Global Assessment of Urological Endoscopic Skills (GAUES): development and validation of a novel assessment tool to evaluate endourological skills

OBJECTIVE

To develop and evaluate an assessment tool for endourological skills during simulation including cystoscopy, ureteroscopy (URS) and transurethral resection (TUR) procedures.

METHODS

We designed a Global Assessment of Urological Endoscopic Skills (GAUES) tool, comprised of nine endourology task-specific and two global-rating skills items. The tool was developed through two rounds of the Delphi process. The GAUES tool was used to assess acquisition of URS and TUR skills of novices (Year 2 core surgical trainees, CT2) and intermediate level trainees (residents at the start of the UK higher surgical training programme in Urology, Speciality Trainee Year 3, ST3) at the Urology Simulation Boot Camp (USBC) between 2016 and 2018. Validity was evaluated by comparing scores between trainees with different levels of urological experience. Inter-rater reliability was also assessed.

RESULTS

We evaluated 130 residents, 52% of trainees were at an intermediate stage of training and 39% were novices. In all, 9% of the anonymous forms were missing demographics. The completion rate of the GAUES tool during the USBC for URS and TUR was 85% and 89%, respectively. Our analysis demonstrated a significant difference in all domains between intermediates and novices at assessment in URS, except for one domain more suited to clinical assessment (P = 0.226). There was excellent intraclass correlation (ICC) overall between the two experts' judgements, ICC = 0.841 (95% confidence interval 0.767-0.893; P < 0.001, n = 88).

CONCLUSIONS

We have developed the novel GAUES tool for cystoscopic, URS and TUR skills. Overall, we demonstrated good face, content and construct validity and excellent reliability, suggesting that the GAUES tool can be useful for endourological skills assessment.

Complex Renal Cysts (Bosniak ≥ IIF): Outcomes in a Population-Based Cohort Study

Simple Summary

Researchers from the University of Dundee have found that not all kidney cancers will need urgent surgery. In a published research in the Cancers, Dr Lucocq et al have carefully established database record of patients with kidney cancer looking like water filled sacs on CT scan and reported that these cancers are low grade and perhaps less harmful on long-term follow-up. In fact, behaviour of these cancer cells is much slower compared to other diseases such as heart failure and high blood pressure. Most people die from chronic disease much before cancer spread or progression. The researchers in this group have shown that surgical removal of these cancers, particularly in elderly people and those with other health conditions such as heart failure may not be necessary. Patients in Tayside Urological Cancers (TUCAN) database were carefully assessed using CT scans and discussed in multidisciplinary meetings and were followed up for more than 6 years. This kind of population-based study adds new knowledge to the understanding behaviour of a subset kidney cancers which otherwise have very poor outcome. The researchers and paper highlight careful documentation of cohort to understand natural history of disease.

Abstract

There is emerging evidence to suggest that con-current medical conditions influence the outcome of cancers, irrespective of therapy offered. The prevalence and impact of co-morbidities on the survival outcome of complex renal cystic masses in not known. The objective was to study complex renal cysts (Bosniak ≥IIF ) and assess the overall and renal cancer-specific survival in a population-based database including impact of con-current morbidities. The Tayside Urological Cancer Network (TUCAN) database covering a stable population of more than 416,090 inhabitants in a defined geographical area identified 452 complex renal cysts in 415 patients between 2009 and 2019. Each patient was tracked and followed up using a unique identifier and deterministic linkage methodology. The last date of follow-up including cause of death was determined. Co-morbidities were recorded from primary care referrals. Renal cancer-specific mortality was 1.7% at a median follow-up of 76.0 months; however, overall survival was poor, particularly in patients ≥ 70 years of age and with ≥ 2 significant co-morbid conditions (p < 0.0001). A total of 38.3% of the cohort showed con-current morbidities. Age and co-morbidities were significant risk factors for overall survival in patients with complex renal cystic disease and a careful assessment should be made to recommend surgical intervention in the elderly population, in particular in those with other health-related conditions.

Massive use of disinfectants against COVID-19 poses potential risks to urban wildlife

•Globally, massive disinfectants are used to contain the rapid spread of COVID-19. •Applying massive disinfectants pose a significant threat to urban environment and wildlife. •Policies are required to minimize the adverse effects on wildlife due to overuse of disinfectants.

Detecting viral outbreaks in future using enhanced environmental surveillance

•Severe Acute Respiratory Syndrome Coronavirus 2 can be detected in the sewage system. •Sewage surveillance can estimate disease burden and recurrent epidemic dynamics. •Enhanced surveillance on sewage system can identify early warning calls.

Risk of COVID-19 pneumonia in aquatic mammals

•The SARS-CoV-2 can enter the oceans, rivers, and lakes in several ways. •Aquatic mammals can recognise the receptor binding domain of SARS-CoV-2. •Cetacean species should be screened and monitored for the virus during a pandemic.

Complex renal cysts (Bosniak ≥IIF): interobserver agreement, progression and malignancy rates

Objective

The objective was to assess the interobserver agreement rate, progression rates and malignancy rates in the assessment of complex renal cysts (≥ Bosniak IIF) using a population-based database.

Methods

A regional database identified 452 complex renal cysts in 415 patients between 2009 and 2019. Each patient was tracked and followed up using a unique identifier and deterministic linkage methodology. The interobserver agreement rate between radiologists was calculated using a weighted kappa statistic. Progression and malignancy rates of cysts (Bosniak ≥IIF) over the 11-year period were calculated.

Results

The linear-weighted kappa value was 0.69 for all complex cysts. The rate of progression and regression of Bosniak IIF cysts was 4.6% (7/151) and 3.3% (5/151), respectively. All malignant IIF cysts progressed within 16 months of diagnosis. The malignancy rate of surgically resected Bosniak III and IV cysts was 79.3% (23/29) and 84.5% (39/46), respectively. Of all malignant tumours, 73.8% and 93.7% were of low ISUP grade and low stage, respectively.

Conclusions

This study further confirms that there is a good degree of agreement between radiologists in classifying complex renal masses using the Bosniak classification. The progression rate of Bosniak IIF cysts is low, but the malignancy rates of surgically resected Bosniak IIF, III and IV cysts are high. Benign cysts are frequently resected, and a very high proportion of histopathologically confirmed cancers in complex renal cysts are of low grade and stage.

Key Points

•There is a good degree of agreement between radiologists in classifying complex renal masses using the Bosniak classification.

•The rate of progression of Bosniak IIF cysts is low, and malignant cysts progress early during surveillance. Although the malignancy rates of resected Bosniak IIF, III and IV cysts are high, the rate of benign cyst resection is significant.

Electronic supplementary material

The online version of this article (10.1007/s00330-020-07186-w) contains supplementary material, which is available to authorized users.

High Quality Growth of Cobalt Doped GaN Nanowires with Enhanced Ferromagnetic and Optical Response

Group III-V semiconductors with direct band gaps have become crucial for optoelectronic and microelectronic applications. Exploring these materials for spintronic applications is an important direction for many research groups. In this study, pure and cobalt doped GaN nanowires were grown on the Si substrate by the chemical vapor deposition (CVD) method. Sophisticated characterization techniques such as X-ray diffraction (XRD), Scanning Electron Microscope (SEM), Energy Dispersive X-Ray Spectroscopy (EDS), Transmission Electron Microscopy (TEM), High-Resolution Transmission Electron Microscopy (HRTEM) and photoluminescence (PL) were used to characterize the structure, morphology, composition and optical properties of the nanowires. The doped nanowires have diameters ranging from 60-200 nm and lengths were found to be in microns. By optimizing the synthesis process, pure, smooth, single crystalline and highly dense nanowires have been grown on the Si substrate which possess better magnetic and optical properties. No any secondary phases were observed even with 8% cobalt doping. The magnetic properties of cobalt doped GaN showed a ferromagnetic response at room temperature. The value of saturation magnetization is found to be increased with increasing doping concentration and magnetic saturation was found to be 792.4 µemu for 8% cobalt doping. It was also depicted that the Co atoms are substituted at Ga sites in the GaN lattice. Furthermore N vacancies are also observed in the Co-doped GaN nanowires which was confirmed by the PL graph exhibiting nitrogen vacancy defects and strain related peaks at 455 nm (blue emission). PL and magnetic properties show their potential applications in spintronics.

COVID-19: Clinical aspects and therapeutics responses

COVID-19 has created havoc in the world by causing thousands of demises in a short period of time. Up till now, several attempts have been made for potential therapeutics against SARS-COV2. In this retrospective, single-center study, we extracted data from 122 COVID-19, RT-PCR confirmed patients. who were treated with a new treatment strategy of lianhuaqingwen with Arbidol Hydrochloride. The patients were either asymptomatic or had mild symptoms for COVID-19 disease. Of 122 patients 21 (17.21%) patients developed severe conditions of COVID-19, while total 111 (90.9%) experienced mild symptoms such as fever in 93 (76.22%) patients, cough in 23 (20.17%) and muscle pain were observed in total 8 (7%) patients. Furthermore our newly applied drugs combination (Lianhuaqingwen and Arbidol Hydrochloride) showed therapeutic effects in 5-7 days in patients with mild symptoms with 98% recovery rate. These results indicate that COVID-19 patients with mild symptoms can be treated with Lianhuaqingwen and Arbidol Hydrochloride. However, extensive clinical investigations are required to confirm the effectiveness of these drugs.

Coping with extremes: convergences of habitat use, territoriality, and diet in summer but divergences in winter between two sympatric snow finches on the Qinghai-Tibet Plateau

On the Qinghai-Tibet Plateau, extreme environmental conditions have imposed intense selective pressure on the evolution of phenotypic traits of wild animals. To date, limited information is available on behavioral and ecological traits concerning niche differentiation among sympatric animals on the Qinghai-Tibet Plateau, especially during winter when the environments are most severe. Here, we studied the seasonal variations in habitat occurrence, territorial behavior, and diet in two sympatric snow finches (the white-rumped snow finch, Onychostruthus taczanowskii, WRSF; and the rufous-necked snow finch, Pyrgilauda ruficollis, RNSF) to determine convergence and divergence of ecological traits in such severe climatic conditions. Our results showed that: (i) WRSF occupied rural areas as a dominant species throughout the annual cycle while RNSF occupied the rural areas in summer and then shifted to human-occupied areas in winter and spring; (ii) WRSFs exhibited robust aggressive behavior and territoriality during winter relative to RNSFs; (iii) the diets of both species varied with the season but did not vary between species except that WRSF ate significantly more seeds but RNSF consumed more starchy material derived from human food waste during winter. Therefore, the separations in the spatial niche and territoriality between WRSF and RNSF, especially in winter, may contribute to alleviating the pressure of interspecific competition, and promoting the coexistence of the two sympatric snow finches in the extreme environments on the Qinghai-Tibet Plateau.

Preventing bat-born viral outbreaks in future using ecological interventions

•Bats naturally host pathogenic viruses having epidemic and pandemic potentials. •Deforestation and expanding human population increase bat-human interactions. •Halting bat consumption, trade, and higher surveillance can stop future outbreaks.

Coping with extremes: Remarkably blunt adrenocortical responses to acute stress in two sympatric snow finches on the Qinghai-Tibet Plateau during winter relative to other seasons

The extreme climatic conditions (ECCs) of the Qinghai-Tibet Plateau impose strong selective pressures on the evolution of phenotypic traits in free-living animals. It is not well understood how animals on the Qinghai-Tibet Plateau modify their adrenocortical functions in response to both predictable and unpredictable events of ECCs, especially when the available resources are lowest during the wintering life-history stage. To uncover potential physiological mechanisms, we studied the life history stage dependent features of morphology, the plasma corticosterone response to acute stress and brain glucocorticoid receptor (GR) and mineralocorticoid receptor (MR) mRNA expression in two sympatric snow finches: the white-rumped snow finch (Onychostruthus taczanowskii, WRSF); and the rufous-necked snow finch, Pyrgilauda ruficollis, RNSF) in Qinghai Province, China. Our results showed that (a) baseline corticosterone and stressor-induced corticosterone levels significantly varied with life history stage, but not between the species; (b) in WRSF, GR mRNA expression in the paraventricular nucleus was higher in the wintering stage compared to the pre-basic molt stage. There were no differences in hippocampus MR mRNA expression between stages in either species; (c) in the wintering stage, the suppression of corticosterone secretion in both species was an unexpected strategy in free-living animals. Both convergent and divergent phenotypic traits of adrenocortical responses to acute stress in two sympatric snow finches contribute to our understanding of the coping mechanisms of closely related species in the severe winter on the Qinghai-Tibet Plateau.

Prediction of prostate cancer Gleason score upgrading from biopsy to radical prostatectomy using pre-biopsy multiparametric MRI PIRADS scoring system

An increase or ‘upgrade’ in Gleason Score (GS) in prostate cancer following Transrectal Ultrasound (TRUS) guided biopsies remains a significant challenge to overcome. to evaluate whether MRI has the potential to narrow the discrepancy of histopathological grades between biopsy and radical prostatectomy, three hundred and thirty men treated consecutively by laparoscopic radical prostatectomy (LRP) between July 2014 and January 2019 with localized prostate cancer were included in this study. Independent radiologists and pathologists assessed the MRI and histopathology of the biopsies and prostatectomy specimens respectively. A multivariate model was constructed using logistic regression analysis to assess the ability of MRI to predict upgrading in biopsy GS in a nomogram. A decision-analysis curve was constructed assessing impact of nomogram using different thresholds for probabilities of upgrading. PIRADS scores were obtained from MRI scans in all the included cases. In a multivariate analysis, the PIRADS v2.0 score significantly improved prediction ability of MRI scans for upgrading of biopsy GS (p = 0.001, 95% CI [0.06–0.034]), which improved the C-index of predictive nomogram significantly (0.90 vs. 0.64, p < 0.05). PIRADS v2.0 score was an independent predictor of postoperative GS upgrading and this should be taken into consideration while offering treatment options to men with localized prostate cancer.

Patient-Specific 3-Dimensional Model for High-Intensity Focused Ultrasound Treatment Through the Rib Cage: A Preliminary Study

OBJECTIVES

The purpose of this study was to develop a patient-specific 3-dimensional model for high-intensity focused ultrasound (HIFU) treatment through the rib cage using patient data.

METHODS

Experimental testing to derive parameters used in defining the amount of energy and alteration needed in treatment protocols for upper abdominal disorders under the rib cage was performed. Reconstructed rib cage models based on patient data, tissue-mimicking material phantoms, and magnetic resonance imaging-guided HIFU using a multielement phased array transducer were used in the experiments. Changes in the focal temperature, acoustic power, and acoustic pressure distribution were investigated with and without the presence of the rib cage model. An ExAblate system (InSightec Ltd, Tirat Carmel, Israel) was used to sonicate phantoms by varying the target phantom or rib cage model location.

RESULTS

The effect of the rib cage on the acoustic pressure distribution and acoustic power was closely related to the anatomic structures of the ribs. Thermometry revealed that heating at the focus could be controlled by changing either the power or duration of HIFU application to improve the focal temperature change. The focal temperature change was found to be related to the distance between the rib cage model and focus and the shadow area on the transducer elements covered by the rib cage model in the beam path.

CONCLUSIONS

Experimental results suggest that the rib cage model is a valuable and useful tool that can provide realistic human anatomic structures and properties for evaluating the effects of the rib cage on ultrasound propagation.