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Editorial Comment: Prevalence, Incidence, and Determinants of Kidney Stones in a Nationally-representative Sample of US Adults 编辑评论:具有全国代表性的美国成年人样本中肾结石的流行率、发病率和决定因素
Pub Date : 2024-02-01 DOI: 10.1097/ju9.0000000000000117
Alfred Krebs, Mario I. Fernandez
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引用次数: 0
Trends in PubMed-Indexed Research in Matched Urology Applicants: A Cross-Sectional Analysis of the 2017 to 2021 Match Cycles 泌尿外科匹配申请人的 PubMed 索引研究趋势:2017 至 2021 年匹配周期的横断面分析
Pub Date : 2024-02-01 DOI: 10.1097/ju9.0000000000000103
D. Hinojosa-González, Shane Kronstedt, Gal Saffati, Nicholas Corsi, Anton Wintner, Dimitar V Zlatev, Wesley A. Mayer, Ruslan Korets, Brian H. Eisner
Urology is one of the most competitive specialties for residency matches in the United States. Data reported by the American Urological Association from match cycles spanning 2014 to 2021 reveal a median of 0.34% (0%-3%) of unfilled spots, a median of 1.48 (1.28-1.87) applicants per position, and a median of 75% (63%-87%) match rate. Recent research has shown that program directors value applicants' research highly. We sought to assess the research productivity of matched urology residency applicants, identify trends in research volume over time, and investigate the potential correlation between research output and program ranking. Doximity Urology program ranking list from the 2017 to 2021 match cycles was sorted by reputation, extracted, and populated using each program's official website resident roster, including name, medical school, postgraduate year, and additional degrees. Rosters were crossed-checked against social media posts from the official accounts. Each identified urology resident was queried in PubMed. Journal ranking was determined through Scimagojr; top-quartile journals were classified as Q1. In total 131 of 145 programs were identified, and 1605 matched applicants spanning the 2017 to 2021 match cycles. The mean and median total publications were 2.44 and 1, respectively, and 2.17 and 1 when excluding case reports. 64.2% of applicants had at least one publication, and 42.2% had at least one urological publication. Applicants matching into higher-ranked programs had more research and urological research. Multivariable regression analysis revealed that Q1 research (β 2.38) and urology research (β 2.33) significantly affected rank. Match cycle analysis revealed an increase in total and urology-focused research, whereas regression analysis demonstrated significant increases in total publications (β 0.019) per cycle. Overall research, urology-focused research, first authorship, and publication in higher-ranked journals play an essential role in the urology match.
泌尿外科是美国住院医师配对竞争最激烈的专业之一。美国泌尿外科协会报告的 2014 年至 2021 年匹配周期的数据显示,未填补名额的中位数为 0.34%(0%-3%),每个职位的申请人数中位数为 1.48(1.28-1.87)人,匹配率中位数为 75%(63%-87%)。最近的研究表明,项目主任非常重视申请人的研究成果。我们试图评估匹配的泌尿科住院医师申请者的研究成果,确定研究数量的长期趋势,并调查研究成果与项目排名之间的潜在相关性。 我们使用各项目官方网站上的住院医师名册,包括姓名、医学院、研究生年级和其他学位,对2017年至2021年匹配周期的Doximity泌尿外科项目排名表进行了声誉排序、提取和填充。名册与来自官方账户的社交媒体帖子进行交叉核对。在 PubMed 上查询了每位已确认的泌尿科住院医师。期刊排名通过 Scimagojr 确定;排名前四位的期刊被列为 Q1。 共确定了 145 个项目中的 131 个,2017 年至 2021 年匹配周期内有 1605 名匹配申请人。论文发表总数的平均值和中位数分别为 2.44 篇和 1 篇,如果不包括病例报告,则分别为 2.17 篇和 1 篇。64.2%的申请人至少发表过一篇论文,42.2%的申请人至少发表过一篇泌尿外科论文。与排名较高的项目匹配的申请人有更多的研究和泌尿科研究。多变量回归分析显示,第一季度研究(β 2.38)和泌尿科研究(β 2.33)对排名有显著影响。匹配周期分析表明,总研究和以泌尿外科为重点的研究有所增加,而回归分析表明,每个周期的论文总数有了显著增加(β 0.019)。 总体研究、以泌尿学为重点的研究、第一作者和在排名较高的期刊上发表论文在泌尿学匹配中发挥着重要作用。
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引用次数: 3
Editorial Comment: Practice Patterns and Patient Experience of Care Among US Veterans with Prostate Cancer: A 10-Year Scoping Review 编辑评论:美国退伍军人前列腺癌患者的诊疗模式和护理体验:十年范围回顾
Pub Date : 2024-02-01 DOI: 10.1097/ju9.0000000000000116
Reno P. Maldonado, Granville L. Lloyd
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引用次数: 0
Editorial Comment: A Propensity Score-Matched Analysis of the Impact of Carcinoma In Situ on the Clinical Outcomes in Patients with Upper Tract Urothelial Carcinomas—A Nationwide Multi-Institutional Cohort Study 社论评论:原位癌对上尿路癌患者临床结局影响的倾向得分匹配分析--一项全国性多机构队列研究
Pub Date : 2024-01-01 DOI: 10.1097/ju9.0000000000000100
Drupad Annapureddy, Jacob Taylor
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引用次数: 0
Prevalence, Incidence, and Determinants of Kidney Stones in a Nationally Representative Sample of US Adults 具有全国代表性的美国成年人样本中肾结石的流行率、发病率和决定因素
Pub Date : 2024-01-01 DOI: 10.1097/ju9.0000000000000107
Ben H. Chew, Larry E. Miller, Brian H Eisner, Samir Bhattacharyya, N. Bhojani
To determine the prevalence, incidence, and determinants of kidney stones among adults in the United States. This cross-sectional observational study evaluated the lifetime prevalence of kidney stones and the 12-month incidence of kidney stone passage from the 2017 to 2020 National Health and Nutrition Examination Survey. Survey statistical methods were used to estimate kidney stone prevalence and incidence and the association of patient characteristics with these outcomes using logistic regression. The analysis included 9208 participants with prevalence data and 9193 with incidence data. The mean age of the sample was 51 ± 17 years, 49% were male, and the mean body mass index was 30 ± 8 kg/m2. The prevalence of kidney stones was 9.9% (95% confidence interval (CI): 8.7%-11.3%), and the incidence of stone passage was 1.8% (95% CI: 1.4%-2.4%). The most important covariates predicting kidney stone prevalence were a history of gallstones (OR = 2.89: 95% CI: 2.16-3.89, P < .001), hypertension (OR = 1.73: 95% CI: 1.06-2.83, P = .03), and chronic kidney disease (OR = 1.99: 95% CI: 1.01-3.90, P = .046). The same variables were most important in predicting the incidence of kidney stone passage: history of gallstones (OR = 2.66: 95% CI: 1.47-4.81, P = .002), chronic kidney disease (OR = 3.34: 95% CI: 1.01-11.01, P = .048), and hypertension (OR = 2.24: 95% CI: 1.17-4.27, P = .02). The self-reported prevalence and incidence of kidney stones in the US adult population between 2017 and 2020 were 9.9% and 1.8%, respectively. History of gallstones, hypertension, and chronic kidney disease were important predictors of both outcomes. Individuals with these risk factors may require more frequent monitoring or targeted preventative lifestyle interventions.
目的:确定美国成年人肾结石的患病率、发病率和决定因素。 这项横断面观察性研究评估了 2017 年至 2020 年全国健康与营养调查中肾结石的终生患病率和 12 个月内肾结石通过的发病率。研究采用调查统计方法,使用逻辑回归法估算肾结石患病率和发病率以及患者特征与这些结果的关联。 分析包括9208名有患病率数据的参与者和9193名有发病率数据的参与者。样本的平均年龄为 51 ± 17 岁,49% 为男性,平均体重指数为 30 ± 8 kg/m2。肾结石患病率为 9.9%(95% 置信区间:8.7%-11.3%),结石排出率为 1.8%(95% 置信区间:1.4%-2.4%)。预测肾结石发病率最重要的协变量是胆结石病史(OR = 2.89:95% CI:2.16-3.89,P < .001)、高血压(OR = 1.73:95% CI:1.06-2.83,P = .03)和慢性肾病(OR = 1.99:95% CI:1.01-3.90,P = .046)。同样的变量对预测肾结石通过的发生率最为重要:胆结石病史(OR = 2.66:95% CI:1.47-4.81,P = .002)、慢性肾病(OR = 3.34:95% CI:1.01-11.01,P = .048)和高血压(OR = 2.24:95% CI:1.17-4.27,P = .02)。 2017年至2020年间,美国成年人口中自我报告的肾结石患病率和发病率分别为9.9%和1.8%。胆结石病史、高血压和慢性肾病是这两种结果的重要预测因素。有这些风险因素的人可能需要更频繁的监测或有针对性的预防性生活方式干预。
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引用次数: 0
Effect of 3-Dimensional, Virtual Reality Models for Surgical Planning of Robotic Partial Nephrectomy on Surgical Outcomes: Qualitative Data from a Randomized Clinical Trial 用于机器人肾部分切除术手术规划的三维虚拟现实模型对手术结果的影响:来自随机临床试验的定性数据
Pub Date : 2024-01-01 DOI: 10.1097/ju9.0000000000000101
J. Shirk, David D. Thiel, Eric M. Wallen, Jennifer M. Linehan, Wesley M. White, K. Badani, James R. Porter
Planning for robotic-assisted partial nephrectomy requires surgeons to review two-dimensional CT or MRI scans to understand three-dimensional (3D) anatomy. We sought to determine the drivers of improvements in key surgical outcomes when using patient-specific 3D virtual reality (VR) models for operative planning. A multicenter, randomized, single-blind clinical trial was conducted from January 2019 to December 2020. Patients undergoing robotic-assisted partial nephrectomy were randomly assigned to a control group undergoing usual preoperative planning with CT and/or MRI only or to an intervention group where imaging was supplemented with a 3D VR model. A survey was administered to surgeons after review of the model and after the operation. The primary outcome measure was operative time, and secondary outcomes included clamp time, estimated blood loss, and hospital stay. Qualitative data analysis of 44 cases in the treatment arm was performed. Surgeons reported seeing anatomic details much better in the 3D model 55% of the time and modified their preoperative plan based on anatomy shown in the 3D model 30% of the time. Cases in which the surgeon reported modifying their preoperative plan after viewing the model (30%) had significantly lower operative time, blood loss, and clamp time (P < .05). In addition, increased surgeon confidence after viewing the model significantly lowered operative time, estimated blood loss, and clamp time (P < .05). We demonstrate that surgeons who use 3D VR models for robotic kidney surgery are able to visualize anatomic structures and select the optimal approach, leading to better surgical outcomes. ClinicalTrials.gov identifier NCT0333434.
规划机器人辅助肾部分切除术需要外科医生查看二维 CT 或 MRI 扫描,以了解三维(3D)解剖结构。我们试图确定在使用患者特异性三维虚拟现实(VR)模型进行手术规划时改善关键手术结果的驱动因素。 我们于 2019 年 1 月至 2020 年 12 月进行了一项多中心、随机、单盲临床试验。接受机器人辅助肾部分切除术的患者被随机分配到对照组,仅使用CT和/或MRI进行常规术前规划;或分配到干预组,使用3D VR模型对成像进行补充。外科医生在查看模型后和手术后都要接受调查。主要结果是手术时间,次要结果包括钳夹时间、估计失血量和住院时间。 对治疗组的 44 个病例进行了定性数据分析。55%的外科医生表示在三维模型中能更好地看到解剖细节,30%的外科医生根据三维模型中显示的解剖结构修改了他们的术前计划。外科医生表示在观看模型后修改术前计划的病例(30%)的手术时间、失血量和钳夹时间都明显减少(P < .05)。此外,外科医生在观看模型后信心增强,也大大缩短了手术时间、估计失血量和钳夹时间(P < .05)。 我们证明,使用三维 VR 模型进行机器人肾脏手术的外科医生能够直观地观察解剖结构并选择最佳方法,从而获得更好的手术效果。 ClinicalTrials.gov 标识符 NCT0333434。
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引用次数: 0
Polymer-Coated Urinary Catheter Reduces Biofilm Formation and Biomineralization: A First-in-Man, Prospective Pilot Study 聚合物涂层导尿管可减少生物膜形成和生物矿化:首例前瞻性试点研究
Pub Date : 2024-01-01 DOI: 10.1097/ju9.0000000000000097
K. Kalenderski, J. Dubern, C. Lewis-Lloyd, Nicola Jeffery, Stephan Heeb, Derek J. Irvine, Tim J. Sloan, Brian Birch, Daniela Andrich, David Humes, Morgan R Alexander, P. Williams
Biofilm formation and biomineralization on urinary catheters may cause severe complications including infection and obstruction. Here, we describe an in vitro evaluation and prospective pilot clinical study of a silicone catheter coated with a biofilm-resistant polymer. Biofilm biomass and biomineralization on uncoated and coated catheters were quantified by confocal microscopy using fluorescently tagged bacteria or stained for biofilm and minerals. Biomineral identity was determined using scanning electron microscopy and X-ray spectroscopy. Biofilm formation and biomineralization were evaluated in vitro using uropathogens Proteus mirabilis and Pseudomonas aeruginosa and on catheters recovered from hospitalized patients. Fibrinogen in patient urine and on catheters was quantified using an immunofluorescence assay. In vitro P. mirabilis and P. aeruginosa formed significantly less biofilm and biomineral and failed to block coated compared with uncoated catheters in a bladder model after 89 h. Biofilm-resistant polymer-coated catheters (n = 83) recovered from hospitalized patients exhibited significantly lower biofilm biomass and biomineralization compared with uncoated silicone catheters (n = 78). Electron microscopy with elemental analysis of recovered catheters revealed calcium oxalate crystals on coated compared with the struvite and apatite crystals on uncoated catheters associated with catheter blockage. Lower levels of biofilm-promoting fibrinogen in postcatheterization urine and on catheters from patients receiving coated catheters was observed compared with those receiving uncoated catheters indicative of a reduced inflammatory response. These data provide evidence that polymer-coated urinary catheters exhibit enhanced resistance to fibrinogen deposition, biofilm formation, and encrustation, reducing the risks associated with catheter-associated urinary tract infections and obstruction.
导尿管上生物膜的形成和生物矿化可能会导致严重的并发症,包括感染和阻塞。在此,我们介绍了对涂有抗生物膜聚合物的硅胶导尿管进行的体外评估和前瞻性试点临床研究。 使用荧光标记细菌或生物膜和矿物质染色,通过共聚焦显微镜对未涂层和涂层导尿管上的生物膜生物量和生物矿化进行量化。使用扫描电子显微镜和 X 射线光谱法确定生物矿物质的特征。利用泌尿病原体奇异变形杆菌和铜绿假单胞菌以及从住院患者身上回收的导管,在体外对生物膜的形成和生物矿化进行了评估。使用免疫荧光检测法对患者尿液和导管中的纤维蛋白原进行了量化。 在膀胱模型中,与未涂层导管相比,体外奇异变形杆菌和铜绿假单胞菌形成的生物膜和生物矿化物明显较少,且在 89 小时后未能阻塞涂层导管。与未涂层硅胶导管(n = 78)相比,从住院患者身上回收的抗生物膜聚合物涂层导管(n = 83)显示出明显较低的生物膜生物量和生物矿化。对回收的导管进行电子显微镜和元素分析后发现,与未涂层导管上与导管堵塞有关的结石和磷灰石晶体相比,涂层导管上有草酸钙晶体。与接受未涂层导管的患者相比,接受涂层导管的患者导管术后尿液和导管上的生物膜促进纤维蛋白原水平较低,这表明炎症反应有所减轻。 这些数据证明,有聚合物涂层的导尿管对纤维蛋白原沉积、生物膜形成和结壳有更强的抵抗力,从而降低了导尿管相关尿路感染和梗阻的风险。
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引用次数: 1
Practice Patterns and Patient Experience of Care Among US Veterans with Prostate Cancer: A 10-Year Scoping Review 美国退伍军人前列腺癌患者的诊疗模式和护理体验:十年范围审查
Pub Date : 2024-01-01 DOI: 10.1097/ju9.0000000000000106
Mital Patel, Erin Turner, Natalie C. Edwards, Olubiyi Aworunse, Samir Bhattacharyya
This study evaluated and synthesized the literature on prostate cancer practice patterns and patient experience of care within the US Veterans Affairs (VA) population. A scoping review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews standards. Search terms were prostate cancer, Veterans, treatment patterns, healthcare, resource, patient experience, quality of care, healthcare quality. The search was limited to human studies published in English in the past 10 years (2013-2022). Studies were included if they evaluated treatment patterns, health care resource use, and/or patient experience of care among US Veterans with prostate cancer. Among 150 included studies, most were retrospective VA database evaluations (n = 119, 79.3%) or retrospective cohort studies (n = 8, 5.3%), with the remaining being prospective observational cohort studies (n = 16, 10.7%), randomized controlled trials (n = 5, 3.3%), a meta-analysis (n = 1, 0.7%), and a provider survey (n = 1, 0.7%). Sample sizes ranged from 11 to 214,649 patients. The most common topics were pharmacological therapies (n = 28), racial/ethnic disparities (n = 27), and definitive radiation therapy or radical prostatectomy (n = 24). Some studies indicated Veterans may not have access to the same quality of prostate cancer care compared with the general population. Opportunities for improvement in shared decision making remain. Some findings from this scoping review indicate that Veterans may not have access to the same quality of prostate cancer care compared with the US general population. Research is needed to confirm whether observed practice pattern differences are warranted given the potential negative care impact.
本研究评估并综合了有关美国退伍军人事务局(VA)人群中前列腺癌诊疗模式和患者护理体验的文献。 根据《系统综述和荟萃分析扩展报告的首选报告项目》(Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews)标准进行了范围界定综述。检索词为前列腺癌、退伍军人、治疗模式、医疗保健、资源、患者体验、护理质量、医疗保健质量。搜索仅限于过去 10 年(2013-2022 年)内用英语发表的人类研究。对美国退伍军人前列腺癌患者的治疗模式、医疗资源使用情况和/或患者就医体验进行评估的研究均被纳入。 在 150 项纳入的研究中,大部分是退伍军人数据库回顾性评估(119 项,占 79.3%)或回顾性队列研究(8 项,占 5.3%),其余为前瞻性观察性队列研究(16 项,占 10.7%)、随机对照试验(5 项,占 3.3%)、荟萃分析(1 项,占 0.7%)和医疗服务提供者调查(1 项,占 0.7%)。样本量从 11 到 214,649 例患者不等。最常见的主题是药物疗法(n = 28)、种族/民族差异(n = 27)以及确定性放射治疗或根治性前列腺切除术(n = 24)。一些研究表明,与普通人群相比,退伍军人可能无法获得同等质量的前列腺癌治疗。在共同决策方面仍有改进的余地。 本次范围界定综述的一些研究结果表明,与美国普通人群相比,退伍军人可能无法获得同等质量的前列腺癌治疗。鉴于潜在的负面护理影响,需要进行研究以确认观察到的实践模式差异是否合理。
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引用次数: 0
A Propensity Score–Matched Analysis of the Impact of Carcinoma In Situ on the Clinical Outcomes in Patients with Upper Tract Urothelial Carcinomas—A Nationwide Multi-Institutional Cohort Study 原位癌对上尿路癌患者临床结局影响的倾向得分匹配分析--一项全国性多机构队列研究
Pub Date : 2024-01-01 DOI: 10.1097/ju9.0000000000000098
Shin Mei Wong, H. Ke, Wei‐Ming Li, Chao-Hsiang Chang, Chi-Ping Huang, Shu-Yu Wu, Yao-Zhou Tsai, Steven K. Huang, Wen-Hsin Tsing, I. Chen, Jen-Tai Lin, Chung-You Tsai, P-Y. Cheng, Yuan-Hong Jiang, Yu-Khun Lee, B. Chiang, Yung-Tai Chen, Leonard S. Chuech, Thomas Y. Hsueh, W. Lin, Chia-Chang Wu, Jen-Shu Tseng, Pi-Che Chen, Chao-Yuan Huang, Jian-Hua Hong
This study aimed to explore the clinical prognostic features of patients treated with radical nephroureterectomy for upper tract urothelial carcinoma (UTUC) with carcinoma in situ (CIS) compared with those without it. We retrospectively reviewed the data of 3285 patients with UTUC. Propensity scores were calculated using a logistic regression model to regress disease status on various baseline covariates, including cell type, tumor size, histology, lymphovascular invasion, surgical margin, and pathological stage. Using these scores, we adopted a one-to-two pair matching approach to form matched pairs between the two groups, ensuring patients within each pair had similar propensity score values. Prognostic factors were identified using univariate and multivariate Cox regression models. The Kaplan-Meier method was used to estimate the rates of prognostic outcomes, and survival curves were compared using the stratified log-rank test. Matched cohorts of 810 patients without and 405 with CIS from each group were compared. There was no discernible difference in the 5-year overall survival. The Kaplan-Meier curves for cancer-specific survival were significantly different in the adjusted group only (P = .043). Multivariate Cox regression analyses indicated that disease-free and bladder recurrence-free survival rates were similar between the two groups. The CIS status was not significantly correlated with the disease-free or bladder recurrence-free survival (P = .066 and .179, respectively). Patients with UTUC with CIS did not exhibit significantly worse oncologic outcomes than those without it.
本研究旨在探讨上尿路膀胱癌(UTUC)伴原位癌(CIS)的根治性肾切除术患者与非原位癌患者的临床预后特征。 我们对 3285 名 UTUC 患者的数据进行了回顾性研究。我们使用逻辑回归模型计算了倾向评分,将疾病状态与各种基线协变量(包括细胞类型、肿瘤大小、组织学、淋巴管侵犯、手术切缘和病理分期)进行回归。利用这些评分,我们采用一对二配对的方法在两组之间形成配对组,确保每对配对组中的患者具有相似的倾向评分值。我们使用单变量和多变量 Cox 回归模型确定了预后因素。采用 Kaplan-Meier 法估算预后结果的发生率,并使用分层对数秩检验比较生存曲线。 比较了每组 810 名无 CIS 患者和 405 名 CIS 患者的匹配队列。5年总生存率没有明显差异。癌症特异性生存率的 Kaplan-Meier 曲线仅在调整后的组别中存在显著差异(P = .043)。多变量 Cox 回归分析表明,两组患者的无病生存率和无膀胱复发生存率相似。CIS状态与无病生存率和无膀胱复发生存率无明显相关性(P = .066 和 .179)。 与无CIS的UTUC患者相比,有CIS的UTUC患者的肿瘤治疗效果并不明显更差。
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引用次数: 0
JU Open Plus: The Cultures of Our Meetings JU Open Plus:我们的会议文化
Pub Date : 2024-01-01 DOI: 10.1097/ju9.0000000000000119
John W. Davis
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引用次数: 0
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