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Zusammenfassung Hintergrund Publikationen verschiedenster medizinischer Fachgesellschaften und Länder weisen auf einen negativen Einfluss der COVID-19 Pandemie auf die Weiterbildung von Ärzten hin. Fragestellung Ziel dieser Arbeit war es, die Weiterbildungssituation urologischer Assistenzärzte in Deutschland während der 1. Welle der Pandemie zu erfassen. Material und Methoden Vom 20.05.2020 bis 20.06.2020 wurde eine deutschlandweite Onlineumfrage zur Weiterbildungssituation über die Mitglieder der Arbeitsgruppe Versorgungsforschung & Soziale Medien des Forschungsnetzwerkes GeSRU Academics, über soziale Netzwerke (Facebook, Twitter, Instagram) und den monatlichen Newsletter der German Society of Residents in Urology (GeSRU e.V.) an die Zielgruppe der urologischen Assistenzärzte verteilt. Die Umfrage erfasste 3 Teilbereiche: 1) Grundcharakteristika der Teilnehmer, 2) genereller und 3) subjektiver Einfluss der COVID-19 Pandemie auf Klinik und Weiterbildung. Ergebnisse Insgesamt nahmen 50 Assistenzärzte an der Umfrage teil, davon waren 54% Frauen. Das Durchschnittsalter betrug 30,9 Jahre. Die meisten Teilnehmer befanden sich im 2. (22%) sowie im 5. (26%) Ausbildungsjahr und arbeiteten in einer Universitätsklinik (44%) oder in einem Haus der Maximalversorgung (30%) in Baden-Württemberg (18%), Hamburg (16%) oder Bayern (14%). 38% der Befragten gaben an, aufgrund der COVID-19 Pandemie nur noch im Notfallbetrieb zu arbeiten. Für 28% bedeutete dies eine sehr starke Verzögerung (80-100%) der Facharztausbildung, während weitere 28% nur eine geringe Einschränkung angaben. 66% dokumentierten Beeinträchtigungen der Ausbildung aufgrund eines reduzierten OP-Einsatzes, weniger Einsätzen in der Ambulanz (50%) sowie der Absage von Kongressen (50%) und Weiterbildungen (44%). 46% der Befragten gaben direkten Kontakt zu COVID-19 Patienten an. 10% wurden fachfremd auf interdisziplinären Überwachungsstationen eingesetzt. Insgesamt wurden zahlreiche Schritte zum „physical distancing“ und Hygienemaßnahmen von den Kliniken umgesetzt, um Infektionsausbreitungen zu vermeiden. Diskussion Mehr als die Hälfte (56%) der urologischen Assistenzärzte gaben deutliche Einschränkungen in der Weiterbildung durch die COVID-19 Pandemie an. Die Verzögerung der Ausbildung lässt sich aktuell noch nicht in Zeiteinheiten messen, es ist jedoch anzunehmen, dass die Weiterbildung für Ärzte während der Pandemie eine geringere Qualität im Vergleich zu vorausgehenden Generationen haben dürfte.

Purpose Hospital rating websites (HRW) offer decision support in hospital choice for patients. To investigate the impact of HRWs of uro-oncological patients undergoing elective surgery in Germany. Methods From 01/2020 to 04/2021, patients admitted for radical prostatectomy, radical cystectomy, or renal tumor surgery received a questionnaire on decision-making in hospital choice and the use of HRWs at 10 German urologic clinics. Results Our study includes n = 812 completed questionnaires (response rate 81.2%). The mean age was 65.2 ± 10.2 years; 16.5% were women. Patients were scheduled for prostatectomy in 49.1%, renal tumor surgery in 20.3%, and cystectomy in 13.5% (other 17.1%). Following sources of information influenced the decision process of hospital choice: urologists’ recommendation (52.6%), previous experience in the hospital (20.3%), recommendations from social environment (17.6%), the hospital's website (10.8%) and 8.2% used other sources. Only 4.3% (n = 35) used a HRW for decision making. However, 29% changed their hospital choice due to the information provided HRW. The most frequently used platforms were Weisse-Liste.de (32%), the AOK-Krankenhausnavigator (13%) and Qualitaetskliniken.de (8%). On average, patients rated positively concerning satisfaction with the respective HRW on the Acceptability E-Scale (mean values of the individual items: 1.8–2.1). Conclusion In Germany, HRWs play a minor role for uro-oncologic patients undergoing elective surgery. Instead, personal consultation of the treating urologist seems to be far more important. Although patients predominantly rated the provided information of the HRW as positive, only a quarter of users changed the initial choice of hospital.

The objective of our study is to examine the impact of monorchism on contralateral testicular size in children with non-palpable testis (NPT). Enhanced contralateral testicular volume or longitudinal diameter (length) serves as a predictor of monorchism. In the present study, we assessed the ability of ultrasound measured enlarged contralateral testicular length for predicting monorchism (and hence a testicular nubbin) in children with NPT. Furthermore, we evaluated the general prevalence of viable versus non-viable testes in patients referred to our institution with unilateral undescended testis between 2005 and 2020.We analysed the records of 54 patients who underwent diagnostic laparoscopy for NPT between 2005 and 2020 in a European tertiary care centre. Testicular lengths (longitudinal diameter) and testicular volume of the contralateral testis, as well as surgeon (surgeon 1 vs surgeon 2 vs others) and age at surgery (months) were assessed and stratified according to intraoperative findings (presence or absence of a testicular nubbin). Testicular length and volume were evaluated by ultrasound examination in office prior to surgery. Chi-square and t-test for descriptive analyses as well as uni- and multivariable logistic regression analyses were performed using R Version 3.1.0 (R Project for Statistical Computing, www.R-project.org).A total of 15 children presented with viable testes and 39 patients with testicular nubbin. Mean age was 20.5 months in the overall cohort and 22.6 vs 19.7 months in children with viable testis vs testicular nubbin (p = 0.4). In patients with presence of a testicular nubbin, the contralateral testis was larger (median length 17 mm (16-19.2)) as compared to patients with a viable testis (median length 15 mm (14-17), p = 0.001). Similarly, contralateral testicular volume was lower in patients with a present viable testis (0.6 ccm vs 0.8 ccm; p 0-001). This effect remained statistically significant when logistic regression analyses were adjusted for age and weight at surgery, year of surgery, surgeon, and laterality. OR (odds ratio) for presence of a testicular nubbin was 1.6 (per mm) [95% CI (confidence interval) 1.13-2.17; p = 0.007].Patients with preoperative increased length and volume of the contralateral testis in the ultrasound examination are at significantly higher risk of monorchism than their counterparts with lower testicular length. This should be emphasized during counselling of the parents prior to surgery. In our experience parents cope more easily with the diagnosis of monorchism, once this has already been discussed and explained thoroughly prior to surgery.

Purpose EAU guidelines recommend multiparametric MRI of the prostate (mpMRI) prior to biopsy to increase accuracy and reduce biopsies. Whether biopsy can be avoided in case of negative mpMRI remains unclear. Aim of this study is to evaluate predictors of overall prostate cancer (PCa) in negative mpMRI. Methods A total of 216 patients from 2018 to 2020 with suspicion of PCa and negative mpMRI (PI-RADS ≤ 2) were interviewed by telephone about outcome and further follow-up. Clinically significant PCa (csPCa) was defined as ISUP ≥ 2. Patients with vs. without biopsy and with vs. without PCa were compared. Univariate and multivariate analyses were performed to evaluate predictors of PCa occurrence in patients with negative mpMRI. Results 15.7% and 5.1% of patients with PI-RADS ≤ 2 on mpMRI showed PCa and csPCa, respectively. PCa patients had higher PSAD (0.14 vs. 0.09 ng/ml2; p = 0.001) and lower prostate volume (50.5 vs. 74.0 ml; p = 0.003). Patients without biopsy (25%) after MRI were older (69 vs. 65.5 years; p = 0.027), showed lower PSA (5.7 vs. 6.73 ng/ml; p = 0.033) and lower PSA density (0.09 vs. 0.1 ng/ml2; p = 0.027). Multivariate analysis revealed age (OR 1.09 [1.02–1.16]; p = 0.011), prostate volume (OR 0.982 [0.065; 0.997]; p = 0.027), total PSA level (OR 1.22 [1.01–1.47], p = 0.033), free PSA (OR 0.431 [0.177; 0.927]; p = 0.049) and no PI-RADS lesion vs PI-RADS 1–2 lesion (OR 0.38 [0.15–0.91], p = 0.032.) as predictive factors for the endpoint presence of PCa. Conclusions Biopsy for selected patient groups (higher age, prostate volume and free PSA as well as lower PSA-Density) with negative mpMRI can be avoided, if sufficient follow-up care is guaranteed. Detailed counseling regarding residual risk for undetected prostate cancer should be mandatory.

High-resolution geochronology is essential for determining the growth rate of volcanoes, which is one of the key factors for establishing the periodicity of volcanic eruptions. However, there are less high-resolution eruptive histories ( > 10 6 years) determined for long-lived submarine arc volcanic complexes than for subaerial complexes, since submarine volcanoes are far more difficult to observe than subaerial ones. In this study, high-resolution geochronology and major-element data are presented for the Milos volcanic field (VF) in the South Aegean Volcanic Arc, Greece. The Milos VF has been active for over 3 Myr , and the first 2 × 10 6 years of its eruptive history occurred in a submarine setting that has been emerged above sea level. The long submarine volcanic history of the Milos VF makes it an excellent natural laboratory to study the growth rate of a long-lived submarine arc volcanic complex. This study reports 21 new high-precision 40 Ar / 39 Ar ages and major-element compositions for 11 volcanic units of the Milos VF. This allows us to divide the Milos volcanic history into at least three periods of different long-term volumetric volcanic output rate ( Qe ). Periods I (submarine, ∼ 3.3–2.13 Ma ) and III (subaerial, 1.48 Ma –present) have a low Qe of 0.9 ± 0.5 × 10 −5 and 0.25 ± 0.05 × 10 −5 km3 yr−1 , respectively. Period II (submarine, 2.13–1.48 Ma ) has a 3–12 times higher Qe of 3.0 ± 1.7 × 10 −5 km3 yr−1 . The Qe of the Milos VF is 2–3 orders of magnitude lower than the average for rhyolitic systems and continental arcs.

Several international medical societies reported a negative impact on urology residency training programs due to the COVID-19 pandemic.The aim of this study was to investigate the impact of the pandemic on urological residency in Germany.From the 20A total of 50 residents took part in the survey; 54% were women. The median age was 31 years. Most of the participants were in their 2nd (22%) and 5th (26%) year of training and worked in a university hospital (44%) or in a clinic of maximum care (30%). 38% of the respondents stated that they only served urological emergencies during the COVID-19 pandemic. For 28% this meant a very large delay (80-100%) in the specialisation, while 28% stated only a minor impact. 66% documented training impairments caused by fewer operations, low patient numbers in the outpatient department (50%), congress (50%) and workshop (44%) cancellations. 46% of residents reported direct contact with COVID-19 patients while 10% were deployed on interdisciplinary IMC units. Numerous physical distancing and hygiene measures have been implemented by the clinics.On average, around 50% of the urology residents indicated significant restrictions in training due to the COVID-19 pandemic in Germany. The delay in training cannot currently be measured in units of time, but it can be assumed that training for residents during the pandemic is likely to be of a lower quality compared to previous generations.Publikationen verschiedenster medizinischer Fachgesellschaften und Länder weisen auf einen negativen Einfluss der COVID-19 Pandemie auf die Weiterbildung von Ärzten hin.Ziel dieser Arbeit war es, die Weiterbildungssituation urologischer Assistenzärzte in Deutschland während der 1. Welle der Pandemie zu erfassen.Vom 20.05.2020 bis 20.06.2020 wurde eine deutschlandweite Onlineumfrage zur Weiterbildungssituation über die Mitglieder der Arbeitsgruppe VersorgungsforschungSoziale Medien des Forschungsnetzwerkes GeSRU Academics, über soziale Netzwerke (Facebook, Twitter, Instagram) und den monatlichen Newsletter der German Society of Residents in Urology (GeSRU e.V.) an die Zielgruppe der urologischen Assistenzärzte verteilt. Die Umfrage erfasste 3 Teilbereiche: 1) Grundcharakteristika der Teilnehmer, 2) genereller und 3) subjektiver Einfluss der COVID-19 Pandemie auf Klinik und Weiterbildung.Insgesamt nahmen 50 Assistenzärzte an der Umfrage teil, davon waren 54% Frauen. Das Durchschnittsalter betrug 30,9 Jahre. Die meisten Teilnehmer befanden sich im 2. (22%) sowie im 5. (26%) Ausbildungsjahr und arbeiteten in einer Universitätsklinik (44%) oder in einem Haus der Maximalversorgung (30%) in Baden-Württemberg (18%), Hamburg (16%) oder Bayern (14%). 38% der Befragten gaben an, aufgrund der COVID-19 Pandemie nur noch im Notfallbetrieb zu arbeiten. Für 28% bedeutete dies eine sehr starke Verzögerung (80-100%) der Facharztausbildung, während weitere 28% nur eine geringe Einschränkung angaben. 66% dokumentierten Beeinträchtigungen der Ausbildung aufgrund eines reduzierten OP-Einsatzes, weniger Einsätzen in der Ambulanz (50%) sowie der Absage von Kongressen (50%) und Weiterbildungen (44%). 46% der Befragten gaben direkten Kontakt zu COVID-19 Patienten an. 10% wurden fachfremd auf interdisziplinären Überwachungsstationen eingesetzt. Insgesamt wurden zahlreiche Schritte zum „physical distancing“ und Hygienemaßnahmen von den Kliniken umgesetzt, um Infektionsausbreitungen zu vermeiden.Mehr als die Hälfte (56%) der urologischen Assistenzärzte gaben deutliche Einschränkungen in der Weiterbildung durch die COVID-19 Pandemie an. Die Verzögerung der Ausbildung lässt sich aktuell noch nicht in Zeiteinheiten messen, es ist jedoch anzunehmen, dass die Weiterbildung für Ärzte während der Pandemie eine geringere Qualität im Vergleich zu vorausgehenden Generationen haben dürfte.

Digitalization of patient documentation and introduction of the electronic patient record (ePA) pose challenges to everyday clinical practice.We investigated the acceptance and status of the digitalization of patient data and the introduction of the ePA among German urologists.A questionnaire with 30 questions about the acceptance and status of digitalization of patient documentation and ePA was sent out via the newsletter of the German Society of Urology.A total of 80 urologists participated in the survey (response rate 2%). Digital platforms such as Urotube or Researchgate are used by 63% of participants. The complete implementation of digital patient documentation was reported by 72% of respondents working in medical practice and by 54% of those working in the hospital (p = 0.042). While 76% see the digitalization process as reasonable, 34% expressed partial or strong concerns about the complete digitalization of patient documentation. Only 14% of the participants offer video consultations. Advantages for ePA include better networking of the healthcare system (73%), improved diagnosis, indication (41%) and treatment quality (48%), and avoidance of medication errors (70%).German urologists are open to the digitalization process and ePA. Especially younger urologists are using digital media. The advantages of digitalization are, in particular, an improvement in treatment processes. For a smooth introduction, a cross-departmental establishment and, if necessary, an adaptation of the treatment processes are necessary.HINTERGRUND: Die Digitalisierung der Patientendokumentation und die Einführung der elektronischen Patientenakte (ePA) stellen den klinischen Alltag vor große Herausforderungen.Wir untersuchten die Akzeptanz und den Stand der Digitalisierung von Patientendaten sowie die Einführung der ePA bei den deutschen Urologen.Nach einem iterativen Entwicklungsprozess erhielten wir einen Fragebogen mit 30 Items, welcher über den Forschungsnewsletter der Deutschen Gesellschaft für Urologie e. V. versendet wurde.Insgesamt beantworteten 80 Urologen den Fragebogen (Rücklaufquote 2 %). Digitale Plattformen wie Urotube oder Researchgate wurden von 63 % der Teilnehmer verwendet. Die komplette Einführung der digitalen Patientendokumentation erfolgte bei 72 % der ambulant Tätigen und bei 54 % der in der Klinik Tätigen (p = 0,042). 76 % der Befragten sahen den Digitalisierungsprozess als sinnvoll an. 34 % äußerten teilweise oder starke Bedenken bzgl. einer kompletten Digitalisierung der Patientendokumentation. Nur 14 % der Teilnehmer haben eine Videosprechstunde angeboten. Als Vorteile für die ePA wurden u. a. die bessere Vernetzung des Gesundheitswesens (73 %), die Verbesserung der Diagnose, der Indikations- (41 %) und der Behandlungsqualität (48 %) sowie die Vermeidung von Fehlmedikation (70 %) gesehen.Die deutschen Urologen stehen der Digitalisierung der Patientendokumentation und der ePA insgesamt offen gegenüber. Insbesondere jüngere Urologen nutzen digitale Medien. Die Vorteile der Digitalisierung sind insbesondere eine Verbesserung der Behandlungsabläufe. Für eine reibungslose Einführung sind eine bereichsübergreifende Etablierung und ggf. eine Anpassung der Behandlungsprozesse notwendig.

The purpose of this study was to investigate adherence to recommended adjuvant radiotherapy (aRT) in radical prostatectomy (RP) patients with adverse pathologic features and to analyse the outcome of patients who followed or denied this recommendation.We included 1140 consecutive RP patients (2006-2015) with non-organ confined (pT3) prostate cancer and either positive surgical margins (R1) and/or lymph node involvement (pN1) and non-detectable postoperative prostate-specific antigen who received multidisciplinary aRT recommendations. Patients were stratified into adherence versus non-adherence to recommendations. Additionally, subgroups within pathologic criteria (pT3R1N0, pT3R0N1, pT3R1N1) were analyzed. Kaplan-Meier, as well as multivariable Cox regression analyses were used to assess biochemical recurrence (BCR)-free survival, metastasis-free survival, cancer-specific survival, and overall survival.Overall, 508 (44.6%) patients were non-adherent. Of those, 273 (53.6%) did not receive any RT, and 235 (46.4%) received salvage RT. At 8 years, BCR-free survival was 57.7 versus 20.1%, metastasis-free survival was 76.5 versus 75.4%, cancer-specific survival was 91.7 versus 87.4%, and overall survival was 80.4 versus 75.8% in adherent versus non-adherent patients, respectively (P .001). In multivariable Cox regression predicting BCR, metastatic progression, cancer-specific mortality, and overall mortality, non-adherence to aRT recommendation represented an independent predictor (hazard ratio [HR], 3.8; 95% confidence interval [CI], 3.1-4.5; HR, 1.6; 95% CI, 1.2-2.2; HR, 2.8; 95% CI, 1.5-5.3; and HR, 1.8; 95% CI, 1.2-2.8, respectively).Only about 55% of patients followed our multidisciplinary recommendations. Adherent patients were significantly less likely to experience BCR, metastatic progression, cancer-specific mortality, and overall mortality. Thus, patients with high risk of recurrence may be advised about the possibility of improved oncologic outcomes in case of adherence to aRT recommendations.

OBJECTIVES: To investigate the safety of robotic surgery during COVID-19 pandemic concerning new-acquired COVID-19 infections for patients and healthcare workers. PATIENTS: We performed a retrospective single-centre cohort study of patients undergoing robotic surgery in initial period of COVID-19 pandemic. Patients and Healthcare workers COVID-19 infection status was assessed by structured telephone follow-up and/or repeated nasopharyngeal swabs. RESULTS: After 61 robotic surgeries (93,5% cancer surgery), 1 patient (1.6%) had COVID-19 infection. 60 healthcare workers cumulatively exposed to 1,187 hours of robotic surgery had no infection. One patient with postoperative proof of SARS-CoV-2 had complete recovery. After this potentially contagious robotic surgery, 8 healthcare workers had no COVID-19 infection after follow-up with each 3 nasopharyngeal swabs. CONCLUSIONS: Early clinical experience of robotic surgery during COVID-19 pandemic shows that robotic surgery can be safely performed for patients and healthcare workers. Despite our results we recommend elective surgery only for verified COVID-19 negative patients. This article is protected by copyright. All rights reserved.

Background Transrectal prostate biopsy (pbx) is the most frequent outpatient procedure in the urological field. Septic complications are a major health issue. Objective To evaluate complication rates with or without an antimicrobial lubricant. Design, setting, and participants A total of 1000 patients received pbx between 2013 and 2015. Information about complications was collected by a 3-wk questionnaire. Return rate was 73.2% (n = 732). Intervention Randomization for pbx with the instillation of an antimicrobial lubricant (intervention group, n = 385) or the standard lubricant (control group, n = 347) was performed. Outcome measurements and statistical analysis Multivariable analyses assessed the association between infectious complications at biopsy and use of an antimicrobial lubricant, International Prostate Symptom Score (IPSS), history of urogenitourinary infections, and several other confounders. Results and limitations The use of an antimicrobial lubricant did not reduce infection rate. Overall complication rate was very low. Of all patients, 69.3% described the procedure as pain free. Fever ≥38.5 °C was reported in overall 1.9% of patients. Urinary retention with catheterization occurred in 3.1%. Most common complications were hematospermia (47.4%), macrohematuria (23.8%), and rectal bleeding (7.4%). Readmission rate was 1% (n = 7). In multivariable analyses, IPSS and previous infectious complications were associated with a higher risk of infectious complications. Our results stem from a large German single center and therefore are limited to this patient group. Conclusions No significant reduction was shown in infectious complications in the intervention group with the antimicrobial agent. Low incidence of those complications may be the underlying cause. Severe morbidity at pbx is uncommon. Specifically, the rate of infection was very low. Patient summary Severe complications at prostate biopsy are rare. Among participants, 69.3% had no pain. Fever was rare (1.9% of patients). Voiding issues with catheterization occurred in 3.1%. Most common complications were blood in the semen (47.4%), urine (23.8%), or stool (7.4%). Men with voiding issues or previous infectious complications had a higher risk of infectious complications.

This study describes and interprets Upper Cretaceous volcaniclastics interbedded with hemipelagic to pelagic limestones, marls, and turbidites from the Western Pontides, northwestern Turkey. The Dereköy Formation, the Unaz Formation (red pelagic limestone unit), and the Cambu Formation can be distinguished, overlain by the turbiditic Akveren Formation. Biostratigraphic ages from the predominantly volcaniclastic Dereköy Formation indicate Turonian (Dicarinella concavata planktonic foraminifera zone, CC13/UC8-9 nannofossil zones) to middle/late Santonian ages up to CC17/UC13. The Unaz Formation, deposited during the late Santonian (UC13, Dicarinella asymetrica Zone), is overlain by the volcaniclastic Cambu Formation of latest Santonian (CC17b/UC13) to early/middle Campanian (CC20/UC15a) age. However, turbidite intercalations are already present diachronously from CC19/UC14d onwards, and the turbiditic Akveren Formation ranges up into the late Maastrichtian (Abathomphalus mayaroensis Zone). Geochemistry of the volcaniclastic units reveals information about the volcanic series and tectonic setting, although element mobility has to be considered. An overall trend of calc-alkaline to high-K calc-alkaline series and basaltic to basalt-andesitic rock types was identified. A negative Nb anomaly with respect to Th and Ce in all samples confirms the existence of a volcanic arc, also indicated by a negative Ti anomaly. Biostratigraphic age constraints give evidence for volcanic arc activity mainly between Turonian and early Campanian, ca. 91 - 79 Ma. Various geochemical data, especially element variations normalized to N-MORB, show two types of volcanic arc basalts (VAB): (1) Calc-alkaline to high-K calc-alkaline VAB have increased Nb and Zr values, (2) more tholeiitic VABs are depleted in Nb, Zr, Ti, V. The volcaniclastics successions were deposited in an arc setting triggered by different stages of subduction of the Neotethys Ocean to the south and contemporaneous spreading in the Western Black Sea Basin to the north. An extensional regime caused formation of small but deeper-water sedimentary basins along the southern shore of the Black Sea where volcaniclastic complexes interfingered within short lateral distances with pelagic and mass-flow deposits.

Background: The use of primary androgen deprivation therapy (PADT) is common in elderly men with early-stage prostate cancer (PCa), despite the absence of guideline recommendations. Objective: To examine survival patterns of octo- and nonagenarian men with organ-confined PCa exposed to PADT, to assess whether their life expectancy warrants androgen deprivation therapy use. Design, setting, and participants: In the Surveillance, Epidemiology, and End Results-Medicare-linked database, we identified 14 785 octo- and nonagenarian organ-confined PCa patients treated with PADT between 1991 and 2009. Outcome measurements and statistical analysis: The smoothed cumulative incidence method was used to examine 10-yr overall mortality, cancer-specific mortality (CSM), and other-cause mortality (OCM) rates. Multivariable Cox regression analyses focused on the combined effect of age and Charlson comorbidity index (CCI) after adjusting for different confounders. Results and limitations: Of all the deaths observed during the study period, 80% were due to non-cancer causes and 20% were due to PCa. The 10-yr overall survival (OS) rate in the overall population was 15.4%. The 10-yr OS rates ranged from 19.9% in patients aged 80-84 yr to 3.1% in those aged ≥90 yr. Similarly, the 10-yr OS rates ranged from 18.7% in patients with CCI = 0 to 11.5% in those with CCI. ≥. 2. The 10-yr OCM rate in the overall population was 68.2%. The 10-yr OCM rates ranged from 64.6% in patients aged 80-84 yr to 77.2% in patients aged ≥90 yr. Similarly, the 10-yr OCM rates ranged from 62.1% in patients with CCI = 0 to 75.2% in those with CCI. ≥. 2. The 10-yr CSM rate in the overall population was 16.4%. The 10-yr CSM rates ranged from 15.5% in patients aged 80-84 yr to 19.7% in those aged ≥90 yr, and from 19.2% in patients with CCI = 0 to 13.3% in those with CCI. ≥. 2. Conclusions: Of the elderly patients with organ-confined PCa exposed to PADT, only 15% survive at 10-yr follow-up. Mortality related to non-cancer causes is the leading cause of death in the same follow-up period. These figures question the rationale for PADT in elderly men with organ-confined PCa. Patient summary: In this study, we looked at the survival patterns of octo- and nonagenarians treated with primary androgen deprivation therapy for organ-confined prostate cancer. We found that a small proportion of patients who received primary androgen deprivation therapy remain alive at 10-yr follow-up, and the leading cause of death was not attributable to prostate cancer. A small proportion of octo- and nonagenarians with organ-confined prostate cancer exposed to primary androgen deprivation therapy (PADT) remain alive at 10-yr follow-up. Moreover, the main cause of death in these patients is related to non-prostate cancer. Such findings question the rationale for PADT in these patients.

ZusammenfassungProstatakrebs weist im Vergleich zu anderen Tumorentitäten ein heterogenes genetisches Profil auf. Dementsprechend sind auch Mutationen, die das Prostatakarzinomrisiko erhöhen, vielfältig. Manche genetische Varianten fallen bei der Risikoerhöhung nur milde ins Gewicht. Andere Genmutationen (BRCA1 /2; HOXB13) erhöhen das Risiko jedoch teils erheblich. Insgesamt ist die Wahrscheinlichkeit für einen nicht familiär vorbelasteten Mann, ein Träger von Mutationen zu sein, welche mit einem erhöhten PCa-Risiko assoziiert sind, niedrig. Ist aber die familiäre Belastung durch in jungem Alter erkrankte Verwandte oder eine bereits bekannte Mutation in der Familie vorhanden, so steigt auch diese Wahrscheinlichkeit an. In diesen Fällen sollte die genetische Beratung und Testung in Betracht gezogen werden. Insbesondere soll hier an BRCA1 /2-Mutationen und HOXB13-Mutationen gedacht werden. Für die breite Bevölkerungsmasse kann genetic profiling bislang jedoch nicht die PSA-Wert-Bestimmung, mpMRT der Prostata und/oder die Prostatabiopsie im Rahmen der Vorsorge oder des diagnostischen Algorithmus ersetzen. Lediglich können Männer bei Vorliegen der mit PCa assoziierten Mutationen einem engmaschigeren und früheren Screening unterzogen werden und ggf. früher eine definitive Therapie erhalten.

Background Biologic psoriasis treatments are differentiated by efficacy, side effects, and other attributes. Objective Determine attributes of biologic psoriasis treatments that drive patients' treatment choices. Methods Respondents (USA: n = 300; Germany: n = 300) with moderate-to-severe psoriasis completed a discrete-choice-experiment survey, choosing between hypothetical treatments characterized by attributes with varying levels: chance of clear skin after 1 year, number of first-year treatments, first-year risks of mild-to-moderate injection site reaction (ISR) and serious infection, and years of proven efficacy/safety. Results U.S. respondents most valued clear skin (conditional relative importance, 1.88; p Limitations Respondents evaluated hypothetical treatments and were recruited from web panels. Conclusions Clear skin and ISR risk are stronger drivers of treatment choice than injection frequency and infection risk.

Objective To assess the outreach and influence of the main recommendations of surgical governing bodies on adaptation of minimally invasive laparoscopic surgery (MIS) procedures during the coronavirus disease 2019 (COVID-19) pandemic in an anonymized multi-institutional survey. Materials and Methods International experts performing MIS were selected on the basis of the contact database of the speakers of the Friends of Israel Urology Symposium. A 24-item questionnaire was built using main recommendations of surgical societies. Total cases/1 Mio residents as well as absolute number of total cases were utilized as surrogates for the national disease burden. Statistics and plots were performed using RStudio v0.98.953. Results Sixty-two complete questionnaires from individual centers performing MIS were received. The study demonstrated that most centers were aware of and adapted their MIS management to the COVID-19 pandemic in accordance to surgical bodies’ recommendations. Hospitals from the countries with a high disease burden put these adoptions more often into practice than the others particularly regarding swabs as well as CO2 insufflation and specimen extraction procedures. Twelve respondents reported on presumed severe acute respiratory syndrome coronavirus 2 transmission during MIS generating hypothesis for further research. Conclusion Guidelines of surgical governing bodies on adaptation of MIS during the COVID-19 pandemic demonstrate significant outreach and implementation, whereas centers from the countries with a high disease burden are more often poised to modify their practice. Rapid publication and distribution of such recommendation is crucial during future epidemic threats.

High-resolution geochronology is essential for determining the growth rate of volcanoes, which is one of the key factors for establishing the periodicity of volcanic eruptions. However, there are less high-resolution eruptive histories (> 106 years) determined for long-lived submarine arc volcanic complexes than for subaerial complexes, since submarine volcanoes are far more difficult to observe than subaerial ones. In this study, high-resolution geochronology and major-element data are presented for the Milos volcanic field (VF) in the South Aegean Volcanic Arc, Greece. The Milos VF has been active for over 3 Myr, and the first 2 × 106 years of its eruptive history occurred in a submarine setting that has been emerged above sea level. The long submarine volcanic history of the Milos VF makes it an excellent natural laboratory to study the growth rate of a long-lived submarine arc volcanic complex. This study reports 21 new high-precision 40Ar/39Ar ages and major-element compositions for 11 volcanic units of the Milos VF. This allows us to divide the Milos volcanic history into at least three periods of different long-term volumetric volcanic output rate (Qe). Periods I (submarine, ∼ 3.3–2.13 Ma) and III (subaerial, 1.48 Ma–present) have a low Qe of 0.9 ± 0.5 × 10−5 and 0.25 ± 0.05 × 10−5 km3 yr−1, respectively. Period II (submarine, 2.13–1.48 Ma) has a 3–12 times higher Qe of 3.0 ± 1.7 × 10−5 km3 yr−1. The Qe of the Milos VF is 2–3 orders of magnitude lower than the average for rhyolitic systems and continental arcs.

Introduction Overdiagnosis and overtherapy in prostate cancer (PCa) treatment should be avoided, which has led to an awareness of the need to decrease treatment in cases of low-risk PCa with radical prostatectomy (RP). Simultaneously, prostate-specific antigen testing has become less popular in the last few years, which has resulted in higher cancer grade and stage at diagnosis. We evaluated stage and grade migration in the disease of patients treated with RP in a large German cohort. Patients and Methods Overall, 4842 patients undergoing RP between 2000 and 2019 were included. Age, prostate-specific antigen level, biopsy, and pathologic Gleason score as well as clinical and pathologic stage were collected. D’Amico risk groups and Gleason score were evaluated over different time points. Results We detected a significant grade migration toward higher grade. The proportion of biopsy Gleason sum ≤ 6 dropped from 45.8% to 20.6% between ≤ 2010 and 2017-2019. Further, the proportion of patients with low D’Amico risk scores also decreased by almost 50% (20.8% vs 12.2%). Finally, the proportion of non–organ-confined PCa increased over time, and the proportion of postoperative Gleason sum ≤ 6 decreased from 20% to 10% over time. Conclusion Taken together, data indicate a significant preoperative grade and stage migration toward disease of higher grade in RP-treated PCa. Between the years 2000 and 2019, the proportion of biopsy Gleason sum ≤ 6 and the proportions of D’Amico low risk disease decreased by approximately 50% (respectively, 45% to 20% and 20.8% to 12.2%). This might indicate better patient selection for RP, but might also be a telltale sign of the rising mortality and morbidity of PCa.

Purpose: The coronavirus disease 2019 (COVID-19) pandemic is disrupting urology health-care worldwide. Reduced emergency room visits resulting in adverse outcomes have most recently been reported in pediatrics and cardiology. We aimed to compare patients with emergency room visits for pyelonephritis in 2019 (pre-COVID-19 era) and within the first wave of pandemic in 2020 (COVID-19 era) with regard to the number of visits and severe adverse disease outcomes. Methods: We performed a retrospective multicentre study comparing characteristics and outcomes of patients with pyelonephritis, excluding patients with hydronephrosis due to stone disease, in 10 urology departments in Germany during a 1-month time frame in March and April in each 2019 and 2020. Results: The number of emergency room visits for pyelonephritis in the COVID-19 era was lower (44 patients, 37.0%) than in the pre-COVID-19 era (76 patients, 63.0%), reduction rate: 42.1% (p = 0.003). Severe adverse disease outcome was more frequent in the COVID-19 era (9/44 patients, 20.5%) than in the pre-COVID-19 era (5/76 patients, 6.6%, p = 0.046). In detail, 7 versus 3 patients needed monitoring (15.9 vs. 3.9%), 2 versus no patients needed intensive-care treatment (4.5 vs. 0%), 2 versus no patients needed drain placement (4.5 vs. 0%), 2 versus no patients had a nephrectomy (4.5 vs. 0%), and 2 versus 1 patient died (4.5 vs. 1.3%). Conclusion: This report of collateral damage during CO­VID-19 showed that emergency room visits were decreased, and severe adverse disease outcomes were increased for patients with pyelonephritis in the COVID-19 era. Health authorities should set up information campaign programs actively encouraging patients to utilize emergency room services in case of severe symptoms specifically during the actual second wave of pandemic.

The current coronavirus disease 2019 (COVID-19) pandemic has placed considerable strain on hospital resources. We explored whether telemedicine (defined as a videoconference) might help. We undertook prospective structured phone interviews of urological patients (n = 399). We evaluated their suitability for telemedicine (judged by a panel of four physicians) and their risks from COVID-19 (10 factors for a poor outcome), and collected willingness for telemedicine and demographic data. Risk factors for an adverse outcome from COVID-19 infection were common (94.5% had one or more) and most patients (63.2%) were judged suitable for telemedicine. When asked, 84.7% of patients wished for a telemedical rather than a face-to-face consultation. Those favouring telemedicine were younger (68 [58-75] vs 76 [70-79.2] yr, p < 0.001). There was no difference in preference with oncological (mean 86%) or benign diagnoses (mean 85%), or with COVID-19 risks factors. In subgroup analysis, men with prostate cancer preferred telemedicine (odds ratio: 2.93 [1.07-8.03], p = 0.037). We concluded that many urological patients have risk factors for a poor outcome from COVID-19 and most preferred telemedicine consultations at this time. This appears to be a solution to offer contact-free continuity of care. PATIENT SUMMARY: Risk factors for a severe course of coronavirus disease 2019 are common (94.5%) in urology patients. Most patients wished for a telemedical consultation (84.7%). This appears to be a solution to offer contact-free continuity of care.

Zinc as therapeutic agent in skin and wound care has been known for centuries, but its role is controversial and comprehensive investigations in nutrient-deficient environments are lacking. We aimed to provide a broad analysis of different zinc derivatives on proliferation, apoptosis and antimicrobial properties in a simulated nutrient-deficient environment in vitro. Human fibroblasts (CRL2522) and keratinocytes (HaCaT) were treated with a broad concentration range (10 – 0.0001 µg/mL) of zinc-sulfate (ZnSO4), -gluconate (ZnGluc) and -histidine (ZnHis) for 1-6 days under nutrient-deficient media conditions. Cell proliferation was investigated by XTT assay. Targeted analyzes in proliferation (E2F1, PCNA) and apoptosis (TP53) associated genes were performed via qRT-PCR and apoptosis was determined via FACS (annexin V/7-AAD staining). Antimicrobial efficacy was investigated using a quantitative suspension method against S. aureus, P. aeruginosa, E. coli, and C. albicans. The results indicated that 0.1 to 0.001 µg/mL Zn increased cell proliferation in both cell lines. Fibroblasts were more susceptible with significant proliferation peaks on days 2 & 6, and days 1 & 4 for keratinocytes. No relevant changes in gene expression were detected for E2F1 and PCNA nor for TP53. Annexin-V/7-AAD-staining of fibroblasts revealed a small, yet insignificant reduction of apoptosis induction for ZnGluc and ZnSO4. ZnGluc and ZnSO4 (0.1%) achieved high microbial reductions (4-5 log10 reductions) against tested pathogens. ZnGluc and ZnSO4 showed relevant pro-proliferative and antimicrobial, as well as tendential anti-apoptotic features in a simulated nutrient-deficient microenvironment in vitro. This further validates a potential benefit of local zinc treatment in deficient wound microenvironments.

Upper Cretaceous strata at Göynük, northwestern Anatolia, Turkey, provide a geological record of the Campanian–Maastrichtian from the Sakarya Terrane along the active Neotethys margin. Shales and shaly marls with siliciclastic and volcaniclastic intercalations indicate a pelagic palaeoenvironment rich in planktonic and benthonic foraminifera and calcareous nannofossil assemblages. A composite record from the Campanian to the Maastrichtian records nannofossil standard zones UC15c (CC21) to UC20a (CC26) as well as the Globotrunanella havanensis planktonic foraminifera Zone to the Racemiguembelina fructicosa planktonic foraminifera Zone. The complete ‘mid’-Campanian to early Maastrichtian composite section can be correlated to other western Tethyan sections. The Campanian–Maastrichtian boundary is positioned between the first occurrence of the planktonic foraminifera Gansserina gansseri and the last occurrence of the nannofossil Uniplanarius trifidus. Clastic input and higher sedimentation rates constrain regional sea-level lowstands around the late Campanian calcarata Zone and the Campanian–Maastrichtian boundary, corresponding to the Campanian–Maastrichtian boundary event.

Systemic treatment is necessary for one third of patients with renal cell carcinoma. No valid biomarker is currently available to tailor personalized therapy. In this study we established a representative panel of patient derived xenograft (PDX) mouse models from patients with renal cell carcinomas and determined serum levels of high mobility group B1 (HMGB1) protein under treatment with sunitinib, pazopanib, sorafenib, axitinib, temsirolimus and bevacizumab. Serum HMGB1 levels were significantly higher in a subset of the PDX collection, which exhibited slower tumor growth during subsequent passages than tumors with low HMGB1 serum levels. Pre-treatment PDX serum HMGB1 levels also correlated with response to systemic treatment: PDX models with high HMGB1 levels predicted response to bevacizumab. Taken together, we provide for the first time evidence that the damage associated molecular pattern biomarker HMGB1 can predict response to systemic treatment with bevacizumab. Our data support the future evaluation of HMGB1 as a predictive biomarker for bevacizumab sensitivity in patients with renal cell carcinoma.

To assess whether real-time elastography-targeted biopsy (RTE-bx) is superior to the standard systematic transrectal ultrasound (TRUS)-guided biopsy in predicting subsequent prostate cancer (PCa) rates in patients with initially negative biopsy and to specifically reveal differences in the occurrence of high-grade (Gleason ≥ 4 + 3) PCa by comparing both biopsy methods. Overall, 630 patients had an initially negative prostate biopsy between 2007 and 2015, either RTE targeted (n = 213) or systematically (n = 417). Follow-up data, ascertained by a questionnaire, of patients receiving RTE-bx were compared to data of patients receiving systematic biopsy (sbx) using Mann–Whitney-U test and Chi-square test. We performed logistic regression analyses to assess any association with PCa or high-grade PCa occurrence. In total, 258 (41%) patients were diagnosed with PCa at repeat biopsy whereof 54 (8.6%) harboured high-grade PCa. PCa occurred in 95 (44.6%) patients with initially negative RTE-bx and in 163 (39.1%) patients with initially negative sbx (p = 0.003). 24 (11.3%) patients receiving RTE-bx and 30 (7.2%) patients receiving sbx were diagnosed with high-grade PCa (p = 0.095). Logistic regression analyses showed that patients with the initial RTE-bx vs. those with the initial sbx neither resulted in a significant higher risk for PCa occurrence (OR 1.35 [CI 0.87–2.1]; p = 0.2) nor for high-grade PCa occurrence (OR 1.52 [CI 0.66–3.35]; p = 0.3). We found no statistically significant association of prior biopsy method to subsequent PCa or high-grade PCa occurrence. Referring to our analyses, RTE is not superior to sbx in predicting subsequent PCa rates and, therefore, not eligible to decide on repeat biopsy.

Opal films with their vivid structural colors represent a field of tremendous interest and obtained materials offer the possibility for many applications, such as optical sensors or anti-counterfeiting materials. A convenient method for the generation of opal structures relies on the tailored design of core-interlayer-shell (CIS) particles. Within the present study, elastomeric opal films were combined with stimuli-responsive photoacids to further influence the optical properties of structurally colored materials. Starting from cross-linked polystyrene (PS) core particles featuring a hydroxy-rich and polar soft shell, opal films were prepared by application of the melt-shear organization technique. The photoacid tris(2,2,2-trifluoroethyl) 8-hydroxypyrene-1,3,6-trisulfonate (TFEHTS) could be conveniently incorporated during freeze-drying the particle dispersion and prior to the melt-shear organization. Furthermore, the polar opal matrix featuring hydroxylic moieties enabled excited-state proton transfer (ESPT), which is proved by spectroscopic evaluation. Finally, the influence of the photoacid on the optical properties of the 3-dimensional colloidal crystals were investigated within different experimental conditions. The angle dependence of the emission spectra unambiguously shows the selective suppression of the photoacid’s fluorescence in its deprotonated state.

Introduction: Digital media have revolutionized communication and information dissemination in healthcare. We aimed to quantify and evaluate professional digital media use among urology residents.Methods: We designed a 17-item survey to assess usage and perceived usefulness of digital media, as well as communication type and device type and distributed it via email to 143 Canadian and 721 German urology residents.Results: In total, 58 (41% response rate) residents from Canada and 170 (24% response rate) from Germany reported professional usage rates of 100% on the internet, 89% on apps, and 46% on social media (SoMe). For professional use, residents spent a median of 30 minutes per day on the internet, 10 minutes on apps, and 15 minutes on SoMe. 100% rated the internet, 89% apps, and 31% SoMe as useful for clinical practice. Most (94%) used digital media for communication with colleagues and 23% for communication with patients. Digital media use was allocated to desktop computers (55%) and mobile devices (45%). Canadian residents had higher usage rates of apps (96% vs. 86%; p=0.042) and SoMe (65% vs. 39%; p=0.002) and longer daily usage times for the internet, apps, and SoMe than German residents (p

Recent years have seen the rise of crossover fiction that is marketed as young adult literature but also attracts a large adult audience. While critics have addressed this phenomenon as a symptom o...

Background Radical prostatectomy (RP) is the gold standard for clinically localized prostate cancer (PCa) patients with life expectancy (LE) of at least 10 years. We examined long-term survival of men aged 80 years or older treated with RP and we attempted to identify criteria based on age and comorbidities that could predict survival of at least 10 years after RP, to identify those that might be considered for RP. Patients and methods In Surveillance Epidemiology and End Results (SEER)-Medicare-linked database, we identified 234 octo- and nonagenarians with clinical T1, T2 or T3 PCa treated with RP between 1991 and 2009. Kaplan–Meier analyses examined 10-year survival patterns. Multivariable Cox regression analyses focused on the combined effect of age and/or Charlson Comorbidity Index (CCI) after adjusting for different confounders. Results The 10-year overall survival (OS) and cancer specific mortality (CSM) rates in the overall population were 51 and 9.9%. In individuals aged 80–81 years old, the 10-year OS was 62.4 vs. 39.6% in older patients (p = 0.001). Moreover, combination of age 80–81 with CCI = 0 yielded 10-year OS of 67.9 vs. 28.5% in older and sicker patients (p < 0.001). Age 80–81, absence of comorbidities and the combination of age 80–81 with CCI = 0, represented independent predictors of lower overall mortality (all p ≤ 0.01). Conclusions Two out of three individuals selected for RP aged 80–81 years and without comorbidities, fulfill the criterion of LE of 10 years or more. Therefore, elderly PCa individuals can be suitable for surgical management, if appropriately selected, based on LE criterion.

The cultural history of the antique has always been tightly linked to the rise of new techniques of print and engraving. As Elizabeth Eisenstein has famously argued, the validation of material obje...

The work of many early eighteenth-century antiquaries roots the discovery of authentic facts about the past in the empirical study of antiquities in situ and in immediate sensory experience of the material world. This article explores visual and verbal representations of antiquarian fieldwork in antiquarian works and travelogues by William Stukeley, Daniel Defoe, Alexander Gordon, and others. It shows that these authors developed novel and often self-reflexive modes of visual and verbal representation in order to ask how the empirical approach renders the past visible and material. In doing so, they ushered in important changes in chorographic writing. However, for Stukeley in particular, recording artefacts and the process of empirical observation also became a way of reflecting on the limitations of empiricism in elucidating the past: the arrangement of text and illustration in his later work reveals that Stukeley used the friction between the visual and the textual medium in order to consider h...

To investigate the usage and perceived usefulness of new media for educating urology residents in Canada and Germany.We designed an 11-item online survey to assess the use and perceived usefulness of new media for education. We performed a comparative analysis.The survey was distributed via e-mail to 143 Canadian and 721 German urology residents.The survey included 58 urology residents from Canada and 170 from Germany.A total of 58 residents from Canada (41% response rate) and 170 from Germany (24% response rate) responded to this survey. Residents spent 45% of their education time on new media. The Internet was used by 91% (n = 208) of the residents for professional education purposes, with a median time of 270 minutes (interquartile range [IQR]: 114-540) per month. Apps were used by 54% (n = 118) of the residents, with a median time of 101 minutes (IQR: 45-293) per month. A total of 23% (n = 47) of the residents used social media (SoMe) for education, with a median time of 90 minutes (IQR: 53-80) per month. In all, 100% (n = 228) rated the Internet, 76% (n = 173) apps, and 43% (n = 97) SoMe as being useful for professional education purposes. A total of 90% (n = 205) watched medical videos for education, and 89% (n = 203) of these videos were on surgical procedures. Canadian urology residents used more new media sources for professional education than did the Germans (58% vs. 41%, p0.001). The time spent for education on new media was higher among Canadian residents for the Internet (p0.001), apps (p0.001), and SoMe (p = 0.033). Canadian residents reported more privacy concerns (p0.001).New media play a dominant role in the education of urology residents. The primary source for personal education in urology is the Internet. Future studies and technological developments should investigate and improve new media tools to optimize education during residency.

Background While the diagnostic value of pelvic lymph node dissection (PLND) during radical prostatectomy (RP) is undisputed, its therapeutic benefit remains a matter of debate. Objective To investigate the association between total and positive lymph node (LN) counts and oncological outcomes in pN1 patients at RP. Design, setting, and participants The records of 706 LN-positive patients undergoing RP and PLND between 1998 and 2012 in a single center were analyzed. The median follow-up was 47.8 mo. Intervention RP and PLND. Outcome measurements and statistical analysis The number of harvested and positive LNs and their influence on biochemical recurrence-free survival, metastasis-free survival, and cancer-specific survival was evaluated using univariate and multivariate Cox regressions. The number of harvested LNs was used as a continuous and dichotomous variable with a cut-off of 13 LNs. Results and limitations The mean (median) number of removed LNs was 15.0 (13) and the mean (median) number of positive LNs was 2.4 (1). In multivariate analysis, the number of removed LNs did not significantly influence oncologic outcomes (biochemical recurrence, metastasis-free survival, or cancer-specific survival). The occurrence of metastasis and cancer-specific mortality significantly increased with higher number of positive LNs. The main limitation was the retrospective nature of the study. Conclusions While a higher number of positive LNs were significantly associated with worse oncological outcomes, the number of removed LNs was not a significant predictor. Patient summary We found that only the number of positive lymph nodes (LNs) but not the total number of removed LNs was a factor adversely influencing oncological outcomes in LN-positive patients undergoing radical prostatectomy.

Background Local tumour ablation (LTA) may yield better perioperative outcomes than partial nephrectomy (PN), however the impact of each treatment on perioperative mortality and health care expenditures is unknown. The aim of the study was to compare mortality, morbidity and health care expenditures between LTA and PN. Patients and methods A population-based assessment of 2471 patients with cT1a kidney cancer treated with either LTA or PN, between 2000 and 2009, in the SEER-Medicare database was performed. After propensity score matching, 30-day mortality, overall and specific complication rates, length of stay, readmission rates and health care expenditures according to LTA or PN were estimated. Multivariable logistic and linear models addressed the effect of each specific LTA approach on overall complication rates, length of stay, readmission rates and health care expenditures. Results The 30-day mortality was

The impact of repeat biopsy sessions on radical prostatectomy remains controversial regarding perioperative, pathological and oncologic outcome.We analyzed the records of 12,624 patients who underwent radical prostatectomy from 2007 to 2013. The association of the number of biopsy sessions (range 1 to 3 or more) with pathological outcomes and perioperative complications was analyzed using the Wilcoxon matched pair test. To test the association between biopsy sessions and biochemical recurrence-free survival we used Kaplan-Meier curves and multivariable Cox regression analysis.Of the patients 89.2% had 1 biopsy session, 7.4% had 2 sessions and 3.4% had 3 or more sessions. Median followup was 36.6 months. In patients with 1, 2 and 3 or more biopsy sessions prostate volume (38, 44 and 45 ml) and prostate specific antigen (6.7, 7.6 and 10.1 ng/ml, respectively) were greater (each p0.001). The perioperative outcome was more favorable. Patients with 1, 2 and 3 or more biopsy sessions more often had organ confined tumors (67.6%, 72.1% and 72.9%, p = 0.003) and higher tumor volume (3.1, 3.0 and 3.6 ml, p0.001) but a lower tumor percent (7.5%, 3.7% and 2.4%, respectively, p0.001). More biopsy sessions were associated with fewer lymph node metastases (1, 2 and 3 sessions 0.23, 0.13 and 0.17, respectively, p0.001). Gleason score and surgical margin status did not differ. The overall biochemical recurrence rate was 18.9% and it was comparable among the biopsy groups. No association was found between the number of biopsies and biochemical recurrence.Patients with multiple biopsy sessions experience a slightly more favorable pathological outcome without an impact on the oncologic outcome. The perioperative outcome was more favorable in patients with multiple biopsies.

This chapter explores how eighteenth-century antiquaries used the figure of the living female statue to articulate ideas about imaginary transport and historical understanding. It traces configurations of the imaginative link between the living female body and ancient statuary in the antiquarian research of William Hamilton, the collector and British envoy to the Court of Naples; in the famous “attitudes”—silent performances of Classical poses—by Hamilton’s wife Emma; and in the writings of Charlotte Lennox. The chapter examines antiquarian representations in which the link between a modern woman’s body and ancient statuary signifies the desire to gain access to the past. It also traces how this imaginative link allowed for the construction of an object of inquiry that promised to turn this fantasy into reality.

Prostate cancer has a heterogeneous genetic profile compared with other tumour entities. Accordingly, there are also various mutations that increase the risk of prostate cancer. Some genetic variants only have a mild impact, whereas other gene mutations (BRCA1 /2; HOXB13) may increase the risk significantly. All in all, a man with a negative family history is unlikely to be a carrier of mutations that are associated with an increased risk of PCa. However, this likelihood increases if the family history is positive for a known mutation or if there are relatives who were affected at an early age. In such cases, genetic counselling and testing should be considered, with a particular focus on BRCA1/2 mutations and HOXB13 mutations. However, genetic profiling has not had the potential to replace PSA testing, mpMRI of the prostate gland and/or prostate biopsies as part of cancer screening or the diagnostic algorithm in the general population. The presence of mutations associated with PCa merely allows patients to undergo screening earlier and in tighter intervals and possibly receive earlier definitive treatment.Prostatakrebs weist im Vergleich zu anderen Tumorentitäten ein heterogenes genetisches Profil auf. Dementsprechend sind auch Mutationen, die das Prostatakarzinomrisiko erhöhen, vielfältig. Manche genetische Varianten fallen bei der Risikoerhöhung nur milde ins Gewicht. Andere Genmutationen (BRCA1 /2; HOXB13) erhöhen das Risiko jedoch teils erheblich. Insgesamt ist die Wahrscheinlichkeit für einen nicht familiär vorbelasteten Mann, ein Träger von Mutationen zu sein, welche mit einem erhöhten PCa-Risiko assoziiert sind, niedrig. Ist aber die familiäre Belastung durch in jungem Alter erkrankte Verwandte oder eine bereits bekannte Mutation in der Familie vorhanden, so steigt auch diese Wahrscheinlichkeit an. In diesen Fällen sollte die genetische Beratung und Testung in Betracht gezogen werden. Insbesondere soll hier an BRCA1 /2-Mutationen und HOXB13-Mutationen gedacht werden. Für die breite Bevölkerungsmasse kann genetic profiling bislang jedoch nicht die PSA-Wert-Bestimmung, mpMRT der Prostata und/oder die Prostatabiopsie im Rahmen der Vorsorge oder des diagnostischen Algorithmus ersetzen. Lediglich können Männer bei Vorliegen der mit PCa assoziierten Mutationen einem engmaschigeren und früheren Screening unterzogen werden und ggf. früher eine definitive Therapie erhalten.

Background The D'Amico risk stratification, Cancer of the Prostate Risk Assessment (CAPRA) score, and Stephenson nomogram are widely used prediction tools for biochemical recurrence and survival after radical prostatectomy (RP). These models have not been compared with respect to cancer-specific mortality (CSM) prediction. Objective To validate and compare the prediction tools for 10-yr CSM. Design, setting, and participants Overall, 2485 prostate cancer patients underwent RP in a European tertiary care center. Outcome measurements and statistical analysis Three preoperative models (D'Amico, CAPRA, and Stephenson) were compared in terms of their ability to predict 10-yr CSM; therefore, accuracy tests (area under the receiver operating characteristic curve [AUC]), calibration plots, and decision curve analysis (DCA) were assessed for each model. Results and limitations CSM at 10 yr was 3.6%. The AUC was 0.76, 0.77, and 0.80 for the D'Amico, CAPRA, and Stephenson models, respectively. In calibration plots, predicted probabilities were close to the observed probabilities for the D'Amico model but showed underestimation of CSM for the Stephenson nomogram and overestimation of CSM for the CAPRA score. DCA identified a benefit for the CAPRA score. These results apply to patients treated at a European tertiary care center. Conclusions Despite good discriminatory power, all tested models had some shortcomings in terms of prediction of 10-yr CSM. All three models showed good performance in North American cohorts, but our results suggested a lack of generalizability to European patients. To overcome this issue, local recalibration of the variable weights could be performed. Another possibility is the development of more universal markers that are independent of regional practice differences or, alternatively, the development of better tools to quantify clinical practice differences. Patient summary Prediction tools can predict cancer survival prior surgery, relying on points for age, prostate-specific antigen levels, aggressiveness, and percentage of cancer at biopsy. These tools are reliable in North American patients but have shortcomings for identifying patients at high risk of prostate cancer death in Europe.

Current guidelines recommend local tumour ablation (LTA) over partial nephrectomy (PN) in nonsurgical candidates; however, objective definitions of these candidates are lacking.To identify specific patients who would benefit from LTA more than PN.A population-based assessment was performed of 2476 patients in the Surveillance Epidemiology and End Results-Medicare database who had cT1a kidney cancer treated with either LTA or PN, between 2000 and 2009.The outcome of the study was the relevant perioperative complications rate. A multivariable logistic regression model was fitted to predict the risk of complications after PN. Model-derived coefficients were used to calculate the risk of complication in case of PN among patients treated with LTA. Locally weighted scatterplot smoothing method was used to plot the observed complication rate against the predicted risk of complication in case of PN.At multivariable logistic regression, age (odds ratio [OR]: 1.04; p0.001), Charlson comorbidity index (OR: 1.14; p0.001), acute kidney injury (OR: 1.91; p=0.04), or chronic kidney disease (OR: 2.16; p=0.002), tumour size (OR: 1.02; p=0.01), and minimally invasive approach (OR: 0.77; p0.03) emerged as significant predictors of complications. When LTA was chosen over PN, the reduction in the risk of complications was greatest in high-risk patients, intermediate in intermediate-risk patients, and least in low-risk patients.When postoperative complications are evaluated, the benefit of choosing LTA is not the same in all patients diagnosed with T1a kidney cancer. Specifically, patients at high risk of complications in case of PN may benefit the most from LTA and represent ideal LTA candidates.Elderly patients at high risk of complications in case of surgical treatment with partial nephrectomy for kidney cancer should be instructed that local tumour ablation might decrease their perioperative morbidity.

This article focuses on Thomas Middleton’s engagement with the economic value of intellectual work and university learning in his city comedies The Puritan Widow, Your Five Gallants , and No Wit/Help Like a Woman’s . It explores Middleton’s representation of the pecuniary dilemmas of university wits cast adrift in a changing society that saw the wane of aristocratic patronage and the rise of new commercial outlets for learned and literary works. Middleton’s city comedies, the article shows, use the figure of the scholar in order to articulate their extended reflection on the commercialization of intellectual labor and literary production.