Precision Medicine Proof-of-Concept Study of a TNF Inhibitor in FSGS and Treatment-Resistant Minimal Change Disease.

Background: Focal segmental glomerulosclerosis (FSGS) and treatment-resistant minimal change disease (TR-MCD) are heterogeneous disorders with subgroups defined by distinct underlying mechanisms of glomerular and tubulointerstitial injury. A non-invasive urinary biomarker profile has been generated to identify patients with intra-kidney tumor necrosis factor (TNF)-activation and to predict response to anti-TNF treatment. We conducted this proof-of-concept, multi-center, open-label clinical trial to test the hypothesis that in patients with FSGS or TR-MCD and evidence of intra-renal TNF activation based on their biomarker profile, short-term treatment with adalimumab would reverse the elevated urinary excretion of MCP-1 and TIMP-1.

Routine Sperm Cryopreservation before Vasectomy Is Not Cost-Effective and Does Not Increase Live Birth Rates Compared to Surgical Sperm Retrieval or Vasectomy Reversal.

Objectives: To determine if routine pre-vasectomy sperm cryopreservation is more cost-effective than fertility restoration for patients who desire additional children following vasectomy?

Methods: A scoping review was performed to collect published data regarding efficacy and outcomes of cryopreservation, vasectomy reversal, surgical sperm retrieval, and assisted reproductive technologies (ART). Cost data were collected from US-based facilities performing cryopreservation and andrology clinical care. A cost-effectiveness model was generated using TreeAge Pro cost-effectiveness modeling software with three different variations representing a balanced scenario with median expected parameter values, a scenario with assumptions/variables favoring pre-vasectomy cryopreservation, and a scenario favoring fertility restoration.

The influence of seminal microbiota on human testicular steroidogenesis: a prospective study.

Objective: Preclinical evidence has demonstrated that gut microbiota composition can influence steroid hormone biosynthesis and spermatogenesis. This study aims to investigate the association of seminal microbiota and testicular steroidogenesis.

Patients And Methods: One hundred adult eugonadal men were consecutively enrolled.

Implementation of a Comprehensive Protocol for Enhanced Recovery After Surgery (ERAS) in Kidney Transplant Recipients Improves Patient and Graft Outcomes.

Background: Enhanced recovery after surgery (ERAS) protocols have gained widespread acceptance as a means to enhance surgical outcomes. However, the intricate care required for kidney transplant recipients has not yet led to the establishment of a universally recognized and dependable ERAS protocol for kidney transplantation.

Objective: We devised a customized ERAS protocol to determine its effectiveness in improving surgical and postoperative outcomes among kidney transplant recipients.

Mitochondrial dysfunction signatures in idiopathic primary male infertility: a validated proteomics-based diagnostic approach.

Research Question: Male infertility accounts for almost half of all infertility cases worldwide, with idiopathic male infertility accounting for up to 30% of the cases. Sperm proteomics has revealed critical molecular pathway changes in men with infertility. However, the sperm mitochondrial proteome remains poorly understood.

Urothelial carcinoma in situ with "early papillary formation" vs "lateral spread/shoulder lesion" of prior high-grade noninvasive papillary urothelial carcinoma: A survey of pathologist and urologist interpretations.

Objectives: Urothelial carcinoma in situ (CIS) with early papillary formation is terminology sometimes used to suggest incipient high-grade papillary urothelial carcinoma (PUC) but may lead to confusion between true CIS and lateral flat spread of PUC.

Methods: It remains unclear how pathologists and urologists interpret this scenario, so a survey was circulated to 68 pathologists (group 1 = 28 academic genitourinary pathologists; group 2 = 17 pathologists with a self-reported genitourinary focus; group 3 = 23 pathologists self-reported as not genitourinary specialists) and 32 urologists.

Results: Regarding atypical urothelial lesions that appear mainly flat but contain possible papillae, group 3 was more likely to label this as CIS compared with groups 1 and 2 (35% for group 3 vs 13% for groups 1 and 2), while groups 1 and 2 more often adopted another descriptive diagnosis, such as "CIS with early papillary features" (38% for groups 1 and 2 vs 13% for group 3).

Role of gliflozins on hepatocellular carcinoma progression: a systematic synthesis of preclinical and clinical evidence.

Introduction: The risk of HCC is twice as high in diabetic patients compared to non-diabetic ones, suggesting that diabetes advances carcinogenesis in the liver through a variety of mechanisms. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been shown to improve liver outcomes, emerging as promising agents to treat hepatocellular carcinoma (HCC) in patients with type 2 diabetes mellitus (T2DM).

Methods: We searched PubMed and Scopus databases for articles presenting an association between SGLT2is and HCC to explore the putative mechanisms of action underlying the anti-proliferative activity of SGLT2is.

External validation of predictive models for antibiotic susceptibility of urine culture.

Objective: To develop, externally validate, and test a series of computer algorithms to accurately predict antibiotic susceptibility test (AST) results at the time of clinical diagnosis, up to 3 days before standard urine culture results become available, with the goal of improving antibiotic stewardship and patient outcomes.

Patients And Methods: Machine learning algorithms were developed and trained to predict susceptibility or resistance using over 4.7 million discrete AST classifications from urine cultures in a cohort of adult patients from outpatient and inpatient settings from 2012 to 2022.

Diuretic management protocol to improve quality and safety in managing acute heart failure in an integrated health system: An implementation science approach.

Background: Effective and timely decongestion in acute heart failure (AHF) coupled with careful discharge planning is critical in the successful treatment of patients hospitalized for AHF. We leveraged an implementation science framework to develop a health system-wide diuretic management protocol (DMP) based on emerging clinical evidence.

Methods: We conducted stakeholder interviews using the Integrated Promoting Action on Research Implementation in Health Services (iPARiHS) Framework.

Mechanism of Nephrolithiasis: Does the Microbiome Play a Role?

Nephrolithiasis imposes a significant health care burden around the world. In the past decade, there has been considerable interest in the human microbiota in relation to the onset of nephrolithiasis. Most of the research has focused on degradation of oxalate, a known causative factor for nephrolithiasis, by bacteria in the gut.

Novel bioabsorbable, low-dose rate brachytherapy device (CivaSheet) with radical prostatectomy and adjuvant external beam radiation for the management of prostate cancer.

Objective: To investigate the safety and cancer control of a novel bioabsorbable, low-dose rate brachytherapy device, CivaSheet (CivaTech Oncology Inc., Durham, NC, USA), in combination with radical prostatectomy (RP) with or without adjuvant external beam radiation therapy (EBRT) for the management of prostate cancer (PCa).

Patients And Methods: This is an initial, single-centre experience, two-dose level, two-stage study conducted on patients with intermediate- and high-risk PCa.

Sarcopenia may increase cisplatin toxicity in bladder cancer patients with borderline renal function.

Objectives: To assess whether the effect of sarcopenia on neoadjuvant chemotherapy (NAC) toxicity is modified by borderline renal function (estimated glomerular filtration rate [eGFR] 40-65 mL/min) and whether sarcopenia and borderline renal function are independently associated with NAC toxicity risk.

Patients And Methods: All patients with muscle-invasive bladder cancer (MIBC) who underwent radical cystectomy (RC) between 2010 and 2022, with available cross-sectional imaging prior to NAC initiation, were included. Skeletal mass was measured from axial computed tomography images obtained at the level of the L3 vertebral body, using Aquarius Intuition software.

Pure open versus robotic radical cystectomy with intracorporeal urinary diversion: a propensity matched analysis.

Objective: To compare surgical parameters and short-term outcomes between open radical cystectomy (ORC) and robotic radical cystectomy with total intracorporeal urinary diversion (icRARC).

Methods: Among the study period, 133 patients who underwent ORC and pelvic node dissection for bladder cancer (group 1) were matched and compared to 61 patients who underwent icRARC during the same period (group 2). The groups were matched 1:1 according to their propensity scores adjusted on their baseline demographics and disease characteristics.

Microbiome-based Therapeutics: Cutting-edge Innovation.

From bacillus Calmette-Guérin to cutting-edge research, the microbiome has played an integral role in urology treatments and will continue to do so for many generations to come.

The Role of Prostate-Specific Membrane Antigen-Radioligand and Magnetic Resonance Imaging in Patients with Prostate Cancer Biochemical Recurrence.

A significant proportion of men with prostate cancer will experience biochemical recurrence (BCR), which is characterized by an elevation in prostate-specific antigen (PSA) levels after receiving treatment with curative intent. Imaging plays an important role in the management of patients with BCR. It can help identify sites of recurrence to determine the most appropriate management strategies, ranging from salvage treatment for local recurrences to systemic treatments for those with advanced, distant disease.

Complex system modelling reveals oxalate homeostasis is driven by diverse oxalate-degrading bacteria.

Decades of research have made clear that host-associated microbiomes touch all facets of health. However, effective therapies that target the microbiome have been elusive given its inherent complexity. Here, we experimentally examined diet-microbe-host interactions through a complex systems framework, centered on dietary oxalate.