Distance to Treatment With Radical Cystectomy in a Rural State: Long Car Rides, Equivalent Outcomes.

Introduction: Radical cystectomy is a complex surgery with better outcomes reported when performed at high-volume centers. This may lead to patients traveling farther for care. We examined the impact of travel distance on clinical outcomes.

PRState: Incorporating genetic ancestry in prostate cancer risk scores for men of African ancestry.

Background: Prostate cancer (PrCa) is one of the most genetically driven solid cancers with heritability estimates as high as 57%. Men of African ancestry are at an increased risk of PrCa; however, current polygenic risk score (PRS) models are based on European ancestry groups and may not be broadly applicable. The objective of this study was to construct an African ancestry-specific PrCa PRS (PRState) and evaluate its performance.

Total Synthesis of Mutanobactins A, B from the Human Microbiome: Macrocyclization and Thiazepanone Assembly in a Single Step.

We report the first total syntheses of tricyclic mutanobactins A and B, lipopeptides incorporating a thiazepanone, isolated from Streptococcus mutans, a member of the human oral microbiome. A rapid, solid-phase peptide synthesis (SPPS) based route delivers these natural products from a cascade of cyclization reactions. This versatile process was also employed in a streamlined synthesis of mutanobactin D.

Mutanobactin D from the Human Microbiome: Total Synthesis, Configurational Assignment, and Biological Evaluation.

Mutanobactin D is a non-ribosomal, cyclic peptide isolated from and shows activity reducing yeast-to-hyphae transition as well as biofilm formation of the pathogenic yeast . We report the first total synthesis of this natural product, which relies on enantioselective, zinc-mediated 1,3-dipolar cycloaddition and a sequence of cascading reactions, providing the key lipidated γ-amino acid found in mutanobactin D. The synthesis enables configurational assignment, determination of the dominant solution-state structure, and studies to assess the stability of the lipopeptide substructure found in the natural product.

National Recommendations against Prostate Specific Antigen Screening versus Statewide Medicaid Expansion Initiatives: A Battle of the Titans.

Purpose: Medicaid expansion under the Patient Protection and Affordable Care Act occurred almost concurrently with 2012 U.S. Preventive Services Task Force recommendations against prostate specific antigen screening.

Meditative and mind-body practice among patients with genitourinary malignancy.

Introduction And Objective: Research on the utility of meditative and mind-body (MB) practices has increased dramatically in the last two decades and both have been suggested as useful adjuncts in coping with stressors associated with cancer survivorship. There exists little data on use among genitourinary (GU) cancer survivors. This study seeks to describe meditative and MB utilization among GU cancer survivors.

Impact of health literacy on shared decision making for prostate-specific antigen screening in the United States.

Background: Current guidelines endorse shared decision making (SDM) for prostate-specific antigen (PSA) screening. The relationship between a patient's health literacy (HL) and SDM remains unclear. In the current study, the authors sought to identify the impact of HL on the rates of PSA screening and on the relationship between HL and SDM following the 2012 US Preventive Services Task Force recommendations against PSA screening.

Pathologic nodal downstaging in men with clinically involved lymph nodes undergoing radical prostatectomy: Implications for definitive locoregional therapy.

A prostate cancer (CaP) patient with nonmetastatic but clinical positive lymph nodes (cN+) represents a difficult clinical scenario. We compare overall survival (OS) between cN+ men that underwent radical prostatectomy (RP) and were found to have negative node status (pN) with those found to have positive nodal status (pN+), and assess predictors of discordant nodal status. We queried the National Cancer Data Base between 2004 and 2015 for patients that were cT1-3 cN+ cM0 CaP treated with RP.

Receipt of Survivorship Care Plans and Self-Reported Health Status among Patients with Genitourinary Malignancy.

Purpose: Implementation of survivorship care plans has been emphasized as a key component to improving care for cancer survivors. Our objective was to determine the prevalence of survivorship care plan receipt for survivors of genitourinary malignancy including kidney, prostate and bladder cancer, and evaluate whether receipt was associated with a measurable health benefit.

Materials And Methods: Data from the Behavioral Risk Factor Surveillance System Cancer Survivorship modules in 2012, 2014, 2016 and 2017 were analyzed.

Impact of Volume and Type of Overnight Pages on Resident Sleep During Home Call.

Background: Little research exists regarding factors that contribute to resident fatigue during home call.

Objective: We objectively tracked the number and type of pages received, as well as residents' sleep time, during home call. We then examined the relationship between paging volume, resident sleep, and resident fatigue.

Prostate cancer navigation: initial experience and association with time to care.

Objective: To evaluate factors associated with use of patient navigation in a prostate cancer population and identify whether navigation is associated with prolonged time to care. Cancer patient navigation has been shown to improve access to cancer screening, diagnosis, and treatment, but little is known about patient navigation in prostate cancer care.

Methods: All men diagnosed with localized prostate cancer between 2009 and 2015 were abstracted from the MaineHealth multi-specialty tumor registry.

Review of the comparative effectiveness of radical prostatectomy, radiation therapy, or expectant management of localized prostate cancer in registry data.

Unlabelled: Evidence regarding the effectiveness of treatment for prostate cancer is primarily based on randomized controlled trials. Long-term outcomes are generally difficult to evaluate within experimental studies and may benefit from large pools of observational data. We conducted a systematic review of administrative and registry studies to evaluate the comparative effectiveness of treatment for clinically localized prostate cancer on overall and prostate-cancer specific mortality.

The Association between Mortality and Distance to Treatment Facility in Patients with Muscle Invasive Bladder Cancer.

Purpose: Regionalization of bladder cancer treatment is suggested to improve quality of care. As an unintended consequence some patients travel farther for care with unknown implications on outcomes. We characterized the relationship between distance and overall mortality in patients with invasive bladder cancer and those who underwent radical cystectomy.

Prostate Cancer Screening in Early Medicaid Expansion States.

Purpose: The PPACA (Patient Protection and Affordable Care Act) of 2010 included a provision to expand Medicaid by 2014. Six states and jurisdictions elected to expand Medicaid early before 2012. This provided a natural experiment to test the association between expanded insurance coverage and preventive service utilization, including prostate cancer screening.

The evolution of uncertainty in second opinions about prostate cancer treatment.

Background: People who have cancer increasingly seek second opinions. Yet, we know little about what motivates patients to seek them and how beneficial they are. Uncertainty-experienced by patients or communicated by physician and patient-may be crucial throughout the second opinion process.

The Use of Bowel in Urologic Reconstructive Surgery.

Intestinal surgery involves an operative space shared by both general surgeons and urologists and is a border region where these 2 surgical disciplines often intersect. Urologists routinely use both small and large bowel for reconstructive procedures and surgeons often encounter such reconstructions of the urinary tract. It is essential for surgeons to understand the urologic indications for using intestinal segments for reconstructive procedures, the variety of such reconstructions, the anatomic landmarks and potential pitfalls that should be considered when intraoperatively encountering such reconstructions, and the potential metabolic consequences of the incorporation of bowel segments into the urinary collecting system.

Use of percutaneous nephrostomy and ureteral stenting in management of ureteral obstruction.

The management options for ureteral obstruction are diverse, including retrograde ureteral stent insertion or antegrade nephrostomy placement, with or without eventual antegrade stent insertion. There is currently no consensus on the ideal treatment or treatment pathway for ureteral obstruction owing, in part, to the varied etiologies of obstruction and diversity of institutional practices. Additionally, different clinicians such as internists, urologists, oncologists and radiologists are often involved in the care of patients with ureteral obstruction and may have differing opinions concerning the best management strategy.

Hydrogenase Gene Distribution and H2 Consumption Ability within the Thiomicrospira Lineage.

Thiomicrospira were originally characterized as sulfur-oxidizing chemolithoautotrophs. Attempts to grow them on hydrogen failed for many years. Only recently we demonstrated hydrogen consumption among two of three tested Thiomicrospira and posited that hydrogen consumption may be more widespread among Thiomicrospira than previously assumed.

Determinants of Prostate Specific Antigen Screening among Black Men in the United States in the Contemporary Era.

Purpose: Although black men represent a high risk population for prostate specific antigen screening for prostate cancer, recommendations in black men are unclear. To our knowledge the resultant effect of conflicting recommendations and disparities in access to care on prostate specific antigen screening in black men is unknown.

Materials And Methods: We compared the rate of self-reported prostate specific antigen screening in black men relative to that in nonHispanic white men.

Reasons for Thiomicrospira crunogena's recalcitrance towards previous attempts to detect its hydrogen consumption ability.

The first Thiomicrospira species was isolated in 1972 and was described as a sulfur-oxidizing chemolithoautotroph. Since then, several other Thiomicrospira species have been recovered from around the globe and have been classified as common sulfur oxidizers. In the past, attempts to demonstrate hydrogen consumption of a Thiomicrospira species have failed.

A novel hydrogen oxidizer amidst the sulfur-oxidizing Thiomicrospira lineage.

Thiomicrospira species are ubiquitously found in various marine environments and appear particularly common in hydrothermal vent systems. Members of this lineage are commonly classified as sulfur-oxidizing chemolithoautotrophs. Although sequencing of Thiomicrospira crunogena's genome has revealed genes that encode enzymes for hydrogen uptake activity and for hydrogenase maturation and assembly, hydrogen uptake ability has so far not been reported for any Thiomicrospira species.

Development of clinical models for predicting erectile function after localized prostate cancer treatment.

Objectives: To develop clinical prediction models estimating the probability of maintaining erections adequate for intercourse 2 years after prostate cancer treatment, based on pretreatment characteristics.

Methods: Study participants consisted of prostate cancer patients with localized disease and functional erections before undergoing surgery (n = 536) or radiation therapy (n = 240) at a single USA institution. Baseline patient- and treatment-related data were collected from a clinical database and through chart review.