Istanbul University

Robot-assisted partial nephrectomy (RAPN) represents the preferred minimally-invasive approach for localized renal tumors. Increasing attention has focused on optimizing parenchymal preservation, with enucleation proposed as a potentially advantageous strategy. This study aimed to compare perioperative and functional outcomes of enucleation versus enucleoresection in a large, contemporary multicenter RAPN cohort. Data were extracted from the multicentric and multicontinental European Association of Urology Young Academic Urologists (EAU-YAU) Renal Cancer Working Party database. Patients undergoing RAPN between 2015 and 2024 with clearly documented resection technique (enucleation vs enucleoresection) were included. The resection technique was chosen based on the surgeon's preference. Perioperative, pathological, and renal functional outcomes were evaluated. Acute kidney injury (AKI - defined according to the AKIN classification) and chronic kidney disease (CKD) worsening served as primary endpoints. Logistic regression and Cox proportional hazards models were used to assess the association between surgical technique and the risk of AKI and CKD progression; Kaplan-Meier curves were used to depict time-to-event and functional outcomes, while longitudinal eGFR analyses were performed to evaluate renal function trends over time. Among 1260 patients, 527 (42%) underwent enucleation and 733 (58%) enucleoresection. Adoption of both techniques remained stable over time. Baseline characteristics were comparable. Enucleoresection was associated with longer ischemia time, higher intraoperative complication rates, and a lower positive surgical margin rate (5.2% vs 8.3%, p=0.003). Postoperative AKI occurred more frequently after enucleoresection (18% vs 3%, p<0.001), although eGFR recovery was similar at a median follow-up of 12 vs 25 months. In the overall cohort and among patients with baseline CKD stages 1-2, enucleation was associated with a lower risk of CKD progression (p<0.001). Enucleation during RAPN offers a parenchyma-sparing approach with potential functional advantages, particularly in patients with preserved baseline renal function. This benefit must be balanced against a slightly higher risk of positive margins, reinforcing the necessity of thoughtful case selection and standardized surgical technique.

To determine how visual motion direction and the engagement of central versus peripheral visual fields modulate cervical vestibular evoked myogenic potentials (cVEMP). We investigated whether optokinetic stimulation and smooth pursuit, delivered centrally or peripherally, alter cVEMP latency and amplitude. Forty-five healthy adults completed cVEMP testing across seven visual conditions: baseline (fixed gaze) and various optokinetic stimulation directions and smooth pursuit tasks. These stimuli were delivered using either a light bar (central vision, n=13) or an expanded visual surround (peripheral vision, n=32). Primary outcomes were P13 and N23 latencies and peak-to-peak amplitudes, with within-subject comparisons assessing deviations from baseline. Central visual stimulation via the light bar produced no significant changes in cVEMP latencies or amplitudes relative to baseline (p > 0.008). In contrast, peripheral stimulation yielded significant latency prolongations, most prominently for N23 during vertical and horizontal optokinetic motion. P13 effects were less pronounced and inconsistent. Amplitudes did not show systematic changes across any condition. The divergent behaviour of P13 and N23 indicates differential susceptibility of early versus later cVEMP components to visual and cognitive influences. Peripheral visual motion exerts a more substantial influence on vestibulo-collic pathways than central foveal input, primarily by delaying cVEMP latencies without enhancing amplitudes. This pattern contrasts with prior vection-linked reports of latency reductions and amplitude increases, suggesting distinct neural processing for vection versus purely visual motion cues. These findings highlight the potential to leverage peripheral motion to modulate otolith reflex timing in vestibular rehabilitation, warranting confirmation in patient cohorts and with explicit vection quantification

Methylprednisolone aceponate (MPA) is a nonhalogenated, diester corticosteroid, specifically designed to treat eczema. The amount of benzyl alcohol (BA), an excipient, is quite high in the cream formulation of MPA; therefore, the simultaneous determination of MPA, active ingredient, and BA is important. Chromatographic analysis was performed on an Agilent Poroshell 120 EC-C18 (100 × 2.1 mm 2.7 μm) column using acetonitrile-water (40:60, v/v) mixture as mobile phase with isocratic elution. The diode array detector (DAD) was set at 245 and 258 nm. The column was thermostated at 40°C ± 1°C. A flow rate of 0.5 mL/min was used to elute the analyte from the column. The calibration curve was linear in the concentration range 0.17-4.20 μg/mL for MPA and 1.50-35.0 μg/mL for BA. The R2 values for MPA and BA were found to be 0.9989 and 0.9999, respectively. The limit of detection was found to be 0.048 μg/mL for MPA, 0.46 μg/mL for BA, and the limit of quantification was found to be 0.17 μg/mL for MPA and 1.50 μg/mL for BA. MPA was exposed to stress conditions, and the stressed samples were analyzed using the proposed method, which can effectively separate MPA from its degradation products.