Steve Kim

Human capital gains associated with robotic assisted laparoscopic pyeloplasty in children compared to open pyeloplasty.

PURPOSE Robotic assisted laparoscopic pyeloplasty is an emerging, minimally invasive alternative to open pyeloplasty in children for ureteropelvic junction obstruction. The procedure is associated with smaller incisions and shorter hospital stays. To our knowledge previous outcome analyses have not included human capital calculations, especially regarding loss of parental workdays. We compared perioperative factors in patients who underwent robotic assisted laparoscopic and open pyeloplasty at a single institution, especially in regard to human capital changes, in an institutional cost analysis. MATERIALS AND METHODS A total of 44 patients 2 years old or older from a single institution underwent robotic assisted (37) or open (7) pyeloplasty from 2008 to 2010. We retrospectively reviewed the charts to collect demographic and perioperative data. The human capital approach was used to calculate parental productivity losses. RESULTS Patients who underwent robotic assisted laparoscopic pyeloplasty had a significantly shorter average hospital length of stay (1.6 vs 2.8 days, p <0.05). This correlated with an average savings of lost parental wages of

Cryptorchidism and testicular germ cell tumors: comprehensive meta-analysis reveals that association between these conditions diminished over time and is modified by clinical characteristics

90.01 and hospitalization expenses of

Shorter Androgen Receptor CAG Repeat Lengths Associated with Cryptorchidism Risk among Hispanic White Boys

612.80 per patient when excluding amortized robot costs. However, cost savings were not achieved by varying length of stay when amortized costs were included. CONCLUSIONS Robotic assisted laparoscopic pyeloplasty in children is associated with human capital gains, eg decreased lost parental wages, and lower hospitalization expenses. Future comparative outcome analyses in children should include financial factors such as human capital loss, which can be especially important for families with young children.

Early comparison of nephrectomy options in children (open, transperitoneal laparoscopic, laparo-endoscopic single site (LESS), and robotic surgery)

Introduction: Risk of testicular germ cell tumors (TGCT) is consistently associated with a history of cryptorchidism (CO) in epidemiologic studies. Factors modifying the association may provide insights regarding etiology of TGCT and suggest a basis for individualized care of CO. To identify modifiers of the CO-TGCT association, we conducted a comprehensive, quantitative evaluation of epidemiologic data. Materials and Methods: Human studies cited in PubMed or ISI Web of Science indices through December 2011 and selected unpublished epidemiologic data were reviewed to identify 35 articles and one unpublished dataset with high-quality data on the CO-TGCT association. Association data were extracted as point and 95% confidence interval estimates of odds ratio (OR) or standardized incidence ratio (SIR), or as tabulated data. Values were recorded for each study population, and for subgroups defined by features of study design, CO and TGCT. Extracted data were used to estimate summary risk ratios (sRR) and evaluate heterogeneity of the CO-TGCT association between subgroups. Results: The overall meta-analysis showed that history of CO is associated with four-fold increased TGCT risk [RR = 4.1(95% CI = 3.6–4.7)]. Subgroup analyses identified five determinants of stronger association: bilateral CO, unilateral CO ipsilateral to TGCT, delayed CO treatment, TGCT diagnosed before 1970, and seminoma histology. Conclusions: Modifying factors may provide insight into TGCT etiology and suggest improved approaches to managing CO. Based on available data, CO patients and their parents or caregivers should be made aware of elevated TGCT risk following orchidopexy, regardless of age at repair, unilateral vs. bilateral non-descent, or position of undescended testes.

Predicting DNA methylation susceptibility using CpG flanking sequences.

CONTEXT Cryptorchidism is the most frequent congenital malformation among males, the major established risk factor for testicular germ cell tumors, and a presumed infertility risk factor. Androgens are essential for testicular descent, and functional genetic polymorphisms in the androgen receptor gene (AR) are postulated to influence cryptorchidism risk. OBJECTIVE The aim of the study was to investigate whether the CAG repeat length polymorphism in exon 1 of the AR is associated with cryptorchidism risk. DESIGN AND SETTING We conducted a family-based genotype-risk association study employing the transmission disequilibrium test for genotypic variants transmitted on the X-chromosome at a university-affiliated regional childrens hospital. PARTICIPANTS We studied 127 Hispanic boys with persistent cryptorchidism and comorbidities described in detail and their biological mothers. INTERVENTION Genotypes defined by number of CAG repeats were measured for each member of participating son-mother pairs. MAIN OUTCOME MEASURE Associations between CAG tract length genotype and cryptorchidism risk were estimated using matched-pairs logistic regression. RESULTS Cryptorchidism risk was significantly associated with shorter CAG repeats [CAG≤19 vs. CAG≥20, odds ratio (OR)=0.44; 95% confidence interval (CI), 0.23-0.88]. This association was restricted to cryptorchidism with accompanying comorbidities, which was primarily hernia [CAG≤19 vs. CAG≥20, OR=0.35 (95% CI, 0.16-0.78)], and was strongest for bilateral cryptorchidism [CAG≤19 vs. CAG≥20, OR=0.09 (95% CI, 0.010-0.78)]. CONCLUSIONS Androgen receptor genotypes encoding moderate functional variation may influence cryptorchidism risk, particularly among boys with bilateral nondescent or congenital hernia, and may explain in part the elevated risk of testicular seminoma experienced by ex-cryptorchid boys. Mechanistic research is warranted to examine both classical and nonclassical mechanisms through which androgens may influence risk of cryptorchidism and related conditions.

Aberrant activation of Notch signaling inhibits PROX1 activity to enhance the malignant behavior of thyroid cancer cells

Study Type – Therapy (case series)

MP18-11 PEDIATRIC NEPHROLITHIASIS: PRACTICE PATTERNS AND COST OF SURGICAL MANAGEMENT

DNA methylation is a type of chemical modification of DNA that adds a methyl group to DNA at the fifth carbon of the cytosine pyrimidine ring. In normal cells, methylation of CpG dinucleotides is extensively found across the genome. However, specific DNA regions known as the CpG islands, short CpG dinucleotide-rich stretches (500 bp - 2000bp), are commonly unmethylated. During tumorigenesis, on the other hand, global de-methylation and CpG island hypermethylation are widely observed. De novo hypermethylation at CpG dinucleotides is typically associated with loss of expression of flanking genes, thus it is believed to be an alternative to mutation and deletion in the inactivation of tumor suppressor genes. In this paper, we report that sequences flanking CpG sites can be used for predicting DNA methylation levels. DNA methylation levels were measured by utilizing a new high throughput sequencing technology (454) to sequence bisulfite treated DNA from four types of primary leukemia and lymphoma cells and normal peripheral blood lymphocytes. After measuring methylation levels at each CpG site, we used 30 bp flanking sequences to characterize methylation susceptibility in terms of character compositions and built predictive models for DNA methylation susceptibility, achieving up to 75% prediction accuracy in 10-fold cross validation tests. Our study is first of its kind to build predictive models for methylation susceptibility by utilizing CpG site specific methylation levels.

Link aggregation path selection method

Papillary thyroid cancer (PTC) is one of the most common endocrine malignancies associated with significant morbidity and mortality. Although multiple studies have contributed to a better understanding of the genetic alterations underlying this frequently arising disease, the downstream molecular effectors that impact PTC pathogenesis remain to be further defined. Here, we report that the regulator of cell fate specification, PROX1, becomes inactivated in PTC through mRNA downregulation and cytoplasmic mislocalization. Expression studies in clinical specimens revealed that aberrantly activated NOTCH signaling promoted PROX1 downregulation and that cytoplasmic mislocalization significantly altered PROX1 protein stability. Importantly, restoration of PROX1 activity in thyroid carcinoma cells revealed that PROX1 not only enhanced Wnt/β-catenin signaling but also regulated several genes known to be associated with PTC, including thyroid cancer protein (TC)-1, SERPINA1, and FABP4. Furthermore, PROX1 reexpression suppressed the malignant phenotypes of thyroid carcinoma cells, such as proliferation, motility, adhesion, invasion, anchorage-independent growth, and polyploidy. Moreover, animal xenograft studies demonstrated that restoration of PROX1 severely impeded tumor formation and suppressed the invasiveness and the nuclear/cytoplasmic ratio of PTC cells. Taken together, our findings demonstrate that NOTCH-induced PROX1 inactivation significantly promotes the malignant behavior of thyroid carcinoma and suggest that PROX1 reactivation may represent a potential therapeutic strategy to attenuate disease progression.

Low cost link aggregation method and system

INTRODUCTION AND OBJECTIVES: Extracorporeal shockwave lithotripsy (ESWL) previously predominated in the surgical management of pediatric nephrolithiasis. More recently, ureteroscopy (URS) has been increasingly utilized as improvements in endoscopic instrumentation have been made. Additionally, studies have demonstrated that URS has better stone-free rates and acceptable complication rates compared to ESWL. This study examines the cost and pattern of surgical management associated with pediatric stones in two private insurer databases. METHODS: Claims from the Humana and Ingenix administrative databases were queried using appropriate current procedural terminology (CPT) and international classification of disease, 9th Revision (ICD-9) codes between 2004 and 2012. Procedural, associated medication, outpatient, and emergency room (ER) utilization and costs were analyzed. RESULTS: 1100 procedures in 618 pediatric patients were identified (368 primary URS, 250 primary ESWL). The average total cost associated with primary URS and ESWL were

A COMPARATIVE STUDY BETWEEN LAPAROSCOPIC AND ROBOTICALLY ASSISTED PYELOPLASTY IN THE PEDIATRIC POPULATION

2671 95% CI [