ChatGPT is an advanced natural language processing technology that closely resembles human language. We evaluated whether ChatGPT could help patients understand kidney cancer and replace consultations with urologists. Two urologists developed ten questions commonly asked by patients with kidney cancer. The answers to these questions were produced using ChatGPT. The five-dimension SERVQUAL model was used to assess the service quality of ChatGPT. The survey was distributed to 103 urologists via email, and twenty-four urological oncologists specializing in kidney cancer were included as experts with more than 20 kidney cancer cases in clinic per month. All respondents were physicians. We received 24 responses to the email survey (response rate: 23.3%). The appropriateness rate for all ten answers exceeded 60%. The answer to Q2 received the highest agreement (91.7%, etiology of kidney cancer), whereas the answer to Q8 had the lowest (62.5%, comparison with other cancers). The experts gave low assessment ratings (44.4% vs. 93.3%, p = 0.028) in the SERVQUAL assurance (certainty of total answers) dimension. Positive scores for the overall understandability of ChatGPT answers were assigned by 54.2% of responders, and 70.8% said that ChatGPT could not replace explanations provided by urologists. Our findings affirm that although ChatGPT answers to kidney cancer questions are generally accessible, they should not supplant the counseling of a urologist.

Plant genetic engineering, which has led to the production of plant-derived monoclonal antibodies (mAb^Ps), provides a safe and economically effective alternative to conventional antibody expression methods. In this study, the expression levels and biological properties of the anti-rabies virus mAb^P SO57 with or without an endoplasmic reticulum (ER)-retention peptide signal (Lys-Asp-Glu-Leu; KDEL) in transgenic tobacco plants (Nicotiana tabacum) were analyzed. The expression levels of mAb^P SO57 with KDEL (mAb^PK) were significantly higher than those of mAb^P SO57 without KDEL (mAb^P) regardless of the transcription level. The Fc domains of both purified mAb^P and mAb^PK and hybridoma-derived mAb (mAb^H) had similar levels of binding activity to the FcγRI receptor (CD64). The mAb^PK had glycan profiles of both oligomannose (OM) type (91.7%) and Golgi type (8.3%), whereas the mAb^P had mainly Golgi type glycans (96.8%) similar to those seen with mAb^H. Confocal analysis showed that the mAb^PK was co-localized to ER-tracker signal and cellular areas surrounding the nucleus indicating accumulation of the mAb^P with KDEL in the ER. Both mAb^P and mAb^PK disappeared with similar trends to mAb^H in BALB/c mice. In addition, mAb^PK was as effective as mAb^H at neutralizing the activity of the rabies virus CVS-11. These results suggest that the ER localization of the recombinant mAb^P by KDEL reprograms OM glycosylation and enhances the production of the functional antivirus therapeutic antibody in the plant.

Shin TY, et al. Investig Clin Urol. 2020 Nov;61(6):555-564. https://doi.org/10.4111/icu.20200086

Laparoscopic donor nephrectomy (LDN) is currently accepted as the gold standard procedure for living donor nephrectomy. Robot-assisted LDN (RALDN), an evolving procedure, has recently shown potential to ultimately emerge as the preferred procedure. Here, we report our experience and the surgical technique followed for employing RALDN for living donation. This retrospective study involved 56 consecutive patients who underwent RALDN between January 2015 and August 2018. Intraoperative and postoperative functional outcomes were analyzed and compared with the 45 patients who underwent hand-assisted LDN (HALDN) between May 2011 and December 2014. Mean procedure time for RALDN was 150 (range 90-210) min, and mean overall intraoperative blood loss was <100 (range 50-200) mL. Mean warm ischemic time recorded was 2 (range 1-5) min. Intraoperative complications, including blood transfusion or open conversion, did not occur in any patient. The procedural results of RALDN were comparable or superior to HALDN. Our RALDN approach is safe and feasible, and the procedure appears to be significantly easier for the surgeon. We suggest that our findings be externally validated to reassure reproducibility of the measurement in a prospective evaluation.

Background: We aimed to assess the trends in urinary tract infections (UTIs) and prognosis of patients with prostate cancer after radical prostatectomy (RP) and radiation therapy (RT) as definitive treatment options. Methods: The data of patients diagnosed with prostate cancer between 2007 and 2016 were collected from the National Health Insurance Service database. The incidence of UTIs was evaluated in patients treated with RT, open/laparoscopic RP, and robot-assisted RP. The proportional hazard assumption test was performed using the scaled Schoenfeld residuals based on a multivariable Cox proportional hazard model. Kaplan–Meier analysis were performed to assess survival. Results: A total of 28,887 patients were treated with definitive treatment. In the acute phase (< 3 months), UTIs were more frequent in RP than in RT; in the chronic phase (> 12 months), UTIs were more frequent in RT than in RP. In the early follow-up period, the risk of UTIs was higher in the open/laparoscopic RP group (aHR, 1.63; 95% CI, 1.44–1.83; p < 0.001) and the robot-assisted RP group (aHR, 1.26; 95% CI, 1.11–1.43; p < 0.001), compared to the RT group. The robot-assisted RP group had a lower risk of UTIs than the open/laparoscopic RP group in the early (aHR, 0.77; 95% CI, 0.77–0.78; p < 0.001) and late (aHR, 0.90; 95% CI, 0.89–0.91; p < 0.001) follow-up periods. In patients with UTI, Charlson Comorbidity Index score, primary treatment, age at UTI diagnosis, type of UTI, hospitalization, and sepsis from UTI were risk factors for overall survival. Conclusions: In patients treated with RP or RT, the incidence of UTIs was higher than that in the general population. RP posed a higher risk of UTIs than RT did in early follow-up period. Robot-assisted RP had a lower risk of UTIs than open/laparoscopic RP group in total period. UTI characteristics might be related to poor prognosis.

Background: We aimed to compare the oncologic outcomes of intracorporeal urinary diversion (ICUD) and extracorporeal urinary diversion (ECUD) following robot-assisted radical cystectomy (RARC) in patients diagnosed with bladder cancer. Materials and methods: Medical records of 730 patients who underwent RARC between April 2007 and May 2019 in 11 tertiary referral centers were retrospectively reviewed. We assessed recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) in the two groups using the Kaplan–Meier method. Cox regression models were used to identify factors associated with RFS, CSS, and OS. Results: Among 591 patients neobladder diversion was performed more frequently in the ICUD group (70.8% vs 52.5%, P=0.001). The median follow-up duration was shorter in the ICUD group than in the ECUD group (16 vs 26 months, P<0.001). The rates of overall recurrence (36.5% vs 25.5%, P=0.013) and pelvic recurrence (12.1% vs 5.9%, P=0.031) were higher in the ECUD group. However, no differences in 5-year RFS (43.2% vs 58.4%, P=0.516), CSS (79.3% vs 89.7%, P=0.392), and OS (74.3% vs 81.4%, P=0.411) were noted between the two groups. Multivariable analysis revealed that when compared to ICUD, ECUD was not associated with RFS (hazard ratio [HR], 0.982; P=0.920), CSS (HR, 0.568; P=0.126), and OS (HR, 0.642; P=0.124). Conclusion: Although there was a difference in recurrence rate between the two groups, multivariable analysis indicated that the diversion technique after RARC did not affect the oncologic outcomes. Large prospective studies with long-term follow-up are warranted to verify the oncologic outcomes of ICUD and ECUD following RARC.