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Pulmonary metastasectomy in sarcoma—experiences with laser-assisted resection

Severin Schmid, Uyen-Thao Le, Christoph Zeisel, Benedikt Haager, Bernward Passlick
2018 Journal of Thoracic Disease  
doi:10.21037/jtd.2017.12.06 pmid:29600062 pmcid:PMC5863185 fatcat:eswtbrrpv5cqzhxv5n47hwf6eq

Implementation of Fused Filament Fabrication in Dentistry

Jörg Lüchtenborg, Felix Burkhardt, Julian Nold, Severin Rothlauf, Christian Wesemann, Stefano Pieralli, Gregor Wemken, Siegbert Witkowski, Benedikt C. Spies
2021 Applied Sciences  
Additive manufacturing is becoming an increasingly important technique for the production of dental restorations and assistive devices. The most commonly used systems are based on vat polymerization, e.g., stereolithography (SLA) and digital light processing (DLP). In contrast, fused filament fabrication (FFF), also known under the brand name fused deposition modeling (FDM), is rarely applied in the dental field. This might be due to the reduced accuracy and resolution of FFF compared to vat
more » ... ymerization. However, the use of FFF in the dental sector seems very promising for in-house production since it presents a cost-effective and straight forward method. The manufacturing of nearly ready-to-use parts with only minimal post-processing can be considered highly advantageous. Therefore, the objective was to implement FFF in a digital dental workflow. The present report demonstrates the production of surgical guides for implant insertion by FFF. Furthermore, a novel approach using a temperature-sensitive filament for bite registration plates holds great promise for a simplified workflow. In combination with a medical-grade filament, a multi-material impression tray was printed for optimized impression taking of edentulous patients. Compared to the conventional way, the printed thermoplastic material is pleasant to model and can allow clean and fast work on the patient.
doi:10.3390/app11146444 fatcat:zmxyracgo5acfnwxz34o3ylmgm

Pure Bipolar Plasma Vaporization of the Prostate: The Zürich Experience

Benedikt Kranzbühler, Marian Severin Wettstein, Christian D. Fankhauser, Nico C. Grossmann, Oliver Gross, Cédric Poyet, Remo Largo, Boris Fischer, Matthias Zimmermann, Tullio Sulser, Alexander Müller, Thomas Hermanns
2013 Journal of endourology  
Introduction and Objectives: Bipolar plasma vaporization (BPV) has been introduced as an alternative to transurethral resection of the prostate (TURP). Promising short-term results, but inferior mid-term results compared to TURP have been reported following first-generation bipolar electrovaporization. Outcome data following second-generation BPV are still scarce. The aim of this investigation was to evaluate the intra-and postoperative outcomes of contemporary BPV in a center with
more » ... expertise on laser vaporization of the prostate. Methods: A consecutive series of 83 patients undergoing BPV in a tertiary referral center was prospectively evaluated. The investigated outcome parameters included the maximum flow rate (Qmax), postvoid residual volume, International Prostate Symptom Score (IPSS)/quality of life (Qol), and prostate-specific antigen (PSA) tests. Follow-up investigations took place after 6 weeks, 6 months, and 12 months. The Wilcoxon signed-rank test was used to compare pre-and post-treatment parameters. Results: The median (range) preoperative prostate volume was 41 mL (17-111 mL). The preoperative IPSS, Qol, Qmax, and residual volume were 16 (2-35), 4 (0-6), 10.1 mL/s (3-29.3 mL/s), and 87 mL (0-1000 mL), respectively. One third of the patients were undergoing platelet aggregation inhibition (PAI). No intraoperative complications occurred. Postoperatively, 13 patients (15.7%) had to be recatheterized. Three patients (3.6%) had clot retention and 28 patients (34%) reported any grade of dysuria. After 6 weeks, all outcome parameters improved significantly and remained improved over the 12-month observation period [IPSS: 3 (0-2); Qol: 1 (0-4); Qmax: 17.2 mL/s (3.2-56 mL/s); residual volume 11 mL (0-190 mL)]. The PSA reduction was 60% at study conclusion. Three patients (3.6%) developed a urethral stricture and four patients (4.8%) bladder neck sclerosis. Re-resections were not necessary. Conclusions: Contemporary BPV is a safe and efficacious treatment option even for patients undergoing PAI. Early urinary retention and temporary dysuria seem to be specific side effects of the treatment. Bleeding complications are rare. Long-term follow-up is needed to confirm these promising short-term results. Abbreviations Used BPV ¼ bipolar plasma vaporization IPSS ¼ International Prostate Symptom Score PAI ¼ platelet aggregation inhibition PSA ¼ prostate-specific antigen Qmax ¼ maximum urinary flow rate Qol ¼ quality of life TURP ¼ transurethral resection of the prostate 1266 KRANZBÜ HLER ET AL.
doi:10.1089/end.2013.0335 pmid:23806049 fatcat:tdolfvmlyrbafoggcc3qqze5ty

Intrapulmonary Castleman's Disease Pretending to Be a Lung Cancer—Work Up of an Intrapulmonary Tumour

Benedikt Haager, Gian Kayser, Severin Schmid, Bernward Passlick, Sebastian Wiesemann
2016 Annals of Thoracic and Cardiovascular Surgery  
doi:10.5761/ pmid:26581496 pmcid:PMC5045854 fatcat:jhzhgcxk6bbnjkwdqlqepkge2q

Identification of the Tumor Infiltrating Lymphocytes (TILs) Landscape in Pure Squamous Cell Carcinoma of the Bladder

Lennert Eismann, Severin Rodler, Alexander Buchner, Gerald Bastian Schulz, Yannic Volz, Robert Bischoff, Benedikt Ebner, Thilo Westhofen, Jozefina Casuscelli, Raphaela Waidelich, Christian Stief, Boris Schlenker (+1 others)
2022 Cancers  
Tumor infiltrating lymphocytes (TILs) are known as important prognostic biomarkers and build the fundament for immunotherapy. However, the presence of TILs and its impact on outcome in pure squamous cell carcinoma (SCC) of the bladder remains uncertain. Methods: Out of 1600 patients undergoing radical cystectomy, 61 patients revealed pure bladder SCC in the final histopathological specimen. Retrospectively, immunohistochemical staining was performed on a subset of TILs (CD3+, CD4+, CD8+,
more » ... Endpoints were overall survival (OS), cancer-specific survival (CSS) and progression-free survival (PFS). The Kaplan–Meier method was used to evaluate survival outcomes. Results: Strong infiltration of CD3+ was found in 27 (44%); of CD4+ in 28 (46%); of CD8+ in 26 (43%); and of CD20+ in 27 tumors (44%). Improved OS was observed for strong CD3+ (p < 0.001); CD4+ (p = 0.045); CD8+ (p = 0.001); and CD20+ infiltration (p < 0.001). Increased rates of PFS were observed for CD3+ (p = 0.025) and CD20+ TILs (p = 0.002). In multivariate analyses, strong CD3+ (HR: 0.163, CI: 0.044–0.614) and strong CD8+ TILs (HR: 0.265, CI: 0.081–0.864) were revealed as predictors for OS and the strong infiltration of CD20+ cells (HR: 0.095, CI: 0.019–0.464) for PFS. Conclusions: These first results of TILs in bladder SCC revealed predictive values of CD3+, CD8+ and CD20+.
doi:10.3390/cancers14163999 pmid:36010989 pmcid:PMC9406640 fatcat:w3agr2xxh5d2db5u5b5dxp3b5u

Automated Payment and Contract Management in the Construction Industry by Integrating Building Information Modeling and Blockchain-Based Smart Contracts

Katharina Sigalov, Xuling Ye, Markus König, Philipp Hagedorn, Florian Blum, Benedikt Severin, Michael Hettmer, Philipp Hückinghaus, Jens Wölkerling, Dominik Groß
2021 Applied Sciences  
Construction projects usually involve signing various contracts with specific billing procedures. In practice, dealing with complex contract structures causes significant problems, especially with regard to timely payment and guaranteed cash flow. Furthermore, a lack of transparency leads to a loss of trust. As a result, late or non-payment is a common problem in the construction industry. This paper presents the concept of implementing smart contracts for automated, transparent, and traceable
more » ... ayment processing for construction projects. Automated billing is achieved by combining Building Information Modeling (BIM) approaches with blockchain-based smart contracts. Thereby, parts of traditional construction contracts are transferred to a smart contract. The smart contract is set up using digital BIM-based tender documents and contains all of the relevant data for financial transactions. Once the contracted construction work has been accepted by the client, payments can be made automatically via authorized financial institutions. This paper describes the framework, referred to as BIMcontracts, the container-based data exchange, and the digital contract management workflow. It discusses the industry-specific requirements for blockchain and data storage and explains which technical and software architectural decisions were made. A case study is used to demonstrate the current implementation of the concept.
doi:10.3390/app11167653 fatcat:sgxvqhgfkfbj5fiqk32z4ax3bm

Accelerated Muscle Deoxygenation in Aerobically Fit Subjects During Exhaustive Exercise Is Associated With the ACE Insertion Allele

Benedikt Gasser, Martino V. Franchi, Severin Ruoss, Annika Frei, Werner L. Popp, David Niederseer, Silvio Catuogno, Walter O. Frey, Martin Flück
2022 Frontiers in Sports and Active Living  
*Correspondence: Benedikt Gasser,; Martin Flück, Walter O. Frey, Klinik Hirslanden, Zürich, Switzerland † Present address: Martino V.  ... 
doi:10.3389/fspor.2022.814975 pmid:35295536 pmcid:PMC8918772 fatcat:ppocr72qnjfi7d3n6wtxh7pfna

Intraoperative detection of circulating tumor cells in pulmonary venous blood during metastasectomy for colorectal lung metastases

Uyen-Thao Le, Peter Bronsert, Francesco Picardo, Sabine Riethdorf, Benedikt Haager, Bartosz Rylski, Martin Czerny, Friedhelm Beyersdorf, Sebastian Wiesemann, Klaus Pantel, Bernward Passlick, Jussuf Thomas Kaifi (+1 others)
2018 Scientific Reports  
Circulating tumor cells (CTC) have been studied extensively in various tumor types and are a wellestablished prognosticator in colorectal cancer (CRC) . This is the first study to isolate CTC directly from the tumor outflow in secondary lung tumors. For this purpose in 24 patients with CRC who underwent pulmonary metastasectomy in curative intent blood was drawn intraoperatively from the pulmonary vein (tumor outflow). In 22 samples CTC-enumeration was performed using CellSieve-microfilters and
more » ... immunohistochemical-and Giemsa-staining. Additionally 10 blood samples were analyzed using the CellSearch-System. We could isolate more CTC in pulmonary venous blood (total 41, range 0-15) than in samples taken from the periphery at the same time (total 6, range 0-5, p = 0.09). Tumor positive lymph nodes correlated with presence of CTC in pulmonary venous blood as in all cases CTC were present (p = 0.02). Our findings suggest a tumor cell release from pulmonary metastases in CRC and a correlation of CTC isolated from the tumor outflow with established negative prognostic markers in metastasized CRC. The presented data warrant further investigations regarding the significance of local tumor compartments when analyzing circulating markers and the possibility of tumor cell shedding from secondary lung tumors. During the course of disease up to one half of patients with colorectal cancer (CRC) develop metastasis with a predilection for the liver and lung 1 . Prognosis in metastasized CRC is often unfavorable, however pulmonary metastasectomy in selected patients is associated with a considerable prognosis with 5-year survival rates between 40 and 70% and sometimes even results in cure 2-4 . The decision making for treatment modalities is a multidisciplinary challenge and application of local measures to a systemic disease remains controversial and is thought to only be beneficial if there is no dissemination of tumor cells and metastases. Consequently a good selection of patients for surgical therapy is crucial. Current criteria are based solely on clinical observations such as the disease-free interval, tumor burden and general dynamics which are surrogate parameters for a favorable tumor biology 5-7 .
doi:10.1038/s41598-018-26410-8 pmid:29884810 pmcid:PMC5993733 fatcat:w3ig5imfyvghfclfjfm3gbbppe

A systematic review of treatment outcomes in localised and metastatic spermatocytic tumors of the testis

Josias Bastian Grogg, Kym Schneider, Peter-Karl Bode, Marian Severin Wettstein, Benedikt Kranzbühler, Daniel Eberli, Tullio Sulser, Joerg Beyer, Thomas Hermanns, Christian Daniel Fankhauser
2019 Journal of Cancer Research and Clinical Oncology  
Introduction Because spermatocytic tumors of the testis are rare, only limited evidence exists regarding the malignant potential and the optimal management of localized and metastatic disease. Materials and methods We performed a systematic review through MEDLINE, EMBASE, Scopus, Cochrane Database of Systematic Reviews and Web of Science to identify reports including patients with testicular spermatocytic tumors. Results From originally 7863 studies, we extracted data of 146 patients of which
more » ... % were treated with radical orchiectomy. Metastases in patients with initially localised disease were diagnosed in 7% of patients and detected after a median follow-up of 5.5 months (range 2-21 months). Patients with aggressive histology (sarcoma or anaplastic subtype) were more likely to have metastatic disease (6/124 (5%) vs 9/22 (41%), p < 0.001). Patients with metastatic disease had larger primary tumors (92.5 vs 67.5 mm, p = 0.05). Life expectancy in patients with metastatic disease ranged from 1 to 25 months. Conclusion The published literature does neither support the use of testis sparing surgery nor adjuvant therapy. Patients with aggressive variants or larger tumors were more likely to have metastases and develop recurrences within the first few years. Patients with metastatic disease have a limited life expectancy and metastatic spermatocytic tumors are not as responsive to chemotherapy as germ cell cancers. Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
doi:10.1007/s00432-019-03056-1 fatcat:43rwchlbrbhsvkwzt57d2kzxuy

Microstructure and Elastic Constants of Transition Metal Dichalcogenide Monolayers from Friction and Shear Force Microscopy

Xiaomin Xu, Thorsten Schultz, Ziyu Qin, Nikolai Severin, Benedikt Haas, Sumin Shen, Jan N. Kirchhof, Andreas Opitz, Christoph T. Koch, Kirill Bolotin, Jürgen P. Rabe, Goki Eda (+1 others)
2018 Advanced Materials  
Optical and electrical properties of two-dimensional transition metal dichalcogenides (TMDCs) grown by chemical vapor deposition (CVD) are strongly determined by their microstructure. Consequently, the visualization of spatial structural variations is of paramount importance for future applications. Here we demonstrate how grain boundaries, crystal orientation, and strain fields can unambiguously be identified with combined lateral force microscopy (LFM) and transverse shear microscopy (TSM)
more » ... CVD-grown tungsten disulfide (WS2) monolayers, on length scales that are relevant for optoelectronic applications. Further, angle-dependent TSM measurements enable us to acquire the fourth-order elastic constants of monolayer WS2 experimentally. Our results facilitate high-throughput and nondestructive microstructure visualization of monolayer TMDCs, insights into their elastic properties, thus providing an accessible tool to support the development of advanced optoelectronic devices based on such two-dimensional semiconductors.
doi:10.1002/adma.201803748 pmid:30133006 fatcat:v6l63diirbdvvpbbga3gfbt6g4

C‐reactive protein flare‐response predicts long‐term efficacy to first‐line anti‐PD‐1‐based combination therapy in metastatic renal cell carcinoma

Niklas Klümper, Philipp Schmucker, Oliver Hahn, Benedikt Höh, Angelika Mattigk, Severine Banek, Jörg Ellinger, Julia Heinzelbecker, Danijel Sikic, Markus Eckstein, Arne Strauß, Friedemann Zengerling (+3 others)
2021 Clinical & Translational Immunology  
Immune checkpoint blockade (IO) has revolutionised the treatment of metastatic renal cell carcinoma (mRCC). Early C-reactive protein (CRP) kinetics, especially the recently introduced CRP flare-response phenomenon, has shown promising results to predict IO efficacy in mRCC, but has only been studied in second line or later. Here, we aimed to validate the predictive value of early CRP kinetics for 1st-line treatment of mRCC with αPD-1 plus either αCTLA-4 (IO+IO) or tyrosine kinase inhibitor
more » ... KI). In this multicentre retrospective study, we investigated the predictive potential of early CRP kinetics during 1st-line IO therapy. Ninety-five patients with mRCC from six tertiary referral centres with either IO+IO (N = 59) or IO+TKI (N = 36) were included. Patients were classified as CRP flare-responders, CRP responders or non-CRP responders as previously described, and their oncological outcome was compared. Our data validate the predictive potential of early CRP kinetics in 1st-line immunotherapy in mRCC. CRP responders, especially CRP flare-responders, had significantly prolonged progression-free survival (PFS) compared with non-CRP responders (median PFS: CRP flare-responder: 19.2 months vs. responders: 16.2 vs. non-CRP responders: 5.6, P < 0.001). In both the IO+IO and IO+TKI subgroups, early CRP kinetics remained significantly associated with improved PFS. CRP flare-response was also associated with long-term response ≥ 12 months. Early CRP kinetics appears to be a low-cost and easy-to-implement on-treatment biomarker to predict response to 1st-line IO combination therapy. It has potential to optimise therapy monitoring and might represent a new standard of care biomarker for immunotherapy in mRCC.
doi:10.1002/cti2.1358 pmid:34925829 pmcid:PMC8648498 fatcat:g2gxay6xfze73mxjdkmr2dgify

Impact of Time to Castration Resistance on Survival in Metastatic Hormone Sensitive Prostate Cancer Patients in the Era of Combination Therapies

Mike Wenzel, Felix Preisser, Benedikt Hoeh, Maria Schroeder, Christoph Würnschimmel, Thomas Steuber, Hans Heinzer, Severine Banek, Marit Ahrens, Andreas Becker, Pierre I Karakiewicz, Felix K H Chun (+2 others)
2021 Frontiers in Oncology  
To evaluate the impact of time to castration resistance (TTCR) in metastatic hormone-sensitive prostate cancer (mHSPC) patients on overall survival (OS) in the era of combination therapies for mHSPC. Of 213 mHSPC patients diagnosed between 01/2013-12/2020 who subsequently developed metastatic castration resistant prostate cancer (mCRPC), 204 eligible patients were analyzed after having applied exclusion criteria. mHSPC patients were classified into TTCR <12, 12-18, 18-24, and >24 months and
more » ... yzed regarding OS. Moreover, further OS analyses were performed after having developed mCRPC status according to TTCR. Logistic regression models predicted the value of TTCR on OS. Median follow-up was 34 months. Among 204 mHSPC patients, 41.2% harbored TTCR <12 months, 18.1% for 12-18 months, 15.2% for 18-24 months, and 25.5% for >24 months. Median age was 67 years and median PSA at prostate cancer diagnosis was 61 ng/ml. No differences in patient characteristics were observed (all p>0.05). According to OS, TTCR <12 months patients had the worst OS, followed by TTCR 12-18 months, 18-24 months, and >24 months, in that order (p<0.001). After multivariable adjustment, a 4.07-, 3.31-, and 6.40-fold higher mortality was observed for TTCR 18-24 months, 12-18 months, and <12 months patients, relative to TTCR >24 months (all p<0.05). Conversely, OS after development of mCRPC was not influenced by TTCR stratification (all p>0.05). Patients with TTCR <12 months are at the highest OS disadvantage in mHSPC. This OS disadvantage persisted even after multivariable adjustment. Interestingly, TTCR stratified analyses did not influence OS in mCRPC patients.
doi:10.3389/fonc.2021.659135 pmid:33968764 pmcid:PMC8103198 fatcat:j3dnorixmbe6hjsyis7xnlkhyq

Anatomical Fundamentals and Current Surgical Knowledge of Prostate Anatomy Related to Functional and Oncological Outcomes for Robotic-Assisted Radical Prostatectomy

Benedikt Hoeh, Mike Wenzel, Lukas Hohenhorst, Jens Köllermann, Markus Graefen, Alexander Haese, Derya Tilki, Jochen Walz, Marina Kosiba, Andreas Becker, Severine Banek, Luis A. Kluth (+4 others)
2022 Frontiers in Surgery  
ContextMeticulous knowledge about the anatomy of the prostate and surrounding tissue represents a crucial and mandatory requirement during radical prostatectomy for reliable oncological and excellent replicable, functional outcomes. Since its introduction two decades ago, robotic-assisted laparoscopic radical prostatectomy (RALP) has evolved to become the predominant surgical approach in many industrialized countries.ObjectiveTo provide and highlight currently available literature regarding
more » ... tate anatomy and to help in improving oncological and functional outcomes in RALP.Methods/Evidence AcquiringPubMed database was searched using the following keywords: "robotic-assisted radical prostatectomy," "anatomy," "neurovascular bundle," "nerve," "periprostatic fascia," "pelvis," "sphincter," "urethra," "urinary incontinence," and "erectile dysfunction." Relevant articles and book chapters were critically reviewed and if eligible, they were included in this review.ResultsNew evidence in regards to prostatic anatomy and surgical approaches in RALP has been reported in recent years. Besides detailed anatomical studies investigating the meticulous structure of the fascial structures surrounding the prostate and neurovascular bundle preservation, debate about the optimal RALP approach is still ongoing, inspired by recent publications presenting promising functional outcomes following modifications in surgical approaches.ConclusionsThis review provides a detailed overview of the current knowledge of prostate anatomy, its surrounding tissue, and its influence on key surgical step development for RALP.
doi:10.3389/fsurg.2021.825183 pmid:35273992 pmcid:PMC8901727 fatcat:n447jsyil5dmlanghavhm3y72u

Age at surgery is not a prognostic factor for the AdVance‐XP male sling efficacy: A post‐hoc analysis of a prospective 7‐year multicentric study

Jan‐Niclas Mumm, Benazir Abrarova, Julius Schütz, Benedikt Klehr, Severin Rodler, Theresa Vilsmaier, Christian Gozzi, Peter Rehder, Florian May, Roland Homberg, Peter Gebhartl, Christian G. Stief (+2 others)
2021 Neurourology and Urodynamics  
Julius Schütz, Benedikt Klehr, Christian Gozzi, Florian May, Roland Homberg, and Peter Gebhartl, carried out the method. Christian G. Stief and Ricarda M.  ...  Theresa Vilsmaier, Severin Rodler, Alexander Buchner, Benazir Abrarova, and Ricarda M. Bauer revised the manuscript for critical content and helped with statistical evaluation.  ... 
doi:10.1002/nau.24727 pmid:34082470 fatcat:rm3tcmtgdzd7vj2nnbpwhiqhsu

Dynamics of urinary and respiratory shedding of Severe acute respiratory syndrome virus 2 (SARS-CoV-2) RNA excludes urine as a relevant source of viral transmission

Jan-Niclas Mumm, Stephan Ledderose, Andreas Ostermann, Martina Rudelius, Johannes C. Hellmuth, Max Münchhoff, Dieter Munker, Clemens Scherer, Yannic Volz, Benedikt Ebner, Clemens Giessen-Jung, Christopher Lampert (+11 others)
2021 Infection - Journal for the clinical study and treatment of infections  
Purpose To investigate the expression of the receptor protein ACE-2 alongside the urinary tract, urinary shedding and urinary stability of SARS-CoV-2 RNA. Methods Immunohistochemical staining was performed on tissue from urological surgery of 10 patients. Further, patients treated for coronavirus disease (COVID-19) at specialized care-units of a university hospital were assessed for detection of SARS-CoV-2 RNA in urinary samples via PCR, disease severity (WHO score), inflammatory response of
more » ... ients. Finally, the stability of SARS-CoV-2 RNA in urine was analyzed. Results High ACE-2 expression (3/3) was observed in the tubules of the kidney and prostate glands, moderate expression in urothelial cells of the bladder (0–2/3) and no expression in kidney glomeruli, muscularis of the bladder and stroma of the prostate (0/3). SARS-CoV-2 RNA was detected in 5/199 urine samples from 64 patients. Viral RNA was detected in the first urinary sample of sequential samples. Viral RNA load from other specimen as nasopharyngeal swabs (NPS) or endotracheal aspirates revealed higher levels than from urine. Detection of SARS-CoV-2 RNA in urine was not associated with impaired WHO score (median 5, range 3–8 vs median 4, range 1–8, p = 0.314), peak white blood cell count (median 24.1 × 1000/ml, range 5.19–48.1 versus median 11.9 × 1000/ml, range 2.9–60.3, p = 0.307), peak CRP (median 20.7 mg/dl, 4.2–40.2 versus median 11.9 mg/dl, range 0.1–51.9, p = 0.316) or peak IL-6 levels (median: 1442 ng/ml, range 26.7–3918 versus median 140 ng/ml, range 3.0–11,041, p = 0.099). SARS-CoV-2 RNA was stable under different storage conditions and after freeze–thaw cycles. Conclusions SARS-CoV-2 RNA in the urine of COVID-19 patients occurs infrequently. The viral RNA load and dynamics of SARS-CoV-2 RNA shedding suggest no relevant route of transmission through the urinary tract.
doi:10.1007/s15010-021-01724-4 pmid:34716901 pmcid:PMC8556791 fatcat:hxpqq4ma4zcnlpsbaud4p63m4m
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