Exploring positive surgical margins after minimally invasive radical prostatectomy: Does body habitus really make a difference ?

BACKGROUND: Positive surgical margins (PSMs) at radical prostatectomy (RP) are generally recognized as a surrogate of poor or difficult dissection of the prostatic gland. In open RP cohorts, obesity seems to be associated to an increased risk of PSMs, probably due to the technical challenge that obese men pose to surgical access. Minimally invasive RP has been claimed to possibly reduce PSM rate. Aim of the study was to explore the impact of obesity and body habitus on PSM risk and their localisation during laparoscopic and robotic-assisted RP. MATERIALS AND METHODS: We reviewed 539 prospectively enrolled patients undergoing laparoscopic and robotic-assisted RP with pT2 prostate cancer. The outcome measured was rate of PSM according to the BMI and surgical approach (laparoscopic vs robotic-assisted). Patients were categorized in BMI<25kg/m2, BMI 25-29.9kg/m2 and BMI >30kg/m2 groups respectively and compared using Kruskall-Wallis or χ2 test, as appropriate. Uni- and multivariate logistic regression models were constructed to assess the impact of BMI and surgical technique on PSM risk. RESULTS: Overall, 127 (24%) of men had PSMs detected at final specimen evaluation. Mean PSM length was 3.9±3.4mm, and 30 (6%) men presented significant margins ≥4mm. Analysing the rate of PSMs across BMI categories, no significant association between increased BMI and PSM was detected (all P>0.48). On uni- and multivariate logistic regression BMI was not a statistically significant risk factor for PSM (P=0.14), nor was the minimally invasive technique (laparoscopic vs robotic-assisted) (P=0.54). CONCLUSIONS: In this study obese men do not appear to have a significant increase in risk of PSMs at RP compared to lean and overweight men when operated by a minimally invasive approach. The magnified vision and increased access to the pelvis allowed by a laparoscopic and robotic-assisted approach may be accountable for our findings. Larger studies are needed to validate our results. LEVEL OF PROOF: 4.

A characterization of grapevine trunk diseases in France from data generated by the National Grapevine Wood Diseases Survey.

Farmers' field survey data sets represent extremely valuable information, often having a heterogeneous data format. A large number of methods are available to process this kind of information, which may be combined to address successive, connected hypotheses, with definite objectives. The National Grapevine Trunk Diseases Survey was established in France in order to monitor and analyze the importance and progress of several grapevine diseases, in particular Eutypa dieback and Esca decline. Here we report a first series of analyses pertaining to the years 2003 to 2005 to characterize the incidences of the two diseases, as well as grapevine mortality, in relation to grapevine age, crop management, cultivars, and growing regions. Information representing 256 individual vineyards indicated mean incidences of 2.23 and 3.25% for Eutypa dieback and Esca decline, respectively. A combination of approaches (hierarchical cluster analysis, multiple correspondence analyses, and binomial logistic regressions) indicated distinct patterns of variation in the incidences of the two diseases according to crop management practices; limited linkage of specific crop management practices with diseases, especially Esca decline; a shared contribution of both diseases to mortality; and a weak linkage of the (now banned) arsenite-based pesticides with reduced Esca decline symptoms, but no such association with grapevine mortality. Differences and complementarities of the analytical approaches are discussed, as well as the implications of these analyses on grapevine health.

Aluminum acid alizarin violet: a general purpose nuclear fluorochrome.

Acid alizarin violet N in an acidified aluminum potassium sulfate solution (AAV) is presented as a nuclear fluorochrome. We demonstrate using 1 N HCl, deoxyribonuclease, and ribonuclease digestion methods that this stain has specificity for nucleic acids similar to other aluminum mordant stains in 95% ethanol-fixed material. The method presented gives stable preparations and is resistant to fading for at least two years. Strong fluorescence of AAV stained material is detected under conventional mercury vapor lamp and argon ion laser illumination. AAV stained confocal scanning laser microscope (CSLM) images are collected in the red channel of the microscope (detecting lambda > 600 nm), there being no AAV emission in the green channel (detecting lambda 527-565 nm). The xanthene dyes eosin Y and dichlorofluorescein are used as counterstains and can be imaged in both channels. We present a method for use with the CSLM, utilizing double imaging techniques.

Team building with information system departments: a hospital librarian's experience in coexisting, collaborating, and cooperating.

Hospital librarians and information systems (IS) staff regard themselves as information professionals and have coexisted in the same institutions for many years. While hospital librarians have increased their computer literacy, IS staff have begun to recognize the value of knowledge-based information as an IS resource. Parallel growth and mutual interest have resulted in increased opportunities for information professionals to share skills and network for mutual advantage. Creating positive relationships between the hospital librarian and IS staff can be critical to the success of the hospital library. This paper provides a framework in which to explore the levels of relationship that exist within institutions between hospital librarians and IS staff. The "knowing/caring ladder" is presented as a model to illustrate levels of relationship and their consequences. The authors contend that recognition of the levels of professional relationship determines the success or failure of team building.

Hearing impairment in idiopathic hypoparathyroidism and pseudohypoparathyroidism.

Sensorineural hearing impairment is a lesser known feature of hypoparathyroidism. The hearing of 20 patients with idiopathic hypoparathyroidism was investigated by pure-tone audiometry. Bilateral sensorineural hearing loss was found in three (15%). Sensorineural hearing loss is considered to be associated with a prolonged low calcium level in the inner ear fluid and is a possible complication of hypoparathyroidism.