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Three-dimensional models-assisted minimally-invasive partial nephrectomy: looking forward to more evidence
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Lymphatic drainage in renal tumours and implications for management
No full textPurpose: Lymphatic drainage from renal tumors is unpredictable and in vivo drainage studies ofprimary lymphatic landing sites may reveal the variability and dynamics of lymphatic connections.The purpose of this study was to investigate the lymphatic drainage pattern from renal tumors in vivo with SPECT/CT imaging after intra-tumoral radiotracer injection.Materials and methods: We conducted a phase II prospective single-arm study to investigate thedistribution of SNs from renal tumors on SPECT/CT imaging. Patients with cT1-3 (<10 cm) cN0M0renal tumors of any subtype were enrolled. After intra-tumoral ultrasound guided injection of 0.4 ml99mTc-nanocolloid, preoperative imaging of SNs with lymphoscintigraphy and SPECT/CT wasperformed. SN and locoregional non-SNs were resected using a gamma probe in combination with amobile gamma camera. The primary study endpoint was location of SNs outside the locoregionalretroperitoneal templates (LRT) on SPECT/CT imaging. Using a Simon Minimax two-stage design todetect a 25% extra-LRT location of SNs on imaging with an alpha of 0.05 and a power of 80%, at least40 patients with SN imaging on SPECT/CT were needed.Results: Sixty-eight patients were included. Forty patients had preoperative SPECT/CT imaging ofSNs and were used for primary endpoint analysis. Lymphatic drainage outside the LRT was observedin 14 (35%) patients. Eight patients (20%) had supradiaphragmatic SN.Conclusions: SNs from renal tumors were mainly located in their respective LRT, but simultaneousSNs located outside the suggested LND templates, including supradiaphragmatic SNs were observedin more than one third of the patients
Local Treatment of Recurrent Renal Cell Carcinoma May Have a Significant Survival Effect Across All Risk-of-recurrence Groups
Get PDFBACKGROUND: Retrospective comparative studies suggest a survival benefit after complete local treatment of recurrence (LTR) in renal cell carcinoma (RCC), which may be largely due to an indication bias. OBJECTIVE: To determine the role of LTR in a homogeneous population characterised by limited and potentially resectable recurrence. DESIGN, SETTING, AND PARTICIPANTS: RECUR is a protocol-based multicentre European registry capturing patient and tumour characteristics, risk of recurrence (RoR), recurrence patterns, and survival of those curatively treated for nonmetastatic RCC from 2006 to 2011. Per-protocol resectable disease (RD) recurrence was defined as (1) solitary metastases, (2) oligometastases, or (3) renal fossa or renal recurrence after radical or partial nephrectomy, respectively. INTERVENTION: Local treatment of recurrence. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Overall survival (OS) and cancer-specific survival was compared in the RD population that underwent LTR versus no LTR. We constructed a multivariate model to predict risk factors for overall mortality and analysed the effect of LTR across RoR groups. RESULTS AND LIMITATIONS: Of 3039 patients with localised RCC treated with curative intent, 505 presented with recurrence, including 176 with RD. Of these patients, 97 underwent LTR and 79 no LTR. Patients in the LTR group were younger (64.3 [40–80] vs 69.2 [45–87] yr; p = 0.001). The median OS was 70.3 mo (95% confidence interval [CI] 58–82.6) versus 27.4 mo (95% CI 23.6–31.15) in the LTR versus no-LTR group (p < 0.001). After a multivariate analysis, having LTR (hazard ratio [HR] 0.37 [95% CI 0.2–0.6]), having low- versus high-risk RoR (HR 0.42 [95% CI [0.20–0.83]), and not having extra-abdominal/thoracic metastasis (HR 1.96 [95% CI 1.02–3.77]) were prognostic factors of longer OS. The LTR effect on survival was consistent across risk groups. OS HR for high, intermediate, and low risks were 0.36 (0.2–0.64), 0.27 (0.11–0.65), and 0.26 (0.08–0.8), respectively. Limitations include retrospective design. CONCLUSIONS: This is the first study assessing the effectiveness of LTR in RCC in a comparable population with RD. This study supports the role of LTR across all RoR groups. PATIENT SUMMARY: We assessed the effectiveness of local treatment of resectable recurrent renal cell carcinoma after surgical treatment of the primary kidney tumour. Local treatment of recurrence was associated with longer survival across groups with a risk of recurrence
Treatment of renal angiomyolipoma. Pooled analysis of individual patient data endourology and technology
No full textBackground: This study was performed to evaluate the impact of baseline characteristics and treatment methods
on the outcome of sporadic renal angiomyolipoma (AML).
Methods: This was a pooled analysis of individual data of 441 patients with AML retrieved from 58 studies and 3
institutional series.
Results: Ninety-three patients underwent nephrectomy, 163 partial nephrectomy/enucleation, 128 embolisation,
19 cryoablation, 6 radiofrequency ablation, and 32 conservative treatment. Their mean follow-up period was
44.5 months. Patients who experienced major bleeding at presentation had significantly larger tumours than
did those without bleeding (mean diameter, 10.1 vs. 5.9 cm, respectively; p < 0.0001). A total of 9.4 % and
26.4 % of bleeding tumours had a diameter of <4 and <6 cm, respectively. A tumour diameter of ≥8.0 cm
(hazard ratio, 2.07; 95 % confidence interval, 1.20–4.77) and the treatment method (p = 0.001) were independent
predictors of re-intervention. The risk of re-intervention was significantly higher after embolisation, particularly
for large tumours (5-year rate of freedom from re-intervention: diameter of ≥8.0 cm, 49.2 %; diameter of <8.0 cm,
74.8 %; p = 0.018). Conservatively treated AMLs had a mean baseline diameter of 3.2 ± 2.7 cm; after 41 months, their
mean diameter was 3.7 ± 3.1 cm (p = 0.109).
Conclusions: The prevalence of major bleeding is high in sporadic AMLs with a diameter of >6 cm. These
results suggest that conservative treatment can be considered in AMLs of <6 cm in diameter. Among current
treatment methods, embolisation was associated with a significantly higher risk of re-intervention. Further studies
are needed to define risk factors for bleeding and assess the relative benefits of different treatment modalities.
Keywords: Angiomyolipoma, Bleeding, Radiofrequency ablation, Surgery, Embolisation, Re-interventio
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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