Ductal adenocarcinoma (DAC) is the second most common subtype of prostate cancer and is believed to have more aggressive biology compared to acinar adenocarcinoma (AAC). This study aimed to compare pathological and oncological outcomes between DAC and AAC in patients undergoing robotic-assisted radical prostatectomy (RARP). This was a single-center, retrospective cohort study of consecutive patients who underwent RARP between 2008 and 2023. Patients with DAC or AAC on final pathology were included. A 1:1 propensity score matching was performed based on key clinicopathologic variables. Primary outcomes included adverse pathological features, biochemical persistence, and biochemical recurrence (BCR). Statistical analyses included logistic regression and Cox proportional hazards models. Among 844 DAC and 14,357 AAC patients (median follow-up: 4.1 years), DAC was associated with higher extracapsular extension (48.2

Background and objective: Telesurgery is as a promising solution to support and deliver advanced health care services to underserved areas. The primary endpoint of our study was to prove the concept of low-latency long-distance connectivity and to describe the feasibility of remote surgery. Methods: A prospective study was conducted from February 29 to March 1, 2024, in live animal models (porcine) connecting surgeons from Orlando (USA) to the animal laboratory in Shanghai (China) using 5G and Wi-Fi connections, in combination with continental and transpacific fiber. We performed ten radical nephrectomies and two partial nephrectomies in five animals using the MicroPort MedBot robotic platform. Intraoperative and telesurgery connection variables were reported with a descriptive statistical analysis. Key findings and limitations: No complications or conversions were reported. The mean animal weight was 38.2 (35-40) kg, the mean operative time was 32.7 (21-45) min, and the mean blood loss was 23.3 (20-30) ml. The mean latency was 296 (+/- 50) ms. Findings from animal studies may not always translate directly to human outcomes. Conclusions and clinical implications: We described the feasibility of transpacific lowlatency telesurgery in live porcine models with no intraoperative complications. essential for effectively performing the surgical procedures. However, we still need further investigation to achieve even lower latencies for human trials. We found that long-distance telesurgery is safe and feasible in animal models. However, it is a complex practice, and we still need further studies before translating these results to human trials. Patient summary: Our research has demonstrated the feasibility of low-latency long-distance telesurgery in live animal models. However, this type of telesurgery is a complex procedure, and further work is needed to translate these results to (c) 2024 The Author(s). Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Background/Objectives: Small Intestinal Bacterial Overgrowth (SIBO) and Small Intestinal Fungal Overgrowth (SIFO) are distinct yet often overlapping conditions characterized by an abnormal increase in microbial populations within the small intestine. SIBO results from an overgrowth of colonic bacteria, while SIFO is driven by fungal overgrowth, primarily involving Candida species. Both conditions present with nonspecific gastrointestinal (GI) symptoms such as bloating, abdominal pain, diarrhea, and malabsorption, making differentiation between SIBO and SIFO challenging. This review aims to elucidate the underlying mechanisms, risk factors, diagnostic challenges, and management strategies associated with SIBO and SIFO. Methods: A comprehensive review of current literature was conducted, focusing on the pathophysiology, diagnostic modalities, and therapeutic approaches for SIBO and SIFO. Results: SIBO is commonly associated with factors such as reduced gastric acid secretion, impaired gut motility, and structural abnormalities like bowel obstruction and diverticula. It is frequently diagnosed using jejunal aspirates (≥105 colony forming units (CFUs)/mL) or breath tests. In contrast, SIFO is linked to prolonged antibiotic use, immunosuppression, and gut microbiome dysbiosis, with diagnosis relying on fungal cultures from small intestinal aspirates due to the absence of standardized protocols. Conclusion: The clinical overlap and frequent misdiagnosis of SIBO and SIFO highlight the need for improved diagnostic tools and a multidisciplinary approach to management. This review emphasizes the importance of understanding the mechanisms behind SIBO and SIFO, how they relate to other health outcomes, and potential management strategies to optimize patient care and therapeutic outcomes.

Objective: The primary aim of this study was to evaluate and compare the effects of Carbon dioxide (Co2) laser or mechanical therapy and water irrigation on dislodgement of surface deposits, surface decontamination and surface integrity of bacterially contaminated implant surfaces. Background: Currently, there is a lack of evidence about optimal surface decontamination for implants affected with peri-implantitis. This study compares these two methods of surface decontamination on two implants which were explanted due to bone loss caused by periimplantitis. Method: This in-vitro comparison study was performed on two failed dental implants that were affected by advanced levels of peri-implantitis and required explanation. Two periimplantitis affected implants were removed with one treated with mechanical cleaning and saline irrigation and the other with high-power laser irradiation using a 1.0mm spot size, 60% cutting speed and energy output of 13.9 watt (w) 100% mist for one minute. Post treatment, both implants were dehydrated, mounted on aluminum studs and gold plated for surface topography and surface disinfection level Scanning electron microscope (SEM) evaluation. Results: High power laser treatment for one minute showed no deposits attached to the implant surface. The entire surface appeared intact with no surface scratches and no adherent bacterial colonies. The mechanical and water treated implants showed deposits still adherent to the implant surface with multiple areas of implant surface scratches and surface distortion. Conclusions: A 9.3-micron Co2 laser setting used with a high-power setting of 1.0mm spot size, 60% cutting speed, 100% mist and an energy output of 13.9w for one minute could be a safe effective setting providing maximum antiplaque effect with minimum to no effects on implant surface integrity. Mechanical hand cleaning with saline irrigation was not effective in removing all biofilm and left scratches on the implant surface.

Introduction: Acne guidelines recommend the addition of benzoyl peroxide (BPO) to antibiotics to reduce resistance in Cutibacterium acnes (C. acnes). Pairing the antibiotic/BPO combination with a retinoid, such as adapalene, may further increase treatment efficacy, although research on adapalene’s antibacterial activity is limited. To determine if adapalene improves antimicrobial activity, this in vitro study evaluated minimum inhibitory concentration (MIC) of clindamycin, adapalene, and BPO alone or in combination against both susceptible and resistant C. acnes isolates. Methods: Part 1a: C. acnes sensitivity to clindamycin, adapalene, or BPO was assessed via MIC values obtained by the broth microdilution method, with lower MIC indicating higher susceptibility. Part 1b: The effect (synergistic, additive, antagonistic, or indifferent [no interaction]) of combining adapalene with clindamycin or BPO on C. acnes inhibition was evaluated using a checkerboard assay, wherein two test compounds are combined in varying concentrations. Part 2: Susceptibility to single formulations of clindamycin, adapalene, and BPO, and fixed-dose combination formulations of an antibiotic (clindamycin or erythromycin) with BPO was determined by measuring antibacterial zone of inhibition using agar diffusion method, with larger diameter indicating increased bacterial inhibition. Results: Part 1a: Clindamycin demonstrated strain-dependent activity (MIC range: <0.125-64 μg/ml), while BPO and adapalene had no/low activity as indicated by high MIC (>512 and >64, respectively) against the 6 acne-associated strains tested. Part 1b: The combination of adapalene with clindamycin resulted in an additive effect for 3 and no interaction for 1 strain, whereas adapalene with BPO did not result in any interaction against the 4 acne-associated strains tested. Part 2: Activity of single formulations varied, with adapalene 0.1% having no activity (zone of inhibition: 0 cm) against any of the 8 acne-associated C. acnes strains tested. The fixed-dose combination formulations had generally similar activity against all strains tested (range: 0.9-5 cm). Conclusions: In these in vitro analyses, adapalene and BPO had no/low activity against C. acnes, whereas clindamycin alone or in combination formulations demonstrated strain-dependent activity. The relatively high MIC of BPO is not unexpected and aligns with previous studies in which the in vitro activity of BPO was low compared to its high in vivo antimicrobial activity. Further, addition of the retinoid adapalene had an additive effect on the antimicrobial activity of clindamycin against 3 out of 4 C. acnes strains tested, but no effect on the activity of BPO in vitro. Taken together, these data suggest that when combined with clindamycin/BPO, adapalene may enhance antimicrobial activity, while also bringing its own, unique retinoid mechanism of action to the triple combination, adding to clindamycin's bacteriostatic and anti-inflammatory properties. Funding: Ortho Dermatologics

In a retrospective analysis of biopsies from January 1, 2019 to December 31, 2020, at University Hospitals Cleveland Medical Center, we aimed to determine the frequency of dermatologic conditions biopsied in African Americans (AA). Given that AAs constitute 13.4% of the US population, understanding the skin disease profile within this significant demographic is crucial. From a total of 1701 biopsies collected from 1442 AA patients, benign neoplasms emerged as the most common diagnosis, accounting for 26.7%, predominantly in females. Notably, cutaneous T-cell lymphoma was the most frequently biopsied malignancy, whereas pigmentary disorders were the least common at 1.4%. The study highlighted the higher occurrence of squamous cell carcinoma compared with basal cell carcinoma in AA, contrasting trends in other racial demographics. Moreover, recognizing the unique presentations of skin disorders in different racial backgrounds is essential, especially because disparities have been reported in skin of color training among dermatology residency programs. Understanding these racial differences in skin diseases can assist clinicians in refining their diagnostic approach. Future research could further explore the potential gaps between clinical expectations and histologic findings, improving diagnostic accuracy.

Objectives The present study goal was to assess clinically and radiographically using simvastatin (SMV) loaded xenograft for guided bone regeneration (GBR) around simultaneously placed implants with alveolar ridge splitting in patients with horizontally atrophic jaw defect. Materials and methods Randomized distribution of the twenty-two patients into two groups (11 patients each) was performed. Group I participants received alveolar ride splitting (ARS) with GBR using SMV gel mixed bone graft and a barrier membrane with simultaneous implant placement. Group II received the same treatment protocol without SMV gel. At the baseline, 6- and 9-months post-surgery, clinical and radiological alterations were assessed. Results Six months after therapy, PES records of group I were statistically significantly improved than those of group II ( P < .001). Group I exhibited statistically significant expansion of the alveolar ridge over group II after 6 and 9 months ( P < .001). When compared to group II over the evaluation interval between 6 and 9 months, group I demonstrated statistically substantially minimal loss of the mean marginal bone level ( P < .001). At the 6- and 9-month observation periods, bone density gain was considerably higher in group I than that in group II ( P < .001). Conclusion Alveolar ridge splitting along with GBR-augmented SMV improve the clinical and radiographical outcomes around dental implant over GBR alone. Clinical relevance Augmenting GBR with SMV in alveolar ridge splitting could boost implant osseointegration and enhance peri-implant tissue changes. Clinical trial registration: NCT05020405.

Ouyang, Kelsey BS; Gamal, Ahmed MD; Wilkowski, Caroline M. BS; Mahlberg, Scott J. DO; Carroll, Bryan T. MD, PhD Author Information

We describe a case of tinea genitalis in an immunocompetent woman in Pennsylvania, USA. Infection was caused by Trichophyton indotineae potentially acquired through sexual contact. The fungus was resistant to terbinafine (first-line antifungal) but improved with itraconazole. Clinicians should be aware of T. indotineae as a potential cause of antifungal-resistant genital lesions.

Background: Recently, an increasing number of resistant-to-terbinafine dermatophytosis cases have been reported. Thus, identifying an alternative antifungal agent that possesses broad-spectrum activity, including against resistant strains, is needed. Methods: We compared the antifungal activity of efinaconazole with that of fluconazole, itraconazole, and terbinafine against clinical isolates of dermatophytes, Candida, and molds using in vitro assays. Minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) of each antifungal agent were quantified and compared. Susceptible and resistant clinical isolates of Trichophyton mentagrophytes (n = 16), Trichophyton rubrum (n = 43), Trichophyton tonsurans (n = 18), Trichophyton violaceum (n = 4), Candida albicans (n = 55), Candida auris (n = 30), Fusarium spp, Scedosporium spp, and Scopulariopsis spp (n = 15 for each) were tested. Results: Efinaconazole was the most active antifungal agent tested against dermatophytes, with MIC50 and MIC90 (concentrations that inhibited 50% and 90% of strains tested, respectively) values of 0.002 and 0.03 µg/mL, respectively. Fluconazole, itraconazole, and terbinafine showed MIC50 and MIC90 values of 1 and 8 µg/mL, 0.03 and 0.25 µg/mL, and 0.03 and 16 µg/mL, respectively. Against Candida isolates, efinaconazole MIC50 and MIC90 values were 0.016 and 0.25 µg/mL, respectively, whereas fluconazole, itraconazole, and terbinafine had MIC50 and MIC90 values of 1 and 16 µg/mL, 0.25 and 0.5 µg/mL, and 2 and 8 µg/mL, respectively. Against various mold species, efinaconazole MIC values ranged from 0.016 to 2 µg/mL versus 0.5 to greater than 64 µg/mL for the comparators. Conclusions: Efinaconazole showed superior potent activity against a broad panel of susceptible and resistant dermatophyte, Candida, and mold isolates.

You have accessJournal of UrologySurgical Technology & Simulation: Artificial Intelligence I (MP07)1 May 2024MP07-02 DETECTION OF PROSTATE CANCER EXTRACAPSULAR EXTENSION WITH MRI USING DEEP LEARNING METHODS Shady Saikali, Pegah Khosravi, Ahmad Gamal, Abdelrahman Jaber, Marcio Covas Moschovas, Travis Rogers, Evan Patel, Sumeet Reddy, Srirama Venkataraman, and Vipul Patel Shady SaikaliShady Saikali , Pegah KhosraviPegah Khosravi , Ahmad GamalAhmad Gamal , Abdelrahman JaberAbdelrahman Jaber , Marcio Covas MoschovasMarcio Covas Moschovas , Travis RogersTravis Rogers , Evan PatelEvan Patel , Sumeet ReddySumeet Reddy , Srirama VenkataramanSrirama Venkataraman , and Vipul PatelVipul Patel View All Author Informationhttps://doi.org/10.1097/01.JU.0001008728.41882.d7.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: This study addresses the imperative challenge of detecting extracapsular extension (ECE) in prostate cancer (PCa) using T2-weighted magnetic resonance imaging (MRI) and deep learning (DL) techniques. The objective is to develop a comprehensive framework that facilitates the training of a convolutional neural network (CNN), with the intention of identifying ECE, and making it accessible for clinical practice, thus benefiting radiologists and surgeons. METHODS: A retrospective analysis was conducted on a dataset comprising 510 patients with pathologically confirmed T3 PCa (ECE-positive) and 491 patients with pathologically confirmed T2 PCa (ECE-negative). The CNN model underwent training (701 patients), validation (200 patients), and testing (100 patients) on this dataset to assess its performance in ECE detection. RESULTS: The trained DL model, based on multi-slice image data, demonstrated an accuracy of 77% and an area under the curve (AUC) of 87% on a blind test set. These results were achieved after training the model for 50 epochs with RMSprop optimizer, learning rate=0.0001, alpha=0.8, eps=1e-08, weight decay=0.00001, and momentum=0.8 parameters. CONCLUSIONS: This study establishes the effectiveness of CNN applied to T2-weighted MRI images for the detection of ECE in PCa. The findings have significant clinical implications for the diagnosis and treatment of this disease. The CNN model offers improved accuracy and holds promise as an alternative to human experts for ECE staging through MRI. Furthermore, it provides a data-driven and reproducible approach to ECE detection, applicable across various MRI sequences, and offers a personalized strategy to potentially enhance treatment outcomes. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e105 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Shady Saikali More articles by this author Pegah Khosravi More articles by this author Ahmad Gamal More articles by this author Abdelrahman Jaber More articles by this author Marcio Covas Moschovas More articles by this author Travis Rogers More articles by this author Evan Patel More articles by this author Sumeet Reddy More articles by this author Srirama Venkataraman More articles by this author Vipul Patel More articles by this author Expand All Advertisement PDF downloadLoading ...

This study aimed to assess the impact of 0.12%, 1%, and 2% curcumin concentrations on the adherence of periodontal ligament cells to root surfaces damaged by periodontal disease. Materials and Methods: Twenty periodontally compromised teeth were removed and sectioned into root specimens. PDL fibroblasts were harvested from freshly extracted teeth for orthodontic purposes, and subsequently grown and incubated. PDL fibroblast cells were then introduced to curcumin-coated root samples at varying dosages. The study samples were categorized into four groups: Group 1 (0.12% curcumin paste), Group 2 (1% curcumin paste), Group 3 (2% curcumin paste), and Group 4 (control group). All samples were examined using a scanning electron microscope. Results: Group 3, with a 2% curcumin concentration, exhibited distinctly defined multilayered adhering cells that encompassed the whole surface, characterized by entirely flat polyhedral bodies featuring elongated cytoplasmic extensions and minimal to no bacterial colonization, along with sporadic isolated planktonic bacterial adherence.Conclusion: Curcumin at 2% concentration optimally stimulates cellular attachment and exhibits antibacterial properties on root surfaces damaged by periodontitis.

The illustrations above demonstrate that as the percentage of niobium increases, the grain size decreases, leading to an increase in the stability of transformation induced plasticity steel. This, in turn, results in improved mechanical strength. The optimal volume fraction of retained austenite for a significant transformation induced plasticity effect to occur is reported to be in the range of 10 vol. %–20 vol. %. The volume fraction of retained austenite directly determines the carbon content and grain size of the retained austenite, its two main stabilization factors. The stability of the retained austenite dictates when the strain‐induced martensite transformation (SIMT) occurs during straining of transformation induced plasticity high strength steel. Unstable retained austenite transforms almost immediately upon deformation, increasing work hardening rate and formability during the stamping process. At the appropriate stability of the retained austenite, the Strain‐Induced Martensite Transformation begins only at strain levels beyond those produced during stamping and forming, and the retained austenite is still present in the final part; it can transform into martensite in the event of a crash, providing greater crash energy absorption. The tensile strength level of micro‐alloyed transformation induced plasticity steels may exceed 1 GPa. Grain refinement mechanism is considered as the most applied mechanism used in increasing of steel strength without deterioration of ductility and toughness. Recently, it was proposed that the grain refinement could act positively on promoting the transformation induced plasticity effect of advanced high strength steel through improving the stability of retained austenite. In this research, quenching and partitioning heat treatment technique was applied to four grades of low carbon steel with different percentage of niobium. Then, the effect of niobium on grain refinement has been detected by microstructure observations. Mechanical properties and strain hardening properties of investigated steel have been determined. In addition, by using x‐ray diffraction, as well as a new electric resistance‐based sensor, it was possible to characterize the stability of the retained austenite through the plastic deformation of steel. Grain refinement by using of niobium has a great impact on promoting the stability of retained austenite against the plastic stress at the plastic deformation zone.