Publications by authors named "Silvia Proietti"

105 Publications

Retrograde Intrarenal Surgery Versus Miniaturized Percutaneous Nephrolithotomy for Kidney Stones >1cm: A Systematic Review and Meta-analysis of Randomized Trials.

Eur Urol Focus 2021 Feb 21. Epub 2021 Feb 21.

European Training Center in Endourology, Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.

Context: Although miniaturized percutaneous nephrolithotomy (mPCNL) and retrograde intrarenal surgery (RIRS) are both options for treating >1cm kidney stones, controversies exist on whether one is more effective and safer than the other.

Objective: To systematically appraise randomized trials comparing the effectiveness and safety of mPCNL and RIRS for treating >1cm kidney stones.

Evidence Acquisition: A systematic search on PubMed/Medline, Web of Science, Embase, and ClinicalTrials.gov was conducted in August 2020 following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA). Randomized trials comparing mPCNL and RIRS for >1cm kidney stones, and reporting stone-free rate (SFR), hemoglobin drop, transfusion rate, length of hospital stay (LOS), and/or complications, were included.

Evidence Synthesis: Eight studies compared mPCNL and RIRS, but one was not included due to its high risk of bias. SFR was higher for mPCNL (RR: 1.06 [95% coefficient interval {CI}, 1.01-1.10], p=0.008). Hemoglobin drop was higher for mPCNL (mean difference [MD]: 0.35 [95% CI, 0.05-0.65] g/dl, p=0.02); however, transfusion rates were similar (p=0.44). Complication rate was similar between mPCNL and RIRS (p=0.39), and the LOS was higher for mPCNL (MD: 1.11 [95% CI, 0.06-2.16] d, p=0.04). A subgroup analysis of lower pole stones showed that SFR was higher for mPCNL (RR: 1.09 [95% CI, 1.00-1.19], p=0.05).

Conclusions: Both approaches are effective and safe. Among these approaches, mPCNL has a higher SFR than RIRS for overall >1cm renal and lower pole stones, but longer LOS, and a higher hemoglobin drop that does not translate into higher transfusion rates. Complications are comparable.

Patient Summary: Randomized trials have evaluated whether miniaturized percutaneous nephrolithotomy (mPCNL) or retrograde intrarenal surgery is more effective and safer for treating >1cm stones. After comparing the stone-free rate, hemoglobin drop, transfusion rate, length of hospital stay, and complications between both the approaches, mPCNL was found to be slightly more effective, but both were equally safe.
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http://dx.doi.org/10.1016/j.euf.2021.02.008DOI Listing
February 2021

Editorial: Novel Plant Molecules Regulating the Interaction With Pathogenic and Beneficial Fungi.

Front Plant Sci 2021 27;12:644546. Epub 2021 Jan 27.

Department of Ecological and Biological Sciences, University of Tuscia, Viterbo, Italy.

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http://dx.doi.org/10.3389/fpls.2021.644546DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7873959PMC
January 2021

Laser Lithotripsy: The Importance of Peak Power and Pulse Modulation.

Eur Urol Focus 2021 Jan 30;7(1):22-25. Epub 2021 Jan 30.

Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.

Despite the worldwide spread of Ho:YAG lasers in urology departments, the physical principles behind their functioning may still seem obscure to many urologists. Moreover, a new laser source, the thulium fiber laser (TFL), was recently approved for stone lithotripsy. Here we describe the concepts of peak power and pulse modulation for laser lithotripsy, analyzing both Ho:YAG lasers and TFLs. Different pulse modalities are available for Ho:YAG lasers-long and short pulses and Moses technology-each with a different pulse shape and peak power. Lower peak power and a more rectangular pulse shape provide higher ablation efficiency and lower stone retropulsion. These characteristics are perfectly embodied by TFL, which shows the most effective ablation efficiency in laboratory studies. A long pulse is the most effective modality for Ho:YAG lasers. Moses technology, despite its promising rationale, is not superior to long-pulse mode. Clinical studies are needed in order to confirm these laboratory data. PATIENT SUMMARY: Laser lithotripsy is one of the main options for the treatment of urinary stones. The peak power and pulse modulation influence the choice of the optimal laser mode for the treatment of urinary stones. Thulium fiber lasers have shown the most favorable dusting profile in terms of both peak power and pulse modality in laboratory studies, but clinical evidence is still lacking.
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http://dx.doi.org/10.1016/j.euf.2021.01.012DOI Listing
January 2021

Endourologic Treatment of Late Migration of Embolization Causing Nephrolithiasis in Two Patients.

J Endourol Case Rep 2020 29;6(4):278-282. Epub 2020 Dec 29.

Ville Turro Division, Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.

Selective renal artery angioembolization is the first treatment option in case of significant bleeding after percutaneous nephrolithotomy. Migration of embolization material into the collecting system is extremely rare. The treatment of this condition is not standardized, but manual extraction, ultrasound fragmentation, and holmium laser lithotripsy have been described. We report the laser extraction of these coils in two patients at our center with two different approaches: retrograde intrarenal surgery (RIRS) and endoscopic combined intrarenal surgery (ECIRS). They were young male patients aged 25 and 29 years at the time of surgery, and they were 2-5 years postembolization when they presented to our center for symptoms such as hematuria and passage of small stone fragments. The first patient was managed solely with RIRS, whereas the second patient required ECIRS because of significant bleeding after coil removal, which necessitated hemostasis using a resectoscope. For patients who present with recurrent stones or other symptoms such as pain, hematuria, or flank pain, the diagnosis of migrated embolization coils should be considered. Management can be via the retrograde or percutaneous approach, but in the setting of significant amount of migrated coils or significant bleeding after their removal, percutaneous access may allow more definitive hemostasis.
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http://dx.doi.org/10.1089/cren.2020.0028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797275PMC
December 2020

Decision making and treatment options in endourology post-coronavirus disease 2019 - adapting to the future.

Curr Opin Urol 2021 03;31(2):109-114

Department of Urology, European Training Center of Endourology, IRCCS San Raffaele Hospital, Milan.

Purpose Of Review: To describe and critically discuss the most recent evidence regarding stone management during the coronavirus disease 2019 (COVID-19) and post-COVID-19 era.

Recent Findings: There is a need to plan for resuming the normal elective stone surgery in the post-COVID era, keeping a clear record of all surgeries that are being deferred and identifying subgroups of surgical priorities, for the de-escalation phase. Telehealth is very useful because it contributes to reduce virus dissemination guaranteeing at the same time an adequate response to patients' care needs. Once the pandemic is over, teleurology will continue to be utilized to offer cost-effective care to urological patients and it will be totally integrated in our clinical practice.

Summary: This COVID-19 pandemic represents a real challenge for all national health providers: on the one hand, every effort should be made to assist COVID patients, while on the other hand we must remember that all other diseases have not disappeared in the meanwhile and they will urgently need to be treated as soon as the pandemic is more under control. A correct prioritization of cases when surgical activity will progressively return back to normality is of paramount importance.
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http://dx.doi.org/10.1097/MOU.0000000000000857DOI Listing
March 2021

Re: "Prospective Evaluation of Bilateral Retrograde Intrarenal Surgery: Is It Really Safe?" by Danilovic et al.

J Endourol 2021 Apr 13;35(4):560. Epub 2020 Nov 13.

European Training Center in Endourology at Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.

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http://dx.doi.org/10.1089/end.2020.0867DOI Listing
April 2021

Holmium laser for RIRS. Watts are we doing?

Arch Esp Urol 2020 Oct;73(8):735-744

European Training Center in Endourology at Department of Urology. IRCCS San Raffaele Hospital. Ville Turro Division. Milan. Italy.

Objective: To review recent and relevant information regarding the use of high-power (HPL) and low-power (LPL) Holmium:YAG lasers (Ho:YAG) in retrograde intrarenal surgery (RIRS) for lithotripsy. METHODS: A PubMed/Embase search was conducted and recent and relevant papers on Ho:YAG for RIRS were reviewed.

Results: Settings for Ho:YAG are pulse energy (PE), pulse frequency (PF), and pulse width. Currently, the majority of LPL can also adjust pulse-width but cannot reach PF as high as HPL, however, the higher energy outputs reached by HPL are rarely useful in lithotripsy. Higher PE might enhance ablation but generates larger fragments and higher retropulsion. Pulse width does not affect energy output but delivers energy for a longer time-length. Dusting and basketing are complementary techniques. Dusting seeks to pulverize stones into particles ≤250 μm avoiding the use of instruments for stone retrieval, whereas in fragmenting, the stones are break into smaller pieces which are then retrieved. Dusting can prevent the use of supplies such as access sheaths and baskets and also prevent the complications related to their use. However, is not always feasible in clinical practice to fully ablate a stone into dust, then the use of this supplies and popcorn technique are helpful for rendering a patient stonefree. The energy gap between HPL and LPL is wide and leaves room for a mid-power laser classification, which can overcome the main drawback of LPL, the expenses of HPL, and still holding its versatility for other procedures beyond stones.

Conclusions: HPL and LPL have similar effectiveness, but long-term cost-effectiveness comparisons are underexplored. Newer HPL would need to be compared to emerging technologies as the thulium fiber, and prove superiority to mid-power laser to determine how powerful is enough for Ho:YAG in the years to come.
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October 2020

Prone versus supine percutaneous nephrolithotomy: a systematic review and meta-analysis of current literature.

Minerva Urol Nephrol 2021 Feb 5;73(1):50-58. Epub 2020 Oct 5.

Department of Urology, Campus Bio-Medico University, Rome, Italy.

Introduction: Percutaneous nephrolithotomy (PNL) can be performed either in prone or supine position. This study aimed at gathering together randomized controlled trials (RCTs) comparing efficacy and safety between prone and supine PNL.

Evidence Acquisition: Systematic review of literature was conducted using the Scopus, Medline and Web of Science databases. Study selection, data extraction and quality assessment were independently assessed by two authors. Meta-analysis was performed with Review Manager 5.3. Sensitivity analyses were performed to exclude studies with high risk of bias.

Evidence Synthesis: Pooled data from 12 studies including 1290 patients were available for analysis. Only one study was found to have overall low risk of bias. Significantly shorter operative time was found in favor of supine PNL (mean difference 13 minutes, 95% confidence interval [CI]: 3.4-22.7; P<0.01). Stone-free rate (SFR)≥14 days after surgery was significantly higher in prone PNL (odds ratio [OR]=2.15, 95% CI: 1.07-4.34; P=0.03). Significantly higher fever rate was found in prone PNL (OR=1.60, 95% CI: 1.03-2.47; P=0.04). Overall SFR, hospital stay length, complications rate, transfusions rate and blood loss, as well as non-lower calyx puncture rate, puncture attempts and tubeless intervention rate did not differ between prone and supine PNL (P>0.05).

Conclusions: Efficacy of PNL seems balanced between prone and supine position, with comparable overall SFR and shorter operative time in favor of supine PNL. Safety of PNL appears in favor of supine PNL, with lower fever rate. Because of study heterogeneity and possible risks of outcome bias, results from this study should be interpreted with caution. Altogether, both prone and supine PNL account for appropriate therapy options.
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http://dx.doi.org/10.23736/S0393-2249.20.03960-0DOI Listing
February 2021

Thulium:YAG Holmium:YAG Laser Effect on Upper Urinary Tract Soft Tissue: Evidence from an Experimental Study.

J Endourol 2021 Apr 7;35(4):544-551. Epub 2020 Sep 7.

Ville Turro Division, Department of Urology, European Training Center of Endourology, IRCCS San Raffaele Hospital, Milan, Italy.

There are limited data regarding the effect of thulium laser (Tm:YAG) and holmium laser (Ho:YAG) on upper urinary tract. The aim of this study was to compare soft tissue effects of these two lasers at various settings, with a focus on incision depth (ID) and coagulation area (CA). An experimental study was performed in a porcine model. The kidneys were dissected to expose the upper urinary tract and the block samples containing urothelium and renal parenchyma were prepared. The laser fiber, fixed on a robotic arm, perpendicular to the target tissue was used with a 100 W Ho:YAG and a 200 W Tm:YAG. Incisions were made with the laser tip in contact with the urothelium and in continuous movement at a constant speed of 2 mm/s over a length of 1.5 cm. Total energy varied from 5 to 30 W. Incision shape was classified as follows: saccular, triangular, tubular, and irregular. ID, vaporization area (VA), CA, and total laser area (TLA = VA + CA) were evaluated. Statistical analysis was performed using the SPSS V23 package, -values <0.05 were considered statistically significant. A total of 216 experiments were performed. Incision shapes were saccular (46%), triangular (38%), and irregular (16%) with the Ho:YAG, while they were tubular (89%) and irregular (11%) with the Tm:YAG. ID was significantly deeper with the Ho:YAG ( = 0.024), while CA and TLA were larger with the Tm:YAG ( < 0.001 and  < 0.005). ID was deeper with Ho:YAG, whereas CA and TLA were larger with the Tm:YAG. Considering surgical principles for endoscopic ablation of upper tract urothelial carcinoma, these results suggest that Tm:YAG may have a lower risk profile (less depth of incision) while also being more efficient at tissue destruction. Future studies are necessary to corroborate these findings.
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http://dx.doi.org/10.1089/end.2020.0222DOI Listing
April 2021

The performance improvement-score algorithm applied to endoscopic stone. Treatment step 1 protocol.

Minerva Urol Nefrol 2020 Aug 4. Epub 2020 Aug 4.

Department of Urology, University of Southampton, Southampton, UK.

Background: Pi-score (Performance Improvement score) has been proven to be reliable to measure performance improvement during E-BLUS hands-on training sessions. Our study is aimed to adapt and test the score to EST s1 (Endoscopic Stone Treatment step 1) protocol, in consideration of its worldwide adoption for practical training.

Methods: The Pi-score algorithm considers time measurement and number of errors from two different repetitions (first and fifth) of the same training task and compares them to the relative task goals, to produce an objective score. Data were obtained from the first edition of 'ART in Flexible Course', during 4 courses in Barcelona and Milan. Collected data were independently analysed by the experts for Pi assessment. Their scores were compared for inter-rater reliability. The average scores from all tutors were then compared to the PI-score provided by our algorithm for each participant, in order to verify their statistical correlation. Kappa Statistics was used for comparison analysis.

Results: 16 Hands-on Training expert tutors and 47 3rd year residents in Urology were involved. Concordance found between the 16 proctors' scores was the following: Task1=0.30 ("fair"); Task2=0.18 ("slight"); Task3=0.10 ("slight"); Task4=0.20, ("slight"). Concordance between Pi-score results and proctor average scores per-participant was the following: Task1=0.74 ("substantial"); Task2=0.71 ("substantial"); Task3=0.46 ("moderate"); Task4=0.49 ("moderate").

Conclusions: Our exploratory study demonstrates that Pi-score can be effectively adapted to EST s1. Our algorithm successfully provided an objective score that equals the average performance improvement scores assigned by of a cohort of experts, in relation to a small amount of training attempts.
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http://dx.doi.org/10.23736/S0393-2249.20.03747-9DOI Listing
August 2020

Hospital care in Departments defined as COVID-free: A proposal for a safe hospitalization protecting healthcare professionals and patients not affected by COVID-19.

Arch Ital Urol Androl 2020 Apr 24;92(2). Epub 2020 Apr 24.

Musumeci GECAS Clinic, Gravina di Catania, Catania.

The COVID-19 pandemic influenced the normal course of clinical practice leading to significant delays in the delivery of healthcare services for patients non affected by COVID-19. In the near future, it will be crucial to identify facilities capable of providing health care in compliance with the safety of healthcare professionals, administrative staff and patients. All the staff involved in the project of a Covid-free hospital should be subjected to a diagnostic swab for COVID-19 before the beginning of healthcare activity and then periodically in order to avoid the risk of contamination of patients during the process of care. The modifications of various activities involved in the process of care are described: outpatient care, reception of inpatients, inpatient ward and operating room. For outpatient care, modality of appointment procedure, characteristics of waiting room and personal protective equipment (PPE) for healthcare professionals and administrative staff are presented. Reception of inpatients shall be conditional on a negative swab for COVID-19 obtained with a drive-in procedure. The management of the operating room represents the most crucial step of the patient's care process. The surgical team should be restricted and monitored with periodic swabs; surgical procedures should be performed by experienced surgeons according to standard procedures; surgical training experimental treatments and research protocols should be suspended. Adequate personal protective equipment and measures to reduce aerosolization in the operating room (closed circuits, continuous cycle insufflators, fume extraction) should be adopted. Prevention of possible transmission of the virus during procedures in open, laparoscopic and endoscopic surgery is to use a multi-tactic approach, which includes correct filtration and ventilation of the operating room, the use of appropriate PPE (FFP3 plus surgical mask and protective visor for all the staff working in the operating room) and smoke evacuation devices with a suction and filter system.   on behalf of the UrOP Executive Committee Giuseppe Ludovico, Angelo Cafarelli, Ottavio De Cobelli, Ferdinando De Marco, Giovanni Ferrari, Stefano Pecoraro, Angelo Porreca, Domenico Tuzzolo.
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http://dx.doi.org/10.4081/aiua.2020.2.67DOI Listing
April 2020

Induced tolerance to abiotic and biotic stresses of broccoli and Arabidopsis after treatment with elicitor molecules.

Sci Rep 2020 06 25;10(1):10319. Epub 2020 Jun 25.

Laboratorio de Biotecnología Agrícola y de Alimentos-Ingeniería en Agronomía, Colegio de Ciencias e Ingenierías El Politécnico, Universidad San Francisco de Quito USFQ, Campus Cumbayá, 17-1200-841, Quito, Ecuador.

The plant hormones salicylic acid (SA) and jasmonic acid (JA) regulate defense mechanisms capable of overcoming different plant stress conditions and constitute distinct but interconnected signaling pathways. Interestingly, several other molecules are reported to trigger stress-specific defense responses to biotic and abiotic stresses. In this study, we investigated the effect of 14 elicitors against diverse but pivotal types of abiotic (drought) and biotic (the chewing insect Ascia monuste, the hemibiotrophic bacterium Pseudomonas syringae DC 3000 and the necrotrophic fungus Alternaria alternata) stresses on broccoli and Arabidopsis. Among the main findings, broccoli pre-treated with SA and chitosan showed the highest drought stress recovery in a dose-dependent manner. Several molecules led to increased drought tolerance over a period of three weeks. The enhanced drought tolerance after triggering the SA pathway was associated with stomata control. Moreover, methyl jasmonate (MeJA) reduced A. monuste insect development and plant damage, but unexpectedly, other elicitors increased both parameters. GUS reporter assays indicated expression of the SA-dependent PR1 gene in plants treated with nine elicitors, whereas the JA-dependent LOX2 gene was only expressed upon MeJA treatment. Overall, elicitors capable of tackling drought and biotrophic pathogens mainly triggered the SA pathway, but adversely also induced systemic susceptibility to chewing insects. These findings provide directions for potential future in-depth characterization and utilization of elicitors and induced resistance in plant protection.
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http://dx.doi.org/10.1038/s41598-020-67074-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7316721PMC
June 2020

Semirigid Ureteroscopy: Step by Step.

J Endourol 2020 05;34(S1):S13-S16

Department of Urology, San Raffaele Hospital, Ville Turro Division, Milan, Italy.

This article aims to demonstrate a step-by-step technique of semirigid ureteroscopy (URS) for the treatment of ureteral stones, urothelial tumors, and ureteral stenosis. Operating room setup, camera settings, access to the bladder, and negotiation of the ureteral orifice, lasertripsy, basketing of the stone fragments, endoscopic treatment of ureteral tumors and ureteral stenosis, flexible URS at the end of semirigid URS, and Double-J stent placement are described step by step.
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http://dx.doi.org/10.1089/end.2018.0286DOI Listing
May 2020

Guess Who's Coming to Dinner: COVID-19 in a COVID-free Unit.

Urology 2020 08 18;142:22-25. Epub 2020 May 18.

Department of Urology, Santa Chiara Hospital, Trento, Italy.

Objective: To assess the impact of the pandemic on surgical activity and the occurrence and features of Covid-19 in a Covid-free urologic unit in a regional hospital in Northern Italy.

Materials And Methods: Our Department is the only urologic service in the Trento Province, near Lombardy, the epicenter of Covid-19 in our Country. We reviewed the surgical and ward activities during the 4 weeks following the national lockdown (March 9 to April 5, 2020). The following outcomes were investigated: surgical load, rate of admissions and bed occupation, and the rate and characteristics of unrecognized Covid-positive patients. Data were compared with that of the same period of 2019 (March 11 to April 7).

Results And Conclusion: About 63%, 70%, 64%, and 71%, decline in surgery, endoscopy, bed occupation, and admission, respectively, occurred during the 4 weeks after the lockdown, as compared to 2019. Urgent procedures also declined by 32%. Three (8%) of 39 admissions regarded unrecognized Covid-19 overlapping or misinterpreted with urgent urologic conditions such as fever-associated urinary stones or hematuria. In spite of a significant reduction of activity, a non-negligible portion of admissions to our Covid-free unit regarded unrecognized Covid-19. In order to preserve its integrity, we propose an enhanced triage prior to the admission to a Covid-free unit including not only routine questions on fever and respiratory symptoms but also nonrespiratory symptoms, history of exposure, and a survey about the social and geographic origin of the patient.
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http://dx.doi.org/10.1016/j.urology.2020.05.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233200PMC
August 2020

Endourological Stone Management in the Era of the COVID-19.

Eur Urol 2020 08 14;78(2):131-133. Epub 2020 Apr 14.

European Training Center for Endourology, Department of Urology, IRCCS San Raffaele Hospital, Ville Turro Division, Milan, Italy.

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http://dx.doi.org/10.1016/j.eururo.2020.03.042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7195508PMC
August 2020

Teleurology in the Time of Covid-19 Pandemic: Here to Stay?

Urology 2020 06 13;140:4-6. Epub 2020 Apr 13.

Department of Urology, Santa Chiara Hospital, Trento, Italy.

Objective: To assess the implementation and outcomes of telemedicine in a Department of Urology in Northern Italy during the outbreak of the Covid-19 pandemic.

Methods: All the outpatient clinical activities during the 4 weeks following the national lockdown (March 9-April 3, 2020) in the Department of Urology of the Trento Province, Italy, were reviewed and categorized. Expert staff members examined the electronic records, selecting whether the clinic appointments should be canceled or confirmed (via telephone consultation or face-to-face visit). The rate, indication, and modality of visits were investigated.

Results: Overall, 415 of 928 (45%) scheduled patients canceled their clinic appointment themselves or were canceled by staff members without rescheduling. The remaining 523 (55%) cases were screened undergoing telephone consultation in 295 (56%) and face-to-face visit in 228 (44%). The rate of face-to-face visit decreased from 63% to 9% during week 1 and 4, respectively. Seventy-four percent of face-to-face visits regarded suspected recurrent or new onset malignancy or potentially dangerous clinical conditions (severe urinary symptoms or complicated urinary stones or infection). The median age of patients in the face-to-face and telephone groups was 59 (range 20-69) and 65 years old (range 37-88), respectively.

Conclusion: A pandemic is a dynamic scenario, requiring reorganization and flexibility of the healthcare delivery. Forty-five percent visits were canceled without rescheduling. Although a minimum portion of face-to-face visit (<10% 1 month after the lockdown) was preserved mostly for suspected malignancy or potentially life-threatening conditions, telemedicine proved a pragmatic approach allowing efficient screening of cases and adequate protection for patients and clinicians.
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http://dx.doi.org/10.1016/j.urology.2020.04.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7153527PMC
June 2020

Influence of Lower Pole Infundibulopelvic Angle on Success of Retrograde Flexible Ureteroscopy and Laser Lithotripsy for the Treatment of Renal Stones by Dresner et al. (J Endourol 2020;34(6):655-660; DOI: 10.1089/end.2019.0720).

J Endourol 2020 06 22;34(6):660-661. Epub 2020 Apr 22.

Department of Urology, Tel-Aviv Sourasky Medical Center Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

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http://dx.doi.org/10.1089/end.2020.0209DOI Listing
June 2020

ALS skin fibroblasts reveal oxidative stress and ERK1/2-mediated cytoplasmic localization of TDP-43.

Cell Signal 2020 06 29;70:109591. Epub 2020 Feb 29.

Department of Ecological and Biological Science (DEB), University of Tuscia, Largo dell'Università, 01100 Viterbo, Italy. Electronic address:

The main hallmark of many forms of familiar and sporadic amyotrophic lateral sclerosis (ALS) is a reduction in nuclear TDP-43 protein and its inclusion in cytoplasmic aggregates in motor neurons. In order to understand which cellular and molecular mechanisms underlie the mislocalization of TDP-43, we examined human skin fibroblasts from two individuals with familial ALS, both with mutations in TDP-43, and two individuals with sporadic ALS, both without TDP-43 mutations or mutations in other ALS related genes. We found that all ALS fibroblasts had a partially cytoplasmic localization of TDP-43 and had reduced cell metabolism as compared to fibroblasts from apparently healthy individuals. ALS fibroblasts showed an increase in global protein synthesis and an increase in 4E-BP1 and rpS6 phosphorylation, which is indicative of mTORC1 activity. We also observed a decrease in glutathione (GSH), which suggests that oxidative stress is elevated in ALS. ERK1/2 activity regulated the extent of oxidative stress and the localization of TDP-43 in the cytoplasm in all ALS fibroblasts. Lastly, ALS fibroblasts showed reduced stress granule formation in response to HO stress. In conclusion, these findings identify specific cellular and molecular defects in ALS fibroblasts, thus providing insight into potential mechanisms that may also occur in degenerating motor neurons.
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http://dx.doi.org/10.1016/j.cellsig.2020.109591DOI Listing
June 2020

Conservative treatment of upper urinary tract carcinoma in patients with imperative indications.

Minerva Urol Nefrol 2020 Feb 19. Epub 2020 Feb 19.

Department of Urology, IRCCS San Raffaele Hospital, Ville Turro, Milan, Italy.

Background: To report our experience for endoscopic treatment of upper urinary tract carcinoma (UTUC) in patients with imperative indications for management.

Methods: Retrospective data were collected for all patients who underwent endoscopic management of UTUC for imperative situations, from September 2013 to January 2019. Comorbidity was determined by using the age-adjusted Charlson comorbidity index (CCI). The primary endpoint of the study was overall survival (OS). Secondary outcomes were recurrence- free survival (RFS) rates, complication rates and global renal function.

Results: A total of 29 patients were enrolled in the study. The median age was 69.0 (IQR 63.0- 79.0) years and the median CCI was 6 (IQR 4-8). Overall, 137 endoscopic procedures were performed; 117 (85.4%) had no complication. Clavien-Dindo grade III and IV complications were 3 (2.2%) and 1 (0.7%) respectively. The median follow-up of 23 months (IQR 14-35). During the follow-up, 2 (6.9%) patients died for cause not related to cancer. Recurrence of UTUC occurred in 18 patients (61.1%). The 24-month OS was 96.4 ± 3.5% and the 24-month RFS was 31.7 ± 9.4%. Lower RFS rates were found in high grade tumor patients (22.2 ± 13.9%) compared to low grade tumor patients (35.6 ± 12.3%) (p=0.237). There was statistical difference in creatinine and eGFR values when comparing baseline to last follow-up (p=0.018 and p=0.005, respectively).

Conclusions: Endoscopic management of UTUC in patients with imperative indications appears to be a reasonable alternative to nephroureterectomy. However, stringent endoscopic follow- up is necessary due to the high risk of disease recurrence.
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http://dx.doi.org/10.23736/S0393-2249.20.03710-8DOI Listing
February 2020

Modulation of the Root Microbiome by Plant Molecules: The Basis for Targeted Disease Suppression and Plant Growth Promotion.

Front Plant Sci 2019 24;10:1741. Epub 2020 Jan 24.

Plant-Microbe Interactions, Department of Biology, Science4Life, Utrecht University, Utrecht, Netherlands.

Plants host a mesmerizing diversity of microbes inside and around their roots, known as the microbiome. The microbiome is composed mostly of fungi, bacteria, oomycetes, and archaea that can be either pathogenic or beneficial for plant health and fitness. To grow healthy, plants need to surveil soil niches around the roots for the detection of pathogenic microbes, and in parallel maximize the services of beneficial microbes in nutrients uptake and growth promotion. Plants employ a palette of mechanisms to modulate their microbiome including structural modifications, the exudation of secondary metabolites and the coordinated action of different defence responses. Here, we review the current understanding on the composition and activity of the root microbiome and how different plant molecules can shape the structure of the root-associated microbial communities. Examples are given on interactions that occur in the rhizosphere between plants and soilborne fungi. We also present some well-established examples of microbiome harnessing to highlight how plants can maximize their fitness by selecting their microbiome. Understanding how plants manipulate their microbiome can aid in the design of next-generation microbial inoculants for targeted disease suppression and enhanced plant growth.
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http://dx.doi.org/10.3389/fpls.2019.01741DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6992662PMC
January 2020

Worldwide survey of flexible ureteroscopy practice: a survey from European Association of Urology sections of young academic urologists and uro-technology groups.

Cent European J Urol 2019 14;72(4):393-397. Epub 2019 Oct 14.

University Hospital Southampton NHS Foundation Trust, Department of Urology, Southampton, United Kingdom.

Introduction: To understand the current practice of flexible ureteroscopy (fURS), we conducted a worldwide survey among urologists with a special interest in endourology.

Material And Methods: A 42-question survey was designed after an initial consultation with European Association of Urology young academic urologists (YAU) and uro-technology (ESUT) groups. This was distributed via the SurveyMonkey platform and an ESUT meeting to cover practice patterns and techniques in regard to ureteroscopy usage worldwide.

Results: A total of 114 completed responses were obtained. A safety guidewire was reportedly used by 84.5% of endourologists, an access sheath was always or almost always used by 71% and a reusable laser fibre was used by two-thirds of respondents. While a combination of dusting and fragmentation was used by 47% as a preferred mode of intra-renal stone treatment, some used dusting (43%) or fragmentation with basketing (10%).Disposable scopes were only used by 40% and three quarters of them used it for challenging cases only. Antibiotic prophylaxis was limited to a single peri-operative dose by two-thirds (67%) of respondents. The procedural time was limited to between 1-2 hours by two-thirds (70%) of respondents and very rarely (7.4%) it exceeded 2 hours. The irrigation method varied between manual pump (46%), mechanical irrigation (22%) or gravity irrigation (27%).

Conclusions: Our survey shows a wide variation in the available endourological armamentarium and surgical practice amongst urologists. However, there seems to be a broad agreement in the use of peri-operative antibiotics, access sheath usage, method of stone treatment and the use of post-operative stent.
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http://dx.doi.org/10.5173/ceju.2019.0041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6979553PMC
October 2019

Complications of ureteroscopy: a complete overview.

World J Urol 2020 Sep 20;38(9):2147-2166. Epub 2019 Nov 20.

Sorbonne Université, Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.

Introduction: The aim of this paper was to give a complete overview of all published complications associated with ureteroscopy and their according management and prevention in current urological practice.

Materials And Methods: This review was registered in PROSPERO with registration number CRD42018116273. A bibliographic search of the Medline, Scopus, Embase and Web of Science databases was performed by two authors (V.D.C. and E.X.K.). According to the Population, Intervention, Comparator, Outcome (PICO) study design approach and Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) standards, a consensus between these authors was found relating to the thematic structure of this review.

Results: Ureteral stent discomfort, ureteral wall injury and stone migration are the most frequently reported complications. The worst complications include urosepsis, multi-organ failure and death. Incidence rates on these and other complications varied extensively between the reviewed reports.

Conclusion: Ureteroscopy seems to be associated with more complications than currently reported. The present overview may help urologists to prevent, recognize and solve complications of ureteroscopy. It may also stimulate colleagues to perform prospective studies using standardized systems for classifying complications. These are warranted to compare results among different studies, to conduct meta-analyses, to inform health care workers and to counsel patients correctly about possible risks of ureteroscopy.
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http://dx.doi.org/10.1007/s00345-019-03012-1DOI Listing
September 2020

The current use of human cadaveric models in urology: a systematic review.

Minerva Urol Nefrol 2020 Jun 11;72(3):313-320. Epub 2019 Nov 11.

Department of Urology, San Martino Hospital Polyclinic, University of Genoa, Genoa, Italy.

Introduction: We aim to perform a systematic review of the current use of cadaveric models in urology and analyze their role within urological training and the experimentation of novel surgical techniques.

Evidence Acquisition: A systematic review of the current literature was conducted through the Medline and NCBI PubMed, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL) databases in September 2019. All papers published after 2000, concerning studies conducted on human cadaveric models for training in urological surgical procedures, developing of new techniques and technologies were considered for the review.

Evidence Synthesis: From the literature search we found a total of 3769 different articles of those only 58 articles were included in the study. Eleven studies (19%) were published between 2000 and 2009, and the trend increased almost fourfold in the following period (2010-2019) with 47 studies (81%) being published. Surprisingly, a clear statement on the approval of the use of cadavers was written in less than 50% of the studies. About the 48% of the studies were aimed to experiment a novel surgical technique while in the 31% of studies the cadavers were used for surgical training. More than half of the studies evaluated did not provide any information about the type and method of preparation of cadaveric models while specific outcomes in terms of satisfaction with the use of cadaver models were reported clearly only in less than a third of them.

Conclusions: The quality of the materials and methods described in most studies is often characterized by poor detail with regards to the preservation and preparation of the bodies and the satisfaction of use, which might affect training and testing.
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http://dx.doi.org/10.23736/S0393-2249.19.03558-6DOI Listing
June 2020

Supine percutaneous nephrolithotomy: tips and tricks.

Transl Androl Urol 2019 Sep;8(Suppl 4):S381-S388

Department of Urology, IRCCS San Raffaele Hospital, Ville Turro Division, Milan, Italy.

This paper aims to give an exhaustive overview of supine percutaneous nephrolithotomy (PCNL) illustrating some tips and tricks in order to optimize its execution in full safety. Critical review of Pros and cons of supine PCNL is accomplished to allow the urologist to experience the beauty of this position while being ready to overcome its minimal shortcomings.
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http://dx.doi.org/10.21037/tau.2019.07.09DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6790418PMC
September 2019

Pictorial review of tips and tricks for ureteroscopy and stone treatment: an essential guide for urologists from PETRA research consortium.

Transl Androl Urol 2019 Sep;8(Suppl 4):S371-S380

Sorbonne Université, GRC n°20 LITHIASE RENALE, AP-HP, Hôpital Tenon, 75020 Paris, France.

With an increase in the number of ureteroscopy (URS) procedures, URS is now performed more widely and is becoming a standard procedure for all urologists. There is also a rise in the complexity of these procedures and URS is now offered for treatment of stones as well as for diagnosis and treatment of urothelial tumours. We wanted to provide a 'pictorial review' of the 'tips and tricks' of URS, as the finer and technical details are often easier to understand and remember with images rather than through textual explanations.
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http://dx.doi.org/10.21037/tau.2019.06.04DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6790416PMC
September 2019

GLYI4 Plays A Role in Methylglyoxal Detoxification and Jasmonate-Mediated Stress Responses in .

Biomolecules 2019 10 22;9(10). Epub 2019 Oct 22.

Department of Ecological and Biological Sciences, University of Tuscia, 01100 Viterbo, Italy.

Plant hormones play a central role in various physiological functions and in mediating defense responses against (a)biotic stresses. In response to primary metabolism alteration, plants can produce also small molecules such as methylglyoxal (MG), a cytotoxic aldehyde. MG is mostly detoxified by the combined actions of the enzymes glyoxalase I (GLYI) and glyoxalase II (GLYII) that make up the glyoxalase system. Recently, by a genome-wide association study performed in Arabidopsis, we identified GLYI4 as a novel player in the crosstalk between jasmonate (JA) and salicylic acid (SA) hormone pathways. Here, we investigated the impact of knock-down on MG scavenging and on JA pathway. In mutant plants, we observed a general stress phenotype, characterized by compromised MG scavenging, accumulation of reactive oxygen species (ROS), stomatal closure, and reduced fitness. Accumulation of MG in plants led to lower efficiency of the JA pathway, as highlighted by the increased susceptibility of the plants to the pathogenic fungus . Moreover, MG accumulation brought about a localization of GLYI4 to the plasma membrane, while MeJA stimulus induced a translocation of the protein into the cytoplasmic compartment. Collectively, the results are consistent with the hypothesis that GLYI4 is a hub in the MG and JA pathways.
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http://dx.doi.org/10.3390/biom9100635DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6843518PMC
October 2019

Does working channel position influence the effectiveness of flexible ureteroscopy? Results from an in vitro study.

BJU Int 2020 03 7;125(3):449-456. Epub 2019 Nov 7.

GRC n°20 sur la Lithiase Urinaire, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France.

Objective: To evaluate whether the position of the working channel affects the effectiveness of flexible ureteroscopy.

Materials And Methods: We compared the ureteroscopes Flex-X2S and Flex-XC (working channel at the 9 and 3 o'clock positions, respectively) in eight cavities of a K-Box model, simulating the distribution of the right and left intrarenal calyces. In the first and second settings, each cavity contained a 1-cm stone, lying on the bottom and fixed on the anterior sheet covering the box, respectively. In the third setting, the posterior and lateral surface of each cavity was draped with graph paper. Once the flexible ureteroscope entered each cavity, we measured and compared (i) the proportion of stone surface targeted by the laser (STL) and (ii) the proportion of graph paper burned by the laser (PBL) obtained with the two instruments.

Results: Higher STLs and PBLs were obtained with the 3 o'clock position than the 9 o'clock position in the right posterior and left anterior cavities (mean ± sd STL 87% ± 15% vs 46% ± 38% and 78% ± 35% vs 43% ± 24%, respectively; P < 0.05), and on the right posterior surfaces of the middle-lower/lower cavities (PBL 72% vs 31% and 77% vs 35%, respectively; P < 0.01) and on the left lateral surface of the lower cavities (PBL 45% vs 25%; P = 0048), respectively. Conversely, the 9 o'clock position provided higher STLs and PBLs than the 3 o'clock position in the left posterior and right anterior cavities (mean ± sd STL 84% ± 20% vs 65% ± 28% and 79% ± 30% vs 44% ± 35%, respectively; P ≤ 0.02), and on the left posterior and right lateral surfaces of the lower cavities (PBL 59% vs 34% and 50% vs 21%, respectively; P ≤ 0.04).

Conclusions: The position of the working channel of the flexible ureteroscope should be considered when planning flexible ureteroscopy, especially when dealing with the lower pole.
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http://dx.doi.org/10.1111/bju.14923DOI Listing
March 2020

Development of a photographic handbook to improve cystoscopy findings during resident's training: A randomised prospective study.

Arab J Urol 2019 24;17(3):243-248. Epub 2019 Apr 24.

Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy.

: To evaluate if the use of a photographic handbook (PH) can be a useful tool to improve the detection of disorders during cystoscopy training, as several hands-on tools have been proposed to improve technical skills but very few aim to improve specificity and sensitivity. : Eight junior residents (JRs) were divided into two groups: Group A, comprised four JRs with previous limited experience of performing cystoscopies; and Group B, including four inexperienced JRs who were asked to study a specific PH before performing cystoscopies. The findings of the two groups were compared using the chi-squared test. : A total of 401 consecutive cystoscopies, of which 214 (53.4%) were performed by Group A and 187 (46.6%) by Group B, were considered. Group B showed superior ability in detecting uncommon findings (i.e., carcinoma , bullous oedema, interstitial cystitis, etc.) with 24/46 (52.2%) detected vs eight of 32 (25%) in Group A ( = 0.016). : The PH was a useful tool for improving identification of pathological conditions, which could be used to enhance hands-on simulator and practical tutored training. : CIS: carcinoma ; JR: junior resident; PH: photographic handbook; VR: virtual reality Classification: Stones/Endourology.
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http://dx.doi.org/10.1080/2090598X.2019.1596400DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6711137PMC
April 2019

Physiological response of Posidonia oceanica to heavy metal pollution along the Tyrrhenian coast.

Funct Plant Biol 2019 09;46(10):933-941

Department of Ecological and Biological Sciences, University of Tuscia, Largo dell'Università, 01100 Viterbo, Italy; and Corresponding author. Email:

Heavy metal (HM) pollution of marine coastal areas is a big concern worldwide. The marine phanerogam Posidonia oceanica (L.) Delile is widely considered to be a sensitive bioindicator of water pollution due to its ability to sequester trace elements from the environment. The analysis of specific biomarkers, like reactive oxygen species scavengers, could allow us to correlate the physiological response of P. oceanica meadows to water pollution. In this study, we analysed the activity of some antioxidant enzymes and the expression level of the corresponding genes in the leaves of P. oceanica plants harvested from four meadows distributed along the Tyrrhenian coast; lipid peroxidation and the expression level of two genes related to HM response, metallothionein-2b and chromethylase, were also measured. The results of biochemical and molecular analyses were correlated with the concentration of some HMs, such as Cr, Cd, Cu, Ni and Pb, measured in P. oceanica leaves. We found a very strong antioxidant response in plants from the Murelle meadow whose HM concentration was the lowest for most of the analysed HMs, particularly Cu.
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http://dx.doi.org/10.1071/FP18303DOI Listing
September 2019

Proteomic Analysis of MeJa-Induced Defense Responses in Rice against Wounding.

Int J Mol Sci 2019 May 22;20(10). Epub 2019 May 22.

Department of Ecological and Biological Sciences, University of Tuscia, 01100 Viterbo, Italy.

The role of jasmonates in defense priming has been widely recognized. Priming is a physiological process by which a plant exposed to low doses of biotic or abiotic elicitors activates faster and/or stronger defense responses when subsequently challenged by a stress. In this work, we investigated the impact of MeJA-induced defense responses to mechanical wounding in rice (). The proteome reprogramming of plants treated with MeJA, wounding or MeJA+wounding has been in-depth analyzed by using a combination of high throughput profiling techniques and bioinformatics tools. Gene Ontology analysis identified protein classes as defense/immunity proteins, hydrolases and oxidoreductases differentially enriched by the three treatments, although with different amplitude. Remarkably, proteins involved in photosynthesis or oxidative stress were significantly affected upon wounding in MeJA-primed plants. Although these identified proteins had been previously shown to play a role in defense responses, our study revealed that they are specifically associated with MeJA-priming. Additionally, we also showed that at the phenotypic level MeJA protects plants from oxidative stress and photosynthetic damage induced by wounding. Taken together, our results add novel insight into the molecular actors and physiological mechanisms orchestrated by MeJA in enhancing rice plants defenses after wounding.
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http://dx.doi.org/10.3390/ijms20102525DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567145PMC
May 2019