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Background and objective: Clinical practice guidelines for prostate cancer (PCa) are a valuable resource for everyday clinical practice. The clinical practice guidelines and recommendations produced by various societies should demonstrate a considerable level of consistency in terms of quality, regardless of the society that developed these given the common evidence base. However, to date, no study has assessed the quality of PCa clinical practice guidelines. As part of the Optimal Treatment for Patients with Solid Tumours in Europe Through Artificial intelligence (OPTIMA) project, we evaluated the quality of the most frequently used national and international clinical practice guidelines for PCa using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool. Methods: The quality of the identified clinical practice guidelines was assessed independently by two assessors using the AGREE II tool. The AGREE II tool comprises 23 different items organised into six domains, rated on a 7-point scale (1: strongly disagree to 7: strongly agree). The total score of the appraisal was the mean value of the two assessments. The agreement between assessors’ scores was calculated using the interclass correlation coefficient (ICC). Four key recommendations were compared among the included clinical practice guidelines to assess consistency. Key findings and limitations: Sixteen clinical practice guidelines were assessed using their latest available version (cut-off April 2024). The European Association of Urology, S3LL PCa, Belgian Health Care Knowledge Centre, National Comprehensive Cancer Network, and Prostatacancer—Nationellt vårdprogram guidelines received the highest overall scores with a mean domain score of 82.4% (range: 75.5–88.3%). The de l’Association Française d’Urologie (AFU), American Urological Association, and National Institute for Health and Care Excellence received a mean domain score of 77.6% (range: 73.7–84.0%). Below average were the European Society for Medical Oncology, localised (L) and systemic (S) CPPC American Society of Clinical Oncology, and Nederlandse Vereniging voor Urologie (NVU) with a mean domain score of 58.4% (range: 43.5–76.3%). The reasons for scoring below average included the following: inadequate information about the methodology applied, limited scope of the guideline, and limited patient engagement. The highest inter-rater variability was observed in NVU (ICC: 0.58) and the lowest in AFU-L (ICC: 0.84). When examining the scores of each domain, “clarity of presentation” (domain 4) achieved the highest score with a mean of 86.9% ± 12.6%. The domain with the lowest score was applicability (domain 5), with a mean of 48.3% ± 24.8%. The ICC was calculated to be 0.72 (±0.08). Conclusions and clinical implications: This is the first study in which a comprehensive quality assessment of the majority of international and national clinical practice guidelines was undertaken, and the key recommendations were compared to assess consistency. Our study shows that the majority of international and national clinical practice guidelines demonstrate high-quality standards when assessed using the AGREE II evaluation tool. The clinical practice guidelines that did not meet the expected standards could be improved by adopting several key recommendations outlined by our study. Patient summary: The OPTIMA project used the Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool to evaluate the quality of 16 commonly used national and international clinical practice guidelines for prostate cancer. While some of these international and national clinical practice guidelines received the highest score, few guidelines scored below average due to methodological deficiencies and limited patient engagement. These findings highlight the need for a standardised process to ensure high-quality, consistent guidelines across practices.

This study explores the enhanced thermal performance of heat exchangers utilizing spirally coiled tubes, particularly in applications such as heating saltwater in solar desalination plants, which require elevated heat transfer coefficients. A numerical investigation is conducted to assess the impact of mechanically rotating horizontal spiral tubes on flow patterns and temperature profiles along their length. A detailed physical model was developed using COMSOL Multiphysics software. The findings from computational fluid dynamics simulations indicate that mechanical rotation significantly modifies both velocity and temperature gradients at each cross-section of the tube. This rotation effectively reduces the formation of thermal hotspots in the outer regions, thereby improving and accelerating heat dispersion. Notably, substantial variations in velocity and temperature profiles occur at rotation speeds up to 4 rpm; however, these changes diminish beyond this speed threshold. The study reveals that rotation increases the Nusselt number of the heated flow within the tube by over 145 %. Furthermore, the effects of rotation are more pronounced in smaller diameter tubes compared to larger ones. Ultimately, the performance factor indicates that the benefits of enhanced heat transfer outweigh the increased pressure drops associated with tube rotation, validating the effectiveness of the proposed heating system.

By the end of 2020, the unknown and contagious COVID-19 virus had spread across the globe. Failure to follow health instructions and the ambiguity of the nature of the virus caused it to infect every single citizen in a short period of time and even lead to the death of vulnerable people. Nearly two years of experience in medical research and humanities findings show that in addition to the measures of government institutions, it is the people and civil society who can be very effective in breaking the chain of transmission, and with self-care, social oversight and collective responsibility Manage. However, improper performance of people in observing the necessary health instructions and care can, in addition to the criminal title of threat to public health (subject of Article 688 of the Islamic Penal Code adopted in 1375) and also the Act on the prevention of sexually transmitted diseases and infectious diseases approved in 1320, in some cases lead to death, disability, or benefit of other persons. It also leads to intentional, quasi-intentional or pure error, depending on the case. Government criminal policy by legislative, judicial, and executive methods alone is not effective in counteracting such criminal titles, and the components of participatory (comprehensive) criminal policy need to be expanded. In fact, the purpose of this study, which has been written in an analytical and descriptive way, is to find a significant answer to the question of the effectiveness and ineffectiveness of participatory criminal policy in controlling and combating the virus. Participation as an effective and efficient method in today's difficult campaigns such as Corona. As a rule, the hypothesis of this research that the effectiveness of these components has been proved in the following and can be implemented by taking measures at different levels of government and people. Therefore, the application of this research can be hoped to eliminate the damage of Covid virus 19 and prevent, control and deal with its spread and contagion.

Abstract Background Plasma soluble urokinase-type Plasminogen Activator Receptor (suPAR) predicts disease aggressiveness in renal cell carcinoma (ccRCC), but its prognostic accuracy has not been investigated. To investigate the prognostic accuracy of preoperative plasma suPAR in patients who received curative treatment for initially localized ccRCC. Methods We retrospectively analyzed plasma samples stored in the Danish National Biobank between 2010 and 2015 from 235 patients with ccRCC at any stage. Relationships with outcome analyzed using univariate and multiple logistic Cox regression analysis. Results There were 235 patients with ccRCC. The median follow-up period was 7.7 years. In univariate analysis suPAR ≥ 6 ng/mL was significantly associated with overall survival (OS) and recurrence-free survival (RFS). Patients with elevated suPAR were more likely to recur, with a Hazard Ratio (HR) of 2.3 for RFS. In multiple logistic regression, suPAR ≥ 6 ng/mL remained a negative predictor of OS and RFS. Limitations include retrospective study design, wide confidence intervals, and tumor subtype heterogeneity bias. Conclusions ccRCC patients with high plasma suPAR concentrations are at an elevated risk of disease recurrence and see lower OS. suPAR is a promising surveillance tool to more precisely follow up with ccRCC patients and detect future recurrences. Patient Summary In this study, we showed that new type of liquid marker in blood plasma, called suPAR, is associated to a higher risk of kidney cancer recurrence when elevated above 6ng/mL. We also showed suPAR to independently be able to predict patients overall and recurrence free survival in patient with any stage of kidney cancer.

Context: Radiotherapy of the pelvis is a widely used method for the treatment of malignancies, and local complications including pain following pelvic radiation therapy are acknowledged complications. Objective: The primary objective is to assess the clinical effectiveness and safety of pharmacological therapies on postradiation pelvic pain. Evidence acquisition: A systematic review of the use of different pharmacological treatments in the management of post-radiation pelvic pain was conducted (PROSPERO-ID: CRD42021249026). Comprehensive searches of EMBASE, Medline, and Cochrane library were performed for publications between January 1980 and April 2021. The primary outcomes were improvement in pain and adverse events following treatment. The secondary outcomes included quality of life, bowel function, and urinary function. Evidence synthesis: After screening 1514 abstracts, four randomised controlled trials were identified, enrolling 355 patients with bladder and anorectal subtypes of postradiotherapy chronic pelvic pain (CPP). A narrative synthesis was performed as heterogeneity of included studies precluded a meta-analysis. A single study reported a significant reduction in pain after 6 mo in patients with bladder pain syndrome treated with hyaluronic acid or hyperbaric oxygen. Anorectal pain was reported to be reduced by the application of 4% formalin, but the use of hyperbaric oxygen in postradiotherapy anorectal pain remains controversial. Adverse event reporting was generally poor. Studies looking at medications used routinely in guidelines for neuropathic pain, such as gabapentin, pregabalin, amitriptyline, and duloxetine, were absent or of poor quality when it came to postradiation pelvic pain. Conclusions: Beneficial effects of hyperbaric oxygen or formalin on pain, quality of life, and functional symptoms were seen in patients with certain CPP subtypes, but the current evidence level is too weak to allow recommendations about the use of any pharmacological treatment for postradiation pelvic pain. Patient summary: Different pharmacological treatments are used to treat pain after radiotherapy, but current studies are of insufficient quality to determine whether these should be recommended and many chronic pelvic pain subtypes are not covered. Further research is needed.

Abstract Background There is inconsistency in outcomes collected in renal cell cancer (RCC) intervention effectiveness studies and variability in their definitions. This makes critical summaries of the evidence base difficult and sub‐optimally informative for clinical practice guidelines and decision‐making by patients and healthcare professionals. A solution is to develop a core outcome set (COS), an agreed minimum set of outcomes to be reported in all trials in a clinical area. Objectives To develop three COS for (a) localised, (b) locally advanced and (c) metastatic RCC study design, participants and methods The methods are the same for each of our three COS and are structured in two phases. Phase 1 identifies potentially relevant outcomes by conducting both a systematic literature review and patient interviews (N ~ 30 patients). Qualitative data will be analysed using framework analysis. In phase 2, all outcomes identified in phase 1 will be entered in a modified eDelphi, whereby patients and healthcare professionals (50 of each) will score each outcome's importance (Likert scale from 1 [not important] to 9 [critically important]). Outcomes scored in the 7–9 range by ≥70% and 1–3 by ≤15% will be regarded as ‘consensus in’, and the vice versa of this will constitute ‘consensus out’. All other combinations will be regarded as equivocal and discussed at consensus meetings (including 10 patients and 10 healthcare professionals) in order to vote on them and ratify the results of the eDelphi. Discussion The R‐COS will reduce outcome reporting heterogeneity and improve the evidence base for RCC. Study registration The study is registered with the COMET initiative: https://www.comet-initiative.org/studies/details/1406.

Introduction Benzoyl peroxide (BPO) is a diacyl peroxide with bactericidal activity used in topical drug products up to 10% concentration and is available through prescription or over-the-counter (OTC) for treatment [...]

Biogas upgrading via biomethanation has been extensively studied recently, but the influence of organic loading rate on process performance remains to be fully understood. This is particularly significant because both organic loading rate and hydrogen injection can lead to volatile fatty acid accumulation during anaerobic digestion. This study investigated the impact of a wide range of organic loading rates (from 1.25 to 3.25 g VS/L/d) on hydrogen consumption rates, organic acid accumulation, and microbial communities during in situ biomethanation. It also provided kinetics data and metabolite production data for different control reactors, including anaerobic digestion, ex situ biomethanation, and endogenous control reactors. Hydrogen was injected into parallel batch reactors using digestate from a semi-continuous lab-scale reactor subjected to increasing organic loading rates (1.25–3.25 g VS/L/d) as an inoculum. The inoculum was well adapted to each tested organic loading rate. The batch experiments were replicated following a 12 h hydrogen starvation period to assess the stability of hydrogen consumption rates. High organic loading rate values resulted in increased hydrogen consumption rates, peaking at 68 mg COD/L/h at an organic loading rate of 3.25 g VS/L/d (maximum value tested), with no significant organic acid accumulation despite the high hydrogen partial pressures. The hydrogen consumption rates were maintained after the starvation period. Furthermore, the addition of an organic substrate did not impact the hydrogen consumption rate (i.e., the in situ and ex situ rates were similar). A higher organic loading rate resulted in higher relative abundances of hydrogenotrophic methanogens (i.e., Methanospirillum sp.). This study highlights that increasing the organic loading rate can accelerate the rate of hydrogen consumption during in situ biomethanation, consequently reducing both capital and operational costs.

For years, cold plasma processing has been used as a non-thermal technology in industries such as food. As interfacial properties of protein play a remarkable role in many processes, this study investigates the effect of cold plasma on the foaming and interfacial behavior of WPI. The objective of this study is to evaluate the effect of different gases (air, 1:1 argon–air mixture, and sulfur hexafluoride (SF6)) used in low-pressure cold plasma (VCP) treatments of whey protein isolate (WPI) on the surface and foaming behavior of aqueous WPI solutions. Dynamic surface dilational elasticity, surface tension isotherms, surface layer thickness, and the foamability and foam stability were investigated in this study. VCP treatment did not significantly affect the adsorption layer thickness. However, an increase in induction time, surface pressure equilibrium value, and aggregated size is observed after SF6VCP treatment, which can be attributed to the reaction of WPI with the reactive SF6 species of the cold plasma. The surface dilational elastic modulus increased after VCP treatment, which can be related to the increased mechanical strength of the protein layer via sulfonation and aggregate formation. VCP treatment of WPI increases the foam stability, while the average diameter of foam bubbles and liquid drainage in the foam depends on the gas used for the cold plasma.

Context: Outcomes in renal cell carcinoma (RCC) are reported inconsistently, with variability in definitions and measurement. Hence, it is difficult to compare intervention effectiveness and synthesise outcomes for systematic reviews and to create clinical practice guidelines. This uncertainty in the evidence makes it difficult to guide patient-clinician decision-making. One solution is a core outcome set (COS): an agreed minimum set of outcomes. Objective: To describe outcome reporting, definitions, and measurement heterogeneity as the first stage in co-creating a COS for localised renal cancer. Evidence acquisition: We systematically reviewed outcome reporting heterogeneity in effectiveness trials and observational studies in localised RCC. In total, 2822 studies (randomised controlled trials, cohort studies, case-control studies, systematic reviews) up to June 2020 meeting our inclusion criteria were identified. Abstracts and full texts were screened independently by two reviewers; in cases of disagreement, a third reviewer arbitrated. Data extractions were double-checked. Evidence synthesis: We included 149 studies and found that there was inconsistency in which outcomes were reported across studies and variability in the definitions used for outcomes that were conceptually the same. We structured our analysis using the outcome classification taxonomy proposed by Dodd et al. Outcomes linked to adverse events (eg, bleeding, outcomes linked to surgery) and renal injury outcomes (reduced renal function) were reported most commonly. Outcomes related to deaths from any cause and from cancer were reported in 44% and 25% of studies, respectively, although the time point for measurement and the analysis methods were inconsistent. Outcomes linked to life impact (eg, global quality of life) were reported least often. Clinician-reported outcomes are more frequently reported than patient-reported outcomes in the renal cancer literature. Conclusions: This systematic review underscores the heterogeneity of outcome reporting, definitions, and measurement in research on localised renal cancer. It catalogues the variety of outcomes and serves as a first step towards the development of a COS for localised renal cancer. Patient summary: We reviewed studies on localised kidney cancer and found that multiple terms and definitions have been used to describe outcomes. These are not defined consistently, and often not defined at all. Our review is the first phase in developing a core outcome set to allow better comparisons of studies to improve medical care.

Upper extremity reconstruction may pose clinical challenges for surgeons due to the often-critical, complex functional demands of the damaged and/or missing structures. The advent of vascularized bone grafts (VBGs) has aided in reconstruction of upper extremity (UE) defects due to their superior regenerative properties compared with nonvascularized bone grafts, ability to reconstruct large bony defects, and multiple donor site options. VBGs may be pedicled or free transfers and have the potential for composite tissue transfers when bone and soft tissue are needed. This article provides a comprehensive up-to-date review of VBGs, the commonly reported donor sites, and their indications for the treatment of specific UE defects.

Background: No liquid biomarkers are approved in renal cell carcinoma (RCC), making early detection of recurrence in surgically treated nonmetastatic (M0) patients dependent on radiological imaging. Urine- and plasma free glycosaminoglycan profiles—or free GAGomes—are promising biomarkers reflective of RCC metabolism. Objective: To explore whether free GAGomes could detect M0 RCC recurrence noninvasively. Design, setting, and participants: Between June 2016 and February 2021, we enrolled a prospective consecutive series of patients elected for (1) partial or radical nephrectomy for clinical M0 RCC (cohort 1) or (2) first-line therapy following RCC metachronous metastatic recurrence (cohort 2) at Sahlgrenska University Hospital, Gothenburg, Sweden. The study population included M0 RCC patients with recurrent disease (RD) versus no evidence of disease (NED) in at least one follow-up visit. Plasma and urine free GAGomes—consisting of 40 chondroitin sulfate (CS), heparan sulfate, and hyaluronic acid (HA) features—were measured in a blinded central laboratory preoperatively and at each postoperative follow-up visit until recurrence or end of follow-up in cohort 1, or before treatment start in cohort 2. Outcome measurements and statistical analysis: We used Bayesian logistic regression to correlate GAGome features with RD versus NED and with various histopathological variables. We developed three recurrence scores (plasma, urine, and combined) proportional to the predicted probability of RD. We internally validated the area under the curve (AUC) using bootstrap resampling. We performed a decision curve analysis to select a cutoff and report the corresponding net benefit, sensitivity, and specificity of each score. We used univariable analyses to correlate each preoperative score with recurrence-free survival (RFS). Results and limitations: Of 127 enrolled patients in total, 62 M0 RCC patients were in the study population (median age: 63 year, 35% female, and 82% clear cell). The median follow-up time was 3 months, totaling 72 postoperative visits —17 RD and 55 NED cases. RD was compatible with alterations in 14 (52%) of the detectable GAGome features, mostly free CS. Eleven (79%) of these correlated with at least one histopathological variable. We developed a plasma, a urine, and a combined free CS RCC recurrence score to diagnose RD versus NED with AUCs 0.91, 0.93, and 0.94, respectively. At a cutoff equivalent to ≥30% predicted probability of RD, the sensitivity and specificity were, respectively, 69% and 84% in plasma, 81% and 80% in urine, and 80% and 82% when combined, and the net benefit was equivalent to finding an extra ten, 13, and 12 cases of RD per hundred patients without any unnecessary imaging for plasma, urine, and combined, respectively. The combined score was prognostic of RFS in univariable analysis (hazard ratio = 1.90, p = 0.02). Limitations include a lack of external validation. Conclusions: Free CS scores detected postsurgical recurrence noninvasively in M0 RCC with substantial net benefit. External validity is required before wider clinical implementation. Patient summary: In this study, we examined a new noninvasive blood and urine test to detect whether renal cell carcinoma recurred after surgery.

Background: Pioglitazone is the selective PPAR-γ receptor agonist, which is prescribed for the treatment of type 2 diabetes and may also have antidepressant effects. Nitric oxide (NO) has been involved in some crucial roles, including learning, cognition and neurogenesis as well as some neurodegenerative diseases, including Parkinson, Alzheimer's disease (AD) and depression. Reduced estrogen levels throughout ovariectomy, postpartum and menopause make women more likely to suffer from depression. The existing study was designed to examine the antidepressant-like effects of pioglitazone, a PPAR-γ agonist, and the probable involvement of NO with the use of non-specific NO synthase inhibitor (L-NAME) or an NO precursor (L-arginine) in female ovariectomized (OVX) mice. Methods: The present study was conducted experimentally on female NMRI mice from April to December 2019 at the Pharmacology Department of Pharmacy Faculty, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Female mice were subjected to bilaterally ovariectomy, and various doses of pioglitazone (10, 20, 40 mg/kg) were administered either alone or in combination with non-specific NO synthase (NOS) inhibitor (L-NAME) or a NO precursor (L-arginine). Antidepressant-like activity of pioglitazone was evaluated in the forced swimming test (FST) and the tail suspension test (TST). Moreover, the open field test was done to evaluate the locomotor activity of mice following different treatments. Results: OVX mice demonstrated a major increase in immobility time versus sham therapy following procedure (P≤0.05). Mice were injected with 40 mg/kg pioglitazone Intraperitoneally, 4 h before the behavioral test, exhibited marked antidepressant-like effects in OVX mice (P≤0.01, P≤0.05 in FST and TST, respectively). Co-administration of sub-effective dose of L-NAME (2 mg/kg) with a sub-effective dose of pioglitazone (20 mg/kg) resulted in a strong antidepressant-like effect in OVX mice (P≤0.01), whereas L-arginine inhibited this effect. The various treatments did not change the total locomotion of mice in OFT. Conclusion: Antidepressant-like effects of pioglitazone may be associated with inhibition of the NO synthase/NO in OVX mice and provided a new strategy for depression.