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Buller D, Sahl J, Staff I, Tortora J, Pinto K, McLaughlin T, Olivo Valentin L, Wagner J. Prostate Cancer Detection and Complications of Transperineal Versus Transrectal Magnetic Resonance Imaging-fusion Guided Prostate Biopsies. Urology 2023; 177:109-114. [PMID: 37059232 DOI: 10.1016/j.urology.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVE To assess the rates of detection of clinically significant prostate cancer (csPCa) and complications associated with transperineal (TP) and transrectal (TR) biopsy approaches to magnetic resonance imaging (MRI)-fusion targeted biopsy. MATERIALS AND METHODS We retrospectively identified men who underwent TP or TR MRI-targeted biopsy with concurrent systematic random biopsy from August 2020 to August 2021. Primary outcomes were detection rates of csPCa and 30-day complication rates between the 2 MRI-biopsy groups. Data were additionally stratified by prior biopsy status. RESULTS A total of 361 patients were included in the analysis. No demographic differences were observed. No significant differences were observed between TP and TR approaches on any of the outcomes of interest. TR MRI-targeted biopsies identified csPCa in 47.2% of patients, and TP MRI-targeted biopsies identified csPCa in 48.6% of patients (P = .78). No significant differences were observed in csPCa detection between the 2 approaches for patients on active surveillance (P = .59), patients with prior negative biopsy (P = .34), and patients who were biopsy naïve (P = .19). Complication rates did not vary by approach (P = .45). CONCLUSION Neither the identification of csPCa by MRI-targeted biopsy nor rates of complications differed significantly based on a TR or TP approach. No differences were seen between MRI-targeted approaches based on prior biopsy or active surveillance status.
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Affiliation(s)
| | - Jessa Sahl
- University of Connecticut School of Medicine, Farmington, CT.
| | - Ilene Staff
- Hartford Hospital Research Program, Hartford Hospital, Hartford, CT.
| | - Joseph Tortora
- Hartford Hospital Research Program, Hartford Hospital, Hartford, CT.
| | - Kevin Pinto
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT.
| | - Tara McLaughlin
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT.
| | - Laura Olivo Valentin
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT.
| | - Joseph Wagner
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT.
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Bandin A, Staff I, McLaughlin T, Tortora J, Pinto K, Negron R, Olivo Valentin L, Dinlenc C, Wagner J. Outcomes over 20 years performing robot-assisted laparoscopic prostatectomy: a single-surgeon experience. World J Urol 2023; 41:1047-1053. [PMID: 36930256 DOI: 10.1007/s00345-023-04346-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVE To evaluate a single surgeon's 20-year experience with robotic radical prostatectomy. METHODS Patients who had undergone robot-assisted laparoscopic prostatectomy by a single surgeon were identified via an IRB approved prospectively maintained prostate cancer database. Patients were divided into 5-year cohorts (cohort A 2001-2005; cohort B 2006-2010; cohort C 2011-2015; cohort D 2016-2021) for analysis. Oncologic and quality of life outcomes were recorded at the time of follow-up visits. Continence was defined as 0-1 pad with occasional dribbling. Potency was defined as intercourse or an erection sufficient for intercourse within the last 4 weeks. RESULTS Three thousand one hundred fifty-two patients met criteria for inclusion. Clavien ≥ 3 complication rates decreased from 5.9% to 3.2%, p = 0.021. There was considerable Gleason grade group (GG) and stage migration to more advanced disease between cohort A (6.4% GG4 or GG5, 16.2% pT3 or pT4, 1.2% N1) and cohort D (17% GG4 or GG5, 45.5% pT3 or pT4, 14.4% N1; p < 0.001). Consistent with this, an increasing proportion of patients required salvage treatments over time (14.6% of cohort A vs 22.5% of cohort D, p < 0.001). 1-year continence rates improved from 74.8% to greater than 92.4%, p < 0.001. While baseline potency and use of intraoperative nerve spare decreased, for patients potent at baseline, there were no significant differences for potency at one year (p = 0.065). CONCLUSIONS In this 20-year review of our experience with robotic prostatectomy, complication rates and continence outcomes improved over time, and there was a migration to more advanced disease at the time of surgery.
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Affiliation(s)
- Alexander Bandin
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT, 06106, USA.
| | - Ilene Staff
- Hartford Hospital Research Program, Hartford Hospital, Hartford, CT, 06106, USA
| | - Tara McLaughlin
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT, 06106, USA
| | - Joseph Tortora
- Hartford Hospital Research Program, Hartford Hospital, Hartford, CT, 06106, USA
| | - Kevin Pinto
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT, 06106, USA
| | - Rosa Negron
- Hartford Hospital Research Program, Hartford Hospital, Hartford, CT, 06106, USA
| | - Laura Olivo Valentin
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT, 06106, USA
| | - Caner Dinlenc
- Department of Urology, Mount Sinai Beth Israel Medical Center, New York, NY, 10003, USA
| | - Joseph Wagner
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT, 06106, USA
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Wagner J, McLaughlin T, Pinto K, Tortora J, Gangakhedkar A, Staff I. The Effect of a Peritoneal Iliac Flap on Lymphocele Formation After Robotic Radical Prostatectomy: Results From the PLUS Trial. Urology 2023; 173:104-110. [PMID: 36549574 DOI: 10.1016/j.urology.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/28/2022] [Accepted: 12/04/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess the effectiveness of a peritoneal flap on the formation of lymphoceles after robotic assisted radical prostatectomy with bilateral extended pelvic lymph node dissection. METHODS We conducted a single surgeon, assessor blinded prospective randomized controlled trial (the Prospective Lymphocele Ultrasound Study) in men undergoing robotic assisted radical prostatectomy with bilateral extended pelvic lymph node dissection. At the conclusion of the node dissection, patients were block randomized 1:1 to either standard of care (no bladder peritoneal flap) or to the creation of a bladder peritoneal flap. Lymphocele formation was assessed by pelvic ultrasound postoperatively. The primary outcome was lymphocele formation. Rates of lymphocele formation and complications were analyzed using chi-square. Other outcomes, including length of stay, number of lymph nodes removed, lymphocele volume, and quality of life measures, were analyzed by t-tests or Wilcoxon Ranked Sum Tests, as appropriate. An a priori power calculation was performed using O'Brien-Fleming alpha sharing for the interim analyses. Two preplanned interim analyses were performed when 45 and 90 patients per group had follow-up ultrasounds. RESULTS A statistically significant difference in lymphocele formation was seen on the second interim analysis for 183 patients (4.3% vs. 15.6%, p = .011) stopping enrollment; this remained significant in the final analysis of 216 patients (3.6% vs 14.2%, p = .006). No other significant differences were observed. CONCLUSION This prospective randomized trial supports the implementation of this simple modification for robotic assisted radical prostatectomy with bilateral extended pelvic lymph node dissection.
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Affiliation(s)
- Joseph Wagner
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT.
| | - Tara McLaughlin
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT
| | - Kevin Pinto
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT
| | - Joseph Tortora
- Hartford Hospital Research Program, Hartford Hospital, Hartford, CT
| | - Akshay Gangakhedkar
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT
| | - Ilene Staff
- Hartford Hospital Research Program, Hartford Hospital, Hartford, CT
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Renna M, Sinha A, Pinto K, Roe C, Koh C, Cheung K. TH2.3 Elective versus emergency management of gallstone disease at a tertiary referral centre amidst the COVID-19 pandemic - should the protocol be altered? Br J Surg 2022. [PMCID: PMC9384678 DOI: 10.1093/bjs/znac248.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background Gallstones are a common pathology affecting approximately 15% of the population in UK, 20% of which are symptomatic. It is suggested symptomatic patients undergo cholecystectomies. Guidelines recommend this is performed within one week of initial emergency presentation or 52 weeks for elective case. Surgical capacity to manage emergency cholecystectomies was limited due to the COVID pandemic. We assessed wait time discrepancy between elective and emergency cholecystectomies. Methods A retrospective review of all patients undergoing cholecystectomies between January and November 2021 in a major tertiary referral centre in London was undertaken. Initial pathology at the time of presentation, elective vs emergency presentation, pre-surgical biliary complications along and wait times were reviewed. Results 219 (74 elective, 145 emergency) patients underwent surgery, mean age 48 years (23% Male and 77% Female). Average wait times for elective cholecystectomies were 69.7 days (min 0, max 246) in comparison to 68.9 days (min 1, max 253) for emergency surgery. 22 (15%) of the patients of initial emergency presentation re-attended hospital and 6 (4%) had adverse events such as gallbladder perforation or pancreatitis due to delayed treatment. Comparatively, 9 (12%) elective patients attended A&E due to pain, with no adverse outcomes. Conclusions Overall wait time of emergency vs elective cholecystectomies were similar. This review indicates emergency cases require prioritisation over elective cholecystectomies due to the higher number of re-attendance and adverse events. Emergency cases need to be prioritised to meet guidelines, which could also reduce complication rates whilst awaiting surgery and lead to fewer adverse outcomes.
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Affiliation(s)
| | | | | | | | - Chloe Koh
- Guy's & St. Thomas’ NHS Foundation Trust
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Pinto K, Roe C, Koh C, Cheung K, Sinha A, Ebied H, Renna M. TH2.12 Difficulties in managing acute gallstone disease at a Tertiary Referral Centre admist COVID-19. Br J Surg 2022. [PMCID: PMC9384756 DOI: 10.1093/bjs/znac248.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background Aims Method Results Conclusions
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Affiliation(s)
| | | | - Chloe Koh
- Guy's and St Thomas’ NHS Foundation Trust
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Buller DM, McLaughlin T, Staff I, Pinto K, Gangakhedkar A, Tortora J, Manetti G, Wagner JR. Outcomes of MRI fusion-guided versus systematic standard prostate biopsies. Can J Urol 2022; 29:10980-10985. [PMID: 35150219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The current utility of MRI-fusion targeted biopsy as either an adjunct to or replacement for systematic template biopsy for the detection of clinically significant prostate cancer is disputed. The purpose of this study is to assess the current effectiveness of MRI-targeted versus systematic template prostate biopsies at two institutions and to consider possible underlying factors that could impact variability between detection rates in our patient population compared to others. MATERIALS AND METHODS A retrospective review from our prospectively maintained prostate cancer databases was conducted. Patients with prostate MRI lesions (PI-RADSv2) receiving concurrent systematic 12-core and MRI-fusion targeted biopsies were reviewed. Clinically significant cancer was considered to be Grade Group ≥ 2. RESULTS A total of 457 patients were included in the analysis; 255 patients received their biopsy at Institution A and 202 at Institution B. Overall cancer detection rate was 68%; the clinically significant cancer detection rate was 34%. Both MRI-targeted and systematic biopsies identified unique cases of clinically significant prostate cancer that the other modality missed. Out of 157 cases of clinically significant prostate cancer, MRI-targeted biopsy identified 29/157 cases (18%) missed by systematic biopsy, while systematic biopsy identified 37/157 cases (24%) missed by MRI-targeted biopsy (p = .39). Individual biopsy performance was similar when stratified by active surveillance or prior biopsy status, PI-RADSv2 score, and institution. CONCLUSIONS MRI-fusion targeted and systematic biopsy each identified unique cases of clinically significant prostate cancer. Both biopsy modalities should be utilized in order to provide the greatest sensitivity for the detection of clinically significant prostate cancer.
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Affiliation(s)
- Dylan M Buller
- Urology Division, UConn Health, Farmington, Connecticut, USA
| | - Tara McLaughlin
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, Connecticut, USA
| | - Ilene Staff
- Hartford Hospital Research Program, Hartford Hospital, Hartford, Connecticut USA
| | - Kevin Pinto
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, Connecticut, USA
| | - Akshay Gangakhedkar
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, Connecticut, USA
| | - Joseph Tortora
- Hartford Hospital Research Program, Hartford Hospital, Hartford, Connecticut USA
| | - Guy Manetti
- Urology Associates of Danbury, PC. Danbury, Connecticut, USA
| | - Joseph R Wagner
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, Connecticut, USA
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Pinto K, Bansal HO, Goyal P. A comprehensive assessment of the techno-socio-economic research growth in electric vehicles using bibliometric analysis. Environ Sci Pollut Res Int 2022; 29:1788-1806. [PMID: 34714474 DOI: 10.1007/s11356-021-17148-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 10/18/2021] [Indexed: 06/13/2023]
Abstract
Electric vehicles (EVs) have proved capable of solving many of the environment's problems such as reducing harmful pollutants' emission along with having greater motor efficiency than gasoline vehicles. This study presents a bibliometric analysis of 10,426 publications from the year 1989 to 2020, obtained from Web of Science™ (WoS) core collection (CC). An initial citation analysis was done using Histcite to identity the leading nations, institutes, authors, and journals performing research related to EVs. Following this, a co-citation analysis was performed using VOSviewer, which generates clusters that are further analyzed to identify the key domains in EV research. A research overview in EVs over the last three decades is presented that can serve various stakeholders in this field of study. The results of this study will highlight the critical research areas in the field of EVs. Additionally, it will also provide various insights that may help the policymakers, practitioners and associations to accelerate EV adoption by the end-users.
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Affiliation(s)
- Kevin Pinto
- Department of Electrical and Electronics Engineering, Birla Institute of Technology and Science, Pilani, Rajasthan, India
| | - Hari Om Bansal
- Department of Electrical and Electronics Engineering, Birla Institute of Technology and Science, Pilani, Rajasthan, India.
| | - Praveen Goyal
- Department of Management, Birla Institute of Technology and Science, Pilani, Rajasthan, India
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White C, Staff I, McLaughlin T, Tortora J, Pinto K, Gangakhedkar A, Champagne A, Wagner J. Does post prostatectomy decipher score predict biochemical recurrence and impact care? World J Urol 2021; 39:3281-3286. [PMID: 33743058 DOI: 10.1007/s00345-021-03661-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 03/06/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To examine the ability of the Decipher test to predict early biochemical recurrence after radical prostatectomy and to impact clinical decisions in advance of metastasis and death. METHODS We identified Decipher tests ordered after radical prostatectomy for adverse pathology in men treated for prostate cancer between 1/1/14 and 8/31/18. Biochemical recurrence was defined as prostate-specific antigen > 0.02 ng/mL. Decipher score is reported as lower risk (< 0.6) and higher risk ≥ 0.60). Kaplan-Meier analysis was used to examine the relationship between Decipher score and time to biochemical recurrence (months). Cox regression was used to analyze the relationship between Decipher score and time to biochemical recurrence while controlling for a number of clinical characteristics. Secondary analyses focused on a subset of men with prostate-specific antigen > 0.02 and < 0.20 ng/mL to determine if high-risk Decipher scores were associated with receipt of salvage treatment. RESULTS A total of 203 cases were analyzed: 37.9% and 62.1% had lower and higher risk Decipher scores respectively, and 56.2% had a biochemical recurrence. Median (inter-quartile range) follow-up was 20 (13.5, 25.3) months. Decipher score was significantly associated with time to biochemical recurrence (p = 0.027) while in the secondary analyses, high-risk Decipher scores (≥ 0.60) were associated with salvage treatment (p = 0.018). Stage category and Decipher score were significant predictors of time from elevated PSA to salvage treatment in the secondary analyses. CONCLUSION While it might not contribute statistically, Decipher score can be clinically useful in helping patients reach treatment decisions.
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Affiliation(s)
- Christine White
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, 85 Seymour Street, Suite 416, Hartford, CT, 06106, USA
| | - Ilene Staff
- Hartford Hospital Research Program, Hartford Hospital, Hartford, CT, 06106, USA
| | - Tara McLaughlin
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, 85 Seymour Street, Suite 416, Hartford, CT, 06106, USA.
| | - Joseph Tortora
- Hartford Hospital Research Program, Hartford Hospital, Hartford, CT, 06106, USA
| | - Kevin Pinto
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, 85 Seymour Street, Suite 416, Hartford, CT, 06106, USA
| | - Akshay Gangakhedkar
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, 85 Seymour Street, Suite 416, Hartford, CT, 06106, USA
| | - Alison Champagne
- Hartford Hospital Research Program, Hartford Hospital, Hartford, CT, 06106, USA
| | - Joseph Wagner
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, 85 Seymour Street, Suite 416, Hartford, CT, 06106, USA
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Nolan J, Kershen R, Staff I, McLaughlin T, Tortora J, Gangakhedkar A, Pinto K, Champagne A, Wagner J. Use of the Urethral Sling to Treat Symptoms of Climacturia in Men After Radical Prostatectomy. J Sex Med 2020; 17:1203-1206. [PMID: 32265147 DOI: 10.1016/j.jsxm.2020.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/17/2020] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Climacturia affects up to 45% of men after radical prostatectomy (RP). Although urethral slings decrease the severity and frequency of stress incontinence after RP, their efficacy as a treatment for climacturia after RP has not been well studied. AIM The aim of this study was to assess patient-reported changes in climacturia symptoms after implantation of a urethral sling as a treatment for stress incontinence after RP. METHODS After Institutional Review Board approval, a retrospective chart review identified males aged 18-80 years who received urethral slings for stress incontinence after RP at our institution from 2012 to 2017. These patients were mailed an 11-item questionnaire asking them about climacturia symptoms before and after implantation of a urethral sling. Written informed consent was obtained from patients participating in the mailed questionnaire. OUTCOMES Respondents were asked to report on climacturia frequency and severity, bother, partner bother, and incontinence before and after implantation of urethral slings. RESULTS A total of 42 questionnaires were mailed; 17 were available for analysis. The median age (and interquartile range, IQR) of the sample at RP was 64 (59.5, 68.0). Almost all (94.1%) of the men were sexually active at the time of the study and 64.7% reported experiencing urinary leakage during sexual arousal. Most (58.8%) underwent the urethral sling procedure to treat general incontinence; 35.3% underwent the procedure to treat both general incontinence and incontinence during sexual activity and 1 (5.9%) underwent it for other reasons. A median of 28.1 months elapsed between RP and sling procedure (IQR: 18.36, 53.88; minimum: 8.00; maximum: 108.36). Statistically significant shifts toward improvement from presling to postsling were noted for frequency of leakage during sexual arousal or orgasm (P = .041) and for the degree to which leakage of urine during sexual arousal or orgasm was a "bother" (P = .027). While almost all (94%) of the men were incontinent before sling, this percentage dropped to 53% after sling (P = .031). CLINICAL IMPLICATIONS Urethral slings should be discussed as a treatment strategy for climacturia during clinical consultations with patients. STRENGTHS & LIMITATIONS Strengths include consistent surgical technique. Limitations include retrospective design, lack of a nonsling comparison group, subjective nature of outcome measures, possible response bias, and variability in time interval between RP and sling procedure. CONCLUSION Use of urethral slings after RP is associated with improvements in climacturia symptoms, bother, and incontinence. Nolan J, Kershen R, Staff I, et al. Use of the Urethral Sling to Treat Symptoms of Climacturia in Men After Radical Prostatectomy. J Sex Med 2020;17:1203-1206.
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Affiliation(s)
- James Nolan
- Urology Division, Hartford Healthcare Medical Group, Hartford, CT, USA
| | - Richard Kershen
- Urology Division, Hartford Healthcare Medical Group, Hartford, CT, USA
| | - Ilene Staff
- Hartford Hospital Research Program, Hartford Hospital, Hartford, CT, USA
| | - Tara McLaughlin
- Urology Division, Hartford Healthcare Medical Group, Hartford, CT, USA.
| | - Joseph Tortora
- Hartford Hospital Research Program, Hartford Hospital, Hartford, CT, USA
| | | | - Kevin Pinto
- Urology Division, Hartford Healthcare Medical Group, Hartford, CT, USA
| | - Alison Champagne
- Hartford Hospital Research Program, Hartford Hospital, Hartford, CT, USA
| | - Joseph Wagner
- Urology Division, Hartford Healthcare Medical Group, Hartford, CT, USA
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Baber J, Staff I, McLaughlin T, Tortora J, Champagne A, Gangakhedkar A, Pinto K, Wagner J. Impact of Urology Resident Involvement on intraoperative, Long-Term Oncologic and Functional Outcomes of Robotic Assisted Laparoscopic Radical Prostatectomy. Urology 2019; 132:43-48. [PMID: 31228477 DOI: 10.1016/j.urology.2019.05.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/23/2019] [Accepted: 05/16/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the impact of resident involvement in robot assisted laparoscopic prostatectomy on oncologic, functional, and intraoperative outcomes, both short and long term. METHODS We queried our prospectively maintained database of prostate cancer patients who underwent robotic-assisted laparoscopic prostatectomy from November 20, 2007 to December 27, 2016. We analyzed cases performed by 1 surgeon on a specific day of the week when the morning case involved at least 1 resident (R) and the afternoon case involved the attending physician only (nonresident [NR]). We compared R versus NR on a number of clinical, perioperative, and oncological outcomes. RESULTS A total of 230 NR and 230 R cases met inclusion criteria and were included in the analysis. Over one third (36.7%) of the NR group was Gleason 4+3 (Grade Group 3) or higher, relative to 25.9% of the R group, P = .015. Median operative time (OT) was significantly longer for R versus NR (200 minutes versus 156 minutes, P<.001) as was robotic time (161 minutes versus119 minutes, P<.001). No significant differences were noted for any other measure. Median follow-up for oncological outcomes was 30 and 33.5 months for NR and R, respectively (P= .3). Median OT and median estimated blood loss were both significantly greater in later years relative to the earlier years for R (2012-2016 versus 2007-2011; P< .001 for OT; P= .041 for median estimated blood loss) but not for NR. CONCLUSION Neither safety nor quality is diminished by R involvement in robot assisted laparoscopic prostatectomy.
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Affiliation(s)
- Jacob Baber
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT
| | - Ilene Staff
- Hartford Hospital Research Program, Hartford Hospital, Hartford, CT
| | - Tara McLaughlin
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT.
| | - Joseph Tortora
- Hartford Hospital Research Program, Hartford Hospital, Hartford, CT
| | - Alison Champagne
- Hartford Hospital Research Program, Hartford Hospital, Hartford, CT
| | - Akshay Gangakhedkar
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT
| | - Kevin Pinto
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT
| | - Joseph Wagner
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT
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Gorman K, Pinto K, Giuliano A. C - 34Montreal Cognitive Assessment: Clinical Utility in Public Psychiatry. Arch Clin Neuropsychol 2018. [DOI: 10.1093/arclin/acy061.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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12
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Weil R, Pinto K, Lincoln J, Hall-Arber M, Sorensen J. The use of personal flotation devices in the Northeast lobster fishing industry: An examination of the decision-making process. Am J Ind Med 2016; 59:73-80. [PMID: 26443130 DOI: 10.1002/ajim.22537] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND This study explored perspectives of Northeast commercial lobstermen regarding the use of personal flotation devices (PFDs). Researchers sought to identify factors contributing to low PFD use, and motivators that could lead to increased use of PFDs. METHODS This qualitative research (n = 72) included 25 commercial fishermen who participated in in-depth, semi-structured interviews, and 47 attendees of Lobstermen's meetings who engaged in focus groups. RESULTS The results showed substantial barriers to PFD use. Fishermen described themselves as being proactive about safety whenever possible, but described a longstanding tradition of not wearing PFDs. Key factors integrally linked with the lack of PFD use were workability, identity/social stigma, and risk diffusion. CONCLUSION Future safety interventions will need to address significant barriers to PFD use that include issues of comfort and ease of use, as well as social acceptability of PFDs and reorientation of risk perceptions related to falls overboard.
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Affiliation(s)
- R. Weil
- The Northeast Center for Occupational Health and Safety: Agriculture; Forestry and Fishing, Bassett Healthcare Network; Cooperstown New York
| | - K. Pinto
- Fishing Partnership Support Services; Burlington Massachusetts
| | - J. Lincoln
- Commercial Fishing Safety Research and Design Program, Alaska Pacific Office; National Institute for Occupational Safety and Health; Anchorage Alaska
| | - M. Hall-Arber
- MIT Sea Grant; Massachusetts Institute of Technology; Cambridge Massachusetts
| | - J. Sorensen
- The Northeast Center for Occupational Health and Safety: Agriculture; Forestry and Fishing, Bassett Healthcare Network; Cooperstown New York
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Trantidou T, Rao C, Barrett H, Camelliti P, Pinto K, Yacoub MH, Athanasiou T, Toumazou C, Terracciano CM, Prodromakis T. Selective hydrophilic modification of Parylene C films: a new approach to cell micro-patterning for synthetic biology applications. Biofabrication 2014; 6:025004. [PMID: 24658120 DOI: 10.1088/1758-5082/6/2/025004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We demonstrate a simple, accurate and versatile method to manipulate Parylene C, a material widely known for its high biocompatibility, and transform it to a substrate that can effectively control the cellular microenvironment and consequently affect the morphology and function of the cells in vitro. The Parylene C scaffolds are fabricated by selectively increasing the material's surface water affinity through lithography and oxygen plasma treatment, providing free bonds for attachment of hydrophilic biomolecules. The micro-engineered constructs were tested as culture scaffolds for rat ventricular fibroblasts and neonatal myocytes (NRVM), toward modeling the unique anisotropic architecture of native cardiac tissue. The scaffolds induced the patterning of extracellular matrix compounds and therefore of the cells, which demonstrated substantial alignment compared to typical unstructured cultures. Ca(2+) cycling properties of the NRVM measured at rates of stimulation 0.5-2 Hz were significantly modified with a shorter time to peak and time to 90% decay, and a larger fluorescence amplitude (p < 0.001). The proposed technique is compatible with standard cell culturing protocols and exhibits long-term pattern durability. Moreover, it allows the integration of monitoring modalities into the micro-engineered substrates for a comprehensive interrogation of physiological parameters.
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Affiliation(s)
- T Trantidou
- Centre for Bio-Inspired Technology, Institute of Biomedical Engineering, Imperial College London, SW7 2BT, UK
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Hinson SA, Silva EG, Pinto K. Ovarian serous cystadenofibromas associated with a low-grade serous carcinoma of the peritoneum. Ann Diagn Pathol 2012; 17:302-4. [PMID: 22921726 DOI: 10.1016/j.anndiagpath.2012.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 05/15/2012] [Indexed: 11/15/2022]
Abstract
Ovarian serous cystadenofibromas are benign neoplasms that sometimes have focal areas of borderline serous tumor and rarely have been associated with epithelial proliferations in the peritoneum, resembling implants. We are reporting 2 cases of ovarian serous cystadenofibromas with serous peritoneal lesions of higher grade than the ovarian tumor: 1 case had a serous carcinoma and another 1 a serous borderline tumor.
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Affiliation(s)
- Stacy A Hinson
- Department of Pathology, Baylor University Medical Center, Dallas, TX, USA.
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15
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Sause WT, Rees W, Belnap T, Rowley B, Pinto K, Orr L. Quality control: Surgical management of breast cancer—Opportunities and challenges. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.6521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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16
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Teixeira C, Vieira S, Silva N, Savi L, Nasi L, Horer J, Oliveira R, Tonietto T, Wickert R, Cremonese R, Brodt S, Oliveira E, Alves F, Barth J, Trevisan C, Callefe F, Pinto K, Hartmann K, Borges L. Crit Care 2005; 9:P48. [DOI: 10.1186/cc3111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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17
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Sause WT, Nkoy F, Rees W, Brammer A, Pinto K. Improved cancer outcomes across multiple institutions using an integrated data system. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- W. T. Sause
- Intermountain Health Care, Salt LakeCity, UT
| | - F. Nkoy
- Intermountain Health Care, Salt LakeCity, UT
| | - W. Rees
- Intermountain Health Care, Salt LakeCity, UT
| | - A. Brammer
- Intermountain Health Care, Salt LakeCity, UT
| | - K. Pinto
- Intermountain Health Care, Salt LakeCity, UT
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18
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Horowitz N, Pinto K, Mutch DG, Herzog TJ, Rader JS, Gibb R, Bocker-Edmonston T, Goodfellow PJ. Microsatellite instability, MLH1 promoter methylation, and loss of mismatch repair in endometrial cancer and concomitant atypical hyperplasia. Gynecol Oncol 2002; 86:62-8. [PMID: 12079302 DOI: 10.1006/gyno.2002.6724] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE MLH1 methylation is associated with the microsatellite instability (MSI) phenotype in endometrial cancer and atypical endometrial hyperplasia, a premalignant precursor to carcinoma. The observation that methylation is also seen in atypical endometrial hyperplasia without MSI suggests that methylation is an early event in endometrial tumorigenesis. Our objective was to determine if methylation is always present in MSI-positive atypical hyperplasia concomitant with MSI-positive, methylation-positive carcinoma. METHODS We used laser capture microdissection to study MLH1 methylation and MSI in a large series of endometrial cancer cases that had previously been shown to have methylation and the MSI-high (MSI-H) phenotype. We resampled areas of carcinoma from 27 patients along with 51 foci of concomitant atypical endometrial hyperplasia. RESULTS Consistent with previous reports, we saw MLH1 methylation in areas of atypical endometrial hyperplasia that did not show MSI. In addition, we noted that 18% of the MSI-H atypical endometrial hyperplasia DNAs lacked methylation of critical cytosines in the MLH1 promoter. Immunohistochemistry studies showed that these MSI-H unmethylated foci of atypical endometrial hyperplasia failed to express MLH1, as did regions of simple hyperplasia. CONCLUSION Methylation of the MLH1 promoter is an early event in endometrial tumorigenesis. Given that not all MSI-positive tissues had methylation at cytosines -229 and -231, it appears that methylation may not be required for MLH1 silencing and loss of mismatch repair.
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Affiliation(s)
- N Horowitz
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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19
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Abstract
OBJECTIVES To examine the incidence of postoperative ventriculoperitoneal shunt infections in patients after augmentation cystoplasty. METHODS We retrospectively reviewed the charts of 21 patients with a ventriculoperitoneal shunt who had bladder augmentation (18 ileal and 3 ileocecal) with attention to the preoperative urine culture, perioperative antibiotics, and the length of time drains were maintained. The abdominal end of all shunts was wrapped in an antibiotic-soaked sponge during the procedure. All patients had at least 1 year of follow-up. RESULTS Seven patients (33%) had culture proven, preoperative urinary tract infections. All patients received at least 24 hours of preoperative and 48 hours of postoperative antibiotics. No postoperative shunt infections occurred during the study period. CONCLUSIONS The incidence of postoperative ventriculoperitoneal shunt infections after augmentation cystoplasty can be kept low when prophylactic antibiotics and short-term drains are used.
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Affiliation(s)
- K Pinto
- Urology Associates of North Texas, Cook Children's Medical Center, Fort Worth, USA
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20
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Moya F, Grannum P, Pinto K, Bracken M, Kadar N, Hobbins JC. Ultrasound assessment of the postmature pregnancy. Obstet Gynecol 1985; 65:319-22. [PMID: 3883259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The use of ultrasound to identify the fetus at risk for postmaturity among postterm pregnancies was evaluated. The ultrasound findings in 85 postterm pregnancies were reviewed. No grade 0 or grade 1 placentas were observed and grade 2 and 3 placentas were found with similar frequency. The incidence of advanced postmaturity was 12.9%. Advanced postmaturity was found with grade 2 and 3 placentas. Oligohydramnios was very common (81.8%) among pregnancies resulting in postmaturity. The neonatal ponderal index was higher with grade 2 placentas than with grade 3 placentas. The presence of immature placentas (grade 0 or 1) is rare after 42 weeks of gestation. Placental grading cannot be used to predict postmaturity.
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