Influence of tumor size in the progression of venous tumor thrombus in renal cell carcinoma: A 7-year single-center experience.

Objective: The objective of the study is to describe the perioperative outcomes, disease-specific, and overall survival status in patients diagnosed with renal cell carcinoma with inferior vena cava (IVC) tumor thrombus. Patients and Methods: We did a retrospective analysis of all patients who underwent radical nephrectomy along with IVC thrombectomy from the year 2013 to 2020. Mayo's classification was used to stratify the level of IVC thrombus. Demographic, perioperative, histopathology data, complications, and survival status were analyzed. Results: Total number of patients included in the study was 39, (Male: Female = 84.6%: 15.4%). Median age of patients was 58 (interquartile range [IQR] 50-63) years. Median size of renal tumor (in cms) was 9.5 (IQR 7.5-12), 8 (IQR 7-11.5), 8.5 (IQR 7-11.75), and 11 (IQR 9.5-11) (P = 0.998) in level 1,2,3, and 4 tumors, respectively. Clear cell variant was seen in 32 patients (82%) with R0 resection in 17 patients. Twelve patients (30.7%) had systemic metastasis on presentation. The overall mean survival time was 66.4 months with 95% confidence interval (CI) (52.4-80.5 months). Mean recurrence-free survival is 76 months with (63-90) CI of 95%. Mean survival in patients who presented with metastasis is 47 months with 95% CI (52.4-80.5). Perioperative mortality rate was 5.12% in this study. Conclusion: The tumor size does not have an influence on the progression of tumor thrombus into IVC. Significant difference in survival was observed between different levels of thrombus with high mortality in level four tumors.

Propositional Inference for IoT Based Dosage Calibration System Using Private Patient-Specific Prescription against Fatal Dosages.

IoT-based insulin pumps are used to deliver precise quantities of insulin to diabetic patients to regulate blood glucose levels. Generally, these levels correspond to the dietary patterns observed at time intervals that vary between patients. However, any misrepresentation in insulin levels may lead to fatal consequences. As a result, most IoT-based insulin pumps are rejected due to the possibility of external threats, which include software and hardware attacks. However, IoT-based insulin pumps are extremely useful in real-time patient monitoring, and for controlled insulin delivery to the patient based on their current glucose level. We propose a blockchain-based method to protect against the above-mentioned attacks. The system creates a patient-specific private blockchain wherein the dosage information is added as a new block by obtaining the approval of the doctor, chief doctor, nurse, and caretaker of the patient who are authorized blockchain miners. Secondly, it securely transfers prescription data, such as dosage quantity and time of delivery, to the IoT insulin pump, which ensures the dosage information is not modified during transit before insulin administration to the patient. The proposed approach uses a state-behavior-based solution that detects anomalies in the behavior of the insulin pump via temporal data analysis and immutable ledger verification, which are designed to eliminate fatal dosages in case of anomalies. The system is designed to work within binary outcome conditions, i.e., it verifies and delivers dosage or halts. There is no middle ground that an attacker can exploit, resulting in accountability for the system.

A Prospective Study on the Efficacy of Cognitive Targeted Transrectal Ultrasound Prostate Biopsy in Diagnosing Clinically Significant Prostate Cancer.

PURPOSE: We present our study, done to identify the diagnostic yield of cognitive targeted biopsy using mpMRI data, to diagnose clinically significant prostate cancers, in a cohort of biopsy and treatment naive men. MATERIALS AND METHODS: This is a prospective, single institutional study, done from September 2018 to March 2020 in 75 biopsy naive men. The patients with 3, 4 and 5 PIRADS scores underwent mpMRI cognitive target biopsy (mpMRI CTB) followed by standard biopsy (SB) in the same setting by two different urologists. Diagnostic yield of biopsy cores, complications, and stage migration of Gleason's grades was analyzed. RESULTS: Out of 75 patients, 34.6% had abnormal digital rectal examination (DRE), and the median serum PSA was 10.6 (4.5-20) ng/mL. Total MRI suspicious lesions were 163. Out of 1263 SB cores, 371 cores were positive for cancer (29.35%), and out of 326 mpMRI CTB cores, 120 were positive for cancer (36.8%) (P<0.0001). Histopathological examination (HPE) revealed 88%, 92%, and 100% clinically significant cancers in PIRADS 3, 4 and 5 lesions. SB and mpMRI CTB in combination have better cancer detection yield than either of the modality when used alone (P-<0.0001). Clavien-Dindo grade 1 and grade 4a complication were seen in 47 (62.6%) and three (4%) patients. CONCLUSION: In biopsy-naive men with suspected prostate cancer and equivocal DRE, the addition of pre-biopsy mpMRI detects greater numbers of people with clinically significant prostate cancer when compared with SB alone. Combining SB with mpMRI CTB has a superior diagnosing ability when compared with either of the biopsy modalities when used alone.

Prospective analysis of laparoscopic versus open radical nephrectomy for renal tumours more than 7 cm.

AIMS: To analyse the feasibility of laparoscopic radical nephrectomy (LRN) for renal tumours >7 cm and to compare the operative and oncologic outcomes with open radical nephrectomy (ORN). SETTINGS AND DESIGN: This was a prospective, observational, comparative study. SUBJECTS AND METHODS: The study was conducted at a tertiary care super-speciality hospital. All the patients who underwent radical nephrectomy for >7 cm renal tumours during a period of 2 years (April 2012 to May 2014) were included in the study. Thirty patients were included in each ORN and LRN group. Pre-operative, intra-operative and post-operative data for all these patients were collected and analysed. STATISTICAL ANALYSIS USED: Statistical Package for the Social Sciences (SPSS, version 11.0 for Windows, Chicago, IL). RESULTS: Mean age of patients in ORN and LRN groups was 57.3 ± 6.1 years and 54.9 ± 5.7 years, respectively (P = 0.220). As compared to ORN, LRN had less drop in post-operative haemoglobin (1.39 ± 0.55 g/dl vs. 4.07 ± 1.023 g/dl, P < 0.05), less drop in haematocrit value (4.7 ± 3.25% vs. 9.5 ± 5.13%, P < 0.05), less analgesic requirement for tramadol hydrochloride (165 ± 74.5 mg vs. 260 ± 181.66 mg) and less mean hospital stay (4.2 days vs. 6.1 days, P < 0.05). There was no statistically significant difference in post-operative complication rate and recurrence-free survival over a median follow-up of 17 months (93.9% - LRN vs. 90% - ORN). CONCLUSIONS: LRN for large renal tumours is feasible and achieves oncologic outcomes similar to that obtained with ORN.