1226 The Clinical Utility of Prostate Health Index Density in The Diagnosis of Clinically Significant Prostate Cancer: A Systematic Review

Aim

Prostate health index (PHI) is a diagnostic test for prostate cancer that combines free prostate specific antigen (PSA), total PSA and [-2]proPSA. PHI has been shown to be more accurate than PSA testing at detecting prostate cancer and its use has been shown to reduce unnecessary prostate biopsies. Prostate health index density (PHID), derived by dividing PHI by prostate volume, has been suggested as a more accurate test compared to standard PHI by several authors. The aim of this systematic review was to evaluate the diagnostic accuracy of PHID for clinically significant prostate cancer, identify an optimal diagnostic threshold and assess the clinical utility of PHID as a novel diagnostic test for prostate cancer.

Method

A systematic review of primary studies was conducted. Medline, Embase, Scopus and Cochrane databases were searched with key terms. Results were screened and full papers reviewed by two reviewers with pre-determined inclusion criteria. QUADAS-2 was used for quality appraisal. Data analysis was conducted in line with PRISMA guidelines.

Results

Nine studies were included. Quality appraisal revealed a high degree of heterogeneity between studies. PHID thresholds ranged 0.32-1.38. PHID had an area under the curve value of 0.59-0.9 and negative predictive value of 81-100% for clinically significant disease. PHID outperformed PHI in three studies, but this was not replicated in the other studies.

Conclusions

This systematic review found PHID did not consistently outperform PHI. PHID was found to have low clinical utility in the diagnosis of prostate cancer based on the available evidence, with further research warranted.

842 Teleurology; A Prospective Study of Patient’s Perception and Real Time Experience in A Tertiary UK Centre

Aim

To evaluate the clinical outcome and patient’s satisfaction of our real-time teleurology experience.

Materials

A prospective study, the whole cohort of face-to-face [FTF] clinics was shifted for telephone clinics. The data were collected prospectively for all appointments from 30th March to 3rd April. The primary objectives were clinic outcome and patient’s satisfaction evaluated using a validated questionnaire. The secondary objectives were number of non-attendance, percentage of face-to-face clinics and clinic demographics.

Results

Overall, 95 scheduled appointments for 7 consultants and 2 trainees. Telephone consultations performed for 75 patients, while 6 patients reviewed in FTF Clinics, and 14 patients classified as non-attendant. The non-attendance rate was 14.7%, with estimated 50% reduction in comparison to FTF rate prior to pandemic. The majority of patients (58%) treated conservatively while 14 (17.2%) patients commenced on medications, and 20 patients (24.6%) were listed for surgery. All patients but one (98.1%) agreed that cancelling FTF clinics was reasonable. The majority of the patients 94.2%, 96.2%, 84.6% found the telephone clinic was effective, long enough, and was easy to express their concerns over the phone, respectively. Approximately 90.4% and 100% satisfied with teleurology service and that clinicians were careful, respectively.

Conclusions

Our study elucidated the feasibility of teleurology in a real time setting and showed that it meets the tetrafecta of clinical outcomes, continuity of care, patient’s safety, and patient’s satisfaction. To our knowledge, this is the first study to assess patient’s perception of teleurology using a validated questionnaire.

1532 Strict Trifecta Outcomes of Robotic-Assisted Partial Nephrectomy inT1a and T1b Renal Tumours

Aim

To evaluate and compare strict Trifecta outcomes of robotic assisted partial nephrectomy (RAPN) in patients with T1a and T1b renal tumours.

Method

A retrospective analysis of 146 consecutive patients undergoing a robotic assisted partial nephrectomy for T1a and T1b renal tumours from 2014-2019. Patient demographics, tumour characteristics, strict trifecta measures including warm ischaemia time, minimal renal function change (≤15% postoperative eGFR decrease), complications, and surgical margin positivity were collected, as well as intra-operative and oncological outcomes.

Results

In total 146 patients underwent RAPN. 113 patients had T1a tumours, 30 had T1b with a mean tumour size of 2.5cm (0.8-3.9cm) and 4.5cm (4.1-7cm) respectively, and 3 patients had T2a tumours. The nephrometry score was higher in stage T1b patients, however all other variables were similar between the two stage groups. Overall strict Trifecta was 75.5% with 77.9% in T1a group compared to 66.7% in T1b group (p = 0.21). Postoperative renal function was preserved in 102 patients in T1a vs 26 patients in T1b. Approximately 9 patients with T1a had positive surgical margin compared to 3 patients in T1b cohort. Post-operatively 3 patients in T1b (10%) group developed a Clavien Dindo score of 3 complications, compared to none in the T1a group (p 0.009). These were due to pseudoaneurysm and bleeding. No statistical difference in Fuhrman score and tumour types in the two groups. No cancer recurrences were observed during the 30 months follow up period in both T1a and T1b groups.

Conclusions

RAPN is a feasible treatment choice in selected T1b renal tumours.

An outbreak of Middle East Respiratory Syndrome (MERS) due to coronavirus in Al-Ahssa Region, Saudi Arabia, 2015

Between 19 April and 23 June 2015, 52 laboratory-confirmed cases of Middle East Respiratory Syndrome due to coronavirus (MERS) were reported from Al-Ahssa region, eastern Saudi Arabia. The first seven cases occurred in one family; these were followed by 45 cases in three public hospitals. The objectives of this investigation were to describe the epidemiological characteristic of the cluster and identify potential risk factors and control measures to be instituted to prevent further occurrence of MERS. We obtained the medical records of all confirmed cases, interviewed the members of the affected household and reviewed the actions taken by the health authorities. All the cases were connected. The index case was a 62-year-old man with a history of close contact with dromedary camels; three of the seven infected family members and 18 people in hospitals died (case-fatality rate, 40.4%). The median incubation period was about 6 days. The cluster of cases appeared to be due to high exposure to MERS, delayed diagnosis, inadequate risk communication and inadequate compliance of hospital health workers and visitors with infection prevention and control measures.

Introduction of Cotton leaf curl Gezira virus into the United Arab Emirates

Severe leaf curl and small vein thickening symptoms were observed in okra fields in Al-Ain, United Arab Emirates (UAE) during the winter season, 2013. These symptoms were reminiscent of those often associated with begomovirus infection. Based on the symptoms observed in okra plants growing in adjacent fields (20 × 20 m) on two small holding farms, the disease incidence ranged from 90 to 100%. The fields were infested with the whitefly Bemisia tabaci (Genn.), the insect vector of begomoviruses. Total DNA was extracted from four symptomatic okra leaves collected from two plants per field and used for PCR amplification of the core region of the begomovirus coat protein gene using the degenerate primers AVcore 3'-GCCHATRTAYAGRAAGCCMAGRAT-5' and ACcore 3'-GGRTTDGARGCATGHGTACANGCC-5'. Amplicons of the expected size (~579 bp) were cloned and sequenced. BLASTn analysis of the partial coat protein sequences against the NCBI database revealed that the closet match to the four okra isolates was the Cotton leaf curl Gezira virus (CLCuGeV). CLCuGeV is a widespread Old World monopartite begomovirus described from the Nile Basin, sub-Saharan Africa, and southwestern Arabia (1). Recently, this virus has been reported in Jordan (GU945265) and Pakistan (3). To obtain the full-length viral genomic DNA for cloning and sequencing, total DNA extracts were enriched for circular dsDNA by rolling circle amplification (RCA) using Illustra TempliPhi (GE Healthcare, Life Sciences, Piscataway, NJ). The RCA products from each sample were digested with PstI, resulting in ~2.7 and 1.3 kbp molecules, respectively, and cloned into the pGEM plasmid vector (Promega, Madison, WI), linearized with PstI. Two inserts were selected from each cloning event and subjected to DNA sequencing using primer walking. The four resultant sequences of the 2.7 kbp (identified as virus genome) and the 1.3 kbp (betasatellite) inserts shared 99 to 100% nucleotide (nt) identity with each other, respectively. Therefore, only two representative genome and betasatellite sequences of 2,772 bp (KJ939446) and 1,356 bp (KM279620) were deposited in GenBank. Analysis using the Species Demarcation Tool (SDT) (v.1.0) (2) showed that the CLCuGeV UAE isolate sequence shared its highest nt identity (96 to 97%) with isolates from Egypt (AF155064), Pakistan (FR751142), and Jordan (GU945265). In contrast, it was only 93% identical to an isolate of CLCuGeV (HG530540) from the west coast of Saudi Arabia, nonetheless indicating they are all isolates of the same species. Analysis of the CLCuGeV sequence indicated that it was like other monopartite begomoviral genomes, containing a predicted hairpin, REP-binding iterons (GGTACTCA), and a TATA-box in the intergenic region. The genome contained six open reading frames encoding proteins with high homology to other CLCuGeV isolates. The 1,356-bp betasatellite shared its highest nt identity, at 97%, with the Okra leaf curl Oman betasatellite (KF267444) reported from infected okra plants in a neighboring country, Oman. The recent practice of transporting plants between the Gulf countries represents an important means and route for introducing begomoviruses among neighboring countries, compared to the long-distance aerial dispersal of viruliferous whiteflies, which is less likely because the Arabian desert poses a major barrier to long-distance whitefly flights. References: (1) A. Idris et al. Viruses 6:1219, 2014. (2) B. M. Muhire et al. Arch. Virol. 158:1411, 2013. (3) M. N. Tahir et al. PLoS ONE 6:E20366, 2011.

Using the National Death Index to obtain underlying cause of death codes

This study evaluated the comparability of underlying cause of death codes obtained from NDI Plus, a new feature of the National Death Index (NDI), with codes assigned by two study nosologists or by a National Center for Health Statistics (NCHS) nosologist. Two study nosologists and an NCHS nosologist independently reviewed the death certificates of 493 decedents and assigned each an International Classification of Diseases code for the underlying cause of death. Using the NCHS codes as the reference standard, we determined discrepancy rates for NDI Plus codes; for each study nosologist's original codes; and for "final study codes," derived by comparing the two sets of study nosologists' codes and resolving discrepancies by using the NCHS code. For all causes of death combined, the discrepancy rate was 4% for NDI Plus codes, 4% for the final study codes and 6%-7% for the study nosologists' original codes. The discrepancy rate for selecting the appropriate cancer site was 1% for NDI Plus codes and 3% for the final study codes. For noncancer conditions, the discrepancy rate was 5% for NDI Plus codes and 4% for the final study codes. NDI Plus underlying cause of death codes are comparable to codes developed using standard but more cumbersome procedures. The use of NDI Plus codes may enhance the validity of comparisons of an occupational cohort's mortality rates with national or state rates.

Occurrence of an accessory pancreatic duct in the sheep

An accessory pancreatic duct was studied in 10 Dorset male sheep (5 to 12 months old) and in 7 sheep fetuses (crown-rump length, 63 to 200 mm). The duct was present in 9 of the 10 adult sheep examined. It could not be seen grossly, but in serial sections, an accessory duct with some pancreatic tissue was seen to pass distally from the main pancreatic mass ahead of the bile duct, enter the wall of the duodenum at the beginning of its descending portion, pass distally in the submucosa for about 10 mm, and then approach the mucosa. The wall of the duct acquired tubular mucous glands and was supported by muscle bundles during its intramural course. The sections from the sheep fetuses confirmed the presence of a patent accessory duct until it united with the duodenal mucosa. In the adult, the accessory duct and the accompanying pancreatic tissue and glands appeared functional. It could not be determined how much of the pancreas may be drained by the accessory duct.

Observations on the distribution of the omentum in the one-humped camel (Camelus dromedarius)

The greater omentum of the camel has been studied for the first time. Although the camel belongs to the suborder Artiodactyla, the greater omentum exhibits a striking similarity to that of Perissodactyla.

Ossification and mineralization in the tendons of the chicken (Gallus domesticus)

Fifty broiler chickens of both sexes were used in this study. The chickens were bought at 8 weeks old and kept until 40 weeks old. During this period the development of ossification and mineralization was followed. The chickens were killed at weekly intervals. After having been examined fresh, the tendons were fixed in appropriate fixatives and processed for histological and histochemical examination. The earliest signs of mineralization were noted at 15 weeks and mineralization was apparent on X-ray photographs at 20 weeks. The development of ossification of the tendons has been described. The fibroblasts transformed into osteoblasts which secreted around the cells and later between the fibres. This was followed by the appearance of osteoblasts and resorption cavities and then the latter became lined by osteoblasts, and osteones were formed.

Morphometric observations on the kidney of the camel, Camelus dromedarius

Morphometric analysis of the kidney of the camel was carried out on gross slices and histological sections using standard morphometric methods. The renal cortex occupied about 50% by volume of the kidney, and the ratio of the thickness of the medulla to that of the cortex was about 4:1. The relative thickness of the medulla was about 7.89. This parameter is an indicator of the lengths of the loops of Henle and vasa recta, and, according to the countercurrent theory, is consequently an indicator of the ability of the kidney to concentrate urine. In each kidney the volume and surface area of the cortical tubules and the number of glomeruli were determined and compared with these parameters in some other mammals. In addition the architectures of the renal pelvis and medulla and their significance in relation to the excretion of hypertonic urine were discussed. It was concluded that the kidney of the camel possesses the anatomical requisites for the production of hypertonic urine.

Observations on the morphology and histochemistry of the oviducts of the sheep

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