through searches of the following terms: "prostate cancer AND differential expression", "prostate cancer prognosis", and "prostate cancer AND microRNAs". Results. Though numerous differentially expressed genes and microRNAs were identified as possible prognostic markers, the significance of several of these genes is either debated due to conflicting results or is not validated in other study populations. A few of the articles constructed predictive nomograms using a panel of biomarkers which require further validation. Challenges to the development of useful markers include different methodology, cancer heterogeneity, and sampling error. These can be overcome by categorizing prognostic factors into particular gene pathways or by supplementing biopsy information with blood or urine-based biomarkers. Conclusion. Though biomarkers based on differential expression offer the potential to improve decision making concerning prostate cancer, further validation of their utility and accuracy at the biopsy level is needed.

Currently, little is known about strength and conditioning programs at the high school level. Therefore, the purpose of this research was to explore current practices in strength and conditioning for varsity high school athletes in selected sports. The following were specifically examined: who administers programs for these athletes, what kinds of training activities are done, and whether the responsible party or emphasis changes depending on the gender of the athletes. Coaches of varsity soccer, basketball, softball, and baseball in 3 large Idaho school districts were asked to complete an online survey. Sixty-seven percent (32/48) of the questionnaires were completed and used for the study. The majority of coaches (84%) provided strength and conditioning opportunities for their athletes, although only 37% required participation. Strength training programs were designed and implemented primarily by either physical education teachers or head coaches. Compared with coaches of male athletes, coaches of female athletes were less likely to know the credentials of their strength coaches, and they were less likely to use certified coaches to plan and implement their strength and conditioning programs. Most programs included dynamic warm-ups and cool-downs, plyometrics, agility training, speed training, and conditioning, and most programs were conducted 3 d·wk(-1) (76%) for sessions lasting between 30 and 59 minutes (63%). Compared with their female counterparts, male athletes were more likely to have required training, participate in strength training year round, and train using more sessions per week. This study provides additional information related to the practice of strength and conditioning in a sample of high school athletic teams.

Purpose: We present our experience of training residents in a weekend robotic training program to assess its effectiveness and perceived usefulness., Methods: Bimonthly training sessions were arranged such that residents could sign up for hour-long, weekend training sessions. They are required to complete four training sessions. Five tasks were scored for time and accuracy: Peg-Board, checkerboard, string running, pattern cutting, and suturing. Participants completed surveys (5-point Likert scale) regarding program utility, ease of attendance, and interest in future weekend training sessions., Results: Mean number of trials completed by 19 residents was >4, and 16 completed the trials within an average of 13.7±8.1 mos. Significant improvements (P<0.05) were seen in final trials for Peg-Board accuracy (95.8% vs 79.0%), checkerboard deviation (4.8% vs 18.2%), and time (293 s vs 404 s), pattern-cutting time (257 s vs 399 s), and suture time (203 s vs 305 s). Time to previous session correlated with relative improvement in Peg-Board and pattern-cutting time (r=0.300 and 0.277, P=0.021 and 0.041), but no specific training interval was predictive of improvement. Residents found the course easy to attend (3.6), noted skills improvement (4.1), and found it useful (4.0)., Conclusion: Training in the weekend sessions improved performance of basic tasks on the robot. Training interval had a modest effect on some exercises and may be more important for difficult tasks. This training program is a useful supplement to resident training and would be easy to implement in most programs.

Ultrarunners participate in running events that exceed the 26.2-mile marathon distance (e.g., 50k, 50-100 miles). Very little research exists on ultrarunners, especially women. This study is a descriptive study detailing the motivation, goal orientation, demographic characteristics (e.g., age, job demands, family structure), training habits (e.g., hours per week of training), and coach utilization of women ultrarunners. Participants (N = 344) were recruited via the Ultra List serve and 4 popular ultrarunning websites, and they completed a questionnaire on motivation, goal orientation, training, and coaching using Survey Monkey. General health orientation (mean ± SD) (4.71 ± 1.06) and psychological coping (4.71 ± 1.03) were the 2 strongest motivational factors. Participants were higher in task orientation (1.38 ± 0.68) (e.g., finishing the race or accomplishing various goals) than ego orientation (3.38 ± 1.01) (e.g., placing in the top 3 overall or beating an opponent). Women trained an average of 12.49 h·wk(-1) and spent 64% of their time training alone. Training information came from their own experience, blogs, websites, and the Ultra List Serve. Over three-fourths of the participants (80%) did not use a coach because of cost and a perceived lack of necessity. Women ultrarunners in this study were task oriented, internally motivated, health, and financially conscious individuals. With additional information about women ultrarunners, coaches will be better prepared to work with this population and ultrarunners can improve their performance by learning about current participants' practices.

Objective: • To evaluate the diagnostic accuracy of urine cytology for detecting aggressive disease in a multi-institutional cohort of patients undergoing extirpative surgery for upper-tract urothelial carcinoma (UTUC)., Methods: • We reviewed the records of 326 patients with urinary cytology data who underwent a radical nephroureterectomy or distal ureterectomy without concurrent or previous bladder cancer. • We assessed the association of cytology (positive, negative and atypical) with final pathology. Sensitivity and positive predictive value (PPV) of a positive (± atypical) cytology for high-grade and muscle-invasive UTUC was calculated., Results: • On final pathology, 53% of patients had non-muscle invasive disease (pTa, pTis, pT1) and 47% had invasive disease (≥ pT2). Low-grade and high-grade cancers were present in 33% and 67% of patients, respectively. • Positive, atypical and negative urine cytology was noted in 40%, 40% and 20% of cases. Positive urinary cytology had sensitivity and PPV of 56% and 54% for high-grade and 62% and 44% for muscle-invasive UTUC. • Inclusion of atypical cytology with positive cytology improved the sensitivity and PPV for high-grade (74% and 63%) and muscle-invasive (77% and 45%) UTUC. Restricting analysis to patients with selective ureteral cytologies further improved the diagnostic accuracy when compared with bladder specimens (PPV > 85% for high-grade and muscle-invasive UTUC)., Conclusions: • In this cohort of patients with UTUC treated with radical surgery, urine cytology in isolation lacked performance characteristics to accurately predict muscle-invasive or high-grade disease. • Improved surrogate markers for pathological grade and stage are necessary, particularly when considering endoscopic modalities for UTUC., (© 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.)

Purpose: We examined conversions in laparoscopic renal surgery, evaluating the causes and outcomes., Patients and Methods: A single institution review of all laparoscopic renal surgeries, excluding renal donors, over a nine-year period was performed. Cases were evaluated for intraoperative results, conversions, and complications., Results: 399 laparoscopic renal surgeries were identified (394 available for review) with 41 conversions (31 open, 8 hand-assisted, 2 retroperitoneal). Intraoperative and postoperative complications occurred in 3.0% and 12.2%, respectively. The most common reason for conversion was a lack of progress (20), followed by difficult anatomy (8), tumor thrombus (5), and bleeding (4). Open conversion rates for hand-assisted laparoscopic (HAL), transperitoneal laparoscopic, retroperitoneal laparoscopic (RPL), and robot-assisted were 17.1%, 6.9%, 13.2%, and 1.8%, respectively, although HAL and RPL were more often used for bilateral procedures, previous abdominal surgery, and large specimens (P<0.05). Surgical indication significantly impacted perioperative outcome, where autosomal dominant polycystic kidney disease and partial nephrectomy were associated with the highest rate of open conversion (13%), while nephroureterectomy had the highest rate of complications (40%). Cases in which there were large specimens weighing over 1500 g were converted in 40% of cases vs 8.2% for smaller specimens, P<0.001. Previous abdominal surgery did not impact conversion rate (11.9% without vs 9.3% with previous surgery, P=0.401). Cases that were converted had a significantly higher blood loss, operative time, transfusion rate, hospital stay, and complication rate (P<0.05)., Conclusions: Rate of conversion to an open procedure is significantly impacted by surgical indication, specimen size, and surgical technique. Any conversion is associated with an increased perioperative morbidity.

Rust fungi are some of the most devastating pathogens of crop plants. They are obligate biotrophs, which extract nutrients only from living plant tissues and cannot grow apart from their hosts. Their lifestyle has slowed the dissection of molecular mechanisms underlying host invasion and avoidance or suppression of plant innate immunity. We sequenced the 101-Mb genome of Melampsora larici-populina, the causal agent of poplar leaf rust, and the 89-Mb genome of Puccinia graminis f. sp. tritici, the causal agent of wheat and barley stem rust. We then compared the 16,399 predicted proteins of M. larici-populina with the 17,773 predicted proteins of P. graminis f. sp tritici. Genomic features related to their obligate biotrophic lifestyle include expanded lineage-specific gene families, a large repertoire of effector-like small secreted proteins, impaired nitrogen and sulfur assimilation pathways, and expanded families of amino acid and oligopeptide membrane transporters. The dramatic up-regulation of transcripts coding for small secreted proteins, secreted hydrolytic enzymes, and transporters in planta suggests that they play a role in host infection and nutrient acquisition. Some of these genomic hallmarks are mirrored in the genomes of other microbial eukaryotes that have independently evolved to infect plants, indicating convergent adaptation to a biotrophic existence inside plant cells.

We describe the draft genome of the microcrustacean Daphnia pulex, which is only 200 megabases and contains at least 30,907 genes. The high gene count is a consequence of an elevated rate of gene duplication resulting in tandem gene clusters. More than a third of Daphnia's genes have no detectable homologs in any other available proteome, and the most amplified gene families are specific to the Daphnia lineage. The coexpansion of gene families interacting within metabolic pathways suggests that the maintenance of duplicated genes is not random, and the analysis of gene expression under different environmental conditions reveals that numerous paralogs acquire divergent expression patterns soon after duplication. Daphnia-specific genes, including many additional loci within sequenced regions that are otherwise devoid of annotations, are the most responsive genes to ecological challenges.

Minimally invasive pyeloplasty has achieved success that has approached open pyeloplasty. Key principles such as removal of fibrosis, extensive mobilization of the ureteropelvic junction and crossing vessels, and creation of a tension-free, widely spatulated anastamosis are important in successful repair. In this review, we discuss the preparation and operative steps in performing a robotic pyeloplasty. Patient selection and diagnostic approach is discussed in the preoperative setting. Important surgical steps described include port placement, management of crossing vessels, division and spatulation of the ureter, and reanastamosis. Finally, management of more difficult cases is discussed.

Objectives: Hydronephrosis at the time of diagnosis of bladder cancer is associated with advanced disease and is a predictor of poorer outcomes. There is, however, limited information addressing whether a similar relationship exists for upper-tract urothelial carcinoma (UTUC). We investigate the prognostic impact of hydronephrosis on preoperative axial imaging on clinical outcomes after radical nephroureterectomy., Materials and Methods: The records for 106 patients with UTUC who underwent radical nephroureterectomy at 2 medical centers were reviewed. Preoperative computed tomography (CT) images were evaluated for ipsilateral hydronephrosis by radiologists blinded to clinical outcomes. Association of hydronephrosis with pathologic features and oncologic outcomes after surgery was assessed., Results: Sixty-seven men and 39 women with a median age of 69 years (range, 36 to 90) were evaluated. One-third of these patients had muscle invasive disease or greater (≥T2), 44% had high grade tumors, and 3% had lymph node (LN) metastases. At a median follow-up of 47 months (range, 1 to 164), 43% of patients experienced disease recurrence, 18% developed metastasis, and 12% died of their cancer. Thirty-nine patients (37%) had hydronephrosis on preoperative axial imaging; 35% of these patients had ureteral tumors, and 27% had multifocal disease. The presence of hydronephrosis was associated with advanced pathologic stage (P = 0.03) and disease in the ureter (vs. renal pelvis) (P = 0.007). Hydronephrosis was a predictor of non-organ confined disease on final pathology (hazard ratio [HR] 3.7, P = 0.01). On preoperative multivariable analysis controlling for age, gender, tumor location, ureteroscopic biopsy grade, and urinary cytology, hydronephrosis was independently associated with cancer metastasis (HR 8.2, P = 0.02) and cancer-specific death (HR 12.1, P = 0.03)., Conclusions: Preoperative hydronephrosis on axial imaging is associated with features of aggressive disease and predicts advanced pathologic stage for UTUC. Hydronephrosis can be a valuable prognostic tool for preoperative planning and counseling regarding disease outcomes., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Purpose: In patients with autosomal dominant polycystic kidney disease we compared the outcome of bilateral laparoscopic nephrectomy at a single operation vs staged nephrectomy, including 1 during transplantation and the other via laparoscopic unilateral nephrectomy., Materials and Methods: We reviewed the records of patients with autosomal dominant polycystic kidney disease requiring renal transplantation and native bilateral nephrectomy. We compared transplantation with ipsilateral nephrectomy to transplantation alone and then compared unilateral to bilateral laparoscopic native nephrectomy. Indications included pain, infection, bleeding and compressive symptoms., Results: We followed 42 patients, including 16 with transplantation and nephrectomy, 22 with transplantation alone and 4 awaiting transplantation. In those with transplantation vs transplantation with nephrectomy there were no differences in median age (48.3 vs 53.3 years, p = 0.178) or greatest kidney length (19.5 vs 20.9 cm, p = 0.262). Operative time (208 vs 236 minutes, p = 0.104), estimated blood loss (200 vs 250 ml, p = 0.625), hospital discharge creatinine (1.60 vs 1.50 mg/dl, p = 0.491) and complications were similar. We separately compared 24 bilateral and 18 unilateral laparoscopic native nephrectomies, and noted similarities in median age (52.0 vs 56.3 years, p = 0.281) and kidney length (19.5 vs 19.8 cm, p = 0.752). Bilateral nephrectomy showed greater estimated blood loss (125 vs 50 ml, p = 0.001) and operative time (302.8 vs 170.2 minutes, p <0.001). There were 4 open conversions, 9 perioperative complications at bilateral surgery and 1 complication after unilateral surgery. Median followup in the unilateral and bilateral groups was 13.3 vs 35.9 months (p = 0.015)., Conclusions: Renal transplantation and ipsilateral native nephrectomy carry no significant additional morbidity compared to that of renal transplantation alone. Staged unilateral laparoscopic nephrectomy was superior to the bilateral procedure in perioperative outcome., (Copyright © 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Objective: To compare the initial perioperative outcomes of our robot-assisted laparoscopic nephrectomies with laparoscopic and hand-assisted nephrectomies performed by 2 experienced laparoscopic surgeons., Patients and Methods: We retrospectively evaluated all patients who underwent laparoscopic (LN), hand-assisted (HALN), and robot-assisted laparoscopic nephrectomy (RALN) for benign and malignant diseases between August 2006 and December 2008. Data collected included patient age, body mass index, operative times, estimated blood loss, complications, and hospital stay. Radical nephrectomy was performed for renal neoplasms, and simple nephrectomy was performed for suspected benign diseases. In addition, average direct costs and total costs were calculated for each laparoscopic approach., Results: Forty-six patients underwent LN, 20 underwent HALN, and 13 underwent RALN. The median operative time was 171, 210, and 168 minutes, respectively. LN, HALN, and RALN groups had similar median EBL [(100 mL (IQR=113 mL), 100mL (IQR=150 mL), and 100mL (IQR=125 mL); P=0.695], length of hospital stay [2.0d (IQR=1.0d), 3.0d (IQR=2.0d), and 2.0d (IQR=3.0d); P=0.233], and postoperative morphine equivalent analgesic requirements [33 mg (IQR=43 mg), 45 mg (IQR=50 mg), and 30 mg (IQR=16 mg); P=0.766]. Three patients (6%) in the LN group had complications, 2 (10%) in the HALN group had complications, and 4 (30%) in the RALN group had complications. The average total direct operating room costs were $5,500, $6,979, and $6,869 for the LN, HALN, and RALN groups, respectively., Conclusions: Early experience with robotic assistance for radical and simple nephrectomy offers no significant advantage over traditional laparoscopic or hand-assisted approaches. It was also more costly.

Purpose: We evaluated the value of hydronephrosis, ureteroscopic biopsy grade and urinary cytology to predict advanced upper tract urothelial carcinoma., Materials and Methods: We reviewed the charts of 469 patients with upper tract urothelial carcinoma treated with radical nephroureterectomy or distal ureterectomy. Complete data on hydronephrosis (present vs absent), ureteroscopic grade (high vs low) and urinary cytology (positive vs negative) were available in 172 patients. The outcome was muscle invasive (pT2-pT4) or nonorgan confined (pT3 or greater, or lymph node metastasis) upper tract urothelial carcinoma., Results: Of the patients 92 (54%) had hydronephrosis, 74 (43%) had high grade disease on ureteroscopic biopsy and 137 (80%) had positive cytology. On univariate analysis hydronephrosis (p <0.001), high ureteroscopic grade (p <0.001) and positive cytology (p = 0.03) were associated with muscle invasive and nonorgan confined disease. On multivariate analysis adjusting for tumor site, gender and age hydronephrosis and high ureteroscopic grade were associated with muscle invasive carcinoma (HR 12.0 and 4.5, respectively, each p <0.001) but cytology was not (HR 2.3, p = 0.17). However, all 3 variables were independently associated with nonorgan confined disease (HR 5.1, p <0.001; HR 3.9, p <0.001; and HR 3.1, p = 0.035, respectively). Combining these 3 tests incrementally improved the prediction of upper tract urothelial carcinoma stage. Abnormality of all 3 tests had 89% and 73% positive predictive value for muscle invasive and nonorgan confined upper tract urothelial carcinoma, respectively, but when all tests were normal, the negative predictive value was 100%., Conclusions: Preoperative evaluation for hydronephrosis, ureteroscopic grade and cytology can identify patients at risk for advanced upper tract urothelial carcinoma. Such knowledge may impact surgery choice and extent as well as the need for perioperative chemotherapy regimens., (Copyright (c) 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Historically, renal cancer has been treated with radical nephrectomy. Consequently, many patients developed renal insufficiency and the health problems associated with this. With the increasing diagnosis of small renal masses, nephron-sparing treatments have been developed to treat these masses adequately, while maximizing renal function. Focal ablative therapy is a means to treat small renal masses in a minimally invasive manner. Yet, there are few studies that have focused on their ability to preserve renal function. In this article, we review the existing literature on the renal function outcomes of patients treated with either radio frequency ablation or cryoablation.

The western clawed frog Xenopus tropicalis is an important model for vertebrate development that combines experimental advantages of the African clawed frog Xenopus laevis with more tractable genetics. Here we present a draft genome sequence assembly of X. tropicalis. This genome encodes more than 20,000 protein-coding genes, including orthologs of at least 1700 human disease genes. Over 1 million expressed sequence tags validated the annotation. More than one-third of the genome consists of transposable elements, with unusually prevalent DNA transposons. Like that of other tetrapods, the genome of X. tropicalis contains gene deserts enriched for conserved noncoding elements. The genome exhibits substantial shared synteny with human and chicken over major parts of large chromosomes, broken by lineage-specific chromosome fusions and fissions, mainly in the mammalian lineage.