During the past 10 years, preclinical studies implicating sustained androgen receptor (AR) signalling as the primary driver of castration-resistant prostate cancer (CRPC) have led to the development of novel agents targeting the AR pathway that are now in widespread clinical use. These drugs prolong the survival of patients with late-stage prostate cancer but are not curative. In this Review, we highlight emerging mechanisms of acquired resistance to these contemporary therapies, which fall into the three broad categories of restored AR signalling, AR bypass signalling and complete AR independence. This diverse range of resistance mechanisms presents new challenges for long-term disease control, which may be addressable through early use of combination therapies guided by recent insights from genomic landscape studies of CRPC.

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Emerging Mechanisms of Resistance to Androgen Receptor Inhibitors in Prostate Cancer

Nephron sparing surgery for renal tumors: indications, techniques and outcomes.

Laparoscopic Dismembered Pyeloplasty

Cystic Fibrosis Adult Care: Consensus Conference Report

Background: Although technology-enhanced simulation is increasingly used in health professions education, features of effective simulation-based instructional design remain uncertain. Aims: Evaluate the effectiveness of instructional design features through a systematic review of studies comparing different simulation-based interventions. Methods: We systematically searched MEDLINE, EMBASE, CINAHL, ERIC, PsycINFO, Scopus, key journals, and previous review bibliographies through May 2011. We included original research studies that compared one simulation intervention with another and involved health professions learners. Working in duplicate, we evaluated study quality and abstracted information on learners, outcomes, and instructional design features. We pooled results using random effects meta-analysis. Results: From a pool of 10 903 articles we identified 289 eligible studies enrolling 18 971 trainees, including 208 randomized trials. Inconsistency was usually large (I 2 4 50%). For skills outcomes, pooled effect sizes ( positive numbers favoring the instructional design feature) were 0.68 for range of difficulty (20 studies; p5 0.001), 0.68 for repetitive practice (7 studies; p ¼ 0.06), 0.66 for distributed practice (6 studies; p ¼ 0.03), 0.65 for interactivity (89 studies; p5 0.001), 0.62 for multiple learning strategies (70 studies; p5 0.001), 0.52 for individualized learning (59 studies; p5 0.001), 0.45 for mastery learning (3 studies; p ¼ 0.57), 0.44 for feedback (80 studies; p5 0.001), 0.34 for longer time (23 studies; p ¼ 0.005), 0.20 for clinical variation (16 studies; p ¼ 0.24), and � 0.22 for group training (8 studies; p ¼ 0.09). Conclusions: These results confirm quantitatively the effectiveness of several instructional design features in simulation-based education.

https://www.tandfonline.com/doi/pdf/10.3109/0142159X.2012.714886

Comparative effectiveness of instructional design features in simulation-based education: Systematic review and meta-analysis

On February 12, 1992, a laparoscopic partial nephrectomy was performed on a woman with a lower-pole caliceal diverticulum containing a stone. By incorporating the laparoscopic argon beam coagulator and a tourniquet device, the procedure was completed in 6 hours and 10 minutes. The postoperative course and period of convalescence was markedly improved over that expected from open surgery. This laparoscopic intervention demonstrates the expanding horizons of minimally invasive surgery and the remarkable development of new laparoscopic devices.

James F. Donovan

Papers

Laparoscopic partial nephrectomy: initial case report for benign disease.

Laparoscopic Varix Ligation

Urological Laparoscopic Surgery

Retroperitoneal and pelvic extraperitoneal laparoscopy: an international perspective

Laparoscopic Partial Nephrectomy: Initial Experience and Comparison to the Open Surgical Approach