Diagnosis and Treatment of Early-Stage Testicular Cancer: AUA Guideline Amendment 2023

PURPOSE

The purpose of this American Urological Association (AUA) guideline amendment is to provide a useful reference on the effective evidence-based treatment strategies for early-stage testicular cancer.

METHODOLOGY/METHODS

The original methodology protocol included searches of PubMed®, Embase®, and the Cochrane Central Register of Controlled Trials (CENTRAL) from January 1980 through August 2018. The search strategy used medical subject heading (MeSH) terms and key words relevant to the diagnosis and treatment of early-stage testicular cancer. The searches conducted for the update presented herein utilized the same methodological protocol to capture literature published through March 2023. When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions.

RESULTS

Updates were made to statements on imaging, seminoma management, non-seminoma management, surveillance for stage I testicular cancer, and additional survivorship. Further revisions were made to the methodology and reference sections as appropriate.

CONCLUSIONS

This guideline seeks to improve clinicians' ability to evaluate and treat patients with early-stage testicular cancer based on currently available evidence. Future studies will be essential to further support or refine these statements to improve patient care.

Ocular Cicatricial Pemphigoid With IgM-Positive Biopsy

PURPOSE

The aim of this study was to investigate the prevalence of IgM along the basement membrane zone (BMZ) of patients with ocular cicatricial pemphigoid (OCP) and the outcomes of these patients with immunomodulatory therapy.

METHODS

This study is a retrospective chart review of patients with conjunctival biopsy-proven OCP. Clinical data, including the presence of linear IgM deposition along the BMZ on either direct immunofluorescence or avidin-biotin complex immunohistochemistry, were recorded. Response to IMT was also recorded.

RESULTS

A total of 817 patients with documented conjunctival biopsies were identified, with 93 (11.4%) positive for OCP with linear IgM deposition along the BMZ. Forty-six patients with sufficient follow-up were evaluated for clinical outcomes, with 35 (76.1%) able to achieve durable remission an average of 24.3 months after initiation of IMT. Most of these patients, 82.9%, were able to achieve durable remission with first-line antimetabolite therapy. Three patients were identified with solely IgM-positive conjunctival biopsies.

CONCLUSIONS

Our study suggests that IgM positivity is seen in a minority of patients with OCP and that outcomes are comparable for these patients to the general OCP patient population.

Substance use and victimization experiences among college students in Spain

OBJECTIVE

We examined relationships between different types and patterns of substance use and victimization experiences.

PARTICIPANTS

College students from two universities in Spain completed an online, cross-sectional survey.

METHOD

A series of tetrachoric correlations were estimated to examine the bivariate associations between different types of substances and victimization experiences. Regression analyses then examined relationships between patterns of substance use (non-users, mono-users, and poly-users), and victimization.

RESULTS

Slightly over half (57.7%) of students reported any form of victimization during the previous year, and most students (87.0%) reported using substances during the last three months. Polysubstance users were more likely than non-users to experience any victimization, as well as multiple forms of victimization.

CONCLUSIONS

Findings highlight the importance of differentiating types and patterns of substance use when developing prevention and intervention programs. Implementing intervention strategies that target polysubstance users and decrease substance use could reduce rates of victimization among college students.

A peculiar case of aqueous misdirection from a pseudophakic secluded pupil in a patient with chronic angle closure glaucoma

Purpose

To explore the course of a pseudophakic and pseudoiridic 61-year-old man with a history of open angle glaucoma in his right eye who developed a sub-totally secluded pupil then later presented with angle closure, a significant pressure spike, and a marked myopic refractive shift, consistent with aqueous misdirection.

Observations

Goniosynechialysis, surgical removal of much of the native peripheral iris, and zonulohyaloidectomy led to a return to his prior refraction and improve intraocular pressure (IOP) control.

Conclusions and Importance

This case demonstrates that a diagnosis of aqueous misdirection should not be disregarded in the presence of a prior vitrectomy and that aqueous misdirection should be strongly considered in cases of elevated IOP with a patent peripheral iridotomy, myopic shift and angle narrowing.

How Engineers and Roadside Vegetation Managers Maintain Roadside Vegetation in Iowa, USA

Recently the value of roadside vegetation as habitat for pollinators has gained increased attention, particularly in areas dominated by agriculture where there is little native vegetation available. However, many factors, including safety, cost, public perception, erosion control, and weedy plants must be considered when managing roadside vegetation. Although their decisions influence thousands of hectares of public rights-of-way, how engineers and roadside managers maintain roadside vegetation has been the subject of little research. In this study, we surveyed county engineers and roadside managers who manage vegetation along secondary roads in Iowa, USA to assess how they maintain roadside vegetation. Some counties employ roadside managers, who often have an environmental sciences background, to implement the on-the-ground management of roadside vegetation, while some counties use other staff. Compared to engineers, roadside managers more strongly agreed that using the ecological principles of integrated roadside vegetation management (IRVM) provided environmental benefits. Engineers in counties with a roadside manager more strongly agreed that IRVM practices reduce the spread of invasive species and provide attractive roadsides. Both engineers and roadside managers mentioned challenges to managing roadside vegetation, including interference with some native plantings by adjacent landowners, and ranked safety and soil erosion concerns as the highest priorities when making decisions. Four in ten roadside managers said their counties had protected native plant community remnants on secondary roadsides. Our findings can inform conservation outreach efforts to those responsible for managing roadside vegetation, and emphasize the importance of addressing safety and soil erosion concerns in roadside research and communications.

Validation of the virtual measurement of the Essential Frailty Toolset

Funding Acknowledgements

Type of funding sources: None.

Background

The Essential Frailty Toolset (EFT) is a valid measurement of frailty in people with heart valve disease. COVID-19 has prompted the transition to virtual health consultations and necessitates the validation of the virtual assessment of frailty.

Methods

We conducted a prospective observational cohort study to compare the measurement of EFT in person and virtual format within a maximum 2-week window of repeated measurement. The weighted Kappa tests was used to measure the agreement of EFT scores between assessments; we explored the effect of the sequence of measurement using the Cochran-Mantel-Haenszel statistic to test the general association between the timing of measurement and differences of EFT score.

Results

We recruited a sample of 49 patients, with a mean age of 81 ± 7 years, including 29 men (59.2%); the primary valvular heart diseases were aortic stenosis (n=40, 81.6%), mitral regurgitation (n=2, 4.1%) and tricuspid regurgitation (n=7, 14.3%). The virtual measurement of frailty was conducted using a standardised protocol. The platform for virtual connection selected by patients was FaceTime (n=20, 40.8%) and Zoom (n=29, 59.2%); the median (IQR) number of days between the in-person and the virtual assessment was 5 (3,10). The weighted Kappa estimate was 0.69 (95% CI 0.55, 0.82), illustrating a strong agreement between the separate scores obtained. The test for the general association was non-significant (p=0.82), indicating a lack of evidence for detecting an association between EFT scores and chronological order of assessment.

Conclusion

The EFT can be reliably measured virtual in older patients with valvular heart disease to inform clinical care.

Implementation of nurse-led early mobilisation after transcatheter aortic valve implantation: Identification of barriers to standardised practice

Funding Acknowledgements

Type of funding sources: None.

Background

We examined the barriers of early nurse-led mobilisation after transcatheter aortic valve implantation (TAVI) to support safe next-day discharge home.

Methods

We conducted a prospective observational cohort study of patients treated in 2019-2021 using a standardised post-procedure nursing care standard to promote mobilisation in 4 to 6 hours after TAVI. Results are presented as mean (standard deviation) for continuous variables and as number (percentage) for categorical data; student t test was used to compare continuous variables and χ2 and Fisher exact tests were used to compare categorical variables. All analyses were performed in SAS version 9.4 (SAS Institute).

Results

The cohort included a convenience sample of 139 patients (64 women, 46%) mean age 82.5±6.7 years, NYHA III/IV 72 (51.8%), prior pacemaker 18 (13%), and prior SAVR 11 (7.9%). Patients were treated under local anaesthesia only (n=29, 20.9%) or conscious sedation (n=106, 76.3%) with a balloon expandable device (n=134, 96.4%) in a cardiac catheterisation laboratory (n=111, 79.9%) or hybrid operating room (n=28, 25.2%), and early recovery in cardiac telemetry (n=101, 72.7%) or critical care unit (n=38, 27.3%). Early mobilisation was achieved in 113 patients (81.3%: 4 hours: n=100, 71.9%, 4-6 hours: n=13, 9.4%); there were no significant (p≤0.05) differences in baseline characteristics between patients with early vs. late mobilisation; the primary reasons for delayed mobilisation included monitoring and/or managing cardiac conduction issues (n=6), vascular access hemostasis (n=6) and neurological status (n=4), patient preference or other self-reported issue (n=5) and nursing workload (n=5). In patients who achieved early mobilisation, 81.4% were discharge on post-operative day 1 and 86.3% by day 2, with 99.1% returning directly home. There was no significant difference in 30-day readmission between the two groups.

Conclusions

Early nurse-led protocol-driven mobilisation is safe and effective to facilitate rapid reconditioning and safe transition home after uncomplicated TAVI. Research is needed to better understand patient and systems-level enablers to improve standardisation of practice.

Human-Centered Intelligent Training for Emergency Responders

Emergency response (ER) workers perform extremely demanding physical and cognitive tasks that can result in serious injuries and loss of life. Human augmentation technologies have the potential to enhance physical and cognitive work-capacities, thereby dramatically transforming the landscape of ER work, reducing injury risk, improving ER, as well as helping attract and retain skilled ER workers. This opportunity has been significantly hindered by the lack of high-quality training for ER workers that effectively integrates innovative and intelligent augmentation solutions. Hence, new ER learning environments are needed that are adaptive, affordable, accessible, and continually available for reskilling the ER workforce as technological capabilities continue to improve. This article presents the research considerations in the design and integration of use-inspired exoskeletons and augmented reality technologies in ER processes and the identification of unique cognitive and motor learning needs of each of these technologies in context-independent and ER-relevant scenarios. We propose a human-centered artificial intelligence (AI) enabled training framework for these technologies in ER. Finally, how these human-centered training requirements for nascent technologies are integrated in an intelligent tutoring system that delivers across tiered access levels, covering the range of virtual, to mixed, to physical reality environments, is discussed.

Local Decision-makers' Perspectives on Roadside Revegetation and Management in Iowa, USA

Environmental practitioners must understand those they collaborate with to implement programs that are both socially and ecologically effective. Practitioners who understand decision-makers' perspectives are better able to collaborate to lower political, financial, and cultural obstacles. In this study, we surveyed decision-makers involved with a voluntary environmental program in Iowa, USA. Iowa counties can choose to manage their roadside vegetation using an ecological approach, called integrated roadside vegetation management. Key decision-makers who decide whether a county has a roadside program are the county board of supervisors and the county conservation board. We used a mixed-mode design to survey the conservation board directors and chairs of the board of supervisors in each county. Our main goals were to understand the decision-makers' perceived benefits and barriers to having a roadside program in their counties, as well as the key factors influencing their decisions about roadside vegetation management. Safety, maintenance cost savings, and erosion control were the main factors that influenced decision-making, while pollinators and other wildlife received the least consideration. However, decision-makers in counties with a roadside vegetation manager were more influenced by pollinators and other wildlife compared to their counterparts in counties without a roadside vegetation manager. The main barriers to having a program include a lack of resources or other concerns being a higher priority. Emphasizing safety, cost savings, and erosion control benefits of roadside programs, and identifying ways to lower startup costs may increase buy-in with county decision-makers.

Victimization Status of Female and Male College Students in Spain: Prevalence and Relation to Mental Distress

Despite the growing body of research concerning victimization and mental health among college populations around the world, there remains a need for additional studies that emphasize the role that victimization has on mental health. This study builds on previous research by analyzing the relationship between mental distress and victimization status in Spanish college students (n = 828, 490 women and 338 men). Using online surveys, we examined the prevalence rates of seven types of victimization (threats, insults, online slander, theft, physical abuse, sexual harassment, and sexual abuse) and three mental health disorders (stress, anxiety, and depression, as measured by the DASS-21 [Depression Anxiety Stress Scale-21]) among students at two universities in southeastern Spain. According to their victimization experiences during the 12 months prior to the interviews, participants were classified into three victimization status groups: nonvictims (42.3%), single-type victims (23.3%), and polyvictims (34.4%). Except for threat and physical abuse, women reported significantly higher rates than men for each type of victimization and were classified more often as polyvictims. MANCOVA showed significant associations between polyvictimization and all three indicators of mental distress after controlling for sex. Interestingly, there were no differences between single-type victims and nonvictims in their self-reported levels of anxiety, stress, and depression. Female students reported a higher prevalence of severe and extremely severe levels of anxiety and stress than did their male counterparts. This study highlights the fact that a nontrivial proportion of college students experience mental distress, reinforces the existing link between polyvictimization and mental health disorders, and stresses the importance of violence awareness and prevention activities targeting this population.

Treatment of Noninfectious Retinal Vasculitis Using Subcutaneous Repository Corticotropin Injection

Purpose

To show whether subcutaneous repository corticotropin injection (RCI, Acthar® Gel, a repository corticotropin injection, can be an effective potential therapeutic agent for noninfectious retinal vasculitis.

Methods

Patients with active retinal vasculitis were followed with serial ultra-wide-field fluorescein angiograms and treated with 80 units of subcutaneous repository corticotropin injection twice weekly.

Results

Primary outcome of ≥50% improvement in response level (RL) for retinal vasculitis and percent improvement in retinal vasculitis severity scoring (RVSS) by more than one quartile (≥25%) at week 12 was met in 15 and 16 of the 30 total eyes, respectively, including 1 eye with severe retinal vasculitis in each group. Complete resolution of retinal vasculitis was seen in seven eyes with a mean time of 17.1 weeks. Intraocular pressure elevation requiring therapy and cataract progression were noted in two and three eyes, respectively. One patient stopped medication due to side effects (injection site reaction).

Conclusion

Repository corticotropin injection was well-tolerated overall. Repository corticotropin injection may be an effective therapeutic agent in the treatment of noninfectious retinal vasculitis.

CRYOPYRIN-ASSOCIATED PERIODIC SYNDROME-ASSOCIATED UVEITIS AND PAPILLITIS

PURPOSE

To report a case of uveitis and papillitis in a patient with cryopyrin-associated periodic syndrome.

METHODS

Case report. A 44-year-old white woman with a long history of inflammatory arthritis, diffuse erythematous rashes and hives, and hearing loss was referred to the Massachusetts Eye Research and Surgery Institution for an evaluation of chronic ocular inflammation. She was diagnosed with bilateral papillitis and uveitis after a comprehensive eye examination, which included dilated fundoscopy, optic nerve ocular coherence tomography, fluorescein angiography, indocyanine green angiography, and B-scan ultrasonography. She was later diagnosed with cryopyrin-associated periodic syndrome, an interleukin-1-driven autoimmune disease, as confirmed by genetic testing. Soon after starting treatment with anakinra, a human interleukin-1 receptor antagonist, she experienced rapid improvement of her ocular and systemic symptoms, including rash, uveitis, and arthritis.

RESULTS

Cryopyrin-associated periodic syndrome-associated ocular inflammation in remission with anakinra 100-mg daily subcutaneous injection.

CONCLUSION

Anakinra is a very effective treatment for both cryopyrin-associated periodic syndrome and cryopyrin-associated periodic syndrome-associated ocular inflammation.

Substance Use, Family Functionality, and Mental Health among College Students in Spain

Mental health symptoms are overrepresented among college students worldwide. The current research investigates the associations among substance use, family functionality, and mental health (depression, anxiety, and stress) among college students in Spain. A total of 828 (59.2% female and 40.8% male) college students from two public universities completed a self-reported online survey that included items on demographic information, substance use (alcohol, tobacco, cannabis, cocaine, prescription sedatives, and recreational sedatives), mental health symptoms (using the DASS-21 questionnaire) and family functionality (using the APGAR questionnaire). College students reporting substance use (especially recreational sedatives) and family dysfunctionality were more likely to exhibit symptoms of depression, anxiety and stress. These findings provide support for the underlying role of substance use and family functionality on mental health symptoms. Treatments targeting depression, anxiety, and stress among college students in Spain should aim to reduce substance use by and increase family support of students.

Identifying opportunities for health promotion and intervention in the ED

BACKGROUND

ED staff assess patients with modifiable risk factors for acute and chronic illness. Health promotion interventions delivered in the ED have been advocated for these patients. The engagement of staff is essential to provide effective screening and brief interventions for patients. This survey aimed to assess if staff support the ED as an environment for health promotion.

METHODS

A multicentre, structured survey was conducted in four EDs in Scotland from 2017 to 2018. Physician and nursing staff at two teaching and two district general hospitals (n=423) were study eligible and offered a multicomponent survey. Outcomes measured included perceived barriers to practice and risk factor specific ED interventions.

RESULTS

Of the 283 respondents, 116 (41%) were physicians and 167 (59%) were nurses. More physicians (86.1%) than nurses (49.7%) reported offering health promotion interventions. Time constraints and a lack of health promotion infrastructure in the ED were cited as challenges to intervention delivery. Staff believed that alcohol (n=170/283, 60.1%) and drug misuse (n=173/283, 61.1%) were more appropriately managed in the ED than primary care. ED staff believed same day brief interventions were more appropriate when alcohol/drug misuse and smoking were directly related to ED presentations.

DISCUSSION AND CONCLUSIONS

Staff support the concept of the ED as a potential environment for offering health promotion interventions. ED physicians and nurses have different perspectives on the delivery of health promotion. The role of the ED in health promotion is likely to be multimodal and dependant on the reason for ED attendance.

Long-term outcomes of systemic corticosteroid-sparing immunomodulatory therapy for Birdshot Retinochoroidopathy

PURPOSE

To report the visual prognosis, electroretinography (ERG) and perimetry outcomes of systemic corticosteroid-sparing immunomodulatory treatment (IMT) for birdshot retinochoroidopathy (BSRC).

METHODS

Retrospective non-comparative case series of 132 patients (264 eyes) with BSRC treated with IMT from Massachusetts Eye Research and Surgery Institution.

RESULTS

The average follow-up time was 60.1 months. After one year on IMT, 39.4% showed no clinically active inflammation. After 5 years of IMT, 78.0% had no signs of clinical inflammation. No significant differences were observed on best-corrected visual acuity (BCVA), ERG parameters, and perimetry parameters between baseline and subsequent visits on IMT.

CONCLUSION

Long-term systemic corticosteroid-sparing IMT was associated with a low rate of BSRC disease exacerbation. While differences were seen on testing parameters, they were not consistent trends and difference were attributed to variability of testing or fluctuation of inflammation that may be expected in the course of the disease.

Long-term survival of pig-to-rhesus macaque renal xenografts is dependent on CD4 T cell depletion

The shortage of available organs remains the greatest barrier to expanding access to transplant. Despite advances in genetic editing and immunosuppression, survival in experimental models of kidney xenotransplant has generally been limited to <100 days. We found that pretransplant selection of recipients with low titers of anti-pig antibodies significantly improved survival in a pig-to-rhesus macaque kidney transplant model (6 days vs median survival time 235 days). Immunosuppression included transient pan-T cell depletion and an anti-CD154-based maintenance regimen. Selective depletion of CD4⁺ T cells but not CD8⁺ T cells resulted in long-term survival (median survival time >400 days vs 6 days). These studies suggested that CD4⁺ T cells may have a more prominent role in xenograft rejection compared with CD8⁺ T cells. Although animals that received selective depletion of CD8⁺ T cells showed signs of early cellular rejection (marked CD4⁺ infiltrates), animals receiving selective CD4⁺ depletion exhibited normal biopsy results until late, when signs of chronic antibody rejection were present. In vitro study results suggested that rhesus CD4⁺ T cells required the presence of SLA class II to mount an effective proliferative response. The combination of low pretransplant anti-pig antibody and CD4 depletion resulted in consistent, long-term xenograft survival.

Clinically Localized Prostate Cancer: ASCO Clinical Practice Guideline Endorsement of an American Urological Association/American Society for Radiation Oncology/Society of Urologic Oncology Guideline

PURPOSE

In April 2017, the American Urological Association, American Society for Radiation Oncology, and Society of Urologic Oncology released a joint evidence-based practice guideline on clinically localized prostate cancer. The American Society of Clinical Oncology (ASCO) has a policy and set of procedures for endorsing clinical practice guidelines that have been developed by other professional organizations.

METHODS

The Clinically Localized Prostate Cancer guideline was reviewed for developmental rigor by methodologists. An ASCO Expert Panel then reviewed the content and the recommendations.

RESULTS

The ASCO Expert Panel determined that the recommendations from the Clinically Localized Prostate Cancer guideline were clear, thorough, and based upon the most relevant scientific evidence. ASCO endorsed the Clinically Localized Prostate Cancer guideline except for two recommendations on cryosurgery. The two recommendations covering cryosurgery were not endorsed because the panel found that there is insufficient evidence to support the use of cryotherapy in this setting.

RECOMMENDATIONS

The ASCO Expert Panel endorsed all but two of the original guideline recommendations as written and offered a series of discussion points to guide practice.

Clinically Localized Prostate Cancer: ASCO Clinical Practice Guideline Endorsement of an American Urological Association/American Society for Radiation Oncology/Society of Urologic Oncology Guideline

Purpose

In April 2017, the American Urological Association, American Society for Radiation Oncology, and Society of Urologic Oncology released a joint evidence-based practice guideline on clinically localized prostate cancer. The American Society of Clinical Oncology (ASCO) has a policy and set of procedures for endorsing clinical practice guidelines that have been developed by other professional organizations.

Methods

The Clinically Localized Prostate Cancer guideline was reviewed for developmental rigor by methodologists. An ASCO Expert Panel then reviewed the content and the recommendations.

Results

The ASCO Expert Panel determined that the recommendations from the Clinically Localized Prostate Cancer guideline were clear, thorough, and based upon the most relevant scientific evidence. ASCO endorsed the Clinically Localized Prostate Cancer guideline except for two recommendations on cryosurgery. The two recommendations covering cryosurgery were not endorsed because the panel found that there is insufficient evidence to support the use of cryotherapy in this setting.

Recommendations

The ASCO Expert Panel endorsed all but two of the original guideline recommendations as written and offered a series of discussion points to guide practice.

Computational modelling of solvent effects in a prolific solvatomorphic porous organic cage

Crystal structure prediction methods can enable the in silico design of functional molecular crystals, but solvent effects can have a major influence on relative lattice energies, sometimes thwarting predictions. This is particularly true for porous solids, where solvent included in the pores can have an important energetic contribution. We present a Monte Carlo solvent insertion procedure for predicting the solvent filling of porous structures from crystal structure prediction landscapes, tested using a highly solvatomorphic porous organic cage molecule, CC1. Using this method, we can understand why the predicted global energy minimum structure for CC1 is never observed from solvent crystallisation. We also explain the formation of three different solvatomorphs of CC1 from three structurally-similar chlorinated solvents. Calculated solvent stabilisation energies are found to correlate with experimental results from thermogravimetric analysis, suggesting a future computational framework for a priori materials design that factors in solvation effects.

Outcomes of "Early" Withdrawal of Corticosteroid Sparing Immunomodulatory Therapy for Birdshot Retinochoroidopathy

Purpose: To review early withdrawal of immunomodulatory therapy (IMT) for birdshot retinochoroidopathy (BSRC). Design: Retrospective case-series of sixteen patients with Human-leukocyte-antigen-A29-positive BSRC treated with IMT ≥ 1 year and discontinued prior to achieving durable remission, observed ≥ 6 months off IMT. Results: Mean duration on IMT was 42.4 months. At discontinuation, quiescence was achieved in 75.0% of eyes. Subjects off IMT for 6 months, 1 year, and 3 years showed quiescence in 75.0%, 77.8%, and 80.0% of eyes. No significantly decreased vision was found 6 or 12 months after discontinuation. One eye experienced significantly decreased vision following 3 years without IMT. Significantly decreased amplitude on electroretinography and worse deviation parameters in perimetry were found in patients 3 years after withdrawal that experienced early discontinuation when compared with those achieving durable remission on IMT > 2 years (p < 0.05). Conclusion: The possibility of electroretinography and perimetry results worsening after early IMT discontinuation remained if the patients couldn't achieve remission.

Near-Ideal Xylene Selectivity in Adaptive Molecular Pillar[ n]arene Crystals

The energy-efficient separation of alkylaromatic compounds is a major industrial sustainability challenge. The use of selectively porous extended frameworks, such as zeolites or metal–organic frameworks, is one solution to this problem. Here, we studied a flexible molecular material, perethylated pillar[n]arene crystals (n = 5, 6), which can be used to separate C8 alkylaromatic compounds. Pillar[6]arene is shown to separate para-xylene from its structural isomers, meta-xylene and ortho-xylene, with 90% specificity in the solid state. Selectivity is an intrinsic property of the pillar[6]arene host, with the flexible pillar[6]arene cavities adapting during adsorption thus enabling preferential adsorption of para-xylene in the solid state. The flexibility of pillar[6]arene as a solid sorbent is rationalized using molecular conformer searches and crystal structure prediction (CSP) combined with comprehensive characterization by X-ray diffraction and ¹³C solid-state NMR spectroscopy. The CSP study, which takes into account the structural variability of pillar[6]arene, breaks new ground in its own right and showcases the feasibility of applying CSP methods to understand and ultimately to predict the behavior of soft, adaptive molecular crystals.

Ahmed glaucoma valve in uveitic patients with fluocinolone acetonide implant-induced glaucoma: 3-year follow-up

Purpose

To evaluate the efficacy and safety of Ahmed glaucoma valve (AGV) in eyes with noninfectious uveitis that had fluocinolone acetonide intravitreal implant (Retisert™)-induced glaucoma.

Methods

This retrospective study reviewed the safety and efficacy of AGV implantation in patients with persistently elevated intraocular pressure (IOP) after implantation of a fluocinolone acetonide intravitreal implant at the Massachusetts Eye Research and Surgery Institution between August 2006 and November 2015.

Results

Nine patients with 10 uveitic eyes were included in this study, none of which had preexisting glaucoma in the study eye. Mean patient age was 42 years; 6 patients were female and 3 were male. Baseline mean IOP was 30.6 mmHg prior to AGV placement while mean IOP-lowering medications were 2.9. In the treatment groups, there was a statistically significant reduction in post-AGV IOP. IOP was lowest at 1-week after AGV implantation (9.0 mmHg). Nine out of 10 eyes achieved an IOP below target value of 22 mmHg and/or a 20% reduction in IOP from baseline 1 month and 1 year following AGV placement. All other postoperative time points showed all 10 eyes reaching this goal. A statistically significant decrease in IOP-lowering medication was seen at the 1-week, 1-month, and 3-year time points compared to baseline, while a statistically significant increase was seen at the 3-month, 6-month, and 2-year post-AGV time points. No significant change in retinal nerve thickness or visual field analysis was found.

Conclusion

AGV is an effective and safe method of treatment in fluocinolone acetonide intravitreal implant-induced glaucoma. High survival rate is expected for at least 3 years.

The Challenge of Pediatric Uveitis: Tertiary Referral Center Experience in the United States

Purpose: To describe the distribution, clinical findings, visual outcomes, treatment, and complications of children with uveitis at a tertiary referral ophthalmic center. Methods: Retrospective cohort study. We reviewed the medical records of all patients ≤16 years with uveitis referred to Massachusetts Eye Research and Surgery Institution from March 2005 to July 2016. Results: Of 286 included children, 62.24% were female. Mean age of onset was 8.4 years. The uveitis was mainly anterior (61.9%), recurrent (68.53%), bilateral (81.82%), and noninfectious (96.5%). Idiopathic cases accounted for 51.4%. The most frequent systemic association was juvenile idiopathic arthritis (34.96%). The majority of patients (78.32%) experienced complications. All patients, except one, needed systemic therapy. Conclusion: Pediatric uveitis is challenging to diagnose and manage, with frequent and potentially severe complications. Most cases were bilateral, recurrent, and idiopathic. Prompt referral to uveitis-specialized centers and an appropriate systemic therapy are mandatory for good visual outcomes.

Penile-sparing modalities in the management of low-stage penile cancer

Penile-sparing modalities are gaining widespread adoption for the management of low-stage penile cancer due to an increasing demonstration of sound oncologic, cosmetic, sexual, psychosocial, and quality of life outcomes. This review aims to provide a comprehensive overview of the respective treatment options in the armamentarium of the practicing urologist in dealing with this rare but problematic condition.