Node-positive renal cell carcinoma in the absence of distant metastases: predictors of cancer-specific mortality in a population-based cohort.

Unlabelled: Nodal metastases, even in the absence of distant metastases, portend a bad prognosis. The percentage of positive nodes (PPN) represents an important predictor of cancer-specific mortality (CSM) in patients in the group T(any) N(1) M(0) . In consequence, universal inclusion of PPN should be considered in prospective and retrospective CSM analyses.

Morbidity and mortality of radical prostatectomy differs by insurance status.

Background: Private insurance status may favorably affect various health outcomes including those associated with radical prostatectomy (RP). We explored the effect of insurance status on 5 short-term RP outcomes.

Methods: Within the Health Care Utilization Project Nationwide Inpatient Sample (NIS) we focused on RPs performed within the 5 most contemporary years (2003-2007).

Radical prostatectomy at academic versus nonacademic institutions: a population based analysis.

Purpose: Radical prostatectomy outcomes may be better at academic institutions than at nonacademic centers. We examined the effect of academic status on 5 short-term radical prostatectomy outcomes.

Materials And Methods: In the Health Care Utilization Project Nationwide Inpatient Sample we focused on radical prostatectomy performed within the 7 most contemporary years (2001 to 2007).

Robotic-assisted aortic surgery with and without minilaparotomy for complicated occlusive disease and aneurysm.

Objective: Published reports of robotic-assisted aortic surgery involve a combination of laparoscopy for aortic dissection and a robotic system for vascular reconstruction. The objective of this study is to determine the feasibility and advantage of a total robotic-assisted aortic dissection and vascular reconstruction vs robotic-assisted aortic procedures for aortoiliac occlusive disease (AIOD) and abdominal aortic aneurysm (AAA).

Methods: From February 2006 to August 2010, 21 patients were selected for robotic-assisted aortic procedures: aortobifemoral bypass in 12, AAA repair in 6, iliac aneurysm repair in 1, and ligation of type II endoleak after endovascular aneurysm repair in 2.

Does partial nephrectomy at an academic institution result in better outcomes?

Purpose: Partial nephrectomy (PN) outcomes may be better at academic institutions than at non-academic centers. Peer-review, sub-specialized practice profile, higher individual surgeon and institutional caseload may explain this observation. To the best of our knowledge, the role of institutional academic affiliation has not been examined with regard to PN postoperative outcomes.

Improvement of racial disparities with respect to the utilization of minimally invasive radical prostatectomy in the United States.

Background: Race represents an established barrier to health care access in the United States and elsewhere. We examined whether race affects the utilization rate of minimally invasive radical prostatectomy (MIRP) in a population-based sample of individuals from the United States.

Methods: Within the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS), we focused on patients in whom MIRP and open radical prostatectomy (ORP) were performed between 2001 and 2007.

Open radical prostatectomy in the elderly: a case for concern?

Unlabelled: Study Type--Therapy (case series). Level of Evidence 4. What's known on the subject? And what does the study add? Adverse outcomes after radical prostatectomy are more often recorded in the elderly.

The effect of insurance status on outcomes after partial nephrectomy.

Background: Privately insured patients may have favorable health outcomes when compared to those covered by federally funded initiatives. This study explored the effect of insurance status on five short-term outcomes after partial nephrectomy (PN).

Methods: Within the Health Care Utilization Project Nationwide Inpatient Sample (NIS), we focused on PNs performed between 1998 and 2007.

A pan-HPV vaccine based on bacteriophage PP7 VLPs displaying broadly cross-neutralizing epitopes from the HPV minor capsid protein, L2.

Background: Current human papillomavirus (HPV) vaccines that are based on virus-like particles (VLPs) of the major capsid protein L1 largely elicit HPV type-specific antibody responses. In contrast, immunization with the HPV minor capsid protein L2 elicits antibodies that are broadly cross-neutralizing, suggesting that a vaccine targeting L2 could provide more comprehensive protection against infection by diverse HPV types. However, L2-based immunogens typically elicit much lower neutralizing antibody titers than L1 VLPs.

Robot assisted radical prostatectomy for elderly patients with high risk prostate cancer.

Objectives: The role of robot assisted radical prostatectomy (RARP) for high-risk prostate cancer (CaP) is controversial, as is the role of RARP in elderly men. We evaluate outcomes of elderly patients with high-risk CaP who have chosen RARP over radiation or hormonal therapy.

Materials And Methods: Between April 2001 and November 2009, 69 elderly patients (≥70 years) with high-risk CaP underwent RARP at our institution.

Anastomosis during robot-assisted radical prostatectomy: randomized controlled trial comparing barbed and standard monofilament suture.

Objective: To compare perioperative and functional outcomes after urethrovesical anastomosis (UVA) with barbed polyglyconate and monofilament poliglecaprone in robot-assisted radical prostatectomy (RARP). Barbed polyglyconate suture was first used for the UVA during RARP beginning in January 2010; safety and feasibility were previously demonstrated in 51 patients.

Methods: From May to September 2010, 64 patients meeting all the inclusion criteria participated in the present multisurgeon prospective, randomized, controlled trial and underwent posterior repair and UVA during RARP with either barbed polyglyconate (n=33) or monofilament poliglecaprone (n=31) suture.

Do doctors under-provide, over-provide or do both? Exploring the quality of medical treatment in the Philippines.

Objective: To assess the quality of medical treatment by disaggregating quality into components that distinguish between insufficient and unnecessary care.

Design: Randomly selected doctors were asked how they would treat a sick child. Their responses were disaggregated into how much of an evidence-based essential treatment plan was completed and the number of additional non-essential treatments that were given.

Adjuvant radiation treatment after prostatectomy. Where do we stand?

Introduction: Prostate cancer is the second most common cause of cancer death in American men. For patients with adverse pathologic features, postoperative radiotherapy to prostate bed after radical prostatectomy has been shown in randomized studies to improve many important clinical endpoints including overall survival. In this review article, we distinguish adjuvant radiation treatment (ART) from salvage radiation treatment (SRT), discuss the evidences for ART and its potential side effects focusing on the debate concerning the optimal timing of post prostatectomy radiation treatment (RT).

Peptide epitope identification by affinity selection on bacteriophage MS2 virus-like particles.

Filamentous phages are now the most widely used vehicles for phage display and provide efficient means for epitope identification. However, the peptides they display are not very immunogenic because they normally fail to present foreign epitopes at the very high densities required for efficient B-cell activation. Meanwhile, systems based on virus-like particles (VLPs) permit the engineered high-density display of specific epitopes but are incapable of peptide library display and affinity selection.

Financial incentives and measurement improved physicians' quality of care in the Philippines.

The merits of using financial incentives to improve clinical quality have much appeal, yet few studies have rigorously assessed the potential benefits. The uncertainty surrounding assessments of quality can lead to poor policy decisions, possibly resulting in increased cost with little or no quality improvement, or missed opportunities to improve care. We conducted an experiment involving physicians in thirty Philippine hospitals that overcomes many of the limitations of previous studies.

Pushing on a String: How policy might encourage private doctors to compete with the public sector on the basis of quality.

Results from the Philippine Quality Improvement Demonstration Study show that a policy that expands insurance coverage improves quality of care, as measured by clinical performance vignettes, among public physicians, and induces a spillover effect that improves quality among private physicians.

Management of rectal injury during robotic radical prostatectomy.

Objectives: To review the incidence and management of rectal injury in 4400 consecutive cases of robotic radical prostatectomy at a single institution.

Material And Methods: From September 2001 to September 2009, 4400 patients underwent robotic radical prostatectomy. We reviewed the intraoperative and postoperative data from patients with rectal injuries.

A comparison of objective biomarkers with a subjective health status measure among children in the Philippines.

Unlabelled: Large health surveys use subjective (self-reported) and objective (biomarkers) measures to assess heath status. However, the linkage or disparity of these measures has not been systematically studied in developing countries.

Method: Using data from the Philippine Quality Improvement Demonstration Study, QIDS, this study evaluated the associations between General Self-Reported Health Status (GSRH) and height, weight, hemoglobin, red blood cell folate, C-reactive protein, and blood lead levels.

Content validation of a novel robotic surgical simulator.

Objective: • To assess the content validity of an early prototype robotic simulator. Minimally invasive surgery poses challenges for training future surgeons. The Robotic Surgical Simulator (RoSS) is a novel virtual reality simulator for the da Vinci Surgical System.

Long-term functional urinary outcomes comparing single- vs double-layer urethrovesical anastomosis: two-year follow-up of a two-group parallel randomized controlled trial.

Objectives: To evaluate long-term urinary outcomes in participants of a two-group randomized clinical trial comparing continence after robotic prostatectomy (RP) between those who had reconstruction of the rhabdosphincter and puboprostatic collar (double-layer anastomosis) with those who had not.

Methods: Consecutive patients (n = 116) undergoing RP at a single institution were randomized to either single- or double-layer urethrovesical (UV) anastomosis between August and December of 2007. Patients were contacted an average of 23.

Comparative analysis of global practice patterns in urologic robot-assisted surgery.

Objectives: To determine and compare the status of urologic laparoscopic and robot-assisted surgery (RAS) across the world.

Methods: Two hundred ninety-one surveys were completed by urologists at various national and international conferences in 2008. The 58-item questionnaire assessed the individual and institutional practice patterns of minimally invasive surgery with a focus on RAS.

Does previous robot-assisted radical prostatectomy experience affect outcomes at robot-assisted radical cystectomy? Results from the International Robotic Cystectomy Consortium.

Objectives: To evaluate the effect of previous robot-assisted radical prostatectomy (RARP) case volume on the outcomes of robot-assisted radical cystectomy. Little is known regarding the effect of previous robotic surgical experience on the implementation and execution of robot-assisted radical cystectomy.

Methods: Using the International Robotic Cystectomy Consortium database, 496 patients were identified who had undergone robot-assisted radical cystectomy by 21 surgeons at 14 institutions from 2003 to 2009.

A novel method of urethrovesical anastomosis during robot-assisted radical prostatectomy using a unidirectional barbed wound closure device: feasibility study and early outcomes in 51 patients.

Purpose: To describe the safety and feasibility of a running urethrovesical anastomosis (UVA) in robot-assisted radical prostatectomy (RARP) using a unidirectional self-locking barbed suture.

Patients And Methods: Fifty-one consecutive patients with organ-confined prostate cancer underwent RARP by one of two experienced surgeons. UVA was performed in two layers, using a unidirectional barbed suture fashioned into a double-ended stitch.