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  • 1
    Language: English
    In: Journal of Emergency Medicine, September 2018, Vol.55(3), pp.319-326
    Description: Acute renal colic (ARC) is an emergency that can mostly be treated conservatively, but can be life threatening in combination with urinary tract infection (UTI). Assessment for infection includes white blood cell (WBC) count and C-reactive protein (CRP), but these parameters are often unspecifically elevated and might lead to antibiotic over-therapy. In times of increasing antibiotic resistance, however, unnecessary antibiotic therapy should be avoided. The goal of the study was to investigate the prevalence of UTI proven by urine culture (UC) in patients with ARC and to identify predictive factors in the emergency setting. We prospectively enrolled 200 consecutive patients with ARC and evaluated blood test results, urinalysis, UC, symptoms suspicious for UTI, and time between symptom onset and admission, as well as body temperature. Logistic regression analyses were performed to identify predictive factors. There were 196 patients eligible for statistical analysis. UTI proven by positive UC was detected in 26 patients (13%). On multivariate logistic regression analysis, suspicious urinalysis (positive nitrite or bacteria 〉 20/high-power field [hpf] or WBC 〉 20/hpf), patient age ≥ 54 years and CRP ≥ 1.5 mg/dL (fivefold increase) were significant predictors for the presence of UTI. Neither elevated WBC count nor typical UTI symptoms were associated with UTI. Based on our results, a routine antibiotic prophylaxis in patients with ARC does not seem to be appropriate. Patient age and CRP can help to decide if antibiotic treatment might be indicated, even in case of a not clearly suspicious urinalysis.
    Keywords: Acute Renal Colic ; Urinary Tract Infection ; Leukocytosis ; C-Reactive Protein ; Medicine
    ISSN: 0736-4679
    E-ISSN: 2352-5029
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  • 2
    Language: English
    In: Journal of endourology, September 2014, Vol.28(9), pp.1034-9
    Description: Shockwave lithotripsy (SWL) is the gold standard treatment of patients with most renal and proximal ureteral calculi. Severe bleeding complications in SWL are extremely rare. Uncorrected bleeding diathesis might increase the risk and is considered to be an absolute contraindication for SWL. Perioperative management of anticoagulative and antiplatelet therapy has changed in the recent past. In particular, low-dose acetylsalicylic acid (ASA) is no longer a contraindication for many surgical procedures. A systematic Medline/PubMed literature search of peer-reviewed scientific articles in urology and cardiovascular medicine was performed concerning the management of anticoagulative and antiplatelet medication during SWL. The literature on medically acquired and pathological bleeding diathesis and SWL in general is rare, retrospective, nonstandardized, and of low quality. Routine cessation of obligatory indicated anticoagulative or antiplatelet medication implies a significant risk for cardiovascular adverse events (CAE). Ureterorenoscopy is recommended in patients with uncorrected bleeding diathesis, although this is not based on high-level evidence. In patients with obligatory intake of anticoagulative or antiplatelet medication, the risk for CAE must be balanced against the SWL-induced bleeding risk. In patients with low-dose ASA-intake, SWL should be considered as an option instead of being disregarded as an absolute contraindication. Prospective randomized trials designed to define the optimal management of anticoagulants and antiplatelets during SWL are warranted.
    Keywords: Anticoagulants -- Administration & Dosage ; Aspirin -- Administration & Dosage ; Hemorrhage -- Prevention & Control ; Kidney Calculi -- Therapy ; Lithotripsy -- Adverse Effects ; Platelet Aggregation Inhibitors -- Administration & Dosage ; Ureteral Calculi -- Therapy
    ISSN: 08927790
    E-ISSN: 1557-900X
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  • 3
    In: BJU International, February 2016, Vol.117(2), pp.272-279
    Description: Byline: Atiqullah Aziz, Shahrokh F. Shariat, Florian Roghmann, Sabine Brookman-May, Christian G. Stief, Michael Rink, Felix K. Chun, Margit Fisch, Vladimir Novotny, Michael Froehner, Manfred P. Wirth, Marco J. Schnabel, Hans-Martin Fritsche, Maximilian Burger, Armin Pycha, Antonin Brisuda, Marko Babjuk, Stefan Vallo, Axel Haferkamp, Jan Roigas, Joachim Noldus, Regina Stredele, Bjorn Volkmer, Patrick J. Bastian, Evanguelos Xylinas, Matthias May Keywords: bladder cancer; radical cystectomy; mortality; nomograms; outcome Objective To externally validate the pT4a-specific risk model for cancer-specific survival (CSS) proposed by May etal. (Urol Oncol 2013; 31: 1141-1147) and to develop a new pT4a-specific nomogram predicting CSS in an international multicentre cohort of patients undergoing radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB) Patients and Methods Data from 856 patients with pT4a UCB treated with RC at 21 centres in Europe and North-America were assessed. The risk model proposed by May etal., which includes female gender, presence of positive lymphovascular invasion (LVI) and lack of adjuvant chemotherapy administration as adverse predictors for CSS, was applied to our cohort. For the purpose of external validation, model discrimination was measured using the receiver-operating characteristic-derived area under the curve. A nomogram for predicting CSS in pT4a UCB after RC was developed after internal validation based on multivariable Cox proportional hazards regression analysis evaluating the impact of clinicopathological variables on CSS. Decision-curve analyses were applied to determine the net benefit derived from the two models. Results The estimated 5-year-CSS after RC was 34% in our cohort. The risk model devised by May etal. predicted individual 5-year-CSS with an accuracy of 60.1%. In multivariable Cox proportional hazards regression analysis, female gender (hazard ratio [HR] 1.45), LVI (HR 1.37), lymph node metastases (HR 2.54), positive soft tissue surgical margins (HR 1.39), neoadjuvant (HR 2.24) and lack of adjuvant chemotherapy (HR 1.67, all P 〈 0.05) were independent predictors of an adverse CSS rate and formed the features of our nomogram with a predictive accuracy of 67.1%. Decision-curve analyses showed higher net benefits for the use of the newly developed nomogram in our cohort over all thresholds. Conclusions The risk model devised by May etal. was validated with moderate discrimination and was outperformed by our newly developed pT4a-specific nomogram in the present study population. Our nomogram might be particularly suitable for postoperative patient counselling in the heterogeneous cohort of patients with pT4a UCB. Article Note: A.A. and S.F.S. contributed equally to the study.
    Keywords: Bladder Cancer ; Radical Cystectomy ; Mortality ; Nomograms ; Outcome
    ISSN: 1464-4096
    E-ISSN: 1464-410X
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  • 4
    In: Current Opinion in Urology, 2019, Vol.29(2), pp.89-95
    Description: PURPOSE OF REVIEW: To give an overview about state-of-the-art antibiotic prophylaxis in urolithasis therapy and focus on recent publications in this field. RECENT FINDINGS: The number of high-quality publications within the recent time is limited. Preoperative inflammatory blood parameters like C-reactive protein and erythrocyte-sedimentation rate might help in prediction of postoperative systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL). White blood cell count is nonpredictive for urinary tract infection (UTI) in patients with acute renal colic. In patients with low risk for infectious complications, antibiotic prophylaxis during shock-wave lithotripsy (SWL) is unnecessary and single-dose antibiotics are comparably effective as prolonged antibiotic usage during PCNL and ureterorenoscopy (URS). SUMMARY: Current findings support the American Urological Association (AUA) and European Association of Urology (EAU) guideline recommendations for a risk-adapted minimal antibiotic usage. Single-dose antibiotic prophylaxis is sufficient for low-risk PCNL and URS. For SWL no antibiotic prophylaxis is needed.
    Keywords: Antibiotics -- Dosage And Administration ; Urinary Stones -- Drug Therapy ; Urinary Stones -- Research;
    ISSN: 0963-0643
    E-ISSN: 14736586
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  • 5
    Language: English
    In: Annals of Surgical Oncology, 2014, Vol.21(12), pp.4034-4040
    Description: Byline: Matthias May (1), Sabine Brookman-May (2), Maximilian Burger (3), Christian Gilfrich (1), Hans-Martin Fritsche (3), Michael Rink (4), Felix Chun (4), Margit Fisch (4), Florian Roghmann (5), Joachim Noldus (5), Roman Mayr (6), Armin Pycha (6), Vladimir Novotny (7), Manfred Wirth (7), Stefan Vallo (8), Axel Haferkamp (8), Jan Roigas (9), Antonin Brisuda (10), Regina Stredele (11), Bjorn Volkmer (11), Christopher Dechet (12), Marco Schnabel (3), Stefan Denzinger (3), Christian G. Stief (2), Patrick J. Bastian (13), Atiqullah Aziz (4) Abstract: Purpose To evaluate the prognostic value of concomitant seminal vesicle invasion (cSVI) in patients with urothelial carcinoma of the bladder (UCB) and contiguous prostatic stromal infiltration in a large cystectomy series. Methods A total of 385 patients with UCB and contiguous prostatic infiltration comprised our study. Patients were divided in two groups according to cSVI. Median follow-up was 36 months (interquartile range 11--74) the primary end point was cancer-specific mortality. The prognostic impact of cSVI was evaluated using multivariable Cox regression analysis. The predictive accuracy was assessed by a receiver operating characteristic analysis. Results A total of 229 patients (59.5 %) without cSVI comprised group A, and 156 patients (40.5 %) with cSVI comprised group B. Positive lymph nodes (63 vs. 44 %, p 〈 0.001) and positive surgical margins (34 % vs. 14 %, p 〈 0.001) were more common in patients with cSVI. The 5- and 10-year cancer-specific survival rates were 41 % and 32 % (group A) and 21 and 17 % (group B) (p 〈 0.001). In multivariable analysis, pathological nodal stage (hazard ratio [HR] 2.19, p 〈 0.001), soft tissue surgical margin (HR 1.57, p = 0.010), clinical tumor stage (HR 1.46, p = 0.010), adjuvant chemotherapy (HR 0.40, p 〈 0.001), and cSVI (HR 1.69, p 〈 0.001) independently impacted cancer-specific mortality. The c-indices of the multivariable models with and without inclusion of cSVI were 0.658 (95 % confidence interval 0.60--0.71) and 0.635 (95 % confidence interval 0.58--0.69), respectively, resulting in a predictive accuracy gain of 2.3 % (p = 0.002). Conclusions In patients with UCB and prostatic stromal invasion, cSVI adversely affected cancer-specific survival compared to patients without cSVI. The inclusion of cSVI significantly improved the predictive accuracy of our multivariable model regarding survival. Author Affiliation: (1) Department of Urology, St. Elisabeth Medical Center Straubing, Straubing, Germany (2) Department of Urology, Ludwig-Maximilians-University Munich, Munich, Germany (3) Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany (4) Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (5) Department of Urology, Marienhospital Herne, Ruhr-University Bochum, Herne, Germany (6) Department of Urology, General Hospital of Bolzano, Bolzano, Italy (7) Department of Urology, University Hospital "Carl Gustav Carus", Dresden Technical University, Dresden, Germany (8) Department of Urology, Goethe-University Frankfurt, Frankfurt am Main, Germany (9) Department of Urology, Vivantes Medical Center Im Friedrichshain and Am Urban, Berlin, Germany (10) Department of Urology, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic (11) Department of Urology, Kassel Medical Center, Kassel, Germany (12) Division of Urology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA (13) Department of Urology, Paracelsus Medical Center Golzheim, Dusseldorf, Germany Article History: Registration Date: 17/05/2014 Received Date: 17/03/2014 Online Date: 04/06/2014 Article note: Matthias May and Sabine Brookman-May contributed equally to this article, and both should be considered first author.
    Keywords: Adjuvant Chemotherapy – Analysis ; Mortality – Analysis ; Carcinoma – Analysis;
    ISSN: 1068-9265
    E-ISSN: 1534-4681
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  • 6
    Language: English
    In: Journal of pediatric urology, 25 September 2019
    Description: Ureteroureterostomy is a commonly adopted, minimally invasive approach in the management of duplex anomalies requiring diversion, e.g., ectopic upper pole ureters. The authors hypothesized that a large diameter of the donor ureter could affect the outcome of this procedure. Forty-two patients from two centers were retrospectively reviewed. To compare patients with small (group 1) vs large donor ureters (group 2), they were split at the median of the sonographically measured diameter at the level of the future anastomosis... There was no significant difference in operation time (127 vs 121 min; P = 0.59) or duration of hospital stay (4.15 vs 4.09 days; P = 0.89) or number of postoperative complications (3 febrile urinary tract infections [fUTIs] in group 1 and one fUTI in... After its first description in 1928, it took almost 40 years for ipsilateral ureteroureterostomy to become a widely adopted technique in the management of duplex malformations, especially for obstructive or ectopic upper pole moieties. Whereas it has... A donor ureter diameter ≥1.2 cm in ureteroureterostomy was not associated with a higher complication rate or worse outcome considering further fUTIs or reoperations. The postoperative reduction in hydronephrosis grade was more pronounced in patients with...
    Keywords: Ureteroureterostomy ; Duplex Kidney ; Complication ; Ureter;
    ISSN: 14775131
    E-ISSN: 1873-4898
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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  • 7
    Language: English
    In: Urologia internationalis, 2019, Vol.103(3), pp.270-278
    Description: Focal therapy (FT) by high-intensity focused ultrasound (HIFU) is an emerging option for localized prostate cancer (PC). Due to the lack of long-term data, a close monitoring after FT is essential, but there are still uncertainties about the optimal follow-up regimen. Here we report on a series of FT-HIFU patients with the focus on oncological short-term outcome and the value of postoperative magnetic resonance imaging (MRI). We included 21 patients treated by FT-HIFU using the Focal One® device (EDAP TMS, France) between November 2015 and May 2018. PC localization was assessed by preoperative multiparametric MRI (mpMRI) and transrectal ultrasound-guided targeted and systematic biopsy. Oncological follow-up included prostate-specific antigen (PSA) development, mpMRI, control biopsies (targeted and systematic) of the treated and untreated areas and salvage treatment rate. Control mpMRI and control biopsy were performed after 6-12 months. 15 patients (71.4%) were managed by focal ablation of a solitary lesion, while 6 patients (28.6%) underwent zonal tumor ablation. All patients underwent control mpMRI and biopsy. After a mean follow-up period of 11.7 months, cancer relapse was detected in 8 patients (38.1%), with 4 patients (19%) having infield recurrence. Postoperative mpMRI revealed 3 out of 4 infield PC relapses but missed 5 out of 7 outfield relapses. Clinically significant cancer recurrence was present in 1 patient (4.8%), which was missed by mpMRI. Posttreatment mpMRI had a sensitivity, specificity, positive and negative predictive value of 62.5, 92.3, 83.3 and 80.0%, respectively, for overall relapse detection based on patient level. Only 1 of the 8 recurrences was suspected based on PSA progression. 4 of the 8 patients with PC relapse (19%) underwent salvage therapy (2 patients by radical prostatectomy, 2 patients by salvage FT-HIFU). Postoperative mpMRI might play a valuable role during follow-up after focal HIFU therapy, particularly in terms of infield relapse detection. Irrespective of mpMRI results, the repeat biopsy regimen should incorporate systematic biopsy including cores of the treated and untreated prostate areas.
    Keywords: Focal Therapy ; High-Intensity Focused Ultrasound ; Magnetic Resonance Imaging ; Prostate Cancer
    ISSN: 00421138
    E-ISSN: 1423-0399
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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  • 8
    Language: English
    In: PLoS Biology, 2007, Vol.5(9), p.e237
    Description: Using DNA sequences 5′ to open reading frames, we have constructed green fluorescent protein (GFP) fusions and generated spatial and temporal tissue expression profiles for 1,886 specific genes in the nematode Caenorhabditis elegans . This effort encompasses about 10% of all genes identified in this organism. GFP-expressing wild-type animals were analyzed at each stage of development from embryo to adult. We have identified 5′ DNA regions regulating expression at all developmental stages and in 38 different cell and tissue types in this organism. Among the regulatory regions identified are sequences that regulate expression in all cells, in specific tissues, in combinations of tissues, and in single cells. Most of the genes we have examined in C. elegans have human orthologs. All the images and expression pattern data generated by this project are available at WormAtlas ( http://gfpweb.aecom.yu.edu/index ) and through WormBase ( http://www.wormbase.org ). ; Knowing where a protein is expressed provides an important clue about its potential function. As critical as this information is, we have complete developmental expression profiles for only a small fraction of all genes expressed in any metazoan. Here, we have generated spatial and temporal tissue expression profiles for 10% of all genes in the nematode . Worms expressing putative gene regulatory elements fused with green fluorescent protein were analyzed at each stage of development from embryo to adult. Among the regulatory regions identified are sequences that regulate expression in all cells, in specific tissues, in combinations of tissues, and in single cells. Most of the genes we have examined in have human orthologs. Our analysis of complex expression patterns for so many genes may not only facilitate functional analysis in but also create a foundation for decoding the informational hierarchies governing gene expression in all organisms. ; Using DNA sequences 5' to open reading frames, the authors construct green fluorescent protein fusions and generate spatial and temporal tissue expression profiles for 10% of all genes in the nematode .
    Keywords: Research Article ; Biochemistry ; Cell Biology ; Cell Biology ; Cell Biology ; Computational Biology ; Computational Biology ; Developmental Biology ; Developmental Biology ; Genetics And Genomics ; Genetics And Genomics ; Genetics And Genomics ; Molecular Biology ; Caenorhabditis
    ISSN: 1544-9173
    E-ISSN: 1545-7885
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  • 9
    Language: English
    In: Pl o S Biology, Sept, 2007, Vol.5(9), p.1981(17)
    Keywords: Gene Expression -- Research ; Proteins -- Research ; Caenorhabditis Elegans -- Research
    ISSN: 1544-9173
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  • 10
    In: Nature Genetics, 2011, Vol.43(10), p.940
    Description: Carotid intima media thickness (cIMT) and plaque determined by ultrasonography are established measures of subclinical atherosclerosis that each predicts future cardiovascular disease events. We conducted a meta-analysis of genome-wide association data in 31,211 participants of European ancestry from nine large studies in the setting of the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Consortium. We then sought additional evidence to support our findings among 11,273 individuals using data from seven additional studies. In the combined meta-analysis, we identified three genomic regions associated with common carotid intima media thickness and two different regions associated with the presence of carotid plaque (P 〈 5 x 10 super(-8)). The associated SNPs mapped in or near genes related to cellular signaling, lipid metabolism and blood pressure homeostasis, and two of the regions were associated with coronary artery disease (P 〈 0.006) in the Coronary Artery Disease Genome-Wide Replication and Meta-Analysis (CARDIoGRAM) consortium. Our findings may provide new insight into pathways leading to subclinical atherosclerosis and subsequent cardiovascular events.
    Keywords: Heart ; Data Processing ; Replication ; Aging ; Arteriosclerosis ; Homeostasis ; Ultrasonography ; Blood Pressure ; Lipid Metabolism ; Epidemiology ; Single-Nucleotide Polymorphism ; Reviews ; Plaques ; Genomics ; Cardiovascular Diseases ; Heart Diseases ; Signal Transduction ; Human Genetics ; Miscellaneous;
    ISSN: 1061-4036
    E-ISSN: 15461718
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