The Caprini VTE risk assessment model is valid. This study supports the use of individual risk assessment in critically ill surgical patients.

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ObjectiveTo evaluate the outcomes of robot-assisted partial nephrectomy RAPN after major prior abdominal surgery (PAS) using a large multicentre database. Patients and methodsWe identified 1 686 RAPN from five academic centres between 2006 and 2014. In all, 216 patients had previously undergone major PAS, defined as having an open upper midline/ipsilateral incision. Perioperative outcomes were compared with those 1 470 patients who had had no major PAS. The chi-squared test and Mann-Whitney U-test were used for categorical and continuous variables, respectively. ResultsThere was no statistically significant difference in Charlson comorbidity index, tumour size, R.E.N.A.L. nephrometry score or preoperative estimated glomerular filtration rate (eGFR) between the groups. Age and body mass index were higher in patients with PAS. The PAS group had a higher estimated blood loss (EBL) but this did not lead to a higher transfusion rate. A retroperitoneal approach was used more often in patients with major PAS (11.2 vs 5.4%), although this group did not have a higher percentage of posterior tumours (38.8 vs 43.3%, P = 0.286). Operative time, warm ischaemia time, length of stay, positive surgical margin, percentage change in eGFR, and perioperative complications were not significantly different between the groups. ConclusionsRAPN in patients with major PAS is safe and feasible, with increased EBL but no increased rate of transfusion. Patients with major PAS had almost twice the likelihood of having a retroperitoneal approach.

SUMMARYMicroparticles (MPs) are small membrane vesicles released from activated cells and are associated with thrombosis and inflammation. Microparticles contain a unique subset of surface proteins derived from the parent cell and may be responsible for their diverse biological functions. To identify these proteins juvenile baboons (Papio anubis, n=4) underwent iliac vein thrombosis with six-hour balloon occlusion. Plasma samples were taken at baseline and at 2 days post thrombosis for MP analysis. Microparticles were extracted from platelet-poor plasma, digested separately with trypsin and tagged using iTRAQ reagents. The digests were subjected to 2-D LC separation followed by MALDI tandem mass spectrometry. Peak lists were generated and searched against all primate sequences. For protein identity, a minimum of two peptides at 95% confidence was required. Later, iTRAQ ratios were generated comparing relative protein level of day-2 to baseline. The proteomic analysis was performed twice for each blood sample, totaling 8 experiments. Proteins were considered elevated or depressed if the iTRAQ ratio deviated by 20% change from normal and a p-value less than 0.05. Significantly, 7 proteins were differentially expressed on day-2 compared to baseline, and appeared in at least two animals and regulated in at least 4 experiments, and appeared in at least three animals and regulated in at least four experiments. Among these 7 proteins, up-regulated proteins include various forms of fibrinogen and alpha-1-antichymotrypsin, and down-regulated proteins include immunoglobulins. These proteins influence thrombosis and inflammation through hemostatic plug formation (fibrinogen), inhibiting neutrophil adhesion (alpha-1-antichymoptrypsin), and immunoregulation (immunoglobulins). Further studies are needed to confirm the mechanistic role of these proteins in the pathogenesis of venous thrombosis.

E859Cite as: Can Urol Assoc J 2015;9(11-12):E859-62. http://dx.doi.org/10.5489/cuaj.3197 Published online December 14, 2015. AbstractIntroduction: We sought to evaluate the association of obesity with surgical outcomes of robotic partial nephrectomy (RPN) using a large, multicentre database. 2 ). Patient characteristics and outcomes were compared between obese and non-obese patients. Multivariable analysis was used to assess the association of obesity on RPN outcomes. Results: A total of 806 (44%) patients were obese with median BMI of 33.8kg/m 2 . Compared to non-obese patients, obese patients had greater median tumour size (2.9 vs. 2.5cm, p<0.001), mean RENAL nephrometry score (7.3 vs. 7.1, p=0.04), median operating time (176 vs. 165 min, p=0.002), and median estimated blood loss (EBL, 150 vs. 100 ml, p=0.002), but no difference in complications. Obesity was not an independent predictor of operative time or EBL on regression analysis. Among obese patients, males had a greater EBL (150 vs. 100 ml, p<0.001), operative time (180 vs. 166 min, p<0.001) and warm ischemia time (WIT, 20 vs. 18, p=0.001), and male sex was an independent predictor of these outcomes on regression analysis. Conclusions:In this large, multicentre study on RPN, obesity was not associated with increased complications and was not an independent predictor of operating time or blood loss. However, in obese patients, male gender was an independent predictor of greater EBL, operative time, and WIT. Our results indicate that obesity alone should not preclude consideration for RPN.